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Cyperus 18 is derived from Bamboo and Ginseng Combination (Zhuru Wendan Tang). The traditional prescription disperses stagnant qi and conducts out accumulated phlegm. It is used for cases of chronic mental distress, such as depression, anxiety, irritability, and restlessness. These are the indications for Cyperus 18 as well. Qi stagnation arises from excesses of the emotions, which then yield a physiological imbalance that perpetuates emotional distress. Phlegm accumulation solidifies the pattern so that it becomes difficult to treat. In Cyperus 18, bupleurum, cyperus, perilla leaf, saussurea, and citrus materials (aurantium and chih-shih) disperse stagnated qi; the citrus materials with bamboo sap, pinellia, and arisaema conduct out phlegm (see Arisaema 10 and Bamboo 11). The formula has some sedative herbs, including uncaria, ginseng, fu-shen, coptis, and ophiopogon, to calm the internal agitation of liver and heart. This formula is often selected for treatment of depression, but is suitable for a wide range of disorders that are based on the qi and phlegm pattern described here. It could also be applied to treating persisting lung disease with chronic production of mucus (see Pinellia 16) and for effects of alcoholism or drug addiction, where phlegm accumulation and liver-qi stagnation are the underlying pattern. Other formulas to consider for depression include Albizzia 9, Ardisia 16, Salvia-Amber Tablets, Bamboo 11, and Nuphar 14, each of which fits a different pattern of disharmony.