Neurological & Emotional Disorders
In the neurological field, headaches, migraines and neuralgia (pain distributed through a nerve or nerves, such as sciatica) are the common painful conditions treated with acupuncture. Strokes and their sequelae (conditions resulting from stroke) are another major indication for acupuncture. In the emotional and psychological areas, the most frequently treated disorders by acupuncture include stress-related and mood disorders such as insomnia and anxiety.
Headache & Migraine
There are many types of headaches. While tension headaches are most common, migraine is most debilitating. Tension-type headaches occur in up to 80% and migraine occurs in about 15% of the general population.(1,2) No matter what the type, headaches exact a heavy toll on the patients, and are responsible for significant amount of health care expenses. The most common cause of headaches is prolonged tension or stress. Most headaches disappear on their own or with the help of mild pain relievers. Although most headaches are mild, some people have headaches that are so severe they need to consult a doctor for pain relief.
Prescribed and over-the-counter medications are usually taken to alleviate headaches and migraine. Such medications are often used incorrectly or abused,(3) which can lead to a state of drug dependency. In addition, use of some drugs both frequently and regularly can have a paradoxical effect, causing headaches rather than relieving them, and leading to medication overuse headache.(4) Furthermore, the side effect of some medications should not be ignored. These include sleepiness, fatigue, dizziness, nausea, muscle weakness etc. These have led headache patients to try non-medication approaches, especially acupuncture.(5)
Numerous studies have provided evidence supporting the use of acupuncture in headache treatment. For example, a well-conducted systematic review of randomized controlled trials concluded that "needling acupuncture was superior to sham acupuncture and medication therapy for reducing chronic headache intensity, frequency and improving response rate".(6) Findings from other studies indicate that "not only did acupuncture decrease the frequency and intensity of migraines, but also the benefit had not subsided for 12 weeks after the final acupuncture session".(7) The results of validated survey show that the quality of life of chronic headache patients is significantly improved after acupuncture therapy.
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Stress, Anxiety & Depression
Stress, anxiety and depression are collectively categorized as "a vague, unpleasant and sometimes debilitating emotion that is usually experienced in anticipation of some misfortune".(1) It is believed that when we feel stressed, anxious or depressed, our brains discharges or absorbs chemicals either too rapidly or too slowly. Depressed feeling is triggered by an imbalance of specific chemicals in the brain, such as serotonin and dopamine.(2) If left alone, a chemical imbalance may become more severe as time passes.
Antidepressants and anxiolytics are most commonly used therapies for chemical imbalance in the brain. These drugs are believed to have a direct effect on key neurotransmitters. Although these medications work in about 60% of the patients, patients who use them usually experience a variety of side effects. Relapse rates are also high in about 50% of the patients.(3,4) Ultimately, many patients turn to complementary and alternative medicines (CAMs), such as acupuncture.(5)
Acupuncture has long been used to treat emotional problems, and is considered a powerful tool for management of depression and anxiety. The number of patients, particularly women, seeking acupuncture treatment for affective disorders is increasing.(6,7) According to TCM theory, Qi Deficiency (Lung and/or Kidney), Blood Deficiency (usually Liver and Spleen), Blood Stagnation (Liver), Cold Invasion causing Qi and Blood Stagnation, as well as Jing and Yuan Qi Deficiency all affect the Shen (Mind), and therefore are all associated with anxiety and depression.
Acupuncture treatment of anxiety and depression relies on the diagnosis of each individual patient and on formulating use of a distinct group of acupoints unique to each individual, along with a strategy that may also include other recommendations, including, but not limited to, herbal therapy and lifestyle modifications. Scientific studies have shown promising results in acupuncture treatment of anxiety and depression, and there is high-level evidence to support the use of acupuncture for treating major depressive disorders.(8)
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Insomnia, or sleeplessness, is a sleep disorder in which there is an inability to fall asleep or to stay asleep as long as desired.(1,2) Insomnia can be classified as transient (lasting for less than a week), acute (lasting for less than a month) or chronic (lasting for longer than a month). It is believed that 10%–15% of the adult population suffers from chronic insomnia, and an additional 25%–35% have transient or occasional insomnia.(3) Insomnia can affect people of all ages. However, people in the following groups have a higher chance of acquiring insomnia, including individuals older than 60 years, people with history of mental disorders such as depression, emotional stress, working late night shifts, travelling through different time zones.
Insomnia can be treated with medications, herbal therapy, and psychological or physical therapy. Pharmacological treatments have been used mainly to reduce symptoms in transient and acute insomnia. The role of medications in the management of chronic insomnia remains unclear, and such medications are not recommended for long-term use.(4) Long-term use of sleeping drugs may cause adverse effects such as memory damage, drug resistance, dependency, and addiction. On the other hand, nondrug therapy including acupuncture is commonly used by patients with chronic insomnia. The mechanism of acupuncture treatment is to regulate Yin and Yang, to reinforce health, to eliminate the pathogenic, and to improve sleep.
In a systematic review of randomized control trials, the majority of the trials showed that acupuncture was significantly better on improving parameters in sleep quality and duration, compared with no treatment, sham acupuncture, or medications. The review also indicates that the combination of acupuncture with other interventions appears more effective than those interventions alone.(5) In lab test, acupuncture was shown to increase the content of g-amino butyric acid that is capable of enhancing sleep quality.(6) Furthermore, both auricular acupressure and auricular acupuncture have been shown to have a hypnotic effect.(7,8)
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A stroke, or "brain attack," is the loss of brain function due to a disturbance in the blood supply to the brain. Strokes can be classified into two major categories: ischemic and hemorrhagic.(1) About 87% of strokes are ischemic, the rest being hemorrhagic. Spasticity (unusual tightness or increased muscle tone) is the most common poststroke complication, appearing in 20–40 percent of stroke survivors.(2) It not only restricts motor function but also leads to deterioration in the quality of life for stroke patients.(3,4) Therefore, poststroke rehabilitation is vital for the recovery process of stroke patients.
Rehabilitation therapy for spasticity after stroke includes medications, neuromuscular electrical stimulation, orthotics, stretching, treadmill exercises, and physical modalities, such as ultrasound, vibration, and thermotherapy.(5) However, more than half of stroke survivors with spasticity experience moderate to severe disabilities in spite of the conventional treatments.(6) These limitations have prompted researchers to look for new treatments to improve conventional treatments for poststroke spasticity. Acupuncture has been used to treat stroke patients for many years in Asian countries(7) and also recently in the West.(8)
Possible mechanisms of acupuncture for neurologic conditions include stimulation of neuronal cell proliferation,(9) facilitation of neural plasticity,(10) reduction of the post-ischemic inflammatory reaction(11) and prevention of neuronal apoptosis.(12) It has been suggested that acupuncture stimulation sends signals to the central nerve system to release opioid peptides, resulting in an increase in the threshold of pain receptors.(13) By controlling pain, acupuncture therapy helps muscles to relax and move more passively, resulting in an increase in rehabilitation.(14) A systematic review suggests that acupuncture be effective in decreasing poststroke spasticity, although long-term studies are needed to determine the longevity of treatment effects.
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