The past two years of uncertainty have been a challenging time for all of us – physically, mentally and emotionally.
Since the Covid-19 pandemic hit, the mental health crisis has soared to unprecedented levels as people struggle to cope with social isolation, loneliness, fear of infection, death of loved ones, grief after bereavement, and financial or employment worries.
The World Health Organization (WHO) estimates that in the first year of the pandemic, global prevalence of anxiety and depression increased by a massive 25% – and that’s just the tip of the iceberg,
Concerns about potential increases in mental health conditions have already prompted many countries to include mental health and psychosocial support in their Covid-19 response plans, but major gaps and concerns remain.
Already, local care lines and support groups are overwhelmed with pleas for help, and for those who prefer face-to-face counselling, the wait time is long to secure an appointment with a mental health professional.
The more familiar forms of mental health support and intervention include peer and community support, as well as psychological and pharmacological interventions.
In addition, traditional and complementary medicine therapies can also have a positive effect on neurochemistry, without the dependence or side effects that medications can cause.
When these services were allowed to resume operations last year, senior traditional Chinese medicine (TCM) practitioner-cum-lecturer Dr Ong Siew Siew assumed individuals would be returning to manage their physical pain.
Instead, she found many patients came to seek help to relieve mental anguish arising from the pandemic.
“At present, both the infected and non-infected are experiencing emotional stress.
“In Chinese medicine, such stress is understood in terms of the seven emotions – joy, anger, grief, melancholy, worry, fear and fright – which disturb the circulation of qi (vital energy) and blood, and can directly affect the organs.
“Sometimes, patients are unaware their mental state is affected because their presenting symptoms could be indigestion, headache, insomnia, coughing, etc.
“A lot of people attend only to physical symptoms, but the pandemic’s effect on people’s mental state also requires immediate attention,” she shares.
For Covid-19 survivors, the physical effects of the SARS-CoV-2 virus, in which various organs and systems are attacked, include damage to the nervous system, which can affect the mental health of all age groups.
“When the intense symptoms of the infection subside, that is not the end of the story.
“In fact, recovery from the disease is proving to be a long journey for many people,” she adds.
A medical doctor or therapist may hear that a patient has headaches, an upset tummy, rapid heartbeats, sleep problems or episodes of anger, and view these as separate symptoms, treatable by separate medications.
But the acupuncturist sees a pattern that points to a particular imbalance in the organ systems.
Rebalancing energy
There’s a longstanding history of TCM physicians using acupuncture to alleviate psychological disorders.
Like blood in the circulatory system, qi moves throughout the body via pathways called meridians.
If the flow of qi is disrupted, you may feel ill.
The insertion of extremely fine needles at specific points in the body releases endorphins – the body’s natural feel-good, pain-killing hormone – and affects the part of the brain that governs serotonin, a brain chemical involved with regulating mood.
Dr Ong explains: “Acupuncture can adjust xing, regulate qi and balance shen to effectively rebalance your energy and improve emotional health.
“The Western model uses anatomy, physiology and Western medical principles.
“Dry needling, often used by physical therapists and chiropractors to release muscle knots and trigger points, is commonly used for treating musculoskeletal conditions.
“Our approach is to restore the flow of qi, which travels through acupuncture channels.
“So, we may not necessarily put the needle in the affected area, but somewhere along the meridian channels to address qi blockages in the whole body.”
The acupuncturist might also turn or twirl the needles, or apply heat or electrical stimulation, to enhance the effects.
He or she might also burn a therapeutic herb near the skin – this is called moxibustion.
Dr Ong further elaborates that the state of xing determines the quality of qi and shen, e.g. if a Covid-19 patient has prolonged pneumonia, it affects the quality of qi and shen.
The TCM theory believes that the heart acts as the body’s “emperor” and the lung as the “prime minister”.
“When the qi is stagnant, it cannot remove excess water, so the patient might end up with phlegm in the lungs.
“The lung then loses its ability to disperse qi and regulate the liver.
“If impaired, the lung can contribute to emotional disturbances such as irritability, frustration, sadness, tears, anxiety, chest tightness and restlessness due to qi stagnation and heat accumulating in the lung and liver,” she says.
Multi-directional flow
The four directions of qi movement in the body are upward, downward, outward and inward.
If qi cannot travel smoothly and appropriately in these directions, life will be under “threat”.
“For example, the lung qi is supposed to move down, but if it goes up instead, that causes a cough.
“Once the qi cannot travel freely, it affects the harmonious movement and coordination between the internal organs.
“The emotional state easily affects the movement of qi, while conversely, imbalances of qi in different organs affect the smooth expression of emotions.
“Moreover, qi should be sufficient and not in excess.
“Disorders of qi in terms of movement or quantity will cause sickness, both physically and mentally,” says Dr Ong.
In Covid-19 patients, inflammatory changes and immune activity may continue long after the early symptoms have disappeared.
As qi and blood are closely related, blockage of the former can cause blood stasis, which explains why many Covid-19 patients develop thrombosis and cerebrovascular accidents (i.e. stroke).
However, Dr Ong points out that without identifying and addressing the root of the illness, acupuncture is unlikely to be effective.
How fast a patient recovers depends on the individual’s body constitution – usually, some improvement can be seen within four sessions of acupuncture.
Recently, two post-Covid patients who both presented with a persistent cough, consulted Dr Ong.
She shares: “I took their pulse and had a look at their tongue – one was red (heaty) and the other was pale (cold/damp), so I could not prescribe the same herbs for them.
“One required a clearance of heat, while the other needed heat replenishment.
“If I just cleared the heat for both, it would deplete the water in the body for the latter patient, which would cause future irritation to the body system.
“Hence, I have to make the appropriate analysis based on syndrome differentiation and identification of the root cause.
“It’s not about the disease name, but looking at the presenting symptoms and prescribing acupuncture or herbs to balance the body system.”
Needles first, herbs next
If the acupuncture does not work well and the body is still weak, she then suggests adding herbs to boost the results.
“Normally, after four acupuncture sessions, if the patient is picking up momentum, I let it be.
“Our body is very intelligent, it can do the work.
“But lifestyle is also important, so you’ve to avoid certain foods until the body builds a buffer, then you can eat those foods again.
“Cancer patients always ask me if they need to eat organic food and I say no.
“If someone is used to eating beef, and suddenly, you ask him to switch to being a vegetarian, the brain is not happy and it will produce a certain negative effect in the body,” says Dr Ong, whose interest lies in neurological problems.
She advises people not to wait for mental issues to surface before trying out acupuncture, but to sort out the imbalances quickly to prevent them from worsening.
The earlier you address the problem, the faster you will see results.
Those suffering from severe anxiety are encouraged to see a Western medicine practitioner first to get an assessment before approaching an acupuncturist.
How can one tell if the qi is being regulated properly?
Dr Ong says: “Unless we do clinical trials, there is no way to measure it, so we base it on how the patient is feeling.
“I will ask the patient if there is any improvement, then adjust the strategy until he feels better.
“Remember that your qi is travelling its own way when it is impaired, so when I put in a needle, I’m creating a new route and it has to follow my ‘map’.”
Essentially, the acupuncturist is rewiring the pathway to help the qi flow in a more optimum manner to correct the imbalance in the body.
When Dr Ong removes the needles, she will ask the patient to rate their pain or discomfort, and usually, they will say it’s less.
“But a few days down the road, the qi will overrule my ‘map’, so the pain level may increase, and we continue to play tug-of-war until your body builds a memory of how the qi should travel, then you will consistently feel better,” she explains, adding that there is no instant fix.
For patients with newly-diagnosed depression or anxiety, this “map” can be rewired quickly, but if the pain or depression has been there for a decade or more, it will take a longer time to see a difference.
The patient just has to be patient.
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