Professional Empowerment for Practitioners

Depression (Stress)

Depression (Stress)

Presentation by Dr Wang Shiping at SAACMAs first CPD event “Anxiety and Depression in a Changing Environment”.
(The diagram: although the text format of the diagram is not very clear, it is included for its valuable information. Case studies right at the end were discussed during the presentation, but not transcribed for the presentation in this article format.)

 

General description      

     Depressive syndrome is due to emotional upsets and stagnation of Qi flow, clinically manifested as mental depression, restlessness, feeling of fullness and oppression over the chest, distending pain over the hypochondrium or irritability and susceptibility to cry, or feeling of a foreign body in the throat.

     郁证是由于情志不舒,气机郁滞所致的以心情郁忧,情绪不宁,胸部满闷,胁肋胀痛,或易怒易哭,或咽中如有异物梗塞等为主要临床表现的一类病症。

      The cause of depressive syndrome is emotional upsets. Pathogenically, if the liver fails to control the dispersion, the stagnant liver Qi attacks the spleen, which impairs the spleen’s function of transportation and transformation and the heart is deprived of nourishment. Thus, disorders of the viscera, Yin, Yang, Qi and blood appear. At the initial stage, depressive syndrome is attributed to the excess type. It is usually caused by stagnation of Qi, complicated by blood stagnation, fire transformation, phlegm accumulation and food stagnation. However, prolonged cases will change from the excess type into the deficiency type, and there may appear different pathological changes of the heart, spleen, liver or kidney, as a result of different conditions of the involved viscera and the consumption of Qi, blood, Yin or Yang.

    本病的病因是情志内伤,其病机主要是肝失疏泄,脾失健运,心失所养及脏腑阴阳气血失调。郁证处起病变以气滞为主,常兼有血郁,化火,痰结,食滞等,多属实证。病久则易由实转虚,随其影响的脏腑及气血阴阳的不同,而成为心,脾,肝,肾亏虚的不同病变。

        This disease is including neurasthenia, hysteria and anxiety in western medicine and also in Perimenopausal syndrome and reactive psychosis.

        本病主要见于西医学中的神经衰弱,癔病和焦虑证等。也可见于更年期综合症,反应性精神病等。

Explanation of pathogenesis for depression:

       (Chart – included right at the end of this article)


Essential for diagnosis

      The patients always get the major symptoms that are mental depression, restlessness, distending pain over the chest and hypochondrium or irritability and susceptibility to cry, or feeling of a foreign body in the throat, mostly they are young and middle-aged women. The patients usually have a history of emotional upsets, such as melancholy, anxiety, sorrow, terror and resentment. Its recurrence is closely with the emotional factors. Examinations of all systems and laboratory examinations are normal.

      通常患者的主要症状是精神压郁,情绪不宁,胸胁闷痛,烦躁和悲伤易哭,咽中有异物感,患者多为青中年妇女,并且大多数病人多有忧愁,焦虑,悲哀,恐惧,愤慨等情志内伤的病史,其病情的反复与情志因素密切相关。各系统检查和实验室检查均属正常。

Syndrome differentiation and treatment

      There are 8 kinds of the depressive syndromes existing clinically and they can be changed from each other according to the patients’ emotions and clinical manifestations:

      郁证临床上,通常有八种证型。根据患者的情志和临床表现,其证型可以相互转换。

    A, Stagnation of liver Qi: the patients can get mental depression, restlessness, feeling of fullness and oppression over the chest, distending and wandering pain in the hypochondrium, abdominal flatulence, eructation, loss of appetite, irregular bowel movement,thin and greasy tongue coating, wiry pulse

   气滞型:患者精神压郁,烦躁不安,胸部满闷压迫感,胸胁痛无定处,腹闷嗳气,不思饮食,大便不调,舌苔薄腻,脉弦。

    B, Stagnation Qi transforming into fire: the patients can get irritability, distention and fullness over the chest and hypochondrium, dry mouth and bitter taste, or headache, red eyes, tinnitus, or gastric upset and acid regurgitation, constipation, fever, yellow urine, insomnia, etc.,red tongue with yellow coating, wiry and rapid pulse.

    气郁化火型:患者性情急躁易怒,胸胁胀满,口苦口干,或头痛,目赤,耳鸣,或嘈杂吞酸,大便秘结,小便黄赤,失眠等。舌红台黄,脉弦数。

     C, Stagnation of blood: the patients can get mental depression, irritability, headache, insomnia, amnesia, or stabbing pain over the chest and hypochondrium, irregular menstruation or amenorrhea, purple lips and tongue, dark purple tongue or with petechia and ecchemosis, wiry or unsmooth pulse.

      血郁型:患者主要症状为精神郁忧,性情急躁,头痛,失眠,健忘,或胸胁疼痛,刺痛,月经不调,闭经,唇舌瘀紫,舌暗红有瘀斑,脉或弦或涩。                      

     D, Stagnation of Qi and phlegm retention: the patients can get mental depression, feeling of oppression over the chest, distention and fullness over the hypochondrium, feeling of a foreign body in the throat with difficult to swallow or spit out, enlargement of lymph nodes,white  and greasy tongue fur, wiry and smooth pulse.

      气痰郁结型:患者感到精神忧郁,胸部闷塞,胁肋胀痛,咽中如有物梗塞感,吞之不下,吐之不出,或淋巴结肿大。舌苔白腻,脉弦滑。

     E, Mental confusion: the patients can get restlessness, trance, suspiciousness, timidness, sentimentality, liability to cry, changeable moods, or frequent stretching and yawning or unrestrained flourishing and shouting,pale tongue, and wiry pulse.

     心神不宁型:精神恍惚,心神不宁,多疑善惊,悲伤易哭,喜怒无常,或时时欠伸,或手舞足蹈,骂嗔喊叫,舌质淡,脉弦。

     F, Heart and spleen deficiency: the patients can get suspiciousness, dizziness, listlessness, palpitation, timidness, insomnia, amnesia, poor appetite, lassitude, lusterless complexion, pale tongue with thin and white fur, and thready pulse.

    心脾两虚型:多思善疑,头晕神疲,心悸胆怯,失眠,健忘,纳差,面色无华,舌质淡,苔博白,脉细。

     G, Heart Yin deficiency: the patients can get restlessness, palpitation, amnesia, insomnia, dreamfulness, burning sensation of the palms, soles and chest, night sweating, dryness of the mouth and throat, tidal fever,red and dry tongue, thready and rapid pulse.

    心阴亏虚型:患者有情绪不宁,心悸失眠健忘,多梦,五心烦热,盗汗,口咽干燥,舌红少津,脉细数等症状。

      H, Liver and kidney Yin deficiency: the patients can get restlessness, irritability, dizziness, timidness, and tinnitus, dryness of the eyes, photophobia, blurred vision, or headache and feeling of distention in the head, flushed face, red eyes, and dry mouth, red and dry tongue, wiry and thready or rapid pulse.

      肝肾阴虚型:主要症状有:情绪不宁,急躁易怒,眩晕,耳鸣,目干畏光,视物不明, 或头痛且胀,面红目赤,舌干红,脉弦细或数。

Prevention for depression:

      Depressive syndrome is a disease which belongs to mental and physical disorder. Nowadays, it is the big social problem that there are so many people can’t bear the press of society and job as well as family. And then the press may be changed into the contradiction in the mind. According the theory of Chinese medicine, the psychological press may affect the physical material movement, and vice versa, the latter may also affect the psychological activity reversely; this is a malignant circulation. The doctor should break this bad circulation, but the doctor should get the cooperation of the patients. I, as a doctor, should give the patients some useful suggestions as follows:

    郁证是一种属于身心性的失调,今天,它已经成为巨大的社会问题了,很多人不能忍受社会,职业和家庭的压力,其压力在心里转化成矛盾。根据中医的理论,心理压力可以影响其生理的物质活动,反之,生理的物质运动也可以影响其心理活动,这就形成了一个恶性循环。医生应该打破这种恶性循环。作为医生,我应该给于患者一些有用的建议:

  1. If you feel discomfort in your thought; you have big contradiction in your mind that you can’t resolve it and you always produce the sad idea in your mind, you should see a doctor, and if you have some symptoms as well, you should take the Chinese medicine for regulation, such as: irregular menstruation, sleep, palpitation, or your appetite is so bad that you can’t feel hungry in all day, or you get durable chest oppression or chest pain, or you feel nausea and vomiting always. All these symptoms may show that you get pre-depression, and you should be treated with medicine as well as mental therapy. There is a famous ward in China: the mental problem should be healed by mental therapy. Therefore, a good doctor should be a psychotherapist simultaneously.

  如果你感到心里不舒服,在你的精神中产生了你无法解决的矛盾,你的思想里经常出现不好的念头,你就应该看医生了。如果你还有某些症状,你就应该服中药调理,譬如:月经不调,睡眠失调,心悸,或者食欲甚差,成天没有饥饿感,或者持续性地胸闷胸痛,或者经常呕恶。这些症状都可能表示为郁忧症的前期,你应该接受药物治疗和精神治疗。中国有句名言:心病还要心药治疗。所以,好的医生应该同时是个心理学家。

  1. You don’t think that the patients with depressive syndrome are only those negative people. In facts, the movement of the body material can also affect the mental change. If you get the sprout of depression at the moment, and you ignore it, it can grow up under the bad circumstances of inner organic functions. Especially, if your condition has developed further, you can’t control your emotions. So many actresses and actors have the tendency to suicide; it is caused by the psychological and physical circulation. Therefore, the medicinal treatment and psychotherapy both are same important for the patients.

  你不要认为只有那些消极的人才患郁忧症,实际上,机体的物质运动可以影响精神活动。假如你出现情绪郁忧的苗头,你不去管它,在内部功能环境不利的情况下它就有可能发展壮大,特别是如果你的情况继续发展,你不能控制你的情绪。因此许多男女演员出现自杀倾向,这是由于心理和生理的循环造成的。所以,对于患者来说,药物治疗和心理治疗两者都是必要的。

  1. The destination of psychotherapy is to pursue the patients giving up their incorrect ideas: greedy love, hatreds and under intelligence are common human shortcomings. Many people want to get benefits from the society, but if their benefits are against other people’s benefits, they can get a big contradiction in their mind. If the patients can give up their benefits, demands, hope and love, their problems are easy to be resolved; but if their conditions last a long time, their spirits and body would be damaged. And then they can’t be healed by mental therapy easily.

     心理治疗的目的就是劝导患者放弃他们的不正确的念头:贪爱和嗔恨以及那些不明智的人类普遍的弱点。很多人都想从社会获取利益,但如果他们的利益和大众的利益相冲突的时候,在他们的心里就产生了巨大的矛盾。患者如果能放弃他们的利益,要求,愿望和所爱,他们的问题就好办得多;但如果他们的状态持续很长时间,他们的身心都可能受到伤害,精神疗法就很难单独奏效了。

    

  1. Acupuncture is a good therapeutic method for these patients, because it can regulate the Qi and blood circulation and loosing the patients’ spirit, relieve the patients’ anxiety. After acupuncture treatment, the patients can get relaxation. The patients can get improvement for their emotions, appetite, sleep and even their thought. This is a good testimony of body materials affecting spirit.

    由于针灸可以调整气血循环,松弛患者的精神,减轻患者的焦虑,针灸是一种很好的治疗方法。针灸治疗后,患者能够放松,改善他们的情绪,食欲,睡眠,甚至他们的念头。这就证明了物质对精神的作用。

  1. If you can’t calm down your spirit, and you get mental upsets, Qigong (meditation) is a good psychotherapy. But you should understand the original theory of Qigong, and you are willing to yielding your private benefits. If you can’t do so, I suggest you to go to study Buddhism and so on. Comparatively, health or benefits, which do you prefer? If you have no health and even your life, your benefits are useless. Everybody should learn how to give up.

      如果你不能安定神志,你总是有精神刺激。气功是一种很好的心理治疗方法,但你必须了解气功的基本理论,你愿意放弃你的私人利益。如果你不能作到,我建议你去学习佛教及其它宗教。相比而言,你愿意得到健康还是牟取私人利益,如果健康都没有了,私人利益还存在吗?我们每个人都要学会放弃。

  1. Depressive syndrome is easy to be recovered but it is too difficult to be healed yet. It is decided by the attitude of the patients, and patients’ willing. On other side, the patients should understand its risk and avoid the risk actively. There is a famous sentence: a healthy spirit should be living in a healthy body. Therefore, if you are sick, you should check yourself: which is your shortcoming: your attitude, thought, plan, or your food, or your ideas or your living habits or your surroundings etc. The ancient doctors said: sickness is the penalty from God. That is true. If you can give the forgiveness, sympathy, and kindness to other people, your depression has been recovered half.

     郁忧症易于康复,但治愈却很困难,这取决于患者的态度以及愿望。另外,患者应该懂得它的危害,积极避免其危害性。名言说:健康的精神是寓于健康的躯体中的。因此,如果你生病了,你应该反省你自己的缺点,你的态度,思想,计划,你的饮食,念头和你的生活习惯,居住环境等。古代医生们说:疾病是神的惩罚,这是对的。如果你能对其他人谅解,同情,慈悲,那么你的郁忧症就好了一半。

  1. The important point for you is that you should persist in your treatment. You should understand that your treatment has to change your spirit, your organic functions as well as your constitution; so you should have an active attitude to do your treatment.

   重点是你应该坚持你的治疗。你应该懂得,你的治疗必须改变你的身心活动,以及你的素质,因此,你必须对治疗抱积极的态度。

  1. Many patients with depressive syndrome pay more attention to their dignity; they can’t bear other people’s blame. They also can’t bear praise from other people. This is a big problem. They should remember they are sick from bad emotions. If they can treat any emotion in common, and they have enough patience to keep silence in the mind, they can get a good future.

    许多患郁忧症的患者很重视他们的尊严,他们难于接受其他人的褒贬,这是很大的问题,应该提醒他们,患病的原因是情绪问题,如果他们能够以平常心对待情绪问题,有足够的忍耐保持心理的宁静,那么他们就会有好的未来。

Case analysis:

  1. Female, 45yd, after her divorced, she was very sad and anxious about family and her work. And then she got insomnia, chest pressure and short breath, amenorrhea for 3 months, thirsty, bad appetite, constipation, and cry sometimes, mutter to herself sometimes, purple tongue with exfoliating fur, unsmooth pulse. She was diagnosed as visceral irritability. (zang cao 脏躁)

    女性,45岁,离婚后她情绪低落,焦虑她的家庭和工作。她的症状是失眠,胸闷,气紧,闭经三月,口渴,食欲差,便秘,有时哭泣,有时喃喃自语,舌质有瘀斑舌苔剥离,脉涩。诊断为脏躁。

Syndrome differentiation: (辩证)
Therapeutic method: (治则)
Prescription: (处方)
Acupuncture: (针灸)

 

  1. Male, 7yd, he was frightened during earthquake in Tangshan City, and then he was manifested with palpitation during sudden voice specially, bed-wetting, bad sleep and wake-up with a start, red tongue with thin yellow fur, wiry and thready pulse.

  男孩,7岁,唐山地震受到惊吓,于是他出现症状:心悸,特别是突然听到声音时,尿床,眠差,易于突然惊醒,舌红苔薄黄,脉弦细。

Syndrome differentiation:
Therapeutic method:
Prescription:
Acupuncture or Tuina:

 

  1. Male, 45yd, he was angry with somebody during his duty, and then he was sick with dizziness, blurred vision, irritability, tinnitus, bad appetite, distension over hypochondrium,  Bp 150/100mmHg, red tongue with yellow fur, wiry and rapid pulse.

男性,45岁,上班时跟别人争吵,于是感到身体不适,头晕目昏花,心烦耳鸣,食欲差,两胁胀满,血压:150/100mmHg, 舌红苔黄,脉弦数。

Syndrome differentiation:
Therapeutic method:
Prescription:
Acupuncture:

 

  1. Male, 43yd, he was very sensitive for other people’s speech, criticize and facial expression. He was in coma, falling down on the ground without consciousness in May last year, spasm over 4 limbs without spitting mouth water. He got once attack in 1 or 2 months at the beginning, and then his condition was more and more serious gradually; his attack could happen one time in 2 or 3 days. After he was treated by the method of Chinese medicine combining with western medicine, his therapeutic effect was not obvious. At the present, he feels lassitude, dizziness and blurred vision, easy frightening during sleep at night, bad appetite, white and greasy tongue fur, wiry and smooth pulse. He was diagnosed by the hospital as epilepsy.

     男性,43岁,他对于别人的言语,批评和面部表情非常敏感。去年5月份时,他突然昏倒,摔倒地上失去知觉,四肢抽搐,不吐痰液,开始每1至2月发作1次,以后他的情况逐渐恶化,2至3天就发作1次,中西医治力偶安置疗治疗效果不佳。现在他感到乏力,头晕,视力模糊,睡眠时易受惊吓,食欲差,舌苔白腻,脉弦滑。医院诊断为癫

Syndrome analysis:
Therapeutic method:
Prescription:
Acupuncture:  

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