TCM Approach to Mental and Emotional Disorders

Mental illness is a delicate and complicated topic. Is it an illness or just something we do not understand? Where does Traditional Chinese Medicine (TCM) chime in on this topic?

In ancient times Chinese doctors recognized the following imbalances. These can also be categorized as mental illnesses. ⁽¹⁾

• Depression
• Manic Depression
• Agitation.

Plus three more which need explanation:

• Lily Disease
• Plum Pit
• Running Piglets.

Lily Disease presents as low-grade anxiety. The person is restless and comfort cannot be found. He wants to eat but cannot swallow. That food smells bad, yuck. He wants to walk, but is soon tired. A 220 AD description of this condition adds although the patient may look normal, he or she is suffering. Plum Pit refers to the feeling of having something stuck in the throat. This condition is due to depression or anxiety. Running Piglets, as you have already guessed, is the equivalent of panic attacks. As with modern diagnosis, each of these categories is a spectrum of mild and few, to severe and many signs.

癲狂

Examining the Chinese character for Manic Depression or Dian Kuang is noteworthy. When all the pieces are considered together in the narrative form we have a worthy person who has lost their soul/spirit and now acts like a mad dog. In 652 AD Sun Si Miao describes Dian Kuang as the following:

“In Dullness and Mania, the patient may be silent and emit no sound, speak incessantly, sing and cry, chant or laugh, sleep sitting in ditches, eat his or her own feces. Discard clothes to be naked, sleepwalk and shout. It must be treated with acupuncture and herbs.” (1) In ancient times behaviors were duly noted and helped with diagnosis. The ancient usage of the term “talking to ghosts” would be the modern schizophrenia. All mental-emotional imbalances can be traced back to the Shen. Often translated as “Spirit” “Soul” or “Mind”. In this article, the definition given by Giovanni Maciocia (1) is used. Shen is “mind”. “Spirit” refers to all the parts of the Shen. There are five: Shen, Hun, Po, Yi, and Zhi. Each of which has a balanced aspect and one of imbalance. Each has a special relationship with the other parts. Shen is one of the vital substances of the body. It is the most subtle and non-material type of Qi.

Shen

Shen is translated as “Mind” and is associated with the Heart. The Shen in balance gives us appropriate behavior. It knows right from wrong. It gives us compassion for others and the ability to communicate with them. People feel good being around a person with good Shen. A strong Shen provides clear thinking. A weak or disturbed Shen results in slow and dull thinking. The Shen of the Heart is responsible for our identity of self as individuals. When the Shen is obstructed self-identity is lost resulting in serious mental illness such as schizophrenia or bipolar disease. Obstruction of the Shen may occur in different degrees of severity and it does not always lead to serious mental illness.

Hun

Hun is translated as the “Ethereal Soul” and is associated with the Liver. The free flow of Liver-Qi is the physical equivalent of the Hun’s essential nature, which is movement. Movement such as going out and returning to the body as in dreaming. Towards the others in relationships. It is the movement that projects into the future for planning and projects. Insight, inspiration, intuition and artistic creation all depend on the Hun. Excessive movement of the Hun may cause manic behavior or more extremely Bipolar. A lack of movement results in depression.

The Hun provides intuition, vision, and inspiration to the rationally minded Shen. This gives the Shen the capacity for insight and introspection, and the ability to relate to others. If the Shen is weak it cannot restrain the Hun or if the Hun is overactive, chaos and confusion assails the Shen. The person will become scattered and unsettled. An example is a person who is full of ideas, dreams, and projects that never come to fruition.

Po

Po is translated as the “Corporeal Soul” and is associated with Lungs. The Po regulates the physical body. It gives the capacity for sensation, feeling, hearing and sight. Coordination, agility, and balance depend on the Po. Tonify the Po through the Lung Qi for better sports! ⁽²⁾Self-interest and self-care depend on the Po. A sign of imbalance in the Po can be either lack of self-care or self-aggrandizement.

Yi

Yi is translated as “Intellect” and is associated with the Spleen. The Yi imparts the concentration to study, do research, and memorize facts. It generates ideas. This is different than the intuition of Hun as it is a conscious effort.
The relationship of the Yi and the Shen is very close. The Intellect depends on the direction of the Mind. The Mind depends on the Intellect to memorize, concentrate and focus.

If the Yi is weak thinking will be dull, memory poor and focusing difficult; brain fog. The weakness of the Yi is an aspect of ADD.

Zhi

Zhi is translated as “Will Power” and also “Memory”, and is associated with the Kidneys. Zhi is the basis for ambition, uprightness, determination, and confidence. It gives the ability to memorize and store data. A lack of Zhi/Will Power causes chronic depression.

The Shen and Zhi need to be coordinated. When the Shen is strong plans and aims are clear, and Zhi provides the drive to achieve goals. If the Shen is stronger than the Zhi there will be no drive to finish objectives. When the Zhi is stronger the situation is similar to the “no” stage of a toddler. In an adult, this combination can result in recklessness and excessive risk-taking.

The Shen in entirety, as “Spirit” is seen in the eyes and the skin. Shen produces a quality of flourishing or luster which is observed in health. Without the Shen, the eyes are dull and lackluster.

There are many formulas that can harmonize mental and emotional imbalances. A good practitioner can match the patient with the right formula. Progress must be monitored, and the formula modified or changed as is appropriate. Let’s step into the herb clinic and look at four classic formulas.

Gan Mai Da Zao Tang – Licorice, Wheat, and Jujube Decoction

Primary usage: depression, anxiety, panic

First recorded in Essentials from the Golden Cabinet (c.220) Three gentle herbs with profound abilities. Gan Mai Da Zao Tang is primarily for emotional disorders. It is the go-to formula for Restless Organ Disorder. This imbalance is caused by excessive worry, anxiety, or pensiveness. Often there is an underlying blood deficiency or an event, such as childbirth, which has caused blood loss. The Shen becomes injured and the Hun and Po become unsettled. When the Hun and Po lose their moorings spirit is literally lost. The patient becomes detached from the conventions of normal behavior. At first, the patient is mentally disoriented, anxious, impulsive, and sleep is fitful. During acute phases there is extremely upset or depression to the point of uncontrollable weeping, manic behavior or severe disorientation. This formula does it’s the best to work when taken long term.

“It guides the floating souls back within the bounds of normal behavior, allowing the patient to feel at ease with self once again.” ⁽³⁾

In the modern clinic this formula is used for the following emotional conditions:

• general anxiety disorder
• schizophrenia
• ADHD.

It is used the following physical conditions:

• epilepsy
• Parkinson’s.
• gastric spasms
• migraines
• sinus tachycardia
• ectopic heartbeats
• Women’s issues
• postpartum depression
• PMS
• perimenopausal syndrome

Gan Mai Da Zao Tang has many studies under its herbal belt. For chronically stressed rats it reversed the biochemical brain changes caused by the stress. Glutamate levels returned to normal. High glutamate levels are associated with anxiety, depression, schizophrenia, and Parkinsons.⁽⁴⁾

Gan Mai Da Zao Tang is particularly helpful in cases of post-stroke depression. ⁽⁵⁾

Wen Dan Tang – Warm The Gallbladder Decoction

Primary usage: severe insomnia, early schizophrenia, psychosis

Dating back to the 6th C, this formula is first recorded in Discussion of Illnesses, Patterns, and Formulas Related to the Unification of the Three Etiologies from the Song Dynasty (960-1279). It is for when “after a severe illness the patient suffers from irritability and insomnia.” Indications for use are: dizziness, vertigo, nausea or vomiting, insomnia, dream disturbed sleep, palpitations, anxiety, bitter taste in the mouth, indeterminate gnawing hungry, and stifled chest. The tongue coating is yellow and greasy. These signs and symptoms are caused by phlegm heat. The heat harasses the Heart and disturbs the Shen/Mind causing the lions to share of the symptoms. Wen Dan Tang is traditionally used for treating copious phlegm created by weak digestion.

Wen Dan Tang has used clinically the following mental-emotional issues:

• depression
• severe insomnia
• early-stage schizophrenia
• psychosis
• Bipolar Disorder.

Wen Dan Tang is also used for digestive disorders:

• chronic gastritis
• peptic ulcer
• cholecystitis
• chronic hepatitis.

Wen Dan Tang is used for cardiovascular diseases:

• Hypertension
• angina
• myocarditis
• pericarditis
• premature partial contractions.

A rat study helps to understand how Wen Dan Tang helps with severe insomnia. Through the gut-brain axis, Wen Dan Tang regulates peptides in the brain. ⁽⁶⁾

Factoid: Although Wen Dan Tang claims to warm the Gallbladder it is focused on resolving phlegm heat the lungs and heart through cooling and drying herbs. The reason for this is that it is a modification of formula that did focus on warming the Gallbladder.⁽⁷⁾

Also see: AcuAtlanta article

Ban Xia Hou Po Tang – Pinellia and Magnolia Bark Decoction

Primary usage: Plum Pit, neurosis, globus hystericus, hysteria, neurogenic vomiting, psychosis, depression
Recorded c. 220 in Essentials from the Golden Cabinet. Originally this formula was for women who felt as if a piece of roasted meat was stuck in their throats. Later writings expand on this image, “something that can neither be expectorated nor swallowed.” Known historically as Plum Pit throat, this condition goes by globus pharynges or, if induced by anxiety, globus hystericus. Other indications for Ban Xia Hou Po Tang are stifled chest, coughing, and vomiting. The tongue will have a moist or greasy white coating. The problem here is an obstruction of phlegm. This damp blockage can affect the Shen causing anxiety, depression, insomnia, and palpitations. These are accompanied by abdominal discomfort, bloating, nausea, and a tendency to develop edema.

Clinically Ban Xia Hou Po Tang is used to treat:

• globus hystericus
• neuroses
• neurogenic vomiting
• IBS
• hysteria
• psychosis
• epilepsy
• depression
• perimenopausal syndrome
• Parkinsons
• disorders of the throat and surrounding structures
• Digestive disorders
• Respiratory disorders.

Chai Hu Long Gu Mu Li Tang – Bupleurum plus Dragon Bone and Oyster Shell Decoction

Primary usage: schizophrenia, generalized anxiety disorder, depression, neuro-psychiatric disorders, addictions*
From c.220 Discussion of Cold Damage. Under actions for this formula is listed “sedates and calms the spirit”. Indications for use are fullness in the chest, irritability, occasional attacks of fright palpitations, urinary difficulty, constipation, delirious speech, inability to rotate the trunk, a sensation of bodily heaviness. The tongue is red with slippery coatings or red around the edges. These symptoms are due to constraints in all three Yang channels. This formula enters the Liver channel, so it is one that will have an effect on the Hun. There are a small number of tonifying herbs in this formula, don’t be tricked. It is not for treating deficiency, only excess. If it is used for deficiency symptoms such as anxiety, insomnia, irritability, or hypertension will get worse. Switch formulas immediately.

Clinically Chai Hu Long Gu Mu Li Tang is used to treat:

• neurosis
• depression
• general anxiety disorder
• schizophrenia
• Parkinson’s
• epilepsy.

Also used for:

• HTN
• tachycardia,
• hyperthyroidism
• Meniere’s Disease
• sternocleidomastoid spasm
• post-concussion
• gastritis
• constipation
• epilepsy.

In a mouse study, Chai Hu Long Gu Mu Li Tang had a regulatory effect on the central nervous system. Mice pre-treated with uppers showed a decrease in autonomous activity. Whereas mice treated with downers had autonomous activity increased. ⁽⁸⁾

In a human research study for the treatment of Schizophrenia Chai Hu Long Gu Mu Li Tang showed a total effective rate of 84.13%. 10 cases fully recovered, 41 significantly improved, 55 improved, and 20 did not respond to the treatment.⁽⁸⁾

Another study treated 32 cases of psychoneurosis with Chai Hu Long Gu Mu Li Tang. Results compared the effect of the formula alone to that of combining the formula with Western medication. Chai Hu Long Gu Mu Li Tang was found to significantly ameliorate the patient’s restlessness, insomnia, anxiety, susceptibility to fatigue, and feelings of insecurity, with a total effective rate of 81.3%. Using the formula alone was found to be superior to combining this formula and Western medication in treating anxiety.⁽⁹⁾

In a combined modality study Chai Hu Long Gu Mu Li Tang and behavioral therapy were used to treat 36 cases of insomnia. The formula was taken daily plus 1-2 daily sessions of relaxation exercise. One of exercise session was before bedtime. This was done for seven days. 19 cases significantly improved, 13 improved, 4 did not respond to the treatment. The total effective rate was 88.9%.(8)

“Shen is the process of Qi working.”Li Dong Yuan 1180 – 1252 CE

Use herbs wisely
In some cases, herbal formulas can be taken in conjunction with other medications. It is critical that interactions be researched before embarking on a course of treatment. There are plenty of resources. Before taking any of these formulas to consult with a knowledgeable practitioner. Chinese herbalism is based on treating the pattern of symptoms, not a western medical diagnosis. If you have questions or special considerations, please work with your practitioner.

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. Serving size is according to instructions on the label or as per your practitioner. Feel better soon.

References
1 The Psyche in Chinese Medicine, Giovanni Maciocia, Churchill Livingstone, published 2009
2 Shen Disorders CEU with Alex Tiberi, L.Ac., class notes by Diana Moll, L.Ac.
3 Chinese Herbal Medicine Formulas & Strategies 2nd Edition, Scheid, Bensky, Ellis, Barolet, Eastland Press, 1990
4 Phamaceuticeutical Biology, Volume 48, 2010 – Issue 12, Research Article
Protective effect of gan mai da zao decoction in unpredictable chronic mild stress-induced behavioral and biochemical alterations
Jian-Shu Lou, Chang-Yu Li, Xiao-Chun Yang, Jie Fang, Yuan-Xiao Yang & Jian-You Guo
Pages 1328-1336 Published online: 26 Aug 2010
5 Mauritius, Volume 79, Issue 4, December 2014 , Pages 370-380
Herbal medicine (Gan Mai Da Zao decoction) for depression: A systematic review and meta-analysis of randomized controlled trials, Ji HeeJunaTae-YoungChoiaJu AhLeeaKyung-JinYunabMyeong SooLeea
6 Effects of Wen Dan Tang on insomnia-related anxiety and levels of the brain-gut peptide Ghrelin, Liye Wang, Yuehan Song, Ph.D., Feng Li, Ph.D., Yan Liu, Jie Ma, Meng Mao, Fengzhi Wu, Ying Wu, Sinai Li, Binghe Guan, and Xiaolan Liu
7 Acupuncture Today, December, 2007, Vol. 08, Issue 12, The Origin of Wen Dan Tang,
By Lawrence Hsiao, MD, MS, Eric Hsiao, MD, PhD and Wen-Shuo Wu, MPH, MSAOM, LAc
8 Foreign Medicine (TCM vol). 1987;(4):45 Jiang Yong Shan.
9 Journal of Applied TCM. 1998;14(3):3-4 Liang Kai Rong.
10 Foreign Medicine (TCM vol). 1987;(6):50 Jiang Yong Shan.
11 Journal of TCM. 1999;16(2):25-26, Shen Li. Tianjin