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Beth Conroy Compendium - PTSD - Traditional Chinese Medicine

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PTSDOverview[1]
Definition:PTSDisatypeofanxietydisorderthat'striggeredbyatraumaticevent.Itis asyndromeofresponsestoextremelydisturbing,oftenlifethreateningeventssuchas combat,naturaldisaster,torture,abuse,orrape.Itdevelopswhenyouexperienceor witnessaneventthatcausesintensefear,helplessnessorhorror.
DiagnosticCriteriaforPTSD:

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Thepersonhasbeenexposedtoatraumaticeventinwhichbothofthefollowing werepresent: thepersonexperienced,witnessed,orwasconfrontedwithaneventor eventsthatinvolvedactualorthreateneddeathorseriousinjury,orathreat tothephysicalintegrityofselforothers. Theperson'sresponseinvolvedintensefear,helplessness,orhorror. Note:Inchildren,thismaybeexpressedinsteadbydisorganizedor agitatedbehavior Thetraumaticeventispersistentlyreexperiencedinone(ormore)ofthefollowing ways: Recurrentandintrusivedistressingrecollectionsoftheevent,including images,thoughts,orperceptions.Inyoungchildren,repetitiveplaymay occurinwhichthemesoraspectsofthetraumaareexpressed. Recurrentdistressingdreamsoftheevent.Inchildren,theremaybe frighteningdreamswithoutrecognizablecontent. Actingorfeelingasifthetraumaticeventwererecurring(includesasense ofrelivingtheexperience,illusions,hallucinations,anddissociative flashbackepisodes,includingthosethatoccuronawakeningorwhen intoxicated).Inyoungchildren,traumaspecificreenactmentmayoccur. Intensepsychologicaldistressatexposuretointernalorexternalcuesthat symbolizeorresembleanaspectofthetraumaticevent. Physiologicalreactivityonexposuretointernalorexternalcuesthat symbolizeorresembleanaspectofthetraumaticevent. Persistentavoidanceofstimuliassociatedwiththetraumaandnumbingof generalresponsiveness(notpresentbeforethetrauma),asindicatedbythree(or more)ofthefollowing: Effortstoavoidthoughts,feelings,orconversationsassociatedwiththe trauma Effortstoavoidactivities,places,orpeoplethatarouserecollectionsofthe trauma Inabilitytorecallanimportantaspectofthetrauma Markedlydiminishedinterestorparticipationinsignificantactivities Feelingofdetachmentorestrangementfromothers Restrictedrangeofaffect(e.g.,unabletohavelovingfeelings) Senseofaforeshortenedfuture(e.g.,doesnotexpecttohaveacareer, marriage,children,oranormallifespan) Persistentsymptomsofincreasedarousal(notpresentbeforethetrauma),as indicatedbytwo(ormore)ofthefollowing: Difficultyfallingorstayingasleep Irritabilityoroutburstsofanger

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Beth Conroy Compendium - PTSD - Traditional Chinese Medicine

Difficultyconcentrating Hypervigilance Exaggeratedstartleresponse OtherCommonClinicalSymptoms: Anxiety Depression Insomnia Headache BodyPain Fatigue PoorAppetite Acute:ifdurationofsymptomsislessthan3months Chronic:ifdurationofsymptomsis3monthsormore WithDelayedOnset:ifonsetofsymptomsisatleast6monthsafterthestressor

PTSD:TraditionalChineseMedicine(TCM)
SincePTSDisamodernpsychiatricconceptanditisnotmentionedinanyoftheTCM textbooksreviewed,IhavedecidedtolisttheTCMpatternsanddiagnosesrelatedto anxiety,depression,andinsomniabasedontheSinclairLianstudydiscussedbelow. DuetocomplexnatureofPTSD,theTCMpatternsandtreatmentsdiscussedbelow shouldbeusedusedasastartingpoint.PTSD,likeanyothermodernbiomedical diagnosis,willpresentwithdifferentprimaryandsecondarysymptomsdependingonthe patient'sconstitution,severityoftrauma,anddurationofillness. Anxiety(SharonZhao'sClassNotes20082009): TCM Pattern Symptoms Tongue Pulse Treatment Points Principles Thin White Coat Weak& Nourish Rapid theHT, calmthe spirit, relieve anxiety BL15, CV14, HT7, PC6, GV20

Disturbance Anxiety,fear&fright,heartpalpitation, ofMind irritability,restlessness,dreamdisturbed sleep

HT&SP Fear,worry,anxiety,frightpalpitation, Disharmony insomnia,poormemory,lackof concentration,fatigue,lassitude,poor appetite,palecomplexion

Pale

Weak& Strengthen BL15, Thready theSP, BL17, Nourish BL20, theHT, SP6, TonifyQi, HT7, Calmthe spirit PC6

HT&KD Yindeficiency,emptyfireflaringupward Disharmony Fear,anxiety,tendencytofright,heart palpitation,agitation,irritability,insomnia, dizziness,blurredvision,tinnitus,5palm heat,drymouthandthroat,sorenessof back. Retention ofPhlegm Fluid Heartpalpitation,anxiety,dizziness, fullnessanddistentionofchestand epigastrium,lassitude,coldlimbs,scanty urine,swollenlowerlimbs,thirstbutno desiretodrink,nausea,vomitingfluid.

Red Thready Nourish BL15, without &Rapid yinand BL23, coator clearfire, KD6, thin nourishHT CV14, coat andcalm HT7, thespirit PC6 White& Slippery Warmthe BL15, Slippery &wiry Yang, CV14, coat transform PC6, thefluid CV4, andrelieve CV8 anxiety (moxa), CV9,

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Beth Conroy Compendium - PTSD - Traditional Chinese Medicine

CV9, SP9 Blood Heartpalpitation,anxiety,fearfulthrobbing, Dark Thin, Stasis oppressionsensationandpaininthechest, purplish choppy, Obstructing darkcomplexion,purplishlipsandnails. spots &wiry thevessels MoveQi& blood, dissolve blood stasis, calmspirit BL15, BL17, SP10, HT7, PC6, CV17, LR3

Depression(SharonZhao'sClassNotes20082009): TCM Pattern Symptoms Tongue Pulse Treatment Points Principles Thin White Coat Wiry SootheLR LR3, Qiand BL18, resolve CV12, depression ST36, SP4, CV17, LR14, PC6 DrainLR LR2, Fire, GB sootheLR 43, Qi, GB harmonize 34,TB ST,and 6,PC resolve 6,CV depression 13 LR3, CV17, PC6, HT7,

LRQi Emotionaldepression,tendencytosigh, Stagnation fullnessandpainofchestand hypochondrium,belching,distentionof abdomen,diminishedappetite,vomiting, irregularbowelmovement,irregular menstruation

LRQi Stagnation transform intoFire

LRQiStagnationsymptoms+irritability,dry mouth,bittertaste,sourregurgitation, gnawinghunger,constipation,headache,red eyes,tinnitus.

Red with yellow coat

Rapid, wiry

PhlegmQi Stagnation (PlumPit Qi)

Emotionaldepression,discomfortwithinthe White Slippery Dissolve throatasifthereweresomethingobstructing greasy orwiry phlegm, andblockingthethroatwhichcanneitherbe coat regulate swalloweddownorspitout,fullnessofchest Qi,and andhypochondrium,tendencytosighandbe suspicious.

resolve LU10, depression ST40 Pale with thin white coat Pale Thready Nourish BL15, &wiry theHT, CV14, calmthe PC6, spirit, SP6, resolve LR3, depression GV20 Weak& Strengthen BL15, Thready SP, BL17, nourish BL20, HT,tonify HT7, Qiand SP6, blood ST36 KD3, KD6, SP6, HT7, PC6, GV 20, GB

Depression DuetoQistagnation&Blooddeficiency &Shen Lossofcontroloveremotions,sorrowand Disturbance cryingwithoutreason,irregularjoyoranger, tendtobefrightened,irritability,insomnia, frequentyawning. HT&SP Excessivethinkingandworry,heart Disharmony palpitation,GBtimidity,insomnia,poor memory,palecomplexion,dizziness, lassitude,poorappetite.

KD&HT YinDeficiencyandEmptyFireflaring Disharmony upwards Dizziness,heartpalpitation,insomnia, irritability,easytoanger,soreback,seminal emission,irregularmenstruation.

Red Wiry, Nourish without Thready, Yin,clear coator &Rapid heat, less settleHT coat andclam thespirit

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Beth Conroy Compendium - PTSD - Traditional Chinese Medicine

GB 20, Yin Tang Insomnia(SharonZhao'sClassNotes20082009): TCM Pattern LRFire Flaring Upward Symptoms Dreamdisturbedsleep,irritability,thirst,desire todrink,headache,redeyes,bittertasteof mouth,distendingpainofhypochondrium, scantydarkurine,constipation. Tongue Pulse Treatment Points Principle Red Wiry& DrainLR with Rapid fire, yellow sootheLR coat Qi,calm spirit LR2, GB 41, GB 20, HT7

Phlegm Fire Disturbing theMind

Restlesssleep,tossingandturning,irritability, Sticky Slippery Clearheat, ST dizziness,afeelingofheavyhead,afeelingof yellow &Rapid resolve 40, oppressionofchest,fullnessofepigastrium, coat phlegm, CV nausea,noappetite. harmonize 12, Middle ST Jiao,calm 44, spirit HT7, PC6, ST8

HT&KD Restlessness,wakingupfrequentlyduringthe Red, Thready Nourish BL Disharmony night,difficultyinfallingbacktosleep, nocoat &Rapid Yin,clear 15, palpitation,irritability,dizziness,tinnitus,poor heat,clam BL memory,sorenessofback,seminalemission, 5palmheat,drymouthandthroat. spirit 23, KD3, KD6, PC7, HT7

HT&SP Difficultyfallingasleep,wakeupeasilyduring Disharmony night,lotofdreams,palpitation,poormemory, dizziness,fatigue,lassitude,poorappetite, palecomplexion.

Pale with thin white coat

Weak& Strengthen BL Thready SP, 15, Nourish BL HTblood, 20, clamspirit SP6, HT7 Thready TonifyHT BL &Wiry &GBQi, 15, calmspirit BL 19, GB 40, HT7

Deficiency Insomniawithlotsofdreams,easilywakingin Pale ofHT&GB fright,timidity,heartpalpitation, Qi breathlessness,andtiredness.

PossibleTCMDiagnosticPatternsforPTSDBasedonStudy conductedbySinclairLianEtAl:[2]
Note:PTSDisamodernconceptandthereisnodiagnosticschemainTCM.TheTCM patternsofdisharmonylistedbelowarefromastudythatcomparedpsychiatricdiagnostic criteriaalongwithsignsandsymptomstodeterminepossibleTCMpatterns.Theauthorsofthe studyperformedEnglishTCMtextbookreviewfor"anxiety","depression",and"insomnia", surveyed20experiencedpractitionersofTCM,andreviewedTCMassessmentof21
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Beth Conroy Compendium - PTSD - Traditional Chinese Medicine

individualsaffectedbyPTSDinNewMexico,USA. LiverPatterns HeartPatterns Heart&Kidney Patterns Heart&Spleen

LRQiStagnation HTfire HT(Yin)&KD(Yin) LRoveractingonSP HTYinDeficiency deficiency LRFire HTBlood/Yin Deficiency HTQiDeficiency Heart&GallBladder HT(Qi)&GB(Qi) Deficiency KidneyPatterns Phlegmfluid

HT(Blood)&SP(Qi) Deficiency

QiandBlood Qi&/orBloodStasis QiDeficiency(LUor SP) BloodDeficiency (includingLR)

KDYangorQi PhlegmFire Deficiency PhlegmDamp KDYinDeficiency

MostLikelyTCMPatternsforPTSD: Primary: HeartShenDisturbancecausedbyheat,fire,orconstitutionaldeficiency LiverQiStagnation KidneyDeficiency Secondary: LiveroveractingonSpleen/Stomach(duetolongtermLiverQiStagnation) LiverFire PhlegmFire PhlegmDamp HeartFire ConstitutionaldeficienciesofHeart,Kidney,andSpleenorgansystems TreatmentofPTSDfromtheStudy: CorePointPrescriptionforPTSD: FrontTreatment LR3,PC6,HT7,ST36,SP6,andYinTang BackTreatment GB20,BL(14,15,18,20,21,23) HTpatternswereincludedincoreprescriptionduetoreexperiencingandincreased arousalsymptoms. LRpatternswereincludedsinceLRreflectsPTSDsymptomsofirritabilityandoutburst ofanger,feelingdetached,restrictedrangeofaffect,depression,somaticpain,and digestivedisorders. KDpatternsincludedsinceKidneyistheorganassociatedwithfearandshockin acupuncturetheory. STandSPpointswereincludedtoaddressdigestiveproblems,symptomsof exhaustion,andmetabolicdysfunctionpatterns(Qi,Blood,Phlegm,andDamp).Moving LiverQitooquicklymightcausethepatienttoexperienceemotionaldistressduring treatment.STandSPpointswereincludedtominimizethispossibility. TreatmentofPrimary&SecondaryPatterns: PrimaryPatterns FrontPoints BackPoints

HTShenDisturbance HT7,PC6,YinTang(even) BL14,BL15(even) LRQiStagnation

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LR3,PC6(even)

GB20,BL18(even) BL23
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KDDeficiency

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Beth Conroy Compendium - PTSD - Traditional Chinese Medicine

KDDeficiency Qi&BloodDeficiency ST36,SP6(even)

BL23 BL20,BL21(even)

SecondaryPatterns LRoveractingonSP LRoveractingonST STFire LRFire PhlegmHeat PhlegmDamp HTYin/BloodDeficiency SPQi/YangDeficiency KDYang/QiDeficiency LRYin/BloodDeficiency STYinDeficiency

FrontPoints LR13(tonify)

BackPoints BL18(disperse),BL20(tonify)

LR14(disperse) BL(18,21)(disperse) ST44(disperse) DU14,BL21(disperse) LR2(disperse) DU14,BL18(disperse) ST40(disperse) DU14,BL21(disperse) SP9(disperse) BL20(disperse) HT6(tonify) SP3(tonify) KD7(tonify) LR8(tonify) ST44(tonify) BL(17,15)(tonify) BL(20,23)(tonify) BL(23,52)(tonify) DU14,BL23(tonify) BL(17,18)(tonify) BL21(tonify)

KDYinEssenceDeficiency KD6(tonify)

RecommendedDuration&FrequencyofTreatment:Twiceaweekfor12weeks(thiswill durationandfrequencyalongwiththetreatmentpointsdiscussedabovewillbeusedinthenext stageofthestudy). 1. ^AmericanPsychiatricAssociation.DiagnosticandStatisticalManualofMental Disorders(DSMIV),FourthEdition(TextRevision).Washington,DC:American PsychiatricAssociation,2000. 2. ^SinclairLianN,HollifieldM,etal.DevelopingaTraditionalChineseMedicine DiagnosticStructureforPostTraumaticStressDisorder.JAlternComplementMed. 2006JanFeb12(1):4557

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