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Case Report
A Case Report Demonstrating the Efficacy of Acupuncture as a Viable Treatment for Mild Episodes of Depression
Pamela E Hall1,2* DOM, MAc, MOM, BS, LAc
1University of Baltimore, Baltimore, USA
2Maryland University of Integrative Health, Maryland, USA

ABSTRACT
The diagnosis of depression has increased significantly in the United States within the past twenty (20) years. Many who are diagnosed with depression are placed under a doctor’s care and are prescribed antidepressants. The antidepressants are categorized based on which neurotransmitters, whether serotonin, dopamine or nor-epinephrine, the drug is elevating or restricting in the body. The method of drugs is an individual trial run as what works best for one patient may not be the best for another. This case study is reflective of treatments administered to a patient seeking assistance for episodes of mild depression following a major event in her life. The symptoms of the patient, who showed classic signs of mild episodes of depression, had improved remarkably. The patient’s chief concerns, in her own words were ‘stress relief, over thinking and needing (her) spirit to be elevated”. In the months leading to her initial treatment, she spoke of feeling sad all the time, being unable to sleep, loss of appetite, ruminating thoughts, weight loss (without effort on her part), lengthy crying spells and saw no hope for the future. After five (5) treatments, the patient began making plans for her future. She saw improvements in her sleeping habits, her appetite increased and she began an exercise program at a local gym. The crying spells decreased significantly and her overall mood began to be elevated. The patient received a total of eleven treatments. In this patient’s case, acupuncture proved to be an appropriate therapeutic intervention for the treatment of mild episodes of depression.

Introduction
The principle strategy that was utilized was the JR Worsley Five Element treatment strategy. This strategy consists of 1) clearing away any blocks that would hinder the effectiveness of treatment, 2) determining and treating the Causative Factor (CF) of the patient which can be described as the element in which disharmony would more than likely appear when there is an imbalance within the patient, 3) balancing and strengthening the patient’s meridian system, 4) providing support for and facilitating the body’s natural healing abilities. On average, following the initial intake, these could take at least five to six treatments that include both dispersion (pulling energy from an overactive meridian) and tonification (supporting the weakened meridian).

The patient is a thirty-five year old African American female who works the night shift at a local warehouse. In her initial examination, employing the diagnostic criteria of color, sound, odor and emotion, her color was blue, the sound of her voice was a groan, her emotion was very deep fear and her odor was putrid. She sat planted and low in the chair, she picked at her hands and her voice trembled as she spoke. Based on this observation, the student practitioner determined her causative factor to be the water element. She revealed a history of severe traumatic experiences and being ‘set off’ by the recent event of a one year relationship coming to an abrupt end. It was noted that she had never been formally diagnosed with nor treated for depression.

Statistically, the Center for Disease Control and Prevention (CDC) reports that over 80% of people with symptoms of clinical depression are not receiving any specific treatment for depression. Throughout the interview, the patient referenced that she was aware of her shifting from being happy and social to becoming more withdrawn from getting to know people.

Between 2009 and 2012, 7.6% of Americans aged twelve and over experienced depression ranging from moderate to severe with symptoms that lasted at least two weeks [1]. The patient reported having experienced three months of disturbed sleep, crying episodes, feelings of regret and grief at the loss of the recent relationship which prompted memories of abusive past relationships and traumas of domestic violence which led to the still birth of her first and only child. When speaking of these personal issues, she often sat with her arms wrapped around herself, as if protecting herself. The patient was very open in discussing her painful experiences even though it was apparently difficult for her to do so.

Many people report serious difficulties in social activities. Although the patient is actively working and has successfully sustained employment in the same company for over seven years, she often referenced a feeling of uselessness because she has been diagnosed since childhood with dyslexia and spent her school years in special education. In understanding the classical Five Element Acupuncture Theory, when a patient’s causative factor is determined, this does not change except in the intensity due to the relative state of balance in the individual. The other exceptions are regarding specific findings such as an energetic block. All of the patient’s treatments are to support, harmonize and benefit their primary imbalance whether on a body, mind and/or spirit level depending upon how the patient presents for that treatment [2]. After all of the treatment blocks were cleared and in the interaction with the patient, it was determined, with the guidance of the licensed clinical supervisors, that the patient would be treated in the water element which include the energetics of the bladder and kidney meridians.

Depression is a serious medical illness with mood, cognitive and physical symptoms. It is associated with higher rates of chronic disease, increased healthcare utilization and impaired functioning. Rates of treatment remain low and the treatment received is often inadequate. Therefore, treating this patient in Classical Five Element Acupuncture on the water element and providing a nurturing space for her proved to be a successful measure throughout her treatment process.
Case Report Description
Treatment determination was based upon the Worsley Five Element method of observing color (the patient’s skin, particularly around the eyes); sound (the voice quality); odor (natural fragrance emanating from the patient) and emotion (energetic display of the patient). Other diagnostic tools included the quality and quantity of the patient’s pulses, her tongue and any reported symptoms of the patient.

Needle depth varied depending on the treatment being performed. Needle depth ranged from one to five fens. Needle action was determined by the treatment being administered. For dispersion treatments, needles were inserted at full fen depth right to left, top to bottom, against the meridian’s natural flow of energy and were rotated 180° counter clockwise. For tonification treatments, needles were inserted at full fen depth, left to right, top to bottom and rotated 180° clockwise with the natural flow of the meridian’s energy. The only exception being the Aggressive Energy treatment (AE) where the needle depth is very shallow, approximately one fen and no needle action such as rotation is required [2]. The patient for this case report was treated eleven times within a four month period.

Outcomes of this case study can be measured by the color, sound, odor, emotion paradigm as well as pulse and tongue quality and individual account of the patient regarding the shifting of her quality and overall health. Although the patient later showed signs of emotional regression it was, in part, due to a prolonged length of time between appointments due primarily to her feeling better and the decrease in finances. However, once her financial situation improved and she realized the correlation between her improvement and acupuncture, treatments resumed and her quality of health once again improved.
Discussion
The acupuncture rationale that was used by the practitioner to determine diagnosis was JR Worsley’s Classical Five Element method. The patient’s color (skin), sound (voice), odor (natural body fragrance) and emotions (energetic display) were observed. This also included the quality and quantity of the pulses and tongue. The standard series of Five Element strategies were followed. This consisted of removing ‘blocks’ that could hinder the effectiveness of the treatments that were to come.

The initial Worsley Five Element treatment was the first of three ‘clearing’ treatments. The primary diagnosis for performing this treatment is the absence of ‘Shen’ (glow/life) in the patient’s eyes. The absence would suggest an internal blockage. Other supportive signs for this treatment include the patient having no control of their mind, spirit or body and the patient may even claim that ‘something’ has a hold of them. Talking to the patient will be like talking to a shell and the practitioner may even feel uneasy in their presence.

The acupuncture points for this treatment are: the master point approximately 6 3/4 inches above the umbilicus on the anterior meridian line, stomach 25 (Heavenly Pivot), stomach 32 (Prostate Hare) and stomach 41 (Released Stream). The points were ‘dispersed’ by needles being inserted approximately three to five fen depth, from right to left, top to bottom against the direction of the meridian’s natural flow of energy. The needles were rotated 180° counter clockwise and removed by order of insertion and were retained for approximately twenty (20) minutes. After this treatment, the patient reported being able to ‘feel the energy circulating’ and that she felt relaxed. The color returned to her face and was a deeper blue. Her odor had a more defined putrid smell and the Shen returned to her eyes. In the days that followed, the patient reported feeling elevated as if ‘something had been lifted’ from her.

The second treatment was also a clearing treatment. It is used when a patient has experienced a degree of external factors which may have contributed to the impediment of energy properly flowing through the meridians. In this particular case, it was reported that by the patient that she had experienced years of physical abuse at the hands of a significant other who was a mixed martial arts fighter. This resulted in the still-birth and burial of her only pregnancy. This procedure is administered using the dispersion technique as stated above and the acupuncture points in GV20 (place of 100 meetings), bladder 11 (great shuttle), bladder 23 (kidneys correspondence) and bladder 61 (servant’s aide) and were retained for approximately twenty (20) minutes. Immediately following this treatment, the patient remarked that she ‘came in stressed and sad and (doesn’t) feel that way anymore’. She stated that she felt ‘relaxed’ and that her mind felt ‘calm’.

The third treatment that was administered to the patient tested for what is called aggressive energy. With this procedure the test is also the treatment and the only way to test for the presence of aggressive or toxic energy is to perform the procedure. This is done by inserting needles at a very shallow fen depth (approximately one) with one ‘test’ needle inserted in a non-acupuncture point at each of the three Jiao on the back. The points used for this treatment included bladder 13 (lungs correspondence), bladder 14 (circulation-sex correspondence), bladder 18 (liver correspondence), bladder 20 (spleen correspondence), bladder 23 (kidneys correspondence) and lastly, after all others have cleared, bladder 15 (heart correspondence). If aggressive or toxic energy is present in the patient’s body, the acupuncture needles that have been inserted in the specified points will produce a reaction that will turn the area surrounding the needles red. This appearance will be different from the histamine affect that will be produced by the ‘test’ needles placed in non-acupuncture points in the three Jiao areas. The color will be deeper, the diameter will be wider and if the practitioner were to place their hands over the patient’s back, they will feel heat emanating from it. When the toxic energy has been cleared, the color of the patient’s skin will return to normal and coolness or the absence of heat will be felt when the practitioner places their hand above the needles. After this treatment, the patient reported immediately feeling relaxed, ‘good all over’ and elevated mentally.

The Akabanes treatment is used to test the Yinyang balance of the body.  All twelve meridian pathways are tested using an incense stick which is saved or held over specific Acupuncture points on the nail beds of the fingers and toes.  If the patient is able to feel the warmth more on one side of the body than the other, the side where the point is least felt is considered out of balance and the junction point of that meridian is tonified.  A junction point is a point where two or more meridian pathways connect.  If, up on second testing, the imbalance is still present, then the source point is tonified.  A source point is where energy can be easily and abundantly accessed without causing harm to the body [2].

The patient returned for her next appointment two weeks later. This appointment, treatment number five (5), was the first needling in support of what JR Worsley terms the Causative Factor (CF). A tonification procedure was administered using the source points for the water element; bladder 64 (capital bone) and kidney 3 (greater mountain stream). Needles were inserted a full fen depth in the direction of the flow of energy within the meridian from left to right, top to bottom, were rotated at 180° clockwise and retained for approximately twenty (20) minutes. In the days that followed, the patient reported feeling encouraged about her future and was making plans to attend college to become an Obstetrics/Gynecologist (Ob/Gyn). This was a significant shift from the person who initially came in for treatments. She went from walking in a very defeated, broken manner, stating that absolutely nothing was flourishing in her life and that she saw no hope for the future to walking with purpose and making definitive plans for a hopeful future.

When the patient came for her sixth treatment, she spoke of how much better she had been doing since coming in for acupuncture treatments. She said she noticed the difference in her overall mood, her thoughts were no longer circular and ruminating, she was able to focus and stay on task and she had an increased desire to ‘hang out’ with friends. When asked what she wanted to get out of treatment on that day, she replied that she would like to continue the direction that she was in. At this session, the patient’s constitutional factor was supported via tonification of the junction points of the metal element. Junction points, also known as connecting points, are acupuncture points that connect and move energy between the Yin and Yang meridians without an element and are used to balance the energy between paired meridians. Bladder 58 (flies and scatter) and kidney 4 (great bell) were tonified. A spirit point, kidney 24 (spirit burial ground), was also used during this treatment. These acupuncture points are specific exclusively to the Worsley treatment protocol and are used to influence the patient at the spirit level. Kidney 23 (spirit seal) can be used to resurrect a person’s spirit especially when they have experienced such trauma that would leave them feeling dead or drained inside. Following this treatment, the patient spoke of feeling peaceful inside and the pulse quality showed a continued progression in a positive and strong direction.

At the seventh treatment, the patient disclosed information regarding her menses. She reported heavy flow, dark colored menstrual blood with clots and a decrease in energy. Therefore, during this appointment, acupuncture points were used that would support Qi and Blood. The points selected were bladder 38 (rich for the vitals correspondence), bladder 14 (circulation sex correspondence) and the Water Element Xi Cleft Points; bladder 63 (golden gate) and kidney 5 (water spring). Xi Clefts points on the elements are also known as accumulation points and are points where Qi and Blood can accumulate. They are often used for acute situations and severe or persistent issues [3].

Approximately three weeks had passed before the patient came in again and she reported an incident that had occurred with someone else that left her feeling discouraged about her life’s goals that she had just recently set. Upon palpating the patient’s pulses and noting the shift in quality, it was determined that the patient possessed what is called in the Worsley tradition as an 8/9 blocks which needed to be cleared in order for any further needling to be successful. It was cleared using the tonification method on acupuncture points lung 1 (middle palace) and liver 14 (gate of hope). Blocks observed via the pulses are designated as such, according to the Chinese Meridian Clock, when the quality and quantity of a meridian is greater than the one that follows it. Each block also can be observed in the manifestation of the patient’s behavior and conversation. In this case, a person manifesting an 8/9 blocks will show signs of not feeling good about themselves, unresolved anger and can’t let go, chronic frustration, deep sense of emptiness and resentment. The patient’s spirit was also nurtured by way of kidney 22 (walking on the verandah), used to give patient’s a brighter perspective on their lives and the world around them. The treatment was solidified and grounded using the source points of the water element; bladder 64 (capital bone) and kidney 3 (greater mountain stream) [4]. The patient reported feeling sleepy at the end of the treatment. In the days that followed, the patient reported having a lot of energy, feeling encouraged about. She had completed a college application and was looking into programs that help adults with dyslexia.

At the ninth appointment, the patient was experiencing a bit of anxiety because she began to think about that entire Undergrad and Medical School would entail. Fear is the classic emotion of individuals observed as being of the Water Constitutional Factor and it is not uncommon for them to experience this at a level more heightened than any of the other elements. The patient required some coaching during this appointment and was guided to looking at the situation in, not as a big picture, but as pieces to a puzzle and was encouraged to handle one piece at a time until the picture is complete. Points used to calm and nourish the patient were CV 4 (first gate) and the metal element within the water element; bladder 67 (extremity of Yin) and kidney 7 (returning current) [3]. The patient claimed she felt relaxed and mentally settled. This treatment was repeated upon the next visit.

During the final treatment, the patient was doubly grounded by tonfying the water element within the water element. These points were bladder 66 (penetrating valley) and kidney 1 (bubbling spring). At the end of this treatment, the pulse quality and quantity was significantly stronger and full and she reported that her mind was calmer than it had ever been. After a few days, a follow-up call was made. The patient reported having ‘no fear’ and that she had taken the entrance exam to a local Maryland College and would begin classes in that coming semester. She contributed her progress to the treatments she received from acupuncture.
Conclusion
While there are cases where patients may need assistance with pharmaceuticals for depression or mild depressive episodes, based upon this case study, acupuncture proved to be a viable treatment for this patient. During the course of treatment, the patient’s mood became elevated and consistent. She became more active and reported no longer being ‘fearful’. She took steps to enroll in college because she began to have hope for the future. Currently, 2018, the patient continues to be employed full-time and is now in the management position that she was previously fearful of applying for. She is also enrolled full-time in a College in Maryland and is majoring in medicine. She accredits acupuncture for giving her a new outlook on life and the courage to live it.

Citation: Hall PE (2018) A Case Report Demonstrating the Efficacy of Acupuncture as a Viable Treatment for Mild Episodes of Depression. J Altern Complement Integr Med 4: 051.
Copyright: © 2018 Hall PE. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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