Depression is primarily due to an imbalance of Qi.
Imbalance has two aspects:
First, the pathways of Qi are blocked; second, the Qi is weak and cannot flow.
This so-called Qi refers to Yang Qi.
Yang governs movement; thus, depression is an excess of stillness and a lack of harmony in Yang Qi.
Therefore, there are two types of depressive disorders: one is Yang stagnation, and the other is Yang deficiency.
Yang stagnation refers to an unimpeded flow of Yang Qi; Yang deficiency refers to weak Yang Qi.
Yang stagnation is more common in young adults, while Yang deficiency is often seen in the elderly.
Treatments for Yang stagnation resemble the formulas of Si Ni San; treatments for Yang deficiency are similar to Si Ni Tang.
It is not necessary to choose between the two formulas; rather, it indicates two different treatment methods.
The key to Si Ni San is in its ability to unblock and facilitate smooth Qi flow in the body.
This is because young individuals usually have strong bodies and vital Qi, so even if they exhibit symptoms of deficiency, it’s not significant.
Thus, the use of Si Ni San focuses on harmonization, not simply tonifying or treating blood, but rather regulating the autonomic nervous system.
The essence of Si Ni Tang lies in enhancing cardiac function; the elderly, being physically weak, need to invigorate circulation and revive their waning energy.
The difference of two words conveys vastly different meanings and treatment approaches.
Formulas like Chai Hu Shu Gan San and Xiao Yao San are all derived from the modifications of Si Ni San.
In summary, for treating depression, the first step is to ensure the smooth flow of Qi. Even if depression transforms into mania, it is still necessary to resolve the Yangming excess; what is the purpose?
The goal is to eliminate the source of excess heat and facilitate the flow of Qi up and down.
In cases of depression, only after the Qi is smooth can the spirit be calmed; otherwise, medications will be ineffective, and nothing will work.
Yesterday, we had a discussion on the timing and methods for calming the spirit; can you recall it?
There are three methods for resolving depression and calming the spirit, tonifying Qi and calming the spirit, and promoting water metabolism to calm the spirit.
Before calming the spirit, one may need to resolve depression, tonify Qi, or promote water metabolism, all stemming from the lack of smooth Qi flow. One may first resolve depression, or first tonify Qi, or first promote water metabolism.
Thus, it is said: in cases of depression, only when the Qi flows smoothly can the spirit be calmed; otherwise, all efforts will be in vain.
