Medicine Buddha Healing Center
of
www.Ayurveda-Berkeley.com www.Ayurveda-California.com
Researched and Compiled
by
Ms. Sheng-wei Lan, C.A.H.S., 2004
Chinese-Ayurvedic Herbalist Specialist
This topic of manic-depression (now referred to as bipolar
disorder) and its treatment interests me due to my studies in Traditional
Chinese Medicine at
As my research question, I will find out which treatments – TCM, Ayurvedic and Western medicine / psychotherapy – are most beneficial and what the limitations of each treatment are.[1] Especially when working with emotional and mental problems so common in today's fast-paced Vata[1]-genic and competitive Pitta-disturbing society, it is important to simultaneously study and use several methods (not just Western psychology and psychiatry or drug medicine), integrating them into one. This point is shown in the ancient East Indian Vedic literature: “By knowing one science alone, one cannot arrive at an accurate scientific assessment. Therefore, a physician should study other sciences in order to arrive at correct diagnosis.”[2] Therefore, in this paper on manic-depressive disorders and its therapies, I will discuss mixture of modern Western biochemical psychiatry and psychology, TCM, East Indian and Tibetan Ayurveda, and the ancient Asian philosophies of Buddhism[3], Hinduism, Taoism (Dao de Jing[2] – Zhuang Zi) and Confucianism. In the last eleven months of study that have resulted in writing this paper, during which I have been learning these healing, religious, and philosophy arts of Asia combined with modern psychology, I have discovered that “the truth is one” and that they are all (in the traditional Buddhist metaphor) “fingers pointing at the moon.”
I expect to discover evident that TCM can receive good results in the treatment of manic-depression (bipolar disorder). [4] My focus will especially be where there is a more common frequency of manic episodes since that is the tendency of my case study patient mentioned above (who I treated for 11 months now).
Because
of my limited financial resources (just a student), I chose a “survey method”
for this study – which I have summarized and included in the Appendix B the
actual research documents. I first
developed questions which focus on my topic of TCM treatments for bipolar
disorder with a focus on the manic episodes.
I then interview a group of 12 Licensed Acupuncturists and Doctors of
Oriental Medicine (D.O.M./O.M.D.) from the
Clearly, mental disorders like manic-depression
take a big toll on our lives. Efforts to
understand manic-depression disorder depends on research in different areas from
cell biology to sociology. “About
one-third of the
Although it is not the only method for classifying mental disorder, the DSM-IV has strongly influenced most mental health environments - from diagnosis to treatment to medical insurance billing. Therefore, much of the terminology for the disorders discussed in this paper comes indirectly from this large manual “used to provide a common language for therapists, researchers, social agencies, and health workers.”[8]
The most important aspect of Manic-depression disorders (bipolar) for my case-study patient are the manic or anger aspects: According to the book Rooted in Spirit – a translation of the Lingshu portion of the Huangdi Neijing, “when the accumulated pressure” of anger “explodes, blood and breaths are taken massively toward the upper regions. When it is held inside, the internal agitation and dissatisfaction generate blockages that have no resolution. Blocked situations that have no resolution eat away at us.” (Larre-Rochat:95: 168) This is when anger with fire rising eats away at the liver and heart and lungs as is seen in my case study patient. But it all starts with the liver disturbance. The authors of Clinical Applications of the Yellow Emperor’s Canon on Internal Medicine say “The liver stores blood and houses the soul, it cannot house the soul when heat disturbs liver blood, and restlessness of the hands and feet, fright, talking too much or too little, poor sleeping or an unclear mind are encountered.” (Wang 99: 117 Chinese, 272 English) My manic case study patient has hot liver blood, restless legs, feet and mind, with too much talking (require by his computer engineer job), and poor sleep (cause by computer work late at night). The authors of Rooted in Spirit go on to say, “Anger corresponds to the liver. When it expressed the normality of the Wood element, it is the very impetuosity of life, especially in the power of things at their beginning. It is the strength of wind that blows, or the young plant breaking through the still-frozen ground, or the fierceness of birth that expels a being into the light of day and then causes it to grow and unfurl. Wind is the ‘anger’ of Heaven.” (Larre-Rochat:95: 168) This describe well my patient when he is “healthy” or “in remission.” Rooted in Spirit continues on to say, “Pathological anger is perverse movement of the Wood. This is the force that unleashes impulses and pushed them to their extreme; it is the upward leap, the impetuosity that carries everything along before it. When it breaks its moorings, leaving its roots, and goes out of control, it is rage, unleashed fury, and irrational anger.” (Larre-Rochat:95: 168) These above three paragraphs are good describe of my manic case study patient in both “remission” and “active disease.”
Manic-depression disorders (bipolar) are manifested by over-confident, talkative, excessiveness, over-spending (money, time, energy) and hyperactive, followed by short times of depression and thought of suicide. The symptoms of manic-depression disorders look like those of schizophrenia (Wu 91: 256-257). There are also genetic factors, and some mental illness, such as schizophrenia or mania, may be inherited.[9] “This affective disorder is marked by severe pathologic mood swings from hyperactivity and euphoria to sadness and depression. Either the manic or the depressive episodes may predominate, or the two moods can be mixed.” (Eckman-97: 46) The brain can be affected in a way which is illness but is not necessarily mental illness according to usual definitions. A tumor in brain, for example, is not likely to be very much different from tumor in any other part of the body. There are many other examples of this kind. Cerebral hemorrhage, or stroke, is an organic condition, and not a form of insanity.[10] But, in any case, human body is complex and integrated, and definitions are only useable within certain limits. In other words, as the Tao Te Ching says, “The Tao that can be told is not the eternal Tao. The name that can be named is not the eternal Name. The unnamable is the eternally real. Naming is the origin of all particular things.” (Mitchell 88:1) What I mean by this, is that naming and definition are limited – they are not the whole person themselves, and they can “cage” the patient into the identifying their label mania as an inseparable, and therefore incurable, part of their personality. So by labeling the patient “manic” or “schizophrenic” you are reinforcing their identification with the named disease. On the other hand, the TCM method is too diagnose them via unique individualized pattern discrimination as “liver-fire rising – with phlegm heat harassing the portals of the heart” (gan1 huo3 shang4 yen2 – tan2 mi2 xin1 chiao4). (Wiseman 98: 135) (Mong 01: 137) This way, we can treat the patient without labeling them.
The DSM-IV recognizes 10 types of Personality Disorders:[11]
The DSM-IV mentions people having manic episodes may have “a pattern of disregard for, and violation of, the rights of others. This pattern brings the individual into continuous conflict with society.”[12] This is often seen in liver-fire-phlegm (pitta) disturbed patients. As with Histrionic Personality Disorder, manic episodes may show a need for drama or “acting out” - most pitta disturbed persons like such theatrical episodes. I have seen with this one in my case study patient’s actions at times. Some call it “drama addict.” The influence of TV and movies have contributed to this phenomena. In Avoidant Personality Disorder, we see manic-depressive tendencies with “a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.”[13] This would be a pitta disorder. Pitta people, like my case study patient hate being criticized.
“The common cold of psychopathology”[15] everyone has it at some time or other - that deep and long lasting sadness. “One European study found that people with recurrent depression spend a fifth of their entire adult lives hospitalized, while 20% of their sufferers are totally disabled by their symptoms and do not ever work again.”[16]
“21% of females and 13% of males suffer a major unipolar depression at some time in their lives.”[17]
Combination of manic and major depressive alternation. Severe depression (kapha), followed by mania (pitta), then back again. Manic episodes – Abnormal and persistently elevated, elated and expansive mood[19] “Sometimes the individual's predominant mood is irritability rather than elation, especially if the person feels thwarted in some way.”[20] These mania symptoms are all pitta liver fire phlegm symptoms: Abnormal big feeling of self-confidence; Unrealistic belief that they have special powers or abilities; Decreased need to sleep; Too much work, social, or other pleasures; Uncalled-for optimism; Take unnecessary risks; Promise anything; May give away everything. My patient has many of these. The standard Traditional Chinese Medicine textbook from Beijing, Chinese Acupuncture and Moxibustion (a required basic text in my current TCM studies as the Academy of Chinese Culture and Health Sciences) states that “depressive disorder is manifested by mental dejection, reticence or incoherent speech, while manic disorder by shouting, restlessness and violent behaviors. As described in Classic on Medical Problems, depressive disorder is caused by excessive Yin, while manic disorder by abundant Yin, while manic disorder by abundant Yang.”[21] I treated my manic case study patient with acupuncture and Chinese herbs (many different), Ayurvedic herbs (Brahmi [Centella asiatica or Di Qien Cao in Mandarin]) (Reid 95: 129) (Tierra 88: 200) and Western herbs (St. John’s Wort) (Tierra 88:199-200), lifestyle and dietary changes and suggested Buddhist meditation and repentance ceremonies. He mostly have symptoms of manic episodes much more often than depressive episodes. “The most important etiological factor of manic-depressive disorder is emotional injury. Pathologically, Phlegm plays the primary role. Depressive disorder is due to stagnation of Phlegm combined with Qi, while manic disorder is due to Phlegm fire. Although they are different in symptomatology, they are related to each other. A prolonged depressive disorder, in which fire is produced by Phlegm stagnation, may change into manic disorder, while a protracted manic disorder, in which stagnated fire is gradually dispersed, but the phlegm is still existing, can change into depressive disorder. Therefore, they are termed together as manic-depressive.”[22] (Wu 91: 256-257) (Wiseman 98: 135) As an example: “Kay Jamison had a major bout with mania, filled with hallucinations and delusions shortly after finishing her Ph.D. in psychology. Despite her academic training, she was unaware that she was a manic-depressive and needed to be on lithium. In defiance of her academic expertise in the area of depressive disorders, like other manic-depressives she would sometimes stop taking lithium because she was addicted to the highs of mild mania. But extreme depression always followed, and after one of the more fierce high-and-low cycles typical of manic-depression, she attempted suicide and went into a temporary coma. After coming out of it, she said, "It was very clear to me…that if I were going to live, I had to stay on lithium."[23]
According to Bob Flaws, in his article “Thoughts on the Integration of Chinese Medicine & Western Psychiatry”, “One of the fundamental and important statements of methodology in Chinese medicine is, ‘Same disease, different treatments; different diseases, same treatment.’ In Chinese medicine, two patients with the same disease presenting different overall patterns receive different treatments. This is because, in professional Chinese medicine, treatment is predicated on the patient’s pattern first and foremost and only secondarily on their disease diagnosis. Conversely, two patients with different disease diagnoses may get essentially the same treatment if their patterns are the same.” (Flaws TCM-Western Psychiatry 2001) Therefore, although we are talking about TCM treatments for manic-episodes in general, we must always remember that TCM treats individuals with specific “TCM patterns” based on classical “TCM pattern discrimination” diagnoses, not general western disease names like Manic-Depressive. Ayurveda works the same way as TCM in this regard. Again from the above article, Flaws says, “This is what makes our” TCM “treatments safe and effective, because they take into account the patient’s whole situation, not just their disease diagnosis.” In Combined Treatment of Depressive Episodes with Acupuncture & Psychotherapy,” on pages 65-66 of that journal, “At the same time as acupuncture, patients were treated with psychotherapy. This consisted of guided progressive muscular relaxation. The comparison group received the same acupuncture treatment. However, during treatment, they were told to simply focus their mind on their Dan Tian. All patients were treated with even supplementing even draining technique and needles were retained for 30 minutes. During acupuncture, all patients received supplemental inhaled oxygen. One treatment was given per day, five days per week, and one course of treatment consisted of six weeks of such therapy. In addition, members of the treatment group received cognitive behavioral therapy, while members of the comparison group did not. In issue #2, 2003 of Tian Jin Zhong Yi Yao (Tianjin Chinese Medicine & Medicinals), Dr. Cui Jin-bo of the An Ding Municipal Hospital in Tianjin, China published an article titled, “The Combined Treatment of Depressive Episodes with Acupuncture & Psychotherapy.” According to study by Dr. Cui “While acupuncture at these points was definitely effective for ameliorating depression, it was even more effective when combined with psychotherapy.” (Flaws TCM-Psychotherapy 2003: 2) My patient tried psychotherapy for 2 years, but without using TCM. I suggest him to do both at same time.
According to my research in Ze-lin Chen, M.D., A Comprehensive Guide to Chinese Herbal Medicine, manic-depressive psychosis is said as follow: “Depressive psychosis is characterized by alternating bouts of complete silence, incoherent speech and unprovoked laughter, while mania is typified by ravings, greatly increased activity, euphoria and delusions of grandeur. If these states alternate, the condition is known as manic-depressive psychosis or simply manic depression.” (Chen 92: 303)
“Irritability” (pitta dosha), “susceptibility to anger” (pitta dosha in mano vaha srotas and sadhaka pitta, along with liver fire), “a red complexion” (pitta dosha fire in the liver), “conjunctival congestion” (pitta-kapha dosha in alochaka pitta and the liver), “fixed staring” (pitta dosha in alochaka pitta and the liver), “frequent crying” (kapha dosha in mano vaha srotas), “restlessness” (vata or pitta dosha with rajas guna), “excessive aggressiveness which results in injury to others” (pitta dosha with tamas guna), “, greater-than-normal strength” (pitta-kapha dosha), “a red tongue” (pitta dosha – Giovanni Maciocia says “dark red with redder sides and tip, this definitely indicates that anger rather than sadness is the cause of the depression.” (Maciocia 95: 120) “with a greasy, yellow coating” (pitta dosha with ama [toxins] in the liver and heart) “and a wiry, slippery pulse are indicators of an ascent of phlegm-fire.” (vata pushing pitta or simply pitta pushing kapha in the liver) (Chen 92: 305) (Reid-Kreuzer 04) “Phlegm-Fire obstructs the Mind but it also agitates it. It therefore makes the person agitated” (pitta dosha), “restless and anxious” (vata dosha). “In some cases, the person may alternate between periods of depression and confusion (due to Phlegm)” (and due to kapha dosha) “and periods of abnormal elation, agitation and manic behavior (due to fire)” (due to pitta dosha). “In severe cases this leads to manic-depression. Chinese books always describe this condition as alternation of periods of severe depression (the depressive state called Dian1) and periods of manic behavior (the manic phase called Kuang2). The manic phase is usually described as shouting, scolding or hitting people, climbing mountains, taking off clothes” (Wu 85: 265) (all of the previous five are pitta dosha and have been manifested by my manic case study patient), “crying or laughing uncontrollably”. In Hua Tou’s 200 A.D. TCM classic Zhong Zang Jing (Master Hua’s Classic of the Central Viscera), he states that yang inversion causes “sudden congestion”, “red cheeks and vexation of the heat, a cloudy brain,” “fire-red eyes, burning heat of the whole body, performance of what is beyond normal conditions, climbing up heights to sing and laugh, running about disrobed, manic speech and confused talk”, “excessive agitation, incessantly drinking water, inflation and distention of the chest and diaphragm, abdominal and hypochondriac fullness and oppression,” “shouting and screaming. The pulse in yang inversion suggests survival if it feels strong whether pressure is applied or not, but death if it is expiring.” (Yang 93: 15-16) My manic case study patient has sometimes manifested this crying or laughing uncontrollably and had manifested most of the symptoms described above by Dr. Chen, Dr. Maciocia, and ancient TCM master Hua. “It is important to realize that, in practice, much milder versions of this condition appear fairly frequently and one should not always expect such violent symptomatology in order to diagnose this condition.” My manic case study patient has manifested them all fairly frequently at different times of his life. “Phlegm-Fire manifests with a Slippery and Rapid pulse with a Red-Swollen tongue with a sticky yellow coating and a Heat-crack in the midline.” Ayurveda calls this pitta dosha with ama (heating and mucous toxins blocking up the subtle channels of the heart and brain [mano vaha srotas]). (Maciocia 94: 226) (Maciocia 95: 163) (Wu 85: 265) (Reid-Kreuzer 04) It appears that more serious cases of manic-depression are clearly a mixture of all three doshas (vata, pitta, and kapha) disturbed by ama (toxic heat phlegm).
This “taking off clothes” (Wu 85: 265), “running about disrobed” (Yang 93: 15-16), and “tendency to become nude” (Lad 91) all seem to be common to the description of TCM and Ayurveda for the manic episodes of bipolar. My case study patient has reported to me that several times when he had “nervous breakdowns” over last 20 years, he tore off his clothes quickly and ran outside or jumped into cold stream-river or walked down the street nude with craziness or ran naked up onto roof of his house in cold weather fog to yell or sing out like crazy. It confirms this behavior as symptom of manic side of bipolar when it says in TCM Ming dynasty text Divinely Responding Classic (Shen Ying Jing from the Zhen Jiu Da Cheng) compiled by Yang Ji-zhou that one should needle “for enduring mania with climbing heights to sing and running about naked: Spirit Gate (Shen Men, Ht 7), Back Ravine (Hou Xi, SI 3), and Surging Yang (Chong Yang, St 42).” (Yang 94: 51)
Dr. Ze-Lin Chen (M.D. China) recommends Iron Filings Combination Decoction – called Sheng Tie Luo Yin in Mandarin (Sheng1 Tie3 Luo4 Yin4) (Bensky-Barolet 1990: 386)
(Chen 92: 305) Ingredients: Asparagus radix (Tian Men Dong) – Asparagus, 3g; Ophiopogonis rhizoma (Mai Meng Dong) – Ophiopogon, 3g; Fritillariae bulbus (Bei Mu) – Fritillaria, 3g; Arisaema cum bile (Dan Nan Xing) – Arisaema with bile, 1g; Citri exocarpium rubrum (Ju Hong) – Orange peel, 1g; Polygalae radix (Yuan Zhi) – Polygala, 1g; Acori rhizoma (Chang Pu) – Acorus[24], 1g; Forsythiae fructus (Lian Qiao) – Forsythia, 1g; Poria sclerotium (Fu Ling) – Hoelen, 1g; Poria cor (Fu Shen) – Fu-Shen, 1g (Chen 92: 305)
According to Giovanni Maciocia, the treatment principle for phlegm-heat harassing the mind is “Resolve Phlegm, open the orifices and calm the Mind.” (Maciocia 94: 240) (Wu 91: 256-257)
Acupuncture Treatment: ST40 Fenglong, P7 Daling, P6 Neiguan, P5 Jianshi, Du14 Dazhui, BL15 Xinshu. (Maciocia 94:226) (Reid-Kreuzer 04)
According to my research in Philippe Sionneau and Lu Gang’s textbooks The Treatment of Disease in TCM – Volume 1: Diseases of the Head and Face Including Mental / Emotional Disorders (Sionneau 96), the western term bipolar disorder (manic-depression) seems to match up with three TCM pattern categories:
Vexation and Agitation (Fan2 Zao4) – Annoyance due to a hot sensation in the chest (Sionneau 96: 207)
Irascibility (Shan4 Nu4) – Easily becoming incensed or having a hot-temper which is not under one’s conscious control. (Sionneau 96: 227)
Frequent Joy (Shan4 Xi2) – mental-emotional excitement or exultation (Sionneau 96: 233) (“psyched up”)
“Vexation here means annoyance due to a hot sensation in the chest. Agitation refers to a restless state of the limbs due to a hot sensation in them. The former is a subjective symptom, while the latter is an objective sign. Although they are different, they are usually considered one term (Fan Zao) since, in most cases, they occur in combination and share the same disease mechanisms. The vexation and agitation which signal a crisis in an extremely severe disease is not covered by the discussion” here. (Sionneau 96: 207) My case study patient has many years of frequent expression of both vexation (hot chest) and agitation (restless limbs).
“The invasion by wind cold” (vata dosha in Ayurveda) “is
often the causative factor in this pattern.
Such invasion may depress yang” (pitta in Ayurveda) “when it invades the
exterior. When yang is depressed, it
will transform into internal heat” (pitta dosha in Ayurveda). “Vexation and agitation” (pitta dosha) “will
then occur when this heat disturbs the heart spirit” (sadhaka pitta in
Ayurveda). (Sionneau 96:
207) (Reid-Kreuzer 04) In ancient master physician Hua Tou’s 200 A.D.
TCM classic Zhong Zang Jing (Master
Hua’s Classic of the Central Viscera), he states that “mania and frenzy…all
this arises out of wind.”[3] (Yang
93: 47) In Ayurveda, this is vata pushing pitta (wind
creating excess heat). (Reid-Kreuzer 04) Before he became vegetarian in 1997 (which
decreased his excessive internal fire – pitta dosha), my manic case study
patient had many years of often exposing himself to wind cold (vata dosha) when
walking around in shorts and t-shirt in windy-cold (vata dosha) foggy
“Vexation and agitation” (pitta dosha), “generalized pain”
(vata dosha), “fever” (pitta dosha), “aversion to cold” (vata dosha), “absence
of sweating” (vata dosha), “headache” (vata dosha), “slight thirst” (vata
dosha), thin, yellowish-white tongue fur” (pitta yellow -kapha white), and a
floating, tight, rapid pulse” (pitta dosha).
(Sionneau 96: 209) (Reid-Kreuzer 04) My case study patient had “everyday vexation
and agitation”, many pain, sometimes night-time fever (around
“Resolve the exterior and scatter cold” (soothe vata dosha), “clear heat and eliminate vexation and agitation.” (soothe pitta dosha) (Sionneau 96: 209) (Reid-Kreuzer 04)
According to Bob Flaws, “Psychiatric disorders are often categorized as ‘knotty, difficult to treat diseases’ in Chinese medicine. The main modality and standard of care in professional Chinese medicine for the treatment of psychiatric disorders is the internal administration of Chinese medicinals. However, as Ding De-zheng points out in an article titled, ‘Knowledge Based on Experience of the Acupuncture Treatment of Psychiatric Disorders,’ the combination of acupuncture with such internally administered medicinals is often able to achieve an even better effect than internally administered Chinese medicinals alone.”[25] (Flaws-Ding 2001) Thus, we shall always discuss both the herbal and the acupuncture treatments together.
Shao Fu (Ht 8) Clears the heart and eliminates vexation
Zhi Zheng (SI 7) Together, these points expel wind and
scatter cold,
Feng Men (Bl 12) resolve the exterior and eliminate
vexation
He Gu (LI 4) Together, these points clear internal heat
and
Qu Chi (LI 11) resolve the exterior (Sionneau 96: 207)
“Modified Da Qing Long Tang (Great Blue Dragon Decoction)
Ingredients: Uncooked Herba Ephedrae (Ma Huang), 9g; uncooked Ramulus Cinnamomi (Gui Zhi), 6 g; mix-fried Radix Glycyrrhizae (Zhi Gan Cao), 5g; uncooked Semen Pruni Armeniacae (Xing Ren), 6g; uncooked Gypsum Fibrosum (Shi Gao), 25g; uncooked Rhizoma Zingiberis (Sheng Jiang), 3g; Fructus Zizyphi Jujubae (Da Zao), 3 fruits; clear Semen Praeparatus Sojae (Dan Dou Chi), 9g.” (Sionneau 96: 207-208)
My case study patient would sometimes cook soups with licorice and jujube fruits. Ayurveda used licorice (called Yasthi madhu in Sanskrit) along with other herbs like Brahmi (Centella asiatica) to treat manic-depression when there is both vata and pitta doshas disturbed. (Reid-Kreuzer 04)
“In externally contracted warm diseases” (pitta dosha), “if the evils are not eliminated and remain in the body, they may enter the yang ming channels and struggle there. ‘The yang ming channel shared plenty of qi and blood.’ Therefore, a fight in the yang ming will make the heat worse. In addition, heat evils can easily bind with the stool, causing blockage of the bowel qi” (perhaps pitta blocking apana vata) “and also add much heat. When this heat disturbs the heart spirit” (sadhaka pitta in Ayurveda), “vexation and agitation occur.” (Sionneau 96: 207) There is no clear Ayurvedic equivalent for yang ming. (Reid-Kreuzer 04)
“Vexation and agitation” (pitta dosha), high fever ” (pitta dosha due to ama [toxins]), “sweating” (pitta dosha), “coarse breathing, thirst” (vata or pitta dosha), “constipation or dry stools” (vata dosha) “with fluid defecation”, “abdominal fullness with palpable dry stools” (vata dosha), “pain in the abdomen exacerbated by pressure” (pitta dosha), “in severe cases, delirium” (vata dosha), “dry, yellow” (vata-pitta) or “dry, black tongue fur” (vata dosha), and a surging, large, or deep, replete pulse.” (Sionneau 96: 210) (Reid-Kreuzer 04) My case study patient has had high fever only two or three times in his adult life. He sweat a lot (pitta dosha), is often thirsty, but has almost never in life had constipation or dry stool. He tend toward loose stools (pitta dosha) for more than 7 years. He rarely has abdominal pain, has only once had delirium (as a child). He rarely has dry tongue (vata dosha), but most often has greasy yellow tongue fur (pitta dosha). So this pattern doesn’t really apply to his manic-depression.
“Clear heat, engender fluids, and greatly precipitate heat bind.” (Sionneau 96: 210)
In Ayurveda this is called “pitta soothing, not vata disturbing”. (Reid-Kreuzer 04)
He Gu (LI 4) Together, these point clear heat in the yang
Nei Ting (St 44) ming.
Zhi Gou (TB 6) Together, these points free the
stool (but are less
Shang Ju Xu (St 37) effective than internally administered
medicinals).
Wei Shu (Bl 21) Together, these points engender
fluids
Ran Gu (Ki 2) (Sionneau 96: 210)
“For heat in the yang ming channel: Modified Bai Hu Tang (White Tiger Decoction)
Ingredients: Uncooked Gypsum Firbrosum (Shi Gao), 25g; uncooked Rhizoma Anemarrhenae (Zhi Mu), 9g; Radix Glycyrrhizae (Gan Cao), 6g; Semen Oryzae Sativae (Geng Mi), 9g; clear Semen Praeparatus Sojae (Dan Dou Chi), 6g; stir-fried Fructus Gardeniae Jasminoidis (Zhi Zi), 6g.” (Sionneau 96: 210-211)
“For heat in the yang mind bowel: Da Chang Qi Tang (Major Order the Qi Decoction)
Ingredients: Uncooked Radix et Rhizoma Rhei (Da Huang), 9g; Mirabilitum (Mang Xiao), 6g; ginger-processed Cortex Magnoliae Officinalis (Hou Po), 6g; bran stir-fried Fructus Immaturus Aurantii (Zhi Shi), 6g.” (Sionneau 96: 211)
“If an evil qi has not been eliminated but the righteous qi has become vacuous” (vata dosha), evils and the righteous qi will fight in-between the exterior and interior and thus produce heat which will bind in the shao yang channel. When this heat disturbs the heart spirit, it causes vexation and agitation.” (Sionneau 96: 208) In Ayurveda, there seems to be no close equivalent to this. (Reid-Kreuzer 04)
“Vexation and agitation” (pitta dosha), “alternating chills” (vata dosha) “and fever” (pitta dosha due to ama [toxins]), “chest and lateral costal fullness and oppression exacerbated by lying on one’s side”, “susceptibility to fright” (vata dosha), “cumbersome limbs” (vata dosha), “a bitter taste in the mouth” (pitta dosha), “inhibited urination” (vata dosha), “and a wiry pulse” (vata dosha). (Sionneau 96: 211) (Reid-Kreuzer 04) With my case study patient, out of all of the above symptoms, he generally only had a bitter taste in the mouth.
“Harmonize the shao yang, clear heat” (soothe pitta), “and eliminate vexation” (soothe pitta). (Sionneau 96: 211) (Reid-Kreuzer 04) With my case study patient, my main treatment principle has always been to clear heat. In Ayurveda, this is the best way to decrease excess pitta that leads to manic episodes. (Reid-Kreuzer 04)
Qi Men (Liv 14) Harmonizes the shao yang
Da Zhui (GV 14) Together, these points clear heat and
eliminate
Jian Shi (Per 5) vexation.
Zu Lin Qi (GB 41) Leads the heat, water, and qi in the chest and lateral costal region downward in order to relieve the fullness and oppression. It also disinhibits the urination.” (Sionneau 96: 211)
Summary Treatments for Phlegm-Heat Mania According to ACCHS Professors
My audio-taped research interviews were with TCM Doctors B.K. Chin, W. Chung, Y.M. Fang, H.H. Hsiao, D.M. Li, M.L.D. Liang, H.J. Wang, L. Wang, S. Woodley, J. Yeh, and W.Y. Zhu. As a sample of the variety of answers, I will cite one or two particular teacher’s answers. For those who interested, I can make available my original audio recordings of the professor TCM doctor interviews on CD for you listening to. To save space, I decide to summarize all of the teacher’s answers as follows:
Survey for TCM Research - Manic Disorder (few Depressive Episodes)
Treatment Principle: Clear Fire, Eliminate Phlegm
Professor/Teacher are all either M.D. (
1.
What are the top
2.
What are the top
3.
What are the top
moxibustion points? (or is it contraindicated for mania) Dr. Hsiao says: No. Dr. Chung says: No. Dr. Fang says: No. J. Horowitz says: For loose stool
moxibustion on Ren8; for cold hands and feet use moxibustion on K1 and P8. In general, most doctors said that moxa is
not recommended for bi-polar with mostly manic episodes since it increase heat
too much.
4.
What are the top
cupping points/meridians? (or is it contraindicated for mania) Dr. Hsiao says: No.
Dr. Chung says: No. Dr. Fang
says: Heart, Liver and Kidney, Small Intestine meridians. J. Horowitz says: For mania do cupping on
UB15 and UB13, UB20. In general, most
doctors said that cupping is not useful for bi-polar with mostly manic
episodes.
5.
What are the
scraping (gua sha) points/meridians? (or
is it contraindicated for mania) Dr.
Hsiao says: Hua Tuo Jia Ji (on back). Dr. Chung says: No. Dr. Chung says: Same as above. Most
said no.
6.
What are the top
5 to 10 bleeding points? (or is it
contraindicated for mania) Tip of each
of the ten fingers (shi shen) should be bled is what many teachers said. Others, say to bleed the ear apex. Dr. Li-Chun Huang, M.D. (
7.
What is your
recommended herbal patent medicine tablets (pian-wan)? Dr. Horowitz, Dr. Liang, Dr. Wang and Dr.
Bensky recommended three possible formulas: Jia Wei Shao Yao San (Bensky-Barolet 1990: 148) and Bai He He Huan Pi and Gan Mai Da Zao Tang (Bensky-Barolet 1990: 383). Dr. Hsiao,
Dr. Horowitz, Dr. Wu and Dr. Bensky recommended Wen Dan Tang Pian. (Wu 85: 265) (Bensky-Barolet
1990: 435) Dr. Chin and Dr. Liang recommend Mong Shi Gun Tang Wan (Wu 85: 265). Also
referred to as Gun3 Tan2 Wan2, “drains fire and drives out phlegm” and contains
Duan Meng Shi 30g, Da Huang 240g, Huang Qin 240g, Chen Xiang 15g” (Bensky-Barolet 1990: 424) Dr. Chin, Dr.
Fang, and Dr. Liang recommend Di Tan Tang.
“Di2 Tan2 Tang1 – Guide Out the
Phlegm Decoction” (Wu
85: 265) (Bensky-Barolet 1990: 424) The Qing
Dynasty Dr. Liu Yi-Ren, author of the classic Yi Xue Chuan Xin Lu (The
Heart Transmission of Medicine) says that mania (with joy or excitation) “requires
clearing the heart and nurturing the spirit with Ning Zhi Hua Tan Tang (Calm Mind & Transform Phlegm Decoction as
the ruling (formula). Mania” (with anger) “requires dispelling wind and
eliminating heat with Fang Feng Tong
Sheng San (Notopterygium Sage-communicated Powder) as the ruling
(formula).” (Liu 97:
138-139) (Bensky-Barolet 1990: 58)
8. What is your recommended customized bulk herb decoction formula? Same as above.
Dr.
Wu of Zhiang Xi Publishing recommends in the Chinese Mandarin textbook, to take
the decoction of Xie4 Xin1 Tang1 for phlegm-fire with mental disturbances. (Wu 91: 256-257) Bensky says it
contains “Da Huang 6g, Huang Lian 3g, and Huang Qin 3g.” (Bensky-Barolet 1990: 79) Dr. Fang
says: Add Shen Tie Luo and Ci Shi to the standard Di Tan Tang formula. (Wu 85: 265) (Bensky-Barolet
1990: 424)
9.
If you had to use
a simple two herb or four herb combination using classical “dui
Philippe Sionneau in his book Dui Yao –
The Art of Combining Chinese Medicinals says to use Long Gu (Os Draconis)
and Mu Li (Concha Ostreae) to “calm the liver and subdue yang, quiet the
spirit” to help with “vexation and agitation, insomnia, dizziness, vertigo,
photophobia, and tinnitus due to liver yang hyperactivity harassing the spirit”
with “chronic diarrhea” and “excessive perspiration due to vacuity.” (Sionneau 97: 111-112) My manic case study patient has
all of these symptoms. Ayurveda also
uses conch shell as a purified ash called Shanka
Bhasma for similar reasons. (Reid-Kreuzer 04).
Dr. Li and Dr Chin recommend the dui
10.
What are the best
recommended foods to treat this manic-disorder?
Dr. Fang says: Hei Mu Ar (Black
Wood Ears), Lian Oh (Lotus Root Stalks), Ku Gua (Bitter Melon). Bai He and Mai Dong and Shan
11. What the recommended flavors to enjoy in order to better treat this manic-disorder? (sweet, sour, salty, bitter, pungent, astringent, bland) Dr. Fang says: Bitter and Pungent. Most doctors say bitter and bland. Ayurveda, Yoga, Buddhism and Tibetan Medicine strongly agree with bitter, bland, astringent (dry) being the best flavors. (Reid-Kreuzer 04)
12.
Do you recommend
that such a manic disorder patient be vegetarian to improve their condition?
Dr. Chung says: Yes, there will be less anger if one is vegetarian. 9 TCM doctors said it is not necessary, but 3
doctors recommend vegetarianism strongly: Dr. Zhu, Dr. Wang, Dr. Chung. Ayurveda, Yoga, most Mahayana Buddhism say that
it is vital to be vegetarian, but not vegan if you have manic angry episodes. Being
vegan however will help decrease the mucous of the phlegm-fire. (Reid-Kreuzer
04)
13.
What are worst
foods that such a manic disorder patient should avoid in order to not worsen
their condition? Dr. Chung says: Spicy
foods, coffee and alcohol. Dr. Fang
says: Hot and Spicy foods, especially avoid goat meat and beef. Most of the doctors say avoid spicy.
Ayurveda agrees. (Reid-Kreuzer 04)
14.
What are the
recommended flavors to avoid in order to better treat this manic-disorder?
(sweet, sour, salty, bitter, pungent, astringent, bland) Most of the TCM doctors say avoid pungent. Ayurveda, Buddhism, Yoga and Tibetan Medicine
say avoid especially pungent, then excess salty, and excess sour. (Reid-Kreuzer
04)