Imbalances' – Chinese Medicine and Psychiatric Disorders
David A. Dawson, Ph.D., L.Ac.
In the long history of Chinese medicine, every aspect of human health and disease has been addressed and treated by acupuncture and herbal medicine. Warts, schizophrenia, insomnia, eating disorders, heart disease, menopause – all of these feature in the thousands of years of the Chinese medical tradition. This web page is focused on the way Chinese medicine looks at so-called psychiatric illnesses. I have chosen to present a much deeper look at this topic here than you usually find in an acupuncturist's website. My experience with patients who are interested in this area suggests that they are generally hungry for information about treatment, and want no simple answers. In hopes of meeting that need I am going into some considerable detail here.
A Different Way of Thinking about 'Mental Illness'
What Western medical professionals call 'mental illness,' or 'psychiatric disorders,' Chinese medicine calls Shen Disharmony. The term Shen has a wide range of meaning, and may refer to:
the spirit of a person, such as one refers to in religious traditions,
the thinking mind,
the psycho-spiritual aspect of the Heart organ system,
the liveliness and presence of one's eyes, or
the freshness and sparkle of one's complexion.
When referring to a disorder, however, the Shen most often refers to the spirit, either as a reference to the whole psycho-spiritual nature of a person, or as the spirit which resides in the heart.
Each organ system in Chinese medicine has a psycho-spiritual aspect. Some of these aspects may seem oddly paired (for example, the gall bladder is said to govern decision-making). Yet this is significant in several ways. Firstly, what is termed mental illness in the West is seen as part of the organic, physical system, and is treated as such; secondly, disharmonies that give rise to disordered thinking (such as depression or schizophrenia) are diagnosed as part of a much broader array of symptoms.
Because of these two features, a third significant difference can be seen: patients are not, for example, diagnosed as having depression, but rather depression due to Lung Qi impaired by Cold, or depression due to Spleen Qi Deficiency, or depression due to Liver Blood Deficiency not Nourishing the Heart. Diagnoses not only specifically account for the symptoms of the condition, but also detail the originating disharmonies. This allows for more precisely targetted treatments, with greater success and fewer side effects, than most western approaches.
Where the Healing Begins ...
Yet another significant feature should be mentioned here. Because the symptoms of Shen disturbance are seen as a normal (if pathological) process related to organ imbalances or other pathologies, there is no stigma attached to Shen disharmonies in Chinese medicine. No patient need feel like a 'freak' for having bipolar disorder, or depression, or even schizophrenia, since his or her symptoms can be clearly related to organic disharmonies, and can be seen to have a direct correlation to other signs and symptoms he or she experiences. In addition to the benefit to the patient's sense of well-being, there is the added benefit of better compliance with medical regimes, as the patient does not need to see his or her medicine as implying that he or she is 'crazy' or 'disturbed.'
The Spirit in Chinese Medicine
As mentioned before, Chinese medicine has a strong place for the mental/emotional/spiritual component of life. Each organ system has responsibilities in maintaining the health of this area. The Shen is affected along with the rest of the organism when a disorder occurs. A few examples may help to make sense of this concept:
The Shen, the spirit of the Heart organ system, governs all the other psycho-spiritual elements of the body. It enables a person to be calm under stress, it allows a person to perceive the world with a sense of humor, and it sustains the realm of imagination and ideas. It is said to be anchored by the Yin (the cooling, calming, moistening energy of the body; Yin is the opposite of Yang), the Blood, and the Jing (the Essence, that which is the source of all the energy and structure of the body). When a person has a fever, the Yin can be consumed by the Heat of the fever, and the Shen may become unrooted, leading to delirium or agitation. To treat this condition, we need to clear Heat if it is still present, nourish the Yin, and generate Fluids, in addition to calming the Shen.
In the same way, post-natal depression is most often related to the loss of Blood and Body Fluids during childbirth. Restoring the Blood and Fluids anchors the Shen, and enables the healing of the Shen.
The Spleen governs the appetite, is the first stop in the building of both Qi and Blood, and houses the Yi, which enables and controls focused thought. The habits of our culture often deplete the Spleen Qi, not least because we tend to overwork our faculties for focused thought. As students, we put in long hours at the books; as workers, we sit at computers all day, and are asked to take breaks only every two hours (during which many will pick up a book and read). We tend to eat poorly, and irregularly (both of which tend to tax the Spleen, and weaken it). Typically, then, we see a lot of Spleen Qi Deficiency patients in clinic, who manifest with poor appetite, low energy, sallow complexion, and an inability to turn off their mind to go to sleep, or a tendency to worry.
Worry is a churning of the mind which one can't turn off, and indulging in worry can damage the Spleen Qi, and lead to these other symtoms. Yet at the same time, depleting the Spleen Qi in other ways can lead to worry, as the Spleen fails to regulate the focused thought.
One of the important steps in restoring the Spleen to combat worry is to learn to rest the mind – to be aware of when the mind gets tired and needs a break. Children do this naturally. You can watch a child play for hours with the same toy on one day, while on another occasion, he or she moves from one thing to another as the attention span dictates. This honoring of the attention span is a needed part of survival for those who use their brains constantly. Fairly early on in life our culture teaches us to override those reminders that the attention span signals, and we learn to 'play' computer games for hours without ever looking away from the screen, or reading a book in the same manner. Playing as a child does, by honoring the limits of our attention span, is one of the ways we can help restore the Spleen.
Pathologies that Affect the Shen
Chinese medicine categorizes illness or imbalance according to the characteristics of the illness, and according to its location, or the elements affected. The examples above included and Heat Consuming the Heart Yin, Blood Deficiency Failing to Nourish the Heart, and Spleen Qi Deficiency. The balance and harmony of the Shen can be particularly affected by certain pathogens in particular. The two main pathogens that disturb the Shen are Heat and Phlegm.
Heat may come from external sources (such as sun-stroke), or internal sources (such as happens in peri-menopausal hot flashes). It is characterized by such things as fever, flushed skin, a sensitivity to heat, agitation, and increased heart rate. Not all these signs need to be present for there to be pathogenic Heat. Heat tends to agitate the Shen, leading to anxiety, restlessness, irritability, and so on. Heat can also injure the Yin and Body Fluids. Treatment of conditions arising from Heat is done by draining or expelling the pathogenic Heat, and by protecting and nourishing the Yin and Fluids. Where there is damage to the Shen as well, we must calm or sedate the Shen.
Phlegm is a pathogen that comes only from internal imbalance. If fluids are not properly transformed so they can be used by the body, they will accumulate and cause problems (the Chinese refer to these unusable fluids as Dampness). Depending on where they lodge, they can cause problems like productive cough, diarrhea, or edema. Over time, these stationary, unusable fluids may generate their own Heat conditions, which 'cook them down' into Phlegm conditions. Phlegm is by nature obstructive and tenacious. Because of this, it can create not only the same conditions as Dampness, but also it can obstruct or 'veil' the connections between the patient and his or her environment, leading to conditions like paranoia, severe depression, and even coma. It is one of the more difficult pathogens to eradicate, but it responds well to treatment with herbs to break up and transform Phlegm to drive it out.
Heat and Phlegm conditions can combine to create such conditions as bipolar syndrome and schizophrenia. Again, they are treated with herbs to clear Heat and transform Phlegm.
Treating these conditions involves working at several levels at the same time. The symptoms must be alleviated, whether they be agitation, racing heartbeat, or insomnia. Heat and Phlegm must be eradicated so that they do not immediately recreate the symptoms. There is a third level which must be addressed as well: Heat and Phlegm do not occur without cause – we must find and treat the imbalance that has allowed the Phlegm and Heat to arise in the first place. Very often this is due to a weakness in the system that must be gently returned to strength.
Conditions which affect the Shen are complex, and require a commitment to a sometimes extended course of treatment if the patient wants to see substantial change. This is the hardest part of dealing with these issues. The compete eradication of symptoms of 'mental illness' is not uncommon, but is a long-term project. The degree of success is usually related to the degree of severity and duration of the condition, and is dependent on one's definition of a 'cure.' With some patients, the 'cure' may include life-long treatment with herbs to support a constitutionally weak Spleen or Kidney system, for example, while eliminating the depression, or bipolar symptoms. In every case, however, the degree of success is directly related to the consistency of compliance to the treatment plan.
I believe very strongly that the human body is made to heal itself. If we provide it with the right support, and assist in the process properly, almost any condition can be improved substantially, or eradicated altogether.
The Treatment of Shen Disorders with Chinese Medicine
Chinese medicine incorporates a range of techniques for treating illness (please see the Methods of Treatment page for more information). When treating patients with psychological or psychiatric conditions, a combination of acupuncture and herbs is most effective. Massage may also very helpful, as it can help reintegrate the Shen with the body. Combinations of all three can be very effective for dissociative disorders, severe depression, and the like.
Chinese Medicine and Psychiatry
Patients sometimes are concerned that they may have to choose between Chinese medicine and Western medicine. This is not the case. If you are taking pharmaceutical medications, we can work with them through herbal formulas to assist the healing process, or we can simply focus on non-herbal techniques if that is preferable. Western doctors are beginning to see the benefits of combining the strengths of both traditions, and often are pleased when a patient is getting acupuncture and Chinese medical treatment to support the healing process.
Please contact me with any questions or concerns you may have about these issues