Integrated Chinese-Ayurvedic-Western Perspectives on Manic-Depression (Bi-Polar) with Focus on Manic Episodes

Integrated Eastern and Western Perspectives on Manic – Depression (Bipolar) Psychological Disorder and the Major Approaches to Treatment – with a focus on Manic Episodes

Medicine Buddha Healing Center
of Berkeley, California
www.Ayurveda-Berkeley.com www.Ayurveda-California.com

Researched and Compiled by
Ms. Sheng-wei Lan, C.A.H.S., 2004

Chinese-Ayurvedic Herbalist Specialist

Introduction

This topic of manic-depression (now referred to as bipolar disorder) and its treatment interests me due to my studies in Traditional Chinese Medicine at Academy of Chinese Culture and Health Sciences (ACCHS), East Indian Ayurveda (“The Science of Life”) at the Ayurveda Healing Arts Institute, and the basics of Western medicine basics at the Life Chiropractic School West. Since I observed patients who suffered much from mania and anger and since I worked to heal them using Traditional Chinese Medicine (TCM) and Ayurvedic medicine combined with the meditative psychological wisdom of Buddhism, I will discuss their treatments and research that has let me to help heal others through major life style and dietary changes combined with herbs and acupuncture. I will use the case study example of one bi-polar manic patient with whom I have worked for more than 11 months.

Research Question

As my research question, I will find out which treatments – TCM, Ayurvedic and Western medicine / psychotherapy – are most beneficial and what the limitations of each treatment are.[1] Especially when working with emotional and mental problems so common in today's fast-paced Vata[1]-genic and competitive Pitta-disturbing society, it is important to simultaneously study and use several methods (not just Western psychology and psychiatry or drug medicine), integrating them into one. This point is shown in the ancient East Indian Vedic literature: “By knowing one science alone, one cannot arrive at an accurate scientific assessment. Therefore, a physician should study other sciences in order to arrive at correct diagnosis.”[2] Therefore, in this paper on manic-depressive disorders and its therapies, I will discuss mixture of modern Western biochemical psychiatry and psychology, TCM, East Indian and Tibetan Ayurveda, and the ancient Asian philosophies of Buddhism[3], Hinduism, Taoism (Dao de Jing[2] – Zhuang Zi) and Confucianism. In the last eleven months of study that have resulted in writing this paper, during which I have been learning these healing, religious, and philosophy arts of Asia combined with modern psychology, I have discovered that “the truth is one” and that they are all (in the traditional Buddhist metaphor) “fingers pointing at the moon.”

Hypothesis

I expect to discover evident that TCM can receive good results in the treatment of manic-depression (bipolar disorder). [4] My focus will especially be where there is a more common frequency of manic episodes since that is the tendency of my case study patient mentioned above (who I treated for 11 months now).

Method

Because of my limited financial resources (just a student), I chose a “survey method” for this study – which I have summarized and included in the Appendix B the actual research documents. I first developed questions which focus on my topic of TCM treatments for bipolar disorder with a focus on the manic episodes. I then interview a group of 12 Licensed Acupuncturists and Doctors of Oriental Medicine (D.O.M./O.M.D.) from the USA and China who are teaching and practicing at ACCHS or elsewhere. Most of them have at least 5 years of experience in practice as shown in the faculty biographic listed in the ACCHS Catalog.[5] They are TCM Doctors B.K. Chin, W. Chung, Y.M. Fang, H.H. Hsiao, D.M. Li, M.L.D. Liang, H.J. Wang, L. Wang, S. Woodley, J. Yeh, and W.Y. Zhu. I also interview one practitioner of Ayurveda with over 8 years of study and practice – Michael Reid Kreuzer, D.Ayur – who is writing a book on Ayurveda. I had a chance to review his rough draft of the unpublished book. (Reid-Kreuzer 04)

Purpose

Clearly, mental disorders like manic-depression take a big toll on our lives. Efforts to understand manic-depression disorder depends on research in different areas from cell biology to sociology. “About one-third of the U.S. population at some point during a typical lifetime reports symptoms that fulfill the defining features of a major psychiatric disorder.”[6] “In these disorders, a person’s mood becomes so intense and persistent that it interferes with his social and psychological function. Mood disorders include bipolar disorder and major depression.” (Eckman-97: 46) Therefore, manic-depression disorder and its treatment deserve attention. I will use the eyes of psychology, biology, pharmacology, chemistry, Western medicine and nutrition, TCM, Ayurvedic medicine, and a small “dose” of Asian philosophy. My goal is to research the different treatments offered for manic-depression disorder and try to summarize. Therefore, we will also understand various ways in which the mind and emotions can go wrong – therefore, causing mania.

Definitions

The Diagnostic and Statistical Manual of Mental Disorders - DSM-IV[7]: The "Bible" of Psychology

Although it is not the only method for classifying mental disorder, the DSM-IV has strongly influenced most mental health environments - from diagnosis to treatment to medical insurance billing. Therefore, much of the terminology for the disorders discussed in this paper comes indirectly from this large manual “used to provide a common language for therapists, researchers, social agencies, and health workers.”[8]

Bipolar Disorder – Manic-Depression

The most important aspect of Manic-depression disorders (bipolar) for my case-study patient are the manic or anger aspects: According to the book Rooted in Spirit – a translation of the Lingshu portion of the Huangdi Neijing, “when the accumulated pressure” of anger “explodes, blood and breaths are taken massively toward the upper regions. When it is held inside, the internal agitation and dissatisfaction generate blockages that have no resolution. Blocked situations that have no resolution eat away at us.” (Larre-Rochat:95: 168) This is when anger with fire rising eats away at the liver and heart and lungs as is seen in my case study patient. But it all starts with the liver disturbance. The authors of Clinical Applications of the Yellow Emperor’s Canon on Internal Medicine say “The liver stores blood and houses the soul, it cannot house the soul when heat disturbs liver blood, and restlessness of the hands and feet, fright, talking too much or too little, poor sleeping or an unclear mind are encountered.” (Wang 99: 117 Chinese, 272 English) My manic case study patient has hot liver blood, restless legs, feet and mind, with too much talking (require by his computer engineer job), and poor sleep (cause by computer work late at night). The authors of Rooted in Spirit go on to say, “Anger corresponds to the liver. When it expressed the normality of the Wood element, it is the very impetuosity of life, especially in the power of things at their beginning. It is the strength of wind that blows, or the young plant breaking through the still-frozen ground, or the fierceness of birth that expels a being into the light of day and then causes it to grow and unfurl. Wind is the ‘anger’ of Heaven.” (Larre-Rochat:95: 168) This describe well my patient when he is “healthy” or “in remission.” Rooted in Spirit continues on to say, “Pathological anger is perverse movement of the Wood. This is the force that unleashes impulses and pushed them to their extreme; it is the upward leap, the impetuosity that carries everything along before it. When it breaks its moorings, leaving its roots, and goes out of control, it is rage, unleashed fury, and irrational anger.” (Larre-Rochat:95: 168) These above three paragraphs are good describe of my manic case study patient in both “remission” and “active disease.”

Manic-depression disorders (bipolar) are manifested by over-confident, talkative, excessiveness, over-spending (money, time, energy) and hyperactive, followed by short times of depression and thought of suicide. The symptoms of manic-depression disorders look like those of schizophrenia (Wu 91: 256-257). There are also genetic factors, and some mental illness, such as schizophrenia or mania, may be inherited.[9] “This affective disorder is marked by severe pathologic mood swings from hyperactivity and euphoria to sadness and depression. Either the manic or the depressive episodes may predominate, or the two moods can be mixed.” (Eckman-97: 46) The brain can be affected in a way which is illness but is not necessarily mental illness according to usual definitions. A tumor in brain, for example, is not likely to be very much different from tumor in any other part of the body. There are many other examples of this kind. Cerebral hemorrhage, or stroke, is an organic condition, and not a form of insanity.[10] But, in any case, human body is complex and integrated, and definitions are only useable within certain limits. In other words, as the Tao Te Ching says, “The Tao that can be told is not the eternal Tao. The name that can be named is not the eternal Name. The unnamable is the eternally real. Naming is the origin of all particular things.” (Mitchell 88:1) What I mean by this, is that naming and definition are limited – they are not the whole person themselves, and they can “cage” the patient into the identifying their label mania as an inseparable, and therefore incurable, part of their personality. So by labeling the patient “manic” or “schizophrenic” you are reinforcing their identification with the named disease. On the other hand, the TCM method is too diagnose them via unique individualized pattern discrimination as “liver-fire rising – with phlegm heat harassing the portals of the heart” (gan1 huo3 shang4 yen2 – tan2 mi2 xin1 chiao4). (Wiseman 98: 135) (Mong 01: 137) This way, we can treat the patient without labeling them.

The DSM-IV recognizes 10 types of Personality Disorders:[11]

The DSM-IV mentions people having manic episodes may have “a pattern of disregard for, and violation of, the rights of others. This pattern brings the individual into continuous conflict with society.”[12] This is often seen in liver-fire-phlegm (pitta) disturbed patients. As with Histrionic Personality Disorder, manic episodes may show a need for drama or “acting out” - most pitta disturbed persons like such theatrical episodes. I have seen with this one in my case study patient’s actions at times. Some call it “drama addict.” The influence of TV and movies have contributed to this phenomena. In Avoidant Personality Disorder, we see manic-depressive tendencies with “a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.”[13] This would be a pitta disorder. Pitta people, like my case study patient hate being criticized.

Mood Disorders[14] - "Disturbances of emotion" - Major Depressive Episode

“The common cold of psychopathology”[15] everyone has it at some time or other - that deep and long lasting sadness. “One European study found that people with recurrent depression spend a fifth of their entire adult lives hospitalized, while 20% of their sufferers are totally disabled by their symptoms and do not ever work again.”[16]

Unipolar depression - Clinical depression

“21% of females and 13% of males suffer a major unipolar depression at some time in their lives.”[17]

Bipolar disorder (Manic-Depression)[18]

Combination of manic and major depressive alternation. Severe depression (kapha), followed by mania (pitta), then back again. Manic episodes – Abnormal and persistently elevated, elated and expansive mood[19] “Sometimes the individual's predominant mood is irritability rather than elation, especially if the person feels thwarted in some way.”[20] These mania symptoms are all pitta liver fire phlegm symptoms: Abnormal big feeling of self-confidence; Unrealistic belief that they have special powers or abilities; Decreased need to sleep; Too much work, social, or other pleasures; Uncalled-for optimism; Take unnecessary risks; Promise anything; May give away everything. My patient has many of these. The standard Traditional Chinese Medicine textbook from Beijing, Chinese Acupuncture and Moxibustion (a required basic text in my current TCM studies as the Academy of Chinese Culture and Health Sciences) states that “depressive disorder is manifested by mental dejection, reticence or incoherent speech, while manic disorder by shouting, restlessness and violent behaviors. As described in Classic on Medical Problems, depressive disorder is caused by excessive Yin, while manic disorder by abundant Yin, while manic disorder by abundant Yang.”[21] I treated my manic case study patient with acupuncture and Chinese herbs (many different), Ayurvedic herbs (Brahmi [Centella asiatica or Di Qien Cao in Mandarin]) (Reid 95: 129) (Tierra 88: 200) and Western herbs (St. John’s Wort) (Tierra 88:199-200), lifestyle and dietary changes and suggested Buddhist meditation and repentance ceremonies. He mostly have symptoms of manic episodes much more often than depressive episodes. “The most important etiological factor of manic-depressive disorder is emotional injury. Pathologically, Phlegm plays the primary role. Depressive disorder is due to stagnation of Phlegm combined with Qi, while manic disorder is due to Phlegm fire. Although they are different in symptomatology, they are related to each other. A prolonged depressive disorder, in which fire is produced by Phlegm stagnation, may change into manic disorder, while a protracted manic disorder, in which stagnated fire is gradually dispersed, but the phlegm is still existing, can change into depressive disorder. Therefore, they are termed together as manic-depressive.”[22] (Wu 91: 256-257) (Wiseman 98: 135) As an example: “Kay Jamison had a major bout with mania, filled with hallucinations and delusions shortly after finishing her Ph.D. in psychology. Despite her academic training, she was unaware that she was a manic-depressive and needed to be on lithium. In defiance of her academic expertise in the area of depressive disorders, like other manic-depressives she would sometimes stop taking lithium because she was addicted to the highs of mild mania. But extreme depression always followed, and after one of the more fierce high-and-low cycles typical of manic-depression, she attempted suicide and went into a temporary coma. After coming out of it, she said, "It was very clear to me…that if I were going to live, I had to stay on lithium."[23]

TCM Etiology and Treatment of Manic-Depression (Bipolar Disorder)

According to Bob Flaws, in his article “Thoughts on the Integration of Chinese Medicine & Western Psychiatry”, “One of the fundamental and important statements of methodology in Chinese medicine is, ‘Same disease, different treatments; different diseases, same treatment.’ In Chinese medicine, two patients with the same disease presenting different overall patterns receive different treatments. This is because, in professional Chinese medicine, treatment is predicated on the patient’s pattern first and foremost and only secondarily on their disease diagnosis. Conversely, two patients with different disease diagnoses may get essentially the same treatment if their patterns are the same.” (Flaws TCM-Western Psychiatry 2001) Therefore, although we are talking about TCM treatments for manic-episodes in general, we must always remember that TCM treats individuals with specific “TCM patterns” based on classical “TCM pattern discrimination” diagnoses, not general western disease names like Manic-Depressive. Ayurveda works the same way as TCM in this regard. Again from the above article, Flaws says, “This is what makes our” TCM “treatments safe and effective, because they take into account the patient’s whole situation, not just their disease diagnosis.” In Combined Treatment of Depressive Episodes with Acupuncture & Psychotherapy,” on pages 65-66 of that journal, “At the same time as acupuncture, patients were treated with psychotherapy. This consisted of guided progressive muscular relaxation. The comparison group received the same acupuncture treatment. However, during treatment, they were told to simply focus their mind on their Dan Tian. All patients were treated with even supplementing even draining technique and needles were retained for 30 minutes. During acupuncture, all patients received supplemental inhaled oxygen. One treatment was given per day, five days per week, and one course of treatment consisted of six weeks of such therapy. In addition, members of the treatment group received cognitive behavioral therapy, while members of the comparison group did not. In issue #2, 2003 of Tian Jin Zhong Yi Yao (Tianjin Chinese Medicine & Medicinals), Dr. Cui Jin-bo of the An Ding Municipal Hospital in Tianjin, China published an article titled, “The Combined Treatment of Depressive Episodes with Acupuncture & Psychotherapy.” According to study by Dr. Cui “While acupuncture at these points was definitely effective for ameliorating depression, it was even more effective when combined with psychotherapy.” (Flaws TCM-Psychotherapy 2003: 2) My patient tried psychotherapy for 2 years, but without using TCM. I suggest him to do both at same time.