Treating Stress with Acupuncture and Aromatherapy Essay
Treating Stress with Acupuncture and Aromatherapy
a. Thesis Statement
Acupuncture and aromatherapy are two alternative therapies used to diminish stress levels experienced by the body. Therapeutics practicing aromatherapy and acupuncture believe in the paramedical effects channeled through the body’s sensorium. Meanwhile, medical studies have debated the effectiveness of acupuncture and aromatherapy in reducing or treating stress levels based on the body’s physiologic response to the therapy.
b. Overview: Stress, Acupuncture and Aromatherapy
Theoretically, stress is brought by heightened state of autonomic nervous system (ANS) manifesting with various symptoms, such as pounding headache, cold and moist skin, depression, anxiety, etc (Porth, 2005 p.196). Both chronic and acute stress triggers several imbalances in the body’s neural and hormonal pathways (e.g. decreased immunity, hormonal imbalances, etc.) predisposing various chronic illnesses in cardiovascular, gastrointestinal and immune systems (Porth, Gaspard and Matkin, 2006 p.160). Acupuncture and aromatherapy activate the limbic mechanisms of the hypothalamic apparatus, which consequently stimulates the release of different biochemicals to induce sympathetic mechanism producing the therapeutic effects of the therapies. In order to correct the alterations induced by stress, alternative therapies, most commonly aromatherapy and acupuncture, have been introduced to rebalance the hormonal and neural conditions of the body (Khyasudeen and Bakar, 2007).
The use of aromatherapy and acupuncture in treating stress has been studied by several medical experts (Middlekauff, Yu and Hui, 2001; Middlekauff, 2002) countering the healing effects brought by the treatments. The medical foundation of stress physiology consists of neuro-hormonal alterations involving catecholamines, corticotrophin-releasing factors, adrenal hormones, and antideuretic chemical mediators (e.g. vasopressin, adenocorticotropic hormone, etc) (Porth, Gaspard and Matkin, 2006 p.160). On the other hand, other scholarly studies (Yun, Park and Yeom et al., 2002; Cannard, 1996; Davis, Cooke and Holzhauser, et al., 2002) focusing on alternative medicine support the idea of using aromatherapy and acupuncture in treating chronic and acute stress conditions. Therapeutic applications of acupuncture and aromatherapy have always been associated with the neurological, hormonal, and musculoskeletal bodily responses aimed at reducing stress levels. Aromatherapy uses natural essential oils derived from concentrated derivatives from plants, which are paramedically believed to contain “herbal energy” (D’Amelio, 1998 p.49). The entry point of aromatherapy is through the sense of smell, which provides strong impact to the body’s psychological, physiological and emotional status (Jones, 2000 p.78). Meanwhile, Western acupuncturists have derived the point system through careful observation guided by Taoism principles of wu-wei, which connotes the idea of submitting to the spontaneous impulses generated by “bodily nature and the underlying universal pattern of physical forces, interconnectedness, change and development in all things” (White and Ernst 1999, p.33). The paper conducts an analysis on the therapies to reduce stress.
c. Scopes and Limitations
The paper covers the medical arguments, studies, and discussions concerning the effectiveness of aromatherapy and acupuncture as stress reduction therapies. The following subsections included in this paper include (a) the therapeutical foundations of acupuncture and aromatherapy, (b) the different studies published addressing the validity of the claims, (c) physiological imbalances resulting from stress and its relations to the five phases of acupuncture, and (d) rebalancing body functions through stress reduction via the discussed therapeutic procedures.
a. Acupuncture and Aromatherapy as Stress Treatment
Acupuncture and aromatherapy have always been believed to influence body stress levels through stimulation of hormonal responses, reduction of sensory stresses, and balancing of neuronal pathways. Theoretically, acupuncture aims to “balance physical and emotional disorders, to restore the body’s harmony in all its processes, and thus reintegrate the sick individual into the social and natural order” (Roemer, Kempfle and Reuther, 2005 p.5). Even with the vague bodily processes induced by acupuncture, the World Health Organization (WHO) recognizes the validity of four meridians or physiological systems affected by needle acupuncture, specifically (1) musculoskeletal, (2) cardiovascular, (3) endocrine and (4) neural systems (Torshin, 2004 p.14). According to Roemer, Kempfle and Reuther (2005), there are five phases comprising the cyclical effect of acupuncture towards the different body systems, namely (1) wood phase – represents potential activity or development, (2) fire phase – represents the actual activity and growth, (3) earth phase – represents times of change, transitions or transformations, (4) metal phase – anticipations of results regardless of actual materialization, and (5) water phase – preservation of results obtained (p.4-5). The five phases of acupuncture demonstrates the balances, imbalances, and potential rebalancing of bodily responses in order to reduce stress experienced by various systems of the body. Acupuncture improves and rejuvenates energy or chi balance from the body’s excess or deficient condition, and in return reduces the stress-causing elements experienced by the body (Clark and Gordon, 1999 p.286).
On the other hand, aromatherapy involves the use of essential oils to relax bodily and mental tensions. Different essential oils, such as basil, benzoin, bergamot, carnation, clary sage, lavender and others, are commonly used in aromatherapy to induce the antistress effects (Jones, 2000 p.78). Clinically, aromatherapy has been used to treat stress-related disorders, such as depression, infections, sleep problems, cardiovascular imbalances and arrhythmias (Fink, 153). In the study conducted in Tullamore Nursing Development Unit (NDU), patients who regularly receive aromatherapy sessions prior to sleep have markedly improved their sleep patters evidenced by the reduced amount of night sedatives required by the patients as well as the significant dose reductions on their sleeping medications (Cannard, 1996). Despite the clear benefits of aromatherapy on stress reduction, the actual mechanisms involved are still unclear and often theoretical (Fink, 153).
Theoretically, aromatherapy and acupuncture influence the sympathetic neuronal pathways and natural stress hormones of the body (Porth, Gaspard and Matkin, 2006 p.160). In acupuncture, four specific meridian centers are carefully manipulated to induce stress reduction, specifically (1) heart meridian, (2) muscles (nerve stimulations are also directed within muscles’ insertion site), (3) kidneys and (4) endocrine meridian (Torshin, 2007 p.14). Acupuncture reduces stress by stimulating the neuronal impulses within the sympathetic nerve pathways present on these meridian centers, which results to the activation of sympathetic systems depending on meridian targeted by the needle insertion (Fuster, Hurst and Alexander et al., 2004 p.2467). Therapeutic effects of acupuncture are then produced by the activation of spinal and central reflexes and beta-endorphinergic system from the hypothalamus to the periaqueductul grey in the brain stem (Shifrin and Greene, 2000). In aromatherapy, the effects of essential oils are resulted by the inhalation of oil fragrances affecting the cerebral blood flow, which stimulate the sensory neural pathways in the spinothalamic tract of the cerebral cortex (Tiran, 2002 p.42). Based on the physiology study of Khyasudeen and Bakar (2007), olfactory nerves attached to the olfactory bulb produce electric impulses depending on the aromatic molecules produced by different essential oils inhaled by the body. Volatile essential oil molecules trigger specific stimulations through olfactory fiber bundles, which are eventually relayed to the different hemispheres of the brain (Tiran, 2002 p.42). Aroma eventually reaches the limbic systems activating the release of neurochemicals, which induce stress-reduction (Khyasudeen and Bakar, 2007).
b. Stress Treatment: Studies and Experiments
Various studies have attempted to uncover and prove the stress reducing effects of aromatherapy and acupuncture. Studies exploring the effects of acupuncture on stress levels consisted several neurological and hormonal elements related to stress mechanisms. Based on the reviews analysis of Middlekauff, Yu and Hui (2001), animal studies support the idea that acupuncture relieves stress through the mechanism of sympatho-inhibitory effect; however, the mechanism of sympatho-inhibition is not entirely clear among humans. After the activation of sympathetic reflexes, excitatory responses are initiated through endorphin and enkepaphalin secretions, which are neuronal hormones possessing morphine effect (Hopwood, Lovesey and Mokone, 2007 p.21). In the animal study conducted by Yun, Park and Yeom et al. (2002), electroacupuncture (electronic-based acupuncture) has been used to treat the stress-induced condition among rat samples brought by the decline of brain-derived neurotrophic factor (BDNF).
Results reveal that electroacupuncture is able to restore BDNF expression suggesting the potential stress-reducing effect of acupuncture-based therapies among rats by affecting the neural systems, such as the BDNF response. According to White and Ernst (1999), there is a marked increase in blood flow during the commencement of the treatment due to the stimulation of sensory peripheral nerves that control vascular dilatation. With the increased blood flow, heart rate and cardiac output most expectedly increase, which consequently increase cardiac oxygen demand as well.
In the study of Middlekauff, Yu and Hui (2001), stress testing has been administered among controlled samples (n=19) obtaining records from both pre- and post-acupuncture therapy. Results reveal no effect on muscle sympathetic nerve activity (MSNA), blood pressure and heart rate after series of nonacupoint or “no-needle” acupuncture. On the other hand, needle acupuncture reveals significant bodily changes in mean arterial pressure (Pre: 4.5 mmHg vs. Post: 1.7 mmHg), but still no changes in the body MSNA response and heart rate (Middlekauff, Yu and Hui, 2001). In another study of Middlekauff (2002), MSNA response is again tested among advanced heart failure patients (n=15) who underwent acute mental stress testing before and during acupuncture therapy. Using peroneal microneurography, SNA has been recorded occurring among patients who have had needle acupuncture (149 ± 171 versus −169 ± 130, P = .03). On the other hand, different researchers have also studied the physiologic analogy behind the therapeutic effects of aromatherapy.
By principle, vapor produced by essential oils stimulates the nerve endings present in the olfactory system, which eventually moves towards the pituitary gland to induce hormonal activity in the adrenal glands (D’Amelio, 1998 p.49). In the quasi-experimental study of Cooke, Holzhauser and Jones et al. (2007), emergency nurses have been given a total of 365 massage sessions for over two 12-week periods (summer and winter periods) in order to identify the stress and anxiety reducing effects of aromatherapy. Results reveal that stress reductions are higher on pre- and post-aromatherapy conducted during the winder than in summer.
In another study utilizing aromatherapy to reduce job-related stress among psychiatric nurses (n=18), the samples have been provided with six aromatherapy sessions once a week (Hansen, Hansen and Ringdal, 2006). The study has utilized Cooper’s Job Stress Questionnaire (CJSQ) to measure the stress reduction effects of the treatment. Hansen, Hansen and Ringdal (2006) have found significant decrease in reported stress among the experimental group. Meanwhile, the study of Kuriyama, Watanabe and Nakaya et al. (2005) links the stress-reducing benefits of aromatherapy to its immunological and psychological therapeutic effects. In the study, both psychological testing instruments, namely (a) State–Trait Anxiety Inventory (STAI) questionnaire and (b) Self-rating Depression Scale (SDS), have been used among recipients (n=11) in order to determine the pre- and post-effects of aromatherapy massage consisting of carrier, almond, lavender, sweet marjoram and cypress oils. In addition, preliminary blood investigations involving red blood cells (RBCs), white blood cells (WBCs), neutrophils, peripheral lymphocytes (PBLs), hematocrit and humoral parameters have also been examined to determine the possible immunological changes stimulated by the post-therapy. STAI and SDS results reveal significant stress-level reduction after aromatherapy treatment, while PBL levels and associated immunologic components (CD8+ and CD16+ lymphocytes) have markedly increased as well. (Kuriyama, Watanabe and Nakaya et al., 2005). Despite the clinical trials showing marked decreases of stress levels among patients receiving aromatherapy, its therapeutic value on stress is still subjected for long-term critical studies and advanced clinical trials.
c. Imbalances Resulting to Stress: Theories on Five Phases and Dosha Imbalances
Understanding the five phases of acupuncture is essential to the therapy’s medical function. As discussed in latter section, the five phases consist of (1) wood (development, (2) fire (growth), (3) earth (transformation), (4) metal (absorption) and (5) water (preservation) (Roemer, Kempfle and Reuther, 2005 p.4-5). In acupuncture, pathogenic factors from external or internal environment are believed to cause the bodily disturbances resulting to the imbalance of life force known as Qi (Ernst, 1999 p.19). According to Roemer, Kempfle and Reuther (2005), imbalances of these phases result to “energy stagnation, energy vacuity, and energy repletion” that cause disorders or diseases brought by the weakened state of qi (p.4-5). Each phase moves in cyclical manner reinforcing the next phase in an engendering sequence. As supported by Ernst (1999), each phase is interdependent to one another wherein “a change in one can potentially create changes in other corresponding elements in the phase” (p.19).
Each phase point comprises of elemental designations similar to the meridian on which it is located (e.g. fire meridian – fire point representing the heart, vasculatures, etc) (Helms, 1995 p.227). Imbalances in any of the five phases produce systemic reaction affecting other points of the body. According to Ernst (1999), the system designations of each phase are as follows: (1) wood – controls the liver and gallbladder meridians, (2) fire – controls the heart, pericardium and small intestine meridians, (3) earth – controls the spleen and stomach meridians, (4) metal – controls the lungs and large intestine meridians, and (5) water – controls the kidneys and bladder meridians (p.20). According to the beliefs of acupuncturists, the circulation of qi in the channel systems affects the function of the organs, and when an organ loses its normal function, the caused imbalance results to “xu” or vacuous or “zhi” stagnant body function (Ernst, 1999 p.20). Imbalances that occur in one single phase affect the entire physiological, psychological and mental functioning of the person. Using the five-phase treatment in curing stress conditions aims to form a balance and harmony
FIVE-PHASE ELEMENT DIAGRAM
among the five elements interrelated to each other.
Stress develops when one element overcomes another element causing a generalized body imbalance. Meanwhile, moderately generating the counter element resolves the imbalance reducing and consequently reducing stress levels experienced by the body. In terms of fire point imbalances, stress develops when water points empower the fire meridians, and when fire meridian empowers the metal element. Water retention in the kidney due to the secretion of stress related hormones – mineralocorticoids, cortisol – increasing blood flow, and producing higher workload for heart that predispose various cardiovascular problems, such as palpitations, hypertension, cariomegaly, etc (Helms, 1995 p.227). Meanwhile, with the heart function increasing due to the increased cardiac input/output, oxygen reuptake in the lungs (metal points) also increases in order to supply the pulmonary circulation. During this condition, hyperventilation and palpitation develop and form part in the general manifestation of stress (Ernst, 1999 p.20). Stress also develops when wood point overcomes earth point. In a classic example, if liver activity (wood element) is increased brought by high consumptions of fat or indigestion, stomach activity (earth element) usually suffers stress of coping in the need to secrete exocrine substances in aid of digestion (Helms, 1995 p.227).
In aromatherapy, the fundamental belief supporting the treatment through olfaction is the Ayuverdian theory on Dosha imbalance (Miller and Miller, 1995 p.93). The theory holds that bodily imbalances are resulted by Vata imbalance characterized by dryness, lightness and coldness, which can only be treated via essential oils containing the opposite characteristics. According to Fischer-Rizzi, Ebenhoch and Hartmann (1991), Vatas are formed when the body accumulates toxins, which are most of the time mediated through air and absorbed via skin, smell or taste (p.10). Vata blockages and deficiencies trigger the imbalances of dosha sites, which eventually predispose illness or body disorders. According to Thirtha, Uniyal and Sandhu et al. (2007), there are specific sites on the body that are capable of balancing the doshas upon application of essential oils (i.e. Vayu – located between eyebrows, Pitta – located in the chest, and Kapha – between navel and pubic bone) (p.247). Aromatherapists believe that Vata can cause blockage of system channels or deficiencies affecting the normal body functioning and eventually resulting to body ailments (e.g. poor elimination, unhealthy diet, indigestion, etc) (Miller and Miller, 1995 p.93.). The imbalances of qi in acupuncture and dosha systems in aromatherapy result to untoward bodily responses, such as stress. In acupuncture, if one of the five phases has been strongly emphasized unequal to the restricting or reinforcing element, stress in the body area commonly results. Meanwhile, in aromatherapy, if vata clogs or vata-caused deficiencies have altered one dosha site (e.g. Vayu site, etc.), stress in the area usually results and this commonly comes in the form of mental stress.
Correcting stress with the combination of five phase model and aromatherapy’ dosha site balancing essential oils. Based on the understanding of the five phase model, fire acupoints controlled by excess water element can be drained by increasing the wood element. Based on Dosha site manipulation, pitta site can be balanced by selecting the appropriate essential oil. According to Miller and Miller (1995), essential oils categorized as warming diaphoretics (e.g. eucalyptus, sage, chamomile, etc.) can be best combined with wood acupoint treatment in curing stress symptoms caused by the imbalance. Similar essential oil selection applies to the treatment of fire and metal imbalances with additional kappha-based essential oils categorized as heating alternatives (e.g. cinnamon, myrrh, coriander, etc.) to aid the earth element. In case the imbalances causing stress are brought by wood and earth, heating nervines (basil, chamomile, eucalyptus and myrrh) essential oils are the best selection in aid of fire point treatment.
d. Rebalancing System via Acupuncture and Aromatherapy
In order to counter the imbalances in the areas of qi and dosha systems, needle pricks following the networked channels (acupuncture) and/or the use of essential oils (aromatherapy) can fundamentally reduce the body alterations causing stress. In acupuncture, the technique requires stainless steel acupuncture needles of varying lengths depending on the body insertion site. According to Bonica, Loeser and Butler et al. (2001), “the needle length is dictated by the location of the point to be treated; deeper and thicker muscles usually require longer needles” (p.1835). Acupuncture corrects the energy disturbances by inducting therapeutic stimulus through needle pricking, which produces electrical impulses connected by so-called channels (Roemer, Kempfle and Reuther, 2005 p.4-5). In order to correct the elemental imbalances that are causing stress, the counter element must be increased in order to absorb the excess levels of the overcoming element. For example, if water element overcomes fire, wood element must be increased to absorb excess water element and eventually normalizing the water-fire relationship. Balancing the qi systems works by realigning the network channels, which also corrects the pathways of energy generated by these sites. According to Clark and Gordon (1999), western acupuncture is often prescribed in order to improve and rejuvenate energy or qi balances alleviating the body’s excess or deficient condition, while at the same time removing the body’s pathogenic components (p.286). As supported by Ernst (1999), acupuncture treatment rebalances the body function by targeting specific “acupoints” or “acuholes” influencing the needed changes in qi function or qi circulation (p.20). Acupuncture is able to rebalance the disrupted qi system through the re-networking of the energy pathways; thereby, facilitating the treatment on bodily stresses brought by the qi system imbalances (Clark and Gordon, 1999 p.286). In the quasi-experimental study of Davis, Cooke and Holzhauser (2002), a group of nurses has been studied using pre- and post-tests after their regular aromatherapy with massage sessions lasting for 12 weeks. After comparing the pre-and post data, post-test results reveal significant reductions on occupational stress among the entire group of nurses (Davis, Cooke and Holzhauser, 2002).
In aromatherapy, rebalancing of dosha sites to remove the bodily stresses experienced by the body can be done by administering essential oils through olfaction or as a topical medicine (Thirtha, Uniyal and Sandhu et al., 2007 p.247). According to Miller and Miller (1995), obstructed Vata-caused problems can be cured by using essential oils providing (a) heating alternatives (e.g. cinnamon, myrrh, coriander, etc.), (b) heating carminatives (e.g. basil, thyme, lime, etc.) and (c) warming diaphoretics (e.g. eucalyptus, sage, chamomile, etc.). Based on the study of Takeda, Tsujita and Kaya et al. (2008), aromatherapy, as a phytotherapeutic remedy for stress, works by inducing bacteriocidal and antiseptic action stimulated within the body upon absorption of aroma molecules within the cerebral blood flow. In the study, volunteer samples (n=7 for females; n=6 for males) have undergone three series of aromatherapy session. Each session requires one subject to fill out Advanced Trail Making Test (ATMT) to measure stress-inducing tasks before and after treatment. Results evaluated via State Anxiety Inventory (SAI), the Visual Analog Scale, and the Face Scale indicate significant reductions in subjects’ stress, anxiety and negative mood, while promoting feelings of comfort and positive mood. Physically, immunologic and hormonal components, such as salivary cortisol, secretory immunoglobulin a, leukocytes and interleukins, have consistently increased throughout the treatment regimen (Takeda, Tsujita and Kaya et al., 2008). As indicated by the study, the effects of aromatherapy in balancing the body disruptions producing stress are facilitated by olfaction of essential oil molecules transported during the process of treatment. Using the idea of dosha theory, disorders and diseases caused by physiological stresses (Vata blockages and caused deficiencies) by improving the body’s immunological elements to confront the predisposing external and internal disease elements introduced to the body.
In conclusion, acupuncture and aromatherapy provide distinct ways of treating stress experienced by the body. Acupuncture works by inserting acupuncture needles to re-channel the disrupted qi systems. The therapy of acupuncture follows the cyclical and interrelated Five Phase Theory consisting of the elements of wood, fire, earth, metal, and water in understanding the insertion sites to be cured. Meanwhile, aromatherapy believes in the balances that have to be achieved by manipulating dosha sites and removing vata-caused toxic blockages or deficiencies. As a stress treatment, the effectiveness of aromatherapy and acupuncture have been clinically studied revealing consistent data on its therapeutic benefits on relieving mental stress, anxieties and negative moods through various physiological and psychological evaluations. However, the said therapies are still regarded as alternative treatments to stress, and currently under continuous studies determining the exact mechanisms and biochemicals involved in their stress-reducing nature.
IV. Works Cited
Cannard, G. (1996, April). The effect of aromatherapy in promoting relaxation and stress reduction in a general hospital. Complementary Therapies in Nursing and Midwifery, 2, 38-40.
Clark, C., & Gordon, R. J. (1999). Encyclopedia of Complementary Health Practice. New York, U.S.A: Springer Publishing Company.
Cooke, M., Holzhauser, K., & Jones et al., M. (2007, August). The effect of aromatherapy massage with music on the stress and anxiety levels of emergency nurses: comparison between summer and winter. Journal of Clinical Nursing, 16, 1695 – 1703.
D’Amelio, F. S. (1998). Botanicals: A Phytocosmetic Desk Reference. New York, London: CRC Press.
D’Amelio, F. S. (2000). The Antibiotic Alternative: The Natural Guide to Fighting Infection and Maintaining a Healthy Immune System. New York, U.S.A: Bear & Company Publishing.
Davis, C. M., Cooke, M., & Holzhauser et al., K. (2002, January). The effect of aromatherapy massage with music on the stress and anxiety levels of emergency nurses. Australasian Emergency Nursing Journal, 8, 43 – 50.
Ernst, E. (1999). Acupuncture: A Scientific Appraisal. New York, U.S.A: Elsevier Health Sciences.
Fink, G. (2000). Encyclopedia of Stress. New York, U.S.A: Academic Press.
Fischer-Rizzi, S., Ebenhoch, P., & Hartmann, G. (1991). Complete Aromatherapy Handbook: Essential Oils for Radiant Health. New York, London: Sterling Publishing Company, Inc.
Fuster, V., Hurst, J., & Alexander, R. (2004). Hurst’s the Heart. New York, U.S.A: McGraw-Hill Professional.
Hansen, T. M., Hansen, B., & Ringdal, G. I. (2006, April). Does aromatherapy massage reduce job-related stress? Results from a randomized, controlled trial. International Journal of Aromatherapy, 16, 89-94.
Helms, J. M. (1995). Acupuncture Energetics: A Clinical Approach for Physicians. New York, London: Thieme Press.
Hopwood, V., Lovesey, M., & Mokone, S. (2007). Acupuncture and Related Techniques in Physical Therapy. New York, U.S.A: Elsevier Health Sciences.
Khyasudeen, S. F., & Bakar, M. A. (2007, January). Aromatherapy: It’s Effect on Brain Signal, Math Computation, Blood Pressure and Heart Rate. Biomedical Engineering, 15, 447-450.
Kuriyama, H., Watanabe, S., & Nakaya et al., T. (2005, April). Immunological and Psychological Benefits of Aromatherapy Massage. Evidence-Based Complementary Alternative Medicine, 2, 179-184.
Middlekauff, H. R. (2002, January). Acupuncture inhibits sympathetic activation during mental stress in advanced heart failure patients. Journal of Cardiac Failure, 8, 399 – 406.
Middlekauff, H. R., Yu, J. L., & Hui, K. (2001, May). Acupuncture inhibits sympathetic activation during mental stress in advanced heart failure patients. American Journal of Physiology, 280, R1462-R1468.
Miller, L., & Miller, B. (1995). Ayurveda & Aromatherapy: The Earth Essential Guide to Ancient Wisdom and Modern Healing. New York, London: Lotus Press.
Porth, C. C. (2005). Pathophysiology: Concepts of Altered Health States. New York, U.S.A: Lippincott Williams & Wilkins.
Porth, C. C., Gaspard, K. J., & Matfin, G. (2006). Essentials of Pathophysiology: Concepts of Altered Health States. New York, U.S.A: Lippincott Williams & Wilkins.
Roemer, A. T., Kempfle, T., & Reuther, I. (2005). Medical Acupuncture in Pregnancy: A Textbook. London, New York: Thieme Publications.
Shifrin, K., & Greene, E. (2000, December). Understanding Acupuncture. The Journal of Alternative and Complementary Medicine, 6, 561-563.
Takeda, H., Tsujita, J., & Kaya et al., M. (2008, November). Differences between the Physiologic and Psychologic Effects of Aromatherapy Body Treatment. The Journal of Complementary and Alternative Medicine, 14, 655–661.
Tirtha, S., Uniyal, R. C., & Sandhu, S. (2007). The Ayurveda Encyclopedia: Natural Secrets to Healing, Prevention, & Longevity. New York, New Delhi: Sat Yuga Press.
Torshin, I. Y. (2007). Physiology and Medicine: Bioinformatics in the Post-genomic Era. London, New York: Nova Publishers.
Yun, S., Park, H. J., & Yeom et al., M. (2002, January). Effect of electroacupuncture on the stress-induced changes in brain-derived neurotrophic factor expression in rat hippocampus. Neuroscience Letters, 318, 85-88.