Anxiety and Acupuncture in the Age of COVID - An Acupuncturist’s Perspective

August 10, 2020

I am still pinching myself over the fact that I am working right now (during a pandemic no less!). It’s been roughly two months since I have returned to work and I am still in awe over the fact that we have been able to keep things moving at almost pre-pandemic levels, despite small changes to the daily treatment routine. (Don’t get me wrong! I am thankful everyday for the fact that I can operate and see each and every one of you at the clinic - even though I have to wear an outfit that makes me look like an extra playing a CDC scientist in a zombie / alien attack apocalypse movie as seen below!) 

 

 

During my two months back at work, I have made a really interesting observation of almost all the conditions that I have been treating: and that is, most (if not all) of the conditions that I have worked on, no matter how unrelated each of them may seem to each other, stem from your everyday, standard anxiety!

 

Anxiety is often described in TCM theory as “over-worry” or “over-thinking”. There is a sense of urgency to it and I have noticed that people talk about their anxieties as being something that needs instant resolution. We usually target a few key meridians when treating anxiety: The Spleen, Heart and Liver Meridians. And it occurred to me that no matter what condition I was treating during these last eight weeks back, in almost 90% of my treatments, I was often using acupoints on any combination of (or all three of these meridians) in most of my acupuncture treatments. 

 

Now I’m sure that for many of you, you’re probably wondering why I’m even addressing this because some of you have had relatively good success with acupuncture for anxiety in the past. True. I know this. However, when I got back to the clinic, for some stubborn reason, my brain went straight to TCM analysis mode and started to automatically categorize each condition I saw as a specific TCM syndrome and didn’t put the common denominator together in my diagnosis and treatments - anxiety. 

 

 

Though the TCM syndrome approach to diagnosis and treatment was working just fine, it was only “just fine”. Not excellent like it usually was in pre-pandemic lockdown times. At the end of the second week back I hit upon a realization that most of the patients I was seeing all shared symptoms that sounded very much like plain old, ordinary anxiety. The minute I tweaked my treatment focus on underlying anxiety, I noticed how quickly people responded and how much faster they bounced back.   

 

In the TCM world, we talk a lot about disharmonies. When it relates to stress, the Liver and the Spleen usually come up in diagnosis in an average of almost 80% of the cases that I have seen. The syndrome is usually defined as a Liver and Spleen Disharmony. As an analogy to what this means, this looks like two housemates (let’s call them Liver and Spleen) living together in a tiny apartment during lockdown. At some point, with restricted abilities to move freely outside the apartment, feeling stuck working at a shared makeshift kitchenette “desk” and having to see each other everyday in the same space, there’s bound to be some friction and disharmony. 

 

What Liver and Spleen Disharmony feels like in the body is a sense of unease with the state of a person’s surroundings, anxiety and worry that tends to overrun a person’s usual train of thought, and the occasional burst of unexpected irritation and impatience. In short, the two housemates in this analogy will more likely be at loggerheads with each other than is usual. And for most of the patients that I have treated at the clinic, this was essentially what was happening - not just in their personal living (and now also home-based working) spaces but, it was also happening within their bodies as a direct reflection of their immediate surroundings. 

 

Liver is often described as “overacting” on Spleen. In times of perceived threat and stress in the environment, the Liver tends to get stagnant or basically, “stuck” in a never-ending cycle of frustration, irritation and what I usually perceive as “submerged, chronic state anger”. It’s a kind of anger that I can only describe as the type that arises when a person is forced to do things counter to how they would otherwise prefer but they cannot safely express this. You will see in patients with a lot of stagnant Liver qi or energy, a tendency to feel frustrated and impatient until they suddenly explode. 

 

 

Spleen is seen in TCM theory as the seat of the emotion of “over-worry” or “over-thinking”. What I see in patients with Spleen syndrome issues is often what they describe as “over-analysis paralysis” or, the paralyzing worry about unforeseeable future events. 

 

Put the two syndromes together and you get a better idea of how the disharmonies stemming from the interruptions of healthy, flowing Spleen and Liver qi arise. In the majority of my patients, I saw very much nothing other than shades and variations of the degree of intensity of Liver and Spleen Disharmonies that sat at the heart of all the different conditions that people booked their treatments for. 

 

A lot of them were going through a tough and unexpected time at home with their families or their closely crammed housemates. It doesn’t take a lot of imagination to see how anxiety can result from the home base when we are suddenly expected to fit our previously externalized work and social lives into the narrow confines of the home unit. Add to this, the trying effects of navigating through unforeseen circumstances that come up during a lockdown: from having to set up a remote office in a living room or kitchen, assuming the additional role of teacher for suddenly remote-schooled children, and/or for some of us that could not work even remotely, trying to just keep our heads above water without income; all of these situations were the perfect precursors to anxiety and the clinical conditions that I saw in practice that stemmed from it.  

 

 

Without a roadmap for the future during these trying times, Liver and Spleen Disharmonies were showing up as all sorts of seemingly random and unrelated conditions that people came in seeking acupuncture for, ranging from: acne and skin lesions (which I admit myself, I was also experiencing), to GI tract disruptions (like acid reflux, IBS symptoms, indigestion, distension and bloating after meals etc), to worsening PMS, hormone fluctuations during a woman’s cycle or very painful periods, to migraines and body pains that did not easily correspond to a cause such as physical injury or an underlying medical condition (like arthritis), and the list goes on. 

 

On reading this list, you may get the impression that I just selected at random, any kind of disorder. But when you think of it at a human level, how many times were you affected by having to stuff in an anger response to a situation where you know you couldn’t change a negative situation and which resulted in digestive ailments, emotionally disruptive PMS, heavier than normal periods, angry acne lesions or outbreaks and such? The human body can only communicate its state of discomfort with physical manifestations. These act as physical red flags to a person’s state of mental health and it is challenging to see how unexpressed frustration cannot negatively impact a person’s nervous system, resulting in physical health disruptions. 

 

Now mental health (plus a healthily functioning nervous system) and the involvement of the Heart Meridian was largely left out of the discussion until now. Liver and Spleen disharmonies are but one facet of the larger health issue of anxiety. It takes Heart syndromes to form one more essential piece of the complex picture of what it means to be human and to experience anxiety.    

 

Liver, Spleen and Heart Disharmonies coalesce together to form a clearer picture of what generally happens in the real world to the human body (and mind). It’s rare to find a clear cut and pure Liver, Spleen or Heart syndrome and in most cases that I see clinically, its always some mixture of all these conditions that come up and that need to be considered before a treatment plan (that addresses the restoration of the healthy collaboration of body and mind) can be administered.   

 

The Heart is usually the meridian that I select (sometimes alongside its companion meridian on the Pericardium Channel) when it comes to treating emotional and mental issues. 

 

 

Basically, in addition to Liver and Spleen disorders, I was also seeing what we Acupuncturists usually diagnose as Heart Meridian related conditions like: insomnia (either of the type where its hard to fall asleep or where you wake up a lot at night), vivid and emotionally volatile dreams, anxiety at bedtime, stress related compensation behaviours (such as overeating, binge eating, perfectionism, episodes of panic, and yes, even what people refer to as “doomscrolling”) and physical manifestations of anxiety (like racing heart rate, extreme fatigue, shortness of breath, digestive or bowel related disorders).  

 

They sound an awful lot like mental and emotional health issues don’t they? 

 

Heart is seen as the mind in TCM theory. A sound mind is required for a sound body. If the Heart (or the mind) is not intact, gets disturbed by external events or agitated by emotional upsets, then the body’s normal regulatory functions get derailed. The physical body basically exists in harmony with the mind and the natural extensions of the mind - usually found in the healthy functioning of the nervous system. If the Heart is battered by the perception of the loss of control in the immediate, external environment, the nervous system will sound the alarm and start to funnel all of its energies into getting the body prepared to either fight, take flight or hide from danger. 

 

Now we all know that lockdown was not an immediate physical threat to our well being. But our nervous systems are wired like our caveman ancestors. It doesn’t understand this distinction and we tend to react emotionally to anything that disrupts, even though our common sense, academic brains know that the threat does not endanger us. When the sympathetic nervous system reacts to perceived danger, the physical body tends to automatically and instinctively respond with typical reactions like loosening of the bowels (our bodies empty the bowels in case of evisceration from predators to prevent gut related infections from full bowels at the time of injury) or rapid heart rate and increased blood pressure (a more vigorously beating heart muscle raises the pressure so that blood can be more effectively pumped to muscles that can enable a person to escape from danger). 

 

This explains why I saw so many patients coming in with physical symptoms like unexplained rapid heart rate (or what a lot described as “fluttering heart”), really tense and tight muscles (usually of the neck and shoulders) despite not doing a lot of physically intense workouts, panic and overwhelming anxiety at bedtime, or nightmares and waking up at night. Though these all look like completely different conditions, all share anxiety and the overstimulation of an already taxed sympathetic nervous system as their common cause. 

 

Anxiety is a feeling of “being out of control”. Control was something that we all thought we had in the pre-pandemic world. Once we realized about two weeks into lockdown, that we had absolutely no control over anything in our lives, everyone’s problems prior to lockdown amplified. And it was the simple act of stopping everything that made us each realize just how attached we all were to routines that were predictable and knowable (even if they were stressful to begin with and ate up our self care time). 

 

Not knowing what lay ahead of us just overloaded our nervous systems and rang the body’s alerts for impending danger, resulting in conditions like panic, nighttime anxiety and shortness of breath. Being stuffed all together into what we usually saw as the home sanctuary and an escape from our daily work and social routines, compounded by the overly alert sympathetic response to danger, resulted in stuffed in simmering anger, followed by sudden emotional eruptions and sometimes, even analysis paralysis. 

 

 

What I have learned from all of this upheaval and upset in the daily routines of our lives is that we need to have a good hard look at and to really take the time to prioritize what is truly important and essential in our lives. I usually leave and close an article about acupuncture with something about seeing someone for an acupuncture treatment because of how well it works. 

 

But given that the world has been forced to look at itself and our collective places in it, I wish to close with these two observations and learnings that I have been humbled with. It is: that we have lost touch with our own biological rhythms and have been trying to work within artificial and socially constructed, pre-pandemic schedules that sometimes clash with what our bodies and minds really need and, that we are actually incredibly resilient as human beings. Despite what is thrown at us and the despair or upset that pandemic restrictions may have placed on us, our family units or social circles, we have found ways to find our natural rhythms again because we have had all our usual distractions taken away from us. And we had to once again, learn to rely on what our bodies and minds are really messaging us with. Acupuncture has demonstrated that resilience to me and I hope that it impresses on you, the reader, an unshakeable faith in the innate intelligence of the human body to weather the storms that can come up in life. 

 

 

Until next time, thank you for taking the time to read this and I wish you good, sound mental, physical and emotional strength and health. 

 

   

 

 

 

 

 

 

 

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© 2017 by Daryl Fang. R.Ac. B.App.Sci. B.A.

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