by Bob Flaws

On pages 30-31 of issue #2, 2009 of Si Chuan Zhong Yi (Sichuan Chinese Medicine), Lai Yong-de and Jin Hong-bo, both from Sichuan, published an excellent article on the onset of depression due to blood vacuity in turn resulting in or associated with liver depression qi stagnation. This is something I have been teaching for years since it helps explain the fact that more women suffer from depression than men. Lai and Jin even quote the same lines as I usually do from the Su Wen (Simple Questions) discussing how any organ or tissue in the body can only do its (qi) function if it obtains sufficient blood to nourish it. Since the liver('s qi) governs coursing and discharge, failure of blood to nourish the liver leads to or aggravates liver depression qi stagnation. As Lai and Jin state:

Follow up:

"The qi mechanism's spreading and extending and the liver's storage of blood are closely related. If liver blood is full and sufficient, then coursing and discharge, spreading and extending are normal. If the blood is vacuous, the liver loses its nourishment and coursing and discharge lose their normalcy.This then easily gives rise to symptoms of qi depression and qi hyperactivity."

Lai and Jin then go on to explain how, if the liver is depressed and the qi is stagnant, dampness may gather and phlegm may congeal. In addition, enduring depression may exhaust and consume yin-blood. Hence heart and liver blood both become vacuous. Since the heart stores the spirit, the spirit loses its abode as well as its brilliance. This combination of disease mechanisms (heart blood vacuity, liver depression qi stagnation, and phlegm)may lead to the pattern of heart vacuity-gallbladder timidity, a commonly seen pattern in clinical practice in patients with depression and/or anxiety.

Based on the foregoing, Lai and Jin say that the basic principles for treating depression should be to nourish the blood and fortify the spleen, course the liver and resolve depression. Because blood vacuity leads to liver depression as well as lack of nourishment and construction of the heart spirit, they make nourishing the blood and fortifying the spleen the root of their treatment, while coursing the liver and rectifying the qi or resolving depression is secondary. For this, they like to use formulas such as Gui Pi Tang (Restore the Spleen Decoction) and Sheng Yu Tang (Sagely Healing Decoction) which they then typically modify with spirit-quieting and additional blood-supplementing medicinals.

When it comes to coursing the liver, Lai and Jin note that this is typically accomplished by acrid, warm, fragrant, and dry medicinals which consume and cause detriment to yin-blood. Therefore, they recommend Xiang Yuan (Fructus Citri) and Fo Shou (Fructus Citri Sacrodactylis) which they say rectify the qi without damaging yin.

All good advice.

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