Thursday, November 09, 2006

Schizophrenia, or Phlegm Misting the Heart Orifice?

As both a nurse and an acupuncturist, I specialize in the treatment of people with mental health conditions. I have always been fascinated by the western medical pathologies and the colorful descriptions of the TCM diagnosis. Unfortunately, most people know very little about what an Axis One or Axis Two disorder really means and there is a huge stigma on those who have psychiatric disorders. Just the other day I was relating a story about a patient and was asked "well if they know they are crazy, why can't they just stop being crazy?" I responded with, "if you know you have cancer, can you just stop having cancer?"

The treatment of mental illnesses must be holistic to be successful. Gone are the days of the asylum where nurses and doctors routinely kept patients drugged or threw them in quiet rooms in four point restraints for hours on end. In a hospital setting today, patients are provided with a therapist social worker to talk to, group processing therapy, art and activity therapy, and dietary education in addition to medication. In some settings, yoga and guided imagery sessions are available as well. There are outside groups such as depression anonymous, caregiver support, and codependency. So where does acupuncture fit into the picture?

I am, as always, an integrationist. In someone who as severe bipolar disorder or schizophrenia, western medication is nearly always in order. As one of my Chinese professors said "all window of sky points are on or near neck - when patient has crazy, they not let you put needles there." Certainly for these cases, acupuncture can be utilized as an adjunct, especially to combat some of there more unpleasant side effects like weight gain. By contrast, those with Axis Two/personality disorders, require cognitive behavioral therapy more then medication. When receptive, this population reacts most beneficially to complementary therapies.

In my practice, I see many people with anxiety and depression. In many cases, the anxiety and depression are a symptom of a root pathology, such as chronic pain, and not the primary imbalance. Some are on western medication and others want a "natural" approach. In western medicine, if you have depression or Bipolar Disorder, more than likely you will be given an SSRI of some sort and possibly and anti anxiety medication. In Chinese Medicine, you may be given herbs to reconnect heart and kidney Qi, tonify spleen Qi and heart blood, or subdue liver fire. There is no standard treatment because there is no diagnosis that can be made independent of the individual. And there come the difficulty in "proving" the effectiveness of acupuncture for mental health disorders in a research setting . . . again.

Challenges in Determining Effectiveness of Acupuncture
Western research models may be inappropriate for verifying traditional Chinese medicine treatment for depression.

By Simon Miller, Epoch Times U.K. Staff

Depression and anxiety are seen, from a TCM perspective, as both emotional/psychological and physiological in nature, resulting from imbalanced energy effecting physical and mental health. Acupuncture claims to be effective in preventing and relieving various health problems through the correction of imbalanced energy. It is a holistic approach that, it is claimed, gives patients a more optimistic assessment of their problems and has few side effects.

There are a number of conceptual problems with carrying out acupuncture research. Staebler et el (1994) describes how conventional medical research looks for a "constellation of symptoms" and tries to apply one diagnostic label and one standard treatment. Acupuncture, however, is based on the whole-person approach. It takes into consideration the constitution of the person as well as the present disposition, by paying attention to the continuously changing equilibrium of life energy due to external and internal factors such as trauma, diet, climate and social conditions.

In daily practice, an acupuncturist would design treatment according to the specific needs of the individual patient. Attempts are made to establish the causative factors, and every case of depression and anxiety has some variation requiring different strength and location of needling. This presents another challenge in experimental research: test-retest reliability can be problematic as different therapists use slightly different techniques that vary according to the idiosyncratic nature of the individual's condition.

There are further problems for researchers. The use of one diagnostic label and one standard treatment would seem to be inappropriate in most cases of depression and anxiety. There are issues to be addressed of whether conditions are assessed according to Western diagnosis or TCM diagnosis, and which model is used to measure outcomes. The researcher could use conventional Western medical indices or incorporate TCM specific measures such as pulse and tongue diagnosis.

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