Acupuncture & Moxibustion Treatment for Depression
Shudo Denmei
Introduction
According to the statistics of the Japanese Police Ministry, last year the annual number of suicides surpassed 30,000 for the seventh year in a row. This is approximately four times the number of fatalities in traffic accidents. Also the number of suicides for 100,000 people is 27 people (2003 figures from the above Ministry), which is unusually high for advanced nations. This abnormal state, in which Japan could be called a “suicide nation,” still continues.
The above was taken from an article in a major newspaper in Ohita Prefecture. Further, on November 1, 2004, major Japanese papers reported as follows:
According to a study by Tsunoda Kenzo, an assistant professor at the Hokkaido Daigakuin University, it has been found that depressive symptoms, which could possibly lead to serious depression, can be found in approximately 8% of primary school students and approximately 23% of junior high school students. Children with these symptoms, in addition to feeling so listless that “nothing is interesting,” expressed strong melancholy such as “feeling like crying” and “feeling all alone.”
It has been found that there are several million cases of depression, including latent cases, and therefore the Japan Depression Task Force was established. There are those who think over 10% of the Japanese, or approximately ten million people, suffer from depression or a depressed condition. (Murazaki Mitsuya, director of the East Kitasato University Hospital) Some believe that the economic recession in past years has led to a psychological downturn. What is the cause of this depression, however, if it does not decrease even after there has been an economic upturn and we have gotten through the low spot? Is there a social cause or is it due to pollution, or could it be an ethnic or cultural issue? In any case, depression is a serious problem.
It seems that until recently acupuncturists have avoided the treatment of depression. It is true that patients with serious depression might plan suicides when they begin to feel a little better. It may be safer, therefore, not to get involved at all. In my experience, however, acupuncture is a very effective treatment modality for depression. It is particularly effective for depressive states, which precede serious depression. Setting aside the fear of being misunderstood, acupuncture is very effective for depression and it is a waste not to use it.
Looking around me, I find that there are many people who experience depressive states. When people receive acupuncture invariably their mood brightens. Japan has a surplus of acupuncturists, so if many acupuncturists tackled depression, Japan will become a very happy country. This might seem like a dream, but I am serious about it.
The Treatment of Depression
There are two indispensable requirements for the treatment of depression. The first is pattern differentiation. The second is to use super-superficial insertion. The first pertains to diagnosis and the second, to treatment.
Pattern differentiation
The pattern must be discriminated. I primarily use Meridian Therapy. In Meridian Therapy we use the term sho-kettei (pattern determination). This means to decide which meridians are affected. In Liver deficiency, for example, it means the Liver meridian is the primary meridian affected. In Traditional Chinese Medicine it is called meridian differentiation or Zangfu differentiation. The meridians and Zangfu are inextricably linked. This is my understanding, so treating the Liver meridian benefits not only the Liver meridian but the liver organ as well.
Differentiation, especially that among the five Zang, is important. I originally realized that acupuncture was effective for psychosomatic conditions including depression when I came across the term “the spirit of the five Zang” in the beginning of Zhenjiu Jiayi Jing (The Systematic Classic of Acupuncture and Moxibution). I believe this text proposes, “The seat of the spirit or mind is in the five Zang.” The view in Western medicine is that seat of the spirit is in the brain, and this is diametrically opposed to the view in Oriental medicine. Practicing acupuncture and moxibustion, I have come to feel that the spirit is housed in the five Zang.
The five Zang are filled with special Qi, respectively called Shen (Heart), Hun (Liver), Yi (Spleen), Po (Lung), and Zhi (Kidney), which are collectively called the Five Spirits. When the Lung is diseased, for example, the Po housed in the Lung diminishes so a person becomes tearful or loses motivation. Similar changes take place when other Zang are diseased. The psychological state varies by the pattern, but the main problems caused by deficiencies in the Five Spirits are as follows:
(1) depressed mood
(2) loss of motivation
(3) lack of interest and loss of enjoyment
(4) easily fatigued and desire to lie down
(5) no appetite
(6) poor sleep
(7) loss of sexual desire
Psychological imbalances are alleviated by regulating the five Zang so, one must have a way to figure out which Zang have a problem. I primarily use pulse diagnosis to determine the pattern. Whether Liver, Kidney, Spleen, or Lung deficiency, the worse the deficiency, the more difficult it is to treat.
In the classics it says the pulse quality of depression is sunken. The worse the depression, the deeper the pulse sinks, until it almost disappears under the bone. This is known as the hidden pulse. There is in fact such a tendency. When our mood sinks our pulse sinks, and when our mood raises our pulse begins to float. The patient is easy to cure when the pulse is floating. Patients with sunken pulses are difficult to treat. If you check the pulses as you give treatment and it begins to become more floating, you can be confident that the treatment is having a good effect. What can you do if you don’t know how to take the pulses? Is there another way to confirm the effect? I am working on another method, and I will mention this later.
Super-superficial insertion
Let’s say you have decided the pattern, and it is Liver Deficiency. There are two approaches in Meridian Therapy, root treatment and branch treatment. The root treatment is especially important for psychological problems. For Liver Deficiency I usually tonify LR-8, KI-10, ST-36, and LI-11. Just needling LR-8 on one side is often enough to make the pulses floating and large. When just one needle does not change the pulse, I needle LR-8 on the opposite side, and continue with the other points listed. One must be careful here. The needle must not be inserted deeply. No matter if the person has a solid body or loves acupuncture, if you want it to be effective for the mind, the needle must be kept very superficial. If one is a master, of course, even deep needling may be effective, but I am considering my own approach here and not others.
Here I want to introduce super-superficial insertion, which I use often in my treatments. How I got to this method is detailed in articles in the Journal of the Traditional Japanese Acupuncture Society and the Journal of Japanese Acupuncture and Moxibustion (1 & 2; see NAJOM #26 & 27 for English articles), but I will attempt to give a simple explanation.
The super-superficial insertion technique
It is not that difficult. Place the tube with the needle on the skin and very gently press the head of the needle to make the tip of the needle press up against the skin. (I call this setting the needle.) Even light tapping on the head of the needle will cause the needle to go in a few millimeters, so it is better not to tap at all. Next remove the tube and begin to twist the needle back and forth 1/16 of a turn (about 20 to 30 degrees) with your thumb and index finger. My style is to hold the index finger steady and move the thumb only. (See photo.) I rapidly rotate the handle of needle held between the pad of the right index finger and the tip of the right thumb.
The rotations should be done as fast as possible. About 500 times a minute is desirable. At first one can only manage about 150 times minute, but the number of rotations increase with practice. As these rapid rotations are continued patiently, one feels the Arrival of Qi. By this time the needle has worked its way in a little. There is no need to try and work the needle in. It works best when you just think of it as contact needling and try to feel for the Arrival of Qi. Remove the needle once the Qi arrives, and close the hole when tonifying, and don’t close the hole when dispersing.
When I speak of the Arrival of Qi, this is not something that is felt as clearly as when actually inserting the needle. It is a vague feeling, as if something was there, but it’s hard to describe.
The needles to use for super-superficial insertion
Any needle that one is used to using will suffice. I use a one cun 01-gauge (30mm, 0.14mm) needle. The one cun needle is handy for super-superficial insertion. It allows one to do the treatment very quickly.
The definition of super-superficial insertion Super-superficial insertion refers to a depth between contact needling and superficial needling. The actual depth is 0.5mm. Furthermore, in this technique the needle is rotated over 500 times per minute. Superficial insertion is between 1 and 5mm, shallow insertion is between 5 and 30mm, and deep insertion is deeper than 30mm.
Ono Bunkei developed a technique called contact needling, in which the needle is not inserted. Inoue Keiri used scatter needling, which was inserted very superficially. Okabe Sodo frequently retained needles superficially. There are needling techniques, which are even shallower than super-superficial insertion, but the main difference is the high-speed rotation of the needle. This high-speed rotation is something that has not been mentioned in any text before. In this sense, super-superficial insertion might even be called “super rotation technique.”
The definition of super-superficial insertion
There are the following effects and benefits:
(1) It is effective for various types of pain, especially spontaneous pain.
(2) It can even be effective for pain from cancer.
(3) It is immediately effective in reducing fatigue and heaviness in the body.
(4) It changes hardness to softness. This technique has a softening effect, even if the needle is not inserted into the center of the hardness.
(5) It seems to have a good effect not only for physical symptoms, but also for psychological issues. One’s mood brightens, and sleep improves. One begins to feel that it is really wonderful to be alive.
(6) Those who don’t like acupuncture, especially those who refuse the pricking sensation, like this technique.
(7) It is suited to children and old patients. This is something, which cannot be overlooked with the demographics of aging.
(8) Finally, there is an effect on the acupuncturist. First of all, one doesn’t get tired. Also it is ideal if the acupuncturist gives himself treatments using super-superficial insertion.
The treatment is completed with the patient not really know what was being done. In this context, the effect of lifting one’s spirit is the most important.
Case studies of depression
Case 1: 56 year old female
First treatment: May 7, 2005
Chief complaints: Many symptoms including headache, anxiety, insomnia (taking sleep medication), stiffness in neck and shoulders, palpitations, and tendency to become fatigued. She has had this condition for two years. Her physician diagnosed her with “chronic pain syndrome,” but injections for depression has been helpful at times. She has an appetite.
History: Uterine fibroid tumors, chronic pain, autonomic imbalance.
Six position diagnosis: Lung deficient
Pulse quality diagnosis: sunken, slow, and deficient. The left side is especially sunken.
Tender points: SP-6, BL-52, GV-9, GV-10, GV-11, GV-22
Treatment: super-superficial insertion at LU-9, SP-3, CV-12, CV-6, BL-2, LI-11, GV-9, GV-10, GV-11, BL-13, BL-20, BL-52, BL-58, GB-20, GB-21. Direct moxibustion on GV-22, SP-6, GV-9, GV-10, GV-11, and BL-58.
Progress:2nd treatment (May 14) Liver deficiency – this pattern continues below.
5th treatment (June 3) She can sleep without medication.
7th treatment (June 22) Insomnia returns with worries about her child’s marriage.
13th treatment (Aug. 12) Doing well. I told her she only needed treatments every other week.
14th treatment (Aug. 17) Her pulse was more floating for the first time.
Observations: One look at this patient and you could tell she was depressed. One of her neighbors became really concerned and brought her in for treatment against her wishes. As she continued to come for treatments, she began to smile and her face became more round. She started to gain weight, and we almost started to worry about her figure. Chronic pain (without cause) is a new concept, but treatments chasing after the pain are ineffective. Treating the condition as a psychosomatic problem will make the pain also diminish.
Case 2: 47 year old female
Profession: company owner
Chief complaints: She has no motivation. She comes for treatment several times a year. She has lost her energy. She asks me to give her a boost. As for physical symptoms, occasionally she experienced bladder discomfort, hives, and heaviness of the head. She usually gets over her symptoms in one or two treatments. She seems to come in more often recently since she got a divorce and became the head of her company.
Six position diagnosis: Liver deficient
Pulse quality diagnosis: sunken, slow, and deficient.
Treatment: super-superficial insertion at CV-12, CV-6, CV-3, SP-6, LR-8, LI-11, BL-2, BL-52, BL-23, BL-18, BL-43, BL-58, GB-21, and GB-20.
Direct moxibustion on SP-6, CV-6, and BL-52.
Case 3: 18 year old female
First treatment: Nov. 29, 2004
Chief complaints: She is preparing for college entrance examinations and is slightly depressed. Physical symptoms include shoulder stiffness, headache, heaviness in the head, anxiety, numbness in the four limbs, constipation, chapped lips, flushing, upper back pain, swelling, and menstrual pain.
Six position diagnosis: Lung deficient
Treatment: Direct moxibustion on SP-6 (tender) GV-10, BL-52; super-superficial insertion on various other points.
Progress: She received fifteen treatments until March 23, 2005. She got in an automobile accident and had cervical pain in this period, but she was accepted into a college and is doing very well.
Observations: The acupuncture treatments served to boost her spirit when she tended to be depressed, and she passed a college entrance exam. Probably this is the first time in her life she has experienced depression, but every time she encounters it in the future she will probably think of acupuncture.
Case 4: 61 year old female
First treatment: May 8, 2002
Chief complaints: Three months before while on a trip she had a fever of 37 degrees Celsius (35 C is normal temp.), diarrhea, and loss of appetite. She lost 5kg and was hospitalized in a public hospital for a thorough exam. The cause of her low-grade fever was not determined, and she was told that 37 degrees Celsius was nothing to worry about. Currently she has a depressed mood. She wakes up in the middle of the night, and sleeps only about four hours. She has no appetite and loose stools. Her temperature is 36 degrees Celsius.
Six position diagnosis: Spleen deficient
Pulse quality diagnosis: sunken and slow
Tongue: white coating
There is sensitivity to pinching at ST-21 on the left. It is depressed between BL-17 to BL-21 on the left, and this area is tender but feels good to be pressed. I thought this was a case of viral infection from the initial symptoms, but this possibility was denied at the hospital. The sensitivity to pinching at ST-21 on the left and the mild tenderness on the back indicate abnormality in the pancreas or the stomach. Lack of appetite and loose or watery stools are a sign of chronic pancreatic disease. The targets for treatment for this patient are poor appetite and low-grade fever.
Treatment: super-superficial insertion at SP-3, PC-7, CV-12, left ST -21, CV-6, BL-20, BL-15, GB-20, GB-21, Onodera point, left BL-17, left BL-18, left BL-19.
Direct moxibustion on ST-36 and BL-17, 18, 19 and 20 on the left.
Intradermal needle retained at left ST-21.
Progress: She received only three treatments in 2002. She started to come in for regular treatments after March 31, 2003. She went to a university hospital for a detailed exam of her pancreas, and was told there was a possible chronic inflammation in the pancreas and that she had depression. She was prescribed antidepressants and tranquilizers. Later the possibility of pancreas pathology was denied. She received a total of 36 treatments in 2003. In this period doctors told her she might have multiple gastric polyps or refluxive gastritis, but her poor appetite did not change. Her pulses often indicated Spleen Deficiency, but sometimes she was Lung or Kidney Deficient. In 2004 she received seven treatments by March 15. On March 22, she got spontaneous sciatic pain on the right. On June 7, she reported that her weight had increased 2kg. On June 15, she said she had gained 3kg. One June 29 she had gained 4kg, and her appetite had returned. In 2004 she received a total of 36 treatments, and in this period her appetite came and went, and there was some prolapse of the anus. In 2005 she received 16 treatments up to August 1. Her appetite and sleep were better. Her tongue coating was normal. Her lower abdomen was firm, and her waist and hip were larger and she had more strength. On May 30 she complained of diarrhea and abdominal pain. At this time her amylase count went up. “In that case,” her physician said, “the earlier symptoms may have been related to the pancreas.”
Observations: Treatments can be continued if there is just a little bit of improvement, but you often lose patients when there is no improvement after many treatments. This patient held out (without results) for one whole year. She became friends with two other patients forming a friendly threesome – one from outside the prefecture and two from inside. They are about the same age and seem to get along well. They were always in touch by phone and comparing notes. First the rheumatoid arthritis of the woman from outside the prefecture began to go away little by little. Once the pain disappeared she began to gain weight, and she became cheerful. Because she could see the change in her friend, this patient must have continued to have hope “Maybe I can too.” Much later, there was a positive influence when her first grandchild was born. Although she complains it is exhausting to come for treatment from far away, she seems to be happy to come. I believe her persistence is what has really worked in this case.
Case 5: 37 year old female
First treatment: April 17, 2005
Chief complaints: Hay fever; in addition to hay fever, the intake form says she has low back pain, migraines, and autonomic dysfunction. Her sleep is poor and she has no appetite.
Six position diagnosis: Lung deficient
Pulse quality diagnosis: sunken, slow, and deficient
Treatment: super-superficial insertion at CV-12, LU-9, SP-3, LI-11, ST-36, GB-20, GB-21, GV-10, GV-11, BL-21, iliac point, BL-32, BL-40. And BL-59.
Needles retained superficially at LI-20 and upper BL-10.
Direct moxibustion on GV-24, GV-10, and GV-11.
Progress: April 26 (2nd Tx) Lung deficiency. She got dizzy after having her neck and shoulders massaged.
May 20 (5th Tx) Lung deficiency. She feels depressed.
June 6 (7th Tx) She has dizziness and palpitations. She feels very depressed.
June 14 (8th Tx) Lung deficiency. She felt better for four days after the last treatment. She is sneezing; her temperature is 36.9 C. She got dizzy during the treatment, but needling LR-1 stopped it.
June 21 (9th Tx) She’s been doing great since the last treatment. A member of her family said that she didn’t seem like the same person when she got back from the treatment. She loves to clean and got tired doing it. (Manic?)
July 5 (10th Tx) She feels depressed. She got a headache, but examination at the neurologist showed no abnormality.
August 2 (13th Tx) She started a job in August at a pickling company.
August 16 (14th Tx) She is somehow getting through work.
Observations: The patient was smiling when she first came for treatment, but I suspected depression from her symptoms. After a few treatments she began to say that she had been to a hospital for treatment of depression. She has not become better all at once, but she has gained some energy and desire to work. I will remain patient, considerate and resolute about this long-term effort.
Conclusion
I will conclude with things I have noticed treating depression. In terms of examination, you can learn to tell if someone is depressed by observing his or her facial expression. There are those, however, who are depressed even though they are smiling. So you just can’t be sure. Depressed patients have a characteristic way of speaking. Rather than being taciturn, they tend to omit crucial information. So we must fully utilize the four examinations to surmise their condition.
In terms of treatment, as I stated before, it is better not to insert needles at all. They seem to tolerate super-superficial insertion better, but even this if done too much can cause fatigue. So in the beginning it is best to do as little treatment as possible. It is better to refer the patient to a specialist if you feel the case is complex or difficult. Specialists are more knowledgeable after all, and the information you get from them will serve in giving a better acupuncture treatment. Also there are very effective miracle drugs like SSRI. Many people are really helped by them. It has been pointed out, however, that the long-term use of psychotropic drugs can cause personality changes. It is very good if the use of drugs can be reduced or stopped all together with acupuncture treatments. Even so, it is dangerous for acupuncturists to give suggestions about medications. It can cause great harm. Also, one should abstain from giving words of encouragement. All you have to do is show understanding. If you say anything, all you have to do is repeat the words spoken by the patient. This give and take can be tricky when a patient has a real case of depression. It requires careful study.
I said “real depression,” but does that mean there is false depression? There seems to be. Some doctors call it pseudo-depression. When the times are hard, things sometimes don’t go according to what one would expect. Among increasing numbers of immature adults, a child can be overprotected and many are not raised to have forebearance. Children grow up used to getting their way and expect this as they get through school and go out into the world. Then they run into some difficulty. They cannot put up with it; they reach their wit’s end, and become depressed. They never think, “This is life.” “I was born to overcome challenges like this.” or “I’ll gladly take this on.” They think, “I might have depression, which is being talked about so much these days.” They go to a clinic and say that I must be afflicted with depression. Even if they think otherwise, there are doctors who will say, “Let’s prescribe a mild anti-depressant just in case.” Of course, the drugs don’t work. The patient just doesn’t have the gumption to overcome challenges. In cases like this, there is an imbalance in the Zangfu. When this imbalance is corrected with super-superficial insertion, emotional stamina is sure to increase.
Now, what about practitioners who don’t do pulse diagnosis or differential diagnosis? Is there a good approach for them? Practitioners of the Sawada style, for example. The Sawada style has standard points. My teacher said that these didn’t need to be treated unless they were tender. One might apply acupuncture instead of moxibustion on these points. As my teacher said, often there is no tenderness. I would actually select the points that are depressed or deficient. The standard points include CV-12, left TB-4, LI-11, ST-36, KI-6 (which is Sawada style KI-3), GV-12, TB-15, BL-17, BL-18, BL-20, BL-22, and BL-32. This adds up to quite a few points. You might also add GV-20 and GV-11 to these. In any case, the technique must be super-superficial insertion.
The main thing is that every practitioner can use his own treatment system. The only requirement is that the needling technique be changed to super-superficial insertion. This approach is likely to yield good results.
Human beings are composed of both mind and body, and health is a state where both the mind and body are in balance. If this is true, so many people who are unhealthy! When acupuncture is given for physical problems, not only do the physical problems disappear, but also one’s attitude becomes more positive. When acupuncture is given for a gloomy mood, not only does one’s mood improve, but physical problems are resolved as well. This is ideal, and for this result the Five Zang must be harmonized, and super-superficial insertion can be used to good effect for this purpose. I am convinced that this will bring people as close to the ideal state of health as possible.
Reference:
“Can Acupuncture Heal the Mind – The World of Super-superficial Insertion,” Journal of Japan Traditional Acupuncture Society, Vol. 29 No. 1 (#48), July 10, 2002.
“Psychosomatic Disorders and Acupuncture and Moxibustion Therapy,” Journal of Japanese Acupuncture and Moxibustion (Ido-no-Nippon), No. 719, Oct. 2003.
Shudo Denmei
Introduction
According to the statistics of the Japanese Police Ministry, last year the annual number of suicides surpassed 30,000 for the seventh year in a row. This is approximately four times the number of fatalities in traffic accidents. Also the number of suicides for 100,000 people is 27 people (2003 figures from the above Ministry), which is unusually high for advanced nations. This abnormal state, in which Japan could be called a “suicide nation,” still continues.
The above was taken from an article in a major newspaper in Ohita Prefecture. Further, on November 1, 2004, major Japanese papers reported as follows:
According to a study by Tsunoda Kenzo, an assistant professor at the Hokkaido Daigakuin University, it has been found that depressive symptoms, which could possibly lead to serious depression, can be found in approximately 8% of primary school students and approximately 23% of junior high school students. Children with these symptoms, in addition to feeling so listless that “nothing is interesting,” expressed strong melancholy such as “feeling like crying” and “feeling all alone.”
It has been found that there are several million cases of depression, including latent cases, and therefore the Japan Depression Task Force was established. There are those who think over 10% of the Japanese, or approximately ten million people, suffer from depression or a depressed condition. (Murazaki Mitsuya, director of the East Kitasato University Hospital) Some believe that the economic recession in past years has led to a psychological downturn. What is the cause of this depression, however, if it does not decrease even after there has been an economic upturn and we have gotten through the low spot? Is there a social cause or is it due to pollution, or could it be an ethnic or cultural issue? In any case, depression is a serious problem.
It seems that until recently acupuncturists have avoided the treatment of depression. It is true that patients with serious depression might plan suicides when they begin to feel a little better. It may be safer, therefore, not to get involved at all. In my experience, however, acupuncture is a very effective treatment modality for depression. It is particularly effective for depressive states, which precede serious depression. Setting aside the fear of being misunderstood, acupuncture is very effective for depression and it is a waste not to use it.
Looking around me, I find that there are many people who experience depressive states. When people receive acupuncture invariably their mood brightens. Japan has a surplus of acupuncturists, so if many acupuncturists tackled depression, Japan will become a very happy country. This might seem like a dream, but I am serious about it.
The Treatment of Depression
There are two indispensable requirements for the treatment of depression. The first is pattern differentiation. The second is to use super-superficial insertion. The first pertains to diagnosis and the second, to treatment.
Pattern differentiation
The pattern must be discriminated. I primarily use Meridian Therapy. In Meridian Therapy we use the term sho-kettei (pattern determination). This means to decide which meridians are affected. In Liver deficiency, for example, it means the Liver meridian is the primary meridian affected. In Traditional Chinese Medicine it is called meridian differentiation or Zangfu differentiation. The meridians and Zangfu are inextricably linked. This is my understanding, so treating the Liver meridian benefits not only the Liver meridian but the liver organ as well.
Differentiation, especially that among the five Zang, is important. I originally realized that acupuncture was effective for psychosomatic conditions including depression when I came across the term “the spirit of the five Zang” in the beginning of Zhenjiu Jiayi Jing (The Systematic Classic of Acupuncture and Moxibution). I believe this text proposes, “The seat of the spirit or mind is in the five Zang.” The view in Western medicine is that seat of the spirit is in the brain, and this is diametrically opposed to the view in Oriental medicine. Practicing acupuncture and moxibustion, I have come to feel that the spirit is housed in the five Zang.
The five Zang are filled with special Qi, respectively called Shen (Heart), Hun (Liver), Yi (Spleen), Po (Lung), and Zhi (Kidney), which are collectively called the Five Spirits. When the Lung is diseased, for example, the Po housed in the Lung diminishes so a person becomes tearful or loses motivation. Similar changes take place when other Zang are diseased. The psychological state varies by the pattern, but the main problems caused by deficiencies in the Five Spirits are as follows:
(1) depressed mood
(2) loss of motivation
(3) lack of interest and loss of enjoyment
(4) easily fatigued and desire to lie down
(5) no appetite
(6) poor sleep
(7) loss of sexual desire
Psychological imbalances are alleviated by regulating the five Zang so, one must have a way to figure out which Zang have a problem. I primarily use pulse diagnosis to determine the pattern. Whether Liver, Kidney, Spleen, or Lung deficiency, the worse the deficiency, the more difficult it is to treat.
In the classics it says the pulse quality of depression is sunken. The worse the depression, the deeper the pulse sinks, until it almost disappears under the bone. This is known as the hidden pulse. There is in fact such a tendency. When our mood sinks our pulse sinks, and when our mood raises our pulse begins to float. The patient is easy to cure when the pulse is floating. Patients with sunken pulses are difficult to treat. If you check the pulses as you give treatment and it begins to become more floating, you can be confident that the treatment is having a good effect. What can you do if you don’t know how to take the pulses? Is there another way to confirm the effect? I am working on another method, and I will mention this later.
Super-superficial insertion
Let’s say you have decided the pattern, and it is Liver Deficiency. There are two approaches in Meridian Therapy, root treatment and branch treatment. The root treatment is especially important for psychological problems. For Liver Deficiency I usually tonify LR-8, KI-10, ST-36, and LI-11. Just needling LR-8 on one side is often enough to make the pulses floating and large. When just one needle does not change the pulse, I needle LR-8 on the opposite side, and continue with the other points listed. One must be careful here. The needle must not be inserted deeply. No matter if the person has a solid body or loves acupuncture, if you want it to be effective for the mind, the needle must be kept very superficial. If one is a master, of course, even deep needling may be effective, but I am considering my own approach here and not others.
Here I want to introduce super-superficial insertion, which I use often in my treatments. How I got to this method is detailed in articles in the Journal of the Traditional Japanese Acupuncture Society and the Journal of Japanese Acupuncture and Moxibustion (1 & 2; see NAJOM #26 & 27 for English articles), but I will attempt to give a simple explanation.
The super-superficial insertion technique
It is not that difficult. Place the tube with the needle on the skin and very gently press the head of the needle to make the tip of the needle press up against the skin. (I call this setting the needle.) Even light tapping on the head of the needle will cause the needle to go in a few millimeters, so it is better not to tap at all. Next remove the tube and begin to twist the needle back and forth 1/16 of a turn (about 20 to 30 degrees) with your thumb and index finger. My style is to hold the index finger steady and move the thumb only. (See photo.) I rapidly rotate the handle of needle held between the pad of the right index finger and the tip of the right thumb.
The rotations should be done as fast as possible. About 500 times a minute is desirable. At first one can only manage about 150 times minute, but the number of rotations increase with practice. As these rapid rotations are continued patiently, one feels the Arrival of Qi. By this time the needle has worked its way in a little. There is no need to try and work the needle in. It works best when you just think of it as contact needling and try to feel for the Arrival of Qi. Remove the needle once the Qi arrives, and close the hole when tonifying, and don’t close the hole when dispersing.
When I speak of the Arrival of Qi, this is not something that is felt as clearly as when actually inserting the needle. It is a vague feeling, as if something was there, but it’s hard to describe.
The needles to use for super-superficial insertion
Any needle that one is used to using will suffice. I use a one cun 01-gauge (30mm, 0.14mm) needle. The one cun needle is handy for super-superficial insertion. It allows one to do the treatment very quickly.
The definition of super-superficial insertion Super-superficial insertion refers to a depth between contact needling and superficial needling. The actual depth is 0.5mm. Furthermore, in this technique the needle is rotated over 500 times per minute. Superficial insertion is between 1 and 5mm, shallow insertion is between 5 and 30mm, and deep insertion is deeper than 30mm.
Ono Bunkei developed a technique called contact needling, in which the needle is not inserted. Inoue Keiri used scatter needling, which was inserted very superficially. Okabe Sodo frequently retained needles superficially. There are needling techniques, which are even shallower than super-superficial insertion, but the main difference is the high-speed rotation of the needle. This high-speed rotation is something that has not been mentioned in any text before. In this sense, super-superficial insertion might even be called “super rotation technique.”
The definition of super-superficial insertion
There are the following effects and benefits:
(1) It is effective for various types of pain, especially spontaneous pain.
(2) It can even be effective for pain from cancer.
(3) It is immediately effective in reducing fatigue and heaviness in the body.
(4) It changes hardness to softness. This technique has a softening effect, even if the needle is not inserted into the center of the hardness.
(5) It seems to have a good effect not only for physical symptoms, but also for psychological issues. One’s mood brightens, and sleep improves. One begins to feel that it is really wonderful to be alive.
(6) Those who don’t like acupuncture, especially those who refuse the pricking sensation, like this technique.
(7) It is suited to children and old patients. This is something, which cannot be overlooked with the demographics of aging.
(8) Finally, there is an effect on the acupuncturist. First of all, one doesn’t get tired. Also it is ideal if the acupuncturist gives himself treatments using super-superficial insertion.
The treatment is completed with the patient not really know what was being done. In this context, the effect of lifting one’s spirit is the most important.
Case studies of depression
Case 1: 56 year old female
First treatment: May 7, 2005
Chief complaints: Many symptoms including headache, anxiety, insomnia (taking sleep medication), stiffness in neck and shoulders, palpitations, and tendency to become fatigued. She has had this condition for two years. Her physician diagnosed her with “chronic pain syndrome,” but injections for depression has been helpful at times. She has an appetite.
History: Uterine fibroid tumors, chronic pain, autonomic imbalance.
Six position diagnosis: Lung deficient
Pulse quality diagnosis: sunken, slow, and deficient. The left side is especially sunken.
Tender points: SP-6, BL-52, GV-9, GV-10, GV-11, GV-22
Treatment: super-superficial insertion at LU-9, SP-3, CV-12, CV-6, BL-2, LI-11, GV-9, GV-10, GV-11, BL-13, BL-20, BL-52, BL-58, GB-20, GB-21. Direct moxibustion on GV-22, SP-6, GV-9, GV-10, GV-11, and BL-58.
Progress:2nd treatment (May 14) Liver deficiency – this pattern continues below.
5th treatment (June 3) She can sleep without medication.
7th treatment (June 22) Insomnia returns with worries about her child’s marriage.
13th treatment (Aug. 12) Doing well. I told her she only needed treatments every other week.
14th treatment (Aug. 17) Her pulse was more floating for the first time.
Observations: One look at this patient and you could tell she was depressed. One of her neighbors became really concerned and brought her in for treatment against her wishes. As she continued to come for treatments, she began to smile and her face became more round. She started to gain weight, and we almost started to worry about her figure. Chronic pain (without cause) is a new concept, but treatments chasing after the pain are ineffective. Treating the condition as a psychosomatic problem will make the pain also diminish.
Case 2: 47 year old female
Profession: company owner
Chief complaints: She has no motivation. She comes for treatment several times a year. She has lost her energy. She asks me to give her a boost. As for physical symptoms, occasionally she experienced bladder discomfort, hives, and heaviness of the head. She usually gets over her symptoms in one or two treatments. She seems to come in more often recently since she got a divorce and became the head of her company.
Six position diagnosis: Liver deficient
Pulse quality diagnosis: sunken, slow, and deficient.
Treatment: super-superficial insertion at CV-12, CV-6, CV-3, SP-6, LR-8, LI-11, BL-2, BL-52, BL-23, BL-18, BL-43, BL-58, GB-21, and GB-20.
Direct moxibustion on SP-6, CV-6, and BL-52.
Case 3: 18 year old female
First treatment: Nov. 29, 2004
Chief complaints: She is preparing for college entrance examinations and is slightly depressed. Physical symptoms include shoulder stiffness, headache, heaviness in the head, anxiety, numbness in the four limbs, constipation, chapped lips, flushing, upper back pain, swelling, and menstrual pain.
Six position diagnosis: Lung deficient
Treatment: Direct moxibustion on SP-6 (tender) GV-10, BL-52; super-superficial insertion on various other points.
Progress: She received fifteen treatments until March 23, 2005. She got in an automobile accident and had cervical pain in this period, but she was accepted into a college and is doing very well.
Observations: The acupuncture treatments served to boost her spirit when she tended to be depressed, and she passed a college entrance exam. Probably this is the first time in her life she has experienced depression, but every time she encounters it in the future she will probably think of acupuncture.
Case 4: 61 year old female
First treatment: May 8, 2002
Chief complaints: Three months before while on a trip she had a fever of 37 degrees Celsius (35 C is normal temp.), diarrhea, and loss of appetite. She lost 5kg and was hospitalized in a public hospital for a thorough exam. The cause of her low-grade fever was not determined, and she was told that 37 degrees Celsius was nothing to worry about. Currently she has a depressed mood. She wakes up in the middle of the night, and sleeps only about four hours. She has no appetite and loose stools. Her temperature is 36 degrees Celsius.
Six position diagnosis: Spleen deficient
Pulse quality diagnosis: sunken and slow
Tongue: white coating
There is sensitivity to pinching at ST-21 on the left. It is depressed between BL-17 to BL-21 on the left, and this area is tender but feels good to be pressed. I thought this was a case of viral infection from the initial symptoms, but this possibility was denied at the hospital. The sensitivity to pinching at ST-21 on the left and the mild tenderness on the back indicate abnormality in the pancreas or the stomach. Lack of appetite and loose or watery stools are a sign of chronic pancreatic disease. The targets for treatment for this patient are poor appetite and low-grade fever.
Treatment: super-superficial insertion at SP-3, PC-7, CV-12, left ST -21, CV-6, BL-20, BL-15, GB-20, GB-21, Onodera point, left BL-17, left BL-18, left BL-19.
Direct moxibustion on ST-36 and BL-17, 18, 19 and 20 on the left.
Intradermal needle retained at left ST-21.
Progress: She received only three treatments in 2002. She started to come in for regular treatments after March 31, 2003. She went to a university hospital for a detailed exam of her pancreas, and was told there was a possible chronic inflammation in the pancreas and that she had depression. She was prescribed antidepressants and tranquilizers. Later the possibility of pancreas pathology was denied. She received a total of 36 treatments in 2003. In this period doctors told her she might have multiple gastric polyps or refluxive gastritis, but her poor appetite did not change. Her pulses often indicated Spleen Deficiency, but sometimes she was Lung or Kidney Deficient. In 2004 she received seven treatments by March 15. On March 22, she got spontaneous sciatic pain on the right. On June 7, she reported that her weight had increased 2kg. On June 15, she said she had gained 3kg. One June 29 she had gained 4kg, and her appetite had returned. In 2004 she received a total of 36 treatments, and in this period her appetite came and went, and there was some prolapse of the anus. In 2005 she received 16 treatments up to August 1. Her appetite and sleep were better. Her tongue coating was normal. Her lower abdomen was firm, and her waist and hip were larger and she had more strength. On May 30 she complained of diarrhea and abdominal pain. At this time her amylase count went up. “In that case,” her physician said, “the earlier symptoms may have been related to the pancreas.”
Observations: Treatments can be continued if there is just a little bit of improvement, but you often lose patients when there is no improvement after many treatments. This patient held out (without results) for one whole year. She became friends with two other patients forming a friendly threesome – one from outside the prefecture and two from inside. They are about the same age and seem to get along well. They were always in touch by phone and comparing notes. First the rheumatoid arthritis of the woman from outside the prefecture began to go away little by little. Once the pain disappeared she began to gain weight, and she became cheerful. Because she could see the change in her friend, this patient must have continued to have hope “Maybe I can too.” Much later, there was a positive influence when her first grandchild was born. Although she complains it is exhausting to come for treatment from far away, she seems to be happy to come. I believe her persistence is what has really worked in this case.
Case 5: 37 year old female
First treatment: April 17, 2005
Chief complaints: Hay fever; in addition to hay fever, the intake form says she has low back pain, migraines, and autonomic dysfunction. Her sleep is poor and she has no appetite.
Six position diagnosis: Lung deficient
Pulse quality diagnosis: sunken, slow, and deficient
Treatment: super-superficial insertion at CV-12, LU-9, SP-3, LI-11, ST-36, GB-20, GB-21, GV-10, GV-11, BL-21, iliac point, BL-32, BL-40. And BL-59.
Needles retained superficially at LI-20 and upper BL-10.
Direct moxibustion on GV-24, GV-10, and GV-11.
Progress: April 26 (2nd Tx) Lung deficiency. She got dizzy after having her neck and shoulders massaged.
May 20 (5th Tx) Lung deficiency. She feels depressed.
June 6 (7th Tx) She has dizziness and palpitations. She feels very depressed.
June 14 (8th Tx) Lung deficiency. She felt better for four days after the last treatment. She is sneezing; her temperature is 36.9 C. She got dizzy during the treatment, but needling LR-1 stopped it.
June 21 (9th Tx) She’s been doing great since the last treatment. A member of her family said that she didn’t seem like the same person when she got back from the treatment. She loves to clean and got tired doing it. (Manic?)
July 5 (10th Tx) She feels depressed. She got a headache, but examination at the neurologist showed no abnormality.
August 2 (13th Tx) She started a job in August at a pickling company.
August 16 (14th Tx) She is somehow getting through work.
Observations: The patient was smiling when she first came for treatment, but I suspected depression from her symptoms. After a few treatments she began to say that she had been to a hospital for treatment of depression. She has not become better all at once, but she has gained some energy and desire to work. I will remain patient, considerate and resolute about this long-term effort.
Conclusion
I will conclude with things I have noticed treating depression. In terms of examination, you can learn to tell if someone is depressed by observing his or her facial expression. There are those, however, who are depressed even though they are smiling. So you just can’t be sure. Depressed patients have a characteristic way of speaking. Rather than being taciturn, they tend to omit crucial information. So we must fully utilize the four examinations to surmise their condition.
In terms of treatment, as I stated before, it is better not to insert needles at all. They seem to tolerate super-superficial insertion better, but even this if done too much can cause fatigue. So in the beginning it is best to do as little treatment as possible. It is better to refer the patient to a specialist if you feel the case is complex or difficult. Specialists are more knowledgeable after all, and the information you get from them will serve in giving a better acupuncture treatment. Also there are very effective miracle drugs like SSRI. Many people are really helped by them. It has been pointed out, however, that the long-term use of psychotropic drugs can cause personality changes. It is very good if the use of drugs can be reduced or stopped all together with acupuncture treatments. Even so, it is dangerous for acupuncturists to give suggestions about medications. It can cause great harm. Also, one should abstain from giving words of encouragement. All you have to do is show understanding. If you say anything, all you have to do is repeat the words spoken by the patient. This give and take can be tricky when a patient has a real case of depression. It requires careful study.
I said “real depression,” but does that mean there is false depression? There seems to be. Some doctors call it pseudo-depression. When the times are hard, things sometimes don’t go according to what one would expect. Among increasing numbers of immature adults, a child can be overprotected and many are not raised to have forebearance. Children grow up used to getting their way and expect this as they get through school and go out into the world. Then they run into some difficulty. They cannot put up with it; they reach their wit’s end, and become depressed. They never think, “This is life.” “I was born to overcome challenges like this.” or “I’ll gladly take this on.” They think, “I might have depression, which is being talked about so much these days.” They go to a clinic and say that I must be afflicted with depression. Even if they think otherwise, there are doctors who will say, “Let’s prescribe a mild anti-depressant just in case.” Of course, the drugs don’t work. The patient just doesn’t have the gumption to overcome challenges. In cases like this, there is an imbalance in the Zangfu. When this imbalance is corrected with super-superficial insertion, emotional stamina is sure to increase.
Now, what about practitioners who don’t do pulse diagnosis or differential diagnosis? Is there a good approach for them? Practitioners of the Sawada style, for example. The Sawada style has standard points. My teacher said that these didn’t need to be treated unless they were tender. One might apply acupuncture instead of moxibustion on these points. As my teacher said, often there is no tenderness. I would actually select the points that are depressed or deficient. The standard points include CV-12, left TB-4, LI-11, ST-36, KI-6 (which is Sawada style KI-3), GV-12, TB-15, BL-17, BL-18, BL-20, BL-22, and BL-32. This adds up to quite a few points. You might also add GV-20 and GV-11 to these. In any case, the technique must be super-superficial insertion.
The main thing is that every practitioner can use his own treatment system. The only requirement is that the needling technique be changed to super-superficial insertion. This approach is likely to yield good results.
Human beings are composed of both mind and body, and health is a state where both the mind and body are in balance. If this is true, so many people who are unhealthy! When acupuncture is given for physical problems, not only do the physical problems disappear, but also one’s attitude becomes more positive. When acupuncture is given for a gloomy mood, not only does one’s mood improve, but physical problems are resolved as well. This is ideal, and for this result the Five Zang must be harmonized, and super-superficial insertion can be used to good effect for this purpose. I am convinced that this will bring people as close to the ideal state of health as possible.
Reference:
“Can Acupuncture Heal the Mind – The World of Super-superficial Insertion,” Journal of Japan Traditional Acupuncture Society, Vol. 29 No. 1 (#48), July 10, 2002.
“Psychosomatic Disorders and Acupuncture and Moxibustion Therapy,” Journal of Japanese Acupuncture and Moxibustion (Ido-no-Nippon), No. 719, Oct. 2003.