A comparison between Chinese medicine stagnation ('yu') syndrome and depression

Abstract

Depression was translated into Chinese as ‘yiyu’, with reference to the stagnation (‘yu’) syndrome in traditional Chinese medicine (TCM). The 2 disorders are, however, rather different in many aspects. Literally ‘yu’ means not flowing, entangled or clogged, which underscores the distinct conceptualisation of stagnation syndrome. Repression of emotions, especially anger, is often the first step in the aetiology of stagnation syndrome. According to the Five Elements Theory of mind / body connection in TCM, repression of anger will lead to a cluster of symptoms associated with the liver and spleen meridians. The characterising symptoms include obstruction-like feelings at head, throat, heart, stomach, and intestine. Despite an aetiology closely related to emotions, the clinical presentations are mostly somatic, and thus stagnation syndrome is generally seen at general TCM practice. Since stagnation syndrome is regarded as a bodily rather than mental disorder, it is a socially legitimate health concept for seeking attention. My earlier study has operationalised stagnation as a construct useful to all mental health practitioners.1 Exploratory factor analysis showed that stagnation comprised 3 components, namely (1) body-mind obstruction, (2) affectposture inhibition, and (3) overattachment. A 12-item selfreport scale with good psychometric properties was produced for screening for and assessing stagnation. Subsequently confirmatory factor analysis was performed with a different sample, supporting the robustness of the 3-factor structure.2,3 The 3 revealed factors of stagnation have significant clinical implications. Most stagnation patients present with somatic, obstruction-like symptoms, which are the entry point for working with these patients. When a trustful working relationship is in place, psychobehavioural interventions may be offered to deal with affect-posture inhibition. Last but not the least, if the patient is ready, interventions addressing overattachment may be offered, which is arguably the most challenging because it is in the spirituality domain. My previous studies have revealed stagnation syndrome as having a demographic pattern different from depression. Stagnation showed no gender difference and was more common in adults who were younger, single, better educated, and occupying managerial / professional positions. In the subsequent study of a random community sample of 755 adults recruited by cluster sampling in Hong Kong, 6.2% of participants appraised themselves to be suffering from stagnation syndrome to a degree of an illness, of which 1.9% intended to seek treatment.2,3 Stagnation showed positive correlations with multiple somatic symptoms, depression, and anxiety (r = 0.59-0.76, p < 0.01). To conclude, stagnation is a fairly common condition associated with treatmentseeking behaviours.