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Depression
Ms. Dubois, 38, mother of two and health home attendant, consults for general fatigue. Three months ago, she was sick leave from work by her doctor and, since then, she has taken antidepressants and undergoes psychotherapy. Despite this, she still feels tired, has difficulty concentrate and frequently suffer from insomnia. She consults in acupuncture, because she would like to have more energy and get back to work as soon as possible possible.
Ms. Dubois suffers from the most common mental illness today: depression which it seems will affect one in four people during of his life1. This disorder can also be associated with burnout (burnout), at seasonal depression and anxiety. The Traditional Chinese Medicine (TCM), as a therapy energy, can act not only on physical health of the individual, but also on his emotional states.
In the four-step approach, it is important for the acupuncturist to realize an in-depth case history. Depression does not happen overnight tomorrow, it is often the result of a long evolution which the source is not always clear. Our accelerated life rhythms sometimes prevent us from seeing what we are getting bogged down in …
It also very often happens that apparently early warning signs harmless (insomnia, physical pain, headache, palpitations, etc.) manifest before the depression is well and truly installed. In in such a case, the acupuncturist can detect the emerging imbalance, hence the great utility, in addition to a thorough interrogation, of taking the pulse (see Palper) and exam of the tongue (see Observe).
1- Question
The interrogation concerning the psychological imbalances carries on three important aspects, namely physical, cognitive and emotional signs.
Questions about signs physical relate in particular to vitality, digestion and sleep; they are part of the study of "ground" carried out using Ten Songs (see Questioning). The acupuncturist asked Ms. Dubois to clarify what she meant by fatigue. She reports general weariness and explains how they feel tiredness especially when getting up, and that she often goes back to sleep after lunch. In the past few weeks, she has resumed doing certain activities daily and resolved to take a walk every day. However, she is exhausted after a 15 minute walk and on some days she feels no motivation to do it. Sometimes, she manages to go to the grocery store or to her hairdresser, other days it empties her completely and she feels very tired, physically and mentally.
With regard to the digestive sphere – which will be decisive in the energy balance – Ms. Dubois actually has less appetite, but she says it's because she no longer tastes food. She often feels bloated after eating and tummy lots of annoying gurgles. Her stools are soft, whether she eats or not fibers, which discourages her.
Asked about her insomnia, Ms. Dubois says that it takes her hours to fall asleep because she thinks of lots of things. When the acupuncturist questions him on her thoughts, she mentions among other things that she does a lot of worries about her 15 year old boy who sometimes comes health home late at night. Moreover, that's how his fatigue started. Her boy came in late, she worried, didn't sleep … in the long run, tired, she went to see her doctor with the result that we know.
The acupuncturist completes his gathering of information using the Ten Songs, looking for signs like palpitations, numbness, dizziness, headache, back pain, etc. Mrs Dubois feels palpitations in the evening, which are mainly manifested sleepless nights. She also has dizziness, especially on days when she feels very tired.
The sphere cognitive is then examined. Ms. Dubois says to herself discouraged by the fact that she has difficulty focus on just reading an article in the newspaper. His ideas frolicking left and right and she must often read the same phrasing. Most of the time she gives up, exhausted. She also admits, embarrassed, that her children noticed that she sometimes forgot what she was doing or saying.
Finally, the acupuncturist tackles the story emotional of the patient, in order to trace the possible origins of depression. Ms. Dubois is invited to talk to her about her professional and family life, everything as a hobby. Adoring her work, Ms. Dubois explains that she worked sometimes more than 50 hours a week, one of his colleagues being on maternity leave. She had no choice, and could not leave plan beneficiaries. The relationship with her partner is going well, but the one with her "teenager", who asserts her independence, is more problematic. Finally, she finds her ten-year-old daughter particularly overwhelming since she was off work, feeling like a bee constantly revolves around it.
2- Auscultate Auscultation is not used in this case.
3- Palpate
In such a case, palpation is generally limited to taking pulse. It turns out to be fine and weak, but we can also feel some points like the back shu points on the Meridian bladder or Viscera.
4- Observe
The acupuncturist, attentive to Ms. Dubois' non-verbal, notices that she is rather calm, that her facial expression is minimized and that she performs few movements when it moves. In other words, his organism is based on economy of resources. A few times during the interrogation, the acupuncturist must bring it back to the subject, because it tends to get lost in the little details. Finally, the observation of the face reveals a dull complexion, just like her lips. Language is pale, covered with a white coating, and has teeth marks on the sides (it is said to be "indented").
Chinese medicine has identified six areas inside which an imbalance can lead to depression:
the emotions;
heredity;
food;
sexual activity;
overwork;
drug use.
In the case of Ms. Dubois, it is both overwork, as she describes it so well herself, and the emotions that caused his problem. As is often the case with depression and exhaustion professional we are dealing with a type of person for whom work well done is very important. These people sometimes consider themselves indispensable, feel obliged to "perform" and no longer know say no, even when their professional task exceeds their capabilities.
In addition to being a perfectionist, Ms. Dubois works in a relationship field help demanding physically and psychologically. Let's add that she has the impression to be drained by the requests of his daughter and that his boy worries him, and we have the winning combination for depression. With the little Ms. Dubois did not notice that she had enough time to take care of herself her body was getting tired and she didn't hear the alarm signal his insomnia.
On the energy side, we see that the Qi of the Spleen / Pancreas is physically drained by excessive demands on his professional life, and that he is affected by a excess worry (thoughts about her son). You have to know that the Qi of the Spleen / Pancreas, in association with the Qi of Food, allows the production of Blood that nourishes the Heart. If the Spleen / Pancreas Qi is deficient, the Heart Blood will be also in the more or less long term. Often, as is the case here, anxiety thus not only affects the Spleen / Pancreas, but also disturbs the Mind, whose seat is the Heart. This disturbance, which can be caused by any Excess emotion, agitates and destabilizes the Heart which can no longer assume its role well of Blood, hence the Void of Heart Blood.
In TCM, mental aspects are an integral part of physiology and are interpreted within the different analysis grids (see Questioning) which allow to pose a energy balance. Since the Spirits (or psychovisceral entities) are housed in the Organs, the energy state of these will influence the state emotional and vice versa.
Ms. Dubois shows physical signs of a lack of energy the Spleen / Pancreas (a Void of Qi). The general weariness she feels shows that this Organ does not adequately carry out its work of transporting the elements nutritious to all body tissues. The weak pulse and the fact that the patient performs few movements confirm this hypofunction. Tiredness is marked at sunrise, when the body must go from state Yin (the rest of the night) in Yang (daily activities). This moment is demanding for Ms. Dubois, because her Qi is so weak that he does not have the minimum spring to make the transition. And if she feels the need to go back to bed after lunch, is that the Spleen / Pancreas is then in full digestion and has no more energy for the rest of the body.
Ms. Dubois believes she has less appetite because she no longer tastes food, when in fact both of these are symptoms a weakened Spleen / Pancreas. The same goes for bloating with gurgling and loose stools: digestion is difficult and this has repercussions on all digestive structures.
In addition, unable to assume its role in the production of blood, the Spleen / Pancreas improperly nourishes the Heart, which causes all kinds of symptoms arising of a Heart Blood Void. So the blood cannot go to the head correctly, causing dizziness; the mind It is also a victim, hence mental exhaustion. Insomnia and constantly flowing thoughts are also signs of an impairment of bringing Blood to the Spirit. Indeed, the Blood gives it support material necessary to anchor; in deficit of Blood, it "floats" and its activity is dispersed. It’s for the same reasons that Ms. Dubois can't focus on just reading an article newspaper, that she frequently forgets and that her speech tends getting lost in the little details (see Yi and Zhi in Spirits). Unfortunately this only adds to the troubles that disturb already the Spleen / Pancreas.
The Void of Blood from the Heart is also perceived by the fine pulse and palpitations, results of a Heart Qi Void underlying a Blood Void of the Heart. The heart pump is no longer well regulated, the Heart throbs. Finally, the tongue is pale and "indented" because of the Void of Qi of the Spleen / Pancreas which cannot bring the Blood; the white coating reveals the incapacity of the Spleen / Pancreas to circulate the Organic liquids, which accumulate; and the complexion and the lips dull reflect the Void of Blood.
The energy approach will favor a background treatment where it will be just as important to act on the Heart as on the Spleen / Pancreas. All the treatments will aim to nourish the Blood of the Heart and tone the Qi of the Spleen / Pancreas. It will also be important to stabilize the Spirit and promote sleep, a determining factor in reconstruction some blood. All this can be achieved by acupuncture, combined with other modalities (pharmacopoeia, Qi Gong, massages, etc.).
Dietary changes may prevent burnout of Spleen / Pancreas Qi and promote recovery of the patient. To avoid therefore, sweets, Foods of Nature cold or raw, and fatty. The exciting ones like tea, coffee and chocolate are also to be taken in moderation, as they create heat in the upper body and especially in the head, where the Spirit is already too dispersed (see Food). Ms. Dubois should also persist in taking her walks, if only a few minutes a day, and reserve good periods rest (see Overwork). Finally, the meditation and energy exercises (Tai Ji and Qi Gong) could be beneficial in giving back to the Spirit a solid and serene foundation.