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A person presents with fullness and distension in the heart and abdomen, occasional borborygmus (intestinal rumbling), frequent urge to defecate, and in severe cases, heart pain. The two hypochondriac regions feel filled and solid, accompanied by vomiting or regurgitation, expectoration of phlegm and saliva, or vomiting clear water, or sudden violent diarrhea. This leads to edema on the dorsum of both feet, and gradually the whole body feels heavy. For such diseases, at the initial stage, treatments are often chaotic and disordered; later on, they are invariably treated as Gu Zhang (Gu Distension). Who would know that this is actually a disease of Earth Depression (Tu Yu)? Earth Depression refers to the stagnation of Qi in the Spleen and Stomach. *The Inner Canon* attributes Earth Depression to the Earth phase of the Five Movements (Wu Yun), failing to realize that within the five Zang organs of the human body, there originally exists a disease of Earth Depression. One must not merely blame the annual Qi (sui qi) without carefully examining the Qi of the Zang organs. The Qi of Earth (Spleen/Stomach) prefers ascending and rising, not descending. If Liver Wood insults it, Earth Qi cannot ascend; if Lung Metal steals from it, Earth Qi descends instead. Unable to ascend and descending simultaneously, Earth Qi becomes depressed and unable to extend, inevitably counter-attacking Water (Kidney). Once Water is controlled, it dares not flow directly into long rivers, but naturally floods into streams and paths, overflowing where shallow and drilling into orifices wherever it goes. Wherever it flows, that meridian suffers disease. The treatment method should be to dredge the Earth, allowing the Spleen and Stomach Qi to ascend, so that the stagnant Qi can be resolved. However, the reason Spleen and Stomach form depression is not only due to excess Liver Wood and deficiency of Lung Metal, but also because the Spleen and Stomach Qi has been inherently weak, allowing Liver Wood to insult it and Lung Metal to consume it. If Spleen and Stomach Qi were robust, how could depression form! Therefore, to open depression, one must tonify Spleen and Stomach Qi first; after tonifying Spleen and Stomach, then employ draining methods, so that Earth Depression is easily resolved. Use Shan Duo Tang: Fu Ling (Poria, 1 liang), Che Qian Zi (Plantago Seed, 3 qian), Bai Zhu (Atractylodes Macrocephala Rhizome, 3 qian), Chai Hu (Bupleurum Root, 1 qian), Bai Shao (White Peony Root, 5 qian), Chen Pi (Tangerine Peel, 3 fen), Ban Xia (Pinellia Tuber, 1 qian). Decoct in water and take orally. After four doses, all symptoms gradually improve.

This formula promotes urination without dispersing Qi, soothes depression while tonifying healthy Qi. This "draining without draining" is more miraculous than direct draining. Why must one open the ghost gate (diaphoresis) and drain the pure residence (diuresis/defecation) to be called draining?

For this syndrome, Shu Tu Tang is also excellent.
Bai Zhu, Fu Ling (each 1 liang), Rou Gui (Cinnamon Bark, 3 fen), Chai Hu (1 qian), Bai Shao (3 qian), Zhi Ke (Bitter Orange Fruit, 3 fen), Ban Xia (5 fen). Decoct in water and take orally. Cured in four doses.

A person suffers from cough and rebellious Qi, fullness and distension in the heart and hypochondrium, pain radiating to the lower abdomen, inability to turn or lie on the side, dry tongue and throat, pale and dusty complexion, asthma preventing lying flat, thick and dense sputum, and scorched, dry skin and hair. People assume it is Dryness of Lung Qi, unaware that it is actually Depression of Lung Qi. Depression of Lung Qi invariably forms first under the pressure of Heart Fire. However, excessive Fire results from deficient Water. Insufficient Kidney Water cannot avenge the Lung Mother (note: In Five Elements, Kidney Water generates Lung Metal; thus Kidney is the Mother of Lung. Here it implies Kidney fails to support Lung against Fire), causing Lung Metal to be impaired and depression to arise. Thus, when treating Lung Metal depression, can one avoid venting Lung Metal Qi? Although so, one cannot directly vent Lung Metal Qi. One must greatly tonify Kidney Water. When Water is sufficient, Heart Fire finds satisfaction in its resources and will no longer invade the Lung. Tonifying Kidney Water is precisely venting Lung Metal. Use Shan Xie Tang: Shu Di Huang (Prepared Rehmannia Root, 1 liang), Shan Zhu Yu (Cornus Fruit, 5 qian), Xuan Shen (Scrophularia Root, 1 liang), Jing Jie (Schizonepeta Spike, 3 qian), Niu Xi (Achyranthes Root, 3 qian), Chao Zao Ren (Fried Sour Jujube Seed, 3 qian), Sha Shen (Glehnia or Adenophora Root, 3 qian), Bei Mu (Fritillaria Bulb, 1 qian), Dan Pi (Moutan Cortex, 2 qian). Decoct in water and take orally. Lighter after one dose, lighter still after two, completely cured after ten doses.

This formula nourishes Kidney Water to control Heart Fire, effectively nourishing Kidney Water to rescue Lung Metal. Lung Metal is calmed by the venting/nourishment of Kidney Water; Kidney Water is strengthened by the venting/descending of Lung Metal. Mother and child share one heart, making external invasions easy to control. What resentment remains! This is the profound meaning behind "venting Lung Metal depression."

For this syndrome, He Jin Tang is also effective.
Mai Dong (Ophiopogon Tuber, 5 qian), Su Ye (Perilla Leaf, 1 qian), Jie Geng (Platycodon Root, 2 qian), Gan Cao (Licorice Root, 1 qian), Fu Ling (3 qian), Huang Qin (Scutellaria Root, 1 qian), Ban Xia (5 fen), Bai He (Lily Bulb, 3 qian). [Text incomplete]

A person experiences heart pain upon exposure to cold, heaviness in the waist, joint stiffness, difficulty in flexion and extension, occasional reversal cold (Jue Ni), hard epigastric masses, abdominal fullness, and yellow-black complexion. People attribute this to Cold Evil invasion, unaware that it is Water Depression (Shui Yu). Water depression mostly occurs in years where Earth overcomes and Wood retaliates. However, excessive Spleen and Stomach Qi and overly dry Liver and Gallbladder Blood can also cause Water Depression. Thus, how can the treatment abandon the Spleen, Stomach, Liver, and Gallbladder meridians to treat Water Depression elsewhere? Although Water Depression stems from Water Deficiency, the nature of deficiency varies. There is deficiency caused by Fire (True Fire deficiency); there is deficiency caused by Water itself (True Water deficiency). When True Water is deficient, Evil Water flourishes; when True Fire is deficient, True Water declines further. Regardless of whether True Fire or True Water is deficient, the key lies in tonifying Fire within Water. When Fire is sufficient, Water naturally flourishes; when Water flourishes, depression cannot form. Use Bu Huo Jie Yu Tang: Shu Di Huang (1 liang), Shan Yao (Chinese Yam, 5 qian), Ba Ji Tian (Morinda Officinalis Root, 5 qian), Rou Gui (5 fen), Du Zhong (Eucommia Bark, 5 qian), Yi Ren (Coix Seed, 5 qian). Decoct in water and take orally. Spontaneously cured after four consecutive doses.

This formula contains Water-nourishing ingredients amidst Fire-tonifying ones. Naturally, Fire generates Water, and Water generates Fire. With mutual assistance between Water and Fire, what depression could exist? It is unnecessary to nourish Liver/Gallbladder and regulate Spleen/Stomach.

For this syndrome, Jun Shui Tang is also effective.
Bai Zhu (1 liang), Du Zhong (3 qian), Shan Yao (1 liang), Yi Ren, Qian Shi (Euryale Seed, each 5 qian), Fang Ji (Stephania Root), Gui Zhi (Cinnamon Twig, each 5 fen). Decoct in water and take orally. Cured in four doses.

A person suffers from shortness of breath, distension and oppression in the hypochondrium, abdomen, chest, back, face, eyes, and limbs, occasional retching, sore and swollen throat, dry mouth and bitter taste, sudden pain above and below the epigastrium, or violent abdominal pain, red eyes and dizziness, heat in the heart with irritability, mental restlessness, potential sudden death, sweat soaking the skin, profuse thick turbid phlegm, red malar flush, and miliaria (heat rash). People attribute this to Phlegm-Fire disturbance, unaware that it is Fire Depression (Huo Yu). The nature of Fire is to flare upwards. When depressed, Fire cannot flare upwards, violating its nature. The Fire of the five Zang organs differs: there are Deficient Fire, Excess Fire, Ministerial Fire, and Sovereign Fire. However, Fire that forms depression is generally Deficient Fire and Ministerial Fire, i.e., Dragon-Thunder Fire. Thunder Fire does not activate unless depressed; if too depressed, it cannot activate. Unlike Sovereign Fire or Excess Fire, which can activate even when depressed. Therefore, treating Fire depression involves treating Deficient and Ministerial Fire alone. Since it is Deficient Fire, purgatives cannot be used; since it is Ministerial Fire, cold herbs cannot be used. One must follow its nature and disperse it. Use Fa Huo Tang: Chai Hu (1 qian), Gan Cao (1 qian), Fu Shen (Poria with Hostwood, 3 qian), Chao Zao Ren (3 qian), Dang Gui (Angelica Sinensis Root, 3 qian), Chen Pi (3 fen), Shen Qu (Medicated Leaven), Chao Zhi Zi (Fried Gardenia Fruit, each 1 qian), Bai Jie Zi (White Mustard Seed, 2 qian), Bai Zhu (2 qian), Guang Mu Xiang Powder (Costus Root Powder, 5 fen), Yuan Zhi (Polygala Root, 1 qian). Decoct in water and take orally. Fire depression resolves after one dose; all symptoms cure after the second dose.

This formula enters the Pericardium Collateral directly to resolve stagnant Qi, without directly purging Fire, but instead tonifying Qi and Blood, eliminating phlegm and stagnation, allowing Fire to follow its upward-flaring nature. Some doubt that Dragon-Thunder Fire resides in Liver/Kidney, not Pericardium, questioning if treating Pericardium can resolve Dragon-Thunder Fire depression. They fail to realize that Pericardium Fire connects downward to Liver and Kidney. If Pericardium Fire is not resolved, how can Dragon-Thunder Fire depression be resolved? Resolving Pericardium郁 Fire is precisely resolving Dragon-Thunder郁 Fire. Otherwise, if Pericardium depression remains, merely resolving Dragon-Thunder Fire causes it to want to rise but be blocked by Pericardium, leading to greater disaster (burning forests). Only by resolving Pericardium Fire can Upper Fire reach down, allowing Lower Fire to rise gradually or remain peaceful without forcing ascent. This is the most ingenious treatment method.

For this syndrome, Tong Huo Tang is also wonderful.
Bai Shao, Xuan Shen, Mai Dong (each 1 liang), Sheng Di Huang (Rehmannia Root, 5 qian), Gan Cao (1 qian), Chen Pi (5 fen), Jing Jie (1 qian), Bai Jie Zi (2 qian), Fu Ling (3 qian), Ban Xia (8 fen). Decoct in water and take orally. Depression resolves after one dose, completely cured after two.

A person fears cold and heat, feels like wind but isn't, has headache and cheek pain, gastric fullness and stuffiness, severe connection between heart and hypochondrium with distension, blockage in diaphragm and throat, acid regurgitation and vomiting food, liking the sight of food but feeling pain after eating, severe boiling tinnitus, vertigo and fainting, blindness/unrecognizing people. People attribute this to Wind Evil, unaware it is Wood Depression (Mu Yu). Wood belongs to Liver and Gallbladder. Once Liver/Gallbladder Qi depresses, it cannot reach the Pericardium upwards and must attack Spleen/Stomach downwards. The post-heaven basis of the body relies on Spleen/Stomach. Wood controlling Spleen Earth prevents Spleen transformation; Wood controlling Stomach Earth prevents Stomach reception. Empty Spleen/Stomach leads to withered fluids, unable to distribute to the five Zang and seven Fu organs. Moreover, Wood loves Water. If Spleen/Stomach become scorched dry earth, Wood lacks water nourishment, attacking Earth deeper, making Earth sicker. As Earth sickens, it fails to generate Lung Metal, weakening Lung Metal's ability to control Liver Wood. Over-dry Liver Wood becomes restless and disruptive. Treatment should urgently soothe the original Qi of Liver/Gallbladder. However, merely soothing Liver/Gallbladder Qi without nourishing Liver/Gallbladder Blood means Blood cannot moisten, and Wood's depression is not fully resolved. Use Kai Yu Zhi Shen Tang: Ren Shen (Ginseng Root, 1 qian), Xiang Fu (Cyperus Rhizome, 3 qian), Fu Ling (2 qian), Bai Zhu (1 qian), Dang Gui (2 qian), Bai Shao (5 qian), Chen Pi (5 fen), Gan Cao (5 fen), Chao Zhi Zi (1 qian), Chai Hu (5 fen). Decoct in water and take orally. Depression slightly resolves after one dose, completely resolves after the second.

This formula contains no harsh/scraping herbs yet removes stagnant knots, surpassing Xiao Yao San significantly. Some doubt that depression diseases require dispersing agents, not tonics like Ren Shen. They fail to realize that life circumstances vary, with many frustrations causing sorrowful hearts to knot. Wood depression does not solely stem from annual movements. Thus, treatment methods must change. One cannot stick to the dogma that depression is hard to treat with tonics, abandoning Ren Shen for pure dispersing drugs. Using Ren Shen within dispersing formulas causes no harm and facilitates depression resolution.

For this syndrome, Shu Mu Tang is also effective.
Bai Shao, Dang Gui (each 3 qian), Chuan Xiong, Jing Jie, Yu Jin, Cang Zhu (each 2 qian), Xiang Fu, Che Qian Zi, Zhu Ling, Gan Cao (each 1 qian), Qing Pi (Green Tangerine Peel, 5 fen), Tian Hua Fen (Trichosanthes Root, 1 qian). Decoct in water and take orally. Cured in four doses.

Depression diseases are most common in women and hardest to relieve. If someone lies listless all day, speechless and foolish, people think it is impending Dumb Disease (Dai Bing), unaware it is thoughts knotting in the heart and Middle Qi depressing without smoothing. Relying solely on medicine is not the ideal treatment, nor is ignoring it expecting spontaneous cure. Generally, thought-induced depression resolves with joy;其次 (secondarily) with anger can also resolve it. Spleen governs thought; excessive thought closes Spleen Qi, causing food aversion. Joy causes Heart Fire to flare, generating Stomach Earth, opening Stomach Qi. Once Stomach Qi opens, Spleen Qi cannot stay closed. Anger belongs to Liver Wood; Wood controls Earth. Anger makes Qi vigorous, bursting open Spleen closure. Once Spleen Qi opens, digestion improves, nutrients nourish the body, overcoming depression. Thus, for such cases, provoke anger first, then guide with joy, followed slowly by medicine. This is an excellent method. Use Jie Yu Kai Jie Tang: Bai Shao (1 liang), Dang Gui (5 qian), Bai Jie Zi (3 qian), Bai Zhu (5 qian), Sheng Zao Ren (Raw Sour Jujube Seed, 3 qian), Gan Cao (5 fen), Shen Qu (2 qian), Chen Pi (5 fen), Bo He (Mint, 1 qian), Dan Pi (3 qian), Xuan Shen (3 qian), Fu Shen (2 qian). Decoct in water and take orally. Knots open and depression resolves after ten doses.

This formula is a variation of Xiao Yao San, best for resolving depression. For mild depression/anger, it brings peace and joy. No need for the extra steps of provoking anger or guiding with joy.

For this syndrome, Shu Mu Tang plus Zhi Zi (1 qian) and Shen Qu (5 fen) is also very effective (formula seen previously).