One of the most popular topics in both allopathic and integrative medicine at the moment is the issue of “long COVID.” I will cover some important clinical considerations on Chinese herbal medicine in cases of long COVID in future columns; however, in this column let’s focus on the issue of long-term psychological stress and its impact on health.
The Epidemic of Loneliness
Recently, the U.S surgeon general declared loneliness a new public-health epidemic in America. I have seen such issues in my clinical practice over the past decade and am extremely happy to see this being addressed publicly in mainstream circles.
Over the past years of the pandemic, a large amount of attention has been paid to topics such as viral infections with co-existing health conditions such as obesity and diabetes, as well as the potential long-term effects of viral challenges. In my private practice, I have seen more patients coming to my clinic for psychological challenges than for viral infections, with fear and loneliness being extremely common issues.
The TCM View: The Heart
We can refer to important quotes from classic Chinese medical texts to shed some light on how mental stress can affect the health of the individual from a TCM perspective. The Ling Shu (chapter 28) states: “Sorrow, grief, anxiety, and worry stir the heart. When the heart stirs, the five viscera and six bowels all shake”; while chapter 8 states: “When there is fear and dread, the spirit becomes jittery and cannot gather itself.” The Su Wen (chapter 4) states: “Worry and fear damage the heart”; chapter 73 states: “Worry, anxiety, thought, and preoccupation damage the heart.”
These are just a few quotes that illustrate how we can think of stress and its effects on the overall constitution of a patient. This concept becomes especially germane when considering the implications of the public epidemic of loneliness and psychological malaise.
These concepts have much deeper clinical implications than simply “boosting the immune” when encountering patients struggling with the past years of pandemic issues and overall psychological issues such as fear, anxiety and loneliness. Much like TCM patterns, which are not always stand-alone and most often occur in several layers, the concept of “loneliness” encompasses many aspects of anxiety, fear and depression.
Depression is more commonly discussed by patients in my clinical experience than a direct expression of loneliness. However, the deeper aspects of TCM expressed in the aforementioned classical quotes shows how emotional states affect the body on many levels. In particular, the TCM concept of the heart is important to keep in mind when creating acupuncture protocols for patients suffering from emotional disturbance of almost any type.
Even with the basic concept of “depression,” the TCM lens is much broader than the allopathic model: Is the depression a depressed state of mind or a depressed activity in the body? Liver depression can express clinically as blood stasis, food stagnation, heat, and phlegm patterns just as frequently as emotional disturbance. When we say “depression” as practitioners of Chinese medicine, what exactly do we mean?
Using Four Gates to Create Point Combinations
This can be complex or simple depending upon the unique pattern presentations of the respective patient. For this article, we can use the ever-popular “Four Gates” acupuncture formula of LI 4 + Liv 3, adding heart points and back shu points to target overall emotional health as a foundation. This foundation can be adapted and adjusted as needed depending upon the overall unique pattern presentation of the individual patient.
In cases of both acute and chronic emotional stressors such as fear, loneliness and anxiety, liver depression will almost always be present, but it rarely manifests in isolation; therefore, adding heart meridian points can play an important role. The foundation formula could be:
BL 15, the back shu point for the heart, clears heat, nourishes the heart, invigorates the blood, stimulates the brain, and calms the mind. Ht 7, the yuan source / shu stream point of the heart meridian, nourishes heart blood and calms the mind.
This Four Gates combination moves the qi, invigorates the blood and calms the mind. In presentations with very obvious heat complications, this foundation formula can easily be adjusted with minimal changes:
This simple modification adds Ht 8, the ying spring point of the heart meridian, to clear heart fire, heart phlegm, phlegm fire, and yin deficiency heat, and calm the mind. In cases of extreme heat and/or recalcitrant phlegm fire, adding Ht 8 + Pc 8 can be highly effective. Pc 8, the ying spring point of the pericardium meridian, strongly clears heart fire and calms the mind.
In these uncertain times, it’s critical that as clinicians, we effectively create unique acupuncture protocols for patients suffering from emotional stress or emotional exhaustion. Always keep the heart in mind!
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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