Using Acupuncture and Chinese Medicine to treat Anxiety and Panic Attacks

Frequently acupuncturists are called upon to treat anxiety disorders in the clinic. When the acupuncture performs a skillful diagnosis and is able to create a proper treatment plan, our clients almost always respond powerfully and well. So true is this that it is quite common, at the Northside Holistic Center, to see physicians and psychologists refer their patients to us to address this concern. This happens most frequently when either the patient hasn't been responding to medication fully, has side effects from the medication that makes it undesirable, or simply would prefer not to be using drugs to influence their mental state. 

When treating any sort of anxiety disorder, diagnosis is key. Chinese medicine approaches anxiety, as it does most types of health issue, by taking the whole body into account. The first visit to our clinic would begin with a detailed intake form which asks the client for information on their health history. It is often surprising to clients that in treating anxiety, panic attacks, or even post-traumatic stress disorder (PTSD) that we care as much about their digestion, immune system, or skin as we do about the clearer signs of anxiety. This is because, from the perspective of Chinese medicine, all bodily systems are interrelated and can communicate a deeper truth about the disorder at hand. After we discuss the presentation of their anxiety issues I will examine the client's tongue and feel their pulse on both wrist. This gives an acupuncturist, trained in these arts, additional information to refine the treatment protocol. 

 

Articles/Research:

Time Magazine covered some interesting research looking into the mechanism by which acupuncture treats anxiety, stress and depression. The scientists noted that,

Rats who got acupuncture showed fewer symptoms of anxiety and depression than stressed-out rats who didn't get treatment. [and that] Acupuncture may work by targeting the same pathways that stress travels along, according to a new study in rats from Georgetown University Medical Center and published in the journal Endocrinology.

“There was nothing in the literature about acupuncture for PTSD and chronic stress,” [the researcher said] says, so she decided to study it. To find out if acupuncture was affecting chronic stress, Eshkevari and a team of researchers looked at what happened in a key pathway in dealing with stress for both humans and rats: the hypothalamus-pituitary-adrenal axis (HPA). It’s the same pathway targeted by some anti-anxiety drugs and antidepressants, Eshkevari says, and the HPA is involved in the production of the stress hormone cortisol.

• A nice overview of how Chinese medicine conceptualizes anxiety and depression with reference to several good studies citing the benefits of acupuncture for both. It can be read here.

In a comprehensive literature review appearing in a recent edition ofCNS Neuroscience and Therapeutics, it was proved that acupuncture is comparable to cognitive-behavioral therapy (CBT), which psychologists commonly use to treat anxiety (Errington-Evans, 2011). Another study published in the Journal of Endocrinology in March 2013 discovered stress hormones were lower in rats after receiving electric acupuncture (Eshkevari, Permaul and Mulroney, 2013).

• A pilot study from the National Institutes of Health (NIH) demonstrated that not only was acupuncture very useful for treating PTSD but that the results persisted, once a postive effect had been achieved, for three months after the acupuncture was stopped. This is our goal with acupuncture: to take the client incrementally to a state where they are no longer experiencing symptoms and then gradually ween them off of the acupuncture as well.

• A tangential article from the Institute for Traditional Medicine on using acupuncture and Chinese Medicine to withdraw from anti-depressants. One of the frequent side effects from withdrawal from these drugs is anxiety, which is how it seemed to be a good match for this blog entry.

• From a Chinese Medical journal from China, Tian Jin Zhong Yi Yao comes an study evaluating acupuncture as an treatment for Generalized  Anxiety Syndrome (GAS). The results were very positive with more than 94% showing improvement. The English translation can be read here. 

• Another Chinese medical journal has an article called, A mechanism of endogenous opioid peptides for rapid onset of acupuncture effect in treatment of depression which attempts to look at the biochemical changes which underpin the dramatic effects that acupuncture has on depression and anxiety. The PubMed stub can be read here.

• Acupuncture Today has a very interesting overview of the use of acupuncture and Chinese medicine to treat anxiety using ear acupuncture, citing several studies which demonstrate dramatic results.

Based on their findings, the researchers concluded that auricular acupuncture could decrease anxiety levels in otherwise healthy subjects. They added that "the results of the study suggest that acupuncture may be an effective treatment for individuals experiencing intense levels of daily stress and anxiety," and recommended "a randomized controlled trial be performed to evaluate the effectiveness of this technique for the treatment of preoperative anxiety."

• The Department of Defense Live has an very interesting article on treating PTSD and brain injury amongst soldiers with acupuncture. I've posted about it here. It summarizes by saying,

As it turns out, PTSD symptoms are very similar to those of mild TBI [Traumatic Brain Injury] – insomnia, headaches, memory problems, attention problems, anxiety and irritability. Studies have shown that acupuncture is an effective treatment for PTSD, leading Navy Cmdr. (Dr.) Keith Stuessi, former director of the Concussion Restoration Care Center at Camp Leatherneck in Afghanistan to believe the treatment could be used for mild TBI as well.

Stuessi describes the Concussion Restoration Care Center as a success – treating more than 320 concussion patients thus far. Of the more than 20 troops he personally treated, almost all saw marked improvements in their sleep, anxiety levels and frequency of headaches. Cmdr. Earl Frantz, who replaced Steussi at Camp Leatherneck in March, continued the practice of using acupuncture on troops with symptoms of mild TBI.

The Department of Defense is putting its weight behind acupuncture. For example, the most recent Veterans Affairs (VA) clinical guidance recommends acupuncture as a supplementary therapy for PTSD, anxiety, pain and sleeplessness. The VA is even recruiting candidates for a formal study of acupuncture’s effectiveness on PTSD and mild TBI.

As it turns out, PTSD symptoms are very similar to those of mild TBI – insomnia, headaches, memory problems, attention problems, anxiety and irritability. Studies have shown that acupuncture is an effective treatment for PTSD, leading Navy Cmdr. (Dr.) Keith Stuessi, former director of the Concussion Restoration Care Center at Camp Leatherneck in Afghanistan to believe the treatment could be used for mild TBI as well.
Stuessi describes the Concussion Restoration Care Center as a success – treating more than 320 concussion patients thus far. Of the more than 20 troops he personally treated, almost all saw marked improvements in their sleep, anxiety levels and frequency of headaches. Cmdr. Earl Frantz, who replaced Steussi at Camp Leatherneck in March, continued the practice of using acupuncture on troops with symptoms of mild TBI.
The Department of Defense is putting its weight behind acupuncture. For example, the most recent Veterans Affairs (VA) clinical guidance recommends acupuncture as a supplementary therapy for PTSD, anxiety, pain and sleeplessness. The VA is even recruiting candidates for a formal study of acupuncture’s effectiveness on PTSD and mild TBI.

• The Department of Veterans Affairs published a study on PTSD and the various ways in which it can manifest and concluded that, among other things, 

For major depressive disorder (MDD), acupuncture showed greater effects than sham control on depressive symptoms

Knee problems and Acupuncture

A frequent problem which clients present with at our clinic is knee pain. Knee problems can stem from several causes, ranging from athletic injury to more chronic degenerative pain. Acupuncture is usually extremely useful for treating this entire spectrum and can often completely resolve the problem and, at the very least, can powerfully manage chronic pain. 

Research and Articles:

Though we usually prefer to completely solve knee problems for our patients, occasionally they have already had surgery and seek us out in order to speed the post surgical healing process along. A new study demonstrates just how useful this strategy can be, concluding that,

... compared with rehabilitation training alone, acupuncture combined with rehabilitation training can better improve the patients’ knee joint support and swing torques after meniscus arthroscopy, correct their abnormal gaits, increase their motor function of the lower limb and benefit the balance abilities of their lower limbs during walking.

A landmark study, from the Annals of Internal Medicine, has shown that acupuncture both provides pain relief and improves functionality for people with osteoarthritis of the knee and serves as an effective complement to standard care. The study, the largest Phase III clinical trial of acupuncture for knee osteoarthritis, was funded by NCCAM and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, both components of the National Institutes of Health.

The Effect of Acupuncture on the Knee and Tibialis Anterior Muscle

Chin Med. 2008; 3: 17.

The immediate effects of local and adjacent acupuncture on the tibialis anterior muscle: a human study

Larissa Araujo Costa1,2 and João Eduardo de Araujo2

1Acupuncture specialization course, Instituto Paulista de Estudos Sistêmicos (IPES), Praça Boaventura Ferreira da Rosa 384, Ribeirão Preto (SP) 14049-900, Brazil

2Laboratory of Bioengineering, Neuropsychobiology and Motor Behavior, Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, School of Medicine – University of São Paulo, Ribeirão Preto (USP-RP), Avenida dos Bandeirantes 3900, Ribeirão Preto (SP) 14049-900, Brazil

This study compares the immediate effects of local and adjacent acupuncture on the tibialis anterior muscle and the amount of force generated or strength in Kilogram Force (KGF) evaluated by a surface electromyography.

Methods

The study consisted of a single blinded trial of 30 subjects assigned to two groups: local acupoint (ST36) and adjacent acupoint (SP9). Bipolar surface electrodes were placed on the tibialis anterior muscle, while a force transducer was attached to the foot of the subject and to the floor. An electromyograph (EMG) connected to a computer registered the KGF and root mean square (RMS) before and after acupuncture at maximum isometric contraction. The RMS values and surface electrodes were analyzed with Student's t-test.

Results

Thirty subjects were selected from a total of 56 volunteers according to specific inclusion and exclusion criteria and were assigned to one of the two groups for acupuncture. A significant decrease in the RMS values was observed in both ST36 (t = -3.80, P = 0,001) and SP9 (t = 6.24, P = 0.001) groups after acupuncture. There was a decrease in force in the ST36 group after acupuncture (t = -2.98, P = 0.006). The RMS values did not have a significant difference (t = 0.36, P = 0.71); however, there was a significant decrease in strength after acupuncture in the ST36 group compared to the SP9 group (t = 2.51, P = 0.01). No adverse events were found.

Conclusion

Acupuncture at the local acupoint ST36 or adjacent acupoints SP9 reduced the tibialis anterior electromyography muscle activity. However, acupuncture at SP9 did not decrease muscle strength while acupuncture at ST36 did.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2615752/?tool=pmcentrez&report=abstract

References

Ernst E, Lee MH. Sympathetic effects of manual and electrical acupuncture of the tsusanli knee point: comparison with the hoku hand point sympathetic effects. Exp Neurol Oct 1986;94(1):1-10.

Fang Z. Arthralgia treated by acupuncture within "chifu" area. J Tradit Chin Med Sep 1999;19(3):207-9.

Jensen R, Gothesen O, Liseth K, Baerheim A. Acupuncture treatment of patellofemoral pain syndrome. J Altern Complement Med Dec 1999;5(6):521-7.

Myhal D, Lebel E, Leung CY, Camerlain M. Radioisotope study of the effect of acupuncture on the articular vascularization of the knee. Union Med Can Dec 1981;110(12):1046-8. French.

Shafshak TS. Electroacupuncture and exercise in body weight reduction and their application in rehabilitating patients with knee osteoarthritis. Am J Chin Med 1995;23(1):15-25.

Wu ZM, Chen CG. Treatment of hydrarthrosis of the knee with manual manipulation and herbs. J Tradit Chin Med Dec 1998;8(4):251-3.

Yurtkuran M, Kocagil T. TENS, electroacupuncture and ice massage: comparison of treatment for osteoarthritis of the knee. Am J Acupunct 1999;27(3-4):133-40.

Zhang WB, Aukland K, Lund T, Wiig H. Distribution of interstitial fluid pressure and fluid volumes in hind-limb skin of rats: relation to meridians? Clin Physiol May 2000;20(3):242-9.

Knee Pain

3. From Castanet, a Canadian newspaper, comes an article on the use of acupuncture for knee problems.

Acupuncture Extraordinarily Helpful for Vertigo and Dizziness

Many patients seek our help in resolving vertigo, both for acute or chronic symptoms, as well as from a variety of causes. Dizziness tend to respond very well to acupuncture and herbal intervention and clients are usually delighted with their progress.

There are many studies which demonstrate the utility of our strategy including this recent study which found that acupuncture,

. . . conclusively demonstrates that the application of acupuncture to [named acupuncture points] results in immediate reductions in discomfort and improvements of VAS for dizziness and vertigo. The researchers note that the “study provided clinical evidence on the efficacy and safety of acupuncture to treat dizziness and vertigo in (the) emergency department.

Another study found that treating clients for their dizziness led to dramatic improvements in cervical blood flow to the brain:

Researchers made an interesting discovery during the study. Two phenomena occurred simultaneously as a result of acupuncture treatments. Vertigo decreased and blood supply to the vertebral arteries improved significantly.

Study Demonstrates Acupuncture's Efficacy with Coma Patients

Though not routinely seen in American acupuncture clinics, working with unconscious patients, including those in a coma, is something that practitioners are taught in school and familiar with. I post the study below largely because we do frequently see brain injury, strokes and neurologic problems which respond similarly well.

A recent study, which can be read here, found that,

Acupuncture improves the time it takes to regain consciousness from a coma after a severe brain injury.

Irritable Bowel Syndrome Well Treated by Acupuncture and Chinese Medicine

Irritable Bowel Syndrome (IBS) is extraordinarily well treated by acupuncture and traditional Chinese medicine (TCM) and is something that we see at the clinic almost every day. IBS is a functional bowel disorder characterized by chronic or episodic abdominal pain, bloating, and alteration of bowel habits in the absence of any detectable organic cause. Diarrhea or constipation may predominate, or they may alternate. IBS may begin after an infection, a stressful life event, or even without any other medical triggers.

Like most conditions that we treat, irritable bowel syndrome is differentiated according to how it presents in the individual patient and the rest of the person's constitution. As such, each individual will receive a tailored treatment approach.

 Research and Articles 

• An analysis of seven studies on irritable bowel syndrome may be found here, though the consensus from the research was:

Acupuncture and moxibustion alleviate irritable bowel syndrome (IBS). Research confirms that acupuncture and moxibustion significantly reduce abdominal pain, diarrhea, and the ratio of abnormal stools. The research was conducted on patients with IBS-D, a type of irritable bowel syndrome characterized by insidious attacks of diarrhea. The total effective rate was 96.7% with many patients experiencing a complete recovery with no relapses.

• Columbia University published a study which looked at the treatment of IBS with acupuncture, viewable here, which demonstrated that:

After 4 weeks of twice-weekly acupuncture/moxa treatment, average daily abdominal pain/discomfort improved whereas the control group showed minimal reduction. This between-group difference adjusted for baseline difference was statistically significant. The intestinal gas, bloating, and stool consistency composite score showed a similar pattern of improvement. The findings indicate that Acu/Moxa treatment shows promise in the area of symptom management for IBS.

• A Chinese medical study, which can be read here, compared a western medical treatment with acupuncture for IBS and found that:

Acupuncture at [the acupuncture points] Tianshu (ST 25) and Dachangshu (BL 25) may remarkably relieve the clinical symptoms of IBS and its efficacy is superior to that of oral medication with trimebutine maleate.

• A research report from the Hong Kong Department of Digestive Health found that:

Electro acupuncture attenuates visceral hyperlagesia through down-regulation of central serotonergic activities in the brain-gut axis.

 From a practical perspective, this means that electro-acupuncture reduces the urgency of IBS in patients.

• The Nanjing Medical School published a study which evaluated the use of acupuncture in managing the chronic constipation which can be associated with one type of constipation. In the conclusion of the study the researchers found that:

The scores of defecation frequency, difficulty degree of defecation, defecation time, endless sensation of defecation, stool quality, awareness of defecation and PAC-QOL were obviously improved after treatment . . . The effect of acupuncture for CFC with exact etiology, disease location and classification diagnosis is definite, but different dynamic mechanism has different effect. 

• One of the most famous studies of traditional Chinese herbs for IBS was published in the Journal of the American Medical Association (JAMA) and can be read here. The study found that:

Compared with patients in the placebo group, patients in the active treatment groups had significant improvement in bowel symptom scores as rated by patients (P = .03) and by gastroenterologists (P = .001), and significant global improvement as rated by patients (P = .007) and by gastroenterologists (P = .002). Patients reported that treatment significantly reduced the degree of interference with life caused by IBS symptoms (P = .03). Chinese herbal formulations individually tailored to the patient proved no more effective than standard CHM treatment. On follow-up 14 weeks after completion of treatment, only the individualized CHM treatment group maintained improvement. Conclusion: Chinese herbal formulations appear to offer improvement.