With the rising incidence of depression and the increasing recognition of depression by clinicians, as well as the increasing demand for TCM treatment by depressed patients, research on the evidence and treatment of depression in TCM is expanding. However, some issues have emerged in theoretical and clinical research that need to be re-conceptualized. Among them, whether depression can be classified as “depression evidence” in TCM, the pathogenesis and treatment of depression, etc. are becoming hot spots and difficulties in TCM research on depression.
I. Depression cannot be equated with depression
(a) Depression and depression evidence are different. Some doctors and researchers believe that depression should be classified as “depression evidence”. Throughout the recent years, most of the TCM literature on depression, especially the postgraduate dissertations, classify depression as a category of yu-zhi. In turn, depression research has been conducted by drawing on theories and clinical research literature.
A careful analysis of the characteristics of depression and the clinical findings reveals that the two are actually different. The textbooks of the sixth and seventh editions of Internal Medicine in Chinese Medicine give the same definition of depression as follows: “Depression is a type of illness caused by emotional discomfort and qi stagnation, with depression, emotional restlessness, fullness in the chest, distension and pain in the ribs, or irritability and crying, or obstruction of foreign bodies in the throat as the main clinical manifestations.” From the symptoms described, most of the symptoms of depression belong to “hysteria” and “neurosis”.
Combined with clinical observations, the description of symptoms of depression in Chinese medicine should also be diagnosed as “hysteria” and “neurosis”. The corresponding treatment method as well as prescriptions such as prolotherapy, Danjuania prolotherapy, Chaihu sparing the liver, Yueju pill, etc. are also clinically more effective in treating “hysteria” and “neurosis”. This has been verified by clinical practice, and some physicians engaged in psychiatric clinical practice also have the same experience.
(Depression is characterized by persistent depressed mood, of which low energy, lack of motivation, and easy fatigue are its prominent features and core symptoms; this is basically not available in depression. In addition, clinical manifestations such as psychomotor retardation, self-blame, decreased ability to live, and suicide also do not occur in patients with depression. In particular, it is difficult to find clear records of light-heartedness and suicide in the common TCM literature on “depression” from ancient to modern times.
In short, depression is characterized by “laziness”, “dullness”, “change”, “worry”, “anxiety” and “lack of passion”. The clinical manifestations of lack of passion such as “worry” and “concern” are the main evidence, obviously, depression and depression should not be confused.
(3) The name of the disease does not need to be borrowed from “yu zhi”. There are fundamental differences between depression and yu zhi in terms of clinical manifestations. The confusion of concepts will only hinder the understanding of the dangers of depression and affect the research on the prevention and treatment of depression. Therefore, it is suggested that the name “depression” should be directly used as the name of the disease in TCM clinical and research, which will be consistent with the diagnosis and efficacy of Chinese and Western medicine, and will not only standardize but also facilitate academic exchange, but also avoid unnecessary confusion can be avoided.
(4) The causes of depression and depression are different Mental stimulation and emotional disorders may be the same as depression. However, a deeper analysis will reveal that there are differences between them, and they are very different. The etiology of depression is recognized in the textbook “Internal Medicine in Chinese Medicine” as “The etiology of depression is always due to the injury caused by emotions, and the pathogenesis is most closely related to the liver, followed by the heart and spleen, and the main etiology of depression is the loss of drainage of the liver, the loss of health of the spleen, the loss of nourishment of the heart, and the imbalance of qi and blood in the internal organs.”
There are three scenarios of depression, endogenous and exogenous, as well as secondary. Endogenous depression can have no obvious cause; exogenous depression is often associated with negative life events, and mental and emotional changes, which are usually referred to as etiology, are only a causative factor; secondary depression is caused by illness, and at this point Zhang Jiebin’s academic view of “depression caused by illness” can be drawn upon. Therefore, depression is obviously different from depression in terms of etiology.
II. Analysis of the etiology and pathogenesis of depression
Since there is no evidence corresponding to depression, there is no more consistent or similar content to draw on in terms of etiology and pathogenesis. Although the research on depression in Chinese medicine is being widely carried out, there is no consensus on the understanding of the pathogenesis of depression. Therefore, the etiology and pathogenesis of depression need to be carefully analyzed and studied in order to continuously deepen the understanding and gradually reach a consensus.
Depression is a multifactorial and multi-manifest disease syndrome. Among the prominent clinical manifestations, low energy, lack of motivation, and easy fatigue are the core symptoms; at the same time, psychomotor retardation, self-blame, decreased ability to live, sleep disorders, diet and weight changes, and suicide occur. The above clinical manifestations are mainly recognized in terms of the heart and mind and Yang Qi lesions.
(a) Depression is located in the heart and brain The heart is the master of the mind, and the brain is the house of the spirit. It is the place where the spirit and consciousness come out. The “Spiritual Pivot” says: “So the person who is in charge of things is called the heart, the heart has a memory is called the intention, the intention is stored is called the will ……”. Su Wen – six sections of the hidden elephant theory said: “the heart, the essence of life, the change of God also. The mind is in the heart, and change comes from the heart. Depression, low mood, lack of energy, fatigue and lack of desire, is precisely the heart is not the master of the order, the image of the Shen Qi is not revitalized. Therefore, it is said that depression is located in the heart, often involving other organs, manifested in the Shen Qi is not invigorated, or even the Shen Qi is decrepit, the shape of the gods is not normal.
The heart is the sun of Yang, which is connected to the summer qi, and is the master of the whole body. Yang Qi is the master of warmth and longevity, inspiration, warmth and light, and is the embodiment of vitality. Therefore, “Su Wen – angry Tong Tian Lun” said: “Yang Qi, essence is to nourish the spirit, soft is to nourish the tendons”.
(2) Yang depression is the basic pathogenesis of depression. All kinds of vital activities of human body need the inspiration of Yang Qi, and these activities can be summarized by the word “Shen”. The reason why people can be invigorated, glowing and vibrant is the prosperity of Yang energy. As “Su Wen – angry Tong Tian Lun” said: “Yang Qi, if the sky and the sun, lost its place, it will be broken life and not manifest, so the sky when the day bright, Yang thus up, for the outside of the guard also”. Yang Qi is active, depression patients show “lazy”, “dull”, “worried” are Yang Qi depression can not be developed.
In short, the main mechanism of depression is that Yang is depressed and not reached, and the spirit is decrepit. Yang depression does not reach, lose its warmth, encouragement, warmth, brightness, that is, the depression of the clinical see.
(3) Yang Qi is depressed and closed for a long time, and there are many changes in the initial stage of depression, and Yang depression is the main and basic pathological change. But the depression disease for a long time, qi depression is not resolved, the changes from qi and blood, affecting the internal organs of qi, can lead to phlegm, stagnation of blood, qi, phlegm, stagnation, the most heat into fire pathological changes. The stagnation of phlegm, stagnation of blood and stagnation of phlegm can easily become the arena of heat and depression, and it is difficult to get rid of the knotting of all the evils quickly, resulting in a long-lasting depression, always based on Yang depression.
In conclusion, the etiology and pathogenesis of depression are different from that of depression, and should not be confused. It is necessary to explore the pathogenesis of depression according to its clinical manifestations, and the appropriate part of the theory of depression can only be borrowed, but not copied.
Innovative ideas and difficulties in the treatment of depression
Guided by the theory of yang qi in Nei Jing and closely combined with the pathogenesis of depression, we have created a major method to promote yang to open the depression and invigorate the spirit, forming the basic idea of depression treatment.
(Based on the understanding of the pathogenesis of depression as Yang depression and Shen decay, we studied and understood the academic thought of “The Treatise on Typhoid Miscellaneous Diseases” and the composition of scripture prescriptions, tried to use scripture prescriptions to treat depression, and formed a series of evidence and treatment of the treatment of Yang depression to cope with depression clinical.
(II) Difficulty in treating depression and relapse The problem of difficulty in treating depression is the core of the clinical cure, mainly due to the lack of clinical understanding of depression by patients as well as physicians, and also related to patients’ inability to adhere to medication or difficulty in adhering to long-term use of herbal tonics.
(3) Relapse is a common clinical problem in depression Inadequate treatment course is the key, and inconvenience of dosage form is also an important influencing factor, and the physician’s knowledge and clinical guidance of depression treatment course is especially important. It is important to strengthen clinical health education and research on suitable dosage forms has become a clinical need.
(About 10% of depressed patients will have clinical changes of transient mania, or alternating depressive and manic episodes, i.e. bipolar disorder, which has become one of the hot spots of clinical research. The understanding of the pathogenesis of the transformation of epileptic and manic evidence and its evidence and treatment experience can be drawn from depression to mania and bipolar disorder. Among them, the most important thing is that in the treatment of depression, we should not use too much hot and pungent products to prevent them from turning into heat and depression into mania. Once it turns to agitation, the advantages of TCM theory and prescriptions should be fully utilized to regulate both yin and yang, but both diarrhea of fire and determination of will and the promotion of yang to open depression should be moderate.
(E) Pay attention to the research and treatment of somatic symptoms of depression Somatic symptoms are common and sometimes may be the main clinical manifestation of depression, among which painful somatic symptoms are the most common. The severity of pain of somatic symptoms, especially painful somatic symptoms, is closely related to the prognosis of depression. Therefore, the treatment of somatic symptoms should not be neglected, and the improvement of somatic symptoms can improve the cure rate of depression.
(F) Exploring the pathogenesis and treatment of somatic symptoms of depression from both the form and the spirit of disease. According to the theory of Chinese medicine related to form and spirit, fully understand the relationship between mental and psychological symptoms and somatic symptoms of depression patients, bring into play the characteristics of Chinese medicine theory and prescriptions, and gradually form the method and rule of treating depression with form and spirit.
(7) Major depression needs to be studied more seriously Major depression is a difficult point of clinical treatment. Patients’ lack of energy and incompetence in life are more common, and the pathogenesis is complex, but the basic characteristics are paralysis and depression of yang energy and vagueness of the divine mechanism, so it is worth exploring further how to invigorate yang energy and activate the divine mechanism. At this point, the combination of Chinese and Western medicine is indispensable.