A 22-year-old man suffering from post-graduation depression, severe bloating, and insomnia was managed using a Phlegm-resolving herbal strategy combined with targeted emotional counseling.

Case ID: CHC-0028

Case Summary

This case describes a 22-year-old man who presented with a relapsing history of depression, emotional restlessness, and poor sleep triggered by post-graduation life and work stress. The original report documented a conventional diagnosis of depression and a TCM assessment of Depression Syndrome (Yu Zheng) driven by Qi stagnation and Phlegm obstruction. The patient was managed through a dual approach: a customized herbal decoction to physically clear the phlegm and dampness, and classical TCM psychological counseling to address the emotional root.

Patient Presentation

• Patient: 22-year-old male.
• Main Complaint: Mental depression, emotional restlessness, and declining sleep quality.
• History: Following university graduation, the patient experienced significant stress related to life and work transitions, leading to depression and insomnia. He had previously sought treatment at another hospital, utilizing conventional antidepressants and sleep aids. While these provided temporary relief, his symptoms repeatedly relapsed.
• Physical Signs: At the time of the initial consultation on July 28, 2021, the patient presented with marked lethargy and a low, weak speaking voice. Physically, he appeared overweight with a visibly bloated, puffy face. He also reported knee discomfort severe enough that he required crutches to walk.

Examination and Diagnosis

• Conventional Diagnosis: Depression.
• TCM Tongue and Pulse: The tongue was red with a yellow, greasy coating. The pulse was stringy and slippery (弦滑).

TCM Assessment

The original practitioner interpreted the presentation as Depression Syndrome driven by Qi Stagnation and Phlegm Obstruction (郁证 – 气滞痰阻).

According to the holistic principles of yin and yang Chinese Medicine, intense emotional stress and chronic overthinking directly impair the physiological functions of the Liver and Spleen. The original report noted that the patient’s post-graduation stress caused his Liver Qi to stagnate, resulting in emotional distress. Concurrently, excessive worrying damaged his Spleen, compromising its ability to properly metabolize fluids.

These unprocessed fluids accumulated into heavy, turbid Phlegm and Dampness. This systemic dampness physically manifested as his bloated facial appearance, lethargy, and joint (knee) heaviness. Meanwhile, the combination of stagnant Qi and sticky Phlegm drifted upward to obstruct the mind, triggering his depression and disrupting his sleep. The red tongue with a yellow, greasy coating objectively confirmed that this stagnant phlegm-dampness had begun generating internal heat.

Treatment Approach

The primary treatment principle was to soothe the Liver, resolve depression, strengthen the Spleen, and transform phlegm (疏肝解郁，健脾化痰). The strategy aimed to physically drain the water retention and clear the mental fog by restoring the digestive system’s motility, while actively employing psychological counseling.

Herbal Formulas and Modifications

• Initial Formula (July 28, 2021): A 13-herb decoction focused on regulating Qi and draining damp-turbidity.
  • Soothing Liver and Resolving Depression: He Huan Pi (Albizia Bark, 30g) and Cu Xiang Fu (Vinegar-prepared Cyperus, 15g) were utilized to soothe the stagnant Liver Qi and calm the spirit.
  • Drying Dampness and Strengthening Spleen: Cang Zhu (Atractylodes, 15g), Bai Zhu (White Atractylodes, 15g), and Pei Lan (Eupatorium, 15g) were used to strongly dry the heavy dampness and rebuild the Spleen’s digestive function. Fu Ling Pi (Poria Peel, 30g) was specifically chosen to promote urination and reduce the systemic bloating.
  • Regulating Qi and Phlegm: Mu Xiang (10g) and Jiang Hou Po (10g) moved stagnant Qi in the abdomen, while Jie Geng (20g) and Huang Qi (30g) ascended clear Qi and resolved chest phlegm.
  • Clearing Heat and Dampness: Bai Mao Gen (30g) and Ze Xie (15g) cleared internal heat and provided a downward exit pathway for the damp-turbidity through urination. Gan Cao (15g) harmonized the formula.
• Modification (Second Visit – August 11, 2021): The tongue coating shifted to white and greasy. To enhance the therapeutic effect on his sleep and lingering fatigue, the practitioner added Mu Dan Pi and Yu Jin to clear heat and resolve emotional constraint, Tian Ma and Jiang Ban Xia to further dry phlegm and settle the head, and heavy minerals Duan Long Gu and Duan Mu Li to strongly anchor the agitated spirit.

Follow-Up

• August 11, 2021 (Second Visit): The patient’s sleep showed slight improvement, though fatigue remained. During this visit, the practitioner engaged in deep communication with the patient to uncover his specific mental burdens, employing the TCM strategy of “using emotion to control emotion” (以情制情) to encourage and guide him. The practitioner also counseled the family on supportive interactions and advised the patient to initiate physical exercise.
• Subsequent Visits (Visits 3 & 4): The source reported a significant improvement in the patient’s mental state following the modified herbal course and counseling. He did not require further visits for nearly a year.
• July 6, 2022 (Fifth Visit): The patient returned due to a minor, one-week bout of poor sleep. The report noted a dramatic physical transformation: his mental state remained highly positive, and his physique was noticeably leaner (the pathological bloating had fully resolved). Furthermore, his joint issues had cleared, and he no longer required crutches to walk. The practitioner made minor formula adjustments to consolidate his recovery.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is how clearly it demonstrates the physical, metabolic consequences of psychiatric distress. In conventional medicine, depression is primarily localized to neurology and brain chemistry. However, this patient presented with severe physical bloating and knee pain requiring crutches—symptoms that seem entirely unrelated to a mood disorder.

The original practitioner recognized these seemingly disparate symptoms as a singular pathology: the Spleen was damaged by overthinking, resulting in massive Phlegm-Dampness accumulation. By treating the digestive system to drain the physical “swamp” of dampness, the treatment not only cleared the mental fog (resolving the depression) but also completely resolved his physical bloating and restored his mobility. Furthermore, the explicit documentation of the practitioner’s psychological intervention highlights the ancient TCM understanding that herbal medicine must often be paired with active emotional counseling to truly uproot a psychiatric illness.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: [【以案说医】王进东：气滞痰阻郁难舒，以情制情心神复]
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 14, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation