How Depression was Treated in Ancient China?


The first officially documented management of the mentally ill in China was in the Tang Dynasty (618-907 AD), when homeless widows, orphans and the mentally ill were cared for in the Bei Tian Fang, a type of charity facility administrated by monks.

In ancient China, depression and mental health disorders were understood and treated within the context of traditional Chinese medicine (TCM). The approach to treating depression in ancient China was holistic and encompassed a combination of herbal remedies, acupuncture, lifestyle adjustments, and philosophical practices.

Chinese Philosophy

Mental illness is often thought to be a matter of individual disorder. Modern psychiatry looks to features of individual experience, behavior and thoughts to diagnose mental illness, and focuses on individual remedies to treat it. If you are depressed, this is understood as your response to circumstances, based on features of your genetics, disordered patterns of thinking, or personal problems and emotional states. Western treatment of mental illness follows these same individualistic lines. The individual is provided with medicine and therapy, which are certainly helpful.

But such an emphasis on the individual can lead us to neglect communal approaches to treatment. Often overlooked are the ways in which social norms, cultural beliefs and communal attitudes contribute to mental illness. Ancient Chinese scholars understood this well.

These thinkers recognized a number of mental and behavioral disorders as illnesses (bing), which were categorized and discussed in the earliest-known medical text in China, the Huangdi Neijing Lingshu Jing (the oldest parts of which date to the 4th century BCE). This text describes a number of mental illnesses, most prominently dian, marked by ‘unhappiness, headache, red eyes and a troubled mind’, and kuang, marked by ‘manic forgetfulness, flying into rages’ and ‘wild activity’, among other symptoms. Early Chinese medical scholars understood such mental illnesses to have a number of contributing causes, including overabundance of emotion, failure to control desires, the depletion of ‘vital energy’ from the organs – and the community to which one belongs.

Mental illness is linked to emotion in a number of early philosophical and medical texts. A passage from the Guanzi instructs that harmonious and effective action is possible only in the absence of the kinds of extreme joy, pleasure and anger that can disorder the mind, leading it to ‘lose its (original) form’. The Zhongyong associates harmony (he) with the proper restriction of the emotions. A passage in the Huangdi Neijing reads: ‘When anger abounds and does not end, then it will harm the mind.’ Just as in the case of tools or machines, there are ways in which we can use our bodies that overtax or harm them, and thus cause injury and illness (including mental illness), according to ancient Chinese scholars. This is an astute insight into the nature of illness.

According to ancient Chinese scholars, we can avoid illnesses caused by overabundant emotion (or treat them) by learning to restrain the mind. ‘Let the mind have no anger,’ instructs a passage from the Huangdi Neijing. However, achieving this requires more than just individualized approaches aimed at restructuring the way that ill individuals think about their experience.

Early Confucians recognized that the behaviors and attitudes of individuals are not due solely to individual character and decisions. This is the reason why Confucius taught that, if you wish to become virtuous, you must be careful whom you are around. He advised that we should take as friends only those who are at least as morally good as we are. Being part of harmonious and virtuous communities is necessary for the development of healthy behaviors, attitudes and emotions. If we are in bad, vicious or unhealthy communities, our beliefs, emotions, expectations and attitudes (among other things) will be disordered in critical ways.

This is relevant when it comes to mental illness, because such illness is at least in part a matter of behavioral and emotional norms governed by society. Confucians would likely have said of our own modern world that the alienation created by the self-centeredness required for modern economic and consumer culture plays a major role in driving mental illness. Tu Weiming, a contemporary scholar of Confucianism, writes that, according to the Confucian view, ‘self-centeredness easily leads to a closed world … to a state of paralysis’. The kinds of community that promote self-centeredness and self-concern – ranging from the seemingly innocuous concern with ‘defining oneself’, via various individual and consumer choices, to the corrosive lack of empathy or care for others in the community – are communities likely to inculcate in individual members behavioral and attitudinal traits that contribute to mental illness.

Herbal Medicine

Traditional Chinese medicine relied heavily on herbal remedies. Specific herbs were used to balance the body's energy (Qi) and restore harmony.

While the concept of depression in ancient China may not directly correlate with modern clinical definitions, TCM had methods to address symptoms that align with what we now understand as depression. Here are some herbs that were commonly used in traditional Chinese medicine to address emotional imbalances and mood issues:

1.       St. John's Wort (Hypericum perforatum): This herb was used in TCM to treat conditions related to emotional disturbances, including symptoms that resemble depression. St. John's Wort was believed to have calming and mood-stabilizing effects.

2.       Chinese Skullcap (Scutellaria baicalensis): This herb has been used to address anxiety, stress, and restlessness in TCM. It was believed to have sedative and calming properties.

3.       Polygala Root (Polygala tenuifolia): Also known as Yuan Zhi, this herb was used to address mental and emotional imbalances. It was believed to help clear the mind, soothe irritability, and calm the spirit.

4.       Rehmannia Root (Rehmannia glutinosa): This herb was used to nourish and tonify the Yin energy in TCM. It was believed that imbalances in Yin could lead to emotional issues, and Rehmannia root was used to restore this balance.

5.       Atractylodes Root (Atractylodes macrocephala): This herb was used to strengthen the Spleen and Stomach energies, which are important in TCM for overall well-being. An imbalanced Spleen energy was thought to contribute to symptoms like fatigue and low mood.

6.       Ginseng (Panax ginseng): Ginseng is a well-known herb in TCM with adaptogenic properties. It was believed to help the body adapt to stress and improve overall vitality, which could indirectly impact mood.

7.       Licorice Root (Glycyrrhiza glabra): This herb was used to harmonize and balance other herbs in herbal formulas. It was believed to support the function of other herbs and assist in overall treatment.

8.       Astragalus Root (Astragalus membranaceus): Astragalus was used to tonify Qi energy, which is important for vitality and resilience. Addressing Qi imbalances was seen as a way to support emotional well-being.

Acupuncture and Acupressure

Acupuncture was one of the therapeutic techniques used in ancient China to address various health issues, including emotional and mental imbalances. While the concept of depression in the modern clinical sense may not have existed in ancient times, traditional Chinese medicine (TCM) had a framework for understanding and treating emotional disturbances that align with what we now recognize as mood disorders. Acupuncture was employed as part of a holistic approach to restore balance and harmony within the body's energy (Qi) and organ systems. Here's how acupuncture was used for emotional well-being in ancient China:

1.       Qi Flow and Balance: In TCM, the body's vital energy, known as Qi, flows through pathways called meridians. It was believed that disruptions or imbalances in the flow of Qi could contribute to emotional and mental symptoms. Acupuncture involves the insertion of thin needles into specific points along these meridians to regulate the flow of Qi and restore balance.

2.       Regulation of Energy: Acupuncture points were selected based on an individual's pattern of disharmony. For emotional issues, points related to the Heart, Liver, Spleen, and Kidney meridians might be targeted. These points were believed to have a direct influence on emotions and mental states.

3.       Harmonizing Organ Systems: In TCM, emotions were connected to specific organ systems. For example, the Heart was associated with joy and sadness, while the Liver was linked to anger and frustration. Acupuncture could be used to balance and harmonize these organ systems to address emotional symptoms.

4.       Stress Reduction: Acupuncture was believed to have a calming and relaxing effect on the nervous system. By stimulating specific points, practitioners aimed to reduce stress, anxiety, and restlessness, which could contribute to emotional imbalances.

5.       Release of Endorphins: Acupuncture was thought to stimulate the release of endorphins, the body's natural pain and stress-relieving compounds. This could contribute to an improved mood and a sense of well-being.

6.       Restoring Yin and Yang: TCM views health as a balance between the opposing forces of Yin and Yang. Emotional imbalances were often seen as a disruption of this balance. Acupuncture was used to restore harmony between Yin and Yang energies.

7.       Individualized Treatment: Acupuncture treatments were personalized based on an individual's constitution, symptoms, and patterns of disharmony. This approach aimed to address the underlying causes of emotional issues rather than just treating the symptoms.

8.       Holistic Approach: Acupuncture was often combined with other TCM therapies, such as herbal medicine, dietary adjustments, and lifestyle recommendations, to create a comprehensive treatment plan for emotional well-being.

Dietary Changes: Diet played a crucial role in traditional Chinese medicine. Specific foods were recommended to support emotional balance. For instance, foods that were considered to have a calming effect on the mind, such as herbal teas and certain fruits, were incorporated into the diet. Here are some dietary considerations that were believed to promote emotional balance in ancient China:

1.       Balancing Yin and Yang: TCM emphasizes the balance between Yin (cooling and nourishing) and Yang (warming and energizing) energies. A balanced diet included foods from both Yin and Yang categories to maintain harmony.

2.       Moderation: Moderation in food consumption was a key principle in ancient Chinese dietary practices. Overindulgence or extreme dietary habits were believed to disrupt the body's balance.

3.       Warm and Cooked Foods: Cooked and warm foods were preferred over raw and cold foods. Cooked foods were considered easier to digest and gentler on the digestive system.

4.       Herbs and Spices: Certain herbs and spices were incorporated into the diet for their potential to support emotional balance. For example, ginger, garlic, and scallions were believed to have warming properties that could invigorate the body's energies.

5.       Seasonal Eating: TCM emphasizes eating foods that are in season and locally available. Seasonal foods were believed to be more aligned with the body's needs.

6.       Bitter and Astringent Flavors: Bitter and astringent flavors were thought to have a calming effect on the mind. Foods with these flavors, such as bitter greens and certain grains, were included in the diet.

7.       Avoiding Excess Sugar and Stimulants: Excessive consumption of sweets and stimulants (such as caffeine) was discouraged, as these substances were believed to lead to imbalances and disrupt emotional harmony.

8.       Qi-Building Foods: Foods that were believed to strengthen the body's vital energy (Qi) were considered beneficial. These might include foods rich in complex carbohydrates, such as whole grains.

9.       Bone Broths: Nutrient-rich bone broths made from simmering bones and vegetables were often recommended for their nourishing properties.

10.   Mindful Eating: TCM emphasizes mindful eating, paying attention to the flavors, textures, and aromas of food. This practice was thought to promote a deeper connection between the body and mind.

Physical Activity

In ancient China, physical exercises were considered an important aspect of maintaining overall health and well-being, including emotional balance. These exercises were often rooted in the principles of traditional Chinese medicine (TCM) and were designed to promote the flow of vital energy (Qi) and harmonize the body's energies. Here are some examples of physical exercises that were believed to have benefits for emotional balance in ancient China:

1.       Tai Chi (Taijiquan): Tai Chi is a traditional Chinese martial art that is now widely practiced for its health benefits. It involves slow, flowing movements that are performed in a meditative and mindful manner. Tai Chi is believed to promote the smooth flow of Qi and balance Yin and Yang energies. The practice's emphasis on relaxation and mindfulness can contribute to a sense of calm and emotional well-being.

2.       Qigong (Chi Kung): Qigong is a system of exercises that involves breath control, gentle movements, and meditation. Like Tai Chi, Qigong aims to cultivate and balance Qi within the body. There are various forms of Qigong, some of which specifically target emotional imbalances and promote inner peace.

3.       Daoist Yoga and Stretching: Ancient China had its own forms of stretching and yoga-like practices that were associated with Daoist philosophy. These practices were aimed at maintaining flexibility, enhancing circulation, and promoting a harmonious flow of Qi.

4.       Five Animal Frolics (Wu Qin Xi): This is a set of exercises that imitate the movements and behaviors of five animals: the tiger, deer, bear, monkey, and bird. Each animal's movements were thought to correspond to specific meridians and organs in the body. The Five Animal Frolics were believed to have physical and mental health benefits.

5.       Walking Meditation: Walking meditation involves combining mindfulness with walking. It's a practice that encourages focusing on each step and the sensations of walking, which can help quiet the mind and reduce stress.

6.       Breathing Exercises: Controlled and mindful breathing exercises were often used in conjunction with other physical practices. These exercises aimed to regulate the breath, promote relaxation, and balance the body's energies.

7.       Calm Abiding Meditation: This form of meditation involves focusing the mind on a single point, often the breath or an image. It aims to bring about a state of mental clarity, calmness, and inner peace.

8.       Dance and Movement: Traditional dances and ceremonial movements were sometimes used to promote emotional release, expression, and connection with the body's energies.

Mind-Body Practices

Ancient Chinese philosophy, including Daoism and Confucianism, emphasized the importance of finding harmony and balance in one's life. Meditation, mindfulness, and contemplative practices were used to cultivate inner peace and emotional resilience.

Here are some examples of meditation practices that were used for promoting emotional well-being in ancient China:

1.       Daoist Meditation: Daoism is a philosophical and spiritual tradition in China that emphasizes living in harmony with the Dao, often translated as the "Way" or the natural order of the universe. Daoist meditation practices involved cultivating stillness, mindfulness, and aligning with the flow of Qi (vital energy) in the body. These practices aimed to bring about a sense of tranquility, clarity, and connection with the natural world.

2.       Chan Buddhism (Zen Buddhism): Although originating in India, Chan Buddhism was adopted and adapted in China as a form of meditation practice. Chan meditation focused on direct experience and insight into one's true nature. Practitioners engaged in seated meditation (zazen) to calm the mind and cultivate awareness, which could lead to a sense of inner peace and freedom from attachments.

3.       Confucian Self-Cultivation: Confucianism, a philosophy emphasizing ethics, social harmony, and self-cultivation, included meditative practices as a means to cultivate virtue and inner balance. These practices often involved contemplation on moral principles, reflecting on one's actions, and cultivating a sense of equanimity.

4.       Visualization and Imagery: Meditation techniques involving visualization of serene landscapes, symbols, or deities were used to create a sense of tranquility and mental clarity. These practices were believed to promote positive emotions and a peaceful state of mind.

5.       Body Scan Meditation: Body scan meditation involved directing focused attention to different parts of the body, promoting relaxation, and heightening body awareness. This practice aimed to release tension and create a sense of physical and mental ease.

6.       Mantra Meditation: Repeating sacred sounds or mantras was used as a way to focus the mind and create a sense of inner peace. The rhythmic repetition of sounds was believed to have a calming effect on the mind.

Literature and Art

Depictions of depression and related emotional states in ancient Chinese literature and art are often embedded within broader cultural, philosophical, and artistic contexts. While the concept of depression as understood in modern clinical terms might not have existed, ancient Chinese literature and art do contain portrayals of emotional struggles, inner turmoil, and existential contemplations. Here are a few examples:

1.       Poetry: Chinese poetry, with its emphasis on emotions, nature, and the human experience, often contains expressions of inner turmoil and melancholy. Some poets, like those from the Tang Dynasty (618-907 AD), used nature metaphors to convey emotional states. For instance, Li Bai's poem "Drinking Alone with the Moon" reflects a sense of isolation and introspection.

2.       Literary Classics: Classic Chinese texts, such as the "Dao De Jing" attributed to Laozi and Confucian texts, address themes of balance, virtue, and the search for meaning. These texts often touch on the nature of human emotions and the challenges of maintaining emotional equilibrium.

3.       Philosophical Discourses: The works of Confucian scholars, Daoist philosophers, and other thinkers offer insights into the exploration of emotions, desires, and the pursuit of contentment. Philosophical discourses often examined the complexities of the human psyche and the search for a fulfilling life.

4.       Paintings and Calligraphy: Chinese painting and calligraphy reflect the inner world of the artists. Depictions of landscapes, solitary figures, and scenes of contemplation convey a sense of introspection and emotional depth. Some artists, like those from the literati tradition, conveyed emotions through their brushstrokes and compositions.

5.       Fictional Narratives: Ancient Chinese fictional works, such as "Dream of the Red Chamber" (also known as "The Story of the Stone"), often delve into themes of love, desire, suffering, and the impermanence of life. While not explicit depictions of clinical depression, these narratives explore the emotional and psychological experiences of characters.

6.       Opera and Drama: Traditional Chinese opera and drama, such as Peking opera, sometimes portrayed characters experiencing emotional turmoil and inner conflicts. These performances incorporated stylized movements, costumes, and music to convey emotions and character psychology.

7.       Spiritual Texts: Buddhist and Daoist texts, which were influential in ancient China, addressed the nature of suffering, attachment, and the quest for spiritual enlightenment. These texts explored the human experience from a spiritual and existential perspective.

8.       Inscriptions and Epitaphs: Inscriptions on tombs, monuments, and epitaphs sometimes conveyed emotional expressions and reflections on life and death. These writings offer glimpses into personal thoughts and feelings of individuals from ancient times.


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