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Can TCM acupuncture and herbs help patients with Depression?

Depression in Western Medicine’s View

Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.

Postpartum depression Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.

Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.

(Above is cited from https://www.nimh.nih.gov/health/topics/depression/index.shtml)

The main symptoms and signs of depression are:painful thoughts,anxiety and agitation,loss of interest,loss of self-esteem,derealization and depersonalization,hypochondriasis,disorders of perception, insomnia,loss of appetite,diurnal variation (worse in the morning).

Depression in Chinese Medicine’s View

Depression as defined in Western medicine has aspects relative to these five ancient disease categories of mental illness mentioned in the TCM classics:

Lilium Syndrome (Bai He Bing百合病), Depression (Yu Zheng鬱症), Plum-Stone Syndrome (Mei He Qi梅核氣), Agitation (Zang Zao臟躁) and Palpitations and Anxiety(Xin Ji Zheng Chong心悸怔忡)

(Above is Cited from Giovanni Maciocia CAc (Nanjing):The Practice of Chinese Medicine.The Treatment of Diseases with Acupuncture and Chinese Herbs 2nd edition 2008, P334)

In Chinese medicine, stagnation (Yu) and mental depression (Yu鬱) are almost synonymous, implying that all depression is (at least initially) due t stagnation. There are six stagnations according to Zhu Dan Xi (Dan Xi Xin Fa, 1347):1. Qi,2. Blood,3. Dampness,4. Phlegm,5. Heat,6. Food. According to Zhang Jing Yue(Jing Yue Quan Shu 1624) ,there are six stagnations as well:1. Anger,2. Pensiveness 3. Worry,4. Sadness,5. Shock,6. Fear.

In severe depression, there is a disconnection  between the Mind (Shen (神)of the Heart) and Ethereal Soul (Hun魂): the Ethereal Soul lacks its normal “movement”, and the person lacks creativity, ideas, imagination and, most of all,plans, projects, life aims and inspiration, so that depression results.

The Zhi(志) of the Kidneys has several different meanings; for example, it can mean “memory”, reflecting the influence of the Kidneys on the Sea of Marrow and the Brain and therefore memory. Zhi (志)can also mean“Will-Power”, and it is in this context that it plays an important role in depression. “Will-Power” as a translation of Zhi includes will-power itself, drive, determination, steadfastness, enthusiasm and physical and mental power. A deficiency of the Kidneys’ “Will-Power” (Zhi) is nearly always a feature of depression and, for this reason, in depression TCM acupuncturist tonifies the Will-Power with BL-23 Shenshu and BL-52 Zhishi.

The Lilium Syndrome (Bai He Bing) is described in the Essential Prescriptions of the Golden Chest (Jin Gui Yao Lue, c.AD 220), Chapter 3-1. This syndrome sounds remarkably like the description of a depressed patient.It says:6“The patient wants to eat but is reluctant to swallow food and unwilling to speak. He or she wants to lie in bed but cannot lie quietly, as he or she is restless. He or she wants to walk but is soon tired. Now and then, he or she may enjoy eating but cannot tolerate the smell of food. He or she feels cold or hot but without fever or chills, bitter taste ordark urine [i.e. it is not external Wind or internal Heat]. No drugs are able to cure this syndrome. After taking the medicine, the patient may vomit or have diarrhoea. The disease haunts the patient (hu huo) [hu means “fox” and huo means “bewildered”] and, although he or she looks normal, he or she is suffering. The pulse is rapid.

Agitation (Zang Zao) literally meaning “visceral restlessness”, was first mentioned in the chapter Pulse, Syndromes and Treatment of Miscellaneous Gynaecological Diseases of the Essential Prescriptions of the Golden Chest (Jin Gui Yao Lue, c.AD 220). This text says: “The patient suffers from Agitation [Zang Zao], feels sadand tends to weep constantly as if she were haunted. She stretches frequently and yawns repeatedly. The decoction of Fu Xiao Mai, Zhi Gan Cao and Da Zao can calm the patient.” The formula for Agitation (Zang Zao) is therefore Gan Mai Da Zao Tang Glycyrrhiza-Triticum-Jujuba Decoction.This formula is not only for Agitation but also for Depression arising against a background of Qi and Blood deficiency.

Plum-Stone Syndrome (Mei He Qi) was first described in the chapter Pulse, Syndromes and Treatment of Miscellaneous Gynaecological Diseases of the Essential Prescriptions ofthe Golden Chest (Jin Gui Yao Lue, c.AD 220). This text says: “The patient has a suffocating feeling as if there was a piece of roast meat stuck in the throat. Use Ban Xia Hou Po Tang.”The points suggested by the book Chinese Acupuncture Therapy (Zhong Guo Zhen Jiu Zhi Liao Xue) are as follows.7:HT-7 Shenmen, KI-3 Taixi, LU-9 Taiyuan;HT-5 Tongli, LU-7 Lieque, KI-4 Dazhong, SP-6 Sanyinjiao;HT-9 Shaochong, PC-9 Zhongchong, KI-7 Fuliu ;BL-15 Xinshu, BL-13 Feishu, BL-23 Shenshu; LU-7 Lieque, KI-6 Zhaohai, LIV-3 Taichong.The herbal formula Bai He Zhi Mu Tang Lilium-Anemarrhena Decoction will be chosen. The combination of these two herbs is particularly good to treat sadness and grief.

For Depression (Yu Zheng) and Palpitations and Anxiety(Xin Ji Zheng Chong), both acupuncture and herbs can be used to treat them as well.

(Above is Cited from Giovanni Maciocia CAc (Nanjing):The Practice of Chinese Medicine.The Treatment of Diseases with Acupuncture and Chinese Herbs  2nd edition 2008 P334-P340)

Scientific researches and Clinical Trials

Scientific researches showed that acupuncture has evidence of potential positive effect on treating depression(with antidepressant).12

There are also clinical trials showed that acupuncture has positive effect on treating Depression.

The findings of a clinical trial suggests that in patients with minor depression or anxiety only true acupuncture leads to a relative increase of cardiovagal modulation of heart rate and facilitates the physiological regulatory autonomic nervous system function in response to alterations of the external or internal environment.3

There was one clinical trial designed to compare the effect of electroacupuncture and maprotiline in treating depression.The conclusion was “Both electroacupuncture and maprotiline are effective in treating depression. ”4

In a placebo-controlled, randomized, modified double blind study, the effects of acupuncture were investigated in 43 patients with minor depression and 13 patients with generalized anxiety disorders. The severity of the disease was assessed by the Clinical Global Impression Scale. The conclusion was“Acupuncture on the points HE-7 Shenmen, P-6 Neiguan, Du-20 Baihui, BL-62 Shenmai and Ex-6(Yuyao extra point) leads to a significant clinical improvement as well as to a remarkable reduction in anxiety symptoms in patients with minor depression or with generalized anxiety disorders. The total sum of acupuncture sessions and the specific location of acupuncture needle insertions might be important factors for bringing about therapeutic success.”5

On studying the effect of acupuncture on treating depression during pregnancy, sixty-one pregnant women with major depressive disorder and a 17-item Hamilton Rating Scale for Depression were randomly assigned to one of three treatments delivered over 8 weeks: active acupuncture(20), active control acupuncture (21) and massage(20). Acupuncture treatments were standardized but individually tailored, and were provided in a double blind fashion. Responders to acute phase treatment continued the treatment until 10 weeks postpartum. The conclusion was “Despite limitations, this randomized controlled pilot study indicates that acupuncture holds promise as a safe, effective, and acceptable treatment of depression during pregnancy, and that a larger clinical trial is warranted. This study also indicates that any successful treatment of depression during pregnancy incurs protection from postpartum depression.”6

 

References:

1.Mel Hopper Koppelman, DAc, MSc, MSc.Acupuncture: An Overview of Scientific Evidence.       https://www.evidencebasedacupuncture.org/present-research/acupuncture-scientific-evidence/

2.MacPherson H1, Vickers A2, Bland M1, Torgerson D1, Corbett M3, Spackman E4, Saramago P4, Woods B4, Weatherly H4, Sculpher M4, Manca A4, Richmond S1, Hopton A1, Eldred J1, Watt I5.Acupuncture for chronic pain and depression in primary care: a programme of research. Source: Southampton (UK): NIHR Journals Library; 2017 Jan.                        https://www.ncbi.nlm.nih.gov/pubmed/28121095

3.Agelink MW, Sanner D, Eich H, Pach J, Bertling R, Lemmer W, Klieser E, Lehmann E.       Does acupuncture influence the cardiac autonomic nervous system in patients with minor depression or anxiety disorders? Fortschritte der Neurologie-Psychiatrie 2003 March,Vol. 71, Issue 3, pp. 141–149(Cited in Giovanni Maciocia CAc (Nanjing):The Practice of Chinese Medicine.The Treatment of Diseases with Acupuncture and Chinese Herbs  2nd edition 2008, P370)

4.Han C, Li XW, Luo HC.The use of acupuncture in the treatment of depression.Zhong Guo Zhong Xi Yi Jie He Za Zhi [Chinese Journal of Integrated Traditional and Western Medicine] 2002 July, Vol. 22, Issue 7, pp. 512–514, 521.(Cited in Giovanni Maciocia CAc (Nanjing):The Practice of Chinese Medicine.The Treatment of Diseases with Acupuncture and Chinese Herbs  2nd edition 2008,P371)

5.Eich H, Agelink MW, Lehmann E, Lemmer W, Klieser E.Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study.Fortschritte der Neurologie Psychiatrie 2000 March, Vol. 68, Issue 3, pp. 137–144.(Cited in Giovanni Maciocia CAc (Nanjing):The Practice of Chinese Medicine.The Treatment of Diseases with Acupuncture and Chinese Herbs  2nd edition 2008,P371)

6.Manber R, Schnyer RN, Allen JJ, Rush AJ, Blasey CM.Acupuncture: a promising treatment for depression during pregnancy. Journal of Affective Disorders 2004 November, Vol. 83,Issue 1, pp. 89–95.