Depression as a Technical Term in Chinese Medicine

In English, the term depression usually implies a behavioral health condition characterized by taciturn mood and suicidal ideation.  The Chinese term 郁 yu has the same meaning, but it is also used in Chinese medicine to describe pathologies where the flow of bodily resources is compressed and inhibited.  In naming the pattern of liver qi depression and binding, the term depression primarily refers to depressed qi movement, but, since emotional depression is a key indicator of this pattern, it also serves as a mnemonic device to remind us of the intimate connection between the mental state and the pattern of disharmony.

Clinically, it is extremely important to understand that liver qi depression and binding patterns potentially give rise to six other patterns, all of which can be referred to as depressions.  The six depressions, as defined by the Jin-Yuan period (1127-1368 CE) medical scholar Liu Wan-Su include

·       Qi

·       Fire

·       Blood

·       Dampness

·       Phlegm

·       Food

Qi is the primary depression, while fire depression, also called depressive heat, is secondary to qi depression.  Many cases presenting liver qi depression and binding will eventually be complicated by depressive heat, where more severe or enduring depression results in qi transforming into heat or fire.  Due to a lack of familiarity with this technical terminology, the clinically important concept of depressive heat is used less often in the West than in China. 

Depressive Heat–Depressive heat presents with signs and symptoms of liver qi depression and binding along with additional heat signs and symptoms.  The indications of heat include red eyes, red complexion, a bitter taste in the mouth (mostly in the mornings), and oral thirst. When heat ramifies to the heart it may also lead to vexation, insomnia, and profuse dreams, while the presence of heat in the blood aspect can manifest as early or profuse menstruation or flooding or leaking.  Anger will often escalate into rage, while the combination of heat and stagnation may manifest as hypersensitivity and/or pain of the nipples.  The pulse is normally rapid, and the tongue body or margins may be red.

TREATMENT involves coursing the liver and rectifying qi, and clearing heat and resolving depression.  Using acumoxatherapy, substituting LIV-2 xing jian for LIV-3 tai chong is a common strategy, while internal medicine might add both shan zhi zi gardenia and mu dan pi moutan to Xiao Yao San Free and Easy Wanderer Powder to form Jia Wei Xiao Yao San or Free and Easy Wanderer Powder with Added Flavors.