Anxiety and Chinese Medicine: Zang­Fu and Channel Pathologies

Emotions are part of the essential human experience, from love to fear, anger to pensiveness. But oftentimes emotions become pathological, lingering or triggering long after the original stimulus has disappeared. Fear and anxiety can be seen in such a relationship. Anxiety differs from fear in that fear is a normal emotional response to a particular stimulus or situation. Anxiety, however, is the response that carries over and perpetuates. For example, a woman who gets attacked in an evening parking lot will have the appropriate response of fear. But that same woman who, thereon, fears every parking lot she sees, lives in a state of anxiety. And as there are an entire spectrum of people, personalities, and life situations, there are also a wide variety of anxiety patterns, and therefore treatments, in Chinese Medicine.

As anxiety, fundamentally, originates with fear, the Kidney would be involved. Furthermore, the Heart­Mind, which experiences fear, and is also always involved in cases of anxiety. So Heart and Kidney Disharmony can be seen as one of the classic anxiety disorders in Chinese Medicine. When one experiences chronic fear, the Kidneys are depleted. As a result, Kidney Water cannot control Heart Yin, and deficient fire flares as a result. Acupuncture treatments of this pattern would definitely include K­6 and H­7 to nourish the Heart Yin and Kidney Yin. Additionally, one could use points like K­2 to remove deficient heat from the Kidney channel (which connects to the Heart organ) or, even better, K­1 to remove heat and ground the Qi. The classic herb formula, Tian Wan Bu Xin Dan, which has the great Kidney Yin tonic, Tian Men Dong, would be ideal.

One pattern of anxiety which, according to Giovanni Maciocia, has both an excess and deficient classification is “Rebellious Qi of the Chong Mai Vessel”. According to Maciocia, the symptoms of this disorder are: cold feet, abdominal fullness of the hypogastric as well as the umbilical and epigastric regions, tightness below the xiphoid

process, chest tightness, palpitations, breast distention, trouble breating, sighing, a feeling of a lump in the throat and a feeling a heat in the face. While the Chong Mai Vessel originates in the uterus, and its first point is REN­1, it has a branch that reaches the medial aspect of the foot, around Spleen­4, thus giving the symptoms of cold feet. The remaining symptoms, from abdominal fullness to a feeling of heat in the face, all occur along the Chong Mai’s traditional pathway. According to Maciocia, there is both an excess version of Chong Mai rebelling as well as a deficient pattern. In excess cases, emotional extremes can actually cause rebelling up the Chong Mai’s pathway. In these cases, one might be able to better explain the excess nature of the channel pattern with a coinciding zang­fu pattern, such as liver excess. Additional excess patterns are phlegm obstructing the Chong Mai, and blood stasis in the Chong Mai. The deficient pattern is one explained by Li Shi Zhen in “An Exposition on the Eight Extraordinary Vessels: Acupuncture, Alchemy and Herbal Medicine.” According to his text, when blood is deficient qi can rebel up the Chong Mai. Therefore, the heat experienced in the face is deficient in it’s nature. One rather interesting facet of Chong­Mai Rebellion is that the Chong Mai, according to Ron Teeguarden’s book The Ancient Wisdom of Chinese Tonic Herbs,“The Penetrating Vessel is one of the energy channels that regulate the functions of the body­mind. This vessel is blocked, resulting in a de­linking of our sexual energy and our emotional feelings. It is essential for our true health and well being that feelings of love and the functions of sexual are united.” Indeed, the Chong Mai has a branch that enters the Kidneys and the Heart, which are also the primary organs of expressing fear (kidneys) to the mind (heart).

From one viewpoint, the reason anxiety is experienced in a Chong Mai Rebelling pathology is that the lower Dantian experiences a loss of Qi, thus giving the sensation of un­rootedness. Following this Qi escapes and rises up to the heart, disturbing it. Finally, the pathological Qi rises into the head, where it is experienced as anxiety. However, from a deeper and more causal viewpoint, some Qigong systems (and especially internal alchemy neidangong, like Kan and Li) refer to the Chong Mai as the “core channel”. The core channel, simply put, is the residence our innermost self exists. In the


East, this innermost self is sometimes referred to as the “Big Mind” (in Zen traditions) and in the West is called the “Inner Witness”. When one’s innermost self experiences a deep unrootedness, Qi cannot reside in the lower Dantian, and the result is that the inner witness experiences the world through the head, where it foolishly attempts to seek “grounding” through analysis and reason.

Treatment strategies for Chong­Mai pathologies include both acupuncture and herbal medicine. Spleen­4 is the Confluent Point of the Chong Mai, and in both excess and deficient patterns of the pathology it should be needled. The most popular selection method chosen for it is on the left foot in men, and right foot in women. In excess cases, one can also needle Pericardium­6 on the opposite side (right in men, left in women.) Points along the Chong Mai pathway are: Ren­1, Stomach­30, Kidney 11­21, and Ren­7. One may choose the points based on any feelings of discomfort experienced in that area; if umbilical distention predominates, one may choose to needle Kidney­16. If discomfort is experienced around the xiphoid, one may consider needling Kidney­21. According to Leon Hammer, some ancient and family traditions advocate needling the Confluent and Coupled points first, followed by the points along the pathway and no additional points from other channels are used. Herbal treatments can also be used. In excess cases, according to Li Shi Zhen, several herbs can be used to treat rebelling in the Chong Mai, such as Tao Ren.
In deficient cases, Gui Ban, which strongly tonfies Yin (and thus the relating Ren Meridian) can be used. Additionally, Li Shi Zhen states that “when there is Blood deficiency leading to internal urgency, use dang gui”. This would tonify blood which should root the Qi and prevent it from leaking upwards. But perhaps no herb would be better than Zi He Che, a powerful blood and essence tonic, which nourishes “Humanity” in the system of Heaven (Du Channel and Lu Rong), Earth (Ren Channel and Gui Ban) and Humanity (Chong Channel and Zi He Che.)

In cases of anxiety due to timidity and shyness, and especially when one has difficulty making decisions, one would look at a Heart­Gallbladder Deficient pattern of anxiety. When the Liver’s planning function does not carry over into decisive action, the

gallbladder is deficient, manifesting as a lack of courage. In the five element generating cycle, wood generates fire. If one lacks courage, the Heart’s shen cannot carry out whatever decision the liver is planning. So, in a five element perspective, wood isn’t exactly deficient­­but rather the ability of wood to generate fire is lacking. As a result, the treatment strategy one would use would not be the 4­Needle technique. Afterall, the mother isn’t entirely deficient, only the gallbladder. Maciocia uses an acupuncture treatment emphasizing Gall Bladder­40, the Yuan Source point of the Gall ­Bladder. According to Maciocia, it specifically stimulates the “psychic” aspect of the Gall­Bladder’s function, namely decisiveness and courage. Additional points are Heart­7, the Yuan Source point of the Heart, Heart 5, Urinary­Bladder­15 (Back Shu of the Heart) and Ren­14 (Front Mu of the Heart). Additional points worth considering would be Gall­Bladder 34 and 24, which are the He­Sea and Front­Mu points of the Gall­Bladder, respectively. Finally, one might consider the outer Bladder line, as it helps treat Shen disorders, and here UB­44 and UB­48 could be helpful. An herbal formula one might consider using is Wen Dan Tang (Warm the Gall­Bladder Decoction), which is specific to tonifying the gallbladder.

Quite a common deficient pattern is Heart­Blood Deficiency, especially in women who are so often blood deficient. Blood is the material basis, or foundation, of Shen. Therefore, one’s symptoms of anxiety would be worse in the evenings since Qi cannot go inward to be housed. Additionally, the hallmark sign of this form of anxiety would be poor memory and concentration, along with palpitations. Other signs would be pale face, light­headedness, inability to fall asleep, and pale face. The tongue would be pale in color and the body would be thin, and the pulse should also be thin, especially on the left (blood) side. Oftentimes, this pattern would be combined with others: Spleen Qi Deficiency and Liver Blood Deficiency. Afterall, in order for Heart­Blood to become deficient, other organs might be involved. The Spleen Qi/Heart Blood Deficient pattern would be caused by weak Spleen Qi not transforming Gu Qi into Ying and Wei. If one does not extract Ying from food, the Heart cannot transform it into blood. Another way Heart Blood becomes deficient is due to the mother/son relationship of Liver and Heart.

When Liver Blood is deficient, Heart Blood can suffer as well, as part of a larger pattern of overall Blood Xu. With regard to the first sub­pattern, the treatment principle would be to tonify Spleen Qi and Heart Blood. Points to use would be St­36, Ht­7, Sp­3, Sp­6, UB­15, UB­20, UB21, and Ren­14 and any additional points such as Yintang, Du­20, Ren­17 or P­6. Perhaps the ideal formula to use would be Giu Pi Tan, with its excellent Spleen Qi tonifying herbs such as Bai Zhu and Ren Shen (or Dang Shen) Fu Ling, Huang Qi and excellent Heart­Blood tonics like Suan Zao Ren and Long Yan Rou. Regarding the second pattern of Liver and Heart Blood Deficiency, particular points of use would be: St­36, Ht­7, Lv­8, Lv­3, UB­15, UB­17, UB­18, as well as any additional points to calm shen, such as Yintang or Du­20. Particular herbs would be Shu Di Huang, Gou Qi Zi, He Shou Wu, and Dang Gui to nourish Liver Blood, and Suan Zao Ren and Long Yan Rou to tonify Heart Blood.

Anxiety presents itself with many different patterns, and, thus, many different treatments. But one overarching characteristic is how the Heart is always involved, regardless of differentiation, whether it be a Zang­Fu pattern such as Gall­Bladder/Heart Qi Deficiency or a channel pattern such as Chong Mai Disharmony. Here, though, the true power of the Heart is seen: While an Emperor can experience disorder in one of his provinces, it can also rouse that Emperor to action. He can then correct the underlying problem. Perhaps in that light, anxiety can be seen as a blessing. For without it’s manifesting characteristics, something truly disasterous could come about, giving one something to truly worry about.