Chinese Medicine and Depression

In a previous post, we covered the bigger picture of depression, including a number of factors that may contribute to depression. In this post, we’ll look at how Chinese Medicine views depression; including common symptoms and suggestions for each primary pattern.

Of course, every individual’s presentation is different and acupuncture and herbal therapies are customized accordingly by your practitioner. Furthermore, there are almost always multiple patterns involved that influence the entire picture of one’s health. The following patterns are broad stroke pictures of how depression can manifest. Included with each pattern are helpful tips and strategies to utilize if you or someone you know experiences depression.

General Etiology

Prolonged emotional factors such as internalized anger, anxiety, rumination and grief can obstruct the proper flow of qi (the motive force of the body). Since all systems of the body depend on the smooth flow of qi, stagnation of it over a period of time can cause pathological blood stasis, phlegm, dampness, heat or food (which can manifest as indigestion, acid reflux, etc). Interestingly, this is one way in which Chinese Medicine sees the connection between the emotions and pain in the body. In fact, it’s not a far stretch to find the emotional connection to nearly any pathological process in the body.

Primary Patterns that can contribute to Depression:

Liver Qi Stagnation

One of the more common patterns, often manifesting with some of the following symptoms:

despondence and/or irritability
bloating, or a feeling of fullness without eating much
belching
frequent sighing
fullness or pain of the chest and flank area
changes in menstrual cycle, PMS symptoms
abnormal or irregular bowel movements

With acupuncture, we use points to help regulate the flow of liver qi, some of which are found on the feet or near the ribs. With herbal formulas, herbs with a strong aromatic quality are chosen for their ability to disperse qi.

Patients with this predominate pattern may find help with the following dietary and lifestyle modifications:

Cardio activity which gently “pumps the lungs”. This means something that gets you a little out of breath, like 20 jumping jacks, walking uphill, a vinyasa style yoga class, or dancing. There’s no need to over-do it, the consistency is more important. Try to pump your lungs a couple of times per day for 5-10 minutes and you may notice a little more pep in your step and a lightness in your heart.
Eat foods with an aromatic quality like garlic, onions, scallions, basil, cilantro, fennel, ginger, and black pepper. These foods have the ability to disperse stagnant qi. Try to minimize greasy, heavy foods like dairy, fried foods, or large amounts of nuts.
Have a plan of action, no matter how small. The Liver system in Chinese medicine is like a general in the army, who carries out “the plan”, getting everyone to do their job. Constructing some action plan, starting with goals that are easy to accomplish can be helpful to soothe this system in your body. This may include simply a to-do list for 1 day and taking great satisfaction in crossing off items such as grocery shopping, taking a walk, 5 minutes of meditation, doing the dish. Check, check, check!

Stagnant Qi Turning Into Fire

This pattern is a progression of stagnant qi. When qi stagnates for a prolonged period of time time, extreme heat is created (think of a car stuck in traffic unmoving and running for weeks). In addition to some of the stagnation symptoms from above, one may also experience some of the following:

strong agitation and irritability
a feeling of oppression or tightness in the chest
acid reflux or heart burn
dry mouth with a bitter taste
constipation
severe indigestion and/or vomiting
headaches
bloodshot eyes
tinnitus (ringing in the ears)

Acupuncture points are chosen to drain heat, soothe the stomach, move the bowels, and regulate qi. Some common points are found at the elbows and near the ankles and knees. Herbs used in this pattern will often have a very strong bitter taste. As the heat is cleared from the body, your herbal formula will change to be less bitter and more aromatic.

Nutrition and lifestyle strategies for patients with this pattern include:

Avoid overly hot, stimulating, or greasy foods, such as: hot peppers, hot sauce, curries, fried foods, fatty cuts of meat (i.e. bacon, salami), alcohol, dairy products, and coffee.
Embracing cooling, heat clearing foods like: dark leafy greens, apples, pears, grapes, seaweeds, radish, millet, tofu (in small amounts) and mung beans.
Minimizing artificial stimulation like television, computer and smart phone screens. Take gentle walks in nature. The soothing properties of trees and fresh air are very therapeutic for this pattern.
Engage in moderately vigorous exercise such as cycling, kickboxing or weight lifting if you need to release a bit before being able to go for a walk in nature. Sometimes if there is a lot of heat present, it can be agitating to try something quiet and soothing. Move the energy a bit if you need to at first, but be mindful that too much vigor can aggravate this condition. If you do engage in a little more movement first, always end with 15 minutes of deep breathing and stretching.

Obstruction by Static Qi and Phlegm

In this pattern, depression begins again with stagnation of qi. However, this time internal fluids begin to accumulate and congeal, instead of creating overt heat. When these fluids, which can be considered nourishment to your organs and tissues (as well as waste removal) are blocked, it’s like a road being obstructed. Substances cannot be transported to where they need to go.

Clinical manifestations may include:

a feeling of something obstructing the throat, like a pit. (This can also feel as if you need to clear your throat, but can’t seem to relieve the discomfort by coughing, or swallowing).
a sensation of heaviness in the body
the sensation of congestion/ blockage in the chest
pain in the costal area (in the lower portion of your rib cage)
lack of appetite and/or nausea
frequent bloating
foggy-headedness, lack of focus

Acupuncture points are chosen which disinhibit blocked qi and transform accumulated fluids in the body. Common points that are used are found on the shins, near the wrists and on the abdomen. Herbal formulas will focus on draining the dampness, re-establishing proper fluid metabolism, dissipating blockages and regulating the flow of qi. These herbs are fairly bland to the taste and can increase the desire to drink water (which is highly encouraged).

Helpful tips for patients with this primary pattern:

Eat at least 80% of your foods cooked. This means steam or stir-fried veggies instead of salads, and oatmeal instead of a smoothie in the morning.
Avoid iced water and other cold beverages. Try to drink your water at room temperature. Adding a touch of lemon can be a nice way to make this more palatable if you’re used to drinking iced water. A mug of hot water with lemon can be a nice way to get in small amounts of water if you are adverse to drinking water.
Minimize or eliminate sweets. Choose dark chocolate over milk, honey over granulated sugar and avoid artificial sweeteners all together.
Consistent and moderately vigorous exercise. A wet piece of clothing needs sun and wind to dry, right? With heat-generated, muscular movement and by pumping the lungs, dampness can be transformed through perspiration. Daily movement for 20-30 minutes is an ideal minimum. This can be as simple as brisk walking. Occasional saunas can usually be tolerated by the person with this pattern.

Deficiency of Yin and Blood

In this pattern, there are simply not enough nourishing, healthy fluids in the body (yin). Independently, but often concurrently, there is not enough blood or the quality of blood is not as rich as it needs to be. This is a harder one for our Western minds to understand. For the yin deficiency, we can return to the auto analogy. It’s a bit like running an engine with low oil. The entire system begin to run a little hot, fluids dry up and problems ensue. Blood deficiency is not exactly the same as anemia, although the two can have common symptoms and it is possible to have both. More often, we see a quality of blood that is lacking and that can arise from many different causations.

The person with this primary pattern may experience depression with some of the following:

agitation or restlessness
insomnia
abnormal and strong emotional responses
suspiciousness or lack of trust
spells of grief and crying without apparent cause
trance-like mental states

Acupuncture points are used to calm restlessness, clear agitation and nourish fluids. The commonly used points are found on the forehead, ears, wrists, ankles and shins. Herbs used in this pattern tend to be a mix of nourishing, sweet flavors with mild bitter flavors.

Lifestyle ideas for those with this primary pattern:

Commit to a mellow movement routine that has community. Weekly walking groups can be helpful, but even better would be weekly yoga classes, taiji or qigong.
Eventually, meditation can be very helpful for this pattern, but easing into it through a movement form with community can help to create sustained results. The biggest challenge here is commitment. Those who experience this pattern can be easily discouraged from new endeavors. Find a friend and commit to something together. Support goes a long way in sustaining new routines.
Avoid spicy foods, too much caffeine and processed sugar.
Eat more steamed beets, dark leafy greens and sweet potatoes. If you enjoy meat, pork and chicken are good choices as well as occasional beef.

Receiving acupuncture releases endorphins into the blood stream. Therefore, with any chronic or acute feelings of depression, coming in to receive acupuncture provides immediate relief. The herbal formulas work slowly but consistently everyday to shift the body back into balance and alleviate depression. Once you begin feeling a bit better, the lifestyle suggestions are easy to incorporate. Most people find Chinese Medicine very helpful for their feelings of depression for this reason. There is an immediate intervention and change of feeling with acupuncture. There is a steady, slow, lasting change that comes about from taking internal herbs. With these two combined, daily choices that benefit one’s physical and mental health become easier to assimilate. Feelings of depression can be overwhelming, but Chinese Medicine offers a non-pharmaceutical intervention that many find very helpful. Try it yourself or offer the suggestion to someone you know who may be experiencing feelings of depression.