Acupuncture successfully alleviates depression when combined with moxibustion. Guangzhou University of Chinese Medicine researchers (Second Affiliated Hospital) determined that acupuncture plus moxibustion provides both short and long-term benefits for patients suffering from depression. The university researchers discovered that traditional manual acupuncture stimulation increases the rate of positive patient outcomes. When manual acupuncture techniques were used to elicit deqi at the acupoints, the total treatment efficacy rate significantly improved.

Deqi encompasses a specific set of sensations elicited by manual acupuncture stimulation. The researchers determined that achieving the arrival of deqi sensations produces superior patient outcomes for patients suffering from depression. In addition, true acupuncture was found effective and sham acupuncture did not produce significant positive patient outcomes. The sham controls eliminated concerns regarding the placebo effect and confirmed the validity of the true acupuncture results.

The research team of Fan et al. compared three treatment groups. Group 1 received acupuncture and moxibustion with the elicitation of deqi at the acupoints. Group 2 received the same therapy but without the elicitation of deqi. Group 3 received the same therapy as group 2; however, the acupoints were moved from the true acupoint locations to sham areas. Based on the data, the Guangzhou University of Chinese Medicine researchers conclude that combining acupuncture with moxibustion for the treatment of depression is effective and that a deqi sensation plays a decisive role in patient outcomes.

Evaluation standards were largely based on the Hamilton Depression Scale. Data points were determined immediately after completion of the treatment regimen, one month later, and at three months. Acupuncture combined with moxibustion using deqi stimulation produced a 93.62% total effective rate at the completion of the treatment regimen. This produced a 4.04% greater efficacy rate than acupuncture plus moxibustion without deqi elicitation, which produced an 89.58% total effective rate. The sham control group had an initial 62.50% effective rate, but this rate dropped sharply over the long-term whereas true acupuncture total effective rates were maintained. This highlights that placebo effects may be significant but do not last.

Two more data points are of interest. The researchers measured the total treatment effective rate at one month and three months after completion of all acupuncture therapy. After one month, acupuncture plus moxibustion with deqi stimulation produced an 89.36% effective rate. The same procedure without deqi stimulation produced an 83.33% effective rate. The sham control group effective rate dropped to 47.92%. After three months, acupuncture with moxibustion and deqi stimulation maintained an 87.23% effective rate. The same procedure minus deqi stimulation yielded a 79.17% effective rate. The sham group effective rate dropped to 35.42%. The researchers note that the group receiving true acupuncture plus moxibustion and deqi stimulation significantly outperformed the other groups, especially when measured at the three month follow-up data point.

Deqi is often experienced by patients as an electrical, heavy, or dull pressure sensation. The arrival of deqi may also be verified by acupuncturists by reactions at the acupoint needling site. One of the more common deqi responses is the needle grasp. Historically, this deqi response was documented in the Biao You Fu (Song to Elucidate Mysteries), part of the Zhen Jiu Da Cheng (Great Compendium of Acupuncture and Moxibustion). The needle grasp sensation was described as "the arrival of qi like a fish biting on a fishing line;" the acupuncturist feels a tugging sensation on the needle and then the needle is then firmly grasped at the acupoint by surrounding tissues.

The correlation of the deqi response with the efficaciousness of acupuncture treatments for patients with depression is supported by the Guangzhou University of Chinese Medicine research. This has its roots in the classical foundations of Traditional Chinese Medicine (TCM). Deqi is the subject of acupuncture continuing education in ongoing investigations and translations from classical literature. It is written in the Ling Shu (The Miraculous Pivot), "The arrival of qi [deqi] is of great importance in acupuncture. It indicates that the treatment is effective." In the Bai You Fu it is written, "An immediate deqi sensation means the treatment is instant and effective."

The Guangzhou University of Chinese Medicine research had a sample size of 163 patients with mild to moderate depression, measured by the Hamilton Depression Scale. Patients were randomly divided into three groups. Group 1 received acupuncture and deqi elicitation at the following acupoints:
LI4
LV3
GV20
Yintang

Upon disinfection at the acupoint sites, 0.35 mm x 25 mm filiform acupuncture needles were inserted. Perpendicular insertion to a depth of 10–12 mm was applied to LI4 and LV3, together known as the four gates combination. GV20 (Baihui) and Yintang were needled at a 30° transverse-oblique angle to a depth of 4–5mm. Manual acupuncture techniques included rotating, lifting, and thrusting as a means to elicit the deqi response. After completion of needle insertion, moxibustion was applied to acupoints BL17 (Geshu) and BL19 (Danshu) to produce a warming sensation. Next, intradermal needling was applied to BL15 (Xinshu) and BL18 (Ganshu). Group 2 received the same treatment protocol with minor changes; no deqi response was elicited and moxibustion was applied, but without producing a warming effect. Group 3 received the identical protocol that was applied to group 2; however, sham acupoint locations replaced all true acupoint locations.

The total needle retention time was 30 minutes per acupuncture session. All groups were treated two times per week and one course of treatment consisted of 12 weeks. Clinical outcomes were evaluated immediately after the treatment regimen, one month after, and three months after completion of the treatment regimen. The researchers commented that the acupoint selection was based, in part, on the TCM principle that depression involves qi stagnation and emotions are governed by the mind. The researchers comment, "Soothing the liver to calm exaggerated emotions is the key."

In related research, Luo et al. (Guangzhou Panyu District Traditional Chinese Medicine Hospital) find acupuncture effective for the relief of depression and associated neck pain. A total of 70 patients with depression and neck pain were divided into two groups. Group one received acupuncture at the following acupoints:
GV20 (Baihui)
Yintang
LI4 (Hegu)
LV3 (Taichong)
HT7 (Shenmen)
SI4 (Wangu)
BL15 (Xinshu)
BL18 (Ganshu)

Deqi was elicited at all of the acupoints. Next, moxibustion was applied to BL17 (Geshu) and BL19 (Danshu). The second treatment group received acupuncture at the following acupoints:
BL10 (Tianzhu)
GB20 (Fengchi)
TB5 (Waiguan)
EX-HN15 (Bailao)
EX-NH24 (Xinshe)
BL11 (Dashu)

Deqi was elicited at all of the acupoints. Moxibustion was applied to EX-HN15 (Bailao) and SI15 (Jianzhongshu). Both protocols were effective for the relief of depression and associated neck pain; however, group 1 had a higher rate of positive patient outcomes. In both studies presented in this article, acupuncture demonstrated that it is both safe and effective for the relief of depression.

References
1. Fan L, Fu WB, Xu NG, Liu JH, OU AH, Randomized Controlled Trials of Acupuncture and Moxibustion for Treatment on Depression by Soothing Liver Qi and Regulating Spirit [J]. China Journal of Traditional Chinese Medicine and Pharmacy. 2012(4):841-846.

2. Luo BY, Fu WB, Efficacy Evaluation on Acupuncture of Regulating Liver and Spirit for Depression with Somatic Symptoms of Neck Pain. Chinese Manipulation & Rehabilitation Medicine. 2016, 7(19):22-23.