Post-Traumatic+Stress+Disorder+(PTSD)

//Western Diagnosis// the re-experiencing of an overwhelming traumatic event, causing intense fear, helplessness, horror, and avoidance of stimuli associated with the trauma

Signs & Symptoms
1. re-experience of some traumatic event: ---nightmares ---flashbacks 2. depression

Treatment
1. SSRI’s 2. psychotherapy

-Joe Chang—acu/researcher at the Integrative PTSD Treatment Program at Ft. Bliss Restoration & Resilience Center. -Many, many presentations with PTSD, but he feels the most common involve XS patterns, esp.. in H and LV. Most common sx: anger, frequent panic attacks, anxiety, left arm numbness, heaviness in chest, dream disturbed sleep. ANS. -Underlying Xu (usually (Sp/K) pattern emerges after balancing XS. Sx: fatigue, loss of interest in everyday activity, memory loss, poor digestion/appetite, low back pain. Adrenals. -He strongly believes an integrative approach is best. -Focus on patient AND environment/social relationships.

HOW ACUPUNCTURE CREATES COHERENCE -REDIRECTS BLOOD FLOW FROM THE LIMBIC SYSTEM TO THE PFC -BALANCE PARA/SYMPATHETHIC RESPONSE, thus restoring coherence -INHIBITS AMYGDALA, thus alleviating hyper vigilance -REDUCES EPINEHPRINE PRODUCTION, thus facilitating a return to optimal state -SECRETES ENDORPHINS, thus reducing pain

Liver Qi Stagnation
pain in chest/hypochondria, hiccups/sighing, poor appetite, insomnia,globus hystericus, possible abdominal masses. Women irregularmenses, dysmenorrhea, distending breast pain. good for emotional constraint) all move Qi. LV 13 (Sp) and 14 (St) regulate Qi in Middle Jiao.
 * S/S :** Hyperarousal aggravated by suppressed emotions (anxiety, overthinking,anger, sorrow), depression, irritability, labile mood, distending
 * Tongue:** red, thin white coat
 * Pulse:**wiry or slippery
 * Pathomechanism:** extreme emotions disrupt LV function of regulating Qi. Branches through hypochondria region. Dysregulation of Qi dysregulation of fluids phlegm and/or blood stasis. LV governs Chong-Ren women’s issues.
 * Tx Approach:** Soothe Liver, regulate Qi.
 * Herbs:** Chai Hu Su Gan San
 * Points:** GB 34 (hypochondria), LV 3 (throat/head), SJ 6 (sides), P6 (esp.

Liver Qi Stagnation -> Fire
pain hypochondria, insomnia, nightmares, dry stools, dark urine disturb Spirit. LV/GB (ears). Branches through hypochondria region. Heat sx. regulate Qi in Middle Jiao.
 * S/S** : Hyperarousal, irritability, severe headaches, dizziness, red eyes/complexion, tinnitus, bitter taste, dry throat, thirst (cold), burning
 * Tongue:** red,yellow coat
 * Pulse:** wiry, rapid
 * Pathomechanism:** If extreme emotions disrupt LV function of regulating Qi not treated swiftly fire. LV eyes and vertex. Ascending LV fire
 * TX Approach:** Clear liver fire, move liver qi
 * Herbs:** Dan Zhi Xiao Yao San
 * Points:** GB 34 (hypochondria), LV 2 (LV heat), SJ 6 (sides), P6 (esp. good for emotional constraint) all move Qi. LV 13 (Sp) and 14 (St)

Heart Fire
complexion, mouth/tongue ulcers, dry mouth, delirious speech, mania, dry stools, painful (dark yellow) urination channel to chest/face/tongue. H/SI relationship transfers heat to SI -> painful urination. H fire -> H/K disharmony.
 * S/S :** Hyper vigilance, irritability, vexation, insomnia (falling asleep), 5 center heat,. Dizziness, tinnitus, lower back pain, seminal emission, red
 * Tongue:** red, dry coat
 * Pulse:** thready, rapid
 * Pathomechanism:** Prolonged anxiety -> qi stag -> heat rises up to disquiet the heart -> Spirit. Heat reduces fluids. Branches of heart
 * Tx Approach:** Clear heat, calm spirit
 * Herbs:** Modified Dao Chi San
 * Points:** H9 and 8 (clear H fire), H7 (calm mind), Ren 15 (Calm mind, clears heat), Sp6 and K6 (cool fire, promote yin), LI11 (heat), Du 24, 19 (Calm Mind)

Phlegm Fire Rising to Heart and Gallbladder
Can also do 13 Ghost points. I generally do not use Ghost points
 * S/S :** Hyperarousal, insomnia, intrusive images/disturbing dreams of the traumatic event, easily frightened, frequent nightmares, dizziness, stuffiness and fullness in abdomen, bitter taste, v/n, excessive and random speech, excessive exercising, aggression, poor appetite, sticky/greasy sensation in mouth, sputum
 * Tongue:** red, yellow greasy, coat
 * Pulse:** wiry or rapid, slippery
 * Pathomechanism:** Prolonged extreme emotion -> qi stag -> LV/GB and GB governs decision, sound judgment. Fright esp. damages GB. Qi stag->phlegm -> fire -> rises up to H, disquiets Spirit. Phlegm fire -> H and GB, as well as Stomach Phlegm -> Mind and Heart Spirit. Qi stag and phlegm impair t/t
 * Tx Approach:** Clear heat, resolve phlegm, calm spirit
 * Herbs:** Modified Wen Dan Tang
 * Points:** P5 (H phlegm, clear orifices), H7 (clear H, calm mind), H8,9 (clear H fire, restore consciousness), P7 (calm mind, clear H fire), Ren 15 (pacify mind), Ren12 (restore Sp), St40 (phlegm), Sp6 (resolve phlegm, calm mind), UB20, (Sp), Du 20 (restore consciousness), GB13 with Du24 (calm Mind), GB (open mind orifices)

Heart and Spleen Deficiency
Moxa at St36/Sp6 terrific for boosting energy.
 * S/S :** Hyper vigilance, insomnia, emotional disturbance, dizziness, mental fatigue, palpitation, timidity, poor memory, poor appetite, pale lips/complexion
 * Tongue:** pale, thin white coat
 * Pulse:** thready weak
 * Pathomechanism:** Damage from the 7 emotions -> consume Sp qi and H blood -> disquiets Spirit
 * Tx Approach:** Nourish H blood, Tonify Sp qi
 * Herbs:** Modified Gui Pi Tang
 * Points:** H7 (Nourishes H blood, calm mind), P6 (calm mind, tonify H qi, esp. good for sadness), Ren 14 and 15 (tonify H blood, pacify mind, great for anxiety), [Ren4, UB 17 and 20] (all tonify blood), [St36, Ren12, Sp3, Sp 6] (all tonify Sp qi).

Heart and Gallbladder Deficiency
Timidity, lack of initiative, and indecision are enough to Dx GB qi xu.
 * S/S :** Palpitations, timidity, difficulty falling asleep, frequent nightmares, fear of experiencing traumatic event, difficulty making decisions, dizziness, blurred vision, SOB, fatigue
 * Tongue:** pale, white coat
 * Pulse:** thready wiry
 * Pathomechanism:** Fright-> qi dysfunction -> H cannot govern Spirit. GB qi xu -> St -> vomiting, nausea, SOB
 * Tx Approach:** Tranquilize the mind, calm the Spirit
 * Herbs:** Modified AN Shen Ding Zhi Wan
 * Points:** H7 (Nourishes H blood, calm mind), Sp6 (tonify Sp) GB40 (Source point GB, calm mind), P6 (calm mind, tonify H qi, esp. good for sadness),Anmian, UB15, 18, 19, UB47 (regulates Ethereal Soul), Ren 17 (Gathering point Qi, esp. good for sadness as it tonifies Lu qi too), Ren 6 (Tonify Qi)

Auricular Protocols
NADA: Shenmen, Sympathetic, Liver, Kidney, Lung Battlefield Acupuncture: Shenmen, Point Zero, Omega 2, Thalamus, Cingulate Gyrus Auricular Trauma Protocol: Shenmen, Point Zero, Hypothalamus, Hippocampus, Amygdada, Master Cerebral

1. Sympathetic- balance ANS 2. Shen Men – Settle Spirit, comfort Heart and Shen 3. Kidney- warm freeze response, find safety in self, restore vitality/reserves 4. LV- soften anger/hyper-vigilance, freeze fight response 5. Hippocampus-ease mind’s grip on traumatic memory, bring relief to hyperarousal/intrusive images 1. Hypothalamus-stimulate PNS, triggers HPA axis, imp for attention/vigilance/arousal 2. Amygdala-modulates expression of anger/fear/aggression/irritability 3. Hippocampus-memory encoding/emotional experiences. Imp for memory/concentration 4. Master Cerebral-psychoemotional/psychosomatic disorders, emotions around chronic pain, pain. Zones for Limbic system (memory, emotions, compulsive behavior, and PFC (concentration, decision making, initiating action). 5. Point Zero-mind/body/emotions -> homeostasis 6. Shen Men-psychospiritual vitality, balance to H channel, hypersensitivity to needles

=
=============================================================
 * IBIS:**

Definition:
The after-effect of a stressful situation that can cause a chronic complex of emotional and physical symptoms.

Etiology:
Although a traumatic event is the trigger for the anxiety disorder known as PTSD, not all people experiencing traumatic events acquire the continued acute emotional responses to it.

Another factor in the development of PTSD, outside of the traumatic event, is the person's own innate ability to cope with the stress. While some soldiers become "battle-fatigued" after fighting with the enemy, others emerge from battle exhilarated by the encounter. It is hard to determine who exactly is at highest risk for development of PTSD in situations of severe stress (like soldiers before going to battle, or survivors of a massive natural disaster). Many "strong" people wind up unable to cope with stress while "weak" people can rise to the occasion. For that matter, all who encounter stresses should be made aware of any untoward personality, emotional or physical changes that might signify the beginnings of PTSD.

Somatic Therapies:
• aerobic exercise: regular exercise helps minimize stress • qigong • tai qi chuan

Nutrition:
therapeutic foods: • increase foods that calm the Shen (Spirit), tonify the Heart, harmonize the Stomach and Spleen

fresh juices: • carrot (Walker, p. 147) • carrot and spinach (Walker, p. 147) • carrot and celery (Walker, p. 147)

specific remedies: • 2 oz. fresh walnuts, 2 oz black sesame seeds, crush together and eat three times daily (Butt and Bloomfield, p. 149) • for nervous tension: 3 oz. fresh oysters, 3 oz. peanuts, 2 oz. celery. Boil in 2 pt. water until reduced to half. Divide into 2 halves and eat and drink twice daily for 7-14 days (Butt and Bloomfield, p. 149)

avoid: • meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar

Botanicals
• Panax spp.: adaptogen, increases resistance to stress • Valeriana spp.: used in post-bombing shock in Europe (Anderson Geller)

consider: other nervines • Avena sativa • Ferula sumbul: nerve tonic and reconstructive in convalescence from serious illness (Felter, p. 670) • Humulus lupulus • Passiflora incarnata • Scutellaria latifolia

Chinese Formulae
• Ding Zhi Wan (Settle Emotions Pill): Heart Qi Xu (Deficiency) resulting from severe emotional shock or bad fright: apprehensiveness, easily frightened or incessant laughter and glee (Bensky and Barolet, p. 381) • Licorice and Jujube C. (Gan Mai Da Zao Tang): Shen Disturbance: absentmindedness, moodiness, crying spells, restless sleep (Hsu, 1980, p. 347; Yeung, p. 102; Dharmananda, 1986, p. 110; Bensky and Barolet, p. 383) • Fu-shen 16 (patent) plus Zizyphus 18 (patent): Heart Fire Blazing causing Shen Disturbance (Dharmananda, 1990; Fu-shen, p. 68: Zizyphus, p. 29) • Ardisia 16 (patent): Liver Wind Arising From Liver Yang Rising (Dharmananda, 1990, p. 36)

Acupuncture
after assessing the person and palpating, consider these patterns: Heart Qi Xu (Deficiency); Shen Disturbance; Heart Misted by Cold Phlegm; Heart and Kidney not Communicating; Liver Wind Arising From Liver Yang Rising; Jing (Essence) Deficiency; Shi (Excess) of the Yin Wei Mai (Yin Linking Vessel); Shi (Excess) of the Du Mai (Governing Vessel)

» therapeutic note: see also conditions which may be manifestations of post-traumatic stress disorder, such as "anger", "anxiety", "depression", "fear", "grief", "mania","manic depression", "nightmares" and the myriad of potential illnesses that might also appear

• Lv-3 and LI-4: open the Four Gates; regulate Qi and Xue (Blood) circulation; remove Obstruction of the channels; open the Orifices; release bodily tension; relax clenching of jaws; free constraint; calm the mind; relieve mental cloudiness; provide sedative and analgesic effect; pacify Liver Yang (Finkelstein, p. 7; Flaws, 1989, p. 76) • CV-11 and PC-6: open the chest and diaphragm, harmonize the Stomach, and stop vomiting (-); reduce Heart Fire to ease the Mind (Finkelstein, p. 88); "sweep away bitterness in the chest" (Ellis, et al, 1988, p. 356) • Kd-27 with tender sacral point for depression (Matsumoto) • Kd-3, UB-23 and UB-15: adjust disharmony of Heart and Kidney (Finkelstein, p. 53) • UB-15, UB-23 and PC-6: descend Heart Fire, communicate Heart and Kidney, and treat spermatorrhea with dreams (Finkelstein, p. 40) • Lu-11, GV-26 and Sp-1: clear the Brain, regain mental clarity; release Heat and stabilize nerves (Finkelstein, p. 5) • CV-14, TW-10 and UB-15: treat mental instability (Shanghai, p. 178) • GV-24 and GB-13 (-): relieve "severe anxiety and fears" (Maciocia, p. 472) • GV-23, GV-16 and UB-62: tranquilize the mind and calm the emotions (Finkelstein, p. 82) • UB-15 and Ht-7: calm the Heart Spirit, remove Obstruction from the Orifices of the Heart, calm the emotions, and treat insomnia due to Xu (Deficiency) of the Heart and Spleen (Flaws, 1989, p. 78; Finkelstein, p. 40) • Ht-7, PC-6, UB-15, Sp-6 and Kd-3: treat loss of sleep, forgetfulness, palpitations and dream-disturbed sleep (Flaws, 1989, p. 98) • Sp-1 and St-45 (D): drain perverse Heat and cure excess of dreams and light sleep (Finkelstein, p. 25) • PC-6, St-45, St-44, CV-15 and CV-14 for nightmares, esp. in association with neurasthenia (McWilliams, et al., Lesson 31, p. 160) • UB-58, St-23 and St-24 for psychosis (madness and insanity) (Shanghai, p. 630) • GV-26, Lu-11, Sp-1, PC-7, UB-62 (hot needle), GV-16, St-6 (warming needle), CV-24, PC-8, GV-23, CV-1 (for males; for females, use a point at the opening of the vagina), LI-11 (hot needle) and hai quan (prick) known as the thirteen Ghost points, these are needled in the order presented for psychosis (madness and insanity) (Shanghai, p. 630) • CV-4, CV-12, CV-22 and GV-9 are the Reunion Points of the Yin and Yang, they are needled when there is conflict between Yin and Yang, according to Su Wen (Finkelstein, p. 78) • GV-15, PC-8, Sp-6, Kd-1, Kd-3, CV-12, GB-30, St-36 and LI-4 are the Nine Needles for Returning the Yang (Li, p. 627-628; Ellis, et al, 1988, p. 66) • UB-15, UB-11, UB-13, UB-17, UB-18, UB-20 and UB-23: disperse Yang Shi (Excess) in the organs (Finkelstein, p. 40) • GV-26, Lu-11, Sp-1, PC-7, UB-62, GV-16, St-6, CV-24, PC-8, GV-23, CV-1 and LI-11 for mania and melancholia (Lee and Cheung, p. 325) • UB-58, St-23 and St-24 for melancholia and mania with protrusion of the tongue (Lee and Cheung, p. 325) • GV-15, GV-20, CV-11, PC-6, Ht-5 and Sp-6 (also consider Kd-4, GB-34, Lv-5 and Ht-7) for melancholia (Lee and Cheung, p. 324) • CV-13 and Ht-7: treat "manic running amok" (Ellis, et al, 1988, p. 357) • Ht-7 and PC-5: awaken the Soul (Finkelstein, p. 33) • Ht-7 and GV-24: quiet the Soul and clear the Brain (Finkelstein, p. 33) • Ht-7, CV-14 and Sp-6: nourish the Xue (Blood); ease the Mind and calm the nerves (Finkelstein, p. 33) • Ht-7, PC-6 and Sp-6: calm the Heart and ease the Mind (Finkelstein, p. 33) • Ht-7 and UB-15: clear the Heart Shen and remove Obstruction to calm the nerves and emotions (Finkelstein, p. 33) • UB-15 and PC-8: suppress Heart Fire to calm the Spirit and ease the Mind (Flaws, 1989, p. 78; Finkelstein, p. 40) • CV-14, TW-10 and UB-15: treat mental instability (Shanghai, p. 178) • CV-14, Ht-7 and PC-6: nourish Xue (Blood), calm the nerves, and ease the Mind (Finkelstein, p. 90) • Ht-7, UB-15 and LI-1 for unclear mind • consider treatment for "Internal Dragons" or "External Dragons"; External Dragons: GV-20, UB-11, UB-23, UB-61; Internal Dragons: Master point 1/4" below CV-15, St-25, St-32, St-41; In both treatments, sedate first. If the person and the pulses change, fine. If no change with sedation, then tonify. (Worsley) • SI-3 and UB-62: open the Du Mai (Governing Vessel) for which Shen disorders are a symptom of Shi (Excess) • PC-6 and Sp-4: open the Yin Wei Mai (Yin Linking Vessel) for which nightmares are a symptom of Shi (Excess) • GV-4 and GV-20: strengthen the Du Mai (Governing Vessel) and support the Ren Mai (Conception Vessel) and Chong Mai (Penetrating Vessel) (Finkelstein, p. 78)
 * » illustrative combinations:**

Homeopathy
• Arsenicum album: loss of consciousness; vertigo; loss of memory; thoughts crowd the mind • Aurum metallicum: mental dullness and stupidity; insanity; joy from thoughts of death; ailments: brief, lost love • Folliculinum: history of birth control pills and/or estrogen replacement therapy, esp. bad reaction, i.e., estrogen poisoning; tendency to put others' needs before her own, and then become resentful later; woman has lost touch with her own inner rhythms and her reference has become external rather than internal; often best used in a single dose, or repeated every two weeks, possibly at new and full moons • Ignatia: fright followed by grief; grief from loss of dear persons or objects • Natrum muriaticum: bad effects of anger; violent rage if comforted; gloominess; sensitive to comments

Subtle Support
• Mi (Gardner, p. 72, 78) • Fa# (Gardner, p. 82, 87)

mental/emotional: • rhythmic folk songs • County Derry • songs of Steven Foster • Spanish tangos • Brahms' Hungarian dances • Sousa's marches • Strauss' waltzes • Gilbert and Sullivan • Indian Love Call • My Wild Irish Rose • Wishing • Estrellita (Heline, p.18)

Mind/Body
Types of stressors that can induce PTSD (according to DSM III-R): • Threat to one's life or physical integrity. • Serious threat or harm to one's children, spouse, other close relatives, or friends. • Destruction of one's home or community. • Seeing another person who is mutilated, dying, or dead. • Being the victim of physical violence (including child abuse). (Kaplan, p. 1000)

• Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. Chronic Yin Xu (Deficiency) predisposes to Empty Fire, acute and chronic. » Heart Shi (Excess) signs include false or facile laughter; sobbing; agitated spirit; insomnia (Seem, p. 28); frightful dreams; anxiety; tongue feels numb and heavy; heavy chest; hot sweat; and orange-colored urine. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted. » Mental signs of Heart channel disorders include insomnia, anxiety, and all Shen disturbances. (Seem, p. 28)
 * Chinese psychophysiology:**

• Pericardium ~ Xin Bao is the Minister who protects the Heart, the Emperor, and maintains the order of the Heart energy; and as such may be adversely affected by emotional stresses internally or invasion of Heat externally. The Pericardium is said to be the origin of joy and sadness. » Healthy expressions are joy, happiness, and healthy relationships. » Weakness, dysfunction, and illness are associated with confusion, delirium, nervousness, and psychosis. » Mental signs of Pericardium channel disorders include depression, sexual perversion, aversions, and phobias. (Seem, p. 28)

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the "Fire of Life" through its Yang functions; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities; nourishes the brain to sustain concentration, clear thinking, and memory; and displays the effects of sexual dissipation, overwork, aging, chronic debilitation, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat and/or acute inflammation. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

• Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); expresses itself in the nervous system; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind and Liver Yang Rising. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc. » Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, rashes, itching, and neurological problems.