Treating anxiety with Traditional Chinese Medicine

By Melissa Carr, BSc, DrTCM

With about 18 percent of the U.S. population struggling with anxiety disorders, it is the most common mental health issue, though the majority are not receiving treatment. As healthcare practitioners, we also know that anxiety is commonly linked with a vast array of physical symptoms and diseases, and it may not even be the main reason a patient comes in. Many of my patients come in seeking treatment for things like digestive distress, chronic pain, insomnia, or fatigue, but at the root of it is anxiety.

Anxiety in TCM

Questions about emotions and mental state are important in a Traditional Chinese Medicine (TCM) assessment and diagnosis. Anxiety can be considered a blend of overthinking or worry paired with fear.

Overthinking and worry are emotions that are categorized in TCM’s Earth element—Spleen/pancreas and Stomach. Too much time spent ruminating with the mind drains the digestive system’s ability to process and assimilate food and drink, so common symptoms here include bloating, poorly digested food seen in stool, loose stool, diarrhea, constipation, stomach or abdominal pain or discomfort, acid reflux, nausea, vomiting, and indigestion. It can also cause feeling foggy-headed, trouble concentrating, issues with short-term memory, and fatigue.

Fear is classified in TCM’s Water element—Kidneys and Urinary Bladder. The adrenal glands sit atop the kidneys, pumping out adrenaline and cortisol as signaled by stress and fear. The urinary bladder is also likely to void quickly in the event of intense fear. Symptoms associated with Kidney (Qi, Yin, Yang, and/or Jing) deficiency include fatigue, sore or weak lower back, achy joints, weak bones, hair loss, shortness of breath, tinnitus, infertility, low libido, erectile dysfunction, urinary issues, and prostate problems.

Because the TCM Heart houses all the emotions, it too is involved in anxiety with symptoms of palpitations, insomnia, dream-disturbed sleep, restlessness, poor memory, and dizziness.

Assessing the Patient

Though many of our patients will come in for a visit with at least one chief complaint they would like to address, the role of a holistic healthcare professional is to obtain a more complete picture of the patient as a whole person, including their personal and family health history, environment, emotions, and lifestyle choices. Much of this information can be collected by asking questions, but some can be acquired through observation.

Patients may be open about their anxiety, describing their symptoms and triggers. They may also deny feeling stressed or anxious, though they begin to sweat, pick at their fingernails, or vibrate their leg when asked about family or work life. As TCM practitioners, we pay attention to visual, auditory, olfactory, and touch clues.

What is the tone and volume of the patient’s voice? Does it change when asked particular questions? Some patients may tense up or pull away when touched, so it’s important to ask if it’s okay to touch first. Body temperature at the skin surface can also change when a patient is experiencing anxiety, even if they seem to be containing it well. It may also be possible to smell anxiety and fear, though we may not consciously interpret it as such, but instead be more likely to have a “sense” of it.

Acupuncture Needles and Anxiety

It might seem odd that someone could choose to get needled when anxiety is one of their concerns, especially if it’s the main complaint. But anxiety is something I often treat with acupuncture in my practice, and it is one of the best therapies to calm someone and help them retrain their brains to better manage their anxiety.

Acupuncture causes the release of feel-good neurotransmitters—including serotonin, dopamine, and endogenous opioid peptides—while decreasing the stress hormones adrenaline and cortisol. It’s these biochemical effects that allow patients to somewhat “cheat” their way into a meditative or calm state. A systematic review of the clinical research on acupuncture for anxiety published in Complementary Therapies in Clinical Practice states that there is good scientific evidence that acupuncture is effective at treating anxiety disorders and has fewer side effects than conventional treatment.

Though patients new to acupuncture may at first be fearful, I remind them that they are ultimately in control of the treatment, with the option to speak up and end or alter the session at any time. After explaining that acupuncture is not painful and setting them up on the treatment table so that they are as comfortable as possible, I explain to them the sensations that they may feel: numbness, tingling, aching, heaviness, lightness, warmth, coolness, electric, or even “hard to explain.” I tell patients who appear very nervous that I could do just one acupuncture point (I’m careful not to use the word “needle,” as patients often have negative associations with this word) to try it out. If they want to stop then, I will, no argument.

Almost always, patients are surprised by how comfortable treatment is, and they choose to continue. Once patients have had acupuncture once, they often settle in and relax quickly on subsequent sessions, seeking it out when they are struggling with bouts of anxiety, though we should be mindful that each time can be a different experience and we cannot assume that they are always going to react in the same way.

Case Study

John is a 48-year-old male patient who, over the course of the last 10 years, has had acupuncture many times from me, typically for pain or anxiety. This time he had come in appearing quite tense, pacing in the waiting room. Normally happy to chat, he was very quiet and subdued. He explained that he was experiencing some anxiety. He could barely speak and told me that he’d rather not talk, so I asked if I could feel his pulse. It was thin, weak, and deep, especially at the Kidney pulses. His tongue was thin and pale, red at the tip, and with teeth marks and a thin white coat.

While I typically like to ask a lot of questions, because John was having a difficult time answering, I needed to rely mostly on the classical TCM tongue and pulse diagnostic tools, and I assessed him as having Kidney and Spleen Qi deficiency with some Heart Fire.

I chose the acupuncture points ST36, SP6, KI3, HT7, SI5, REN17, and Yintang. I always leave a bell for my patients to ring if they need me when I leave the treatment room while they relax with the needles in. I check in every five to 20 minutes, depending on the patient’s needs. In John’s case, he mostly wanted to be left alone, so I checked in just once every 20 minutes, removing the needles after about 40 minutes.

By the end of the session, it was clear that John was in a better state of mind, able to chat a bit more, though he needed to see me for three more sessions over the next two weeks. Each time his anxiety was reduced. I was able to learn that there were external causes—work stressors—for his anxious state, and he told me that the acupuncture sessions were the only thing that allowed him to concentrate enough to complete his work project successfully on time.

References

Amorim, D., et al. (2018). Acupuncture and electroacupuncture for anxiety disorders: A systematic review of the clinical research. Complementary Therapy of Clinical Practice, 31, 31-37.

Eshkevari, L., Permaul, E., & Mulroney, S. E. (2013). Acupuncture blocks cold stress-induced increases in the hypothalamus-pituitary-adrenal axis in the rat. Journal of Endocrinology, 217(1), 95-104.

Wen, G., He, X., Lu, Y., & Xia, Y. (2010). Effect of Acupuncture on Neurotransmitters/Modulators. Acupuncture Therapy for Neurological Diseases, Berlin: Springer, 120–142.