Gentle Treatment for General Anxiety Disorder, Posttraumatic Stress and Episodic Anxiety
By Skya Abbate, DOM
As the Lingshu so wisely stated centuries ago, "To every needling, the method is above all not to miss the rooting in the Spirits. To be effective and at the same time not to violate the organism goes all the way to the origin of the patient's life, to the place where the Spirits are rooted.
"The Spirits, vacillating under the emotional shock of apprehension and worry, are no longer guarded in their place and can no longer guarantee the person. There is a dispossession of that which makes the person; one loses possession of oneself."1
These ancient and astute words certainly speak to our times, not just for the 10 million Americans who suffer on a daily basis from generalized anxiety disorder (a sustained acute disorder defined as lasting six months or longer), but likewise the millions who experience posttraumatic stress (defined as symptoms persisting for longer than a month after a traumatic or catastrophic event) and episodic anxiety (a normal type of anxiety linked to an extraordinary life event). Such anxiety can be overwhelming to the person and can manifest as further social isolation; uncontrollable worry; tension; irritability; fatigue; muscular aches and pains; sleep disorders; restlessness; extreme anxiety; numbness to the event; palpitations; and being easily startled.
While each of these varieties of anxiety have nuances in terms of their definitions, they share more in common than not. Western treatments tend to center around prescription drug therapy to assist in restoring chemical balance to the brain. Most of these drugs are meant to be used in the short-term; some can become addictive, such as benzodiazepines like valium and ativan. Many produce other undesirable side-effects such as decreased appetite; dry mouth; sweating; constipation; tremor; fatigue; sexual side-effects; and more.
Dr. Allen Keller, a primary care physician at New York's Bellevue Hospital who heads up a group called Survivors of Torture, recommends the following mechanisms as ways to cope with these disorders:
Encourage the patient to maintain social connections in the wake of these problems.
Don't force the patient to talk about the traumatic event that is affecting them. (The keyword here is force - my italics.) However, allow them to talk about it even if all you can do is listen. You do not have to have a solution, just a compassionate ear.
Acknowledge the person's experience of the event and support them in their experience over emphasizing the medicalization (somatatizing) of their condition.
Periodically check in with the person on the somatic symptoms of their distress.
As practitioners, I believe these principles can be applied by us as well. This is not to say that the experience of anxiety is not real, nor that the somatized symptoms are likewise false, for they are very real physically and can be problematic to the functioning of the person and his or her health. Our aim as practitioners is to bring them back to balance. The strength of our medicine is twofold: its energetic paradigm, which recognizes patterns of disharmony, and the gentle treatment tools we employ.
While a nonspecific stress reaction serves to disturb the flow of energy in the body, a specific stress reaction may involve various zang-fu organs. They typically involve the liver, spleen, heart, lung and kidney. The correct differentiation of signs and symptoms can reveal their roles. Such stress can lead to symptoms of stagnation, particularly of the blood. Various acupuncture points may be selected for treatment based on proper discernment of the pattern of disharmony, with the generalized aim of treatment to move the blood, strengthen the organs (if need be), and redistribute and balance the qi.
In my experience with all three varieties, both personally and professionally, I have found that there is room for the judicious use of Western medications for the initial phase of shock and stabilization, the therapeutic advice of stress experts, and the unsurpassed efficacy of acupuncture for rebalancing the patient's energy and promoting recovery.
Certainly as practitioners, we must treat what we see and do no harm, so there are no set formulae for treatment. Treatments should be conservative (that is, the use of few needles). My repertoire of preferred point selection includes the ones that follow. For space considerations and clinician convenience, their unique energetics, preferred locations and needling techniques are summarized in table format. Due to the nature of the problem being addressed, and for patient comfort, use #1 30mm Seirin needles. Needles may be retained for 10-15 minutes.
Heart 7, the earth point and sedation point of the heart meridian, quiets the heart, calms the spirit, and puts the patient into a state of receptivity for treatment.
Standard Chinese location: in the depression at the wrist crease between the pisiform and the ulnar bones on the radial side of the tendon of the muscle flexor carpi ulnaris.
Puncture perpendicularly 0.3 in.
As group luo of the three leg yin (LR, SP, KI), SP6 nourishes the yin of the entire body. It regulates the blood.
Standard Chinese location: three cun above the tip of the medial malleolus, on the posterior border of the fibula, on the line drawn from the medial malleolus to SP9.
Puncture perpendicularly 0.3-0.5 in. Contraindicated in pregnancy.
As the reflex point of the pituitary gland, it regulates the blood. By doing so, it controls hormonal secretions and the chemical composition of the blood. It calms the spirit and promotes relaxation. It is the so-called "happy point."
Standard Chinese location: In the center of the glabella, between the medial end of the eyebrows.
Puncture subcutaneously and transversely downward (toward the nose) with a threading technique 0.5-0.8 in.
Awakens the brain, strengthens the brain as a sea of marrow. Opens the orifices, clears the mind, stabilizes the will and purifies the spirit. Expels liver wind, spreads liver qi, restores collapsed yang. Regulates the qi of the heart. Clears heat, stops spasm.
Standard Chinese location: five cun within the anterior hairline on the midpoint that connects the apex of the two auricles.
Puncture subcutaneously and transversely anteriorly (toward the nose) 0.3-0.5 in.
As the sedation point, tonifies yin, clears heat, subdues wind and empty heat, clears the brain, restores consciousness. Suppresses the liver, regulates blood to the upper part of the body.
Standard Chinese location: On the sole of the foot; when the foot is in plantar flexion, the point is located at the upper third and middle two-thirds of the sole.
Massage deeply or puncture gently with a #1 Seirin needle 03-0.5 in.
Strengthens root qi, tonifies the kidney, connects to the heart. Tonifies lung, spleen and kidney because the navel = earth element; earth is mother of lung and grandmother of kidney.
Japanese location: 0.5 cun all around the center of the umbilicus.
Puncture obliquely 0.5-1.0 in. towards the navel.
In summary, Oriental medicine has tremendous clinical relevance for the normal stresses of daily life and the inordinate stresses of the 21st century. It is efficacious physically and psychologically, yet gentle, and nourishes on the deepest level of our existence - the Spirit.
Quoted in Rooted in Spirit, by Jean Claude Larre and Elizabeth Rochat de la Valle. Barrytown, NY: Station Hill Press, 1995, pp. 4-5.
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