There is a difference between having panic attacks and living in a state of anxiety, and most people who cross from one to the other can't say when it happened. The episodes used to have edges — a trigger, a peak, an aftermath. Then at some point the edges dissolved, and what's left is a low constant hum: heart never quite settled, always braced for something.
A 1613 Korean medical text describes both states, distinguishes them carefully, and — this is the part that surprises people — names the crossing itself.
Two words for two states
The Donguibogam devotes a chapter to the spirit (신 神), which is where Korean medicine keeps its psychiatry. Two of its sections sit next to each other:
경계 (驚悸), fright palpitations — the acute state. The text's description is unmistakable: at worst the heart leaps and one feels about to faint. It lists the triggers as a loud sound in the ear, a strange thing struck by the eye, meeting danger — and one more, which is the interesting one: being touched by an affair and losing one's purpose. Not just fright. Being knocked off your footing by something that mattered.
정충 (怔忡), fearful throbbing — the chronic state. Here the definition is one of the best descriptions of generalized anxiety I've read anywhere: a restless stirring within the heart that will not settle — apprehensive, as though someone were about to seize you. And the timing marker: arising at no fixed time.
Then the line that connects them:
> Fearful throbbing comes of fright palpitations grown long-standing.
That's the clinical arc, stated in 1613. Panic left untreated long enough stops being episodes and becomes a background state. The chapter isn't describing two unrelated conditions; it's describing a progression.
We translated this chapter in full: The Spirit — full translated chapter.
What it says causes the chronic version
Here the text does something modern clinical writing rarely does. It names the causes of 정충 as:
> anxiously chasing wealth and rank, or grieving over poverty and low station, and not attaining what one wished for.
Ambition and thwarted circumstance. Not a chemical imbalance, not a personality — a life situation, named directly as the cause of a cardiac symptom.
This is not an isolated remark. The same text, in its chapter on the womb, gives one of three causes of heavy uterine bleeding as a reversal of fortune — someone once secure who has lost status or money — and warns the physician that such a patient will look well and the examination will show little. Its first instruction there isn't a herb: talk with her first, until the heart is no longer stirring, and only then prescribe.
Whatever one makes of the underlying theory, that is a seventeenth-century text prescribing a conversation as the opening move of medical treatment, for a physical symptom whose cause it locates in a person's circumstances rather than their body. This is the root of what Korean medicine later named hwa-byeong (화병) — illness from suppressed anger and grief, recognized as a Korean cultural syndrome.
Why the treatment differs between the two
The chapter's formulas fork on a question that has nothing to do with what frightened you:
Is the person empty, or is something stuck?
For emptiness — a heart racing because it's thin and dry rather than because something is pressing on it — the approach is to refill and settle. The chapter's own phrase for this state is the finest line in it: no Blood within the heart, like a fish without water. Not racing so much as stranded.
Formulas here include Ansinbosim-tang 安神補心湯, and where the depletion came from sustained mental strain, Igyeong-tang 益榮湯 — written for the diagnosis the chapter states most plainly: thought and worry past measure wearing away the Heart Blood. Its indication pairs the palpitations with an abstracted, not-quite-present state — what overworked people describe as being unable to hold a thought. The tradition treats both as one deficiency.
For constraint — where the problem is that something has stopped moving rather than that something is missing — the formulas are different, and so is the goal.
The observation worth taking home
Two things in this chapter are worth carrying even if you never see an acupuncturist.
First: the progression is real and it is described. If your panic has been getting less episodic and more constant, that isn't you getting worse at coping. It's a recognized trajectory, and it was recognized four hundred years ago.
Second: the exhaustion is part of the condition, not a side effect. The chapter treats persistent anxiety and the wrung-out, can't-hold-a-thought state as a single deficiency with one cause. People often apologize for mentioning the fatigue, as though it were off-topic. In this framework it's the main topic.
Read more: [Anxiety, Insomnia & Mental Health] · [Chronic Fatigue & Burnout]
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Frequently asked questions
Can acupuncture help with panic attacks?
Acupuncture is commonly used for anxiety and panic, typically alongside — not instead of — therapy and any medication you're taking. Patients often report the physical layer settling first: heart rate, sleep, the braced feeling in the chest.
Should I stop my medication?
No. Don't change psychiatric medication without your prescriber. This care works alongside it, and many patients use both long-term.
My heart pounds — should I see a cardiologist?
If palpitations are new, severe, come with chest pain, breathlessness, or fainting, or if you have any known cardiac history — yes, get evaluated first. Palpitations should be assumed cardiac until they've been shown not to be.
How many sessions before I notice anything?
Most people notice something within four to six sessions, usually in sleep or in the intensity of the physical symptoms. The chronic background state takes longer than the acute episodes.
Is there a Korean medicine explanation for anxiety from financial stress?
Yes, quite explicitly — this chapter names chasing status and grieving its loss as direct causes of the chronic form. It's unusual among classical medical texts in doing so, and it's one reason Korean medicine developed a specific framework for illness arising from suppressed emotion.
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Eui Young (Justin) Chung, L.Ac., Dipl. O.M. practices at Raah Acupuncture in Koreatown, Los Angeles, and is the translator of the ongoing English edition of the Donguibogam at formulas.raahacupuncture.com.