By Stephanie Schneider-Guild, L.Ac.
At the turn of the
century, health care seems to have come light years from the
days of leeches, country-side doctors and a lack of remedies
for ailments such as polio, rubella and the German measles.
Yet, the world of medicine finds itself in an enormous quagmire
because mere survival in the fast-paced modern world requires
a step back into the shadows of time where the magical healing
powers of nature and traditional medicine reside. One of the
predominant manifestations of present day life lies in the emotional/psychological
realm resulting in depressions, anxieties, and all sorts of
other related dilemmas. The focus of this article, however,
will implement the theories and principles of Traditional Chinese
medicine in diagnosing, differentiating and treating depression
in accordance with the five elements.
In order to gain
clear insight into the many multi-faceted aspects of depression,
it is crucial to look at it from every perspective. Therefore.
it is vital to glimpse into the world of western medicine to
provide one model regarding the complexity of the human mind.
and its functioning.
According to many
western medical resources. depression may be the response of
the body to an overwhelming and constant stress that seems to
the patient to be insurmountable. This stress could be life
experiences, food or nutritional deficiencies or excesses, allergies
to environmental factors, and numerous other so-called stressors.
Regardless of the etiology of the depression, the majority of
western MDs diagnose the patient's condition as a depression.
The symptomology must be rather significant. Among symptoms
falling into the category of a depressive illness, there must
be at least five of the following symptoms for a period of at
least two weeks. These symptoms are:
most of the day, nearly every day
interest in pleasure in almost all activities most of the
day, every day
loss or weight gain without dieting, or major changes in
appetite or eating habits
Insomnia or hypersomnia
or retardation (anxiety or lack of desire to do any thing)
Fatigue or loss
of energy nearly every day
Feelings of worthlessness,
guilt, desperation, and psychic pain that are ongoing
think or concentrate; indecisiveness daily
of death or suicide, or a specific plan or attempt of suicide
The symptoms cause
significant distress or impair social, occupational, or other
important functions. In sever cases, hallucinations and delusions
may occur, perhaps as a result of the emotional overload. In
any case, once the diagnosis has been made, the treatment method
is generally very similar from patient to patient. Usually,
anti-depressive medications, of which there are many, are administered,
and often it takes up to six weeks for the medications to take
effect. In many cases, these medications are a saving grace,
but in the case of the suicidal depressive, extra measures must
be taken to assure that the patient maintains his or her integrity.
The general consensus in the western model is that these treatments
be accompanied by psychological counseling in order to rebalance
and rebuild the person's inner world. Currently, there is a
great deal of research and medical attention regarding depressive
illnesses. and a significant branch of western MDs are turning
to megavitamin therapies. aminoacid. and nutritional therapies
as alternatives to drugs. In the not-so-distant future, it seems
the trend is coming back home... to nature and its innate wisdom.
is perhaps one of the foremost therapeutic avenues that invites
nature to assist in the rebalancing of the human organism. Since
humankind functions on so many levels, from spiritual, to physical,
to emotional, each of these strata need be addressed. The somewhat
magical art of Traditional Chinese Medicine works beautifully
at uniting body-mind-spirit, so that harmony may again be achieved.
This is not to say that TCM is a wonder cure because in some
in some cases, it may even be ineffective. in which case there
are other options and modalities of treatment, from western
medicine to Indian or homeopathic medicine. The point is: other
options exist, and should not be ruled out.
In TCM alone, there
are many approaches to the same problem. The scope of this article
is on the five elements and their significance in diagnosing
and treating depression. Each element encompasses a symptomological
picture that varies from the others. Becoming aware that a patient
is depressed does not suffice. It is important to understand
and address the individual and unique manifestations of that
person's depression. The five elements provide a clear and interesting
framework in which many cases of depressive illness can fit,
be diagnosed and treated. For the sake of clarity, this article
will present each element and its unique manifestations, without
addressing the interactions of the elements. Although elemental
interdependence is fundamental to the five element theory, it
is the goal of this article to highlight the differences among
the elements in order to present a clear theoretical model.
It should be understood that cases of purely Wood-element depression,
for example. would be rare. Usually there is a combination of
elements in the same person, which will hopefully become more
decipherable through deeper understanding of each element.
The Wood Element
the Wood element, one thinks of the obvious characteristics
such as Spring, Wind, Eyes, Tears, Shouting, Anger, Sour, etc.
However, there are also more subtle features pertaining to this
element that are less obvious, but can be of great value when
determining a person's elemental predominance. For example,
some of the traits of a Wood case of depression could be that
the patient has a great deal of difficulty relaxing or being
at ease, that they want to control everything and fall into
depression when defeated, and they have a stormy type of personality
that is prone to many moods. The Wood personality can be arrogant,
confident, aggressive, confrontational, driven and eager. They
can be very demanding of themselves and others. and can easily
be disappointed at which point they may fall into the clutches
of a darkness known as depression. Usually this type of depression
has a great well of repressed anger, disappointment, and frustration
brewing underneath the surface. The primary issue is control
in the Wood cases. As far as their appearance, a Wood type may
present with a reddish facial skin tone, reddish eyes, and disgruntled
look. Wood types are usually rather tall and slender.
The Fire Element
The Fire type, on
the other hand, has quite different features than those of Wood.
A Fire element depression most often has to do with relationships
and "heartbreak." Most frequently, Fire types feel let-down
or disillusioned by love. Their depressions are usually of a
cyclical nature in that they get over one heartbreak, and then
move on to the next. Their depressions can be quite severe,
and they can often become suicidal due to their impulsive, and
"living on the edge" character type. Fire predominance includes
Anxiety, chest pains, nightmares of a vivid nature,
and a lack of laughter and the ability to feel joyous. Depressive
episodes readily deplete heart qi, and can cause the usual Fire
related symptoms of palpitations, shortness of breath, mental
confusion (due to the heart's relationship to the Shen or cognitive
functioning of the individual), and listlessness. Since all
emotions have an influence on the heart, the Fire element can
transmit imbalances that stem from other organ or emotional
disturbances. Yet. in those cases there would be a mixed symptomological
picture. As far as appearance is concerned, the Fire types tend
to have a reddish face with a rather pointy chin. Their hair
tends to be curly, and when in balance they tend to move quickly
and to frequently be in a rush. When depressed, however, they
tend to feel unmotivated and unable to appreciate the beauty
of life that they usually thrive on. Paradoxically, their strong
point is also their weak point in that Fire types lean towards
vigorous and healthy blood and blood vessels when well, but
can easily become depleted in this area when out of balance.
Since the heart rules the blood. Fire predominance can lend
itself to a host of blood related and mental problems when the
individual succumbs to stress and relational pressures.
The Earth Element
The Earth element
would encompass its typically characteristic digestive imbalances.
However, in depressive episodes, Earth types tend towards significant
changes in their eating habits. Some will have no appetite whatsoever,
whereas others become ravenous and try to eat in order to fill
the dark emptiness inside. It appears to be a way of seeking
warmth and comfort. When depressed, Earth elementers become
unmovable, perhaps because they have a tendency towards dampness.
At any rate, they virtually sink into their depressions and
become heavy and unmotivated. The Earth element's energies contribute
greatly to the human affect of centeredness, being grounded,
peace, calm and compassion. In adversity, the serenity of this
element becomes distorted into listlessness, obsessive worry,
over concern and their sense of self strongly diminishes as they
lose their usual propensity to being grounded.
The Earth element's
physical characteristics are unique, and usually quite detectable.
They tend to be stockier, more portly, and generally move more
slowly than most of the other elements. They often have round
faces, and appear rather jovial when in balance. An interesting
note is that their body shapes can alter significantly when
under the duress of depressive illness. They may fluctuate in
weight, depending on their individual tendency to either halt
or greatly increase their food intake. A major clue in recognizing
Earth element cases is their oral natures. They often need to
have something in their mouth - chewing gum, candies, foods.
Perhaps this is the reason for their propensity towards being
damp and somewhat overweight.
The Metal Element
The Metal element
encompasses a great deal of issues regarding giving and taking
to and from the environment. Frequently, this element winds
up depressed when there is loss or grief. Often these emotions
can be repressed and manifest in unusual respiratory difficulties,
asthmas, and frequent upper respiratory infections. Commonly,
when depressed, Metal types sigh, cry and sob, and lack a sense
of boundary between the "self' and others. They are prone to
the sufferance of the world, which is termed "weltschmerz''
This is a Freudian term that depicts the person who takes the
pains and suffering of the world onto their own shoulders. Therefore,
this type of a case may also involve a sense of grieving that
seems overwhelming and all-encompassing. The Metal element types
are environmentally sensitive, but are also more easily influenced
in a therapeutic setting with regards to their emotional status.
They often appear with soft weak voices, and pale complexions.
They are generally of thin stature and when depressed, appear
meager and weak. In many cases, these patients will have rather
clear regrets over the past and feel that there is a significant
desire to wish things could only have gone differently. These
people often feel plagued by circumstance, and therefore grieve
over past issues and losses that they hang on to.
In strong contrast
to the above mentioned elements is the Water element. This is
the most clinically significant and potentially dangerous type
of elemental depression. This is the element that is most greatly
influenced by the pre-natal Jing - hence, genetics. In these
cases, the patient is depressed and does not have any insight
into why or any reasons that may have caused the descent into
a depressive illness. These patients are most susceptible to
severe psychological imbalances, such as schizophrenia, psychoses,
and severe major depressive episodes. In many cases. the patient
will become despondent and unable to do even the simplest of
chores for themselves. Their depression seems to reach down
into the very core of the person's being - their spirit and
soul. These patients become incommunicable, and sink rather
deeply into their illness. These are the most difficult of all
of the elements to treat successfully. These patients appear
desperate, paranoid, and out of touch. They fear life and death,
and don't have any sense of what their fear means. Usually these
people feel that they are beyond help, and no longer seek assistance
in their grave dilemma over their life. They also reluctantly
fear leaving their homes, and seem to lose their sense of purpose
in life. They may appear in a clinic, usually accompanied, and
be ungroomed, easily distracted and very scattered. They may
have nervous tremors, and seem fearful or totally apathetic.
These cases may be misdiagnosed, because it is easy to interpret
the patient's signs as arrogance or poor hygiene. Yet, it is
important to recognize the desperation of the person's plight
because these patients are the ones most prone to suicidal tendencies.
Since they feel so lost and don't grasp what is plaguing them
on such a pervasive and personal level, they often resort to
the ultimate escape from their misery - suicide.
In each of the elements
discussed, there are specific clues and hints as to which element
is predominant in the given case. It is helpful to ask questions
that may evoke the necessary information in order to reach a
diagnosis. One must use tact, empathy and a direct approach
that is not overly involved, while still maintaining a concerned
and caring disposition. The use of the five elements is only
a tool in diagnosing and dealing with a case of depression.
The elements afford practitioners an added sense of comprehension
and clarity in a patient's case. However, it is important to
focus on the most comprehensive and effective means of treatment.
As alternative health care practitioners, it is also crucial
to recognize the importance of dealing with the patient on a
psychologically therapeutic level. In most cases of depression,
there are unseen, underlying triggers that we as acupuncturists
are not trained to deal with. Hence, it requires a delicate
balance that always keeps the patients' best interests foremost
In conclusion, depression
must be dealt with on every level of the person's being. The
theoretical model of the five elements can be useful in diagnosing
and treating a patient suffering from depressive illness. As
stated previously, it is vital to assess the severity of a depressive's
condition, and tend to their individual needs. In any case,
the five element approach can be seen as one perspective in
dealing with these conditions.
L.Ac., MTOM is a graduate of Pacific College or Oriental Medicine
and maintains a private practice. She can be reached at (914)