Mental Disorders

The symptoms of psychological disorders deserve particular attention since in my group of patients they ranked second only to those of the musculoskeletal apparatus with 22.5% of the total. Psychological/ psychiatric problems were declared by patients to be the main reason for their visit or were identified among other symptoms during the diagnostic procedure. As Table 7.2d reports, in 325 patients mental disorders were identified more frequently through ESRT than PPT (P<0.05).

If we wanted to outline and clearly differentiate anxiety disorders from depressive conditions on the auricle, we would probably be disappointed to find only minor differences between these two major fields of psychiatry. In a first analysis we compared two groups of 30 randomly chosen patients declaring only anxiety or depression with a third group of 30 control patients without these symptoms. Compared to the control group, the anxiety group showed at least five sectors which had a significantly higher concentration of points, whereas the depression group showed not a single one. This phenomenon could be interpreted as a better recognition of anxiety by the practitioner and the patient himself, especially when excessive anxiety and worry are accompanied by additional symptoms such as restlessness, difficulty in concentrating, muscle tension, trembling, sweating, frequent urination, etc.

It can be more difficult to diagnose depression because some depressed subjects suffer from increased irritability or persistent anger which could be misinterpreted as anxiety. Other individuals emphasize somatic complaints (for example pain syndromes) rather than reporting feelings of sadness. As is well known, culture can influence the experience and communication of symptoms of depression which can be expressed widely in somatic terms. According to DSM IV:

complaints of 'nerves' and headaches in Latino and Mediterranean cultures; weakness, tiredness or 'imbalance' in Chinese and Asian cultures; problems of the 'heart' in Middle Eastern cultures may all express the depressive experience. Such presentations combine features of the depressive, anxiety and somatoform disorders.5

The frequent combination of symptoms and possible co-morbidity are in my opinion the main reason why in my patients only sectors 9-11 of the anxiety group (on the right of Fig. 7.7) showed a significantly higher number of points with low ESR compared to depression. Only the clusters of points corresponding to the Chinese spleen area or to Nogier's cervical sympathetic ganglia seem therefore to mark anxiety disorders. The expert in traditional Chinese medicine (TCM) is well aware that a deficiency of qi of Spleen and Heart are at the basis of worry, which is an essential feature of anxiety disorders. The treatment of this area is indeed very suitable for anxiety symptoms such as difficulty in swallowing or 'a lump in the throat', aphonia, etc.

There are, however, further minor clusters of points which can orient diagnosis more toward depressive disorders (on the left of Fig. 7.7), such

Fig. 7.7 Clusters of points with low ESR in 30 patients with depression on the left; clusters of points with low ESR in 30 patients with anxiety on the right. The colored sectors correspond to a significantly higher concentration of points, respectively, for depression vs. anxiety on the left side or for anxiety vs. depression on the right side of the figure. Colored areas = lateral surface; blank areas = medial surface.

Fig. 7.7 Clusters of points with low ESR in 30 patients with depression on the left; clusters of points with low ESR in 30 patients with anxiety on the right. The colored sectors correspond to a significantly higher concentration of points, respectively, for depression vs. anxiety on the left side or for anxiety vs. depression on the right side of the figure. Colored areas = lateral surface; blank areas = medial surface.

as the two areas related to mood located on sectors 7-8 and 4-6. The pituitary-adrenal gland area is slightly enlarged and there is also a small cluster observable on the kidney area. Both disorders show a similar activation of the Shen men area and an interesting distribution of points on the scapha, in proximity to the internal border of the helix.

This distribution corresponds partially to the 'vegetative groove' of Lange and to the concentration of points observed in patients with fibromyal-gia (see Fig. 5.15).

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