This case study demonstrates not only a very successful traditional Chinese medicine (TCM) treatment result for stress reaction and anxiety disorder, but also confirms the positive impact of TCM in stopping reliance on habit-forming sedative-hypnotic drugs such as Xanax. The diagnosis procedure and the treatments are based on the mental energy, i.e., shen qi, theory, which includes four components: ben shen acupuncture, ben shen herbology, ben shen psychotherapy, and ben shen preservation.
Presentation / History / Initial Evaluation
A 55-year-old female presented with a high level of anxiety and stress as the chief complaint. Within the past year, the patient experienced stressful life events including the suicide of a friend and a deteriorating marital relationship. The patient came to Emperor’s College acupuncture clinic on Sept. 10th, 2022, seeking treatment for emotional support.
Her chief complaint was feeling overwhelmed and excessively worried and fearful. Secondary complaints included urinary urgency, frequency, pain during urination, and white vaginal discharge. Her breathing inclined to be shallow, especially when she was anxious. Her bowel movements were usually once a day, but when she felt anxious, they could increase to 2-3 times a day, or she developed constipation. Her dietary choices comprised of starting the day with juicing fruit or cold fruit smoothies for breakfast.
Review of systems was unremarkable except for occasional insomnia, which caused the patient to wake up around 3 a.m. She reported increased insomnia for the past 2-3 nights due to increased urination at night. Her energy level was moderate (5/10). She reported “feeling overwhelmed, and excessively worried about her physical and emotional health,” as well as anxiety and a sense of helplessness during stressful situations.
During her intake, the patient had an emotional reaction, becoming teary-eyed with a sad facial expression. She was uncomfortable, with tense muscles when she was expressing her marital problems. Although she and her spouse were not divorced, they were living separately in two separate bedrooms.
She mentioned that she walked in nature with her dog, practiced yoga, and meditated when she felt anxious and overwhelmed. Besides her physician, she had not consulted a psychiatrist or psychotherapist. The patient preferred psycho-emotional support through holistic medicine and acupuncture, yet she had underlying irritability and exhibited sensory hypersensitivity. She mentioned that “her body is extremely sensitive and she’s worried that the pain from needles would keep her awake for many nights.”
Upon palpation, her lateral hips and thighs were tender to touch along the iliotibial ligament (on the gallbladder channel). (We assured her that we would minimize her pain / discomfort by using the sedating acupuncture techniques.) The patient experienced menopause five years ago, when she was 50. Her complexion was pale and she generally had borborygmus sounds during her treatments.
Despite urinary difficulties, she did not intend to take the antibiotic her doctor had prescribed to preserve her body’s natural microbiome. The patient’s past medical history includes a case of shingles last summer; mild, but persistent aching back pain (1/10); and a history of chronic anxiety and excessive worries.
The patient’s medications and supplements included: Xanax / alprazolam* (sedative-hypnotic: benzodiazepine-schedule IV, a CNS depressor to treat anxiety and panic attack disorders)1; gabapentin 200 mg per night (GABAergic agent, an anti-convulsant to decrease abnormal excitement in the brain and relieve the pain of postherpetic neuralgia /PHN);2 magnesium citrate3 (laxative, vasodilator, with anti-anxiety effects); 5HTP 150 mg/night (5-hydroxytryptophan - precursor of serotonin); estradiol transdermal patches (0.5 microgram 2x/week); progesterone (100 mg); ashwagandha; melatonin 3g/night; and amoxicillin (which she later took for one week).
*It is important to note that Xanax / alprazolam has a potential side effect of drug dependency, memory impairment and reduced libido. Xanax may also cause physical dependence; sudden withdrawal may cause symptoms including worsening anxiety.2
TCM Case Analysis
1. Mental Evaluation: There are three levels of mental energy diagnosis according to the model. The first level is yin yang and dian kuang diagnosis; the second level is mental energy of shen qi patterns; and the third level is five shen diagnosis. Here are the three levels of this patient’s diagnosis with simple analysis.
2. Physical Diagnosis: Due to her chief complaint, the patient undoubtedly has mental energy disharmony. Because of commonly encountered signs and symptoms, shen is generally manifesting as physical weaknesses. Therefore, based on the patient’s daily lifestyle, exercise patterns, and the zang fu organ evaluation, her physical diagnoses are spleen and kidney qi deficiencies, moderate lung qi deficiency, and lower burner damp stagnation.
3. Treatment Principles: For mental energy: stabilize shen qi and sooth the shen qi; anchor heart shen. For physical energy: support the qi and transform the lower burner dampness.
4. Acupuncture Points:
Note: Following her acupuncture treatment, she was also taught about deep Dan Tien breathing to prevent shallow breathing at the time of anxiety. We utilized deep breathing to calm down feelings of anxiousness.)
5. Psychological Care: Based on the ben shen psychotherapy principle, we had a gentle and flexible communication style with her. Our dialogues involved more listening to her complaints with empathy (listening is healing). The patient has had a stressful life and relationship in the past and especially recently, so the so-called “emotional knot” has been developing in her deep consciousness, as in an organ shen level, so, the open-ended dialogues ought to be used in the beginning and for the next several sessions.
6. Life Coaching: Following the TCM ben shen preservation principle, we have recommended that she try more psychical and outdoor activities, connect with nature, enjoy the relationship with her friends, and engage in other social circles.
Case Analysis
This case demonstrates the positive impact of acupuncture treatment for psycho-emotional issues. Studies have shown that acupuncture can naturally open GABA-receptors in the brain, effectively calming anxiety disorders and an overactive brain, reducing the need for addictive drugs such as Xanax.4
The treatment we applied for this case study included four major modalities, ben shen acupuncture, ben shen herbology, ben shen psychotherapy and ben shen preservation, all applied together. Even with very minimal herbs, her case is improving faster than expected.
After receiving eight acupuncture treatments, the patient had a significant improvement in her psycho-emotional anxiety and stress levels. Her experience of anxiety changed from “being extremely overwhelmed” to “feeling happy and excited.” After the first acupuncture treatment, the patient gave up using gabapentin. After the fourth treatment she discontinued the use of Xanax, as her anxiety and panic disorders had already diminished.
In addition, with reduced anxiety levels, the patient’s sensory overload also diminished. She shifted from feeling “overly sensitive and overwhelmed” to open, relaxed, and receptive to acupuncture needles with deep-breathing techniques. Even when she becomes anxious, the patient can now manage her symptoms and release her emotions.
We will continue to monitor the patient to prevent the potential relapse of underlying anxiety conditions, withdrawal symptoms, and hypersensitivity in the next few sessions. She may still have some symptoms if some events trigger emerging emotions and increase the stress level; yet overall, with her healthy coping style and our support, we are confident the patient will maintain her recovery.
References
Governor Gavin Newsom has retracted the proposed budget cuts to the Medi-Cal acupuncture program for low-income Californians for the 2024-2025 budget year. This decision marks a significant victory for health care providers and advocates who have long championed acupuncture as a vital component of comprehensive medical care.
There’s no doubt that many of your patients visit your practice because they are in pain. And there’s certainly no doubt that curcumin from turmeric (Curcuma longa) can be incredibly effective in stopping that pain, whether due to chronic conditions like arthritis or acute pain from intensive workouts. But your patients may also benefit from curcumin for other reasons.
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Fair and appropriate wages in health care are typically based on economic evaluations. A simple literature review illuminates that acupuncture is missing economic evaluations; which implies you are either underpaid or overpaid. The complexity of services provided by most American acupuncturists, which they are trained and certified to provide, must be reimbursed fairly.
