Severe mood swings...

May 21, 2004

Good Afternoon May,

What a wonderful case you have! There is a tendency among depression patients

not to seek treatment even though they know they need treatment. So, this case

is a God-send. Do hold on to this one until she gets better.

While I can't consider myself an expert on depression yet, I did have success

with a few depression patients before. Let me start sharing my experience with

you by sharing the points that I have used and the my logic behind them. If all

of you out there have comments, please don't hesitate to post them.

Given the symptoms that you've described, it sounds like this patient is

suffering from a mix of the excess liver and deficient spleen. For acupuncture

treatment, the points should change depending upon the patient's mood at the

time she walks into the clinic. If her symptoms leans more toward extreme

anger, crying, and being belligerent. SP 9 and ST40 are very good points to

start along with Liv 3. Liv 3, as you already know, can release the anger by

circulate the liver qi stagnation. SP 9 and ST40 are here mainly to break up

the phlegm/dampness which builds up as a result of spleen deficiency. The

phlegm/dampness here frequently contributes the anger. From my personal

observation, by relieving the patient of her phlegm, these 2 points alone can

also bring the patient back to her senses in addition to tonifying the spleen.

Add these points to the Du 20, Yin Tang, and GB20 that you are already using,

you should be able to see some noticeable changes immediately after

treatment. This is, of course, assuming that you are accurate in hitting those

acupoints where they are, which is crucial in any effective acupuncture

treatment.

GB41 may be useful here as well. Based upon my experiences, it is my suspicion

that a depression patient that expresses extreme anger has an imbalance, but the

imbalance between the spleen and the liver is not the most important. It is the

imbalance of her wood element, i.e. between her liver and gall bladder, that

would be the greatest concern. My observation has been excees liver

accompanying deficient gallbladder. My observation seems to indicate that

cowardice, however it is manifested, maybe one of her personality traits. As

much as she is unhappy with her situation, she may also seem complacent to her

situation, because she lacks the courage to take on whatever that's making her

life miserable. This would explain the excessive anger (excess liver) and

inability to face her challenges (deficient gallbladder). If that is indeed her

case, do add this point to the treatment.

If the patient's symptoms is leaning more toward being down, not able to

concentrate, tired, negative, and being forgetful, it is a good assessment that

the qi deficiency symptoms are more prominent in this patient. The goal here is

to lift her qi so that her qi can circulate upward. In this case Du 10, Du 11,

and/or Du12 are good points to use in addition to Du 20. Check these points and

see if she feels soreness in any of the three. Usually 2 of these 3 points will

do well to allow qi to circulate to the head. Accompany these points with UB23,

UB20, and SP 6, and SP10, you should see results when she leaves the clinic

after treatment. UB19 is a good point to use for building courage.

Incidentally, the Chinese concept for courage depends on how much " gall " one

has. How effective and consistent is it? All I can say for now that it can be

effective, but the consistency needs more observation.

UB13 and UB17 can also be a great, maybe be crucial, combination in that

together they strengthen the lung qi by allowing patient to have greater

capacity to breath " in " air. Furthermore, since lung belongs to the metal

element, strengthening it is useful to counter the excess liver which is the

wood element.

That's all for now. I hope you will find these points useful.

Sincerely,

Ming H. Lee, MPH, L.Ac.

May Lucken <maylucken wrote:

Hi everyone!

I would like to have your advices about one of my patients.

She is 33 and has quite severe mood changes.

When she is very down, she won't be able to concentrate, will be very tired,

very negative, very very sad, cries a lot or be completely indifferent to

everything around her, her memory would be very bad, she will get forgetful.

Then suddenly she would have bouts of extreme anger.

She has a history of some sort of abuse as a child, but hasn't really talked

about it in any details;

Her mood change, are related to some memories from the past but not only.

She often lies in bed unable to fall asleep for a long time. (though that is

nearly gone after 3 acupuncture sessions)

She often is constipated (3-4 days without bowel movement, and recently that

comes back to normal for 2 days after the acupuncture session and stops

again);

Apart from that she suffers often from hemorrhoids and candida infections.

Her tongue has very marked tooth-marks, but isn't really very swollen.

As I said I have seen her 3 times. She always feels well for about 2 days

after each treatment; and then goes down again.

Some of the points I have been using are Liv2 through to liv 3, P6, Ht 7. St

36 (+ moxa), Sp 6, Yin tang, GB 20, Du 20 (+ moxa), some Ren channel points,

mainly with some variations.

She is refusing to take herbs as decoction as she says I once made her

really unwell; so I have been giving her Bu Zhong Yi Qi Tang is the morning

and She Gan Wan at midday and evening as tablets.

The problem is that by feeling better for a couple of days when she then

feels bad again the disappointment is hard to take for her.

Any advice?

Thanks

May

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May 21, 2004

Hi May,

From a non-TCM perspective and from personal experience of similar

symptoms I would guess your patient may have an eating disorder.

Although I am not a practitioner, a lot of the TCM books I have read

suggest that diet should be addressed in conjunction with needle

treatment for a full TCM approach. I wonder if this could be checked

or addressed complementary to the acupuncture treatment.

Caroline

Chinese Medicine , May Lucken

<maylucken@q...> wrote:

> Hi everyone!

> I would like to have your advices about one of my patients.

>

> She is 33 and has quite severe mood changes.

> She often lies in bed unable to fall asleep for a long time.

(though that is nearly gone after 3 acupuncture sessions)

> She often is constipated (3-4 days without bowel movement, and

recently that comes back to normal for 2 days after the acupuncture

session and stops again);

> Apart from that she suffers often from hemorrhoids and candida

infections.

> >

> As I said I have seen her 3 times. She always feels well for about

2 days after each treatment; and then goes down again.

> The problem is that by feeling better for a couple of days when she

then feels bad again the disappointment is hard to take for her.

>

> Any advice?

>

> Thanks

>

> May

May 21, 2004

May,

Have you determined a TCM pattern and Tx principle? It looks like you're going

for Lr

Depression Qi Stagnation with Sp Vacuity/Deficiency.

Why did you select Bu Zhong Yi Qi Tang?

You've left out some possibly key differentiations on determining if, for

example,

there is Blood pathology (stasis, vacuity/deficiency) or Phlegm, both of which

can be

implicated in mood disorders. What are her menstrual periods like? Any phlegm

sx,

dizziness, etc? What is her pulse quality?

You also didn't mention how long she's had the mood swings, and what might

aggravate or relieve the condition.

If you're certain of your diagnosis, then another thing to consider is dosage --

you

might increase the formula for a period of time and see if the condition

responds.

robert hayden

Chinese Medicine , May Lucken

<maylucken@q...> wrote:

> Hi everyone!

> I would like to have your advices about one of my patients.

>

> She is 33 and has quite severe mood changes.

> When she is very down, she won't be able to concentrate, will be very tired,

> very negative, very very sad, cries a lot or be completely indifferent to

> everything around her, her memory would be very bad, she will get forgetful.

> Then suddenly she would have bouts of extreme anger.

>

> She has a history of some sort of abuse as a child, but hasn't really talked

> about it in any details;

> Her mood change, are related to some memories from the past but not only.

>

> She often lies in bed unable to fall asleep for a long time. (though that is

> nearly gone after 3 acupuncture sessions)

> She often is constipated (3-4 days without bowel movement, and recently that

> comes back to normal for 2 days after the acupuncture session and stops

> again);

> Apart from that she suffers often from hemorrhoids and candida infections.

>

> Her tongue has very marked tooth-marks, but isn't really very swollen.

>

> As I said I have seen her 3 times. She always feels well for about 2 days

> after each treatment; and then goes down again.

>

> Some of the points I have been using are Liv2 through to liv 3, P6, Ht 7. St

> 36 (+ moxa), Sp 6, Yin tang, GB 20, Du 20 (+ moxa), some Ren channel points,

> mainly with some variations.

>

> She is refusing to take herbs as decoction as she says I once made her

> really unwell; so I have been giving her Bu Zhong Yi Qi Tang is the morning

> and She Gan Wan at midday and evening as tablets.

>

> The problem is that by feeling better for a couple of days when she then

> feels bad again the disappointment is hard to take for her.

>

> Any advice?

>

> Thanks

>

> May

May 21, 2004

Hi May!

Treat her every other day before she gets to feeling bad again. Eventually

she will be able to go longer between treatments. If she would not take

herbs, work on her diet, vitamins and the like.

At 05:59 PM 5/20/2004, you wrote:

>Hi everyone!

>I would like to have your advices about one of my patients.

Regards,

Pete

May 21, 2004

Hi May,

can you send me your patient's DOB off line? if so I may be in a

position to add some clarity also.

salvador

http://www.meridian-qi-acupuncture.com

----------------

--- May Lucken <maylucken@q...> wrote:

> Hi everyone!

> I would like to have your advices about one of my patients.

>

> She is 33 and has quite severe mood changes.

> When she is very down, she won't be able to concentrate, will be

very tired,.........

May 21, 2004

Dear Ming,

Thanks you so much for your comments.

I have used the Sp 9, St 40, Liv 3 LI4, Du 20, Yin Tang, GB 20 in my

treatment a few days ago, and you are right; it worked very very well. She

was extremely calm for the rest of the day and the next day. But after those

2 days, she went back to have those mood swings and specially being very

sad, crying, no focus etc...

My problem seams to be to be able to maintain her for more than a few days.

Will try the other suggestion when I see her next.

> GB41 may be useful here as well. Based upon my experiences, it is my

> suspicion that a depression patient that expresses extreme anger has an

> imbalance, but the imbalance between the spleen and the liver is not the most

> important. It is the imbalance of her wood element, i.e. between her liver

> and gall bladder, that would be the greatest concern. My observation has been

> excees liver accompanying deficient gallbladder. My observation seems to

> indicate that cowardice, however it is manifested, maybe one of her

> personality traits. As much as she is unhappy with her situation, she may

> also seem complacent to her situation, because she lacks the courage to take

> on whatever that's making her life miserable. This would explain the

> excessive anger (excess liver) and inability to face her challenges (deficient

> gallbladder). If that is indeed her case, do add this point to the treatment.

>

I have been feeling this as well, as she doesn't talk much about how she is,

more than in a superficial way; but she keeps coming so...

So will try this point and tell you what happens!

Regards

May

May 21, 2004

Hi Caroline,

She hasn't got a eating disorder as such, but when she is in the down, sad,

crying or indifferent mood, she doesn't feel like eating. She feels often

very bloated, though the acupuncture session have changed that.

I have advised her to go on a " clear bland diet " , so will see. Any other

thing you thing I should advise her on?

Thanks

May

On 21/5/04 2:57 am, " c_bertorelli " <c_bertorelli wrote:

> Hi May,

>

> From a non-TCM perspective and from personal experience of similar

> symptoms I would guess your patient may have an eating disorder.

> Although I am not a practitioner, a lot of the TCM books I have read

> suggest that diet should be addressed in conjunction with needle

> treatment for a full TCM approach. I wonder if this could be checked

> or addressed complementary to the acupuncture treatment.

>

> Caroline

May 21, 2004

Hi Robert.

So...

> Have you determined a TCM pattern and Tx principle? It looks like you're

> going for Lr

> Depression Qi Stagnation with Sp Vacuity/Deficiency.

Liver- spleen disharmony

With liver qi invading the stomach, and stomach qi counterflowing upwards.

> Why did you select Bu Zhong Yi Qi Tang?

To replenish her qi and supplement the qi in the middle burner

> What are her menstrual periods like?

The blood is red (neither dark nor bright bright red), sometimes with small

clots not rarely. Cycle is regular 28days. Duration of flow= 3days, rarely

any pain. PMS such as breast distension and bloating and more irritable.

> Any phlegm sx, dizziness, etc?

No major phlegm signs, except tongue with very very marked teeth mark and

fatigue

No dizziness

> What is her pulse quality

84bpm

All fine and quite forceless

Right:

- inch- fine forceless

- bar- quite soggy( floating, fine forceless)

- cubit- deep

Left:

- inch- fine forceless

- Bar- wiry or bowstring

- cubit- deep

> You also didn't mention how long she's had the mood swings, and what might

> aggravate or relieve the condition.

She has been having these mood swings for 10 years at least (she wasn't

sure), but was able to deal with them and it wouldn't affect her

concentration, and her moods wouldn't be as dramatic. After a period of

stress and exams she went to see another acupuncturist and after the first 2

treatments her mood swings started to get much more intense. She says it was

never that bad. She stopped seeing him . That was a bit more than 6 months

ago.

I have been treating her partner with very good results and since she still

was experimenting those mood swings, with such intensity she came to see me.

Nothing seams to make them better or worse. She feels that because she feels

good for a few days after her acupuncture treatment then the down bit is

more felt. So she is worried at each treatment because she anticipates when

she will feel bad again.

>

> If you're certain of your diagnosis, then another thing to consider is dosage

> -- you

> might increase the formula for a period of time and see if the condition

> responds.

>

> robert hayden

Thanks for your response!

May

May 21, 2004

Hi Pete,

Thanks. Will try to see if she can afford to come that often.

Any ideas on diet (except the clear bland type)? Or vitamins? Or where can I

have a look?

Thanks

May

On 21/5/04 5:00 am, " Pete Theisen " <petet wrote:

> Hi May!

>

> Treat her every other day before she gets to feeling bad again. Eventually

> she will be able to go longer between treatments. If she would not take

> herbs, work on her diet, vitamins and the like.

>

> At 05:59 PM 5/20/2004, you wrote:

>> Hi everyone!

>> I would like to have your advices about one of my patients.

>

> Regards,

>

> Pete

>

May 21, 2004

Chinese Medicine , May Lucken

<maylucken@q...> wrote:

>

> Liver- spleen disharmony

> With liver qi invading the stomach, and stomach qi counterflowing upwards.

I'm not sure i saw the ST qi counterflow -- nausea, vomiting, belching, hiccup?

I'll

look again.

>

> > Why did you select Bu Zhong Yi Qi Tang?

>

> To replenish her qi and supplement the qi in the middle burner

If she does have ST qi counterflow, remember that BZYQT is an ascending

prescription. If the Tx principle is downbear ST qi, BZYQT might be

counterproductive. It may also possibly aggravate the constipation since one of

its

functions is to hold things up.

Really, this is one of those cases that might respond well to Xiao Yao San -- I

think

there is probably a Blood component from some of the sx and pulse. Shu Gan

really

is more of a coursing kind of formula, Xiao Yao San harmonizes LR & SP and also

nourishes (and to some extent moves) Blood. Dan Zhi (or Jia Wei) Xiao Yao San

can be

used if there are heat signs, but also moves Blood due to its inclusion of Mu

Dan Pi. I

know XYS is overprescribed but in this case it may be appropriate.

take care,

robert hayden

May 21, 2004

Dear May,

Happy to see that you are getting results. It looks like her wood element is

completely out of control. Treating the spleen and liver alone just seems to be

perpetuating a vicious cycle of emotional highs (anger) and lows (depression)

unless the metal element becomes strengthen to keep the wood element in check.

Furthermore, prolong spleen deficiency will eventually lead to lung deficiency,

since earth gives rise to metal, and that lung deficiency, I suspect, is what's

responsible for her liver excess.

Go ahead and add UB13, UB17, UB23, and UB25 for your patient along with the Du

points I recommended previously. UB23 can help UB13 in strengthening the

patients metal element. UB25 is part of that metal element. So, it is vital

that this point be used along with UB13. UB15 can also be helpful in

strengthening her spleen since fire gives rise to earth. As for lung and LI

channel points, you might try LI11, Lu5, Lu1(strictly horizontal insertion

only), Lu7. Palpate these points and see if you get a soreness or comfort

reaction from your patient. If you get no reaction from palpating these points,

don't needle these points for the sole reason that you might just be wasting

needles on individual points that need no treatment.

As for herbal prescription, Robert Hayden's suggestion of Xiao Yao Wan is

definitely worth a try. I've used it myself in quite a few instances, and they

worked very well for me, and it's practically tailor made for your patient's

conditions. You might also try Gan Mai Da Zhao Tang for her condition. You can

use it in conjunction with Xiao Yao Wan.

Let me know what happens next.

Ming