Case history: Anxiety in Young Adult Female

This is a case history from a follow up consultation yesterday that serves as an example of treating severe anxiety in a young adult, a situation that will likely sound familiar to parents.

13 y/o female CC: severe anxiety, screaming outbursts, panic affecting ability to attend school/scholastic endeavors

Patient is the daughter of another established patient of mine who is experienced in Chinese herbal medicine. PMH is unremarkable. She has history of good health and strong academic interest until severe and prolonged bullying began last year. Patient developed anxiety disorder with panic, screaming outbursts, and inability to attend school/extracurricular activities. Symptoms are worse the week prior to menses. Patient had attempted multiple stress management techniques including meditation, yoga, biofeedback with limited results. She and her mother would prefer to avoid the prescribed antipsychotic if possible.

Evaluation: Being trapped in a threatening situation strongly impacts the liver, and thus free-coursing of qi. This creates a constriction of the diaphragm and abdominal cavity (and cavities everywhere, ultimately) and therefore impinges upon Middle Jiao function in particular. Fear destabilizes kidney qi, and as a result of the two processes mingmen fire/steamed fluids have difficulty ascending from the Lower through the Middle Jiao to support Upper Jiao physiology. The kidneys and heart can lose their ability to communicate, and/or the UJ loses its ability to descend through the MJ and stay contained in the LJ, ultimately resulting in UJ function becoming disordered and, if left untreated, an eventual mix of excess and deficiency.

Rx: Ding Zhi Wan with additions:
Bai Ren Shen 9
Yuan Zhi 9
Shi Chang Pu 9
Fu Shen 9
Chai Hu 9
Dan Shen 9

Fx: Ding Zhi Wan helps restore order to the heart qi dynamic in several important ways. In total, this formula works on supplementing the heart and shen, removing phlegm obstructions so heart yang can flow timely and harmoniously, and guiding heart yang downward to reunite with the kidneys. Bai ren shen calms and nourishes the shen, yuan zhi guides heart yang downward to unite with kidney yin, and fu shen and shi chang pu eliminate phlegm from the sensory and cognitive faculties. Shi chang pu, fu shen, and bai ren shen combine to supplement the spleen, drain damp, and transform phlegm to support MJ function and promote clear intentions that arise from mingmen fire reflecting upon itself in the spleen. Chai hu is added to dredge the liver of obstruction, promote free-coursing of the qi dynamic, and regulate the Dai Mai in order to support movement through the MJ. Dan shen supports blood flow in the chest, nourishes and cools the blood, combines with chai hu to soothe irritability, and works with bai ren shen and fu shen to calm the shen.

Result: Patient responded in a manner that is consistent with my clinical experience. With 48-72 hours she reported to her mother that she was feeling different, and by the end of the first ten days her mother reported “she had a different kid”. She was visibly and behaviorly calmer, and in her own words the patient described that she doesn’t feel the tensing reaction to stressors she once did, and if she does it is less severe and she can manage it better. Patient has developed an affinity for the taste and taking of the formula, the regular habit of which helped to form her daily routine. This is what I refer to when I speak of herbal therapy as a functional keystone habit: in terms of physical and psychoemotional behavior the regular taking of the herbs create a start/stop point in the day that facilitates rhythm and consistency of one’s self-care regimen. Patient is back in school and sports, has made new friends, and, most importantly, beyond the acute therapeutic intervention she has learned stress management techniques that are critical to the pursuit of health and happiness. Financial cost: two phone consultations and a couple packets of herbs, less than the price of a standard doctor’s visit.

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