The two different approaches together can treat anxiety disorders effectively
Anxiety, as seen from the perspective of Traditional Chinese Medicine (TCM), can work together with the Western approach to maximize the benefits for patients.
Anxiety Disorder is a mental/emotional disorder that affects millions of people all over the world. In the US, every third person suffers from one form or another of Anxiety Disorder during their lifetime. It is very common and one of the most ancient disorders that has afflicted humans as long as the species has existed. It takes its origins from animal fear of self-preservation - “Will I have dinner tonight?” or “Will I BE dinner tonight?” Traditional Chinese Medicine, which roots can be traced back thousands of years, has developed theories and methodology of how to help people deal with anxiety
Western medicine relies on the diagnosis developed empirically by the experts in the field. Anxiety Disorders as a group have several different conditions such as Panic Disorder, Social Anxiety Disorder, etc. These conditions are grouped on symptoms and what people are fearful of. Recent research considers dimensions of the symptoms, but the benefit of that is not yet clear. Recent transdiagnostic theories offer a more dynamic and individualistic approach to research, diagnosis, and treatment (such as the ABC anxiety theory) but they still need empirical validation. This approach sees anxiety as a dynamic interaction between Alarms, Beliefs, and Coping strategies that determine a clinical picture and represent interaction of the neuronal networks underlying these presentations.
Current research, especially neuroimaging and neurochemistry, provides ample information about neuronal circuits, neurotransmitters and synaptic connections associated with the disorders. All these disorders are considered to be polygenetic and heavily influenced by environmental stress.
In the Western scientific approach, the treatments of anxiety disorders have usually been studied on selected groups of patients that often are not representative of the overall anxiety population because the patients’ selection criteria are not often realistic. There is a significant co-existence of several diagnoses in clinical groups of people. The science relies heavily on statistical analysis of associations of the symptoms for diagnosis and statistical probabilities of the positive outcomes of the treatments for these diagnostic groups.
Nevertheless, the clinicians who treat these disorders are faced with a variety of patients coming to them with unique presentations. Diagnoses not only overlap often but also emerge in different compositions in the same patients. The treatments are frequently possibly incorrectly rejected because of significant placebo responses in these patients. Despite being the gold standard in current medicine and psychology, the Western scientific approach still has serious limitations. Approximately, 20-30 % of patients stay symptomatic for a variety reasons.
In contrast, TCM has a completely different approach, which is sometimes difficult to understand within Western scientific views. Chinese medicine sees the body and its functions in a holistic way, meaning that all things are seen as part of a whole. No entity can be isolated from its relationship to other entities; no one thing can exist in and of itself.
Therefore, physical as well as mental/emotional problems are interconnected and are viewed as a result of disharmonies of “Five Spirits” (energies, not to be confused with pertaining to divinity) and their associated “5 Zhang Organs”.
The “Five Spirits” are:
- Shen - mind, connecting Spirit
- Hun – non-corporeal Spirit
- Po - corporeal Spirit
- Yi - intellect, thought
- Zhi - will
Each of the “Five Spirits” has an emotion associated with it:
- Shen – joy
- Hun – anger
- Po - grief, sadness, worry
- Yi – pensiveness
- Zhi - fear.
They are residing in ”5 Zhang Organs” - heart, liver, lungs, spleen and kidneys. And there is Qi (the life force) that provides means of communication for all existing energies. So, for example, if Liver Qi is stagnant, that person will experience anger.
This approach is highly individualistic and relies heavily on the assessment of these energies in a given patient prior to the treatment. The treatment involves a combination of acupuncture and mixtures of ancient herbal remedies.
Initially and not surprisingly, this approach was raising eyebrows in the Western medical community. The combination of the complex diagnostic and treatment factors becomes problematic for double-blind experiments and statistical analysis. TCM had a challenge to explain the above theories to Western scientists and to convince the medical community to adapt them to the medical world with its response/no response outcomes.
However, some progress has been made recently by the scientists who tried to “westernize” TCM. As more and more positive descriptive outcomes in the form of case reports appeared in the scientific literature, TCM became more mainstream. With specific licensing and quality controls in place, the education of professionals and practice of TCM became normal and supported by many insurance companies. Scientific progress was made when TCM became a part of NCCAM (National Center for Complementary and Alternative Medicine) of the National Institutes of Health as well as WHO (World Health Organization).
As Chinese medicine has become more mainstream in the last decade, the number of patients with anxiety disorders who are seeking help from TCM practitioners has grown significantly. One can draw a lot of similarities between Chinese and Western medicine, as they are describing the same object, a human body, yet in fundamentally different ways.
When you are being treated by a doctor specializing in Chinese medicine, you might be surprised by a strange sounding diagnosis. For example, you can be diagnosed as having “Dampness in your Spleen” or “Liver Qi stagnation”, or “Heart Fire.” Even though Chinese medicine uses very different terminology than Western medicine and doesn’t have a notion of nervous or endocrine systems, it treats the same diseases.
Mental/emotional dysregulation problems are viewed in terms of disturbance of one’s Shen, the Heart energy. With anxiety there is also always disturbance of Po, the Lung energy. Interestingly, some of the typical symptoms that come with anxiety are heart palpitations and shortness of breath. In fact, recent studies found disturbances in breathing patterns in patients with panic disorder
Along with the energetic disturbances come physiological ones in the form of stagnant Qi in the corresponding meridians. There are 12 main meridians along which the Qi flows, not unlike blood in blood vessels. There are also associated “Patterns of Disharmony” of the associated Zhang organs. And all have to be treated and brought to a balance in order to achieve lasting results.
Here is one example of a clinical case Chinese medicine practitioner Polina Bowler worked on to demonstrate the theories we talked about above:
- “Zoe”, a patient of 40 years of age, came in with a complaint of experiencing severe anxiety, which had not bothered her for years. She experienced panic attacks (3 in a week) and sudden development of wrist pain, which she never had before. Her other symptoms were palpitations, tightness in the chest, nausea, shortness of breath, sweating easily, sleeping poorly, and irritability with outbursts of anger. She had Lupus that was successfully controlled with minimum medications for the last three years. During the consultation she explained that she had a lot of stress for the last two months, being forced to move her residence in a rush. Her landlord was very verbally abusive and threatening and it made her very angry. Yet she managed to keep it together and was able to move. She did not understand why now, when the stress subsided, she was “going nuts.” After carefully observing her face and tone of her voice, taking her pulse and checking her tongue, as those are essential parts of Chinese diagnostic system, Bowler explained to Zoe how stressful events in the last couple of months caused her to experience strong emotions of worry, anger, frustration. She suppressed all those emotions in order to get over the hurdle. That in turn constrained the flow of Liver Qi, as Liver Qi is responsible for the smooth, downward flow of Qi in the body. Constrained Liver Qi led to Liver Qi Stagnation, which reversed the natural downward flow to upward direction, which damaged Lung energy, Po. That lead to a feeling of tightness in her chest. Over time, the constrained Liver energy, Hun, built up, and caused heat accumulation in the upper body, leading to a feeling of agitation, irritability, palpitations, apprehension, and insomnia known as Heat in the Heart and disturbance of her Shen energy, her mind. In Western terminology, we call this condition anxiety. Excessive Heat dried up the fluids, damaging Zoe’s already compromised kidneys due to Lupus (all chronic conditions in TCM weaken the kidneys), leading to panic attacks, since the emotion of the kidneys is fear, and panic attacks are an unsubstantiated sudden feeling of intense fear.
Bowler diagnosed Zoe’s anxiety being mainly due to Liver Qi stagnation, Heart Heat and kidney deficiency. She treated Zoe with acupuncture points to move the Liver Qi, subdue the Heat in the Heart, strengthen the kidneys and calm the Shen (mind).
Bowler also gave her a Chinese herbal formula, called Chai Hu Long Gu Mu Li Tang, which was modified for her to address her weak kidneys. The doctor increased her omega 3 oils and put her on a low sugar and no dairy diet. She also put her on aashwagandha for a month and clary sage oil to put on the inner sides of her wrists. After three treatments in a period of 10 days, Zoe’s anxiety decreased dramatically, and she had stopped having panic attacks.
The amazing thing that never fails to impress us in TCM is how seamlessly everything relates to one another. Nothing is ever random. If one does not see the relationship between things, it is just because one lacks the ability or knowledge to do so. The pain in her wrists were perfectly related to the Heat in her Heart. The surface heart meridian emerges from the heart in the underarm and runs down the inner elbow along the medial side of the forearm, crosses the wrist and the palm, and ends at the inside of the little finger. Heart Qi was not flowing properly and caused a stagnation in the meridian around her wrist area. Have you ever noticed, when a person is nervous, they fidget with their fingers?
Her wrist pain was gone after the first treatment.
There are many types of anxiety possible, and many ways that an individual can experience it. In TCM there are no diseases and there are no set treatments. By differentiating each patient’s imbalances, a Chinese medicine practitioner will arrive with an individualized treatment plan and as signs and symptoms change, so does the treatment. There are no two people alike and the ability of TCM to tailor each treatment to an individual makes it very effective in treating Anxiety.
As TCM has been gaining more respect and acceptance in the Western medical community, the westernized approach was developed for medical and psychological disorders even though TCM does not distinguish between them. This approach purposely omitted the spiritual (life forces, not as pertaining to God) parts of TCM, and retained the mechanistic strategies that could be tested in clinical trials. The traditional understanding of the energetic forces and highly individualistic approach are such an essential part of TCM that removal of it would compromise the treatment outcome.
At the same time, it will increase the scientist’s ability to evaluate TCM treatment outcomes and possibly to compare them with Western treatment approved for these disorders. This is the trade-off that must be accepted. Still, many clinical trials have been conducted with very optimistic results. Points like Qiuxu (GB-40), Baihu (DU-20), Yintang, Neiguan (P-6), Shenmen (HT-7), Teaching (LV-3), Sanyinjiao (SP-6, Zusanli (ST-36), scalp acupuncture with electric stimulation and ear acupuncture with points like Shen Men, Tranquilizer, and Relaxation were used on a number of patients suffering from anxiety. The above-mentioned acupuncture points are known for their strong sedative, calming effect on Shen (the mind, the spirit), and have been used for centuries in cases of Shen disturbance. The conclusion of those trials: “Acupuncture is a common practice in the clinic for the treatment of anxiety disorders, and scientific data have demonstrated its statistically significant effectiveness”.
This is work in progress; it is possible that Western medicine has something to learn from TCM and more patients who are non-responsive to front-line medications need to be treated individually. Unfortunately, success stories described in the scientific literature in the form of case reports are currently only infrequently published in the major scientific journals. To be fair, treatment-resistant patients with severe anxiety are frequently treated with several medications and behavior therapy - and most experienced Western practitioners treating anxiety disorders would readily tell you that they use individualized approaches taking into account symptom dynamics, environmental factors, family, and other factors. Thus, an individualistic approach is good for the patients no matter what treatment philosophy is employed.
Another field of extensive research in the last decade are Chinese herbs and traditional Chinese herbal formulas. TCM uses herbal medicine along with acupuncture in treatments of depression and anxiety.
Ginkgo Biloba (a famous Chinese herb, first documented in a Chinese book about 2800 BC), Chai Hu (Bupleurum), Suan Zao Ren (Zizyphi Spinosi Semen), Da Zao (Jujube Date), Shen Di Huang (Rehmania Root), Ginseng, and Gan Cao (Licorice root) are just some herbs known for their ability to calm spirit irritability, restlessness, and emotional disturbances.
Some examples of traditional Chinese herbal formulas for anxiety, as well as other psychiatric disorders, are:
- Ban Xia Huo Po Tang, (Pinellia and Magnolia Formula)
- Xiao Chai Hu Tang, (Minor Bupleurum decoction)
- Jia Wei Xiao You San, (Bupleurum and Tangkwei Formula)
- Gan Mai Da Zao, (Licorice Jujube Combination)
- Chai Hu Jia Long Gu Mu Li Tang, (Bupleurum, Dragon Bone, and Oyster Shell Formula)
Even though these and other Chinese herbal formulas share a common usage for anxiety, they are very different and would have to be matched with a person’s individual constitution and energetic imbalances. By using this approach, the symptoms as well as the root causes of anxiety can be significantly improved.
Similarly, Western science in recent years started to use more and more herbal medicine and food supplements to treat anxiety. In addition, individual genetic analysis is starting to be employed in an attempt to match psychiatric medications with the person’s genetic code for relevant mechanisms of action and liver metabolism.
In conclusion, combining Western and TCM approaches and being respectful of both could be very effective for treating anxiety as well as for management of difficult, treatment-resistant cases. Close collaborative care utilizing all the tools available to clinicians will help a larger number of people to manage their anxiety and improve the quality of life for the people suffering from this condition.
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Date of original publication: April 22, 2021
Updated: April 26, 2021