Anxiety – Theoretical Considerations and Chinese Herbal Approaches
Written by Prof. Heiner Fruehauf
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Anxiety is very common in our society today. How does it reflect in Chinese medicine terms and which (surprising) herbal formulas may be useful for treatment?
Anxiety represents one of the most common symptoms seen in modern clinical practice. It is a reflection of modern life-style, characterized by inordinate amounts of stress, working late, ever present noise and light pollution, a dramatically increasing presence of microwave pollution in the environment (caused by the rapid expansion of cell phone towers, cell phone usage, and wireless networking), declining digestive health impacting brain chemistry, and life style habits that de-emphasize restorative modes of being such as rest, sleep, and meditation.Within the clinical framework of Chinese medicine, anxiety, insomnia and palpitations are primary symptoms that indicate a dysfunction of the Heart and related organ systems. The Heart is considered to be the container of Shen (the light of human consciousness), and anxiety is the first sign that this most central container is cracked and leaks the secret and hidden fire of life as a type of pathological anxiety fire, which now races through the body uncontrollably in an upward direction.
Before we examine the various approaches that the science of Chinese herbal medicine has devised to treat this condition, I find it important to look at this topic from the most basic diagnostic perspective. In the framework of Chinese medicine, all diseases can be classified in terms of yin or yang. These two words, in their most primordial sense, designate the life force in a state of expansion (yang) and contraction (yin). 2,000 years of recorded medical case studies in China have shown us that anxiety is primarily a failure of the life force to contract and return to a state of rest and storage (yin), thus creating symptoms of counterflow in the upper burner, with anxiety being only the most common and uncomfortable example of this phenomenon.
On the so-called “organ clock” of Chinese medicine describing the energetic flow characteristics of the organ systems, the networks on the left or Eastern side of the clock are primarily in charge of the expansion of energy, while those on the right or Western side are in charge of the descending motion, containment, and storage of energy. It is therefore those networks on the right—the Heart, Small Intestine, Bladder, Kidney, Pericardium and Triple Warmer—that we need to look toward as the primary culprits in the development of anxiety.
We can see that four of these six organs are classified by the phase element Fire (Heart, Small Intestine, Pericardium, Triple Warmer), with the Kidney also belonging to Fire from the perspective of its Shaoyin (Imperial Fire) association. In comparison to the other four phase elements, Fire is the only one that flares upward rather than sinking down, and thus represents the volatility of pure disembodied yang qi. “Fire” represents Shen (the light of human consciousness), the rarified aspect that is stored in the human heart, which needs to be grounded in yin substance (Heart blood, Kidney jing, etc) in order to burn safely, consistently and calmly. Anxiety, therefore, represents a type of energetic counterflow that needs to be remedied by a regulation of the downward flow of energy and the restoration of yin in order to contain fire. So important is the grounding of this fire that the ancient creators of Chinese medicine originally designated the Heart as the Earth organ (Shuowen jiezi dictionary: “The Heart…is the Earth organ”) to underscore the importance of the fact that Shen (Fire) needs to be contained (Earth) in order to burn calmly and safely. The Heart and Kidney systems in particular are in charge of the vital task of grounding and containing Shen Fire within their yin nature, and are therefore appropriately labeled Shaoyin—the organ networks that easily suffer from a shortage of yin. This primary relationship of anxiety to the various aspects of the Heart is further corroborated by the fact that the physiological emotional state traditionally associated with the Heart is xi (joy/excitement), which can also be translated as hysteria or anxiety to describe the pathological side of the emotional spectrum of the Heart.
Chinese herbal medicine offers a wide variety of approaches for the treatment of anxiety. From the perspective of my own clinical experience, however, many of the better known formulas such as Guipi Tang (Restore the Spleen Decoction) disappoint when used to address the unique anxiety patterns of the modern Western patient. Here are the main diagnostic patterns and treatment approaches I have found particularly useful for treating anxiety in a modern urban context:
1) Inability of the Lung (“Upper Source of Water”) to Descend Qi
- Typical symptoms: Cough/wheezing and/or a sensation of pressure in the throat and/or chest; anxiety paired with a general sense of depression, sadness, and hopelessness; slippery pulse in cun position on right side.
- Recommended prescription: She Jie Xing Chong Tang (modern remedy created by Dr. Wu Sheng’an according to principles devised by the Qing dynasty master of energy dynamics Huang Kunzai: Shegan 9g, Jiegeng 9g, Xingren 9g, Jiangcan 9g) plus Pingjia Tang (Wu Sheng’an remedy: Banxia 9g, Fuling 9g, Chenpi 9g, Baishao 9g, Huangqin 9g) plus Baihe Huashi Tang (Jingui yaolüe remedy: Baihe 15-30g, Huashi 3-6g).
- Corresponding Classical Pearls remedy: Metal Pearls.
- Commentary: This situation is similar to two related conditions described in the Jingui yaolüe (Essentials from the Golden Cabinet) by the classic physician Zhang Zhongjing: 1) “plumpit” anxiety, covered by the remedy Banxia Houpo Tang, and 2) the unique anxiety pattern characterized by restlessness and indecision in the “Baihe Bing” (Lily Disease) chapter of the classic.
2) Compromised Small Intestine Taiyang Barrier Function
- Typical symptoms: Food allergies, IBS, SIBO, Leaky Gut Syndrome, etc. affecting brain chemistry and causing anxiety and mood swings; floating pulse on right side.
- Recommended prescription: Guizhi Tang or Guizhi Jia Longgu Muli Tang (Shanghan lun remedies) plus Heart, Lung or Kidney yin tonics; combine with Huanglian Ejiao Tang (Shanghan lun remedy) in case of eruption of localized fire symptoms (red tongue tip, red skin eruptions).
- Corresponding Classical Pearls remedy: Cinnamon Pearls (combined with Dragon Pearls in case of heat symptoms).
- Commentary: This is a common condition seen in children with brain chemistry issues and psychological diagnoses such as ADHD, Asberger’s Syndrome, Autism, etc.
3) Counterflow of Heart Qi Accompanied by Deficiency of Heart/Lung Yin
- Typical symptoms: stress, shortness of breath, pressure sensation in heart region; tendency to volatile blood sugar, high cholesterol, acid reflux, high blood pressure; wiry pulse on right side.
- Recommended prescription: Xuanfu Daizhe Tang plus Shengmai San plus Danshen Yin.
- Corresponding Classical Pearls remedy: Counterflow Pearls.
- Commentary: This is a condition seen primarily in stressed middle-aged people who worry too much and/or work too hard. At the same time, it is a remedy suitable for teenagers with metabolic problems involving liver and brain chemistry.
4) Kidney Yin/Qi Deficiency Unable to Ground Shen Fire
- Typical symptoms: palpitations, irregular heart beat, pain/sensitivity along the Kidney points in vicinity of the sternum; ringing in the ears, poor memory; weak back and knees, night sweats, urination issues; floating/big pulse in chi position on left side.
- Recommended prescription: Mai Wei Dihuang Wan or Shenqi Wan .
- Corresponding Classical Pearls remedy: Water Pearls.
- Commentary: The Dihuang Wan approach is favored in modern TCM herbalism, but I find that a straightforward Kidney yin deficiency pattern causing anxiety is rarely found in a modern urban context. This approach utilizes a variety of sticky herbs that tend to be hard to digest, and anxiety in modern patients is generally accompanied by various aspects of digestive weakness. Traditionally, this remedy may have been used for a tubercular patient with hysteria symptoms. In modern patients, this particular type of anxiety tends to be accompanied by autoimmune issues.
5) Yin/Blood Deficiency of HT/PC Causing Inability to Contain Shen
- Typical symptoms: adrenal stress syndrome, trauma, panic attacks, crying, spasmodic coughing, inability to control emotions; insomnia; slippery pulse in cun position, especially on left side.
- Recommended prescription: Suanzaoren Tang plus herbs that open the Orifice of the Heart
- Corresponding Classical Pearls remedy: Spirit Pearls.
- Commentary: This approach acts like a calming food grade balm for the nervous system. I find this approach particularly useful for the treatment of anxiety in modern times. It is particularly useful for the amelioration of shock symptoms that result from an abrupt change of life circumstances, like anxiety brought on by acute trauma (i.e., accident, rape) or divorce or loss of work. At the same time, it is useful for the patient with chronically exhausted adrenals due to suppressed trauma or chronic nervous system inflammation.
6) Yang Deficiency of KID/TW (“Lower Source of Water”) Causing Inability to Draw Qi/Shen Down Into the Lower Dantian
- Typical symptoms: burnout syndrome, anxiety/insomnia accompanied by overall exhaustion and cold symptoms; pale tongue, potentially with toothmarks; deep/slippery pulse in chi position on left side.
- Recommended prescription: Qianyang Dan (created by the Qing dynasty founder of the Fire Spirit School, the scholar-physician Zheng Qin’an: Fuzi 18g-30g, Sharen or Baidoukou 9-15g, Ganjiang 9-15g, Zhi Gancao 6g) plus Heart yin tonic herbs.
- Corresponding Classical Pearls remedy: Peace Pearls.
- Commentary: This approach is another extremely relevant approach for anxiety and insomnia patients in modern times. It is based on the assumption of the Fire Spirit School that not only cooling and moistening herbs can be categorized as “yin” (enhancing the storage process of yang qi), but that it is the pungent and warming herb Fuzi (aconite) that, when prescribed in larger amounts, is particularly suitable to draw qi into the Lower Dantian. This assessment is corroborated by the ancient herbal primer Tangye jing (Decoction Classic), wherein Fuzi is classified as “water within wood”—yin within yang, storage within movement. This remedy is particularly suitable for the modern insomnia patient who does not respond favorably to the administration of mere yin/blood tonics such as Suanzaoren Tang.
7) Chronic Inflammatory Syndrome
- Typical symptoms: Chronic inflammation of the nervous system (by spirochetes or viruses such as borrelia, babesia, bartonella, malaria, herpes, coxsackie, etc) causing symptoms such as systemic body pain, muscle twitching, ticks, skin eruptions, headaches, palpitations, anxiety, insomnia, pain or electrical sensations around the heart, and a host of mental-emotional symptoms.
- Recommended prescription: Su He Tang Jiawei (from Lu Shunde’s Qing dynasty work Zhigu xinfang: Zisuye 15g, Bohe 15g, Baizhi 15g, Danggui 21g, Chuanxiong 15g, Huangqi 15g, Gancao 15g, Wujiapi 15g, Heshouwu 15g, Baihe 15g, Dingxiang 3g, Chenpi 6g, Zelan 6g, Yujin 3g, Muxiang 3g, Sanleng 6g, Ezhu 6g) plus Suanzaoren Tang (HT yin/blood deficiency) or Qianyang Dan (Kidney yang deficiency).
- Corresponding Classical Pearls remedy: Lightning Pearls or Ease Pearls (in case of shaoyang involvement), most often used in combination with Spirit Pearls (Heart yin/blood deficiency) or Peace Pearls (Kidney yang deficiency).
- Commentary: This condition reflects the ancient clinical diagnosis of Gu Syndrome (guzheng, literally “possession syndrome caused by superinfection of parasites”), an often overlooked cause for anxiety/insomnia in modern patients. The best example for this type of anxiety are patients suffering from Lyme disease, FSME, or other hidden inflammations of the nervous system associated with mystery syndrome diagnoses such as fibromyalgia and chronic fatigue.
Check out Prof. Freuhauf wonderful lectures on TCM Academy.
*Heiner Fruehauf has researched Chinese culture and medicine for over 30 years, and holds a PhD from the Dept. of East Asian Languages and Civilizations at the University of Chicago. He founded the School of Classical Chinese Medicine at National College of Natural Medicine in Portland, Oregon, where he has taught and practiced since 1992. A selection of his publications, as well as archived video lectures by him and other contemporary scholar physicians can be accessed at http://www.ClassicalChineseMedicine.org. A comprehensive introduction to his herbal teachings can be found at ProD Seminars: http://www.prodseminars.net/bio/heiner-fruehauf. His popular audio podcasts on natural healing can be downloaded at www.TrueNatureRadio.com.