Integrated Eastern and Western Perspectives on

Manic – Depression (Bipolar) Psychological Disorder and

the Major Approaches to Treatment – with a focus on Manic Episodes

by Sheng-wei Lan, C.A.H.S. of Medicine Buddha Healing Center

. - .www Ayurveda Berkeley com www.Ayurveda-California.com Sheng-wei@Chinese-Medicine-California.com

For Mania, Herbs and Acupuncture are only 5% of the Cure

Key treatments are self-treatments – Daily Routine1. Sleep early, wake up early (10 PM, 5:30 AM) 2. Daily Meditation in morning and evening3. Mostly bland fresh-cooked vegan foods

with focus on bitter and avoiding spicy, and decreasing sour and salty. No alcohol-drugs

4. Daily early morning exercise: Tai Qi, Qi Gong, Yoga, Aikido, swimming.

5. Decrease sexual activity to preserve kidney Jing-Qi (Ojas in Ayurveda - Immunity) and to decrease liver fire-rising.

Manic psychosis (Flaring up of phlegm fire) TCM symptoms

– Sudden onset, irritability, easily angered, flushed face, blood-shot eyes, behind-eye headache, insomnia followed by excessive motor activity and unusual strength, mania, restlessness, very frequently abusive and violent behavior, climbing up to a high place and singing, suddenly running around naked in public. Source: Source: 12 ACCHS TCM Professors

Manic psychosis (Flaring up of phlegm fire) Ayurvedic symptoms

– Excessive thirst, perspiration, burning or hot sensation, huge appetite, insomnia, desire for shade, cold and wind and walks on the banks (of rivers or water tanks), fits of anger or violence, tearing off of clothes in public, desiring cold water are the symptoms which characterize the Pitta (fire-water) type of Unmad (Insanity). From 200 A.D. Indian Ayurvedic Classic Sushruta Samhita Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Western Treatments for Mania

– Lithium carbonate (Eskalith)

– Lithium salts have been confirmed capable in the therapy of bipolar disorders like manic-depression.

– Side Effects: Nausea, increased urination, thirst, hand tremor, GI distress, slurred speech, confusion when toxic

– Source: Flaws, 2001

TCM & Ayurvedic Assessment of Manic Psychosis

– Tongue: Red or pink with yellow greasy coating. TCM, Tibetan Medicine, and Ayurveda agree.

– Pulse: TCM - Wiry, slippery and rapid pulse. Ayurveda says Strong, warm, rapid, pitta pulse. Source: 12 ACCHS TCM Professors, 2004. Dr. Vasant Lad 98, Reid-Kreuzer 04

– Treatment Principle: TCM - Purge fire, remove phlegm heat tranquilizing mind and calm Shen. Ayurveda agrees and says decrease Pitta (fire and water) increase Sattva (purity-clarity-patience-wisdom by eating bland vegan diet, yoga and meditation daily, chant prayers-mantras, follow five precepts (yama or shila), be patient, serve the world through 3 spiritual practices of Shila, Samadhi, Prajna) Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Be Veggie for Treatment for Manic Episodes – Phlegm-Heat?

– Do you recommend that such a phlegm – heat manic disorder patient be vegetarian to improve their condition?

– Dr. Chung says: Yes, there will be less anger if one is vegetarian. 9 TCM ACCHS doctors said not necessary. But 3 doctors recommend vegetarianism strongly: Dr. Zhu, Dr. Wang, and Dr. Chung. Source: 12 ACCHS TCM Professors

– Ayurveda, Yoga, most Mahayana Buddhism say that it is vital to be vegetarian, but not vegan if you have manic angry episodes. Being vegan however will help decrease the mucous of the phlegm-fire. Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Foods to AvoidManic Episodes – Phlegm-Heat?

– What are worst foods that such a manic disorder patient should avoid in order to not worsen their condition?

– Most ACCHS doctors say avoid spicy. Dr. Chung says: Spicy foods, coffee and alcohol. Dr. Fang says: Hot and Spicy foods, especially avoid goat meat and beef. Source: 12 ACCHS TCM Professors

– Ayurveda, Yoga, Buddhism agrees to avoid hot-spicy, coffee-tea and alcohol. Source: Dr. Vasant Lad 98,

Reid-Kreuzer 04

Flavors to Avoid inManic Episodes – Phlegm-Heat?

– What are the recommended flavors to avoid in order to better treat this manic-disorder? (sweet, sour, salty, bitter, pungent, astringent, bland)

– Most of ACCHS TCM doctors say avoid pungent (acrid). Source: 12 ACCHS TCM Professors

– Ayurveda, Buddhism, Yoga and Tibetan Medicine say enjoy all six tastes in each meal, BUT to first use less pungent, then avoid excess salty, and avoid excess sour.Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Chinese Dietary Treatment for Manic Episodes – Phlegm-Heat

– Dr. Fang says: Hei Mu Ar (Black Wood Ears), Lian Oh (Lotus Root Stalks), Ku Gua (Bitter Melon). Bai He and Mai Dong and Shan Yao and Tian She. Most of the doctors recommend bland flavor. Source: 12 ACCHS TCM Professors

– Ayurveda also recommends Lian Oh (Lotus Root Stalks), Ku Gua (Bitter Melon)Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Ayurvedic Dietary Treatment for Manic Episodes – Phlegm-Heat

– Ayurveda, Yoga, Buddhism and Tibetan Medicine says cooling non-mucousy pitta-soothing sattvic (clarity, calm, meditative) foods

– Such as mangoes, pomegranates, coconuts, figs, dates, pears, sweet potatoes, sprouts, leafy greens, dandelions, bitter melons, bitter greens, non-spicy leafy greens, yellow squash, asparagus, white (not brown) basmati rice, mung beans (sprouts and dal), fresh-unprocessed organic cow’s milk and ghee, peeled and soaked almonds, saffron, turmeric, cardamom, coriander and cilantro, fennel, cumin, licorice tea, and brahmi tea are good. Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Flavors to Enjoy for Treatment for Manic Episodes – Phlegm-Heat

– What the recommended flavors to enjoy in order to better treat this manic-disorder? (sweet, sour, salty, bitter, pungent, astringent, bland)

– Most TCM doctors say bitter and bland. Source: 12 ACCHS TCM Professors

– Dr. Fang says: Bitter and Pungent. Source: ACCHS Professor

– Ayurveda, Yoga, Buddhism and Tibetan Medicine strongly agree with bitter, bland, astringent (dry) being the best flavors. But strongly disagree that pungent (acrid or spicy) is good. Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Physical Exercise to TreatManic Episodes – Phlegm-Heat?

– Dr. Chung says: Qi Gong, Tai Chi and Yoga in the morning. Go to bed at 10 PM is best. Tai Chi is recommended by Dr. Chin, Dr. Chung, Dr. Liang and Qi Gong by Dr. Wang, Dr. Chung, Dr. Horowitz, H.J. Wang, L. Wang. Source: 12 ACCHS TCM Professors

– Ayurveda, Buddhism, Yoga and Tibetan Medicine says it is important for mania and suggest yoga poses (Moon salutation 16x, moderately fast; Fish; Boat; Bow) and Prostrations (full-body five point Buddha-bowing).

– Avoid intense competitive sports or hot mid-day exercise. Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

– Buddhist Spiritual Practice to Decrease Mania: – Yantras, Mandalas and Tangkhas are Buddha,

Bodhisattva, Deity, Guru images– Master Hua’s Mantra for ending anger?

– Quell the fire in your liver!– “Patience, Patience, Don’t Get Angry, Svaha!”– “Om Namo Kshanti, Kshanti, Om Shanti, Svaha!”– “Om Homage to Patience, Patience, Om Peace, Blessed Be!”

Pitta (Fire-Water) is Fire: “Tejas” or “Agni” in Sanskrit

Buddhist Five Precepts Heal Mania

The Pancha Shila are: 1. No killing, no harming, be vegetarian

2. No stealing 3. No sexual misconduct – preserve Jing Qi

4. No lying, no harsh speech, no gossiping or disparaging, no chit-chat frivolous speech (preserve Qi, Ojas and Prana)

5. No taking alcohol, drugs or other mind-altering substances in order to preserve mental clarity and Sattva (patience and wisdom)

Daily Meditation to TreatManic Episodes – Phlegm-Heat?

• Ayurveda, Buddhism, Yoga and Tibetan Medicine says it is key treatment for mania

• While it is important as a Christian, Muslim, Jew, or Buddhist (world’s 4 major religions) to chant mantras or pray regularly, in these hectic modern times, especially if one is manic, “it is vital for mental-physical health to meditate silently morning and evening for at least 20 minutes.” Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Daily Meditation to TreatManic Episodes – Phlegm-Heat?

• “Meditate in the way you are accustomed, or silently walk in nature or practice counting your breath for 108x or try mantra meditation, chant 108x ‘Om Kshanti – Shanti Paramita’ (Perfection of Patience and Peace) or ‘Om Namo Amitabha’ or ‘E Na Li Pi She Ti’ or ‘She Dan Dwo Bwo Da La’ or ‘Om Mani Padme Hum’.

• Auspicious mantra meditation combined with silent Vipassana or Ch’an (Zen) or Qi Gong meditation brings healing, protection, balance, peace and into your life and the world.” Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Acupuncture Treatments for Manic Episodes – Phlegm-Heat

– P6, ST40, ST36, SP6, LV3, P7, DU20, DU14, Si Shen Chong, Shen Men, UB15, UB20, and UB14. Source: 12 ACCHS TCM Professors, 2004.

– In the ancient 1601 A.D. classic by master Yang Jizhou The Golden Needle (Jing Jen), he states “Houxi SI3 – The Back Ravine” “this point cures schizophrenia – even if mild.” Source: Bertschinger_91: 99

Acupuncture and Acupressure Treatments for Manic Episodes – Phlegm-Heat

– Yang Jizhou also says to needle Shangwan CV13 “in mania and running about – the Upper Duct together with the Spirit Gate” (Shenmen H7) Source: Bertschinger_91: 99

– Ayurveda and Yoga say that it is important to do acupressure on Shui Gou (DU26), Yin Tang (third eye), Bai Hui (DU20 or crown chakra called Brahma Randra in Sanskrit) with sandalwood (Santalum album) essential oil. Source: Dr. Vasant Lad, Reid-Kreuzer 04

Ear Seed Treatments for Manic Episodes – Phlegm-Heat

– Chinese auriculotherapy Dr. Li-Chun Huang, M.D. (China), O.M.D., says to in general use “Forehead, Liver, Heart, Brain Stem, Subcortex” and for manic type “(kuang) due to flaring up of phlegm fire” to use supplementary points of Shen Men and Occiput with Spleen added during depressive phase. She also recommends Forehead to clear the mind. Source: Huang 97:320-321.

Bleeding Treatments for Manic Episodes – Phlegm-Heat

– Bleed the tip of each of the ten fingers (shi shen) is what many ACCHS teachers said. Others said don’t need it. Source: 12 ACCHS TCM Professors, 2004.

– Ayurveda says to do “rakta moksha” (blood-letting) of the tips of middle finger (fire finger) and of the Ear Apex with a diabetic lancet. Drain on 10 to 30 drops out of each point.Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Moxibustion and Cupping Treatments for Manic Episodes – Phlegm-Heat

– In general, all but two ACCHS doctors said that moxa is not recommended for bi-polar with mostly manic episodes since it increase heat too much. Source: 12 ACCHS TCM Professors, 2004.

– In general, all but one ACCHS doctors said that cupping is not useful for bi-polar with mostly manic episodes. Dr. Fang says cup Heart, Liver and Kidney, Small Intestine meridians. J. Horowitz says to cup UB15 and UB13, UB20. Source: 12 ACCHS TCM Professors, 2004.

Gua Sha Scraping Treatments for Manic Episodes – Phlegm-Heat

– Dr. Hsiao says: Hua Tuo Jia Ji (on back).– The rest said it is not useful.

Source: 12 ACCHS TCM Professors, 2004.

Herbal Patent Medicine Tablets (pian-wan) for Manic Episodes – Phlegm-Heat

– ACCHS professors Dr. Chin and Dr. Liang suggest Mong Shi Gun Tang Wan. Also referred to as Gun3 Tan2 Wan2, “drains fire and drives out phlegm” Source: 12 ACCHS TCM Professors, 2004. Bensky-Barolet 1990: 424

– ACCHS professors Dr. Chin, Dr. Fang, and Dr. Liang recommend Di Tan Tang. “Di2 Tan2 Tang1 – Guide Out the Phlegm Decoction” Source: 12 ACCHS TCM Professors, 2004, Wu 85: 265, Bensky-Barolet 1990: 424

Herbal Patent Medicine Tablets (pian-wan) for Manic Episodes – Phlegm-Heat

– Dr. Horowitz, Dr. Liang, Dr. Wang and Dr. Bensky recommended three possible formulas: Jia Wei Shao Yao San Source: 12 ACCHS TCM Professors, 2004.

Bensky-Barolet 1990: 148 and Bai He He Huan Pi and Gan Mai Da Zao Tang Source: Bensky-Barolet 1990: 383

– Dr. Hsiao, Dr. Horowitz, Dr. Wu and Dr. Bensky recommended Wen Dan Tang Pian. Source: 12 ACCHS TCM Professors, 2004, Wu 85: 265, Bensky-Barolet 1990: 435

Herbal Patent Medicine Tablets (pian-wan) for Manic Episodes – Phlegm-Heat

– The Qing Dynasty Dr. Liu Yi-Ren, author of the classic Yi Xue Chuan Xin Lu (The Heart Transmission of Medicine) says that Mania (with anger) “requires dispelling wind and eliminating heat with Fang Feng Tong Sheng San (Notopterygium Sage-communicated Powder) as the ruling (formula).” Source: Liu 97, Bensky-Barolet 1990: 58

Customized Bulk Herb Decoction Formula for Manic Episodes – Phlegm-Heat

– Dr. Wu of Zhiang Xi Publishing recommends in the Chinese Mandarin TCM Textbook, to take the decoction of Xie4 Xin1 Tang1 for phlegm-fire with mental disturbances. Source: Wu 91: 256-257, Bensky-Barolet 1990: 79

– Dr. Fang of ACCHS says: Add Shen Tie Luo and Ci Shi to the standard Di Tan Tang formula. Source: ACCHS TCM Professors, 2004, Wu 85: 265, Bensky-Barolet 1990: 424

“Dui4 Yao4” Formula for Manic Episodes – Phlegm-Heat

– If you had to use a simple two herb or four herb combination using classical “dui yao” pairs, what would be your recommended herbal combination pairs?

– Dr. Chung says: Long Gu and Mu Li. Zhen Zhu Mu and Huai Shao Mai. Source: ACCHS TCM Professors, 2004

– Dr. Fang says: Ju Ru and Huang Lian/Ah Jiao. Source: ACCHS TCM Professors, 2004

“Dui4 Yao4” Formula for Manic Episodes – Phlegm-Heat

– Philippe Sionneau in his book Dui Yao – The Art of Combining Chinese Medicinals says to use Long Gu (Os Draconis) and Mu Li (Concha Ostreae) to “calm the liver and subdue yang, quiet the spirit” to help with “vexation and agitation, insomnia, dizziness, vertigo, photophobia, and tinnitus due to liver yang hyperactivity harassing the spirit” with “chronic diarrhea” and “excessive perspiration due to vacuity.” Source: Sionneau 97: 111-112

– Ayurveda also uses conch shell as a purified ash called Shanka Bhasma for similar reasons. Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

“Dui4 Yao4” Formula for Manic Episodes – Phlegm-Heat

– Dr. Li and Dr Chin recommend the dui yao of Shi Chang Pu and Yu Jin. Philippe Sionneau similarly recommends Shi Chang Pu (Rhizoma Acori Graminei) and Yuan Zhi (Radix Polygalae Tenuifolia) for “go to the heart, transform phlegm, open the portals of the heart and kidneys, boost the intelligence and arouse the spirit” – it helps with the depressive side of bi-polar to help with “insomnia, and mental agitation due to the heart not interacting or phlegm confounding the orifices of the heart.” Source: Sionneau 97: 124

– Ayurveda also uses Vacha (Acorus calamus – calamus root - Shi Chang Pu) combined with Brahmi (Centella asiatica or Di Qien Cao in Mandarin) for this same reason Source: Dr. Vasant Lad 98, Reid-Kreuzer 04, Reid 95: 129, Tierra 88: 200

How to Imbalance Pitta Fire Constitution and

Worsen Mania

– Drink plenty of alcohol– Eat hot spicy, salty and sour foods– Engage in frustrating, competitive activities– Emphasize tomatoes, chilies, garlic, raw onions,

and store bought yogurt in your diet– Exercise competitively at hottest time of the day– Use drugs, especially cocaine, speed, crystal-meth,

and large doses of caffeine and marijuana

How to Imbalance Pitta Fire Constitution and Worsen Mania

– Avoid cool fresh peaceful places

– Repress your feelings

– Eat as much red meat and salted fish as possible

– Be an ambitious workaholic

– Do all of the above during summer

Yama – Niyama of Yoga Heal Mania

– Similar to Buddhist Five Precepts (Shila), the Yogic Five Moral Disciplines / Restraints () are: – 1. Celibacy or Less Sex

– 2. Harmlessness

– 3. Truthfulness

– 4. Non-stealing

– 5. Non-possessiveness.

Ayurveda’s Ideal Patient and Doctor

– 200 B.C. Ayurvedic sage Charaka says:– Engage in serious study– Respect teachers, saints, sages, and all

beings– Conserve vital energies– Observe non-violence (ahimsa)– Speak the truth (satya)– Don’t speak ill of others or gossip– Refrain from envy, competitiveness and

anger– Eat a vegetarian diet,

not take drugs, alcohol or smoke

– slightly oily(snashneha)

– Sharp (tikshna)

– Hot (ushna)

– Light (laghu)

– Fetid, fleshy, pungent, sour smelling (vishram)

– Spreading / motile (saram)

– Liquid(dravam)

– acute (intense)

The Gunas of Pitta Dosha

The Doshas & the Elements

Pitta - The Fire and Water Constitution that Most-often gets

Mania– Slightly oily - skin, hair, diarrhea

– Hot - hot-tempered, hot-headed, hot-flash

– Sharp - sharp mind, sharp tongue, cuts like a knife

– Penetrating - penetrating insight, hot oil, spicy

– Light - bright, brilliant, radiant, shining, visionary

– Acidic - inflammatory, sour belly, heart-burn

– Spreading - like a fire! Spreading name and fame!

Elements, Doshas and Energy

The Qualities of the 3 DoshasVata Pitta Kapha

Catabolic

Dehydrate

MetabolicDiaphoresisPolydipsia

AnabolicEdematous

Cold hands & feet,Raynaud’s

Inflammation,Fever, Hot,Ulceration

Cool

Dry, Desiccation,Dandruff,Split-ends

Slightly oily,lipidmetabolism

Oily, fats,

Source: Scan from Dr. Lad, Vasant, M.A.Sc., Textbook of Ayurveda, Albuquerque, NM: Ayurvedic Press, 2001

Use under the "fair use" provision (17 USC §107) of the U.S. Copyright Act for non-profit educational purposes only.

Pitta is Fire: “Tejas” or “Agni”

– Location: Small intestine, liver, gall bladder, eyes– Personality: Hot-headed, Hot-blooded, Hot-tempered,

Sharp, Caustic, Burned out, Tigerish, Catty, Sarcastic “sharp clawed” humor cuts like a knife, Brilliant, Warm

– Heat expands, cold contracts– Spreading of fire, rash, and possessions,

spread knowledge, big ego, name and fame– Energy: “Radiant energy” – heat, light– Reaction: Metabolism,

transformation, comprehension, appreciation, recognition and total understanding

Source: Scan from Dr. Lad, Vasant, M.A.Sc., Textbook of Ayurveda, Albuquerque, NM: Ayurvedic Press, 2001

Use under the "fair use" provision (17 USC §107) of the U.S. Copyright Act for non-profit educational purposes only.

Fire & Water

– Metabolism - acids

– Sharp

– Photosensitive

– Oily skin

– Inflammations

– Motility - IBS

Gunas of Pitta (Fire and Water)

– hot

– light

– acute (intense)

– sharp

– mobile / motile

– spreading

– liquid

– oily

– pungent smelling

– sour taste / smell

Pitta: