8.

DEPRESSION
DEFINITION
• Depression (Yu4 Zheng4) refers to a class of patterns arising from emotional disturbance that are characterized
by stagnation and obstruction of the flow of qi.
• A depressive illness is primarily characterized by a change in mood consisting of a feeling of sadness that may
vary from mild despondency to the most miserable despair. The change in mood is relatively fixed and period
over a period of days, weeks, months, or years. Associated with the change in mood are characteristic changes
in behavior, attitude, thinking, efficiency and physiological functioning.
• Depression accounts for 35-40% of all psychiatric illnesses. It is twice as common in women as in men.
• The onset of depression increases towards middle age, with a maximum onset in the 55-60 age group.
ETIOLOGY
• Emotional disturbance
o Anger, sadness & grief, worry, guilt can lead to functional disturbance and pathological changes in Zang Fu
including LV, SP, HT. All emotions lead to some Qi stagnation initially (also those that deplete Qi, such as
sadness and grief.
o Disturbance of heart spirit constitute the major etiology and pathogenesis of Yu Zheng.
• Weak Constitution
o A constitutional deficiency of the KD, with its resulting weakness of the Will-Power (Zhi), is a frequent
underlying background for the development of depression.
o A constitutional tendency to Heart patterns is also an important contributory factor to the development of
depression. The most important and reliable sign of a tendency to emotional problems is a midline Heart
crack on the tongue.
• Irregular Diet
o Excessive consumption of dairy foods, sweets, sugar and bread may lead to the formation of Phlegm.
Phlegm would aggravate any deficiency and stagnation of Qi. It is also obstructive and heavy and therefore
would cloud the Mind, leading to mental confusion.
o A diet lacking in nourishment leads to deficiency of Qi and Blood, which are the conditions underlying
Deficiency types of depression. This occurs when patients follow strict slimming diets or when they apply a
vegetarian diet inappropriately.
• Overwork
o Overwork, in the sense of working long hours without adequate rest for several years, leads to KD-Yin def.,
and this often forms the background for depression in older people.
PATHOGENESIS
• Depression always due to Excess causes, at least in its beginning stages, with Liver-Qi stagnation being the
main, fundamental pathology underlying this disease. Other excess pathologies include Qi stagnation turning
into Heat, Phlegm and Blood stasis.
• The main deficient conditions underlying depression are deficiency of Blood of the Spleen and Heart, deficiency
of Qi and Yin of the Heart, deficiency of Liver- and Kidney-Yin.
• In the later stages, the Excess can change into a deficiency types of mental depression.
o Heat can injure Yin and lead to Kidney Yin deficiency.
o Phlegm can impair the function of the Spleen and lead to Spleen deficiency.
• Major pathological change: all are initiated by stagnation of qi; correct treatment looks at stagnation of qi.
DIAGNOSIS
• Despondency, moodiness, a weird mental state, melancholy, or bouts of crying.
• May also be costal pain and distension, uncomfortable sensation in the thorax as if obstructed by some object.
• Most patients have the emotional disturbance history like sadness, anxiety, grief, anger, overthinking.
TREATMENT PRINCIPLES
• Patterns of depression are categorized as excess and deficiency.
• Excess patterns usually present during the initial stages of illness. Treatment is directed at soothe the liver
and regulating qi. Depending on the clinical manifestations, this can be accompanied by invigorate blood,
dissolve phlegm, transforming dampness, purging heat or removing food stasis.
• Prolonged cases are generally deficient. Treatment is to nourish the blood, moisten yin, disinhibit qi.
• During the later stages of illness,
• Dry aromatic qi-regulating medicines must be used cautiously to avoid further injury to yin and fluids.
• In addition to herbal medicine and acu-moxa therapy, psychological therapy is very important in treating
depression. The physician should pay attention to the power of suggestions. The language chosen must be such
that it helps the patient to relieve apprehension and that establishes an attitude of certain victory over the illness.
Such changes in attitude have a definite benefit effect on therapeutic results.
DEPRESSION DIFFERENTIATION AND TREATMENTS
1. Depression - LV Qi Stagnation
• Manifestations
• Depression and moodiness - despondence, moodiness, sadness, cry easily, irritability, easily angry,
• LV Qi stagnation: frequent sighing, distention and pain of the chest and hypochondrium,
• LV overact on SP/ST: epigastric fullness, belching, poor appetite, vomiting in some cases, abdominal
distention,
• BM: abnormal BM or amenorrhea,
• T: thin, white coating, (unremarkable)
• P: wiry
• Treatment method:
• Soothe LV qi, regulate Qi.
• Chai Hu – spread LV qi and relieve stagnation, disperse W-H, resolve Shao-Yang disorders raise
Yang-Qi (Cu Zhi better for LV qi stagnation, 6-9g; Sheng better for Shao Yang syndrome, 12g; Mi Zhi
better for SP qi sinking, 3-6g)
• Bo He – spread/regulate LV qi and relieve stagnation, disperse W-H, clear head and eyes, benefit the
throat. (cook last)
• Xiang Fu - spread/regulate LV qi and relieves stagnation, regulate menstruation and alleviate pain.
• Fo Shou - spread/regulate LV qi and relieve stagnation, harmonize ST, resolve phlegm. (within the
Qi-moving herbs, Fo Shou has a particularly strong mental effect in relieving depress)
• Mu Xiang - regulate SP/ST/LV qi and relieve stagnation including from tonic herbs, move qi and
relieve pain, also treat diarrhea, dysentery, tenesmus (focus more on SP/ST qi)
• Relieve depression.
• He Huan Pi – remove constraint, calm the spirit, invigorate blood. He Huan Hua better to soothe LV
Qi which is very useful to treat mental depression accompanied by anxiety and insomnia.
• Yu Jin - remove constraint, invigorate qi and blood, clear HT, cool blood, open mind’s orifices and
resolve phlegm. (Yu Jin is commonly use w/Yuan Zhi)
• Chai Hu - remove constraint, spread LV qi
 • Bo He - spread LV qi, clear head/eyes. (cook last)
He Huan Hua (Mimosa Tree Bark)

It is a in the Nourish the Heart and Calm the Spirit category. It is traditionally used to calm the spirit
and relieve emotional constraint when the associated symptoms of bad temper, depression,
insomnia, irritability, and poor memory are present. He Huan Pi is one of the most important herbs for
the treatment of external trauma and injuries.
Special Notes:
• compare insomnia herb: He Huan Hua, Ye Jiao Teng and Bai Zi Ren.
o He Huan Hua for insomnia due to LV qi stagnation,
o Ye Jiao Teng is for insomnia due to general blood deficiency.
o Bai Zi Ren is for insomnia due to HT blood deficiency.
• compare depression herb: Ye Jiao Teng, He Huan Hua, Bai Zi Ren
o For depression due to blood deficiency choose Ye Jiao Teng.
o For depression due to Qi stagnation choose He Huan Hua.
o For depression with phlegm choose Yuan Zhi,
o For blood stagnation depression is best treated with He Huan Pi.
• Prescription: Chai Hu Shu Gan Tang; Yue Ju Wan; Xiao Yao Wan
• To assist invigorate LV qi in relieving depression + Yu Jin, Qing Pi
• Frequent belching w/epigastric & chest discomfort + Xuan Fu Hua, Dai Zhe Shi.
• Food stasis & abdominal distension + Shen Qu, Shan Zha, Ji Nei Jin
• Fixed pain in chest & hypochondrium, sometimes accompanied by dysmenorrhea in female patients and
a rough pulse + Dang Gui, Dan Shen, Tao Ren, Hong Hua.
• Acupuncture: UB18, LV14, RN12, RN17, ST36 (LI4, LV3, P6, SP4, GB34, UB18, UB47)
Note: UB47 is the outer Back-Shu of the Liver. Its special feature is that it helps treat the psychological aspect
of the Liver. It is usually used to treat depression, frustration, and stress.
• Chai Hu Shu Gan Tang (Bai Shao, Chuan Xiong, Chen Pi, Zhi Ke, Chai Hu, Xiang Fu, Zhi Gan Cao) is a
well-known and much-used formula for Liver-Qi stagnation; it acts primarily on the Lower Burner, and it
would therefore be suitable if the patient summarizes his or her feelings in the lower abdomen with digestive
problems such as abdominal distension and pain and bowel irregularity. This formula is aromatic, acrid, and
drying. It readily injures the qi and yin, and is therefore contraindicated for long-term use or in patients with
Liver qi stagnation-type pain due to qi or yin deficiency.
Qing Pi strengthens the moving-Qi effect, and it directs it to the upper part of the body and the head; Yu Jin
moves Qi and invigorates Blood and opens the Mind’s orifices. It has a specific effect on mental depression
from Qi stagnation.
 • Yue Ju Wan (“Yueju” - namely, depression-overcoming. Xiang Fu, Chang Zhu, Chuan Xiong, Zhi Zi, Shen
Qu) is the formula for mental depression deriving from Liver-Qi stagnation. It was formulated by Zhu Dan Xi
for the six stagnations of Qi, Blood, Dampness, Phlegm, Heat and Food. It contains five herbs for six
stagnations, that is Qi depression by Xiang Fu, blood depression by Chuan Xiong, fire depression by Zhi Zi,
damp & phlegm depression by Cang Zhu, and food depression by Shen Qu. because Cang Zhu treats
stagnation both from Dampness and from Phlegm. Although this formula is for the six stagnations, it is
primarily for Qi stagnation, and therefore Xiang Fu is its emperor herb. This is an intriguing formula as, when
considered individually, none of its ingredients has a particularly strong mental effect, but together they form
a prescription that has an undoubted mental effect in relieving depression.
• Xiao Yao Wan (Bai Shao, Chai Hu, Dang Gui, Bai Zhu, Fu Ling, Sheng Jiang, Zhi Gan Cao) is selected
when Liver-Qi stagnation derives from or occurs against a background of LiverBlood deficiency and Spleen-
Qi deficiency. In my experience, this formula is probably overused to treat mental depression from Liver-Qi
stagnation; it is specifically for Liver-Qi stagnation deriving from or occurring against a background of Liver-
Blood deficiency. In “pure” Liver-Qi stagnation with a Full and Wiry pulse on all positions, one should use
Yue Ju Wan rather than Xiao Yao Wan.
Pattern Pulse Tongue Emotional sx
Chai Hu Shu LV qi stagnation Wiry, may be wiry only Sl. red sides Depression, anger
Gan Tang on left side
Yue Ju Wan LV qi stagnation Full, wiry on all position Sl. red sides Depression,
suppressed anger
Xiao Yao LV qi stagnation, Fine, sl. wiry; weak in Body color may be Depression,
Wan LV blood def. general and sl. wiry on normal or pale sadness, crying
SP qi def. the left

2. Depression - Transformation of Stagnated LV qi into fire

• Manifestations
• Depression and easily upset - agitation, irritability, easily upset. Life stressors provoke upset
• LV qi stagnation - oppression in the chest, distention of the hypochondrium
• LV over acting on SP/ST - acid regurgitation, clamoring stomach,
• Heat - dry bitter taste in the mouth, headache, blood shot eyes and tinnitus,
• BM - constipation
• T: red with yellow coating,
• P: rapid, wiry
• Note: In Liver-Qi stagnation, the clinical manifestations are centred primarily in the hypochondrium and
abdomen, while in Stagnant Liver-Qi turning into Heat there are also manifestations in the head, such as
headache, dry mouth, red eyes and face and bitter taste. The Heat deriving from the long-term Qi
stagnation, on the other hand, agitates the Mind and leads to anxiety.
• Treatment method:
• Clear stagnant heat
• Zhi Zi – clear heat, reduce fire and eliminate irritability in the San Jiao, clear Damp-heat in the San
Jiao, cool blood and relieve toxicity, stop bleeding.
• Xia Ku Cao – clear LV Fire and brighten the eyes, dissipate nodules, treat hypertension.
• Huang Qin - clear LV Fire, dry damp-heat.
• Ju Hua – disperse W-H, calms LV, brighten LV fire.
 • Soothe LV, regulates Q, calm the stomach
• Dang Gui – soften LV, nourish blood, invigorate blood, relieve pain, moisten bowel
• Bai Shao - soften LV, nourish blood, preserve yin, relieve pain and spasm.
• Chai Hu – relieve constraint, disperse W-H, resolve Shao-Yang disorders raise Yang-Qi
• Bo He – spread/regulate LV qi and relieve stagnation, disperse W-H, clear head and eyes,
• Xiang Fu - spread/regulate LV qi and relieve stagnation, regulate menstruation and alleviate pain
• Fo Shou - spread/regulate LV qi and relieve stagnation, harmonize ST, resolve phlegm.
• Relieve depression
• He Huan Pi – remove constraint, calm the spirit, invigorate blood. He Huan Hua better to soothe LV qi
• Yu Jin - remove constraint, invigorate qi and blood, clear HT, cool blood
• Chai Hu - remove constraint, spread LV qi
• Bo He - spread LV qi, clear head/eyes. (cook last)
• Prescription: Jia Wei Xiao Yao San (= Dan Zhi Xiao Yao Wan = Zuo Jin Wan + Mu Dan Pi, Zhi Zi) + Zuo Jin Wan
(Huang Lian 6 + Wu Zhu Yu 1)
• Bitter taste, yellow TC, constipation + Long Dan Cao, Da Huang to drain fire and free the stool
• Acupuncture: GB43, GB34, LV2, RN13. (LI4, LV3, P6, SP4, GB34, UB18, UB47, DU20 add SJ3, GB43, LV2)
Constipation + SJ6

3. Depression - Obstruction by Stagnant Qi and Phlegm

• Manifestations:
• Depression w/throat plum pit qi - discomfort in the throat as if obstructed by a plum pit, unrelieved by
coughing nor swallowing, worse when more depressed, moodiness, suspicion, distrustfulness.
• Stagnant LV Qi - sensation of congestion and blockage in the chest, costa & hypochondriac pain.
• LV Qi overacting on SP/ST - Epigastric and abdominal distention, nausea, poor appetite
• T: white greasy coating.
• P: wiry, slippery
• Treatment method:
• Transform phlegm
• Shi Chang Pu - open orifices, vaporize phlegm, quiet spirit. (commonly use with Yuan Zhi)
• Yuan Zhi - calm spirit, quiet heart, expel phlegm, open orifices.
• Ban Xia - dry damp, transform phlegm.
• Hou Po - dry damp and transform phlegm, move qi in the MJ and resolve stagnation, descend
rebellious Qi, resolve Phlegm and calm wheezing.
• Remove stagnation
• He Huan Pi - relieve constraint, calm spirit, invigorate blood.
• Yu Jin - relieve constraint, invig blood, promote qi movement.
• Xiang Fu - spread/regulate LV qi, regulate menstruation, relieve pain.
• Qing Pi - spread LV qi, break up stagnant qi, reduce stagnation.
• Soothe LV
• Chai Hu – relieve constraint, disperse W-H, resolve Shao-Yang disorders raise Yang-Qi
• Bo He – spread/regulate LV qi and relieve stagnation, disperse W-H, clear head and eyes,
• Xiang Fu - spread/regulate LV qi and relieve stagnation, regulate menstruation and alleviate pain
• Chuan Lian Zi – promote movement of Qi, alleviate pain
• Relieve depression
 • He Huan Pi – remove constraint, calm the spirit, invigorate blood. He Huan Hua better to soothe LV qi
• Yu Jin - remove constraint, invigorate qi and blood, clear HT, cool blood
• Chai Hu - remove constraint, spread LV qi.
• Bo He - spread LV qi, clear head/eyes. (cook last)
• Prescription: Ban Xia Hou Po Tang (Ban Xia, Hou Po, Fu Ling, Sheng Jiang, Zi Su Ye)
• Acupuncture: RN17, P6, LV3, ST40, RN12, RN22.
• To reinforce regulating qi + Xiang Fu, Zhi Ke, Fo Shou, Xuan Fu Hua, Dai Zhe Shi, to dispel phlegm and
relieve depression

4. Phlegm-Heat Harassing the Mind

• Manifestations: The pattern of Phlegm-Heat harassing the Mind is more common in people over 35 and with a
tendency to obesity. The etiology is usually long-standing emotional stress (particularly worry, guilt and anger)
together with irregular diet and the excessive consumption of greasy foods and alcohol.
• Depression and mental restlessness - anxiety, agitation, restless sleep, excessive dreaming, insomnia,
palpitations, mental confusion, in severe cases loss of insight.
• Phlegm-Heat - a feeling of heaviness of the head, dizziness, a feeling of oppression of the chest,
expectoration of phlegm, nausea, vomiting, bitter taste, sticky taste.
• T: Red, Swollen, sticky tongue coating, possibly Heart crack.
• P: Slippery-Rapid
• Treatment method:
• Resolve Phlegm, open the Mind’s orifices.
• Shi Chang Pu – Open orifice, vaporize phlegm, transform turbid Damp, quiet spirit
• Yuan Zhi - Expel phlegm, open orifices, calm spirit, quiet HT
• Clear Heat,
• Mu Dan Pi – clear fire, eliminate irritability, transform stasis, clear deficient heat.
• Huang Lian – clear HT fire, clear damp-heat from MJ, drain ST fire, clear heat, relieve toxicity, stop
bleeding
• Huang Qin – clear damp heat in the UJ, clear LU heat, cool blood, stop bleeding, calm fetus, clear heat
from LV/GB channel
• Zhi Zi – drain fire, relieve irritability, drain D-H, cool blood, stop bleeding, reduce toxic swelling
• Relieve depression
• He Huan Pi – resolve constraint, calm spirit, invigorate blood
• Yu Jin – resolve constraint, invigorate blood, promote qi movement, clear HT, cool blood
• Chai Hu – Resolve constraint, spread LV qi (6-9 g)
• Bo He - Spread LV qi, clear head/eyes (cook last)
• Prescription: Wen Dan Tang (Zhu Ru, Zhi Shi, Ban Xia, Chen Pi, Fu Ling, Zhi Gan Cao, Sheng Jiang, Da
Zao)
• Wen Dan Tang is an excellent formula for the pattern of Phlegm-Heat agitating and obstructing the
Mind and causing depression; It is generally modified with the addition of Yuan Zhi and Suan Zao
Ren.
• Add Huang Qin, Zhe Bai Mu, Gua Lou Pi, to more able to transform phlegm and clear heat.
• Acupuncture: RN12, BL20, ST40, SP9, SP6, PC5, PC7, DU20, DU24
(P5 Resolves Heart Phlegm, calms the Shen, regulates the Stomach; P7 Calms the Shen, clears Heat in Heart,
opens the chest, regulates Heart Qi, harmonizes the Stomach.)
5. Depression – Blood Stasis Obstructing the Mind
• Manifestations:
• Depression and irritability - Insomnia, mental restlessness, agitation at night, short temper, poor
memory
• Blood stasis - Sharp, fixed HA, pain in chest/hypochondrium, varicose veins, purpura, ecchymosis or
petechia, numbness/coldness of extremities
• T: dark purple, purple spots and/or congested sublingual
• P: wiry or choppy/rough
• Note: When stagnant Blood in the Heart affects the Mind, it may cause depression, palpitations,
insomnia, a suffocating sensation in the chest, irritability, mood swings and, in severe cases, psychosis.
Sleep is very disturbed, the patient waking up frequently at night, tossing and turning and with
nightmares.
• The pattern of Blood stasis obstructing the Mind is more common in people over 40 and in women. It is
usually due to long-standing repressed anger, worry or guilt.
• Treatment method
• Invigorate blood
• Dan Shen - Invigorate blood, clear heat, calm spirit/agitation.
• Yu Jin – resolve constraint, invigorate blood, promote qi movement, clear HT, cool blood
• He Huan Pi - resolve constraint, calm spirit, invigorate blood.
• Dang Gui - Soften liver, nourish blood, invigorate blood, reduce pain, moisten bowels
• Remove blood stasis
• San Leng - Break blood stasis, promote qi movement, reduce pain, tx cancer
• E Zhu - Break blood stasis, promote qi movement, reduce pain, tx cancer
• San Qi - stop bleeding, trx stasis
• Pu Huang -stop bleeding d/t stasis, invigorate blood, dispel blood stasis
• Relieve depression
• He Huan Pi – resolve constraint, calm spirit, invigorate blood
• Yu Jin – resolve constraint, invigorate blood, promote qi movement, clear HT, cool blood
• Chai Hu – Resolve constraint, spread LV qi (6-9 g)
• Bo He - Spread LV qi, clear head/eyes (cook last)
• Prescription: Xue Fu Zhu Yu Tang
• Acupuncture: PC6, SP10, UB17, RN14, GB15, DU20

6. Depression - Def. of Heart Yin & Heart Blood

• Manifestations
• Depression with
• hysteria, trance-like mental state,
• susceptibility to fright, agitation, restlessness, suspiciousness, disorientation, frequent attacks of
melancholy & crying spells, inability to control oneself, restless sleep sometimes with night sweats,
frequent bouts of yawning.
• inappropriate emotional responses: spells of grief and cry without apparent reason, irregular
manifestations of happiness and anger, initiation of symptoms by random psychological stimuli (more
often observed in female patients), broken heart, severe grief.
• LV Qi stagnation -
 • presentation of sudden oppression in the chest/hypochondrium
• In severe cases
• behavior & speech become abnormal, deafness, loss of voice or convulsions & disturbance of
consciousness in severe cases.
• T: pale with thin white coating.
• P: thready, wiry
• Note: It is caused primarily by worry, which knots Qi, but also, in the long run, leads to depletion of Qi and
Blood. Heart-Blood is the residence of the Mind, and when it is deficient the Mind is deprived of its residence,
resulting in depression, anxiety and insomnia.
• Treatment method:
• Nourish the Heart and calm the spirit
• Long Yan Rou – tonify HT & SP, nourish blood, calm the spirit.
• Bai Zi Ren – nourish HT yin/blood, calm the spirit, moisten Intestines.
• Suan Zao Ren - nourish HT Yin tonify LV blood, calm the spirit, stop sweat.
• Dan Shen - invigorate blood, regulate menses, clear heat, soothe HT, calm spirit, cool blood.
• Regulate LV Qi
• Xiang Fu - spread/regulate LV qi and relieve stagnation, regulate menstruation and alleviate pain.
• Chuan Lian Zi – promote movement of Qi, alleviate pain.
• Qing Pi - spread LV qi, break up stagnant qi, reduce stagnation.
• Mu Xiang - regulate SP/ST/LV qi and relieve stagnation including from tonic herbs, move qi and relieve
pain, also treat diarrhea, dysentery, tenesmus (focus more on SP/ST qi)
• Relieve depression.
• He Huan Pi – remove constraint, calm the spirit, invigorate blood. He Huan Hua better to soothe LV qi
• Bai Zhi Ren – nourish Ht yin/blood, calm the spirit, moist int/unblock bowels
• Ye Jiao Teng – nourish HT Yin and Blood, calm the spirit, nourish blood, dispel wind in channels.
• Prescription: Gan Mai Da Zao Tang
• To increase effect + Bai Zi Ren, Suan Zao Ren, Fu Shen, He Huan Pi (Hua)
Note : This formula is good when the patient is not only depressed but also mentally confused and kind of
“absent”. Often, this can be the result of heavy cannabis use in the past.
• Acupuncture: RN14, HT7, SP6, ST36, LI4

7. Depression - Def. of Yin & Blood with Heart and Spleen Deficiency
• Manifestations:
• Depression with brooding
• HT blood deficiency - palpitation, insomnia, tiredness, lusterless complexion
• SP deficiency - epigastric fullness & discomfort, loss of appetite,
• T: pale.
• P: weak thready
• Note: The pattern of Heart and Spleen deficiency is more common in young women. It is usually caused by
sadness and grief.
• Treatment method:
• Fortify the Spleen.
o Ren Shen - tonify SP/ST, tonify yuan qi, tonify Lu qi, tonify Ht qi and calm spirit
o Dang Shen - tonify SP qi, tonify LU qi, tonify Qi and generate fluids/blood
 o Huang Qi - tonify SP qi, raise yang, etc. also nourish qi to move blood
o Bai Zhu - tonify Sp/qi, strengthen SP, dry Damp.
• Nourish the Heart, quiet the spirit,
o Long Yan Rou – tonify HT & SP, nourish blood, calm the spirit.
o Bai Zi Ren – nourish HT yin/blood, calm the spirit, moisten Intestines.
o Suan Zao Ren - nourish HT Yin tonify LV blood, calm the spirit, stop sweat.
o Dan Shen - invigorate blood, regulate menses, clear heat, soothe HT, calm spirit, cool blood.
• Relieve depression.
o He Huan Pi – remove constraint, calm the spirit, invigorate blood. He Huan Hua better to soothe LV qi
o Bai Zhi Ren – nourish HT yin/blood, calm the spirit, moist int/unblock bowels
o Ye Jiao Teng – nourish HT Yin and Blood, calm the spirit, nourish blood, dispel wind in channels.
• Prescription: Gui Pi Tang + Yu Jin, He Huan Hua
Ingredient: Huang Qi, Dang Gui, Suan Zao Ren, Mu Xiang, Long Yan Rou, Yuan Zhi, Ren Shen, Bai Zhu, Fu
Ling, Zhi Gan Cao, Sheng Jiang, Da Zao
• Acupuncture: ST36, SP6, UB15, UB20, UB21, RN15, HT7, DU20

8. Depression - Def. of Yin & Blood (with LV and KD Yin Deficiency with excess fire)
• Manifestations:
• Depression and restlessness, irritability, anxiety
• HT blood/Yin deficiency:
o palpitations, forgetfulness, insomnia, dream disturbed sleep
• KD Yin deficiency:
o dizziness and vertigo, tinnitus, weak or aching lumbar/knees
• LV yin deficiency with fire:
o Distending headache, blurred vision, red eyes
• General Yin deficiency heat:
o vexing heat in the five hearts, lower backache, dry mouth, dry throat, night sweat, malar flush
• T: red T with scanty coating.
• P: thready rapid
• Treatment method:
• Nourish yin, clear heat, settle the Heart
o Bai He – nourish yin, clear HT and calm the Shen for insomnia w/def. signs, irritability, restlessness.
o Sheng Di Huang – nourish Yin, generate fluids, clears Heart fire, settle irritability and restlessness.
o Zhi Mu – nourish KD Yin, clear deficient fire, generate fluids, moisten dryness.
o Shi Jue Ming – Nourish Yin, anchor LV Yang and brighten eyes
o Ci Shi – anchor Yang and calm spirit, calm LV, anchor floating Yang, nourish LV/KD, improves vision
and hearing
o Mu Li – calm LV, anchor floating Yang
o Zhen Zhu Mu - calm LV, anchor floating Yang, anchor Heart, calm spirit, clear LV, brighten eyes.
• Quiet the Heart, relieve depression.
o He Huan Pi – remove constraint, calm the spirit, invigorate blood. He Huan Hua better to soothe LV qi
o Bai Zhi Ren – nourish HT yin/blood, calm the spirit, moist int/unblock bowels
o Ye Jiao Teng – nourish HT Yin and Blood, calm the spirit, nourish blood, dispel wind in channels.
o Yuan Zhi – calm spirit, quiet Heart, open the orifices.
 o Suan Zao Ren – nourish HT and LV, calm the spirit, prevent abnormal sweating.
o Dan Shen – clear heat, soothe Heart, calm the spirit
• Prescription: Zi Shui Qing Gan Yin (Nourishing Water and Clearing the Liver Decoction) + Zhen Zhu Mu 30g, Ci
Shi 30g
o This formula nourishes KD-Yin and clears LV-Heat. It is indicated for patients suffering from depression and
irritability.
o Ingredients: Shu Di Huang, Shan Zhu Yu, Shan Yao, Mu Dan Pi, Ze Xie, Fu Ling, Chai Hu, Bai Shao, Dang
Gui, Zhi Zi, Suan Zao Ren
• Acupuncture: RN14, HT 7, SP6, ST36, LI4, K2, K3, K6, K9, UB52
ALTERNATE THERAPEUTIC METHODS
1. Qi Gong
• Qi Gong routines are beneficial to patients suffering from depression. The slow, gentle, repetitive movements of
the Eight Brocade Exercises and Tai Qi Quan induce relaxation while encouraging movement and may
significantly reduce symptoms. These exercises may be done as part of a group to encourage social interaction,
which many depressed patients reject. These exercises also strengthen the Zang Organs and induce a smooth
flow of Qi and other fundamental essence in the body.
2. Meditation, especially if practiced regularly, also may be helpful.
Depressive Disorder Singles
Qi Stagnation Turbid Phlegm Blood Stasis Calm Shen/Heart- Nourish Heart
Mind
Chai Hu Shi Chang Pu Yu Jin He Huan Pi Long Yan Rou
Xiang Fu Yuan Zhi Tao Ren Yuan Zhi Dang Gui
Fo Shou Meng Shi Dan Shen Suan Zao Ren Suan Zao Ren
He Huan Pi Ban Xia Chuan Xiong Long Gu Dan Shen
Yu Jin Zhu Ru Wu Wei Zi Fu Shen
Dan Nan Xing Fu Shen
Zhe Bei Mu Dan Shen
 Liver Qi Stagnation Stagnated LV Heat Qi Stagnation + Phlegm Phlegm-heat harassing
the Mind
Depression; moodiness; Depression; Anger; Depression; moodiness Depression: restlessness,
sadness; Irritability irritability suspiciousness; anxiety, agitation, restless
LV Qi sx plus LV Qi over easy upset; life stress = distrustfulness; sensation of sleep, excessive dreaming,
act on SP sx: sighing. anger, agitation ‘plum pit qi’ worse with insomnia, palpitations, mental
chest/ hypochondrium LV Qi stagnation more depressiveness confusion, in severe cases
tight, w/stagnant heat sx: Qi stagnation sx and loss of insight.
epigastrium/ abdomen full oppression of chest/ digestive sx: Phlegm-Heat - a heavy
& distention. belching; poor hypochondrium tight/ oppression in chest/ head feeling, dizziness,
appetite; abnormal bm; red face/eyes; h/a; bitter hypochondrium oppression of the chest,
dysmenorrhea /amenorrhea taste; acid reflux; epigastric/abd. distention; expectoration of phlegm,
halitosis; dark urine; nausea; poor appetite n/v, bitter taste, sticky taste.
constipation
T: thin white coating T: red + yellow coat T: white greasy coat T: Red, Swollen, sticky
(unremarkable) tongue coating, possibly
Heart crack.
P: wiry P: wiry, rapid P: wiry, slippery P: Slippery-Rapid
regulate LV qi, relieve Clear the Liver, drain Regulate qi, transform Resolve Phlegm, open the
depression heat, calm the stomach, phlegm, dissipate binds, Mind’s orifices, clear heat,
relieve depression relieve depression relieve depression

Chai Hu Shu Gan San Jia Wei Xiao Yao San Ban Xia Hou Po Tang Wen Dan Tang

Blood Stasis HT Spirit Disturbed Heart/Spleen Def. Liver/KD Yin Def.

Depression; irritability Depression: bouts of Depression: brooding. Depression: restlessness. irritability
Blood/stasis sx: cry/hysteria w/ or w/o timidity. low motivation. Blood def. sx: insomnia, poor
sharp fixed ha; pain in reason; agitation; HT blood def. sx: memory
chest/ hypochondrium; worry; anxiety; insomnia; poor memory. KD def. sx: dizziness, tinnitus,
varicose veins; suspicion; palpitations; dizziness. weak or aching lumbar/knees
purpura, ecchymosis, inappropriate pale dull complexion General Yin def.: malar flush. dry
petechia; numb/cold in emotional response Spleen def. sx: poor mouth. night sweats
extremities; insomnia; appetite. tiredness. low LV def. heat: distending h/a. blurry
poor memory motivation vision. red eyes
T: dak purple, purple T: pale + white coat T: pale + thin white coat T: dry, red T + scanty coat
spots. or w/ congested
sublingual
P: wiry or P: thready, wiry P: thin and/or weak P: thready, wiry, rapid
choppy/rough
Invigorate Blood, Nourish the Heart and Nourish the Heart, calm Nourish the HT/LV/KD Yin, calm
remove blood stasis, calm the spirit, the spirit the spirit.
relieve depression regulate LV Qi
Xue Fu Zhu Yu Tang Gan Mai Da Zao Tang Gui Pi Tang Zi Shui Qing Gan Yin