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A Local Nosology of Anxiety and Panic 

Severity:
A spectrum of khyâl severity
Mild 
khyâl 

Moderate 
khyâl 

Severe khyâl
(called ripe  
khyâl or broken 
khyâl)

Khyâl 
overload 

Coining (“stratching khyâl”): 
Its Role in Healing and Nosology
•A key way of determining the severity of khyâl by 
assessing the color and bumpiness revealed by 
coining
•A key way of removing blockages and restoring 
flow
•A key way to warm the body
•A key way to remove khyâl from the body 

“Coining, or “gaoh
khyâl,” literally
“scratching khyâl”

Image Credit: 
Gregory Juckett, 
MD, MPH

A Spectrum of Khyâl Attack Severity
 

•Typical symptoms
•What coining reveals
•Degree of dangerous
•Treatment depending on the severity of khyâl

Mild Khyâl
Typical symptoms

What coining reveals

Slight dizziness,
A red color, or very slightly
anxiety, nausea, chills, purple, in the coined area
cold extremities,
muscle and joint
soreness, other
anxiety-like symptoms,
feeling out of energy,
and may have slight
dizziness on standing

Degree of
dangerousness

Treatment

Not dangerous
unless left
untreated; if
untreated will
then progress to
next stage of
khyâl severity

Apply khyâl oil
or ointment
under the nose,
sniff the khyâl
oil dabbed on a
finger, apply and
rub in the khyâl
oil or ointment
at the temples,
behind the ears,
on the neck;
may eat a sour
food; may do
the vessels (e.g.,
snap the joints).

Moderate Khyâl 
Typical symptoms

What coining reveals

Degree of
dangerousness

Treatment

Symptoms as above,
but more and more
severe, and may have
moderate dizziness
upon standing

Dark purple streaks where
the skin has been coined

May cause loss of
the use of arms
and legs
(“stroke”), heart
arrest, asphyxia,
fainting, vision
loss, hearing loss

Do coining and
other khyâl
treatments (e.g.,
cupping khyâl,
pinching khyâl,
and “doing the
vessels,” such as
snapping the
joints)

“Severe Khyâl” (called “ripe khyâl” or “broken khyâl”)
Typical symptoms

What coining reveals

Degree of
dangerousness

Treatment

Even more severe
Dark purple and even black Great chance of Do coining and
symptoms as above,
in the coined area, as well
the dire events
other khyâl
and special symptoms
as bumps
listed above, with treatments (e.g.,
such as jaw tightness,
significant risk of cupping khyâl,
and the patient may
death
pinching khyâl,
have great dizziness on
and “doing the
standing
vessels”), may
well go to the
emergency room

Khyâl Overload (Khyâl koeu)
Typical symptoms

What coining reveals

Fainting, loss of
As above, but darker streaks
consciousness, death, and more prominent bumps
which often first occurs
upon standing

Degree of
dangerousness

Treatment

All the events
above are in the
process of
occurring, death
is imminent

Bite the ankles,
pull the vessels
in the arm pit and
other areas, and
then do coining
and other khyâl
treatments (e.g.,
cupping and
pinching khyâl);
may call an
ambulance