Anxiety and Thinking (Shan You Si)

Refers to a tendency to worry and continuous or excessive thinking. Worry and anxiety, preoccupation and obsessional thinking are the key symptoms
of this disorder

Diagnosis: 
A. Moody, requent emotional changes
B. Improper emotional expression
C. Long-term emotional stimulant and stressor
D. Acute emotional outburst
Should have any one of the above

Prognosis: 
In almost all cases of this disorder will get better after the factors or stressors have been relieved. Exempting the emotional change as a preliminary
sign for some severe Shen disturbance disease, in general this disease can be treated and cured in a scheduled treatment plan including Shen
treatment techniques.

Differential Diagnosis: 
Medical Disorders: 
1. Infection or injury of CNS
2. Tourette’s disorder
3. Neurologic disorders including tourettes, parkinson’s disease, and huntington’s disease
4. History of traumatic brain injury
5. History of cerebrovascular accident (CVA)

Psychiatric Disorders: 
1. Obsessive-compulsive disorder (OCD)
2. Obsessive-compulsive personality disorder
3. Schizophrenia, catatonic subtype, and other psychotic disorders
4. Major depressive episode
5. Specific phobias
6. Social phobias

TCM Etiology and Pathogenesis: 

Thinking is the “affect” or mental-emotional sensation or event associated with the spleen. Therefore, on the one hand over-thinking damages the
spleen. According to the Nei Jing, thinking causes the Qi to bind. This binding inhibits the spleen’s Qi mechanism, hindering and obstructing its
upbearing of the clear.

TCM Pattern Differentiation: 

Spleen and Stomach Qi Vacuity1 
Overthinking all the time, no appetite, bloated abdomen ater eating a small amount of food, low energy and tired quickly, feeling sleepy but difficulty
falling asleep, waking up frequently at night, loose stool, diarrhea, dizziness, vertigo, very heavy/weak feeling in extremities 
Tongue: Pale, very thin coat
Pulse: deep, weak
Acupuncture Treatment: SP-3, SP-6, ST-25, ST-40, ST-42, CV-6, CV-11, GB-8, GV-20 
Herbal Treatment: [Huang Qi, Ren Shen, Bai Zhu, Cang Zhu, Chai Hu, Fu Shen, Yuan Zhi, Xian Ling Pi, Da Zao, Gan Cao] 

Liver-Spleen Disharmony1,2 
Persistent anxiety and preoccupation, prone to obsession, moodiness, vexation, irritability, suspiscious, chest oppression, breast/rib-side distention,
poor appetite, loose stools, possible painful diarrhea, insomnia, menstrual irregularities and PMS 
Tongue: pale, fat, may also be somewhat dark or dull in color
Pulse: Bowstring
Treatment Principles: Course the Liver and rectify the Qi, fortify the spleen and boost the Qi
Acupuncture Treatment:
-LR-14, LR-3, LR-13, SP-4, ST-36. Even technique 1
-LR-3, LR-6, CV-12, ST-8, ST-25, ST-36, ST-40, SP-4, SP-13, Yintang 2
Herbal Treatment: 
-Si Ni San Jia Wei1 -[Chai Hu (10g.), Bai Shao (10g.)+Bo He (6g.), Lu O Mei (3g.), Mei Gua Hua (6g.), Xiang Fu (6-10g.), Bai Zhu (10g.), Dang Shen
(10g.), Gan Cao (6g.)]1
-[Chai Hu, Chuan Xiong, Mu Xiang, Sha Ren, Dang Shen, Bai Zhu, Fu Ling, Gan Cao, Xiang Fu, Zhi Ke, Su Gen]2

Heart-Spleen Dual Vacuity1,2 

Persistent anxiety and preoccupation, obsessional thinking, poor memory, no concentration, shortness of breath, disinclination to talk, lassitude of the
spirit, heart palpitations, insomnia, waking up frequently, anxiety dreams at night, sensitive to sounds, lights and emotional stimulants, torpid intake,
loose stools, sallow yellow or pale white facial complexion, pale lips and nails
Tongue: pale fat tongue, thin coat
Pulse: fine, weak, deep
Treatment Principles: Fortify the spleen and boost Qi, nourish the heart and relieve anxiety
Acupuncture Treatment:
-BL-15, BL-20, SP-4, SP-6, GV-20. Tonification technique1
-HT-3, JT-7, SP-3, SP-6, CV-6, CV-11, CV-14, CV-17, GV-202
Herbal Treatment: 
-Gui Pi Tang Jia Jian1 - [Bai Zhu (10g.), Fu Shen (10g.), Huang Qi (10-15g.), Suan Zao Ren (12g.), Yuan Zhi (6-10g.), Mu Xiang (6-10g.), Dang Gui
(10g.), Dang Shen (10g.), Yu Jin (10g.)]1
-[Ren Shen, Huang Qi, Bai Zhu, Dang Gui, Fu Ling, Yuan Zhi, Suan Zao Ren, Mu Xiang, Long Yan Rou, Da Zao, Ye Jiao Teng]2
Modifications:
Insomnia1: + He Huan Pi, Bai Zi Ren
Severe heart blood vacuity1: + Bai Shao, E Jiao, Bai Zi Ren
Epigastric distention & nausea due to phlegm-damp1: +Ban Xia, Chen Pi, Zhi Ke

Lung-Spleen Qi Vacuity1 
Anxiety and preoccupation, moodiness, sorrow, a desire to cry, lassitude of the spirit, fatigue, chest oppression, shortness of breath, faint voice,
sweating on slight exertion, possible persistent weak cough provoked by taking or exertion, cold hands and feet, loose stools, torpid intake
Tongue: Pale, fat tongue; thin coat
Pulse: Fine, weak
Treatment Principles: Fortify the spleen and boost the Qi, supplement the lungs and relieve anxiety
Acupuncture Treatment: BL-13, BL-43, CV-4, CV-6, ST-36. Tonifying technique
Herbal Treatment: Bu Fei Tang1
[Dang Shen(10g.), Huang Qi(10-15g.), Shu Di(12g.), Wu Wei Zi(10g.), Zi Wan(10g.), Bai Zhu(10g.), Chen Pi(3g.), Gan Cao(3-6g)]
Modifications:
Loose stools or diarrhea w/ poor appetite: + Fu Ling
Food stagnation w/ loss of appetite, abdominal distention, loss of taste: + Mai Ya, Shen Qu, Shan Zha
Spontaneous perspiration: + Fu Xiao Mai, Ma Huang Gen