The Three Treasures and Women's Treasure - Giovanni Maciocia Chinese Medicine UK


	By Pattern By Symptom		By Pattern By Symptom

The Three Treasures Newsletters

SUMMER 2003
DEPRESSION

This is the first of a series of newsletters discussing "families" of Three Treasures and Women's Treasure remedies. To follow will be newsletters on digestive conditions, Bi syndrome, respiratory problems, tonics, Phlegm conditions, Damp conditions and eye problems.

You lay down at night and you roll from one side of the bed to the other all night long, you can't sleep, what's the matter? The blues has got you. You get up and sit on the side of your bed in the morning and you may have a sister, brother, mother and father around you but you don't want no talk out of them, what's the matter? The blues has got you. You go and put your feet under the table and look down on your plate and you've got everything you want to eat but you shake your head and get up and say "Lord, I can't eat, I can't sleep", what's the matter? The blues has got you.

Leadbelly

The purpose of this newsletter is to take an in-depth look at the Three Treasures and Women's Treasure remedies which are applicable in the treatment of mental and emotional disorders ranging from severe depression on the one hand to anxiety, obsessive thinking and worry on the other.

CHINESE VIEW OF DEPRESSION

The Chinese term for depression is yu or yin yu. "Yu" has the double meaning of "depression" or "stagnation".

Yu as stagnation
The "Simple Questions" in chapter 71 talks about Five Stagnations of Wood, Fire, Earth, Metal and Water. It says: "When Wood stagnates it extends, when Fire stagnates it rises, when Earth stagnates it seizes, when Metal stagnates it discharges, when Water stagnates it pours."

The "Essential Method of Dan Xi" (Dan Xi Xin Fa 1347) talks about Six Stagnations of Qi, Blood, Dampness, Phlegm, Heat and Food. It says: "When Qi and Blood are harmonized, no disease arises. If they stagnate diseases arise. Many diseases are due to stagnation...stagnation makes things accumulate so that they cannot flow freely, they would like to rise but cannot, they would like to descend but cannot, they would like to transform but cannot...thus the 6 Stagnations come into being".

The "Complete Book of Jing Yue" (Jing Yue Quan Shu 1624) gives it an emotional interpretation and talks about Six Stagnations of anger, pensiveness, worry, sadness, shock and fear. This confirms that all emotions can lead to stagnation of Qi. He said: "In the Six Stagnations, stagnation is the cause of disease. In emotional stagnation, the disease [i.e. the emotion] is the cause of the stagnation."

Yu as mental depression
"Yu", besides meaning "stagnation" also means mental depression and Chinese books usually ascribe it to Full causes, i.e. Liver-Qi stagnation, Qi stagnation turning to Fire, and Qi-Phlegm, and a heavy emphasis is put on Liver-Qi stagnation at least in the beginning stages. In the later stages, they talk about Qi-Blood-Yin deficiency.

Thus, in Chinese medicine stagnation and depression are almost synonymous implying that all depression is due to stagnation. However, this is not true in practice as there are many types of depression due to Deficiency, and especially Kidney deficiency. It is true, however, that also within the Deficiency types there is an element of stagnation which manifests in the typical resistance to improvement by chronic depressives.

THE MIND (Shen)

Shen is our consciousness which allows us to feel our emotions. For example, when we are angry it is due to the Liver, but it is the Shen of the Heart that feels the anger and knows that we are angry. Therefore one of the functions of the Shen is that it governs our emotional life and by implication it is therefore always involved in mental and emotional conditions.

This explains partly why a Red tip of the tongue is such a common clinical finding. It does not necessarily indicate a problem solely with the Heart, but it could have its root in any emotion affecting any organ, e.g. worry and pensiveness affecting the Spleen, sadness affecting the Lungs, anger affecting the Liver. Such emotions affect various organs but the Heart, housing the Shen, is the organ that "feels" them.

THE ETHEREAL SOUL (Hun)

While the Shen gives us our consciousness as a human, the Hun belongs to a different world - to the world of the spirits. The Hun is Yang in nature and it is imparted to the child three days after birth.

The nature of the Hun is that it is constantly moving, searching and exploring; it is never still. When the Hun wanders a bit at night, we dream - this is normal. However, if there is excessive dreaming, the Hun is searching, moving etc. too much. It is interesting to note that from a Western point of view, the most dreaming occurs during REM phase of sleep when the eyes are flickering and from the Chinese point of view the Liver controls and nourishes the eyes.

So the Hun is an essential complement to the Shen because it gives it this coming and going movement, which manifests as our ability to have plans, vision, inspiration, sense of direction, relationships etc. Without the Hun, the Shen would be like a computer without software.

THE SHEN AND THE HUN IN DEPRESSION

The relationship between Shen and Hun is everything in depression; they cannot function without each other and their relationship must be balanced in order for a person to be mentally and emotionally healthy. The Hun gives the Shen the movement of coming and going - this manifests as being able to cultivate relationships with other people, a relationship with the environment, to have plans, dreams, creativity, inspiration, original thinking and vision. These things all come from the Hun and not from the Shen and the Heart. When a person is undecided and unsure of what to do with their life, it is due to the Hun not having that movement, and coming and going as it is in its nature to do.

On the other hand, the Shen gives the Hun control and integration. If the Shen does not control the Hun, the Hun will be "coming and going" too much. Furthermore, the Shen has to integrate all these things into the consciousness. The Hun is a sea of ideas that bubble up all the time and the Shen can only deal with one at a time so it has to control the Hun and integrate all the material coming from the Hun into the total psyche. We can often witness an "overactive" Hun in children who give life to inanimate objects and have an amazingly developed sense of imagination. After the age of seven, the Shen begins to become stronger and gradually "orders" and "controls" the imaginings of the Hun.

We can therefore see the role that the Shen and the Hun play in bipolar depression. The Hun is being "overactive" and producing endless ideas but the Shen is not able to integrate them: that is why manic depressives are often very creative. So in the manic phase of bipolar depression the Hun is coming and going too much. In extreme cases of mania, it becomes psychotic and causes "madness". However, it exists in many different degrees and is not always as extreme as this. In a milder degree, people have lots of ideas, start lots of courses, become very active at night, restless, confused, spend too much money - nothing ever comes to fruition.

Conversely, when the Hun isn't coming and going enough, the depressive phase of bipolar disease sets in. This manifests in extreme lethargy, fatigue, disinterestedness, despair, apathy and a feeling of hopelessness, lack of vision, lack of plans, etc..

DEPRESSION

SHI CONDITIONS

Liver Qi Stagnation
Depression, moodiness, anxiety, frustration, uptight, tense, pre-menstrual tension. Wiry pulse. Often the subdued and depressed appearance of the patient may belie the true origin of the problem, but the Wiry pulse gives it away.
Three Treasures remedies: Release Constraint, Freeing Constraint.

Liver-Qi Stagnation Turning Into Fire
Anxiety, depression, agitation, short-temper, a feeling of oppression of the chest, tongue Red on the sides with a yellow coating, Rapid-Wiry pulse.
Three Treasures remedy: Freeing the Sun.

Diaphragm Heat
Mental restlessness, depression, anxiety feeling below the heart, insomnia, yellow tongue coating, Rapid pulse.
Three Treasures remedy: Clear the Soul

Phlegm-Heat Harassing Mind
Mental restlessness, depression, agitation, restless sleep, excessive dreaming, Swollen tongue with a sticky tongue coating, Slippery pulse.
Three Treasures remedy: Clear the Soul

Blood Stasis
Mental restlessness, depression, agitation at night, short temper, restless sleep, dreaming a lot, Purple tongue, Wiry or Choppy pulse.
Three Treasures remedy: Red Stirring

Stagnation Of Qi With Phlegm
Moodiness, up and down, pre-menstrual tension, also mild symptoms of "Dian" such as apathy, forgetting to eat, slowed thinking, sleep disturbance, tongue coating sticky, Wiry or Slippery pulse.
Three Treasures remedies: Clear the Soul, Open the Heart.

MIXED CONDITIONS

Liver-Blood Deficiency Leading To Liver-Qi Stagnation
Pre-menstrual tension, frustration, tension/irritability before the period, crying and tiredness after the period, insomnia, lack of direction, Pale tongue, Wiry-Choppy or Thin pulse.
Three Treasures remedies: Freeing the Moon, Precious Sea, Calm the Spirit

EMPTY CONDITIONS

Worry Injuring The Mind
Depression, absent, anxiety, no desire to do anything, sadness, worry, crying, stretching and yawning, tongue Pale, tongue coating sticky-white, Wiry and Fine pulse.
Three Treasures remedies: Calm the Spirit, Breaking Clouds.

Heart And Spleen-Blood Deficiency
Brooding, depression, always thinking, palpitations, timidity, difficulty in falling asleep, poor appetite, Pale tongue, Weak or Choppy pulse.
Three Treasures remedy: Calm the Spirit.

Heart Yang Deficiency
Depression, chilliness, curling up, not wanting to do anything, anxiety, palpitations, easily startled, insomnia, Pale tongue, Deep-Weak or Knotted (in severe cases) pulse.
Three Treasures remedy: Breaking Clouds.

Yin Deficiency With Empty-Fire Blazing
Depression, anxiety in the evening, mental restlessness, insomnia, Red tongue, Wiry-Fine or Floating-Empty pulse.
Three Treasures remedy: Root the Spirit.

Kidney-Yang Deficiency
Exhaustion, depression, does not want to do anything or go out, weariness, chilliness, curling up, no will power, no initiative, very Pale tongue, Weak-Deep-Slow pulse.
Three Treasures remedy: Breaking Clouds, Strengthen the Root.

THE THREE TREASURES FORMULAE FOR TREATING DEPRESSION

Breaking Clouds
Depression can be caused by many patterns and the present formula, a variation of Bu Zhong Yi Qi Tang, addresses depression primarily from Qi deficiency and secondarily from Qi stagnation. Its primary action is that of "lifting" things, both on an emotional and physical level.

This person, on the one hand, may have a mild case of depression manifesting in a chronic low mood, despondency and depression. On the other hand, they may be intensely depressed and suffer from lack of self-esteem and self-confidence. They will find pleasure in nothing and will suffer from intense feelings of guilt. Although they may bravely try to soldier on, they are in a constantly depressed mood and the strain of carrying on may sometimes feel too much for them. They will have a feeling of unreality and will find it difficult to cope socially; they have a tendency to bouts of crying and will often describe their feeling as "if being in a dark tunnel without exit".

Release Constraint
Release Constraint is extremely effective in dealing with emotional strain and depression deriving from stagnation of Liver-Qi especially, though not exclusively, in men. It is indicated when the condition is predominantly a Full one, i.e. not when the stagnation of Liver-Qi derives from an underlying deficiency.

The formula addresses the emotional and mental manifestations of stagnation of Liver-Qi when it causes the Shen to be obstructed: moodiness, mental depression, pre-menstrual tension, irritability, frustration, annoyance and impatience. A typical feature of this condition of Shen obstructed is first of all a certain mental confusion deriving from stagnation, and secondly, a strong resistance to any mental or affective change. This person may have a huge amount of pent-up anger but be unable to use this to help bring about positive change.

A person suffering from severe Liver-Qi stagnation will not always appear angry and raging. In some cases, Liver-Qi stagnation can equally cause someone to appear subdued, quiet, depressed and introverted.

Freeing The Moon
This variation of the classical prescription "Free and Easy Wanderer" (Xiao Yao San), aims at treating pre-menstrual emotional strain occurring against a background of Liver-Qi stagnation and some Liver-Blood deficiency.

The patient will feel tense, wound-up and irritable, but also rather sad and depressed. They may oscillate between crying and flying off the handle. Thus on the one hand Liver-Blood deficiency causes the Hun to be unrooted and on the other hand stagnation of Liver-Qi harasses the Hun giving rise to irritability and depression.

The combined patterns of Liver-Qi stagnation against a background of Liver-Blood deficiency are seen together especially in women, when the Liver-Qi stagnation is especially predominant before the period. The subject around which a woman is depressed pre-menstrually may not cause her any concern for the rest of the month. However, if the same issues cause a woman to be depressed pre-menstrually month after month, it indicates that these issues need to be addressed and are very "real" (even though they may not bother her at other times).

Clear The Soul
This formula, a variation of "Warming the Gall-Bladder Decoction" (Wen Dan Tang) is aimed at treating emotional tension and anxiety occurring against a background of Phlegm obstructing the chest and therefore the Lungs and Heart.

The formula is called Clear the Soul because on the one hand it settles the Hun by resolving Phlegm and clearing Heat and on the other it releases tension of the Corporeal Soul by relaxing the chest and Lungs.

Phlegm-Heat disturbs the Shen in two ways: Phlegm obstructs the Mind's orifices and Heat agitates the Shen. The combination of these two factors will cause mental restlessness and manic behaviour alternated with severe depression, crying or laughing without reason and insomnia. The patient may feel jumpy and talk of a "flustered feeling" in the heart region. This could be seen as a very mild form of dian-kuang (as discussed above). In women, these symptoms may only appear pre-menstrually, in which case the formula need only be taken during the fourth phase of the menstrual cycle.

This pattern is usually caused by pensiveness, jealousy, worry, or obsessive thinking over a long period of time. The more obsessive a person's thinking becomes, the more Heat is created and the more Heat there is, the more the person will be prone to over-thinking: thus a vicious circle is created.

Open The Heart
Open the Heart is a variation of "Pinellia-Magnolia Decoction" (Ban Xia Hou Po Tang). It is aimed at dealing with emotional strain deriving from worry, frustration, or bottled-up anger, manifesting as tightness of the chest or a feeling of obstruction of the throat. The formula is often cited as one to move Liver-Qi when in fact its clinical use is really to deal with stagnation of Qi in the chest deriving not so much from the Liver as from the Lungs and Heart.

This person becomes anxious as well as sad, feels depressed, sighs frequently and has the typical feeling of obstruction in the throat and chest. This is caused by the constriction of the Corporeal Soul in the throat and chest. The chronic stagnation of Heart-Qi obstructs the Shen and causes severe confusion. Therefore this formula is used literally to "get it off one's chest".

Whereas Liver-Qi stagnation derives often from pent-up and unexpressed feelings, stagnation of Heart- and Lung-Qi derives more from chronic worry and sadness. Therefore, where Open the Heart is indicated, the person will have a sense of someone whose soul is not at peace and they may be dealing with very deep issues in their life.

Calm The Spirit
Calm the Spirit treats the conditions of Spleen- and Heart-Blood deficiency. These patterns are caused by sadness, grief, worry or shock over a long period of time. These emotions deplete Qi of the Spleen, Heart and Lungs and, after some time, this gives rise to Blood deficiency. This patient will be sad, despondent, depressed and weary: he or she is prone to bouts of crying especially at the end of the day or when tired. Since this crying derives from a deficiency rather than from repressed, stagnant Qi, it does not relieve the mental state.

This pattern is commonly seen in students who are doing a lot of mental work and have a poor diet - both factors which weaken the Spleen. They may oscillate between feeling anxious and uptight about their work on the one hand, and sad, depressed and despondent on the other hand.

Root The Spirit
Root the Spirit is a variation of the ancient prescription "Attracting Sleep Decoction" (Yin Mei Tang). It is aimed at treating mental restlessness, anxiety, vexation and insomnia deriving from a deficiency of Liver-Blood and/or Liver-Yin; this leads to the Hun being unrooted and the person feeling restless and aimless.

Frustration, resentment, or old grudges can cause Liver-Blood or Liver-Yin to become deficient. The patient's Liver-Yin has been consumed by repressed anger over many years. He or she feels tense and anxious and sleeps badly, disturbed by unpleasant dreams. Another characteristic sign may be that the person has a peculiar floating sensation accompanied by a vague feeling of anxiety just as they are about to drop off to sleep.

In some cases, sadness depletes Liver-Blood or Liver-Yin. When it does, the person feels depressed and sad and sleeps badly, but does not dream much.

The patient also lacks a sense of direction and finds it difficult to focus on life's personal aims. They may seem "stuck in a rut" and be unable to see anyway out of their current situation. To ease their pain, they may resolve to work even harder which further depletes the Liver-Yin, and the more the Yin is depleted the harder they may find it to "switch off" and take a break; thus a vicious circle is created.

Freeing Constraint
The pre-menstrual tension addressed by this formula, a variation of Yue Ju Wan manifests with outbursts of anger, moodiness, depression, resentment, etc. all symptoms of severe stagnation of Liver-Qi. In this instance, the severe stagnation of Liver-Qi leads not only to unsettling of the Shen, but also a slight obstruction of the Shen. This many manifest with irrational behaviour and shouting at or hitting members of her family.

This formula addresses the emotional and mental manifestations of stagnation of Liver-Qi when it causes the Shen to be obstructed: moodiness, mental depression, pre-menstrual tension, irritability, frustration, annoyance and impatience. A typical feature of this condition of Shen obstructed is first of all a certain mental confusion deriving from stagnation, and secondly, a strong resistance to any mental or affective change.

Penetrating Vessel
This formula is specific to harmonize the Penetrating Vessel. Disharmonies of the Penetrating Vessel with rebellious Qi are very common in women. Rebellious Qi causing the feeling described as li ji in Chinese, is the major pathology of this vessel. This symptom can be interpreted on a mental level as a feeling of anxiety, or on a physical level as a tension of the connective tissues of the abdomen. Both these interpretations are valid.

This patient will feel anxious and agitated, especially pre-menstrually, as well as tired and depressed. They may be easily panicked. They will be pale and lack Shen in their eyes.

Freeing The Sun
This formula clears Liver-Heat deriving from Liver-Qi stagnation. This pattern is more common in men suffering from long-standing Liver-Qi stagnation (deriving from emotional problems) leading to some Liver-Heat. This formula could be described as a men's Freeing the Moon.

Liver-Qi stagnation is typically caused by repressed anger, frustration or resentment. This person may find it difficult to express anger appropriately, i.e. they may avoid expressing it when they have suffered an abuse as they tend to shy away from conflict, or they may "fly off the handle" at the smallest aggravation. They may oscillate between these two responses. Usually when anger is expressed it gives rise to Liver-Yang rising while, when it is repressed, it causes Liver-Qi stagnation. This patient is typically a man who is either irritable and prone to bouts of anger or he will appear depressed and subdued but the Wiry pulse betrays the pattern of Liver-Qi stagnation caused by anger. Long-term stagnation of Liver-Qi may give rise to Heat in the Liver which will cause the person also to become anxious and restless. However, this remedy is often applicable to women too.

COMPARISON OF FORMULAE

Release Constraint and Freeing the Moon
Release Constraint differs from Freeing the Moon in so far as it is suitable for cases when the stagnation of Liver-Qi predominates and the condition is primarily full. Instead, Freeing the Moon is indicated in conditions of mixed deficiency and excess, with a deficiency of Liver-Blood and Spleen-Qi and with stagnation of Liver-Qi. The pulse and tongue are good discriminating factors between these two formulae: if the pulse is Wiry and the tongue is Red, Release Constraint is indicated; if the pulse is Choppy or Fine overall and Wiry in parts, and the tongue is Pale on the sides, Freeing the Moon is indicated.

Clear the Soul and Open the Heart
Clear the Soul is indicated when there is Phlegm-Heat in the chest, while Open the Heart is indicated when there is stagnation of Qi in the chest. Both these patterns may manifest with depression and a feeling of oppression and tightness in the chest. However, in the case of Phlegm-Heat, the patient will be more restless and may show some signs of manic behaviour, whereas in the case of stagnation of Qi in the chest, these manic signs (such as jumpiness, flustered feeling) will not be present.

As the names imply, when there is Phlegm-Heat in the chest, the spirit needs to be "cleared"; when there is stagnation, the appropriate action is one of "opening" to allow Qi and stuck emotions to "move on".

The most important discriminating factors, however, are the pulse and tongue. When Clear the Soul is indicated, there will be a sticky-thick-yellow coating on the tongue and the pulse will be Slippery-Rapid. When Open the Heart is indicated, the thick tongue coating will not be present and the pulse will be slightly Wiry in the front positions, as opposed to Slippery.

Calm the Spirit and Root the Spirit
Both Calm the Spirit and Root the Spirit are indicated when there is Blood deficiency and therefore in both cases there will be anxiety and insomnia. However, Calm the Spirit is indicated when the Blood deficiency is primarily of the Spleen and the Heart, where as Root the Spirit nourishes Liver-Blood. In terms of clinical manifestations, Calm the Spirit is more suitable for someone suffering from sadness, weariness and crying, together with symptoms of weak Spleen-Qi, whereas Root the Spirit is suitable for someone suffering from anxiety, tension, insomnia and a lack of direction, together with symptoms of Liver-Blood and/or Yin deficiency.

When Spleen- and Heart-Blood deficiency are present, the spirit will be unsettled and anxious and thinking, sleep and the ability to feel joyful will be affected. As the name implies, the spirit needs to be "calmed". However when Liver-Blood and/or Yin are deficient, the Hun does not have a proper resting place and begins to wander. Therefore, it needs to be "rooted" rather than merely calmed.

Freeing the Sun and Freeing the Moon
Both Freeing the Sun (from the Three Treasures) and Freeing the Moon (from the Women's Treasure) are indicated when there is Liver-Qi stagnation against a background of Liver-Blood deficiency. However, in the case of Freeing the Sun, the chronic Liver-Qi stagnation has lead to some Liver-Heat causing additional symptoms such as a feeling of heat, slight thirst or a slight bitter taste. The sides of the tongue being Red (in the Liver area) is, in itself, enough to confirm the presence of some Heat in the Liver. In cases where Freeing the Moon is indicated, the sides of the tongue would be Pale.

In both cases, the person may oscillate between "flying off the handle" and feeling tired, tearful and lethargic. However, where Freeing the Sun is indicated, there will also be an element of restlessness and anxiety.

Breaking Clouds and Calm the Spirit
The names of these two remedies conjure up an image of the type of depression they are indicated for. A cloudy sky is heavy, oppressive and dark and it obscures one's view. And so with a patient suffering from Spleen-Qi deficient and sinking, they will have a sense of heaviness and oppression, a loss of insight and their mood will be gloomy and dark. "Breaking" the clouds will allow light to seep through, the heaviness and oppressiveness will diminish and the view will become clearer: lifting and strengthening Spleen-Qi can be equated with allowing the sun to begin to peep through the clouds. Its effect is to "lighten" the mood.

Conversely, when Spleen-Blood as opposed to Spleen-Qi is deficient, the person will lack a sense of being grounded and centred. Calm the Spirit helps to "root" and "hold" the person's Spirit by calming an overactive mind. So this formula has more of an "earthing" effect as opposed to Breaking the Clouds which has a "lifting" effect.

Researched by Rebecca Avern