Bipolar Disorder in Chinese Medicine and Culture
Bipolar disorder (BD), characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression), is recognized in Chinese culture and medicine. While different from Western medicine, the Traditional Chinese Medicine (TCM) approach has not only lasted for thousands of years, there is research pointing to its efficacy. Even though these concepts may not directly relate to Western psychiatry, it’s important to think of mental health as a dynamic interplay.
History of Bipolar Disorder in TCM
In Chinese culture, mental health issues are often viewed through a holistic lens, recognizing the interconnectedness of the body, mind, and environment. Historically, mental illnesses were attributed to imbalances in the body’s vital energies (qi), disruptions in the flow of energy along meridians, or disturbances in the balance of Yin and Yang forces.
There are few references to bipolar disorder in traditional Chinese medical literature, especially in the older classics. While there are plenty of references to mania (kuang) and depression (dian), there is no reference to a combined syndrome of the two. There’s a theory that mania was more concerning than depression because it’s seen as more destructive.
In TCM, mania is characterized by abnormally outgoing, aggressive, and excited behavior, as well as a tendency to shout and talk loudly. The patient may be restless or forceful, hit things, or expose themselves in public. The opposite is true in depression: quiet, withdrawn, low-voiced, untalkative, easily scared or saddened. A depressed person may withdraw socially or mutter incoherently to themselves in extreme cases.
Accordingly, mania can be regarded as yang and depression as yin. The treatment of bipolar disorder is therefore based on the principles of TCM — restoring balance and harmony to the body. Recent clinical research shows that the Yin-Yang disharmony theory for bipolar patients is correct. To help the mind and body find balance, Yin should be replenished and Yang needs to be regulated.
In spite of their differences, mania and depression are both disorders of the spirit mind (shen zhi). And, both mania and depression can be caused by emotions themselves. That is, even if the root cause of an emotional disorder is physical in nature, extreme emotions can make the condition worse. For example, in the Ling Shu ancient medical text, it states that mania can be caused by extreme anger; by excessive joy, which damages the “inferior mind” (po); and by sadness, which damages the “soul” (hun). Another potential cause of both mania and depression is disorder of the Heart and Liver, the two organs most responsible for generating emotions.
However, some causes of bipolar are exclusive to one or the other. For example, excess Yang heat can give rise to mania by disturbing the shen. And in the Su Wen, it is said that, “all mania belongs to fire.” This fire is often caused by other pathogens stagnating in the body, such as blood stasis or phlegm, or by extreme emotions such as anger, joy, or even sorrow – the latter emotion causing stagnation which can lead to fire.
In the Clinical Guide to Case Studies from the Qing dynasty, it is said that long-term worry can cause qi to stagnate, which allows phlegm to accumulate and “cloud” the shen, causing depression. Therefore, depression is essentially a disorder of yang qi, either in excess or deficiency. Today, depression is more often referred to as Liver qi stagnation. But depression can also be caused by yang qi deficiency, resulting in a yin constitution, exhaustion and withdrawal from social contact.
Causes of Mania
Fire transformed from stagnation
Causes of Depression
Yang qi deficiency (+ / – phlegm)
Yang qi stagnation ( + / – phlegm)
Causes of both Mania and Depression
Extreme emotions
Disorders of the Liver and Heart
Treatment of Bipolar Disorder in TCM
Traditional Chinese Medicine offers many modalities for mental health issues, including bipolar disorder, such as acupuncture, herbal remedies, and mind-body movement. The ultimate goal is to restore homeostasis within the individual, addressing both physical and psychological factors.
Acupuncture
With the goal to regulate the flow of qi and restore balance in the body, acupuncture is a great option for bipolar disorder. Acupuncture may help reduce the severity and frequency of mood swings, decrease anxiety and agitation, and improve sleep quality—all common challenges faced by individuals with bipolar disorder.
Research on acupuncture’s efficacy in treating BD is still emerging, but existing studies suggest promising results. For example, acupuncture modulates neurotransmitter levels, including serotonin and dopamine, both of which play a crucial role in mood regulation. In individuals with bipolar disorder, it has been shown that acupuncture may improve mood stabilization and emotional resilience by influencing these neurochemical pathways.
Herbal Remedies
Emotional regulation can also be achieved with the use of formulas containing herbs such as Rhodiola rosea and Baihe (Lilium brownii). However, a qualified TCM practitioner is required for a proper diagnosis and treatment.
Mind-Body Movement
Physical activity, even something as simple as walking, has been shown to be beneficial for mental health. However, bridging the mind and body through practices like qigong and tai chi have been shown to help balance yin and yang, correct organ imbalances, and therefore improve mental well-being. Some good videos to try: Tai Chi to Strengthen Mental Health and Tai Chi for Depression.
For a more in-depth understanding of bipolar in the treatment room, check out Dr. Yong Ping Jiang’s article, The TCM Diagnosis and Treatment of Bipolar Disorder, Part Two in Acupuncture Today.
Bipolar Disorder in Chinese Culture and in the U.S.
While bipolar disorder is recognized and treated within Chinese culture and medicine today, the approach may encompass a combination of traditional and modern methods, emphasizing holistic well-being and restoring harmony within the individual.
However, stigma, shame, and “losing face,” can impact seeking help and access to care. Chinese culture emphasizes family involvement in the treatment and recovery of individuals with bipolar disorder, particularly due to privacy reasons. Several factors contribute to this, including a value system that accepts sadness and worry, but not extreme forms of emotion. Furthermore, societal and family pressure to succeed academically, professionally, and personally leaves little room for mental health problems.
Therefore, the number of people diagnosed with bipolar disorder in China is quite low (.12%). This follows a statistical trend that rates of bipolar are lower in countries with more stigma. In comparison, the United States has the highest lifetime rate of bipolar disorder at 4.4% (world average is around 2.4%). Even still, stigma and shame are the biggest barriers to seeking treatment for both China and the U.S.
On a Personal Note
I, the author, was diagnosed with bipolar disorder nearly 30 years ago. I know how living with bipolar can affect one’s education, career, relationships, finances, physical health, literally every facet of life. And, I can attest that Traditional Chinese Medicine has been highly beneficial for my mental health.
The general rule of thumb in Traditional Chinese Medicine is that results can be seen more quickly with acute issues. On the other hand, chronic issues like an old injury need more effort and time.
Therefore, the efficacy of TCM in mental health involves a series of treatments; an acupuncture session here and there will resolve nothing. It’s about incremental progress that builds upon each other that ultimately creates a substantial shift, along with other lifestyle changes including medication, herbal formulas, and physical activity.
From personal experience, acupuncture and herbal medicine has helped me bring my mind and body back into balance during periods of recovery. However, it isn’t until I am well enough or have come to terms with my experience that I am able to seek treatment for myself, and I assume the same is true for others. No matter, for anyone experiencing a mental health crisis, the best course of action is to seek help from a psychiatric provider first before turning to TCM’s more gradual approach.
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If you or someone you love is suffering from bipolar disorder and you need support, contact NAMI or the Bipolar and Depression Support Alliance.
Sources:
Gardner, Amanda. U.S. Has Highest Bipolar Rate in 11-Nation Study. 7 Mar. 2011.
Jiang, Yong Ping. The TCM Diagnosis and Treatment of Bipolar Disorder, Part One. Acupuncture Today, Nov. 2023.
Jiang, Yong Ping. The TCM Diagnosis and Treatment of Bipolar Disorder, Part Two. Acupuncture Today, Nov. 2023.
Single Care. Bipolar Disorder Statistics 2024. 20 Jan. 2023.
Susman, David. 8 Reasons Why People Don’t Get Treatment for Mental Illness. Advocating for Better Mental Health, 12 June 2015,
Tsang, Allen, and Tiffany Chin. Views on Mental Health & Traditional Beliefs in Chinese Culture. Accessed 9 May 2024.
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Wang, Dongxin, et al. Characteristics of Help-Seeking Behavior Among Bipolar Disorder Patients. Medicine, vol. 98, no. 46, Nov. 2019, p. e17687. PubMed Central.
Zhang, Ling, et al. The Prevalence of Bipolar Disorder in China: A Meta-Analysis. Journal of Affective Disorders, vol. 207, Jan. 2017, pp. 413–21. ScienceDirect.
