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General situation of acupuncture treatment of depression in recent years

General situation of acupuncture treatment of depression in recent years

2017-04-13 10:36:44 Chinese Society of Acupuncture and Moxibustion

Ma Lanping Translation

(Institute of Acupuncture and Moxibustion, China Academy of Chinese Medicine, Beijing 100700)

According to the most conservative estimates, there are more than 26 million people suffering from depression in China, and the number of people suffering from depression worldwide is increasing, and 10% to 15% of depression patients are at risk of suicide. Experts predict that by 2020 In 2015, depression will become the second killer of human beings after cancer. The cause of this disease is not yet fully understood, and may be related to psychosocial factors, genetic factors, neuroendocrine and central neurotransmitter dysfunction. Depression is generally divided into two categories: exogenous and endogenous. The so-called exogenous usually refers to depression caused by external environmental events, such as reactive depression and depressive neurosis. The endogenous depression is caused by physical “internal” factors. It is a group of mental disorders characterized by persistent low emotions, which can be accompanied by changes in thinking and behavior, and often suffer from sleep disorders and loss of appetite. , Dry mouth, constipation and other physical symptoms. There are many treatment methods for depression, such as psychotherapy, sleep deprivation therapy, phototherapy and electroconvulsive therapy, etc. However, in modern times, drug therapy is still the mainstay and psychotherapy is supplemented. Acupuncture therapy has received very good results in the treatment of depression. It has a very good effect on exogenous depression such as post-stroke depression, and its effect on endogenous depression is also very significant. This article reviews the literature on acupuncture and moxibustion treatment of endogenous depression in recent years, hoping to help clinical work.

1 Theoretical basis

    Depression is the name of a modern medical disease. According to its clinical manifestations, combined with ancient medical records, its similar symptoms include depression, mania, mania, lily disease and so on. Wang Lingling et al. [1] researched that the disease is located in the brain, involving liver, heart, spleen, kidneys and other internal organs. The main pathological change is Qi disorder, leading to stagnation of Qi, internal resistance of phlegm and blood stasis, disturbance of brain, brain Loss of regulation, or chronic illness, the qi and blood essence cannot be promoted in the brain, the brain is out of regulation, and emotional symptoms such as low mood and decreased performance appear; Seven emotions are out of control, causing the five internal organs to be unbalanced, phlegm and blood stasis blocking the meridian, and There are various physical symptoms. Treatment should be based on the syndrome differentiation of the main symptom. The basic principle of acupuncture treatment of this disease is to regulate the mind and qi, take the points of the Du Channel meridian to invigorate the brain and regulate the mind, and take the points of the liver meridian to soothe the liver and relieve depression and adjust emotions. Liu Yang et al. [2] believe that the pathogenesis of depression is mainly liver failure, spleen failure, heart failure, and visceral yin and yang qi and blood imbalance. The disease location is mainly in the liver, and on this basis, the heart, spleen, and kidneys. All dirty. Human emotional activity mainly depends on the normal operation of qi and blood, which is also inseparable from the liver’s function of dredging, so the key to treating depression is to regulate the function of dredging. Xie Buni et al. [3] believe that the basic pathogenesis of depression is the obstruction of orifice, the disorder of qi and blood is the material basis of the onset of depression, and the imbalance of the viscera is the pathological basis of the onset. The main physiological function, combined with the regulation of qi, blood and viscera functions, has a good prospect for clinical use in the treatment of depression. Liu Lanying et al. [4] believe that depression is mostly caused by various life events that cause long-term depression of mood and can not be alleviated, causing brain-organ qi disorders, brain disorders and causing the disease, and at the same time affects the functions of the heart, liver, spleen, and kidneys. The main pathological changes are Qi disorder, which can be seen in the pathological changes such as Qi stagnation, internal resistance of phlegm and blood stasis, liver depression and fire, liver depression and spleen deficiency, heart and spleen deficiency, spleen and kidney yang deficiency and other pathological changes, which affect the brain. “The brain is the home of the soul”, so regulating the brain is the fundamental principle of acupuncture and moxibustion for the treatment of this disease. The treatment takes the Du Channel acupoints to invigorate the brain and regulates the mind. It can reduce the treatment of concurrent symptoms and achieve better curative effects. Liu Ligong et al. [5] analyzed the characteristics of ancient acupuncture and moxibustion for depression syndrome and collected 93 ancient medical books. The frequency of selecting acupoints along the meridian in descending order is Heart Meridian, Pericardium Meridian, Bladder Meridian, Du Meridian, Ren Vessel Points, spleen and stomach meridian points. The characteristics of partial acupoint selection are the upper limb Yinmian acupoints, the head acupoints, the foot Yinbu acupoints, the upper back and the chest cavity acupoints. Through analysis, it is determined that the reference prescriptions for acupuncture treatment of depression are Daling, Laogong, Jianshi, Shenmen, Tongli, Shaochong on the pudendal area of ​​the upper arm; Baihui, Shuigou, Fengfu on the head and face; and yong on the yin surface of the foot Quan, Rangu, Gongsun, Shangqiu; Xinyu, Shendao, and Danshu on the back of Shang; Zhongwan and Shangwan on the chest.

2 Mechanism research

    The research on the mechanism of acupuncture and moxibustion in the treatment of depression has gone deep into all aspects. Huang Yong et al. [6-12] did a series of studies, observing the changes of glucose in each brain area of ​​normal people and depression patients. The results of the study showed that the brain glucose metabolism of depression patients is indeed different from that of ordinary people. The glucose metabolism of the temporal lobe, occipital lobe, and thalamus on both sides is higher than that of normal people, and the glucose metabolism of parietal lobe is slightly lower than that of healthy people. After scalp acupuncture treatment, the abnormal metabolism can be restored to normal. The brain is consistent.

    Han Wei et al. [13] observed the effect of electroacupuncture on serum cytokines in patients with depression, and the results showed that the levels of serum IL21β, IL26, and TNF2α in patients with depression before treatment were significantly higher than those in normal people. They were treated with electroacupuncture and tetracyclic antidepressants. The drug maprotiline treatment, with the relief of depression symptoms, the levels of the above cytokines gradually decreased, and basically returned to normal by the 6th weekend, indicating that cytokines play a certain role in the onset of depression, and electroacupuncture inhibits cytokines. The role is one of the mechanisms of electroacupuncture in the treatment of depression. Qian Ruiqin et al. [14] observed that the combined treatment of electroacupuncture and Shuxuening can improve the immune function of patients with depression. Li Haiyan et al. [15] studied the effect of electroacupuncture and fluoxetine on platelet protein kinase C (PKC) in the treatment of depression, and the results showed that electroacupuncture and fluoxetine had an effect on the changes of PKC content in different subtypes of platelet membrane and platelet substance. The different effects suggest that the post-receptor mechanism of electroacupuncture treatment of depression is different from fluoxetine. Song Yuqing et al. [16] observed the changes in platelet membrane guanylate binding protein content before and after treatment of depression with electroacupuncture and fluoxetine, and the study showed that the concentrations of platelet membrane Gαi and Gαq in untreated depression patients were significantly higher than those of normal controls. After antidepressant treatment, their high-level state cannot be changed. It is speculated that GαI and Gαq are characteristic signs of depression, rather than state signs. Tang Shengxiu et al. [17] observed the effect of electroacupuncture on the serum thyroid hormone level (FT4) in patients with depression, and the results showed that when acupuncture has a significant effect in the treatment of depression, it is accompanied by a decrease in the level of thyroid hormone, indicating that acupuncture is in the process of treating depression FT4 acts as a medium and consumes moderately. Xu Hong et al. [18] observed the effect of acupuncture on the hypothalamic-pituitary-adrenal (HAP) axis in patients with depression, and the results showed that the effect of acupuncture on the HPA axis of depression patients is state-dependent, that is, with acupuncture With the emergence of curative effect, the patient’s HPA axis function has gradually returned to normal.

    In addition to the clinical mechanism study of depression, animal experiments were conducted at the same time. Jia Baohui et al. [19] discussed the model of electroacupuncture antidepressant research, and the results showed that the experimental study of acupuncture on depression should choose animals with depression induced by changing environmental conditions The model is performed, and the drug-induced depression model may be inappropriate. Han Yan et al. [20,21] observed the effects of electroacupuncture on the HAP axis, central and peripheral monoamine neurotransmitters in depressed rats. Some scholars have observed the behavioral changes of acupuncture in depressed rats[22,23]. Many scholars have observed the effects of acupuncture on the brains of depressed rats [24-28].

    Among the various hypotheses on the pathogenesis of depression, the most convincing one is the imbalance of monoamine neurotransmitters. Most antidepressants support this hypothesis by increasing the level of neurotransmitters in the synaptic cleft to produce antidepressant effects [16]. It can be seen that whether it is for depression patients or depression rats, the research focuses on brain material metabolism, changes in monoamine neurotransmitters, changes in the HAP axis, etc., which will be the mechanism of depression Explore and provide basis for further in-depth research in the future.

3 Clinical research

    The literature on clinical research on depression is very rich, and the research level is relatively high, most of which are controlled observations, including electroacupuncture[29-36], acupuncture[37-40], abdominal acupuncture[41] and western medicine. Contrast, electroacupuncture[42-46], acupuncture[47,48] combined with western medicine or electroacupuncture combined with placebo[49] compared with western medicine, electroacupuncture combined with traditional Chinese medicine[50,51], comprehensive therapy[52] and traditional Chinese medicine In contrast, electroacupuncture combined with western medicine and electroacupuncture [53-55], and simple acupuncture [56], ear acupuncture [57] or electroacupuncture treatment [58-61] and comprehensive therapy [62-67]. The above various methods have achieved good curative effects in the treatment of depression. It can be seen that in the treatment of depression, electroacupuncture is the most widely used, and its curative effect can be equivalent to that of the control treatment of Chinese and Western medicine; when it is used as an adjuvant therapy, it can be Improve the treatment effect, which provides reliable evidence for the treatment of depression with electroacupuncture. In the future, electroacupuncture can be used as a key treatment method for the treatment of depression.

4 summary

    In summary, acupuncture has a profound theoretical basis for the treatment of depression, and clinical and animal experiments are also abundant. A large number of clinical studies have shown the effectiveness of acupuncture in the treatment of depression. In future research, the study of electroacupuncture parameters and the standardization of acupuncture prescriptions should be deepened. In the past, scholars have made statistics on the frequency of acupuncture and moxibustion treatment of depression. Baihui, Yintang, Neiguan, Sanyinjiao, Sishencong Shenmen is the most commonly used acupuncture point[68], which is basically similar to the acupoint selection rules of the articles involved in this review. The selected acupoints are the result of syndrome differentiation and treatment, which is very consistent with the understanding of the etiology and pathogenesis of depression in TCM and reflects TCM. Dialectical correctness. Compared with western medicine, acupuncture treatment of depression has great advantages in reducing side effects and can increase the patient’s compliance with treatment, thereby improving the treatment effect. Therefore, acupuncture and moxibustion have extremely broad prospects for the treatment of depression.

Translation Acupuncturist, Hua Ying lyle, United Kingdom

5 References

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