Five Spirits, Five Paths

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Complex PTSD in Today’s World

What happens to us when we are forced to witness ghastly trauma on a weekly basis? When we must work day in and day out, making barely enough money to pay our rent or afford a vacation while our boss owns 6 homes and vacations half the year? When the world’s economic system is hinged upon the exploitation of labor and wage theft? When a medical emergency could bankrupt you at any second? When you grew up in a family that could not emotionally, physically, or spiritually support you, or a family that abused you? When you feel trapped in a relationship that does not serve you or is abusive that you cannot leave because you are financially dependent on it?

These examples may seem extreme but are a reality for many people living in America today. The consistent devaluation of our intrinsic goodness as human beings is often reduced to only the value we provide another, rather than who we are as a person, unique and full of passion and creativity. The effects of this type of society extend beyond making ends meet and feeling safe. Over time this can actually cause significant trauma, now known clinically as Complex Post Traumatic Stress Disorder. cPTSD is different from PTSD in that it is not so much associated with the trauma or reaction to outward events, but instead manifests inwardly - how we see and think about ourselves - and as a result, how we see the world. It may be caused by a single traumatic event, but more likely is the accumulation of smaller, more covert trauma that usually revolve around the core issue of not being seen or valued in a way that we needed to be or not being able to escape a situation or event that was a threat. As we look around at our communities of people hurting deeply, acting out in ways we would have never imagined, it seems easy to cast it aside as being an issue belonging only to that person, but truly this is a systemic community issue that begins in childhood and continues into adulthood.

What is cPTSD?

Complex Post Traumatic Stress Disorder is a condition that occurs when an individual experiences an event or situation in which they have (or perceive to have) little control or ability to escape. Generally, these are prolonged or repetitive events. cPTSD is related to chronic abuse (sexual, physical, emotional, neglect), chronic partner violence and abuse, witnessing chronic violence or abuse, victims of kidnapping, hostages, indentured servants, slavery, human trafficking, sweatshop workers, prisoners of war, solitary confinement, or defectors from authoritarian religions. There is also a strong correlation with the economic and social climate of the world today that strongly resembles these types of traumas. Working two full time minimum wage jobs is comparable to sweatshop labor, and the constant witnessing of shootings, violence, war, and the effects of poverty is linked to experiencing chronic violence and abuse. Simply living in the world today, connected to the news or social media, causes a bombardment of traumatic sensory input that impacts our mental health and can cause a host of symptoms.

Five Spirits, Five Paths

The Chinese medicine concept of the Five Spirits 五神 wǔ shén is a helpful tool when working with cPTSD or when helping a patient to find more peace and balance with which to navigate their existence in the world. At first glance, the Five Spirits may be thought of as only symptomatic type presentations: a Shen disturbance causes anxiety while a Hun disturbance presents with anger outbursts and so forth. However, the deeper layers of these spiritual disturbances reside in the conscious and unconscious psyche of the person and can dictate their world view and how they see themselves. This gives us clues as to their life lessons and stagnations they often experience. By looking at the Five Spirits we can help a person struggling with cPTSD by addressing it from their unique vantage point - their spirit. It is also important to remember that a spirit disturbance can occur within a gradation, a range. It doesn’t need to be extreme or severe, it can also be minimal or minor, and working with the Five Spirits is still appropriate. Spiritual disturbance can range from just not feeling quite like yourself to more severe presentations that require in-patient psychiatric attention.

The Shen - Compassion, Insight and Awareness

The Shen 神 shén is the most Yang of the Five Spirits, all of which are Yang in nature as compared to the physical body itself. The Shen and Hun combined might be comparable to the western idea of the soul. Shen is our inherent divinity, our connection to source, the Tao, God, the Universe, quantum field, or however you view the consciousness that exists outside of the human form and permeates through all of reality. Shen gives us insight and inspiration, it’s the spark of an idea and the awareness of the bigger picture of things. Shen also gives us our capacity for deep connection and compassion, seeing others as ourselves and the ability to truly connect on a deep level.

All Five Spirits can be disturbed or dislodged by seemingly minimal things, but the Shen is particularly sensitive, something as simple as a phone call with bad news is enough to jar the Shen from its seat. Watching the news today is a surefire way to dislodge the Shen, mass shootings, a pandemic, you name it - all of these cause an emotional reaction and upset which upsets the Shen. A patient history that includes shock and abuse at any age points to Shen disturbance, and a childhood where the caregivers could not or would not see the child for who they truly were and / or inhibited the child’s expression of their true nature would set the stage for a Shen disturbance throughout their life. The main takeaway is that this person’s unique nature has been pushed down, shunned, or even attacked.

Physical symptoms we might notice are insomnia, anxiety, restlessness or deflecting from feeling emotions by covering them with humor and laughter. Emotionally this person may seem detached from reality, the life of the party, or stuck in false joy, toxic positivity. On a spiritual level, a person with a long-term Shen disturbance feels like they have a lack of coherence to life, their unique abilities and interests don’t match the life they are living, they have a very hard time discerning what’s right for them, and they have an absence of awareness.

To help heal the Shen we must create a safe space for it to return to. It isn’t so much about specific point prescriptions or herbs, but the creation of calm space that helps this transformation to occur. It often begins with any modality that will help pull that patient from sympathetic overdrive into a parasympathetic nervous system state. Calming the nervous system is essential alongside cultivating awareness through practices like meditation, journaling, mindfulness practice or therapy. Any acupuncture done for the purpose of spiritual integration needs to be done with complete focus and attention in a very gentle manner. De Qi or Sha reactions will further dislodge the spirit, so be gentle, use a few fine needles and shallow insertions.

Gan Mai Da Zao Tang

This is a simple food-based formula that can have a profound effect on the body and nervous system. Think of it as a warm hug to the heart that tells us that even though things are tough right now, you in this moment are ok. Its general calming nature is incredibly helpful to cultivate that safe home for the Shen to return to.

The Hun - Vision, Planning, Imagination, Direction

Stepping down in Yang nature is the Hun 魂 hún, more magnified by the experience of the Yin Earth than the Shen, but still Yang and free flowing. The Hun helps us to see things clearly, both literally and figuratively, taking insight from the Shen and giving us the direction and passion to create an actionable plan. The Hun is sensitive to the functions and stagnations of the Liver, this includes alcohol and cannabis along with other drugs, poor diet, lack of exercise, hormone shifts, etc. The emotion of the Wood element is anger, and the flip side of anger is repressing our emotions. Repressing emotions is particularly impactful to the Hun. Growing up in a household where alcohol, drug use and abuse and violence were predominant will impact the Hun. Having caregivers who employed a ‘laissez-faire’ parenting style, where the child was given seemingly too much freedom and nearly no direction in life, will also impact the Hun.

Hun disturbance has three distinct patterns - excess, deficient and mixed. Excess Hun disturbance is characterized by angry emotional outbursts, a sense of righteous indignation, and anger at the world for injustices that are fabricated by the mind. With an inability to see clearly, this person will perceive things to be unjust which actually are not. By contrast, a deficient Hun disturbance is a person who is more disconnected and down, there’s no color or passion to life, no sensation of feelings. In this case, numbness predominates, as does depression, combined with a difficulty to express emotions. A mixed pattern is where the patient alternates between the two dynamics, and instead of displaying mixed traits, they swing from one to the other. We may see this in cases of bipolar mania and premenstrual dysphoric disorder (PMDD). There may be sleep and dream issues in either case, difficulty expressing or acknowledging emotions, and they may have a hard time starting projects and making decisions. Spiritually this person feels like they have no control over their life, it does not matter what they do or how they do it - nothing will work for them, they are stuck, indefinitely. They lack inspiration and ideas, or when they get a flash of inspiration they cannot turn it into an actionable plan, and nothing gets off the ground.

For treating the Hun, we look to clarify the Liver and move Liver Qi stagnation in any way possible. Vigorous exercise with the intention to move stuck Qi is particularly helpful, as is spending time in nature. For the more deficient cases, tonifying Liver Qi and Blood is also indicated. Patients should be advised to abstain from alcohol, cannabis, and other drugs, and utilize in or outpatient rehabilitation programs as necessary.

Xiao Yao San

A classic, and almost always useful formula for Liver Qi Stagnation, this can also help the Hun. This formula moves Liver Qi, which is the direct type of effect we need on the Liver to help with the Hun. As the name implies, the Free and Easy Wanderer is what we are like when the Hun is healthy and at home. Use modifications as appropriate.

Milk Thistle

This is a western herb that is helpful for clearing the physical liver and can be used for Hun disturbance, particularly with an excess presentation.

The Yi - Setting and Holding Intention, Clear Thought and Digestion

The Yi 意 yì is the center point of the Five Spirits, bridging the above with below, the Yang with Yin. The Yi is responsible for setting and holding our intentions, it takes the ideas and plans of the Shen and Hun and holds the intention for them to be set into action. Similar to the functions of the Spleen and Stomach, the Yi helps us digest our food as well as our own reality and helps us to have a clear mind, free of worry or clouded thinking. The Yi aligns our thoughts with our actions; we say what we mean and can follow through on our intentions with a healthy Yi.

Disordered eating is a big precursor (and also a symptom) of a detached Yi. Fasting, restricting food groups, obsessing over food ingredients or “clean eating”, anorexia, bulimia, or binge eating disorders all have a Yi component associated with them. At the core level of disordered eating is an aspect of us denying our reality. We are hungry but choose not to eat, thereby literally denying our own nourishment which is very destabilizing, ungrounding and un-centering, and eating the proper foods is exactly what the Yi needs to function properly. Excessive worry and overthinking also contribute to Yi disturbance. Worry takes the Qi outside of us and uses it fruitlessly, depleting the entire system and is again de-centering and destabilizing. Growing up in a family or caregiving environment that had obsessions and shame around body image and food or exercise is a common finding in the history of Yi disturbed patients. Early childhood exposure to alcoholism and codependency are also common, which often results in the patient playing out that dynamic in adulthood.<.p>

On a physical level a Yi disturbed patient with a history of disordered eating may experience digestive upset, and often suffer from unclear muddled thinking, overthinking, or excessive worry. This patient may also have a history of codependency, particularly falling into the role of the people pleaser. They will be more concerned about your personal life than telling you about their symptoms. They may be stuck in relationships or jobs that don’t serve them, yet they are unable to leave because they don’t want to harm anyone in the process. On a spiritual level this person lacks the ability to set and hold intention. While the ideas and initiation of plans may be there, finishing the project rarely occurs. They consistently over-nurture others at the expense of themselves, either by truly expending all their energy into the other, or by using that role as an excuse to avoid dealing with their own internal issues. They have a hard time digesting and assimilating their reality and experience, repeating the same mistakes because they just can't seem to truly learn the lesson at hand. They feel stuck in a circle of doing but not going anywhere.

Healing the Yi requires patients to learn or re-learn how to trust themselves, to bring everything back to center again. Making small daily promises and keeping them is vital. This isn’t a pledge to go on a 30 minute walk every day, it’s making their bed or watering a plant, that is, a small promise, because the Yi loves consistency. Healing their dysfunctional relationship with food will be incredibly helpful, especially if this is a presenting symptom. Eating with presence and intention and turning to intuitive eating practices teaches the patient to listen to their body. Learning how to say ‘no’ and saying it often may be prescribed. Overall, the treatment principle is to return to center, regain grounding, and learn to center the self.

Stomach 25 - Celestial Pivot

This acupuncture point is the quintessential point for calling the Yi home, it’s the pivot of above and below, Yin to Yang. This point is about finding our true center, being grounded and at home in our body.

Bu Zhong Yi Qi Tang

While Si Jun Zi or Liu Jun Zi Tang are also appropriate formulas, Bu Zhong Yi Qi Tang’s uplifting nature helps hold and set intention and boundaries. It not only tonifies the Qi but it helps us stand up and say ‘yes I am here and I deserve it!’ It brings this type of power back to the patient, helping them with the movement they need to stay firm and choose themselves first.

The Po - Animal Wit, Instinctual Knowing, Appreciation of the Now Moment

Next, we come closer to Yin and the underworld, the realm of our unconscious. The Po 魄 pò closely resembles the western idea of the soma, our somatic memory, the way our physical body can store emotional experience. The seven Po are responsible for the creation of our physical body in utero, breathed in at the first breath and excreted out of the body after death through the colon where they then decompose with the body. We can see the elements of the Po present in all animal life. Watch your cat, that’s the Po - instinctual knowing and being in the present moment. The Po is also responsible for taking the ideas and plans of the Shen and Hun and the intention of the Yi and manifesting them into the physical reality. With a healthy Po we are able to let go with ease and trust the rhythm of life.

Po disturbance often occurs during childhood where the child had parenting that restricted bodily autonomy and movement, or they might have not had enough touch and tactile stimulation. Coming from a familial system that swept things under the rug instead of addressing and dealing with them will also contribute to Po disturbance. It’s worth noting that a family structure does not need to be just the typical nuclear family. A church congregation, social club, school, etc. are all family type structures. Early childhood or even adulthood abuse or trauma that has been forgotten by the mind yet remembered by the body will have a direct effect on the Po.

Physical symptoms of Po disturbance include lung and large intestine related issues like asthma, skin conditions, IBS, digestive upset. There is also a phenomenon called “Po Spirit Pain” which is characterized by chronic body pain that has no identifiable or diagnosable cause and does not respond to treatments and a history of some type of trauma or emotional issues in the past. We may also see benign lumps, bumps, and tumors. Emotionally this patient seems dulled, may have depression or anxiety (this anxiety is usually vague and without obvious cause), or have obsessions, often related to the accumulation of valuable things. On a spiritual level this person will have vague anxieties and a sensitivity to the energy of other people that is often so severe that it limits their activities and lifestyle. Overall, the crux of the Po disturbance is an inability or refusal to look at past trauma.

To help heal the Po we need to create movement from the stagnation that is present and clear the fogginess that prevents or blocks the patient from releasing emotional pain that has stagnated deep below the surface. We can think of the physical manifestations of Po disturbance like condensations of emotional upsets - pain, tumors, GI, and lung issues. Cultivating conscious awareness is the treatment principle, through bringing awareness to the emotional body and the sensation of emotion in the physical body. Recommend that patients engage in practices that feed the senses - eating delicious food, wearing or using nice fragrances in the house, having clothes or textiles that feel nice against their skin, listening to their favorite music, or looking at beautiful art.

Shen Tong Zhu Yu Tang

A classic blood moving formula for body pain, this formula also serves the purpose of moving emotional pain. When giving this formula we may need to prepare the patient that unexpected emotions may arise as well as new awareness of their past or memories that can come back. Use the full dose for the patient if they present with body pain, and a half dose for a patient without.

The Zhi - The Wisdom of the Tao, Aligned Will and Courage

The Zhi 志 zhì is the deepest Spirit and is connected with not only our unconscious but also the collective unconscious, our ancestry, lineage, and genetic programming. In American acupuncture schools we traditionally learn that the Zhi is associated with will power, however it is actually quite the opposite. Will power is an ego-based concept, we push and do so that we achieve the result we desire. The aligned will of the Zhi is about letting go, surrendering to the will of the Tao, our divine nature and path. It is allowing what we need to come through and releasing the wants and desires. We move more into the realm of the Zhi later in life as the ego softens and we open to this type of alignment. The Zhi gives us courage to face our fears, to move forward in the face of darkness and uncertainty, to let it all go and trust that we will be carried through.

Zhi disturbance tends to occur when we have taxed every aspect of ourselves to the brink of complete exhaustion. Living a go-go-go type of life will surely have this effect, overworking, overdoing, and the use of stimulants to help continue this level of activity all impact the Zhi. Significant traumas in life that have been repressed and not fully processed also impact the Zhi. A childhood where there was a lack of discipline and guidance, chronic fear, anxiety, and uncertainty will impact the Zhi. A lack of encouragement in childhood, producing the feeling of not only being alone, but not being seen or acknowledged affects the Zhi. Physically, severe blood loss and chronic disease can also cause a Zhi disturbance.

Zhi disturbance often presents in two polar opposite presentations - extreme or absent motivation - the first is the overachiever, the go-go-go person who takes on everything, or the complete opposite, the incredibly lazy person who is totally unmotivated and not inspired by any part of life. Both types may use stimulants. This patient may also exhibit a type of ‘con-man’ behavior, always cutting corners to try to get ahead, like refusing to go to the gym unless he uses steroids. They have an incredibly difficult time accessing or naming their true feelings, there is usually a strong disconnect and this person may seem un-integrated or shallow. They may experience states of over excitement or a need for high adrenaline type activities followed by depression. On a spiritual level this person has an inability to face their fears, be it current fears around their life or situation or past fears around trauma they have experienced but not processed. They often feel a sense of despair and lack of purpose, which stems from the inability to look at their fears and shadow self, because without this type of integration having a depth of purpose in life is almost impossible to connect to. In very severe presentations when the Zhi has been pushed beyond its capacity, our will is exhausted along with the Water element and complete collapse occurs, resulting in a nervous breakdown.

Healing the Zhi requires us to face our fears, which the Po also requires to some degree. The Po is about accessing stored emotion in the body whereas the Zhi is accessing unconscious programming and past history in the psyche. Cultivating a mental space that allows us to feel strong enough to look into the deep caverns of the unconscious and confronting whatever we find is paramount. Spending time in and around water can be beneficial for the Water element, and therapy or coaching may be mandatory if not strongly encouraged. Healing the adrenals is also an important focus. The adrenals are taxed with any type of trauma, so at a base level improving cortisol levels and supporting adrenal function will be useful to boost the patient so that they are able to do the work on their hero’s journey.

Zuo Gui Yin and Yuo Gui Yin

Depending on the specific presentation of the patient - Yin or Yang deficient, these formulas will help to tonify and support adrenal function.

• Zuo Gui Yin - Restore the Left - use for primarily Yin deficient presentation
• Yuo Gui Yin - Restore the Right - for primarily Yang and Jing deficient presentation

These formulas tend to be reserved for elderly patients or those with severe presentations, but a long-term Zhi disturbance is a severe presentation. We need to help this patient conserve and prevent the complete exhaustion of the Water element. Dosage and length of treatment should be adjusted as the patient progresses.

The Creation of a New Home

It’s not so much about what specifically happens to us in life, but how we respond to it that matters. We may have no control over this response initially but through intentional healing we become aware and have a greater understanding of how to move forward - how to transform ourselves into the more unified, more aware and more compassionate person we get to become after healing from past traumas. This type of healing allows us to create a new home for ourselves where we can let go of what no longer serves us, and move into a new mental and spiritual space.

The nature of the world right now is a constant flow of upheaval and great change. It is incredibly difficult to witness and to be subjected to, but we must face it head forward, taking breaks as needed but not turning a blind eye. As acupuncturists we have a unique opportunity to help our patients navigate the world of physical, emotional and spiritual healing because the art and science of acupuncture hinges upon all three aspects of this triad. Emotional and spiritual healing is directly connected with the physical body, and through acupuncture, herbs, and compassion we can help transform and heal all layers of our existence.

References

• Dechar, L., Five Spirits: Alchemical Acupuncture for Psychological and Spiritual Healing, Lantern Publishing, 2006.
• Riccardi, S., “Understanding the differences between CPTSD & PTSD”, https://www.embodiedexpressionstherapy.com/post/understanding-the-differences-between-cptsd-ptsd-part-1
• Riccardi, S., “Understanding the differences between CPTSD & PTSD”, https://www.embodiedexpressionstherapy.com/post/understanding-the-differences-between-cptsd-ptsd-part-2-symptoms