abstracted & translated by
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

On pages 42-43 of issue #12, 2007 of Xin Zhong Yi (New Chinese Medicine) there is an article titled “Observations on the Therapeutic Efficacy of Treating 176 Cases of Psychological Depression by the Methods of Acupuncture for Regulating the Liver.” This article was written by 12 authors, the first of which was Fu Wen-bin. This article describes a three-wing comparative study conducted at several different hospitals in differing provinces in China from October 2004 to December 2006.

Cohort descriptions:

Altogether, there were 440 cases enrolled in this study, all of whom met the criteria for unipolar depression based on the Hamilton Depression Rating Scale (HAMD) and who also exhibited either the pattern of liver qi depression and binding or qi depression transforming fire based on the Zhong Yi Bing Zheng Shen Duan Liao XiaoTiao Shun (Criteria for Chinese Medical Disease & Pattern Diagnosis and Therapeutic Efficacy). All these patients were required to be between 18 and 65 years of age, to be free of serious concomitant cardio- or cerebral vascular disease, liver, kidney, or systemic blood disease, and not pregnant. These 440 cases were then randomly divided into three groups: 1) a liver-regulating acupuncture treatment group, 2) a Prozac treatment group, and 3) a sham acupuncture group.

In the liver-regulating acupuncture group, there were 176 cases, 67 males and 109 females, with a median age of 41.87 ± 12.29 years and a median disease duration of 4.59 ± 3.00 years. Thirty of these cases had been previously treated with Western medicine and 20 had been treated with psychotherapy.

In the Prozac treatment group, there were 176 cases, 54 males and 122 females, with a median age of 39.88 ± 11.04 years and a median disease duration of 3.91 ± 2.38 years. Fifty-four of these cases had been previously treated with Western medicine and nine had been treated with psychotherapy.

In the sham acupuncture group, there were 88 cases, 28 males and 60 females, with a median age of 43.51 ± 11.43 years and a median disease duration of 4.59 ± 2.83 years. Fourteen of these cases had been previously treated with Western medicine and three had been treated with psychotherapy.

Therefore, in terms of age, sex, disease duration, and prior treated, these three groups were considered statistically comparable for the purposes of this study.

Treatment methods:

All members of the liver-regulating acupuncture group were needled at:

Si Guan (the Four Bars, i.e., Tai Chong, Liv 3, and He Gu, LI 4)
Bai Hui (GV 20)
Yin Tang (M-HN-3)

The Four Bars were needled perpendicularly to a depth of 0.5 inches. Bai Hui was needled subcutaneously at a 30 degree angle to a depth of 0.5 inches. Yin Tang was needled level or parallel to the skin also to a depth of 0.5 inches. Twisting and turning of the needles was administered until the qi was obtained and then stopped. The needles were then retained for 30 minutes accompanied by the abducting the qi method. Patients were instructed to breath in and out through their noses deeply. In addition, ear acupuncture using press needles was applied unilaterally at the Liver and Heart points. These needles were retained for three days and then switched to the opposite ear. This treatment was carried out two times per week for a total of three months.

All members of the Prozac treatment group were orally administered 20mg of American-made Prozac per day for three months.

In terms of the sham acupuncture, needling was carried out at none-point points 0.5 centimeters to Tai Chong, He Gu, Bai Hui, and Yin Tang. Similarly, non-acupoint points were needled in the ear. The techniques of depth, manipulation, and retention were the same as those used on the liver-regulating acupuncture group. Likewise, treatment was administered two times per week for three months.

Patients who experienced sleep disturbances during their participation in this study were allowed to take 1-2mg of Valium for a short period of time.

Study outcomes:

All patients in this study were assessed by the HAMD prior to treatment and then at one, two, and three-month intervals. In addition, the incidence of side effects were scored via the Asburg Depression Medicinal Side Effects Rating Scale (SERS). The following table shows the comparative mean HAMD scores in the three groups at various intervals.

This shows that, at the end of three months of treatment, the liver-regulating acupuncture group as a whole experienced a significantly better reduction in their HAMD scores than did the Prozac group or the sham acupuncture group. In this case, the liver-regulating acupuncture group got a better therapeutic effect than the Prozac group which got a better therapeutic effect than the sham acupuncture group.

In terms of side effects as a result of treatment, the mean SERS score in the liver-regulating acupuncture group was 0.16 ± 0.95, while it was 6.51 ± 5.09 in the Prozac group and 0.23 ± 1.36 in the sham acupuncture group. Thus when you take into account the better therapeutic effect with less side effects, the liver-regulating acupuncture was clearly a better treatment than Prozac.

Discussion:

According to the authors of this study, psychological depression and liver qi depression and binding are closely related. Therefore, they chose the Four Bars plus Bai Hui and Yin Tang as the main part of their real acupuncture treatment. Bai Hui is a meeting point of the liver channel and governing vessel which is also situated at the vertex of the cranium. It rectifies the qi and regulates the liver as well as arouses the spirit. Yin Tang is a governing vessel point located between the glabella. It is also a meeting point of the governing vessel and liver channel. Therefore, it also has a coursing and abducting function. Tai Chong is the source point of the liver channel which mainly governs “chest and rib-side branch fullness.” when combined with He Gu, these two settle, still, and quiet the spirit, level the liver and extinguish wind. The addition of the ear points increases and strengthens the coursing of the liver, rectifying of the qi, and resolving depression. By using ear needles retained between regular body acupuncture session, the therapeutic effects are secured and consolidated.

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