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Massage Today
April, 2001, Vol. 01, Issue 04

The Five Elements of Depression, Part I

By Barbra Esher, AOBTA CI. Dipl. ABT & Ac. (NCCAOM), LAc

In the last two issues of Massage Today, I have talked about headaches and other physical complaints. Pain relief may be the most common reason clients seek shiatsu and other Asian bodywork therapies, but it certainly is not the only benefit they can receive.

A physical problem will bring a client in, like the woman's headaches in the example I use later on in this article. But we need to look beyond the physical manifestation at our client's emotional and spiritual climate, to explore and treat the person, not just the symptoms.

When we do any form of Asian bodywork therapy (ABT), we are working with Qi -- the vital force that moves us through the dance of life. Qi is not only involved in every emotional and physiological process of our bodies; it also binds us together as individuals and connects us spiritually, reverberating through every being on this earth. This awareness of the interconnectedness of all, along being present and compassionate, are more essential than ego-based, "clever" techniques.

image - Copyright – Stock Photo / Register Mark

Keeping this in mind, we are looking beyond any Western diagnosis our clients may have come to us with, to see the energetic relationships within themselves and to the world. An excellent paradigm for doing this is the Five Elements. The five elements are a poetic but scientific way of using natural phenomenon, like the changing of the seasons, to explore and treat our psyche, spiritual state, anatomy, physiology, and the dynamics of the disease process as a whole.

Often, clients come to us with the Western diagnosis of depression. A major depressive episode implies a prominent and relatively persistent (nearly every day for at least two weeks) depressed or dysphoric mood that usually interferes with daily functioning, and includes at least five of the following nine symptoms:

  • depressed mood;
  • loss of interest in usual activities;
  • significant change in weight and/or appetite;
  • insomnia or hypersomnia;
  • psychomotor agitation or retardation;
  • increased fatigue;
  • feelings of guilt or worthlessness;
  • slowed thinking or impaired concentration; and
  • suicide attempt or suicide ideation.

So what do we do with a diagnosis of depression? Is there a magic point that cures depression? Wouldn't that make it easy! The beauty of shiatsu and Asian bodywork therapy is that we have the tools to see people as a vortex of natural forces, as great works of art, with their life force as an integral part of that picture. We have to see the symptom of depression as part of a whole being, manifesting differently in everyone. The five elements allow us to look at the person's individual "climate." Depression could lie in any of the five elements; often, it's a combination of the dynamic relationship between two or more elements.

Five-element Sheng/ko cycle. - Copyright – Stock Photo / Register Mark Reprinted with permission from the Acu-Coloring Book by Loren Nelson, . The Wood Element closely relates to the season of spring. The energy of the flowers pushing through the still frozen ground upward resembles the force of wood. It's a powerful, yang force within our bodies, responsible for moving the Qi upward. It has an energy that can flare up quickly and move rapidly, often like wind.

The wood organs, Liver and Gall Bladder, are related to the ease and flow of Qi and the emotions, particularly anger. Wood also gives us the ability to make decisions. Wood gives us flexibility in our tendons and sinews, which manifests on an emotional level as well. Someone who is very "woody" may be rigid, inflexible and have issues about being in control. Their anger will flare upward easily; they will hold themselves and others to a high standard of perfection. The eyes relate to the wood element -- not just physically, but in having a life vision and plan. When thwarted, their energy can get stuck or stagnate, causing resentment, repressed anger and, over a long period of time, depression.

Let me give you an example of a typical dark, moody, wood-type of depression. I had a client who was a single mother in her 40's. For years, she worked in a job that she didn't like, with a demanding boss. She got angry, but she always stifled it because she was afraid to lose her job. Her kids had a lot of behavior problems that caused her even more stress. She often spoke of how frustrated she was and how she felt like she had no control in her life. She felt as if she had no options. She would ineffectually explode at her kids and then get mad at herself for doing so. Her physical symptoms included menstrual cramps, PMS and temporal migraines. (Do you remember shaoyang headaches?) Her pulse was wiry and the sides of her tongue were red. Her doctor diagnosed her with mild depression and suggested that she try Prozac, but she wanted to wait a bit longer, trying shiatsu as a last resort recommendation from a friend.

Don't you hate it when you are a last resort? I'd much rather have seen her years before she got into such a desperate state! Luckily, she responded very quickly to shiatsu. Not only was that due to the wood element's easily changeable nature, she also realized that she was spiraling downward and she was committed to making changes in her life.

I focused treatments on the wood meridians, Lv and GB, and the shaoyang meridians, which are Gall Bladder and Triple Heater. I also supplemented the treatments with the Water or Earth meridians intermittently as a precaution. Point combinations that I used were Lv 3 and GB 34. I also held both GB 20s with one hand as I thumb pressed down the TH meridian, stopping and holding TH 6, then TH 5 on one side with Pc 6 on the other. I worked on the TH and GB meridians on the temples, around the ears, occiput and shoulders. In the side position, I worked on the ribs, hips, the outside and the inside of the legs, ending with work on the feet including GB 41 and Lv 3. I also included many meridian stretches.

I recommended that she take a yoga class, which she did. Stretching literally "cools you out" by opening up the meridians, allowing heat to be released. A wood depression due to stagnant liver Qi often starts to generate heat, which can cause irritability, restlessness and insomnia. The stretching not only helped her become calmer, but also more flexible at all levels.

I suggested that she cut out fatty, greasy and spicy foods. Due to her schedule, she relied far too heavily on fast food. She also cut back on coffee and alcohol, which previously had just added fuel to her fire.

She didn't quit her job, but she got better at not letting her boss get to her. She started communicating with her kids more effectively, and they responded by acting out less. Her moods improved, and her headaches and PMS symptoms became less frequent.

This woman's particular case was a straightforward, classic wood case with little complications from other elements. This is unusual. More often than not two or more elements are involved. Deficient water can cause a wood imbalance in the shen-growth cycle. Wood can overact in the ko-control cycle, causing the earth element to be affected and dampness to accumulate.

In future articles, I will give examples of how depression manifests in the other elements. I am hoping that this series will spark your interest in further study. Are you getting tired of hearing this yet? This is just a taste - it in no way takes the place of actual training!

For a list of schools that offers programs in ABT, go to For information on the national ABT exam, go to

Click here for previous articles by Barbra Esher, AOBTA CI. Dipl. ABT & Ac. (NCCAOM), LAc.


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