Bipolar + Herbal Pattern Differentiation

I agree with Chad. It more like yin deficiency plus yang excess. Other than Chad suggested, I would add more tonifying yin herbs, like "Tian Hua Fen", "Shen Di", "Xuan Shen", "Mai Dong", ect.

Thanks for your reply - I appreciate it.

I had thought about treating Liver Stagnation - but the signs seemed too strong between these other two patterns. Although - I now do think it could be a good first formula and see how she respondsd and then maybe move on to Sheng tie luo yin + da huang.

Within the formula Chai Hu Shu Gan San, some of the ingredients can overlap and help her other signs and symptoms - such as -

Chai Hu

obviously for her stress, irritability, depression

Bai Shao

for her cramping and spasms of abdomen

supplement and nourish blood - harmonizing the liver

Chuan Xiong

help with her bruising – increase microcirculation

help with her abdominal pain caused by Qi and blood stasis

Supplement and nourish blood - harmonizing the liver

Moves qi within blood - effective for stopping pain.

Xiang Fu

Course the liver, rectify the qi

Zhi Ke

Course the liver, rectify the qi



Gan Cao

Abdominal pain

Harmonizes the other medicinals in the formula - With Bai Shao, it relaxes cramping and tension.

Thanks again for your input

- Jacob

Her mania and depression symptom already control by her own prescription, and she only has menstruate pain, and her pulse is strong, there is not any deficiency sympton, only body heat and thirsty, that mean she is Yang high without yin deficiency, if she has yin deficiency, she must has night sweating, and anxious heat at feet and hands and heart, there are no mention about these sympton.

Yes, please send some more information when you see her again - particularly of the tongue and pulse and perhaps some probing to parcel out yin vs. yang symptoms - any night time heat, etc. It&#39s also good to ask her about her psychological issues before medications to see how she was really feeling. It is a common misconception that when people have conditions controlled on medicine that they "don&#39t have" this condition. What we do know is that if you remove the medicine in many conditions within days or weeks everything will come back as it was in many cases (hypertension, diabetes, psychological conditions, etc.). So probing about how things were before they were under control gives you an idea of some of the masking that may (or may not) be happening.

And don&#39t get me wrong, I&#39m not necessarily saying your diagnosis is incorrect - just that I didn&#39t see the phlegm signs or even strong blood stagnation signs - qi stagnation maybe with some kind of heat (yin or yang is not entirely clear with the information we have now). And simply to not assume empty heat cannot create the bipolar symptoms.

As an aside you might be interested to note that there was a clinical trial for the treatment of bipolar disorder with acupuncture - the final study abstract is here. It is a treatable condition in many cases and with Chinese Medicine it can lead to a resolution requiring no further treatment compared to being on medicine for life - or at least a combination will lead to less medication and better quality of life in most cases. So it is good she is coming to see you.

With regards to yin deficiency as Feng points outs you would ask questions about whether she has hot hands and/or feet particularly in the afternoon/evening - if there is an aggravation of symptoms in the evening, hot at night (does she sleep with little covers, with the air on low, with a fan, etc.) - she does not, however, have to have nightsweats to be yin deficient.

And, again, according to giovanni the lack of tongue coating on p192 "The tongue provides a crucial indication of Full Heat; in this condition, it is red with a yellow coating. If the tongue body is Red and there is a coating with root there is Full Heat (even if the coating is not yellow). If the tongue is Red but without coating (totally or partially), it is Empty Heat. The other important manifestation is the pulse; in Full Heat, this is Full in general (which may include Wiry, Overflowing, Big or Firm), it should also be rapid but frequently it is not ... In empty heat the pulse is floating-empty and rapid --- Yin Fire accounts for symptoms of Heat in mental emotional problems that may defy a classification into Full or Empty Heat - this is illustrated by symptoms of heat above (red face, thirst, hot face) with Cold below (cold feet, general cold feeling) (Yin Fire is treated by building original qi and not clearing heat/fire)....

Thanks also for the input. I will look into the herbal options you recommended. Thanks for your time.

I need to re-look at pulse/tongue – but so far this is what I still think >

Pulse > Rapid, Strong

Tongue > Red Body, No Coat

I did notice her face when she came in and did not mention it since I thought it to be makeup/blush? I will need to ask her when I see her in two days. But her entire face was quite red? But I still think it could be makeup? Will look closer next time. Entire face would be Yang Excess and just the cheeks would be Yin Xu - correct?

Appetite > I also did not mention her appetite > she said she has lost 5 pounds and feels too skinny. She eats a lot but does not put any weight on. She is in good physical shape and does work out and do yoga. I would describe her as thin but not emaciated. She looks fit. So it would be a Yang Excess since she eats a lot - but does not gain weight?

Thirst > again is that she says she drinks a lot

Reproduction > Also neglected to mention that she said she has a strong sex drive and is a very sexual person. That could be both Yin Xu or Yang Excess? Not sure if she fatigues easily? - that might be more of a male issue anyhow?

Thanks again for putting so much devoted time into helping my patient. I really appreciate it

Now it is more clear, if she is just Yang excess, the king medicine should be Shi Gao, add Da Huang for stomach heat will be ok, if she also yin deficiency, you can add Huang Bai, Zhi Mu. By the way, if she is realy blood stagnation, the tongue should has red dots, and pulse will also astringent feeling. Her sick location should be Liver and Stomach, maybe spleen also. right now no kidney yin deficiency sympton yet, because of her sexal power.

Hello Chad,

Thank you again for your great contributions for developing our knowledge :).

Few years ago I saw this great article, which helped me with treatment of one very dificult case of mine, who had bipolar disorder.

http://www.fiveelementtraining...

Drink a lot of water is stomach strong heat, and hurt body yin energy, cause yin deficiency( night time sweat), for stomach heat use Shi Gao & Zhi Mu, for yin deficiency use Er Yin Jian, so this formula should combine with Shu Gao, Zhi Mu & Er Yin Jian+-.

I will look into different formulas that include Shi Gao, Zhi Mu & Er Yin Jian.

Thanks for all your help.