Mania+and+Depression

=Mania and Withdrawal/Diān Kuáng= Mania and Withdrawal/Diān Kuáng is a severe psychological condition characterized by extreme fluctuations between depressive psychosis and manic psychosis that are usually episodic and recurrent.

Withdrawal/Diān is a form of depressive psychosis caused by Qi stagnation complicated by Phlegm misting the Heart orifice; it is characterized by depression, apathy, incoherent speech, dementia, subdued and non-violent behavior.

Mania/Kuáng, by contrast, is caused by Phlegm-Fire harassing the Heart and characterized by mental hyperactivity and manic behavior, manifesting with shouting, hostility and violent behavior.

Clinically, Mania and Withdrawal/Diān Kuáng are not distinct disease entities; they are two aspects of one disorder and their clinical manifestations may be interchangeable.

Relevant Biomedical Conditions
-Bipolar Affective Disorder (BAD) -Schizophrenia -Major depression -Senile dementia -Alzheimer’s disease -Brain tumor

Pathological Factors
Phlegm – this is primary, and often results from Qi stagnation; during the Withdrawal phase Phlegm mists/clouds/obstructs the Heart/Spirit; during the Manic Phase Phlegm combines with Fire to harass the Heart/Spirit Qi stagnation Fire Blood stasis
 * Deficiencies of Qi and Yin commonly co-exist with the above excess pathological factors.

Diagnosis
Depression Apathy Incoherent speech Dementia Subdued and non-violent behavior
 * Diān**

Mental hyperactivity and manic behavior Shouting Hostility and violent behavior
 * Kuáng**

Qi & Phlegm Stagnation(depressive state)
[Fa Ban Xia (Pinellia Tuber) 9g, Chen Pi (Tangerine Peel) 9g, Fu Ling (Poria) 12g, Dan Xing (Bile-processed Arisaema) 6g, Zhi Shi (Unripe Bitter Orange) 9g, Mu Xiang (Saussurea Root) 9g, Xiang Fu Zi (Cyperus Root) 9g, Sheng Jiang (Fresh Ginger) 9g, Zhi Gan Cao (Honey-fried Licorice Root) 6g]
 * Main Symptoms:** Gradual onset of depression with increasing flat affect, apathy, and dulled senses followed by muttering to oneself, unregulated emotions and moods, delirium, anxiety, suspicion
 * Additional Symptoms:** loss of appetite
 * Tongue:** Pale, white greasy coating
 * Pulse:** Wiry, slippery
 * Treatment Principles:** Move Qi, resolve stagnation, transform Phlegm, open orifices, relieve depression
 * Acupuncture Treatment:**[DU24, GB13, PC4, PC5]+ CV14, CV17, LR3, ST40, LI4
 * Herbal Treatment:** Shun Qi Dao Tan Tang (Qi-Normalizing Phlegm-Abducting Decoction)

Qi Vacuity with Phlegm Accumulation(depressive state)
[Ren Shen (Ginseng) 9g, Bai Zhu (Atractylodes Root) 9g, Fu Ling (Poria) 9g, Fa Ban Xia (Processed Pinellia Tuber) 6g, Chen Pi (Tangerine Peel) 6g, Zhi Gan Cao (Honey-fried Licorice Root) 6g] + [Fa Ban Xia (Processed Pinellia Tuber) 9g, Zhi Tian Nan Xing (Arisaema Root) 6g, Chen Pi (Tangerine Peel) 9g, Zhi Shi (Unripe Bitter Orange) 9g, Fu Ling (Poria) 12g, Ren Shen (Ginseng) 6g, Shi Chang Pu (Acorus Root) 9g, Zhu Ru (Bamboo Shavings) 9g, Sheng Jiang (Fresh Ginger Root) 6g, Gan Cao (Licorice Root) 3g]
 * Main Symptoms:** Depression and anxiety, flat affect, non-violent mood swings
 * Additional Symptoms:** No appetite, lusterless complexion, loose stools
 * Tongue:** Pale, puffy, white greasy coating
 * Pulse:** Slippery, wiry, weak
 * Treatment Principles:** Strengthen Spleen, tonify Qi, resolve phlegm, open orifices, relieve depression
 * Acupuncture Treatment:**[DU24, GB13, PC4, PC5]+ ST36, ST40, CV12, CV14, CV17
 * Herbal Treatment:** Liu Jun Zi Tang (Six Gentlemen Decoction) + Di Tan Tang (Phlegm-Flushing Decoction)

Vacuity of Heart & Spleen(depressive state)
[Huang Qi (Astragalus Root) 9g, Ren Shen (Ginseng) 9g, Fu Ling (Poria) 9g, Fu Shen (Poria Root) 9g, Dang Gui (Tangkuei) 9g, Chuan Xiong (Ligusticum Root) 6g, Zhi Ban Xia (Pinellia Tuber) 6g, Bai Zi Ren (Biota Seed) 9g, Yuan Zhi (Polygala Root) 6g, Suan Zao Ren (Spiny Jujube Kernel) 15g, Wu Wei Zi (Schisandra Berry) 6g, Rou Gui (Cinnamon Bark) 3g, Zhi Gan Cao (Honey-fried Licorice Root) 6g]
 * Main Symptoms:** Chronic depression, trance-like mental state, no contact with reality, easily frightened, disturbed thoughts, incoherent speech
 * Additional Symptoms:** Pale and lusterless complexion, fatigue and lassitude, reduced appetite, palpitations, insomnia, loose stools
 * Tongue:** Pale, flabby, tooth-marked, thin white coating
 * Pulse:** Thready, weak, forceless
 * Treatment Principles:** Tonify Spleen & Heart, benefit Qi, calm shen, relieve depression
 * Acupuncture Treatment:**[DU24, GB13, PC4, PC5]+ ST36, SP6, BL15, BL18, BL20, CV6, HT7
 * Herbal Treatment:** Yang Xin Tang (Heart-Nourishing Decoction)

Phlegm-fire Disturbing the Heart(manic state)
[Meng Shi (Lapis Stone), Da Huang (Rhubarb Root), Huang Qin (Baikal Skullcap), Chen Xiang (Aloeswood), Mang Xiao (Mirabilitum)] + [Tian Men Dong (Asparagus Tuber) 9g, Mai Men Dong (Ophiopogon Tuber) 9g, Zhe Bei Mu (Zhejiang Fritillaria Bulb) 9g, Dan Nan Xing (Arisaema Root, Bile-processed) 3g, Ju Hong (Red Tangerine Peel) 3g, Yuan Zhi (Polygala Root) 3g, Shi Chang Pu (Acorus Root) 3g, Lian Qiao (Forsythia Fruit) 3g, Fu Ling (Poria) 3g, Fu Shen (Poria Root) 3g, Xuan Shen (Scrophularia Root) 4.5g, Dan Shen (Salvia Root) 4.5g, Gou Teng (Uncaria Stem/Thorn) 4.5g]
 * Main Symptoms:** Acute onset with symptoms of manic and aggressive/destructive behavior, red eyes and face, insomnia, complete loss of appetite
 * Additional Symptoms:** Agitated, irritable, distending headache prior to episode, increased thirst with preference for cold drinks, dry mouth and throat, constipation
 * Tongue:** Red, yellow greasy coating
 * Pulse:** Rapid, wiry, slippery
 * Treatment Principles:** Purge fire, resolve phlegm, settle the Heart, drain Liver, stop mania
 * Acupuncture Treatment:**[DU24, GB13, PC4, PC5]+ DU14, DU16, DU26, LI4, PC6, PC8, ST40, LR3
 * Herbal Treatment:** Meng Shi Gun Tan Wan (Chlorite-Mica Phlegm-Shifting Pill) + Sheng Tie Luo Yin (Iron Flakes Beverage)

Excessive Fire Injuring Yin(manic state)
[Sheng Di Huang (Rehmannia Root) 12g, Mai men Dong (Tuber) 12g, Xuan Shen (Scrophularia Root) 9g, Huang Lian (Coptis Root) 6g, Mu Tong (Mutong Stem) 6g, Zhu Ye (Black Bamboo Leaf) 9g, Fu Shen (Root Poria) 9g, Deng Xin Cao (Juncus Pith) 3g, Suan Zao Ren (Spiny Jujube Kernel) 12g, Gan Cao (Licorice Root) 6g]
 * Main Symptoms:** Prolonged manic psychosis, emotional instability, irritability, anxiety
 * Additional Symptoms:** Insomnia, fatigue, easily frightened, panic attacks, palpitations, scanty and dark urine, five palm heat
 * Tongue:** Red, scanty or no coating
 * Pulse:** Rapid, thready, wiry
 * Treatment Principles:** Nourish Yin, clear Fire, quiet the Spirit, stabilize emotions
 * Acupuncture Treatment:**[DU24, GB13, PC4, PC5]+ KI1, LV3, SP6, HT7
 * Herbal Treatment:** Er Yin Jian (Two Yin Brew)

Tx of Mania and Withdrawal with Acupuncture and Moxibustion
Depressive State: Manic State: ==
 * Basic Points:** DU24, GB13, PC4, PC5
 * Qi & Phlegm Stagnation:** +CV14, CV17, LR3, ST40, LI4
 * Qi Vacuity with Phlegm Accumulation:** +ST36, ST40, CV12, CV14, CV17
 * Heart & Spleen Vacuity:** +ST36, SP6, BL15, BL18, BL20, CV6, HT7
 * Phlegm-Fire Disturbing the Heart:** +DU14, DU16, DU26, LI4, PC6, PC8, ST40, LR3
 * Excessive Fire Injuring Yin:** +KI1, LV3, SP6, HT7