How Do You Treat Post-Traumatic Stress in Your Clinic?

By Alaine D. Duncan - September 10, 2021

This article was slightly edited from one published as a Clinical Pearl in The Journal of the American Society of Acupuncturists, Vol 6, No 2, Spring 2019.

By Alaine D. Duncan, MAc, DiplAc

Chinese medicine (CM) is a powerful modality for treating dysregulation caused by traumatic stress. Our foundational premise of opposing poles of energy that together support the easy rise and fall of activity and rest are mirrored in the autonomic nervous system’s division into its sympathetic and parasympathetic branches. Our theoretical foundation is a powerful one for restoring balance and regulation in survivors of traumatic stress.

The Unique Approach of Chinese Medicine to Trauma

Traumatic stress affects our mental, physical, emotional, and spiritual health. It impacts educational success, criminal behavior, driving habits, work, family, and community life, as well as survivors’ capacity for joy, pleasure, and intimacy in relationships of all kinds. It is quite possible that the impact of traumatic stress is our most urgent public health issue.[1]

Traumatic stress does not arise from the story of the event per se, but from the lived experience of that event, uniquely manifesting in an individual’s energy body. The vibration of trauma’s impact remains long after the analytical mind has considered and evaluated a narrative. CM’s focus on restoring system-wide coherence and fundamental balance and regulation of qi, rather than parsing out discrete symptoms, can unleash multi-system healing responses with the power to address underlying causes of the complex and multi-system impact of overwhelming life threat.

The tendency to look for formulaic or reductionist approaches to treating survivors can be alluring, especially when the number of people impacted is so great, and the institutions responsible for the impact of war and abuse are so ponderous. However, the risk of missing trauma’s unique expression in individual survivors is high.

Peter Levine, founder of the Somatic Experiencing® model of trauma resolution has given acupuncturists an integrative lens for exploring traumatic stress. He studied animal predator-prey relationships and noted that (1) two-legged and four-legged animals go through five phases of self protection when responding to danger; (2) completing each of these five steps mitigates trauma’s imprint; (3) symptoms arise when a step is thwarted or remains incomplete; and (4) the particular step that remains incomplete influences where and how trauma’s imprint affects a survivor’s tissues, psychological constructs, functional challenges, and spiritual longings.

His observations paint a fascinating interface with the Five Elements. His steps of the self-protective response mirror the movement through the Five Elements:

  • Metal – Awaken Arousal – recognize and respond to something new in our environment/
  • Water – Signal Threat – discern safety and threat, seek help.
  • Wood – Mobilize a response that is commensurate with the level of threat.
  • Fire – Restore Coherence – recognize that the threat is over in the return to a regular rhythm of the heart.
  • Earth – Digest the Gristle – break these experiences down into digestible bits and harvest their inherent lessons.

The impact of a lightning bolt hitting a tree does not exclusively impact that tree. Every bug in its bark, bird on its branches, bush crushed by its fall, and the soil disturbed by its uprooting are affected. Recovery of the forest will require quality minerals, water, new sprouts, warm sun, and good soil. Similarly, when we experience a lightning bolt of trauma, we are impacted in a comprehensive way. It cannot be exclusively pinned to a certain organ system or function, nor can the transformation of its impact be reduced to universally applicable formulas or prescriptions. Each one of us, struck by the same “lightning bolt,” will have different elemental needs for recovering the health and vitality of our individual tree and the relationships we have in our communal forest.

The Five Element model is helpful for exploring the diverse expressions of trauma’s impact.[2] It supports providers to locate and work with the tissue, organ, or function where a thwarted or incomplete step in the threat response has left its imprint in the energy body. Given that trauma is often “hidden away” under a variety of management strategies, having the correspondences of the Five Elements can help providers know where to support the completion of as yet incomplete impulses for self-defense.

Traumatic stress gives rise to unpredictable and unusual physiology and clinical outcomes that are often not accounted for in acupuncture training programs, in spite of their common presence in our patient population.

I believe acupuncturists—and our patients—will benefit from including the neurobiology of traumatic stress, approaches for recognizing dysregulation caused by trauma in our patients, and nuanced methods for working with fragile nervous systems in our training programs. Our treatment rooms are filled with people with “strange, rare and peculiar” symptoms that baffle Western providers and are emblematic of the dysregulation in the autonomic nervous system caused by traumatic stress, whether known or unknown, spoken or unspoken.[3] Symptoms such as insomnia; chronic pain; metabolic and digestive disturbance; obesity; problems with memory, cognition, or mood; interpersonal challenges; and autoimmune illness or endocrine disorders are often intertwined as “complex, multi-symptom illness” and are nearly impossible to tease apart as discrete phenomena.[4]

Integrating Modern Trauma Understanding with Chinese Medicine

Research in the last ten to twenty years in the neurobiology of trauma has revolutionized mental health treatment for trauma spectrum disorders, but trauma doesn’t only impact mental health. Our patients will benefit when we integrate modern understandings of the human response to threat into how we offer our needles, manage clinical interactions, and interpret our client’s signs and symptoms.


[1] Kathryn M. Magruder, Nancy Kassam-Adams, Siri Thoresen, and Miranda Olff, “Prevention and Public Health Approaches to Trauma and Traumatic Stress: A Rationale and a Call to Action,” European Journal of Psychotraumatology 7 (2016) 10.3402/ejpt.v7.29715.

[2] Alaine D. Duncan and Kathy L. Kain, The Tao of Trauma: A Practitioner’s Guide for Integrating Five Element Theory and Trauma Healing (Berkeley: North Atlantic Books, 2019.

[3] Vincent J. Felitti, Robert Anda, Dale Nordenberg, David F. Williamson, Alison M. Spitz, Valerie Edwards, Mary P. Koss, and James S. Marks, “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults,” American Journal of Preventative Medicine 14, no. 4 (1998).

[4] Wayne B. Jonas, Joan A. G. Walter, Matt Fritts, Richard C. Niemtzow, “Acupuncture for the Trauma Spectrum Response: Scientific Foundations, Challenges to Implementation,” Medical Acupuncture  23, no. 4 (2011): 249–62.

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Alaine D. Duncan

Alaine Duncan is an acupuncture clinician, educator, and researcher. She has a passion to integrate the wisdom of Chinese medicine with the study of neurobiology and traumatic stress in both the classroom and the treatment room. It has carried her heart and hands to places and people she never imagined when she graduated from Maryland University of Integrative Health in 1990 and completed Somatic Experiencing training in 2007. Her book The Tao of Trauma: A Practitioner’s Guide for Integrating Five Element Theory and Trauma Treatment is the foundation for classes and workshops she offers for acupuncturists, somatic psychotherapists, and bodyworkers.

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