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Home > Newsletters > December 2007 > Chinese Medicine and the Mind - Page 3

Chinese Medicine and the Mind - Page 3

By Efrem Korngold, LAc, OMD and Harriet Beinfield, LAc

Inadequacy of love, caring, and nurturance creates feelings of deprivation and inadequacy, which, in turn, may lead to a constant craving to be filled up and to prove competence, suspecting all the time that these demonstrations may be fraudulent. Not feeling able or deserving may prompt a person to seek satisfaction through enabling others, thereby deriving vicarious enjoyment from their achievements. The recognition that a person is habitually putting another’s life first may tumble her into a crevasse of self-pity and a panic of identitylessness. This individual is suffering because she does not recognize her own identity independently of others and thus feels lost without a compass to map her own destiny. Obsessions arise: with food, details, recognition, material security, and
enterprises that ensure becoming indispensable to others. The failure
to juggle many competing demands is what finally destabilizes the Spleen and leads to physical inertia and a pervasive feeling of
amorphousness.

Recurring loss, or separation from what one esteems or values, injures the Lung. Such insult feels as if there is no longer enough air to breathe or enough power to open the lungs so that the air can fill them. Extreme anguish over what has been lost may cause the chest to collapse or to become frozen in expansion. In either case, respiration is impeded along with the voicing of grief. On the other hand, unending travail and bemoaning of fate saps the Qi. Without the Qi of the air and the dynamic rhythm of breathing itself, the Kidney Qi erodes, sapping the Will and dulling the Mind. Depression of this type transforms a person into a husk of her/his former self, a kind of ghost, sentimental and nostalgic, without color, humor, or animation. This often happens to older people who survive
an adored spouse or child or lose a business or vocation that has been the central source of meaning and purpose.

The Chinese classics offered no specific term for depression as a separate and distinct pathology, although they did describe two forms of madness termed kuang (mania) and dian (withdrawal), the former a condition of unbridled Yang and the latter a condition of overflowing Yin. In contemporary language, kuang suggests mania and dian connotes catatonia. Sometimes these conditions were observed to occur in alternation like the modern manic-depressive psychoses. According to the fundamental laws of Yin and Yang, extreme Yin can transform into Yang—inertia and apathy can become agitation and panic—and vice versa. In severe cases, they might deteriorate into states of collapse, semiconsciousness, or even coma that might now be diagnosed as toxic brain disorders such as those that occur in alcoholism, Addison’s disease, or HIV/AIDS.

Prior to the development of the distinct disciplines of clinical psychology and psychiatry in America in the 1950s, mental and emotional disturbances that were not identified as clear cases of madness (mania, catatonia, psychosis) were often subsumed within the broadly defined categories of neurasthenia, psycasthenia, hysteria, Anxiety neurosis, and melancholia. In particular, neurasthenia was a diagnosis given to a syndrome of diverse symptoms that included both somatic and psychic complaints but for which no material cause could be found—what today would be called psychosomatic illness or a functional psycho-neuro-immunological disorder. The symptoms of neurasthenia included insomnia, disturbing dreams and nightmares, dyspepsia, nausea, vomiting, headache, sweating, tremors, vertigo, hyperventilation, fatigue, poor concentration, feelings of worthlessness and inadequacy, irritability, phobias, Anxiety, spinal pain, diminished sense of taste, smell or hearing,
and temporary aphonia and aphasia. Yu or Yu Zheng, the Chinese term that is commonly translated as depression, refers to an abnormal condition of Qi in which it is confined or oppressed by the powerful suppression of emotion and self-expression. This obstructs the Qi in a manner that begins to generate a kind of friction (Heat) as a consequence both of the excessive effort required to inhibit it as well as the actual force of the Qi itself attempting to break through the constraint. If Heat becomes extreme, there may be sudden outbursts of rage, panic, sobbing, or laughter as well as eruptions in the form of boils, hives,
blisters, and nose bleeds. The condition of Heat engenders a feed forward
cycle in which surplus Yin substances (blood and fluids) are mobilized to cool down and pacify, but become progressively attenuated, leading to a secondary condition of depletion in which hyperactivity (agitation and emotionality) begins to alternate with periods of collapse (lethargy, apathy, loss of interest in food, sex, and social interaction). Ultimately, the strength of the organism begins to decline as the Qi becomes depleted. The Heat, however, remains and continues to produce irritability, nervousness, Anxiety, and physical and emotional sensitivity, along with fatigue. Although tired, the person cannot sleep, which in turn produces more restlessness and more fatigue. As the condition progresses, Yang (animation and metabolism), unsupported by Yin, begins to fail, and a condition of Heat transforms into one of Cold. Now, the person is easily chilled, difficult to engage, sleeps an inordinate
number of hours without feeling rested, and has great difficulty rousing himself to respond to either external promptings or internal urges. The person appears dull and lifeless, feeling deadened, perhaps with the desire to die, feeling out of life.

The question, “Does the depression cause the illness or the illness
cause the depression?” is moot. From the Chinese medicine perspective,
obstruction of the natural movement of Qi through social or autoinhibition will lead just as readily to collapse of the vital power of the organism as will physical damage to the body through trauma, illness, or impoverishment. In either case, the Mind (Shen) and its faculties will lose their moorings, and the individual’s fundamental sense of integrity, identity, and purpose will erode, leaving her/him disconnected from life and compromised in the capacity for joy and satisfaction. Yang depression is essentially a Qi congestion or constraint syndrome, whereas Yin depression is a Qi depletion or collapse syndrome.

Essentially, depression is viewed as one of the consequences of stress: environmental exposure, illness, overwork, inadequate nutrition, emotional trauma, mental strain, excessive sexual indulgence, physical trauma, or other cumulative influences. Those diagnosed with primary, essential, or idiopathic depression, from the Chinese medicine perspective, must have suffered early trauma or deficiencies during gestation, birth, or early development that were probably ignored or simply not recognized. Those who are constitutionally vulnerable will be more likely to suffer deeply from insults not only to the body but to the mind. Those who are constitutionally robust may or may not succumb to afflictions of the mind and spirit, but, if they do, they are more likely to recover given the right conditions and influences. The weaker individuals (poorly endowed or somehow drained of Qi, Blood, and Essence) may not recover even under optimal conditions. Then there is the issue of coherence: regardless of the endowment or current reserve of Qi/Blood/Essence, if the negative influence is powerful enough, it can permanently derange or disorganize
the continuum primum of Shen-Jing: all the kings horses and all the kings
men.. .. These individuals will need constant support from “drugs” and social milieu for a lifetime to hold themselves together; and as they age and the Qi declines, they will become more and more unstable, and vulnerable to future insults.

DIAGNOSIS

The impact of both physiological and psychological stress—whether
distress or eu-stress—is handled by all the Organ Networks, but especially the Liver and Heart. The initial burden of any insult or discomfort is born by the Liver, then interpreted and given its meaning by the Heart. Whether and how these experiences are integrated into an individual’s life is then influenced by the Spleen, which digests them; the Lung, which evaluates them; and the Kidney, which ultimately archives and accepts them not only in memory but in identity. However, not all life experiences are easily or self-consciously incorporated into the self. Over time, ambivalence and lack of resolution may lead to underlying feelings of Anxiety, uncertainty, lack of self-confidence, vulnerability, and insecurity. Anxiety will affect the Heart, vulnerability the Lung, doubt the
Liver, insecurity the Spleen, and lack of confidence the Kidney. For example, irritable bowel syndrome can be interpreted as entrenched ambivalence and indecision, a disharmony between the Liver and Spleen. Loss of physical power can be a metaphor for a loss of self-confidence and a posture of helplessness, a depletion of the Kidney. Asthma can be seen as an incomplete reconciliation with feelings of anger and sorrow because of loss, humiliation, or abandonment, a disharmony between the Liver and Lung.

Most contemporary manuals and textbooks of traditional Chinese
medicine (TCM) focus on disturbances of the Liver Network as the origin of depression. This is because it is the role of the Liver not only to assume the brunt of negative sensations and feelings but to “detoxify” them as they are absorbed into the Blood, softening their impact so as not to disturb the Heart, Spleen, Lung, and Kidney. In Chinese medical thought, the Blood is the medium of the mind, ubiquitous in its penetration of the organism as a whole, a concept paralleled in contemporary medical thinking by the peptide theory (neuropeptides are produced simultaneously by the gut, the cells of the immune system, and the brain). Because the Liver stores the Blood, negative or shocking experiences that are not adequately processed by the Liver (that is, detoxified and eliminated, or psychically neutralized and rejected) will
remain in the Blood, and therefore the Mind, as toxic residues or negative imprints and will eventually engender a disorganization of Qi that leads to various Organ Network dysfunctions. However, the Liver’s capacity for accommodating distressing feelings or toxic substances while also maintaining a smooth flow of Qi and Blood, and an even temperament, is limited. The strain of this effort causes the Liver to decompensate, manifesting as irritability, heightened emotional reactivity, and increasing physical sensitivity. As a backup strategy, the Liver may shunt these residues and imprints into the Kidney Network, which has a much greater capacity for storage and containment: The Kidney stores the Essence
(Jing). There are two problems that arise from this development: toxic agents and negative imprints that remain in the Blood are always available to consciousness and begin to undermine a person’s ability to focus and maintain equanimity. Those that are stored with the Essence (Jing) by the Kidney become subconscious and, therefore, functionally speaking, forgotten—that is, suppressed. According to this model, the early stages of depression are characterized by patterns of Liver Qi Stagnation, Liver Heat, Liver Blood stagnation, deficient Liver Blood, and the adverse impact of these conditions on other Organ Networks.

The later and more serious stages of depression are characterized by patterns of Kidney Qi deficiency because of attrition of Jing (Essence): Kidney Yin and Yang. Why is the pattern of Kidney depression more serious? Because the Jing (Essence) is the somatic source and foundation of Shen (Mind), identity, and selfhood.

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