Research

Oriental Medicine and the Treatment of Rape Trauma Syndrome
Krisztina Samu, Licensed Acupuncturist

The treatment of Rape Trauma Syndrome using acupuncture and herbs as an adjunct to traditional responses is a newly emerging therapeutic approach worthy of exploration. Rape Trauma Syndrome was first discussed in 1974 in the American Journal of Psychiatry by psychiatrist Ann Wolbert Burgess and sociologist Lynda Lytle Holmstrom who interviewed and followed 146 patients admitted to the emergency ward with a presenting complaint of having been raped.1 The symptoms of Rape Trauma Syndrome share some similarities to Post-Traumatic Stress Disorder (PTSD).

PTSD was first recognized as a psychiatric disorder in the third edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (1980). The current criteria, in the fourth edition of this manual (DSMIV; APA, 1994), define PTSD as a syndrome comprising three clusters of signs and symptoms:

1. repeated reexperience of the trauma (e.g., intrusive recollections of the event, nightmares);
2. emotional numbing (e.g., difficulty experiencing positive emotions) and avoidance of activities and stimuli reminiscent of the trauma; and
3. heightened arousal (e.g., exaggerated startle reflex, insomnia; night terrors)
4. Finally, a diagnosis of PTSD requires that these symptoms still be evident at least 1 month after trauma exposure and cause impairment or clinically significant distress.

The description of Rape Trauma Syndrome overlaps these findings, but also presents some unique characteristics. Wolbert and Holstrom describe what they observe to be a two-phase reaction. Based on their observations, they found women's Impact Reactions to be fairly equally distributed between the Expressed style: (fear, anger, anxiety, crying sobbing) and Controlled style (emotions presenting as masked, hidden, composed or subdued). Common somatic reactions during the first few weeks following a rape may include physical trauma, skeletal muscle tension, gastrointestinal irritability, genitourinary disturbance. Emotional reactions included a wide gamut of feelings including fear, humiliation, embarrassment, anger, revenge, self-blame.

Long-term reactions involved reorganization of the victim's life as a result of the rape. This included any combination of the following: moving residences, changing phone numbers, traveling away to other states or countries, turning to support to family members not normally seen on a regular basis. Patients coped in different ways regarding the trauma depending upon their ego strength, social network support, and the way they were treated by others as a response to their victimization.

Other long-term reactions based on Wolbert and Holstrom's findings include: nightmares, the development of various phobias related to the trauma, such as: fear of indoors, fear of outdoors, fear of being alone, fear of crowds, fear of people behind them. Additionally, patients reported fears and crisis in their sexual life. Additionally, some patients had what is called Compounded Reactions. In such cases the trauma of rape was preceded by existing physical, social, psychiatric, or unresolved past sexual assault/sexual abuse histories. In such circumstances, the tendency for depression, psychotic behavior, alcoholism, drug abuse, acting out behavior or suicidal behavior was increased.

The usage of "Rape Trauma Syndrome" to describe the constellation of symptoms experienced by victims has become accepted by national and international organizations that deal with the topic, such as RAINN (Rape and Incest National Network.2), Planned Parenthood and rape crisis centers worldwide.

Many of the psycho-emotional and somatic symptoms of Rape Trauma Syndrome easily translate to the diagnostic language of Oriental Medicine, and can be treated with the methods and modalities of the same as we will explore in this paper.

Oriental Medicine (OM), also known as Chinese Medicine or Traditional Chinese Medicine, is one of the world's oldest systems of medicine. It is a sophisticated system that has been refined for thousands of years and its use predates the birth of Christ. Unlike some forms of medicine, OM treats both the root (the cause) of a disease as well as its symptoms. The objective in Oriental Medicine is to restore balance in the body based on elemental paradigms developed from observation of nature. In Oriental Medicine, all diseases are seen as a departure from homeostasis and the treatment objective is to restore balance and proper functioning of the various organ systems of the body, which results in the relief of physical pain and emotional distress and the restoration of spiritual harmony. Oriental Medicine encompasses a variety of therapies including acupuncture, herbal medicine, dietary therapy, Tui Na medical massage, and Qi Gong (life force cultivation exercises).

In the past two decades, acupuncture has grown in popularity in the United States. According to the 2002 National Health Interview Survey 3--the largest and most comprehensive survey of Complementary and Alternative Medicine (CAM) use by Americans to date, an estimated 8.2 million U.S. adults had ever used acupuncture, and an estimated 2.1 million U.S. adults had ever used acupuncture the year before.

The rise in popularity of this form of medicine is further evidenced by the incorporation of acupoints into various contemporary healing modalities. Some examples are EFT - Emotional Freedom Technique®4, TAT -Tapas Acupressure Technique®5, the Tara Approach for healing shock and trauma 6 and Zero Balancing®7 to name a few. The emergence of these therapies indicates that there is a therapeutic effect achieved from the stimulation of acupoints, when used alone, or in conjunction with verbal processing.

With the growth in popularity of Oriental Medicine as a treatment modality, more and more studies have been conducted according to the formal scientific model, which demonstrate the efficacy of acupuncture in treating a variety of conditions that are commonly associated with Post Traumatic Stress and/or Rape Trauma Syndrome.

Several studies suggest that acupuncture may treat conditions and symptoms such as depression, anxiety and insomnia that are not uncommon among Rape Trauma Syndrome sufferers. A University of Arizona Study concluded that from a small sample of 38 women who received acupuncture, 1/3 who received depression-specific treatment, 1/3 who received treatment not specific to depression and 1/3 who were waitlisted for the duration of the study, but received depression-specific treatment later, the first group obtained significant symptom relief, at rates comparable to those of psychotherapy or pharmacotherapy.8

A Yale University School of Medicine study found that acupuncture can be an effective treatment for chronic anxiety disorders. The study used 55 healthy volunteers, all of whom received bilateral auricular acupuncture. 1/3 were needled on the "relaxation" point, 1/3 were needled on "Shenmen" which is also known for it's calming effect, and 1/3 received needles in a sham point. The researchers concluded that auricular acupuncture at the "relaxation" point can decrease the anxiety level in a population of healthy volunteers.9

A 2004 Canadian study at the Centre for Addiction and Mental Health found that of 18 adult subjects with anxiety complicated by insomnia experienced significant improvements in sleep quality after 5 weeks of acupuncture treatment.10

A Maine study assessed outcomes of 25 patients in long-term mental health counseling who combined counseling with a complementary therapy of their choice; either massage, Reiki, acupuncture or Healing Touch. Of the 25 patients, all had histories of trauma of which 10 involved sexual abuse. 10 subjects had PTSD, 9 had major depression, 3 had anxiety disorder and 3 had dual diagnosis. The study concluded that the integration of complementary therapies into community mental health practice may hold promise of enhancing mental health outcomes and improving quality of life for long-term users of mental health services.11

Another study conducted by four researchers at the University of New Mexico concluded that "acupuncture provided large treatment effects for PTSD, similar in magnitude to group CBT (Cognitive Behavioral Therapy)", and it "may be an efficacious and acceptable nonexposure treatment option for PTSD"12. By nonexposure treatment, we understand that the patients experienced symptomatic relief equal to that of patients who participated in Cognitive Behavioral Therapy but their treatment did not require the self-disclosure that is normally part of talk therapy. This finding is noteworthy for Rape trauma survivors because it offers patients the option of symptom relief without the need to retell the tale of the traumatizing event, which may be a preferred choice for some survivors.

Traditional Western treatment modalities for Rape Trauma Syndrome include crisis counseling, psychotherapy and the use of pharmaceutical drugs 13 to manage PTSD symptoms 14, however use of and interest in Complimentary Alternative Therapies (CAM) by treatment providers is growing.

An informal survey of rape crisis centers around the world revealed the following with regard to the use of complimentary therapies as an adjunct to traditional (cognitive therapy) oriented treatment. It should be noted that different centers offer varying levels of intervention and service and this is reflected in the array of responses. That said, when asked which therapies the crisis center utilizes in the treatment of their clients, the following answers were submitted:

1. Talk therapy leading to EMDR (Eye Movement Desensitization and Reprocessing 15).16
2. Individual and group talk therapy, using a variety of treatment modalities (i.e. CBT (Cognitive Behavioral Therapy), DBT (Dialectic Behavioral Therapy), etc.) Also a yoga group for survivors, that is a mixture of trauma-informed yoga practice for grounding and reconnection, as well as group psychoeducation. In terms of referrals, we refer to programs and practitioners that offer EMDR, art therapy, and typically maintain referral information for trauma-sensitive/trauma-informed massage therapists, acupuncturists, etc. 17
3. Peer-based support for sexual assault survivors, their friends and family. One-to-one counseling, advocacy and court support & accompaniment. Also body-mapping workshops for survivors, as well as Circulo de Mujeres - Latin American women's circle as a more holistic community based survivor support model. In our work with incarcerated women/women in conflict with the law; we have incorporated acupuncture as well as guided imagery and work with oils. We have organized 'spa days' for volunteers offering massage, acupuncture, juices - info on cleanse and detox. 18
4. I am traditionally trained therefore, Cognitive-Behavioral Therapy is the first choice to address issues surrounding PTSD/Rape Trauma Syndrome. I also have training in DBT, Adlerian, movement, and psychodrama. Basic expressive arts such as art, poetry, music, and dance can be helpful when used as a tool to discover what the client is feeling. One has to be certified as an expressive arts therapist to use the expressive arts as a diagnostic instrument tool. Therapy is always centered around the clients needs, and everyone is unique. Therefore, every client I see receives a unique treatment. Research has demonstrated a therapeutic connection between yoga and trauma. I am trained in Yoga and have movement certifications. 19
5. About your questions, we, Tokyo Rape Crisis Center, do not offer any therapies. We can offer in house telephone counseling only. When a client wants to know the information, we provide it such as art therapy, group session or others. 20
6. I read your mail and am sending you a rather brief answer for the simple reason that we are not a therapy centre (nor are the large majority of the other 8 centers in Israel). We have a hotline which functions 24/7 and we offer our callers emotional and practical support but not actual therapy. We can only refer our callers to private therapists who specialize in treating sexual abuse and to various other specialist centers, some supported by Social Services. We also unfortunately, do not refer our callers to alternative therapy practitioners as we have no way of examining their abilities or methods and there are no official professional unions to whom we could refer queries regarding specific therapists and their qualifications and professional capabilities. We have had quite a number of complaints from women who have been sexual abused by alternative therapists (also by "regular" therapists – but in their case there is a possibility of reporting to their official unions as well as to the police). I do not in any way wish to give the impression that I do not believe in alternative therapies but we personally cannot take responsibility for referrals at this present time. Re-reading your mail, we do refer our callers to art therapists who specialize in treating sexual abuse. 21
7. We use a range of counseling therapies at the NSW Rape Crisis Centre. These include Cognitive Behavioural Therapy, Narrative Therapy, Acceptance and Commitment Therapy, and Dialectical Behaviour Therapy. We only provide counseling services to our clients and we do not have any staff who are qualified to provide any other alternative therapies. While we provide referrals to other counseling services and practitioners, many of our clients initiate their own referrals to other services, which may also include alternative therapies. We do not have any alternative therapies practitioners on our database, but I am aware of some of our clients also accessing Reiki healers, shamanic healers, acupuncturists, massage therapists, attending yoga classes and hypnotherapists. As a feminist service, we encourage our clients to make their own decisions about what they would find helpful in their recovery. However, I personally would encourage clients to be cautious when using any therapies or practices that involve physical touch or having their eyes closed as this can trigger trauma memories. I hope this information assists you in your research. 22
8. At the moment we offer containment counseling on site at hospitals, crisis counseling over the telephone and face-to-face at our three offices, support group counseling, court support and paralegal advice and aromatherapy massage. We also offer survivors an opportunity to speak publicly about their experiences as a part of their healing process in our Speak Out project. 23
9. Our Agency works closely with sexual assault survivors supporting them through the police and medical process, and supporting them in their transition to counseling which they can also do through us. We work with what the client wants and needs and we talk with them about the many different ways in which they may be able to take care of themselves and ways that may help them to relax etc. We will explore with them what might be helpful for them to try. Included in those discussions certainly could be suggestions of trying breathing therapy, massage, retreats etc. We don't offer any of these services at our Agency but will certainly encourage the client to try different things that may work for them. The client will often come up with their own ideas of what they might like to try also. 24
10. The rape crisis center does not offer individual therapy. We refer the women to therapists outside the center, according to their needs. Some of the places we refer to are public services and others are private therapists that we know and trust. The therapists are from different disciplines: dynamic therapy, CBT, various methods of trauma therapy, art therapy, movement, bibliotherapy, physical psychotherapy.
    
    The support groups have been operating in the center for close to fifteen years and they are facilitated by professionals from the therapeutic field with a lot of experience in treating women who have been sexually assaulted. The support groups are for survivors and mothers of survivors.
    
    Recently, we completed a course of a new group, which combined Yoga with some verbalization. This group was created for women who had already been in at least one support group in the past facilitated by a Yoga teacher who volunteers in the center.
    
    In light of the success of the first group and by popular demand from the women, I am happy to announce that there is another Yoga group starting now. 25
11. We currently offer counseling for our survivors free of charge. We also have a 24-hour crisis line available for talking. We have hospital advocacy, court accompaniment, information and referral. In all of our support groups, art therapy is a component, especially with the younger age groups. There are not any outside therapist we refer to primarily due to the lack of services in our area and these services are usually too expensive for our clients if they are offered. 26
12. Initially I want to inform you that the Rape Crisis Center of Milford offers peer counseling and advocacy to sexual assault victims. There are no licensed therapists at the center. We are all state certified sexual assault counselors and although we have had training that includes the emotional dynamics of sexual assault including but not limited to Rape Trauma Syndrome, we do not use therapy techniques such as CBT etc. We do have a referral list for professional therapists should it become necessary. This list includes therapists who list trauma and sexual assault as part of their experiences although I cannot say most "specialize" specifically in this area. A fewer number of these therapists do specialize in dissociative disorder. We also collaborate with mental health professionals in our service area in a number of ways. This includes mutually attended pre-scheduled meetings with the intention of providing comprehensive care to clients and family members. This center staff also attends trainings provided by various agencies and we participate in cross training as well. To my knowledge none of these therapists we refer clients to use alternative medicine to treat victims of sexual assault although I have on occasion suggested some of these alternatives to clients myself during counseling. As an advocate for this center I can say that I am very interested in learning more about alternative medicine such as you introduce to help with victim recovery. It has actually been my intention to research this in our service area to seek out therapists from our area who do use these techniques but quite quite frankly have not had the time to do so. Ours is a very small office with five staff people. I have had this topic introduced several times recently and do intend to follow through. 27
13. In general, referrals within the agency are to licensed MFT, LCSW, PhD clinicians who must follow the standards set in the field. If a client is interested in what is referred to as non-traditional methods (yoga, meditation, body work, jin shin jtsu, etc., we refer but are mindful of setting up legal complications if we espouse to a technique that is not considered "standard practice" by the western medical system. We are also EXTREMELY careful and mindful of both the need for and the danger of hands on work of any kind - with survivors who could be triggered. Also, we are beginning to embrace "alternative" practices of yoga and meditation in the self-care of our staff, who is exposed constantly to vicarious trauma... 28

The above responses reveal that among a small global sample, there is an interest in, as well as concerns about integrative therapies for the rape crisis centers' clients. The last respondent noted, there is both a need for, AND a danger of hands-on-work with traumatized populations since touch can have a "triggering" effect. This concern was addressed in a Boston study, which involved the implementation of acupuncture treatment program as a new service at an existing PTSD clinic for refugees.

The authors write: At the start of the project, several staff members expressed concerns that due to the traumatic history of the refugees, the use of needles would be an inappropriate treatment modality as it could further traumatize the patients. To address this concern, we provided acupuncture treatments for the staff so that they could make informed decisions as to the appropriateness of the modality. All staff members (n = 7) reported the treatments to be surprisingly relaxing and enthusiastically referred their patients to the acupuncture clinic. In fact, several of the staff members continued to receive weekly acupuncture treatments to address symptoms related to secondary trauma. Secondary trauma is an issue that commonly arises in refugee camps and natural disaster sites where healthcare providers are exposed to psychological trauma indirectly via exposure to the stories of his or her patients.

In the end, the Boston study reported that 111 treatments were performed on 16 patients from 13 countries. While there were no clinical measures taken, 14 of 16 patients self-reported a reduction in symptoms. 29

The risk of retraumatization of sexual assault survivors can also be addressed by providing treatments in a community setting. Community Acupuncture 30 is a relatively new model in the United States, in that treatment rooms are typically set up with multiple tables or chairs in each room and treatments are affordable (sliding scale). The community setting makes it possible to avoid the scenario of a potentially nervous patient being alone in a room with a practitioner if that scenario contributes to the patient's sense of vulnerability. Concern may be raised about the privacy available during patient intake, however it should be noted that the details of the trauma need not be recounted in order for the practitioner to be able to determine the correct course of treatment. Describing symptoms such as: inability to sleep, fatigue, anger, palpitations, etc. is sufficient for the practitioner to determine the course of treatment. As an alternative to Community Acupuncture, patients may seek treatments in a private setting and bring a relative or friend into the treatment room. The buddy system may be used throughout the course of the treatments, or until sufficient trust has been established between patient and practitioner. This will of course, not be practical for all patients, but it is an option that may work for some.

For traumatized persons with histories of sexual abuse it is interesting to note that an acupuncturist can choose from hundreds of points on the body when designing a treatment. There are many points on the body that treat regions of the body that are nowhere near the affected area. For this reason, it is possible to use distal points to affect areas of the body traumatized by sexual abuse. The energy activated by the point SP4 (found on the medial side of the foot) for example, acts upon the uterus. Distal points on the Liver meridian, LV3, LV5 (between the first and second toes and on the medial side of the calf, about 5 inches above the ankle) act on the areas of the genitals. The hands, feet and ears are considered microcosms of the body. This means that regions on the sole of the foot (as used in Reflexology), on the dorsal and palmar surfaces of the hand (Korean Hand Acupuncture) and the surfaces of the ear (Auricular acupuncture) correspond to regions on other parts of the body. As such, it is possible for a skilled practitioner to treat all areas of the body, internally and externally through these "microcosms". When healing has progressed and a greater degree of trust has been established between patient and practitioner, it may be possible to mutually agree on the incorporation of local points (points closer to the affected areas) if needed. For example, UB32 is located over the 2nd sacral foramen and is indicated for matters affecting the pelvis. CV17, which is in the middle of the sternum regulates energy in the chest and can resolve palpitations and irregularities with breathing.

Anecdotally, various newspaper articles confirm that acupuncture has been and is currently being used to treat populations suffering PTSD. An April, 2010 article from The Gainesville Sun reported that the Academy for Five Element Acupuncture was offering free treatment for veterans, active military personnel and immediate family members. The article write: Reznek, a licensed acupuncturist, said acupuncture is very successful in treating post-traumatic stress disorder without any side effects. PTSD is an anxiety disorder common to veterans 31.

The News Stories link on the website of the organization: Acupuncturists Without Borders lists dozens of news articles about outreach services that have been offered in response to disasters which by their nature traumatize local populations as well as first responders. Stories cover AWB outreach to survivors of Hurricane Katrina, the Haiti Earthquakes, Southern California fires, and Veterans outreach services. 32

Other news articles inform us of the use of acupuncture in treating sufferers of Rape Trauma Syndrome. Since October of 2008, St. Vincent's Hospital in New York has been offering ear and now full body acupuncture treatments free of charge to survivors of rape/sexual assault and/or survivors of childhood sexual abuse/incest and their allies. 33 The radio station 850 AM announced in August of 2008 that the Alachua County Victim Services and Rape Crisis Center organized a twelve week counseling and acupuncture program for five rape survivors. 34

As mentioned earlier, many of the symptoms of Rape Trauma Syndrome (as well as those of the more general category of PTSD) can be interpreted using the diagnostic language of Oriental Medicine. Leon Hammer, M.D., L.Ac., has effectively "translated" the Western diagnostic language of psychology into Eastern diagnostic language. Dr. Hammer is a Western trained psychiatrist, a scholar, author and a practitioner of Chinese Medicine. He is also the founder of Dragon Rises School of Oriental Medicine in Florida. In his book, Dragon Rises, Red Bird Flies 35 we learn that anxiety, a common sequella to trauma, can be diagnosed as having five causes according to the classical Chinese Medicine model. These causes are:

1. A combination of weak constitution and sudden fright.
2. Heart blood deficiency due to blood loss and chronic disease.
3. Internal retention of pathogenic fluids due to Spleen and Kidney deficiency.
4. Excess fire due to yin deficiency.
5. Internal phlegm-fire.

Of course, identifying the exact pattern in a given patient would require a complete intake by a trained Oriental Medicine practitioner. However, it is worthy to note that each classically defined cause for anxiety points to the root of the problem according to ancient diagnostic paradigms that are not commonly considered by the Western model. As such, consideration of the Eastern diagnostic model along with the Western view may lead to increased diagnostic accuracy and treatment efficacy.

In chapter 13 of Dragon Rises, Red Bird Flies, Dr Hammer describes about 15 types of anxiety and depression identifiable through Chinese medicine. This type of specific focus allows for improved targeting of the treatment by addressing the underlying cause of the depression or anxiety.

In another of Dr. Hammer's books, Chinese Pulse Diagnosis: A Contemporary Approach 36 he discusses the nuances of pulse diagnosis. In the index alone, the book lists qualities we find on the pulse for stress, trauma, and emotions, especially qualities unique to anger, anxiety, denial, depression, despair, explosiveness, fear, guilt, horror, indecision, failure, irritability, loneliness, rejection, melancholy, nervous tension, panic, phobia, rage, reflection, repression, resentment, resignation, labile emotions, sadness, spite, stress, suppressed emotions, tension, terror, vengefulness, withdrawal, worry. For each of these emotions, there are an average of maybe 10 qualities found on the pulse in various combinations. (It is possible to distinguish some 80 qualities in some 25 positions at 6 depths.) The indexes on trauma are also exhaustive. That said, we can see that combining the Eastern diagnostic with the Western model offers more to work with when assessing the patient in order to select the most focused approach for treatment.

Amy Galvan, now a licensed acupuncturist working with Rape trauma survivors in Florida shared with me the following case study from the time that she worked as a student practitioner at Dr. Hammer's school:

A patient's practitioner found pulse qualities relating to vigilance, pushing her physical energy past its reserves, excess sexual activity, guilt, old emotional trauma, spite and "Heart Closed". The patient confided she had been raped years ago, but the practitioner was able to see what no one else could see. The patient was living a double life as a secretary by day and an entertainer by night in the adult entertainment industry. When the practitioner explained what she felt on the pulse and said this was common among sex workers, the patient opened up and got the treatment she really needed, which was for much more than her chief complaint of fatigue.

Dr. Hammer's paper entitled Trauma and Shock in Chinese Medicine 37 explores the concept of trauma as a causative factor in shock to the heart. In the paper he describes the etiology, pathogenesis, signs and symptoms of heart shock, leading to the diagnosis described as "Heart Closed", and offers a case study and treatment. In this paper, he describes the nuanced qualities found on the pulse that can lead to proper diagnosis and treatment.

Additional case studies and treatment protocols specific to survivors of sexual trauma (and other forms of "betrayals of intimacy") can be found in Lonny Jarrett LAc's 38 lengthy 3-part journal article entitled: Chinese Medicine and the Betrayal of Intimacy: The Theory and Treatment of Abuse, Incest, Rape & Divorce with Acupuncture and Herbs. 39 40 Lonny Jarrett is a practitioner of Oriental Medicine, a scholar and author who studied under Dr. Hammer for a number of years, and was influenced by the Contemporary Oriental Medicine lineage, which can be traced even further back to Dr. John H. F. Shen, a teacher of Dr. Hammer's. 41

Written for an audience of Oriental Medicine practitioners, Jarrett's article differentiates between various forms of betrayal, and describes the psycho-emotional and energetic patterns observed in patients who have experienced incest (pre-verbal and post-verbal), rape, as well as divorce. For our purposes, we will focus on incest and rape in our discussion. The distinction between incest and rape is important in the following sense as explained by Jarrett. In the case of incest, the victim has an expectation of intimacy from the perpetrator. The violation happens before the age of 18, and often, the trauma occurs before various social and/or developmental milestones have been reached.

Unlike rape, whereby the victim may already have past experience in healthy intimacy and an awareness of healthy boundaries, the incest victim often does not.

In the case of pre-verbal incest (occurring before the development of language skills), an awareness of personal boundaries had not even had a chance to develop, thus the legacy of the trauma is particularly insidious. Jarrett writes that trauma at the pre-verbal developmental stage can result in difficulty with acceptance of nourishment in general. Treatment may be geared towards the organs that deal with the assimilation and distribution of nourishment as handled by the Small Intestine and Spleen 42 43.

The rape victim, on the other hand, experiences a forcible crossing of an established boundary from the outer to the inner. Oriental Medicine describes the outermost energetic boundary of the physical body as the Wei Qi. The Wei Qi is seen as the body's first line of defensive. It is the energetic barrier that protects us from contracting external illnesses such as colds or other communicable diseases, as well as the boundary that prevents events from emotionally "getting to us". According to the OM model, the Lungs disperse Wei Qi over the outer surface of the body, and the Triple Heater 44, another "organ" of Oriental Medicine, regulates homeostasis between the inner climate and the exterior. Another energetic boundary is maintained by the Pericardium, which protects the Heart from shock. A rape victim may present with stagnant Qi in the Pericardium. This is also described diagnostically as "Heart Closed", meaning that energy is not allowed to reach the Heart. This can result in one of two common scenarios, a Heart that builds up too much heat (reacting from old injury by lashing out when someone tries to get too close), or a Heart that has grown cold (lost passion for life). The treatment objective is to restore the correct function of the Pericardium (also known as the Heart Protector) so that the Heart can continue to receive nourishment (and thus not grow cold), or, so that pent up energy, which generates pathogenic heat, can be released from the organ, and the patient can end the cycle of reacting to present situations from old hurts. In the case of rape victims, treating the Lungs, Triple Heater and the Pericardium may help repair the damaged boundaries on an energetic level.

Another physiological manifestation of trauma is what Jarrett calls a "Congealed Blood Pattern", which is essentially the thickening of blood due to stored memories which have not yet been fully integrated into the consciousness. When this pattern is detected, treatment methods and herbal formulas, which invigorate the blood can allow memories to resurface. Of the many herbal formulas available within the pharmacopoeia of Oriental Medicine, Jarrett considers three formulas to be significant.

Meridian Passage, a formula based on the classical formula Shen Tong Zhu Yu Tang, now modified and formulated by master herbalist and author, Ted Kapchuk 45 quickens blood and thus breaks up and moves "Congealed Blood". This formula often allows old memories to resurface. Jarrett also uses this formula with patients who feel that their memories are too painful to allow them to surface. Jarrett informs us that his patients report that the formula helped the memories to surface effortlessly and to leave without getting stuck.

Yunnan Paiyao is a formula use to stop bleeding and to treat Congealed Blood resulting from traumatic injury. If the patient describes their heartache as having been "shot in the chest" or "stabbed in the back", and also exhibits signs of drowning in their own sorrow ("bleeding"), Yunnan Paiyao can alleviate the piercing sensation in the chest (Congealed Blood), as well as help contain the outpouring of emotions causing the feeling of being overwhelmed. This in turn will help stabilize the patient so that they may process and integrate the emotional material at their own rate.

Jarrett sometimes combines these two formulas to help patients cope with memories. In the case of memories being stuck, he administers Meridian Passage to quicken the blood, but if this results in emotional overwhelm, he balances the treatment with Yunnan Paiyao to restrain the emotional outpouring. This facilitates the emerging and processing of difficult information at a rate that is comfortable for the patient.

Finally, Sheng Mai San, a classical formula also known as Generate the Pulse Powder, is used for patients who have depressed Lung function and consequent Heart heat as a result of having closed off the heart and suppressing lung rhythm due to early trauma. The symptoms of this pattern would be felt as heaviness in the chest with the heart carrying a heavy load inside. The formula soothes the Lung, harmonizes the relationship between the Lungs and Heart and ameliorates the feelings of loss that typically precipitate this disharmony.

Jarrett tells us that in his clinical experience, these formulas help patients with issues of betrayal regardless of the time that has elapsed since the initial shock because the memory of the trauma is stored or encapsulated within the energetic body.

The concept of encapsulated trauma is described as a "Somatic Cyst Formation" and is further explored in a paper by Dr. Michael T. Greenwood, MB, BChir, CCFP, CAFCI, FRSA titled: Psychosomatic Compartmentalization; The Root of Qi and Blood Stagnation. 46 The information contained in the paper is especially relevant for Oriental Medicine practitioners who are in the unique position of treating sexual abuse survivors who present with Multiple Personality Disorders.

Another herbal formula that is worthy of discussion is a Gui Zhi Jia Long Gu Mu Li Tang, which is available as Cinnamon-D formula from Golden Flower Chinese Herbs. In Golden Flower's Clinical Guide to Commonly Used Chinese Herbal Formulas (5th Edition), it is noted that Ted Kapchuk, OMD states that this formula is useful for sexual abuse survivors as well as patients who have difficulty with intimacy, commitment and sexual promiscuity. The Chinese medical actions of this formula, as described in the guide regulate the yin and yang, harmonize the Heart and Kidneys, restrains essence (Jing), harmonizes nutritive (Ying) and protective (Wei Qi), and calms the spirit.

In the case of sexual abuse, the victim's protective energetic barrier (Wei Qi) has been forcibly penetrated, causing a leak of the nourishing energy to the outside. Since humans communicate to each other energetically as much as verbally, this "leak" of nutritive essence may invite further unwanted sexual attention because the protective, containing barrier has lost it's integrity from the trauma. This formula strengthens the body's protective shield (Wei Qi), and consolidates (pulls towards the interior) the nutritive essence (Ying and Jing), thus helping to restore energetic integrity. Two herbs, Long Gu (fossilized bone) and Mu Li (oyster shell), also found in the formula, calm the spirit, which is another key aspect of bringing the patient into balance.

The Heart/Kidney disharmony that the formula addresses may be a consideration for patients who are emotionally disconnected from the sexual experience due to past trauma. In Oriental Medicine, the Kidneys govern sexuality and the Kidney meridian shares points with the meridian called the Chong, which connects the uterus to the heart. During sexual trauma, the victim may feel an internal snapping, which can be likened to too much electricity running through a circuit causing the circuit to burn out. The result of this severed energetic connection, as experienced by the patient, would be the loss of ability to experience the warmth of intimacy in the heart while engaging in genital sexual contact. The deliberate severing of the Heart/Kidney axis is one of the reasons that individuals forced into prostitution are sometimes "broken" by their captors or pimps through rape, in order to prepare them for the task of being able to "service" (energetically nourish) clients without the "burden" of emotional involvement. It is doubtful that pimps consciously realize that they are severing a Heart/Kidney connection as understood in Oriental Medical theory, however the concept that they are more likely cognizant of, that of "breaking" their subject is as old as human history itself. The concept of "breaking" or "breaking in" a sentient being, be it a prostitute, a horse, a slave or a soldier is the forcible imposition of the will 47 by the dominant party onto the subordinate party, to destroy spiritedness 48 and make the master's will the will of the subject. As such, reestablishing the Heart/Kidney connection is a critical aspect in the healing of many individuals who have been sexually abused or exploited.

A point protocol that may be useful in the treatment of rape trauma survivors is the clearing of aggressive energy from the internal organs. In Oriental Medicine, various organs are associated with specific, potentially deleterious emotions. The Lungs with grief, the Liver with anger, the Kidneys with fear, the Spleen with worry and the Heart with joy (of the manic type which is considered harmful). These negative emotions are often associated with trauma, and the aggressive energy protocol is one method that can be used to drain this harmful energy from the organ systems and improve the patient's overall emotional wellbeing. The protocol involves the superficial insertion of needles along points on the back, which directly affect the aforementioned organs, with the addition of the Pericardium, which serves as a gatekeeper for energies entering the Heart (this relates to healthy emotional boundaries). Departing from the traditional protocol, when treating rape survivors, it may be helpful to add needles inserted in the same style and with the same intention over one or more of the sacral foramen as this is likely to release trapped aggressive energy from the pelvic organs. The traditional technique of draining aggressive energy is described step-by-step in Lonny Jarrett's book Nourishing Destiny 49 along with detailed information about pathogenic Qi in general, shock and trauma, as well as addictions as they relate to the organs systems.

Another phenomenon that is described in ancient Chinese medical texts, which is pertinent to this discussion, is called possession. The aforementioned Dr. Greenwood writes in his paper titled Possession 50 -"Although the concept is not acknowledged by modern Western medicine, other medical, shamanic and religious traditions have long recognized possession as a factor in disease." Individuals who have suffered intense trauma or worked with survivors who have experienced the same, be it from combat situations, serious accidents, the sudden or violent death of a loved one, or traumatic rape, may describe the aftermath as a feeling of being haunted by the event. Greenwood describes this phenomenon as a Field Effect whereby the energy field of the body has been fragmented due to the trauma and an exogenous energy form (described in Chinese Medicine as Gui) attaches to the victim, detrimentally affecting his or her quality of life. One way that a rape survivor may experience this attachment, is in the inability to feel clean despite repeatedly washing one's body. In Greenwood's paper, classical and contemporary point protocols for the separation of the parasitic Gui from the host are listed. These include the Internal and External Dragons protocol as well as the use of Ghost points. While such concepts are difficult to integrate into the Western scientific model, and may even be discounted as outdated quackery or superstition, these concepts and their treatments have been used empirically for centuries.

To resolve the problem of empirical efficacy without scientific validity, one group, the International Society for the Study of Subtle Energies and Energy Medicine (ISSSEEM) 51, established in 1989, has been working towards greater acceptance of the validity of subtle energy fields through scientific research, publications and seminars for the purpose of improving human health and advancing medicine worldwide. Through their work and advocacy, they bring much-needed scientific credibility to those ancient healing techniques, which have experienced a popular resurgence in recent years, bridging the gap between scientifically accepted therapies and those that have historically stood the test of time, yet are only empirically proven, thus creating a more solid integrated model.

Much of the suffering experienced by rape trauma survivors exists in the realm of the invisible. In the case of physical trauma such as a broken leg, an accident victim wears a visible cast and will illicit compassion and aid from others. However, in the case of rape trauma survivors, their injuries are often invisible to the naked eye. As such, they will usually not receive the same support. In fact, the outward expression of such a victim's symptoms may illicit further societal shaming if the unresolved suffering results in addictive behavior, emotionally labile expression, or psychological disharmony, which is dismissed by some as simply being "crazy". It is in this realm of the invisible, the realm where the injuries lie and the realm in which Oriental Medicine has worked for over 3000 years that we need to work to improve the lives of those who are suffering.