In my practice I find that many people experience depressive states. When people receive acupuncture invariably their mood brightens. Japan has a surplus of acupuncturists, so if more acupuncturists tackled depression, Japan will become a very happy country. This might sound like a dream, but I am convinced that acupuncture can treat depression. There are two indispensable requirements for my treatment of depression. The first is pattern differentiation. The second is to use super-rotation insertion. The first pertains to diagnosis and the second, to treatment.

Pattern differentiation
In my practice I primarily use Meridian Therapy. In Meridian Therapy we use the term sho-kettei (pattern determination). This means to decide which meridians are affected. In Liver deficiency, for example, it means the Liver meridian is the primary meridian affected. In TCM it is called meridian differentiation or Zangfu differentiation. The meridians and Zangfu are inextricably linked. This is my understanding, so treating the Liver meridian benefits not only the Liver meridian but the liver as well.
Pattern differentiation, especially among the five Zang, is important. I originally realized that acupuncture was effective for psychosomatic conditions including depression when I came across the term “the spirit of the five Zang” in the beginning of Zhenjiu Jiayi Jing (A Classic of Acupuncture and Moxibustion). I believe this text proposes, “The seat of the spirit or mind is in the five Zang.” The view in Western medicine is that seat of the spirit is in the brain, and this is diametrically opposed to the view in Oriental medicine. Practicing acupuncture and moxibustion, I have come to feel that the spirit is housed in the five Zang.
The five Zang are filled with special Qi, respectively called Shen (Heart), Hun (Liver), Yi (Spleen), Po (Lung), and Zhi (Kidney). These are collectively called the Five Spirits. When the Lung is diseased, for example, the Po housed in the Lung diminishes so a person becomes tearful or loses motivation. Similar changes take place when other Zang are diseased. The psychological state varies by the pattern, but the main problems caused by deficiencies in the Five Spirits are: depressed mood, loss of motivation, loss of enjoyment, easily fatigued and desire to lie down, lack of appetite, poor sleep, and loss of sexual desire
Since regulating the five Zang can alleviate psychological imbalances, one must have a way to figure out which Zang has a problem. I primarily use pulse diagnosis to determine the pattern. No mater which Zang is deficient, the worse the deficiency, and the more difficult it is to treat.
In the classics it says the pulse quality of depression is sunken. The worse the depression, the deeper the pulse sinks, until it almost disappears under the bone. This is known as the hidden pulse. There is in fact such a tendency. When our mood sinks our pulse sinks, and when our mood raises our pulse begins to float. The patient is easy to cure when the pulse is floating. Patients with sunken pulses are difficult to treat. If you check the pulses as you give treatment and it begins to become more floating, you can be confident that the treatment is having a good effect.

Use superficial insertion for the spirit
Let’s say you have decided the pattern, and it is Liver Deficiency. There are two approaches in Meridian Therapy, root treatment and branch treatment. The root treatment is especially important for psychological problems. For Liver Deficiency I usually tonify LR-8, KI-10, ST-36, and LI-11. Just needling LR-8 on one side is often enough to make the pulses floating and large. When just one needle does not change the pulse, I needle LR-8 on the opposite side, and continue with the other points listed. One must be careful here. The needle must not be inserted deeply. No matter if the person has a solid body or loves acupuncture, if you want it to be effective for the spirit or mind, the needle must be kept very superficial. Of course, if one is a master even deep needling may be effective, but I am talking here about what works for me. I use the super-rotation technique (SRI) exclusively for patients with depression or fatigue.

Applications of the super-rotation technique
Super-rotation insertion (SRI) refers to a depth between contact needling and superficial needling. The actual depth is 0.5mm. Furthermore, in this technique the needle is rotated over 500 times per minute. Superficial insertion is between 1 and 5mm, shallow insertion is between 5 and 30mm, and deep insertion is deeper than 30mm. Among the Meridian Therapists in Japan, Ono Bunkei developed a technique called contact needling, in which the needle is not inserted. Inoue Keiri used scatter needling, which was inserted very superficially. Okabe Sodo frequently retained needles superficially. There are needling techniques, which are even shallower than super-rotation technique, but the main difference is the high-speed rotation of the needle. I have realized the following benefits with the super-rotation technique:
(1) SRI is effective for various types of pain, especially spontaneous pain.
(2) SRI is immediately effective in reducing fatigue and heaviness in the body.
(3) SRI transforms hardness into softness. SRI has a softening effect, even if the needle is not inserted into the hard tissue.
(4) SRI has a good effect not only for physical symptoms, but also for psychological issues. One’s mood brightens, and sleep improves.
(5) SRI is preferred by those who are afraid of acupuncture, especially those who refuse the needle sensation like this technique.
(6) SRI suited to children and elderly patients.

How to apply the super-rotation technique
SRI is not so difficult to learn. Place the tube with the needle on the skin and very gently press the head of the needle to make the tip of the needle press up against the skin. (I call this setting the needle.) Even light tapping on the head of the needle will cause the needle to go in a few millimeters, so it is better not to tap at all. Next remove the tube and begin to twist the needle back and forth 1/16 of a turn (about 20 to 30 degrees) with your thumb and index finger. My style is to hold the index finger steady and move the thumb only. I rapidly rotate the handle of needle held between the pad of the right index finger and the tip of the right thumb.
For best effect the rotations should be done as fast as possible. About 500 times a minute is ideal. At first one can only manage about 150 rotations a minute, but the number of rotations increases with practice. As these rapid rotations are continued patiently, one feels the Arrival of Qi. By this time the needle has worked its way into the skin a little. There is no need to try and get the needle in. SRI works best when you just think about it as skin stimulation and focus on feeling the Arrival of Qi. Remove the needle when the Qi arrives. Close the hole after removing the needle when tonifying, and don’t close the hole when dispersing.
When I speak of the Arrival of Qi, this is not something that is felt by the practitioner. It is not felt as clearly as when actually inserting the needle, but it can be felt from the surface. The ability to feel this subtle Arrival of Qi take years of practice, but a treatment can be effective without this ability. The results of treating depression and mental problems improve dramatically when we learn to feel the Arrival of Qi.