I want to discuss an anxiety case who came to me a few months ago, but first it would be good to go through some of the thinking that informs the Chinese medicine approach. Anxiety is an effect about which the causes must be determined through proper diagnosis. We’ll start the discussion by discussing the differences between root and branch treatments and then briefly outline some of the diagnostic parameters that frame the herbal approach to treating anxiety. Finally, I’ll go into the case to further illustrate the utility of these concepts for addressing anxiety.
Root Versus Branch Treatment
Chinese medicine is renowned for treating the underlying causes of conditions as opposed to just the symptoms. This approach is articulated as root versus branch. Anxiety is the branch, i.e., the symptomatic presentation, of an underlying organ imbalance which gives rise to it. Quite simply, it is a matter of cause-and-effect. Anxiety is not one thing. It is the effect that manifests from specific imbalances that are sussed out through Chinese diagnosis. In ideal circumstances, root treatments will eliminate the need for medication of any sort, pharmaceutical or natural, but it depends on whether the cause is nutritional or lifestyle in origin. Often when circumstances dictate, root and branch will be treated simultaneously, with the purpose of eliminating the branch treatment as soon as possible. Root treatments are longer in duration than branch. Once specific variables shown particularly in the pulse and tongue are resolved, then the root treatment is discontinued as well.
Diagnostic Parameters for Anxiety
All treatments in Chinese medicine are governed by organ associations. Anxiety is no different. Imbalances with any given organ or multi-organ relationship can give rise to any manner of disease. The particularity of disease expression depends upon the individual, but to some extent the herbal interventions remain the same. That said, there are certain herbs that take the fore in treating anxiety. We will not be discussing them here, rather a basic fleshing out of the organs affecting anxiety will be introduced along with how they relate to the ensuing treatment strategy. Some herbs that treat the symptoms of anxiety possess essential nutrients, but others are more geared toward regulating organ function.
In Chinese medicine, it can easily be said that there are at least five different causes to any condition. This is because there are five organs (and six bowels) in Chinese anatomy and physiology: heart, liver, lung, spleen, and kidney. We’re keeping it simple here. Each organ is associated with a particular physiological system. For example, the lung naturally enough refers to the respiratory system and the spleen to the digestive system. Any diagnosed imbalance dictates may give rise to anxiety under the right conditions.
The heart rules emotions generally. A heart imbalance may be confirmed either by an erratic pulse, a longitudinal tongue crack, heart or breastplate tenderness upon the touch, or some combination thereof. Liver governs blood quality and thus hormones. Liver imbalance is expressed by a wiry pulse, a sullen demeanor, neck pain specific to the third cervical, and tenderness upon the touch. Lung and spleen imbalance may often appear in the form of phlegm. The lung occupies the upper region of the torso along with the heart. Lung imbalance therefore can spread to an otherwise healthy heart. A week spleen can transmit phlegm to the heart and lung giving rise to symptoms of anxiety. The kidney is the organ of shock (惊)， which can be analogous to trauma according to Japanese acupuncturist Master Matsumoto Kiiko. Kidney imbalance will manifest in the form of metabolic deficiency, a slow pulse, subjective coldness, or water accumulation in the legs.
Every practitioner has preferences into which he likes to pigeonhole his cases. Alas, though I endeavor not to, I’m in the same boat. Aside from addressing nutritional deficiencies, particularly boron and iodine, addressing kidney deficiency is a concerted focus of mine. That is to say, a clear case of cold, slow pulse, and metabolic deficiency will function as a cornerstone of my treatment approach because a cold body is incapably of carrying out basic metabolic function. This will have wide-ranging effect upon the body as a whole. It is not uncommon that a patient is unaware of any of these factors. The prevailing approach of most modern medicine is toward quelling fire at the expense of the patient’s specifics. I do not presume that this treatment approach is in itself wrong, but since it is rare that I am the first doctor consulted on internal matters since it is reasonable to deduce that special attention should be paid to this matter. Let’s now proceed to the case.
Anxiety Case: East Coast Transfer to Los Angeles
Beowulf is an early 30 something transplant from the East Coast with anxiety. He had been receiving community acupuncture there with positive results. Symptoms appeared after his work had sent him abroad into areas affected by war. His treatments on the East coast were able to control his symptoms and he wanted to maintain the results.
Upon diagnosis, two factors stood out, a very slow pulse and excessive sweat on the hands and feet. He also reported feeling very thirsty, even though he drank a good deal of water. In addition to acupuncture, I prescribed fire water. He was instructed to drink as much fire water as he pleased but to completely stop drinking plain water. He instantly felt more balanced in terms of anxiety. After one month on the fire water his thirstiness abated. After five months on fire water his pulse-rate normalized.
He did not feel that the sweating was a problem. Excessive sweating, however, depletes the body of the essential fluids it needs to function properly. Deficient fluids could lead to more serious problems in the future, so all subsequent acupuncture treatments have been directed toward balancing the nervous system imbalance which is causing excessive sweat. This matter has improved by about 70%. Herbal treatment have primarily been directed toward balancing liver function. Formulas have been selected based on positive muscle-test results which are cross-referenced in the Chinese medical literature, usually in Chinese. After five months his response to herbs have changed from a focus on the liver to now the heart. One of the key herbs is haw, which has a strong reputation in Western herbalism for addressing heart conditions and possessing anti-anxiety properties. In Chinese medicine haw has a strong function on the digestion of lipids and regulating the liver. Thus, treatment of the liver is on-going but the focus has shifted. It is an ongoing case. We’ve not only been able to knock out the principle branch symptom but have also been simultaneously directing attention to the root imbalances that will prevent a future recurrence, while heading future more serious conditions off at the pass. As we’ve progressed, three organs have been at the root: initially the kidney with fire water for 5 months; second, was the liver with two stock formulas known to affect anxiety and depression for three months; and most recently the heart with a formula containing haw among 10 other herbs.
I discussed an anxiety case to illustrate the thinking process behind Chinese medicine’s diagnostics and treatment strategies. A distinction was drawn between branch and root treatments. Any organ pathology has the potential to manifest as anxiety. Sometimes more than one organ or organ-to-organ relationship is involved. In the case of Beowulf, the branch was never addressed, rather attention was directed toward first eliminating cold as evinced by the pulse. The next aspect of imbalance was the liver, a determination derived through muscle-testing and corroborated in the literature. The same could be said for the heart, though the latest formula could plausibly be considered to work upon the heart-liver relationship. Root treatments are slower than branch treatments, which are mostly geared to suppressing symptoms. It is not uncommon for the root focus to shift as one layer peels away revealing another that commands attention. At each interval, the body should elicit clear signs indicating progress is being made.