Traditional Chinese Medicine, Western Medicine, and Massage Therapy

Clinical Depression: How We View It and How We Heal It

Isabelle LoPresti

“DSM-IV Criteria for Major Depressive Disorder (MDD)

·             Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.

·             Mood represents a change from the person’s baseline.

·             Impaired function: social, occupational, educational.

·             Specific symptoms, at least 5 of these 9, present nearly every day:

1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful).
2. Decreased interest or pleasure in most activities, most of each day
3. Significant weight change (5%) or change in appetite
4. Change in sleep: insomnia or hypersomnia
5. Change in activity: psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Guilt/ worthlessness: feelings of worthlessness or excessive or inappropriate guilt
8. Concentration: diminished ability to think or concentrate, or more indecisiveness
9. Suicidality: thoughts of death or suicide, or has suicide plan”

-Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes, Diagnostic and Statistical Manual of Mental Disorders (DSM) IV

 

A woman speaks –

“Depression is messy. It feels like sadness or guilt or anger. It feels illogical and irrational. It doesn’t make sense. It hurts. Depression makes you want to give in, give over, give up. It splits you from yourself and turns on you with anger. Depression makes you angry with your body, your self, your life but it never allows the anger to be released. Depression despairs of hope and cannot see a light at the end of the tunnel. Nothing can make you feel better when you are depressed.

Except maybe...

A soft and gentle hand on your back that asks for nothing and gives only soothing. A quiet voice that gives you direction and helps you to move. A deep release from the tension behind your eyes and the headache and soul ache that wakes you every morning. The salve of kindness that eases low back pain or massages the feet with warm lotion or oil. A respite. A break from the isolation and pain. And after a while, if the dark clouds part and it’s possible to see into the day again, the depression may lift, if only momentarily. In that moment, the isolation fades and it may be possible to connect with another human being – the person behind the hand on the back and the fingers on the brow.”

- Lois

 

Pamela Fitch, RMT, “Depression: How Can Massage Therapy Help”

Depression from a Western Medicine Point of View

Depression can affect someone in many different ways and does not have one specific cause. The range of causes include:

·        Chemical imbalance- Serotonin receptors do not pick up correctly causing a lack of reuptake.

·        Environmental cause- hours of daylight per day and seasons can have an affect on Seasonal Affective Disorder and the presence of depression bouts.

·        Trauma- recovery from trauma can often induce an inability to cope and overwhelming feelings of sadness and hopelessness.

·        Hereditary- the chemical balance of parents can have an effect on the child’s ability to create and maintain proper serotonin levels in the body. Parents also have a large influence on the way that a child views life and the coping mechanisms the child develops in the face of hardship.

·        Nutritional- a lack of proper nutrition can result in worsened mood and an inability to maintain homeostasis in many ways, including serotonin levels and mental state.

·        Social- problems maintaining a healthy mental state can occur when the human need for a proper support group and a feeling of being loved goes unmet.

·        Financial- in a world where money is a large part of every day life, the inability to pay for basic human needs largely factors into one’s mental state.

How Massage Therapy Treats Depression

Well-intended human touch has a variety of positive benefits that treat symptoms of depression. Decreased cortisol (also known as the stress hormone) levels allow for lower presence of stress, whole body and mind relaxation, and better quality and quantity of sleep. A person suffering from depression can benefit greatly from knowing that there is someone there with them, decreasing feelings of loneliness and helplessness. Human connection through touch can help a person experiencing overwhelming negative emotions allow those feelings to release, knowing they are safe. Focusing on the present moment, taking care of the body, and mindfulness are all parts of massage therapy that are greatly beneficial in decreasing symptoms of depression. Swedish massage therapy techniques such as effleurage, petrissage, and compression focus on soothing and relaxing tense muscles and relieving muscle knots. Temporomandibular joint (TMJ) work helps with headaches that are caused by clenching the jaw and teeth, a common side effect of increased stress that comes with depression. Cranio-Sacral Massage techniques are also very helpful to release occipital-axial compression that may cause dizziness, pain, brain fog, and headache. Proprioceptive Neuromuscular Facilitation (PNF) and Passive Range of Motion (PROM) exercises performed by the Massage Therapist help to ease muscle tension as well as provide a simple self-care practice that the client can take home and work on alone. Having a goal and set of exercises can be very beneficial to provide the right amount of responsibility for one’s self that will boost the person’s confidence in their ability to care and love themselves without being too overwhelming. Exercises and stretches done at home, a regular schedule of massage, human connection, and decreased mental and physical stress all provide a perfect atmosphere to ease the symptoms of someone suffering with depression.

Tips for the Massage Therapist

Working on a person affected by depression can be emotionally draining if the Massage Therapist does not take proper measures to secure their own emotional well-being. It is important to remember that counseling and psychiatric help are to be performed by a professional in that field. Massage therapy work for depression can be similar to working on someone with chronic pain- it is key to keep in mind that the focus is to alleviate symptoms and provide a safe atmosphere for healing rather than attempting to cure the condition.

         Easing hypersensitivity through the use of dim lights, weighted blankets (to promote the parasympathetic nervous system’s “rest and relaxation” response), ear plugs or soft music, and relaxing smells such as lavender and peppermint are great tools to utilize during the massage.

         Communication is key! Checking in with the client and being open-minded about treatment options is a highly effective way to ensure maximum comfort, relaxation, and healing.

        

Depression from a Traditional Chinese Medicine Point of View

Depression is described as “Yu Zheng” in Traditional Chinese Medicine (TCM). Causes include:

·     Lung Qi Deficiency- deficiency of lung qi is characterized with grief, inability to let go, shortness of breath, and difficulty speaking what needs to be said.

·     Liver Qi Stagnation- liver qi that cannot move can cause irritability and frustration, anger, and tension in the muscles.

·     Kidney Yang Deficiency- irrational fear and anxiety can be the result of an insufficient amount of yang energy in the kidneys.

·     Presence of Phlegm- phlegm creates a fog in the brain that makes it hard to think clearly and make decisions. It makes the body feel heavy, fatigued, and sluggish.

·     Excess Yin- too much calm and grounded energy can leave a person in a depressed state, unable to get the energy that they need to function correctly and feeling lackluster toward life. Yin is characterized as a feminine energy, explaining why depression affects more women than men.

Yin Organs and Their Related Energies That Manifest in Depression:

Spleen-worry

Liver-anger

Kidneys-fear

Lungs -grief and anxiety

How Traditional Chinese Medicine Treats Depression

Through a variety of treatment options including Qi Gong, herbs, moxa, acupressure and acupuncture as well as energy work, the symptoms of depression can be addressed and treated through TCM. Special attention to the water element, which is considered the life source, aids in the building of zest for life and ability to function and feel happiness toward one’s state of being. Water building exercises in Qi Gong are a great tool for clients to perform with their Massage Therapist and at home.

         Tonifying the Qi in Yin organs mentioned above can ease the negative symptoms that come from stagnation and deficiency. This can be done through acupuncture and acupressure along the specific meridians and points as well as herbal concoctions or burning moxa.

         The 9 Points to Revive Yang treatment taught by Cynthia McMullen is an excellent way to tonify yang and bring energy back to the person experiencing symptoms of depression. Some herbs recommended for Yu Zheng treatment in TCM include:

·     Suan Zao Ren and He Huan Pi for balancing Shen

·     Bai Zhu, Huang Qi, and Wu Wei Zi for tonifying Lung Qi

·     Chai Hu, Bai Shao, Bai Zhu, and Dang Shen for moving Liver Qi stagnation

·     Ban Xia, Fu Ling, and Hou Po for treating Phlegm and Phlem/ Qi clashing.

·     Gan Cao, Fu Xiao Mai, and Da Zao for Yin and Blood Deficiency

The most important thing in treating depression through TCM is to regain balance in whatever form is best for the client. Many treatments can be used simultaneously and allow for a multi-faceted approach to healing the body and mind.

Sources:

“Depression & Traditional Chinese Medicine”, Stanley J. Swierzewski, III, M.D.

“Depression: How Can Massage Therapy Help”, Pamela Fitch, RMT

“Depression: Causes and Treatment by Traditional Chinese Medicine” by FEMTC of biomanantial.com

Diagnostic Criteria for Major Depressive Disorder and Depressive Episodes, Diagnostic and Statistical Manual of Mental Disorders (DSM) IV

Plantar Fasciitis

       

Plantar Fasciitis

     Has your foot ever hurt so much that you could hardly walk on it? Have you been experiencing a sharp pain in your heel? If so you just might be a part of the four to seven percent of the population that is afflicted by a condition known as plantar fasciitis. Plantar fasciitis is a chronic condition characterized by sharp pain in the bottom or heel of the foot. The pain is usually the worst when first waking up in the morning, and after sitting for prolonged periods of time

This conditioned derives its name from how it affects the plantar fascia of the foot. The plantar fascia is a thick aponeurotica its primary function is to support the arch of the foot, and assist with walking by stretching so that the toes can be flexed when walking. The suffix itis would suggest that the condition has something to do with inflammation, however this has been proven to be inaccurate. In the last decade or so research has discovered that this condition is actually caused by micro tares in the fascia.  

These micro tares can cause the fascia to tighten which leads to pain.  The fascia can become torn by; overuse of the foot in the case of runners, standing for prolonged periods of time, tightness in the gastrocnemius muscle that can because by wearing high heels for prolong periods of time, or by overworking the gastrocnemius. Bone spurs in the bottoms of the feet can also cause this condition when the spurs grow larger enough to be able to stab into the fascia. People with flat feet have a higher chance of developing plantar fasciitis. Lastly obesity will also increase your risk of developing this condition.

Chinese medicine would say that this condition would be caused by insufficient kidney and bladder chi, because those meridians are on or close to the foot. Since the kidney and the bladder are a part of the water element there is could be an imbalance of the earth or metal chi. Since the earth is what controls the water element if the earth is to strong it will weaken the water, and since metal feeds water if metal is weak then the water chi will be starved. These imbalances can be caused by, eating to much or not enough of a particular type of food, seasonal changes, or being in a particular mood for too long.

Western medicinal treatments for this condition include: pain medication, non steroidal anti inflammatory to manage inflammation, Extracorporeal shock wave therapy which uses high amplitude shock waves to reduce pain and decrease recovery time, corticosteroids for inflammation control, physiotherapy which involves stretching and strengthen muscles, special insoles for your shoes to help elevate the pressure on the feet, and surgery as a last resort.

The primary treatment for plantar fasciitis in Chinese’s medicine is acupuncture on the bladder and kidney meridians that will increase chi, improve blood flow, and strengthen the sinews. Other treatments could involve changing the diet to incorporate more pungent foods like almonds broccoli and eggs to strengthen the metal element. Another dietary approach would be to eating more sour foods such as oats, limes, and soft dairy to strengthen the wood element.

Deep tissue massage is a very effective treatment for plantar fasciitis it increases the circulation promoting faster healing, it can eliminate adhesion, and it relaxes the muscle thus reliving pain. . Starting with the gastrocnemius apply deep slow strokes paying special attention to the heel were the plantar fascia originates. Its also a good idea to massage along the entire plantar fascia as small fascial tares can cause the surrounding tissues to adhere to the plantar fascia creating localized trigger points. This can be one cause of the disorder. By relaxing the gastrocnemius, and treating the entire plantar fascia it increases the odds of treating the cause of the symptoms.

           
http://www.naturalawakeningssa.com/foot-relief-traditional-chinese-medicine-remedies-for-foot-pain-and-strain/

http://www.integrativehealthcare.org/mt/archives/2005/08/bodywork_techni.html

https://en.m.wikipedia.org/wiki/Plantar_fasciitis

http://www.orientalmedicine.com/five-element

https://theory.yinyanghouse.com/theory/chinese/five_element_nutrition_theory

Restless Legs Syndrome (RLS)

                                          By: Jessica McInnis

Restless legs syndrome (RLS), also called Willis-Ekbom Disease, causes unpleasant or uncomfortable sensations in the legs and an irresistible urge to move them.  Symptoms commonly occur in the late afternoon or evening hours, and are often most severe at night when a person is resting.  They also occur when someone is inactive and sitting for extended periods. Moving the legs or walking typically relieves the discomfort but the sensations often recur once the movement stops.  RLS is classified as a sleep disorder since the symptoms are triggered by resting and attempting to sleep, and as a movement disorder, since people are forced to move their legs in order to relieve symptoms. It's best characterized as a neurological sensory disorder with symptoms that are produced from within the brain itself.

RLS occurs in both men and women, although women are more likely to have it than men. It may begin at any age; however, many individuals who are severely affected are middle-aged or older, and the symptoms typically become more frequent and last longer with age.  People with RLS feel the irresistible urge to move, which is accompanied by uncomfortable sensations in their lower limbs. The sensations in their legs are often difficult to define but may be described as aching throbbing, pulling, itching, crawling, or creeping.  The sensations can occur on just one side of the body, but they most commonly affect both sides.  They can also alternate between sides.  The sensations range in severity from uncomfortable to irritating to painful. Because moving the legs relieves the discomfort, people with RLS often keep their legs in motion to minimize or prevent the sensations. They may pace the floor, constantly move their legs while sitting, and toss and turn in bed.  RLS symptoms may vary from day to day, in severity and frequency, and from person to person.  In moderately severe cases, symptoms occur only once or twice a week but often result in significant delay of sleep onset, with some disruption of daytime function.  In severe cases, the symptoms occur more than twice a week and result in burdensome interruption of sleep and impairment of daytime function. People with RLS can sometimes experience remissions-spontaneous improvement over a period of weeks or months before symptoms reappear-usually during the early stages of the disorder. In general, symptoms become more severe over time.  

The cause of RLS is unknown (called primary RLS).  It does have a genetic component, however, and can be found in families where the onset of symptoms is before age 40. Evidence indicates that low levels of iron in the brain also may be responsible for RLS. Numerous studies suggests that RLS is related to a dysfunction in one of the sections of the brain that control movement (called the basal ganglia) that use the brain chemical dopamine.  Other factors or underlying conditions include certain medications, neuropathy, pregnancy (especially in the last trimester), use of alcohol, nicotine and caffeine, end-stage renal disease and hemodialysis, and iron deficiency. 

RLS is generally a lifelong condition for which there is no cure. However, current therapies can control the disorder, minimize symptoms, and increase periods of restful sleep.  In western medicine, RLS can be treated, with care directed toward relieving symptoms.  Moving the affected limb(s) may provide temporary relief.  Sometimes RLS symptoms can be controlled by finding and treating an associated medical condition, such as peripheral neuropathy, diabetes, or iron deficiency anemia. Iron supplementation or medications are usually helpful but no single medication effectively manages RLS for all individuals. Trail of different drugs may be necessary.  Treatment options for RLS include:

1. Lifestyle changes and activities may provide some relief in persons with mild to moderate symptoms of RLS. These steps include avoiding or decreasing the use of alcohol and tobacco, changing or maintaining a regular sleep pattern, a program of moderate exercise and massaging the legs, taking a warm bath, or using a heating pad or ice pack. Use of medical devices such as a foot wrap that puts pressure underneath the foot and another that is a pad that delivers vibration to the back of the legs.  Aerobic and leg-stretching exercises of moderate intensity also may provide some relief from mild symptoms.
2. A trail of iron supplements is recommended as the first treatment for individuals with low or low-normal blood tests called ferritin and transferrin saturation. 
3. Anti-seizure drugs, specifically gabapentin enacarbil, is becoming the first-line prescription drug for those with moderate to severe RLS. This drug can decrease such sensory disturbances as creeping and crawling as well as nerve pain.  Other dopamine-related medications are effective in managing RLS symptoms also, however, long-term use can lead to worsening of the symptoms in many individuals. 
4. Opioids are sometimes prescribed to treat individuals with more severe symptoms of RLS who did not respond well to other medications. 
5. Benzodiazepines can help individuals obtain a more restful sleep. These are the last-line drugs due to their side effects. 

In Traditional Chinese Medicine (TCM), RLS is usually diagnosed as a Qi depletion or internal wind resulting from both internal weakness, and excess pathogenic disturbances.   The internal weakness includes dysfunction of the liver and kidney, and insufficiency of blood and Qi. The excess pathogens can be wind, coldness, dampness, and blood stasis. Depending on the accompanying signs and symptoms, one might be diagnosed as not having enough Qi to hold the legs still (Qi depletion) or lack of yin or blood (internal wind). In both diagnosis, the underlying imbalance comes from some kind of depletion, so the strategy would be to build the body back up. Since RLS symptoms can vary from person to person, treatment based on disharmony patterns can be an effective option for the individuals. This is likely to include acupuncture, moxibustion, the use of an herbal formula, and food therapy, as rebuilding usually takes a many-faceted approach. 

Massage is highly beneficial for people with RLS.  Very little research has been conducted in an effort to understand how or why massage for RLS is effective, but most experts strongly recommend considering massage both for relieving and preventing RLS. Still, research is in agreement that both tactile and temperature stimulation appear to relieve the symptoms, and in some cases may prevent them from disrupting sleep.  This is one of the proposed uses of massage - as a way of stimulating the legs in order to reduce RLS. 

References

1. http://acupunctureinthepark.com/health-conditions/how-to-calm-restless-leg-syndrome/
2. http://www.shen-nong.com/eng/exam/restless_leg_syndrome_treating.html
3. http://www.progressivehealth.com/rls-massage.htm
4. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Restless-Legs-Syndrome-Fact-Sheet