General Information

Extra caution should be taken when treating depression:

Kuang (mania), must be sedated and purged, but when moving towards Dian (withdrawl, depressed), we must change treatment principle as to not depress the patient more than they already are.

Clearing Phlegm can always be done as most mental diseases have phlegm misting the mind to some extent.

Etiology (causes) of Depression:

1. Qi Stagnation -Liver/Spleen stagnation produces phlegm and blood stasis blocking Heart meridian and blocks the mind

2. Phlegm -blocks mind

3. Fire -more for Kuang behaviour- fire effects (St/LV/GB) which then attacks Heart and blocks the mind.

4. Blood Stasis -blocks healthy Qi and Blood from nourishing Heart and mind.

TCM Diagnosis of Depression and Mannic Behavior (Kuang Dian):

Yang Symptoms - loud, much action, extroverted (use Ren Meridian)

Yin Symptoms - quiet, minimal action, introverted (use Du Meridian)

Organ Differentiation: heart/lung/liver/kidney/spleen Heart Differentiation:

Mental (hand shao-yin)

Physical (hand jue-yin)

King fire more connects with stomach Minister fire connects with spleen

Brain connects with TCM Heart and Kidney

Phlegm - root of all mental disease!

Phlegm mists the heart - Traditional Diagnosis

1- Invisible or Visible turbid phlegm

2 -Blood nourish spiriTongue - blood stasis

3 -Qi - connects with - blood stasis / phlegm / fire deficient fire with phlegm

- wants to kill self (moxa) King or Minister Fire excess fire with phlegm

- wants to kill others (clear heat) Yin Yang Fan Zhuo

- yin and yang reversed Tan Qi Jiao Jie

- phlegm and qi stagnated and mixed into sticky condition

Liver Rising - Si Jue Ming, Dai Zhi Shi, Sang Tae Lou

Heart Kidney Disharmony - Ci Zhu

Lung not Descending - Da Huang, Lung Hui + phlegm herbs

Dr. Liu Feng (20^th century) expresses the need to balance and connect the triangle of -cognition/personality-, will, and emotions to achieve results within treatment of all mental disease. He also stresses to watch personality changes to understand severity of the patients disease. This helps to determine if the disorder is simply a personality or neurotic disorder, or if it is more severe causing great distress and problems fitting in with society which would lean more towards (affective) Mood disorders or Schizophrenia.

Top 13 Formulas for Mental Disease:

Wen Dan Tang (cousin - Dao Tan Tang, Di Tan Tang) Modifications: Huang Lian (king fire) Huang Qin (minister Fire) Liver Fire Rising + Long Dan Xie Gan Tang,

Mu LiFang Feng Tong Sheng Tang (-mang xiao) + Qiang Huo/Du Huo (wind damp) + Huang LianGui Pi Tang - + Huang Lian + Dan Shen (blood circ.) + Shu Di Xue Fu Zhu Yu Tang 

Blood circulation Tian Wang Bu Xin Tang 

Heart and Kidney Yin Deficiency Meng Shi Guan Tan Wan -

Phlegm Fire Su Hua Xiang Wan 

cold sticky phlegm Bai Jing Wan  (Bai Fan (Ming Fan), Yu Jin)

Any Phlegm Xiang Sha Liu Jun Zi Tang- Long Dan Xie Gan Tang  (Mu Tong Toxic) + Lian Zi Xin, Dan Zhu Ye, Da Huang Huang Lian Jie Du Tang  excess fire, + Si Wu Tang (wen qin yin) Chai Hu Jia Long Gu Mu Li Tang Chai Hu Shu Gan San

Acupuncture For Mental Depression:

Phlegm Fire  Kuang Zheng - Yang 1. Main points: Ren 12, 13, 15 2. Calm: Du 26-28 (strong stimulation), Kidney 1 3. Purge Yangming: Large Intestine 4, 11, Stomach 36, 37, 39, SJ 6 4. Shaoyang: Gall bladder 20 5. Taiyang: Bladder 9, 10 6. yin tang  downwards towards bridge of nose experience points: 1.Clear Minister Fire: Pericardium 5 to SJ 6 2.Fire and Phlegm: Pericardium 5, Stomach 40 3.Phlegm in Lung system: Stomach 40, Lung 7 4.Sweating (night or daytime spontaneous): Heart 6, Kidney 7 5.Fever: Large Intestine 11, Du 14, Heart 3 6.Hearing voices in the head: Small Intestine 19, Gall bladder 2, Pericardium 5 7.Ghosts in dreams: Spleen 1, Stomach 45

Dian Zheng  Yin  Pericardium 6, Du 20, 26, Gall bladder 12, 14, 16, Gall bladder 13, St 40, St 6, Spleen 6 Moxa Ren 4, 6, and back shu points Sun Si Miaos

13 Ghost Points These originated from Thousand Ducat Formulas in the Tang dynasty (618-907 A.D., near the end of the middle ages), which was when the first book was ever printed, and a push to make Buddhism the state religion was attempted. Quite possibly an idea of forced religion, and the beginnings of information-overload provided by the invention of printing, both played a role in the need for more empirical practice concerning mental disorders (Kuang Dian), which we now refer to as mood, personality, and/or Schizophrenic patterns/disorders. Now, early in the new millennia, it seems to be of great importance for Traditional Chinese Medicine and particularly Acupuncture with its unique ability to regulate many aspects of our health and life, to step forward into what seems to be another age with the need for mental health treatment options.

The 13 Ghost Points: Du 26 (Renzhong Palace GhosTongue - Guigong) Du 16 (Fengfu Pillow Zhen Gui) Du 23 (Shangxing Hall ghost Guitang) Ren 24 (Chengqiang Market GuiShi) Lung 11 (Shaoshang Faith Guixin) Large Intestine 11 (Quchi Leg Guitui) Stomach 6 (Jiache Bed Ghosts Guichuang) Spleen 1 (Yinbai Fortress Guilei) Pericardium 7 (Daling Heart Guixin) Pericardium 8 (Laogong Cave Guicu) Bladder 62 (Shenmai Path Guilu) Guifeng  Ghost Seal (Haiquan extra point below tongue) Ren 1 (Huiyin Ghost Store Guicang) It has been said that Guixin  Ghost Heart (Daling Pericardium 7) is actually Taiyuan Lung 9 (connecting these points may be of benefit). It is of popular belief that Guilu  Ghost Path (Shenmai Bladder 62) is actually Jianshi Pericardium 5. Another text includes Shenting Du 24, Ruzhong Stomach 17, Yanglingquan Gall bladder 34, and Xingjian Liver 2, and did not include Shenmai Bladder 62, Shangxing Du 23, Quchi Large Intestine 11, and Huiyin Ren 1.

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Depression - Depressive Psychosis - Dian

Depressed mental state, lack of facial expression, quiet, slow reactions, slow-incoherent speech, lack of physical drive.

In Chinese Medicine Diagnosis all three pulses and levels are thin weak and deep, the patient is very quiet, no concentration, speaks nonsense, lack of expression, eat unclean food from street/garbage, lie or laugh a lot for no reason, think unreasonably, feel guilty, afraid that someone is after them, may think they are having a heart attack (but not so), manic sadness and happiness.

Chinese Medicine Differentiation of Depression:

Yin Phlegm and Qi stagnation. Dian Depression: generally Lung or Liver patterns Antidepressants - Injure Heart (hand Jue-yin) -create blood stasis -damage spleen yang -cause general Qi deficiency People experiencing depression have a severe case when they wake earlier in the morning (ie- more depressed if waking up at 5 than if waking up at 7)

Depression is often mixed with anxiety Depression is usually 50% excess and 50% deficiency Anxiety is usually 90% deficiency and 10% excess

Anxiety - Heart,Spleen,Kidney Suicide - Kidney and Lung Deficiency

Chinese Medicine Differentiation and Treatment

Phlegm and Qi Stagnation depressed, slow, sighing, worry, poor appetite Tongue - thin greasy coat, Pulse - wiry, slippery,

Principle of Treatment: - regulate Qi and eliminate Phlegm to open the mind cavity

Acupuncture points - Bladder 18, Liver 3, Bladder 20, Stomach 40, Bladder 15, Heart 7 - Stomach 40, Ren 4, 6, Bai Hui, Du 4, 14, Stomach 36, Yintang (These may be used for all Dian) - Hallucinations  Bladder 1 - Hearing Things SI 19 - Sad/crying  Lung 9 - Moxabustion is very useful here.

Herbal Formula: Xiao Yao San + Di Tan Tang, Er Chen Tang

Spleen Qi deficiency with accumulation of Phlegm Depressed, dull expression, minimal talking, soft stool, more slow and dull than Phlegm and Qi Stagnation, Tongue - pale swollen, thick white greasy coat, Pulse - weak, soft, slippery

Principle of Treatment: - nourish spleen to eliminate Phlegm

Acupuncture points - foot yangming, front mu and back shu, Bladder 20, Stomach 40, Stomach 36, Bladder 15, Heart 7 - Poor appetite  Pericardium 6

Herbal Formula: Si Jun Zi Tang + Di Tan Tang, or Gui Pi Tang, Ban Xia Huo Po Tang

Deficient Heart and Spleen (Qi and Blood) More heart symptoms than above, insomnia, palpitations, depressed, dull expression, minimal talking, soft stools, Tongue - white coat, pale, Pulse - weak, thin

Principle of Treatment: - nourish heart and spleen to calm mind

Acupuncture points  hand shao yin, foot tai yin and back shu, Bladder 20, Spleen 6, Stomach 36, Bladder 15, Heart 7

Herbal Formula: Yang Xin Tang

Yin deficiency with deficient Fire Easily gets upset, easily shocked, talks excessively (not loud), general emaciation, red cheeks, insomnia, thirsty, Tongue - red, dry, scanty coat, Pulse - thin, rapid

Principle of Treatment: - nourish yin, descend fire to calm spirit

Acupuncture points - foot tai yin, hand jue yin, Bladder 23, Kidney 3, Bladder 15, Heart 7, Pericardium 7, SP6

Alternative treatment methods

Ear Acupuncture - heart, sub cortex, occipital, frontal, shen men, kidney

electrical Acupuncture - Du 20, Yin Tang, Du 26, Heart 5, Stomach 40  alternating current

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Mania - Manic Psychosis - Kuang

Everything is excess, loud, anger, violent, laughing  Phlegm fire blocking the heart cavities

-Tan Re Mi Xin Qiao Hun Po

- Phlegm and Fire disturb mind, Shen, Heart, ethereal and physical spirit.

Western Medicine: Manic Psychosis, Schizophrenia, Hypomania, Postpartum disorders, Substance use disorders, Acute reactive disorders, hysteria.

-Kuang Zheng (mania)is a Fire (Yang) pattern that is usually complicated with Phlegm covering the Heart, mind, spirit, Hun (ethereal) and Po (physical) soul. This manifests as blockage accumulating until the point of bursting causing Fire to surge upwards. It shows a relative excess of Yang and a deficiency of Yin simultaneously.

Yang purge and remove Phlegm-Fire or Blood Stasis.

Symptoms: sudden onset, irritability, flushed face, blood shot eyes, mania, restlessness, climbing to high places, public singing, unusual strength, anorexia, insomnia, constipation,  all three pulses and levels are big and flooding, people may strip in public, sing/scream/swear or act out, become violent (have incredible force), lots of energy (dont need to eat to maintain energy), angry, very out of character, may be suicidal. T- red with yellow coat, P- rapid

Principle of Treatment: Purge the Phlegm and Fire through the Large Intestine by inducing diarrhea, Tonify Yin, remove stagnation. Chinese Medicine Differentiation and Treatment

Phlegm Fire attacking Mind (Heart) Doesnt eat, doesnt sleep, violent, red complexion Tongue - red, yellow greasy coat, Pulse - wiry, slippery, big

Principle of Treatment: - purge liver fire, eliminate Phlegm and calm heart

Acupuncture points - DU meridian, foot jue yin meridian, Du 26, Pericardium 8, Stomach 40, Liver 2, 3, Ren 13 Constipation- SJ 6, Stomach 25

Herbal Formula: San Sheng San (induce vomiting) Gun Tan Tang + Xie Xin Tang (purge) San Huang Tang (purge) Shi Chang Pu (clears Phlegm from Heart meridian) Er Chen Tang

Hyperactive Fire with Yin injury Usually second stage, irritable, angry, easily shocked, doesnt feel safe, insecure Tongue - geographic yellow greasy coat with cracks

Principle of Treatment: - purge Fire, nourish yin and calm mind

Acupuncture points  Heart 7, Pericardium 7, Spleen 6, Kidney 4, Stomach 40, Ren 13

Herbal Formula: Er Yin Jian + Ding Zhi Wan Dan Zhi Xiao Yao San Zhi Bai Di Huang Wan

Qi and Blood stagnation Angry, irritable, loud talking, delusions, hallucinations, pain in chest, palpitations, fullness in chest, dark- dull complexion, Tongue - purple dots, Pulse - uneven

Principle of Treatment: - promote circulation, remove

Blood Stasis to open mind

Acupuncture points- hand shao yin and Du meridian, Du 26, Heart 7, Pericardium 7, Liver 3, Large Intestine 4, Spleen 10, Bladder 17 - Delusion  Small Intestine 19, Bladder - Palpitations  Pericardium 6

Herbal Formula: Dian Kuang Meng Xin Tang + Da Huang Zhe Cong Wan, Xue Fu Zhu Yu Tang

Alternative Treatment Methods

electrical Acupuncture - Du 26  Du 20, Du 16  Du 14(extreme caution)

Scalp Acupuncture points - motor area Note: stop purging treatments as soon as symptoms subside because they are damaging to the Spleen. Tonify Spleen afterwards.

***It is important to fully and completely eliminate the Phlegm in the treatment of Kuang, otherwise recurrence is guaranteed.