Anxiety+Disorder

A class of psychiatric disorders characterized by persisting or recurrent fear that may or may not be associated with a specific object or situation. Anxiety is often accompanied by physiologic changes and behavior similar to those caused by fear. Anxiety disorders is the most common class of psychiatric disorders.

Relevant TCM Diseases: Fright and Fear (Jing Kong), Fright Palpitations (Jing Ji), Fearful Throbbing (Zheng Chong)

Differential Diagnosis: Medical Disorders: A. Hyperthyroidism or hypothyroidism B. Other endocrinological disorders (hyperparathyroidism, adrenal tumor etc.) C. Cardiac arrythmias D. Seizure Disorders E. Hypoglycemia Effects of Substances: A. Alcohol abuse or or illicit substance intoxication or withrawal B. Medication side effects Psychiatric Disorders: A. Panic disorder with or without agoraphobia B. Generalized Anxiety Disorder (GAD) C. Post-Traumatic Stress Disorder (PTSD) D. Obsessive-Compulsive Disorder (OCD) E. Social Phobia and specific phobias F. Schizophrenia and other psychotic disorders

TCM Etiology and Pathogenesis: “In Chinese medicine, this disease is believed to be caused primarily by habitual bodily righteous vacuity and recurrent stimulation of the seven affects. These internally damage the three viscera of the heart, liver, and spleen. This then results in irregularity of the function of the viscera and bowels, disturbance in the flow of qi and blood, and thus substantial depletion and detriment. Unfulfilled desires or damage due to anger may result in liver qi stagnation... overthinking and too much worry and anxiety may directly damage the heart and spleen, causing heart-blood-spleen qi deficiency.”1

TCM Pattern Differentiation: Heart Qi Vacuiy & Blood Stasis Pattern 1 Suden onset of tension, fear, and dread, tensio stretching from GV-14 to the head, a feeling of doom and approaching death causing incessant moaning, restless sitting, crying and sighing, rapid distressed breathing, heart jumping rapidly, chest oppression, suffocating feeling in the chest, palpitations, shortness of breath, listlessness of the essence spirit, insomnia, profuse dreams Suffocating oppressive feeling in the chest, possible piercing pain: + Yu Jin, Gui Zhi, Qian Cao Tension, disquietude, heart qi floating upward: + Long Gu, Zhen Zhu Mu, Mu Li Emotional lability, tension, agitation, easy anger, headache dizziness d/t liver depression -> fire: + Chai Hu, Zhi Zi, Huang Qin or add //Dan Zhi Xiao Yao Wan// Liver depression w/ spleen qi & blood vacuity without stasis: use //Xiao Yao Wan Jia Wei// //Dan Zhi Xiao Yao Wan:// [Mu Dan Pi, Zhi Zi, Chai Hu, Dang Gui, Bai Shao, Bai Zhu, Fu Ling, Gan Cao//]//
 * Tongue:** dark pale tongue, white coat
 * Pulse:** fine, weak, possibly bound or regularly intermittent pulse
 * Treatment Principles:** Boost the qi and nourish the heart, quicken the blood, free the flow of the vessels
 * Acupuncture Treatment:** LR-3, SP-10, LI-4, HT-7, PC-6, ST-36, BL-15, BL-17. even technique.
 * Herbal Treatment:** //Tian Wang Bu Xin Dan//1
 * Modifications:**

Liver Depression-Phlegm Fire Pattern 1 Emotional depression, anxiety, worry, sorrow, tension, vexation and agitation, easy anger, tendency to sighing, insomnia, profuse dreams, chest & diaphragmatic fullness and oppression, bilateral rib-side distention & pain, profuse thick phlegm [Chai Hu (10g.), Chen Pi (10g.), Bai Shao (15g.), Zhi Ke (10g.), Gan Cao (6g.), Chuan Xiong (6g.), Xiang Fu (6g.), Huang Lian (6g.), Ban Xia (10g.), Gua Lou (30g.) Heart vexation & disquietude, constipation, short reddish urine: + Da Huang, Zhi Zi, Huag Qin Headache, dizziness, red complexion, red eyes, irritability: + Long Dan Cao, Ze Xie, Ju Hua, Jiang Can Severe phlegm turbidity: + Chuan Bei Mu, Ban Xia, Bai Zhu Splitting headache w/ red complexion, stiff neck: + Nui Xi, Shi Jue Ming, Xia Ku Cao
 * Tongue:** red tongue, slimy yellow coat
 * Pulse:** bowstring, slippery, rapid
 * Treatment Principles:** Course the liver & resolve depression, transform phlegm, clear heat
 * Acupuncture Treatment:** LR-2, PC-5, LI-4, ST-40, CV-17, CV-12. draining technique.
 * Herbal Treatment:** //Chai Hu Shu Gan San He Xiao Xian Xiong Tang//1
 * Modifications:**

Heat Qi Stagnation & Blood Stasis Pattern 1 Episodes of anxiety & worry that endure for a long time, tension, wanness and sallowness, fearful throbbing, impaired memory, fear and dread, shaking, trembling, torpid stagnat affect, chest area oppression & pain venter & abdominal burping & belching or hiccup, dark stagnant complexion, dark greenish circles around the eyes [Dan Shen (15g.), Dang Gui (15g.), Chuan Xiong (10g.), Chi Shao (10g.), Tao Ren (12g.), Hong Hua (10g.), Chai Hu (15g.), Zhi Ke (12g.), Xiang Fu (15g.), Yu Jin (15g.), Long Chi (15g.), Yuan Zhi (10g.), Hu Po (6g.), Gan Cao (6g.)] Heart vexation & chaos, chaotic qi & heat within the chest, tension, anxiety and worry, insomnia, profuse dreams: Use //Zhu Sha An Shen Wan// [Zhu Sha, Huang Lian, Dang Gui, Sheng Di Huang, Gan Cao]
 * Tongue:** dark red tongue or static spots or macules
 * Pulse:** deep, bowstring or fine, choppy
 * Treatment Principles:** Quicken the blood, move stagnation, settle the heart, quiet the spirit
 * Acupuncture Treatment:** LR-3, LI-4, SP-10, HT-7, PC-6, CV-17, BL-15, Yintang
 * Herbal Treatment:** //Xue Fu Zhu Yu Tang Jia Jian//1
 * Modifications:**

Heart-Spleen Dual Vacuity Pattern 1 Fear & dread, worry & anxiety, fright palpitations, insomnia, profuse dreams, impaired memory, fatigue, lassitude of the spirit, lack of strength in the four limbs, scanty eating, loose stools, cold hands & feet, pale, somber or sallow complexion, pale lips & nails Nourish the heart, nourish the spirit more: + Bai Zi Ren Settle, still, and quiet the spirit more: + Long Gu, Mu Li
 * Tongue:** pale
 * Pulse:** fine, weak
 * Treatment Principles:** Fortify the spleen, supplement the heart, nourish blood, quiet the spirit
 * Acupuncture Treatment:** ST-36, HT-7, PC-6, SP-6, BL-15, BL-17, BL-20
 * Herbal Treatment:** //Gui Pi Tang//1
 * Modifications:**

Yin Vacuity-Fire Effulgence Pattern 1 Fear & dread, susceptibility to fright, vexation & agitation, dizziness, tinnitus, insomnia, palpitations, tidal heat, possible night sweats, malar flush, 5-palm heat, insomnia, dry mouth & throat, low back & knee soreness and weakness, nocturia that is scanty and yellow Dry throat: + Xuan Shen Mai Men Dong Heart vexation: + Zhi Zi, Zhu Ye Pronounced fright susceptibility: + Zhen Zhu Mu, Mu Li Scanty, dark urine: + Deng Xin Cao, Tong Cao
 * Tongue:** red tongue, scanty coat
 * Pulse:** fine, rapid or surging, rapid, rootless
 * Treatment Principles:** Clear the heart & nourish Yin, settle fright, settle the spirit
 * Acupuncture Treatment:** KI-3, KI-7, SP-6, HT-6, PC-5, GV-20, Yintang. Even technique.
 * Herbal Treatment:** //Huang Lian E Jiao Tang//1
 * Modifications:**