Harry’s research about deppression

Hao Chen
2006/10/4

                                                                              Depression
Abstract

Introduction of depression
Introduce the basic facts for depression in New Zealand and the world.
Depression form western medicine point of views, including definition,
Diagnosis and symptoms, causes and treatments.
Depression form Chinese medicine point of views, including four concepts in Chinese Medicine, main basic patterns,

summarizes the acupuncture treatment from literature in the last 5 years
Guasha and cupping
Acupuncture ( filiform needling ) treatments
Ears acupuncture
my own understanding about the mechanism and effect of acupuncture treatment of Depression

Conclusion and references

One: Introduction of Depression

1. Basic facts for Depression

Depression is common to many New Zealanders, their families, and friends.

  • 1 in 5 women and 1 in 10 men experience depression in New Zealand.
  • Rates of depression are increasing for men and women, and people are experiencing it at an earlier age.
  •  There is a strong link between depression and suicidal attempts and behavior; depression is associated with half of suicide cases. 460 people took their lives in 2002 and 5000 were hospitalized after attempting suicide.
  • It’s a global experience – the World Health Organization predicts that by 2020 depression will be the second highest cause of death and disability in the world.

2. Depression from western medicine point of views

Clinical depression (also called severe depression disorder, major depression disorder) is a state of sadness, melancholia or despair that has advanced to the point of being disruptive to an individual’s social functioning and/or activities of daily living. Although a low mood or state of dejection that does not affect functioning is often referred to as depression, clinical depression is a medical diagnosis and is different from the everyday meaning of “being depressed”.

Diagnosis and Symptoms
According to the DSM-IV-TR criteria for diagnosing a major depressive disorder (cautionary statement) one of the following two elements must be present for a period of at least two weeks:

  • Depressed mood, or
  • Anhedonia

It is sufficient to have either of these symptoms in conjunction with five of a list of other symptoms over a two-week period. These include:

  • Feelings of overwhelming sadness or fear or the seeming inability to feel emotion (emptiness).
  • A decrease in the amount of interest or pleasure in all, or almost all, activities of the day, nearly every day.
  • Changing appetite and marked weight gain or loss.
  • Disturbed sleep patterns, such as insomnia, loss of REM sleep, or excessive sleep (Hypersomnia).
  • Psychomotor agitation or retardation nearly every day.
  • Fatigue, mental or physical, also loss of energy.
  • Intense feelings of guilt, helplessness, hopelessness, worthlessness, isolation/loneliness, anxiety, and/or fear.
  • Trouble concentrating or making decisions or a generalized slowing and obtunding (to dull or blunt, especially sensation or pain) of cognition, including memory.
  • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
  • Feeling of being abandoned by those close to you.

An additional indicator could be the excessive use of drugs or alcohol. Depressed adolescents are at particular risk of further destructive behaviors, such as eating disorders and self-harm.

Causes of depression
No specific cause for depression has been identified, but a number of factors are believed to be involved.

  •  Heredity
  •  Physiology – There may be changes or imbalances in chemicals that transmit information in the brain, called neurotransmitters.
  • Seasonal affective disorder (SAD) is a type of depressive disorder that occurs in the winter when daylight hours are short. It is believed that the body’s production of melatonin, which is produced at higher levels in the dark, plays a major part in the onset of SAD and that many sufferers respond well to bright light therapy, also known as phototherapy.
  • Psychological factors – Low self-esteem and self-defeating or distorted
  • thinking are connected with depression. Although it is not clear which is the cause and which is the effect, it is known that depressed persons who are able to make corrections in their thinking patterns can show improved mood and self-esteem.
  • Early experiences – Events such as the death of a parent, abandonment or rejection, neglect, chronic illness, and physical, psychological, or sexual abuse can also increase the likelihood of depression later in life.
  • Life experiences – Job loss, poverty, financial difficulties, gambling addiction, long periods of unemployment, the loss of a spouse or other family member, divorce or the end of a committed relationship, involuntary celibacy, or other traumatic events may trigger depression. Long-term stress at home, work, or school can also be involved. Bullying in late adolescence is also thought to be a contributing factor.
  •  Medical conditions – Certain illnesses, including cardiovascular disease, hepatitis, mononucleosis, hypothyroidism, and organic brain damage caused by degenerative conditions such as Parkinson disease, Multiple Sclerosis or by traumatic blunt force injury may contribute to depression, as may certain prescription drugs such as birth control pills and steroids. Gender dysphoria can also cause depression.
  •  Diet – The increase in depression in industrialized societies has been linked to diet, particularly to reduced levels of omega-3 fatty acids in intensively farmed food and processed foods.
  •  Alcohol and other drugs – Alcohol can have a negative effect on mood, and mis use of alcohol, benzodiazepine-based tranquilizers, and sleeping medications can all play a major role in the length and severity of depression.
  •  Living with a depressed person – Those living with someone suffering from depression experience increased anxiety and life disruption, increasing the possibility of also becoming depressed.

Treatment
Treatment of depression varies broadly and is different for each individual. Various types and combinations of treatments may have to be tried. There are two primary modes of treatment, typically used in conjunction: medication and psychotherapy. A third treatment, electroconvulsive therapy (ECT), may be used when chemical treatment fails.

Other alternative treatments used for depression include exercise and the use of vitamins, herbs, or other nutritional supplements.

3. Depression of Chinese medicine
Depression is similar to TCM’s Yu syndrome, Baihe disease, Zangzao, Diankuang etc. There are four concepts in Chinese Medicine that are extremely useful in understanding the depression patterns.

The Six Depressions or Six Stagnation
The six depressions involve stagnation of either qi, blood, dampness, phlegm, food, or fire. qi stagnation underlies all the others because qi is responsible for the movement and transformation of blood, dampness, phlegm, and food, and also because stagnant qi, being yang in nature, may eventually turn into fire or heat. Blood, dampness, phlegm, and food are all yin substances; if the qi becomes stagnant and depressed, it may result in any of these four not being moved or transformed properly, and they may accumulate. At the same time, the accumulation of any of these four yin substances may obstruct the free flow of yang qi, further complicating qi stagnation.

The theory of similar Transformation
According to Liu Wan Su, a great master of internal medicine from the Jin-Yuan dynasties, he believes any evil qi accumulating in the body, whether externally invading or internally engendered will tend to become warm over time because the basic host or ruling qi of the body is hot. For this reason, even if a disease was initially caused by cold, or is original yin in nature, there is a tendency for this disease to transform into a hot pathology if the host yang qi is sufficiently strong.
When qi becomes stagnant and depressed, it backs up and accumulates, and
may transform into pathological heat or fire because qi is yang in nature. Even though the other four depressions-blood, dampness, phlegm, and food-are originally yin, they obstruct the free flow of qi. The qi tends to become stuck
behind or entangled with these yin accumulations, and these four yin depressions also tend to become hot stagnations: dampness tends to become damp heat, stagnant food tends to become complicated by heat, phlegm tends to transform into phlegm heat or fire, and static blood can become heat stasis.

Liver Qi stagnation
Liver pays a pivotal role in the body. When confronted by continuous and prolonged psychosocial or emotional stress, the liver’s function of spreading the qi is impaired; the liver cannot maintain its free and unobstructed flow and the qi stagnates. The term ‘liver depression qi stagnation’ usually refers to qi stagnation due to damage by the emotions, while qi stagnation alone may be due to other causes. When the qi becomes stagnant due to live depression, one or more of the following mechanisms are set in motion. Stagnant qi may:

  • Accumulate along the pathway of the liver channel and its paired channel the gall bladder
  • Transform into heat
  • Counterflow sideways or upwards
  • Result in blood stasis
  • Result in dampness and phlegm accumulation

Yin Fire
Yin fire is a complex theory developed by another great master of internal medicine, Li Song Yuan, who is known as founder of the school of thought known as Supplementing Earth and author of Pi Wei Lun. Yin fire refers to heat that stems from the spleen and that is associated with dampness; it is heat that arises from the yin or lower part of the body. It is a type of pahological heat versus the healthy heat.
There are five basic mechanisms associated with the production of yin fire: spleen deficiency, damp heat, liver stagnation, blood deficiency, stirring of ministerial fire. These five mechanisms are interdependent , and they mutually engender and promote one another.

The main basic patterns are:
1. Qi stagnation
A. Liver depression qi stagnation
B. Liver depression transforms heat
C. Qi stagnation affecting the heart and lung
D. Blood stasis and stagnation
2. Shen disturbance: vacuity
A. Heart blood vacuity
B. Heart qi vacuity
C. Heart fire flaming upward
3. Shen disturbance: repletion
A. Qi stagnation affecting the heart and lung
B. Depressive heat affecting the heart or lung
C. Exuberant heart fire
D. Phlegm confounding the heart orifices
E. Phlegm fire harassing the heart
4. Qi/Yang vacuity
A. spleen/Lung qi vacuity
B. Spleen yang vacuity
C. Kidney qi vacuity
D. Kidney yang vacuity
5. Dampness and phlegm
A. spleen vacuity, dampness accumulation
B. Phlegm confounding the heart orifices
C. Heart vacuity, gall bladder timidity
D. Phlegm dampness obstruction and stagnation
E. Phlegm fire harassing the heart
6.Blood/yin vacuity
A. heart blood vacuity
B. Liver blood vacuity
C. Liver yin vacuity
D. Kidney yin vacuity
E. Lung yin vacuity
7.Yang repletion and vacuity heat
A. Liver depression transforms heat
B. Hyperactivity of liver yang
C. Liver fire flaming upward
D. Yin vacuity, fire effulgence
E. Spleen vacuity giving rise to fire

Two: summarizes the acupuncture treatment from literature in the last 5 years

Treatments depend on individual syndrome. Also different treatment techniques are only suitable for certain therapeutic actions. To summarize the treatment as follow,

Guasha and cupping
Apply: on Du channel and first line of Foot Taiyang channel, focus on BL13, BL15, BL18 and BL23.
Actions: to regulate Qi and blood.

Balance of local and distal points
To course the liver, rectify the qi: LV14, UB18
LV3, P6
To stimulate the descending of lung qi: SP21, REN 17
LU7, P6
To stimulate the descending of heart qi: REN15, REN14
HT7, P6
To nourish the heart and calm the spirit: UB15, 44 REN14,15
HT7, P6
To fortify the spleen and boost the qi: UB20, REN6, 4
ST36, SP3,4
To harmonize the heart, clear heat, REN14,15, UB15,14
drain fire and settle spirit: HT5,8,GB15
To supplement the kidney: REN6, BU23,52
KD3,7,9
To supplement the kidney and enrich yin: KD22,27, UB23
KD3,6,10
To pacify the liver, subdue rebellious yang, clear heat: LV14,UB18,47
LV2,LI11,GB20

Balance of upper and lower points
To course the liver, rectify the qi, resolve depression, P6, LV3
Open the chest, settle the ethereal soul (hun): LI4, LV3
P7, LV3
To transform dampness, eliminate phlegm, and open
The orifices of the heart: P6, ST40
To supplement the kidney, settle the heart,
And calm the spirit: HT7, KD3
HT6, KD7
HT7, KD9

Points and point combinations useful in the treatment of depression
UB42 Strengthen and roots the corporeal soul( po). Frees up
breathing when worry, sadness, and grief constrict the po.
Calms spirit , settles the po. Makes person turn inward and be
Comfortable with one.
UB44 Nourishes the heart and calms spirit.
Left for longer than 15 minutes, clears heart fire
Stimulates intelligence and mental clarity.
UB47 Settles and roots the ethereal soul (hun).
Strengthens the hun’s capacity for panning, sense of aim in
Life, life’s dreams and projects.
Like a door, facilitates the coming and going of the hun.
Best combined with UB23 and 52, to prevent it from making
the hun too mobile and unsettled, and the patient shaky and
insecure( especially in people who are too open, unstable or
vulnerable.)
UB49 strengthen the intellect, clear spirit, and stimulates memory
and concentration. Relieves obsessive thinking, brooding,
rumination.
UB52 strengthen willpower, drive, determination, capacity to pursue
one’s goal with single mindedness, spirit of initiative,
steadfastness.
In combination with other UB outer line points, used as a solid
mental-emotion foundation for the other aspects of psyche; in
this case it is also paired up with UB23.
DU19 calms spirit and strengthens willpower.
Used in severe anxiety and mental restlessness due to kidney
vacuity with vacuity heat.
DU20 Clears spirit, lifts the mood, and stimulates memory and
concentration.
DU21 strengthens the spirit.
Treats slight anxiety, insomnia and depression.
DU24 Stimulates intelligence and clears the mind.
HT7 Calms and nourishes the spirit.
Specially indicated in heart blood and heart yin vacuity.
P6 Calms the spirit, lifts mood, relaxes the chest.
Rectifies the qi, specially indicated for emotional problems
associated with qi stagnation.

Ears points commonly used in depression
Inferior crus of the antihelix
Antihelix body
Antihelix tail
antytragus

Three: my own understanding about the mechanism and effect of acupuncture treatment of Depression

‘When Yin and Yang is balanced, the Shen could be restored.’ On one hand, any imbalance of the body can disturb Shen, causing the mental disorder to a certain level; on the other hand, by regulating the balance of the body can treat problem related with Shen.
Acupuncture can work directly on the qi in the channels of body, and virtually regulate yin and yang, by means of reinforce the vacuity, eliminate the excess.

Four: Conclusion

‘Diagnosis should target the cause, treatment should target the root.’ ‘If it is urgent, treat the Biao first, if it is not urgent, treat the Ben first.’ Although there are different understanding between western medicine and Chinese medicine about depression. I think the above principles can be applied for both western medicine and Chinese medicine. The western anti-depression drugs might have potential side effects, but they can treat the Biao quite effective. The acupuncture treatment might target the root of depression, but only on physical level. If the cause of depression is emotional factors, we can’t say the acupuncture treatment reach the Ben of the disease.

References
Acupuncture in the Treatment of Depression
–Rosa N Schnyer John J B Allen (2001)

Acupuncture and Guasha for Depression
–Su Sh Xia (2006)

McMan’s Depression and Bipolar Web (2006)

Web site for the American Psychological Society

Medboo TCM Training web(2006)

Depression and Liver Diseases (2004)
–Li Xiao Hong

Study of Emotional Disease in TCM (2003)
–Likai

Advances in the Management and Treatment of Depression(2003)
–John Potokar Micheal Thase

treatment of Emotional Disease by TCM(2006)
–Wang De

Ministry of Health. (2005) Suicide Facts – Provisional 2002 All-Ages Statistics. Wellington: Ministry of Health: pg 1.

Bushnell, J. The nature and prevalence of psychological problems in New Zealand primary healthcare: a report on Mental Health and General Practice Investigation (MaGPIe). New Zealand Medical Journal. 4 April 2003, Vol 116, No 1171, pg 9.

Depression and the Five Elements(2006)
–Stephanie Schneider-Guild, L.Ac.