COVID-19 has quickly become a global health emergency resulting in not only physical health concerns but also psychological concerns as people are exposed to unexpected deaths or threats of death.

For example, healthcare workers who have close contact with COVID patients are not only exposed to the virus on a regular basis, but they may also be witnessing increased illnesses, deaths, and supply shortages. In addition, patients admitted to the hospital with COVID-19 experience social isolation, physical discomfort, and fear for survival. These exposures increase the risk of developing Post-traumatic stress disorder(PTSD). In addition, the risk may further be enhanced during the subsequent weeks when these individuals may lack immediate social support due to the need to self-quarantine.

The PTSD might be referred to emotional disorder caused by emotion scared and frightened. Nei Jing(Yellow Emperor’s Canon of Internal Medicine) discuses the emotion disorders impacting on the five Zang Organ. It says: The emotion of liver is anger, excessive anger will hurt the liver. The emotion of kidney is terror, excessive terror will hurt kidney.

What is the etiology, pathogenesis and therapy?

Horror damages kidney, and kidney water fails to nourish liver resulting in disorder cooperation of liver, or the kidney water fails to nourish the heart resulting in the heart fails to store mind which leads to PTSD. General speaking, the PTSD relates to the heart, liver and kidney.

• Liver Qi stagnation: The working under pandemic, liver qi stagnation, and the Qi fails to sooth and cooperate, resulting in the following manifestations.

Manifestations: depression, unrest, grief and sorrow, break out due to emotional stimulation, hyperchondriac pain, irregular period, sigh and bloating abdomen, thin tongue coating, wiry pulse at left and deep weak at right.

Treatment strategy: Sooth liver Qi and relieve Qi stagnation.

Formula: Si Ni San.

For significant Qi stagnation, add Xiang Fu, Chuan Xiong, Qing Pi, Fo Shou. Add Chen Pi, Ban Xia. For burping, acid regurgitation. For Qi stagnation turning to heat with impatience and irritability, Jia Wei Xiao Yao San is used.

Acupuncture points: PC6, Liv3, Sp6, UB17, UB18, St36.

For Qi stagnation turning fire, add GB34, Ki1.

• Both deficiency of Spleen and heart: terror, insomnia with night mare that relates to Covid-19, dizziness, fatigue and poor appetite. Pale tongue, deep and weak pulse.

Treatment strategy: tonify the spleen and heart, generate blood and calm the mind.

Formula: Gui Pi Tang.

For irritable, add Zhen Zhu Mu, Mu Li. For depression, add He Huan Pi, Ye Jiao Teng. For spontaneous sweating, add Fu Xiao Mai, Duan Mu Li. With Yin and blood deficiency, add Bai He, Mai Men Dong, Wu Wei Zi.

Acupuncture points: UB15, UB20, HT7, Yintang.

For significant fatigue, add ST36, SP6, Du20. For poor sleep, add Anmian, Si Shen Chong.

• Heat phlegm disturbing heart: Stress due to Covid-19, Qi stagnation turns to heat, the heat burns body fluid and causes phlegm. The heat and phlegm accumulates and disturbs the heart mind manifested as following.

Manifestations:  Being easily startled or frightened, feared, anxiety and irritability, restlessness, poor sleep and poor appetite, acid regurgitation, red tongue with yellow greasy coating, slippery and rapid pulse.

Treatment strategy: Clear heat and resolve phlegm, relieve restlessness.

Formula: Huang Lian Wen Dan Tang.

For restlessness, add Suan Zao Ren, Yuan Zhi, Long Gu, Mu Li. For Yin deficiency, add Mai Men Dong, Bai He, Zhi Mu.

Acupuncture points: UB15,UB19, PC6, UB23.

For significant feared, add UB45, UB48. For hypochondric pain, add SJ6, GB34. For insomnia, add HT7, Anmian. For Yin deficiency, add KI3, UB23.

 

• Both deficiency of heart and kidney: Excessive terror will hurt kidney. Patients are suddenly shocked by witness or heard of the death with Covid-19, the sudden terror injures kidney, Kidney Yin fails to nourish the heart Yin or Kidney Yang fails warm the heart Yang, resulting in both deficiency of heart and kidney manifested as the following.

Manifestations:  Trends to be frightened, palpitation, poor sleep, incontinence of urine or feces after scared, low back pain and knee pain, low libido. Red tongue with less coating and thin thread rapid pulse if it is kidney Yin deficiency. Pale and swollen tongue with watery coating, deep and weak pulse if it is Yang deficiency.

Treatment Strategy: Strengthen the heart and Kidney, sedate the terror.

Formula: Ji Gui Shen Qi Wan for Yang deficiency of the heart and kidney. Liu Wei Ji Huang Wan for the Yin deficiency of the heart and Kidney.

For Yang Qi deficiency, add Ren Shen, Long Gu, Mu Li. For deficient heat, add E Jiao, Zhi Mu and Zen Zhu Mu.

Acupuncture points: UB15, DU4, UB23, Si Shen Chong.

For Yang deficiency, add moxa at UB15 and Du4. For Yang Qi deficiency of the heart and kidney Yang, add ST36, Ren12. For Yin deficiency of the heart and kidney, add KI3, SP6.

Other therapies:

Ear acupuncture: Heart, subcortical, Shen Men, forehead, Brain Stem.

Cupping: the UB14, UB15, UB45, UB52.

Exercise: Do Tai Ji, Qi Gong, Yoga.

-Dr. Bai Song Zhong