The Treatment of Melancholy
From The General Practice of Physic, Wirtzung (1598)Edited with commentary by Adam Tate
Introduction
Melancholy is one of the unique concepts in Galenic / Western Traditional Medicine. While it overlaps concepts from other systems such as Damp of TCM and Ama of Ayurveda, none of these totally equate to Melancholy. In addition, Melancholy is deemed to be responsible for various chronic, obstinate and terminal illnesses including Tumors, Cancer, Leprosy, and Mental Illnesses including Schizophrenia, Anxiety and Depression. Further, Melancholy was viewed as needing to be prepared and purged from the body. The Purgatives for Melancholy were some of the stronger purgative medicines used, other systems such as TCM tending to refrain from purging in such chronic diseases.
It is therefore worth viewing some of the medicines and treatment principles used in the treatment of Melancholy.
The following is taken from the section on Melancholy from The General Practice of Physic, Wirtzung (1598)
Of Melancholy
Melancholy can be either: 1. one of the Four Humors (Physiological); or 2. a sickness (Pathological).
COMMENT:
Melancholy is the Cold and Dry Humor of the body. Physiologically, it supports body structure, especially the bones which are also Cold and Dry by nature. Pathological Melancholy or ‘Burnt Bile’ is responsible for chronic obstructions and is associated with some of the most obstinate and chronic diseases. Melancholy also has 2 aspectes. One is of a fine, thin fluid-like nature, the other like a residue or ash. Both of these are obstructive in nature, both are by-products of digestion, and both have an affinity with the Spleen.
- Melancholy is ‘a corruption of the judgement and thoughts altered from their natural kind, into an unnatural and spoiled manner, tempered with Fear and Care [worry]’
- ‘Otherwhiles they be weary of their life; nevertheless they shun Death’
- ‘yea some be also moved in their Wits; albeit that they fear death much, nevertheless sometimes destroy themselves [suicide]’
- ‘Some suppose and imagine that they be Emperors, Kings, Wolves, Devils, Fowls, and what may be more, some Weep, some Laugh, others shun the water’.
COMMENT:
The impure and unrefined nature of Melancholy means that in excess, it clouds the perception and hinders clarity of consciousness. This leads to loss of mental faculties, distortion of perception, lack of rational thinking, and a tendency to dwell on the negative, or perhaps to see only the bad, or imagine bad things that may occur. Thus, various mental diseases as well as chronic depression can be seen to be fed by Melancholy humor. This is also supported by the fact that purging Melancholy people often results in stools of a dark color with a particularly foul smell.
Melancholy is usually associated with either the Spleen or the Brain.
- If the Spleen is affected, there is grievous thoughts, fear, sorrow, anger etc.; there may be pain in the belly, a loathsome color, loss of Appetite and Vomiting. [This is generally similarly viewed to Spleen Qi Deficiency in TCM. Digestion and Appetite are deranged, Dampness accumulates, and the Mind is less able to cope resulting in Stress, Anxiety, Thinking and worrying too much, irrational Fear etc.]
- If the Brain is affected: thoughts are manifested in words or deeds; other Brain-disturbance symptoms, loss of Judgement, Memory, Mania etc. In modern medicine this includes diagnoses such as Schizophrenia, Delusion, Psychosis, Depression. Generally, Mental Illness where there is a loss of senses, judgement and reasoning, or where there is a loss of proper thinking and morals denotes Melancholy. It can lead to Murder, Suicide, Sexual Perversions, Cruel and Inhuman actions.
COMMENT:
Melancholy of the Spleen is closely allied to Damp of TCM, which is also seated in the Spleen. The Spleen controlling digestion from the TCM point of view supports the fact that weakness of the Spleen promotes development of excess Melancholy Humor. Its also worth noting that some medicines used to clear Damp are also effective for Melancholy.
Diet
Food to Avoid: Food that are rich, heavy, hard-to-digest; Roasted and barbequed food; Venison, Hares, all old flesh including that of Oxes, Goats, Bucks; great Sea fish, Salmon, Sturgeon etc.; Cabbage, Beans, Lentils, Peas; dark thick Wine, old Cheese, unleavened bread.
Also avoid: excess Labor, sorrow, heavy thoughts, great hunger and great thirst; avoid cold.
Food that are Beneficial: Easy-to-digest food; Congee, Porridge, Kitchari, Boiled vegetables, Soups; Mutton, Kids, Lamb, Hens, fresh flesh broth, Eggs; Borage, Bugloss, Spinach; white, light and well raised Bread; light, sweet and aromatic wine, Rosemary wine; Balm tea
What else is good: mild baths; pleasant odors (Rose, Violet, Sandalwood, Camphor etc.); Music, laughter.
COMMENT:
Melancholy is not only fed by eating Cold and Dry foods. It is especially created by eating foods which are difficult to digest. This shows Melancholy to be a direct by-product of digestion, and therefore, avoiding foods which are hard of digestion is essential. However, individual sensitivities means that foods otherwise easily digested maybe difficult to digest in some people. This phenomena has grown rapidly in recent decades with food allergies and intolerances growing along with chronic gastrointestinal diseases.
Bloodletting
Open the Liver vein in the Hand; if the Blood is black and thick, bleed as much as the patient can; if red, stop.
Internal Medicines
1. Decoction of Dodder of Thyme:
Indian (Black) Myrobalan,
Dodder of Thyme 1 ¼ oz.
Polypody root 5 drams
Senna leaf 9 drams
Turbith ½ oz.
Boil all except the Dodder in 36 ounces of water down to 24 ounces, then add the Dodder boil for a few minutes, let it cool, then strain it, and keep for use. This is the original version from Rhasis (9th C).
Another version:
Dodder of Thyme, Stoechas,
Black Myrobalan 1 ¼ oz. ea.
Chebulic, Emblic, Beleric
Myrobalan, Turbith, Peony,
Agaric 2 ½ drams ea.
Polypody root, Senna leaf 3 drams ea.
Fumitory, Squinanth 1 ½ drams ea.
Prepared Black Hellebore root 1 dram
Rock Salt 2 scruples
Currants ¾ oz.
Decoct as the preceding.
2. Three hours before giving a Decoction of Dodder (above), it is best to take one of the following:
i. Aloe 1 dram
Agaric 2 scruple
Indian Salt ½ dram
Black hellebore ½ scruple
Form pills; the above makes enough for 2 doses.
ii. Confectio Hamech
iii. Diasenna.
3. Black Myrobalan 1½ oz.
Dried Prunes 1 oz.
Boil in 8 oz. of Water down to half; strain through a cloth; add 2–2 ½ oz. of Manna. Take in the morning.
4. Letificans Almansoris (a compound) is good to be taken at all times when they are resting.
5. A Very Precious Electuary for Melancholy
Prepared Pine Nuts 2 oz.
Cinnamon 2 drams
Nutmegs, Cloves, Mace, Indian
Spikenard, Cyperus roots,
Cubebs, Galangal 1 ½ drams ea.
Cardamons 4 scruples
Prepared Pearls 1 dram
Burnt Deer Horn, Hyssop,
Licorice 2 scruples ea.
Saffron 1 scruple
Burnt Silk, Prepared Coral ½ scruple ea.
White Sugar 24 oz.
Simmer the herbs in Bugloss (or Borage) Water until it is as thick as Honey. Then combine the rest in fine powder, adding a little Musk. Dose: 1–2 drams in Wine. [Note: 24 oz. of Sugar seems an excessive proporation, even for a confection. It may have been written or translated incorrectly. In any case either a weight of Sugar equal to the rest may be used, or ideally, Honey can be used instead]
5. Another
Annis, Fennel 2 oz. ea.
Sweet Almonds, Jujubes 1 oz. ea.
Prepared Armenian Earth 3 drams
Aloeswood, Cloves, Cardamons,
Amaranth burnt to powder,
Rose, Borage, Bugloss flowers,
Prepared Pearls 2 drams ea.
Basil seed 1 dram
Saffron 2 scruples
Parched Hazel nuts ½ dram
Doronicum, Deer’s heart bone,
Zedoary, Jacinth, Emerald,
Sapphire 1 scruple ea.
Beaten Gold leaves 8 (leaves)
‘You are to seethe this together in the juice of Chamedryos [Germander], of field Cypers [Cyperus rotundus], and juice of Bugloss, of each 3 oz, until the juice be consumed. But note, that the precious stones, Gold and Saffron must not be sodden with it, but be at the last tempered amongst it’ [added at the end].
Dose: 3 drams in the morning in wine; before dinner and supper take 15 drams to eat.
6. A Powder much Commended:
Dodder of Thyme 1 ½ oz.
Lapis Lazuli, Agaric 2 drams ea.
Diagridium 1 dram
Cloves 20 (in number)
Beat to a powder;
‘It is said that it has been many times found, that they which had this Melancholy-like passion, have only through this powder recovered health both of body and Mind’
Dose: 1–2 drams twice weekly.
7. Diamargariton (Cooling Pearl Powder) may also be used with benefit instead of the preceding.
8. Take the juice (or water or decoction) of Borage and Fumitory; wash the head with it.
See also:
Black Bile & Melancholy
Preparers and Purgers of Melancholy
Treatment of Melancholy from Praxis Medicinae Theorica et Empirica