Can acupuncture alleviate mood disorders by altering the patient’s unique musculoskeletal tensions (facial

expression and body language) associated with their pathological emotional state?

acupuncture’s ability to treat emotional distress relies on the

General Hypothesis
control of sensory biofeedback.

acupuncture alleviates mood disorders by altering the patient’s

Directed Hypothesis unique musculoskeletal tensions (facial expression and body
language) associated with their pathological emotional state

using acupuncture to relax the muscles associated with a

Testable Hypothesis specific mood or emotion will reduce the valence and
occurrence of the specific emotion.

Yin Tang is a classic acupuncture point for stress, located on the midline of the face, between the corners of the eyebrows.
Whenever a patient self-reports that their stress levels are moderate to high, I puncture Yin Tang with a needle as part of their
treatment protocol. When a patient shows visible signs of acute stress, I often puncture Yin Tang with three needles - one needle
directly on Yin Tang itself, and a needle roughly 1 cm lateral on both sides of Yin Tang, on another point in the same region
known as BL 2. In my experience, this three needle technique is much more effective at relieving acute stress than Yin Tang on its
own.

BL 2 is not traditionally prescribed for stress, which made me wonder why the effect was so much more pronounced. Whereas the
entire BL series is said to be associated with fear, I was curious about the actual mechanism underlying BL 2 ‘s effectiveness.

Although BL 2 is located quite close to Yin Tang, its underlying soft tissues are very different. Whereas Yin Tang is located above
the procerus muscle, BL2 is located above both the depressor supercilii and the corrugator supercilii.

One of the most basic effects of needling is the relaxation of muscle. By needling BL 2, both the depressor supercilii and
corrugator supercilii relax; whereas needling Yin Tang causes the procerus to relax.

I found this very interesting and began wondering if the effects I was seeing were due to something known as the Facial Feedback
Hypothesis.

Christian Saint-Pierre, R.Ac

The Facial Feedback hypothesis is rooted in research that dates back to Charles Darwin. Darwin originally proposed the idea that
certain facial expressions are signals of specific emotions (happiness, anger, fear, surprise and disgust) that are recognized by
people everywhere, regardless of culture or language. The evolutionary basis of these kinds of facial expressions can be traced
back to Darwin’s “The Expression of Emotions in Man and Animals”.

Paul Ekman’s work on facial expressions showed that involuntary facial expressions of emotion are not culturally determined, but
universal across human cultures, i.e. Innate. Further work observed that whereas Voluntary facial expressions are socially
conditioned and follow a cortical route in the brain, Involuntary facial expressions are innate and follow a subcortical route in the
brain.

Ekman then used Carl-Herman Hjortsö’s Facial Action Coding System (FACS) to identify exactly which muscles of the face were
involved in particular facial expressions, and by extension, which facial emotions.

The facial feedback hypothesis itself states that facial movement can influence emotional experience. For example, an individual
who is forced to smile during a social event will actually come to find the event more of an enjoyable experience.

Charles Darwin was the first to suggest that physiological changes caused by an emotion had an impact on, rather than being just
the consequence of, that emotion.

William James elaborated on the idea and proposed that, “contrary to common belief, awareness of bodily changes activated by a
stimulus IS the emotion.” If no bodily changes are felt, there is only an intellectual thought, devoid of emotional warmth. In the
“Principles of psychology”, James wrote: “refuse to express a passion, and it dies”.

The facial feedback hypothesis “that skeletal muscle feedback from facial expressions plays a causal role in regulating emotional
experience and behavior” (Buck. p396) developed almost a century after Darwin. Sylvan Tomkins wrote in 1962 that “the face
expresses affect, both to others ands the self, via feedback, which is more rapid and more complex than any stimulation of which
the slower moving visceral organs are capable.”

The strong version of the hypothesis implies that facial feedback itself can create the whole emotion.
Strong experimental support for a facial feedback mechanism is provided through the research using Botox injections to
temporarily paralyze facial muscles. During imitation of facial expressions, Botox decreased activation of brain regions implicated
in emotional processing and emotional experience (namely the amygdala and brain stem) relative to activation before Botox
injection. These findings show that facial feedback modulates neural processing of emotional content, and that Botox changes how
the human brain responds to emotional situations.

In another study, researchers asked participants to read emotional (angry, sad, happy) sentences before and two weeks after Botox
injections into the muscle used for frowning. Reading times for angry and sad sentences where longer after Botox injections than
before injection while reading time for happy sentences were unchanged. This finding shows that facial muscle paralysis has a
selective effect on processing of emotional content. It also demonstrates that cosmetic Botox affects aspects of human cognition -
namely, the understanding of language and emotion.

Christian Saint-Pierre, R.Ac

Since different facial expressions are dependent on specific muscles, it is of great value and importance to identify which muscles
of the face are involved in particular facial expressions, and by extension, which facial emotions. Ekman was able to do so using
Carl-Herman Hjortsö’s Facial Action Coding System (FACS), which divides specific facial expressions into discrete Action Units
(AU).

Using his information, it is possible to identify which acupuncture points of the face are associated with specific AU. For example,
The points Yin Tang and BL 2 are associated with AU 4 - the “brow lowerer/pincher”, which is an AU involved in the facial
expressions of Anger, Sadness, Fear and Pain.

I therefore hypothesize that applying an acupuncture protocol that specifically relaxes the chronic and acute facial expressions
associated with depression will produce better clinical outcomes than an acupuncture protocol which does not specifically relax the
facial expressions associated with depression.

What follows is a list of the 6 basic emotions, their associated action Units, the muscles involved in each action unit, and the
acupoints which connect to them. The emotions are listed in order of the five elements, starting with anger and including pain.

Emotion Action Units Agonist Muscles Points

Yintang
Procerus BL 2 medially

Anger 4 - brow lowerer Depressor supercilii BL 2

BL 2
Corrugator supercilii Extra Yuyao

Christian Saint-Pierre, R.Ac

 Levator Palpebrae superioris With the eyes looking forwards, the point is
5 - upper lid raiser + located directly above the pupil between the
Superior Tarsal muscle eyeball and the Supra orbital ridge.

7 - lid tightener Orbicularis Oculi No point

Du26, Du 28
Ren 24, Ren 27
23 - lip tightener Orbicularis Oris St 4
Li 19
Extra Jiachengjiang

St 5, St 6, St 7
31 - Jaw clencher Masseter Si 17

St 1, St 2
Gb 1
Orbicularis Oculi BL 1, BL 2
6 - Cheek Raiser
(Pars Orbitalis) SJ 23
Happiness Extra qiu huo

Si 18
12 - Lip Corner Puller Zygomaticus Major St 3 laterally
10.10.18 (Tung)

BL 2
Li 19, Li 20
Levator Labii Superioris St 2
9 - Nose Wrinkler
Alaeque Nasi Extra Bitong
1010.19 (Tung)
Disgust
St 4 laterally & oblique inferiorly
15 - Lip Corner Depressor Depressor Anguli Oris 1010.19 (Tung)

Ren 24
16 - Lower Lip Depressor Depressor Labii Inferioris Extra Jiachengjiang

Emotion Action Units Agonist Muscles Points

BL 2, BL 3, BL 4, BL 5
Du 24
Sadness 1 - Inner Brow Raiser Frontalis (Pars Medialis) GB 14, GB 15
Extra Yuyao

Christian Saint-Pierre, R.Ac

 Yintang
Procerus BL 2

4 - brow lowerer Depressor supercilii BL 1, BL 2

BL 2
Corrugator supercilii Extra Yuyao

St 4 laterally & oblique inferiorly

15 - Lip Corner Depressor Depressor Anguli Oris 1010.19 (Tung)

BL 2, BL 3, BL 4, BL 5
Du 24
1 - Inner Brow Raiser Frontalis (Pars Medialis) GB 14, GB 15
Extra Yuyao

Gb 13, Gb 14
2 - Outer Brow Raiser Frontalis (Pars Lateralis)
St 8

Yintang
Procerus BL 2

4 - brow lowerer Depressor supercilii BL 1, BL 2

BL 2
Corrugator supercilii Extra Yuyao

Fear Levator Palpebrae superioris With the eyes looking forwards, the point is
5 - upper lid raiser + located directly above the pupil between the
Superior Tarsal muscle eyeball and the Supra orbital ridge.

7 - lid tightener Orbicularis Oculi No point

St 4 laterally
Risorius 10.10.17 (Tung)
20 - Lip Stretcher St 5, St 6, St 9, St 10, St 11, St 12
Platysma Li 17, Li 18
Si 16

Relaxed Masseter,
26 - Jaw Dropper
Relaxed Temporalis

Emotion Action Units Agonist Muscles Points

Yintang
Pain 4 - brow lowerer Procerus BL 2

Christian Saint-Pierre, R.Ac

 Depressor supercilii BL 1, BL 2

BL 2
Corrugator supercilii Extra Yuyao

St 1, St 2
Gb 1
Orbicularis Oculi BL 1, BL 2
6 - Cheek Raiser
(Pars Orbitalis) SJ 23
Extra qiu huo

7 - lid tightener Orbicularis Oculi No point

BL 2
Li 19, Li 20
Levator Labii Superioris St 2
9 - Nose Wrinkler
Alaeque Nasi Extra Bitong
1010.19 (Tung)

10 - Upper Lip Raiser Levator Labii Superioris St 2, St 3 medially

Si 18
12 - Lip Corner Puller Zygomaticus Major St 3 laterally
10.10.18 (Tung)

Ren 24
25 - Lips Part Depressor Labii Inferioris Extra Jiachengjiang

Relaxation of Levator
43 - Eyes Closed
Palpebrae Superioris

Proposed experiment (subject to revision as needed):

Select test subjects that have been diagnosed with a mood disorder (perhaps anxiety or depression).
Divide the test subjects into three groups, A, B & C. Measure their mood, emotional frequency and valence.

Group A will receive facial acupuncture based on facial feedback of their mood disorder, group B will receive facial acupuncture at
points associated with the emotional expression of happiness, and group C will receive no acupuncture.

Have an acupuncturist who is not familiar with the facial feedback hypothesis perform “facial rejuvenation acupuncture” on groups
A & B. Explain to the acupuncturist that the study is designed to research the effects of specific points on facial rejuvenation. The
subject will arrive at their appointments (9 30 min sessions over a 3 week period) with their prescription in hand for the
acupuncturist to perform. After 9 treatments, measure the subjects’ mood, emotional frequency and valence again. Remeasure
every month for a year.

Christian Saint-Pierre, R.Ac