Transcript Results: Reason for Acupuncture Referral

NR1-045
Meena Rajendren, MD, Emily Martin, BA, Christina Mangurian, MD, James W. Dilley, MD, Martha Shumway, PhD, Hung Ming Chu, MD
University of California, San Francisco and San Francisco General Hospital
Background

Acupuncture, which was long used for emotional,
psychological and spiritual disorders in China, Japan and
Korea, has become a subject of major interest and a
popular complementary therapy in the West. On the
human body, there are more than 2,000 acupuncture
points connecting with 12 main and 8 secondary pathways
called meridians, which conduct "qi" between the surface
of the body and internal organs. Qi is the circulating life
force that regulates spiritual, emotional, and physical
balance. The opposing forces of yin and yang influence qi.
Acupuncture is believed to balance yin and yang, keep the
normal flow of energy unblocked, and restore health to the
body and mind2.
Increasing evidence supports a biological basis for the use
of acupuncture to treat mental health conditions. For
example, in the treatment of depression, acupuncture
stimulates Group 3 nerve fibers that transmit impulses to
various parts of the central nervous system and induce the
release of serotonin, norepinephrine, substance P,
dopamine, b-endorphin, enkephalin, and dynnorphins,
primarily in the hypothalamus. This suggests a direct
influence on the pathogenic mechanisms of depression2.
Few studies have examined the use of acupuncture in the
context of community mental health services for people
with severe mental illness.
By understanding the prevalence of complementary
alternative medicine use, exploring its epidemiology and
consequences, and determining how it can enhance
physical and mental health treatment, public health
professionals can better serve their patients and
communities3.
Research Questions
• Who utilizes acupuncture treatment in a
community mental health clinic?
• What is the reason for referral to
acupuncture?
• What are the specifics of acupuncture
treatment?
Methods

Demographics
Race and Language

Results:
Specifics of Acupuncture Treatment
Summary:
• There are 8 acupuncture points used for
almost every acupuncture patient in the
clinic, regardless of diagnosis or reason for
referral.

• The standardized traditional Chinese
medicine (TCM) problem for acupuncture
patients in the clinic is “stagnation of the
liver qi”. Qi is the circulating life force in
TCM
• Study type: Retrospective Chart Review
• Study Procedure: Paper charts and electronic
medical records of patients receiving
acupuncture treatment from July 1, 2012 through
June 30, 2013 were reviewed. Demographic and
diagnostic characteristics and mental health
service utilization were abstracted. The reason
for referral to acupuncture, the acupuncturist's
clinical formulation, and the specifics of
acupuncture treatment were recorded.
• The standardized therapeutic principle that
accompanies the stagnation of the liver is
“to disperse the depressed liver qi in order
to relieve emotional distress”
Other Demographics
Results:

Summary:
• There are a variety of reasons for acupuncture
referral, and many patients had more than one
reason for referral.

• Regardless of reason for referral, the traditional
Chinese medicine problem, therapeutic principle,
and acupuncture points used did not differ between
patients.
Chinatown/North Beach Mental Health Services (CTNB)
offers an array of mental health services to adolescents,
adults, and older adult residents in San Francisco.
Services include psychiatric evaluation, individual
therapy/counseling, family intervention, urgent care,
medications, group activities, acupuncture for
psychiatric disorders, as well as adult/geriatric
socialization program. CTNB operates with the basic
philosophy that services must be accessible and
culturally appropriate.
References
Chinatown, San Francisco

The reasons for referral to acupuncture
varied, and many individuals had more than
one reason for referral. The most common
reason was depression, followed by
psychosomatic complaints, insomnia, and
anxiety. Despite the range of reasons for
referral, every patient received a standardized
acupuncture intervention.
Reason for Acupuncture Referral
Setting
Discussion
The majority of patients receiving
acupuncture at Chinatown North Beach are
older (mean age: 57), female (68%), Chinese
(51%), and Cantonese speaking (47%) adults.
There is also a number of English speaking
(38%), Caucasian (27%) adults. The majority are
unemployed (including those who are retired or
disabled) and the majority have not been
educated past high school.
Common Mental Health Acupuncture Points
• Subjects: Patients who received acupuncture
treatment from July 1, 2012 through June 30,
2013.
The community mental health clinic serving San
Francisco’s Chinatown has a full-time acupuncturist,
providing an opportunity for this study. This population is
predominantly Asian American, publically insured, and
severely mentally ill.


1. Badri Rickhi, Hude Quan, Sabine Moritz, Heather Stuart, Julio Arboleda-Florez: Mental Disorders and Reasons for Using Complementary
therapy. Can J Psychiatry Vol 8: 475-479, 2003
2. Hao Wang, Hong Qi, Bai-song Wang, Yong-yao Cui, Liang Zhu, Zheng-xing Rong, Hong-zhuang Chen: Is Acupuncture beneficial in depression:
A meta-analysis of 8 randomized controlled trials? Journal of Affective Disorders 111: 125-134, 2008
3. Lin Fang, Steven Schinke: Complementary Alternative Medicine Use Among Chinese Americans: Findings from a Community Mental Health
Service Population. Psychiatric Services : 402-404, 2007
This work was supported by the San Francisco Department of Public Health, Community Behavioral Health Services.
There were eight acupuncture points used for
almost every patient in the clinic. In traditional
Chinese medicine, all of these points are used
for various emotional and mental problems. In
traditional Chinese medicine, mental and
emotional problems are a result of a stagnation
of the qi in the liver. The therapeutic principle
behind this standardized acupuncture treatment
is dispersing the depressed liver qi in order to
relieve emotional distress. Regardless of
reason for referral, all patients received this
standardized treatment.
While our study did not explore the effect of
acupuncture treatment on mental health, others
have found it be positive. As a complement to
traditional mental health treatment, acupuncture
has multiple potential advantages. Compared to
conventional treatment, acupuncture is relatively
low cost, has relatively few complications, and
offers possibilities for personalized treatment2.
Acupuncture may be particularly helpful to
patients with mental health disorders who are
dissatisfied with conventional treatment, who
want to have a voice in decisions about their
treatment, or who feel that complementary
therapy is congruent with their philosophical
values and beliefs 1.