Stress Management
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Stress Management

People of all ages and walks of life experience acute & chronic stress that result in anxiety & depression, and somatic complaints such as pain. Stress management is core to healing!

I recently interned at a hospital-based pain & stress clinic where I received the same acupuncture treatments given to patients. What I realized from this experience was that while we have an accurate perspective on our acute stressors, we do not have insight into our chronic stress. Stress is not just psycho-emotional in nature but encompasses stressors that are structural, immunological, hormonal, metabolic, nutritional, toxicological /infectious and genetic in nature. 

Acute Stress is short term, recent, episodic, and/or sudden unexpected demands  upon daily living. Acute stress affects the cardiovascular, nervous and endocrine systems. It is relatively easy and quick for healthy individuals to bounce back from acute stress.  Adapinogens, restful sleep, exercise, and acupuncture down regulate the acute stress response. These help allay Chronic stress.

Chronic Stress is the residual of perpetual and/ or unrelenting anticipated challenges upon daily life such as  job/ joblessness-related, poverty, childhood trauma/abuse, family disfunction or discord; infections, illness, injury; toxic exposures, genetics etc. Chronic stress eventfully depletes physiologic coping mechanisms. It takes time to recover from chronic stress, which is like getting farther and farther behind on the physiological rent / mortgage payment. Chinese medicine [CM]  inherently links seemingly unrelated complaints when it comes to stress, anxiety & depression.is all about avoiding & managing chronic stress.

Internalized Stress is when chronic stress has taken its toll and is now manifesting as a Western disease diagnosis - seemingly not associated with stress at all because the symptoms require emergency intervention [e.g. cancer, heart attacks, stroke]. But internalized stress also includes lowered immunity [less lymphocytes or altered T cell function]; more inflammatory cytokines [systemic inflammation]; less DNA repair enzymes, rapid aging at the cellular level [shorter telomerase shorten the lifespan by 4-8 years]; and slower healing/ recover from illness & injury. Chronic stress increases the risk for cancer because stress hormones [epinephrine, norepinephrine, cortisol] bind to cancer cells and fuel their growth. Function Medicine's extraordinary insight into the mechanisms involved in internalized stress states, sheds modern light onto ancient Chinese Medicine treatment principles..

Stress management means balancing rest & repair [yin] and fight & flight [yang] modes by regulating the general response to physiologic, emotional, or mental stressors,  For example, stress triggers brain centers that regulate the response to external & internal stimuli. If this response does not or can not ounce back to a state of rest & recovery the result is mood & personality difficulties. Digestive function is impaired when the “Rest & Digest” mode is put on hold by the "Fight or Flight" mode. This may result in functional digestive problems. The immune system slows down resulting  in frequent colds, flus, and infections. 

Chinese Medicine Views
Stress management is called “Cultivating Yin” in CM: beginning with Right Thinking (spirituality & mindfulness) and ending with nurturing relationship with self, others, and community. In between the two are such things as acupuncture/ acupressure, gentle exercises & breathing movements [qi gong], balanced rest vs. activity, herbal therapies, food-as-medicine, and bodywork [tui na]. Even if existing amidst stressful circumstances, the goal is the ability to maintain a sense of coping & well-being. Western Medicine is only now beginning to understand and respect the complexity & simplicity to what the ancient Chinese Medicine scholars already knew! 

In Chinese medical theory, stress has been defined as the "unfulfilled desire" to gravitate towards things safe & pleasant [rest & repair], while on guard against things threatening or distasteful [fight or flight]. When the struggle between the two is overwhelming, the result is something called Liver Depression with Qi Stagnation that is frequently at the root of many disharmonies: fatigue, vague aches & pains, irritability, restlessness, dyspepsia, insomnia, panic, weepiness, hysteria, dysmenorrhea, addictions etc.

Western Medicine Views
Chronic stress is an inherent part of modern Western lifestyles, such that stress management is multifaceted and ongoing. It aims for better digestion & elimination; sounder sleep & alertness; mood stability, optimal cognition & decision-making; reduction in chronic pain & somatic complaints; ameliorating cravings & addictions etc. 

Feelings of stress, anxiety, or depression may be related to a  Western medical diagnosis (e.g. thyroid dysfunction, infection, nutrient deficiencies, hormone imbalance, drug interactions or side effects etc). It may or may not be feasible, desirable [or acceptable] in the USA to rely upon CM alone for optimal outcomes- many factors involved. But it is apparent that better outcomes have been achieved using both.

For example, research shows that acupuncture has the potential to lower required doses of medications for anxiety or pain. In other studies, combining acupuncture with lower doses of antidepressant medication was more effective at lifting depression than higher doses of the medication alone.

Functional Medicine [FM] Views
According to FM research, feeling stressed out, anxious, then depressed is NOT viewed as pathology, or a character flaw!!! But rather as an adaptive response to force the body to slow down, rest & repair.  What is profoundly moving is that there has been discovered genetic susceptibilities to stress. Meaning some people are wired to handle stress better than others; or visa versa. For example, a genetic polymorphism called "Hypo-methylation" where the body is unable to efficiently eliminate nor-adrenalin [the catecholamine that drives the stress response]. Or produce calming Neurotransmitters [NT] such as serotonin and GABA. There are many metabolic pathways that can be looked at: 

  • Serotonin: LOW--> OCD, poor memory, suicidal thoughts & feelings, aggression. HIGH --> agitation/ anger.
  • Dopamine: HIGH--> paranoia
  • Dopamine + serotonin: LOW -->  poor appetite, aggression.
  • Glutamate: HIGH --> anxiety, insomnia, ADHD/poor concentration. LOW--> Depression, Fatigue, Brain fog, Addiction/ dependency, Slow learning.
  • GABA: LOW --> contributes to Panic/anxiety, Depression, Alcoholism, Bipolar. HIGH--> contributes to Drowsiness/lack of alertness, Difficulty concentrating, Diminished memory, Dampened mood, Decreased cognitive processing, high excitatory neurotransmitters [glutamate].

There are FM lab tests for and interventions to compensate for these metabolic pathway problems. But what is even more outstanding is that the thermal natures of Chinese herbs [hot, cold, neutral] has been correlated with methylation pathways, and already built into CM treatment principles for "psycho -emotional disharmonies" are the same principles now used in FM for methylation polymorphisms.  One very important principle is providing the body with the substrate [yin], before driving the metabolic pathways [yang]. And built into the herbal formulas is such substrate for these pathways [e.g. B vitamins, glycine, sulfur compounds, antioxidants, and antibiotics, and herbs that regulate immune-responses etc].

Stress Management Strategies- Adaptinogens, Sleep, Exercise
Adaptinogens help prevent/ control the toll that stressors place upon the body. Adaptinogens are unique to the herbal kingdom. Most increase ACTH and cortisol with single high doses, but  normalize both when given long term or in anticipation of a stressful event. They reset the sensitivity of the hypothalamus and pituitary to the negative feedback from high cortisol levels. They normalizes the perception of stress- a.k.a. the tendency towards feeling stressed out. They increase physical endurance and oxygen utilization.

Seek professional consultation for which adaptinogen(s) and dose is right for you. And note that proper nutrition, and/or one Chinese herbal formula can equal many supplements needed in combination:
 
  • American Ginseng / Panax Ginseng/ Panax quinquefolius/ YiYang Shen. Use for at least 8 weeks, but meaningful results may not happen until 3 months. Use 2.4-10g of the raw herb cooked in a double boiler, or 1-4 ml of the tincture daily. It is a prime adrenal cortex restorative - tonifies Qi without warming to those who are already warm natured.
  • Siberian Ginseng /Eleutherococcus senticosus/ Acanthopanacis senticosi decreases adrenal hypertrophy, and corticosteroid production. This is a relatively mild herb and can be combined with other tonics to strengthen its effects. Use the Ci Wi Ji species for mild depression. Contraindicated with digoxin, and antiboiotics. Use the Wu Ji Pi species to regulate and balance of bodily functions, said to "To cure the 5 kinds of strain and the 7 kinds of impairment" with 1g daily with wine. 
  • Rhodiola. Unique at improving physical & mental fatigue, for people who have lost/ loosing coping skills & abilities and at high risk for depression. Titrate dose. May feel the effects of only one dose for a couple of days. Beware that your body may demand " I need sleep to repair!!!" and this is a good thing. You may fight it at first but allow yourself to sleep.
  • L- Theanine raises the threshold for stress, in other words it takes more stress to kick off the stress response, and perception of stress
  • Vitamin C. normalizes cortisol in situations of severe stress. Remember a quality vitamin C product comes as a complex [like vitamin E tocopherols], of which ascorbic acid is only one part. And perhaps the liposomal form is best for some individuals.
  • B Complexes: B1/thiamine. Protects the adrenals from functional exhaustion due to extreme stress. B5 /pantothenic acid. Replenishes adrenal cortex and may be able to down-regulate hyper secretion of cortisol in extreme stress.
  • Tyrosine.  Replenishes neurotransmitter receptors thus restoring task performance under stress.
  • R-Lipoic acid. Prevents by degradation the accumulation of epinephrine & norepinephrine in tissues. 
  • Phosphatidyl-serine. One of the best ways to prevent over secretion of cortisol and ACTH for those existing in perpetually stressful environments.

Another part of stress management is normalizing the circadian highs & lows of cortisol in a 24-hr period. Chronic stress leads to dysregulation of the circadian rhythm- cortisol cycle and hypothalmic- pituitary- adrenal axis [HPA-axis]. This can result in sleep disturbances and fatigue.  Sleep is a time of repair: physical, psychological, and spiritual. Achieving better sleep is a very good [perhaps the first] sign that one is on the way to recovery from chronic stress! 

One way TCM regulates the circadian cycle of qi is by dosing certain herbal formulas at particular times of day or night [according to the Horary Clock]. For example, using warming, energizing yang tonics, and adaptingogens form 6 a.m. to noon; calming, cooling yin tonics and adaptinogens from noon to evening; sedatives or hypnotics, at bedtime (Golden Flower Herbs, 2015). Eluethero, American, or Chinese ginseng and a formula called Free & Easy Wanderer are adaptinogens. All herbs and formulas are further refined based on a person's constitution and presentation. 
 
Exercise!!!
  • High-intensity in the morning stimulates cortisol- mimicking the normal diurnal pattern.
  • Moderate or low intensity in the evening lowers cortisol-  mimicking  the normal diurnal pattern.
  • Vigorous to point of sweating & breathlessness prolongs telomeres, and significantly decreased BrCAbreast cancer risk compared to moderate exercise. 
  • Supervised/ partially supervised with a coach or friends, and away from home is found to be more beneficial.
  • 30 minutes 5 x weeklyupping the anti on intensity as tolerated
  • Qi Gong gentle movements & breathing exercises eliminates the risk of injury or over fatigue for weak & vulnerable individuals. Can be done in bed or in a chair/ wheelchair.

The last link to stress-management is 
Something to do, Someone to love & Something to look forward to!


Sources:
Gant, C. (2015). Understanding methylation, the roadmap to wellness: How the perfect storm of methylation defects, oxidative stress and inflammation predisposes you to chronic medical & psychiatric disorders. In Functional Medicine University.

Guomin Li et al (2013). Acupuncture improves cognitive deficits and increases neuron density of the hippocampus in middle-aged SAMP8 mice. Acupuncture in Medicine.

Hsin-Ying Hsieh, Pei-Hsun Chiu, Sun-Chong Wang. (2013). Histone modifications and traditional Chinese medicinals. Complementary and Alternative Medicine, 13(115). DOI: 10.1186/1472-6882-13-115

Larzelere M., Jones G. (2008). Stress and health. Primary Care Clinics in Office Practice 35(4).

Li shen, Hong Yan, Hui Feng. (2007). Clinical observation on general anxiety disorder treated by acupuncture plus herbal medicine. Acupuncture in Medicine 5(4).

Yan Liang et al. (2012). Therapeutic efficacy observation on acupuncture for post-withdrawal syndrome of heroin dependence. Journal of Acupuncture and Tuina Science 10(3).



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