Mental Disorders

‘Tan Re Mi Xin Qiao Hun Po’ –  Phlegm and Fire disturb mind, Shen, Heart, ethereal & physical spirit.

Mood Disorders
Personality Disorders
Schizophrenia
Bipolar (manic-depression)– Kuang Dian

Mood (affective) Patterns/Disorders  (DSM IV)

For the purpose of general understanding of these disorders, they will be divided into 2 groups:

            1. Mood episodes

            2. Mood disorders (depressive, Bipolar, other)

Mood Episodes

Any period of time when a patient feels abnormally happy or sad.  Mood episodes are the foundation, or starting point from which many of the identifiable mood disorders are constructed.  Most mood disorder patients will have one or more of these 4 types of episode:  major depressive, manic, mixed, and hypomanic.  Without additional information, none of these types of mood episodes is an identifiable diagnosis.

Major Depressive Episode:  for at least 2 weeks the patient feels depressed or can’t enjoy life, and has problems with eating and sleeping, feelings of guilt, fatigue, trouble concentrating, and thoughts about death.

Manic Episode:  For at least 1 week the patient feels elated or sometimes irritable, and may be grandiose, talkative, hyperactive, and distractible.  Bad judgment leads to marked social or work impairment.  Often these patients must be hospitalized.

Mixed Episode:  the patient has fulfilled the symptomatic criteria for both a manic and a major depressive, but it has lasted as briefly as 1 week.

Hypomanic Episode:  much like a manic episode but it is briefer and less severe.

Mood Disorders

A pattern of illness due to an abnormal mood.  Nearly every patient who has a mood disorder experiences depression at some time, but some also have ‘highs’ of mood.  Many, but not all, mood disorders are diagnosed on the basis of a mood episode.  Most patients with mood disorders will fit into one of the identifiable categories listed below.  They are divided into 3 groups: depressive, bipolar, other.

Depressive

Major Depressive Disorder:  these patients have never had manic or hypomanic episodes but have had one or more major depressive episodes.  Major Depressive Disorder will be either recurrent or single episode.

Dysthymic Disorder:  not severe enough to be called a major depressive episode.  

This disorder lasts much longer then major depressive disorder, and there are no ‘high’ phases.

Depressive Disorder not otherwise specified:  when a patient has depressive symptoms that do not meet the criteria for the depressive diagnoses above or for any other diagnosis in which depression is a feature.

Bipolar

Bipolar I Disorder:  there must be at least 1 manic episode.  Most Bipolar I patients have also had a major depressive episode.

Bipolar II Disorder:  at least 1 hypomanic episode plus at least 1 major depressive episode.

Cyclothymic Disorder:  have had repeated mood swings, but none that are severe enough to be called major depressive episodes or manic episodes.

Bipolar Disorder not otherwise specified:  has bipolar symptoms that do not meet the criteria for the bipolar diagnoses above.

Other

Mood Disorder due to a general medical condition:  ‘highs’ and ‘lows’ can be caused by various types of physical illness.

Substance-Induced Mood Disorder:  Alcohol or other substances can cause ‘high’ or ‘low’ moods that may not meet criteria for any of the above mentioned episodes or disorders.

Mood Disorder not otherwise specified:  do not fit neatly into any of the mood disorder categories mentioned above.

Schizoaffective Disorder:  symptoms of Schizophrenia coexist with a major depressive or manic episode.

Cognitive Disorders with depressed mood:  could show with dementia or Alzheimer’s.  Delerium may also start with depression, anxiety, or other expressions of dysphoria.  

Adjustment Disorder with depressed mood:  can only adjust to a life stress one way.

Personality Disorders:  may be present in avoidant, dependant, histrionic, but most notably in borderline.

Bereavement:  when symptoms last more than 2 months following the death of a loved one.  

Misc:  Schizophrenia, eating disorders, somatization, sexual and gender identity disorders, anxiety, panic disorder, obsessive-compulsive, phobic disorder, and post traumatic stress disorder.

Personality traits: well ingrained ways in which people experience, interact with, and think about everything that goes on around them.

Generally Personality patterns/disorders are present since early adult life.  All people have components of these patterns but are not considered disorders until they accentuate to the point of impairing one’s normal life functioning, or cause distress.

There are 10 disorders divided into 3 clusters.  301.84 Passive-Aggressive pattern/disorder has been removed since DSM III and put into an appendix to await further study.

Cluster A  (odd cluster)

People with cluster A personality patterns/disorders can be described as withdrawn, cold, suspicious, or irrational.

301.00 Paranoid:  suspicious and quick to take offense.  They often have few confidants and may read hidden meaning into innocent remarks.

301.20 Schizoid:  care little for social relationships, have a restricted emotional range, and seem indifferent to criticism or praise.  Tending to be solitary, they avoid close (including sexual) relationships.

301.22 Schizotypal:  interpersonal relationships are so difficult for these people that they appear peculiar or strange to others.  They lack close friends and are uncomfortable in social situations.  They may show suspiciousness, unusual perceptions or thinking, eccentric speech, and inappropriate affect.

Cluster B  (dramatic cluster)

People with cluster B patterns/disorders tend to be dramatic, emotional, and attention-seeking.  Their moods change rapidly (mood swings) and are often shallow.  They often have intense interpersonal conflicts.

301.70 Antisocial:  irresponsible, often criminal behavior of these people begins in childhood or early adolescence with truancy, running away, cruelty, fighting, destructiveness, lying, and theft.  In addition to criminal behavior, as adults they may default on debts, or otherwise show irresponsibility, act recklessly or impulsively, and show no remorse for their behavior.

301.83 Borderline:  impulsive, make recurrent suicide threats or attempts.  

Affectively unstable, they often show intense, inappropriate anger.  They feel empty or bored and they frantically try to avoid abandonment.  They are uncertain about who they are, and lack the ability to maintain stable interpersonal relationships.

301.50 Histrionic:  overly emotional, vague, and attention-seeking.  Need constant reassurance about their attractiveness.  They may be self-centered and sexually seductive.

301.81 Narcissistic:  self important and often preoccupied with envy, fantasies of success, or ruminations about the uniqueness of their own problems.  Their sense of entitlement and lack of empathy may cause them to take advantage of others.  They vigorously reject criticism, and need constant attention and admiration.  

Cluster C  (anxious cluster)

People with cluster C patterns/disorders tend to be anxious and tense, and are often over-controlled.

301.82 Avoidant:  these timid people are so easily wounded by criticism that they hesitate to become involved with others.  They may fear the embarrassment of showing emotion or of saying things that seem foolish.  They may have no close friends, and they exaggerate the risks of undertaking pursuits outside their usual routines.

301.60 Dependant:  need the approval of others so much that they have trouble making independent decisions or starting projects.  They may even agree with others whom they know to be wrong.  they fear abandonment, feel helpless when they are alone, and are miserable when relationships end.  They are easily hurt by criticism and will even volunteer for unpleasant tasks to gain the favor of others.

301.40 Obsessive-Compulsive:  perfectionism and rigidity.  They are often workaholics and tend to be indecisive, excessively scrupulous, and preoccupied with detail.  They insist that others do things their way.  They have trouble expressing affection, tend to lack generosity, and may even resist throwing away worthless objects they no longer need.

Diagnosis:  Patient displays at least 2 of the following for 6 months or more

delusions:  think they are god or a famous person (grandeur), think they have committed something terrible (guilt), think they have disease, think that spouses or partners have been unfaithful (jealous), think they are being controlled by outside powers i.e. aliens, radio waves, etc. (passivity), think people blame them for things (persecution), even though they may have a job and money in the bank they feel they are poverty stricken or destined for destitution, feel that people are talking behind their backs (reference), they may also believe that others are putting thoughts into their heads (thought control).
hallucinations:  false sensory perception that occurs in the absence of a related sensory stimulus. These can affect all five senses but most commonly affect visual and auditory senses.
disorganized behavior:  physical actions that do not appear to be goal oriented (i.e. taking off clothes in public, strange gestures or postures, etc.), or otherwise bizarre physical activities.
disorganized speech:  mental associations are governed not by logic but by rhymes, puns, and other rules not apparent to the observer, or by no clear rules at all.  Generally the speech is understandable but sometimes may be difficult to understand.
negative symptoms:  reduced range of expression of emotion, obvious reduced fluency of speech, loss of will to do things (avolition).  It seems that something has been taken away from the patient, such as the textural richness of their personality.

5 subtypes of Schizophrenia

Paranoid:  these patients have persecutory delusions and auditory hallucinations, but no negative symptoms, disorganized speech, or catatonic behavior.
Disorganized:  delusions and hallucinations are less prominent than negative symptoms and disorganized speech and behavior.
Catatonic:  excessively retarded or excessively excited behavior that is very bizarre.
Undifferentiated:  some of all the basic types of psychotic symptoms, not one particularly dominates.
Residual:  after an acute psychosis the patient is markedly improved, although they still seem somewhat unusual, odd, or peculiar.

Schizophrenia-like disorders

Schizophreniform:  patients who display the proper signs and symptoms for diagnosis but have only been affected for under 6 months.

Schizoaffective disorder:  for at least one month the patient has had symptoms of schizophrenia, at the same time they have prominent symptoms of mania and/or depression.

Brief Psychotic disorder:  at least one of the psychotic symptoms for under one month.

Other Psychotic Disorders

Psychotic Disorder due to a General Medical Condition:  a wide variety of medical and neurological conditions can produce psychotic symptoms that may not meet criteria for the conditions above.

Substance-Induced Psychotic Disorders:  Alcohol or other substances (intoxication or withdrawal) can cause psychotic symptoms that may not meet criteria fore any of the conditions above.

Psychotic Disorder not otherwise Specified:  this is usually patients with postpartum psychosis or other symptoms that do not seem to fit any of the categories above.

Caution should be taken when treating:  Kuang, must sedate and purge, but when moving towards Dian, must change treatment principle as to not depress patient more.  Clearing Phlegm can always be done.

 Kuang – all three pulses & levels are big & flooding, people may strip in public, sing/scream/swear or act out, become violent (have incredible force), lots of energy (don’t need to eat to maintain energy), angry, very out of character, may be suicidal.

↑ Yang → purge & remove Phlegm-Fire or Blood Stasis.

Dian – all three pulses & levels are thin weak & deep, person is very quiet, no concentration, speaks nonsense, lack of expression, eat unclean food from street/garbage, lie or laugh a lot for no reason, think unreasonably, feel guilty, afraid that someone is after them, may think they are having a heart attack (but not so), manic sadness & happiness.

↑ Yin → Phlegm & Qi stagnation.

Dian

Depression: generally Lung or Liver patterns

Antidepressants

Injure Heart (hand Jue-yin)
create blood stasis
damage spleen yang
cause general Qi deficiency

People experiencing depression have a severe case when they wake earlier in the morning  (ie- more depressed if waking up at 5 than if waking up at 7)

Depression is often mixed with anxiety

Depression is usually 50% excess and 50% deficiency

Anxiety is usually 90% deficiency and 10% excess

 Anxiety – Heart,Spleen,Kidney           Suicide – Kidney and Lung Deficiency

Kuang Zheng

‘Tan Re Mi Xin Qiao Hun Po’ –  Phlegm and Fire disturb mind, Shen, Heart, ethereal & physical spirit.

Western Medicine:  Manic Psychosis, Schizophrenia, Hypomania, Postpartum disorders, Substance use disorders, Acute reactive disorders, hysteria.

 ‘Kuang Zheng’ is a Fire (Yang) pattern that is usually complicated with Phlegm covering the Heart, mind, spirit, Hun (ethereal) and Po (physical) soul.  This manifests as blockage accumulating until the point of bursting causing Fire to surge upwards.  It shows a relative excess of Yang and a deficiency of Yin simultaneously.

Symptoms:  sudden onset, irritability, flushed face, blood shot eyes, mania, restlessness, climbing to high places, public singing, unusual strength, anorexia, insomnia, constipation, T- red with yellow coat, P- rapid

Treatment:  Purge the Phlegm and Fire through the Large Intestine by inducing diarrhea, Tonify Yin, remove stagnation.

***It is important to fully and completely eliminate the Phlegm in the treatment of Kuang, otherwise recurrence is guaranteed.

Sun Si Miao’s 13 Ghost Points

These originated from ‘Thousand Ducat Formulas’ in the Tang dynasty (618-907 A.D., near the end of the middle ages), which was when the first book was ever printed, and a push to make Buddhism the state religion was attempted.  Quite possibly an idea of forced religion, and the beginnings of information-overload provided by the invention of printing, both played a role in the need for more empirical practice concerning mental disorders (Kuang Dian), which we now refer to as mood, personality, and/or Schizophrenic patterns/disorders.  Now, early in the new millennia, it seems to be of great importance for Traditional Chinese Medicine and particularly Acupuncture with it’s unique ability to regulate many aspects of our health and life, to step forward into what seems to be another age with the need for mental health treatment options.

The 13 Ghost Points:

Guigong – Ghost Palace (Renzhong DU 26)
Gui Zhen – Ghost Pillow (Fengfu DU 16)
Guitang – ghost Hall (Shangxing DU 23)
GuiShi – Ghost Market (Chengqiang RN 24)
Guixin – Ghost Faith (Shaoshang LU 11)
Guitui – Ghost Leg (Quchi LI 11)
Guichuang – Ghost’s Bed (Jiache ST 6)
Guilei – Ghost Fortress (Yinbai SP 1)
Guixin – Ghost Heart (Daling MH 7)
Guicu – Ghost Cave (Laogong MH 8)
 Guilu – Ghost Path (Shenmai BL 62)
Guifeng – Ghost Seal (Haiquan extra point below tongue)
Guicang – Ghost Store (Huiyin RN 1)

It has been said that Guixin – Ghost Heart (Daling MH 7) is actually Taiyuan LU 9 (connecting these points may be of benefit).  It is of popular belief that Guilu – Ghost Path (Shenmai BL 62) is actually Jianshi MH 5.  Another text includes Shenting DU 24, Ruzhong ST 17, Yanglingquan GB 34, and Xingjian LR 2, and did not include Shenmai BL 62, Shangxing Du 23, Quchi LI 11, and Huiyin RN 1.

Dr. Liu Feng (20th century) expresses the need to balance and connect the triangle of ‘cognition/personality’, ‘will’, and ‘emotions’ to achieve results within treatment of all mental disease.  He also stresses to watch personality changes to understand severity of the patients disease.  This helps to determine if the disorder is simply a personality or neurotic disorder, or if it is more severe causing great distress and problems fitting in with society which would lean more towards (affective) Mood disorders or Schizophrenia.

TCM Diagnosis:

Yang Symptoms – loud, much action, extroverted (use Ren Meridian)
Yin Symptoms – quiet, minimal action, introverted (use Du Meridian)
Organ Differentiation: heart/lung/liver/kidney/spleen
Heart Differentiation: Mental (hand shao-yin) Physical (hand jue-yin)
King fire more connects with stomach
Minister fire connects with spleen
Brain connects with TCM Heart and Kidney
Phlegm – root of all mental disease! covers heart
1. Invisible or Visible turbid phlegm
2. Blood nourish spirit – blood stasis
3. Qi – connects with - blood stasis / phlegm / fire
   deficient fire with phlegm – wants to kill self (moxa)
   King or Minister Fire?
   excess fire with phlegm – wants to kill others (clear heat)
Yin Yang Fan Zhuo – yin and yang reversed

Tan Qi Jiao Jie – phlegm and qi stagnated and mixed into sticky condition
Liver Rising – Si Jue Ming, Dai Zhi Shi, Sang Tae Lou
Heart Kidney Disharmony – Ci Zhu
Lung not Descending – Da Huang, Lu Hui  + phlegm herbs

Top 13 Formulas for Mental Disease:

Wen Dan Tang (cousin Rx – Dao Tan Tang, Di Tan Tang)
modifications: Huang Lian (king fire)  Huang Qin (minister Fire)
Liver Fire Rising + Long Dan Xie Gan Tang, Mu Li
Fang Feng Tong Sheng Tang (-mang xiao) + Qiang Huo/Du Huo (wind damp) + Huang Lian
Gui Pi Tang - + Huang Lian + Dan Shen (blood circ.) + Shu Di
Xue Fu Zhu Yu Tang – Blood circulation
Tian Wang Bu Xin Tang – Heart and Kidney Yin Deficiency
Meng Shi Guan Tan Wan - Phlegm Fir
Su Hua Xiang Wan – cold sticky phlegm
Bai Jing Wan – (Bai Fan (Ming Fan), Yu Jin) Any Phlegm
Xiang  Sha Liu Jun Zi Tang-
Long Dan Xie Gan Tang – (Mu Tong? Toxic) + Lian Zi Xin, Dan Zhu Ye, Da Huang
Huang Lian Jie Du Tang – excess fire, + Si Wu Tang (wen qin yin)
Chai Hu Jia Long Gu Mu Li Tang
Chai Hu Shu Gan San

Acupuncture:

Phlegm Fire – Kuang Zheng - Yang
1. Main points: RN 12, 13, 15
2. Calm: DU 26-28 (strong stimulation), KI 1
3. Purge Yangming: LI 4, 11, ST 36, 37, 39, TH 6
4. Shaoyang: GB 20
5. Taiyang: BL 9, 10
6. yin tang – downwards towards bridge of nose
Experience points:
1. Clear Minister Fire:  MH 5 to TH 6
2. Fire and Phlegm: MH 5, ST 40
3. Phlegm in Lung system: ST 40, LU 7
4. Sweating (night or daytime spontaneous): HT 6, KI 7
5. Fever: LI 11, DU 14, HT 3
6. Hearing voices in the head: SI 19, GB 2, MH 5
7. Ghosts in dreams: SP 1, ST 45
Dian Zheng – Yin
• MH 6, DU 20, 26,g12, 14, 16, GB 13, St 40, ST 6, SP 6
  Moxa RN 4, 6, and back shu points