Traditional Chinese Medicine (TCM) approaches any disease in a totally distinct way compared to Western Medicine. There is a shift from the accepted scientific and biological reality of how the human body functions; and the connections between the physical body, mind, emotions and environment have a important part to play. TCM is based on Qi being the most fundamental of any aspect in the human body. Qi is the ‘life force’ that gives all spheres of existence form and drives all processes, regardless of it being anatomical, physiological or psychological. In Chinese Medicine every organ’s function is therefore based on an energetic expression and actual physical processes, which impact on mind, body, emotions and spirit.
In order to understand the following information on how TCM views depression, the following points should be kept in mind:
• The Liver is in charge of the smooth, uninhibited flow of Qi (and thus all other substances) in the body.
• The Kidney is the source of all ‘congenital qi’ (everything inherited, also state of health at birth).
• The Heart houses the Mind-‘shen’ and controls our supply of blood.
• The Spleen is responsible for ‘acquired qi’ - digestion and sustenance to the body after birth.
TCM Mechanism of Depression
Depression in Chinese translates to Yu, having the double meaning of ‘stagnation’ which in theory implies that depression is always due to some degree of stagnation in the body.
The onset of depression is mainly due to excessive emotional disturbance such as internalized anger, anxiety, worry, guilt or grief which has a negative effect on the internal balance of the body. There is a resulting dampening of Qi flow mechanism, which if left untreated for prolonged periods can give rise to stagnation of other aspects. These lead to functional disturbances and pathological changes which negatively affect the internal organs and ultimately the mind.
When Qi stagnation lingers it leads to heat which agitates the mind. Phlegm and dampness are also very common pathogenic factors in depression. Their heavy nature is very obstructive to smooth flow and rising of clear Qi to the head. Prolonged qi stagnation also leads to blood stasis which is often associated with feelings of guilt and causes a very ‘dark’ feeling of despair.
The Essential Method of Dan Xi (Dan Xi Xin Fa, 1347) talks about six stagnations i.e. of Qi, Heat, Blood, Dampness, Phlegm, and Food. It says; “When qi and Blood are harmonized, no diseases arise. If they stagnate diseases arise. Many diseases are due to stagnation…”.(12) Zhu Dan Xi formulated the classic Chinese herbal prescription Yue Ju Wan which has been important for treating depression due to stagnation of primarily Qi among other factors.
The basic mechanism of Liver Qi stagnation later puts into action other disease mechanism or syndromes which can be either; replete syndromes (there is a pathological excess in the body), or vacuity syndromes (there is a deficiency in some substance necessary for healthy physiology and functioning). The above disease mechanisms causing depression may be the direct cause, or may be aggravated by and more likely to occur due to the following important factors;
• Constitutional Traits – a lifelong tendency to respond to stress with depression is linked to Kidney qi Deficiency. A depressive personality originates in the inadequate provision of congenital Qi and essence by genetics and during intra-uterine life. These Kidney or congenital energies are the source of all other supplies in the body, so a lack thereof would be related to the root of all other deficiency type depression syndromes. A tendency to Heart patterns is also an important factor contributing to developing depression as in TCM the Heart governs the mind and all emotions.
• Illness – depression may result anytime there is severe loss of Qi, blood and body fluid. This is frequently seen after surgery or prolonged illness without proper rest and care to rebuild the body to at least, close to its original state. This situation is easily reflected in the case of Postpartum Depression or depression following major surgery. In particular, the loss of circulating blood affects the Heart, which in TCM governs blood, ‘houses’ the mind, and is specifically responsible for the emotion of joy. Damaged Heart Qi has a negative effect on mental activities and the absence of the capacity for joy may lead to prolonged depression.
• Poor Diet & Exercise – excessive consumption of certain foods contribute to accumulation of pathological substances which are very obstructive and aggravate qi stagnation, while a diet lacking in nourishment lead to deficiency of Qi and blood which is the cause of deficiency types of depression. Dairy, refined sugars and starches, greasy and oily foods lead to the formation of phlegm and dampness (a pathological factor due to retained and congealed body fluids). Heat forming foods such as alcohol and peppery spicy foods make it more likely that simple liver stagnation will transform into more severe depressive heat. Too many raw or cold foods can damage the Spleen (this doesnot mean physical Spleen organ in anatomy)and lead to more dampness. Likewise, the Spleen can be damaged by too little exercise (as the Spleen governs muscles), while a good amount of exercise strengthens the Spleen and stimulates the flow of Qi helping the free flow of Qi in a depressed stagnant Liver.
• Overwork – working long hours without adequate rest for several years leads to Kidney Yin Deficiency, and this often forms the cause for depression in older people. Like poor nutrition, overwork also depletes Qi and blood causing deficiency types of depression.
TCM 5 Elements Theory and Depression
Another approach in understanding depression is using TCM's 5-Element system in which each of the 5 phases (Fire, Earth, Metal, Water and Wood) corresponds to various aspects of the psyche or emotions; as well as one of the Zang (Yin) organs and its related characteristics. A constitutional trait or a deficiency of particular organ would therefore present various psychological manifestations which can also explain some of diagnosis criteria for depression in Western Medicine.
• ‘Shen’- translating to Mind/ Spirit relates to the Heart and Fire phase. Shen is negatively affected by anger, despair and sadness.
• ‘Yi’-Intellect relates to the Spleen and Earth phase. It is affected by obsessive thinking, brooding and pensiveness.
• ‘Po’-Corporeal Soul relates to the Lung and Metal phase. Its constriction gives rise to morbid thoughts of death.
• ‘Zhi’-Will Power is related to the Kidney and Water phase. A lack of zhi translates to a lack of drive, initiative, enthusiasm or momentum to break out of the depression cycle.
• ‘Hun’-Ethereal Soul relates to the Wood phase and the Liver. It gives courage, the "will to live" and the will to discover the world. The psychic ‘coming and going’ of Hun also depends on the free flow of Liver Qi (particularly its psychological ascending). Free movement of the Hun is kept in check by the Shen to achieve a state of mental stability. A disconnection between the Shen and Hun, (same as Fire & Water, body's relative Yin and Yang aspects) or inhibited movement of Hun due to stagnation or deficiency leads to lack of ability to make plans and decisions. There is weakness in one’s imagination, life dreams, hope, sense of direction, and in severe cases a tendency to becoming suicidal.
Like there are psychological manifestations with the characteristics of the various phases and their related organ, there are also physical manifestations which interestingly support the somatic symptoms for depression established by Western Medicine. The following are three common 5-Element Patterns of depression;
• With Earth type of depression, digestive problems, becoming tired and overwhelmed easily, overthinking and worry, weight gain and loose stool are common. This depression is a result of Spleen Qi deficiency mainly, as Spleen is energetically responsible for digestion and assimilation.
• Water type is due to deficiencies in ‘source Qi” of the Kidney - root of everydingcongenital and responsible for growth and development. This type of depression is most associated with old age, or extreme chronic illness. Common symptoms are sexual dysfunction and lack of libido, morning diarrhea, knee and low back problems and frequent urination.
• A Wood type of depression is due to being all bunched up because of Liver Qi stagnation. Common symptoms include rib pain and chest tightness, temporal headaches, short temper, irritability, frustration and a tendency to a wiry or skinny body build. (9)
Syndromes and their Treatment
In TCM practice a comprehensive evaluation of the patient is made and resulting diagnostic findings fall together into specific TCM diagnoses called syndromes. These describe what systematic situation the patient is presenting at the said time. From these syndromes, it is then easy to formulate a treatment plan for to address the different imbalances occurring with the particular syndrome.
Effectiveness of TCM in Treating Depression.
Conducting highly reliable research into the effectiveness of TCM (acupuncture in particular) in treating clinical depression, using western medical model clinical settings can be quite challenging as TCM understanding veers far from anything that can be explained by absolute scientific, quantifiable or tangible means. Even more so are studies into the realm of mind and emotions which are still mysterious even to western medicine today. Regardless, several studies have been conducted which prove that although the exact mechanisms are not totally understood, TCM definitely has a positive effect in the treatment of depression, especially improving the many somatic problems it causes.
The National Center for Complementary and Alternative Medicine of the National Institutes for Health (NIH), which funds research studies in the holistic treatments has sponsored studies showing positive results in the effectiveness of acupuncture in treating depression. In 1998, Dr. John Allen and other researchers at the University of Arizona used acupuncture to treat a sample of women with depression. After a total of 12 sessions, 70% of the women experienced at least a 50% reduction of symptoms. This research marked the first U.S. randomized, controlled, double-blind study of acupuncture’s effectiveness in treating depression. The NIH funded study concludes, “Acupuncture may alter brain chemistry by changing the release of neurotransmitters and hormones in a good way.”
Despite rigorous clinical data being limited, and the apparent need for further research into the effectiveness of TCM in treating depression, I think that we can take assurance in available data on depression compiled from centuries of study and clinical use in the field of TCM. In addition, it is an encouraging fact that there are no known side effects from acupuncture and herbal treatment for depression, especially since treatment in TCM is centered on each patient’s individual needs.
1. Maciaocia Giovanni. Diagnosis in Chinese Medicine: A Comprehensive Guide. P.380-384. Elsevier Churchhill Livingstone Ltd, 2004
2. Flaws Bob, Schnyer N. Rosa. Curing Depression Naturally with Chinese Medicine. P. 41-44, 49-56. Blue Poppy Press, 1998.
3. Maciaocia Giovanni. The Psyche in Chinese Medicine: Treatment of Mental and Emotional Disharmonies with Acupuncture and Chinese Herbs. P.342 -363. Elsevier Churchhill Livingstone Ltd, 2009.
4. Hammer Leon M.D. Dragon Rises, Red Bird Flies – Psychology and Chinese Medicine. P. 291-293. Eastland Press Inc., 2010.
5. Huang Ellen. Internal TCM I & II. – Alberta College of Acupuncture & TCM Lecture Notes. 2010-2011.
6. Dubowsky Jennifer, L.Ac., M.S.O.M., Dipl.Ac. (2008). Acupuncture and Depression: An Old Answer to an Old Problem. https://www.acufinder.com/Acupuncture+Information/Detail/Acupuncture+and+Depression+An+Old+Answer+to+an+Old+Problem (15 June 2012).