The Nei Jing which can be said to be the "Source" of all ancient theories of Chinese Medicine and which is also widely accepted as the earliest text devoted to medicine says: "In children blame the spleen, in adults blame the liver, in the aged blame the kidneys". What this means is that in children the most common cause of illness is a weak spleen which in effect means weak digestive abilities, in adults the main cause of illness is related to the liver, of which the most common TCM pathology is Liver Qi stagnation. In the aged the kidneys are to blame because it is the kidneys that hold the essence of life which have by now been largely consumed just as a candle consumes itself by giving off light. It is the statement with regard to adults that I will elaborate further on.
The liver in TCM is said to control the flow of qi in the body, it also opens into the eyes, stores blood (which it releases to other areas of the body when required), controls the contraction and relaxation of muscles, controls the emotions of anger, irritability and frustration and also influences strategy and decision making. We say that the liver houses the Hun, the ethereal soul which leaves the body when a person passes away and also allows for the focus of the individual on long term goals and objectives. The reason that the Nei Jing says blame the liver in adults is because adults are by definition those who have now come to live with "delayed gratification" as opposed to a child who seeks "instant gratification". This social constraint of not being able to do what we want to when we want to do it is in effect an inhibition of the qi mechanism, which in turn causes the qi to stagnate. This qi stagnation, since it being a function of the liver to maintain free flow of qi, first affects the liver manifesting as anger, frustration and irritability on a mental emotional level and because of the interrelationships of the liver with other organs can manifest as stomach cramps, nausea and vomiting, and in fact a myriad of other symptoms depending on which organ or system is attacked by the build up of qi in the liver.
Xiu Tang
The classic feature that presents when any of the above symptoms are due to Liver qi stagnation is that the symptoms are worse for stress, it is therefore useful to ask: "Is it worse for stress?" or if you feel you will be leading the patient ask what the symptoms are worse and better for.
Acupuncture points that are useful for liver qi stagnation include Liver 3, Liver 13, LI4, Ren12, UB 18. Herbal formulae that are useful include Xao Yao San, Chai Hu Shu Gan San and even Bu Zhong Yi Qi Tang when accompanied by Spleen qi vacuity.
The liver is the organ/system most often implicated in mental-emotional disorders though the other organs/systems also have similar relationships as follows:
Spleen/Stomach - Excessive worry and thinking can damage the spleen/stomach causing such symptoms as loose stools, metrorhaggia, profuse bleeding, poor appetite and in long standing cases are often the cause of many autoimmune disorders. Such patients may also have difficulty making decisions and be prone to obsessive behaviours
Kidneys - The emotion of the kidney is fear and it houses the Zhi which is the will, hence lack of willpower and inordinate fear are typical when the kidney is weak. Fright or excessive fear may also induce kidney weakness which may then manifest as bedwetting, incontinence and impotence.
Lungs - The lungs are weakened by grief and sadness. Since the lungs are intimately involved in the production of qi in the body this often leads to deficient qi manifesting as chronic fatigue, shortness of breath and asthma.
Heart - The heart is damaged by excessive joy, which we say slows the qi down or causes it to become "slack", this can be fatal if the individual already has a heart condition.
Sometimes patients come in for a particular mental-emotional or prediagnosed psychiatric condition. TCM is well suited to treating such disorders because of the novel approach and tools at the practitioners disposal, here follows the common patterns that are behind many of these disorders and some tips on their treatment:
Obsessive-compulsive disorders/tendencies - This condition is most often related to a weakness of the spleen with resultant accumulation of dampness. Acupuncture points include ST40, SP3. Herbal formulae include Modified Si Jun Zi Tang.
Withdrawal - Often due to either kidney yang vacuity in which case the problem is not enough willpower to engage the outside world or cold-phlegm obstructing the portals of the heart which almost always presents with a tongue with a thick white coating that covers the majority of the tongue surface. Points: Kidney vacuity - UB23, K7; Phlegm - ST40, Yintang. Herbal formulae: Kidney vacuity - Fu Gui Ba Wei Wan; Phlegm - Ban Xia Bai Zhu Tian Ma Wan
Mania - Can be due to liver-fire or phlegm-fire obstructing the heart. Points: Liver-fire - Liv 2; Phlegm - ST40, Liv 2. Herbal formulae: Liver fire - Long Dan Xie Gan Wan; Phlegm - Wen Dan Tang
Anxiety - Usually either blood or yin vacuity.
Paranoia - More often blood stasis but can be blood vacuity as well
Seasonal Affective Disorder - Almost always Kidney yang vacuity
It must be stressed in conclusion that although Acupuncture and Chinese Herbal Medicine can effectively treat many mental-emotional disorders, the practitioner cannot assume the role of the psychotherapist or psychologist. It is essential that if the underlying pattern has an issue that needs addressing by a qualified counselor or therapist, as in the case of trauma, that the TCM practitioner work together with such a professional in managing the illness together.
(Please note: This article is intended for practitioners and to give an insight to the public on how Chinese Medicine is able to treat mental health issues, if you are not a practitioner please do not act on the advice given herein, rather consult a professional practitioner of Chinese Medicine who will be able to treat based on the individual nuances of your condition)
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