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MEDICAL ACUPUNCTURE

Volume 25, Number 1, 2013


CLINICAL PEARLS
# Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2012.2503

How Do You Treat Chronic Nightmares in Your Practice

I n Traditional Chinese Medicine (TCM), nightmares


consist of upsetting dreams during rapid eye movement
(REM) sleep. The Heart, Liver, and Gall Bladder are organ
Acupuncture points: Use BL 17 x2, BL 39 x2,
HT 3 x2, LU 9 x2, SP 6 x2, SP 10 x2, and ST
36 x2.
systems in which Stagnation or Stasis of the Qi and Blood
are associated with nightmares. The human spirit becomes
dissociated, because of an underlying insufficiency of Qi and
ALTERNATIVE TREATMENT
Blood, which can be caused by lack of nourishment or ha-
rassment by Heat and Phlegm. After ruling out neurological (1) Kidney Qi or Yin Deficiency
disorders such as epilepsy or narcolepsy, the plans described Acupuncture points: Use BL 23 x2, KI 3 x2, KI 6 x2,
in the two sections below are recommended for treatment. KI 10 x2, and LR 13 x2
(2) Spiritual reconnection
Acupuncture points: Use BL 17 x2, BL 46 x2, CV 5,
TRADITIONAL TREATMENT GB 41 x2, GV 9, PC 6 x2, and TE 5 x2.
(3) General harmonization and treatment of physical,
(1) Excess Liver and Gall Bladder Yang
mental, and spiritual problems
Treatment plan: Sedate the Liver and Gallbladder,
Acupuncture points: Use EXHN 1 x4, GB 41 x2,
clear the Heat from the Liver and Gallbladder, and
GV 20, LI 11 x2, SP 21 x2, and points for temporo-
quiet the Spirit.
mandibular joint (TMJ; GB 2 x2, SI 19 x2, and TE 21
Acupuncture points: Use BL 18 x2 (Cup), BL 19 x2
x2).
(Cup), GB 20 x2, GB 41 x2, HT 7 x2, LR 2 x2, LR 3
(4) Stabilization of REM sleep
x2, and PC 6 x2.
Acupuncture points: Use EXHN 1 x4, EXHN 8 x2,
Remarks: Tonification of Kidneys will also be bene-
and EXHN 9 x2.
ficial.
(5) Cleansing of psychospiritual part of the body
(2) Accumulation of Heat and Phlegm in the Liver and
Treatment plan: Apply sliding cupping with olive
Gallbladder
oil from BL 11 to BL 28, and from BL 42 to
Treatment plan: Quiet the Spirit, and remove Heat
BL 54.
and Phlegm.
(6) Cleansing and calming the Spirit
Acupuncture points: Use CV 12, CV 17, GV 7, GV 9,
Treatment plan: Apply cupping.
GV 14, HT 7 x2, LI 11 x2, LR 13 x2, and ST 40 x2.
Acupuncture points: Use CV 14 (anteriorly), GV 7
(3) Blood Stasis of Heart, Liver, and Gallbladder
(posteriorly), and HT 7 x2.
Treatment plan: Supplement the Heart, nourish the
(7) Microsystems treatment for nightmares
Liver and Gallbladder, improve Blood circulation,
and quiet the Spirit.  Nose acupuncture: Use Head and Heart.
Acupuncture points: Use BL 14 x2, BL 15 x2, BL 17  Foot acupuncture: Use enuresis points 1 and 2 and
x2, BL 18 x2, BL 19 x2, GB 39 x2, HT 3 x2, HT 7 x2, insomnia point (bilaterally).
LU 9 x2, and SP 10 x2.  Hand acupuncture: Use Heart, Occiput, and
(4) Internal obstruction caused by Blood Stasis Nocturia 1 and 2 (bilaterally).

Medical Acupuncture is pleased to continue this regular feature, Clinical Pearls, which we have found to be very useful for, and
practical to, the readership, and very popular. All of us are confronted with clinical challenges, especially when dealing with
therapeutic strategies. We hope this ongoing collection of Clinical Pearls will be easily accessible and ready to put into action for the
benefit of our patients, and even ourselves. How often do we ask our colleagues: How do you treat .? This time, we posed the
question: How do you treat chronic nightmares in your practice? Herein lie your contributions. We trust that our readership will
continue to participate in this section by either asking the questions or supplying the Pearls. If you have a question you would like
to see answered, please send it to our interim managing editor, Julia Chapman, at: jchapman@liebertpub.com We encourage and
welcome your input and participation. Please address your answers to Pearls to our interim managing editor, at: jchapman@
liebertpub.com

88
CLINICAL PEARLS 89

 Scalp acupuncture: Use MS 1, MS 8, MS 9, and Patients indications should be considered holistically and
foot sensory motor line (bilaterally). can be treated according to the TCM syndrome that un-
 Auricular acupuncture: Use Shenmen, Heart, Psy- derlies the manifestation of all the clinical symptoms.
chosomatic, Occiput, Brain, and Brainstem, with Medical acupuncture is helpful in the majority of cases that
needles followed by ear patches bilaterally. are properly treated, because it serves to balance and har-
monize patients energy. Given that TCM is fairly new to
many patients, it is important to explain the acupuncture
DESCRIPTION OF A CASE approach clearly. Usually, the course of therapy should
begin with treatments, twice per week for 2 weeks, and then
For example, a 55-year-old man with frequent night- continue weekly for 4 weeks, if the patient is responding
mares, fatigue, and a general lack of energy presented to my well. Both classical acupuncture and microsystems treat-
clinic. He had a history of childhood traumaincluding ment are helpful for treating nightmares. It is important to
physical and mental abuse by an alcoholic fatherand ne- emphasize body, mind, and spirit. The spiritual aspects of
glect by a mother with a gambling addiction. This patient acupuncture treatment are those that will produce the opti-
had a lack of exposure to compassion and loving kindness. mum response.
His nightmares were severe, and he experienced restless
sleep with screaming, yelling, and occasional falls from his Steven K. H. Aung, MD, OMD, PhD, FAAFP, CM
bed. Clinically, he had a low Shen, dressed untidily, had Faculty of Medicine and Dentistry
congested red eyes, and bushy hair, which he combed in- & School of Public Health
frequently. His tongue was red in the Heart and Liver areas, Faculties of Pharmacy & Pharmaceutical Sciences,
fissured down the center, and coated at the root. According Rehabilitation Medicine & Extension University of Alberta
to pulse diagnosis, the patient had excessive Yang in the 9904 106 Street NW
Liver and Heart, with Stagnation of Qi in the Kidney. Edmonton, Alberta T5K 1C4
Treatment according to the above program was applied, Canada
achieving a steady gradual response, and regular mainte-
nance was also applied. Because of this patients personal E-mail: draung@aung.com
history, spiritual components of treatment were im-
plemented to achieve a better response, according to the
acupoints described in the section below.
N ightmare disorder as a parasomnia is usually as-
sociated with rapid eye movement REM sleep. The
minimal diagnostic criteria proposed by The International
SPIRITUAL TREATMENT
Classification of Sleep Disorders (ICSD-2) are recurrent
(1) Opening the outer gate for emotional ventilation episodes of awakenings from sleep with recall of intensely
Acupuncture points: Use TE 5 x2. disturbing dreams.1 These symptoms are caused by a con-
(2) Healing the subconscious ditioned response that is regulated by norepinephrine.2 In the
Acupuncture points: Use CV 5 and PC 6 x2. National Autonomous University of Mexicos acupuncture
(3) Reconnection of the spiritual whole person clinic, we have been treating patients with nightmare dis-
Acupuncture points: Use BL 17 x2, BL 46 x2, GB 41 orders that do not respond to conventional therapy with
x2, and GV 9. prazosin, which is used to treat patients who have night-
(4) Realigning of physical, mental, and spiritual aspects mares associated with post-traumatic stress disorder.3 Acu-
of the person puncture treatment involves the use of points related to the
Physical: Use LI 11 x2 and SP 21 x2. symptoms that accompany the nightmares. The points used
Mental: Use EXHN 1 x4. are BL 62, BL 10, and SI 3,4 for Yangqiaomai, according to
Spiritual: Use GB 41 x2 and GV 20. the theory of energetics of living systems applied to acu-
(5) Maintainance of realignment of physical, mental, and puncture.5 We also use BL 2 directed toward BL1 with a
spiritual aspects of the person single needle, BL 59, and BL 63 to remove Excess Yang of
Acupuncture points: Use LU 7 x2 and SI 3 x2. the cephalic region, and scatter the energy of a Yangqiaomai
obstruction. We select points of Yinweimai (SP 4, GV 9, PC
6,4 PC 1, GB 34, and GB 38 to induce a sympathetic
SUMMARY parasympathetic balance, by energetic transition of Jue Yin
Meridian (PC) to the Shao Yang Meridian (GB).
Patients referred from physicians for medical acupunc- In each treatment for primary symptomssuch as
ture consultation may complain of nightmares alone, or nightmares with repeated awakenings from major sleep
these may be part of a larger group of Western symptoms, periods or naps, fear or anxiety, anger, sadness, or dis-
including stress, anger, frustration, or childhood trauma. gust6we use BL 62, BL 10, SI 3, and BL 2 to BL 1, BL 59,
90 CLINICAL PEARLS

and BL 63 with electrical stimulation, using a reducing


method at low frequencies (2 Hz) for 15 minutes with su-
perficial insertion of needles.
W hen I started to treat patients with acupuncture
in 1980, one of the first things I observed was that
most patients reported changes in psyche, mentality, and
For secondary symptomssuch as anxiety and chest ways of dealing with social situations after treatment. The
tightness in some nightmares6we use SP 4, GV 9, PC 6, occurrence of special types of dreams was also inherent
PC 1, GB 34, and GB38 with electric stimulation, using a before treatment, such as dying, falling, and smashing
tonification method at high frequencies (100 Hz) for 20 crystal, for example.
minutes with deep needle insertion. We use the points once The way I treat a patient is always to find the Deficient
per week for 10 treatments. Our results have shown a de- process, and treat this with one needle in one of the com-
crease of patients symptoms at a rate of 50%70% in 20 mand points every 34 weeks. After the initial symptom
typical patients who were treated with this method at several complex has disappeared, or healed, I often continue with
health institutions. treatments every 34 months as a prophylactic treatment.
Notably, if the Kidney process is Deficient, there are prob-
lems with sleeping and the occurrence of unpleasant dreams,
REFERENCES which are often nightmarelike dreams. When the Kidney pro-
cess is stimulated, the patients dreams often change to a more
1. American Academy of Sleep Disorders. International Classi- sensual sort of dream, often with sexual content.
fication of Sleep Disorders, Diagnostic and Coding Manual, If the Heart process is Deficient the patients dreams are
2nd ed. Westchester, IL: American Academy of Sleep Medi- often about loss, sorrow, and also death (as in the Kidneys).
cine; 2005. The cause of a Heart Deficiency in humans is often, in
2. Hudson SM, Whiteside TE, Lorenz RA, Wargo KA. Prazosin
*70% of cases, a bad relationship (a loveless relationship).
for the treatment of nightmares related to posttraumatic stress
Of the Heart Deficient patients, *80% are women, as men
disorder: A review of the literature. Prim Care Companion
CNS Disord. 2012;14(2):ii. often seek alternative methods of addressing such problems.
3. Kung S, Espinel Z, Lapid MI. Treatment of nightmares with The dreams in a Heart Deficiency are usually marked by the
prazosin: A systematic review. Mayo Clin Proc. 2012; sorrow concerning the relationship and are thus character-
87(9):890900. ized by a nightmarelike hopelessness. When treated, a
4. Mussat M. Physiological Energetics of Acupuncture, 1st ed. [in strange effect usually occurs; women can get angry, weep,
French]. Paris: Librairie le Francois; 1979. and shout.
5. Mussat M. Energetics of Living Systems Applied to Acu- The different Deficient processes produce different kinds
puncture [in French]. Paris: Medecine et Sciences Inter- of dreams that are often nightmarish, and these dreams
nationales; 1982. usually change when the Deficiency is gone.
6. American Psychiatric Association. Diagnostic and Statistical
The most extraordinary example of the relationships
Manual of Mental Disorders, 4th ed., text revised. Arlington,
among acupuncture treatment, disease, and dreams hap-
VA: American Psychiatric Association; 2000.
pened just 2 weeks prior to this writing, as I was treating a
Miguel Jesus Reyes-Campos, MD* woman with breast cancer; that is, an Excess of the ST
Biological Sciences Health Meridian and Deficiency of the LV Meridian. Prior to the
Metropolitan Autonomous UniversityIztapalapa treatment, she had numerous dreams about houses burning
Colonia Juarez, Mexico City, Mexico with her inside of them. The dreams usually ended in her
being burnt to death and seeing herself being carried out as a
Livia Gabriela Daz-Toral, MD burnt corpse. Her breasts were often the most burned part of
Acupuncture Clinic, FES-Iztacala the body. In all treatments of patients with breast cancer, I
National Autonomous University of Mexico treat a point located between LR 2 and LR 3. The treatment
Tlalnepantla, Edomex, Mexico is repeated 3 times, at 34 weeks apart. The night after the
Primo F. Reyes-Campos, MD, PhD first treatment the woman I had treated had the most lumi-
Department of Liaison Psychiatry, nous and spiritual dream: An angel came down from the sky
OHoran General Hospital, Merida, Mexico to carry her up to the clouds.

*Correspondence to:
Miguel Jesus Reyes-Campos, MD
CBS (Biological Sciences Health) Are Thoresen, DMV, MAcup
UAM-I (Metropolitan Autonomous University-Iztapalapa) Leikvollgata 31, N-3213
Venecia No. 15 Sandefjord
Colonia Juarez, CP 06600, Mexico City, Mexico Norway
E-mail: migreyca@hotmail.com E-mail: arethore@online.no