00502743

January 19, 2022, 01:37

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Regarding the work entitled: “Efficacy of acupuncture at ghost points combined with fluoxetine in treating depression: A randomized study” presented by authors Yi Wang, Yu-Wei Huang, Dilnur Ablikim, Qun Lu, Ai-Jia Zhang, Ye-Qing Dong, Fei-Cui Zeng , Jing-Hua Xu, Wen Wang, Zhi-Hai Hu. World J Clin Cases 2022; 10(3): 929-938 [DOI: 10.12998/wjcc.v10.i3.929], I think it is worth generating some comments regarding this work that may be useful to its authors. As for depression, it is well known that – as of the 2020s (and even more so after suffering a Covid-19 pandemic) – it has established itself as the cause of disability with the greatest global impact. Therefore, this work is referred to a currently worrying medical problem. However, we must not forget that depression is not just a symptom; neither a category within the DSM - V and less for Chinese Medicine. According to this ancient knowledge, depression is also a syndrome that deserves to be classified according to the sequential affectation suffered by the zang or Yin organs according to the Theory of the Five Elements. Following this Guiding Principle of Chinese Medicine, I have been able to compile in my book: “ACUPUNCTURE “AFFECTED VESSEL CRITERION”: AN INNOVATIVE DIAGNOSIS VADEMECUM TO UPGRADE CHINESE MEDICAL PRACTICE” the following nosological conditions that should be reviewed when faced with depression in Chinese Medicine: -Diathesis from the Metal Element--------------------------------------------------------------melancholy (17) -Xin Tendinomuscular channel affection--------------------------------------sadness (with apathy) (18) -Dan Qi Deficiency syndrome -----------------------------------------------------------------------indecision (21) -Ministerial Fire affection-----------------------------------------------------------emotional disturbances (22) -Fei Yang Qi Deficiency syndrome ------------------------------------------------------melancholy excess (29) -Yang Qi Pi Depression syndrome ---------------------------------------------------------psychic asthenia (38) - Pi Qi Deficiency syndrome ------------------------------------------------insomnia by hyper-ideation (34 j) - Xin Yang Qi Vacuity syndrome ----------------------------------------------------------------hypersomnia (35) - Xue deficiency in Xin syndrome ------------------------------------------------insomnia with starts (34 a) -Gan Blood Deficiency syndrome ------------------------------------------------------------------insomnia (34 b) -Vacuity-Cold in Master of the Heart s-----------------------------------night terror with onirisms (23 k) - Qi of Dan depression syndrome -----------------------------------------------------------------cowardice (24 a) - Fire Flames in Gan syndrome ---------------------------------------------------------------------insomnia (34 c) - Xin Qi Deficiency syndrome -----------------------------------------------------------------------insomnia (34 d) -Repletion –Heat in the Heart syndrome --------------------------------------------------------insomnia (34 e) -Cold-Phlegm clouding the Shen syndrome -----------------------------------psychiatric disorders (40 b) -Qi of Gan Depression or Stagnation syndrome -----------------------------psychiatric disorders (40 c) -Phlegm-Damp Repletion in Xin condition -------------------------maniac-depressive psychosis (41 b) Vacuity-Cold in Pang Guang / Jing of Shen Deficit affection -------------------------------lethargy (47) -Vacuity-Cold syndrome in Gan/Dan system ------------------------------------------------depression (48 a) -Vacuity-Cold in Pericardium syndrome ------------------------------------------------------depression (48 b) - Gan Qi Stagnation syndrome --------------------------------------------------------------------depression (48 d) - Joint Vacuity-Cold in Kidney/Urinary Bladder condition ----------endogenous depression (48 e) -Joint affection of Heart and Kidneys [“Water-Fire Disharmony”]----persecutory delusion (49 d) All these clinical entities show the sequential affectation that – according to Traditional Chinese Medicine – leads to depression: worry, insomnia due to hyper-ideation that generate phobic attitudes from the Earth Element, stagnating Water. Melancholy or sadness - emblematic emotions of the Metal Element - will inevitably end up "hurting" Wood (already insufficiently irrigated by Water), with the most typical pictures of energetic Depression or Liver Qi Stagnation, even avoidance behaviors and cowardice characteristics of Gallbladder energy deficiency. Finally, the damage of the Wood can affect his son Fire, emphasizing the usual daily bipolarity that is experienced these days; and the further aggravation of it into manic-depressive psychosis. There is no doubt about the action of the “ghost” points; I have personally resuscitated 89 patients with Ki-1 Yongquan stimulation alone after failure of basic and/or advanced CPR. I fully trust in the recovery capacity possible through Chinese Medicine; and therefore it seems strange to me that said authors – versed experts on the subject – have not proposed a complete Chinese medical treatment based on any of the possible Chinese medical diagnoses. For this reason I was also amazed that no Chinese syndromic classification or tabulation was available in this work; just a few "ghost" points, almost timidly hidden behind the action of fluoxetine, instead of removing that handicap to Acupuncture and having all the complete treatment to which each entity must submit, according to the rules and principles of the Traditional Chinese Medicine. No known medicine will achieve success if it does not first strive to refine the correct diagnosis. Treating without diagnosis is almost synonymous with not treating at all. That is why I believe that this work could only be useful as a pilot study; but I encourage quoted authors to then open the proposal of a prospective comparative trial, without hiding it results behind the effect of Western drugs. Please excuse my frankness, but I think that was the only reason for not obtaining significant differences in this randomized study.

First, thank you very much for your professional comments on the article published in World Journal of Clinical Cases. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Clinical Cases at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.

05127894

January 17, 2022, 20:39

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The manuscript does not mention the limitations inherent in an unblinded study. The placebo effect in this study is a very important source of bias.

Thank you very much for your comments.