Chinese Medical Treatments

Excerpt from:

Thie, J.Chinese Medical Treatment. In Lake, J and Spiegel, D (ed.),

Clinical Manual of Complementary and Alternative Treatments in Mental Health.

Washington, DC: American Psychiatric Press, Inc. 2006.

Introduction

Treatments used in Chinese medicine include acupuncture, herbs, moxibustion heat therapy, tuina tissue manipulation, and qigong. This chapter reviews the evidence for acupuncture in the treatment of common psychiatric disorders. Qigong is the subject of chapter___. The use of compound herbal preparations in Chinese medicine presents many complicated pharmacological and safety issues for western trained mental health practitioners, and is not reviewed here. Chinese medicine affords patients the opportunity to understand and control factors in the environment that promote health and “balance.” Physiological and diagnostic descriptions of illness in Chinese medicine provide a sense of manageability to western psychiatric patients, contributing to improved coherence in healing. When a western patient is told that he or she is experiencing symptoms due to an imbalance in brain chemistry, the patient frequently has little recourse other than to passively rely on pharmacotherapy. In contrast to this therapy-centered approach, Chinese medicine is a patient-centered approach that attempts to explain symptoms to patients in the context of concepts that are widely understood in China and other Asian countries including qi, yin, and yang. Chinese medical physiology is based on the premise that the human body and its processes are a microcosm of the exterior phenomenal world. Descriptions of illness refer to complementary pairs of natural qualities like hot and cold, and dampness and dryness. A basic premise of Chinese medical theory holds that all disease is attributable to loss of harmony between one's inner and outer worlds. Thus, illness is an indication that one's lifestyle needs to change in order to bring life back into harmony with the natural principles that surround us.

Chinese Medical Theory-A Concise Overview

Different theories in Chinese medicine are used to understand the causes of symptoms and formulate appropriate acupuncture treatment protocols. Before selecting acupuncture points and techniques for needle manipulation or other energetic treatments, a clear differential diagnosis is necessary. Manipulation techniques include: reducing, reinforcing, stimulation, indirect or direct moxabustion, warming needles, cupping, bleeding, pressure techniques and electrical stimulation. The specific clinical approach is selected on the basis of the pathogenic agent(s) identified and inferences about associated energetic imbalances. In Chinese medicine diagnosis is established principally on the basis of empirical findings that are interpreted as a “pattern discrimination” of energetic imbalances. Methods used to obtain information about symptoms include the patient interview, observation of the tongue, eyes, body, smells and sounds, palpation of nine radial pulse locations, and palpation of the abdomen and meridians. “The Doctor of Chinese Medicine widens his (or her) view to assess changes in a broad range of common bodily functions such as urination, defecation, sweating, thirst and so on. Furthermore…(he) takes into account many clinical manifestations ranging from certain facial and bodily signs to psychological and emotional traits.”1

The terminology used in Chinese medicine describes phenomena or attributes that are believed to cause energetic imbalances manifesting as physical or mental illness (eg, Dry, Damp, Hot, Cold, and Wind). The term “blood” in Chinese medical terminology is by no means equivalent to the understanding of “blood” in conventional western medicine. Blood is a liquid that has the functions of nourishing and maintaining the organs, and it is considered to be a “yin” substance. Although “blood” is regarded as principally moving through the blood vessels, certain aspects of “blood” are also believed to move along the meridians. This is complicated by the fact that there is no explicit distinction between blood vessels and meridians in Chinese medical theory. The various organs in Chinese medicine describe functional or energetic states of the body, and not discrete physical organs as understood in western medicine. According to Chinese medical theory, each organ has particular tasks and functions which sometimes overlap with conventional western understandings of physiology. The clinician asks questions and examines the patient in an effort to ascertain how and where these attributes “accumulated.” Many acupuncture points along the meridians are believed to stimulate the elimination of pathogenic factors and restore the body to its optimum balance. Movement of “Qi,” the elemental energetic principle, is stimulated by acupuncture treatment, which signals the body's self-healing capacity.

Meridians, sometimes described as “channels” or “vessels,” have been compared to bioelectrical fields that have specific patterns and functions including “moving” the Qi and inter-connecting the physical components of the body. Smaller vessels that act as connectors to these fields and other structures are called “collaterals.” According to Chinese medical theory each organ (or dynamic principle) is connected to one or more of the twelve main surface meridians. The twelve main meridians are named after internal organs. The channels and collaterals form an intricate web between physical parts of the body, functional patterns described as “organs,” and other meridians. Acupuncture points are selected on the basis of their energetic function within this web, their location on the meridian and the body, and what actions stimulation of a particular point facilitates internally in terms of regulating the flow of qi in beneficial ways. In many instances, several points are associated through the meridians or collaterals with the same organ or dynamic energetic pattern, and stimulating these in a coordinated manner is thus more beneficial than stimulating only one or few points.

Another important framing concept in Chinese medicine is “five-phase theory,” also called “five-element theory.” This concept provides valuable insights when mental and emotional symptoms are being evaluated and treated. Five element theory is the principal focus in many western schools of Chinese medicine. The relationships between the various elements or phases are of fundamental importance when a Chinese medical practitioner is evaluating a patient and formulating a treatment plan. For example, the Heart is regarded as the “Yin” organ ruled by the element of “Fire.” The Fire element, in turn, is controlled by the Water element and is “engendered” or strengthened by the Wood element. Thus when treating symptoms attributable to the Heart/Mind, specific acupuncture points are selected using these principles.

In addition to the 12 main meridians described above, other important meridians are called the “eight extraordinary vessels.” With the exception of the Conception or”Ren” and Governing or “Du” meridians, the extraordinary vessels do not follow external meridian pathways, but overlap with several internally located meridians. The eight extraordinary vessels control and provide nourishment for the twelve main meridians by means of a reservoir of qi and “blood.” The practitioner may choose to stimulate many points along these channels however in clinical practice acupuncture needles are generally inserted in pairs on opposite sides of the body, as described by Yitian Ni, O.M.D., “Clinically, when one point is selected on the right side (e.g.,Sp 4), its paired point (P 6) will usually be treated on the left side. Frequently, two pairs will be used together, further expanding the area of influence of the treatment, and creating an energetic circulation from left to right, and upward and downward, as symbolized in the Pa Gua (Eight Trigrams) and the Tai Ji (Yin/Yang symbol).”2

Evidence for Mental Health Benefits of Acupuncture: Schizophrenia

In a large study conducted in China 213 cases of adolescent schizophrenia were treated using a combination of herbal therapy, body acupuncture and ear acupressure based on pattern discrimination. Three cycles of ear acupressure treatment were administered using small metallic seeds that adhere to the ears and elicit sensation. Each 10 day treatment cycle included one minute of daily acupressure a day, and patients rested 5 days between cycles. Body acupunture using patient specific points was performed twice a week with twenty minutes of needle retention after stimulation. Herbal therapy consisted of a compound formula known as Jia Wei Shao Yao Tang This formula action is believed to move liver qi , nourish blood and clear heat, and reportedly has beneficial effects in cases of depressed mood. At the end of treatment 19.2% were described as “cured,” 29.1% as markedly improved, 47.4% as moderately improved, and 4.4% had not changed. A small control group consisting of 11 patients who received acupuncture and moxibustion, reportedly experienced a similar combined rate of clinical improvement3. These findings are difficult to interpret because of serious methodological short-comings of the study. The diagnosis of schizophrenia according to conventional western criteria cannot be confirmed, outcomes were not measured using standardized instruments, the “control” group was very small in comparison to the verum group, and individuals in the control group also received traditional Chinese treatments addressing the target symptoms. No study arm received conventional antipsychotic medications for comparison, and there was no wait-list group receiving no treatment. Future methodologically sound studies using similar acupuncture protocols are needed.

Evidence for Mental Health Benefits of Acupuncture: Anxiety disorders

Many studies have been done on acupuncture in the treatment of anxiety. In a sham-controlled study, the effects of acupuncture treatment on resting heart activity by ECG in patients diagnosed with “minor depression” or “minor anxiety” included a significant decrease in mean resting heart rate and a significant decrease in the ratio of low to high frequency heart electrical activity in treated patients. Acupuncture needles were applied at classical acupuncture points, including Shen Men (He7), Nei Guan (Pe6), Bai Hui (GV 20), Shen Mai (UB 62), extra point 6 (Ex6). A sham control group was treated using epidermal needles applied at non-acupuncture points. Both groups underwent standardized ECG measurements of 5 minute resting heart rate variability, before the first and after the ninth acupuncture session of a series, and three times during the third acupuncture session (ie, before the start, and five and fifteen minutes after needle application). This German study suggests that in patients with minor depression or anxiety, needling specific acupuncture points causes an increase in parasympathetic activity of the heart, reducing overall heart rate4. Another study using the same acupuncture protocol showed significant clinical improvement in 43 patients diagnosed with mild symptoms of anxiety and depression, and 13 patients with generalized anxiety disorder after 10 acupuncture sessions (Julia, can you elaborate on findings here; eg, how many in the study; what% improved; how frequent were the sessions; any follow-up after study ended?? Thanks J.L);, although not after 5 visits. After 10 sessions, 60.7% of the verum acupuncture group versus 21.4% of the sham group had improved significantly based on a standardized rating scale. In those diagnosed with generalized anxietydisorders, 87.5% showed significant clinical improvement. The findings of this study demonstratethat total acupuncture sessions and the specific protocol used are significant determinants of clinical response5