Depression

//Western Diagnosis// a unipolar disorder characterized by mood disturbance, psychomotor dysfunction, and vegetative symptoms 20% women, 12% men during lifetime twice as much in women begins in ages 20-40

Etiology
a. impaired limbic-diencephalon function b. subcortical extrapyramidal structures and pre-frontal connections c. ACh d. NE, DA e. serotonin a. introversion b. anxiety endocrine changes
 * Genetics**
 * Personality**
 * female gender**
 * physiologic**

Signs & Symptoms
1. depressed, irritable, anxious 2. furrowed brows, slumped posture 3. monosyllabic speech 4. guilt 5. difficulty concentrating 6. indecisiveness 7. loss of interest 8. social withdrawal 9. helplessness, hopelessness 10. recurrent thoughts of death and suicide 11. inability to experience emotions 12. sleep disorders

Diagnosis
-Depressed mood -Apathy/Loss of Interest + -Weight/Appetite change -sleep disturbances -psychomotor change -Guilt/Worthlessness -Cognitive dysfunction -Suicidal Ideation

-Energy -Interest -Concentration || -Impulsivity -Change in sexual activity -Change in appetite ||
 * Norepinephrine/Dopamine || Serotonin ||
 * -Motivation

Melancholia
1. endogenous depression 2. psychomotor slowing or agitation 3. anorexia, weight loss 4. guilt 5. loss of pleasure 6. insomnia 7. decreased libido 8. psychotic subtype in 15% a. delusions of having committed unpardonable crimes b. accusatory hallucinatory voices c. feelings of insecurity and worthlessness: persecution

Treatment
1. SSRI’s 2. heterocyclic antidepressants 3. 5-HT antagonists 4. Hypericum (St. John's Wort)- 300 mg TID 5. B vitamins [especially B12] 6. amino acids -tryptophan -tyrosine -phenylalanine -L-Theanine 7. DHEA 8. food sensitivities 9. psychotherapy 10. meditation* 11. exercise* 12. Hair analysis for heavy metals 13. Calcium (postmenopausal)

//TCM Pathology// =Depression Patterns/Yù Zhèng= Yù refers to any obstruction resulting from stagnation, stasis, accumulation and retention. The broad concept of Depression Patterns/Yù Zhèng encompasses all clinical manifestations caused by stagnation of Qi, Blood, Phlegm, Fire, Dampness, and food arising from internal organs dysfunction or from invasion by exogenous pathogenic influences.

In a more narrow sense, Yù Zhèng refers to a syndrome with a variety of patterns stemming from emotional disturbance characterized by stagnation and obstruction of the flow of Qi. Clinical manifestations include melancholy, moodiness, despondence, depression, anxiety, irritability, or bouts of crying. Associated manifestations may include costal distention or pain and an uncomfortable sensation in the throat as if something were stuck in it.

Relevant Biomedical Conditions
-Hysteria -Neurosis -Depression -Somatoform disorders -Menopause -Bipolar disorder (depressive phase)

Etiology and Pathogenesis
The TCM understanding of the etiology and pathogenesis of depression emphasizes the Liver. The 18th-century text Za Bing Yuan Xi Zhu (Wondrous Lantern Peering Into the Origin and Development of Miscellaneous Diseases) states, “All depression can be classified as a Liver disease.”

The Qing dynasty text Zheng Zhi Hui Bu (Complete Collection of Patterns and Treatments) states, “In all the many cases of depression, their cause is Qi which is not regulated or coursing. Treatment must first normalized the flow of Qi.” Therefore, all patients with depression will exhibit signs and symptoms of Liver Qi stagnation regardless of what other disease mechanisms are also at work.

Early-stage Depression Patterns/Yù Zhèng: emotional stress such as frustration, anger, and depression may cause Liver Qi stagnation. Qi is the motive force of metabolism. In a condition of prolonged Qi stagnation, other pathologies of Blood stasis, accumulation of Dampness or Phlegm, or Food stagnation may arise as a consequence. These pathogenic factors may, in time, turning to Fire, which becomes another source of stagnation.

Later stage Depression Patterns/Yù Zhèng: in contrast to the early stage of Depression Patterns/Yù Zhèng where the pathogenesis is relatively one of excess, the later stage is relatively more deficient. Constrained Liver Qi inhibits the Spleen’s function, resulting in insufficient generation of Qi and Blood and malnourishment of the Heart Spirit. Deficiency of Heart Blood and Yin will lead to Kidney Yin deficiency with empty Fire.

Stagnation of Liver Qi
[Chai Hu (Bupleurum Root) 6g, Bai Shao Yao (White Peony Root) 9g, Xiang Fu Zi (Cyperus Root) 6g, Chuan Xiong (Ligusticum Root) 6g, Chen Pi (Tangerine Peel) 6g, Zhi Ke (Bitter Orange Peel) 6g, Zhi Gan Cao (Honey-fried Licorice Root) 3g]
 * Main Symptoms:** Depression, mood swings, restlessness, chest, epigastric, abdominal, and hypochondriac distention and pain
 * Additional Symptoms:** Sighing, pain and distention relieved by belching and/or passing gas, reduced appetite, menstrual irregularities
 * Tongue:** Thing white or thin greasy coating
 * Pulse:** Wiry, slippery
 * Treatment Principles:** Soothe Liver, regulate Qi, relieve depression
 * Acupuncture Treatment:** [DU20, DU24] + BL18, LR3, ST36, SP4, CV12, CV17
 * Herbal Treatment:** Chai Hu Shu Gan San (Bupleurum Liver-Coursing Powder)

Qi Stagnation turning into Fire
[Chai Hu (Bupleurum Root) 9g, Bai Shao Yao (White Peony Root) 12g, Dang Gui (Tangkuei Root) 9g, Bai Zhu (Atractylodes Root) 9g, Fu Ling (Poria) 9g, Mu Dan Pi (Moutan Root Bark) 9g, Shan Zhi Zi (Gardenia Fruit) 9g, Zhi Gan Cao (Honey-fried Licorice Root) 6g, Sheng Jiang (Fresh Ginger) 3g, Bo He (Field Mint) 3g] + [Wu zhu yu (Evodia fruit) 3g, Huang Lian (Coptis root)18g] Added for significant symptoms of Stomach Heat, such as voracious appetite, acid regurgitation, epigastric pain, and upset stomach
 * Main Symptoms:** Easily agitated and irritable, hypochondriac distention and pain, chest oppression
 * Additional Symptoms:** Headache, red eyes, tinnitus, acid regurgitation, dry mouth, bitter taste in mouth, constipation, stomach upset
 * Tongue:** Red, thin yellow coating
 * Pulse:** Wiry, rapid
 * Treatment Principles:** Clear Liver, drain Fire, calm Stomach, regulate Qi, relieve depression
 * Acupuncture Treatment:** [DU20, DU24] + GB34, GB43, LR2, TB6, CV13
 * Herbal Treatment:** Dan Zhi Xiao Yao San (Moutan & Gardenia Free Wanderer Powder) + Zuo Jin Wan (Left Metal Pills),

Obstruction of Static Qi & Phlegm
[Fa Ban Xia (Pinellia Tuber) 12g, Hou Po (Magnolia Bark) 9g, Fu Ling (Poria) 12g, Sheng Jiang (Fresh Ginger) 9g, Zi Su Ye (Perilla Leaf) 6g]
 * Main Symptoms:** Plum-pit sensation in the throat that cannot be expectorated or swallowed
 * Additional Symptoms:** Chest and hypochondriac distention, costal pain
 * Tongue:** White, greasy coating
 * Pulse:** Wiry, slippery
 * Treatment Principles:** Regulate Qi to relieve constraint, resolve phlegm, relieve depression
 * Acupuncture Treatment:** [DU20, DU24] + CV12, CV17, CV22, ST40, LR3, PC6
 * Herbal Treatment:** Ban Xia Hou Po Tang (Pinellia & Magnolia Bark Decoction)

Vacuity of Yin and Blood (Restless Organ Disorder)
[Gan Cao (Licorice Root) 9g, Xiao Mai (Wheat) 30g, Da Zao (Jujube Fruit) 10 pc]
 * Main Symptoms:** Depression, hysteria, abnormal and unregulated emotional responses, mood swings, suspiciousness, trance-like mental state
 * Additional Symptoms:** Restlessness, disorientation, deafness, aphonia, convulsions, chest oppression, loss of consciousness
 * Tongue:** Pale, thin white coating
 * Pulse:** Wiry, thready
 * Treatment Principles:** Nourish the Heart, quiet the spirit, relieve depression
 * Acupuncture Treatment:** [DU20, DU24] + HT7, SP6, ST36, LI4, CV14, PC6
 * Herbal Treatment:** Gan Mai Da Zao Tang(Licorice, Wheat & Jujube Decoction)

Heart and Spleen Dual Vacuity (Qi & Blood)
[Huang Qi (Astragalus Root) 9g, Ren Shen (Ginseng) 9g, Bai Zhu (Ovate Atractylodes Root) 9g, Fu Shen (Poria Root) 9g, Long Yan Rou (Longan Fruit) 9g, Suan Zao Ren (Spiny Jujube Kernel) 9g, Mu Xiang (Saussurea Root) 6g, Dang Gui (Tangkuei) 6g, Yuan Zhi (Polygala Root) 3 g, Zhi Gan Cao (Honey-fried Licorice Root) 6g, Shang Jiang (Fresh Ginger) 3g, Da Zao (Jujube Fruit) 5 pc]
 * Main Symptoms:** Pensiveness, palpitations, poor memory, insomnia, epigastric fullness and discomfort
 * Additional Symptoms:** Loss of appetite, pale complexion, fatigue
 * Tongue:** Pale
 * Pulse:** Weak, thready
 * Treatment Principles:** Tonify Spleen, nourish Heart, relieve depression
 * Acupuncture Treatment:** [DU20, DU24] + HT7, ST36, SP6, CV12, BL15, BL20
 * Herbal Treatment:** Gui Pi Tang (Spleen-Returning Decoction)

Heart & Kidney Disharmony
[Sheng Di Huang (Rehmannia Root) 30g, Tian Men Dong (Asparagus Tuber) 12g, Mai Men Dong (Ophiopogon Tuber) 12g, Suan Zao Ren (Spiny Jujube Kernel) 12g, Dang Gui (Tangkuei) 9g, Dan Shen (Salvia Root) 9g, Xuan Shen (Scrophularia Root) 9g, Ren Shen (Ginseng) 6g, Fu Ling (Poria) 6g, Wu Wei Zi (Schisandra Berry) 6g, Yuan Zhi (Polygala Root) 6g, Jie Geng (Platycodon Root) 6g, Bai Zi Ren (Biota Seed) 12g]
 * Main Symptoms:** Easily angered and irritable, dizziness, tinnitus, palpitations, insomnia
 * Additional Symptoms:** Weak and sore low back and knees, menstrual irregularities, nocturnal emissions
 * Tongue:** Red, scanty coating
 * Pulse:** Thready, rapid
 * Treatment Principles:** Nourish Yin, clear Heat, sedate the Heart, calm the spirit, relieve depression
 * Acupuncture Treatment:** [DU20, DU24] + HT7, HT5, BL15, BL23, KI3, SP6, CV17, PC6
 * Herbal Treatment:** Tian Wang Bu Xin Dan (Celestial Emperor Heart-Supplementing Elixir)

Tx of Depression with Acupuncture and Moxibustion

 * Basic Points:** DU20, DU24
 * Liver Qi Stagnation:** BL18, LR3, ST36, SP4, CV12, CV17
 * Qi Stagnation turning into Fire:** GB34, GB43, LR2, TB6, CV13
 * Obstruction of Static Qi & Phlegm:** CV12, CV17, CV22, ST40, LR3, PC6
 * Vacuity of Yin & Blood:** HT7, SP6, ST36, LI4, CV14, PC6
 * Heart & Spleen Vacuity:** HT7, ST36, SP6, CV12, BL15, BL20
 * Heart & Kidney Disharmony:** HT7, HT5, BL15, BL23, KI3, SP6, CV17, PC6

Electrical acupuncture has been found in clinical studies to be effective for the treatment of depression: Connect leads to GV 20 and GV24 OR GV20 and Yin Tang Set at 2Hz continuous frequency; if anxiety is present with depression, set at 2/100 Hz mixed frequency



=
=========================================================================== =Potential Contributing Factors= Aspartic Acid Excess Asparagine Excess = = =Treatment=

Recommended Supplements
St. John's Wart 5-HTP SAMe Omega-3 Ginkgo Biloba Licorice Siberian Ginseng Damiana Balm Basil Black Hellebore Borage Clove Ginger Kava Kava Oat Straw Purslane Rosemary Sage Thyme Yohimbine Fo-ti-tieng

Recommended Minerals
-Magnesium -Lithium -Selenium

Orthomolecular Treatment
-Phenylalanine (LPA, LDPA, DPA) -Tryptophan -Tyrosine

Prescription
Morning: Betula Verrucosa D1, 75 drops Evening: Ficus Carica D1, 75 drops

According to symptomology add: Tilia Tomentosa: to be used in case of angst and fear that crisis may lead to a crisis.

Crataegus: used in case of bothersome cardiac erethism with frightening heart palpitation and trachycardia.

Quercus: used when there is bothersome sexual carcergasia. This may appear as frigidity in young women

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 * IBIS:**

Definition:
This is diagnosed when the patient fulfills the categorized signs and symptoms of a major depressive episode.

Etiology:
Depression is classified as the uniform expression of the major affective disorders. Depression is seen twice as often in women than in men, and the usual age of onset is between ages 35-45. There is a familial tendency. Depression is classified as primary when it is the first mental disorder to appear in the patient, or secondary when it appears with another psychiatric or medical condition. In the elderly, the clinician should be aware of "masked" depression: the patient complains of physical illness, and may even frequently smile, when the cause of their illness is a consciously blocked depression.

Somatic Therapies:
• aerobic exercise program: three hours per week can significantly improve mood and reduce the level of depression • qigong • tai qi chuan

Nutrition:
etiologic factors: • Nutrient deficiencies • Vitamin B6: coenzyme in the production of monoamine neurotransmitter; also cofactor for delta-6-desaturase, the rate limiting enzyme for the production of PGE1, a hormone that may be helpful in prevention of depression (Essential Fatty Acids Immunity and Mental Health, by Charles Bates). B6 is also a vital cofactor for the conversion of tryptophan into serotonin and melatonin. (Russ. Nutrition Reports International, 1983;867-873; Adams. Lancet, Apr.28, 1973: 897-904; Baumblatt, et al. Lancet, April 18, 1970, 832-833.) • EGOT TEST (Tahoma Labs) Erythrocyte glutamic oxaloacetic transaminase activation. Start with 100 mg three times daily. Measure the activity of this enzyme. Double the dose to 200 mg three times daily and, after 10 days, measure the enzyme activity again. If it goes up, double the dose again and see if the activity of the enzyme goes up again. Continue doubling until enzyme activity plateaus. Obviously, symptoms should be monitored as well. The dose does not need to go higher once the patient responds favorably. • Folate: often deficient in psychiatric patients • Vitamin B12 • Iron • Thiamin • Vitamin C • Essential fatty acids (especially omega-6 fatty acids) • Excessive consumption of methylxanthines such as theobromine, theophylin or caffeine from coffee, black tea, cola or chocolate • Excessive consumption of simple sugars triggering hypoglycemic reactions. • Imbalance in brain nucleotides • Drug-induced: Oral Contraceptives. It is thought that in a significant number of cases, depression is caused by oral contraceptives. which create a vitamin B6 deficiency. Other nutrient deficiencies thought to be caused by oral contraceptives are folate, vitamin B1, vitamin C, and vitamin B2. Other drugs which can cause depression include alcohol, nicotine, cannabis, caffeine, corticosteroids, betablockers, and other anti-hypertensive medications. • Hypothyroidism is one of the most frequent causes of depression and must be ruled out.

eating principles: • Consider food sensitivities • Hypoglycemic diet • Treat hypothyroidism: Low thyroid function is a very common cause of depression and should always be considered. • Chelate heavy metals • Avoid toxic fumes including cigarette smoke. Inhaling toxic fumes results in an increased level of cortisol and may exacerbate a pre-existing hypoglycemia. Cortisol decreases the uptake of tryptophan in the brain resulting in decreased levels of serotonin. • Elimination/rotation diet, rotation diet, rotation diet expanded

therapeutic foods: • Foods high in omega-3 fatty acids: nut, seed, vegetable oils (safflower, canola, walnut, sunflower, flax seed), evening primrose oil, black currant oil • Foods rich in Vitamin B6 • Foods high in tryptophan: nuts, eggs, meat, fish, dairy • If supplementing tryptophan: give with cofactors (Vitamins B3, B6, and C) and whole wheat toast, bananas, walnuts, pineapples that are high in serotonin

specific foods » for Stagnant Liver Qi or Stagnancy in the Liver channel: • Foods that invigorate the Qi, Liver foods, sour foods, Dispersing foods, foods that open channels • Citrus peel, figs, honey • Liver-cleansing foods: beets, carrots, artichokes, lemons, parsnips, dandelion greens, watercress, burdock root

fresh juices: • Carrot (Walker, 145.) • Carrot and spinach (Walker, 145.) • Carrot, beet, and cucumber (Walker, 145.) • Lemon juice in warm water

specific remedies: • Tea from licorice, Chinese black dates, and wheat chaff (the part that floats on the surface of water) (Ni, 147.)

Therapeutic considerations: • Exercise is essential is the treatment of depression. • Negative Ions • Full spectrum lighting and bright lights

avoid: • Hypoglycemia • Avoid foods containing tyramine if the patient is on MAO inhibitors. Cheese, chicken, liver, sardines, red wine, yeast, beer, soured cream, eggplant, and green bean pods should all be avoided. • Avoid Aspartame which increases CNS tyrosine and phenylalanine while decreasing tryptophan availability. This results in decreased levels of serotonin in the brain. • Consider food sensitivities, avoid food intolerances (Gettis A. Nutr Health 1989;6:135-146; King DS. Biol Psychiatr 1981;16:3-19; Brown M, et al. Practitioner 1981;225:1651-1654; Rippere V. Nutr Health 1984;3(3):125-136.) • Meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods • Coffee, caffeine (Greden JF, et al. Am J Psychiatry 1978;135:963-966; Gilliland K, Bullock W. Adv Alcohol Subst Abuse 1983-84;3:53-73; Christensen L. J Applied Nutr 1988;40:44-50.) • Sugar, diet high in simple carbohydrates, especially if indications of hypoglycemia. (Christensen L. J Applied Nutr 1988;40:44-50.) • Avoid toxic fumes including cigarette smoke. Inhaling toxic fumes results in an increased level of cortisol. (Marz R. 453, 1997.)

Botanicals
• Anemone pulsatilla (toxic): with irritability, nervousness, melancholy, tendency to look on the dark side (Felter, 584.) • Avena sativa: depression, melancholy (British Herbal Pharmacopoeia, 37.) • Bryonia alba (toxic): tendency to delirium, cares little if recovers or dies (Harper-Shove,. 26.) • Cimicifuga racemosa: climactic depression (Ellingwood F, 144, Weiss RF, 319) • Ferula asafoetida: nervous irritation with mental depression, hysteria (Felter, 221) • Ginkgo biloba: especially in the elderly. (Schubert H, Halama P. Geriatr Forsch 1993;3:45-53.) • Hypericum perforatum: also sedates, use long term (Weiss RF, 296); as effective as standard antidepressants for mild or moderate depression. (Harrer G, et al. J Ger Psychiatr Neurol 1994;7(suppl 1);S24-S28; Harrer G, Sommer H. Phytomedicine 1994;1:3-8; Vorbach EU, et al. J Ger Psychiatr Neurol 1994;7(suppl):S19-S23; Staffeldt B, et al. J Geriatr Psychiatry Neurol 1994 Oct;7 Suppl 1:S47-S53; Ernst E.Phytomedicine 1995;2:67-71; Sherman C. Family Pract News. April 15, 1998, 17; Linde K, et al. BMJ, 1996;313:253; Vorbach EU, et al. Pharmacopsychiatry 1997;30(suppl):81-85; Wheatley D. Pharmacopsychiatry 1997;30(suppl):77-80; Chatterjee SS, et al. Life Sci 1998;63:499-510.) • Lavandula officinalis: combines with Rosmarinus officinalis, Sterculia acuminata, Avena sativa (British Herbal Pharmacopoeia, p. 129) • Panax ginseng: depressive states associated with sexual inadequacy (British Herbal Pharmacopoeia, 152.) • Piper methysticum: (Weiss RF. 298.) • Rosmarinus officinalis: depressive states with general debility and indications of cardiovascular weakness, with Avena sativa, Sterculia acuminata, Verbena officinalis (British Herbal Pharmacopoeia, p. 181) • Sterculia acuminata: great mental despondency, brooding, foreboding: more of a quiet or silent character (Ellingwood F, 207.) • Strychnos ignatii (toxic): melancholy, tendency to weep, hysterical, disposition to grieve (Ellingwood F, 162; Felter HW, Lloyd JU. 1044) • Turnera diffusa: combines according to indications, with Avena sativa, Sterculia acuminata (British Herbal Pharmacopoeia, 220.) • Valeriana spp.: depression, despondency due to worry or imaginary wrongs (Felter HW, 686.) • Veronicastrum virginicum: tenderness and heavy pain in the region of the liver with drowsiness, dizziness and mental depression, liver-associated depression (Felter HW, 443.) • Xanthoxylum americanum, carolinianum or fraxineum: with prostration in anemic patients (Harper-Shove, 26.)

Chinese Formulae
• Lindera and Cyperus F.; Cyperus 18 (patent): Liver Qi Stagnation with Liver Yin Xu (Deficiency): frustration, menopausal neurosis, headache, postpartum depression (Lindera and Cyperus: Hsu, 1980, p. 369; Dharmananda, 1986, p. 227; Cyperus 18: Dharmananda, 1990, p. 45) • Pinellia and Magnolia C. (Ban Xia Hou Po Tang): Liver Qi Stagnation with Phlegm: feeling of something stuck in the throat (Yeung, p. 42; Bensky and Barolet, p. 291; Hsu, 1980, p. 395). • Xue Fu Zhu Yu Tang: Liver Qi Stagnation with Xue Yu (Blood Stasis): chronic stubborn headache, depression or low spirits accompanied by sensation of warmth in the chest, irritability, insomnia, extreme mood swings (Yeung, p. 269; Bensky and Barolet, p. 314) • Bupleurum and Tang Kuei F. (Xiao Yao Wan) (available as patent): Liver Qi Stagnation with Xue Xu (Blood Deficiency): headache, bitter taste in mouth, dry mouth, fatigue, reduced appetite, distended breasts or irregular menstruation (Bupleurum: Hsu, 1980, p. 94; Yeung, p. 263; Dharmananda, 1986, p. 228; Bensky and Barolet, p. 147; patent: Zhu, p. 227; Fratkin, p. 157) • Bupleurum and Chih-shih F. (Si Ni San): Liver Qi Stagnation with Liver Invading Stomach: depression, sadness, cold hands and feet, abdominal or hypochondriac pain, diarrhea or loose stools (Bensky and Barolet, p. 145; Hsu, p. 112; Yeung, p. 216) • Qing Shu Yi Qi Tang I: Summer-Heat: desire to curl up, apathy, thirst, dark scanty urine (Yeung, p. 174; Bensky and Barolet, p. 106) • Licorice and Jujube C. (Gan Mai Da Zao Tang): Shen Disturbance: absentmindedness, moodiness, crying spells, restless sleep (Hsu, 1980, p. 347; Yeung, p. 102; Dharmananda, 1986, p. 110; Bensky and Barolet, p. 383) • Ginseng and Zizyphus F. (Tian Wang Bu Xin Dan): Heart Yin Xu (Deficiency): depression, palpitations, poor memory, insomnia, lots of dreams, dry mouth and throat (Bensky and Barolet, p. 378; Yeung, p. 231; Hsu, p. 270). • Tai Wu Sheng Zhu San: Spleen Damp: patient feel foggy, wants to sleep, feels whole body heavy, edema in feet (Dr. Lihua Wang; ingredients: red atractylodes (cang zhu), citrus (chen pi), magnolia bark (hou po) fresh ginger (sheng jiang), red jujube (da zao, agastache (huo xiang), acorus (shi chang pu). • Ginseng and Longan C. (Gui Pi Tang): Heart Xue Xu (Blood Deficiency) with Spleen Qi Xu (Deficiency): depression, dizziness, overthinking or suspiciousness, palpitations, general lassitude, poor appetite (Bensky and Barolet, p. 112; Yeung, p. 112; Hsu, 1080, p. 425). • Bamboo and Hoelen F. (Wen Dan Tang): Damp Phlegm: always wants to sleep, chest and hypochondriac bloating, excess mucus or saliva, obesity (Bensky and Barolet, p. 435; Yeung, p. 241; Hsu, p. 114). • Xue Fu Zhu Yu Tang: Xue Yu (Blood Stasis): depression, very angry, headache, insomnia, poor memory, chest or abdominal pain, purple tongue (Bensky and Barolet, p. 314; Yeung, p. 269). • Six Major Herbs C. (Liu Jun Zi Tang): Spleen Qi Xu (Deficiency): fatigue, somnolence, worse after eating, sallow complexion, poor appetite (Bensky and Barolet, p. 138; Yeung, p. 150; Hsu, p. 242). • Rehmannia Eight F. (Shen Qi Wan): Yang Xu (Deficiency): hypersomnia, aversion to cold, lassitude (Bensky and Barolet, p. 275; Yeung, p. 138; Hsu, 1980, p. 250). • An Mien Pian (patent): Heart Yin Xu (Deficiency) with Empty Fire Blazing (Zhu, p. 327; Fratkin, p. 225) • Bupleurum 12 (patent): Liver Qi Stagnation with Spleen Distressed by Dampness (Dharmananda, 1990, p. 39)

Acupuncture
after assessing the person and palpating, consider these patterns: Heart Xu (Deficiency); Shen Disturbance; Heart Yin Xu (Deficiency) with Empty Fire Blazing; Heart Misted by Cold Phlegm; Spleen Xu (Deficiency); Spleen Dampness; Qi Stagnation and Accumulation of Phlegm; Liver Qi Stagnation, alone or with Spleen Distressed by Dampness and/or Xue Xu (Blood Deficiency); Kidney Xu (Deficiency); Summer-Heat; Xu (Deficiency) of Yin Wei Mai (Yin Linking Vessel)

» illustrative combinations: • PC-5, LI-4 and UB-18 dispel Wind, clear Qi Stagnation, and release emotional depression (Finkelstein, p. 58) • PC-6 and LI-11 (-): relieve depression; treat numbness in extremities; loosen chest and abdomen (EAMSS, p. 240) • PC-6 and CV-17: broaden the chest, descend Rebellious Qi, release depression and stop cough (Finkelstein, p. 91) • Kd-4 (listed as "Kd-5") and UB-15; PC-7 and GV-20; St-8, GB-37 and SI-3 when patient weeps frequently and without adequate cause (Mann, p. 141) • consider treatment for "Internal Dragons" or "External Dragons"; External Dragons: GV-20, UB-11, UB-23, UB-61; Internal Dragons: Master point 1/4" below CV-15, St-25, St-32, St-41; In both treatments, sedate first. If the person and the pulses change, fine. If no change with sedation, then tonify. (Worsley) • SI-19 and UB-20 to eliminate "sorrow and sadness below the heart" (Ellis, et al, 1988, p. 188) • GV-20, St-36 and Lv-3 for depression due to Stagnant Liver Qi with Rebellious Stomach Qi (Jirui and Wang, p. 113) • PC-6, Ht-7, CV-17, St-36, Sp-6 and Lv-3 for depression due to Stagnant Phlegm and Qi due to excessive worry combined with impaired nutrition of Heart and Liver (Jirui and Wang, p. 115) • CV-11 and PC-6: "sweep away bitterness in the chest" (Ellis, et al, 1988, p. 356) • CV-12 and PC-5: broaden the chest and treat depression (Finkelstein, p. 89) • CV-12 and Lv-2: broaden the Middle Warmer and treat depression (Finkelstein, p. 88) • GV-15, GV-20, CV-11, PC-6, Ht-5 and Sp-6 (also consider Kd-4, GB-34, Lv-5 and Ht-7) for melancholia (Lee and Cheung, p. 324) • Kd-4 (listed as "Kd-5") and UB-15; PC-7 and GV-20; St-8, GB-37 and SI-3: when patient weeps without adequate cause (Mann, p. 141) • CV-11 and PC-6: "sweep away bitterness in the chest" (Ellis, et al, 1988, p. 356) • CV-4, CV-12, CV-22 and GV-9 are the Reunion points of the Yin and Yang, they are needled when there is conflict between Yin and Yang, according to Su Wen (Finkelstein, p. 78) • SI-3 and UB-62: open the Du Mai (Governing Vessel) for which Shen disorders are a symptom of Shi (Excess) • PC-6 and Sp-4: open the Yin Wei Mai (Yin Linking Vessel) for which depression is a symptom of Xu (Deficiency) • PC-6, CV-17 and Ht-7 (-): soothe Heart; calm Shen; open chest and regulate Qi • UB-15, UB-23 and Kd-9: adjust disharmony of the Heart and Kidney (Finkelstein, p. 40). • UB-15 and Ht-7 (+): tonify and open Heart • PC-5 and LI-4 (-): clear Qi Obstruction • PC-6 and CV-11 (-): open congestion

» note: • also consider Internal or External Demons (see Materia Medica)

Homeopathy
• Anacardium: depression, with out-of-character swearing; headache > by eating; hates contradiction/suggestion • Arsenicum album: restless and self reproaching; fastidious; easily vexed; restless; fear of death; delirium • Aurum metallicum: "under a black cloud" and potentially suicidal; anger from contradiction; guilt: feels he can never be forgiven; violent anger • Calcarea carbonica: depression with fears of various kinds; old people who become weary of life; mental tiredness; inability to apply self; thinks he’s going insane; dwells on little things • Folliculinum: history of birth control pills and/or estrogen replacement therapy, esp. bad reaction, i.e., estrogen poisoning; tendency to put others' needs before her own, and then become resentful later; woman has lost touch with her own inner rhythms and her reference has become external rather than internal; often best used in a single dose, or repeated every two weeks, possibly at new and full moons • Ignatia: full of contradictions; hysterical female; history of stress, grief, controversy; occasional chronic is nat-m. (recurrent emotional problems) • Lac Humanum: history of difficult mother-daughter relationship; issues of nourishment and self-image as a woman • Lilium tigrinum: hysterical female with mental problems; tends to throw things about • Lycopodium: dyspeptic, melancholic and talkative; state of dread; wants solitude but also needs someone else in house; sensitive-cries when when thanked; anxious; apprehensive • Natrum muriaticum: chronic of ign. excessive irritability; weeps in solitude; hypochondriacal • Nux vomica: depression alternating with bad temper; never contented; impulsive; hates being limited • Pulsatilla: can't fight against circumstances and does not care who sees them weeping; changeable; moody; > consolation • Staphysagria: easily upset by mere trifles and resentful; repressed anger; bad effects of sexual excess • Sulphur: depressed to the point of "I don't care"; religious and philosophical speculation; averse to work; forgetful

Subtle Support
• Mi (Gardner, p. 72, 78) • Fa# (Gardner, p. 82, 87)

mental/emotional: • rhythmic folk songs • County Derry • songs of Steven Foster • Spanish tangos • Brahms' Hungarian dances • Sousa's marches • Strauss' waltzes • Gilbert and Sullivan • Indian Love Call • My Wild Irish Rose • Wishing • Estrellita (Heline, p.18)

Mind/Body
• A review of studies done over a period of 40 years with more than 4000 psychiatric patients showed that approximately half had major medical illnesses. Approximately half of the physicians referring patients had not diagnosed the patient's physical illnesses. (Locke, 1983, p. 170) • Associated with suppressed emotions. (Harrison, p. 77) • Associated with self-directed anger and/or loss. (Epstein, p. 87) • Respiration may sound weak and indecisive as if they can't decide whether to breathe (live) or not. Associated with sighing. (Harrison, p. 82) • Aggression that is psychologically repressed leads to depression; it gets turned inward to the point where the transmitter becomes the receiver. Repressed aggression is responsible for guilt-feelings and numerous somatic symptoms with various types of pain. Those who anxiously repress their aggressive impulses simultaneously repress all their energy and activity, become depressed, and thus avoid taking responsibility. Yet despite a refusal to come to active grips with life, depressives merely go on to find themselves confronted with the theme of responsibility via the back door of their own guilt feelings. (Dethlefsen, p. 231-2) • Impairment of cell-mediated immunity in clinical melancholia. Data indicate that not all person react with the same degrees of depression to stressful events and high and low depressed groups can be differentiated by their immune responses. (Locke, 1983, p. 143) • Most patients on chlorpromazine (Thorazine@, a phenothiazine antipsychotic drug), develop one or more immunologic abnormalities (63% positive ANA, 40% antibodies to native DNA, 58% antibodies to nucleoprotein, 30% decreased T- lymphocytes, plus elevated serum IgM and development of a lupus-like anticoagulant with long term use. (Locke, 1983, p. 63, 75) • Incidence and antibody titers to HSV were found significantly higher in patients with psychotic depression compared to normal controls. Furthermore the cell-mediated immunity to HSV in psychotic depression was similar to that observed after an acute HSV infection or recurrence. (Locke, 1983, p. 163) • Study of HSV, EBV, CMV, and MV (measles) in 68 psychiatric patients and 25 controls with neurological diseases: Antibodies to EBV were highly significant in psychiatric patients with highest titers in the affective disorder group. No significant differences in distribution and titers of antibodies to HSV1, CMV, or MV were found between psychiatric patients and controls. (Locke, 1983, p. 163) • Antinuclear factor (ANF) was present in serum of 30% of 53 patients admitted to a psychiatric hospital for mental depression. Clinically, ANF positive depression closely resembles manic-depressive psychosis but tends to be more resistant to treatment. (Locke, 1983, p. 164) • The presence of antinuclear antibody (ANA) was investigated in a group of patients suffering from recurrent affective disorders. There was no increase in ANA in patients treated with lithium, as compared with patients not on lithium, or controls. (The prevalence of ANA in the normal population is 9%). (Locke, 1983, p. 167) • Possible tuberculin sensitivity. (Locke, 1983, p. 167) • A study was undertaken to compare IgG, IgA, IgM, IgE, and IgD antibodies in adult alcoholic, depressive, and schizophrenic patients with healthy controls. There was no significant difference observed in the total immunoglobulin results between patients and controls. However, there were significant differences between the groups for allergen specific IgE with the depressive patients exhibiting the greatest number of positive test results. (Locke, 1983, p. 180) • 50 patients with manic-depressive psychosis, 120 neurotics, and 100 healthy controls underwent the toxoplasmin intradermal test. The highest percentage of reactors was among manic depressive psychotics (67%), and this group showed a higher intensity of reaction. Patients with depressive neurosis accounted for the highest number amongst the neurotics (56%). It is concluded that the percentage of reactors is higher among patients with depressive mental disorders, and also that this percentage increases with mental deterioration in patients. It is further concluded that the greater the severity of the psychiatric disease, the poorer the hygienic habits and the higher the contact with parasites. (Locke, 1983, p. 164) • Cognitive processes of depressive patients manifest typical state-dependent memory and learning characteristics: able to recall verbal information learned during their depressed state better during their next period of depression; known as 'affect state dependency' which is encoded by endocrine system hormones. (Rossi, 1986, p. 141) • Beta-adrenergic receptors were studied in vitro in lymphocytes obtained from patients with major affective disorders and controls. Results indicated decreased lymphocyte beta receptor functioning in depression and mania. This decrease may be an index of changes in brain beta receptors in mania and depression, or may simply reflect homeostatic regulation of peripheral beta receptors in response to stress-induced increase in circulating catecholamines. (Locke, 1983, p. 166) • Trying to be helpful to a patient whose primary process is hopelessness is a dangerous undertaking, based on an inappropriate paradigm and a bad working hypothesis; 'helping' polarizes the secondary process even more, and you create a situation in which the helper must be resisted. If we constantly act like helpers, a vicious and dangerous cycle is possible, as the client never gets to help herself and is constantly in the position of "the depressed one." If we are unclear about the structure of her process, we are bound to take the unoccupied part in her pattern, in this case, the healer who is trying to get her to live. Furthermore, being helpful to a client who is not interested in help is a goal mismatch and is bound to isolate the client even more. (Mindell, 1988, p. 96-99) • process example: "A woman suffering from long standing-depression threatened she wanted to die. Suicide is yet another method of switching out of to one state into another. I told her to do it right there with me. She closed her eyes, began to breathe deeply, and lay down on the floor. After a few minutes she opened her eyes and spoke of a vision of standing in front of the gates of heaven. A great voice yelled at her, saying, 'Get the hell out of here. Go back to life and work instead of being so lazy.' I then knew how to work with her depression. Instead of being sympathetic to her sad story about life, I told her to stop being so lazy and get to work. This brought immediate positive feedback from her. Altered states are full of unlived creativity. I could never have given her that vision or have helped her in any other way. Instead, I had empathized with her and felt badly for her. But for her, dying meant altering her state of consciousness, dropping out of her feelings of sadness and heaviness. From a process point of view, suicide means killing the primary process. By breathing deeply, she killed the primary experience of sadness, and a new message announced itself through vision and voice. Thus alterations in consciousness can be accomplished through accessing secondary processes." (Mindell, 1988, p. 63) • "Instead of treating depression as if it were something we should overcome, we can also ask what its meaning is. If a depressed and hopeless experience is allowed to come up, then the road is cleared for help. Instead of constantly resisting the processes in front of us, we might stop and admit their presence. Instead of hoping the world will be saved, what if everyone in a community would face all of the depressing and disturbing facts in our lives and risk being depressed by them? This speculation is a form of the hologram theory, a piece of material which carries a particular pattern. The inner personal situation reflects the outer one and vice versa." (Mindell, 1988, p. 100)

• Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.
 * Chinese psychophysiology:**

• Pericardium ~ Xin Bao: Healthy expressions are joy, happiness, and healthy relationships; weakness, dysfunction, and illness are associated with confusion, delirium, nervousness, and psychosis.

• San Jiao ~ Triple Warmer regulates the relations among the three regions roughly delimited by the chest, abdomen, and pelvis; influences the supply of Xue (Blood), Qi and Fluids; is the source of Wei (Protective) Qi; and relates to the function of heat regulation. » Mental signs of Triple Warmer channel disorders include emotional upsets caused by breaking of friendships or family relations; depression; suspicion; anxiety; and poor elimination of harmful thoughts. (Seem, p. 28)

• Lung ~ Fei governs the Qi; regulates the rhythm of respiration, the pulse, and all bodily processes; is the home of the Po (Corporeal Soul); and relates to strength and sustainability. » Healthy expressions are righteousness and courage. » Weakness, dysfunction, and illness are associated with excessive grief, sadness, worry, and depression. Worry depletes the Lung Qi. » Lung Xu (Deficiency) signs include cold shoulder and back; changing complexion; inability to sleep (Seem, p. 28); shortness of breath; changes in urine color; rumbling in the bowels with loose bowel movements; pallor; malar flush; chills; sniffles; sneezing; light cough; and sensitivity to cold.

• Spleen ~ Pi governs digestion and manifests in the muscle tissues; transforms food into Qi and Xue (Blood); governs the Xue (Blood) and holds it in the vessels; resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel balanced and centered. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; easy bruising; pale lips; loose stools; muscular weakness; and, indirectly, obesity. » Spleen Shi (Excess) derives from Spleen Xu (Deficiency) as Dampness accumulates. Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise, overexposure to external Dampness, and excess consumption of sweet and/or Cold foods will also deplete the Spleen.

» Mental signs of Stomach channel disorders include depression; death wishes; instability; suicidal tendencies; mentally overwrought; doubt; suspicions; tendency to mania; and slowness at assimilating ideas. (Seem, p. 27)

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); reflects emotional harmony and movement; opens into the eyes; and expresses itself in the nervous system. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216)

• Kidney ~ Shen houses the Zhi (Will); expresses ambition and focus; provides the "Fire of Life" through its Yang aspects and its intimate relationship with the Ming Men, and displays the effects of aging, chronic degenerative processes, and extreme stress; likewise any severe disturbance in the complementary relationship between the Kidney and Heart expresses itself in emotional dys-stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

Integrative Therapies
This is a condition in which a person is unable to cope with emotional or physical stress. Depression manifests itself in uncontrollable sadness, indifference, and loss of self-esteem. Symptoms include fatigue, inability to maintain daily functioning, loss of appetite, and insomnia. Also present may be overeating, excessive sleeping, constipation, an inability to concentrate, and a decreased sex drive.

Depression can have many causes, and it is important to identify them. These may include illness, genetic predisposition, stress, drug and alcohol abuse, and reactions to drugs such as steroids, digitalis, oral contraceptives, high blood pressure medication, appetite suppressants, or aspirin. Other causes include hypoglycemia, hormonal imbalances, nutritional deficiencies, and environmental factors, particularly overexposure to solvents such as those used in painting and carpentry or exposure to heavy metals.

If symptoms of depression last longer than a week, threaten your day-to-day functioning, or if the depression brings on thoughts of suicide, consult your physician. Seek professional help for drug or alcohol problems.

In cases when depression is associated with extreme fatigue, constipation, and cold extremities, low thyroid hormone should be ruled out. For more information about this, you may want to refer to the "Hypothyroidism" article.

Normal bowel function is important in maintaining good mental health. If constipation is present, the buildup of waste products in the body can make depression symptoms worse. Add fiber to your diet and increase the intake of fluids to 8 glasses per day. For more information about this, refer to the article on constipation.

THE FOLLOWING SUPPLEMENTS ARE USED FOR CONSTIPATION AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. B-vitamin complex – 100 milligrams 2 times a day. 2. Vitamin C – 1,000 milligrams 3 times a day. 3. Folic Acid – 400 micrograms per day. 4. Magnesium – 500 milligrams daily. 5. Tyrosine, an amino acid – 2,000 milligrams 2 to 3 times a day. Used when depression is associated with excessive sleeping and low energy.

THE PROPER DIET FOR DEPRESSION WILL INCLUDE: 1. Eliminating food allergies. Certain foods seem to be more likely to aggravate depression. Removing these foods from the diet is a good way to determine if one or several of them are responsible for the problem. The main problem foods are dairy products (including milk, cheese, ice cream), eggs, wheat, corn, and sugar.

After eliminating all of those foods from the diet, and the symptoms have gone away, one food at a time can be reintroduced to see if the symptoms reoccur. A new food would be introduced each week. If you need more information, refer to the article on Food sensitivities.

2. Caffeine can bring on anxiety, nervousness, and irritability as well as depression. Decrease or eliminate consumption of caffeine, found mostly in coffee, black tea, chocolate, and some over-the-counter medications.

3. As much as possible, avoid sugar foods such as candy, cake, cookies, and refined carbohydrates such as white flour products.

4. Be sure to get enough high-quality protein. Replace red meat with fish and chicken as much as possible, and include beans, nuts, and seeds in your diet.

NOW, ABOUT THE HERBS USED FOR DEPRESSION: 1. St. John's Wort tincture, which is a liquid herbal extract – 2 teaspoons, 3 times per day or 2 capsules, 3 times a day. 2. Kava-Kava: 400-600 milligrams – twice a day 3. Lemon Balm leaves – 1 to 2 cups of the tea per day for 1 to 2 weeks. To make the tea, 1 teaspoon of the dried herb per cup of boiling water is used. 4. Cayenne Pepper – 1/4 of a teaspoon 3 times a day. It can be put into a gelatin capsule for easier swallowing.

HOMEOPATHY: From the following homeopathic remedies, choose the one that best matches your symptoms. Dissolve 3 pellets under your tongue. • Ignatia amara 12C: For depression associated with grief accompanied by sighing. Take 2 times a day. • Kali phos. 12C: For depression due to mental strain where it is hard to concentrate. Take once per day. • Natrum mur. 12c: For disappointment due to romance; also for symptoms of increased thirst, weight loss, and obsessing over problems. If the condition is aggravated by being consoled or by listening to music. Take 2 times a day. • Arsenicum album 12c: If the condition is improved by being with people. If the person feels anxious or has loss of hope and disgust with life. Take 2 times a day. • Sepia 12C: For depression during menstruation or after childbirth. Take once per day.

Note: A wide range of homeopathic medicines can be helpful for individuals with depression. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.

AS A PHYSICAL THERAPY MEASURE: Exercise is of tremendous benefit in improving one's mental health. It is important to exercise regularly. At least 30 minutes 3 times per week should be engaged in physical exercise that will get the heart working vigorously. Brisk walking, aerobics, swimming, tennis, and raquetball are all excellent forms of exercise.