Zi-xu Wang,Jian Du,Hao Wang,Qiu-li Yang

Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China

Abstract

Key words:acupuncture; spirit management; mental disease

Introduction

Traditional Chinese medicine （TCM） psychology focuses on the spirit and mind,and emphasizes “body and spirit as a whole” and “soma and mind as a whole”.In the TCM theory,mental disease is caused by uncomfortable emotions due to internal damage by seven excessive emotions,exogenous affections by six climatic pathogens,and non-endo-non-exogenous cause （that is,socialenvironmental factors）,which induce the imbalance of Yin and Yang,dysfunction of qi movement （ascending,descending,exiting and entering）,dysfunction of viscera,intermingled phlegm and blood-stasis and other pathological states.Acupuncture treatment focuses on the spirit management.Spirit management enhances the therapeutic effects of acupuncture on dredging the channels and collaterals,strengthening body resistance and eliminating pathogenic factors,and reconciling Yin and Yang.At the same time,the process of spirit management by acupuncture reflects the thought of TCM psychology.This article will analyze the correlation between spirit management by acupuncture and treatment of mental disease as follows.

Acupuncture and Spirit Management

The term “spirit management” is first recorded in the Yellow Emperor’s Medical Canon.As stated in the “Plain Question On Protecting Your Body and Treasuring Your Life”,the key of acupuncture treatment is to concentrate on the mind,understand the excess and deficiency of five internal organs,and observe the changes of pulse manifestations in three body parts and nine pulse taking sites,followed by the needling.Notably,spirit management is the pivotal component to achieve the curative effect of acupuncture,and runs through the acupuncture therapy.To achieve spirit management,acupuncture can complete the whole process of “inspecting the mind”,“soothing the mind”,“adjusting the mind”,“guarding the mind” and“tranquilizing the mind”,and ultimately “controlling the mind”.

Inspecting the mind

Inspecting the mind refers to the detailed inspection and observation of the patient’s conditions,as well as psychological counseling given by medical practitioners,prior to the implementation of acupuncture therapy.Physicians should understand the ups and downs,excess and deficiency of the patient’s condition,and the changes in qi movement （ascending and descending）,carefully observe and know the patient’s mind and emotion,episode cause and their awareness of acupuncture therapy.On the basis of respecting the patient’s privacy,physicians provide beneficial suggestions and psychological counseling to patients,help patients to relieve from the worry and morose that may trigger disease and are caused by disease,and enhance the patient’s confidence in conquering diseases.At the same time,physicians apply acupuncture as a therapy approach to improve the patient’s body resistance,and ultimately achieve the therapeutic effect.As stated in the “Miraculous Pivot-Guan Neng”,the mechanism of acupuncture therapy should include the understandings of the physique （fatness and thinness）,body qi （deficiency and excess）,the difference between left and right,between ups and downs,the relationship between Yin and Yang,between exterior and interior,blood qi （deficiency and excess）,pulse qi circulation（reverse or smooth）.Without the understanding of qi circulation,the feasibility of acupuncture technique cannot be determined.Inspecting the root cause and signs,observing the cold-heat symptoms,identifying the pathogenic position,will ensure the therapeutic effect.As stated in the “Miraculous Pivot-Ben Shen”,needling physicians should observe the disease manifestations and the patient’s spirit and mind.Therefore,prior to the acupuncture manipulation,inspecting the mind is the key of spirit management.

Soothing the mind

Soothing the mind refers to the calm and peaceful state of both the physician and the patient maintained prior to the needle insertion.As emphasized in the “Miraculous Pivot-Xie Ke”,the principle of acupuncture therapy is to have a decorous posture and a peaceful mind.Acupuncture stimulates the body’s self-adjustment ability,so that the physiological functions,psychological bearing capability and body immunity that decline due to low mood or instability are mobilized by the body inherent positive factors,the body’s vital qi is restored and the pathogenic qi is eliminated,thus achieving relative equilibrium of Yin-Yang and a transformation from a pathological state to a physiological state.The emotions of both physicians and patients support this transformation process.As stated in the “Introduction of Percussopunctator by Poetry”,when the needling physicians maintain a clear mind during treatment,they are inventive,clever and decisive,and would not be affected by danger or shocked by great fear.When the patients maintain a clear mind during treatment,they are unflappable,have stable qi and blood,are not suspicious of needles and physicians,so that the therapy will be effective and the outcome will be doubled.Therefore,the basis of spirit management is to sooth the mind,which requires a calm and stable mood of both physicians and patients before the needle insertion.

Adjusting the mind

It is advisable to adjust the mind upon the needle insertion,mainly through two processes.On one hand,the needling physicians should pay full attention to the needle insertion,and should not hesitate.They should concentrate their attention on the thumb and index fingers,produce the force penetrated at the needle tip,and act in quick and agile manner.When the patient feels the needle or even has no feeling,the needle has already been inserted.This will enhance the patient’s trust in the physician,promote the patient’s treatment compliance,and facilitate the therapeutic effect of acupuncture; On the other hand,the physicians should emphasize on the patient’s mood and qi during treatment,and rapidly insert the needle only when the patient is in a cathexis.As stated in the “Compendium of Acupuncture and Moxibustion”,when an acupuncture therapy is scheduled to be performed,the patient should be calm and have stable breaths.The physician should also have the above conditions and should not be in a hurry.Only when both physicians and patients are consistent in their mood and breath,the needles can be inserted smoothly,and the treatment is successful[1].At the optimal timing for acupuncture,the physicians and patients are well communicated and cooperated,therefore the physicians concentrate on the needle manipulation,and are intent on the manipulation,as shown in “Miraculous Pivot Nine Classical Needles and Twelve Yuan Acupoints”.

Guarding the mind

It is advisable to guard the mind after the needle is inserted,the patients maintain a peaceful and concentrated mind,accordingly the needling can regulate channel qi and directly act on the lesions.Therefore,after the needle is inserted,the physicians should guide the patients to focus on the acupuncture site,thus enhance the patient’s awareness of propagated sensation along meridians,feel the conduction of the needle,and transfer the qi to the lesions.As stated in the “Miraculous Pivot-Nine Classical Needles and Twelve Yuan Acupoints”,the key of acupuncture therapy is focal arrival of acu-esthesia.Qi arrival plays a pivotal role on determining the therapeutic effect of acupuncture.The ancient doctors believe that,needling manipulation is targeted on the fullness of vitality and arrival of qi.During the needling manipulation,it is necessary to concentrate their attention,conduct finger operations,maintain calm mood and smooth manipulation,and focus on the needle.Meanwhile,physicians should closely monitor the patient’s reaction,carefully capture any sign of qi arrival,ensure the needle act on the lesions,and accordingly achieve persistent effect of acupuncture therapy.Therefore,guarding the mind plays a vital role in the acupuncture process.

Tranquilizing the mind

It is also essential to instruct the patient to calm down and regulate emotions after the needle is withdrawn.In addition to avoiding damage to the human body caused by pathogenic factors in the external environment,it is more important to pay attention on the tranquility and internal concentration within the human body（internal environment）[2].In the TCM psychology theory describing the correlation between five internal organs and mental disorders,mental disease is caused by five excessive emotional activities,which damages five internal organs and induces the visceral dysfunction.Therefore,during the acupuncture treatment,patients should be instructed to tranquilize the mind,regulate emotions,improve mental state,stabilize the mood,which can regulate the vitality,eliminate pathogens and recover the health.

In the whole process of tranquilizing the mind,a close cooperation between physicians and patients is required to comprehensively manage the spirit.The combination of acupuncture as a bridge and psychological guidance,the therapy can dredge the meridians,induce smooth arrival of qi,harmonize the Yin and Yang,strengthen body resistance and eliminate pathogenic factors,thereby removing stagnation and stasis,and improving the curative effect against mental disease.

Acupoint Selection and Mental Disease

In the TCM theory,the viscera is an organic entirety.Qi and blood are the material basis of life activities.The meridians and collaterals are connected to each other.Acupuncture treats mental disease by dredging the channels,regulating qi and blood,improving the visceral function,and reconciling the state of spirit and body to achieve satisfactory therapeutic effect.

Characteristics of acupoints for treating mental disease

The acupuncture points used to treat mental disease are mostly located on the head and face,and follow the Governor Channel.In the “Indications of Acupoints,National Standard”,there are a total of 80 acupoints intended to treat mental disease; Shenmen acupoint is the most frequently used to treat diseases,followed by Baihui acupoint; The channels involved are Governor Channel,Taiyang Bladder Meridian of Foot,Taiyang Small Intestine Channel of Hand,Yangming Stomach Channel of Foot.Among them,Governor Channel contains the most acupoints,accounting for 17 acupoints and 21.25%.The acupoints are mainly located on the head and face,upper limbs,lower limbs,back and waist,chest and abdomen.Those on the head and face account for 30% of the total acupoints[3].

Selection of acupoints for treating mental disease

The rule of acupoint selection in the treatment of mental disease is as follows:

1.A combination of acupoints is selected based on the excess and deficiency of the viscera related to the occurrence of mental disease.The pivotal viscera involved in mental disease are first identified,and the deficiency and excess of the condition is then distinguished.According to the therapeutic principle of reinforcing deficiency and reducing excess,the viscera involving the twelve channels and collaterals are the target,the deficiency syndrome is treated with back-shu point,which is the concerted application of yuan-primary point and he-sea point in this meridian,while sthenic syndrome is treated with xingspring point and front-mu point in this meridian.

2.According to the correlation between five internal organs and mental disorders,the seven emotions correspond to five internal organs.The liver is affected by anger,the heart is affected by joy,the spleen is affected by anxiety,the lung is affected by sorrow,and the kidney is affected by fear.Different emotions cause diseases,because the balance and coordination between the viscera are destroyed,and the body’s metabolic function is abnormal,which leads to various diseases.According to the principle of selecting acupoints for mental disease that damages five internal organs,the main acupoints in superficies-interior channels involving the five internal organs include yuanprimary point,he-sea point,front-mu point,back-shu point and the luo-connecting point.

3.The mental disease is mostly caused by damage of heartspirit.As stated in the “Plain Question-Linglan Midian Lun”,the heart is the monarch organ,and controls mental and emotional activities; the heart also governs the internal organs.The heart controls the mind,so acupuncture points are often selected from Shaoyin Heart Channel of Hand and Jueyin Pericardium Channel of Hand.Shenmen（the yuan-primary point in Channel of Hand） and Daling（the yuan-primary point in Pericardium Channel of Hand） are selected to tranquilize the mind; Neiguan （the luo-connecting point in Pericardium Channel of Hand） is selected to relieve depression; Xinshu （back-shu point） is selected to benefit heat qi.

4.As stated in the “Compendium of Materia Medica”,brain is fu-viscera of mental activity.It indicates that,acupuncture regulates the Governor Channel to regulate the mind,restore and resuscitate consciousness.Baihui,Shuigou,Suliao,Shenting,Shangxing points along the Governor Channel on the head are selected.While Siguan point is also selected to activate blood circulation and dredge collaterals.Taixi and Xuanzhong are selected to nourish the brain.Governor Channel governs the Yang qi in human body.As stated in the “Miraculous Pivot-Meridian”,Governor Channel together with Foot Taiyang,originates from the medial angle of eye,travels to the forehead and crosses on the parietal site,develops meridian stagnation in the brain,and return to the brain.As stated in the “Classic of Questioning on 28 Medical Problems”,Governor Channel originates from the perineum and enters the brain.Governor Channel runs along the spine and enters the collaterals in the brain,the brain is the fu-viscera of mental activity,so the spirit activity of the Governor Channel is closely related to the brain[4].Professor Yang Jun believes that the pathogenesis of mental disease is abnormalities of seven emotions and pathogens of six depressions,which lead to dysfunctions of human viscera,abnormal circulation of qi,blood and body fluid,and loss of brain function.The use and combination of acupuncture points in Governor Channel are often applied in treatment of mental disease,to regulate the whole body,nourish the body and spirit,calm and tranquilize the nerves,and harmonize Yin and Yang[5].

5.The main therapeutic principle in treatment of mental disease is to regulate qi movement.The main treatment approach is to regulate qi and adjust liver.Tanzhong acupoint,commonly known as “the upper reservoir of qi”,is a point where vital energy assembles among the eight influential points.This acupoint is selected to promote qi,regulate qi,relieve stuffiness of the chest-diaphragm,relax heart and guide qi downward; Neiguan,the luoconnecting point in Jueyin Pericardium Channel of Hand,is a point where Shaoyang Sanjiao Channel of Hand and Jueyin Pericardium Channel of Hand are connected.This acupoint is selected to regulate Sanjiao qi.Hegu is the yuan-primary point of Yangming Large Intestine Channel of Hand,and can promote qi and relieve pain,stop endogenous wind and relieve spasm,restore and resuscitate consciousness.Taichong is the yuan-primary point of Jueyin Liver Meridian of Foot,and has significant effect on regulating qi movement.Hegu and Taichong,also known as “Four Opening Points”,can sooth the liver and regulate qi,harmonize qi and blood.Therefore,the compatibility of the above acupoints can regulate qi and relieve depression,enhance the circulation of qi and blood.

6.According to the inter-restriction between emotions and the principle of acupoint selection at five-shu point,for example,anger impairs the liver,the liver controls anger,sorrow prevails over anger,that is mental restricts wood,therefore,the method of converging lung gold is used to extinguish liver fire.Clinically,Taichong and Xingjian in the liver meridian are often used,in combination with Yuji（xing-spring point）,Jingqu （jing-river point） and Chize（he-sea point） in Taiyin Lung Channel of Hand.

7.In addition,thirteen ghost acupoints play miraculous effects in the treatment of mental disease.Tao Ying has summarized the effect of ghost acupoints in the treatment of mental disease within recent 10 years.Results demonstrate that ghost acupoints can balance Yin and Yang,regulate qi and blood,resuscitate the mind,calm the heart and tranquilize the nerves,indicating optimal effect on treating mental diseases[6].

Notably,acupuncture has its systematic treatment principle and acupoint selection rules in the treatment of mental disease.Therefore,acupuncture is an effective approach in the treatment of mental disease,especially for depression syndrome （Melancholia）.

Wu Ling-xiang and Chen Jun-qi et al have conducted retrospective studies on the acupuncture therapy of depression syndrome since 2000.Results demonstrate that moderate depressive disorder is an indication of acupuncture therapy; the appropriate therapy frequency should be 11-20 times; Baihui and Neiguan are the most frequently selected acupoints.A combination of Baihui with Neiguan and Taichong,Baihui with Neiguan and Sanyinjiao can serve as the optimal point combination.The treatment approach is mainly acupuncture,and clinical efficacy of electroacupuncture alone and acupuncture alone is better than that of Fluoxetine alone,and the combination of acupuncture combined with Fluoxetine can improve clinical efficacy[7-8].

The existing clinical studies on acupuncture therapy of depression syndrome in China and globally have their own characteristics and problems.For example,Kou Renzhong et al found that the literature of Chinese researches attached great importance to the syndrome differentiation of acupuncture,and various types of acupuncture intervention and biological effect indicators were applied.The literature of foreign researches presented advantages on RCT quality,and the baseline evaluation and effect evaluation systems were more comprehensive,in addition,more attention was paid to quantitative design of clinical parameters.It was concluded the differences between Chinese and foreign clinical research of acupuncture for depression were unfavorable for the evidence-based research,and the overall quality of researches was in need of improvement.It was recommended the future researchers should be designed and reported in accord with unified criteria,and the registration of acupuncture clinical trial should be valued,which could promote the integration of research results and improve the overall researches level[9].

In summary,the concept of spirit management by acupuncture and the systematic treatment system have significant effects in the treatment of mental disease.Our findings can not only embody the characteristics of acupuncture technique,also demonstrate the psychotherapy and humanism thought throughout the acupuncture therapy,thus providing a more comprehensive approach for the treatment of mental disease.