Anxiety is a common human experience, a natural response to stress that can be beneficial in moderation. It sharpens our focus and helps us navigate challenging situations. However, when anxiety becomes excessive, irrational, and persistent, it transforms into a debilitating disorder. While Western medicine recognizes various anxiety disorders, Traditional Chinese Medicine (TCM) offers a unique perspective on diagnosis and treatment, rooted in centuries of observation and practice. This article delves into the TCM understanding of anxiety, exploring its diagnostic approaches and therapeutic strategies.
Anxiety Through the Lens of Western Medicine
In Western medicine, anxiety disorders are categorized into distinct types, each with specific characteristics, yet all sharing a common thread of excessive and irrational fear, worry, and dread. These include:
- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- Obsessive-Compulsive Disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
- Social Phobia (Social Anxiety Disorder)
- Specific Phobias
Generalized Anxiety Disorder (GAD) is characterized by chronic and uncontrollable worry about everyday matters, significantly impacting daily life and often manifesting in physical symptoms. Diagnosing GAD can be challenging due to the absence of dramatic symptoms like panic attacks seen in other anxiety disorders. A diagnosis typically requires persistent worry occurring more days than not for at least six months.
Physical manifestations of GAD can include:
- Muscle tension
- Sweating
- Nausea
- Cold, clammy hands
- Difficulty swallowing
- Jumpiness
- Gastrointestinal discomfort or diarrhea
- Irritability, feeling on edge
- Tiredness
- Insomnia
Panic attacks, another form of acute anxiety, are defined by sudden episodes of intense fear or discomfort, peaking within ten minutes and accompanied by at least four of the following symptoms:
- Sense of imminent danger or doom
- Urge to escape
- Palpitations
- Sweating
- Trembling
- Shortness of breath or smothering sensation
- Feeling of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Dizziness or lightheadedness
- Feeling of unreality, depersonalization
- Fear of losing control or “going crazy”
- Fear of dying
- Tingling sensations
- Chills or hot flushes
Understanding Anxiety in Traditional Chinese Medicine (TCM)
The term “anxiety” as understood today doesn’t have a direct counterpart in classical Chinese medicine. However, TCM encompasses several disease patterns that closely align with the Western concept of anxiety. Instead of focusing on anxiety as a singular entity, TCM diagnosis, often referred to as Anxiety Tcm Diagnosis, seeks to identify the underlying imbalances within the body’s Qi (vital energy), Blood, and organ systems that contribute to anxious states.
a) Chinese Medicine Equivalents for Anxiety
While there’s no single TCM term for “anxiety,” two primary disease entities in ancient Chinese texts resonate strongly with anxiety disorders:
- “Fear and Palpitations” (Jing Ji): This condition describes a state of fear, worry, and anxiety accompanied by palpitations. Jing Ji is often triggered by external factors like fright or shock and tends to be intermittent, often categorized as a “Full” condition in TCM terms.
- “Panic Throbbing” (Zheng Chong): Similar to Jing Ji, Zheng Chong involves fear, worry, and anxiety, but it’s characterized by a throbbing sensation in the chest and abdomen. Unlike Jing Ji, Zheng Chong is typically continuous, not linked to external events, and considered a more serious “Empty” condition in TCM, often indicating a deeper, chronic imbalance.
In chronic cases, untreated Jing Ji can evolve into Zheng Chong. Severe Zheng Chong can be seen as corresponding to panic attacks in Western medicine. Importantly, the “palpitations” mentioned in Jing Ji and Zheng Chong don’t always manifest physically; the subjective feeling of fear and anxiety can be present even without noticeable heart palpitations.
b) The Role of Rebellious Qi of the Penetrating Vessel (Chong Mai)
Another significant TCM concept related to anxiety, particularly panic attacks, is Rebellious Qi of the Penetrating Vessel (Chong Mai). This condition is marked by “internal urgency” (Li Ji), a symptom recognized since ancient times.
The Penetrating Vessel, or Chong Mai, is one of the extraordinary meridians in TCM, playing a crucial role in the flow of Qi and Blood throughout the body. When the Qi of the Penetrating Vessel rebels and flows upwards instead of downwards, it can lead to “internal urgency,” a feeling of anxiety and restlessness. In severe cases, this can trigger panic attacks with palpitations.
Physically, Rebellious Qi of the Penetrating Vessel can manifest as a tight, uncomfortable sensation starting in the lower abdomen and radiating upwards towards the heart. Palpitations are frequently associated with this type of anxiety because the Penetrating Vessel’s pathway traverses the heart region. The throbbing abdominal sensation characteristic of Zheng Chong can also be attributed to the rebellious Qi in the Penetrating Vessel. Thus, Rebellious Qi of the Penetrating Vessel can be considered a specific form of Zheng Chong.
Rebellious Qi of the Penetrating Vessel can cause a range of symptoms along its pathway, from the lower abdomen to the chest and head. These symptoms, progressing upwards, can include:
- Cold feet
- Fullness, distension, or pain in the lower abdomen
- Hypogastric fullness, distension, or pain
- Painful or irregular periods in women
- Fullness, distension, or pain in the umbilical area
- Fullness, distension, or pain in the epigastrium
- Feeling of tightness below the xyphoid process
- Feeling of tightness in the chest
- Palpitations
- Feeling of breast distension in women
- Slight breathlessness
- Sighing
- Feeling of a lump in the throat
- Feeling of heat in the face
- Headache
- Anxiety, mental restlessness, “internal urgency” (li ji).
c) Palpitations in TCM Diagnosis
Understanding “palpitations” in TCM diagnosis is crucial. In Western medicine, palpitations are often equated with tachycardia (rapid heartbeat). However, in TCM, “palpitations” (Xin Ji) refer to any uncomfortable, subjective awareness of the heart beating in the chest, regardless of heart rate. It’s the sensation itself, not necessarily the speed, that is significant.
When inquiring about palpitations in a TCM context, practitioners often ask, “Are you sometimes aware of your heart beating in an uncomfortable way?” This phrasing helps capture the broader range of subjective heart sensations relevant to TCM diagnosis, which may be missed if only asking about rapid heartbeat.
TCM Differentiation and Treatment of Anxiety
TCM diagnosis for anxiety goes beyond simply labeling it as “anxiety.” It involves identifying specific patterns of imbalance that are causing or contributing to the anxiety symptoms. These patterns are differentiated based on a holistic assessment of symptoms, tongue and pulse diagnosis, and considering the patient’s emotional and physical constitution. Treatment in TCM is then tailored to address the identified pattern, aiming to restore balance and alleviate anxiety naturally.
Here are common TCM patterns associated with anxiety and their corresponding treatment principles:
a) Heart and Gall-Bladder Deficiency
- Clinical Manifestations: Palpitations, anxiety, timidity, easily frightened, lack of self-assertion, easily discouraged, inability to sit or lie down in peace, insomnia, waking up early. Pale tongue, weak pulse.
- Mental-Emotional Profile: Timid, shy, lacking drive, easily discouraged, indecisive, mild anxiety.
- Clinical Principle: Tonify Heart and Gall-Bladder, calm the Shen (Mind).
- Acupuncture Points: HE-7 (Shenmen), HE-5 (Tongli), BL-15 (Xinshu), Ren-14 (Juque), GB-40 (Qiuxu), ST-36 (Zusanli).
- Herbal Therapy Examples: An Shen Ding Zhi Wan (Calming the Mind and Settling the Spirit Pill), Ping Bu Zhen Xin Dan (Calming and Tonifying the Heart Pill), Wu Wei Zi Tang (Schisandra Decoction), Three Treasures formula Breaking Clouds.
b) Heart-Blood Deficiency
- Clinical Manifestations: Palpitations, anxiety, dizziness, pale face, insomnia, poor memory, tiredness. Pale and thin tongue, choppy or fine pulse.
- Mental-Emotional Profile: Often seen in women, pale, potentially depressed and anxious (though may hide it), mild anxiety.
- Clinical Principle: Nourish Heart-Blood, calm the Shen.
- Acupuncture Points: HE-7 (Shenmen), Ren-14 (Juque), ST-36 (Zusanli), SP-6 (Sanyinjiao).
- Herbal Therapy Examples: Gui Pi Tang (Tonifying the Spleen Decoction), Three Treasures formula Calm the Shen.
c) Kidney- and Heart-Yin Deficiency with Empty Heat
- Clinical Manifestations: Palpitations, anxiety worsening in the evening, mental restlessness, insomnia, night sweats, evening heat sensation, five-palm heat, dizziness, tinnitus. Red tongue without coating, floating-empty and rapid pulse.
- Mental-Emotional Profile: More common in middle-aged individuals, marked anxiety, worse in evenings, restlessness, fidgetiness, often aggravated by menopause in women.
- Clinical Principle: Nourish Heart- and Kidney-Yin, clear Empty Heat, calm the Shen.
- Acupuncture Points: HE-7 (Shenmen), Ren-14 (Juque), KI-3 (Taixi), Ren-4 (Guanyuan), SP-6 (Sanyinjiao), HE-6 (Yinxi), KI-7 (Fuliu).
- Herbal Therapy Examples: Tian Wang Bu Xin Dan (Heavenly Emperor Tonifying the Heart Pill), Three Treasures formula Heavenly Empress (Women’s Treasure).
d) Lung- and Heart-Qi Deficiency
- Clinical Manifestations: Palpitations, anxiety, timidity, easily frightened, sadness, tendency to cry, weak voice, slight breathlessness, prone to colds. Pale tongue, weak pulse (especially on front positions).
- Mental-Emotional Profile: Anxious and sad, often affected by grief, pale complexion, weak voice, anxiety felt in the chest.
- Clinical Principle: Tonify Heart- and Lung-Qi, calm the Shen.
- Acupuncture Points: HE-5 (Tongli), HE-7 (Shenmen), BL-15 (Xinshu), Ren-14 (Juque), LU-9 (Taiyuan), LU-7 (Lieque), BL-13 (Feishu), Du-12 (Shenzhu), Ren-12 (Zhongwan), Ren-6 (Qihai), ST-36 (Zusanli).
- Herbal Therapy Examples: Yang Xin Tang (Nourishing the Heart Decoction), Bu Fei Tang (Tonifying the Lungs Decoction).
e) Lung- and Heart-Qi Stagnation
- Clinical Manifestations: Palpitations, anxiety, chest distension or oppression, depression, slight lump in throat sensation, mild shortness of breath, sighing, sadness, upper epigastric distension, slightly purple lips, pale complexion. Slightly pale-purple tongue on sides (chest area), empty but slightly overflowing pulse on front positions.
- Mental-Emotional Profile: Anxious, worried, and sad, pale complexion, weak voice, anxiety felt in the chest.
- Clinical Principle: Move Qi in Heart and Lung, relax the chest, calm the Shen.
- Acupuncture Points: HE-5 (Tongli), HE-7 (Shenmen), P-6 (Neiguan), Ren-15 (Jiuwei), Ren-17 (Shanzhong), LU-7 (Lieque), ST-40 (Fenglong).
- Herbal Therapy Examples: Ban Xia Hou Po Tang (Pinellia-Magnolia Decoction), Three Treasures formula Open the Heart.
f) Heart-Blood Stasis
- Clinical Manifestations: Palpitations, anxiety, insomnia, agitation, poor memory, chest pain. Purple tongue on sides (chest area), wiry, choppy, or firm pulse.
- Mental-Emotional Profile: More common in middle-aged individuals, anxiety worse in the evening and middle of the night, may wake with panic.
- Clinical Principle: Invigorate Heart-Blood, eliminate stasis, calm the Shen.
- Acupuncture Points: HE-5 (Tongli), P-6 (Neiguan), Ren-14 (Juque), Ren-15 (Jiuwei), LIV-3 (Taichong), SP-6 (Sanyinjiao).
- Herbal Therapy Examples: Tao Ren Hong Hua Jian (Persica-Carthamus Decoction), Three Treasures formula Red Stirring.
g) Phlegm-Heat Harassing the Heart
- Clinical Manifestations: Palpitations, anxiety, insomnia, excessive dreaming, chest oppression, sputum in throat, slightly “manic” behavior. Red, swollen tongue with sticky-yellow coating, slippery-rapid pulse.
- Mental-Emotional Profile: Marked anxiety, agitation, hyperactivity, slightly chaotic.
- Clinical Principle: Resolve Phlegm, clear Heart-Heat, calm the Shen, open the Mind’s orifices.
- Acupuncture Points: P-5 (Jianshi), HE-8 (Shaofu), Ren-12 (Zhongwan), ST-40 (Fenglong), ST-8 (Touwei), GB-13 (Benshen), Ren-15 (Jiuwei), Du-24 (Shenting).
- Herbal Therapy Examples: Wen Dan Tang (Warming the Gall-Bladder Decoction), Gui Shen Tang (Restoring the Mind Decoction), Three Treasures formulas Clear the Soul and Settling the Soul.
Case Histories Illustrating Anxiety TCM Diagnosis and Treatment
Case 1: Anxiety from Heart-Blood Deficiency
A 42-year-old woman experienced mild but constant anxiety and insomnia for five years following the birth of her second child. She also reported palpitations, blurred vision, and tingling limbs. Her tongue was pale, and her pulse was choppy.
Diagnosis: Heart-Blood deficiency, likely stemming from postpartum Blood deficiency, a common cause of anxiety and postnatal depression in women. Liver-Blood deficiency was also present, indicated by blurred vision and tingling.
Treatment Principle: Nourish Liver- and Heart-Blood, calm the Shen.
Treatment: Acupuncture points included Ren-4 (Guanyuan), ST-36 (Zusanli), LIV-8 (Ququan), SP-6 (Sanyinjiao) to nourish Liver-Blood; HE-7 (Shenmen) to nourish Heart-Blood; and Du-24 (Shenting) and Ren-15 (Jiuwei) to calm the Shen. She also took the Three Treasures formula Calm the Shen. After nine months of treatment, her anxiety was completely resolved.
Case 2: Anxiety from Kidney-Yang Deficiency
A 50-year-old overweight woman with chronic anxiety, worse during the day, reported good sleep but excessive worry about minor things. She also experienced cold sensitivity, lower backache, dizziness, frequent pale urination, and a history of overwork. Her tongue was pale, and her pulse was weak and deep, especially on the rear positions.
Diagnosis: Kidney-Yang deficiency, as fear is the emotion associated with the Kidneys in TCM.
Treatment Principle: Tonify Kidney-Yang, calm the Shen.
Treatment: Acupuncture points included Ren-4 (Guanyuan) with moxa, BL-23 (Shenshu), KI-7 (Fuliu), KI-3 (Taixi) to tonify Kidney-Yang; and Du-24 (Shenting) and Ren-15 (Jiuwei) to calm the Shen. She was also prescribed the Three Treasures formula Strengthen the Root, a variation of You Gui Wan (Restoring the Right (Kidney) Pill).
Conclusion
TCM offers a comprehensive and nuanced approach to understanding and treating anxiety. By moving beyond a singular diagnosis of “anxiety” and delving into the individual’s unique pattern of disharmony, anxiety TCM diagnosis provides a framework for personalized and effective treatment strategies. Through acupuncture, herbal medicine, and lifestyle recommendations, TCM aims to address the root causes of anxiety, restoring balance within the body and mind to promote lasting well-being. This holistic perspective makes TCM a valuable option for those seeking natural and sustainable solutions for anxiety management.
END NOTES
- Classic of Difficulties, p. 73-4.
