The Emotions In Traditional Chinese Medicine – Part 3 Treatments For Emotion-based Disorders – Uncovering The Shen

Introduction

The advantage of having several different theoretical paradigms to draw upon in clinic is that some patients may accord more closely with one paradigm than another. The symptoms become more intelligible and the solution to their clinical problems become more amenable when viewed through the lens of a more suitable theoretical model. In terms the topic under discussion, certain patients manifest the effects of one specific negative or extreme emotion to the exclusion of all others, and thus we can best understand the pathogenesis of their illness in terms of the Five Elements, as discussed in Part 1. On the other hand, the emotional problems of other patients are more diffuse and may best be understood through tracing the course of their illness through the stages of Yu syndrome, as discussed in Part 2.

In this concluding part of the series, we return to the Five Elements as the main paradigm within which to organize the following discussion on herbal treatments for emotion-based clinical problems. However, the trends for further pathological development according to Yu syndrome are included within each category, thus combining the two main theoretical approaches to these types of disorders.

We need to recognize that an emotional response, including any accompanying distress, is a true expression of the person as he/she is at a particular moment in time. These feelings have their own validity based on past experiences, present beliefs and attitudes, personal likes and dislikes, as well as future aspirations. In the clinical encounter, we strive to avoid negating patients’ experiences of their emotions, while at the same time affirming their innate faculties of self-awareness, understanding and self-control, which will eventually enable them to deal with these emotions in a constructive and healthy manner. In this way, the patient’s distress may become the starting point for a more integrated and more fulfilling life. It would be fair to say that from a TCM perspective, all of the various extreme and negative emotions are a waste of psychic energy; they are essentially the product of an illusory ego, and only serve to cover up the true self, which is the Spirit in the Heart, the ‘Shen’. With the Shen at the centre, all the other psychic faculties fall into place and become positive, life affirming virtues (as discussed in Part 1).

The five ‘spirits”: hun, po, yi, zhi and shen

The technical terms denoting these aspects of psychic functioning have been translated in various ways by various authors. (Maciocia, 2009; Kaptchuk, 2000) There is, in fact no possibility of a direct translation because these concepts do not exist in the same form within the English language. They are taken from the Daoist tradition, which over the centuries has been deeply influenced by Buddhism and Confucianism. The texts upon which the following discussion is based, although part of the Northern School of Quan-zhen (‘complete reality’ or ‘completely real’) Daoism, refer to their teachings as the essential unity of the ‘three Teachings’ (i.e. Daoism, Buddhism and Confucianism). (Cleary, 1991-a; Cleary, 1991-b)

As I understand it, the yi (intention, power of attention) and the zhi (will, memory) are mental faculties that are exercised during meditation and, more broadly, when applying the practice of mindfulness within daily affairs. In this practice, in application of the yi, the attention is directed to events in the here and now, and away from random or reactive mental activity. The will to keep on doing this and the ability to remember this mental objective are the functions of the zhi. For the purposes of our discussion here, the po (‘earthly soul’ or ‘lower soul’), the hun (‘ethereal soul’ or ‘higher soul’) and shen (Spirit, consciousness, Mind), are, in essence, three distinct centers for various classes or levels of emotional experience.

The po (‘earthly soul’ or ‘lower soul’) is centered on physical survival and is much like our pet dog. The emotions within the po are generated as a direct response to events that are perceived in the external environment, via the sense organs: the simple sense of pleasure we feel when the weather is fine and the temperature agreeable, when we enjoy the taste of good food, and so on. Additionally, the po generates the instinctive responses to the threat of danger: the fight, fright and flight reflexes, and the sense of fear or anger that we feel in these situations. These feelings are all impersonal; we share them with the animal kingdom – the movement towards pleasure and away from pain.

In direct contrast to this is the hun (‘ethereal soul’ or ‘higher soul’). The emotions generated here can be compared to a bunch of hungry and aggressive crocodiles! The hun is derived from the childhood and adolescent experiences of developing an ego, with which to deal with the adults in one’s immediate environment and to facilitate integrating oneself with the society in which one lives. The adaptive ego is an essential faculty that we cannot do without. However, in adulthood unless we learn to loosen its grip, it’s unrestrained activity may readily become counterproductive. All of the pathogenic emotional states of adults under normal conditions (i.e. excluding war zones, natural disasters, etc.) are derived from the unbridled activity of the ego. It has the potential to usurp and destroy everything. Daoism refers to ‘refining’ of the hun as a key practice; equivalent to ethical behavior in Confucianism and mental hygiene within Buddhism. Within our experience, emotions generated within the hun are all specifically in relation to ‘me’; they are at the root of human selfishness. Even in their most benign form, they are narrow, limiting, unstable, and engender a sense of separation.

But it is not all bad news with the hun. The establishment and development of the ego, which is at the core, allows us to foresee the consequences of our behavior, plan for the future and assign a value or meaning to these things. It also provides a basis of self esteem upon which to intelligently care for oneself and others.

The shen (Spirit, consciousness, Mind), on the other hand, may be regarded as our ‘higher’ self or ‘true’ self. The feelings generated here are all non-selfish in nature: love, compassion, awe, sense of oneness, ecstasy (in the true sense of the word). The shen is our original or primal nature which tends to become obscured by the activities of the hun, in much the same way as clouds obscure the clear blue sky. The unobstructed expression of the shen is the goal of the three teachings, principally achieved through bringing the hun under control, so that the shen may become manifest – unhindered, unaided and unforced.

HERBAL FORMULAS TO TREAT THE EFFECTS OF EXTREME EMOTIONS

In regard to herbal formulas, the TCM dictum: ‘One disease, many treatments; many diseases, one treatment’, is pertinent. It is inevitable that some formulas may be effectively used in several different clinical presentations. Because the nuances of the presentation are different in each scenario, these formulas have been listed and discussed under more than one heading in the exposition below.

Anger

Under this heading we include various emotions that are related to anger, including resentment, frustration, irritability, rage, indignation, animosity and bitterness. In general, under conditions of repeated and prolonged emotional overstimulation, anger and related emotions that are not expressed may lead to the pattern of Liver constraint, Qi stagnation; while in people who tend to freely express these emotions, Liver Fire or Liver Yang rising patterns may tend to arise. Over the long term, Liver Blood deficiency and Liver Yin deficiency may develop, which subsequently give rise to Heart Blood deficiency or Heart Yin deficiency with deficiency Fire, according to the pathogenetic pathways discussed in Part 2, under Yu syndrome. Such patients now begin to manifest such symptoms as depressed mood, restlessness, irritability, low self-esteem and a lack sense of direction in life, due to the effects of deficiency conditions of the Liver and Heart.

Chinese herbal formulas for anger and related emotions

• Long Dan Xie Gan Tang (Gentiana Formula) a.k.a. Anti-Inflamm. Formula – Liver Fire: rage, angry outbursts. This formula has a very strong cooling action and may cause gastrointestinal upset if taken for a prolonged period. Therefore, it is important that the patient be monitored closely. When the main signs of Heat (red tongue body, yellow tongue coat, red eyes, facial flushing, rapid pulse), have been resolved, the patient should be given a different formula, according to the new signs and symptoms.
• Chai Hu Shu Gan Wan (Bupleurum & Cyperus) a.k.a. Qi Mover Formula – Liver constraint, excess pattern: irritability, lack of free emotional expression. This formula was discussed in Part 2, and is appropriate for treatment in the early stages of an emotion based disorder, as in stage 1 of Yu syndrome.
• Xiao Yao San (Bupleurum & Danggui Formula) a.k.a. Stress Relief 2 Formula – Liver constraint, deficiency pattern: withdrawn disposition, lack of emotional responsiveness, crying easily, sighing. This formula was discussed in Part 2 and is appropriate for treatment in the early stages of an emotion based disorder, as in stage 1 of Yu syndrome.
• Jia Wei Xiao Yao San (Bupleurum & Peony Formula) a.k.a. Stress Relief 1 Formula – Liver constraint, with stagnant Heat: insomnia, restlessness, easily loses temper, together with Heat signs. This formula was discussed in part 2 and is appropriate for treatment in the early stages of an emotion based disorder, possibly at a somewhat more advanced stage than the previous two formulas. It may also be used as a follow up treatment after a course of Long Dan Xie Gan Tang (Gentiana Formula).
• Settle the Emotions (Yi Gan San) – Liver Heat, Liver Blood deficiency with Wind and Phlegm: irritability, excitability, angry outbursts, insomnia with vivid and terrifying dreams, muscle spasms, poor appetite and bloating. The patient may manifest a mixed picture of extreme emotions, centered on anger. The development of Heat, Spleen deficiency and Blood deficiency gives rise to Wind and Phlegm. This is a complex presentation that correlates with stage 3 Yu syndrome.
• Jin Gui Suan Zao Ren Tang (Ziziphus Combination) – Liver-Heart Yin and Blood deficiency with deficiency Fire: restlessness, irritability, lack of sense of direction in life, low self-esteem, anxiety, insomnia. This is for patients with deficiency together with some paradoxical signs of hyperactivity due to the deficiency Fire. Characteristic signs include night sweats, poor concentration and mental fatigue, wiry-rapid-thready pulse and a red tongue that is dry and has little coating. This type of presentation correlates with stage 4 Yu syndrome, while also manifesting aspects of the three previous stages.
• Tian Ma Gou Teng Wan (Gastrodia & Gambir Combination) – Liver Yang rising: angry outbursts, rage, headaches, dizziness, insomnia, possibly also with hypertension. This is for patients who are affected at a fairly deep level: the Liver Yin and the Kidney Yin have become depleted, and the predominant clinical signs are due to the resultant hyperactivity of Yang, which gives rise to headaches, dizziness and hypertension. This type of presentation correlates with stage 4 Yu syndrome, with more apparent clinical features of excess, from the Yang hyperactivity. Clinical signs that would help distinguish this type of presentation from Liver Fire, discussed above under Long Dan Xie Gan Tang (Gentiana Formula), are: absence of tongue coat, thin (thread-like) pulse.

Sadness

Under the heading of sadness, we also include the related emotions of regret, nostalgia and grief. This group of emotions may have two distinct effects on the Lung. On the one hand sadness depletes the Lung Qi, leading firstly to Lung Qi deficiency and subsequently Spleen Qi deficiency, as these two organs are closely related. The main symptoms at this stage are fatigue, reluctance to speak, shortness of breath, muscular weakness, poor appetite and digestion, possibly also with bloating and loose stools. An important pathophysiological consequence of Lung and Spleen Qi deficiency is impairment of the metabolism of fluids, which leads to retention of Damp and the development of Phlegm.

Alternatively, extreme sadness and grief may cause the Lung Qi to congeal and stagnate, which results directly in the formation of Phlegm. The stagnation is thus worsened and Heat readily develops. Thus, a Phlegm-Heat complex may arise, which may be transmitted from the Lung to the Heart, clouding consciousness and giving rise to loss of interest and varying degrees of delusional thinking. According to TCM, the physical aspects of the experience of extreme sadness and grief are explained in terms of Qi deficiency (fatigue, weakness, reluctance to speak, loss of appetite), retained Damp (feeling of bodily heaviness), and Phlegm (mental cloudiness, loss of interest, and possibly delusional thinking in extreme cases).

Chinese physicians have also observed that grief causes the Lung to over-control the Liver, according to the control cycle of the Five Elements. This observation is echoed in the writings of Kübler-Ross, who described the stages of normal grieving in detail, (Kübler-Ross & Kessler, 2005), including the anger and irritability experienced by people who are in the process of coming to terms with a serious loss. In the TCM context, the Lung overcontrolling the Liver may lead to deep sadness alternating with bouts of irritability and angry outbursts.

While it would be an exaggeration to say that there is a cultural taboo on sadness, nonetheless in contemporary Western society we do not encourage the open expression of such feelings. On the other hand, it now appears to be quite fashionable to have ‘depression’, or at least to be able to talk freely about it. Therefore, we need to be careful how we interpret the information provided to us by patients and try to see behind what is presented. In general, the saddened patient is responding to a loss of some kind, and real healing can only take place once the loss is accepted and the patient has resolved to move on, with enhanced self-knowledge and a new set of goals that are more closely aligned to the real person. (Horowitz & Wakefield, 2007; Breggin, 2001, pp.182-200; Glenmullen, 2000, pp.233-71) As clinicians, we can facilitate this process by providing psychological as well as physical support.  

Chinese herbal formulas for sadness and related emotions

• Mood-Uplift 2 Formula – Heart deficiency, Liver constraint, Spleen & Lung Qi deficiency, Phlegm obstruction: persistent feelings of sadness, dull spirit, fatigue, irritability, insomnia. This formula is generally used for depressed mood in a patient who has experienced a loss (e.g. relationship break up, work-related loss, failure to achieve an important goal). The Heart, Liver, Spleen and Lung are all affected with signs of Qi deficiency (fatigue, muscular weakness, poor appetite, pale tongue and weak pulse) together with Blood deficiency (poor concentration, forgetfulness, insomnia, menstrual problems in women, pale fingernail beds, dry skin, thready pulse). There may also be mild signs of Phlegm obstruction, such as mental dullness and loss of interest. This mostly correlates with stage 2 Yu syndrome.
• Mood-Uplift Formula – Heart Qi & Blood deficiency with Phlegm obstruction: depressed mood, severe fatigue, loss of interest, clouding of consciousness. This formula is similar to the above formula (Mood Uplift 2 Formula) but is used for more severe presentations. This correlates with stage 3 Yu syndrome.
• Ban Xia Hou Po Tang – Jia Wei (Pinellia & Magnolia Combination) – Lung Qi and Heart Qi stagnation with Phlegm: anxiety, throat obstruction, sighing, chest oppression. This formula may be used on its own or combined with one of the above ‘Mood Uplift’ formulas where there is significant presence of Phlegm, with mental dullness and loss of interest together with symptoms of sputum in the throat, productive cough without any signs of infection, and a stifling sensation in the chest. This correlates with stage 3 Yu syndrome.
• Wen Dan Tang (Bamboo & Hoelen Formula) a.k.a. Clear the Phlegm Formula – Phlegm obstruction: insomnia, clouded consciousness, extreme irritability. This formula is mostly used together with one of the other formulas when there are signs of Phlegm, with clouding of consciousness, emotional volatility, insomnia, nausea, excessive sputum, and the tongue coat is thick and greasy. This correlates with stage 3 Yu syndrome.

Fear

Under this heading we also include the associated emotions of anxiety, apprehension and sudden severe fright, all of which affect the Kidney and Heart. In addition, deficiency conditions of the Heart, Spleen, Liver and Gallbladder may result in susceptibility to fear with lack of courage and low self-esteem.  

Initially, the emotion of fear may cause the Qi to descend, with loss of control over the bladder, weakness of the legs, etc. However, when patients have been experiencing some degree of fear over a prolonged period, the Qi will tend to rise, due to the development of Kidney Yin deficiency with deficiency Heat. This generally manifests with Kidney-Heart disharmony, which is a pattern where the Kidney and Heart lose their normal harmonious interaction, as discussed in Part 2. This is a common pattern in chronic anxiety disorders, with symptoms of over-excitability and hyperactivity: anxiety, racing thoughts with inability to concentrate, severe insomnia, loss of focus and self-control, accompanied by physical signs such as palpitations, night sweats, oral ulcers, tidal fever, red tongue without coating, and a thread-rapid pulse.

Patients may become more susceptible to fear and experience chronic or intermittent anxiety when there is Blood deficiency affecting the Liver and/or Heart together with Qi deficiency that affects the Spleen and/or Gallbladder. These conditions may arise or become worsened due to physical causes such as poor diet, over-work or over-training, studying for long hours, together with predisposing constitutional factors.

Chinese herbal formulas for fear and related emotions

• Tian Wang Bu Xin Wan (Ginseng & Ziziphus Formula) a.k.a. Calm the Spirit Formula – Kidney-Heart disharmony with Yin deficiency Heat: chronic anxiety or tendency to be easily startled or frightened. This formula is used in cases with various types of anxiety (e.g. generalized anxiety, post-traumatic stress) with insomnia, palpitations, night sweats, and a red tongue with little coating. This correlates with stage 4 Yu syndrome.
• Gui Pi Wan (Ginseng & Longan Combination) a.k.a. Restore The Spleen Formula (Gui Pi Tang) – Heart Blood and Spleen Qi deficiency: chronic anxiety, mixed depressed mood and anxiety, tendency to be easily startled or frightened. The clinical applications for this formula are very similar to those for Tian Wang Bu Xin Wan, above. However, they occur against a background of Qi and Blood deficiency, rather than Yin deficiency. The patients also show the following signs: fatigue, muscular weakness, poor appetite, palpitations, forgetfulness, pale tongue with a thin white coat, weak and thready pulse. This correlates with stage 2 Yu syndrome.
• An Shen Ding Zhi Wan (Ziziphus & Polygala Formula) – Heart Qi and Blood deficiency with insomnia and over-excitement. This formula is used in patients with a predominant deficiency of the Qi (with pale complexion, fatigue, muscular weakness, poor appetite and a weak pulse). This formula assists in calming the mind and emotions in patients who become over-excited very easily with minimal stimulation. Such patients are constitutionally predisposed to over-reacting and tend to manifest features of stage 2 Yu syndrome without necessarily having gone through a period of stage 1 Liver imbalance.
• Jin Gui Suan Zao Ren Tang (Ziziphus Combination) – Heart and Liver Blood deficiency: anxiety, timidity (see also above, under ‘Anger’). This formula is used when the pattern is predominantly Blood deficiency, with palpitations, forgetfulness, postural dizziness, thready pulse and a dry tongue. This formula may also be used in patients with constitutional weakness of the Liver and Heart, which predisposes them to anxiety. The predominant personality feature in these people is a lack of courage, leading to a timid disposition. As with the above formula, the initial response to emotional strain in these cases may manifest stage 2 Yu syndrome.

Happiness

Although enduring happiness is a profound ideal, it is very common for people to seek various types of stimulation in the misguided pursuit of this ideal. Happiness becomes pathogenic when it devolves into mental-emotional over-stimulation, together with unrestrained desires for personal gratification. According to TCM (and also most of the world’s great religions and philosophies), the effects of over-excitement, cravings, and excessive mental stimulation are destructive. Unfortunately, modern social pressures tend to drive this approach to living. For the purposes our discussion, these types of mental and emotional stimulation are referred to as pathogenic happiness.

Pathogenic happiness has the effect of slowing the Heart Qi (i.e. dulling the mind and weakening the discriminatory faculties). It also unsettles the Spirit and ‘deprives’ it of its place of residence (i.e. one may lose one’s center, integrity, personal values etc.). This may lead Heart Qi deficiency, manifesting with palpitations, forgetfulness, tendency to be easily frightened or startled, difficulty in falling asleep, together with other signs of Qi deficiency such as general fatigue, muscle weakness, poor appetite, pale tongue and weak pulse.

An additional effect of unrestrained cravings and desires is to produce pathogenic Fire in Heart, which may lead to the patterns of Heart Fire (in a person of robust constitution), or Heart Yin deficiency Heat (in a person of deficiency constitution).

The above pathological changes may readily be transferred to the Lung, leading to Lung Qi deficiency and the development of Phlegm, which obstructs the Lung as well as the Heart (with clouding of consciousness, loss of interest and delusional thinking). In this way, over-stimulation and habitual excitement seeking behaviour may eventually lead to burnout. Thus, we may see the progression of an excess type syndrome, such as Heart Fire, develop into Heart Yin deficiency with deficiency Heat. In addition, a deficiency syndrome, e.g. Heart Qi deficiency or Heart Yin deficiency, may progress to a mixed deficiency-excess pattern with the development of Phlegm and Phlegm-Heat. Thus, there may be two different types of clinical presentation associated with the effects of pathogenic happiness: the highly-strung, nervous and talkative patients on the one hand, and the depressed, gloomy, and reticent patients on the other.  

Chinese herbal formulas for pathogenic happiness and related emotions

• An Shen Ding Zhi Wan (Ziziphus & Polygala Formula) –  Heart Qi and Blood deficiency: insomnia and over-excitement. (see also above, under ‘Fear’) This formula assists in calming the mind and emotions in patients who become over-excited very easily against a background of Heart Qi and Blood deficiency. Key signs include forgetfulness, poor concentration, pale tongue and a weak-thready pulse. Such patients are constitutionally predisposed to over-reacting and tend to manifest features of stage 2 Yu Syndrome without necessarily having gone through a period of stage 1 Liver imbalance.
• Mood-Uplift Formula – Heart Qi & Blood deficiency with Phlegm obstruction: depressed mood, severe fatigue, clouding of consciousness and loss of interest (see also above, under ‘Sadness’). This formula is appropriate for treating the burn-out stage after a period of over-excitement. This correlates with stage 3 Yu syndrome.
• Huang Lian Jie Du Wan (Coptis & Scute Formula) a.k.a. Antitox 2 Formula – Heart Fire (excess pattern): overexcited behavior, e.g. excessive (i.e. out of character) talking and laughing, emotional volatility, irritability, insomnia. This formula treats excess patterns in patients with a robust constitution. Key clinical features are: absence of fatigue, ruddy complexion, red tongue with a yellow coat, forceful-rapid pulse. This correlates with stage 2 Yu syndrome.
• Tian Wang Bu Xin Wan (Ginseng & Ziziphus Formula) a.k.a. Calm the Spirit Formula – Heart deficiency Fire with Heart-Kidney disharmony: anxiety, insomnia, irritability, over-excitement (see also above, under ‘Fear’). This formula is used in patients with Yin deficiency together with signs of hyperactive Yang. Although the clinical symptomatology is similar to the previous formula, Huang Lian Jie Du Wan (Coptis & Scute Formula), they occur against a background of deficiency. Key features include anxiety, forgetfulness and inability to concentrate, night sweats, scanty or absent tongue coat and a thready pulse. This correlates with stage 4 Yu syndrome.
• Gan Mai Da Zao Wan – Jia Wei (Wheat & Jujube) – Heart Qi, Blood and Yin deficiency: overwhelming emotional responses, emotional instability. This formula is mainly used for treating emotional states that are overwhelming; patients are unable to control the mental and physical effects of their feelings. It is used in deficiency conditions, with key symptoms of emotional instability, fatigue, insomnia, palpitations, night sweats, weak and thready pulse, pale tongue or a red tongue with very little coating. This condition may either develop through progression from stage 1 of the Yu syndrome, or patients may be constitutionally predisposed to over-reacting and manifest features of stage 2 Yu syndrome without necessarily having gone through a period of stage 1 Liver imbalance.
• Gui Pi Wan (Ginseng & Longan Combination) a.k.a. Restore the Spleen Formula (Gui Pi Tang) – Spleen Qi deficiency with Heart Blood deficiency out (see also above, under ‘Fear’): burn-out. This formula may also be used in patients who have exhausted themselves through over-excitement and over-stimulation. The TCM pattern is deficiency of both the Qi and the Blood, with anxiety or depressed mood, insomnia, forgetfulness, fatigue, poor appetite, palpitations, a pale tongue with a thin white coat, weak-thready pulse – compare with Tian Wang Bu Xin Wan (Ginseng & Ziziphus Formula), above. This correlates with stage 2 Yu syndrome.

Pensiveness and Worry

This category includes psychological states with a mixture of thinking and feeling that have a repetitive nature. These states are epitomized by the concept of obsession, where one feels compelled to continue thinking about a certain subject way past the point where such thinking may be useful or productive. Thus, we include over-thinking, worrying and nostalgia as the pathogenic states that relate to the Earth element. For convenience, these states will be referred to as ‘obsessions’.

Obsessions have two main effects. Initially they may cause Qi stagnation, as the emotional responses to the external environment become blunted. Over time, obsessional thinking and the associated fixation on a single emotion may lead to exhaustion of the Qi and Blood, with Spleen and Lung Qi deficiency on the one hand, and Heart and Liver Blood deficiency on the other. These deficiency conditions may be complicated by the continued presence of Qi stagnation and Phlegm as the obsessions continue.

Patients may present in two ways. On the one hand, there a those who intellectualize obsessively and tend to over-think their way through life, with a consequent lack of emotional awareness. On the other hand, patients may complain of a loss of mental clarity with decline in memory and concentration, possibly together with a depressed mood.

Chinese herbal formulas for pensiveness and related emotions

• Gui Pi Wan (Ginseng & Longan) a.k.a. Restore the Spleen Formula – Spleen Qi deficiency, Heart Blood deficiency (see also above, under ‘Fear’ and ‘Happiness’): mind weakened, aimless thinking, insomnia. This formula may be used in patients with mental and physical fatigue following a period of intensive mental activity. Characteristic symptoms include a sense that the mind has become weakened, forgetfulness, poor concentration, depressed mood and/or anxiety, insomnia. This correlates with stage 2 Yu syndrome.
• Ban Xia Hou Po Tang – Jia Wei (Pinellia & Magnolia) – Heart-Lung Qi stagnation with Phlegm (see also above, under ‘Sadness’): mind ‘obstructed’.  This formula addresses the stagnant Qi and Phlegm, which are the pathophysiological counterparts of worry and obsession. Here there is a sense that the mind is obstructed, as opposed to weakened. There is a lack of mental clarity, irritability, despondency and possibly also a vague sense of anxiety. There are also signs of poor appetite (or lack of a sense of feeling hungry), thick and/or greasy tongue coat and the pulse is slippery. This correlates with stage 3 Yu syndrome.
• Peaceful Sleep Formula (An Shen Ning Ye Fang) – deficiency of the Heart Qi and Blood with Liver constraint: insomnia. This formula has a calming action on the mind and may be used for patients in whom the Heart Qi and Blood have become depleted due to excessive mental stimulation, resulting in insomnia. Generally, the mind is not pondering any particular topic but simply continues its activity without any specific purpose. This correlates with stage 2 Yu syndrome. In patients with signs of Phlegm (irritability, thick and greasy tongue coat; stage 3 Yu syndrome), combine with Wen Dan Tang (Bamboo & Hoelen) a.k.a. Clear the Phlegm Formula.
• Mood-Uplift 2 Formula – Heart Blood deficiency, Liver constraint, Phlegm obstructing the Heart: mind weakened and also obstructed. This is for patients who due to long term worrying, obsessive thinking or other mental pre-occupation, show signs of loss of mental clarity, fatigue, depressed mood and/or anxiety. This correlates with stage 3 Yu syndrome.

Concluding remarks

In presenting this material, over the course of three articles, I am aware of the ever-present danger that we may ‘not see the forest for the trees’. It is very tempting to reduce human experience, and specifically human problems, to purely physical causes, in the mistaken belief that it is possible to gain an objective viewpoint, from which may be derived an objective truth. However, while we can be either more objective or less objective, but we can never be completely free from our own subjectivity. (Reid, 2015) To be specific, each of us is wholly and completely immersed in our own mind, with its unique history of experiences, prejudices, needs, desires and blind spots. To be sure, there are common human experiences, desires, aspirations and a shared belief in the goodness of things, such as life, love, health, happiness, fulfilment, practical knowledge, etc. However, ‘the devil is in the detail’, and when we closely examine any specific item, we find an overwhelming degree of subjectivity that separates an individual from all others. ‘One man’s meat is another man’s poison’, as the popular saying goes.

There are three main points that come out of these considerations, and they should provide a suitable context as well as the guiding principles for the application of the TCM therapies discussed above. Firstly, we must always remain aware that the mental is no less an influence than the physical on overall health and well-being. Therefore, therapy should be psychological as well as physical: your patient needs to ingest your wholesome ideas and healing perspective, in addition to receiving the correct herbal medicines. Secondly, that each individual is unique and has different needs. From a psychological point of view, these needs can be classified as deficiency needs and growth needs. We need to ask, ‘what does this person need in order to provide him with a solid foundation to function effectively and happily in his present situation?’ and ‘what does this person need in order to grow and continue to grow, possibly without any regard for the external components of his current life?’

Finally, we need to have a clear idea of the overall purpose of the therapy. Do we wish to follow the Western medical model and treat our patients’ distress as an annoying impediment that must be removed, so that they may happily continue ‘business as usual’? Or do we regard the mental-emotional suffering of patients as a sign of something deeper, possibly requiring a change of attitude, values, orientation and direction in life? In the second case, treatment should serve the twin purposes of providing a measure of relief, together with a renewed sense of balance and inner strength, from which patients may gain a broader and deeper perspective on their lives. In this way, treatment facilitates patients’ learning about themselves, so that they may move past their problems and begin to live more in line with their true nature. The TCM paradigm highlights the role of stagnation of the patient’s Qi as the source of disease and suffering. It stresses the importance of removing the obstacles to free movement of the Qi, in order to restore a dynamic state of health. Applied to the mental and emotional sphere, we can regard all of the psychological problems that have been discussed above as various types of stagnation of the patient’s Qi (i.e. life force). The aim of treatment is to restore movement (i.e. personal growth) by assisting patients to find a new centre, and recognise the roots of their dysfunctional emotional reactions. In other words, we can use TCM to help patients find their Shen.

REFERENCES and BIBLIOGRAPHY

Breggin, P. (2001). The Anti-Depressant Fact Book. Cambridge, MA: Da Capo Press

Cleary, T. (1991) (a). The Secret of the Golden Flower – The Classic Chinese Book of Life. San Fransisco: Harper Collins.

Cleary, T. (1991) (b). Vitality, Energy, Spirit A Taoist Sourcebook. Boston: Shambala

Glenmullen, J. (2000). Prozac Backlash. New York: Simon & Shuster.

Goleman, D. (1994). Emotional Intelligence: Why It Can Matter More Than IQ.

New York: Bantam Books

Horowitz, A., Wakefield, J. (2007). The Loss of Sadness: How psychiatry transformed normal sorrow into depressive disorder. New York: Oxford University Press

Kaptchuk, T. (2000). The Web That Has No Weaver: Understanding Chinese Medicine. Chicago: McGraw-Hill Professional

Kübler-Ross, E., Kessler, D. (2005). On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages of Loss.  New York: Scribner (Simon & Schuster, Inc.)

Maciocia, G. (2009). The Psyche in Chinese Medicine. Edinburgh: Churchill Livingstone Elsevier

Reid, T. (2012). ChinaMed Capsule Range Clinical Guide (5th Edition). Sydney: Sun Herbal Pty Ltd

Reid, T. (2015). The Limitations and Misuses of Evidence-Based Medicine: A Critical Evaluation of EBM in Orthodox and Complementary Medical Contexts. The Natural Therapist. 30(1): 25-40