Treating the Winter Blues

by Kevin Scrimgeour, Tofino

With the low light levels and the poor weather, winter can sometimes make some feel a little blue. Depression and seasonal affect disorder (sad) symptoms can become so extreme that ones ability to function normally is impaired. This may lead people to take antidepressants for their psychological woes.

In Traditional Chinese Medicine (tcm) physical and mental conditions are seen as part of a whole pattern. Psychological or emotional difficulties are often seen as resulting from a physical imbalance. This is one reason why tcm is considered holistic in its approach.

If one is not impaired socially and self-esteem is intact, their depression may not be psychological but of a physical cause. If this is the case medication may be ineffective in treating the root of the problem, despite the relief it provides.

The wisdom of tcm in seeing depression as possibly physical as opposed to psychological may be important to minimizing the use of pharmaceuticals. Examples of physical causes of depression can be: Lack of sunlight, chronic pain or fatigue, grief, vitamin b12 deficiency, folate deficiency, viral infections, arthritis or other pain inducing diseases, organic brain disorders, drug side effects, cancer and endocrine or hormone imbalances. These physical factors are just a few examples of how physical imbalances can lead to feeing blue.

Treatment for depression in tcm does not ignore the mind but integrates into the body as one system. Calming the mind (or shen) while at the same time correcting an individual's physical pattern of disharmony is the main approach to any psychological problem.

Mild to moderate depression can respond well to tcm, which can be combined with conventional medication or alone under supervision of your doctor. Severe depression is best dealt with through conventional therapies but tcm may be used to augment and strengthen the conventional therapy.

Recent studies and my own experience suggest that acupuncture gives immediate relief from depression and is a treatment of choice even when combined with psychotherapy or drug therapy. Herbal therapy is an alternative but should be properly administered to avoid problems. St. John's Wort, used for mild depression, will nullify the effects of antidepressant medication increasing depression type symptoms. However, skullcap and ginkgo will strengthen the nerves and help relieve the cloudiness of the medication.

One particular Chinese herb, the flower of the mimosa tree, is often used to relieve depression related to Constrained Liver Qi (a tcm syndrome) and to calm the mind. Research has shown that the flower of the mimosa tree has a sedative effect relieving the frustrated Liver Qi and thus the resulting depression. German scientists claim that it is part of the closely guarded secret of the Coca-Cola recipe.

Exercise like TaiChi is a great way to boost endorphins and clear winter woes. Qi-Gong, a specific health exercise, has been proven in China to have a long-range effect on depression. It works to calm the mind and relax the body in a way that will break though old muscular (and mental) holding patterns. It moves the Qi to balance and strengthen the body. Qi-Gong clears the cloudy dark energy out of the lungs and one feels euphoric and happy as a result.

A side effect of practicing Tai Chi or Qi-Gong as a group is the social interaction. This is a great way to beat the feeling of isolation associated with depression.

In combination with acupuncture, herbs and medication, Qi-gong will beat most blue moods.

Diagnosis of depression in Traditional Chinese Medicine

In tcm the diagnosis of depression is somewhat complex to newcomers. There are two schools of thought. One is the 5-element school, which defines depression according to elements wood, fire, earth, metal or water type depression. The other is Zang-Fu theory, which defines depression by organ and substance imbalances: heart, liver or lung Qi imbalances or phlegm, blood or Yin substance excess or deficiencies.

In the tcm 5-element system each element is associated with a particular strength, weakness, colour, sound etc. In depression earth, water and wood are the most common classifications and their symptoms. From these specific treatments can be derived.

Earth Type Depression: a person feels they can't keep up they are overwhelmed and tired. This feeling of deficient physical energy leads to depression. Because earth is related to the spleen function, digestive problems are frequently associated with the mental depression. Worry and endless thinking are also signs. Compassion and fairness with nurturing thoughts to oneself will help the earth depression.

Water Type Depression is associated with the kidney. Weakness, impotence, morning diarrhoea, knee and back pain as well as frequent urination will be common. Fear will be a large part of the depressed state. This is associated with old age and chronic illness. The weakness is more severe than the earth type and this weakness also leads to chronic pain, which can cause depression. Gentleness with oneself and rest will help this syndrome.

Wood Type Depression is associated with the liver. The person will be tight in the neck and shoulders and skinnier than the other two types. Mentally they will be irritable, feel frustrated and can be easily angered. Headaches in the top and sides of the head with eye pain or strain are common. These people focus their anger inwards and this stagnant energy leads to depression. Long-term liver stagnation will lead to earth type depression. Anxiety is common with this type as well. Focusing on kindness and forgiveness can help to regulate this liver disharmony.

The five-element theory gives one a general idea of where the possible physical imbalance stems from. However before treatment can begin a more specific diagnosis is often needed. Zhang-Fu theory is used to better define the specific cause of an individual's depression. The assumption is: when the imbalance is removed then the mind will return to normal.

Below are some common Zhang-Fu disharmonies that occur in people who have been diagnosed with depression. Of these specific syndromes any number may occur at the same time. One may have lung Qi stagnation and blood deficiency for example.

Lung Qi Stagnation (Metal): This derives either from worry, which knots Qi, or from sadness and grief, which deplete Qi and lead to Qi-stagnation in the chest after time. This is characterised by oppression and tightness in the chest, palpitations, sighing, mild breathlessness, a weak voice, and a pale complexion. Emotionally one will be depressed and sad and will tend to weep. This state is due to the constriction of the consciousness by stagnation of Qi. The person will also be very sensitive to psychic outside influences. Such people may, for example, tend to be negatively affected by the problems of people with whom they come into contact.

Liver Qi stagnation (Wood) is one of the most common syndromes associated with depression. Treatment involves moving and dispersing the liver Qi and building and harmonizing the spleen. Liver or wood type depression will often lead to earth type deficiency depression. Liver-Qi stagnation consists of distension of the upper abdomen, belching, sighing, nausea, moodiness, feeling wound-up, a feeling of a lump in the throat, pre-menstrual tension and irritability with distension of the breasts.

Lung and Liver Qi stagnation are two of the main syndromes seen in depressed persons. Acupuncture, Herbs and Qi-Gong or TaiChi are effective at regulating these mild physical disharmonies. More serious syndromes involve substances in the body like phlegm, blood or Yin.

Phlegm causing depression is an excess of fluid in the heart or upper part of the body. This will obstruct the mind and thus cause depression. It will also cause dullness of thought, a fuzzy head, a confused mind and dizziness. In severe cases it may cause mental retardation or even coma. This can be cleared with herbs and by increasing circulation with acupuncture. This can be characterized as severe earth type depression where the spleen is so weak it cannot facilitate the transportation of fluid.

Phlegm obstructs the mind and thinking but it does not agitate the mind. Thus the person will not be restless like the Liver Qi stagnant type but, on the contrary, tired, subdued, depressed and quiet.

Yin and Blood Deficiency are other more water related syndromes associated with depression. Blood in tcm is seen as providing the material foundation for the mind and Spirit. Blood, which is Yin, houses and anchors the Mind and Spirit, which are Yang in nature. It embraces the Mind and Spirit providing the harbour within which they can flourish. An ancient text states that "Blood is the Mind of a person" and that "When Blood is harmonized the Mind has a residence".

Blood conditions are closely related to any mental disharmonies. This is believed because of its relation with Heart and Liver. The Heart, in tcm is seen to house the consciousness or the mind, and governs the Blood the conduit for thought. The Liver, which houses the night time dreaming consciousness and spiritual or subconsciousness, purifies and stores the blood. Emotional stress that affects Heart or Liver would influence Heart-Blood or Liver-Blood and therefore the Mind conscious and subconscious.

Yin deficiency is also seen in depression. The effects of emotional stress on Yin are similar to those on Blood. Affection of Yin may, however, be considered as a deeper level of problem than affection of Blood.

Yin supports the blood and is a deeper indicator of health. Yin like Blood helps to anchor of the Mind and Spirit. Different emotional problems can affect the Yin of different organs and especially the Heart, Liver, Kidneys, Lungs and Spleen. For example excessive worry will damage the spleen function.

If a depressed person has a Yin deficiency only, without Empty-Heat, the Mind and Spirit become weakened and the person feels depressed, tired and dispirited, the Mind is confused and the memory and concentration poor. If Yin deficiency gives rise to Empty-Heat, (a false yang fire due to the lack of yin cooling balance) this unsettles the Mind and Spirit causing anxiety and mental restlessness. This mimics Liver Qi stagnation but here it is deficiency stagnation in excess.

It is important to understand the concept of Spirit in tcm. Spirit is seen as conscious awareness, the more emotional and elusive aspect of being. The body must be in a good state of health, and there must be sufficient nourishment and balance for the spirit to be at peace. When improper diet, extreme emotions, trauma, and external diseases injure the body, the spirit is seen as not having a comfortable place to rest. An unhealthy body will lead to an unhealthy spirit. To treat any mental based problem, an acupuncturist will try to balance the underlying physical syndrome. Using points that calm the spirit directly treats the mind. Thus, in tcm, we treat the apparent physical imbalance seen as the cause of the depression and we calm the spirit so that the person will feels happier and more at peace.

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Kevin Scrimgeour is a licensed doctor of Traditional Chinese Medicine, practicing in Tofino. Contact him at (250) 725-2555

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