Releasing Trauma: Considering Late- versus Early-Onset in the Treatment of PTSD
A common archetype of Post Traumatic Stress Disorder (or PTSD) is the aging, war-torn veteran, but in an era of constant and intimate exposure to tragic imagery and social injustice from across the globe, on top of the normal, daily stressors so many people experience, the signs of psychological wear-and-tear at the level of trauma are unfortunately frequent. Whereas we might expect the PTSD-sufferer to experience flashbacks, emotional outbursts, sleep issues, and extreme physical pain, these are just a few of the “re-experiencing” type symptoms of PTSD. Other symptoms of PTSD fall into three basic categories:
- Avoidance-type symptoms, which sound exactly like what they are: avoiding things, places, memories, or feelings that might be reminders of the traumatic events. A perfect example of this is the client that says, “I just can’t go there anymore.”
- Arousal or reactivity-type symptoms include feeling tense or easily startled, difficulty sleeping or concentrating, irritability, and some self-destructive behaviors.
- Cognition-type symptoms include overall negative thinking, patterns of blaming, isolation or lack of engagement with the world, and predominance of so-called “negative” emotions like fear, anger, guilt, or shame (rather than contentment or happiness).
A diagnosis of “acute” PTSD (or the chronic version, C-PTSD), relies on a combination of symptoms from all four types: re-experiencing, avoidance, arousal, and cognition. Some of these symptoms are commonly seen in clinical practice, but as they range from mild-to-severe, it can be hard to diagnose. For just a moment, consider a client that presents with physical tension, sleep concerns, emotional anxiety or irritability, difficulty concentrating (which they might not list, but any inability to report health history in a linear fashion could indicate such), perhaps even reporting ‘numbing’ behaviors like disordered or excessive eating, alcohol, or drug consumption. They might also comment that their life has become smaller or less engaged, blaming pain levels, sleep, anxiety, or concentration issues for the change, while their stress level is consistently 5-8 out of 10. This collection of symptoms indicates potentially undiagnosed PTSD, which is the unfortunate norm in an emotionally over-taxed culture.
Fortunately, resolving Trauma with Chinese Medicine is pretty straightforward, with two major types to consider: late-onset and early-onset. Late-onset PTSD is based on events that occurred well after the individual formed a healthy sense of self and boundaries, with proper development of both physical and mental abilities. Early-onset PTSD is based on events that happened at a young age, or at any time before the sense of self, boundaries, and/or proper development were fully realized. The treatment protocols for the two are quite different, but over the course of a decade I developed a Chinese Medicine approach to diagnose and treat both presentations.
Late-Onset Trauma: Impact on the Fluids
The Heart-Emperor controls our conscious awareness and short-term memory. When an experience becomes too stress-inducing, the overwhelmed Heart will not perform any of its functions properly. The initial shock of any surprise will scatter Qi. When mild – like a small scare from someone jumping around the corner – this affects the Heart’s function for only a few beats. Full recovery from a true state of shock – which impacts the Heart and Kidneys – can take time, even days or weeks, but the impact of severely scattered Qi will eventually fade on its own in a healthy system. Trauma has more lasting impact than shock, so complete recovery within a few minutes, hours, or even weeks just isn’t possible without correct care.
As the Heart is responsible for producing Blood, acute trauma will likely first present with Blood Deficiency symptoms, which is a common pattern from extreme stress. As the saying goes, “Blood is the mother of Qi” so Qi Deficiency – especially that of the Spleen – will often go hand-in-hand with Blood Deficiency from trauma. Of course, the Heart is also in charge of circulating the Blood, so more severe problems with Heart functioning may therefore manifest as Blood Stasis as the Heart “churns” the Blood to process the psychologically distressing input. Here it is important to remember that the Jin Ye / Body Fluids can help thin Blood to prevent Stasis; so instead of allowing Blood Stasis to form, the system may take from the Body Fluids to maintain proper Blood flow, which can lead to Yin Deficiency and / or the formation of Phlegm instead. As Qi is the so-called Commander of Blood, Qi could also work extra hard to keep Blood flowing to prevent Stasis, developing a mixed Qi Deficiency-Stagnation pattern. Clearly these patterns are more likely to show up as Heart organ problems – such as Heart Blood Deficiency, Heart Blood Stasis, Phlegm obstructing the Heart, and so on – but the problem may show up somewhere else, as the Kingdom always serves to protect the Emperor. Thus, any other Yin Organ can show late-onset trauma pathology as they each interact with the Heart: the Lungs through the Upper Jiao and Zong / Chest Qi, the Liver as Heart’s 5 Element Mother, the Kidneys as Heart’s Yin-Yang opposite, and the Spleen as Heart’s 5 Element Child.
So, when a client comes in for ‘Heart Overwhelm’ – except they are more likely to say ‘stress management’ – there are basic patterns to consider based on these aforementioned functions and relationships. As each of these patterns deal with either fluid nourishment or movement, herbs will become critical to get the system working properly, especially if these patterns have existed beyond a few months. When used in conjunction with acupuncture sessions, simple patent formulas do the job effectively, and in my own experience they tend to increase patient compliance over loose herbal formulas. In my practice, I might choose the following herbs based on pattern diagnosis:
- Blood Deficiency: Si Wu Wan, Shao Yao Gan Cao Wan
- Blood Deficiency with Qi Deficiency: Ba Zhen Wan, Gui Pi Wan
- Blood Deficiency with Qi Stagnation: Xiao Yao Wan
- Blood Deficiency with Blood Stasis: Tao Hong Si Wu Wan
- Blood Stasis (without much Blood Deficiency): Xue Fu Zhu Yu Wan, Yan Hu Suo Zhi Tong Wan
- Phlegm: Er Chen Wan, Chai Hu Long Gu Mu Li Wan
- Yin Deficiency: Tian Wan Bu Xin Wan, Liu Wei Di Huang Wan
When choosing herbs, the etiology leading to the traumatic event itself may dictate formula selection. For example, Blood Stasis due to divorce or heartbreak might require Xue Fu Zhu Yu Wan, whereas Blood Stasis associated with labor and delivery could be more appropriately treated with Shao Fu Zhu Yu Wan or Gui Zhi Fu Ling Wan. The age of the client may also play a part in pattern diagnosis and treatment principles as Stagnation is common in middle-aged and older individuals, so Blood Stasis and/or Phlegm may arise more easily than Deficiency.
But what happens when traumatic circumstances impact the system before an individual’s emotional maturity is complete?
Early-Onset Trauma: The 5 Element Axial Approach
Early-onset trauma is more highly correlated with C-PTSD, where there is additional difficulty in emotional regulation, identity, individuation and sense of self, and in maintaining healthy relationships. Traumatic events occurring during the formative years of growth and development – when neuroplasticity levels are at their peak – can directly penetrate the immature psychological fabric, causing long-term changes to a person’s perspective on the world and their body’s overall ability to function properly. Although there are Zang Fu patterns commonly seen in early-onset trauma, the actual damage to the system is always widespread, along the North-South or East-West axis. This concept of ‘axes’ refers to the placement of 5 Elements not in a circular form (such as with the ‘generational sequence’), but in an older visualization from Yin-Yang Theory: where the North-South axis corresponds to Water and Fire, Kidney and Heart, and the East-West axis corresponds to Wood and Metal, Liver and Lung. At the center of these two poles and these four elements sits the Earth element. Earth at the center reflects stability amid transformation, but because of this central position in both axes, the Spleen and/or Stomach Organs are always impacted by early-onset trauma.
Which axis has been damaged, and where that damage occurred, are the most important things to identify. Fortunately, Zang Fu pattern diagnosis can help pinpoint areas where trauma has settled in, as the “dis-harmonic” combinations from axial damage are quite common in clinical practice.
Along the East – West Axis there are three basic types: Wood – Earth, Wood – Metal, and Metal – Earth:
- Wood – Earth Disharmony: Liver-Qi Stagnation & Spleen Qi Deficiency, often with Dampness or Phlegm accumulation in the Middle Jiao. Look for episodes of anger, with IBS and other bowel disorders affecting the Metal Element. Consider Xiao Yao Wan, Xiao Chai Hu Wan, or Shao Yao Gan Cao Wan.
- Wood – Metal Disharmony: Liver & Lung Qi Stagnation, often with Phlegm in the Upper Jiao. Look for asthma or eczema conditions, irritation or chronic worry, “plum pit qi,” and minor digestive upsets. Consider Ban Xia Hou Po Wan (typically in combination with another formula, such as Xiao Yao Wan).
- Metal – Earth: Lung & Spleen Qi Deficiency, often with Phlegm in the Upper Jiao. Look for chronic rhinitis, nasal/ chest congestion, sinusitis. Consider Cang Er San, Er Chen Wan, Si / Liu Jun Zi Wan, Bu Zhong Yi Qi Wan.
Along the North – South Axis there are another three basic types: Fire – Earth, Earth – Water, and Fire – Water:
- Fire – Earth Disharmony: Spleen Qi & Heart Blood Deficiency, often with Dampness. Look for anxiety, insomnia, and scant menstrual flow. Consider Gui Pi Wan or Nu Ke Ba Zhen Wan.
- Earth – Water Disharmony: Spleen & Kidney Yang Deficiency, often with Dampness or Phlegm accumulation in the Middle or Lower Jiao. Look for worry or shame, chronic diarrhea, weight gain, and edema. Consider Ba Ji Yin Yang Wan, Jin Gui Shen Qi Wan (often with Er Chen Wan).
- Fire – Water Disharmony: Heart & Kidney Yang Deficiency or Heart & Kidney Yin Deficiency with Empty-Heat, often with Dampness or Phlegm in any Jiao. Look for panic attacks, insomnia, low back or knee issues, and temperature regulation issues. Consider Tian Wang Bu Xin Wan or Golden Flower’s Gui Zhi Jia Long Gu Mu Li Wan.
By no means is this a comprehensive listing of all Zang Fu Patterns that can develop from early-onset trauma; it is merely a guide to understanding how patterns might develop. There are also two patterns that always exist in any type of early-onset trauma which can help confirm one’s diagnosis: the presence of Dampness and/or Phlegm, and poorly functioning Wei / Defensive Qi.
- Dampness and/or Phlegm involvement: Any axial disruption of Qi movement will obstruct the San Jiao’s ability to regulate the water passages. This, in combination with Earth organ impact, will lead to Dampness and/or Phlegm. The degree of obstruction, chronicity of the condition, diet, lifestyle, and genetic tendencies will all play a part in the level of Dampness and Phlegm that develop, but the presence of these pathogens may be unusually ephemeral, with symptoms that come and go dramatically with stress levels, triggers, diet, or humidity.
- Wei / Defensive Qi involvement: Earth organs, along with either Water-Kidney or Metal-Lung, will always be involved in an axial presentation. Because these three systems are in charge of creating Qi and circulating the Wei Qi, it will naturally be impacted. This will affect the person’s ability to form an energetic buffer – both physically and mental-emotionally– between themselves and the world or people around them. Beyond the classic symptoms of frequent colds or sensitivity to wind, this could lead to other environmental hypersensitivities like allergies, atopic asthma, eczema, as well as auto-immune conditions and relationship struggles like co-dependency.
It is also possible that a client has both early- and late-onset trauma. Pattern diagnosis will naturally lead the treatment principles in these cases, but there will be evidence of patterns mentioned: axial damage, Heart involvement, Blood and Body Fluid concerns, San Jiao malfunctioning with Dampness or Phlegm, and Wei Qi insufficiency.
Treatment Guidelines: The Importance of Etiology
When choosing points, herbs, essential oils, or other therapies, it is critical to remember that the etiology for any of these patterns is trauma: a disease of the Shen-Spirit. Spirit is the most ephemeral and fast-moving form of Qi, so it may take very little work for the pulse to harmonize. No matter what physical symptoms are present, a focus on healing the Spirit naturally affects multiple aspects of a treatment, including:
- Approach: Set your intention before you start treating, and get consent for all aspects of care
- Therapy selection: Traumatized clients sometimes cannot handle needle insertion or retention and may respond better with moxa, essential oils, qigong therapy, or acupressure
- Qi mechanism: The disruption of Qi will obstruct fluids and the San Jiao; incorporate all three Jiaos in your treatment approach to help re-integrate the system
- Point selection: Utilize points that treat the Spirit, not just the presenting physical symptoms
- Needle insertion: Consider issues of depth, speed, gentleness
- Length of treatment session: This varies greatly among individuals, so ask the client for feedback if needed
Etiology also impacts the recommendation of any lifestyle suggestions or at-home treatment. For example, treating Blood Deficiency with herbs while recommending nourishing foods and bone-broth soups may be helpful to make an individual feel better, but inviting them to recognize the true cause for the depletion of Blood quality – along with suggestions for stress management and a referral to a licensed therapist – is a stronger path toward full recovery. It is also critical to inform a client that you are working on releasing past experiences and emotions, as they might experience acute and short-lived emotional upsets during the post-treatment 24 – 48-hour Qi cycle. Providing them guidance to allow this release will help process the event(s) without putting more fear and resistance into their condition.
The good news is that – just like anything in Chinese Medicine – PTSD release work is easy and effective. When done well, dramatic improvements in chronic and debilitating health conditions can happen quickly, and your practice will surely reap the benefits. The following cases are provided to show how transformative Trauma recovery work can be for the individual, and to illustrate the treatment principles described above.
Case #1: Male, early 60’s
“Tom” had experienced PTSD with anxiety, rage, insomnia, night sweats, nightmares, and flashbacks ever since surviving multiple days and nights of continuous battle at the front lines during the Easter Offensive in Vietnam between March – April 1972. The symptoms started each year in early March and would dissipate in early – mid April, but managing family relationships (wife of 30 + years, 2 adult children), work, and the Easter holidays was always difficult. Besides the PTSD, Tom presented with an overbuilt upper body from heavy workouts, and tension areas in his shoulders (GB 21 – SJ 15 area) and intra-scapular region (UB 13 – 17, and 42 – 46). The swollen sides and dark-distended sublingual veins of his tongue, and the wiry-tight Liver-Heart-Lung pulse positions confirmed my diagnosis of Qi and Blood Stagnation. He also had deep-hidden Kidney pulses; likely due to the combination of age and Liver Qi chronically over-drawing on the Kidney energy to help push through stagnation. As Tom’s traumatic event occurred during his early 20’s, I thought there might be some minor involvement of the axes along with Fluid Stagnation (specifically Blood), so I treated Stagnation of Qi & Blood in the Chest (Lungs & Heart) along with Liver Qi Stagnation, which is an East-West Axis disruption of Liver – Lung. I used both acupuncture and herbs to address the patterns and to Calm the Shen & Hun as quickly as possible. Weekly treatments began in late February.
- Points were rotated, selected from the following categories:
- GB 21 & GB 34, GB 41 – SJ 5, Liver 3 & LI 4 (Four Gates) – to course Qi
- Lung 1 or 2, Ren 17, ST 40, Pericardium 6 – to unbind the chest
- Du 20 & Yintang, Du 24, Pericardium 6, Heart 5 – to Calm the Spirit
- Liver 3 or Spleen 4 & Pericardium 6, UB 17, Spleen 10 – to move Blood
- Lung 5 & Kidney 7, Lung 9 & Kidney 3, Lung 7 – Kidney 6 – to support Lungs, tonify Kidneys
- Liver 14 – Lung 1 to harmonize Wood-Metal axis
- Initial herbal formulas: Xue Fu Zhu Yu Tang Wan with Chai Hu Long Gu Mu Li Wan.
- Stationary and running cupping on the upper back and shoulders were done after acupuncture for the first 3 sessions to bring stasis to the surface (cupping was stopped after bruising and redness no longer appeared).
- Once bruising from cupping abated, Tao Hong Si Wu Wan replaced the Xue Fu Zhu Yu Wan.
- Tao Hong Si Wu Wan with Chai Hu Long Gu Mu Li Wan were used until mid-April.
After 8 sessions it was mid-April, the time when the PTSD attacks would typically stop. Over the past 8 weeks, Tom had experienced only mild anxiety and insomnia, which he associated more with the fear of getting a PTSD attack, rather than actually having one. We shifted the treatment schedule to every six weeks (seasonal starts and high points) and used a low daily dose of Xiao Yao Wan to keep Qi and Blood flowing. The next March, we did four weekly treatment sessions, and Tom made it through the month completely symptom free. At that point we discontinued the regular use of Xiao Yao Wan, but Tom was instructed to use it again the next March – April as a preventative measure and schedule an appointment if he felt any anxiety or upset brewing; he used the herbs the next spring, but he did not need to come in for treatment. After 40 years suffering from extreme and disruptive PTSD symptoms, last I spoke to him, Tom had been symptom-free for over three years.
Case #2: Overworked, late 20’s female
“Jane” had a diagnosis of irritable bowel syndrome (IBS) and gluten intolerance along with menstrual irregularities, chronic intrascapular-shoulder-neck-jaw tension, low back pain, and cold feet. Her work for a local non-profit agency was extremely demanding, and the low pay brought constant financial stress. She was also in psychotherapy and AA for a history of teenage alcohol abuse (and sober for almost a decade). Her pale-swollen tongue and wiry-weak pulse confirmed a Liver-Spleen disharmony underlying the IBS, with Liver Qi Stagnation clearly contributing to the tension and menstrual irregularities (delayed timing, cramps, clots, bloating, emotions, fatigue, increased diarrhea). Her Kidney pulses were also incredibly weak, her lower abdomen felt cold, she was born with only one Kidney, and her IBS typically presented as urgent, early morning diarrhea (6 – 7 am), so Spleen & Kidney Yang Deficiency was part of her Pattern diagnosis.
I assumed from the initial intake that Jane had an axis disruption likely due to early childhood sexual abuse because of a combination of factors: 1) the involvement of an axis, specifically East-West / Liver-Spleen-Large Intestine, 2) the symptomatic involvement of all 3 Jiaos, 3) a diagnosed food intolerance indicating a possible inability to accept the world, 4) her history of early alcohol abuse, 5) the impact on the uterus, and 6) her inability to choose better work and pay conditions. Early sexual abuse typically injures the Heart-Kidney axis, so if I was correct it was presenting in an unusual manner. I gently asked Jane about any early childhood trauma or major events; and when she denied any knowledge, I chose simply to treat what was presenting and wait. Due to financial concerns, Jane could not come in more than twice monthly and often had to cancel an appointment to pay bills.
- Points were rotated, selected from the following categories:
- Ren 12 – Ren 6 – ST 25 – i.e. the Four Doors – often with Ren 4 and ST 27 as well – to support Spleen and rectify the digestive tract
- Spleen 4 – Pericardium 6 or GB 41 – SJ 5 – to target Lower Jiao and Uterus
- SI 3 – UB 62, Lung 7 – Kidney 6, Kidney 3, UB 23, Du 4, Du 20, GB 25 – to support Kidneys & Yang
- ST 36, Spleen 6, 3, UB 20 & 22 – to support and tonify Spleen
- GB 21, 30, 34, 40, Liver 3, 5, 8, 13, 14, UB 18, 19, 48 – to course and rectify Liver Qi
- UB 44, 45 – to treat the intra-scapular tension and Calm the Spirit
- Moxa (needle and pole) and heating pads were used extensively during treatment sessions.
- Initial herbal formulas: Xiao Yao Wan for 1 month, then Ba Ji Yin Yang Wan was added. These formulas were continued for over a year (Jiao Wei Xiao Yao Wan was substituted for Xiao Yao Wan and the dosage of Ba Ji Yin Yang Wan was reduced during the hot summer months). A low dose of Yan Hu Suo Zhi Tong Wan was used for menstrual cramping as needed.
- Each treatment session was followed by 5 – 10 minutes of Tuina to smooth the Primary & Muscle Channels and encourage the Luo Vessels to release any hidden memories to the surface.
Over the course of two years of monthly – biweekly treatment, Jane shifted her relationship to her health and body dramatically, putting it much higher on her priority list. She began taking days off before and after major work events, stopped going out with friends when she was too tired, and paid closer attention to avoiding foods that made her feel un-well. She also recommitted to her AA program with more regular sponsor meetings in combination with her on-going therapy and acupuncture. At two years, Jane’s symptoms were minor, only appearing with high stress or fatigue, and she and her female partner became engaged.
A few months after the engagement, Jane’s tongue and pulse presentation changed: a dip at the rear of the tongue became constant, fine red points appeared on a newly thin tongue tip, and the pulse became fine and slightly rapid on the left. Jane reported no unusual symptoms, so I added a Heart-Kidney trauma release protocol (Kidney 6, 16, 26), a combination I use to open the orifices, perceive more clearly, and receive ancestral guidance (using Sishencong directed forward, with Du 24 & Yintang), and running cupping on her upper back to release Fluid stasis (UB 13 – 17, 42 – 46), which left minor bruising and redness. At the next treatment Jane casually mentioned her mother sexually abusing her as a child, confirming my initial concerns. We scheduled two weekly follow-up appointments to help open memories; she cried during and after both sessions. When she came in a month later, she had made the decision to disinvite her mother to the wedding and had no remaining physical symptoms. We scheduled monthly treatments until her wedding to help manage stress, after which Jane was encouraged to come in every 6 – 8 weeks for prevention, working toward seasonal treatments only. Jane, like most survivors, will require regular cognitive therapy and prevention-based acupuncture treatment for many years, but with the incorporation of mindful living practices this does not have to be weekly or monthly.
- Cleveland Clinic, CPTSD (Complex PTSD) Accessed on November 16, 2023.
- National Institute of Mental Health, What is post-traumatic stress disorder, or PTSD? Accessed on November 16, 2023.
About the Author
Dr. Catherine ‘Captain’ Lumenello (they / she) has been in private practice since 2005. As a Qigong and Feng Shui Master, Dr. Lumenello utilizes these two branches of Chinese Medicine extensively in their practice, specializing in the treatment of trauma and PTSD recovery and auto-immune conditions. With a special interest in LGBTQ+ community concerns, Lumenello is the author of Gender & Sexuality in Chinese Medicine (Singing Dragon UK, 2020), and a contributing author for an upcoming text on ethics for Chinese Medicine providers. Dr. Lumenello served on the faculty at both the New England School of Acupuncture and the Asian Institute of Medical Studies where they developed accredited programs in Medical Qigong and Gynecology, and continues to mentor doctoral students from multiple programs. After originally practicing in the Sonoran Desert city of Tucson, Arizona, Dr. Lumenello opened their practice on the edge of the Green Mountains in rural Vermont in 2017. Beyond observing the misty mountains, motorcycling curvy back roads, and raising a 10-year-old, Dr. Lumenello also serves on the Vermont Acupuncture Association board (currently as President), and lectures nationwide on a variety of topics, most recently the impact of oppression and the diagnosis of shame. For more information, please visit CatherineLumenello.com