The Four Yin Depressions

Blood stasis – Blood stasis can complicate liver qi depression and binding and may be explained through the statements of fact, “qi is the commander of blood” and “blood is the mother of qi”.  The statements “when the qi moves, the blood moves; when the qi stops, the blood stops” also show the interrelatedness of qi and blood.  If liver qi depression and binding evolves into blood stasis, there will often be lancinating pain which is worse during the night, blood stasis masses, possible visible signs of dead blood—varicosities, age spots, cherry hemangiomas, and spider veins—dusky or purple tongue body or margins, and/or a rough pulse.  Even more commonly, female patients who present liver qi depression and binding with blood stasis will report clots in the menstruate and/or lancinating pain before, during, or following menstruation.

TREATMENT should quicken the blood and transform stasis.  For acumoxatherapy, SP-10 xue hai is often added, while yi mu cao leonrus is commonly employed for pain with the menstrual movement due to liver qi depression and binding complicated by blood stasis.

Damp accumulation and phlegm obstruction – In Chinese medicine, the qi has five basic functions:  moving, transforming, warming, containment, and protection.  When the actions of moving and transforming are disrupted by a liver qi depression and binding pattern, damp accumulation and phlegm obstruction becomes more likely.  The symptoms often occur along the course of the liver channel, with palpable phlegm nodulations in the chest or abdomen and/or symptoms of damp-heat in the liver and gallbladder with urination or bowel movements with scorching pain and cloudiness of the urine or sticky feces.

TREATMENT requires drying dampness and disinhibiting water and/or drying dampness and transforming phlegm.  For dampness, SP-9 yin ling quan may be needled, while ST-40 feng long is a standard point for phlegm.  In the representative formula for liver qi depression and binding, Xiao Yao San Free and Easy Wanderer Powder, the medicinal agents bai zhu ovate atractylodes and fu ling poria already dry dampness and disinhibit water, but their dosages may be increased to better eliminate dampness.  Chen pi tangerine peel and ban xia pinellia, the base of the formula Er Chen Tang Two Aged Decoction, are often added to Xiao Yao San Free and Easy Wanderer Powder to dry dampness and transform phlegm.

Food stagnation—We depend on digestion several times daily to break down a wide variety of foods and beverages for easy assimilation.  Qi depression, blood stasis, dampness, and phlegm in the abdomen can all impair the movement and transformation function of the spleen and stomach.  Also, the statement “vigorous fire eats qi” explains how depressive heat can negatively affect the ability of the spleen and stomach to move and transform water and grains.  Moving and transforming water and grains effectively requires that the center qi be unencumbered by any of the other five depressions.

TREATMENT methods include abducting stagnation and dispersing food.  The treatment may include draining ST-21, liang men for acumoxatherapy, while shan zha crataegus exemplifies a medical for the treatment of food stagnation.

The architect of the theory of six depressions, the aforementioned Liu Wan-Su, developed a formula with five acrid, dissipating medicinals to treat the six depressions called Yue Ju Wan or Escape Constraint Pill.  This formula may be used to address complex scenarios involving more than one depression, or it may be tapped for individual medicinals to add as necessary to other formulations where the six depressions complicate other patterns. NOTE: This prescription only includes five medicinals, as cang zhu atractylodes both transforms phlegm and dries dampness.