Anxiety disorder is a common mental disorder with a high incidence and a significant social burden in today’s society, seriously affecting the quality of life of patients.
Currently, Western medicine’s main treatment methods involve psychological therapy, medication, or a combination of both. However, severe patients often have poor therapeutic effects, and such Western medicines can cause side effects such as drowsiness, fatigue, dependence, addiction, and memory impairment.
Renowned Chinese medicine practitioner and chief physician at the China-Japan Friendship Hospital, Shi Zaixiang, has effectively diagnosed and treated such diseases with a traditional Chinese medicine approach in clinical practice, often rapidly improving patients’ anxiety symptoms and alleviating their condition.
Based on years of clinical experience, he has put forward the pathogenic theory of qi descent and blood stasis blockage, and has formulated specific treatment methods for this condition, creating a series of empirical prescriptions such as the Qi-Lifting and Blood-Stasis-Dispelling Decoction, Qi-Lifting and Blood-Stasis-Eliminating Formula, widely used in the treatment of anxiety disorders with significant effectiveness.
Etiology and Pathogenesis
As early as the late Yin and Shang dynasties when the Book of Changes was compiled, it mentioned “My heart is not at ease” and “The spirit is clear within oneself,” indicating the connection between the heart and the spirit. This theory matured in the Yellow Emperor’s Internal Classic with the propositions of “The heart governs the spirit’s clarity” and “The heart governs the blood vessels,” emphasizing the relationship between the heart and the spirit.
The spirit includes a person’s thoughts, emotions, spirit, consciousness, and other outward manifestations.
The Yellow Emperor’s Internal Classic states, “Blood and qi are the spirit of the person,” “Blood is the spirit’s qi.” Supporting this series of theories, modern Chinese medicine practitioners have proposed the “Dual Heart” theory.
Humans have five zang organs that transform the five qi, generating joy, anger, worry, thought, and fear, affecting a person’s mental and spiritual state. If the heart qi is weak and unable to regulate the qi and blood of the zang-fu organs, it can easily lead to insomnia, gloominess, and visceral agitation.
The heart holds the superior position in the body. As stated in the “Ling Shu,” “The ancestral qi accumulates in the chest, exits through the throat, flows through the heart’s channels, and governs respiration,” indicating that the ancestral qi circulates through the heart channels to facilitate the movement of qi and blood throughout the body.
Although modern life is materially abundant, the fast pace, irregular diet, alcohol and tobacco consumption, overwork, lack of rest, and mental exhaustion can all lead to excessive qi consumption. Prolonged deficiency can result in qi descent, hindering the normal circulation of qi and blood, inevitably causing blood stasis and internal blood blockages.
Based on this theory, Shi Zaixiang proposed that diseases caused by the heart can be treated by addressing qi descent and blood stasis. Initially, the qi descent and blood stasis theory was used to treat coronary heart disease, arrhythmia, heart failure, and other diseases. However, Shi Zaixiang found through extensive clinical practice that this theory can also be applied to the treatment of emotional disorders such as anxiety disorders, achieving good results by precise clinical differentiation and flexible application.
Principles and Methods of Treatment
Traditional Chinese medicine has the saying “nourish the heart and calm the spirit,” suggesting that a series of mental disorders resulting from heart qi and blood deficiency require nourishing the heart to dispel the disease.
With his rich clinical experience, Shi Zaixiang has put forward unique insights on this condition, utilizing the theory of qi descent to understand its pathogenesis. By combining the emotional characteristics of the patients that contribute to the disease, he employs a Qi-Lifting and Blood-Stasis-Dispelling approach, along with psychological adjustment, effectively targeting the root causes of the disease. This dual-pronged approach leads to swift results and opens up a new path for diagnosing and treating emotional disorders.
Shi Zaixiang formulated the Qi-Lifting and Blood-Stasis-Dispelling Decoction as a foundational prescription. The original composition and commonly used dosages are: Astragalus 30g, Shan Zha 15g, Dang Shen 20g, Zhi Mu 15g, San Leng 12g, E Zhu 15g, Chong Lou 10g, Chai Hu 10g, and Jie Geng 10g.
In this formula, Astragalus is the sovereign herb, tonifying and lifting qi. Dang Shen supplements the spleen qi, nourishes the postnatal qi and blood, and facilitates the source of transformation. Shan Zha supplements the kidney’s original qi and can also consolidate and disperse dissipating energy. San Leng and E Zhu break blood stasis. Accompanied by Chai Hu and Chong Lou to lift qi, Zhi Mu’s cool-natured property counterbalances Astragalus’ warm nature. Jie Geng acts as an envoy, guiding the herbs to the chest area. When these herbs are combined, they promote the replenishment of qi, the lifting of descent, the expansion of the chest yang, and the smooth circulation of qi and blood.
The Qi-Lifting and Blood-Stasis-Dispelling Decoction is suitable for individuals with severe qi deficiency leading to descent, such as in coronary heart disease, dilated cardiomyopathy, angina pectoris, heart failure, chronic obstructive pulmonary disease, pulmonary atelectasis, pulmonary fibrosis, interstitial pneumonia and other respiratory and circulatory system diseases, and mental disorders such as anxiety disorders.
Building upon the Qi-Lifting and Blood-Stasis-Dispelling Decoction, the Qi-Lifting and Blood-Stasis-Eliminating Formula was developed, removing Chai Hu, Jie Geng, and Chong Lou, and adding herbs that resolve phlegm, generate fluids, soften hardness, and disperse stagnation, including Sang Zhi 30g, Cang Zhu 30g, Ji Nei Jin 15g, Tian Hua Fen 30g, Ji Li 15g to create.
Compared to the Qi-Lifting and Blood-Stasis-Dispelling Decoction, the Qi-Lifting and Blood-Stasis-Eliminating Formula is more suitable for diabetic patients with damp-heat obstruction, qi-yin deficiency or those exhibiting the aforementioned clinical manifestations of anxiety disorders.
Classic Case Studies
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Case 1
Ms. Gao, female, 17 years old, first consulted on November 22, 2012. Chief complaint: episodic chest tightness, palpitations, fatigue for six months, worsening for two months. The patient was previously healthy, introverted, prone to stress, and easily irritable; since entering high school a year ago, the patient has been under significant academic pressure. Over the past six months, she experienced episodic chest tightness, palpitations, and fatigue, accompanied by dizziness, cold limbs, sweating, pale complexion, rapid breathing, inability to stand, with no apparent triggers before each episode, lasting about an hour each time, relieving on rest, always occurred at school. In the past two months, the episodes have increased in frequency, occurring once a week on average. During the episodes, she sought treatment multiple times at local hospitals, but all physical and laboratory tests showed no abnormalities. Presenting signs: thin, wiry, and short pulse; slightly dull, dark tongue; thin, white coating.
Diagnosis: Western diagnosis of anxiety disorder and panic attacks, Chinese diagnosis of depression pattern (qi descent, blood stasis blockage).
Prescription of Qi-Lifting and Blood-Stasis-Dispelling Decoction with modifications: Astragalus 30g, Chai Hu 10g, Sheng Ma 10g, Jie Geng 10g, Zhi Mu 15g, Shan Zha 15g, San Leng 15g, E Zhu 20g, Sheng Mu Li 30g, Bai Ji Li 15g. 14 doses, decoct in water, take once daily, divided into two doses. Advised family members and the patient to focus on emotional regulation.
Second visit on December 1: Symptoms occurred twice within ten days, with each episode significantly shorter. Symptoms improved and continued the same prescription for 30 doses.
Third visit on January 7, 2013: Occasionally felt mild chest discomfort but no palpitations, recovered to normal daily life and study routine. Advised to continue emotional regulation. Subsequent follow-ups showed no recurrence.
[Note] Chen Shiduo’s “Compendium of Materia Medica · Ten Formulas” stated, “Fear arises from the gall, but the timidity arises from the heart.” The patient’s condition was caused by academic stress and great pressure, leading to a diagnosis of anxiety disorder and panic attacks in Western medicine. Academic stress causes hidden consumption of heart blood, and intense pressure and mental stress affect the liver’s wood function, further damaging the spleen’s earth, resulting in insufficient generation of vital energy and blood, leading to insufficient blood and vital energy in the heart, thereby sinking qi in the chest, loss of spirits’ nourishment, manifesting as symptoms of chest tightness, palpitations, fatigue, a thin, wiry, and short pulse, slightly dull, dark tongue, among other signs of qi descent and blood stasis. Therefore, treating with the Qi-Lifting and Blood-Stasis-Dispelling Decoction with modifications enabled a swift recovery.
Shi Zaixiang believes that the varied symptoms of panic attacks in anxiety disorders are characterized by chest tightness, shortness of breath, inability to continue, palpitations, fatigue, sweating, and inability to move during episodes, requiring quiet rest for relief. The disease manifests rapidly with quickly changing symptoms. Combining modern psychiatry to understand its causes, it is associated with anxiety emotions, in line with the characteristics of imbalanced qi and blood in the chest, along with pulse diagnosis, suggesting qi descent and blood stasis.
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Case 2
Mr. Zhou, male, 55 years old, first visited on March 3, 2023. Chief complaint: dizziness for two months, accompanied by a sense of fear and blurred vision for over a month. On January 10, 2023, while walking, he suddenly experienced dizziness, chest tightness, palpitations, increased heart rate, sweating, overall weakness, confusion, without shortness of breath. After visiting the emergency department, his symptoms eased. His father passed away, leading to a fear of death and suicidal tendencies, apprehension of meeting with external individuals. On February 4, he began experiencing episodic blurred vision, accompanied by haziness, confusion, resembling hallucinations, subsiding within minutes, occurring twice daily since then. Western medicine considered it an anxiety state and treated with oral diazepam. Presenting signs: recurrent blurred vision, haziness, restlessness, sweating, night sweats, difficulty in urination before sleeping, daily bowel movements with sticky stool, poor appetite, dry mouth, poor sleep quality. Tongue slightly red, dry tongue coating, slimy yellow coat at the root, thick sublingual veins, tense and slippery pulse.
Diagnosis: Western diagnosis of anxiety state, Chinese diagnosis of depression pattern (qi descent blood stasis, phlegm stasis heat entanglement, qi-yin deficiency).
Prescription of Qi-Lifting and Blood-Stasis-Eliminating Formula, Combined Pinellia White Atractylodes and Gastrodia Decoction: Astragalus 30g, Dang Shen 15g, Zhi Mu 15g, Jiu Lu Rou 15g, Cu San Leng 10g, Cu E Zhu 15g, Cu Ji Nei Jin 15g, Chao Ji Li 15g, Tian Hua Fen 30g, Chao Jiao Can 30g, Chao Cang Zhu 30g, Yi Mu Cao 15g, Chao Dan Xia 15g, Tian Ma 20g, Zhi Zi 15g, Dan Dou Chi 30g, Mian Ye Xi 30g, Tu Fu Ling 60g. 14 doses, decoct in water, take once daily, divided into two doses.
Second visit on March 17: Haze, haziness reduced, fatigue, and restlessness improved, appetite increased, night sweats ceased, persisting fear of death, accompanied by tremors when contemplating death, resolved in 30 minutes, sleep affected, with a mild palpitation awakening from 1-3 am. Tongue slightly red, minor trembling, thin coat, slight drooling in the middle.
Prescription revised to Qi-Lifting and Blood-Stasis-Eliminating Formula, Combined Cornus and Poria Decoction with additional Huang Lian 10g, Fu Shen 30g, Mai Dong 12g, Yuan Zhi 10g, Tong Cao 10g, Huang Qin 10g, Zhi Gan Cao 10g, Sheng Jiang 15g, Da Zao 15g, Mian Ye Xi, Fu Xiao Mai. 14 doses, decoct in water, take once daily, divided into two doses.
Third visit on March 31: Significant improvement in overall mental status, blurred vision significantly alleviated, occasional haziness in the morning, persistent fear of death, trembling when contemplating death, resolved in 30 minutes, improved, steps more stable, complexion glossier, gradually returning to normal life and work routine, no longer afraid of meeting with others, fearful of noisy environments, improved dry mouth, poor appetite, slightly improved night sweats, palpitations in the morning, shallow sleep before noon, easily waking between 1-3 am, able to fall back asleep within 20 minutes. Tongue slightly dark, trembling, thin yellow coat, slight drooling.
Further treatment and follow-up visits until July 2023, with no recurrence of blurred vision, decreased intake of diazepam, reduced night sweats, occasional chest tightness, shortness of breath, dizziness, and headaches, often related to emotional states. Nighttime sleep improved, and waking episodes subsided.
[Note] This patient is meticulous and cautious, excessively concerned about health, which consumes mental energy and weakens the heart and spleen over time. Heart and spleen impairment leads to insufficient qi and blood supply in the chest, disrupting normal qi and blood circulation, resulting in blood stasis and qi disharmony. Prolonged illness causes extreme qi descent and stress-induced conditions. Hence, the manifestations include dizziness, chest tightness, palpitations, weakness, as well as other symptoms. Treating with the Qi-Lifting and Blood-Stasis-Eliminating Formula; combining qi and blood restoration with the regulation of hot and cold, symptoms are naturally alleviated.
