Bipolar Disorder (Adjunct)
Overview
Bipolar disorder in TCM falls under the categories of 'dian kuang' (mania and withdrawal) and 'yu zheng' (depression syndrome), characterized by alternating episodes of elevated and depressed mood. The disease is located in the brain and involves the heart, liver, gallbladder, spleen, and kidney. The basic pathogenesis is qi stagnation, internal harassment by phlegm-fire, and yin-yang disharmony. The manic phase is mostly due to phlegm-fire disturbing the heart and liver-fire hyperactivity, manifesting as irritability, pressured speech, and insomnia; the depressive phase is mostly due to heart-spleen deficiency and liver qi stagnation, manifesting as low mood, fatigue, and diminished interest. Clinical practice requires staged pattern differentiation: the manic phase is treated mainly by clearing the heart and draining fire, resolving phlegm and opening the orifices; the depressive phase by soothing the liver and relieving depression, strengthening the spleen and nourishing the heart, with attention to harmonizing yin and yang and calming the spirit.
Pattern differentiation (clinical patterns)
Phlegm-Fire Disturbing the Heart
Elevated mood, irritability, pressured speech, loud voice, insomnia with little sleep, flushed face and red eyes, constipation with dark urine, red tongue with yellow greasy coating, and a slippery rapid pulse.
Clear the heart and drain fire, resolve phlegm and open the orifices, calm the spirit and stabilize the will.
Liver Qi Stagnation
Low mood, distending fullness in the chest and hypochondrium, frequent sighing, belching, irritability, insomnia with profuse dreams, pale red tongue with thin white coating, and a wiry pulse.
Soothe the liver and relieve depression, regulate qi and free the middle, calm the spirit and stabilize the will.
Heart-Spleen Deficiency
Low mood, fatigue and weakness, diminished interest, palpitations and forgetfulness, insomnia with profuse dreams, poor appetite and loose stools, sallow complexion, pale tongue with thin white coating, and a fine weak pulse.
Strengthen the spleen and nourish the heart, boost qi and supplement blood, calm the spirit and stabilize the will.
Connections
Daily care & prevention
Maintain a regular daily routine and avoid staying up late and excessive stimulation. During the manic phase, reduce coffee, strong tea, and spicy foods; during the depressive phase, consume appropriate amounts of red dates, Chinese yam, and millet to strengthen the spleen and nourish the heart. Practice ba duan jin and tai chi to regulate qi movement. When emotions fluctuate, press and knead Taichong (LR3), Neiguan (PC6), and Shenmen (HT7). Family members should offer understanding and companionship and avoid arguments. Keep a mood diary, take medication as prescribed, and do not stop medication on your own.
When to seek medical care
Seek immediate medical attention or contact psychiatric emergency services if there is harm to others or destruction of property, self-harm or suicidal tendencies, refusal of food and water, several consecutive days without sleep, incoherent speech making communication impossible, worsening hallucinations and delusions, or a sudden switch from depression to mania with severe mood swings and impulsive behavior.