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
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
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
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
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
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
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
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
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
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
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.
Kevin Scrimgeour is a licensed doctor of Traditional Chinese
Medicine, practicing in Tofino.