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.)
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.
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.
This disease is including neurasthenia, hysteria and anxiety in western medicine and also in Perimenopausal syndrome and reactive psychosis.
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.
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:
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
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.
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.
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.
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.
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.
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.
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.
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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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)
Syndrome differentiation: （辩证）
Therapeutic method: （治则）
- 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.
Acupuncture or Tuina:
- 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.
- 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.