Case 1: A 35 year old female presents with frequent colds and flus, allergies, has had asthma since she was 16 years of age, around the time there was a death in her immediate family, and depression.
Case 2: A 21 year old female college student complains of indigestion, recurrent yeast infections, long hours of studying, poor eating habits, and depression.
Case 3: A 43 year old male complains of high blood pressure, Hepatitis C, stress, 2:30am wake ups every night, anger and frustration over his career, and depression.
Three completely different presentations, yet all three patients complain of depression. In Traditional Chinese Medicine (TCM), we see the body and mind as inseparable; the health of one affects and reflects the health of the other. We look at the patient’s collection of signs and symptoms, be they physical, mental or emotional, as indicators of organ system imbalance, and we treat those imbalances with acupuncture, herbs, food and lifestyle counseling. Depression is no different.
The oldest records of Chinese Medicine date back about 4000 years with the first medical textbook, The Yellow Emperor’s Classic of Internal Medicine dating back to around 100BC. TCM sees the body as made up of organ systems (noted by a capitalized word, e.g. Lung), comprised of the internal organ itself (noted by normal spelling, e.g. lungs), and the acupuncture channel that connects the organ to other organ systems and other parts of the body. Each system has specific physical signs, symptoms and emotions associated with it. Imbalances in one system can affect the functioning of another. Chinese Medicine, at its core, seeks to understand relationships between these organs systems, between the individual and their life experiences, and between the individual and their environment. Health is a dynamic state of equilibrium among these parts. Disease occurs when that harmony gets disrupted.
Let’s explore the cases mentioned above.
Grief stores in the Lung. When grief and loss are not fully experienced and resolved, they can rob the Lung of vital energy (Qi), making the lungs more susceptible to pathogens and organ dysfunction. Conversely, lung pathology can hamper the ability of the Lung to process the trauma of grief. Research has shown a link between cough variant asthma patients (for whom the primary symptom is a dry, non-productive cough) and increased levels of stress, anxiety and depression (1). Priority number one is to identify current physical triggers to this patient’s allergies and asthma and work to ease them. Likely culprits are dust, mold, pollen, toxic inhalants, and dairy consumption. With stronger lung function, her Lung can better handle the stress of dealing with asthma and better process her unresolved grief.
On a purely physical level, with sinus and respiratory inflammation and consequent congestion, there can be acute and ongoing phlegm production. In TCM, phlegm can be substantial, the kind you can cough up or spit out, or insubstantial, the kind that can interfere with other body processes like thinking and feeling. Often in the context of substantial phlegm, insubstantial Phlegm shows up as brain fog, dull affect, and mental lethargy—all possible signs of depression.
“When the Stomach and Intestines are coordinated, the 5 Yin organs [Lung, Spleen, Heart, Kidney, and Liver] are peaceful, Blood is harmonized and mental activity is stable. The Mind derives from the refined essence of water and food.” (2) There is an entire school of thought in TCM that says if all you did was treat the digestive system, most every health issue would take care of itself. Simplistic, yes. But it does give proper priority to the primacy of good eating habits and efficient digestion.
Pensiveness, worry and overthinking store in the Spleen—akin to the pancreas in modern physiology, a major engine of the digestive system. Parallels between thinking and digestion are plentiful. Studying can deplete the Spleen—the harder the requirements placed on the brain, the more glucose it demands, challenging the digestive system. Even the verb ruminate has its Latin origins in the verb ruminari, or to chew the cud, or muse upon. Current research indicates that:
· Times of stress may reduce concentrations of healthy gut flora (3);
· Gut bacteria might influence mood (4);
· Patients with Non-Celiac Gluten Sensitivity (NCGS) may also suffer from depression (5).
In Case 2, long hours of studying with little physical exercise has certainly slowed digestion leading to low energy. Poor food choices like dairy or excessive wheat and sugar consumption leading to indigestion, plus a likely history of antibiotic use, are possible causes or contributing factors to her NCGS presenting as recurrent yeast infections. Without good digestion, she cannot extract nutrients from food to help create Blood, which, according to TCM, stores and circulates emotions, and nourishes the Heart, calming the Spirit. All this can lead to an overall lack of vitality, lethargy, and depression.
Anger, resentment, and frustration store in the Liver. The Liver thrives when it can smoothly expand and grow unfettered toward the sun, like a tree; it sees a goal and moves headlong toward it. The Liver energy gives movement to the Mind (6). Similarly, the Liver system is responsible for the smooth flow of Qi and Blood in the body. Any imbalance, physical, mental or emotional, that presents as erratic, unsmooth, or stuck is said to be Liver Qi Stagnation. Stress very much stagnates Liver energy as it has in Case 3. Anger and frustration congest the Liver creating Heat that rises up to irritate the Heart affecting sleep, and that rises up to the head in the form of high blood pressure. Without a productive direction to use this stuck energy, depression takes hold. Conversely, chronic liver disease like Hepatitis C can also present with depression (7).
The body affects the mind and the mind affects the body.
The Heart has a unique role in depression. “…The Heart stores the Mind which is responsible for insight. It is for this reason that all emotions eventually affect the Heart (in addition to other specific organs), and it is in this sense that the Heart is the ‘emperor’ of all other organs.” (8) You could say that depression and all long-standing psycho-emotional challenges are ultimately an issue of the Heart, and therefore the Mind. And each individual’s unique presentation is a reflection of the involvement of the other organ systems as in the 3 cases presented above.
When physical symptoms hamper therapeutic progress or suggest a link between the pattern of depression and internal organ imbalance, Traditional Chinese Medicine can offer a significant additional means of support.
My goal is to help patients with depression make connections between their physical ailments and their emotional challenges weighing them down. While acupuncture has been shown to be a “potentially effective monotherapy for depression, and a safe well-tolerated augmentation in antidepressant partial responders and non-responders” (9) and can significantly reduce the severity of depression (10), the addition of counseling is a necessity. Furthermore, patients with comorbid pain and depression do far better when acupuncture is combined with counseling, than either one of their own (11).
No one discipline can treat everything. With depression, addressing the needs of the body and the mind through Chinese Medicine and counseling, patients can begin to resolve old issues while thriving physically, mentally and emotionally.
1. J Psychosom Res. 2015 Mar 25. Cough variant asthma patients are more depressed and anxious than classic asthma patients. Saito N, Itoga M, Tamaki M, Yamamoto A, Kayaba H.
2. Spiritual Axis (Ling Shu), People’s Health Publishing House, Beijing, 1981. First published c. 100BC, p. 71.
3. Biol Psychol. 2008 Feb;77(2):132-7. Epub 2007 Oct 2. Investigating the role of perceived stress on bacterial flora activity and salivary cortisol secretion: a possible mechanism underlying susceptibility to illness. Knowles SR, Nelson EA, Palombo EA.
4. Gut Pathog. 2009 Mar 19;1(1):6. A randomized, double-blind, placebo-controlled pilot study of a probiotic in emotional symptoms of chronic fatigue syndrome. Rao AV, Bested AC, Beaulne TM, Katzman MA, Iorio C, Berardi JM, Logan AC.
5. Aliment Pharmacol Ther. 2014 May;39(10):1104-12. Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity – an exploratory clinical study. Peters SL, Biesiekierski JR, Yelland GW, Muir JG, Gibson PR.
6. The Practice of Chinese Medicine. Maciocia, Giovanni, CAc., Churchill Livingston, London, 1994, p.202.
7. Rev Bras Psiquiatr. 2015 Jan-Mar;37(1):21-30. Depression rather than liver impairment reduces quality of life in patients with Hepatitis C. Silva LD, da Cunha CC, da Cunha LR, Araújo RF, Barcelos VM, Menta PL, Neves FS, Teixeira R, Rocha GA, Gontijo ED.
8. Maciocia, p.199.
9. Can J Psychiatry. 2012 Jul;57(7):397-405. Acupuncture for depression: a review of clinical applications. Wu J, Yeung AS, Schnyer R, Wang Y, Mischoulon D.
10. J Affect Disord. 2008 Dec;111(2-3):125-34. doi: 10.1016/j.jad.2008.04.020. Epub 2008 Jun 11. Is acupuncture beneficial in depression: a meta-analysis of 8 randomized controlled trials?
Wang H, Qi H, Wang BS, Cui YY, Zhu L, Rong ZX, Chen HZ.
11. BMJ Open. 2014 May 2;4(5):e004964. Acupuncture, counselling or usual care for depression and comorbid pain: secondary analysis of a randomised controlled trial. Hopton A, Macpherson H, Keding A, Morley S.
Copyright Jordan Hoffman 2015. All Rights Reserved.
The information presented here is not medical advice, is not intended as medical advice, and is intended to provide only general, non-specific information related to Chinese Medicine and Acupuncture and is not intended to cover all the issues related to the topic discussed. You should consult a licensed health practitioner before using any of this information.