Post Traumatic Stress And The Treatment Of Veterans With Chinese Medicine.

By Rozz Poul Lieght

I believe that Post Traumatic Stress Disorder (PTSD) is not a disease, though people do suffer. I think that to go to war and not come back disturbed is a more serious problem. I believe that there is a natural source of morals that guide human beings and that this becomes violated through the present war process as it is set up today. Being a culture and a nation at war has also touched all of us as well. Grief is also an interwoven factor for all veterans that when they are unable to grieve properly will lead to many other problems including an inability to be intimate. All of us, if we are paying taxes, are part of sending humans into a war zone to risk their lives. We are responsible for sending them out and we should receive them back in, listen to their stories and together plot a direction for the future. 911 has changed us all in a profoundly different way than any other event in our American history; we compounded it by choosing to go to war. We all face a deeper more hushed hidden situation of profound loss of innocence, horror and a strong force of denial is in place. Some part of our soul is suffering and to not be present for the returning stories of the people we all sent out to war deepens this suffering to what we have today i.e.; modern society with its rising rates of depression among other sufferings. Veterans for their part suffer many different symptoms collectively called PTSD, but the larger environment they live in (their family, friends, professional helpers, and community at large) either adds to this suffering, or guides them out to recovery.

From a 2007 citation of the casualties of the Iraq war, it states that PTSD claims have seen a tenfold increase since the start of Iraq war. (1) What does this mean for acupuncturists? What does this mean for Chinese medicine? To the general population of Americans, it is growing problem. From the years 1986-1994, the statistics of suicide among veterans were doubled the civilian population and has led to increased grief for those families, and the people who knew and tried to help them. (2) In 1999, homelessness among veterans rose to 23% . (3) Military families are also hit by the effects of war. Particularly, children are affected by abuse from the non-combatant spouse especially during deployment. The spouses are being affected through secondary-PTSD. Child abuse by the non-combatant spouse went up three times as much and neglect four times as much when their spouse is deployed compared to when their spouse is at home. The spouse showed increased emotional withdrawal, anxiety, and poor anger management. (4) On top of these grave problems, are often fearful of seeking help for their symptoms due to PTSD due to quite realistic threats to their careers. Of one study conducted to assess the quality and delivery of services to Iraq and Afghanistan veterans, 44% replied that they did not seek services because of the fear it might harm their careers. (5)

PTSD affects people profoundly, and if untreated, leads to a worsening condition. Military families are also hit by the effects of war. The American Psychiatric Association outlines it clearly in its DSM IV(Diagnostic and Statistical Manual), defining PTSD as being when a person experiences or witnesses a traumatic or life threatening event that results in feelings of helplessness, horror or intense fear and leads to new behaviors that affect the individual's ability to live normally.  Problems that veterans can experience in adjusting to civilian life or to return to combat  include reflexive sympathetic responses to threats that were non existent in the person's previous experience, such as flashbacks, unreasonably rage, inability to sleep, inability to form intimate relationships, etc.

PTSD has certain basic symptoms that are listed and then rated, much like pain scale checklists are to determine the severity of the problem. Some of the more prominent indicators according to the DSM-IV are:

1. The person has experienced an event that is outside of the range of usual human experience that would be markedly distressing to almost anyone.

2. The traumatic event is persistently re-experienced in at least one of 4 ways.

3. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the trauma), as indicated by at least 3 out of 7

different ways.

D. Persistent symptoms of increased arousal (not present before the trauma) as indicated by 2 of 6 different ways. (See Appendix 1) (6)

In comparing Chinese to American views of PTSD, I found that the terms and descriptions used are basically the same. PTSD has become a term used in modern Chinese westernized medicine under the heading of psychiatry, but not Traditional Chinese Medicine. One long article was written from the point of view of serving military personal in China. It was very interesting due to its slightly different language about the experience and meaning of being a warrior. It was also very true to western type treatment and definition of PTSD. It had an emphasis on treating the person as soon as possible in order to not have the person deteriorate as well as combining medications and psychotherapy to achieve the best results. It was also interesting in that as an article, it covered all aspects of PTSD, treatment research; both medical and societal, and the scope from the whole of the forces down to the individual. (7) However, there was no mention of the soul or the journey the warrior takes from war back to the life of peace.

In American Chinese medicine, there was one study that surveyed what PTSD is considered in Chinese medicine clinical practice. The final core prescription they chose was a front and a back protocol to avoid point fatigue and addressed the core patterns that were found. On the front were Liver 3, Pericardium 6, Heart 7, Stomach 36, Spleen 6 and Yin Tang. On the back were Gall Bladder 20, Bladder4 14, 15, 18, 20, 21 and 23. Then the practitioner could use up to three extra points to address more specific problems. The limitations to the study were the fact that practitioners didn’t always agree on pattern identification for the same symptoms and one should still be careful in one’s own analysis. (8) Depending on the actual symptoms, several patterns can be discerned. Because PTSD can manifest as nightmares, depression, anxiety, somatic disorders, or many other kinds of manifestations, the pattern primarily shows what the treatment method will be.

One practitioner who followed the ideas of Li Dong Yuan, and distilled it to the idea of mental illness as yin fire, listed five scenarios to keep in mind while looking to treatment methods:

1. Spleen Qi Deficiency

2. Liver Stagnation

3. Heat somewhere in the body

4. Other stagnations, such as blood stasis, food stasis, phlegm stasis, blood deficiency heat, etc.

5. Consider in what proportions of each pattern is present, such as 30% Spleen deficiency, plus 50% Liver Stasis, and 15% phlegm stasis and 5% blood stasis and concurrently, there is heat in the lower jiao.(9)

Acupuncture at its roots considers many disorders to be affected by our hearts as described by Heiner Fruehauf in his searching into the Su Wen and Ling Shu for the sources of emotions in the healing of disease. In most indigenous cultures the world over, these principles were found to be important in healing:

“(1) harmony in relations (e.g., with earth, others, nature, society;

(2) personal vulnerability within the person due to imbalance caused by

external forces or inner conflict; (3) the importance of balance in biological

and mental processes; (4) illness results from imbalance and loss of harmony;

and (5) health is the restoration of balance and harmony in mind,

body, and spirit. Thus, healing empowers vital energies contained within.”(10)

In another long article, found online. Subhuti Dharmananda, Ph.D went over the different treatment strategies for spirit disorders using herbs as well as points. The four herbal approaches are to:

1. Nourish, nourish, nourish. Nourish the Kidneys because they are in charge of the marrow, which is what the brain is made up of. Nourish the Liver and/or the Heart in order to calm and settle the spirit. Nourish the Spleen Qi, because emptiness in any of the organs can disturb the spirit, as well as its upward circulation function.

2. Regulate the Qi; Stagnation corresponds to depression, as well as compulsiveness, repetitive thoughts or behaviors, especially those that start to interfere in social situations.

3. Calm agitation, which may include cooling, settling, deficiency, or clearing pathogens from the exterior.

4. Clearing the orifices of phlegm-mist, that may start as stagnation, or damage to the yin, creating phlegm.

Points used to treat the neurological system were also listed and given a fair explanation of their neurological functions. All these treatments are said to treat the Shen. Now what is Shen exactly? According to Dharmananda, it is the aspect of us that looks to the heavens and the divine and is not directly caught up in the emotions, and contributes to wisdom, kindness, and calmness. (11)

The most encouraging Chinese medical practice in America for PTSD, has been developed by Acupuncturists Without Borders (AWB). This form of acupuncture was developed from a few combined methods. One is the history of community style acupuncture started by work of Dr. Michael Smith at Lincoln Hospital in New York City in the late 1970's, which led to the formation of the National Acupuncture Detoxification Association (NADA) and the codification of the NADA protocol. This method uses ­ five needles inserted at specific points in the ear. This was combined with dedicated people who saw a need and passion to respond to hurricane Katrina and has since responded to many other urgent situations, including the newly traumatized Iraq veterans. (12) The NADA protocol itself is a form of ear acupuncture. It consists of five points that address and balance the Sympathetic, Kidney, Lung, Liver, and Shenmen; a point that addresses the spirit that resides in the Heart. (figure 1)(13)

So far, there have been no studies on how this is influencing the patients at Katrina or the veterans who have been coming to AWB for the last year. Over the last year, though, the program has grown. The beginning of AWB’s involvement in serving veterans has grown from one site one year ago to 13 sites across the country with 3 more in the country opening soon. In Seattle, two practitioners who have experience in treating PTSD have currently opened a clinic specifically for treating veterans. (14)

To widen my discussion about trauma I want to introduce a few other ideas that are not currently part of the standard idea of PTSD in western psychology or acupuncture. One is the idea of trauma and recovery put forward by Peter Levine in his landmark book “Waking the Tiger”. He compares animal studies and their reactions to trauma and methods of recovery to what humans and domesticated animals do. Basically, animals first either fight, flee or freeze. When an animal fights or flees, obviously their system is flooded with adrenaline, cortisol and other hormonal and nervous system responses. What happens with playing ‘possum’ is the same internally, but the body has no way to discharge these energies until they are able to move again. Animals naturally will shake and shiver their way out of this. Humans and domesticated animals have learned not to do this. (15) So one aspect of relieving trauma is to discharge this extra stuck array of chemistry, the other is to solve the problem of how to deal with this trauma if it happens again. In other words, one needs to figure out prevention, learn a new defense skill and above all, become a victorious survivor and thrive. Levine calls this renegotiation and in humans it is complicated because of our conceptualizing of our behavior as well as our great fear and awareness of death. (16)

In dealing more with the cultural aspects of our trauma experiences, veterans not only deal with experiences that threaten their life, they also deal with experiences that shake them out of innocence. The experience of horror at one’s own behavior in the grist of battle is also a source of trauma. Edward Tick, a psychologist who went outside of his training to discover better approaches in treating veterans, points out that people are affected at the soul level in these kinds of experiences and that medications and the traditional methods of psychotherapy don’t adequately address the fundamental problem. He further explains that war creates states of mind and emotions that cannot simply be regarded as anxiety, depression, or simple fear. When he had veterans come into his clinic with their truth that their soul had left them, he had to respond. On that level, he has found success. He reframed PTSD, not as a mental disorder, but as an identity disorder. One’s identity must take in the fuller aspect of the self, come to peace with what one has experienced and create a person that has reformatted their basic sense of why they are here, including making amends where possible. He calls that becoming a Warrior. A Warrior is not a person who has seen war per se, but a person that has experienced battle, come back, and restructured their selves to include some renewed dedication to life. (17) This seems to be related to Peter Levine’s concept about renegotiation.

A large important part of this process for the veteran includes the community he comes back to. How is he relieved? Who can lead the veteran back into peace when his/her life has been shattered? Where are the elders in the tradition of Warriorhood? One response to this call for community was answered in May of 2008 in Ashland, Oregon by The Welcome Home Retreat. At this event Michael Meade and Peggy Rubin assisted veterans in expressing their feelings among each other and then expressed their condensed versions in poetry that they then read to the public a few days later. (18)

In coming back to Chinese medicine and how it is talked about in China among acupuncturists and herbalists, I did not find any discussion about PTSD. What I did find was a discussion about ‘fright’ and ‘fear’ and the movements of Shen and Jing, and a discussion of the movement of energy in the body. A good overview of a basic mechanism in guiding the treatment of shock, terror and fright was discussed. The discussion did not list points or prescriptions, but pointed out basic patterns and ideas of thought about how to possibly treat what is now called PTSD. The first idea was to distinguish fright from fear. Fright is yang and fear is yin. Fright affects the Shen, fire and the Heart, while fear affects the Kidneys, water and the Jing. Fright scatters the Qi and the mind aspect of the person, while fear stirs and dislodges the Jing, which will affect the mind as well, but in a more substantial physical manner. The relationship of Jing to stillness was also emphasized especially to the idea of the Will. Will is to be still, and hold and anchor the thoughts, which can fly all over the place if let go. The method of treatment is to collect the Qi in regards to the Shen, and to consolidate the Jing, in regards to the fear. In stilling the Will, and collecting the Qi, recovery can occur. The relation of fire and Shen, and water and Jing, is a critical relationship that needs each other for proper balance. (18)

Case Study

One person suffers from PTSD, and low back pain, but is treated in the SIOM clinic only for the chronic pain due to injuries accrued during the service of the armed forces as well as complications due to stress. He received counseling to help him cope. He took Western medications to help him sleep because he was haunted by nightmares and to deal with pain and depression. He also attended group. In the interview with this person, his most important factor for a good helper was to feel understood and that the helper could express understanding of his feelings. Without that, it would be an intolerable situation. His most helpful treatments were his group sessions with other veterans because that is where he felt most understood. The most difficult symptoms he struggled with due to PTSD was his reaction to people coming up behind him and startling him, in which he would have a huge response of rage, and would have to restrain himself. Fire alarms going off in his building also threatened his ability to be well mannered to his neighbors. He was kindly spared the experience by the building managers, now that they warn him when they go off. The other problem he had was nightmares, of which has been taken care of by a western medication called Trazadone. This unfortunately interferes with the sleep cycle so seriously needed for the body’s ability to heal itself. He has a difficult time still getting to sleep before 1 or 2am in the morning, which wasn’t a symptom mentioned in PTSD, but has implications in TCM, as these are the hours of Liver when he is finally able to get to sleep, and the hours before hand are governed by the San Jiao and then the Gall Bladder. Points chosen for his condition mostly centered on treating chronic back pain, hypertension, congestive heart failure, obesity, and occasional migraine headaches.

On the positive side, these things helped:

1. Going to groups where he felt ‘heard’ and ‘understood’ and where people ‘knew how he felt.’

2. Family was very important in his life.

3. Helping others and getting out of his apartment were essential for him as well.

4. Acupuncture is Very helpful with his chronic back pain.

5. Medications to help him sleep and deal with depression and anxiety. (19)

Concluding thoughts

-Community acupuncture can bring about the stilling of the Zhi and calming of the Shen.

-Community acupuncture allows for the reflection of how trauma has affected more than just ourselves.

-Community can reduce isolation.

-Calming medicinals must be combined with rectifying the Qi mechanism and clearing excesses, and treating the underlying deficiency if present.

-Ear Acupuncture shows promise as a very effective method.

Finally, in treating PTSD, the practitioner must cultivate their own spirit. To be grounded is of utmost importance in treating a veteran or anyone who has had a traumatic experience that has disturbed their Shen or Jing. Being affected by your patient is a common experience that over time one will learn how to be settled and calm while treating someone who is not, and often times cannot even remember what happened to them. In the beginning make sure to take good care of your feelings, because you may feel shocked, drained, and it is possible for one to pick up secondary PTSD from just hearing the stories. The Shen of your body is subtle and can be affected by another’s Shen and one must be strong to do this work. At the same time your Shen can affect that of your patient and can be put to positive use. Staying calm and not becoming frightened yourself is very important in this work. Knowing your limits and creating your own boundaries is necessary to this work. Secondary trauma is a real problem in helpers and daily self care and self assessment is important to avoid doing harm to your patients as well as yourself. (21)

Appendix 1; Complete listing for PTSD.

309.81    DSM-IV Criteria for Posttraumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following have been present: 

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently re-experienced in one (or more) of the following ways: 

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and disassociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: 

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma 

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma 

(3) inability to recall an important aspect of the trauma 

(4) markedly diminished interest or participation in significant activities 

(5) feeling of detachment or estrangement from others 

(6) restricted range of affect (e.g., unable to have loving feelings) 

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: 

(1) difficulty falling or staying asleep 
(2) irritability or outbursts of anger 
(3) difficulty concentrating 
(4) hyper vigilance 
(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Specify if: 
Acute: if duration of symptoms is less than 3 months 
Chronic: if duration of symptoms is 3 months or more

Specify if: 
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

Appendix 2: Translation of Dài Sī Gōng (1324-1405)’s paper

About terror, there is no mention of terror 怖 in the Nei Jing so we will start with the Jin Gui Yao Lue. In the running piglet line, there is discussion about ‘fright’’惊’ and ‘terror’,’ ‘怖’, then it continues on to talk about ‘fright’ and ‘fear’.

It can be seen that ‘fright’ and ‘terror’ means ‘fright’ and ‘fear.’

Terror is similar to dread ’惧’: Afraid is also similar to dread. All together they are called ‘fright’ and ‘fear’. In talking about them in relation to each other, one is Yin and one is Yang. If happy and anger are compared, happiness emerges from the Heart and the Heart lives in the Yang part of the body. Anger emerges from the Liver and the Liver lives in the Yin part of the body. If the will and thought are compared, the Will is still and does not shift around and Thought is always stirring and does not stop. Stillness is Yin and stirring is Yang. If Fright and fear are compared, Fright is caused by a touch from the external, which internally stirs the heart then the heart stirs and the spirit is shaken. Fear is caused by a trigger from an external event and if inside is deficient then the Jing retreats.

The (Nei Jing) says if there is fright, then the heart has nothing to lean on for support. The Spirit then has no place to return to and the thoughts have no focus. Therefore the Qi is in turmoil. So if there is fear, then the Jing goes home, if it retreats, then the upper Jiao shuts. If it shuts, then the Qi is sent back to its source and then the lower Jiao becomes distended (Since everything now gets stuck in the lower jiao). Therefore the Qi doesn’t move. In addition, it says that “If a person is an aristocrat and then afterwards lives on the streets, that experience of being rich and then afterwards becomes poor. “

Grief and worry interiorly binds and then loses the Ying and the Jing.

If disease has gone deep without Qi, then it becomes alarmed and frightened.

All these kinds of diseases are externally caused that then will go interior and stir the mind and spirit of the person. In the case of internal causes, the body is yin or yang, full or empty, and furthermore will cause fright and fear. Then fright is fire and heat restlessly moving the heart. The heart stirs and then the spirit is chaotic. Spirit will be useless without direction, therefore fright’s complications and conditions are not only one kind. There are fright immobilization, fright fantasy, fright mania, fright palpitations etc. type diseases. If fear, then there is heat damage to the Kidneys. If there is kidney damage, then the Jing becomes deficient. If deficient, the Will becomes insufficient. The Will originally has one focus only and doesn’t move and therefore fear is also without other symptoms in normal conditions. In the Nei Jing, it two kinds of fright disease evils; fire and heat. Climatically there are gains and losses of Qi and energy Each Channel has disease caused by heat. There are three Yang accumulations merging. There is Qi joined at the Yang. All are various fright type diseases. Therefore the disease mechanism is summarized and stated: Of all diseases of fright and shock, all belong to fire. In fear disease’s evil; you have Jing, Qi concentrating in the Kidney, then there is fear, if there is insufficient blood then there is fear. If the Shao Yang enters the Yin, then Yin and Yang will struggle and then there is fear, if there is Stomach Heat and Kidney Qi weakness, then there is fear. If there is Kidney stirring, then there is fear.

When there is fright and fear occurring simultaneously in the Liver, because the Liver Qi belongs to the Yang residing with the Yin place. It holds the blood and stores the Hun, the Hun not peaceful, and then Spirit stirs. Shen stirs and then fright. Blood insufficiency the Will is timid, If the Will timid, then there is fear.

Therefore Liver can have both fright and fear at the same time. It seems like this type is due to fire and heat; two external pathogens merged with damp belonging to external evil contractions. The remaining fright and fear are all caused by Qi’s

Yin and Yang stirred and are furthermore interiorly generated. Fright and fear; both diseases are from internal or exterior causes.

Is the treatment method the same or different? It says: “if there is fright then calm the spirit, if fear, then still the Will.“ Treatment should differentiate between Yin and Yang. The Heart is Li fire, inside it is Yin, and outside it is Yang.

The Kidney is Kan water, It is Yang on the inside and Yin on the outside. Internally it is the ruler, externally it is the functions.

Again, internal rules the five spirits, Exterior use the five Qi’s. It is therefore Heart uses the Spirit to rule, Yang is used to perform functions Kidney uses the Will as the Ruler; Yin is used to perform functions. Yang is then Qi, is Fire. Yin is then Jing, is Water and therefore water and fire are already proceeding. All this depends on Jing rising above in order to calm the spirit, and the Yang Qi descending and storing, in order to Still the Zhi. If it isn’t true, then the spirit shakes and not peaceful inside. Yang Qi disperses to the exterior: Will is affected by the middle. Yin Jing goes down below.

Since there are two organs, differentiate the Water and Fire. How could the treatment method not be different? Therefore, if a frightened person you must calm the spirit, and then scattered Qi can be collected. If the Qi is collected, then Yang pathways move; in a fearful person, you must first still the Will.

After that, then their Jing that has walked away can be secured. The Jing consolidates, and then Yin is useful. In terms of using herbal medicine, treat the 2 organs, using the monarch and the minister, envoy’s specific uses.

Internally or externally the affected person also need slightly different treatment.

In meeting an exterior surprise event, Master Zhang talks about calming the frightened patient. Calmness has two meanings: one means normalizing, to cause the patient to frequently experience it. To get them accustomed to it, until natural seeming till not frightened. One meaning is to consolidate the Jing Not assuming that calming the heart. One meaning is to consolidate the Jing Not like that of calming the heart I call this Internal Qi stirring the spirit, then should not to use the method. Only one should use medicines to calm the Yin and Yang’s up and down and after that the spirit is able to calm down and the Will becomes still.

((Inquiry into Teaching Opinions))

怖, <<内 经>> 无 有, 始 于 <<金 匮 要 略>>, 奔 豚 条 有 惊怖, 继 云 惊 恐,

可 见 惊 怖 即 惊恐. 怖, 惧 也; 恐, 亦 惧 也. 凡 连 称 惊恐 者, 以 一 阴一阳 对待 而 言. 如 喜 怒 并 称 者, 喜 出 于 心, 心 居 在 阳; 恐 出 于 肝, 肝 居 在 阴. 志 意 并 称 者, 志 是 静 而 不 移, 意 是 动 而 不 定, 静, 阴 也; 动, 阳 也. 惊 恐 并 称 者, 因 触 于 外 事 , 内 动 其 心, 心 动 则 神 摇; 恐 因 感 于 外 事, 内 慊 而 精 却. <<内 经>> 谓 惊 则 心 无 所 椅, 神 无 所 归, 虑 无 所 定, 故 气 乱 矣; 恐 则 精 却, 却 则 上 焦 闭, 闭 则 气 还, 还 则 下 焦 胀, 故 气 不 行 矣. 又 谓 尝 贵 后 贱, 尝 富 后 贫, 悲 忧 内 结, 至 于 脱 营 失 精,病 深 无 气, 则 洒 然 而 惊. 此 类 皆 病 从 外 致, 所 动 内 之 心 神 者 也.若 夫 在 身 之 阴阳 盛 衰 而 致 其 惊 恐 者, 则 惊 是 火 热 躁 动 其 心, 心 动 则 神 乱, 神 用 无 方, 故 惊 之 变, 状 亦 不 一,为 惊 骇, 为 惊 妄, 为 惊 狂, 为 惊 悸 等 病; 恐 则 热 伤 其 肾, 肾 伤 则 精 虚, 虚 志 不足, 志 本 一 定 而 不 移, 故 恐 亦 无 他 状. <<内经>>有 惊 病 之 邪, 有 火 热 二 淫, 司 天 在 泉 胜 复 之 气, 有 各 经 热 病 所 致, 有 三 阳 积 并, 有 气 并 于 阳, 皆 为 诸 惊 等 病, 鼓 病 机 统 而 言 曰: 诸 病 惊 骇, 皆 属 于 火 也. 于 恐 病 之 邪 者, 有 精 气 并 于 肾 则 恐, 有 血 不 足 则 恐, 有 少 阳 入 阴, 阴阳 相 搏 则 恐, 有 胃 热 肾 气 微 弱 则 恐, 有 肾 是 动 者 恐. 然 于 肝 之 惊 恐 互 作 者, 以 其 脏 气 属 阳 居 阴,纳 血 藏 魂, 魂 不 安 则 神 动, 神 动 则 惊, 血 不 足 则 志 慊, 志 慊 则 恐, 故 二 者 肝 脏 兼 而 有 之. 似 此 之 类, 于 火 热 二 淫 并 湿 属 感 邪 之 外, 其 余 惊 恐 皆 因 气 之 阴阳 所 动 而 内 生 也. 惊 恐 二 病 与 内外 所 因, 治法 同 乎 异 乎? 曰: 惊 则 安 其 神, 恐 则 定 其 志, 治 当 分 阴阳 也. 心 为 离 火, 内 阴 而 外 阳; 肾 为 坎 水, 内 阳 而 外 阴. 内 者 是 主, 外 者 是 用, 又 内 主 者 五 神, 外用 者 五 气.是 故 心 以 神 为 主, 阳 为 用; 肾 以 志 为 主, 阴 为 用.阳 则 气 也 火 也, 阴 则 精 也 水 也, 及 乎 水 火 既 济, 全 在 阴 精 上 承 以 安 于 内, 阳 气 散 于 外; 志 感 于 中, 阴 精 走 于 下.既 有 二 脏 水 火之 分, 治法 安 得 无 异?所以惊 者 必 先 安 其 神, 然 后 则 散 之 气 可 敛, 气 敛 则 阳 道 行 矣; 恐 者 必 先 定 其 志, 然 后 则 走 之 精 可 固, 精 固 则 阴 气 用 矣. 于 药 而 有 二 脏 君 臣 佐 使 之 殊 用, 内 外 所 感 者 亦 少 异. 会 外 事 惊 者, 张 子 和 谓 惊 者 平 之.平 有 二 义: 一 云 平 常 也, 使 病 者 时时 闻 之, 习 熟 自 然 不 惊;一 云 此 固 良 法, 不 若 使 其 平 心 昜 气 以 先 之, 而 后 药 之 也. 吾 谓 内 气 动 其 神 者, 则 不 可 用 是 法, 惟 当 以 药 平 其 阴阳 之 盛 衰, 而 后 神 可 安, 志 可 定 矣.<<推求师意>> 怖, <<内 经>> 无 有, 始 于 <<金 匮 要 略>>, 奔 豚 条 有 惊怖, 继 云 惊 恐, 可 见 惊 怖 即 惊恐. 怖, 惧 也; 恐, 亦 惧 也. 凡 连 称 惊恐 者, 以 一 阴一阳 对待 而 言. 如 喜 怒 并 称 者, 喜 出 于 心, 心 居 在 阳; 恐 出 于 肝, 肝 居 在 阴. 志 意 并 称 者, 志 是 静 而 不 移, 意 是 动 而 不 定, 静, 阴 也; 动, 阳 也. 惊 恐 并 称 者, 惊 因 触 于 外 事 , 内 动 其 心, 心 动 则 神 摇; 恐 因 感 于 外 事, 内 慊 而 精 却. <<内 经>> 谓 惊 则 心 无 所 椅, 神 无 所 归, 虑 无 所 定, 故 气 乱 矣; 恐 则 精 却, 却 则 上 焦 闭, 闭 则 气 还, 还 则 下 焦 胀, 故 气 不 行 矣. 又 谓 尝 贵 后 贱, 尝 富 后 贫, 悲 忧 内 结, 至 于 脱 营 失 精,病 深 无 气, 则 洒 然 而 惊. 此 类 皆 病 从 外 致, 所 动 内 之 心 神 者 也.若 夫 在 身 之 阴阳 盛 衰 而 致 其 惊 恐 者, 则 惊 是 火 热 躁 动 其 心, 心 动 则 神 乱, 神 用 无 方, 故 惊 之 变, 状 亦 不 一,为 惊 骇, 为 惊 妄, 为 惊 狂, 为 惊 悸 等 病; 恐 则 热 伤 其 肾, 肾 伤 则 精 虚, 虚 志 不足, 志 本 一 定 而 不 移, 故 恐 亦 无 他 状. <<内经>>有 惊 病 之 邪, 有 火 热 二 淫, 司 天 在 泉 胜 复 之 气, 有 各 经 热 病 所 致, 有 三 阳 积 并, 有 气 并 于 阳, 皆 为 诸 惊 等 病, 鼓 病 机 统 而 言 曰: 诸 病 惊 骇, 皆 属 于 火 也. 于 恐 病 之 邪 者, 有 精 气 并 于 肾 则 恐, 有 血 不 足 则 恐, 有 少 阳 入 阴, 阴阳 相 搏 则 恐, 有 胃 热 肾 气 微 弱 则 恐, 有 肾 是 动 者 恐. 然 于 肝 之 惊 恐 互 作 者, 以 其 脏 气 属 阳 居 阴,纳 血 藏 魂, 魂 不 安 则 神 动, 神 动 则 惊, 血 不 足 则 志 慊, 志 慊 则 恐, 故 二 者 肝 脏 兼 而 有 之. 似 此 之 类, 于 火 热 二 淫 并 湿 属 感 邪 之 外, 其 余 惊 恐 皆 因 气 之 阴阳 所 动 而 内 生 也. 惊 恐 二 病 与 内外 所 因, 治法 同 乎 异 乎? 曰: 惊 则 安 其 神, 恐 则 定 其 志, 治 当 分 阴阳 也. 心 为 离 火, 内 阴 而 外 阳; 肾 为 坎 水, 内 阳 而 外 阴. 内 者 是 主, 外 者 是 用, 又 内 主 者 五 神, 外用 者 五 气.是 故 心 以 神 为 主, 阳 为 用; 肾 以 志 为 主, 阴 为 用.阳 则 气 也 火 也, 阴 则 精 也 水 也, 及 乎 水 火 既 济, 全 在 阴 精 上 承 以 安 于 内, 既 有 二 脏 水 火之 分, 治法 安 得 无 异?所以惊 者 必 先 安 其 神, 然 后 则 散 之 气 可 敛, 气 敛 则 阳 道 行 矣; 恐 者 必 先 定 其 志, 然 后 则 走 之 精 可 固, 精 固 则 阴 气 用 矣. 于 药 而 有 二 脏 君 臣 佐 使 之 殊 用, 内 外 所 感 者 亦 少 异. 会 外 事 惊 者, 张 子 和 谓 惊 者 平 之.平 有 二 义: 一 云 平 常 也, 使 病 者 时时 闻 之, 习 熟 自 然 不 惊;一 云 此 固 良 法, 不 若 使 其 平 心 昜 气 以 先 之, 而 后 药 之 也. 吾 谓 内 气 动 其 神 者, 则 不 可 用 是 法, 惟 当 以 药 平 其 阴阳 之 盛 衰, 而 后 神 可 安, 志 可 定 矣. <<推求师意>>

References

1. “Veterans are Home but Not at Ease,” James Hohmann, Dallas Morning News, November 11, 2007

2. Suicide among male veterans: a prospective population-based study; Mark S Kaplan, Nathalie Huguet, Bentson H McFarland and Jason T Newsom J. Epidemiology.. Community Health 2007;61;619-624

3. http://www.nchv.org/background.cfm#incarcerated

20% of Iraq, Afghanistan veterans have depression or PTSD, study finds

By Julian E. Barnes, April 18, 2008 Los Angeles Times

4. America’s Military Kids Are Latest Collateral Damage

By Stacy Bannerman; The Women’s Media Center

August 06, 2007

5. http://www.rand.org/pubs/research_briefs/2008/RAND_RB9336.pdf

6. http//www.mental-health-today.com/ptsd/dsm.htm

cites the criteria according to the DSM- IV published in 1994 by the American

Psychiatric Association.

7. 心理科学进展 2006，14（2）：178183 , Advances in Psychological Science journal.psych.ac.cn/jinzhan/qikan/manage/wenzhang/060205.pdf

http//www.geocities.com/dochung/stress30.html

8. Developing a Traditional Chinese Medicine Diagnostic Structure for Post-Traumatic Stress Disorder. Sinclair-Lian D.O.M., Hollifield, M.D., Menache Ph.D., Warner Ph.D. Viscaya D.O.M. and Hammerschlag Ph.D. The Journal of Alternative and Complementary Medicine, vol 12, no 1, 2006 pp45-57.

9. Chinese Medical Psychiatry, Bob Flaws, James Lake, M.D. Blue Poppy Press, 2001, pp 31

10. All Disease Comes From the Heart: The Pivotal Role of the Emotions in Classical Chinese Medicine, By Heiner Fruehauf, Ph.D. Acupuncture Today, vol 43, Spring 2008

11. http://www.itmonline.org/articles/acubrain.htm

12. http://www.acuwithoutborders.org/about_us.php

13. http://www.chinesemedicinetimes.com/section.php?xSec=51

14. http://www.communichi.org/

15. Waking the Tiger: Healing Trauma, by Peter A. Levine, North Atlantic Books, 1997,pp 95-98 This book is simple to read, yet profound in its implications for healing. His work has been repeated and expanded into many different groups of people.

16. Ibid...pp 104,112-123

17. War and The Soul, by Edward Tick, Quest Books, Wheaton, Illinois. This author has deeply impressed me with a lasting new way to view any kind of traumatic experience. He has offered up to the American community a mirror in which to look into and invite the possibility for reclaiming our souls which has been spread thin in these last few wars that we have undergone almost unconsciously. He has a fine lecture online on YouTube, which as been an increasing source of vital information as people interested in getting community change happening are using it, especially more of our older people who have had years of experience in helping others.

http://video.google.com/videosearch?q=Edward%20Tick&ie=UTF-8&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&sa=N&tab=wv#

18. http://thewelcomehomeproject.org/index.php?option=com_frontpage&Itemid=1

19. Heart Palpitations, Inquiry into Teacher’s Opinions, Dài Sī Gōng (1324-1405) 戴思恭(1324-1405), 字元礼, 明代医家

20. SIOM Case study, GEKE

21. Trauma Stewardship, Laura Van Dernoot, Connie Burk, Las Olas Press, Seattle. By far the most useful self care assessment discussion on helper trauma.