Ms. Dubois, 38, mother of two and caregiver, consults for general fatigue. Three months ago, she was put on sick leave by her doctor and has since been taking antidepressants and undergoing psychotherapy. Despite this, she still feels tired, has difficulty concentrating and frequently suffers from insomnia. She consults in acupuncture, because she would like to have more energy and return to work as soon as possible.

Ms. Dubois suffers from the most common mental illness today – depression, which it seems will affect one in four people in her lifetime. This disorder can also be associated with burnout, seasonal depression and anxiety. Traditional Chinese Medicine (TCM), as an energy therapy, can act not only on the physical health of the individual, but also on his emotional states.

In the four-step approach, it is important for the acupuncturist to take a thorough case history. Depression does not occur overnight, it is often the result of a long development, the source of which is not always clear. Our accelerated rhythms of life sometimes prevent us from seeing what we are getting stuck in …

It also happens very often that seemingly harmless warning signs (insomnia, physical pain, headaches, palpitations, etc.) appear before depression has really set in. In such a case, the acupuncturist will be able to detect the incipient imbalance, hence the great utility, in addition to a thorough interrogation, of the taking of the pulses (see Palpating) and the examination of the tongue (see Observe).

1- Question

The questioning about psychological imbalances focuses on three important aspects: physical, cognitive and emotional signs.

Questions about physical signs relate in particular to vitality, digestion and sleep; they are part of the “field” study carried out using the Ten Songs (see Questioning). The acupuncturist asks Ms. Dubois to clarify what she means by fatigue. She reports general weariness and explains that she feels tired especially when getting up, and that she often goes back to bed after lunch. For the past few weeks, she has resumed certain daily activities and made a resolution to take a walk every day. However, she is exhausted after a 15-minute walk, and on some days she feels no motivation to do so. Sometimes she manages to go to the grocery store or to her hairdresser, other days it completely empties her and she feels very tired, both physically and mentally.

Regarding the digestive sphere – which will be decisive in the energy balance – Ms. Dubois has indeed less appetite, but she says that is because she no longer tastes food. She often feels bloated after eating and her stomach makes a lot of annoying gurgling sounds. She has loose stools whether she is eating fiber or not, which makes her feel discouraged.

Asked about her insomnia, Ms. Dubois says that it takes hours to fall asleep, because she thinks of many things. When the acupuncturist asks her about her thoughts, among other things, she mentions that she worries a lot about her 15-year-old son who sometimes comes home late at night. Besides, that’s how his fatigue started. Her boy came in late, she was worried, was not sleeping… in the long run, tired, she went to see her doctor with the result that we know.

The acupuncturist completes his information gathering with the help of the Ten Songs, looking for signs such as palpitations, numbness, dizziness, headache, back pain, etc. Ms. Dubois experiences palpitations in the evening, which are most evident on sleepless nights. She also has dizziness, especially on days when she is feeling very tired.

The cognitive sphere is then examined. Ms. Dubois says she is discouraged by the fact that she has difficulty concentrating on simply reading an article in the newspaper. Her ideas roam left and right and she often has to reread the same sentence. She gives up most of the time, exhausted. She also admits, embarrassed, that her children have noticed that she sometimes forgot what she was doing or saying.

Finally, the acupuncturist discusses the emotional history of the patient, in order to trace the possible origins of the depression. Ms. Dubois is invited to talk to her about her professional and family life, as well as her hobbies. Loving her job, Ms. Dubois explains that she sometimes worked more than 50 hours a week, one of her colleagues being on maternity leave. She had no choice, and could not leave the beneficiaries in the cold. The relationship with her spouse is going well, but that with her “teenager”, who asserts his independence, is more problematic. Finally, she finds her ten-year-old daughter particularly busy since she has been off work, having the impression that a bee is constantly circling around her.

2- Auscultate

Auscultation is not used in this case.

3- Palpate

In such a case, palpation is usually limited to taking the pulse. It turns out to be thin and weak.However, we can also palpate certain points such as the Shu points of the back on the Meridian of the Bladder or Viscera.

4- Observer

The acupuncturist, attentive to Ms. Dubois’ non-verbal comments, notices that she is rather calm, that her facial expression is reduced to a minimum and that she performs few movements when she moves. In other words, his organism is a function of saving resources. A few times during the interrogation, the acupuncturist must bring her back to the subject, as she tends to get lost in the small details. Finally, looking at the face reveals a dull complexion, just like her lips. The tongue is pale, covered with a white coating, and has tooth marks on the sides (it is said to be “indented”).

Chinese medicine has identified six areas within which imbalance can lead to depression:

• the emotions;
• heredity;
• food;
• sexual activity;
• overwork;
• drug use.

In Ms. Dubois’ case, it was both the overwork, as she herself describes so well, and the emotions that caused her problem. As is often the case with depression and burnout, we are dealing with a type of person for whom a job well done is very important. These people sometimes consider themselves indispensable, feel obliged to “perform” and no longer know how to say no, even when their professional task exceeds their capacities.

In addition to being a perfectionist, Ms. Dubois works in a physically and psychologically demanding helping relationship field. Let’s add that she feels like she’s being drained by her daughter’s demands and her boy worries her, and we have the winning combination for depression. With the little time she had left to take care of herself, Ms. Dubois did not notice that her body was getting tired and she did not hear the red flag of her insomnia.

On the energy side, we see that the Qi of the Spleen / Pancreas is drained, on the physical level, by the excessive demands of his professional life, and that he is affected by an excess of worries (thoughts about his son). You should know that the Qi of the Spleen / Pancreas, in association with the Qi of Food, allows the production of Blood which nourishes the Heart. If the Qi of the Spleen / Pancreas is deficient, the Blood of the Heart will also be deficient in the more or less long term. Often, as is the case here, anxiety thus affects not only the Spleen / Pancreas, but also disturbs the Spirit, whose seat is the Heart. This disturbance, which can be caused by any excess emotion, agitates and destabilizes the Heart which can no longer assume its role of governing the Blood, hence the Blood Void of the Heart.

In TCM, mental aspects are an integral part of physiology and are interpreted within the various analysis grids (see Questioning) which make it possible to establish an energy balance. Since the Spirits (or psychovisceral entities) are housed in the Organs, the energetic state of the latter will have an influence on the emotional state and vice versa.

Ms. Dubois shows physical signs of a lack of Spleen / Pancreas energy (a Void of Qi). The general weariness that she feels shows that this Organ does not adequately carry out its work of transporting nutrients to all the tissues of the body. The weak pulse and the fact that the patient does not move much confirm this hypofunction. Fatigue is marked upon rising, when the body must pass from the Yin state (the rest of the night) to the Yang (the activities of the day). This moment is demanding for Ms. Dubois, because her Qi is so weak that she does not have the minimum spring to make the transition. And if she feels the need to go back to bed after lunch, it is because the Spleen / Pancreas is then fully digested and has no more energy for the rest of the body.

Ms. Dubois believes that she has less appetite because she no longer tastes food, when in fact both of these are symptoms of a weakened Spleen / Pancreas. The same goes for bloating with gurgling and loose stools: digestion is difficult and this has repercussions on all digestive structures.

In addition, not being able to assume its role in the production of Blood, the Spleen / Pancreas poorly nourishes the Heart, which causes all kinds of symptoms arising from a Emptiness of Blood from the Heart. Thus, the Blood cannot rise to the head properly, causing dizziness; the Spirit is also a victim, hence mental exhaustion. Insomnia and constantly flowing thoughts are also signs of a deficiency in the supply of Blood to the Spirit. Indeed, the Blood brings him the material support necessary to anchor himself; in deficit of Blood, it “floats” and its activity is dispersed. It is for the same reasons that Mme Dubois cannot concentrate on simply reading a newspaper article, she frequently misses it and her speech tends to get lost in the small details (see the Yi and the Zhi in Spirits). Unfortunately, this only adds to the worries that are already disturbing the Spleen / Pancreas.

The Heart Blood Emptiness is also perceived by the fine pulse and palpitations, results of a Heart Qi Emptiness underlying a Heart Blood Void. The heart pump is no longer well regulated, the heart beats. Finally, the tongue is pale and “indented” because of the Void of Qi of the Spleen / Pancreas which cannot bring the Blood there; the white coating reveals the inability of the Spleen / Pancreas to properly circulate the body fluids, which accumulate; and the dull complexion and lips reflect the Void of Blood.

The energetic approach will favor a basic treatment where it will be just as important to act on the Heart as on the Spleen / Pancreas. All of the treatments will aim to nourish the Blood of the Heart and tone the Qi of the Spleen / Pancreas. It will also be important to stabilize the Spirit and promote sleep, a determining factor in the reconstruction of the Blood. All this can be achieved by acupuncture, combined with other modalities (pharmacopoeia, Qi Gong, massages, etc.).

Changes in diet may prevent further depletion of Spleen / Pancreas Qi and promote patient recovery. So avoid sweets, cold or raw Foods, and fats. Stimulants like tea, coffee and chocolate are also to be taken in moderation, as they create Heat in the upper body and especially in the head, where the Spirit is already too dispersed (see Food). Ms. Dubois should also persist in taking her walks, even if only for a few minutes a day, and set aside good periods of rest (see Overwork). Finally, meditation and energy exercises (Tai Ji and Qi Gong) could be beneficial in restoring the Spirit to a solid and serene base.