Integrated

Eastern and Western Perspectives on

Manic Depression (Bipolar)

Psychological Disorder and
the Major Approaches to Treatment with a
focus on Manic Episodes
by Sheng-wei

Lan, C.A.H.S. of

Medicine Buddha Healing Center

www.Ayurveda-Berkeley.com www.Ayurveda-California.com
Sheng-wei@Chinese-Medicine-California.com

For Mania, Herbs and Acupuncture

are only 5% of the Cure
Key treatments are self-treatments Daily Routine
1. Sleep early, wake up early (10 PM, 5:30 AM)
2. Daily Meditation in morning and evening
3. Mostly bland fresh-cooked vegan foods
with focus on bitter and avoiding spicy,
and decreasing sour and salty. No alcohol-drugs
4. Daily early morning exercise: Tai Qi, Qi Gong, Yoga,
Aikido, swimming.
5. Decrease sexual activity to preserve kidney Jing-Qi
(Ojas in Ayurveda - Immunity) and
to decrease liver fire-rising.

Manic psychosis (Flaring up of

phlegm fire) TCM symptoms
Sudden onset, irritability, easily angered,
flushed face, blood-shot eyes, behind-eye
headache, insomnia followed by excessive
motor activity and unusual strength, mania,
restlessness, very frequently abusive and
violent behavior, climbing up to a high place
and singing, suddenly running around naked
in public. Source: Source: 12 ACCHS TCM Professors

Manic psychosis (Flaring up of

phlegm fire) Ayurvedic symptoms
Excessive thirst, perspiration, burning or hot
sensation, huge appetite, insomnia, desire
for shade, cold and wind and walks on the
banks (of rivers or water tanks), fits of anger
or violence, tearing off of clothes in public,
desiring cold water are the symptoms which
characterize the Pitta (fire-water) type of
Unmad (Insanity). From 200 A.D. Indian
Ayurvedic Classic Sushruta Samhita Source: Dr. Vasant
Lad 98, Reid-Kreuzer 04

Western Treatments for Mania

Lithium carbonate (Eskalith)
Lithium salts have been confirmed
capable in the therapy of bipolar
disorders like manic-depression.
Side Effects: Nausea, increased
urination, thirst, hand tremor, GI
distress, slurred speech, confusion when
toxic

Source: Flaws, 2001

TCM & Ayurvedic Assessment

of Manic Psychosis
Tongue: Red or pink with yellow greasy coating.
TCM, Tibetan Medicine, and Ayurveda agree.
Pulse: TCM - Wiry, slippery and rapid pulse.
Ayurveda says Strong, warm, rapid, pitta pulse.
Source: 12 ACCHS TCM Professors, 2004. Dr. Vasant Lad 98, Reid-Kreuzer 04

Treatment Principle: TCM - Purge fire, remove

phlegm heat tranquilizing mind and calm Shen.
Ayurveda agrees and says decrease Pitta (fire and water)
increase Sattva (purity-clarity-patience-wisdom by eating
bland vegan diet, yoga and meditation daily, chant
prayers-mantras, follow five precepts (yama or shila), be
patient, serve the world through 3 spiritual practices of
Shila, Samadhi, Prajna) Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Be Veggie for Treatment for Manic

Episodes Phlegm-Heat?
Do you recommend that such a phlegm heat manic
disorder patient be vegetarian to improve their
condition?
Dr. Chung says: Yes, there will be less anger if one is
vegetarian. 9 TCM ACCHS doctors said not necessary.
But 3 doctors recommend vegetarianism strongly: Dr.
Zhu, Dr. Wang, and Dr. Chung. Source: 12 ACCHS TCM Professors
Ayurveda, Yoga, most Mahayana Buddhism say that it is
vital to be vegetarian, but not vegan if you have manic
angry episodes. Being vegan however will help decrease
the mucous of the phlegm-fire.
Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Foods to Avoid
Manic Episodes Phlegm-Heat?
What are worst foods that such a manic disorder patient
should avoid in order to not worsen their condition?
Most ACCHS doctors say avoid spicy. Dr. Chung says:
Spicy foods, coffee and alcohol. Dr. Fang says: Hot
and Spicy foods, especially avoid goat meat and beef.
Source: 12 ACCHS TCM Professors

Ayurveda, Yoga, Buddhism agrees to avoid

hot-spicy, coffee-tea and
alcohol. Source: Dr. Vasant Lad 98,
Reid-Kreuzer 04

Flavors to Avoid in
Manic Episodes Phlegm-Heat?
What are the recommended flavors to avoid in
order to better treat this manic-disorder? (sweet,
sour, salty, bitter, pungent, astringent, bland)
Most of ACCHS TCM doctors say avoid
pungent (acrid). Source: 12 ACCHS TCM Professors
Ayurveda, Buddhism, Yoga and Tibetan
Medicine say enjoy all six tastes in each meal,
BUT to first use less pungent, then avoid excess
salty, and avoid excess sour.
Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Chinese Dietary Treatment for Manic

Episodes Phlegm-Heat
Dr. Fang says: Hei Mu Ar (Black Wood Ears),
Lian Oh (Lotus Root Stalks), Ku Gua (Bitter
Melon). Bai He and Mai Dong and Shan Yao
and Tian She. Most of the doctors recommend
bland flavor.
Source: 12 ACCHS TCM Professors

Ayurveda also recommends Lian Oh (Lotus Root

Stalks), Ku Gua (Bitter Melon)
Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Ayurvedic Dietary Treatment for Manic

Episodes Phlegm-Heat
Ayurveda, Yoga, Buddhism and Tibetan Medicine says
cooling non-mucousy pitta-soothing sattvic (clarity,
calm, meditative) foods
Such as mangoes, pomegranates, coconuts, figs, dates,
pears, sweet potatoes, sprouts, leafy greens, dandelions,
bitter melons, bitter greens, non-spicy leafy greens,
yellow squash, asparagus, white (not brown) basmati
rice, mung beans (sprouts and dal), fresh-unprocessed
organic cows milk and ghee, peeled and soaked
almonds, saffron, turmeric, cardamom, coriander and
cilantro, fennel, cumin, licorice tea, and brahmi tea are
good.
Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Flavors to Enjoy for Treatment for Manic

Episodes Phlegm-Heat
What the recommended flavors to enjoy in order
to better treat this manic-disorder? (sweet, sour,
salty, bitter, pungent, astringent, bland)
Most TCM doctors say bitter and bland. Source: 12
ACCHS TCM Professors

Dr. Fang says: Bitter and Pungent. Source: ACCHS Professor

Ayurveda, Yoga, Buddhism and Tibetan
Medicine strongly agree with bitter, bland,
astringent (dry) being the best flavors. But
strongly disagree that pungent (acrid or spicy) is
good. Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Physical Exercise to Treat

Manic Episodes Phlegm-Heat?
Dr. Chung says: Qi Gong, Tai Chi and Yoga in the
morning. Go to bed at 10 PM is best. Tai Chi is
recommended by Dr. Chin, Dr. Chung, Dr. Liang and Qi
Gong by Dr. Wang, Dr. Chung, Dr. Horowitz, H.J.
Wang, L. Wang. Source: 12 ACCHS TCM Professors
Ayurveda, Buddhism, Yoga and Tibetan Medicine says
it is important for mania and suggest yoga poses (Moon
salutation 16x, moderately fast; Fish; Boat; Bow) and
Prostrations (full-body five point Buddha-bowing).
Avoid intense competitive sports or hot mid-day
exercise. Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Pitta (Fire-Water) is Fire:

Tejas or Agni in Sanskrit
Buddhist Spiritual Practice to Decrease Mania:
Yantras, Mandalas and Tangkhas are Buddha,
Bodhisattva, Deity, Guru images
Master Huas Mantra for ending anger?
Quell the fire in your liver!
Patience, Patience, Dont Get Angry, Svaha!
Om Namo Kshanti, Kshanti, Om Shanti, Svaha!
Om Homage to Patience, Patience, Om Peace, Blessed Be!

Buddhist Five Precepts Heal Mania

The Pancha Shila are:
1. No killing, no harming, be vegetarian
2. No stealing
3. No sexual misconduct preserve Jing Qi
4. No lying, no harsh speech, no gossiping or disparaging,
no chit-chat frivolous speech (preserve Qi, Ojas and Prana)
5. No taking alcohol, drugs or other mind-altering substances in order
to preserve mental clarity and Sattva (patience and wisdom)

Daily Meditation to Treat

Manic Episodes Phlegm-Heat?
Ayurveda, Buddhism, Yoga and Tibetan
Medicine says it is key treatment for mania
While it is important as a Christian, Muslim,
Jew, or Buddhist (worlds 4 major religions) to
chant mantras or pray regularly, in these hectic
modern times, especially if one is manic, it is
vital for mental-physical health to meditate
silently morning and evening for at least 20
minutes. Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Daily Meditation to Treat

Manic Episodes Phlegm-Heat?
Meditate in the way you are accustomed, or silently
walk in nature or practice counting your breath for
108x or try mantra meditation, chant 108x Om
Kshanti Shanti Paramita (Perfection of Patience and
Peace) or Om Namo Amitabha or E Na Li Pi She
Ti or She Dan Dwo Bwo Da La or Om Mani
Padme Hum.
Auspicious mantra meditation combined with silent
Vipassana or Chan (Zen) or Qi Gong
meditation brings healing, protection,
balance, peace and into
your life and the world.
Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Acupuncture Treatments for

Manic Episodes Phlegm-Heat
P6, ST40, ST36, SP6, LV3, P7, DU20, DU14,
Si Shen Chong, Shen Men, UB15, UB20, and
UB14. Source: 12 ACCHS TCM Professors, 2004.
In the ancient 1601 A.D. classic by master
Yang Jizhou The Golden Needle (Jing Jen), he
states Houxi SI3 The Back Ravine this
point cures schizophrenia even if mild.
Source: Bertschinger_91: 99

Acupuncture and Acupressure Treatments

for Manic Episodes Phlegm-Heat
Yang Jizhou also says to needle Shangwan
CV13 in mania and running about the
Upper Duct together with the Spirit Gate
(Shenmen H7) Source: Bertschinger_91: 99
Ayurveda and Yoga say that it is important to
do acupressure on Shui Gou (DU26), Yin
Tang (third eye), Bai Hui (DU20 or crown
chakra called Brahma Randra in Sanskrit) with
sandalwood (Santalum album) essential oil.
Source: Dr. Vasant Lad, Reid-Kreuzer 04

Ear Seed Treatments for Manic

Episodes Phlegm-Heat
Chinese auriculotherapy Dr. Li-Chun Huang,
M.D. (China), O.M.D., says to in general use
Forehead, Liver, Heart, Brain Stem,
Subcortex and for manic type (kuang) due to
flaring up of phlegm fire to use supplementary
points of Shen Men and Occiput with Spleen
added during depressive phase. She also
recommends Forehead to clear the mind. Source:
Huang 97:320-321.

Bleeding Treatments for Manic Episodes

Phlegm-Heat
Bleed the tip of each of the ten fingers
(shi shen) is what many ACCHS teachers said.
Others said dont need it. Source: 12 ACCHS TCM Professors, 2004.
Ayurveda says to do rakta moksha (bloodletting) of the tips of middle finger (fire finger)
and of the Ear Apex with a diabetic lancet.
Drain on 10 to 30 drops out of each point.
Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Moxibustion and Cupping Treatments for

Manic Episodes Phlegm-Heat
In general, all but two ACCHS doctors said that moxa
is not recommended for bi-polar with mostly manic
episodes since it increase heat too much.
Source: 12 ACCHS TCM Professors, 2004.

In general, all but one ACCHS doctors said that

cupping is not useful for bi-polar with mostly manic
episodes. Dr. Fang says cup Heart, Liver and Kidney,
Small Intestine meridians. J. Horowitz says to cup
UB15 and UB13, UB20. Source: 12 ACCHS TCM Professors, 2004.

Gua Sha Scraping Treatments for Manic

Episodes Phlegm-Heat
Dr. Hsiao says: Hua Tuo Jia Ji (on back).
The rest said it is not useful.
Source: 12 ACCHS TCM Professors, 2004.

Herbal Patent Medicine Tablets (pian-wan)

for Manic Episodes Phlegm-Heat
ACCHS professors Dr. Chin and Dr. Liang
suggest Mong Shi Gun Tang Wan. Also
referred to as Gun3 Tan2 Wan2, drains fire
and drives out phlegm
Source: 12 ACCHS TCM Professors, 2004. Bensky-Barolet 1990: 424

ACCHS professors Dr. Chin, Dr. Fang, and Dr.

Liang recommend Di Tan Tang. Di2 Tan2
Tang1 Guide Out the Phlegm Decoction
Source: 12 ACCHS TCM Professors, 2004, Wu 85: 265, Bensky-Barolet 1990: 424

Herbal Patent Medicine Tablets (pian-wan)

for Manic Episodes Phlegm-Heat
Dr. Horowitz, Dr. Liang, Dr. Wang and Dr.
Bensky recommended three possible formulas:
Jia Wei Shao Yao San Source: 12 ACCHS TCM Professors, 2004.
Bensky-Barolet 1990: 148 and Bai He He Huan Pi and Gan
Mai Da Zao Tang Source: Bensky-Barolet 1990: 383
Dr. Hsiao, Dr. Horowitz, Dr. Wu and Dr.
Bensky recommended Wen Dan Tang Pian.
Source: 12 ACCHS TCM Professors, 2004, Wu 85: 265, Bensky-Barolet 1990: 435

Herbal Patent Medicine Tablets (pian-wan)

for Manic Episodes Phlegm-Heat
The Qing Dynasty Dr. Liu Yi-Ren, author of
the classic Yi Xue Chuan Xin Lu (The Heart
Transmission of Medicine) says that Mania
(with anger) requires dispelling wind and
eliminating heat with Fang Feng Tong Sheng
San (Notopterygium Sage-communicated
Powder) as the ruling (formula).
Source: Liu 97, Bensky-Barolet 1990: 58

Customized Bulk Herb Decoction Formula

for Manic Episodes Phlegm-Heat
Dr. Wu of Zhiang Xi Publishing recommends
in the Chinese Mandarin TCM Textbook, to
take the decoction of Xie4 Xin1 Tang1 for
phlegm-fire with mental disturbances.
Source: Wu 91: 256-257, Bensky-Barolet 1990: 79

Dr. Fang of ACCHS says: Add Shen Tie Luo

and Ci Shi to the standard Di Tan Tang
formula.
Source: ACCHS TCM Professors, 2004, Wu 85: 265, Bensky-Barolet 1990: 424

Dui4 Yao4 Formula for Manic Episodes

Phlegm-Heat
If you had to use a simple two herb or four herb
combination using classical dui yao pairs,
what would be your recommended herbal
combination pairs?
Dr. Chung says: Long Gu and Mu Li. Zhen Zhu
Mu and Huai Shao Mai.
Source: ACCHS TCM Professors, 2004

Dr. Fang says: Ju Ru and Huang Lian/Ah Jiao.

Source: ACCHS TCM Professors, 2004

Dui4 Yao4 Formula for Manic Episodes

Phlegm-Heat
Philippe Sionneau in his book Dui Yao The Art of
Combining Chinese Medicinals says to use Long Gu (Os
Draconis) and Mu Li (Concha Ostreae) to calm the liver
and subdue yang, quiet the spirit to help with vexation
and agitation, insomnia, dizziness, vertigo, photophobia,
and tinnitus due to liver yang hyperactivity harassing the
spirit with chronic diarrhea and excessive
perspiration due to vacuity. Source: Sionneau 97: 111-112
Ayurveda also uses conch shell as a purified ash called
Shanka Bhasma for similar reasons.
Source: Dr. Vasant Lad 98, Reid-Kreuzer 04

Dui4 Yao4 Formula for Manic Episodes

Phlegm-Heat
Dr. Li and Dr Chin recommend the dui yao of Shi Chang
Pu and Yu Jin. Philippe Sionneau similarly recommends
Shi Chang Pu (Rhizoma Acori Graminei) and Yuan Zhi
(Radix Polygalae Tenuifolia) for go to the heart, transform
phlegm, open the portals of the heart and kidneys, boost
the intelligence and arouse the spirit it helps with the
depressive side of bi-polar to help with insomnia, and
mental agitation due to the heart not interacting or phlegm
confounding the orifices of the heart.
Source: Sionneau 97: 124

Ayurveda also uses Vacha (Acorus calamus calamus root

- Shi Chang Pu) combined with Brahmi (Centella asiatica
or Di Qien Cao in Mandarin) for this same reason
Source: Dr. Vasant Lad 98, Reid-Kreuzer 04, Reid 95: 129, Tierra 88: 200

How to Imbalance Pitta

Fire Constitution and
Worsen Mania

Drink plenty of alcohol

Eat hot spicy, salty and sour foods
Engage in frustrating, competitive activities
Emphasize tomatoes, chilies, garlic, raw onions,
and store bought yogurt in your diet
Exercise competitively at hottest time of the day
Use drugs, especially cocaine, speed, crystal-meth,
and large doses of caffeine and marijuana

How to Imbalance Pitta Fire

Constitution and Worsen Mania
Avoid cool fresh peaceful places
Repress your feelings
Eat as much red meat and
salted fish as possible
Be an ambitious workaholic
Do all of the above
during summer

Yama Niyama of Yoga Heal Mania

Similar to Buddhist Five
Precepts (Shila), the Yogic
Five Moral Disciplines /
Restraints () are:

1. Celibacy or Less Sex

2. Harmlessness
3. Truthfulness
4. Non-stealing
5. Non-possessiveness.

Ayurvedas Ideal Patient and Doctor

200 B.C. Ayurvedic sage Charaka says:
Engage in serious study
Respect teachers, saints, sages, and all
beings
Conserve vital energies
Observe non-violence (ahimsa)
Speak the truth (satya)
Dont speak ill of others or gossip
Refrain from envy, competitiveness and
anger
Eat a vegetarian diet,
not take drugs, alcohol or smoke

The Gunas of Pitta Dosha

The Doshas & the Elements

slightly oily
(snashneha)
Sharp
(tikshna)
Hot
(ushna)
Light
(laghu)

Fetid, fleshy,
pungent, sour
smelling (vishram)
Spreading / motile
(saram)
Liquid
(dravam)
acute (intense)

Pitta - The Fire and Water

Constitution that Most-often gets
Mania

Slightly oily - skin, hair, diarrhea

Hot - hot-tempered, hot-headed, hot-flash
Sharp - sharp mind, sharp tongue, cuts like a knife
Penetrating - penetrating insight, hot oil, spicy
Light - bright, brilliant, radiant, shining, visionary
Acidic - inflammatory, sour belly, heart-burn
Spreading - like a fire! Spreading name and fame!

Elements, Doshas and Energy

The Qualities of the 3 Doshas

Vata

Pitta

Kapha

Catabolic

Metabolic
Diaphoresis
Polydipsia

Anabolic
Edematous

Dehydrate

Cold hands & feet, Inflammation, Cool

Raynauds
Fever, Hot,
Ulceration
Dry, Desiccation, Slightly oily, Oily, fats,
Dandruff,
lipid
Split-ends
metabolism

Source: Scan from Dr. Lad, Vasant,

M.A.Sc., Textbook of Ayurveda,
Albuquerque, NM: Ayurvedic
Press, 2001
Use under the "fair use" provision (17 USC
107) of the U.S. Copyright Act for
non-profit educational purposes
only.

Pitta is Fire: Tejas or Agni

Location: Small intestine, liver, gall bladder, eyes
Personality: Hot-headed, Hot-blooded, Hot-tempered,
Sharp, Caustic, Burned out, Tigerish, Catty, Sarcastic
sharp clawed humor cuts like a knife, Brilliant, Warm
Heat expands, cold contracts
Spreading of fire, rash, and possessions,
spread knowledge, big ego, name and fame
Energy: Radiant energy heat, light
Reaction: Metabolism,
transformation, comprehension,
appreciation, recognition
and total understanding

Fire & Water

Metabolism acids
Sharp
Photosensitive
Oily skin
Inflammations
Motility - IBS
Source: Scan from Dr. Lad, Vasant,
M.A.Sc., Textbook of Ayurveda,
Albuquerque, NM: Ayurvedic
Press, 2001
Use under the "fair use" provision (17 USC
107) of the U.S. Copyright Act for
non-profit educational purposes
only.

Gunas of Pitta (Fire and Water)

Pitta:
hot
light
acute (intense)
sharp
mobile / motile
spreading

liquid
oily
pungent smelling
sour taste / smell