
Depression/Depressive Disorder
Depression, also known as major depressive disorder, manifests with varying symptoms between individuals, and is typically episodic in nature. According to the Canadian Mental Health Association, it will affect one in eight Canadians at some point in their life.
Depression affects people of all ages, and disproportionately affects women, people with chronic illnesses, and individuals with substance use challenges.
Typical symptoms include a sense of hopelessness, alterations to sleeping patterns and appetite, difficulty concentrating, social anxiety, sadness or grief, fatigue or a feeling of heaviness, and possible suicidal ideation.
Western medical treatment typically involves counselling in the form of cognitive-behavioural therapies or interpersonal therapy, various medications such as SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-noradrenaline reuptake inhibitors), and MAOIs (monamine oxidase inhibitors), and self-help approaches such as regular exercise, stress management, and limiting use of alcohol and other drugs.
An important distinction is generally made between experiences of low mood owing to an identifiable cause such as a traumatic life event, and major depressive disorder, which is long-term, and occurs without an identifiable trigger. The former is typically more successfully treated.
In Traditional Chinese Medicine depression is a familiar condition known as 郁证 (yù zhèng). This general term refers to a wide range of disorders that are caused by emotional frustration.郁证 (yù zhèng) includes conditions such as mental depression or restlessness, moodiness, anxiety, irritability, propensity to anger or sadness, sleep disturbances, or any combination thereof.
Acupuncture treatment for depression is performed according to a number of possible TCM syndrome patterns, each of which calls for a different treatment principle and acupuncture point prescription that is determined by the practitioner through a combination of detailed discussion, observations, and possibly palpation. An acupuncturist or TCM practitioner will determine the treatment style and syndrome pattern during the initial assessment process in the clinic.
The common syndrome patterns found in patients experiencing depression are outlined below:
Qì stagnation/constraint
In TCM, health is dependent upon harmonious qi and blood. These two must be found in adequate amounts, and they must be able to freely circulate through the body without impediment.
Qi stagnation is considered to be the main pattern involved in yù zhèng. In the context of Chinese medicine, the first character, 郁 (yù) connotes qì stagnation owing to an emotional cause. Repressed emotions are the main cause of qì stagnation in this regard, and apply most directly to the hun aspect of the spirit. The hun is associated with creativity, intuition, and making plans and following them through. In a harmonious state, one can create freely, make plans, and execute them without frustration. When qì stagnation is affecting the hun the individual experiences a lack of inspiration and an inability to see possibilities and make plans toward accomplishing goals. This produces frustration, resulting in further stagnation of emotions and qì.
Other symptoms experienced in this pattern of depression include frequent sighing and despondency, pain and distension in the chest and hypochondrium, and possible loss of appetite, nausea, or abnormal bowel movements involving loose stools or constipation, which are commonly alternating. There can be painful or irregular menstruation in those with a menstrual cycle.
Low mood is often experienced strongly in the morning, or when there is a lack of physical activity, and is improved with exercise.
The pulse is typically found to have a wiry quality, like a plucked guitar string, and the tongue has a thin white coat.
Acupuncture for this type of depression involves acupuncture points that soothe the Liver and help it to better move qì and relieve the stagnation.
Liver Qì Stagnation with Heat
This pattern develops from the pattern above, given enough time. A fundamental tenet of TCM is that untreated qì stagnation creates heat over time.
In this pattern there is irritability and anger, as the heat affects the mind. There is a tendency toward emotional outbursts, especially involving feelings of anger or frustration.
The individual may experience flushing of the face, increased thirst, and red or bloodshot eyes.
Sleep is often impacted, with experiences of restlessness, and/or vivd dreams.
There can often be neck and upper back tension with headaches or even migraines.
Digestive symptoms may be present and include heartburn, reflux, or constipation. Premenstrual irritability is common, as well as a possible loss of libido.
The tongue is either entirely red, or has red edges, and has a yellow coat.
The pulse has gone from wiry to wiry and rapid or strong.
Acupuncture treatment for this type of depression involves acupuncture points that soothe and clear heat from the Liver, and regulate qì to relieve the stagnation.
Liver and Heart Fire
The Liver and Heart Fire syndrome pattern is apparent in what would be termed an acute manic episode.
If there is already heat appearing in the array of symptoms as in the above syndrome pattern, even a small increase in further heat can produce the condition of Liver and Heart fire. This heat can come in the form of acute emotional frustration or anger, or alcohol or drug use.
In the situation of Liver and Heart fire there is significant mental agitation, outbursts of anger or rage, and aggression. The individual is likely to have a flushed complexion, with red eyes, and is likely to experience tinnitus, dizziness, and possibly migraine headaches. Palpitations and insomnia are likely, as are mouth or tongue ulcers.
Dark yellow urine, and constipation are likely to be experienced as well.
The tongue is red, with a thick or dry yellow coat, and the pulse is rapid and forceful, slippery, or surging.
Acupuncture for this pattern of depression involves point selections that will clear heat from the Heart and Liver, drain the fire, and calm the mind.
Qì stagnation with Phlegm
Qì stagnation with phlegm is the pattern of disharmony produced when the depression experienced is centred around feelings of grief and sadness.
In TCM theory, sadness and grief have a direct effect on the Lung, which is responsible for the dispersing and descending of fluids throughout the body. As the Lung qì is stagnated by these emotions, its function in this regard is compromised, and fluids accumulate in the throat where they congeal to form phlegm.
The phlegm in the throat produces a sensation known in Chinese medicine as “plum pit qì,” which refers to the sensation of a foreign body being lodged in the throat that can be neither swallowed nor spat out. This sensation is worsened by stressful situations, and by the inability to express emotions freely.
Other features of this type of depression include nervousness, sadness, and cyclical or obsessive thought patterns. There is a feeling of the need to clear one’s throat, especially when one needs to speak.
The individual is likely to feel lethargic, heavy, or overburdened, with a strong desire to sleep.
There may be a stifled or constricted feeling in the chest, dizziness, and a productive cough, or accumulation of mucus in the sinuses.
The tongue in this syndrome pattern may be swollen, or have a thick white coat, and the pulse is likely to be slippery.
Acupuncture treatment for this type of depression involves points to move the qì and resolve the phlegm and dampness, regulate the Lung qì, and harmonize the Liver and Spleen.
Spleen Qì and Heart blood Deficiency
While the above syndrome patterns are considered to be of an excess nature, this pattern is one of deficiency.
Rather than an outwardly displayed condition of irritability or restlessness, this pattern involves a chronic form of depression, typically featuring fatigue and over-thinking, worry, timidity, and a poor memory. Palpitations are commonly experienced as well, and a pale complexion and poor appetite are common. One could say there is a tiredness of the spirit in this pattern. There may be difficulty sleeping as well, primarily with difficulty in initially falling asleep.
The tongue colour is likely to be pale, with a thin coat, and the pulse will have a thin, or thready nature, or may be weak.
As the Spleen is the main source of blood in TCM, which it produces from the digestion of food, and the Spirit requires adequate blood to be properly nourished and ‘housed’ in the Heart, the dual deficiencies of Spleen qì and Heart blood need to be treated in this situation.
Acupuncture treatment for this pattern involves strengthening the TCM Spleen, or digestive function, and to nourish the Heart blood to calm the spirit.
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