Treatment of General Anxiety Disorder using Acupuncture and Chinese Herbs
Abstract
This case study documents the treatment of a 66-year-old woman with Generalized Anxiety Disorder (GAD) using an integrative approach combining Classical Chinese Medicine (CCM) herbal formulas and modern scalp acupuncture. The patient experienced significant symptom reduction after just one treatment session and one week of herbal therapy. By the third visit, approximately two weeks into treatment, she reported several anxiety-free days per week—a marked improvement from her baseline condition. This case demonstrates the potential efficacy and safety of combining traditional herbal medicine with contemporary acupuncture techniques for treating GAD.
Introduction
The Scope of Mental Health Challenges
Mental health conditions affect a substantial portion of the Canadian population. According to the Centre for Addiction and Mental Health (CAMH), one in five Canadians experiences a mental illness in any given year. By age 40, one in two Canadians will have experienced or be living with a mental health condition.
Understanding Generalized Anxiety Disorder
The Diagnostic and Statistical Manual of Mental Disorders defines Generalized Anxiety Disorder (GAD) as an anxiety disorder characterized by excessive, difficult-to-control, and often disproportionate worry about everyday events and activities. Individuals with GAD experience persistent anxiety or worry for at least six months about various life domains, including work, family relationships, personal health, and social interactions. While these concerns may seem minor to others, they cause significant distress and functional impairment for those affected.
Common symptoms of GAD include:
Persistent restlessness or feeling on edge
Easy fatigue and low energy
Difficulty concentrating or episodes of mind going blank
Increased irritability
Muscle tension, particularly in response to stress
Inability to control worrying thoughts
Sleep disturbances (difficulty falling or staying asleep)
The Biology of Anxiety
Research into GAD's underlying mechanisms is ongoing and involves complex interactions between genetic predisposition and neurological structures. Theodore A. Stern's Massachusetts General Hospital Comprehensive Clinical Psychiatry describes the pathophysiology of GAD as an active area of investigation focusing on genetic factors and brain structure interactions.
A significant 2009 study revealed that abnormalities within the amygdala (the brain's fear-processing center) and compensatory engagement of the frontoparietal executive control network play key roles in GAD's mechanisms. The research demonstrated that the basolateral complex of the amygdala processes fear-related sensory memories and communicates threat significance to other brain regions, including the medial prefrontal cortex and sensory cortex.
Conventional Treatment Approaches
Standard GAD treatment typically combines psychotherapy and medication. Professor David Baldwin from the University of Southampton conducted a comprehensive systematic review comparing nine pharmacological treatments for GAD. His analysis evaluated efficacy based on response rates, remission rates, and withdrawal due to adverse effects. Among the medications studied, Fluoxetine demonstrated the highest response rate at 62.9%, followed by Lorazepam at approximately 20%. Seven of the nine medications showed response rates below 10%. Sertraline exhibited the best tolerability profile (49.3% completion rate with lowest withdrawal percentage), while seven medications had tolerability rates under 10%.
Traditional Chinese Medicine Perspectives on Anxiety
Foundational Concepts
Traditional Chinese Medicine (TCM) offers a distinct framework for understanding and treating anxiety. Central to this system are several key concepts:
Qi (Energy): Literally translated as "air," Qi metaphorically represents "material energy," "life force," or "energy flow." While scientifically unverified, Qi and its functions form the foundation of Chinese Medicine practice. Both medical practitioners and martial artists experience it as a tangible force in the body.
Holistic Approach: TCM views the body not as a collection of separate parts but as an integrated, whole system. Individual organs or body parts cannot be understood in isolation but must be considered within the context of the entire bodily system. This holistic perspective extends to include mind and spirit, recognizing that mental and emotional issues are inseparable from physical wellness.
Yin and Yang: These represent opposite yet interconnected and interdependent polarities. TCM practitioners work to achieve optimal balance between a patient's Yin and Yang energies.
TCM Classification of Anxiety
In TCM theory, anxiety generally falls into six diagnostic patterns: Heart Qi Deficiency, Heart and Kidney Yin Deficiency, Heart Blood and Spleen Qi Deficiency, Heart Qi and Yin Deficiency, Heart and Gallbladder Qi Deficiency, and Phlegm Heat. The Heart in TCM extends beyond its blood-pumping function to govern emotions. When the Heart is deficient in Qi or Blood (which hosts emotions in TCM theory), emotional imbalance occurs. The balance between Heart and Kidney represents a crucial Yin-Yang relationship essential for overall wellness. Anxiety arises when the Heart cannot properly contain the Shen (spirit), leaving it easily agitated.
Classical Chinese Medicine Understanding
Classical Chinese Medicine (CCM), also known as Jing Fang, predates the second half of the Han Dynasty (ending 220 CE). This case study employs diagnostic and treatment methods from two foundational CCM texts written by Zhang Zhong Jing: Shang Han Lun (Treatise on Cold Damage) and Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet), specifically following the lineage of Dr. Hu Xi Shu.
In Jing Fang theory, anxiety results from a condition called Ben Tun (literally "running piglet"). Ben Tun describes a pathological movement pattern in the body. When external pathogens (such as common cold or flu viruses) invade the body, the healthy response involves sending Antipathogenic Qi (Zheng Qi) upward to the area above the diaphragm. However, if pre-existing undigested material or pathogenic dampness accumulates in the digestive tract, the upward surge of Zheng Qi carries this turbid dampness along with it—traveling to the chest, throat, face, and ultimately the brain. When turbid dampness enters the brain, it clouds the frontal cortex, manifesting as anxiety. Essentially, Ben Tun represents a concurrent syndrome combining Exterior conditions (like common colds) and Interior conditions (poor digestion).
The Jing Fang treatment approach for anxiety follows three principles: (1) descending Ben Tun downward, (2) resolving Exterior pathogenic factors, and (3) strengthening the digestive system.
Case Presentation
Patient Profile and Initial Consultation
Patient: 66-year-old female
First Visit: November 2020
Chief Complaints: Severe anxiety (GAD), persistent fear, overwhelming feelings, and insomnia
Medical History
The patient had a longstanding tendency toward overthinking. However, the COVID-19 pandemic triggered the development of debilitating anxiety and fear that significantly impaired her daily functioning.
Physical Examination
The patient appeared very slim with visible signs of agitation. Her tongue examination revealed a pale, swollen tongue body with teeth marks and white coating. Her pulse was slightly choppy.
Associated Symptoms
Anxiety-Related Symptoms:
Tremor, shortness of breath, and heart palpitations accompanying anxiety episodes
Sensation of a knot in the stomach during anxious periods
Pressure sensation at the base of the pelvis (cystitis symptoms) during anxiety
Anxiety symptoms worsening at nighttime
Mental and Emotional Symptoms:
Excessive, intrusive thinking
Persistent sadness
Feelings of being overwhelmed
Mental agitation and scattered thinking
Inability to relax
Sleep Disturbances:
Excessive thoughts preventing sleep onset
Vivid, intense dreams
Inability to return to sleep after nighttime awakening
Physical Symptoms:
Tachycardia (rapid heartbeat)
Muscle cramps 1-2 times weekly
Generally absent or minimal sweating
Itchy eyes with environmental allergies
Occasional knee pain
Cold hands and feet
Poor night vision
Sensitivity to strong lights (preference for dim lighting)
Aversion to wind exposure
Digestive and Elimination Issues:
Poor appetite in the morning
Occasional bloating after eating certain foods
Preference for room-temperature beverages, consumed in small sips
Frequent, incomplete urination with cloudy appearance
Mild burning sensation during urination (distinct from urinary tract infection)
Hard stools without magnesium supplementation
Occasional incomplete, sticky bowel movements
Other Medical History:
Menopause at age 45
Initial Diagnosis and Treatment Plan
CCM Pattern Diagnosis
Based on Classical Chinese Medicine diagnostic principles, the patient presented with multiple concurrent patterns:
Tai Yang (Greater Yang) pattern: Indicated by exterior symptoms including anxiety (Ben Tun manifestation) and occasional knee pain
Shao Yang (Lesser Yang) pattern: Evidenced by poor morning appetite and preference for room-temperature beverages. This represents a "Half Exterior, Half Interior Yang pattern," characterized by heat in the upper body and cold in the lower body
Yang Ming (Bright Yang) pattern: Manifested through excessive racing thoughts, vivid dreams, and mild burning sensation during urination
Tai Yin (Greater Yin) pattern: The most severe pattern present, showing as overwhelming feelings, stomach knots with anxiety, occasional bloating, cystitis symptoms with anxiety, and urination and bowel irregularities
Blood Deficiency: Indicated by worsening anxiety at night, sleep difficulties, muscle cramps, and choppy pulse quality
Herbal Formula Prescriptions
Formula 1: Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Plus Dragon Bone and Oyster Shell Decoction)
This formula addresses the concurrent Tai Yang, Shao Yang, Yang Ming, and Ben Tun patterns. It works by descending heat from the upper body downward, nourishing the stomach, calming emotions, and treating urination issues. The patient received standard dosage with increased Fu Ling (Poria), taking one dose daily.
Formula 2: Suan Zao Ren Tang (Sour Jujube Seed Decoction)
This formula nourishes Blood in the upper body to address insomnia, palpitations, tachycardia, intrusive thoughts disrupting sleep, and vivid dreams. Initially prescribed at standard dosage, taken once every three days.
Modification: Bai He (Lily Bulb) was added to enhance the calming and spirit-nourishing effects.
Acupuncture Treatment Protocol
The treatment combined modern scalp acupuncture techniques with traditional body acupuncture points.
Scalp Acupuncture Points:
The scalp acupuncture method was adapted from Lin Xue Jian's techniques, targeting the frontal and temporal regions of the brain:
Frontal area: DU20 (Baihui) and DU24 (Shenting), with three needles total—one at the center of the anterior hairline directed toward DU20, and two needles placed 2cm lateral to the midline and 2cm posterior to the hairline, angled toward the central needle
Temporal area: Modified GB8 (Shuaigu) placement—two needles on each side, positioned 1cm anterior and 1cm posterior to GB8, inserted inferiorly and parallel to each other
Body Acupuncture Points:
GB20 (Fengchi), Anmian (Peaceful Sleep), REN12 (Zhongwan), REN6 (Qihai), REN4 (Guanyuan), ST25 (Tianshu), ST21 (Liangmen—left side), PC6 (Neiguan—left side), SJ5 (Waiguan—right side), modified LI10 (Shousanli), ST36 (Zusanli), LI4 (Hegu), LR3 (Taichong), SP6 (Sanyinjiao), and SP10 (Xuehai)
Electrical Stimulation:
Applied to enhance the treatment effect, connecting the frontal needles to the modified GB8 needles bilaterally. The positive electrode was attached to the temporal needles (clipping both together on each side), while the negative electrode connected to the frontal needles. Intermittent pulse mode at 2.5 Hz frequency was used.
Treatment Rationale and Clinical Reasoning
Frontal Scalp Needling Strategy: This technique specifically aims to descend Ben Tun—the upward-rushing internal pathogenic dampness that reaches the frontal brain region and causes overthinking, anxiety, and obsessive thought patterns. Modern neuroscience recognizes that emotional intelligence, including the abilities to identify, express, and manage emotions, is governed and enhanced within the frontal lobe. From the CCM perspective, anxiety fundamentally represents a brain issue caused by poor digestive function. The frontal scalp acupuncture effectively redirects this pathogenic energy downward.
Scalp acupuncture has deep roots in Chinese medicine, with classical points like DU20 used for centuries. However, the modern approach incorporating brain anatomy was developed in China during the 1970s, representing an evolution of traditional techniques informed by neuroanatomical understanding.
Body Acupuncture Strategy: The body point selection focused on strengthening the digestive system and releasing pathogenic factors from the exterior layer of the body. Notably, this patient's digestion was not severely compromised at baseline—it showed only mild dryness, evidenced by poor morning appetite and bloating with certain foods. Additionally, the patient demonstrated healthy lifestyle habits, good nutritional knowledge, and willingness to modify her diet to support healing. These factors contributed significantly to the treatment's effectiveness.
Treatment Progress and Follow-Up Visits
Second Visit (One Week After Initial Treatment)
Patient Report: The patient reported that anxiety persisted but with significantly reduced intensity. Most associated symptoms showed general improvement. While symptoms had not completely resolved, their severity and frequency decreased notably. However, two issues showed minimal improvement: frequent, incomplete urination and sticky stools. These persistent symptoms suggested that pathogenic dampness in the lower body remained. Bloating did not improve, though this was partially attributable to the patient successfully avoiding trigger foods.
Treatment Modifications:
Acupuncture treatment was repeated with the same point selection
Chai Hu Jia Long Gu Mu Li Tang continued at the same dosage
Suan Zao Ren Tang dosage increased from once every three days to once every two days
Cang Zhu (Atractylodes) 15g was added to address the persistent dampness in the lower body
Third Visit (Two Weeks After Initial Treatment)
Patient Report: The patient reported a significant milestone—she experienced two completely anxiety-free days between the second and third visits. Overall, continuous improvement was noted across all symptoms. Sleep quality improved substantially, with only one poor sleep episode on the night of the second treatment. Excessive thinking and frequent urination continued to improve but had not fully resolved.
Treatment Modifications:
Acupuncture points adjusted: REN12, REN6, REN4, ST25, ST21 (left), SJ5, modified LI10, ST36, GB34 (Yanglingquan), LI4, LR3, and SP6
Electrical stimulation intensity reduced
Chai Hu Jia Long Gu Mu Li Tang continued at the same dosage
Suan Zao Ren Tang maintained at the increased frequency (once every two days)
Fu Ling (Poria) dosage increased to 30g to further address remaining dampness
Cang Zhu (Atractylodes) dosage decreased to 10g
The patient was advised to return in two weeks for continued treatment and monitoring.
Discussion
This case demonstrates the rapid and effective response to an integrative treatment approach combining Classical Chinese Medicine herbal formulas with modern scalp acupuncture for Generalized Anxiety Disorder. Several factors contributed to the positive outcome:
Treatment Integration: The combination of CCM herbs, classical body acupuncture, and modern scalp acupuncture proved extremely effective. Each modality addressed different aspects of the patient's condition—the herbs worked systemically to rebalance internal patterns, body acupuncture strengthened digestion and cleared exterior pathogens, and scalp acupuncture directly targeted the brain's emotional regulation centers.
Safety Profile: Throughout the treatment course, the patient experienced no adverse reactions. This contrasts favourably with conventional pharmacological treatments, which often have significant side effect profiles and variable tolerability rates.
Speed of Response: The patient showed noticeable improvement after just one treatment session and one week of herbal therapy. By the third visit (two weeks of treatment), she reported multiple anxiety-free days—a dramatic shift from her baseline state of persistent, debilitating anxiety.
Patient Factors: The patient's relatively good baseline digestive health, healthy lifestyle habits, nutritional knowledge, and willingness to modify her diet all contributed significantly to treatment success. Patient engagement and lifestyle factors play important roles in treatment outcomes.
Continued Care: While the patient showed remarkable improvement, additional treatments would be necessary to consolidate gains and prevent relapse. The progressive reduction in symptom severity and frequency, combined with the emergence of anxiety-free days, suggests a positive trajectory that warrants continued monitoring and support.
Conclusion
This case study illustrates the potential of integrative Chinese medicine approaches for treating Generalized Anxiety Disorder. The combination of Classical Chinese Medicine herbal formulas with modern scalp acupuncture and traditional body acupuncture demonstrated rapid efficacy, an excellent safety profile, and no adverse reactions. The patient's significant symptom reduction—from persistent, debilitating anxiety to experiencing multiple anxiety-free days within two weeks—suggests this integrated approach merits further investigation.
Given the limitations of conventional GAD treatments (variable efficacy and tolerability issues with pharmacological interventions), this case contributes to the growing body of evidence supporting complementary and alternative medicine approaches for mental health conditions. The treatment's rapid onset of action and absence of side effects present compelling advantages, particularly for patients who cannot tolerate or prefer to avoid pharmaceutical interventions.
While this single case report cannot establish general efficacy, it provides a detailed clinical example that can inform future research. The systematic documentation of diagnostic reasoning, treatment protocols, and progressive modifications offers a replicable framework for both clinical practice and research investigation.
Recommendations for Future Study
Generalized Anxiety Disorder affects individuals across all age groups, with particularly concerning prevalence among children and adolescents. Future research should prioritize:
Pediatric and adolescent populations: Additional case reports and clinical trials examining this treatment approach in youth would be extremely valuable, as early intervention may prevent long-term mental health complications
Comparative effectiveness studies: Research comparing this integrative approach to standard pharmaceutical treatments would help establish relative efficacy and safety profiles
Mechanistic investigations: Studies exploring the neurobiological mechanisms through which scalp acupuncture and herbal formulas affect anxiety pathways would strengthen the theoretical foundation
Long-term outcome tracking: Follow-up studies examining sustained benefits, relapse rates, and optimal treatment duration would inform clinical protocols
Larger clinical trials: Randomized controlled trials with adequate sample sizes would provide more robust evidence for treatment efficacy
The urgent need for safe, effective GAD treatments—particularly for vulnerable populations such as children and adolescents—makes this research direction both clinically important and ethically compelling.
References
1. Centre for Addiction and Mental Health (CAMH). Mental Illness and Addiction: Facts and Statistics.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
3. National Institute of Mental Health. Generalized Anxiety Disorder: When Worry Gets Out of Control.
4. Stern TA, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia: Elsevier; 2016.
5. Etkin A, Prater KE, Schatzberg AF, Menon V, Greicius MD. Disrupted amygdalar subregion functional connectivity and evidence of a compensatory network in generalized anxiety disorder. Arch Gen Psychiatry. 2009;66(12):1361-1372.
6. Bandelow B, et al. Treatment of anxiety disorders. Dialogues Clin Neurosci. 2017;19(2):93-107.
7. Baldwin DS, et al. Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol. 2014;28(5):403-439.
8. Kaptchuk TJ. The Web That Has No Weaver: Understanding Chinese Medicine. New York: McGraw-Hill; 2000.
9. Maciocia G. The Practice of Chinese Medicine. Edinburgh: Churchill Livingstone; 2008.