Melancholy  - Yu Zheng

Melancholia is a general term for disorders resulted from emotional depression and stagnation of qi. The symptoms due to emotional frustration, and depression of qi which lead to stagnation of blood, accumulation of phlegm, retention of food, collection of fire, and disharmony of the zang - fu organs fallinto this category. Zhu Danxi said, "There is no disease when qi and blood are in harmony. Once depression occurs, disease results."
This condition is seen in hysteria and neurosis in Western medicine.  

Etiology and Pathogenesis:

Generally speaking, melancholia is caused by emotional injuries resulting in disharmony of the activity of the zang organs. As said in Chapter 28 of Miraculous Pivot: Grief, sorrow, worry and anxiety disturb the mind and disturbance of the mind will affect all the five zang and six fu organs.

Depressed anger may give rise to many disorders of the liver with impairment of the free flow of qi. Then the liver qi may go upward to attack the mind, or conquer the spleen and stomach, or counteract the lung, or go downward to the intestines, leading to various illnesses.

Too much worry may depress the liver and suppress the spleen, causing the failure of the spleen in transportation and transformation, which brings about accumulation of dampness and phlegm and retention of undigested food. Agglomeration of the dampness, phlegm and undigested food in a long duration is apt to produce fire. Over anxiety may also lead to dysfunction of the qi and consumes yin (nutrients and blood,) generating many symptoms.

Differentiate between Dian and Kuang disorders which are longer in duration than melancholic states.  

Main manifestations: Mental depression, distress of the chest, hypochondriac pain, abdominal distension, belching, anorexia, or abdominal pain, vomiting, abnormal bowel movement, thin, sticky tongue coating, string - taut pulse.

Analysis: In case of emotional injury, the liver fails to be harmonious and flourishing, so mental depression appears. The Liver Meridian of Foot - Jueyin runs up to the lower abdomen and curves around the stomach and then branches out in the costal and hypochondriac regions. In case of stagnation of the qi of the liver, there may appear distress in the chest, hypochondriac pain and abdominal distension. If the stomach qi fails to descend, belching and anorexia occur. When the liver qi encroaches the spleen, abdominal pain, vomiting and abnormal bowel movement result. Thin, sticky tongue coating and string - taut pulse are the signs of disharmony between the liver and stomach.

Treatment

Depression of qi in the liver:

Method: The Influential point of qi and the points of the Liver Meridian are selected as the principal points. Even movement is applied to soothe the liver, strengthen the spleen and harmonize the stomach.

Prescription: [BL18 - RN17) - RN12 - ST36 - SP4 - LR3].

Liver Qi Stagnation

Distended pain, belching, sighing
P/T – soothe liver, regulate qi to relieve Yu Syndrome.
Acupuncture – foot jue yin, foot shao yang meridians: LR14 (front MU), LR3 (Yuan Primary) , GB34, TH6, MH6, ST36, RN17 (Qi stag)
• Sore Throat – RN 21, LU11

Explanation: RN17, the Influential point of qi, is able to regulate the flow of qi. BL18 and LR3 are the Back-shu point and yuan-primary point of the liver respectively. When used in combination, they may soothe the liver and remove depression. RN12 and ST36 may harmonize the stomach and make the stomach qi descend. SP4, the luo-connecting point of the Spleen Meridian, may strengthen the spleen and harmonize the stomach.

Main manifestations: Headache, dryness and bitter taste in the mouth, irritability, distress of the chest, hypochondriac distension, acid regurgitation, constipation, red eyes, tinnitus, red tongue with yellow coating, string - taut, rapid pulse.

Analysis: When the depressed qi is transformed into fire, it flares up along the Liver Meridian, resulting in headache, red eyes and tinnitus. When the liver fire evaporates the fluid and heat accumulates in the stomach and intestines, dryness and bitter taste in the mouth and constipation occur. If the liver is hyperactive, it will encroach the stomach, leading to failure of the stomach in descending function, then distress of the chest, hypochondriac distension, and acid regurgitation occur. Irritability, yellow tongue coating, string - taut, rapid pulse are the signs of the fire in the liver.

Treatment

Method: Points of the Liver, Gallbladder and Stomach Meridians are selected as the principal points. Reducing method is used to dispel the fire from the liver and strengthen the stomach function.

Prescription: [RN13 - TH6 - GB34 - LR2 - GB43].

Red eyes, acid reflux, anger, irritable
PT – purge liver fire and relive yu syndrome.
Acupuncture – foot jue yin, foot yang ming meridians
• LR14, LR2 (ying-spring), GB34, TH6, ST44
• Vomiting fluids: GB24
• Nauseous feeling: RN12, ST41

Explanation: LR2 and GB43, the ying-spring points of the Liver and Gallbladder Meridians, may dispel fire from the liver and gallbladder. TH6 in combination with GB34 may treat distress of the chest, hypochondriac distension, bitter taste in the mouth and constipation. RN13 may harmonize the stomach and regulate the flow of qi to treat acid regurgitation.

Main manifestations: Feeling of a lump choking in the throat, hard to spit it out or to swallow it, thin, sticky tongue coating, string - taut, rolling pulse.

Analysis: The depressed liver qi acts over the spleen and stomach, leading to disturbance of transportation and transformation. Dampness derived from the water and food taken is gathered and turned into phlegm, which combined with qi, stays in the throat, giving rise to choking feeling. Thin, sticky tongue coating and string - taut, rolling pulse are the signs of the stagnation of phlegm with qi.

Treatment

Stagnation of phlegm:

Method: Points of the Liver Meridian and Ren Meridian are selected as the principal points. Even movement is applied to soothe the liver, remove the depression, regulate the flow of qi and resolve phlegm.

Prescription: [RN22 - RN17 - MH6 - ST40 - LR3].

Explanation: LR3 is applied to soothe the liver and remove the depression. RN22 is needled to descend the qi and treat the throat trouble. MH6 is used to remove depression from the chest and regulate the flow of qi. RN17, the Influential point of qi, ST40, the luo-connecting point of the stomach, used together, may promote the circulation of qi and resolve phlegm.

Main manifestations: Grief without reasons, capricious joy or anger, suspicions, liability to get frightened, palpitation, irritability, insomnia, or sudden distress of the chest, hiccup, sudden aphonia, convulsion, or loss of consciousness in severe cases, thin, white tongue coating, string - taut, thready pulse.

Analysis: Because of over contemplation and emotional frustration, the qi function is impaired and the blood is gradually consumed, leading to poor nourishment of the mind, thus the above - mentioned symptoms occur. In case the qi is blocked, there may be sudden distress of the chest, hiccup, sudden aphonia and convulsion. Thin white tongue coating, and string - taut thready pulse are the signs of a longstanding stagnation of qi that damages blood.

Treatment

Method: Points of the Heart and Liver Meridians are selected as the principal points. Even movement is applied to nourish blood, soothe the liver and refresh and tranquilize the mind.

Prescription: [RN14 - HT7 - SP6 - LR3].

Supplementary points:

Distress of the chest: MH6, RN17.
Hiccup: SP4, RN22.
Sudden aphonia: HT5, RN23.
Convulsion: LI4, GB34.
Loss of consciousness: DU26, KI1.

Explanation: LR3 is selected to soothe the liver and remove depression. RN14, the Front-mu point of the Heart Meridian, HT7, the yuan-primary point, combined with SP6 of the Spleen Meridian, may nourish blood, refresh and tranquilize the mind. MH6 and RN17 may remove the depression of the chest. SP4 and RN22 causes the qi to descend and checks hiccup. HT5 and RN23 are effective in the treatment of aphonia. LI4 is taken to regulate the flow of qi. GB34, the Influential point of the tendons, is used to check convulsion and relieve pain. DU26 and KI1 are used for resuscitation.

Palpitations, poor appetite, dizziness, fatigue, fullness in chest, easily sweat, insomnia, poor  memory, P- thin, wiry

PT – nourish heart and strengthen spleen to calm spirit, hand shao yin and foot tai yin meridians and back shu points.

Acupuncture

HT7, BL15, BL20, SP6, ST36, RN12, LR13
Stagnation: LR3, MH6

More chronic melancholy, insomnia, anger with kidney yin deficiency symptoms.

PT – nourish yin, clear heat and calm heart and spirit.

Acupuncture – foot shao yin, foot tai yin and hand shao yin

SP6, KI3, LR3, HT7, BL15, BL23
Irritability: GB34,  si shen chong (4 pts on head)

Alternative Treatment Methods

Auricular – shen men, sympathetic, endocrine, heart , kidney
Injection – vit B1 or Dan Shen to GB20, MH6 , BL15