MEDICAL ACUPUNCTURE

Volume 24, Number 3, 2012

# Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2011.0864

A Unique Application of KI 26 (Yu Zhong)

Acupuncture Point for the Treatment of Anxiety

Anne Jeffres, DAOM, LAc

ABSTRACT

Anxiety is a common clinical presentation that is important for practitioners to recognize and address in their
patients. Modern psychological research understands anxiety to be a state of apprehensive fear in the face of
uncertain or uncontrollable challenges. Traditionally, Chinese medicine has several approaches to the treatment of
anxiety, including treatments focused on the Liver, Heart, and Mind. Utilizing the relationships of organs to emotions
in Traditional Chinese Medicine, and an interpretation of Chinese characters used in naming acupuncture points and
describing anxiety, the author discusses a new strategy for the treatment of anxiety, utilizing the acupuncture point KI
26 (Yu Zhong). This is a promising acupuncture point to research in the treatment of clinical anxiety.

Key Words: Acupuncture, Anxiety, Fear, Apprehension, Mind, Kidney, KI 26

INTRODUCTION prolonged or abnormal fear that may be episodic or con-

tinuous, and lead to mental fear and apprehension, physical
The Problem of Anxiety tension, and physical symptomology. Patients with anxiety
are more likely to present to their general practitioners with

A nxiety is a commonly encountered clinical presen-

tation, and one that can have debilitating effects for
those who suffer from it. It is the most prevalent mental
disorder in the United States,1 and is associated with sig-
nificant comorbidity, such as pain conditions, and increased
health care costs and utilization.2 It is also a condition for
which patients often seek acupuncture treatment. In a 1998
survey of 575 acupuncture users, 66.3% received acupunc-
ture predominantly for mood care, the most common rea-
son cited.3 A 2002 study reported that in Massachusetts,
anxiety or depression were cited as the second most
common reason that respondents visited acupuncturists,
after back pain.4
Anxiety disorders are commonly encountered in clinical
practice, although it is often underdiagnosed and treated.
According to the National Institute of Mental Health, 18.1%
of U.S. adults and 25.1% of U.S. children from 13 to
18 years of age suffer from an anxiety disorder.5 Anxiety
disorders represent a group of disorders characterized by
somatic symptoms, such as heart palpitations, gastrointes-
tinal distress, breathing difficulty, and physical pain, and
have a greater likelihood of comorbidity with other psy-
chological disorders such as depression and substance
abuse.6
Anxiety disorders are characterized into five main types:
Generalized Anxiety Disorder, which is persistent and
excessive anxiety and worry over daily life issues for at least
six months; Obsessive-Compulsive Disorder, which is
characterized by obsessive thought patterns or compulsive
actions that alleviate anxiety; Panic Disorder, which is
characterized by acute episodes intense fear and may be
accompanied by chest or abdominal pain, heart palpita-
tions, shortness of breath, and/or dizziness; Post-Traumatic
Stress Disorder (PTSD), which is characterized by the re-
experiencing of a very traumatic event and avoidance of
stimuli that may trigger that trauma; and Social Anxiety or
Phobia, which is characterized by anxiety or excessive self-
consciousness in social situations.7

Columbia University, Herbert Irving Comprehensive Cancer Center, New York.

156
KI 26 ACUPUNCTURE POINT IN THE TREATMENT OF ANXIETY
Neurobiologically, anxiety and fear are in part linked to
increased activity of the amygdala, which stores memories
of emotional stimuli and is involved with processing and
responding to fear, as well as increased activity of the
hypothalamic-pituitary-adrenal (HPA) axis and cortisol
levels, which controls reactions to stress and regulates
emotions and moods. In addition, anxiety is correlated with
low levels of gamma-aminobutyric acid (GABA), which
functions to inhibit activity in the central nervous system,
and serotonin, which moderates several functions including
mood as well as appetite and sleep.1 Conventional treat-
ments for anxiety disorders include psychotherapy and
cognitive behavioral therapy and selective serotonin re-
uptake inhibitors (SSRIs) as first-line therapy, with tricyclic
antidepressants and monoamine oxidase inhibitors (MAOIs)
as second-line treatment due to an increase in the severity of
side effects. SSRIs, however, have potential side effects
such as sexual dysfunction, weight gain, nausea, headache,
insomnia, and even an increase in nervousness and rest-
lessness. Benzodiazepines as sedative hypnotics are also
used for short amounts of time to control anxiety and panic,
although they do have an increased risk of tolerance and
dependence, along with memory impairment and psycho-
motor function and withdrawal symptoms when the drug is
discontinued.8 Beta-blockers are also used to treat anxiety,
especially social phobia, but also have weight gain and
sexual dysfunction as potential side effects.9 Acupuncture
has been shown to be promising in treating anxiety and
anxiety disorders in several clinical studies,10 and has been
shown to be as effective as cognitive behavioral therapy in
the treatment of PTSD.11
MODERN UNDERSTANDING OF ANXIETY
Anxiety is a reaction to stress that helps a person cope
with challenges facing them, and can represent a normal
reaction to a stressful stimuli. If experienced in excess,
anxiety can interfere with normal daily life and function,
and lead to debilitating psychological and physical symp-
toms. Psychologically, in people with abnormal levels of
anxiety, it represents a maladaptive response to stress
characterized by a subjective feeling of helplessness in the
face of unpredictable or uncontrollable threats or chal-
lenges.12 As a response to this perceived threat, a person
may become hypervigilant, resulting in anxiety. A leading
anxiety and anxiety disorder researcher, Dr. David H.
Barlow, PhD, has suggested that anxiety represents a state
of apprehension and anticipation over perceived future
danger, where fear represents a response to present danger
that demands immediate action.5 It has also been suggested
that anxiety results from hypervigilance due to overesti-
mation of the potential for threat in ambiguous situations.13
Anxiety and fear are interrelated but distinct psychological
states.
157
CHINESE MEDICINE UNDERSTANDING
OF ANXIETY
Understand the Chinese characters that describe energetic
states and disease states can yield a tremendous insight into
what is implied by that character. This is especially true in
understanding emotional disorders that are harder to quan-
tify and qualify than physical disease states. In Chinese
Medicine, the emotional state of You (for Chinese charac-
ters, please refer to Fig. 1) has often been described as
anxiety. The traditional character shows a description of a
state in which someone walks slowly with a troubled head
and heart. It connotes a depressive state of mind and is most
often translated into English as anxiety, sadness, or worry,
and is associated with the Lungs. In Traditional Chinese
Medicine (TCM), however, patterns that include You (You
Zheng) are most often described as a type of depression
disorder. It best denotes someone who is aggrieved or
melancholic, which is different from the modern psycho-
logical understanding of anxiety. The most common clas-
sification of depression in TCM is Yu Zheng, a state of Qi
stagnation related to the Liver, and often the result of
emotional stress and anger. Stagnation of the Qi dynamic of
Liver leads to symptoms including hypochondriacal pain
and distention, frequent sighing, and an emotional state that
presents as an anger-turned-inward type of depression.
The traditional character, Yu, can be translated as lush
and denotes something that is difficult to move through. It
refers to depressed movement and activitywhether
physical or emotional. You, on the other hand, is most often
characterized as a type of melancholy and despondency.
You Yu refers to melancholia, dejection, and depression.
You Ju, however, refers to apprehension, with the character
FIG. 1. Chinese terms used in this article.
158
Ju specifically describing a sense of fear or dread. You Ju
can refer to a state of anticipatory fear, which relates to the
energetics of the Kidneys in TCM. According to the Su
Wen, chapter 5, fear relates to the Kidneys and can damage
the Kidneys when in excess. This is an important distinction
when considering the treatment of anxiety with acupuncture
and Chinese medicine. To address what most patients will
describe as anxiety, the energetics of the Kidney need to be
addressed, specifically by treating the Kidney channel.
TCM TREATMENT OF ANXIETY
Current TCM treatment for anxiety most often focuses on
soothing the Liver and calming the Heart and Mind. Psy-
chological disorders are often addressed in TCM through
the Liver and Heart. Treating the Livermost often with a
diagnosis of Liver Qi Stagnationmeans to treat Yu and is
a method to help someone move through the emotional state
in which they are stagnated. It is, in a way, a strategy that
helps someone persevere and move through whatever
emotion they are having a difficult time processingbe it
fear, anger, worry, or sadness. In this paradigm, a persons
condition is characterized by an emotional state that is
worsened by stress, and accompanied by a stagnated Qi
dynamic, including distending hypochondriacal pain, chest
oppression, digestive upset, irregular menses, depression,
epigastric fullness, and a wiry pulse. Treatment for Liver Qi
stagnation most often includes the four gates, LR 3 and
LI 4, along with points to regulate Qi including LR14 ST 36,
CV 17, and CV 12.14
Another TCM strategy to treat emotional disorders and
anxiety is to treat the energetics of the Heart. The Heart, as
the emotional center of the body and the mind, is respon-
sible for being present with and transforming emotional
states. The character for HeartXinis a part of each
character that represents an emotion. The Heart is where a
person feels, and responds to, emotional or mental stimulus.
If the Heart is calm, a person can be present with current and
future potential fear and not be overwhelmed by them.
Acupuncture points that address this aspect of anxiety in-
clude HT 7 and PC 6, and BL 15. To treat the Heart can also
mean to transform Phlegm that is misting the Heart, leading
to confused thoughts and foggy headedness, and that ob-
struct a persons ability to emotionally and cognitively see
things for what they are. Points such as ST 40 and PC 5
clear Phlegm that is misting the Heart, and can lead to im-
proved consciousness and emotional clarity.
A third strategy involves a more modern approach of
treating the mind to alleviate anxiety. This strategy involves
points that specifically function to sedate and calm the
mind and brain. A common strategy involves the use of
points such as Sishencong, GV 20, and Yintang to calm and
sedate the mind. The other involves the use of auricular
acupuncture, based most often either on National Acu-
JEFFRES
puncture Detoxification Association (NADA) protocol or
the Nogier style (i.e., Shen Men, Tranquilizer, and Master
Cerebral Point).9 In one study, using both body points and
auriculotherapy were found to be equally effective in alle-
viating preoperative anxiety.15 All of the above methods
treating the Liver, Heart, and Mindare commonly com-
bined in the treatment of anxiety in clinical practice.
ANOTHER APPROACH TO
TREATING ANXIETY
As discussed, most patients that present in clinic with
anxiety will describe their emotional state more as appre-
hension and fear around uncertainty about future events.
Given that anxiety and fear are interrelated, though, it makes
sense in Chinese medicine to look at what is described in
clinical practice as anxiety through the function of the Kid-
neys. In looking at anxiety as more apprehensive fear (You
Ju), there is one point that characterizes this state more than
any other: KI 26Yu Zhong. In TCM, it functions in TCM to
unbind the chest and benefit the breasts, transform Phlegm,
and lower rebellious Lung and Stomach Qi, and is most
commonly used for dyspnea, cough, and asthma, along with
vomiting and breast abscesses.16 It is not described as having
a strong function to affect the mind and mental status.
KI 26 IN THE TREATMENT OF ANXIETY
An important way to understand the functional dynamics
of a point, however, is to understand the characters used
in the name of the point. For example, HT 7 (Shen Men)
is often translated as Spirit Gate,10 which denotes its
ability to regulate excess and deficient states of the Heart
channelboth physically and emotionally. With KI 26 (Yu
Zhong), there are many translations for Yu Zhong.
Deadman in A Manual of Acupuncture translates this as
Comfortable Chest,17 J.R. Worsley in the 5 Element
tradition translates it as Amidst Elegance,18 and Wise-
man in A Practical Dictionary of Chinese Medicine trans-
lates it as Lively Center.10 Zhong refers to the center of
something. It also refers to being in the midst of something,
as well as to attain or hit a target. Yu commonly refers to
something that is cultured or refined. The first character in
the name of KI 26 can be transliterated as either Huo or Yu
in Pinyin, and has an interesting meaning. In modern Chi-
nese, it can be interpreted as the adverb perhaps, which
connotes a degree of uncertainty. The classical meaning of
the character, however, refers to a primitive, boundary-less
post, castle or town that a landlord defended with the
weapons of his men.19 Yu Zhong, then, can be interpreted as
a point that represents the center of a territory with no known
boundaries, which is an interesting juxtaposition. How can
one know the center of a territory with no known boundaries?
KI 26 ACUPUNCTURE POINT IN THE TREATMENT OF ANXIETY
How can one face the potential challenges and situations in
life when one does not know exactly what will happen or
what a given situation will look like? This fits exceedingly
well into the current understanding of anxiety being a state of
anticipatory apprehension and hypervigilance. It describes a
person who tries to protect themselves in a state in which they
cannot find the center of the situation or, perhaps, themselves.
This point symbolizes finding the center of oneself when one
does know what will exactly what will happen, and the ability
of the Kidneys to turn the disordered emotions of fear and
anxiety into the virtue of wisdom.
CASE STUDY
The author has incorporated KI 26 into a number of
patient treatments where anxiety has been a presenting
issue or complaint, and empirically found it to be ef-
fective in reducing anxiety symptoms. A representative
example of this is the case of a 33-year-old woman, who
had recently moved from Oregon to New York City. She
presented to the clinic with stress and anxiety. She was
enrolled in an intensive business management program,
and reported suffering from insomnia, irregular menses
tension headaches, and feelings of generalized anxiety
and being overwhelmed about family issues and school.
Her TCM pattern diagnosis was Liver Qi Stagnation, and
the focus was on coursing Liver Qi and calming the
spirit. The author needled LR 3, LI 4, ST 36, HT 7, PC 6, and
Yintang for the first treatment. Returning one week later, the
patient reported somewhat decreased anxiety. For the second
treatment, the previous protocol was kept but KI 26 was
added. Upon follow-up, the patient reported significant alle-
viation of anxiety, increased coping ability to deal with stress,
and specifically asked for the point on the chest again.
Within two more treatments, the patient reported remission of
her presenting complaints, and increased ability to cope with
the challenges that she was facing. With the addition of KI 26,
even though her underlying diagnosis related more to the Liver
and Heart, the ability of the treatment to address the energetics
of the Kidney and apprehensive anxiety and to calm fear in the
patient yielded dramatically better clinical results.
DISCUSSION
Anxiety is a common complaint in the modern acu-
puncture clinic. Patients often describe their anxiety more
closely to how modern psychology describes itanticipatory
fear in the face of uncertaintythan how the term translates
in TCM. You, which is most commonly described as anx-
iety, is ascribed to the Lungs and more closely refers to
melancholia and depression than to anxiety. It is sometimes
challenging to translate more modern understandings of
psychological signs and symptomology into Chinese med-
ical terms, but the ability to treat psychological conditions
159
and to support emotional well-being is a tremendous area of
opportunity for acupuncture and Chinese medicine. By in-
terpreting the state of anxiety as one in which a person is
unable to cope with anticipation and fear, we are able to
reinterpret this concept through the frame of TCM.
In TCM, fear and the transformation of fear into wisdom
is governed by the water elements and the Kidneys. This
means that in addition to the normal physical and physio-
logical functions of the Kidneys, such as supporting the low
back, bones, and ears, promoting urination, and so on, the Qi
of the Kidney channel also supports the emotional aspect of
the Kidneys. It can be said that every point on the Kidney
channel may have both a physical and emotional function.
Often, in addition to traditional uses and indications for
these points that can be found in textbooks and Chinese
medical classics, the name and characters used to name each
point can yield a tremendous insight into a points function
and nature. In China, point names are always used to refer to
a given point rather than as a channel and number as in the
West. It is possible that understand the names and characters
of points can yield a deeper energetic understanding of their
use in modern patients and conditions. Points that are
commonly or even not commonly used for their physical
function may be reassessed for their ability to impact the
energetics of the mind, psyche, and emotions. This is an
important area of research and interpretation that may yield
new and important acupuncture treatment ideas in modern
practice and emotional disorders.
An example of this is the point KI 26 (Yu Zhong). By
interpreting its meaning through the energetics of the
Kidney channel, and through the meaning of the characters
used to name the point, we can understand this point in a
new context. Given that it is a Kidney point, we interpret it
as a point that can treat and transform fear to some degree,
and given that the point refers to the center of a territory
with no known boundary, we can understand that it can help
to emotionally center someone who is facing a challenge or
uncertainty in their life and is becoming hypervigilant
or fearful about future events. KI 26 represents potentially
an important point in the treatment of anxiety.
In the case study presented, this point did indeed provide
a center through which the patient could find a sense of calm
that enabled her to process the day-to-day stressors and help
her transition into a new part of her life personally and
professionally. The author has subsequently utilized this
point in patients reporting anxiety, and has found it to be
empirically effective in the treatment of anxiety.
CONCLUSION
Anxiety is an important, mulifaceted clinical problem,
and can be understood as apprehensive fear in the face of
uncertainty. Chinese medicine has methods that address the
treatment of anxiety and anxiety disorders. Traditionally,
160
acupuncturists have addressed anxiety by treating the
energetics of the Liver, which helps someone to move
through a stressful situation, or the Heart or Mind to calm
the emotions and mental restlessness. An important com-
ponent of addressing anxiety, however, has been lacking
from some protocols and methodsthe transformation of
fear, which falls under the domain of the Kidneys. KI 26, as
a point that represents finding a center in an uncertain
situation, is potentially an important point on the Kidney
meridian to help emotionally calm a person and help alle-
viate apprehension and uncertainty that is leading to anxi-
ety. Future research into the acupuncture treatment of
anxiety utilizing the acupuncture point KI 26 is warranted to
help to create effective treatments for patients suffering with
anxiety and anxiety disorders.
ACKNOWLEDGMENTS
The author wishes to acknowledge and thank Thea Elijah,
LAc, for previous discussions on emotional energetics and
Chinese medicine, and Michael Jabbour, LAc, for reviewing
the manuscript.
DISCLOSURE STATEMENT
No competing financial interests exist.
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Address correspondence to:
Anne Jeffres, DAOM, LAc
Columbia University
Herbert Irving Comprehensive Cancer Center
HIP 9th Floor
161 Ft Washington Avenue
New York, NY 10032
E-mail: aj2485@columbia.edu