What is good mental health?
According to the World Health Organisation, mental health is “a state of wellbeing in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
What is the difference between a mental illness and a mental health problem?
“A mental illness is a health problem that significantly affects how a person thinks, behaves and interacts with other people. It is diagnosed according to standardised criteria, and may include: anxiety, schizophrenia, bipolar and mood disorders, personality disorders, eating disorders, and depression.
One in 5 Australians will suffer from a mental illness in any given year.
A mental health problem also affects how a person thinks, feels, and behaves, but to a lesser extent than a mental illness” (Mental Health WA 2016).
Our work and experience
Our team of Chinese Medicine (CM) practitioners complements the work of counsellors, psychologists, and specialists in supporting children and adults with mental health problems, such as acute and chronic distress and insomnia, as well as more serious mental health illness, such as anxiety and depression.
Our experienced team provides over 9,000 acupuncture treatments a year. Approximately 80% of our clients come to us experiencing some level of distress and anxiety, while around 30% of our clients suffer from a significant mental health illness when we begin therapy.
We use a vartiety of practices including acupuncture and Chinese herbal medicine to:
1. Gently relax the mind and body
Our goal is to gently relax the mind and body to facilitate emotional well being and sound quality of life. Most commonly our team find it necessary to use acupuncture and Chinese herbal medicine to switch off chronic distress patterns such as a chronic state of ‘fight and flight’.
The body is programmed to respond to certain stressors in a ‘fight and flight’ mode, in order to react quickly to danger. However, research suggests that we do not cope well in this state when it remains chronic.
For example, after experiencing many months of high levels of personal or work stress, as well as poor sleep, one may live in a constant state of ‘fight and flight’ and symptoms may include feeling extremely distressed, overwhelmed, unhappy, and exhausted, and fearful of not being able to cope. You are tired during the day, but restless and not able to sleep well at night. Often there is also chest tightness and discomfort, and palpitations, as well as increased food intolerances when the immune system joins this hyper vigilant process, perpetuating this distressing state.
Our team uses both Japanese and Chinese acupuncture and herbal medicine techniques in order to initiate deep relaxation by switching off the ‘flight and fight’ mode. Research suggests that Chinese medicine acts directly on the central nervous system to regulate homeostasis and balance chemical processes and hormones in order to reduce stress (see Stress and Anxiety, and Insomnia).
2. Reduce risk factors to mental health and chronic disease
One of our main roles is to identify and address risk factors that are likely to lead to poor mental health, as well as chronic disease. For example, adrenaline and cortisol are released by the adrenal glands in response to alarm bells set off by the hypothalamus in order to activate the ‘fight and flight state’ and get us out of danger as quickly as humanly possible.
However, it is not safe to have adrenaline and cortisol pumping in our veins every hour and day, because adrenaline increases our heart rate, blood pressure, and access to energy supplies; and cortisol impacts mood, motivation and fear, while increasing blood sugar levels and suppressing immune response, digestive function, and reproductive and growth hormones. Both are extraordinary chemicals that insure rapid response to danger but prolonged episodes are not ideal.
Early CM practitioners understood that switching off the body’s state of ‘fight and flight’ was essential in order to initiate deep relaxation as well as reduce risk for mental health problems and chronic disease.
Significant hormonal imbalance as well as any state of chronic pain and discomfort may sabotage emotional resilience, quality of life, and trust in one's body and the future. Our team uses acupuncture and Chinese herbal medicine to alleviate these compounding factors to promote overall wellbeing and quality of life in complement with the work of specialists, family, and counsellors (see Acupuncture, and Chinese Herbal Medicine).
Cortisol may shut down ovulation, impact reproductive hormones, cause menstruation irregularities, infertility, and poor response to IVF (In Vitro Fertilisation) cycles. Cortisol may also increase risk for inflammatory disease such as cardio vascular, autoimmune, allergies, food intolerances, diabetes, dementia, and cancer.
Adrenaline raises blood pressure and damages the walls of the arteries. Cholesterol is sent to patch up the scarring of the artery walls, increasing risk for cardio vascular disease, heart attack, and stroke. Adrenaline is also responsible for keeping us awake and hyper-vigilant at night, leading to increased levels of distress, insomnia, anxiety, exhaustion, depression, and fatigue.
Consequently, our team addresses risk factors related to mental health resilience as well as serious disease, and in this case we use acupuncture and Chinese herbal remedies to gently regulate the behaviour of the central nervous system (see Depression below).
3. Address compounding health complaints
Our team addresses compounding health factors because these may initiate mental health problems and prolong recovery. These factors may include: chronic digestive pain and discomfort, significant hormonal imbalances, ongoing muscle pain and joint inflammation, poor wound healing, poor recovery after surgery or injury, compromised immune system and chronic infections, as well as other chronic diseases.
Significant hormonal imbalance as well as any state of chronic pain and discomfort may sabotage emotional resilience, quality of life and trust in one's body and the future. Our team uses acupuncture and Chinese herbal medicine to alleviate these compounding factors to promote overall well being and quality of life in complement with the work of specialists, family, and counsellors (see Acupuncture, and Chinese Herbal Medicine).
4. Facilitate general health and well being and quality of life
Our team is passionate about supporting children and adults who suffer from stress, anxiety, depression, and insomnia, and these are the mental health problems that we most commonly see in our clinic. Of particular note is anxiety.
Our holistic approach to promoting good mental health is the foundation of our work. We listen to all concerns and aim to alleviate both small and large discomforts and conditions that compromise general wellbeing, emotional resilience, and quality of life.
Importantly, as health professionals, we have the skills to address multiple health problems in a single session, making acupuncture and Chinese herbal medicine a very cost effective therapy.
Our team supports the recommendations of the Mental Health team of the Western Australian government, that includes lifestyle tips to promote positive mental health.
- Talk about or express your feelings,
- Exercise regularly,
- Eat healthy meals,
- Get enough sleep,
- Spend time with friends and loved ones,
- Develop new skills,
- Relax and enjoy your hobbies,
- Set realistic goals,
- Talk to your GP or a health professional.
CM theory and mental health.
For more than two thousand years CM theory has regarded the development of mental health problems and illness with surprisingly enlightened observations, especially for its time. A foundation of this ancient heory is that mind and body are interconnected, and that there are seven emotional states, intrinsically connected to the health of the five main ‘yin’ organs.
The five yin organs and seven emotional states include:
- Joy or lack of joy, which is associated with the heart and Shen,
- Anger which is related to the liver and Hun,
- Anxiety and fear which is related to the kidneys and Zhi,
- Obsessive thoughts and over worrying which is related to the spleen and Yi,
- Sadness or grief which is related to the lungs and Po,
- Importantly, treating the organs associated with the seven emotional states is the basis of the CM complementary support of mental health problems and illness.
As more research emerges, the CM theories on the mind-body connection are slowly becoming more mainstream. For example, recent advances in neuroscience, epigenetics, and theories of the brain’s neuro-plasticity have lead to a greater appreciation of the mind-body interdependence. This, in turn, has encouraged a greater modern scientific alignment to the older CM theory.
To provide a discussion on how complex CM assessment and treatment strategies are, one could easily write a book, however below we have outlined a brief and helpful explanation.
There are eight main causes of disease in CM. These include:
- The seven emotional states,
- Injury or physical trauma,
- Excessive weather patterns (heat, cold, humidity, water, dryness),
- Parasites, bacteria and viruses,
- Inappropriate diet, or excessive consumption of food,
- Hereditary or genetic factors.
CM theory suggests that any one of the causes of disease mentioned above may lead to a weakness in the function of an organ that will in turn create instability and lack of resilience in the ‘associated emotion’ of that organ.
For example, if liver function is damaged by excessive drinking, smoking, or recreational drug use or environmental toxins such as pollution, contaminated drinking water, food, or chemicals (such as hair colourings) or medications, a person may start to experience excessive levels of anger and irritability, even without provocation.
CM strategy would involve treating the liver with various acupuncture points and herbal remedies to calm the anger and irritability and regulate hormonal function.
CM theory entirely embraces the concept that what we eat, if it is inappropriate, may cause disease as well as mental health problems and illness. Recent research on the interconnection between the brain and gut has lead to the digestive system being called ‘the second brain’, and these emerging findings give good reason for the valid contemporary use of ancient CM gut emotion theories.
Further, because of emotional and physical body interdependence early theories suggested that chronic emotional distress in any form may cause disease. For example, an overwhelming experience of grief, loss, and sadness may weaken the functioning of the lungs and the immune system, in turn causing chronic or severe respiratory issues such as pneumonia, or frequent colds and flus, or chest infections because grief is said to affect the lungs and immune response.
The CM strategy to support grief, loss, and sadness is to treat the lungs, boost the immune system (wei qi), and clear infection. Similarly, in order to support the process of rage and anger management, as well as significant frustration and irritability, we treat liver function using specific acupuncture points and Chinese herbal medicines.
There are complex theories and thousands of formula variations to address anger management in CM that allow for multiple emotional imbalances when several organs are not functioning at optimal levels. As a consequence, CM provides an excellent discussion on why mental health problems are complex and are best served by an holistic, integrative approach incorporating support of the mind and body at the same time.
Summary of treatment goals
Our Chinese medicine team complements the support of family and councillors, psychologists, and psychiatrists by focusing on a ‘whole body’ treatment of mental health problems, using acupuncture and Chinese herbal medicine.
The foundation of the theory of the cause of disease in CM is that the emotional and physical body are totally interdependent, and the seven emotions in excess will cause health problems and disease, while poor function or disease of an organ will lead to mental illness or mental health problems. CM theory recommends that the emotional and physical body be supported at the same time for best outcomes in mental health treatment.
Our team aims to:
- Reduce and address compounding risk factors such as poor sleep, fatigue and exhaustion, poor liver function and detoxification processes, pain from injuries, poor immune response and chronic infections, systemic pain and inflammation, poor health and well being, hormonal imbalances, digestive conditions, and allergies,
- Facilitate mind and body relaxation, Switch off a chronic ‘fight and flight’ state,
- Reduce side effects caused by certain medications, Assess and address risk factors to mental health and well being,
- Advise on lifestyle factors and dietary changes based on the insights of CM theory,
- Relieve anxiety, depression and insomnia,
- Relieve fatigue and exhaustion,
- Assist in the withdrawal of drugs and medications under medical guidance,
- Advise on vitamin supplements required as a result of reduced uptake by certain medications. All our practitioners have attended Naturopathy workshops for many years to keep up to date,
- Advise on meditation, pranayama, breathing exercises and practices. Our practitioners are advanced students or teachers in Eastern philosophies such as Qi gong, yoga, pranayama, and meditation and we try to balance our work and life as well. Our team may suggest different exercises and practices to complement our CM treatments, while integrating the very best in Eastern and Western philosophy as well as scientific research in an empathetic, non judgemental way.
Is there good evidence?
Current research includes promising evidence to support the use of acupuncture and Chinese herbal medicine to complement western intervention to more broadly support the mental health and wellbeing of men, women, and children.
In the discussion below we cover:
- Stress and Anxiety,
We list a substantial body of work that has been conducted on these subjects using Chinese medicine (CM). The evidence is growing in Australia as universities with CM departments continue to conduct robust, ’gold standard’ randomised clinical trials. While this research is ongoing, the anecdotal evidence in our clinic is very encouraging as well. On a daily basis we observe significant improvements in severe forms of anger management, anxiety, distress, depression, and emotional and physical exhaustion.
Stress and Anxiety
In treating the effects of stress, the Chinese medicine (CM) practitioner aims to relax on a deep emotional and physiological level; regulate the adrenal function to reduce the fight and flight response; slow down pulse and relieve chest distress, palpitations and irregular heart beat.
If and how acupuncture and Chinese herbal medicine achieves these processes has been the subject of numerous research projects and the results are encouraging. In one randomised, single-blind clinical trial that was recently conducted (Kurebayashi et al., 2014), evaluating the efficacy of auriculotherapy (ear acupuncture) for reducing stress levels among nursing staff, a total of 175 subjects with medium and high stress scores participated. After 12 sessions and 30 days, statistically significant differences between the Control and Intervention groups were found, with the acupuncture treatment group having the greatest impact.
Many studies have investigated the impact of stress on various Chinese medical plants as well, to evaluate why these plants relieve stress. There have been over 300 studies done on Panax ginseng alone (Liu et al., 1992). Panax ginseng was found to relieve stress due to its action on the central nervous system, the cardiovascular system, the endocrine and immune systems as well as metabolism.
The University of Technology Sydney (UTS) is conducting numerous research projects on Chinese medicine including research into post traumatic stress disorder (PTSD), that commenced in 2009 on a cross cultural group who had experienced torture and war.
This is a long term ongoing study that is already showing promising outcomes in the treatment group.
Our team believes this study is very relevant, because we often see signs of PTSD that does not involve war or torture, but may occur as a result of the distress caused by cancer treatment and diagnosis; grief; significant relationship and work distresses; and chronic ill health and pain. We often see traumatised clients with many of these backgrounds and this is often the foundation of our work in addressing the impact of chronic stress.
The British Acupuncture Council website lists several studies that show the many good outcomes of using acupuncture and Chinese herbal medicine to allieviate stress in adults.
- Middlekauf (2002) showed stress in people with advanced heart failure was reduced with acupuncture,
- Fssoulak (2003) showed acupuncture for stress was better than controls,
- Pavao (2011) revealed that acupuncture was better for psychological stress and immunity compared to controls,
- Chan (2002) revealed that acupuncture reduces stress,
- Hui (2009) and (2010) Investigated how acupuncture acts on different areas of the brain deactivating anxiety and worry.
- Kim (2001) revealed how acupuncture acts on the hippocampus to relieve the impact of stress on memory,
- Lee (2009); Cheng (2009); and Zhou in (2008) revealed through resear ch how acupunc ture influences neurotransmitters and their hormones such as serotonin, noradrenaline, dopamine, GABA and ACTH,
- Arranz (2007) showed that acupuncture stimulates endogenous opiods initiating relaxation. The team also revealed how acupuncture reduces inflammatory markers as a result of stress.
The University of Technology Sydney (UTS) is conducting research into Depression and Chinese medicine (CM) and while the research is ongoing for a number of years to come, the initial results are good. At this stage the study has shown clinically and statistically significant reductions on the Beck Depression Inventory (BDI) scores for the treatment group compared to the control or non treatment group.
The average improvement is 15.5 points for the CM treatment group compared to 0.83 points for the control (non intervention) group.
Of note, Sniezek and Siddiqui (2013) conducted a systematic review of all the randomised clinical trials that used acupuncture for treating anxiety and depression in women. They looked at 6 studies and showed good evidence for the use of acupuncture in the treatment of pregnant women with depression and anxiety. The systematic review looked in particular at studies on women.
The British Acupuncture Council mentions two systematic reviews recently conducted on the impact of acupuncture on depression (Zhang 2010; Smith 2010). While there were some disagreements in these reviews and controversies over the use of sham acupuncture, both reviews found that acupuncture was as good as medication for depression (see A to Z of Conditions for Depression).
Several other studies worth mentioning on the British Acupuncture Council website include systematic reviews conducted on clinical trials investigating the active ingredients in Chinese medicinal herbs to determine the chemicals responsible for their effects.
These studies include Butler and Pilkington (2013) who evaluated five systematic reviews that investigated the Chinese medicine formula xiao yao san with variations and its impact on depression. The results of this review suggested that continued research on this subject was worthwhile and recommended and included:
- Imanshahidi and Hosseinzadeh (2006) who looked at the pharmacological effects of Salvia on the central nervous system,
- Kim and colleagues (2004) researched the anxiolytic effects of Albizzia,
- Kawashima and colleagues (2004) analysed the anti-stress impact of polygala tenuifolia,
- Mizoguchi and colleagues (2003) discuss herbal medicine reducing chronic stress induced depressive states,
- Park, Kim, Lee and colleagues (2004) researched the antidepressant like effects of a traditional Chinese herb Kami-Shoyo-San in rats,
- He, Zhang, and Tang (2007) studying the use of acupuncture and herbs in the treatment of depression,
- Qu, Cai, Gu and colleagues (2009) conducted a randomised clinical trial on premenopausal women with depression,
- Zhao, Wan, and Chen (2009) reviewed CM treatment of depression in China and its outcomes,
- Niu, Li, You, Shi, and Liu (2006) studied the effect of integrated therapy using Chinese medicine with western medication with patients having depression. This paper shows that the integration of western medical intervention and Chinese medicine is being actively considered and explored in research,
- Courbasson, Sorkin, Dullard, and Van (2007) studied the acupuncture treatment for women with concurrent substance use and anxiety/depression.
The treatment of insomnia in CM is highly developed and many research projects have been conducted on this subject over several decades. More recently there has been good evidence to support the use of acupuncture and Chinese herbal medicine to treat insomnia in several important studies discussed below.
Tan (2014) and colleagues conducted a systematic review of 8 studies involving 894 patients concluding that the patients receiving ear acupuncture experienced clinically and statistically better sleep compare to the group receiving standard medical drugs.
Earlier, Huijuin (2009) and colleagues conducted a systematic review of 46 randomised clinical trials conducted on 3811 patients. They found that patients receiving acupuncture had increased benefit in relieving insomnia compared to the control group who did not receive acupuncture.
Chen and Hsieh (1985) studied the actions of the CM herbal formula suanzaorentang in treating insomnia. This is only one of many studies investigating the therapeutic actions of this formula that provides good evidence, backed by chemical analysis, to suggest a reason to take positive therapeutic action.
There are many plants and formulas in CM that are used to treat insomnia, with variations available to allow for a tailored approached to match each individual's requirements. Having an alternative to current medication, such as hypnotics, is important because hypnotics, while useful in the short term, are neither recommended for long term use (Joint Formulary Committee, 2009), nor able to provide the deep sleep and REM (rapid eye movement) required for a true deep sleep experience.
As a result, a deep sleep or alpha sleep state is not easily achieved when using hypnotic medication and this results in the progression of grogginess, fatigue, poor attention span, and distress that comes when loosing sleep continues despite medication. Our aim is to address all factors that cause insomnia using acupuncture and Chinese herbal medicine, while improving quality of life and wellbeing (see Acupuncture, and Chinese Herbal Medicine).
- Kurebayashi LF, Silva MJ. Rev Lat Am Enfermagem. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomised clinical trial. 2014 May-Jun; 22(3):371-8.
- Recent advances of Ginseng research in China. Liu Chang-Xial; Xiao Pei-Gen. J. Ethonopharm. Vol 36, Issue 1. Feb 1992: 27-38.
- British Acupuncture Council (18/11/2016) A to Z of Conditions for Depression
- Kawashima K, Miyako D, Ishino Y, Makino T, Saito K, Kano Y. Anti stress effects of 3,4,5- Trymethoxycinnamic acid, an active constitution of polygala tenuifolia. Biological and Pharmaceutical Bulletin. 2004; 27(8): 1317-1319.
- Imanshahidi M, Hosseinzadeh H. The pharmacological effects of Salvia species on the central nervous system. Phytotherapy Research. 2006; 20(6): 427-437.
- Kim WK, Jung KW, Ahn NY et al. Anxiolytic effects of extracts of Albizzia julibrissin bark, in the elevated plus maize of rats. Life sciences 2004; 75(23): 2787-2795.
- Mizoguchi et al. Saiko-ka-ryukotsu-borei-to, a herbal medicine, ameliorated chronic stress induced depressive state in rotorad performance. Pharmacology, biochemistry behaviour. 2003; 75(2):419-425.
- Sniezek D, Siddiqui I. Acupuncture for treating anxiety and depression in women: A clinical systematic review. Med Acupunct. 2013 Jun; 25(3):164-172.
- Q. He, J. Zhang, and Y. Tang, “A controlled study on treatment of mental depression by acupuncture plus TCM medication,” Journal of Traditional Chinese Medicine, vol. 27, no. 3, pp. 166–169, 2007.
- H. Zhao, X. Wan, and J. X. Chen, “A mini review of traditional Chinese medicine for the treatment of depression in China,” American Journal of Chinese Medicine, vol. 37, no. 2, pp. 207–213, 2009.
- F. Qu, X. Cai, Y. Gu et al., “Chinese medicinal herbs in relieving perimenopausal depression: a randomized, controlled trial,” Journal of Alternative and Complementary Medicine, vol. 15, no. 1, pp. 93–100, 2009.
- Fam Community Health. 2007 Apr-Jun; 30(2): 112-20. Acupuncture treatment for women with concurrent substance use and anxiety/depression: an effective alternative therapy? Courbasson CM1, de Sorkin AA, Dullerud B, Van Wyk L. Aut.
- Butler L, Pilkington K. Chinese herbal medicine and depression:The evidence. Evidence-Based Complementary and Alternative Medicine. (2013), Article ID 739716, 14 pages.
- Park SW, Kim YK, Lee JG et al. Anti-depressant like effects of the traditional Chinese medicine Kami- Shoyo-San in rats. Psychiatry and Clinical Neurosciences. 2007; 61(4): 401-406.
- S. Y. Niu, N. Li, H. You, S. X. Shi, and C. M. Liu, “Effect of integrated therapy of Chinese and western medicine on differentiation of symptoms and signs of patients with depression,” Chinese Journal of Clinical Rehabilitation, vol. 10, no. 39, pp. 7–9, 2006.
- Joint Formulary Committee. British National Formulary. Edition 58. London: Royal Pharmaceutical Society of Great Britain and British Medical Association, September 2009.
- Auricular acupuncture for primary insomnia: a systematic review based on GRADE system. Tan et al., Zhong guo Zhen Jiu. 2014 Jul;34 (7) 726-30.
- Huijuin C, et al. Acupuncture for insomnia: A systematic review of randomised controlled trials. J Altern Complement Med. 2009 Nov; 15(11): 1171-1186.
- Chen HC, Hsieh MT. Clinical trial of suanzaorentang in the treatment of Insomnia. Clinical therapeutics. 1985; 7(3):334-337.
- Mental Illness and Health (WA Health).
- Stress Management (Mayo Clinic, US).