Manic Depressive Psychosis in TCM

Continuing with my TCM series in mental illness, the next case I'd like to write about is Manic Depressive Psychosis.  Called Dian Kuang (癲狂) in Chinese, manic depressive psychosis is a bipolar disorder with mood swings that change between depression and mania.  Dian, the depressive disorder, is caused much the same way as the previous article I wrote.  It's characterized by restrained, non-violent behavior.  Kuang, the mania disorder, is caused by phlegm fire of just fire disturbing the Heart.  It's characteristics are the opposite of Dian, having mental hyperactivity and more violent behavior.  They are two parts of a single disorder and relate closely to Yin and Yang.  Just as everyone is different, the disorder affects those who have it differently than others.

While Dian Kuang is caused by emotional, physical, and congenital factors, much like depression, it is closely linked to the balance of Yin and Yang.  Depending on which is in excess, that will decide which symptoms will show more.  An excess of Yin will cause Dian, due to its inward, holding nature.  An excess of Yang will cause Kuang, due to its outward, active nature.  It should be worth noting that this is not something that happens overnight.  Our body's Yin and Yang fluctuate daily to regulate our daily life and normally manifests stress as a warning to an imbalance.   Manic depressive disorder can happen through severe, long term untreated stress, severe trauma to the brain, congenital genetic issues, or a mixture of the three.

Emotional factors are based on the emotions of the 5 Elements (Anger, Joy, Worry, Grief, and Fear).  Too much of any of these emotions (or similar) will manifest stress and cause (Liver) Qi Stagnation.  Eventually, without help and stress relief, this leads to Heart Spleen Deficiency.  While Dian manifests as mild depression symptoms in the beginning, they eventually become much more severe with the Yin Yang imbalance.  Disturbed thoughts last much longer and are more pronounced, crying spells and panic attacks happen much more frequently, and speech is almost incoherent.

Physical factors include head injury that cause Qi and Blood stagnation/stasis.  This obstructs the blood flow to the brain and disrupts normal functions between the brain and body.  Without treatment to clear the stagnation, the condition could eventually regress to manic depressive disorder.  The treatment itself depends on the nature of the injury.  You could use any type of formula that moves Qi and Blood, and stops pain.

Congenital factors include people with a family history of Manic depressive behavior or constitutional weakness.  They are more susceptible to the disorder and are more difficult to treat when it reoccurs.  Even the slightest change to Yin and Yang from the environment could trigger symptoms, so proper management and counseling is very important.

Dian and Kuang need to be treated separately when they appear, so you don't further imbalance the body.  While Dian symptoms manifest with excess Yin, there's usually a deficiency that accompanies it.  So, formulas that tonify help more in that case.  When Kuang symptoms manifest with excess Yang, there's more hyperactivity, so you would use reducing formulas instead.  If done in reverse, reducing Dian or tonifying Kuang, it will make them worse.

For Dian in the early stages of emotional problems, you can use the formula Xiao Yao Wan to help keep the Liver Qi flowing.  Obviously, it won't stop the cause of the stress, but it will help to make the stress less debilitating to the body.  This is a prevention method to lower the chances of the stagnation making things worse over time.  Once the cause of the stress is gone, the body should begin  regulating itself again.  

If things do progress further into Heart and Speleen deficiency, the normal treatment course is to use Ren Shen Yang Ying Tang, Yang Xin Tang, or Gui Pi Tang with the addition of Gan Mai Da Zao Tang.

When Kuang manifests, you need to reduce the amount of Fire (aka. heat disturbing the Heart).  There are two common reasons for the fire.  One is Phlegm Fire and the other just Fire itself.  Either way, the Shen (spirit) is disturbed from heat and needs to be calmed.  For Phlegm Fire,  the formula Meng Shi Gun Tan Wan helps break up the phlegm and drain the heat.  For just Fire itself, the formulas Er Yin Jian and Ding Zhi Wan are used.

For the treatment principle, you need to focus on readjust and restoring Yin Yang balance.  Without it, Dian and Kuang will continue to manifest.  Phlegm is also considered to be one of the major factors for causing Kuang and it needs to be cleared..  While transforming phlegm to remove it from the body, you need to talk to the patient about preventing it from accumulating again.  Without learning how to manage stress, reducing the factors that cause stress, and eating and sleeping properly, phlegm will just come back and cause a relapse.

Acupuncture can also be used for Dian Kuang, but it requires someone very proficient in needle manipulation.  You need to use the Even (regulating) method when in the Dian phase and Reducing in the Kuang phase.  If the manipulation is not done properly, the Dian or Kuang can become worse.  Just the like formulas, tonification points work well in Dian and reducing points work well in Kuang.

I hope you enjoyed this article and it helps you become more aware of how stress makes everything more complicated.  Stress can, literally, kill, so learning prevention methods can help both you and the people who know and love live longer, happier lives.

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Information contained here was referenced from:
Shi, Anshen, Shih-Shun Lin, and Leigh Caldwell. Internal Medicine. 1st ed. Walnut, Calif.: Bridge Pub. Group, 2003. Print.

The information written here is not intended to diagnosis or treat Manic Depressive Disorder or related conditions.  The formulas mentioned are not FDA approved and are not meant to cure, diagnosis, treat any specific condition.  Please speak a licensed health professional for any medical advice pertaining to mental illness.

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