By Stephanie Schneider-Guild, L.Ac.

At the turn of the century, health care seems to have come light years from the days of leeches, country-side doctors and a lack of remedies for ailments such as polio, rubella and the German measles. Yet, the world of medicine finds itself in an enormous quagmire because mere survival in the fast-paced modern world requires a step back into the shadows of time where the magical healing powers of nature and traditional medicine reside. One of the predominant manifestations of present day life lies in the emotional/psychological realm resulting in depressions, anxieties, and all sorts of other related dilemmas. The focus of this article, however, will implement the theories and principles of Traditional Chinese medicine in diagnosing, differentiating and treating depression in accordance with the five elements.

In order to gain clear insight into the many multi-faceted aspects of depression, it is crucial to look at it from every perspective. Therefore. it is vital to glimpse into the world of western medicine to provide one model regarding the complexity of the human mind. and its functioning.

According to many western medical resources. depression may be the response of the body to an overwhelming and constant stress that seems to the patient to be insurmountable. This stress could be life experiences, food or nutritional deficiencies or excesses, allergies to environmental factors, and numerous other so-called stressors. Regardless of the etiology of the depression, the majority of western MDs diagnose the patient's condition as a depression. The symptomology must be rather significant. Among symptoms falling into the category of a depressive illness, there must be at least five of the following symptoms for a period of at least two weeks. These symptoms are:

• Depressed mood most of the day, nearly every day
• Markedly diminished interest in pleasure in almost all activities most of the day, every day
• Significant weight loss or weight gain without dieting, or major changes in appetite or eating habits
• Insomnia or hypersomnia nearly everyday
• Psychomotor agitation or retardation (anxiety or lack of desire to do any thing)
• Fatigue or loss of energy nearly every day
• Feelings of worthlessness, guilt, desperation, and psychic pain that are ongoing
• Inability to think or concentrate; indecisiveness daily
• Recurrent thoughts of death or suicide, or a specific plan or attempt of suicide

The symptoms cause significant distress or impair social, occupational, or other important functions. In sever cases, hallucinations and delusions may occur, perhaps as a result of the emotional overload. In any case, once the diagnosis has been made, the treatment method is generally very similar from patient to patient. Usually, anti-depressive medications, of which there are many, are administered, and often it takes up to six weeks for the medications to take effect. In many cases, these medications are a saving grace, but in the case of the suicidal depressive, extra measures must be taken to assure that the patient maintains his or her integrity. The general consensus in the western model is that these treatments be accompanied by psychological counseling in order to rebalance and rebuild the person's inner world. Currently, there is a great deal of research and medical attention regarding depressive illnesses. and a significant branch of western MDs are turning to megavitamin therapies. aminoacid. and nutritional therapies as alternatives to drugs. In the not-so-distant future, it seems the trend is coming back home... to nature and its innate wisdom.

Chinese medicine is perhaps one of the foremost therapeutic avenues that invites nature to assist in the rebalancing of the human organism. Since humankind functions on so many levels, from spiritual, to physical, to emotional, each of these strata need be addressed. The somewhat magical art of Traditional Chinese Medicine works beautifully at uniting body-mind-spirit, so that harmony may again be achieved. This is not to say that TCM is a wonder cure because in some in some cases, it may even be ineffective. in which case there are other options and modalities of treatment, from western medicine to Indian or homeopathic medicine. The point is: other options exist, and should not be ruled out.

In TCM alone, there are many approaches to the same problem. The scope of this article is on the five elements and their significance in diagnosing and treating depression. Each element encompasses a symptomological picture that varies from the others. Becoming aware that a patient is depressed does not suffice. It is important to understand and address the individual and unique manifestations of that person's depression. The five elements provide a clear and interesting framework in which many cases of depressive illness can fit, be diagnosed and treated. For the sake of clarity, this article will present each element and its unique manifestations, without addressing the interactions of the elements. Although elemental interdependence is fundamental to the five element theory, it is the goal of this article to highlight the differences among the elements in order to present a clear theoretical model. It should be understood that cases of purely Wood-element depression, for example. would be rare. Usually there is a combination of elements in the same person, which will hopefully become more decipherable through deeper understanding of each element.

The Wood Element

When considering the Wood element, one thinks of the obvious characteristics such as Spring, Wind, Eyes, Tears, Shouting, Anger, Sour, etc. However, there are also more subtle features pertaining to this element that are less obvious, but can be of great value when determining a person's elemental predominance. For example, some of the traits of a Wood case of depression could be that the patient has a great deal of difficulty relaxing or being at ease, that they want to control everything and fall into depression when defeated, and they have a stormy type of personality that is prone to many moods. The Wood personality can be arrogant, confident, aggressive, confrontational, driven and eager. They can be very demanding of themselves and others. and can easily be disappointed at which point they may fall into the clutches of a darkness known as depression. Usually this type of depression has a great well of repressed anger, disappointment, and frustration brewing underneath the surface. The primary issue is control in the Wood cases. As far as their appearance, a Wood type may present with a reddish facial skin tone, reddish eyes, and disgruntled look. Wood types are usually rather tall and slender.

The Fire Element

The Fire type, on the other hand, has quite different features than those of Wood. A Fire element depression most often has to do with relationships and "heartbreak." Most frequently, Fire types feel let-down or disillusioned by love. Their depressions are usually of a cyclical nature in that they get over one heartbreak, and then move on to the next. Their depressions can be quite severe, and they can often become suicidal due to their impulsive, and "living on the edge" character type. Fire predominance includes symptoms of Anxiety, chest pains, nightmares of a vivid nature, and a lack of laughter and the ability to feel joyous. Depressive episodes readily deplete heart qi, and can cause the usual Fire related symptoms of palpitations, shortness of breath, mental confusion (due to the heart's relationship to the Shen or cognitive functioning of the individual), and listlessness. Since all emotions have an influence on the heart, the Fire element can transmit imbalances that stem from other organ or emotional disturbances. Yet. in those cases there would be a mixed symptomological picture. As far as appearance is concerned, the Fire types tend to have a reddish face with a rather pointy chin. Their hair tends to be curly, and when in balance they tend to move quickly and to frequently be in a rush. When depressed, however, they tend to feel unmotivated and unable to appreciate the beauty of life that they usually thrive on. Paradoxically, their strong point is also their weak point in that Fire types lean towards vigorous and healthy blood and blood vessels when well, but can easily become depleted in this area when out of balance. Since the heart rules the blood. Fire predominance can lend itself to a host of blood related and mental problems when the individual succumbs to stress and relational pressures.

The Earth Element

The Earth element would encompass its typically characteristic digestive imbalances. However, in depressive episodes, Earth types tend towards significant changes in their eating habits. Some will have no appetite whatsoever, whereas others become ravenous and try to eat in order to fill the dark emptiness inside. It appears to be a way of seeking warmth and comfort. When depressed, Earth elementers become unmovable, perhaps because they have a tendency towards dampness. At any rate, they virtually sink into their depressions and become heavy and unmotivated. The Earth element's energies contribute greatly to the human affect of centeredness, being grounded, peace, calm and compassion. In adversity, the serenity of this element becomes distorted into listlessness, obsessive worry, over concern and their sense of self strongly diminishes as they lose their usual propensity to being grounded.

The Earth element's physical characteristics are unique, and usually quite detectable. They tend to be stockier, more portly, and generally move more slowly than most of the other elements. They often have round faces, and appear rather jovial when in balance. An interesting note is that their body shapes can alter significantly when under the duress of depressive illness. They may fluctuate in weight, depending on their individual tendency to either halt or greatly increase their food intake. A major clue in recognizing Earth element cases is their oral natures. They often need to have something in their mouth - chewing gum, candies, foods. Perhaps this is the reason for their propensity towards being damp and somewhat overweight.

The Metal Element

The Metal element encompasses a great deal of issues regarding giving and taking to and from the environment. Frequently, this element winds up depressed when there is loss or grief. Often these emotions can be repressed and manifest in unusual respiratory difficulties, asthmas, and frequent upper respiratory infections. Commonly, when depressed, Metal types sigh, cry and sob, and lack a sense of boundary between the "self' and others. They are prone to the sufferance of the world, which is termed "weltschmerz'' This is a Freudian term that depicts the person who takes the pains and suffering of the world onto their own shoulders. Therefore, this type of a case may also involve a sense of grieving that seems overwhelming and all-encompassing. The Metal element types are environmentally sensitive, but are also more easily influenced in a therapeutic setting with regards to their emotional status. They often appear with soft weak voices, and pale complexions. They are generally of thin stature and when depressed, appear meager and weak. In many cases, these patients will have rather clear regrets over the past and feel that there is a significant desire to wish things could only have gone differently. These people often feel plagued by circumstance, and therefore grieve over past issues and losses that they hang on to.

In strong contrast to the above mentioned elements is the Water element. This is the most clinically significant and potentially dangerous type of elemental depression. This is the element that is most greatly influenced by the pre-natal Jing - hence, genetics. In these cases, the patient is depressed and does not have any insight into why or any reasons that may have caused the descent into a depressive illness. These patients are most susceptible to severe psychological imbalances, such as schizophrenia, psychoses, and severe major depressive episodes. In many cases. the patient will become despondent and unable to do even the simplest of chores for themselves. Their depression seems to reach down into the very core of the person's being - their spirit and soul. These patients become incommunicable, and sink rather deeply into their illness. These are the most difficult of all of the elements to treat successfully. These patients appear desperate, paranoid, and out of touch. They fear life and death, and don't have any sense of what their fear means. Usually these people feel that they are beyond help, and no longer seek assistance in their grave dilemma over their life. They also reluctantly fear leaving their homes, and seem to lose their sense of purpose in life. They may appear in a clinic, usually accompanied, and be ungroomed, easily distracted and very scattered. They may have nervous tremors, and seem fearful or totally apathetic. These cases may be misdiagnosed, because it is easy to interpret the patient's signs as arrogance or poor hygiene. Yet, it is important to recognize the desperation of the person's plight because these patients are the ones most prone to suicidal tendencies. Since they feel so lost and don't grasp what is plaguing them on such a pervasive and personal level, they often resort to the ultimate escape from their misery - suicide.

In each of the elements discussed, there are specific clues and hints as to which element is predominant in the given case. It is helpful to ask questions that may evoke the necessary information in order to reach a diagnosis. One must use tact, empathy and a direct approach that is not overly involved, while still maintaining a concerned and caring disposition. The use of the five elements is only a tool in diagnosing and dealing with a case of depression. The elements afford practitioners an added sense of comprehension and clarity in a patient's case. However, it is important to focus on the most comprehensive and effective means of treatment. As alternative health care practitioners, it is also crucial to recognize the importance of dealing with the patient on a psychologically therapeutic level. In most cases of depression, there are unseen, underlying triggers that we as acupuncturists are not trained to deal with. Hence, it requires a delicate balance that always keeps the patients' best interests foremost in mind.

In conclusion, depression must be dealt with on every level of the person's being. The theoretical model of the five elements can be useful in diagnosing and treating a patient suffering from depressive illness. As stated previously, it is vital to assess the severity of a depressive's condition, and tend to their individual needs. In any case, the five element approach can be seen as one perspective in dealing with these conditions.

Stephanie Schneider-Guild, L.Ac., MTOM is a graduate of Pacific College or Oriental Medicine and maintains a private practice. She can be reached at (914) 351-2723