Bi-Polar Disorder, Mania-Depression

General

Clinical Manifestations	Alternating bouts of depression: Complete silence Dementia Incoherent speech With mania: Unprovoked laughter Ravings Greatly increased activity Euphoria Delusions of grandeur
Treatment Principle
Herb Formulas
Points	Kuang - Mania: DU-14, DU-16, DU-26, PC-6, ST-40 Duan - Depression: HT-7, PC-6, ST-40 , UB-15, UB-18, UB-20

Yang Ming Fire ( Kuang - Mania)

Clinical Manifestations	Manic behavior Raving walking Shouting Abusing people Climbing to high places Singing Removing one's clothes Unusual strength Foul breath Red face Abdominal pain and distention Constipation T: Red C: Dark and yellow or Black and dry P: Deep and wiry
Treatment Principle	Purge the Intestines Expel Phlegm
Herb Formulas	Da Cheng Qi Tang
Points

Phlegm-Fire Disurbs The Heart ( Kuang - Mania)

Clinical Manifestations	Manic behavior with sudden onset Emotional upset Shouting Scolding or hitting people Exceptional physical strength Not eating or sleeping Agitation A quick temper An angry look in the eyes Fixed staring Frequent crying Excessive aggressiveness, resulting in injury to others Greater than normal strength Inability to answer questions Shouting abuse Desire to climb to high places Irritability Inability to rest Breaking things Rash/impulsive behavior Rash movements Constipation Headache Insomnia Red face and eyes Anger T: Red C: Sticky and yellow - Stomach-Heart crack with a sticky, yellow coating inside it P: Rapid, wiry, overflowing and slippery
Treatment Principle	Sedate the Heart Eliminate Phlegm Clear Fire Calm the Shen
Herb Formulas	Sheng Tie Luo Yin + Gun Tan Wan Gun Tan Wan Wen Dan Tang Huang Lian Wen Dan Tang Dang Tan Tang With Liver Fire: Sheng Tie Luo Yin + Dang Gui Long Hui Wan
Points

Heart And Liver Fire ( Kuang- Mania)

Clinical Manifestations	The mania comes mixed with insomnia, anger or excess joy Headache Red eyes Tinnitus Dizziness A bitter taste in the mouth Sores in the mouth Flank pain T: Red tip and edges C: Little or Thin and yellow P: Wiry, strong, slippery and rapid
Treatment Principle	Drain Heart and Liver Fire Calm the Shen
Herb Formulas	For more prominent Liver Fire symptoms: Long Dan Xie Gan Tang For more prominent Heart Fire symptoms:  Zhu Sha An Shen Wan For more severe symptoms or signs of Phlegm-Fire: Sheng Tie Luo Yin
Points

Heart Blood Deficiency With Liver Qi Stagnation ( Kuang - Mania)

Clinical Manifestations	Absent-mindedness Frequent feelings of extreme sadness with an urge to cry Inability to control one's emotions Depression Restless sleep May be night sweats Abnormal speech or behavior Disorientation Frequent yawning T: Red C: Scanty P: Small and rapid
Treatment Principle	Nourish the Heart Calm the Shen Harmonize the Middle Jiao Ease tension Tonify Spleen Qi
Herb Formulas	Gan Mai Da Zao Tang
Points

Liver Qi Stagnation With Stagnant Heat

Clinical Manifestations	Difficulty falling asleep Insomnia, worse when stressed Dream-disturbed sleep Waking in the early hours of the morning Frontal or temporal headaches Neck and shoulder tension Teeth grinding at night Frequent sighing Dizziness Red eyes Facial flushing Depression Irritability Moodiness Easily angered Hypochondriac tension or discomfort Continuous or sustained nasal congestion Transient, declining sense of smell or loss of sense of smell Nasal swelling Sinus pain Generally severe frontal, maxillary or temporal headache Chronic sinus inflammation and congestion which is worse with stress or emotional upset A sensation of something caught in the throat May have pain or sinus pressure May have occasional postnasal discharge Bitter taste in the mouth Irregular menstruation Premenstrual syndrome Breast tenderness Poor appetite Alternation constipation and diarrhea T: Red edges with spots C: Thin and yellow P: Wiry and possibly rapid
Treatment Principle	Soothe the Liver Qi Clear Heat Open the nose
Herb Formulas	Xiao Yao San  modified Jia Wei Xiao Yao San modified Long Dan Xie Gan Tang modified Si Ni San With underlying Qi and Blood Deficiency: Jia Wei Xiao Yao San Patent Medicines: Xiao Yao Wan Shu Gan Wan Long Dan Xie Gan Wan Chai Hu Shu Gan Wan Bi Yuan Wan (combine with one of the above) Bi Yan Pian (combine with one of the first two) Huo Dan Wan (combine with one of the first two)
Points	Anmian, GB-20, HT-7, LIV-3, PC-6, UB-15, UB-18, Yintang With a lateral headache: + GB-39, SJ-5 With teeth grinding and an aching jaw: + ST-6 With digestive weakness: + SP-6 With plum-pit Qi Stagnation: + PC-5 With Heat or Fire: + GB-44, LIV-2 For sinus problems: LIV-2, LIV-3, LI-4, LI-20, GB-20, SI-3, DU-23, UB-2, Yintang, Taiyang, Bitong

Liver Qi Stagnation Transforms Into Phlegm-Heat ( Kuang - Mania)

Clinical Manifestations	Dizziness Vertigo Nausea and vomiting Insomnia Dream-disturbed sleep with unusual dreams Palpitations Anxiety Profuse white foamy sputum Restlessness Timidity Indecisiveness Indeterminate gnawing hunger Seizures accompanied by copious sputum Flushing up Chest distention Expectoration of yellow Phlegm Bitter taste in the mouth Chills and fever Abdominal distention Frequent dark, scanty urine Irritability Depression Slight thirst Anorexia after serious illness T: Pink or Red tip C: Yellow and greasy P: Slippery and rapid or Wiry and rapid
Treatment Principle	Regulate Qi Transform Phlegm Clear the Gall Bladder Harmonize the Stomach Dry Dampness Dispel Heat
Herb Formulas	Wen Dan Tang
Points

Yin Damage Due To Fire ( Kuang- Mania)

Clinical Manifestations	Mania has continued for a long period of time Less violence Exhaustion Alternating spells of garrulousness and timidity Occasional mania Emaciation Flushed face A dry mouth and lips Fatigue Excessive speech Susceptibility to fright Anxiety Tension Occasional vexation Emaciation A red complexion Five-Sole-Heat A dry mouth with no desire to drink T: Red C: Little or None P: Thready and rapid
Treatment Principle	Nourish Yin Clear Fire Stabilize the Mind Calm the Shen
Herb Formulas	Er Yin Jian Zeng Ye Tang + An Shen Ding Zhi Wan
Points	HT-7, KI-1, LIV-3, PC-7, SP-6

Blood Stagnation Transforming Into Heat ( Kuang - Mania)

Clinical Manifestations	Restlessness Thirst T: Purple, with blue or purple spots on the edges C: White or Yellow P: Strong and rapid
Treatment Principle	Invigorate the Blood Transform Stasis Clear Heat
Herb Formulas	Tao He Cheng Qi Tang
Points

Heart Fire ( Duan - Depression)

Clinical Manifestations	Insomnia Restlessness Agitation Anxiety Difficulty falling asleep Dream disturbed sleep Frequent waking with nightmares Palpitations Ulceration, erosion, and pain of mouth and tongue Thirst with a desire for cold drinks Restlessness Irritability Irascibility Feeling of Heat and disturbance in the Heart Flushed face Bitter taste in the mouth Scanty, dark urine A red complexion Maybe painful urination Maybe hematuria T: Red tip, ulcers especially on tip or Red with a redder tip C: Normal or Yellow P: Excess and rapid
Treatment Principle	Clear Heat Purge Fire Calm the Shen
Herb Formulas	Huang Lian Jie Du Tang For a chronic condition with Yin Deficiency or dysuria: Dao Chi San For Heart Yin Deficiency following a Shao Yin Heat condition: Huang Lian E Jiao Tang For residual Heat following a Summerheat condition: Zhu Ye Shi Gao Tang With severe palpitations and anxiety: Zhu Sha An Shen Wan With Blood and Yin Deficiency: Zhu Sha An Shen Wan Chinese Patent Medicines: Niu Huang Shang Qing Wan Niu Huang Jie Du Pian Dao Chi Pian Xiao Er Qi Xing Cha
Points	HT-7, HT-8, PC-7, PC-8, UB-15 Anmian, HT-7, HT-8, HT-9, KI-6, PC-8, SP-6, UB-15, Yintang

Heart Blood And Spleen Qi Deficiency ( Duan - Depression)

Clinical Manifestations	Palpitations Insomnia Much dreaming Easily startled Poor memory Four limbs tired and lethargic Loss of appetite Distention and fullness of the epigastrium and abdomen Loose stools Sallow complexion Copious, pale menses Uterine bleeding or Light menstrual flow or Amenorrhea T: Pale P: Thready and weak
Treatment Principle	Reinforce and Benefit the heart and Spleen
Herb Formulas	Gui Pi Tang Yang Xin Tang
Points	HT-7, REN-4, SP-1, SP-6, ST-36, UB-15, UB-20

Heart And Gallbladder Qi Deficiency ( Duan- Depression)

Clinical Manifestations	Fear Paranoia There are often no physical symptoms at all Insomnia or frequent waking, often early in the morning Unable to fall back to sleep Nightmares Waking terrified Easily frightened or startled Easily unsettled by seeming trivial events Apprehension Restlessness Inappropriate worry Timidity Phobias Anxiety (frequent and severe) Feeling disheartened Forgetfulness Frequent panic attacks Palpitations Shortness of breath Incessant laughter and glee Lethargy Fatigue Depression Postnatal depression Spontaneous sweating Worry Dizziness T: Normal or Pale (chronic or congenital cases may show a deep narrow crack to the tip C: Thin and white P: Wiry and thready or Weak, thready and rapid
Treatment Principle	Calm the Shen Tonify the Heart Qi Pacify timidity
Herb Formulas	Ding Zhi Wan With Yin Deficiency: Tian Wang Bu Xin Dan
Points

Heart And Gall Bladder Qi Deficiency Due To Shock Or Fright (Duan-Depression)

Clinical Manifestations	Insomnia or frequent waking, often early in the morning Unable to fall back to sleep Nightmares Waking terrified Easily frightened or startled Easily unsettled by seeming trivial events Apprehension Restlessness Fearfulness Inappropriate worry Timidity Phobias Anxiety (frequent and severe) Frequent panic attacks Palpitations Shortness of breath Lethargy Fatigue Depression Postnatal depression Spontaneous sweating T: Normal or Pale (chronic or congenital cases may show a deep narrow crack to the tip C: Thin and white P: Wiry and thready or Weak, thready and rapid
Treatment Principle	Strengthen Qi Calm the Shen Alleviate fearfulness Calm the mind Nourish and tranquilize the Heart
Herb Formulas	An Shen Ding Zhi Wan Ding Zhi Wan With Yin Deficiency: Tian Wang Bu Xin Dan
Points	DU-20, PC-7, HT-7, GB-40, UB-7, UB-23, UB-47, UB-52, ST-36, Anmian, Yintang GB-39, SJ-5, UB-15, PC-6, HT-7, HT-9, REN-14, DU-19, DU-24 Ear: Liver, Gallbladder, Heart, Subcortex, Sympathetic

Liver Qi Stagnation ( Duan - Depression)

Clinical Manifestations	Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Wiry
Treatment Principle	Soothe the Liver Clear Stagnation
Herb Formulas	Chai Hu Shu Gan Tang
Points	GB-40, GB-41, LIV-2, LIV-3, LIV-4, LIV-5, LIV-13, LIV-14, PC-6, SJ-6, SP-6, UB-18

Liver Qi Stagntion Invades The Spleen ( Duan - Depression)

Clinical Manifestations	Abdominal distention and pain Gas Borborygmus Diarrhea Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Women: Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: White and greasy P: Slippery and wiry
Treatment Principle	Soothe the Liver Invigorate the Spleen
Herb Formulas	Xiao Yao San Tong Xie Yao Fang Hei Xiao Yao San
Points	LIV-3, LIV-13, SP-6, ST-25, ST-36, ST-37

Liver Qi Stagnation: Phlegm And Qi Stagnant And Blocked ( Duan - Depression)

Clinical Manifestations	Feeling of obstruction in throat as if a slice of roast meat were stuck there which cannot be coughed up nor swallowed down. This sensation becomes more prominent during emotional upset and subsides when relaxed Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Slippery and wiry (slippery due to Phlegm)
Treatment Principle	Spread Qi Resolve Phlegm
Herb Formulas	Ban Xia Hou Po Tang Shun Qi Dao Tan Tangmodified + Kong Xian Dan
Points	LI-18, LIV-3, PC-5, SI-17, SJ-6

Gall Bladder Deficiency Heat ( Duan - Depression)

Clinical Manifestations	Dizziness Blurred vision Bitter taste in the mouth Nausea Vomiting Agitation Restlessness Irritability Indecision Suspiciousness Palpitations with anxiety Insomnia Frequent sighing Suffocating sensation in the chest T: Pink C: Yellow and greasy or Thin and white P: Slippery and wiry or Thready and wiry- maybe rapid
Treatment Principle	Clear Heat Transform Phlegm Descend Contravecting Qi Harmonize the Stomach
Herb Formulas	Wen Dan Tang modified
Points	GB-34, HT-7, PC-5, PC-6, ST-40, UB-19

Qi And Blood Stagnation With Phlegm

Clinical Manifestations	Mania that persists for an extended period of time Agitation Restlessness Incoherent speech Constant anger A dark complexion Pain and fullness of the chest and flanks A Headache Palpitations Severe: Climbing up to high places, singing and removing one's clothes T: Purple with stasis spots C: White P: Thready and wiry or Thready and choppy
Treatment Principle	Activate the Blood Transform Stasis Regulate Qi Transform Phlegm
Herb Formulas	Dian Kuang Meng Xing Tang Jie Yu San
Points

Phlegm And Qi Accumulation ( Duan - Depression)

Clinical Manifestations	Depression Aphasia Dementia Slurred speech Muttering to oneself Moodiness Anorexia T: Normal C: Greasy P: Wiry and slippery
Treatment Principle	Regulate Qi Transform Phlegm
Herb Formulas	Wen Dan Tang modified Gua Di San
Points

Wind-Phlegm ( Duan -Depression)

Clinical Manifestations	Dizziness Chest fullness and oppression General malaise Maybe nausea Sudden fall and loss of consciousness Convulsions Incontinence of urine and stool Maybe a transient loss of consciousness or falling into a trance without convulsions Spitting up frothy saliva Worsens with cold weather or when the patient has a cold T: Pink C: Thick, sticky and white or White and slimy P: Slippery or Taut and slippery
Treatment Principle	Tonify Spleen Yang Eliminate Phlegm Extinguish Wind Stop convulsions
Herb Formulas	Xing Xiang Er Chen Tang Ban Xia Bai Zhu Tian Ma Tang Ding Xian Wan With Qi and Blood Stagnation: Bu Yang Huan Wu Tang Chinese patent medicines: Ding Xiang Wan Wu Xian Zai Sheng
Points	GB-20, LI-11, LIV-3, PC-6, SP-9, ST-36, ST-40 General points