The Selection Principles and Clinical Application of the Eight Confluent Points in the Treatment of Emotional Disorders within Fu Wenbin’s Integrated Acupuncture System ()
1. Proposition of “Shugan Tiaoshen” Acupuncture and “Xindan Lunzhi” Therapy
Mental health issues have become a major challenge in the global public health field. According to the latest epidemiological survey by the World Health Organization (WHO), more than 350 million people worldwide are affected by depressive disorders [1], and the number of anxiety disorder patients is equally large, exceeding 300 million [2]. More notably, the suicide risk of patients with depression is significantly increased, with relevant studies showing a suicide rate between 10% and 15% [3]. An epidemiological survey of mental disorders in China indicates that the total prevalence rate of various mental illnesses has reached 17.5%, among which the prevalence rate of depression is 6.8% [4]. These diseases not only bring physical and mental suffering to patients but also seriously affect their social functions and daily lives.
Professor Fu has been engaged in clinical practice, teaching, and scientific research on emotionally related disorders (referred to as mental disorders in modern medicine) for more than 30 years. Under the guidance of the “integrated acupuncture” theoretical system [5], he innovatively proposed the “one-needling, two-moxibustion, three-consolidation” acupuncture treatment model. Regarding the pathogenesis of Yu Bing (depression in TCM), Professor Fu put forward the theoretical viewpoint of “dysregulation of brain spirit and failure of the liver to disperse stagnated qi” and established the “soothing the liver and regulating spirit” needling method. The main acupoints include Baihui (GV20), Yintang (EX-HN3), Touwei (ST8), Hegu (LI4), Taichong (LR3), Jiuwei (CV15), Zhongwan (CV12), Qihai (CV6), and Sanyinjiao (SP6). This needling method has been clinically verified to have significant efficacy, and multi-center clinical studies have shown that its overall effective rate for depression-related disorders exceeds 70% [6]. Based on the holistic thinking of “integrated acupuncture”, Professor Fu further proposed treating mental and emotional disorders “based on the heart and gallbladder” [7]. Its core is rooted in the TCM theory that “the heart governs spirit and the gallbladder governs decision-making”—dysregulation of the heart and gallbladder leads to insufficient nourishment of the spirit and impairment of decision-making function. The treatment takes harmonizing the heart and gallbladder, tranquilizing the spirit, and stabilizing the will as the guiding principle. The main acupoints include Baihui (GV20), Yintang (EX-HN3), Neiguan (PC6), Yanglingquan (GB34), Jiuwei (CV15), Zhongwan (CV12), and Guanyuan (CV4). These acupoints work synergistically to regulate zang-fu organs, qi, and blood, jointly achieving the effects of tranquilizing the spirit, stabilizing the will, soothing the liver, and benefiting the gallbladder. Clinically, it is often used for depression comorbid with obsessive-compulsive disorder, anxiety disorders, etc., achieving satisfactory clinical results. When Professor Fu applies the “soothing the liver and regulating spirit” needling method and the “treating mental disorders based on the heart and gallbladder” technique in the treatment of emotional disorders, he excels at flexibly using the Eight Confluent Points with syndrome differentiation and modification in acupuncture prescriptions, achieving favorable clinical outcomes. The details are summarized as follows.
2. The Eight Confluent Points
2.1. Exploration of the Theoretical Origin of the Eight Confluent Points
Although the Nan Jing (Classic of Difficult Issues) does not directly discuss the Eight Confluent Points, its theoretical system of the “Twelve Regular Meridians” and “Eight Extraordinary Meridians” laid the foundation for the later theory of the Eight Confluent Points. Among them, the classic statement that “the Eight Meridians are the root of congenital essence and the ancestor of primary qi” reveals that as carriers of kidney qi and primary qi, the Eight Extraordinary Meridians possess a higher-level function of regulating qi and blood compared to the linear circulation of the Twelve Regular Meridians [8].
During the Jin and Yuan dynasties, Dou Hanqing first systematically proposed the concept of the “Eight Points Converging with the Eight Extraordinary Vessels” in his Zhen Jing Zhi Nan (Guide to the Classic of Acupuncture), clearly recording the “interconnection” between eight specific acupoints and the Eight Extraordinary Meridians. This theory developed significantly in the Ming dynasty: Xu Feng promoted its clinical popularization through the poetic form of “Song of the Eight Confluent Points” in his Zhen Jiu Da Quan (Complete Collection of Acupuncture and Moxibustion); Yang Jizhou further expanded its therapeutic scope by proposing that “the Eight Confluent Points treat diseases of the five zang-organs and six fu-organs” in his Zhen Jiu Da Cheng (Great Compendium of Acupuncture and Moxibustion); Wu Kun inherited and developed Dou Hanqing’s point combination theory in his Zhen Fang Liu Ji·Shen Zhao Ji (Six Collections of Acupuncture Prescriptions·Divine Illumination Collection), emphasizing that “the Eight Methods take the Eight Extraordinary Points as the essence, which are the major meetings of the Twelve Meridians”. He systematically elaborated on the four classic point pairs—Gongsun (SP4)-Neiguan (PC6), Linqi (GB41)-Waiguan (TE5), Lieque (LU7)-Zhaohai (KI6), Huxi (SI3)-Shenmai (BL62)—and their synergistic therapeutic principle of “four-sided attack”.
In the Qing dynasty, Wu Qian and others included the Eight Confluent Points in the official medical education system in their Yi Zong Jin Jian·Ci Jiu Xin Fa Yao Jue (Golden Mirror of Medicine·Essential Compendium of Acupuncture and Moxibustion), particularly emphasizing their role as “the pivot of opening, closing, and pivoting” in qi movement regulation. This marked the theory’s final establishment as a core component of acupuncture. The gradual improvement of this theory from its initial formation to clinical application reflects the continuous development and deepening of TCM academic thought on the basis of inheritance.
2.2. Clinical Application of the Eight Confluent Points
Zhenjiu Dacheng (The Great Compendium of Acupuncture and Moxibustion) states: “The Eight Confluent Points can regulate yin and yang, and harmonize qi and blood”, indicating that the Eight Confluent Points function to connect the Eight Extraordinary Meridians with the Twelve Regular Meridians, regulate yin-yang and qi-blood, and treat internal and external disorders [9]. As one of the Eight Confluent Points, Huxi (SI3) is located behind Qiangu (SI2), receiving meridian qi from Shaoze (SI1). Its meridian qi flows like a stream, and it is connected to the Du Meridian (GV); thus, it can regulate the body’s yang qi by leveraging the qi of the Du Meridian [10]. Since Huxi (SI3) is the Shu-point of the Small Intestine Meridian, and the Small Intestine Meridian and Heart Meridian are internally-externally related, needling Huxi (SI3) can simultaneously regulate disorders of the heart (the organ governed by the Heart Meridian). Meanwhile, its connection to the Du Meridian allows it to transport clear yang qi to the brain, exerting the effect of unblocking the Du Meridian and regulating spirit [11]. Deng Hanzhi [12] treated vertebral artery-type cervical spondylosis by needling Huxi (SI3) under ultrasound guidance, and found that this approach (with deqi achieved under ultrasound) could improve symptoms and local blood supply in patients with the condition. The Lingshu·Kouwen (Miraculous Pivot·Oral Inquiries) notes: “Deficiency of upper qi leads to insufficient nourishment of the brain... Supplement by needling the point below the outer ankle and retaining the needle”, indicating that Shenmai (BL62) can be used for needling in the treatment of brain disorders. Shenmai (BL62) connects to the Yangqiao Meridian; through the synergistic combination of tonifying Zhaohai (KI6) and dredging Shenmai (BL62), it regulates the body’s yin-yang balance, promotes the circulation of qi and blood, and improves sleep quality [13]. Lieque (LU7) was traditionally known as the “god of thunder and lightning”, with the effect of unblocking the upper body and penetrating the lower body. Needling this point is like a thunderclap piercing the sky, dispelling stagnation (comparable to “dark clouds”) and refreshing the head and eyes [14]. Lieque (LU7) has the functions of “unblocking the upper”, “regulating the middle”, and “penetrating the lower”: “Unblocking the upper” dispels wind and releases the exterior, ventilates the lung and unblocks collaterals, mainly treating head-face disorders and lung-system diseases; “regulating the middle” adjusts the qi movement of the spleen and stomach, improving functional disorders of the middle jiao; “penetrating the lower” regulates the qi and blood of the Ren Meridian (CV) and promotes fluid metabolism [15]. Zhaohai (KI6) connects to the Yinqiao Meridian, as first recorded in Zhenjiu Jiayi Jing (A-B Classic of Acupuncture and Moxibustion): “Zhaohai is the origin of the Yinqiao Meridian, located one cun below the inner ankle.” [16] Great Compendium of Acupuncture and Moxibustion records that Zhaohai (KI6) can treat emotional disorders, such as sadness and discontent. After Wang Feng [17] treated patients with panic disorder by needling Zhaohai (KI6) and other points, the patients’ conditions improved significantly. Neiguan (PC6) is a point of the Jueyin Pericardium Meridian and connects to the Yinwei Meridian; stimulating Neiguan (PC6) regulates the metabolism of body fluid and blood. The “spirit” (shen) requires nourishment from blood and body fluid to perform its functional activities—thus, Neiguan (PC6) can nourish, calm, and regulate the spirit by regulating yin and blood [18]. Zhenjiu Jiayi Jing states: “For loss of intellect, Neiguan (PC6) is the main point.” Shenjiu Jinglun (Compendium of Divine Moxibustion) notes: “For palpitations, amnesia, and insomnia: Neiguan (PC6)... Shenmen (HT7).” These are summaries of Neiguan’s (PC6) effects in regulating and calming the spirit. Waiguan (TE5) is the Luo-point of the Triple Energizer Meridian of Hand-Shaoyang and connects to the Yangwei Meridian. Great Compendium of Acupuncture and Moxibustion records: “Waiguan (TE5)... mainly treats deafness, hypochondriac pain, postpartum syncope, and delirium.” Puji Fang (Prescriptions for Universal Relief) states: “Waiguan (TE5)... treats delirium and emotional lability.” These indicate that Waiguan’s (TE5) regulation of emotional abnormalities is related to the spirit-calming function of the Triple Energizer Meridian connecting to the Yangwei Meridian. Under pathological conditions, studies have found that needling Waiguan (TE5) can activate the coordinated interaction between brain regions, exerting a good therapeutic effect on improving language function and emotions in patients with ischemic stroke [19]. Zulinqi (GB41) was originally named “Linqi”; as recorded in Huangdi Neijing (Yellow Emperor’s Inner Canon): “The Gallbladder Meridian originates from Jiaoyin (GB44)... flows into Linqi... which is the Shu-point.” It was first officially named “Zulinqi” (GB41) in Zhisheng Jiluo (Comprehensive Collection of Holy Prescriptions). This point can be combined with other points in the treatment of disorders caused by dysfunction in qi movement and dispersion of the Liver and Gallbladder Meridians [20]. Gongsun (SP4) is the Luo-point of the Spleen Meridian of Foot-Taiyin and an Eight Confluent Point connecting to the Chong Meridian. It was first recorded in Lingshu·Benshu (Miraculous Pivot·Primary Shu-Points): “The collateral of the Foot-Taiyin Meridian is named Gongsun.” In addition to treating spleen-stomach disorders, Gongsun (SP4) can also treat emotional diseases such as heart vexation and insomnia. Great Compendium of Acupuncture and Moxibustion·Xin Pi Wei Men (Great Compendium of Acupuncture and Moxibustion·Section on Heart, Spleen, and Stomach) states: “For heart vexation: Gongsun (SP4), Shenmen (HT7)...” and “for restlessness and inability to sleep: Taiyuan (LU9), Gongsun (SP4)....” In summary, needling the Eight Confluent Points can promote yin-yang harmony, enhance the circulation of qi and blood, and has unique advantages in the treatment of emotional diseases. Their combination is flexible: they can not only exert the characteristics of individual points but also form a synergistic effect to achieve holistic regulation, thereby calming the spirit, harmonizing qi and blood, and balancing the functions of zang-fu organs [21] [22].
3. Characteristics of Professor Fu Wenbin’s Point Combination of the Eight Confluent Points
Based on the research of traditional TCM acupuncture theory and clinical practice, Professor Fu attaches particular importance to the clinical application of the Eight Confluent Points in acupuncture treatment. Long-term clinical practice has revealed that the Eight Confluent Points can not only treat disorders of their corresponding meridians but also exert a holistic regulatory function through their unique confluent relationships. Therefore, the application concept of the Eight Confluent Points is embedded in his clinical acupuncture (the “One Acupuncture” part of his treatment model), fully embodying his academic thought of “taking spirit regulation as the core and confluent points as the means”. Especially in the treatment of emotional diseases, Professor Fu innovatively applies the Eight Confluent Points to regulate qi movement, soothe the liver and relieve stagnation, and calm the spirit to stabilize the will. Clinical observations have shown that rational combination and application of the Eight Confluent Points can significantly improve emotional disorders such as anxiety and depression, with long-lasting and stable efficacy [23].
3.1. Upper-Lower Combination for Mutual Reinforcement of Yin and Yang
In the diagnosis and treatment of depression-related disorders, Professor Fu is skilled in applying the Eight Confluent Points through upper-lower combination. For example, in treating patients with depression accompanied by panic, he selects Neiguan (PC6) in the upper limb and matches it with Yanglingquan (GB34) in the lower limb: Neiguan (PC6) is the Luo-point of the Pericardium Meridian and connects to the Yinwei Meridian, which can calm the heart and stabilize the spirit; Yanglingquan (GB34) is the He-point of the Gallbladder Meridian, with the effects of soothing the liver and benefiting the gallbladder, and clearing damp-heat. The combined use of these two points jointly exerts the effects of calming the spirit to stabilize the will, and soothing the liver to benefit the gallbladder. For patients with depression accompanied by obsessions, he chooses Waiguan (TE5) in the upper limb and matches it with Zulinqi (GB41) in the lower limb—these two points belong to the meridians of the same name in the hand and foot, and the meridian qi of the two meridians communicates with each other. Waiguan (TE5) is the Luo-point of the Triple Energizer Meridian of Hand-Shaoyang, which connects to the Pericardium Meridian of Hand-Jueyin and links to the Yangwei Meridian; the Yangwei Meridian governs the yang qi of the whole body, and dysfunction of the Yangwei Meridian leads to symptoms such as “feeling dispirited and unable to control oneself steadily”. Zulinqi (GB41) is the Shu-point of the Gallbladder Meridian of Foot-Shaoyang, which corresponds to the wood element (in TCM five elements); it can clear fire from the Shaoyang meridian. Both the liver and gallbladder belong to the wood element—Zulinqi (GB41), as the original point of the Gallbladder Meridian and located in the lower limb, can descend turbidity and ascend clarity, and dispel stagnation of the liver and gallbladder. The combined use of these two points dredges the Shaoyang meridian, resolves phlegm and relieves stagnation, thereby achieving the comprehensive therapeutic effects of regulating qi, calming the spirit, and stabilizing the will [23]. For patients with depression accompanied by anxiety, he uses Lieque (LU7) in the upper limb and matches it with Zhaohai (KI6) in the lower limb: Lieque (LU7) connects to the Ren Meridian (CV)—the “sea of yin meridians”, which governs the yin qi of the whole body and regulates qi and blood to balance yin and yang. Anxiety is mostly caused by emotional imbalance, qi stagnation, or yin deficiency with fire hyperactivity; needling Lieque (LU7) can regulate the meridian qi of the Ren Meridian, promote the qi movement in the chest, and relieve stagnation to eliminate irritability. Zhaohai (KI6), a point of the Kidney Meridian, connects to the Yinqiao Meridian, which governs lower limb movement and sleep. Deficiency of kidney yin can lead to floating of deficient yang, clinically manifested as mental symptoms such as palpitations, restlessness during sleep, and frequent disturbing dreams. Needling Zhaohai (KI6) can nourish yin to calm the spirit, and clear heat to soothe the heart. Zhenjiu Jiayi Jing (A-B Classic of Acupuncture and Moxibustion) records that Zhaohai (KI6) mainly treats “palpitations and insomnia”, and it is now commonly used for anxiety accompanied by insomnia, dry throat, and other symptoms. Anxiety is often associated with sympathetic hyperactivity (such as palpitations and sweating); needling Lieque (LU7) and Zhaohai (KI6) can regulate the balance of the autonomic nervous system and inhibit excessive stress responses. Experiments have found that needling these two points can promote the release of inhibitory neurotransmitters such as γ-aminobutyric acid (GABA) and serotonin, thereby relieving anxiety [24].
3.2. Integrating Distant and Local Points, Treating Both Symptoms and Root Causes
When depression is accompanied by local conditions, distant Eight Confluence Points are often combined in treatment. For example, some depressed patients with somatic symptoms such as hiccups or epigastric pain can be treated with acupuncture at the distant point Gongsun (SP4) and the local point Zhongwan (CV12). This combination regulates spleen-stomach function and local qi-blood simultaneously, improving clinical efficacy. Gongsun, as a distant point, regulates the overall qi movement through meridian conduction to address the root cause. Zhongwan, as a local point, directly dredges qi-blood in the lesion area to alleviate symptoms. For patients with insomnia accompanied by palpitations, Zhaohai (KI6)—a point that connects to the Yin Qiao Meridian—is selected as the distant point. It nourishes yin, reduces fire, guides fire back to its origin, and regulates the spirit to treat the root cause. Tanzhong (CV17), the Front-Mu Point of the Pericardium and a local point, relieves chest stuffiness, regulates qi, and calms the spirit to alleviate symptoms. Zhaohai acts on the Kidney Meridian to improve overall yin-yang imbalance, while Tanzhong directly regulates qi movement in the chest to relieve palpitations and chest tightness. For depression accompanied by neck and nape pain, fire needle therapy is first applied locally to promote local qi-blood circulation, resolve blood stasis, and relieve “pain due to blockage” to address symptoms. Subsequently, acupuncture at Houxi (SI3)—a point that connects to the Du Meridian—dredges qi-blood in the neck and nape meridians, regulates overall meridian qi movement, and guides qi from a distance to the lesion area, achieving “treating the root cause”.
3.3. Combining Movement and Stillness, Balancing Firmness and Softness
For patients with depression accompanied by insomnia and vivid dreams, acupuncture often selects points like Shenmai (BL62) and Zhaohai (KI6). This is because the Yang Qiao Meridian governs movement and wakefulness; needling Shenmai, which connects to the Yang Qiao Meridian, can regulate insomnia or excessive sleepiness and address imbalances in dynamic function. The Yin Qiao Meridian governs tranquility and sleep; needling Zhaohai, linked to the Yin Qiao Meridian, can nourish yin and calm the spirit. For insomnia due to yang hyperactivity, techniques involve reducing (xie) Shenmai and tonifying (bu) Zhaohai to subdue excess yang and support deficient yin. Conversely, for patients with low mood, mental fatigue, and drowsiness due to yin excess, tonifying (bu) Shenmai and reducing (xie) Zhaohai can invigorate yang and reduce yin.
3.4. Alternating Left and Right, Balancing Qi and Blood
Based on the therapeutic ideas of “Juci” (Great Needling) and “Miaoci” (Contralateral Needling) from the Nei Jing (Yellow Emperor’s Internal Classic), as well as the theories of yin-yang balance and “left ascending and right descending”, Professor Fu Wenbin excels at alternately using the Eight Confluence Points on the left and right sides. By regulating meridional qi on both sides, he restores the body’s yin-yang balance to achieve disease treatment. For example, in treating depressive obsessive-compulsive disorder, he selects Waiguan (TE5) and Yanglingquan (GB34) on one side, and Neiguan (PC6) and Gongsun (SP4) on the other side, aiming to coordinate and regulate the Yin Wei and Yang Wei Meridians. Waiguan and Yanglingquan focus on regulating the Yang Wei Meridian and Gallbladder Meridian, primarily dispersing stagnant fire in the Shaoyang channel. Neiguan and Gongsun focus on regulating the Yin Wei Meridian and Chong Meridian, primarily harmonizing the stomach and calming the spirit. Together, they form a “multi-pronged approach” to synergistically soothe the liver, relieve depression, regulate the spirit, and stabilize the will. In treating idiopathic deafness and tinnitus, he selects Waiguan (TE5) and Zulinqi (GB41) on the affected side, and Lieque (LU7) and Zhaohai (KI6) on the healthy side. Waiguan and Zulinqi both belong to the Shaoyang Meridian, echoing vertically to dredge meridional qi in the ear. The selection of Lieque from the Lung Meridian of Hand-Taiyin and Zhaohai from the Kidney Meridian of Foot-Shaoyin embodies the therapeutic idea of “metal-water mutual generation”, nourishing the ear orifices by tonifying the lung and kidney.
In clinical practice, Professor Fu particularly emphasizes balancing the stimulation intensity of acupuncture with treatment efficiency. He believes that when the stimulation intensity on one limb meets the therapeutic requirements, additional confluent points on the contralateral side are selected to reduce the number of needles without compromising the treatment of concurrent symptoms. For example, in a patient with right-sided tinnitus accompanied by poor sleep, the treatment plan is adjusted to Waiguan (TE5) and Zulinqi (GB41) on the affected side (right), and Neiguan (PC6) and Yanglingquan (GB34) on the healthy side (left). This point combination ensures therapeutic efficacy while avoiding excessive needling, reflecting the exquisite expertise of Professor Fu in clinical point selection.
Notably, Professor Fu adheres to the principle of “achieving more with less” in point. By precisely selecting points and applying appropriate stimulation intensity, he achieves therapeutic effects while avoiding over-needling. This approach aligns with the TCM therapeutic concept of “aiming for balance” (yi ping wei qi), reduces patient pain, and enhances comfort and relaxation [25] [26].
4. Case Example
A 30-year-old male patient visited the clinic on April 15, 2025.
Chief Complaint: Low mood and obsessive thoughts for 4 years. The patient first developed low mood, decreased interest, obsessive thoughts, memory loss, and poor concentration in 2021 due to heavy work pressure and strained interpersonal relationships. These symptoms gradually worsened, and he began to have negative thoughts and take suicidal actions. He then sought treatment at the Department of Psychology, Guangdong Provincial Hospital of Traditional Chinese Medicine, where he was diagnosed with moderate depressive disorder. He received psychological counseling and antidepressant treatment with sertraline, and reported partial improvement of symptoms. However, he developed a foreign body sensation in the throat—unable to swallow or spit it out. Seeking systematic TCM treatment, he visited our department. Current Symptoms: Low mood, decreased interest, memory loss, poor concentration, excessive rumination over matters, ruminative thinking, difficulty making decisions, foreign body sensation in the throat (unable to swallow), occasional negative thoughts, easy nervousness and anxiety, frequent nightmares, excessive sweating, binge eating, difficulty falling asleep, and easy awakening after sleep. Bowel and bladder functions are normal. Red tongue with thin yellow coating, slippery and rapid pulse.
Past Medical History & Clinical Data
Past Medical History: Healthy. SCL-90 Score. Obsessive-compulsive symptoms: 3.1 points; Depression: 2.2 points; Other factors: <2 points.
Diagnoses & Treatment Principles
TCM Diagnosis: Yu Bing (Depression Syndrome) due to disharmony of the Heart and Gallbladder, and disharmony between the Heart and Kidney. Western Medicine Diagnosis: Depressive Disorder Comorbid with Obsessive-Compulsive Disorder.
Treatment Principle: Clear the Liver and benefit the Gallbladder, tonify the Kidney and calm the spirit. Acupoint Selection: Baihui (GV20), Yintang (EX-HN3), Neiguan (PC6), Yanglingquan (GB34), Waiguan (TE5), Zulinqi (GB41), Jiuwei (CV15), Zhongwan (CV12), Guanyuan (CV4).
Western medicine treatment: Continue oral administration of Sertraline as prescribed by the doctor. TCM treatment: Acupuncture combined with precision moxibustion and press needle therapy, twice a week for 4 consecutive weeks. Second Consultation (May 20, 2025): The patient reported that his mood was more manageable than before, with significant improvement in ruminative thinking and decision-making difficulties. However, he still had trouble falling asleep and experienced frequent nightmares. On the basis of the original acupoint formula, the left Waiguan (TE5) and Zulinqi (GB41) were removed, and the left Lieque (LU7) and Zhaohai (KI6) were added. Treatment continued for another 4 weeks. Third Consultation (June 24, 2025): The patient stated that his mood was controllable and more pleasant than before, and excessive rumination over matters had improved. He still felt nervous and anxious, with a foreign body sensation in the throat. Gongsun (SP4) was added to the acupuncture treatment on the basis of the previous formula, and treatment continued for 4 weeks.
Fourth Consultation (July 16, 2027): The patient reported no obvious discomfort, with an optimistic mood, decisive handling of affairs, no significant negative thoughts, easier falling asleep, and no obvious emotional fluctuations. He was advised to continue consolidation treatment for 1 month, once a week. A follow-up visit 1 month after the end of treatment showed that the patient had a stable mood, made decisions decisively, slept well, and had normal bowel and bladder functions.
Discussion: The patient developed liver qi stagnation due to long-term low mood, and prolonged stagnation transformed into fire, as evidenced by the red tongue, thin yellow coating, and slippery rapid pulse. Liver-gallbladder fire disturbed the spirit, leading to anxiety, frequent nightmares, and poor sleep. Liver stagnation invaded the spleen, impairing its function of transporting fluids; phlegm and qi bound in the throat, resulting in “Mei He Qi” (plum pit qi, i.e., foreign body sensation in the pharynx). Kidney yin deficiency failed to nourish the heart fire upward, causing disharmony between the heart and kidney, which manifested as memory loss, poor concentration, and ruminative thinking (obsessive rumination). Acupuncture at Baihui (GV20) and Yintang (EX-HN3) are core points of the Du Meridian for “connecting the brain and regulating the spirit”. Modern research has confirmed that they can regulate prefrontal lobe function and improve depressive and obsessive symptoms. Neiguan (PC6), the Luo-Connecting Point of the Pericardium Meridian, connects to the Yin Wei Meridian and can calm the heart and spirit. Yanglingquan (GB34), the He-Sea Point of the Gallbladder Meridian, can soothe the liver and benefit the gallbladder. These two points synergistically regulate autonomic nervous function and relieve tension and anxiety. Waiguan (TE5) and Zulinqi (GB41) are points of the Hand and Foot Shaoyang Meridians. Used together, they dredge the Shaoyang Meridian, resolve phlegm and relieve stagnation, and improve obsessive symptoms. Alternating with Lieque (LU7) and Zhaohai (KI6) takes into account improving sleep and the foreign body sensation in the throat. Jiuwei (CV15), Zhongwan (CV12), and Guanyuan (CV4) form a combination of the Ren Meridian for “regulating the middle jiao and consolidating primordial qi”. Jiuwei, the “Yuan-Source Point of the Gao” (the membrane), resolves phlegm and breaks bindings; Zhongwan invigorates spleen-stomach transportation; Guanyuan tonifies the lower yuan, assisting the heart and kidney to communicate, thereby improving sleep.
Characteristics of Point Combination: The left-right alternating needling technique, characterized by “reducing method applied to the left side (Waiguan TE5, Zulinqi GB41) and tonifying method to the right side (Lieque LU7, Zhaohai KI6)”, embodies the fundamental TCM principle of “replenishing deficiency and reducing excess”. Given the favorable therapeutic effects achieved by the previous liver-clearing and gallbladder-benefiting intervention, Waiguan and Zulinqi on the left side were removed to moderate the excessive dispersing function of the liver. Conversely, Lieque on the right side was added to disperse lung qi and descend adverse qi, while Zhaohai was incorporated to nourish yin, tonify the kidney, and tranquilize the spirit. This point modification not only aligns with the TCM theory of qi movement (“left ascending and right descending”) but also directly targets the core pathogenesis of “heart-kidney disharmony”, thereby reinforcing the therapeutic effects of kidney-tonification and spirit-tranquilization. Synergistic Effect of Sertraline and Acupuncture: As a Selective Serotonin Reuptake Inhibitor (SSRI), sertraline may induce gastrointestinal adverse reactions (e.g., binge eating). Acupuncture at Zhongwan (CV12) and Jiuwei (CV15) has been demonstrated to alleviate such drug-related side effects and improve treatment tolerance in clinical practice. Alternating Application of Zulinqi/Waiguan and Lieque/Zhaohai: This alternating needling strategy reflects the TCM therapeutic concept of “seeking yin within yang”. By regulating the functional activities of the Eight Extraordinary Meridians through the Eight Confluent Points, the alternation between the affected and healthy sides effectively prevents point fatigue and sustains stable therapeutic efficacy throughout the treatment course. The acupuncture point selection in this case emphasizes the three-dimensional synergy of “regulating spirit—soothing the liver—adjusting the heart and gallbladder”. Integrating modern neurobiological mechanisms, this therapeutic regimen addresses both the symptoms and the root causes of the disease, providing valuable clinical evidence and theoretical reference for the TCM treatment of depression comorbid with Obsessive-Compulsive Disorder (OCD).
5. Summary and Outlook
Based on the integrated acupuncture system developed from Professor Fu Wenbin’s “soothing the liver and regulating spirit” needling method and “treating mental disorders based on the heart and gallbladder” technique, this study systematically elaborates on the acupoint compatibility principles of the system in applying the Eight Confluent Points, namely “upper-lower combination, distant-proximal integration, dynamic-static harmony, and left-right alternation”. These principles fully embody the core TCM concepts of the holistic view and syndrome differentiation-based treatment. The clinical experience presented not only expands the application scope of the Eight Confluent Points but also provides an effective approach for the acupuncture treatment of refractory diseases. However, this study is a single-case analysis that only initially verifies the clinical value of the proposed acupoint selection principles. Limitations such as a small sample size and lack of controls restrict the generalizability of the conclusions. Future research could first conduct pilot studies, followed by large-sample Randomized Controlled Trials (RCTs), to further validate the scientificity and universality of these acupoint selection principles, thereby providing evidence-based support for the standardized TCM treatment of related disorders.
Fund Projects
National Natural Science Foundation of China (Regional Science Foundation) (82460972); National Natural Science Foundation of China (Regional Science Foundation) (82260967); Guangdong-Ningxia Xinglin Top Talent Training Program (Document No.: [2025] 675); Ningxia Natural Science Foundation (2024A1879); Ningxia Health and Family Planning Appropriate Technology Promotion Project (2024-NWSY-A010); Self-selected Project of Ningxia Clinical Research Center for Acupuncture and Moxibustion (Document No.: Ningke Zipei Zi [2022] No. 25).
NOTES
*The first author.
#Corresponding author.