1. NOTE: To change the image on this slide, select the picture and delete it. Then click the Pictures icon in the placeholder to insert your own image. ANXIETY IN TCM Cristina Soava Acupuncture II March 25 th, 2016

2. Anxiety  Anxiety in Western Medicine  Anxiety in TCM  Fear and Palpitations  Panic Throbbing  Rebellious Qi of Chong Mai  Etiology  Patterns and treatments

3. Anxiety in Western Medicine  Anxiety is a feeling of fear, worry, uneasiness, dread over anticipated events  It is a normal reaction to stress, helping us cope with life  When it is becoming excessive and irrational it turns into a disabling disorder

4. Anxiety in Western Medicine  Distinction between Anxiety and Nervousness  Anxiety is irrational, has a physical component and never goes away  Nervousness is relating to things you need to deal with, has no physical component or a very mild one and it ends when the event is over  Distinction between Anxiety and Fear  Anxiety is an expectation of a future threat (caused by your thoughts)  Fear is a response to a real/perceived immediate threat  Both Fear and Anxiety relate to coping behavior (escape/avoidance); when coping fails because the situation is uncontrollable, fear can turn into anxiety

5. Anxiety in Western Medicine – Causes  Causes of anxiety disorders aren't fully understood.  Life experiences such as traumatic events appear to trigger anxiety disorders in people who are already prone to anxiety  Inherited traits can also be a factor

6. Anxiety in Western Medicine – What happens in the brain The National Institute of Mental Health explains: "Several parts of the brain are key actors in the production of fear and anxiety… scientists have discovered that the amygdala and the hippocampus play significant roles in most anxiety disorders. The amygdala is an almond-shaped structure deep in the brain that is believed to be a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret these signals. It can alert the rest of the brain that a threat is present and trigger a fear or anxiety response. The emotional memories stored in the central part of the amygdala may play a role in anxiety disorders involving very distinct fears, such as fears of dogs, spiders, or flying. The hippocampus is the part of the brain that encodes threatening events into memories.“

7. Anxiety in Western Medicine – Common Physical symptoms  Palpitations  Sweating  Shortness of breath  Insomnia  Tiredness  Cold hands  Muscle tension  Tremors and twitches  Stomach upset or diarrhea  Nausea  Dizziness

8. Anxiety in Western Medicine – Links with underlying conditions  Anxiety might be linked with underlying health conditions and can be sometimes the first indication of a medical issue:  Heart Disease  Diabetes  Thyroid dysfunction  Respiratory disorders  Drug abuse/Withdrawal  Irritable Bowel Syndrome  Rare tumors that produce fight or flight hormones

9. Anxiety in Western Medicine – Different disorders Different degrees of severity however they all have in common an excessive, irrational fear, worry and dread

10. Anxiety in Traditional Chinese Medicine  Anxiety does not have an exact equivalent in TCM  The closest conditions mentioned in TCM are:  “Fear and Palpitations” (Jing Ji)  “Panic Throbbing” (Zheng Chong)  Rebellious Qi of the Chong Mai

11. “Fear and Palpitations” versus “Panic Throbbing”  Fear  Worry  Anxiety  Palpitations (not always though)  Caused by external events (fright/shock)  It comes and goes  Mostly Full condition  Blood deficiency  Can turn into Panic Throbbing  Fear  Worry  Anxiety  Throbbing sensation in the chest and below the umbilicus  Not caused by external events  Continuous  Mostly Empty condition  Blood deficiency  Can correspond to Panic attacks “Panic Throbbing”(Zheng Chong)

12. Rebellious Qi in the Chong Mai Quick refresher on Chong Mai  Central reservoir for Blood (“Sea of Blood”)  Its principal function is to regulate qi and blood in the 12 main meridians and their corresponding organs  Originates in the Ming Men  Penetrates the Heart

13. Rebellious Qi in the Chong Mai - Symptoms  Need at least 3-4 symptoms at different levels  Strong indication: a feeling of energy rising from the lower abdomen up towards the throat  Experiencing a simultaneous feeling of heat in the face and cold feet

14. Rebellious Qi in the Chong Mai  It can be a full condition: emotional stress makes the Qi rise and stagnate  It can be a full /empty condition: deficiency of Blood and/or Kidneys is causing Qi to rebel upwards

15. Rebellious Qi in the Chong Mai – Treatment of full condition Treatment for the full condition: SP 4 / P 6 – opening points LI 4 / LIV 3 – four gates (regulates descending of Qi/ calms rebellious qi) KI 21 – regulates entering/exiting of Qi KI 14 – moves Qi

16. Rebellious Qi in the Chong Mai – treatment of full/empty condition Treatment for the full /empty condition: SP 4 / P 6 – opening points LI 4 / LIV 3 – four gates (regulates descending of Qi/ calms rebellious qi) KI 21 – regulates entering/exiting of Qi KI 13 – tonifies KD, moves qi/blood REN 4 – tonifies KD, nourishes blood/Yin

17. Etiology  Emotional stress  Constitution  Irregular diet  Loss of blood  Overwork

18. Etiology Emotional stress Emotions Stagnant qi Heat Deficiency of Yin & Blood Phlegm Deficient Qi MIND agitates Deprives the Shen of its residence Obstructs

19. Etiology Constitution  Very important  The risk of developing panic disorder appears to be inherited  Main indication is a Heart crack on the tongue (takes longer to treat if present) Irregular diet  Irregular eating causes deficiency of Qi and Yin in the Stomach, leading to Heart Yin deficiency and anxiety  Excessive consumption of Damp producing food leads to Phlegm which might obstruct the mind

20. Etiology Loss of Blood  Leading to Heart Blood deficiency Overwork  Depleting Kidney Yin, affecting the Heart

21. Pathology and Treatment Principles  Organs involved are  Heart - primarily  Kidneys  Liver  Lungs secondarily

22. Heart and Gallbladder deficiency  Clinical manifestations  Mild anxiety  Palpitations  Easily discouraged  Timidity  Insomnia  Lack of self-assertion  Waking up in the morning  Easily frightened  Cannot sit or lie down  Tongue: Pale  Pulse: Weak  Treatment principle  Tonify the Heart and Gallbladder  Calm the Shen POINTMETHODEFFECT HT 7tonifyTonify HT/ Calm Shen HT 5tonifyTonify HT/ Calm Shen BL 15tonifyTonify HT/ Calm Shen REN 14tonifyTonify HT/ Calm Shen GB 40tonifyTonify GB (psychic aspect) ST 36tonifyTonify HT

23. Heart Blood deficiency  Clinical manifestations  Mild anxiety; worse in the evening  Palpitations  Dizziness  Pale face  Insomnia  Poor memory  Tiredness  Tongue: Pale and Thin  Pulse: Choppy and Fine  Treatment principle  Nourish Heart Blood  Calm the Shen POINTMETHODEFFECT HT 7tonifyNourish HT Blood/ Calm Shen REN 14tonifyNourish HT Blood/ Calm Shen SP 6tonifyNourish Blood ST 36tonifyNourish Blood

24. Kidney and Heart Yin deficiency with Empty Heat  Clinical manifestations  Marked anxiety; mostly in the evening  Palpitations  Dizziness  Night sweating  Insomnia  Mental restlessness  Tinnitus  Feeling of heat in the evening  5-palm heat  Tongue: Red without coating  Pulse: Floating - empty and Rapid  Treatment principle  Nourish Heart & Kidney Yin  Clear empty Heat  Calm the Shen POINTMETHO D EFFECT HT 7tonifyNourish HT Yin REN 14 tonifyNourish HT Yin KD 3tonifyNourish KD Yin REN 4tonifyNourish KD Yin SP 6tonifyNourish KD Yin HT 6/ KD 7 tonifyClears Empty Heat/ Treats night sweating

25. Heart Yang deficiency  Clinical manifestations  Anxiety & Depression  Palpitations  Pale face  Feeling cold  Cold hands  Slight breathlessness  Discomfort in the chest  Speaking with difficulty  Everything is an effort  Tongue: Pale and Wet  Pulse: Deep and Weak  Treatment principle  Tonify Heart Yang  Calm the Shen POINTMETHODEFFECT HT 5tonifyTonify HT Yang/ Calm the mind BL 15tonifyTonify HT Yang/ Calm the mind DU 14tonifyTonify HT Yang/ Calm the mind REN 6Tonify /moxaTonify Yang ST 36Tonify /moxaTonify Yang

26. Lung and Heart qi deficiency  Clinical manifestations  Anxiety & Sadness  Palpitations  Timidity  Easily frightened  Tendency to crying  Weak voice  Slight breathlessness  Propensity to catching colds  Tongue: Pale  Pulse: Weak in both front positions  Treatment principle  Tonify Heart and Lung Qi  Calm the Shen POINTMETHODEFFECT HT 5/HT 7tonifyTonify HT/ Calm the mind BL 15/REN 14tonifyTonify HT/ Calm the mind LU 9/LU 7tonifyTonify LU qi BL 13/DU 12tonifyTonify LU qi REN 12/REN 6tonifyTonify qi in general ST 36tonifyTonify qi in general

27. Lung and Heart qi stagnation  Clinical manifestations  Anxiety & Sadness & Worry  Depression  Palpitations  Feeling of distention in the chest  Lump in the throat  Slight shortness of breath  Sighing  Chest/Upper epigastric distention  Slightly purple lips  Pale complexion  Tongue: slightly pale-purple on the sides in the chest area  Pulse: Empty; slightly over-flowing in both front positions  Treatment principle  Move Qi in Heart and Lung  Relax the chest  Calm the Shen POINTMETHODEFFECT HT 5/HT 7/P 6evenMove HT qi/ calm the mind REN 15/REN 17evenRelax the chest/ Calm the mind LU 7evenMove LU qi ST 40/LU 7/P6evenRelax the chest/ Calm the mind

28. Lung and Heart Yin deficiency  Clinical manifestations  Anxiety  Dry cough with scanty-sticky sputum  Weak hoarse voice  Dry mouth and throat  Palpitations  Insomnia and mental restlessness  Dream disturbed sleep  Poor memory  Tiredness; dislike of speaking  Night sweating  Tongue: normal color, dry, no coating in the front  Pulse: Floating empty  Treatment principle  Nourish Lung and Heart Yin  Calm the Shen POINTMETHODEFFECT LU 9/REN 17tonifyNourish LU Yin BL 43/BL 13tonifyNourish LU Yin REN 4/REN 12/SP 6tonifyNourish Yin in general HT 7/ REN 14/REN 15tonifyNourish HT Yin/ Calm the mind

29. Heart Blood Stasis  Clinical manifestations  Anxiety – more in the evening and the middle of the night  Palpitations  Insomnia  Agitation  Might wake up with a panicky feeling  Poor memory  Chest pain  Tongue: purple on the sides(chest area)  Pulse: Wiry, Choppy and Firm  Treatment principle  Invigorate Heart Blood  Eliminate Stasis  Calm the Shen POINTMETHODEFFECT HT 5/ P 6evenInvigorate HT Blood/ Calm the mind REN 14/ REN 15evenInvigorate HT Blood/ Calm the mind LIV 3evenInvigorate Blood in general SP 6evenInvigorates Blood/ Calm the mind

30. Phlegm Heat harassing the Heart  Clinical manifestations  Marked anxiety – to the point of agitation  Palpitations  Insomnia  Dreaming a lot  Feeling of oppression in the chest  Sputum in the throat  Slightly manic behavior  Hyperactive  Tongue: red, swollen with sticky yellow coating  Pulse: Slippery - Rapid  Treatment principle  Resolve Phlegm  Clear Heart Heat  Calm the Shen  Open Mind ’s orifices POINTMETHODEFFECT P 5 / HT 8evenClear HT Heat/ Resolve Phlegm from HT REN 12tonifyResolve Phlegm ST 40evenResolve Phlegm ST 8evenResolve Phlegm from the brain GB 13/REN 15/ DU 24 evenCalm the mind/ Resolve Phlegm from the head

31. Sources  Giovanni Maciocia – The Pshyche in Chinese Medicine  www.mayoclinic.org www.mayoclinic.org  Wikipedia  www.mercola.com www.mercola.com  Maciociaonline.Blogspot.com