Systemic Inflammation & Stress
Current Research
Evidence shows that systemic inflammation caused by chronic stress can be detrimental and cause life-threatening conditions such as heart disease, diabetes, cancer, Alzheimer’s, digestive disorders, infertility, and more (Marriotti, 2015).
In history, humans evolved to have a harmonic balance with their body, called homeostasis, that allowed them to survive in nature. When they were faced with a threat such as an impending fire or larger predator on the prowl, their sympathetic nervous system would activate to release cortisol, norepinephrine, and adrenaline that maximizes muscular exertion and helped them survive the threatening situation.
Still today this autonomic sympathetic response comes in handy. We hear stories of “mom strength” where a small woman can overcome physical odds to protect her baby, or a man wrestling an alligator to save a dog. Though these extreme feats of nature are awe-inspiring and argue the importance of the quick release of these hormones, extreme situations like this are few and far in-between in our modern day society.
Most of our perceived stressors that activate the sympathetic response today include traffic on the way to work, paying bills, or politics. These stressors occur frequently but do not require a sympathetic response to survive. As our bodies release unnecessary amounts of cortisol, norepinephrine, and adrenalin in response to these stressors, systemic inflammation forms (Schneiderman et al., 2005)
Chinese Medical Theory
Each patient is unique and likely has a unique Chinese Medical Theory (CMT) diagnosis. Generally there is one underlying cause that most patients can attribute at least some of their symptoms to and that is: Qi stagnation. (Liu et al., 2017) Stress and rumination mainly lead to qi stagnation of the Liver, Lung, and Heart meridians. Giovanni Maciocia (N.D.) mentions that all emotions lead to heat
Symptoms of Heat from Liver Qi stagnation may include but are not limited to red face, irritability, depression, oppression of chest, a wiry and rapid pulse, and a tongue with red sides or tip. Symptoms of heat from Lung qi stagnation includes but are not limited to depression, crying, shortness of breath, anxiety, red cheeks, a slightly tight pulse, and a tongue with red sides or tip. Symptoms of heat from Heart qi stagnation include but are not limited to palpitations, depression, shortness of breath, weak and cold limbs, a dislike of lying down, a weak pulse that overflows in the cun position and pale purple tongue with a red tip. (Maciocia, N.D.)
Treatment Plan
Chinese herbs falling under the “heat clearing” category, such as huang qin, huang lian, jin yin hua, lian qiao, da qing ye, and ban lan gen, have been shown as effective for reducing inflammatory biomarkers in the body (Muluye et al., 2014). In the case of a patient experiencing heat from qi stagnation, it is appropriate to prescribe classical chinese formulas that incorporate some of these heat clearing herbs. In addition to Herbs acupuncture has also been proven as effective for reducing chronic inflammation (bai et al., 2020)
In the case that a patient presents with heat from Liver Qi stagnation and no other concurrent diagnosis, it is appropriate to prescribe the formula Dan Zhi Xiao Yao San to move qi in the Liver and drain heat. In addition to herbal formula, acupuncture points will be used to move qi in the Liver, drain heat, and calm the mind. These points include but are not limited to: Yin Tang, Du 24, Du 20, Large Intestine 11, Pericardium 6, Gallbladder 34, Liver 14, Liver 3, Liver 2, and San Jiao 6.
In the case that a patient presents with heat from Lung Qi stagnation and no other concurrent diagnosis, it is appropriate to prescribe the formula Ban Xia Huo Pou Tang with Dan Zhu Ye to move qi in the Lung and drain heat. In addition to herbal formula, acupuncture points will be used to move qi in the Lung, drain heat, and calm the mind. These points include but are not limited to: Yin Tang, Du 24, Du 20, Large Intestine 11, Lung 7, Stomach 40, Ren 16, and Pericardium 6.
In the case that a patient presents with heat from Heart Qi stagnation and no other concurrent diagnosis, it is appropriate to prescribe the formula Ban Xia Huo Pou Tang with Dan Zhu Ye and Lian Qiao to move qi in the Heart and drain heat. In addition to herbal formula, acupuncture points will be used to move qi in the Heart, drain heat, and calm the mind. These points include but are not limited to: Yin Tang, Du 24, Du 20, Large Intestine 11, Pericardium 6, Stomach 36, Ren 17, Heart 5, and Heart 7.
Each of these three diagnoses would require patients to commit to at least eight treatments once per week. The needles would be manually stimulated and retained for 30 minutes per treatment.
In addition to acupuncture and herbal formulas, it is necessary for the patient to follow an anti-inflammatory diet, exercise for at least 30 minutes five days per week, and practice 10 minutes of meditation daily.
Alternative Approaches
Many studies have been performed that show exercise as effective for reducing chronic inflammation. One study from Beavers et al. (2010) showed exercise to be effective for reducing c-reactive protein and combating heart disease. A practice of safe exercise at least 5 days per week is recommended for patient suffering from chronic inflammation and stress. This can include walking, jogging, yoga, or weight training.
Meditation has been proven to decrease stress and improve overall wellbeing. (Parmentier et al., 2019) A practice of mindful meditations 10 minutes per day is recommended to help strengthen the mind body connection and reduce inflammation.
Evidence exists to support dietary flavonoids in reducing inflammatory cytokines and CRP production. A study from Panche et al. (2016) mentions that the flavonoid rich food might be the simplest and safest way to reduce chronic inflammation and combat diseases. A diet rich in anti-inflammatory flavonoids is also necessary for these patients to follow for best outcomes. These foods include but are not limited to leafy greens, berries, herbs, citrus fruits, cruciferous veggies, tea, grains, legumes, and nuts.
Biomedical Considerations
Progress may be tracked by testing for inflammatory biomarkers in the body and taking a self-assessment stress test. Inflammatory biomarkers include cytokines, c-reactive protein, white blood count, and serum amyloid A (Brenner et al., 2014). Self-assessment stress tests that will assist in tracking the progression of a patient suffering from stress and chronic inflammation include PHQ-9 and GAD-7.
Community Resources
Many community resources exist to promote healthy stress management. Phone apps such as the Calm app exist with guided meditations to help reduce stress, therefore reducing systemic inflammation. Other apps such as meetup.com exists for you to find community groups that get together for various activities such as nature walks, running clubs, yoga, meditation, and foraging. Most larger cities offer community acupuncture at an affordable price to patients seeking care.
Prognosis
Enough evidence has been found to support a good prognosis for patients who are compliant in their treatment for stress management and reducing inflammation. Some patients find it difficult to comply with cooking raw herbs, though solutions like tea pills exist. Depending on the severity of stress, the duration of stress, and the concurrent medical diagnosis due to inflammation from stress, treatment time could vary. The more sever and complex, the more time and treatment the patient will require. One study by Donaldson (2004), claimed that cancer could be reduced by 60-70% with diet alone.
Summary of Key Findings
Evidence shows that systemic inflammation caused by chronic stress can be detrimental and cause life-threatening conditions such as heart disease, diabetes, cancer, Alzheimer’s, digestive disorders, infertility, and more. In CMT diagnosis, stress and rumination mainly lead to qi stagnation of the Liver, Lung, and Heart meridians. With the use of acupuncture and herbs for moving qi and draining heat, inflammation has been proven to decrease and stress has been proven to reduce. Other alternative approaches have been proven effective for managing stress and reducing inflammation like exercise, meditation and diet. Several community resources exist to aid in the management of this condition like meditation phone aps and meet up groups. Patients have a good prognosis if they can adjust their lifestyle significantly and be compliant with treatment.
References
Schneiderman, N., Ironson, G., & Siegel, S. D. (2005). Stress and health:
psychological, behavioral, and biological determinants. Annual review of clinical psychology, 1, 607–628. https://doi.org/10.1146/annurev.clinpsy.1.102803.144141
Mariotti A. (2015). The effects of chronic stress on health: new insights into the
molecular mechanisms of brain-body communication. Future Science OA, 1(3), FSO23. https://doi.org/10.4155/fso.15.21
Kim, M. J., Loucks, R. A., Palmer, A. L., Brown, A. C., Solomon, K. M.,
Marchante, A. N.,& Whalen, P. J. (2011). The structural and functional connectivity of the amygdala: from normal emotion to pathological anxiety. Behavioural Brain Research, 223(2), 403–410. https://doi.org/10.1016/j.bbr.2011.04.025
Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human
immune system: a meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130(4), 601–630. https://doi.org/10.1037/0033-2909.130.4.601
Maydych V. (2019). The Interplay Between Stress, Inflammation, and Emotional
Attention: Relevance for Depression. Frontiers in Neuroscience, 13, 384. https://doi.org/10.3389/fnins.2019.00384
Salleh M. R. (2008). Life event, stress and illness. The Malaysian journal of
medical sciences : MJMS, 15(4), 9–18.
Pan, M. H., Chiou, Y. S., Tsai, M. L., & Ho, C. T. (2011). Anti-inflammatory
activity of traditional Chinese medicinal herbs. Journal of traditional and complementary medicine, 1(1), 8–24. https://doi.org/10.1016/s2225-4110(16)30052-9
Muluye, R. A., Bian, Y., & Alemu, P. N. (2014). Anti-inflammatory and
Antimicrobial Effects of Heat-Clearing Chinese Herbs: A Current Review. Journal of traditional and complementary medicine, 4(2), 93–98. https://doi.org/10.4103/2225-4110.126635
Cell Press. (2020). Evidence in mice that electroacupuncture reduces
inflammation via specific neural pathways. ScienceDaily. Retrieved July 7, 2021 from www.sciencedaily.com/releases/2020/08/200812115315.htm
Liu, Jiang, Wang, Liu, Wu (2017) The Role of Rumination and Stressful Life
Events in the Relationship between the Qi Stagnation Constitution and Depression in Women: A Moderated Mediation Model, Evidence-Based Complementary and Alternative Medicine, vol. 2017 https://doi.org/10.1155/2017/7605893
Maciocia, (N.D.) Chinese medicine: heat from qi stagnation. Giovanni Maciocia
https://giovanni-maciocia.com/heat-from-qi-stagnation/
Beavers, K. M., Brinkley, T. E., & Nicklas, B. J. (2010). Effect of exercise training
on chronic inflammation. Clinica chimica acta; international journal of clinical chemistry, 411(11-12), 785–793. https://doi.org/10.1016/j.cca.2010.02.069
Panche, A. N., Diwan, A. D., & Chandra, S. R. (2016). Flavonoids: an overview.
Journal of nutritional science, 5, e47. https://doi.org/10.1017/jns.2016.41
Bai, H., Xu, S., Wu, Q., Xu, S., Sun, K., Wu, J., Xia, X., Liu, Y., Zhang, H., & Lu,
S. (2020). Clinical Events Associated with Acupuncture Intervention for the Treatment of Chronic Inflammation Associated Disorders. Mediators of inflammation, 2020, 2675785. https://doi.org/10.1155/2020/2675785
Brenner, D. R., Scherer, D., Muir, K., Schildkraut, J., Boffetta, P., Spitz, M. R., Le
Marchand, L., Chan, A. T., Goode, E. L., Ulrich, C. M., & Hung, R. J. (2014). A review of the application of inflammatory biomarkers in epidemiologic cancer research. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 23(9), 1729–1751. https://doi.org/10.1158/1055-9965.EPI-14-0064
Donaldson M. S. (2004). Nutrition and cancer: a review of the evidence for an
anti-cancer diet. Nutrition journal, 3, 19. https://doi.org/10.1186/1475-2891-3-19
