Anxiety

Traditional Chinese Medicine

Associated Patterns:

  • Heart Blood deficiency
  • Heart Yin deficiency
  • Liver Blood deficiency
  • Liver Yin deficiency
  • Kidney Yin deficiency
  • Heart & Gallbladder Qi deficiency
  • Heart & Spleen Disharmony
  • Heart Fire
  • Heart Blood Stasis
  • Phlegm-Fire Harassing the Mind
  • Liver Qi Stagnation
  • Liver Fire
  • Rebellious Qi of the Penetrating Vessel
  • Diaphragm Heat
  • Liver Yang Rising
  • Kidney & Heart Yin deficiency with Heart empty Heat
  • Heart Yin deficiency with empty heat
  • Yang deficiency leading to retention of phlegm-fluid

Patterns Most Likely to Occur During Pregnancy: 

  • LV Fire
  • Phlegm fire harassing the mind
  • HT fire
  • LV qi stag

Heart Blood Deficiency

Clinical Manifestations: occurs primarily in women; mild anxiety, insomnia, dream-disturbed sleep, poor memory, anxiety, tendency to be easily startled, palpitations, dizziness, dull/pale complexion, pale lips

Pulse: choppy or fine

Tongue: pale and thin

Treatment Principles: build blood, tonify Heart, calm the spirit, relieve anxiety

Acupuncture Points:

  • BL15, CV14
  • BL17, SP10
  • HT7
  • PC6
  • CV4, SP6, ST36 – nourish yin and blood

Clinical Manifestations: vague anxiety worse in the evening, insomnia, poor memory, mental restlessness, dream-disturbed sleep, tendency to be easily startled, uneasiness, “feeling hot and bothered”, palpitations, dry mouth and throat, night sweats

Pulse: floating and empty, especially in the Heart position

Tongue: normal-color without coat or with rootless coat

Treatment Principles: nourish yin, calm shen, tonify Heart

Acupuncture Points:

  • BL15, CV14
  • HT7
  • PC6
  • SP6, KD6, CV4: nourish yin
  • HT6 & KD7 or HT7 & KD6: night sweats
  • HT8 or PC8: insomnia due to Yin Deficiency
  • Anmian: insomnia

Liver Blood Deficiency

Clinical Manifestations: often occurs in women, mild anxiety, mild depression, lack of direction, insomnia, excessive dreaming, dizziness, blurred vision, floaters, numbness/tingling of limbs, scanty menstruation, dull/pale complexion

Pulse: choppy, fine

TONGUE: pale

TX PRINCIPLE: nourish blood, tonify LV, calm shen

TX PLAN:
SP6, SP10, ST36
LV3
LV8
BL17, BL18, BL20
BL23 (LV always invloves KD)
CV4
ear shen men, yintang
PC6, HT7

4. LIVER YIN DEFICIENCY

CLINICAL MANIFESTATIONS: vague anxiety, depression, insomnia, excessive dreaming, dizziness, blurred vision, floaters, dry eyes, dry hair, dry nails, insomnia, numbness/tingling of limbs, scanty menstruation

Pulse: floating, empty

TONGUE: no coat

TX PRINCIPLE: tonify LV, tonify yin, calm shen

TX PLAN:
LV3, BL18
KD6, CV4, SP6 – nourish yin
ear shen men, yin tang
PC6, HT7

5. KIDNEY YIN DEFICIENCY

CLINICAL MANIFESTATIONS: vague anxiety worse in the evening, dizziness, tinnitus, difficulty hearing, poor memory, night sweats, dry mouth and throat at night, low back pain, constipation, scanty dark urine, fatigue

Pulse: floating, empty

TONGUE: normal color without coat

TX PRINCIPLE: tonify KD, tonify yin, calm shen

TX PLAN:
KD3, BL23 – tonify KD
KD6, CV4, SP6 – nourish yin
ear shen men, yintang – calm spirit
PC6, HT7

6. HT/GB QI DEFICIENCY

CLINICAL MANIFESTATIONS: mild anxiety, insomnia, timididty, absent-mindedness, indecisiveness, tendency to be easily startled, palpitations, slight breathlessness, tiredness

Pulse: weak

TONGUE: pale

TX PRINCIPLE: tonify HT, GB, and Qi; calm the spirit

TX PLAN:
BL15, BL19
GB40 – tonifies GB; Maciocia uses this to stimulate the emotional aspects of GB
(courage and assertiveness)
CV6
CV17, ear shen men, yintang
PC6, HT7

7. HT/SP DISHARMONY

CLINICAL MANIFESTATIONS: fear, worry, anxiety, fright palpitations, insomnia, poor memory, lack of concentration, fatigue, lassitude, poor appetite, pale complexion

Pulse: weak and thready

TONGUE: pale

TX PRINCIPLE: tonify HT and SP, tonify Qi, calm the spirit

TX PLAN:
BL15, BL17, BL20
SP6
HT7, PC6
SP3, ST36

8. HT FIRE

CLINICAL MANIFESTATIONS: severe anxiety, mental restlessness, agitation, insomnia, dream-disturbed sleep, palpitations, thirst, mouth/tongue ulcers, feeling heat, red face, dark urine, bitter taste

Pulse: rapid, overflowing

TONGUE: red tongue with redder tip, yellow coat

TX PRINCIPLE: clear or drain Heart Fire, calm shen

TX PLAN:
HT8, HT7, HT9
LI-4, LI-11
SI-2
Ear shen men, yin tang

9. HT BLOOD STASIS

CLINICAL MANIFESTATIONS: severe anxiety, agitation, palitations, stabbing chest pain – may radiate to inner aspect of left arm or to the shoulder, feeling of oppression/constriction of the chest, cyanosis of lips/nails, cold hands

Pulse: choppy or wiry

TONGUE: entirely purple or only purple on the sides in the chest areas

TX PRINCIPLE: invigorate blood, move qi, disslove stasis, calm shen

TX PLAN:
BL15
BL17, SP10
CV17
HT7, PC6

10. PHLEGM-FIRE HARASSING THE MIND

CLINICAL MANIFESTATIONS: severe anxiety, agitation, mental restlessness, manic behavior, phobias, insomnia, dream-disturbed sleep, confusion, depression, palitations, thirst, red face, feeling of oppression in the chest, dark urine, expectoration of phlegm, rattling sound in throat, bitter taste

Pulse: slippery-rapid or slippery-rapid-overflowing

TONGUE: red with redder swollen tip, Heart crack, sticky yellow coat

TX PRINCIPLE: drain HT fire, dissolve phlegm, calm shen

TX PLAN:
HT8, HT7, (HT9 or HT3)
LI-4, LI-11
ST40
PC6, CV17
SI-2

11. LV QI STAGNATION

CLINICAL MANIFESTATIONS: anxiety, depression, irritability, hypochondrial or epigastric distention, plum-pit qi, PMS

Pulse: wiry

TONGUE: qi stag doesn’t show up on the tongue

TX PRINCIPLE: soothe Liver, move Qi, calm shen

TX PLAN:
LV3, LI4
GB34
LV14
PC6, HT7
ear shen men, yin tang

12. LV FIRE

CLINICAL MANIFESTATIONS: severe anxiety, irritability, propensity to outbursts of anger, H/A, red face, dizziness, tinnitus, thirst, bitter taste, constipation, dark urine,

Pulse: wiry and rapid

TONGUE: red with redder sides; dry, yellow coat

TX PRINCIPLE: drain LV Fire, regulate and soothe qi, calm shen

TX PLAN:
LV3, LI-4
GB34
LV14
PC6
LV2
GB43
ear shen men, yin tang
HT7

13. REBELLIOUS QI OF THE PENETRATING VESSEL (Internal Urgency)

CLINICAL MANIFESTATIONS: vague anxiety, panic, constriction of the throat, restlessness, feeling of heat in face, cold feet (the descending branch of the Penetrating Vessel usually warms the feet), possible tight sensation from lower abdomen upwards toward heart; this pattern could be excess or deficient – excess emotions lead to and excess condition, Blood deficiency and/or KD (yin or yang) deficiency lead to a deficient condition

TX PRINCIPLE: descend QI of the Penetrating Vessel, calm shen, address Blood deficiency if present
TX PLAN:
SP4, PC6
LV3, LI-4
KD1 (can add moxa) or KD3
Palpate KD11-21
DU20

14. DIAPHRAGM-HEAT
CLINICAL MANIFESTATIONS: anxiety, a feeling of heat and constriction in the region under the heart, thirst, dry mouth, irritability, insomnia; this pattern is caused by residual heat following an invasion of Wind-Heat

Pulse: rapid

TONGUE: red

TX PRINCIPLE: deconstrain diaphragm, clear heat, calm shen

TX PLAN:
GB41, TH5
LV14
LI11, LI-4
GB38 (fire pt)
LV3
PC6, HT7

15. LV YANG RISING

CLINICAL MANIFESTATIONS: anxiety, H/A, dizziness, tinnitus, irritability, tendency towards outbursts of anger, possible red face, insomnia; this pattern is both excess and deficient – empty heat due to LV yin deficiency (which KD yin deficiency alwys plays a role in)

Pulse: rapid, wiry or thready – depending on whether excess or deficiency is presenting more

TONGUE: red, especially on the sides; yellow coat

TX PRINCIPLE: sedate LV yang, soothe LV qi, tonify KD, calm shen

TX PLAN:
LV2 and LV3 – disperse
GB38 and GB43 – H/A
KD3, KD6 – tonify KD
BL18, BL23
PC6, DU20

16. HEART/KIDNEY YIN DEFICIENCY WITH EMPTY HEAT
CLINICAL MANIFESTATIONS: anxiety, restlessness, agitation that is worse in the evening, insomnia, dream-disturbed sleep, poor memory, palpitations, tinnitus, difficulty hearing, low back pain, nocturnal emissions with dreams, heat in the evening, night sweats, 5-palm heat, scanty urine, dry stools; often seen in the elderly

Pulse: floating, empty, rapid

TONGUE: red tongue with redder tip, Heart crack

TX PRINCIPLE: nourish Heart and Kidney yin, clear heat, calm shen

TX PLAN:
BL15, BL23
SP6, KD6, CV4 – nourish yin
HT7, PC6 – calm shen; also for palpitations; (and HT7, KD6 help with night sweats)

17. HT YIN DEFICIENCY WITH EMPTY HEAT
CLINICAL MANIFESTATIONS: anxiety that is worse in the evening, mental restlessness, insomnia, dream-disturbed sleep, tendency to be easily startled, uneasiness, palpitations, dry mouth and throat, night sweats, “feeling hot and bothered”

Pulse: floating and empty, especially the HT position

TONGUE: normal color, not coat or rootless coat

TX PRINCIPLE: tonify Heart, nourish yin, clear heat, calm shen

TX PLAN:
HT7, BL15
CV4, CV15
PC6
SP6, KD6, CV4 – nourish yin
LI11, LI-4

18. YANG DEFICIENCY LEADING TO RETENTION OF PHLEGM-FLUID
CLINICAL MANIFESTATIONS: anxiety, palpitations, dizziness, fullness/distention of the chest and epigastrium, lassitude, cold limbs, scanty urine, swollen lower limbs, thirst but no desire to drink, nausea and vomiting fluid

Pulse: slippery and wiry

TONGUE: white greasy coat

TX PRINCIPLE: warm yang, transform fluid, calm shen

TX PLAN:
BL15, CV14
PC6
CV9, SP9, ST40

CV8 (moxa)

 

SOURCES:
Foundations of Chinese Medicine: Maciocia
Diagnosis in Chinese Medicine: Maciocia
The Practice of Chinese Medicine: Maciocia

Kiiko Matsumoto Style Acupuncture 

Associated Patterns:

  • Stagnation of Blood in the Head
  • ANS imabalance
  • Anxiety reflex areas
  • Reflection zones of expanding Yi
  • Psychosomatic reflex areas
  • Sphenoid Bone imbalance

Stagnation of Blood in the Head

Clinical Manifestations: pressure pain, edema, heat, or puffy feeling at DU20, sishencong, and Bladder meridian 1 cun around DU20.

Treatment:

  • Bilateral SP6 and SP9
  • Bilateral LU5
  • PC choice – palpate PC8 (fire point):
    • If tender, needle jPC3 and PC5
    • If non-reactive, needle PC6
    • If pressure feels good, needle PC8 or jPC4

ANS Imbalance

Clinical Manifestations: SCM tension.

Anxiety Reflex Areas

Clinical Manifestations: KD23 is where the Shen is abundantly stored; KD24 is where the ancient spirit was, KD25 is where the Shen is kept.  REN17 reflects anxiety and is the cardiac reflex.  REN14 is and anxiety reflex that reflects sleeping disorders.  REN9 shows emotional and mental stress and fatigue and is the sadness reflex; palpate for pressure pain or pulsing.

Treatment:

  • To treat REN17
    • Step 1 – Shao Yang combination: 
      • Slow or normal pulse: bilateral above TW9 and GB40 
      • Rapid pulse: bilateral TW5 and GB41 
  • Step 2 – remove Shao Yang combination after 10 minutes and palpate PC8 (fire point):
    • If tender, needle jPC3 and PC5
    • If non-reactive, needle PC6
    • If pressure feels good, needle PC8 or jPC4

Psychosomatic Reflex Areas

Clinical Manifestations: Huatuojiaji points and the Du meridian between T3 and T8 (centered around T5) are the psychosomatic reflex areas.

Sphenoid Bone Imbalance 

Clinical Manifestations: GB4, GB5, and GB6.  Also SI10 if very strong pressure pain.

GV11 – if painful upon palaption, treat with 7-10 direct thread-sized moxas

For CV14 – needle SP3.2 or PC4

For CV9 – needle right ST24 and apply Kyutoshin if cold

For Huato and DU at T3-T8:
The Yi points BL49 (House of Yi) and BL45 (yi xi)
I-Hi-Kon (BL40, BL58, BL60) – distal points
PC9 – reduces pressure pain at BL17 in patients with anxiety, nervousness, and insomnia
If pressure pain still present on DU line – 8 direct thread-sized moxas – may need 2 or 3 sets
Once pressure pain has been reduced, Huato’s can be needled directly

For all CV points – needle BL2 and yuyao

For sphenoid bone – find specific point at or between GB4, 5, or 6 that reduces pressure pain at the sternum or psychosomatic refelex areas

For SI-10 – needle SI-7 and HT3

If patient is also experiencing depression – Bafeng – needle, moxa and possibly magnets

Sources
Kiiko Matsumoto’s Clinical Strategies Vol.1
Kiiko Matsumoto’s Clinical Strategies Vol. 2

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