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
 Scalp acupuncture: Use MS 1, MS 8, MS 9, and
foot sensory motor line (bilaterally).
 Auricular acupuncture: Use Shenmen, Heart, Psy-
chosomatic, Occiput, Brain, and Brainstem, with
needles followed by ear patches bilaterally.
DESCRIPTION OF A CASE
For example, a 55-year-old man with frequent night-
mares, fatigue, and a general lack of energy presented to my
clinic. He had a history of childhood traumaincluding
physical and mental abuse by an alcoholic fatherand ne-
glect by a mother with a gambling addiction. This patient
had a lack of exposure to compassion and loving kindness.
His nightmares were severe, and he experienced restless
sleep with screaming, yelling, and occasional falls from his
bed. Clinically, he had a low Shen, dressed untidily, had
congested red eyes, and bushy hair, which he combed in-
frequently. His tongue was red in the Heart and Liver areas,
fissured down the center, and coated at the root. According
to pulse diagnosis, the patient had excessive Yang in the
Liver and Heart, with Stagnation of Qi in the Kidney.
Treatment according to the above program was applied,
achieving a steady gradual response, and regular mainte-
nance was also applied. Because of this patients personal
history, spiritual components of treatment were im-
plemented to achieve a better response, according to the
acupoints described in the section below.
SPIRITUAL TREATMENT
(1) Opening the outer gate for emotional ventilation
Acupuncture points: Use TE 5 x2.
(2) Healing the subconscious
Acupuncture points: Use CV 5 and PC 6 x2.
(3) Reconnection of the spiritual whole person
Acupuncture points: Use BL 17 x2, BL 46 x2, GB 41
x2, and GV 9.
(4) Realigning of physical, mental, and spiritual aspects
of the person
Physical: Use LI 11 x2 and SP 21 x2.
Mental: Use EXHN 1 x4.
Spiritual: Use GB 41 x2 and GV 20.
(5) Maintainance of realignment of physical, mental, and
spiritual aspects of the person
Acupuncture points: Use LU 7 x2 and SI 3 x2.
SUMMARY
Patients referred from physicians for medical acupunc-
ture consultation may complain of nightmares alone, or
these may be part of a larger group of Western symptoms,
including stress, anger, frustration, or childhood trauma.
89
Patients indications should be considered holistically and
can be treated according to the TCM syndrome that un-
derlies the manifestation of all the clinical symptoms.
Medical acupuncture is helpful in the majority of cases that
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
approach clearly. Usually, the course of therapy should
begin with treatments, twice per week for 2 weeks, and then
continue weekly for 4 weeks, if the patient is responding
well. Both classical acupuncture and microsystems treat-
ment are helpful for treating nightmares. It is important to
emphasize body, mind, and spirit. The spiritual aspects of
acupuncture treatment are those that will produce the opti-
mum response.
Steven K. H. Aung, MD, OMD, PhD, FAAFP, CM
Faculty of Medicine and Dentistry
& School of Public Health
Faculties of Pharmacy & Pharmaceutical Sciences,
Rehabilitation Medicine & Extension University of Alberta
9904 106 Street NW
Edmonton, Alberta T5K 1C4
Canada
E-mail: draung@aung.com
N ightmare disorder as a parasomnia is usually as-
sociated with rapid eye movement REM sleep. The
minimal diagnostic criteria proposed by The International
Classification of Sleep Disorders (ICSD-2) are recurrent
episodes of awakenings from sleep with recall of intensely
disturbing dreams.1 These symptoms are caused by a con-
ditioned response that is regulated by norepinephrine.2 In the
National Autonomous University of Mexicos acupuncture
clinic, we have been treating patients with nightmare dis-
orders that do not respond to conventional therapy with
prazosin, which is used to treat patients who have night-
mares associated with post-traumatic stress disorder.3 Acu-
puncture treatment involves the use of points related to the
symptoms that accompany the nightmares. The points used
are BL 62, BL 10, and SI 3,4 for Yangqiaomai, according to
the theory of energetics of living systems applied to acu-
puncture.5 We also use BL 2 directed toward BL1 with a
single needle, BL 59, and BL 63 to remove Excess Yang of
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
parasympathetic balance, by energetic transition of Jue Yin
Meridian (PC) to the Shao Yang Meridian (GB).
In each treatment for primary symptomssuch as
nightmares with repeated awakenings from major sleep
periods or naps, fear or anxiety, anger, sadness, or dis-
gust6we use BL 62, BL 10, SI 3, and BL 2 to BL 1, BL 59,
90
and BL 63 with electrical stimulation, using a reducing
method at low frequencies (2 Hz) for 15 minutes with su-
perficial insertion of needles.
For secondary symptomssuch as anxiety and chest
tightness in some nightmares6we use SP 4, GV 9, PC 6,
PC 1, GB 34, and GB38 with electric stimulation, using a
tonification method at high frequencies (100 Hz) for 20
minutes with deep needle insertion. We use the points once
per week for 10 treatments. Our results have shown a de-
crease of patients symptoms at a rate of 50%70% in 20
typical patients who were treated with this method at several
health institutions.
REFERENCES
1. American Academy of Sleep Disorders. International Classi-
fication of Sleep Disorders, Diagnostic and Coding Manual,
2nd ed. Westchester, IL: American Academy of Sleep Medi-
cine; 2005.
2. Hudson SM, Whiteside TE, Lorenz RA, Wargo KA. Prazosin
for the treatment of nightmares related to posttraumatic stress
disorder: A review of the literature. Prim Care Companion
CNS Disord. 2012;14(2):ii.
3. Kung S, Espinel Z, Lapid MI. Treatment of nightmares with
prazosin: A systematic review. Mayo Clin Proc. 2012;
87(9):890900.
4. Mussat M. Physiological Energetics of Acupuncture, 1st ed. [in
French]. Paris: Librairie le Francois; 1979.
5. Mussat M. Energetics of Living Systems Applied to Acu-
puncture [in French]. Paris: Medecine et Sciences Inter-
nationales; 1982.
6. American Psychiatric Association. Diagnostic and Statistical
Manual of Mental Disorders, 4th ed., text revised. Arlington,
VA: American Psychiatric Association; 2000.
Miguel Jesus Reyes-Campos, MD*
Biological Sciences Health
Metropolitan Autonomous UniversityIztapalapa
Colonia Juarez, Mexico City, Mexico
Livia Gabriela Daz-Toral, MD
Acupuncture Clinic, FES-Iztacala
National Autonomous University of Mexico
Tlalnepantla, Edomex, Mexico
Primo F. Reyes-Campos, MD, PhD
Department of Liaison Psychiatry,
OHoran General Hospital, Merida, Mexico
*Correspondence to:
Miguel Jesus Reyes-Campos, MD
CBS (Biological Sciences Health)
UAM-I (Metropolitan Autonomous University-Iztapalapa)
Venecia No. 15
Colonia Juarez, CP 06600, Mexico City, Mexico
E-mail: migreyca@hotmail.com
CLINICAL PEARLS
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
ways of dealing with social situations after treatment. The
occurrence of special types of dreams was also inherent
before treatment, such as dying, falling, and smashing
crystal, for example.
The way I treat a patient is always to find the Deficient
process, and treat this with one needle in one of the com-
mand points every 34 weeks. After the initial symptom
complex has disappeared, or healed, I often continue with
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,
which are often nightmarelike dreams. When the Kidney pro-
cess is stimulated, the patients dreams often change to a more
sensual sort of dream, often with sexual content.
If the Heart process is Deficient the patients dreams are
often about loss, sorrow, and also death (as in the Kidneys).
The cause of a Heart Deficiency in humans is often, in
*70% of cases, a bad relationship (a loveless relationship).
Of the Heart Deficient patients, *80% are women, as men
often seek alternative methods of addressing such problems.
The dreams in a Heart Deficiency are usually marked by the
sorrow concerning the relationship and are thus character-
ized by a nightmarelike hopelessness. When treated, a
strange effect usually occurs; women can get angry, weep,
and shout.
The different Deficient processes produce different kinds
of dreams that are often nightmarish, and these dreams
usually change when the Deficiency is gone.
The most extraordinary example of the relationships
among acupuncture treatment, disease, and dreams hap-
pened just 2 weeks prior to this writing, as I was treating a
woman with breast cancer; that is, an Excess of the ST
Meridian and Deficiency of the LV Meridian. Prior to the
treatment, she had numerous dreams about houses burning
with her inside of them. The dreams usually ended in her
being burnt to death and seeing herself being carried out as a
burnt corpse. Her breasts were often the most burned part of
the body. In all treatments of patients with breast cancer, I
treat a point located between LR 2 and LR 3. The treatment
is repeated 3 times, at 34 weeks apart. The night after the
first treatment the woman I had treated had the most lumi-
nous and spiritual dream: An angel came down from the sky
to carry her up to the clouds.
Are Thoresen, DMV, MAcup
Leikvollgata 31, N-3213
Sandefjord
Norway
E-mail: arethore@online.no