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Home > Newsletters > December 2007 > Chinese Medicine and the Mind - Page 4

Chinese Medicine and the Mind - Page 4

By Efrem Korngold, LAc, OMD and Harriet Beinfield, LAc

When the Essence is compromised, that is, when it is corrupted by images, thoughts, feelings, and memories that negate the true nature and potential of the being, the unity of Shen-Jing is weakened, and the capacity to discover, affirm, and follow one’s life direction is derailed. Therefore, the symptoms and signs of Kidney depression are those that reflect a disengagement and disconnection with the process of living: apathy, lack of affect, lack of will, absence of desire, indifference to pain and pleasure, behavior, and thinking that lacks appropriateness and coherence vis a vis time, place, and persons.

When disturbances of the Liver and/or Kidney negatively affect other Organ Networks, the features of depression become more intricate because of the complexity of interacting functions. Although it may originate in disorders of the Liver and/or Kidney Network, depression has such a global impact on the whole organism, the characteristic symptoms and signs usually reflect Heart, Spleen, and Lung disturbances as well. For example, anorexia, dyspepsia, and discomfort below the diaphragm indicate interference with the natural movement of Stomach Qi; sighing, a weak voice, and shallow breathing indicate impairment of the Lung Qi; whereas insomnia, disturbing dreams, and restlessness represent agitation of the Mind (Shen) consistent with an instability of Heart Qi.

Similarly, disorders of Kidney Qi or Essence (Jing) will also undermine
the Qi of the Heart or Mind (Shen), resulting in feelings of dread and a pessimistic outlook. Indifference to the pleasures of food or social interaction mark a blocking of the Spleen Qi; anguished feelings of separateness and abandonment reveal the contraction of Lung Qi; whereas, the desolation that emerges from the poverty of passion and desire presages the dissolution of Heart Qi. Focusing on the constraint of Liver Qi, toxicity in the Blood, weakening of the Kidney, and erosion of Essence may be fundamental aims of therapy, but the distortions of Organ Network relationships will also need to be rectified to ensure a successful outcome.

TREATMENT

In actual practice, a Chinese medicine practitioner may employ any or all of the traditional modalities—acupuncture, herbal medicine, dietary therapy, physical therapy (tui na), physical exercise (calisthenics), life counseling, Qi cultivation (qi gong, tai chi, or dao yin)—in combination, alternation, or succession in the treatment of depression. For the purposes of modeling a straightforward methodology that can be easily implemented, the use of specific compound herbal formulas and acupuncture protocols can be designated that correspond to each diagnostic pattern or syndrome (combination of patterns). The diagnosis defines the therapeutic principles that are then matched in part or in total by the collective properties of the medicinal ingredients that compose an herbal formula or the selection, sequence, and stimulation of acupuncture points. For example, depression of the Liver type might include the
patterns of Qi stagnation (abdominal cramps, cold hands and feet, tension below the diaphragm), trapped Heat (inflamed eyes, moodiness,
and irritability), deficiency of Blood (dry eyes, brittle nails, and restless fatigue), agitation of the Mind (nervousness and insomnia), as well as Spleen Qi stagnation and deficiency (incessant food cravings, bloating and flatulence, loose stool, lethargy, continual worrying, easy distractibility). A famous classical formula that matches this picture is Xiao Yao San (Powder for Wandering Free) that disperses Liver Qi, tonifies Blood, dispels Heat, and strengthens Spleen. This formula is frequently used to ameliorate premenstrual melancholy, fatigue, and irritability, as well as depression and exhaustion associated with frustration, overwork, dissatisfaction, unacknowledged or unexpressed feelings of resentment, and an inability to resolve interpersonal conflicts. Because it tonifies the Blood and strengthens the Spleen, this formula relieves insomnia (an adequacy of Blood calms the Heart and quiets the Mind), alleviates fatigue, and improves digestion. If persistent insomnia, palpitations, and Anxiety or panic are prominent and indigestion takes the form of difficult or infrequent bowel movements, then the formula Chai Hu Long Gu Mu Li Tang (bupleurum, oyster shell and dragon bone decoction) may be used. This combination is similar to Xiao Yao San but also contains tranquilizing herbs, strong Heat clearing and laxative herbs, and
additional ingredients to tonify the Qi and strengthen the Spleen.
The goal of this formula is to ease quickly the severe mental agitation
caused by an effulgence of Heat in the Liver Network that destabilizes the Heart and Mind to such a degree that a person completely loses his/her center (an important function of the Spleen Network).

At the opposite extreme, depression might take the form of physical
inertia with restlessness and fatigue, lumbar soreness, mental dullness and forgetfulness, fearfulness and apprehension, aversion to being touched or comforted, chilliness, lack of hunger or interest in food, and diminished emotional responsiveness. Fits of ill temper, weeping, or Anxiety might be the limit of this person’s emotional intensity. This  syndrome is a portrait of stagnant Liver Qi afflicting the Stomach, depletion of the Qi of the Liver and Kidney, and deficiency of Yang. A profound anergy, the inability to become emotionally aroused and to rouse the body or sustain any positive interest or activity, is the keynote of this type of depression: there is an absence of heat, motivation, and motility, the fundamental attributes of Qi. A formula that fits this syndrome might be a modified version of Shi Wei Wen Dan Tang (Warm the Gallbladder Decoction) in combination with a modification of Jin Gui Shen Qi Wan (Decoction for Restoring the Kidney). This new combination
of formulas would relieve Anxiety and fear, enliven the emotions, restore the appetite, sharpen the senses, restore metabolic activity and body warmth, strengthen the back and limbs, and reawaken the instinct for survival and the desire for human contact.

Depression often follows in the wake of loss or separation: death of a loved one, dissolution of a friendship or marriage, failure of a business, loss of physical or mental competence because of illness or injury, disillusionment, and disappointment. Sorrow, regret, and anguish impair the Qi of the Lung. These feelings cause the Qi to become constricted in the chest. This not only hinders respiration but inhibits motility throughout the body, including the heart and vascular system. Peristalis, circulation, locomotion, and thinking all slow down, becoming dysrhythmic. Characteristic symptoms include tightness in the chest, feeling of a lump in the throat, a weak voice or fatigue from speaking, a tendency to weep and sigh, occasional palpitations, or changes in the heart rate at rest. A classical formula that fits this presentation is called Si Qi Tang (The Decoction of Four and Seven) that numerically symbolizes the four seasons and seven emotions (pleasure, concern, anguish, awe, ire, terror, shock). This combination of herbs relieves the stagnation and oppression of Qi in the chest, soothes the Heart and Mind, awakens the appetite (and the desire for living), frees the breath and circulation, restores the rhythm of the pulse, and elevates the spirits. The Spleen enables the Mind to consider and reformulate thoughts and feelings—to give them shape—like a lens bringing images into focus. A well-formulated idea gives birth to intention that transforms into motivation and, potentially, actualization.

Depression that engenders turmoil within the Spleen Network often displays ruminative and obsessive features. When the Qi of the Spleen
is oppressed or congested, the process of thinking may become
stuck. This manifests as incessant worry and circular thinking about
problems that seem to have no solution: a person feels trapped in mental quagmires and dilemmas from which there appear to be no exits. The unrelenting concern with intransigent thoughts leads to physical and mental fatigue. It becomes difficult if not impossible to act effectively, literally walking in circles. There may also be constant nail-biting and repetitive movements or sequences of movement—a kind of memory lapse because of the inability to pay attention to anything other than the Mind’s preoccupation. With the loss of a meaningful purpose (intentions) in life, obsessive behaviors become an alternative center around which daily life is organized, but, because the ritual thoughts and activities provide no real satisfaction, constant disappointment leads to futility that leads to paralysis and ennui. Because the Spleen Network is a pivotal source of Qi for the entire body, disturbances of other Organ Networks, especially the Heart and Lung, are part of the depressive syndrome. The pattern of Spleen Qi deficiency, Qi stagnation, and accumulation of Dampness is a common presentation. These symptoms include weakness and easy fatigability of the limbs; heavy feeling of the head and
body; thin, loose, or poorly formed stool; abdominal distension and flatulence; cravings for starches and sweets; inability to discern hunger or decide what to eat; water retention; tender muscles; easy bruising; hard to focus, easily distracted, and forgetful; worried and apprehensive about small matters; overwhelmed by details and complexity; excessively nostalgic and sentimental. If the Heart is also affected, there may be palpitations, insomnia, sleep easily interrupted and difficult to resume, tiredness in the morning and hard to get going, and rapid heart rate with slight exertion. If the Lung is involved, there may be shortness of breath, a feeling of weakness or emptiness in the chest, soreness and pain in the chest and upper back, sinus congestion, and cough with phlegm.
A traditional formula for Spleen-type depression with Heart involvement
is Gui Pi Tang (Decoction for Restoring the Spleen). This formula strengthens the Spleen and Heart by replenishing Qi and Blood, dispersing stagnant Qi, relieving Dampness, and quieting the Mind. For depression that displays a pattern of Spleen and Lung weakness, the
Decoction of Six Noble Ingredients combined with the Powder for
Generating the Pulse maybe used. Together, these two formulas restore
the Qi of the Spleen and Lung, relieve Dampness and dispel Phlegm,
disperse stagnant Qi, open the chest, and revive the spirits.

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