How Do You Treat Chronic Anxiety in Your Practice?

Anxiety is a normal human physiologic mechanism designed to support the human body's response to a threat. When anxiety is associated with high levels of autonomic arousal, erroneous cognitions become manifested, such as exaggerated threat perceptions and dysfunctional coping strategies. Anxiety encompasses a variety of psychiatric symptoms, including excessive worrying, restlessness, irritability, difficulties with concentration, and a constant feeling of being “on edge.”¹ This results in significant distress and impairment with respect to work, school, family, and social relationships, and/or activities of daily living.²

Several epidemiology studies have reported that, in different populations, the prevalence of anxiety disorders vary widely,³ are ∼1.3–2.4 times more prevalent in women than in men,⁴ and are highest in high-income countries.⁵ Anxiety disorders are also more common in people with low education and/or income levels, and/or who are are unemployed.⁶

According to the theory of Traditional Chinese Medicine (TCM), anxiety is depleted in Kidney Qi and makes Qi go down rather than circulating in a balanced whole body.⁷ Depending on the state of the Heart, situations of chronic anxiety will have different clinical effects on the body's Qi. If the Heart function is Deficient, it will cause Qi to become Empty–Heat or cause disruptive hot energy and a lack of cooling energy. Kidney–Yin Deficiency gives rise to Empty–Heat of the Heart, which will manifest in such symptoms as sleep disturbance, flushing, and a rapid pulse. In addition, Liver–Blood Deficiency and Gall Bladder Deficiency can induce an anxiety disorder.⁸

The COVID-19 pandemic has affected the living conditions of the general population seriously. It has been observed that the this pandemic is associated more with anxiety and stress and, to a lesser extent, with other mental health symptoms.⁹

Acupressure originated from TCM theory and is often used as an auxiliary method to treat anxiety, depression, insomnia, cognitive disorders, and other medical conditions. This modality has produced good clinical results.¹⁰

Illustrative Case

A 26-year-old female presented with complaints of anxiety and difficulty falling asleep at night; thus she was unable to get a good night's rest. She stated that she constantly worried about her postgraduate project performance during the COVID-19 pandemic. She also stated that she woke up at night with headaches that lasted for a couple of hours and that she felt tense for the majority of the day. In addition, this patient sometimes also had difficulty paying attention in the laboratory where she worked on her project and had to complete her workload.

Acupuncture was performed on Shenmen (HT 7), Zusanli (ST 36), Hegu (LI 4), Neiguan (PC 6), and Taichong (LR 3). These acupoints were selected based on the acupuncture-point selections of TCM meridian theory used to treat anxiety.^11–13 Size 0.25 x 40mm filiform needles (Jiajian Medical Sdn. Bhd. Malaysia) were used; they were inserted into the muscle layer, and De Qi was elicited. Each needle was rotated by an experienced acupuncturist with the index finger and thumbs in an alternating clockwise-and-counterclockwise fashion at the rate of 3–5 rotations per second for additional stimulation every 5 minutes, with and a total retention time of 30 minutes. This acupuncture was administered 3 times per week.

After her acupuncture treatments, her Hamilton Anxiety Rating Scale¹⁴ score had decreased to 6, compared to the score of 17 that she had prior to her treatment; her Anxiety Symptoms Questionnaire¹⁵ score had decreased to 34, compared to her score of 85 prior to her treatment. She experienced no more sleep disturbances, and she was able to pay attention in the laboratory and complete her work on time. However, sometimes she felt slightly worried and had headaches. No acupuncture-induced side-effects were noted.

Conclusions

Currently, some studies^16,17 have shown that mental health research during the COVID-19 pandemic has focused mainly on anxiety, depression, and stress. Psychologic issues induced by the pandemic have remained at a constantly mild-to-moderate level after time spent in quarantines and lockdowns. Anxiety is an emotion characterized by feelings of tension and worried thoughts or concerns. A patient may thus avoid certain situations because of worry about them. Patients may also have physical symptoms, such as sweating, trembling, dizziness, or insomnia. The current patient's anxiety and related physical symptoms were reduced significantly after acupuncture treatment. A systematic review and meta-analysis, by Tu et al.,¹² suggested that acupuncture may be used as an adjunctive therapy to treat anxiety.

More high-quality randomized controlled trials are required to confirm the effectiveness of acupuncture management for anxiety.

Address correspondence to:

Yun Jin Kim, PhD

School of Traditional Chinese Medicine

Xiamen University Malaysia

Jalan Sunsuria

Bandar Sunsuria

Sepang, Selangor 43900

Malaysia

E-mail: yjkim@xmu.edu.my

In Vietnamese Imperial Medicine, three basic components are used frequently. They are Jing, Qi, and Shen, the Three Treasures, with Shen being the most subtle of the three. Proper functioning of Shen depends not only on the brain, but on each organ performing its function correctly. Thus, in chronic anxiety, it is preferable to use a general formula that restores the patient's balance and then to tone the Three Treasures.

If a patient has symptoms of chronic anxiety, the Thirteen Ghost Points of Sun Si Miao are treated. Information about these points was published in the Qian Jin Yao Fang (Prescriptions Worth a Thousand in Gold, circa 952 bc). The points are:¹

• Guigong (Ghost Palace; i.e., Renzhong DU 26)

• Guizhen (Ghost Pillow; i.e., Fengfu DU 16)

• Guitang (Ghost Hall; i.e., Shangxing DU 23)

• Guishi (Ghost Market; i.e., Chengqiang Ren 24)

• Guixin (Ghost Faith; i.e., Shaoshang LU 11)

• Guitui (Ghost Leg; i.e., Quchi LI 11)

• Guichuang (Ghost's Bed; i.e. Jiache ST 6)

• Guilei (Ghost Fortress; i.e., Yinbai SP 1)

• Guixin (Ghost Heart; i.e., Daling P 7)

• Guicu (Ghost Cave; i.e., Laogong P 8)

• Guilu (Ghost Path; i.e., Shenmai BL 62)

• Guifeng (Ghost Seal; i.e., Haiquan [Extra] below the tongue)

• Guicang (Ghost Store; also known as Yumentou [Extra] in women and Yinxiafeng [Extra] in men; both points corresponding to Huiyin Ren 1).

Acupuncture

A copper steel needle with a guide tube, 0.22 in diameter, 15 mm long, is used. Puncturing should be on the left for a male patient and on the right if for a female patient. All points are punctured bilaterally, except for the Ren, DU, and sublingual points. The needle is applied to make a superficial puncture (1 fen deep or less); until De Qi is elicited, the needle is rotated toward both sides and is then withdrawn. The total time for each treatment is ∼10 minutes.

The result of the treatment is immediate, and the patient is usually quiet (silent), feeling peaceful, or enjoying a restful sleep.

Toning Jing, Qi, and Shen

After the acupuncture treatment, the Three Treasures are toned with acupuncture and moxibustion on: Ren 4, Ren 6, and Ren 7. This is an ancient prescription for toning the basic components: Jing, Qi, and Shen, respectively.

By toning Shen from the Lower Jiao, in the territory of Jing and Water, the functions of the second branch of the Bladder are activated, also balancing the 5 spirits: Zhi, Po, Yi, Hun, and Shen.

This treatment is carried out once per week for 3 consecutive weeks.

Warning

This is a technique of great energy transfer. The therapist may develop these symptoms with the following during treatment: the desire to yawn; fatigue; exhaustion; sleep; intermittent muscle discomfort; and paresthesia (among other general feelings of tiredness). The therapist can prevent this by doing Qigong exercises before entering having a consultation, to raise the levels of Qi and Wei Qi. It is important that, after the consultation is finished, Qigong exercises are also performed to help release the toxic Qi that is released from the patient during treatment.

Address correspondence to:

Felipe Abreu Márquez, MD

ORCID ID https://orcid.org/0000-0003-3328-6255

Urbanización Entre Ríos

Calle sexta Manzana L1 Solar 14

Parroquia la Puntilla Samborondón

Province of Guayas 092301

Ecuador

E-mail: hoathienecuador@gmail.com