Grief

Understanding Grief

Grief is a person's emotional response to loss, and it is a natural and universal one. It is a process, not a fixed state, and most people recover adequately within a year after a loss.^[1] For some people grief persists as prolonged grief disorder, a recognized mental health condition that needs professional care.^[2]

Common symptoms

Acute grief often involves sadness, tearfulness and sometimes insomnia, and it typically requires no treatment.^[1] Grief can also bring poor concentration, anger, guilt and physical tiredness. These reactions vary widely, and there is no single correct way to grieve.

Prolonged grief disorder is different. Its core symptoms are yearning for the person who died, constant preoccupation with them, or both, along with emotional pain, a disturbed sense of identity, loss of meaning and difficulty functioning.^[2] It usually appears 6 to 12 months after the death.^[2]

Causes and risk factors

Grief is caused by loss. Loss is most often the death of a loved one, but it can also be a terminal diagnosis, the loss of a pet, a perinatal loss or other losses that are not openly acknowledged.^[1]

Pooled studies suggest that about 1 in 10 bereaved adults develops prolonged grief disorder, although the studies are varied.^[3] A meta-analysis of 120 studies found the strongest links with grief symptoms before the loss and with depression, with smaller links to a sudden or violent death, the death of a child or partner, anxious attachment, low income and female gender.^[4]

How it is diagnosed and treated conventionally

Normal grief is not treated as an illness. Prolonged grief disorder is diagnosed by a clinician using criteria in current diagnostic manuals, and psychotherapy is its main treatment.^{[2, 5]} Some researchers warn that the line between prolonged grief disorder and normal grief is not yet well established, and that grief should not be medicalized.^[6]

In a randomized trial of 100 adults with prolonged grief disorder, grief-focused cognitive behavioral therapy reduced symptoms more than mindfulness-based cognitive therapy six months later, and both were considered possible options.^[7]

Why Grief calls for a whole-person approach

Grief affects sleep, mood, the body and a person's sense of meaning at the same time. For that reason, care that looks only at emotions can miss part of the picture, and care that looks only at the body can miss the loss.^{[1, 2]}

Supportive care addresses some of those surrounding effects. It does not remove or shorten grief, and it does not replace counseling or medical care.

Sleep

Insomnia is common in acute grief.^[1] Poor sleep can make low mood and exhaustion worse, so sleep is a practical target for supportive care.

Low mood and anxiety

Depression is among the strongest risk factors for prolonged grief symptoms.^[4] Prolonged grief disorder is also associated with higher rates of suicidality.^[2] A persistent low mood, hopelessness or thoughts of death should be assessed by a physician or mental health clinician.

Physical health and stress

Bereavement is described as one of life's greatest stressors, and prolonged grief disorder has been linked with negative health outcomes such as high blood pressure.^{[2, 5]} Keeping regular medical checkups is part of caring for yourself during grief.

Meaning and connection

Grief models describe adjusting to loss as an active process that includes making meaning, moving between facing the loss and rebuilding daily life, and finding support from other people.^[1] Counseling, support groups and rituals that matter to you are central to this, and supportive care is not a substitute.

Acupuncture as supportive care in Grief

What the research shows

No clinical trial of acupuncture for grief was found in our search. Any benefit we describe is for related symptoms such as depression and insomnia, and it cannot be assumed to apply to grief.

A Cochrane review of 64 trials in people with depression found low-quality evidence that acupuncture may reduce depression severity compared with no treatment, and a small reduction compared with sham acupuncture. The authors called for higher-quality trials.^[8] A 2025 review of 60 trials in mild to moderate major depression reported that acupuncture may reduce depression and insomnia compared with antidepressants, but rated the certainty as low to very low.^[9]

For sleep, a review of 13 trials that compared acupuncture with sham acupuncture found a better (lower) sleep-quality score with acupuncture, though two trials in people with major depression showed no significant reduction and the review advised that people with insomnia and major depression should not rely on acupuncture alone.^[10] A review of 24 trials included 15 that compared acupuncture with medication; in those, sleep quality scores were better with acupuncture after three to four weeks but not after one or two, with wide variation between trials.^[11]

How acupuncture may work

The way acupuncture might affect grief has not been studied. For insomnia, the mechanism is described as unclear.^[10] In Chinese medicine, grief is traditionally linked to the lungs and to qi becoming constrained, which guides point selection. This is a traditional explanation, not proven biology.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at selected points, usually left in place for about 20 to 40 minutes. A course is several visits, with reassessment along the way. We keep the focus on sleep, tension and relaxation.

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine as supportive care in Grief

The Ayurvedic view

Ayurveda recognizes grief, called shoka in classical language, as a strong emotional state that can disturb the mind and body. It is often described as aggravating Vata, the principle said to govern movement and the nervous system, which is linked in this tradition with restlessness, poor sleep and anxiety. These are traditional categories, not medical diagnoses.

Therapies that may be used

Care is chosen for the individual and is usually gentle during bereavement.

• Regular meals, steady sleep and wake times, and a calming evening routine
• Warm oil massage and breathing or relaxation practices
• Herbs traditionally used for stress and the nervous system, such as ashwagandha (Withania somnifera), prescribed individually by a qualified practitioner

Panchakarma, the traditional cleansing program, is not appropriate during pregnancy, acute illness or frailty, and we do not use it as a way to treat grief. Where an herbal preparation applied to the skin is relevant, transdermal medication therapy is available, but we make no efficacy claim for it in grief.

What the research shows

There is no research on Ayurvedic treatment of grief. The nearest evidence is for ashwagandha in stress and anxiety. A meta-analysis of 12 randomized trials with 1,002 adults found lower stress and anxiety than placebo, but rated the certainty as low and noted large differences between trials.^[13] Another of nine trials reported lower perceived stress and cortisol, with mild to moderate adverse events in four trials, and said long-term safety needs further study.^[14] Their abstracts describe trials of stress and anxiety, not grief.

Herbal medicine as supportive care in Grief

Herbs and formulas that have been studied

No herb has been tested as a treatment for grief in the studies we found. Herbs studied for related mood symptoms include St. John's wort, saffron, curcumin and lavender for depression, and ashwagandha and lavender for anxiety.^[15] Chinese medicine practice also uses formulas chosen by pattern, such as those aimed at calming the spirit, but we found no trials of them in grief.

What the research shows

Herbal medicine has not been shown to help grief. An international guideline on nutraceuticals and phytoceuticals graded evidence for several herbs in depression and anxiety, not grief. It stressed that such products should mainly be used alongside standard medical care, and that product quality and standardization limit confidence in the evidence.^[15]

Safety and herb-drug interactions

Herbs are active substances and can interact with prescribed medicines. A literature review of herb-drug interactions reports that St. John's wort lowered blood levels of many medicines and caused serotonin syndrome when combined with SSRI antidepressants.^[16] Tell us about any antidepressant, anti-anxiety medicine, sleep medicine, blood thinner or other prescription you take.

In one study, about one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[17] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding or have liver or kidney disease.

Translating traditional medicine into modern biological language

The following links are interpretation, not equivalence. Chinese medicine's picture of grief as constrained qi in the lungs, and Ayurveda's picture of aggravated Vata, both describe tension, poor sleep and exhaustion. Researchers studying bereavement measure these in terms of stress responses, sleep disturbance and blood pressure.^{[2, 5]}

No study has shown that a pattern or dosha corresponds to a specific biological process in grief. These frameworks should not be used to judge how a person is grieving or how long it should last.

How this care fits with your medical care

Supportive care during grief is complementary. Keep your physician, counselor or therapist, and do not stop or change prescribed medicines without your prescriber. We do not diagnose or treat prolonged grief disorder or depression. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

Please bring a list of your medicines and supplements and tell us about any recent changes in sleep, appetite or mood. If grief has lasted more than a year and still prevents you from functioning, ask a clinician about prolonged grief disorder, since psychotherapy is its main treatment.^[2]

When to seek urgent medical care

Intense grief can sometimes become dangerous, and prolonged grief disorder is associated with higher rates of suicidality.^[2]

• Thoughts of suicide, of wanting to die or join the person who died, or of harming yourself. Call or text 988, the Suicide and Crisis Lifeline, at any time.
• Not eating, sleeping or caring for yourself for days
• Severe hopelessness or inability to function at home or work
• Using alcohol or drugs to cope, or losing control of that use
• Chest pain, fainting or severe shortness of breath

For an emergency, call 911 or go to the nearest emergency department.