Depressive-syndrome is a disorder due to emotional upsets and stagnation of qi, manifested as mental depression, susceptibility to anger and crying, hypochondriac pain, obstructive sensation in the throat, insomnia, etc. For cases of neurasthenia, hysteria, climacteric syndrome and some of the reactive psychoses in modern medicine, the syndrome differentiation and treatment mentioned in this section may be adopted.

Etiology and Pathogenesis

The common causes of depressive-syndrome are emotional upsets such as anger, anxiety, grief, melancholia, etc., which lead to the stagnation of liver-qi and then to the dysfunction of other viscera and the disorder of qi and blood. Prolonged stagnation of liver-qi may induce production of fire and stagnation of blood and may also impair the function of spleen and heart. Dysfunction of the spleen may lead to production of dampness-phlegm, stagnation of food and formation of fire and may induce the corresponding types of depressive-syndrome. Dysfunction of the heart may interfere with the equilibrium of the mental state. Furthermore, deficiency of both the spleen and the heart may induce the production of fire which consumes yin and blood and involves the kidneys, resulting in yin deficiency and fire hyperactivity; thus various kinds of asthenia-syndrome ensue.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Identification of the characteristic manifestations: In general, the stagnation of liver-qi is the major clinical manifestation of the syndrome. But since its pathogenesis is so complicated, its manifestations may be exceedingly variable. The subjective symptoms may be serious, but physical examination may reveal nothing. Therefore the clinical manifestations should be carefully analyzed in order to determine the principal cause of the disease.

(b) Identification of the organs involved and the different types of the syndrome: The disease caused by qi stagnation, blood stagnation and fire retention is closely related to the liver; that caused by food stagnation, dampness retention and phlegm retention to the spleen; and that of asthenic type to the heart.

(c) Differentiation between asthenia and sthenia syndromes: The disease caused by qi, blood, fire, food, dampness and phlegm is attributed to sthenia-syndrome, while that due to the dysfunction of heart and spleen and the insufficiency of liver-yin is attributed to asthenia-syndrome. However, in some cases, both asthenia and sthenia syndromes may coexist.

B. Therapeutic principles Release of stagnated qi is the general therapeutic principle for the disease. This may be supplemented by the therapy of activating blood circulation, suppressing fire, eliminating phlegm and dampness and relieving dyspepsia; tonifying therapy may also be applied according to the condition of qi and blood and zang-fu organs. For sthenia-syndrome, application of the therapy of regulating qi should avoid it consumption that of activating blood circulation should avoid the consumption of blood, that of clearing away heat should avoid the impairment of the stomach and that of eliminating phlegm should avoid the damage of healthy qi. For asthenia-syndrome, the therapy of tonifying the heart and spleen should avoid the overuse of drugs of a dry nature and that of nourishing the liver and kidneys should avoid the overuse of drugs of a greasy nature. Moreover, psychotherapy is also essential for the treatment.

Classification and Treatment

A. Sthenia-syndrome

(a) Stagnation of liver-qi

Manifestations: Distention, oppression and wandering pain over the chest, hypochondrium and abdomen, eructation, desire for breaking wind, sighing, variability of mood, susceptibility to anger and crying, loss of appetite, vomiting, irregularity of defecation, amenorrhea, thin and white or greasy tongue coating and wiry pulse.

Therapeutic principles: Release the stagnated liver-qi.

Prescription: The modification of Bupleuri Powder for Dispersing the Depressed Liver-Qi

Radix Bupleuri 10 g
Radix Paeoniae Alba 10 g
Rhizoma Cyperi 10 g
Radix Curcumae 10 g
Fructus Aurantii 10 g
Radix Glycyrrhizae Praeparata 6 g
Rhizoma Chuanxiong 9 g
Rhizoma Atractylodis 9 g
Radix Scutellariae 6 g

Remarks: For cases with frequent eructation, add Flos Inulae, Haematitum and Caulis Perillae to calm the liver, keep the adverse qi downward, regulate the stomach and stop vomiting. For cases with poor appetite and thick greasy coating due to dyspepsia, add Massa Fermentata Medicinalis Pill, Fructus Crataegi, Fructus Hordei Germinatus, Endothelium Corneum Gigeriae Galli and Semen Raphani to relieve dyspepsia. For cases with loose stool and white greasy tongue coating, add Poria and Cortex Magnoliae Officinalis to strengthen the spleen and eliminate dampness. For cases with amenorrhea, add radix Paeoniae Rubra, Radix Angelicae Sinensis, Herba Leonuri and Radix Salviae Miltiorrhizae to activate blood circulation and eliminate blood stasis.

(b) Qi stagnation with production of fire

Manifestations: Irritability, oppression and distending pain over the chest and hypochondrium, gastric upset, acid regurgitation, dryness and bitter taste in the mouth, headache, tinnitus, redness of face and eyes, red tongue with yellow coating and wiry and rapid pulse.

Therapeutic principles: Clear away liver-fire, regulate the stomach, and release the stagnated qi.

Prescription: The Modification of Xiaoyao Powder of Moutan Radicis and Gardeniae with Zuojin Bolus

Radix Bupleuri 10 g
Radix Paeoniae Alba 10 g
Radix Scutellariae 10 g
Fructus Gardeniae 10 g
Rhizoma Cyperi 10 g
Rhizoma Coptidis 6 g
Fructus Evodiae 3 g
Cortex Moutan Radicis 10 g
Radix Curcumae 10 g
Pericarpium Citri Reticulatae 10 g
Poria 10 g

Remarks: For cases with constipation, add Radix Gentianae and radix et Rhizoma Rhei to purge fire and induce bowel movements.

(c) Qi stagnation and phlegm retention

Manifestations: Uneasiness and obstructive sensation in throat, chest oppression or distending pain over the chest and hypochondrium, white greasy tongue coating and wiry and smooth pulse.

Prescription: The Modified Decoction of Pinelliae and Magnoliae Officinalis

Flos Inulae 10 g
haematitum 30 g
Caulis Perillae 10 g
Fructus Perillae 10 g
Rhizoma Pinelliae 10 g
Cortex Magnoliae Officinalis 9 g
Poria 15 g
Pericarpium Citri Reticulatae 10 g
Rhizoma Cyperi 10 g
Radix Curcumae 10 g
Fructus Aurantii 10 g

Remarks: For cases with heat production from phlegm manifested as dryness and bitter taste in the mouth, vexation, nausea, vomiting and yellow greasy tongue coating, use the Modified Decoction for Clearing Away Gallbladder-Heat which contains Poria, Pericarpium Citri Reticulatae, Rhizoma Pinelliae, Radix Scutellariae, Radix Curcumae, Pericarpium Trichosanthis and Radix Coptidis to clear away heat, eliminate phlegm and release the stagnated qi.

B. Asthenia-syndrome

(a) Psychia trauma due to melancholy

Manifestations: Mental aberration, restlessness, tendency to cry and be sorrowful, pale tongue with thin white coating and wiry and thready pulse.

Therapeutic principles: Nourish the heart, and calm the mind.

Prescription: The Modified Decoction of Glycyrrhizae, Tritici Levis and Jujubae

Radix Glycyrrhizae Praeparata 12 g
Fructus Tritici Levis (wizened) 30 g
Fructus Jujubae 6 pcs
Semen Ziziphi Spinosae (fried) 15-30 g
Radix Paeoniae Alba 10 g
Lignum Pini Poriaferum 10 g
Flos Albizziae 10 g
Dens Draconis (decocted first) 30 g
Concha Ostreae (decocted first) 30 g

(b) Deficiency of both the heart and spleen

Manifestations: Overthinking, Anxiety, palpitations, timidness, sleeplessness, poor memory, pale complexion, dizziness, listlessness, loss of appetite, pale tongue and thready and weak pulse.

Therapeutic principles: Strengthen the spleen, nourish the heart, benefit qi, and tonify blood.

Prescription: The Modified Decoction for Invigorating the Spleen and Nourishing the Heart

Radix Pseudostellariae 12 g
Radix Astragali 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Lignum Pini Poriaferum 10 g
Semen Ziziphi Spinosae (fried) 15 g
Arillus Longan 10 g
Radix Angelicae Sinensis 10 g
Radix Aucklandiae 9 g
Radix Glycyrrhizae Praeparata 6 g
Fructus Citri 10 g
Flos Albizziae 10 g

(c) Yin deficiency and fire hyperactivity

Manifestations: Dizziness, tinnitus, palpitations, sleeplessness, irritability or nocturnal emission, lumbago or irregular menstruation, red tongue and wiry, thready and rapid pulse.

Therapeutic principles: Nourish yin, clear away heat, calm the heart, and tranquilize the mind.

Prescription: The Modified Decoction for Producing Water and Clearing the Liver

Radix Rehmanniae 12 g
Fructus Corni 10 g
Rhizoma Dioscoreae 10 g
Cortex Moutan Radicis 10 g
Fructus Ligustri Lucidi 10 g
Herba Ecliptae 30 g
Radix Bupleuri 10 g
Radix Paeoniae Alba 10 g
Fructus Gardeniae 10 g
Lignum Pini Poriaferum 10 g
Concha Margaritifera Usta (decocted first) 30 g
Concha Ostreae (decocted first) 30 g

Remarks: For cases with nocturnal emissions and lumbago, add Plastrum Testudinis, Rhizoma Anemarrhenae, Semen Euryales and Fructus Rosae Laevigatae to strengthen the kidneys and preserve the essence. For cases with irregular menstruation, add Rhizoma Cyperi, Radix Curcumae and Herba Leonuri to regulate menstruation and release the stagnated qi.

Experiential Prescriptions

A. Fructus Aristolochiae (12 g) prepared as decoction; applicable to the case of globus hystericus.

B. Semen Ziziphi Spinosae (fried, 24 g), Poria (15 g), Radix Pseudostellariae (10 g), Pericarpium Citri Reticulatae (9 g), Fructus Tritici Levis (30 g), Concha Ostreae (24 g), Os Draconis (decocted first, 24 g), Rhizoma Acori Graminei (10 g), Semen Nelumbinis (6 g), Rhizoma Coptidis (6 g), Radix Glycyrrhizae praeparata 910 g) and Cinnabaris (taken separately); prepared as decoction and taken as two divided doses daily for ten days; applicable to cases of hysteria.

Copyright 1995 Hopkins Technology