Written by Marc Wasserman Ph.D. L.Ac.

 

Introduction

A concussion is a traumatic injury which may develop into a variety of acute and chronic symptoms, including pain, dizziness, nausea, cognitive impairment, changes in mood and emotions, fatigue, etc.

To understand how Chinese medicine and acupuncture can be applied in treatment of concussions it is best to look at both the pathophysiological causes of injury as well as the specific symptoms. We’ll consider both in the sections below.

 

Pathophysiology of Concussions and Understanding Chinese Medicine Theory and Treatment

A concussion occurs when impact to the head causes the brain to strike the inside of the skull, impact and torsion forces damage tissue similar to bruising in any other part of the body. Symptoms at this time may include headache, dizziness, nausea or vomiting, cognitive impairment, fainting, visual disturbance, etc. In Chinese medical theory, at this point the injury is referred to as YuXue (blood stasis) with heat pattern. Treatment focuses on promoting clearance of waste products from the area and improving cerebral blood flow. This minimizes inflammation, improves oxygenation of the area and limits damage to the periphery.

Secondary injury occurs over a period of days and weeks, and is due to a variety of causes resulting from the initial injury and ongoing damage repair. The complexity of possible ongoing symptoms is due to the brain’s functional processes and its role in commanding all activities in the body.

Specific pathophysiological causes of symptoms are listed below with treatment considerations from Chinese medicine.

Decreased cerebral blood flow

Restoring healthy circulation to the brain and removal of metabolic waste should be primary focus. By increasing and maintaining healthy circulation we accelerate damage repair and a return to normal functioning. Herbal medicines with this function are classified as “enlivening blood and transforming stasis” (活血化瘀）or “cooling blood heat” (涼血）. These include single herbs like ChuanQi, QianCao, CeBaiYe, DangGui, ShaoYao, ChuanXiong, DanShen, etc. ChuanQi, for example, has long been used to treat vascular and cerebrovascular problems and has shown in research to have antioxidant effects(1). Likewise the commonly used combination of ChuanXiong and ChiShao has demonstrated the ability to limit damage from decreased blood circulation to the neurological system (2). This pairing illustrates how the combination is more effective than individual parts, a governing principle in Chinese medicine. In addition to these combinations, other herbs which clear heat and resolve toxicity can be added in small amounts to clear away lactic acid buildup and quiet down inflammation; these include HuangQin, HuangLian, HuangBai, ZhiZi, ShiGao, DaHuang, etc.

Irregular release and reabsorption of neurotransmitters

Damage to brain often results in irregularity in the chemical signaling systems. Depending on the symptoms, (discussed below) irregularity in neurochemistry falls into the categories of “kidney yang deficiency”(腎陽虛） or “spleen deficiency”（脾虛）. Formula choices may  include YouGui Wan, JinGuiShenQi Wan, SiNi Tang, GuiPi Tang, GanMaiDaZao Tang, etc.

Poor clearance of waste products through CSF circulation

Concussion forces can also cause disruption to the brain’s waste removal system. This may lead to chronic and/or delayed symptoms(3). This is known as “phleghm-fluid” （痰飲） or “phlegm reversal”（痰逆）. Common formula options include WenDan Tang, BanXiaBaiZhuTianMa Tang, etc.

Free radical damage

This can be addressed with numerous herbal medicine formulas as most provide antioxidants. However, focusing treatment on “tonifying qi”(補氣) will encourage healthy cellular metabolism. A good example is the combination of ChuanXiong, HuangQin and DangGui which has shown protective effects on mitochondrial function and cellular respiration in brain cells. (4)

Of course treatment will likely focus on a combination of these pathomechanisms, to simultaneously restore function and prevent further damage.

 

Symptoms of Concussions and How to Treat with Chinese Medicine and Acupuncture

Headaches

In a large study published in 2016, returning soldiers suffering headaches due to traumatic brain injuries were treated with either acupuncture or the usual treatment modalities. Results showed that patients in the acupuncture treatment group had less pain and less impact on day to day life when compared against those in the conventional treatment group. (5)

As for prescribing Chinese medical formulas, there are several types of headache symptoms or patterns, all with differing diagnosis and treatments according to Chinese medical theory. Following is a list of headache pattern diagnosis and associated treatments:

1. Blood stasis pattern: Moderate headache pain, nausea, dizziness, occasional eye pain and/or dry eyes, etc. This common pattern is frequently associated with concussions and post concussion syndromes, treatment options include SiWu Tang or BaZhen Tang or similar formulas which enliven blood and transform stasis.
2. Qi Deficiency Pattern: Headache with lightheadedness or feeling of emptiness in the head, fatigue, diminished appetite, shortness of breath, etc. Treatment options include BuZhongYiQi Tang, SiJunZi Tang, XiangShaLiuJunZi Tang, etc.
3. Hyperactive Liver Qi Pattern: Severe headache pain, with pain focused on the temples or crown of the head, irritability, outbursts of anger, insomnia, etc. A common prescription for this pattern is YiGanSan or ChaiLing Tang.
4. Kidney Deficiency Pattern: Mild headache pain, light headedness, tinnitus, extreme fatigue, muscle soreness, etc. Treatment options include LiuWeiDiHuang Wan, YouGuiWan, DaSanWuZi Tang, LiZhongWan etc.
5. Phlegm Reversal Pattern: Headache pain with dizziness, nausea, heaviness of the eyes or inclination to keep eyelids closed, fatigue, and general discomfort. Treatment choices include BanXiaBaiZhuTianMa Tang, WenDan Tang, etc.

Dizziness or Vertigo

Acupuncture has been shown effective in treating dizziness and vertigo in emergency medicine (6). A simple treatment with manual stimulation of points including NeiGuan, ZuSanLi, TaiChong and others may quickly alleviate acute symptoms of dizziness and nausea.

As for prescribing Chinese herbal medicine many of the patterns for dizziness align with those outlined above regarding headaches. They are as follows:

1. Liver yang rising: Severe dizziness with nausea, tinnitus, alternating sensations of chills and overheating of the body, outbursts of anger and moodiness. A common prescription for this pattern is JiaWeiXiaoYao San.
2. Insuffinciency of kidney water: Dizziness with tinnitus, fatigue, lethargy, lack of motivation, night sweats, nausea, etc. Common prescriptions include BaWeiDiHuang Wan, GuiLuErXian Jiao, or many of the variations of LiuWeiDiHuang Wan.
3. Phlegm accumulation and blockage: dizziness with inability to stand up easily, sensation of fullness in the head, difficulty moving, nausea, stuffiness in the chest. This is commonly treated with BanXiaBaiZhuTianMa Tang or WenDan Tang.
4. Dual deficiency of qi and blood: dizziness with agitation, interrupted sleep or difficulty falling asleep, lack of strength in the extremeties, poor appetite, and loose bowel movements. Possible prescriptions in this case include ShiQuanDaBu Tang, RenShenYangLaoTang, GuiPi Tang, etc.

Nausea or vomiting

In recent years acupuncture has continued to increase in widespread usage for treatment of nausea and vomiting from a variety of causes. While recovering from a concussion, acupuncture may be an effective choice in alleviating acute symptoms of nausea and vomiting. Simple techniques such as self applied acupressure to the NeiGuan point may help quiet sudden occurrences of nausea.

Leaving off digestive and infective causes of nausea we are left with three common patterns for these symptoms, as listed here.

1. Phlegm-fluid: vomiting following consumption of food and drink, feeling of congestion or stuffiness in the chest, feeling of thirst. Prescriptions might include ErChen Tang, WenDan Tang, XiaoBanXia Tang, etc.
2. Qi Depression: nausea and vomiting with decreased appetite, fullness of the chest, achiness of the rib cage, intercostal pain, belching, etc. A common prescription is XiaoYao San.
3. Spleen deficiency: nausea with weakness of the body, fatigue, no desire for food, lack of strength in the body, loose bowel movements. This pattern is often prescribed LiuJunZi Tang or XiangShaLiuJunZi Tang.

Insomnia or Excessive Sleeping

Acupuncture is commonly used for treatment of insomnia. Proposed mechanisms of action include controlling pain, decreasing anxiety through adjustments to hormone secretion and to the sympathetic nervous system, and regulation and improvement of cerebrovascular circulation. A large review study in Korea found acupuncture to be more helpful than conventional methods for treatment of insomnia following a stroke (7). This may also be the case for insomnia following concussions.

Chinese herbal medicine has many common prescriptions including SuanZaoRen Tang a famous formula used for general insomnia without other factors. For symptoms of mild anxiety, palpitations, feeling of stuffiness in the chest, difficulty quieting down the mind we can consider using BanXiaHouPo Tang or WenDan Tang. For severe anxiety, formulas such as JianLing Tang or ZhenGanXiFeng Tang my be preferred.

Depression and Cognitive Impairment

Depression, mood and emotional changes are also not an uncommon occurrence following concussions. The initial trauma may induce irregular secretion of neurotransmitters in affected areas of the brain. For symptoms of depression including sadness, crying, disinterest in activities, and general discomfort of the body, the treatment focuses on tonifying the heart and spleen systems with formulas such as GuiPi Tang, GanMaiDaZao Tang, SiJunZi Tang, etc. This is similar in concept to irregularity in the serotonergic systems.

Other common symptoms include difficulty with mental focus and concentration, memory loss, lack of motivation, fatigue, etc. These mostly fall into the patterns of qi deficiency or kidney yang deficiency. Chinese herbal prescription choices include BuZhongYiQi Tang, LiZhongWan, YouGuiWan, GuiZhiFuZi Tang, etc. This is similar in concept to irregularity in the dopaminergic systems.

More detailed information on depression treatment can be found on a previous post at this link.

Conclusions

Symptoms of concussion are complicated and likewise are the treatments. Nonetheless the various possible symptoms can be classified well within the system of Chinese medical theory allowing for a range of options to restore physical and mental health.

 

References:

1. Chan P, Tomlinson B.“Antioxidant effects of Chinese traditional medicine: focus on trilinolein isolated from the Chinese herb sanchi (Panax pseudoginseng).” J Clin Pharmacol. 2000 May;40(5):457-61.

2. Gu J, et al. “Combination of Ligusticum chuanxiong and Radix Paeoniae ameliorate focal cerebral ischemic in MCAO rats via endoplasmic reticulum stress-dependent apoptotic signaling pathway.” J Ethnopharmacol. 2016 Jul 1;187:313-24.

3. https://www.urmc.rochester.edu/news/story/4213/blows-to-head-damage-brains-garbage-truck-accelerate-dementia.aspx

4. Dai Y,et al. “Tongluo Xingnao Effervescent Tablet preserves mitochondrial energy metabolism and attenuates cognition deficits in APPswe/PS1De9 mice.” Neurosci Lett.2016 Sep 6;630:101-8.

5. Jonas, Wayne B. et al. “A Randomized Exploratory Study to Evaluate Two Acupuncture Methods for the Treatment of Headaches Associated with Traumatic Brain Injury.” Medical Acupuncture(2016): 113–130. PMC. Web. 21 Sept. 2016.

6. Chiu, Chih-Wen et al. “Efficacy and Safety of Acupuncture for Dizziness and Vertigo in Emergency Department: A Pilot Cohort Study.” BMC Complementary and Alternative Medicine (2015): 173. PMC. Web. 19 Sept. 2016.

7. Sook-Hyun Lee and Sung Min Lim. “Acupuncture for insomnia after stroke: a systematic review and meta-analysis.” BMC Complement Altern Med. 2016; 16: 228.

 

 

 

 

Written by Marc Wasserman Ph.D. L.Ac.

Introduction

Depression, according to the World Health Organization, is the leading cause of disability worldwide. People are affected regardless of gender, ethnicity, age, social standing, lifestyle, etc. Understanding of causation is often complicated due to a mix of factors including genetics, physiology, environment, medication or drug use, infection and chronic disease.

A general outline of depression symptoms can be found on the NIH website by following this link

https://www.nimh.nih.gov/health/topics/depression/index.shtml

Below we’ll go through modern and classical explanation of depression, causes and treatments as well as some practices to keep your brain and body healthy.

What causes depression?

Infection

Recent research has shown that elevations in pro-inflammatory cytokines have been associated with mood disorders and major depressive disorder. An inflammatory response to viruses, parasites, or bacterial infections, as well as any inflammation resulting from auto-immune diseases, myocardial infarction, diabetes, etc. can all induce short term and chronic changes in the body’s neurological and physiological systems.

Ancient Chinese Medical theory explaining this very phenomenon dates back to the Han Dynasty. The famous text ShangHanZaBingLun written around the year 200 C.E. discusses the possible outcomes of acute infections manifesting into chronic health problems. It begins with an introduction to acute stages of disease, progressing from common respiratory tract infections, digestive tract infections all the way on to life threatening infections of the internal organs, nervous and hematological systems. Following the diagnosis and treatment protocols for acute infections, the text compiles the possible outcomes resultant from infections which are not treated successfully or cleared correctly from the body during the acute stage. Depression is one of the possible outcomes in this situation. Below are two diagnoses of depression from this ancient text.

BaiHe Disease

According to the original text “excessive lingering heat” weakens the body leading to yin deficiency of the heart and lungs. Symptoms of BaiHe disease include intermittent dysregulation of appetite, sleep, movement, and mood; including sleeplessness, lack of appetite with occasional binge eating, unexplained discomfort and no desire for activity. Other symptoms may include palpitations, heat or cold intolerance, withdrawal from social interaction, chronic dry cough, dry mouth, etc.

Bai He disease takes it name from the lily (百合BaiHe) which is used in treatment; including the classical prescriptions BaiHeZhiMu Tang, BaiHeDiHuang Tang, BaiHeJiZi Tang, HuaShiDaiZhi Tang, etc.

BaiHe is a common ingredient in Chinese cuisine. It is sweet and nourishing and can be included as part of a healthy diet, it soothes the body and calms the nerves.

ZangZao Disease

According to the original text, symptoms of this pattern include frequent crying spells, sadness and unexplained discomfort of the body. In addition ZangZao disease patients incline towards anxiety and delusions in severe cases. Along with the chronic depletion of the body’s resources as mentioned above, this syndrome may also be brought on by emotional or psychological trauma. The classical pathology is dual deficiency of the heart and spleen.

Heart system deficiency is consistent across both ZangZao and BaiHe diagnoses, manifesting as the classic depression symptoms of sadness, sleeplessness, fatigue, palpitations, excessive sweating, etc. Whereas BaiHe includes lung yin deficiency manifesting as dry mouth, dry cough, and other respiratory issues; ZangZao includes spleen deficiency manifesting as worry, anxiety, delusions, etc.

Treatment involves supplementing the spleen and heart, the classic prescription for this case is GanMaiDaZao Tang.

Both of these patterns, BaiHe and ZangZao, are due to depletion of the body’s resources and chronic inflammation.

Gut Bacteria: Changes due to infection or antibiotics

Infections or treatment of infections that change bacterial colonies in the digestive tract also influence neurochemistry. This takes place due to changes in what is known as the microbiome-gut-brain axis. The digestive tract environment affects mental health and vice versa, taking place through the enteric nervous system which communicates information to the brain and can influence mood and behavior.

Our guts contain and produce the body’s highest concentration of serotonin. This important neurotransmitter is often targeted for treatment of depression and likewise is implicated in both inflammatory and functional bowel disorders.

This draws strong parallels to the traditional Chinese medical theory of emotions correlated to the organ systems, and to one of the more common treatments of mild depression, supplementing the spleen and stomach. The spleen and stomach paired organ system represents the digestive system’s chemical and physiological processes, and the psycho-emotional state of overthinking and excessive worry. Above we discussed “BaiHe Disease” and “ZangZao Disease,” another common Chinese medical diagnosis of depression is deficiency of the spleen or dual deficiency of spleen and heart. Symptoms of this pattern include excessvie worry, fear and anxiety, palpitations, forgetfulness, trouble focusing, dizziness, and fatigue. Treatment entails supplementing the spleen primarily while simultaneously nourishing the heart and blood. This is one of the most common and most effective treatments for depression. Common prescriptions include GuiPi Tang, BanXiaBaiZhuTianMa Tang, SiJunZi Tang, etc.

Genetics and Neuroanatomy

Imaging studies of the brain have started to show irregular activity associated with depression. These include irregularity of the serotonin transporter, decreased size and activation of the habenula, and both increased and decreased activity in areas of the prefrontal cortex. Irregular function and size of brain regions is what is known in Chinese medicine as qi deficiency or yuan qi deficiency. There are many formulas which can be used for treatment including BuZhongYiQi Tang, ShiQuanDaBu Tang, SiJunZi Tang, LiZhong Wan, etc.

We also commonly see hereditary patterns with depression. Research efforts continue to search for answers, but currently there appears to be correlation between depression symptoms and both irregularities of the serotonin transporter gene and brain derived neutrophic factor. Likewise aging of the brain, toxicity, or disease which leads to loss of dopamine neurons is also implicated in depression pathology. These all generally fall into the category of Yang deficiency or Kidney yang deficiency. Possible treatments include SiNi Tang, BanXiaBaiZhuTianMa Tang, LiZhong Wan, GuiZhiFuZi Tang, etc.

 

Treatment

Acupuncture

Acupuncture helps to balance the neurological system through stimulation of acupoints which activate specific regions of the brain. Proper needle sensation and placement is necessary to elicit the effect. Research has shown acupuncture to be just as effective as prozac in treatment of depression and other studies have demonstrated how acupuncture interrupts cortisol levels disrupting conditioned stress responses. Additionally as acupuncture can decrease the inflammatory response of the immune system and reduce pain in the body it limits the likelihood of developing worsening depression.

Chinese Herbal Medicine

Chinese herbal medicine can provide long term results for people suffering from depression. It is important to be evaluated by a licensed practitioner who can diagnose your condition and prescribe the appropriate herbal formula. There are specific prescriptions for varying pathologies, through modern imaging and research techniques, these clinically proven formulas are beginning to demonstrate effects on neurochemistry and brain health.

Activity

Get outdoors and walk one hour everyday. Movement increases circulation to the brain and being in nature has powerful effects on brain health as well.

Diet

Increase intake of nuts, berries, green leafy vegetables, fruits, seafood, eggs, and moderate amounts of wine.

Sleep

Sleep at least 8 hours a night. Ideally bed time should be no later than 11pm.

 

Conclusion

Depression is debilitating and often leads to other onset of more severe disease. It is important to get symptoms under control quickly but also to avoid generating addiction behaviors or other imbalances. Many patients find themselves overwhelmed with constantly changing or multiple pharmaceutical prescriptions, when in many cases lifestyle changes and conservative treatment are all that are needed.

Acupuncture and Chinese herbal medicine have a long history of treating mental health diseases. Effects are quick and compliment other efforts of the patient and health care provider to reclaim quality of life.