Mental illness and autoimmune disease

CHAPTER 10 Mental illness and autoimmune disease



Contents


1. Western medical aetiology and pathology 173

2. Diagnosis by Western medicine 174

3. Chinese medical aetiology and pathology 174

Differentiation and treatment 175
1 Stagnation of Phlegm and Qi 175

2 Flaring up of Phlegm-Fire 175

3 Fire flaring up due to Yin deficiency 176

4 Yin deficiency with Blood stasis 177

Case studies 178

4. Analysis of the cases 184

5. Lifestyle prescriptions and health issues 186

The term mental illness refers to various mental disorders, including disorders of thought, mood, balance, or behaviour. In this chapter, we discuss mental illness caused by autoimmune disorders.



1 Western medical aetiology and pathology


Autoimmunity may occur in any tissue, organ, or system. Recent findings on the close relationship between the immune system and the central nervous system (CNS) lead to the conclusion that there may be a relationship among psychological, neurological, endocrine and immune factors. This may explain why individuals who experience a high degree of stress in their lives may be predisposed to an organ-specific autoimmunity.


Stanford University Medical Center1 reported finding that a protein called osteopontin was abundant in multiple sclerosis (MS)-affected brain tissue, but not in normal tissue. Since then, other research groups have confirmed that levels of osteopontin are increased just before and during a relapse of MS, so that when the immune system attacks the protective myelin sheath surrounding nerve cells, the volume of osteopontin increases. Osteopontin, produced by immune cells and brain cells themselves, promotes the survival of the T cells that damage myelin. By increasing the number of these T cells, osteopontin increases their destructive potential. This process may exist in many other autoimmune diseases, including rheumatoid arthritis, type I diabetes and lupus.


Indeed, osteopontin may have a great effect on the way the immune system works. Normally, after the immune system does its job of eradicating a microbe, its response is then reduced. If this did not happen, the immune response would go on indefinitely. Imagine having a cold or an attack of poison oak that would last forever. Osteopontin lets the T cells linger in the blood, ready to attack again. This process means that the disease moves in cycles, becoming progressively worse.



2 Diagnosis by Western medicine


The CNS manifestations of chronic autoimmune disease are broadly divided into neurological and psychiatric categories. The criteria for diagnosis of mental illness are to verify the presence of CNS dysfunction using laboratory serum and cerebrospinal fluid analyses, as well as radiological changes.


In mental illness, signs and symptoms generally include:


• behavioural changes, such as repeated hand washing and observation, and hyperactivity

• emotional changes, such as sadness, depression and anxiety

• cognitive changes, such as delusions that the television is controlling a patient’s mind and paranoia

• physiological changes, such as spontaneous sweating and vertigo.


3 Chinese medical aetiology and pathology


Chinese medicine has few terms that characterize mental illness as a particular branch of study. Instead, it describes seven emotions: joy, anger, melancholy, anxiety, grief, fear and terror. These emotions reside in the mind and respond normally to normal changes in physical and environmental stimuli. However, persistent and violent emotions act as pathogenic factors that cause functional derangement of Qi, Blood and the Zang Fu. Chinese medicine uses terms such as Ju Sang image depression, Jiao Lu image anxiety, Yu Zheng image melancholia, Zang Zao image hysteria, Dian image depressive psychosis and Kuang image mania to describe specific types of mental illness.


In Chinese medicine, the seven emotions relate to the five Zang viscera, both in terms of normal reactions and in terms of abnormal pathology. The Heart is related to joy, Liver to anger, Spleen to anxiety, Lung to melancholy and Kidney to fear. Experienced in excess or isolation, or out of balance with the other emotions, each of the seven emotions can damage the body directly and lead to disease by affecting its corresponding viscus. Chapter 5 of Huang Di Nei Jing Su Wen/The Yellow Emperor’s Inner Classic of Medicine Simple Questions says: ‘Anger impairs the Liver … joy impairs the Heart … anxiety impairs the Spleen … melancholy impairs the Lung … and … fear impairs the Kidney’. In Chinese medical theory, the Heart controls mental activities and is the emperor of the five viscera and six bowels. The seven emotions can not only cause diseases but also aggravate them. Chinese medicine pays great attention to calming patients’ emotional state so as to prompt recovery from illness.




Differentiation and treatment



1 Stagnation of phlegm and qi



Clinical manifestations


Depression, apathy, dementia, lack of motivation and fatigue, muttering to oneself, frequent crying or laughing for no reason, caprice and no desire to eat. The tongue has a white, greasy coating. The pulse is taut and slippery.



Treatment principle


Expel Phlegm and regulate the flow of Qi.



Herbal treatment


DAO TAN TANG variation


Navigate Phlegm Decoction


Zhi Ban Xia Pinelliae Rhizoma preparatum 10 g


Chen Pi Citri reticulatae Pericarpium 10 g


Fu Ling Poria 12 g


Zhi Tian Nan Xing Arisaematis Rhizoma preparatum 10 g


Zhi Shi Aurantii Fructus immaturus 10 g


Yuan Zhi Polygalae Radix 10 g


Shi Chang Pu Acori tatarinowii Rhizoma 10 g


Yu Jin Curcumae Radix 12 g


The herbs above are decocted in water for oral administration twice daily.



Acupuncture


Du-20 Baihui, Du-14 Dazhui, PE-5 Jianshi, HE-7 Shenmen, ST-40 Fenglong and ST-36 Zusanli.



Supplementary treatment


If the patient has a chronic illness with insomnia, fatigue, palpitations, and a pale tongue and deep and weak pulse, add Dang Shen Codonopsis Radix, Bai Zhu Atractylodis macrocephalae Rhizoma and Suan Zao Ren Ziziphi spinosae Semen, and needle BL-20 Pishu, BL-23 Shenshu and BL-15 Xinshu.



2 Flaring UP of phlegm-fire



Clinical manifestations


Sudden onset, irritability, flushed face, pink eyes, unusual strength, insomnia and anorexia. The tongue is red with a yellow or greasy coating. The pulse is slippery and rapid.



Treatment principle


Purge Liver Fire, tranquillize the mind and remove Phlegm.



Herbal treatment


MENG SHI GUN TAN WAN and SHENG TIE LUO YIN variation


Chloriti Lapis Pill to Drive Out Phlegm and Iron Filings Decoction


Qing Meng Shi Chloriti Lapis 30 g (decoct first for 30 min)


Sheng Da Huang Rhei Radix et Rhizoma 6 g (decoct later)


Huang Qin Scutellariae Radix 12 g


Huang Lian Coptidis Rhizoma 6 g


Long Dan Cao Gentianae Radix 10 g


Zhi Shi Aurantii Fructus immaturus 10 g


Zhi Ban Xia Pinelliae Rhizoma preparatum 10 g


Zhi Tian Nan Xing Arisaematis Rhizoma preparatum 10 g


Shi Chang Pu Acori tatarinowii Rhizoma 12 g


Tian Zhu Huang Bambusae Concretio sillicea 10 g


The above herbs are decocted in water for oral administration twice daily.



Acupuncture


PE-8 Laogong, Ren-26 Renzhong, Ren-13 Shangwan and KI-4 Dazhong.



Supplementary treatment


If the patient suffers from illness for a long time, the pathogenic Phlegm-Fire will impair Yin and the manifestation will become chronic. Use herbs such as Sheng Di Huang Rehmanniae Radix, Mai Men Dong Ophiopogonis Radix and Xuan Shen Scrophulariae Radix, and needle KI-3 Taixi and BL-23 Shenshu.



3 Fire flaring UP due to yin deficiency



Clinical Manifestations


Insomnia, emaciation, flushed face and panic attacks. The tongue is red with less coating or with cracks on the surface. The pulse is thready and rapid.



Treatment Principle


Eliminate Fire and nourish Yin.



Herbal Treatment


AN SHEN BU XIN WAN variation


Nourish the Heart to Calm the Spirit Pill


Wu Wei Zi Schisandrae Fructus 6 g


Shi Chang Pu Acori tatarinowii Rhizoma 10 g


He Shou Wu Polygoni multiflori Radix preparata 12 g


He Huan Pi Albiziae Cortex 12 g


Zhen Zhu Mu Margaritiferae Concha usta 20 g (decoct first for 30 min)


Tong Ji Li Astragali complanati Semen 12 g


Nu Zhen Zi Ligustri lucidi Fructus 12 g


Sheng Di Huang Rehmanniae Radix 12 g


The above herbs are decocted in water for oral administration twice daily.



Acupuncture


BL-15 Xinshu, BL-14 Juiyinshu, BL-18 Ganshu, BL-23 Shenshu, HE-7 Shenmen and LIV-2 Xingjian.



Supplementary treatment


If the patient has depression, coupled with pain and fullness in the chest, add Chai Hu Bupleuri Radix, Yu Jin Curcumae Radix, Zhi Ke Aurantii Fructus and Bai Shao Paeoniae Radix alba, and needle Ren-17 Tanzhong, PE-6 Neiguan and LIV-14 Qimen.



4 Yin deficiency with blood stasis



Clinical manifestations


Anxiety, insomnia, dizziness, tinnitus, thirst with no desire to drink, and headaches with a fixed location. The tongue is red with less coating and the sublingual veins are distended. The pulse is deep and weak.



Treatment principle


Nourish Yin and remove Blood stasis.



Herbal treatment


ZUO GUI WAN and XUE FU ZHU YU TANG variation


Restore the Left Kidney Pill and Drive Out Stasis in the Mansion of Blood Decoction


Sheng Di Huang Rehmanniae Radix 12 g


Bai Shao Paeoniae Radix alba 12 g


Shan Zhu Yu Corni Fructus 10 g


Mu Dan Pi Moutan Cortex 6 g


Suan Zao Ren Ziziphi spinosae Semen 10 g


Ze Xie Alismatis Rhizoma 10 g


Fu Ling Poria 12 g


Bie Jia Trionycis Carapax 30 g (decoct first for 30 min)


Hong Hua Carthami Flos 10 g


Tao Ren Persicae Semen 10 g


Dang Gui Angelicae sinensis Radix 12 g


Chi Shao Paeoniae Radix rubra 12 g


The above herbs are decocted in water for oral administration twice daily.



Acupuncture


BL-15 Xinshu, BL-17 Geshu, BL-23 Shenshu and SP-10 Xuehai.



Supplementary treatment


If the patient suffers from severe insomnia, add Sheng Long Gu Fossilia Ossis Mastodi and Mu Li Ostreae Concha, and needle Du-20 Baihui, Yintang (extra), and Front head 5 needles (extra); if the patient has cold limbs, hands and feet, add Chi Shao Paeoniae Radix rubra and needle Baxie (extra) and Bafeng (extra).





Case studies



Case One


CL was a 69-year-old woman who came in complaining of anxiety, depression and insomnia. She had taken antidepressants, anxiolytics and sleeping pills for over 20 years. Recently her symptoms became aggravated and could not be controlled by medication. Her insomnia sometimes prevented her from sleeping at all through the night and caused her to wake easily and not be able to fall back asleep. She was easily angry and cried without any reason, had nausea when she was anxious, wanted to commit suicide when she felt depressed and had night sweats. She also reported that she had been diagnosed with psoriasis. Her symptoms were intermittent and she had skin lesions on both elbows. She had also been diagnosed with Graves’ disease and then received a diagnosis of thyroid cancer; her cancer and thyroid were excised 30 years ago. She had a red face and a red tongue with deep fissures on the surface. Her pulse was thready and taut.



Impression:



1. Anxiety (Kidney and Liver Yin deficiency with Liver Qi stagnation)

2. Depression

3. Insomnia

4. Psoriasis





Treatment principle


Nourish Kidney and Liver Yin, smooth Liver Qi and relieve Heart stress.



Herbal treatment


LIU WEI DI HUANG WAN and CHAI HU SHU GAN SAN variation


Six-Ingredient Pill with Rehmannia and Bupleurum Powder to Spread the Liver


Sheng Di Huang Rehmanniae Radix 12 g


Shu Di Huang Rehmanniae Radix preparata 12 g


Chi Shao Paeoniae Radix rubra 10 g


Bai Shao Paeoniae Radix alba 10 g


Shan Zhu Yu Corni Fructus 10 g


Mu Dan Pi Moutan Cortex 6 g


Mai Men Dong Ophiopogonis Radix 10 g


Sha Shen Glehniae/Adenophorae Radix 12 g


Wu Wei Zi Schisandrae Fructus 6 g


Chai Hu Bupleuri Radix 6 g


Zhi Ke Aurantii Fructus 6 g


Huai Shan Yao Dioscoreae Rhizoma 10 g


Zhi Mu Anemarrhenae Rhizoma 10 g


Gan Cao Glycyrrhizae Radix 5 g


The herbs above were decocted in water for oral administration twice daily.

Related posts:

Basic immunology and immune system disorders Scleroderma Hashimoto’s thyroiditis Autoimmune hepatitis Graves’ disease Crohn’s disease

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Jan 19, 2017 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Mental illness and autoimmune disease

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