| BackgroundEveryone periodically experiences fear and anxiety.Fear is an emotional,physical,and behavioral response to an immediately recognizable external threat.Anxiety is a distressing,unpleasant emotional state of nervousness and uneasiness.Its causes are less clear.The word anxiety comes from the Latin word "ango",which means to choke or torment.Anxiety is less tied to the exact timing of a threat.It can be anticipatory before a threat,persist after a threat has passed,or occur without an identifiable threat.Anxiety is often accompanied by physical changes and behaviors like those caused by fear.Generalized Anxiety Disorder(GAD)is a condition characterized by six months or more of chronic,exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience.People with GAD usually expect the worst.They worry excessively about money,health,family,or work,even when there are no signs of trouble.They are unable to relax and often suffer from insomnia.Sometimes the source of the worry is hard to pinpoint;simply the thought of getting through the day provokes anxiety.Many people with GAD also have physical symptoms such as fatigue,trembling,muscle tension,headaches,irritability or hot flashes.People with GAD may feel lightheaded or out of breath.They also may feel nauseated or must go to the bathroom frequently.GAD most often strikes in childhood or adolescence but can also begin in adulthood.It affects women more often than men,may run in families,and may also grow worse with stress.GAD often coexists with depression,substance abuse,and other anxiety disorders.Irritable bowel syndrome often accompanies GAD,and even though the cause is unknown,it commonly coexists in people who have alcohol abuse,major depression,or panic disorder.Acupuncture is a World Health Organization(WHO)approved treatment for GAD and there is a lot of research that shows the effectiveness of acupuncture for this condition.Acupuncture can be considered a good choice of treatment for patients with GAD.Objective:The aim of the study is to evaluate the efficacy of acupuncture as treatment for Generalized Anxiety Disorder(GAD).MethodThe study was implemented at Rayan Center of Complementary Medicine Salah el din 25 Salah Al-din St#20 East Jerusalem,Israel.Patients recruited had anxiety symptoms including palpitations,muscle tension,discomfort or oppression of the chest,feeling as if the heart is being suspended,constantly in a state of anxiety and unable to relax.Forty patients meeting the criteria were divided into two groups.One group received acupuncture on Zusanli(ST 36),Sanyinjiao(SP 6),Hegu(LI 4),Quchi(LI 11)and Lieque(LU 7).These points came from Dr.Miriam Lee’s book(Insights of a Senior Acupuncturist:One Combination of Points Can Treat Many Diseases).The other group received acupuncture on Baihui(DU 20),Sishencong(EX-HN-1),Shangxing(DU 23),Neiguan(PC 6),Hegu(LI 4),Zusanli(ST 36),Sanyinjiao(SP 6),Taichong(LR 3)and Fenglong(ST 40),Shenmen(HT 7),and Yintang(EX-HN-3).These points were selected from Shi Xuemin’s book on Acupuncture and Moxibustion.Patients were asked to answer Anxiety Screen Questionnaire(GAD-7)from the Diagnostic and Statistical Manual of Mental Disorders(DSM IV),and a Visual Facial Anxiety Scale(VFAS)on the first,third,sixth and eighth week after the first treatments.In the first visit,after recording their history,all patients who met the diagnostic criteria of GAD were enrolled in this study.For four days,all the enrolled patients were checked for including and excluding criteria,and the final candidates who met all the inclusion and exclusion criteria were defined and were divided randomly into two groups.Patients were also asked to report about their symptoms and how they feel,in which patients reported having palpitations,restlessness,fatigue,difficulty concentrating,worry,muscle tension,and sleep disturbances(difficulty falling or staying asleep,or restless,unsatisfying sleep).Randomization:final candidates were listed in a paper(n=40).The patients were defined as first group(n=20)and second group(n=20).Then,by a simple draw,it was determined that the first group would receive acupuncture on points selected from the text book Shi Xuemin’s Acupuncture and Moxibustion,including Baihui(DU 20),Sishencong(EX-HN-1),Shangxing(DU 23),Neiguan(PC 6),Hegu(LI 4),Zusanli(ST 36),Sanyinjiao(SP 6),Taichong(LR 3)and Fenglong(ST 40),Shenmen(HT 7),and Yintang(EX-HN-3).The second group would receive acupuncture on points from Miriam Lee’s book(Insights of a Senior Acupuncturist:One Combination of Points Can Treat Many Diseases):Zusanli(ST 36),Sanyinjiao(SP 6),Hegu(LI 4)and Quchi(LI 11),and Lieque(LU 7).Generalized Anxiety Disorder(GAD)is the most common anxiety disorder in primary care.Acupuncture,known as a complementary and alternative medicine,has gained popularity and greater acceptance as a medical therapy.It is a primary component of Traditional Chinese Medicine(TCM).In recent years,several western countries have seen a sharp increase in the number of people using acupuncture to treat common ailments.The aim of this study is to compare the efficacy between two groups of acupuncture points in treating GAD.The points were selected in the study based on their functions and location according to the theory of the Chinese medicine,in addition to being commonly used in the acupuncture clinics in my country.In Miriam Lee’s book we observe the use of Zusanli(ST 36),Hegu(LI 4),Sanyinjiao(SP 6),Quchi(LI 11),and Lieque(LU 7)to treat many disorders,which is a primary reason for choosing these points to compare to an acupuncture combination mentioned in Shi Xuemin’s book in the chapter of anxiety.Baihui(DU 20)is the meeting point of the Governing Vessel and Urinary Bladder,Gall Bladder,Sanjiao and Liver channels.The point of the sea of marrow,which enters the human brain,is the key point of regulating brain function.It has obvious effect in regulating moods,awakening the brain,and calming the mind,when matched with Zusanli(ST 36),and supplements the heart and spleen when matched with Sanyinjiao(SP 6).Sishencong(EX-HN-1)is a key point for calming the mind and relieving depression.Yintang(EX-HN-3)is a main point along the Du Meridian,which calms the spirit and clears the head.Neiguan(PC 6)belongs to the collateral point of the Jueyin Pericardium Meridian,one of the eight meridian intersecting points,which is connected with Yinwei Mai(Yin Link Vessel).The main function of Neiguan is more general,often involving the theory of "Chest and Hypochondrium Internal Guanzhi",and functioning to calm the mind,regulate qi and relieve pain,while also proving to have a good effect on stomach,pericardium,mood disorders,and diseases of the organs and limbs caused by qi blockage.Neiguan also has a good effect on anxiety disorders,and a good inhibitory effect on autonomous nervous system symptoms and motor restlessness.Shenmen(HT 7)is the primary point of the Heart Meridian,which has the effect of regulating mind,calming mind and sleeping.Fenglong(ST 40)clears phlegm from the heart and calms the spirit,which is important because if phlegm-damp obstructs the upper jiao and the head,it may impair the ascent of clear yang to the head and sensory orifices,giving rise to dizziness and headache characterized by a heavy and clouded sensation.Shangxing(DU 23)serves to calm the spirit,and the alternative names for this point reflect its status as one of the "thirteen ghost points"listed in the Supplement to the Thousand Ducat Formulas of Sun Simiao for the treatment of mania disorders and epilepsy.These include Guitang(Ghost Hall),Guigong(Ghost Palace)and Shentang(Hall of the Spirit),indicating the use of this point has potential in treating shen disorders.Taichong(LV 3)is arguably the most important point of the Liver Meridian,with an extensive range of actions,and may be used with equal effect for both excess and deficiency patterns of the Liver organ and its channel.Bilateral Taichong(LV 3)and Hegu(LI 4)are known as ’the four gates’.InterventionFor the first group(the Shi Xuemin Group),the patient relaxed in a supine position.After disinfection by alcohol,sterile acupuncture needles(0.22,Dong Bang Medical instrument,South Korea)were used.Zusanli(ST 36)points were inserted first and other points were inserted later.The needles were inserted at the appropriate depth,and after the arrival of qi they remained for 30 minutes.The manipulation of needles was implemented one at a time.The manipulation technique used for this condition was an even technique.The treatment course was 24 sessions(three times a week for eight weeks).For the second group(the Miriam Lee Group),firstly,the patient relaxed in a supine position.After disinfection by alcohol,sterile acupuncture needles(0.22,Dong Bang Medical instrument,South Korea)were used.The point Zusanli(ST 36)was inserted first,then other points were inserted.The needles were inserted at the appropriate depth and after the arrival of qi,they remained for 30 minutes.The manipulation of needles was performed three times.The manipulation technique usually in this condition was even.The treatment course was 24 sessions(three times a week for eight weeks).Statistical analysis:SPSS version 22 statistics was used for this study and the significant statistic P-value was less than 0.05ResultsIn total,40 GAD patients were enrolled into two groups(20 patients in each group),where 22.5%of them were male and 77.5%of them were female.The average age among all patients was 40(33-55).In both groups,the GAD-7 and the VFAS scores before treatment were not statistically different.When comparing the GAD-7 and VFAS within groups in different stages,it showed that there is statistically a significant difference between before treatment and after the first week after treatment" in the Shi Xuemin Group(P<0.05).Furthermore,there was a statistically significant before treatment and the third week of treatment(P<0.001).In addition,there was a statistically significant difference between before treatment and the sixth week of treatment(P<0.001).With regards to comparing the before treatment with the eighth week,it showed that there is a statistically significant difference between them(P<0.001).In comparing the VFAS in different stages,it showed that there is a statistically significant difference between before the treatment and the first week after treatment in the Shi Xuemin Group(P<0.001),and between the before treatment and the third week of treatment:statistically significant(P<0.001).Furthermore,between before the treatment and the sixth week of treatment,it is also statistically significant(P<0.001)in comparison to the before treatment and the eighth week show that there is a statistically significant between them(P<0.001).In the Miriam Lee Group,comparing the GAD-7 values showed that there is no difference between "the before treatment" and the first week of treatment.Although,there is a statistically significant difference between the before treatment and the third week of treatment(P<0.05).The comparison also shows that there is a statistically significant difference between the before treatment and the sixth week of treatment(P<0.001).Furthermore,between the before treatment and the eighth week of treatment there is a statically significant difference(P<0.001).In comparing VAS values of different stages,it can be observed that there is a statistically significant difference between the before treatment and the first week after treatment in the Miriam Lee Group(P<0.001),as well as the before treatment and the third week of treatment(P<0.001).When comparing the VAS values of the before treatment to the sixth week of treatment,there also is a statistically significant difference(P<0.001),and finally,when comparing the before treatment with the eighth week one can see that there is a statistically significant difference between them(P<0.001).We also further analyzed the difference of GAD-7 values between the groups and examined whether there was a statistical difference between the two treated groups of Shi Xuemin and Miriam Lee.Our data revealed a statistical difference between the two groups with the P-value(0.05)at the first week and P<0.001 in the 3rd,6th and 8th week of the treatment.We analyzed the different VFAS data between the Shi Xuemin and Miriam Lee treatment groups and examined the statistical difference between the two treated groups.Our data revealed a statistical difference between the two groups at all intervals where P-value<0.001,respectively.We also further analyzed the difference between the groups GAD-7 values and examined whether there is a statistical difference between the two treated groups of Shi Xuemin and Miriam Lee.Our data revealed a statistical difference between the two groups,we observed P-value<0.05 and then P-value<0.001 in the 3rd、6th and 8th week of the treatment between the groups,respectively.We analyzed the difference between VFAS scores of the Shi Xuemin and Miriam Lee treatment groups and examined the statistical difference between the two treated groups.Our data revealed a statistical difference between the two groups at all the intervals with P-value 0.001,respectively.ConclusionWe can say that the effects of both acupuncture treatments are good for treating generalized anxiety.We focused on the symptoms that have been mentioned in the diagnosis criteria of the DSM Ⅳ,including restlessness,feeling keyed up or on edge,becoming easily fatigued,having difficulty concentrating or mind goes blank,muscle tension,and sleep disturbances(difficulty falling or staying asleep,or restless,unsatisfying sleep).Patients in the first group that used an acupuncture point combination from Shi Xuemin’s textbook reported that they noticed changes in their symptoms of anxiety when it came to headaches,palpitations,shortness of breath,discomfort in the chest,insomnia,tense muscles,fatigue and difficulty controlling worry,feeling keyed up or on edge,and being easily fatigued,where from the first week of treatment,they felt calmer and able to hold a conversation with people.Then as the weeks progressed,they reported that the palpitations were occurring less and less and the breathing difficulties were decreased,and they started sleeping more peacefully at night.Those that had tense muscles,specifically in the upper right shoulder,reported that they felt less tense in the right shoulder.Most of them reported that even though they experienced good feelings,they still continued to worry,however,it was getting better.Those who had been treated with Miriam Lee points were not satisfied from the treatment during the first three weeks of the study.Although after the third week,they started to report that the palpitations and other symptoms started to decease.Due to an insufficient number of samples in this study,and an absence of a control group,it is necessary to perform another study in the future by having a sufficient number of participants and a control group.This study can serve as a doctorate degree thesis.From my point of view,using Miriam Lee points to treat these cases is not realistic and can cause patients to not continue the course of treatment.In the western world,patients look for fast results,and as an acupuncturist,I believe that for western patients,we need to see the results of the needling immediately after getting the arrival of Qi. |
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