Social Anxiety Disorder
Overview
Social anxiety disorder falls under the TCM categories of 'yu zheng' (depression syndrome), 'jing ji' (palpitations due to fright), and 'zheng chong'. It is commonly caused by internal damage from emotional stress and excessive worry, leading to liver failing to free-flow, qi deficiency of heart and gallbladder, and insufficiency of spleen and kidney. The disease is located in the brain and involves the heart, liver, gallbladder, spleen, and kidney. Clinically it presents with tension in social situations, facial flushing, sweating, palpitations, hand tremor, and avoidance of social contact. The key pathogenesis is qi stagnation, malnourishment of the heart spirit, or internal harassment by phlegm-heat and gallbladder deficiency with phlegm timidity. Pattern differentiation should distinguish excess and deficiency: for excess, soothe the liver and relieve depression, clear heat and transform phlegm; for deficiency, boost qi and nourish blood, warm the gallbladder and calm the heart.
Pattern differentiation (clinical patterns)
Liver Qi Stagnation
Tension and restlessness in social situations, distension and fullness in the chest and hypochondrium, frequent sighing, depressed mood, belching, irregular menstruation in women, pale red tongue with thin white coating, and a wiry pulse.
Soothe the liver and relieve depression; regulate qi and free the middle.
Qi Deficiency of Heart and Gallbladder
Easily frightened by events, palpitations and timidity, shortness of breath and spontaneous sweating, mental fatigue and weakness, insomnia with many dreams, pale tongue with thin white coating, and a fine weak pulse.
Boost qi and calm fright; settle the spirit and stabilize the will.
Phlegm-Heat Harassing Internally
Irritability and restlessness, insomnia with palpitations and fright, flushed face and red eyes, bitter taste in the mouth with profuse phlegm, chest tightness and nausea, red tongue with yellow greasy coating, and a slippery rapid pulse.
Clear heat and transform phlegm; calm the heart and settle the spirit.
Connections
Daily care & prevention
Practice deep breathing and progressive muscle relaxation, and sit quietly for 10 minutes daily to regulate breath. Eat a light diet, avoid spicy and greasy foods, and drink rose or he huan flower tea. Gradually expose yourself to social situations, starting with short and low-intensity interactions. Keep a regular schedule and avoid staying up late, which consumes heart blood. Self-massage neiguan (PC6), shenmen (HT7), and taichong (LR3) for 3 minutes each, twice daily.
When to seek medical care
Seek medical attention promptly if there are severe panic attacks, persistent palpitations and chest tightness, avoidance of all social contact leading to inability to work or live, obvious depression or self-harm thoughts, worsening insomnia, or sudden weight loss. Integrative Chinese-Western medicine intervention may be necessary.