ACUPUNCTURE AND HERBS
Acupuncturists know that a calming effect can often be obtained by simple acupuncture techniques. It is less well-known to what extent acupuncture can affect other aspects of mental function, including serious disorders that involve brain damage, such as stroke, Alzheimer’s disease, ALS, mental retardation, attention deficit disorder, Tourette’s syndrome, manic-depressive syndrome, cerebral palsy, and schizophrenia. Research into these areas has been ongoing in China and the claimed results are often quite good. However, there are so many acupuncture points and herbs that are said to be of some benefit that design of definitive research projects and treatment protocols becomes difficult and practitioners are left with relatively limited guidance. This article is aimed at drawing attention to the main acupuncture points used in the treatments for disorders that involve the brain and mental functions. Herbal therapies are described in Part II.
There are three types of dysfunction of particular concern:
In America, one of the dominant uses of acupuncture therapy, aside from pain relief, is to help people, particularly young and middle-aged people, with drug addiction problems. While these drug problems probably have part of their basis in a genetic tendency towards addictive behavior and/or sensitivity to certain drugs, they mainly reflect the emotional patterns and lifestyle choices of the individual (thus, this falls into the “complex disorder” category, above). In China, one of the important areas of traditional medical research is the use of acupuncture and herbs to treat the elderly who have had a stroke or suffer from senile dementia. Similar techniques have been applied to children who suffer from cerebral palsy, epilepsy, or mental retardation.
To a large extent, Western practitioners have focused their therapeutic efforts aimed at treating drug addiction and emotional distress on the use of an acupuncture technique developed not in China, but in the West: ear acupuncture. In 1958, a French physician, Paul Nogier, introduced the concept of treating numerous points on the ear that were purported to have specific effects on each of the body structures and functions. Although the specificity of ear acupuncture points has never been clearly demonstrated, most acupuncturists agree that ear acupuncture has a calming effect. Indeed, the most frequently cited ear point used in treatments is called shenmen (spirit gate). In Handbook of Chinese Auricular Therapy, it is said that “It is used in numerous diseases of the neuro-psychiatric system....The application of this point is fairly extensive and flexible, covering no less than 30 kinds of diseases or ailments.”
In this article, the use of standard body acupuncture for mind and brain disorders is discussed. It will be seen that only a limited number of points, on just a few of the acupuncture channels (meridians), are repeatedly relied upon to treat a variety of these disorders. This may reflect the unique effectiveness of at least some of these acupuncture points which appear to be grouped around the head, forearms, and lower legs. Similarly, herbal therapies for the disorders rely on a relatively small number of herbs, most of which can be grouped into just three therapeutic categories: tonics, sedatives, and phlegm-mist resolving herbs.
Researchers at the Zhejiang Academy of Traditional Chinese Medicine undertook an extensive review of traditional medical literature and determined the acupuncture points most consistently relied on to treat disorders of the mind and brain (1). That is, they searched for points (called, in their English translation, “intelligence points”) that were repeatedly mentioned in the traditional literature for certain disorders, such as dementia, poor memory, and loss of consciousness. A review of traditional literature offers the opportunity to see what experienced physicians have recommended and claimed to be of benefit in the past.
The authors said that they “read up all the literature on acupuncture before the Ming Dynasty and most of the relevant literature of the Ming and Qing Dynasties, and collected together 29 intelligence points.” For each of the major medical texts consulted, the authors present a listing of the points mentioned that are relevant to treating mental conditions. For example, in the Huangdi Ming Tang Jing, the points listed are tianfu (LU-3), lieque (LU-7), neiguan (PC-6), ximen (PC-4), yongquan (KI-1), and youmen (KI-21). They then determined the frequency of mention of the points among all the texts in relation to treating certain conditions (see Table 1), yielding a total of 17 points mentioned in more than one text. It should be noted that there is not much meridian specificity to the treatment of the various disorders. A total of 10 meridians (out of the basic group of 14) are included, and only one meridian (kidney) has more than 2 of the points.
The fact that a point may be repeatedly mentioned in the literature does not, in itself, confirm the efficacy of treating that point. The repeated mention does, at the least, imply that many generations of doctors did not come up with many alternatives to a point that was determined early on. Acupuncture formulas listed in texts were also collected in an effort to determine the utilization of the points for various disorders of the mind and brain. Frequency of reliance on individual points within the numerous formulas yields a somewhat different result, since formulas are constructed with main and secondary points as well as adjunctive points (supportive therapy that may not be normally directed at treating mental disorders). In the prescriptions, the main points mentioned (5 times or more) were shenmen (HT-7), xinshu (BL-15), baihui (GV-20), and lieque (LU-7). Two adjunctive points were mentioned at least 3 times: zusanli (ST-36) and houxi (SI-3).
The International Acupuncture Training Centers and other organizations in China, such as the Academy of Traditional Chinese Medicine, compiled an acupuncture text: Chinese Acupuncture and Moxibustion (2), published in 1987. In the section on zangfu syndromes, there is a series of descriptions for insomnia, poor memory, heart palpitations, manic-depressive disorders, epilepsy, dizziness (not listed below), and melancholia. The acupuncture points, which were presented in small formulas or groups as main points, are presented in Table 2.
Shogo Ishino, at the Oriental Medicine Research Center of the Kitasato Institute in Japan, reported on acupuncture treatment for senile psychic disorders (3). As a main source text, he relied on the book Highly Valuable Commentaries on Acupuncture and Moxibustion: Grand System of Medical Classics on Acupuncture and Moxibustion, an encyclopedic collection published in China in 1978. The points mentioned in that text are listed in Table 3.
A recently published (1998) Western textbook, Manual of Acupuncture (4), presents summations of uses of the acupuncture points. In one index, for each of several symptoms or diseases, point designations are provided that have those conditions as one of their indications. For disorders of the brain and mind, Table 4 presents the points mentioned in this index (some indications were combined in preparing the table). In a few cases, particularly epilepsy and mania, there were so many points listed in the index that there would be no benefit derived from examining the collection. Perhaps almost any point will help, or, perhaps, numerous points have been recommended with none being particularly effective. A number of the conditions listed here may seem of minor importance, such as apprehension, anxiety, and worry, but in the practice of acupuncture in China (which is the basis for this textbook), patients usually only seek treatment when the condition is quite severe, beyond what is normally encountered in daily life. Thus, patients with that type of emotional or stress conditions would probably be treated, when relying on Western medicine, with potent drug therapies, including anti-depressants. Based on this summary of point indications, it becomes evident that certain points are relied upon for a wide range of mind-brain disorders. Combining the information from the literature cited above yielded the list in Table 5, which presents the main acupuncture points utilized in treatment of mind-brain disorders. Two “extra points,” sishencong (M-HN-1) and yintang (M-HN-3), have become popularized in recent years for treatment of mental disorders though these points received relatively little mention in the literature reviews; they are included in the table to more completely reflect current practice.
While there are only a few points for each of the channels represented, it is evident that there is much emphasis on treating the back (along the spinal column) to address mind and brain disorders. A large number of points along the bladder channel and the governing vessel are mentioned in the literature, even if most of those points are suggested only once or twice. The governing vessel continues along the spine over the top of the head, where baihui (GV-20) and its surrounding points (sishencong; four points on each side) are utilized. This vessel continues over to the face where the extra point yintang is located (between the eye brows) to the end of the channel at renzhong (GV-26). Needling points along the spinal column and on the head, including fengchi (GB-20), may provide a relatively direct means (proximate treatment) of stimulating the central nervous system and affecting the brain. The technique of scalp acupuncture (see: Synopsis of scalp acupuncture), which has been applied in the treatment of stroke patients as the primary use, mainly involves strong stimulation of points along the governing vessel at the top of the head.
Points on the arms and legs may well function via different mechanisms than those associated with the spine and head. The actions of two such distal points, zusanli on the leg and neiguan on the arm, have been described in detail (see: Zusanli and Neiguan). There is a collection of points listed in Table 5 that are located in the interval from the wrist to the elbow, including three pericardium points, two heart points, two large-intestine points, and the main lung point, lieque (LU-7); this grouping extends to the hand with two more pericardium points. Another hand point, hegu (LI-4) is frequently used as an adjunctive point in many modern treatment protocols for these mind-brain disorders. Similarly, there is a group of points on the lower leg, including two kidney points, three stomach points, and two spleen points, and continuing to the foot with the liver points and one more kidney point, yongquan (KI-1). These groupings of points may reflect an ability to stimulate release of certain neural transmitter substances by applying needles or moxibustion to specific peripheral regions of the body. Of the points listed in Table 5, few points seem to diverge from the pattern of treating the spinal column and head or treating the distal portions of the limbs: namely, two conception-vessel points and the lung point on the upper arm, tianfu (LU-3).
Table 1: Frequency of mention of a point for the listed condition in the comprehensive collection of traditional acupuncture texts examined by the researchers in Zhejiang (1). Only those points that are mentioned at least 2 times in the literature search for these disorders are included in the table. The points are listed according to total number of references, in descending order (23 references for baihui for two disorders to only 2 references for dazhong for one disorder).
Table 2: Main points listed for treatment of specified disorders in Chinese Acupuncture and Moxibustion.
Table 3: Points listed in Highly Valuable Commentaries on Acupuncture and Moxibustion for selected disorders. The points in the text were differentiated according to whether the treatment should be acupuncture or moxibustion or both, but this distinction is not presented here.
Table 4: Points listed for each of the specified disorders in the index to Manual of Acupuncture. Epilepsy and mania are not included in this listing because the number of points presented was so large as to be uninformative. Chinese point names (pinyin) are not included due to large number of points listed.
Table 5: Summary of 34 main points relied on for mind and brain disorders according to both traditional and modern literature. The indications presented here are from Manual of Acupuncture, selecting only those conditions associated with mind and brain disorders. To be listed in the table, the point had to be mentioned frequently in the literature cited above (1, 2, 3, 4) and/or in the medical reports listed below, and the indications for use had to include several different types of mind and brain disorder. Taichong (LV-3) was added to reflect modern applications of the point now often used in place of xingjian (LV-2) that is mentioned repeatedly in the traditional literature; similarly fengchi (GB-20) was added to this table because of the high frequency of its use for these applications in modern practice. Some of the points, such as sanyinjiao (SP-9) and zusanli (ST-36) are mainly used in formulas for treatments that require tonification therapy, rather than being chosen for specific effects on mind and brain disorders. Other adjunctive points that are sometimes employed in formulas, such as the hand points hegu (LI-4) and houxi (SI-3), are not included in the table because they have few indications for mind and brain disorders and are not mentioned in the traditional literature in that context, though they are used in modern practice.
RECENT PROTOCOLS: CHILDHOOD AND EARLY ADULT DISORDERS
The modern Chinese medical literature includes a number of reports of treating children with acupuncture. This approach may not be easily applied in the West, but the point selection should be informative. In a small evaluation involving 8 patients with childhood epilepsy (ages 5-16 years), the children were treated to control immediate symptoms (effects reported to occur within 10 minutes) at the Hospital for Mental Diseases in Anhui Province (5). Treatment involved the following collection of points as the main ones, of which a few were selected according to the particular case and some others might be added: hegu (LI-4), taichong (LV-3), renzhong (GV-26), baihui (GV-20), yongquan (KI-1), shixuan (M-UE-1), jianshi (PC-5), daling (PC-7), shenmen (HT-7), guanyuan (CV-4), fenglong (ST-40), yintang (M-HN-3), fengchi (GB-20), and sanyinjiao (SP-6). This point collection includes 7 points from Table 5 and also several of the points listed for epilepsy (during seizure) in Chinese Acupuncture and Moxibustion. Treatment surrounding baihui was done by threading the needles, somewhat like the method of scalp acupuncture; the author reported: “We found the method very effective in treatment of neural and psychic diseases.” The physicians also used blood letting at the fingertip points (shixuan, M-UE-1).
A study of acupuncture for pediatric cerebral palsy was reported from the Children’s Hospital at Shanghai Medical University (6). The 117 children treated were in the age range of 10 and under, mostly in the range of 3-7 years. The main points selected were yamen (GV-15), shenshu (BL-23), fengchi (GB-20), zusanli (ST-36), dazhui (GV-14), and neiguan (PC-6). Auxiliary points could also be added. Injection of fluids (glutamine solution or a combination of blood vitalizing herbs) into the head points was used. Significant improvement was claimed for just over half of the patients. The authors pointed out that the points shenshu and zusanli were selected to tonify the kidneys and benefit the marrow (which includes the brain in TCM theory).
The use of the group of points surrounding baihui (GV-20), called sishencong (M-HN-1), was the subject of a report from the Hospital of Scalp Acupuncture in Anhui Province (14). Six cases were cited as examples of successful protocols, including headache and Meniere’s syndrome, and the following that fit the subject of the current article, in which the points added to sishencong are indicated:
A study on treatment of schizophrenia, involving acupuncture and herbs, was reported from a hospital in Mongolia (7). Acupuncture was performed with three groups of points, with one group treated each day consecutively, then repeated. The point groups were:
Several of the points were treated by acupuncture through to a nearby point, such as neiguan through to waiguan, or hegu through to houxi. The authors claimed that all patients were cured by the treatment, though the condition recurred in 11 cases of 53, which could then be controlled by 1-2 courses of additional treatment. A course of treatment lasted one week to one month, depending on the patient, with daily acupuncture.
Tourette’s syndrome in children aged 6-15 was treated at the affiliated hospital of the Tianjin College of Traditional Chinese Medicine (8). The patients were divided into two groups depending on whether they were classified as having yangming stagnant heat, in which case the main points used were neiting (ST-44), quchi (LI-11), pianli (LI-6), and sibai (ST-2), or if they had deficiency of kidney and heart, in which case the main points used were yamen (GV-15), lianquan (CV-23), shenmen (HT-7), and fuliu (KI-7). According to the report, 73% of the 156 patients were relieved of the syndrome with ability to terminate previous medication.
Mental retardation in children aged 8-14 was reported by the Institute of Acupuncture at the Academy of Traditional Chinese Medicine (9). Three groups of acupuncture points were selected and each group was applied once every other day during the course of a month, followed by the second group the second month and the third group during the third month:
The effects of treatment were relatively modest, with 9 of 128 cases showing marked effect, but any improvement that was noted (about 2/3 of cases had some improvement) appeared to be retained over the follow-up period of one year. Regarding the selection of points, the authors stated:
Since the lesion of mental retardation is in the brain, the acupoints in the head and neck regions are selected for its treatment. The governing channel goes into the medulla and brain as the sea of yang channels, and the urinary bladder channel goes into the brain from the top. Besides the mental and physical development of children are also related to the heart, kidney, and liver, so effective acupoints on the governing, bladder, heart, liver, and kidney channels are selected for regulating the visceral functions to promote the brain functions.
RECENT PROTOCOLS: SENILE DEMENTIA AND NEUROTIC PSYCHOSIS IN THE ELDERLY
The term senile dementia has been largely disposed of in modern medical practice, with the ability to distinguish different causes, including Alzheimer’s Disease, atherosclerosis, and stroke. Recent evaluations have indicated that some degree of mental impairment is present in virtually all persons who pass the age of 90. In China, the medical facilities are insufficient to fully diagnose most cases of mental dysfunction in the elderly, so the general term senile dementia is applied and usually refers to cases of obvious impairment before the age of 90. A summary of recently published acupuncture protocols is presented in Table 6.
Table 6: Summary of results from translated Chinese medical journal reports published after 1995. Various adjunct points were used for some patients.
The data in Table 6 illustrates that the number of acupuncture treatments is at least 30, and the frequency of treatments is daily or every other day, with short breaks of 2 or more days between groups of several daily treatments. Most of the points used in these treatments are listed in Table 5. Improvements were noted in several measures for the patient groups overall, but marked effectiveness of the treatment, where the individual patient response (in terms of mental performance change) was substantial and obvious, usually did not involve more than one-third of patients.
Acupuncture was applied in the treatment of depression and psychosis in aged patients at the Institute of Mental Hygiene in Beijing (14). The patients were aged 50-74 and suffered from conditions such as manic-depressive psychosis, reactive psychosis, and neurosis. The treatment focused on baihui (GV-20) and yintang (M-HN-3), using electroacupuncture stimulation. Of 30 patients treated, it was claimed that marked effects were observed in 19 (about 2/3). The claimed improvements were in depressed mood, suicidal intention, anxiety, insomnia, and irritability, as well as alleviation of some accompanying physical symptoms.
Anxiety neurosis was treated at the Qindao Medical University using acupuncture in 80 patients, some of which were young students (aged 18 or over), but most were older workers, up to age 72 (15). The main points used were zusanli (ST-36), neiguan (ST-25), taichong (LV-3), shenshu (BL-23), mingmen (GV-4), and quchi (LI-11). Treatment was every other day for 10 treatments, with a break of 3-7 days before beginning another course of treatment, up to 40 treatments. The therapy was reported to be highly effective, with 55 of the patients showing obvious alleviation of symptoms.
Dementia due to traumatic injury to the head was treated at the General Hospital of Chengdu (17). 32 patients were treated by acupuncture, which was initiated one to three months after the traumatic event. Two points were used: shenmen (HT-7) and houxi (SI-3). It was reported that 15 of the patients showed marked improvements after 20 daily acupuncture treatments.
Post-stroke depression was treated at the Qiaoli Hospital of Traditional Chinese Medicine in Zhuhai (18). A group of three needles was inserted along the hair line, with one in the center at shenting (GV-24) and the others on either side by about 10 cm, at benshen (GB-13). Additionally, three needles were applied to each side for neiguan (PC-6), shenmen (HT-7), and laogong (PC-8). Adjunct points were used according to syndrome such as qihai (CV-6), zusanli (ST-36), and sanyinjiao (SP-6) for qi and yin deficiency, or the combination of fengchi (GB-20), taichong (LV-3), and baihui (GV-20) for wind-phlegm disorder. The authors commented that:
The influence of depression on patients after stroke is sometimes more serious than the functional disturbance of the limbs and can impact the progression and prognosis of stroke. Many antidepressant drugs produce several severe side effects and the patients had difficulty tolerating those therapies. The ’three intelligence needles’ [scalp points] and hand intelligence needles [forearm/hand points] are frequently used for the treatment of post stroke disorders and also for weak mental function in children by professor Jin Rui at Guangzhou University of Traditional Chinese Medicine. The intelligence needles at the head directly impact the functional activity of the cerebral frontal lobe and the mind and check the liver and calm wind. The hand points are the important ones for treatment of mental diseases: they can regulate the mental state, open orifices, tranquilize the mind, clear the pericardium, and help sleep. Acupuncture can improve the blood flowing in the brain or can promote absorption of hematoma in the brain, leading cerebral cells to be awakened and to gain recovery of functions, speeding up the repair of the injured brain tissues. Acupuncture can also promote release of a large quantity of serotonin in the brain and noradrenalin in the spinal cord.
SUMMARY OF ACUPUNCTURE THERAPY
Though there are numerous acupuncture points that are theoretically useful for patients with mind-brain disorders, only a few are relied upon frequently, both in traditional and modern practice, and might serve as guidance to practitioners and researchers. The most heavily used points are on the head (mainly GV-20), the upper back (mainly BL-15), the forearm (mainly PC-6 and HT-7), and the lower leg (mainly LV-3 and a variety of points on the stomach, spleen, and kidney channels that appear to be used with about equal frequency). It is unclear whether selection of other points in these same regions of the body will yield any better or lesser results, though the principles of acupuncture therapy may dictate selecting one over another based on symptoms, signs, and constitutional factors that lead to a specific diagnostic category (especially affecting the leg points to be selected). In China, needling is performed daily or every other day, and at least 30 treatments within a period of about two months is typical for a course of therapy that leads to notable improvements in many, but certainly not all, of the patients. The mechanism of action, from the Western viewpoint, appears to be regulation of blood circulation to the brain and release of valuable neurotransmitter substances that can affect brain function to aid recovery.