Introduction
Traffic accidents involve damage caused by vehicles. Data from the Health Insurance Review and Assessment Service show that medical expenses for Korean medicine in auto insurance have increased from 2018 to 2022, highlighting its growing role in treating traffic accident patients.
Traffic accident patients report various physical and psychological symptoms1). Physically, they often experience headaches, neck and back pain and bruising, while psychologically, they may have anxiety, stress, depression, and insomnia1). Whiplash Associated Disorders(WAD) involve neck issues from sudden head movements during accidents2). WAD includes motor, sensory, and psychological abnormalities2). Chronic WAD can lead to increased neuropathic or nerve-related pain3). Acute Stress Disorder(ASD) is one of trauma and stressor related disorders that develops within a month following exposure to actual or threatened death, serious injury, or sexual violence4). Symptoms include hyperarousal, sleep disturbances, an exaggerated startle response, and anxiety. ASD is a significant condition occurring in 13–21% of traffic accident patients4), and if not treated appropriately in the early stages, it can develop into Post-Traumatic Stress Disorder(PTSD)4). Therefore, early diagnosis and treatment of ASD are crucial for the long-term mental health of patients.
In Western medicine, pharmacological treatment, psychotherapy, and cognitive behavioral therapy are administered to patients with ASD. For PTSD, first-line medications include SSRIs like paroxetine and sertraline5). Antidepressants, serotonin-norepinephrine reuptake inhibitors, and atypical antipsychotics are also prescribed5). However, benzodiazepines can exacerbate symptoms, reduce the effectiveness of psychotherapy, increase aggression and depression, and lead to drug abuse5). There is a lack of strong evidence supporting the effectiveness of pharmacological agents used in ASD patients for PTSD prevention, indicating limitations in their use.
ASD can be treated in Korean medicine using various approaches. The differentiation of ASD in Korean medicine frequently involves patterns such as Heart-Gallbladder Deficiency, Heart Qi Deficiency, Heart Blood Deficiency6). Similar to ASD, PTSD in Korean medicine can be approached through conditions like Palpitations, Qi Stagnation, and Emotional Trauma due to Fear7). Korean medical treatments include herbal medicine, acupuncture, moxibustion, and Korean psychotherapy8). Korean psychotherapy includes diverse techniques such as IiGyeungByunQi-therapy, Giungoroen-therapy, Oji Sangseung-therapy, and meditation8).
Currently, there are few case reports on Korean medicine treatments for ASD resulting from traffic accidents9). Some cases have reported the use of Korean medicine treatments combined with EFT, as noted by Son et al.9). However, there have been no reported cases of applying Korean medicine treatments and Korean psychotherapy to ASD patients accompanied by panic-like symptoms following traffic accidents. Additionally, despite Giungoroen-therapy, Jeongsin Jeon-i-therapy, and Jeongseo Doin-therapy being fundamental Korean psychotherapy techniques included in basic textbooks, there are very limited studies discussing their application in treating panic and anxiety-related symptoms, highlighting the significance of this paper.
In this case report, a patient with ASD accompanied by panic-like symptoms following a traffic accident was treated with Korean medicine. The treatment included herbal medicine, pharmacopuncture, acupuncture, and cupping, alongside Korean psychotherapy techniques such as Giungoroen-therapy, Jeongsin Jeon-i-therapy, and Jeongseo Doin-therapy. Significant therapeutic effects were observed. This suggests that integrative Korean medicine treatment, combining physical and psychological therapies, can effectively manage ASD and panic-like symptoms. Additionally, a personalized Korean medicine treatment approach that considers the patient’s constitution, symptoms, and living environment showed high effectiveness, emphasizing the importance of individualized treatment plans. Furthermore, by demonstrating the effectiveness of Korean medical approaches for traffic accident patients with psychological trauma, this study suggests the potential for developing integrative treatment strategies in conjunction with existing Western medical treatments.
Case
This study was approved by Jaseng Hospital IRB (No. JASENG 2024-07-020).
1. Study Subject
This study examines a 28-year-old female who visited ○○ Korean Medicine Hospital on ○○, 202○, one day after the accident. The accident occurred when she was in the rear passenger seat during a rear-end collision while the vehicle was moving.
1) Chief Complaints
① Palpitations, anxiety, insomnia(falling asleep at 00:00, total sleep time < 2–3 hours, waking up more than 5 times during the night), panic-like symptoms(total 2 times, once a day, lasting 15 minutes each, with anticipatory anxiety, accompanied by limb tremors and sweating), persistent hand tremors, headache(NRS 5, frontal and occipital areas), inability to eat due to severe nausea, sweating, hyperventilation, dizziness
② Neck, back, lower back, coccyx pain
2) Present Illness
The patient was diagnosed with “no fractures” on X-rays of the left shoulder, rib, C-SPINE, and L-SPINE at Western medical hospital’s ER. Despite receiving W-MED PO treatment, there was no improvement, leading to her visit to our hospital.
3) Four Diagnostic Methods
① Observation: uneven complexion, pale face.
② Listening and Smelling: soft voice, trailing off at the end of sentences, and weak breathing.
③ Inquiry: immediately after the accident, the patient experienced whole-body tremors, severe insomnia, hypersensitivity to food odors with nausea, loss of appetite, and difficulty eating. Depression was mild, but there was aching pain in the neck, lower back, tailbone, back, shoulders, and clavicle.
④ Palpation: thin, rapid, and weak pulse.
2. Diagnosis
1) Korean Medicine Diagnosis
The patient reported symptoms such as palpitations, anxiety, insomnia, limb and hand tremors, and hyperventilation following a traffic accident. Considering comprehensively the results of the four diagnostic methods, it was determined that the symptoms were due to mental and physical fatigue caused by continuous psychological stress and insufficient heart blood, leading to a diagnosis of Heart and Mind Deficiency.
2) Western Medicine Diagnosis
The patient was diagnosed with ASD according to the DSM-5 criteria4). The patient experienced a severe traffic accident experiencing intense fear of death during the collision and exhibited persistent flashbacks and significant psychological distress even at the mere sight of cars, indicating that the accident served as a sufficient traumatic event meeting ASD diagnostic criteria. The patient began experiencing symptoms within 7 days after the car accident, and these symptoms improved by the 24th day post-accident, within a month. The patient showed anxiety manifestations that resembled panic attacks, including palpitations, sweating, shaking, shortness of breath, feelings of choking, chest discomfort, nausea, feeling dizzy, heat sensations, and derealization. The patient experienced a total of 9 symptoms from the DSM-5 criteria for ASD4)(Supplementary Table 1).
3. Treatment
1) Primary Interventions
A. Korean psychotherapy techniques
The following psychotherapy techniques were applied systematically according to the patient’s symptoms:
-
Jeongsin Jeon-i-therapy
- Purpose: To alleviate acute anxiety symptoms during panic-like symptoms
- Method: Redirecting patient’s attention to daily topics(favorite foods, hobbies, etc.)
- Duration: 10–15 minutes per session
- Application: Specifically used during panic-like symptoms to reduce tremors, sweating, and palpitations
-
Giungoroen-therapy
-
Jeongseo Doin-therapy
B. Acupuncture and electroacupuncture for panic-like symptoms
In cases of panic-like symptoms, needling was performed on Neiguan(PC6), Hegu(LI4), Zusanli (ST36), Sanyinjiao(SP6), Taiyang(EX-HN5), Shenmen (HT7), Shaofu(HT8), and Laogong(PC8) for 10 minutes. The needles used were disposable stainless steel needles(Dongbang needles) manufactured by Dongbang Medical, with a diameter of 0.30 mm and a length of 40 mm. Electroacupuncture was performed at bilateral Neiguan(PC6) with 2 Hz frequency for 10 minutes.
C. Herbal medicine
Yangshimtang-gami-bang was prescribed, a modified version of Yangshim-tang with four additional herbs: root of Angelica pubescens Maxim., rhizome and root of Notopterygium incisum Ting ex H.T. Chang, seed of Prunus persica (L.) Batsch and flower of Carthamus tinctorius L. The patient was instructed to take 100 ml twice daily (30 minutes after breakfast and dinner) for a total of two packs per day.
2) Supportive Interventions
A. Acupuncture and pharmacopuncture
The acupuncture treatment was conducted by inserting needles into Ashi points and retaining them for 10 minutes. The treatment involved Shinbaro2 pharmacopuncture, which consists of nine herbs (0.0013 g/mL each, except Paeonia albiflora root at 0.0027 g/mL): rhizome of Cibotium barometz, root of Saposhnikovia divaricata, stem bark of Eucommia ulmoides, stem and root of Acanthopanax sessiliflorus, rhizome and root of Ostericum koreanum, root of Angelica pubescens, root of Achyranthes japonica, whole body of Scolopendra subspinipes, and root of Paeonia albiflora. These ingredients were extracted with 70% ethanol and freeze-dried, and 2 cc of the solution was administered using a 29 G disposable insulin syringe(Sungshim Medical Co., Korea) at painful areas.
B. Chuna
The Chuna therapy was performed using specific techniques including Prone Ilium Correction(1–2 minutes, 5 repetitions on PSIS), Outflare/Inflare Correction(1–2minutes per side on iliac crest), Prone Thoracic Spine Correction(4 minutes on T1–T12), Side-lying Lumbar Spine Correction(3–4 minutes on L1–L5), Trapezius Myofascial Release(1–2 minutes each side), and JS123(3–4 minutes on cervical spine), with treatments administered once daily during hospitalization and 2–3 times weekly for outpatient care.
4. Patient’s Progress(Figure 1)
On the first day of treatment, the patient reported physical symptoms including neck pain, back pain, coccyx pain, frontal and occipital headaches, dizziness, and nausea(all rated NRS 5). The patient was admitted for inpatient care on the second day.
On the night of the fourth day of treatment, the patient experienced panic-like symptoms with anxiety, limb tremors, sweating, and palpitations. Jeongsin Jeon-i-therapy was applied for 15 minutes to redirect attention to daily activities, effectively reducing physical manifestations of stress. This was followed by acupuncture at Neiguan(PC6), Hegu(LI4), Zusanli(ST36), Sanyinjiao (SP6), and Taiyang(EX-HN5), with moxibustion at Guanyuan(CV4), which helped stabilize the patient’s condition.
On the fifth day, the patient experienced the second panic-like symptoms, including shortness of breath, palpitations, limb tremors, and sweating. Jeongseo Doin-therapy was administered for 15 minutes, focusing on breathing regulation through specific acupoints. Following this, a 10-minute Giungoroen-therapy session was conducted for anxiety management. The treatment was completed with acupuncture and electroacupuncture at bilateral Neiguan(PC6).
On the tenth day, the patient showed improvement but still expressed anxiety about the accident. Jeongsin Jeon-i-therapy was administered for 10 minutes, encouraging focus on daily activities and hobbies, which resulted in managing residual anxiety. On the eleventh day of treatment, the patient showed overall improvement but reported intermittent palpitations and anxiety about symptom recurrence. The patient also expressed concern about potential memory loss related to a past snowboarding accident. Giungoroen-therapy was administered for 10 minutes, focusing on positive changes and reassuring the patient about isolated memory loss incidents. This treatment, combined with acupuncture and moxibustion, resulted in reduced anxiety and improved comfort level.
By the 24th day of treatment, the patient demonstrated complete resolution of psychological symptoms, with no recurrence of acute stress reactions. The patient reported no anxiety about the accident or cars, and treatment focus shifted entirely to managing residual physical discomfort.
5. Assessment tool
The Generalized Anxiety Disorder-7(GAD-7)10) was used to assess panic-like symptoms and ASD. The EuroQol 5-Dimension 5-Level(EQ-5D-5L)11) was used to assess the impact of panic-like symptoms, ASD, and pain on a patient’s health-related quality of life. The Numeric rating scale(NRS)9), Oswestry Disability Index(ODI)12), and Vernon-Mior Neck Disability Index(NDI)13,14) were used to assess the patient’s level of pain. The Patient Global Impression of Change(PGIC)15) was used to evaluate the impression of subjective change.
6. Treatment outcomes
1) GAD-7
The GAD-7 scores showed an initial increase from admission to the second panic-like symptoms, peaking at 18. Throughout treatments, the scores steadily declined, reaching 6 by the 24th day of treatment. The scores decreased to a level of 3 after one month and remained stable for the following 2 months(Figure 2).
2) EQ-5D-5L
The EQ-5D scores demonstrated improvements across all domains throughout the treatment period. Most significantly, the Anxiety/depression domain showed the most dramatic improvement, decreasing from an initial score of 3 at admission to complete resolution by the second month (Figure 3).
3) NRS
The NRS scores for lumbar pain, cervical pain, and headaches improved continuously(Figure 4).
Discussion
In this case, the patient’s diagnosis of ASD was well-supported by both the nature of the traumatic event and the patient’s response. The patient experienced symptoms such as palpitations, anxiety, insomnia, limb and hand tremors, and hyperventilation. It was determined that these symptoms were due to Heart and Mind Deficiency caused by Heart damage, and Yangshimtang -gami-bang was prescribed. This prescription nourishes the blood and calms the mind, with added herbs that dispel wind-dampness, relieve pain, invigorate blood circulation, and remove stasis. It is effective for mental and physical shock from traffic accidents, stagnation of qi and blood, circulatory disorders, systemic pain, and mental symptoms. According to the Donguibogam’s section on Shenmen: “It treats anxiety, depression, insomnia due to emotional disturbance or overwork causing Heart and Mind Deficiency.” Pharmacologically, Yangshim-tang is known to inhibit β-amyloid accumulation and regulate excessive activation of N-methyl-D-aspartate receptors16). These effects can alleviate neurological changes seen in acute stress disorder and aid in symptom improvement. Additionally, electroacupuncture at bilateral Neiguan(PC6) has been shown to significantly reduce HAMA and SAS scores and alleviate anxiety by decreasing sympathetic hyperreactivity17). After receiving electroacupuncture treatment at bilateral Neiguan (PC6), the patient’s anxiety-related symptoms were improved.
In patients with traffic accident injury syndrome, the severity of physical symptoms does not necessarily correlate with the degree of psychiatric disorders18). According to one study18), patients with minor physical injuries actually had higher rates of suicide attempts and scored higher on scales of depression, hysteria, and obsessive -compulsive disorder. This suggests that mental illnesses should be carefully considered in the treatment of traffic accident patients, regardless of the severity of their symptoms. Particularly for patients who do not report significant physical pain, psychiatric evaluation is crucial. Additionally, traffic accident patients often report neurological symptoms such as headaches, dizziness, and decreased concentration alongside physical pain18). The study18) indicates that the more severe the concentration impairment, the greater the degree of labor loss, and the more severe the disorientation, the higher the severity of physical injury and labor capacity loss. The primary goal of traffic accident treatment is to restore patients to their daily lives and previous levels of physical ability18). Therefore, symptoms like decreased concentration or mild disorientation should not be overlooked. It is important to approach a patient’s symptoms from a comprehensive perspective that includes both physical and mental aspects.
ASD is a major disorder that occurs in 13–21% of traffic accident patients4). The manifestation of ASD can vary depending on the passage of time after the traumatic event, individual vulnerability, and resilience19). Without appropriate treatment, there is a possibility of retraumatization and worsening symptoms19). The main goal of ASD treatment, first defined in DSM-IV, is to provide appropriate care to patients who find natural recovery difficult due to trauma4). It is important to start ASD treatment within at least one week after the trauma. Notably, even if a patient does not fully meet the diagnostic criteria for ASD, it is crucial to provide timely and appropriate treatment to prevent progression to chronic PTSD4). In this context, personalized integrative Korean medicine treatment offers advantages in ASD treatment by providing tailored interventions that consider individual characteristics such as traumatic situations, personal traits, sensitivity, past psychiatric history, and physical symptoms. Therefore, it is very important to administer appropriate treatment early on, even if the patient cannot clearly express their symptoms. In this case, the patient reported no mental symptoms after one month of treatment, demonstrating that Korean medicine psychotherapy can play a crucial role in preventing the progression from ASD to PTSD. This highlights the potential of Korean medicine approaches in effectively managing acute stress responses and mitigating long-term psychological consequences following traumatic events.
The patient’s symptoms showed significant improvement throughout the treatment period, with GAD-7 scores decreasing from an initial peak of 18 to 6 by day 24, and further improving to 3 after the first month, maintaining stability for the following two months. Most significantly, the Anxiety/depression domain of the EQ-5D-5L showed dramatic improvement, decreasing from an initial score of 3 at admission to complete resolution by the second month. These improvements in both GAD-7 and EQ-5D-5L anxiety/depression scores reflect the effectiveness of our treatment approach in addressing the core psychological symptoms of ASD. The sustained improvement in these measures suggests that the integrated Korean medicine treatment not only alleviated the immediate stress response but also contributed to a comprehensive improvement in the patient’s mental health status, effectively preventing the progression to PTSD.
This case is an important example that demonstrates the effectiveness of Korean medicine treatment and Korean psychotherapy for a patient with traffic accident injury syndrome accompanied by panic-like symptoms. However, as it is a single case study and involves a combination of various Korean medicine treatments, it is difficult to prove the effectiveness of individual treatments. Furthermore, it is necessary to develop personalized treatment guidelines for ASD patients who visit after traffic accidents. Establishing customized treatment guidelines tailored to the individual characteristics and symptoms of ASD patients experiencing panic-like symptoms after traffic accidents would enable a more effective and systematic approach in Korean medicine. Future research should involve systematic studies on more ASD patients who experience panic-like symptoms following traffic accidents, such as clinical trials based on each treatment modality or personalized treatment programs. Objective measures such as PCL-5-K, PC-PTSD-5, PAS, STAI, HAM-A, and BDI should be utilized, and the effectiveness of Korean medicine treatment should be demonstrated through long-term prognosis observation.
Summary
This case report demonstrates the effectiveness of Korean medicine-based psychotherapy combined with traditional Korean medicine treatments for a patient with acute stress disorder(ASD) and panic-like symptoms following a traffic accident.
Korean psychotherapy techniques were systematically applied as the primary intervention. Jeongsin Jeon-i-therapy was used during panic-like symptoms to alleviate acute anxiety symptoms. Giungoroen-therapy focused on treatment progress and symptom improvements to reduce anxiety and prevent recurrence. Jeongseo Doin-therapy employed breathing exercises for relaxation. The patient also received herbal medicine(Yangshimtang-gami-bang), acupuncture, pharmacopuncture, and Chuna therapy.
Treatment outcomes showed significant improvements in GAD-7, EQ-5D-5L, NRS, ODI, and NDI scores. GAD-7 scores decreased from 18 to 6 by day 24 and further improved to 3 after one month, remaining stable for two months. This case highlights the potential effectiveness of Korean medicine-based psychotherapy in managing ASD and preventing progression to PTSD.
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