Some people walk into the clinic carrying a thick folder of records. Inside are blood tests, an ECG, an abdominal ultrasound, sometimes even a stomach endoscopy, collected from three or four places over a few months. Every page says the results are within normal limits. Yet every morning they wake up with a heavy head and stiff shoulders, their stomach feels full one moment and cramping the next, and at night they lie awake for a long time before sleep comes. They often ask: “Doctor, so what is actually wrong with me?”
Normal results are good news. Still, they do not explain why that person keeps feeling tired.
The brain decides how the body responds to stress
The neuroendocrinologist Bruce McEwen placed the brain at the center of stress. A tense meeting or a work message at ten o’clock at night does no harm on its own. The brain decides which events are threats and how strongly the body has to respond, which is why two people facing the same event can react very differently (McEwen, 2007).
When the brain recognizes a threat, the signal travels along two routes. The fast route is the sympathetic nervous system, together with adrenaline: the heart beats faster, breathing quickens, muscles tense up and digestion is put on hold. The slower route is the hypothalamic–pituitary–adrenal axis (HPA axis), which releases cortisol into the blood. In the short term, this response keeps us alert and able to cope. Stress begins in the brain and then spreads through the whole body, reaching the nervous system, the heart and blood vessels, the autonomic nervous system, the immune system and metabolism (McEwen, 2008).
Things change when the stress does not stop. Months of heavy work, caring for a family member who has been ill for a long time, a relationship that never feels steady. Those systems have to run at a high level without a break, and they gradually wear down. McEwen called this wear and tear allostatic load. During such periods, smoking, overeating, drinking alcohol and poor sleep add even more to the load (McEwen, 2008).
The brain areas involved in stress
The limbic system is a group of structures deep inside the brain, linked to emotion and memory. Within it, the amygdala works like a guard, always scanning the surroundings for danger. The hippocampus sits right next to it, turns experiences into memories and helps put the brakes on the stress response once the danger has passed.
Behind the forehead lies the frontal lobe, with the prefrontal cortex. This area handles weighing things up, planning, staying focused and holding back impulsive reactions. The cingulate gyrus is a curved band of cortex lying between the limbic system and the frontal lobe, and it takes part in emotion, attention and the sensing of pain.
Many studies show that the hippocampus, the amygdala and the prefrontal cortex change even in their structure when stress goes on for a long time (McEwen, 2007). We find that patients often tell us they get irritated easily and have trouble concentrating.
Past experiences and today’s stress response
Some people have forgotten almost every detail of a hard year, yet each time that season comes around they cannot sleep. Some hear a phone ring that sounds like the one from back then, and their shoulders hunch and their stomach knots before they even think about who is calling. Experiences from the earliest years of life also shape how a person responds to stress for the rest of their life (McEwen, 2007).
We believe the body stores memories in places outside the brain too, like a group of muscles that tightens every time an old story is touched, or a stomach that reacts before we can put a name to the feeling.
How traditional medicine sees emotions and illness
In traditional medicine theory, excessive emotions such as anger, worry, sadness and fear belong to the group of causes of illness that arise from within, known together as the seven emotions (七情, qī qíng). People who worry a lot tend to harm the Spleen, so they eat poorly, feel bloated and have heavy, weary limbs. Anger or resentment held in for a long time keeps Liver qi from flowing freely, and the person often feels a tight chest, has pain along both sides of the ribs and sighs a lot.
Common signs of long-term stress
The signs below are usually small, keep coming back, and tend to get worse right when the pressure builds.
- Neck and shoulder pain or back pain that appears or gets worse after each stressful stretch;
- Trouble falling asleep, tossing and turning, waking in the night because your mind keeps racing;
- Tiredness and low energy even after rest;
- Poor concentration, forgetfulness, making mistakes even in tasks you know by heart;
- A bloated stomach and poor appetite, or eating a lot and still craving more;
- Nervousness, a pounding heart, shortness of breath and more sweating whenever you are under stress;
- Feeling sad or irritable more easily, and finding it harder to stay calm than before.
These signs also appear in thyroid disease, anemia, heart disease and many other organic diseases (diseases with a physical cause that tests can show), so the doctor rules those out before thinking of stress.
Examining stress at the clinic
The first visit
The first visit lasts about 30 to 45 minutes. Along with a clinical examination, the four examinations of traditional medicine and tests when needed, the doctor asks in detail about your sleep, your work and even hard periods in the past, if you want to talk about them.
Within the health triangle of Structure – Chemistry – Mind, Applied Kinesiology (AK) helps the doctor explore the Mind side further, using muscle testing to check for stress in the frontal lobe, the limbic system and the cingulate gyrus. Sometimes the doctor asks you to recall something that is currently stressing you, then retests a muscle that was just holding strong. You do not need to tell the details; you only need to think about it. As AK reads it, a muscle that gives way shows that the memory is still acting on your nervous system. The mechanism behind the test is explained in our article Why doctors use muscle testing. Muscle testing adds to the examination.
Treatment options
Acupuncture has been studied a great deal for chronic headache and shoulder pain; see our article on acupuncture. The doctor personally does the needling and the moxibustion (warming points with burning mugwort).
The herbal decoction is modified for each person. Herbs can interact with conventional medicines, so if you are taking sleeping pills, antidepressants or heart medicines, bring a list.
Long-term stress and magnesium deficiency often go together, so the doctor may check this further with AK before considering a supplement (see our article Normal blood magnesium but still muscle twitches, cramps and poor sleep: why?).
Regular physical activity and support from the people around you are two very ordinary things that help lighten the load of stress (McEwen, 2007). The doctor will guide you through exercises that suit your strength and ask whether you have someone by your side to talk to.
Can the changes caused by stress be reversed?
If you worry that years of stress have left a permanent mark, there is some easier news. The changes in the hippocampus, the prefrontal cortex and the amygdala caused by a few weeks of stress are mostly reversible once the load is eased (McEwen, 2008). For long years of stress there is no such firm evidence yet, so the doctor does not promise in advance how long it will take you to feel well again.
When to get help right away
- If you have thoughts of harming yourself, call a family member who is nearby right away and go to the nearest medical facility or call emergency services at 115; do not wait for your appointment;
- If you have felt low for many weeks, lost interest in almost everything, and cannot manage daily tasks, you need an assessment by a psychiatrist, and treatment at the clinic will be coordinated with their plan;
- Chest pain, severe shortness of breath or fainting means going to emergency care first; do not assume it is just stress.
Frequently asked questions
My tests are normal. Does that mean I am imagining my illness?
No. Tiredness, pain and sleeplessness caused by stress are real, with a biological pathway through the nerves, hormones and immune system. Normal test results tell you that no physical damage has been found in the things that were measured.
I am taking medicine from a psychiatrist. Can I still be examined here?
Yes. Bring your prescription, and do not stop or lower the dose on your own. The doctor will take interactions into account when prescribing an herbal decoction.
Worth keeping
- For 2 weeks before your visit, note down each day your sleep times, any pain, your meals and what made you feel stressed;
- Bring all your test results and scans to the visit, including the ones marked normal;
- Write out a list of the medicines and dietary supplements you are taking;
- Move every day, starting with a walk around your block;
- Meet or call a friend you trust at least once a week;
- Cut back on alcohol, smoking and late-night meals during stressful periods;
- If you have thoughts of harming yourself, call a family member and a medical facility right away.
If you are coming for your first visit soon, you can read our article What to bring and how to prepare for an Applied Kinesiology examination.
Doctor responsible for the medical content of this article: Dr. Dinh Ngoc Duc (MD, MSc in Traditional Medicine).
References
- McEwen BS. Physiology and neurobiology of stress and adaptation: central role of the brain. Physiol Rev. 2007;87(3):873-904. https://doi.org/10.1152/physrev.00041.2006
- McEwen BS. Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008;583(2-3):174-185. https://doi.org/10.1016/j.ejphar.2007.11.071
