How Acupuncture Relieves Depression

How Acupuncture Relieves Depression

Acupuncture Activates Brain On MRI & Leads to Relief of Depression

A study conducted at the First Affiliated Hospital of Guangxi University of Chinese Medicine demonstrates that acupuncture normalizes brain functions in patients with major depressive disorder (MDD). Using functional magnetic resonance imaging (fMRI) brain scans, the Guangxi University of Chinese Medicine researchers determined that scalp acupuncture at acupoint DU20 (Baihui) restores healthy brain patters to patients experiencing major depressive disorder. Using before and after fMRIs, the researchers determined that acupuncture balances brain states in patients with severe depression and restores healthy brain functional connectivity. In addition, acupuncture successfully downregulated excessive hyperactivity of brain states found in major depressive disorder patients. The researchers determined that acupuncture allows the brain to return to a normal restful state while simultaneously reactivating brain regions suffering from abnormally low functionality.

The researchers compared the fMRI results of 29 first-episode major depressive disorder patients with fMRI results of 29 healthy subjects. The researchers identified areas of the brain with differing functional connectivity (FC) in major depressive disorder patients. After 20 minutes of electroacupuncture (EA) stimulation at acupoint DU20 (Baihui), the patients were given another fMRI scan to determine how electroacupuncture affects functional connectivity in the brain. [1] The outcomes demonstrate that electroacupuncture has the effect of increasing functional connectivity in areas of hypoconnectivity and decreasing functional connectivity in areas of hyperconnectivity, thereby modulating the default mode network (DMN) of the brain toward healthier brain activity. [2] Electroacupuncture restored homeostatic resting states to the brain by balancing DMN functional connectivity.

The DMN is the area of the brain that is used for processing information when the brain is not engaged in an active task. It is involved in the conception of oneself and others, including moral and emotional judgements related to actions, as well as the rumination on past and future events. It is made up of a network of distinct areas of the brain connected both anatomically and functionally. In the absence of malformation or injury, the structural connections are relatively fixed. The degree to which these areas are functionally connected is measured by statistical analysis using technologies, including fMRI, that visually capture the change in blood flow to specific areas of the brain.

Brain Functionality & Acupuncture

This study demonstrates how brain functional connectivity is markedly and predictably different between patients with major depressive disorder and healthy subjects. The study maps how electroacupuncture changes the patterns of functional connectivity in major depressive patients toward the patterns found in healthy subjects that do not have severe depression. [3] Because the nature of the changes in functional connectivity are consistent among patients with major depressive disorder, the hypothesis is that these changes are a symptom or cause of major depressive disorder. The implication is that, if the effect is long-lasting, electroacupuncture can be used to normalize the functional connectivity of patients with major depressive disorder, providing relief for a devastating disease.

Major depressive disorder manifests differently in different people, but it is generally marked by feelings of hopelessness, decreased concentration, and a lack of interest in stimuli that had previously brought joy. Weight change is also common, as is a change in sleeping patterns. Patients with more severe forms of major depressive disorder may also have recurring thoughts about death or suicide. [4] In addition to the impact it has on all aspects of a patient’s daily life, [5] the prevalence of major depressive disorder makes it a profound public health concern. In the United States alone, up to 20% of the population suffers from mild depression, and between 2% – 5% have severe depression. [6] Major depressive disorder dramatically decreases the quality of life of the patient and may have secondary emotional effects on their friends and family. Because lack of motivation is often associated with major depressive disorder, one’s ability to work may also be affected. The social and financial costs to families, and to society as a whole, may therefore be great. There are a variety of environmental causes, including stress and emotional trauma, though epidemiologic studies show that 40% – 50% of the risk is genetic. [7]

Biomedical treatment protocols for major depressive disorder include various forms of antidepressant medications. First generation drugs such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs) were developed in the 1950s and are in current use. While second generation drugs such as serotonin-selective reuptake inhibitors (SSRIs) are often better tolerated than first generation tricyclic antidepressants because they tend to have fewer adverse effects, their mechanisms of action is similar, indicating that our understanding of the mechanisms of depression and its treatment has not changed significantly since the drugs were first developed. [8]

While 80% of patients achieve some benefit from medications, only 50% experience remission of their depression, [9] meaning that many patients must choose between suffering from depression or the long term adverse effects of medications that are only moderately successful. The specific qualities of depression are hard to replicate in animal trials. There is a clear hereditary risk; however, the specific genes involved have not been completely identified, which makes it difficult to develop and test new drug therapies. [10] Finding new treatment modalities outside of the medication arena would therefore potentially help millions of people in the US, and likely billions globally, who suffer the debilitating effects of major depressive disorder.

The fMRI is useful because it is non-invasive and does not require identifying the specific genes or neurotransmitters involved in brain functioning. The fMRI maps neural activity by mapping differential blood flow. “For reasons that we still do not fully understand, neural activity triggers a much larger change in blood flow than in oxygen metabolism, and this leads to the blood being more oxygenated when neural activity increases. This somewhat paradoxical blood oxygenation level dependent (BOLD) effect is the basis for fMRI.” [11] An increase in neural activity is indicated by an increase in oxygenation of a particular area of the brain, and areas that are active at the same time are considered to be functionally connected even if they are anatomically discrete. This is the basis of functional connectivity determinations based on fMRI BOLD responses.

The Guangxi University of Chinese Medicine researchers identified specific brain regions that were reliably different in patients with major depressive disorder versus healthy subjects that did not suffer from mental illness. In the test group, they found that functional connectivity was initially diminished between the posterior cingulate cortex (PCC) and the anterior cingulate cortex (ACC), and that functional connectivity was initially higher between the PCC and the left middle prefrontal cortex (PfC), the left angular gyrus (AG) and the bilateral hippocampus (HIPP). [12] Each of these areas plays a distinct role in cognitive and emotional functioning that may speak to the effects felt by patients when the functional connectivity in these regions has changed.

“The posterior cingulate cortex is a highly connected and metabolically active brain region. Recent studies suggest it has an important cognitive role, although there is no consensus about what this is…. It is a key node in the default mode network and shows increased activity when individuals retrieve autobiographical memories or plan for the future, as well as during unconstrained ‘rest’ when activity in the brain is ‘free-wheeling’.” [13] This study indicates that the PCC is a central hub for communication within the DMN, as each of the areas for which the function is better known is interacting directly with the PCC.

Despite depression appearing as a disease of hypoactivity, most brain regions showed hyperactive functional connectivity with the PCC. The ACC is the exception, initially demonstrating diminished functional connectivity that was subsequently increased after electroacupuncture. “In addition to regulating autonomic and endocrine functions, it is involved in conditioned emotional learning, vocalizations associated with expressing internal states, assessments of motivational content and assigning emotional valence to internal and external stimuli, and maternal-infant interactions.” [14] Motivation and emotional responses to stimuli are two key diagnostic elements of major depressive disorder that decreased in most MDD patients. Thus, hypoactivity between the PCC and ACC is, at least in part, responsible for the decrease in these mental functions and that reversing the hypoactivity may have a positive therapeutic effect.

The fMRI of the major depressive disorder patients showed an initial hyperactivity in the PfC, AG, and HIPP as compared to the control group, and a subsequent dampening of the functional connectivity between these areas and the PCC after electroacupuncture treatment. The PfC integrates cognitive and emotional behaviors and thus aids the process of decision making. [15] The AG has a critical role in processing language and affects thought and attention as well as spatial memory; it is also used for emotional perception and sensory interpretation. [16] The HIPP is “implicated in cognitive-behavioral functions and emotional memory.” [17] Attention and emotional memory and behavior show clear changes in major depressive disorder patients. While it seems that these functions are impaired, it may be just the opposite; “depressed individuals over-recruit a neural network involved more generally in enhancing memory for affective stimuli, and… the degree to which they over-recruit this system is related to the severity of the symptomatology.” [18] This is consistent with the findings of the current study, which indicate that depression is related to hyperactivity of functional connectivity in the brain.

Our Team Can Help Alleviate Ailments with Medicinal Acupuncture Treatments in Nashville, TN

Based on the findings, additional research is warranted to confirm the experimental results of the study. Moreover, the conclusions presented by the research team corroborate the Traditional Chinese Medicine (TCM) understanding that DU20 (Baihui) modulates brain function. The research also provides a solid basis for future long-term studies about the cumulative effect of electroacupuncture for the treatment of major depressive disorder. Major depressive disorder is widespread and devastating both to the patients and their communities. The findings demonstrate that acupuncture is a potential modality that addresses the needs of patients with major depressive disorder and allows for healthier brains states.

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References:
1 Deng, Demao, Hai Liao, Gaoxiong Duan, Yanfei Liu, Qianchao He, Huimei Liu, Lijun Tang, Yong Pang, and Jien Tao. “Modulation of the Default Mode Network in First-Episode, Drug-Naïve Major Depressive Disorder via Acupuncture at Baihui (GV20) Acupoint.” Frontiers in Human Neuroscience Front. Hum. Neurosci. 10 (2016): pg
doi:10.3389/fnhum.2016.00230.
2 Demao Deng et al, Modulation of the Default Mode Network, pg 1
3 Demao Deng et al, Modulation of the Default Mode Network, pg 1.
4 Nestler, E. J., M. Barrot, R. J. DiLeone, A. J. Eisch, S. J. Gold, L. M. Monteggia. “Neurobiology of Depression.” Neuron. 34, no. 1 (2002): 13-25. doi: 10.1016/S0896-6273(02)00653-0. dx.doi.org/10.1016/S0896-6273(02)00653-0
5 Hwang, J. W., N. Egorova, X. Q. Yang, W. Y. Zhang, J. Chen, X. Y. Yang, L. J. Hu, S. Sun, Y. Tu, and J. Kong. “Subthreshold Depression Is Associated with Impaired Resting-state Functional Connectivity of the Cognitive Control Network.” Translational Psychiatry Transl Psychiatry 5, no. 11 (2015). pg 1. doi:10.1038/tp.2015.174.
6 Eric Nestler et al, Neurobiology of Depression, pg 13
7 Eric Nestler et al, Neurobiology of Depression, pg 14
8 Eric Nestler et al, Neurobiology of Depression, pg 14-5
9 Eric Nestler et al, Neurobiology of Depression, pg 15
10 Eric Nestler et al, Neurobiology of Depression, pg 16
11 fmri.ucsd.edu/Research/whatisfmri.html
12 Demao Deng et al, Modulation of the Default Mode Network, pg 1
13 Leech, R., and D. J. Sharp. “The Role of the Posterior Cingulate Cortex in Cognition and Disease.” Brain 137, no. 1 (2013): 12-32. doi:10.1093/brain/awt162. brain.oxfordjournals.org/content/early/2013/07/18/brain.awt16
doi: org/10.1093/brain/awt162
14 Devinsky, Orrin, Martha J. Morrell, and Brent A. Vogt. “Contributions of Anterior Cingulate Cortex to Behaviour.” Brain 118, no. 1 (1995): 279-306. doi:10.1093/brain/118.1.279. ncbi.nlm.nih.gov/pubmed/7895011/
15 Demao Deng et al, Modulation of the Default Mode Network, pg 5
16 Demao Deng et al, Modulation of the Default Mode Network, pg 5
17 Demao Deng et al, Modulation of the Default Mode Network, pg 6
18 Hamilton, J. Paul, and Ian H. Gotlib. “Neural Substrates of Increased Memory Sensitivity for Negative Stimuli in Major Depression.” Biological Psychiatry 63, no. 12 (2008): 1155-16. doi:10.1016/j.biopsych.2007.12.015.

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How Acupuncture is Effective For Lumbar Disc Herniation

How Acupuncture is Effective For Lumbar Disc Herniation

Acupuncture is Leading the Way in Pain Management

Researchers demonstrate excellent clinical results using acupuncture for the treatment of lumbar disc herniations.

Researchers find acupuncture safe and effective for the treatment of lumbar disc herniations across multiple independent clinical trials. A meta-analysis of investigations reveals that Jiaji acupoints yield significant positive patient outcomes when combined with manual and electroacupuncture techniques. Distal and abdominal acupuncture also demonstrated significant positive patient outcomes. This research review covers rare acupuncture points demonstrating clinical efficacy and details a powerful manual acupuncture technique proven effective for relief of lumbar disc herniation symptoms. We’ll start with primary research by Song et al. and then take a close look at a meta-analysis by Wang et al., including specific approaches to clinical care proven to deliver excellent results.

Researchers find both electroacupuncture and manual acupuncture effective for the treatment of lumbar disc herniations. Song et al. conducted a clinical trial at the Xixiang People’s Hospital in Guangdong, China. Electroacupuncture and manual acupuncture significantly reduced patients’ pain levels. Outstanding positive patient outcomes were recorded for the electroacupuncture treatment group. Patients with lumbar disc herniations receiving electroacupuncture had a 91.8% total treatment effective rate. Improvements included pain reductions, increases in range of motion, and improved straight leg lift testing. 

A sample size of 123 patients was randomly divided into two groups. In group one, 61 patients received electroacupuncture therapy. In group two, 62 patients received manual acupuncture. For the electroacupuncture patients, the Jiaji acupoints at the specific vertebra corresponding to the herniated lumbar disc, as well as on the two adjacent vertebrae, were selected as the primary acupoints and treated on both sides. Additional secondary acupoints were selected based on individual patient symptoms. For hip pain, the following acupoints were chosen:

Huantiao (GB30)
Chengfu (BL36)
For calf pain:

Weizhong (BL40)
Chengshan (BL57)
For lateral calf pain, the following acupoint were chosen:

Yanglingquan (GB34)
Zusanli (ST36)
Kunlun (BL60)
Xuanzhong (GB39)
Treatment commenced with the patient in a prone position. Upon disinfection, a 0.30 x 40 mm disposable needle was pierced perpendicularly into each acupoint until a deqi sensation was reported. Next, an electroacupuncture device was connected to the needles in the Jiaji acupoints. A continuous waveform was selected at an initial 0.8 Hz frequency. The intensity was then gradually increased until both sides of the lumbar muscle were twitching rhythmically at a tolerable rate for the patient. Subsequently, a 30 minute needle retention time was observed. One electroacupuncture session was conducted once per day for 20 consecutive days with a one day break after the 10th day. For the manual acupuncture patients, the following acupoints were selected according to the affected area:

Ganshu (BL18)
Shenshu (BL23)
Yaoyan (MBW24)
Huantiao (GB30)
Zhibian (BL54)
Chengfu (BL36)
Weizhong (BL40)
Weiyang (BL39)
Yanglingquan (GB34)
Feiyang (BL58)
Guangming (GB37)
Kunlun (BL60)
Tonggu (BL66)
Jinggu (BL64)
Houxi (SI3)
Treatment commenced with the patient in a prone position. Upon disinfection, a 0.30 x 40 mm disposable needle was pierced perpendicularly into each acupoint until a deqi sensation was felt. During the subsequent 30 minute needle retention time, the acupuncture needle was manipulated once every 10 minutes. One acupuncture session was conducted once per day for 20 consecutive days with a one day break after the 10th day. The total treatment efficacy was measured based on the TCM Treatment Efficacy Guidelines issued by the TCM Governing Board. Efficacy was categorized into 1 of 3 possible tiers:

Effective: Waist and leg pain ceased. Straightened leg lift of 70° and above. Normal waist and leg activity regained.
Improvement: Waist and leg pain relieved. Improvement in extent of waist movement.
Not effective: No improvement in symptoms.
The total treatment effective rate was measured as a percentage of patients who achieved at least the “improvement” tier. Electroacupuncture produced a 91.8% total treatment effective rate including pain reductions, increases in range of motion, and improved straight leg lift testing. Song et al. conclude that acupuncture is effective for the treatment of lumbar disc herniations.

The research team prefaced their study with background information. Lumbar disc herniation is a common disease among adults. Pain, numbness, or weakness arises due to damage or compression of the nerve root caused by herniation of the nucleus pulposus. This is the soft inner core of the vertebral disc that helps absorb compression and torsion. A herniation occurs when the soft material from the inner core escapes through the outer rings of the disc. This stubborn disease is usually characterized by an abrupt onset with a prolonged or repetitive course of symptomatic flare-ups. Main symptoms include leg and lumbar region pain, and also lower limb motor dysfunction. Lower limb paralysis is possible in severe cases.

Song et al. note that acupuncture is a relatively non-invasive treatment for disc herniations that dredges meridians, promotes qi circulation, eliminates blood stasis, and expels wind-dampness. Pain is thereby relieved when blood and qi circulation is restored. In modern terms, acupuncture stimulates parasympathetic tone and downregulates excess sympathetic nervous system activity. Resulting decreases in the inflammatory cascade of endogenous biochemicals results from the regulation of the autonomic nervous system.

Song et al. add that acupuncture regulates nerve activity, facilitates muscles relaxation, mitigates muscular spasms, dilates blood vessels, improves blood circulation, and also reduces both edema and inflammation. The Jiaji acupoints, located on the back beside the Du meridian, are used to treat diseases related to the corresponding affected nerve segments. Electroacupuncture utilizes electrical stimulation to facilitate the regeneration of damaged nerves by improving nerve cell metabolism and nerve cell enzyme activity. The basis of this is that electroacupuncture forms a localized, stable, and subtle electric current that boosts the electrophysiological properties of nerve cells (Sun, 1996).

In a related study, Wang et al. conducted a meta-analysis on the efficaciousness of acupuncture for the treatment of lumbar disc herniations. Without exception, the clinical investigations demonstrate that acupuncture is a safe and effective treatment modality for lumbar disc herniation patients. The following are examples of studies included in the meta-analysis.

Liu et al. investigated the efficacy of conventional acupuncture therapy. Conventional acupuncture treatment was administered by first identifying the vertebrae with lumbar disc herniations. Corresponding Du meridian acupoints and the two adjacent Jiaji acupoints were needled. The identified acupoints were treated with the Shao Shan Huo (Setting the Mountain on Fire) needling technique. Patients were treated for 10 consecutive days and achieved a 95% total treatment effective rate.

Shao Shan Huo is a powerful tonification needling technique in Traditional Chinese Medicine (TCM). Needles are inserted and stimulated to elicit the arrival of deqi for purposes of reinforcing qi. When applied properly, the patient feels a warm sensation at the needle region. In addition, the skin will be flush red as a result of enhanced micro-circulation of blood.

Initially, the needle is inserted slowly to superficial depth beneath the skin. During the procedure, lifting and thrusting is applied to three levels of depth beneath the skin, starting with the most superficial level at approximately a 0.5 cun depth. This is followed by lifting and thrusting at the middle level at approximately 1.0 cun and the deep level at approximately 1.5 cun. Depth varies according to patient size and acupoint location.

At each of the three depths of insertion, the needle motion combines quick and forceful thrusting with slow and gentle lifting for a total of nine times. Rotation may also be applied with the same techniques. After stimulation at all three levels is complete, the needle is lifted to the superficial level and the procedure is repeated, often three times, to ensure elicitation of a qi sensation producing heat and redness of the skin. The patient may also sweat in the region of the needle or throughout the body as a result of the heat sensation produced by this tonification method. Liu et al. achieved a 95% total treatment effective rate using the Setting the Mountain on Fire technique using the Du and Jiajia (Huatuojiaji) acupuncture points at correlated regions to lumbar disc herniations. Notably, acupuncture was applied for 10 consecutive days.

Deng and Cai’s investigation also examined application of the Jiaji acupoints for the treatment of lumbar disc herniations. In a different approach to needle stimulation, Deng and Cai applied electroacupuncture stimulation to the needles. They achieved significant levels of positive patient outcomes in their clinical trial. In their investigation, patients were treated every other day. Short-term results and a three month follow-up confirm significant clinical improvements.

He et al. had an entirely different approach to acupuncture therapy for the treatment of lumbar disc herniations. Their approach focused on abdominal acupuncture and anterior acupoints. The clinical investigation yielded significant positive patient outcomes. In their semi-protocolized investigation, a set of primary acupoints were applied plus secondary acupoints were added for specific diagnostic concerns. The primary acupoints for all patients were the following:

Shuifen (CV9)
Qihai (CV6)
Guanyuan (CV4)
Next, secondary acupoints were added based on diagnostic criteria. For acute lumbar disc herniations, the following acupoints were added:

Shuigou (GV26)
Yintang (MHN3)
For prolonged lumbar disc herniation, the following acupuncture point was added:

Qixue (KD13)
For generalized lumbago, the following acupoints were added:

Wailing (ST26)
Qixue (KD13)
Siman (KD14)
For sciatica occurring when sitting, the following acupuncture points were added:

Qipang
Wailing (ST26), affected side only
Xiafengshidian
Xiafengshixiadian
He et al. measured improvement rates after three weeks of acupuncture therapy. Patients achieved significant improvements. The researchers conclude that the protocol is effective for the treatment of lumbar disc herniation symptoms. He et al. used several acupoints termed ‘extra’ points including Xiafengshidian, Xiafengshixiadian, and Qipang. The acupoints demonstrate that the researchers focused on abdominal acupuncture as a means of treating lumbar concerns.

Xia Feng Shi Dian (Xia Feng Shi Dian, Lower Wind-Damp Point) is located 2.5 cun lateral to CV6 and is indicated for the treatment of knee disorders, including postoperative swelling and pain. Xiafengshixiadian (Xia Feng Shi Xia Dian, Below Wind-Damp Point) is located 3 cun lateral to CV5 and is used for leg, ankle, and foot disorders. Qipang (Qi Pang, Beside Qi) is located 0.5 cun lateral to CV6 and is indicated for lower back and leg pain, swelling, and weakness; including postoperative disorders.

The meta-analysis included the clinical research of Zhang et al. Manual acupuncture was applied to acupoints surrounding the afflicted area. All needles were directed towards the center of the afflicted region. Zhang et al. achieved a 97.5% total treatment effective rate.

Overall, the metal-analysis by Wang et al. documents that acupuncture is a safe and effective treatment modality for patients with lumbar disc herniations. Implementation of Jiaji acupoints was common across several studies. Other techniques including abdominal acupuncture and local Ashi acupoint acupuncture also demonstrated clinical effectiveness. Both electroacupuncture and specialized manual acupuncture demonstrated effectiveness as well. As a result of the findings, the researchers conclude that acupuncture is an important treatment option for patients with lumbar disc herniations.

 

References:
Song YJ, Yu MJ, Li L, Huang WX, Cai ZW, Su DP. (2013). Clinical Observation of Electro-acupuncture in Treatment of Lumbar Disc Herniation. Chinese Manipulation & Rehabilitation Medicne.

Sun ZR. Mechanism of acupuncture in the regeneration of surrounding damaged nerves. 1996(02).

Wang FM, Sun H, Zhang YM. (2014). Advance of Clinical Research in Intervention of Lumbar Disc Herniation(LDH) with Acupuncture Moxibustion. Journal of Clinical Acupuncture and Moxibustion.
30(3).

Deng W & Cai LH. (2011). Electroacupuncture on Jiaji acupoint in treating lumbar disc herniation. Journal of Clinical Acupuncture. (7).

He JX, Lin WR, Chen JQ, Huang Y, Wang SX, Lin HH & Chen HX. Abdominal acupuncture in treating lumbar disc herniation. Shanghai Journal of Acupuncture. 2012. (7).

Liu YZ, Sun XW & Zou W. (2012). Shao Shan Huo acupuncture technique on lumbar Jiaji acupoint in treating lumber disc herniation. Journal of Clinical Acupuncture. (6).

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