Case Study: Anxiety Neurosis

Aerobic exercise for at least 30 minutes duration for a minimum of 3 days per week.

Daily relaxation therapy through the use of a stress reduction tape or meditation technique for 20 to 30 minutes every day.

PATIENT PROGRESS

Patient received treatment 2 times per week and reported gradual improvement after each session. The Panic attacks immediately subsided and the patient was able to resume normal activity (drive a car, grocery shop). The patient reported feeling "more calm".

By the 8th treatment the patient began to exhibit signs of Liver Qi Stagnation (Purple Tongue, Wiry Pulse). To smooth the Liver, Liver 3 was added to the point pattern and a modified Xiao Yao San herbal formula was prescribed.

The symptoms gradually subsided to the point where the chief complaint became focused on dream disturbed sleep.

Treatment is being continued and I believe is important in the patient's regaining self confidence concerning her emotions.

The patient was very compliant in that she kept her clinic appointments and took her herbs as prescribed. She also followed the recommendations concerning exercise and relaxation therapy.

SUMMARY

Conclusions and analysis of diagnosis and treatment: Since diagnosis and treatment in TCM revolve around the chief complaint, the resolving of the chief complaint provides the validation of the diagnosis and treatment. In this case study of Anxiety Neurosis, the patient was relieved of her major symptoms. Therefore, the diagnosis and treatment are labeled as correct. However, some questions are raised by clinical aspects of this case. The 2 Doctors supervising this patient arrived at differing diagnosis, one choosing to emphasis the Liver Qi tendencies (wiry pulse and nervousness) the other the Blood Deficiency aspects (pale tongue, insomnia). Despite this contrast in diagnosis and treatment, the patient steadily improved. How would we explain the improvement?

Was the improvement due to psychogenic factors? Is this a case of emphasizing the Biao (Manifestation) in one diagnosis and the Ben (Root) in the other, as both could reduce the symptoms? Could a homeostatic response be produced irrespective of diagnosis?

Bibliography

• Barnhart, Edward R. Physicians' Desk Reference 40th Edition, 1986. Oradell: Medical Economics Company

• Bates, Barbara A Guide to Physical Examination and History Taking. Philadelphia: J. B. Lippincott Company

• Bensky, Dan and Gamble, Andrew Chinese Herbal Medicine Materia Medica. Seattle: Eastland Press

• Bensky, Dan and O'Connor, John Acupuncture a Comprehensive Text. Seattle: Eastland Press

• Berkow, Robert, and Fletcher, Andrew J. The Merck Manual of Diagnosis and Therapy, 15th Edition. Rahway: Merck Sharp & Dohme Research Laboratories

• Flaws, Bob Endometriosis & Infertility And Traditional Chinese Medicine, A Laywoman's Guide. Boulder: Blue Poppy Press

• Maciocia, Giovanni The Foundations of Chinese Medicine. London: Churchill Livingstone

• Ross, Jeremy Zang Fu The Organ Systems of Traditional Chinese Medicine. London: Churchill Livingstone

• Thomas, Clayton L. Taber's Cyclopedic Medical Dictionary. Philadelphia: F. A. Davis Company

• Turabian, Kate L. A Manual for Writers, 4 h Edition. Chicago: The University of Chicago Press

• Yeung, Him-che Handbook of Chinese Herbs and Formulas, Vol. II. Los Angeles

Suggested reading:

The Shambhala Guide to Traditional Chinese Medicine
by Daniel P. Reid

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