When discussing depression, mania must be mentioned, as well as depression combined with mania, especially the latter needs detailed differentiation.
In the treatment with medicines, there is often a risk of transformation drying, which is clearly stated in Western medicine instructions, without further elaboration.
Similarly, traditional Chinese medicine can also induce mania. As exemplified by a case mentioned earlier where treating excessive phlegm-fire led to mania when taking Chinese herb Bai Zi Yang Xin Tang.
In reality, the treatment methods for depression and mania are different, depending on the appropriate rise and fall of medication.
Simply put: depression should rise, mania should fall, and for those with both conditions, adjusting the proportion of rise and fall is needed.
For severe depression with suicidal thoughts, one can follow the example of Ge Gen Tang, a treatment for Taiyang disease. If depression is combined with bodily pain, it’s appropriate to follow the path of Xiao Chai Hu Jia Gui Zhi Tang, which combines treatments for Shaoyang and Taiyang disorders.
For treating mania, use descending medicines to balance it.
For instance, within Wen Dan Tang, although Zhu Ru is light, its nature is descending. Combined with Ban Xia, Zhi Shi, and Chen Pi, it can relieve agitation and mania.
Of course, Wen Dan Tang is also effective for treating timidity and irritability, with its unique application.
Similarly, formulas like Cheng Qi Tang and Di Tan Tang are effective for treating agitation and even mania, falling under the category of descending treatment methods.
As for those experiencing depression combined with agitation, a combination of rising and falling treatments is recommended, with Xiao Chai Hu formulas being the mainstay.
The essence lies in the rising effects of Chai Hu and Sheng Jiang, and the descending effects of Ban Xia and Huang Qin.
For patients with Chai Hu patterns who have no appetite, feel restless, and have a tendency to vomit, the symptoms are complex.
With formulas like Xiao Chai Hu Tang, Chai Hu Gui Zhi Gan Jiang Tang, and Xiao Chai Hu Jia Long Gu Mu Li Tang, as agitation worsens, the use of descending medicines increases accordingly, following this principle.
Pure cases of depression are rare, while pure cases of mania are even rarer, with the combination of depression and agitation being more common.
Therefore, Xiao Chai Hu formulas are widely used.
They are also utilized for treating sluggish intestines that require promoting movement and transformation.
The effectiveness of Chai Hu is closely related to the dosage – for mild liver depression, 10 grams are sufficient; for severe cases, a larger dosage is needed, such as the original formula using 125 grams of Chai Hu. Only a truly knowledgeable physician dares to use such quantities.
There are few medical cases in later generations that achieve this level.
