Stress

Understanding Stress

Stress is the response of the body to any physical or psychological demand that disrupts its balance. It is mediated by the nervous, hormonal and immune systems, and in short bursts it is adaptive and helps you meet a challenge.^[1] When stress is intense, repeated or prolonged, the response becomes harmful and can contribute to depression, anxiety, cognitive problems and heart disease.^[1]

Stress is not a diagnosis in itself. The research on complementary care mostly measures perceived stress, anxiety and sleep, so this page describes those results.

Common symptoms

Stress shows up in the body, emotions and behavior. Common signs include headaches, muscle tension, fatigue, poor sleep, upset stomach, irritability, worry, difficulty concentrating, changes in appetite, and withdrawing from others.^[1]

• Racing heart, sweating or feeling shaky
• Feeling overwhelmed, restless or on edge
• Trouble falling or staying asleep
• More alcohol, tobacco or other substance use to cope

Causes and risk factors

Stressors can be external, such as work pressure, caregiving, money worries, major life events, illness, noise or unsafe surroundings, or internal, such as worry, perfectionism and negative thinking patterns. Researchers describe acute stress (short term), episodic acute stress (frequent episodes), chronic stress (long lasting) and traumatic stress, which can lead to post-traumatic stress disorder (PTSD).^[1]

How it is diagnosed and treated conventionally

Because stress is a response rather than a disease, a physician or mental health professional usually looks for treatable conditions that cause or follow it, such as anxiety, depression, sleep problems, thyroid disease or medicine effects. Standard approaches include regular exercise, good sleep habits, relaxation and breathing techniques, social support, time management and counseling such as cognitive behavioral therapy. Medicines are used only when an underlying condition, such as an anxiety disorder, needs them.

Why Stress calls for a whole-person approach

Stress affects the whole body, not only the mind. It changes sleep, mood, muscle tension, digestion and heart health, and those changes can in turn make stress harder to bear.

Care that eases several of these at the same time can be a reasonable addition to counseling and healthy habits.

The body's stress systems

The stress response runs through the sympathetic-adreno-medullary axis and the hypothalamic-pituitary-adrenal (HPA) axis, which releases the hormone cortisol.^[1] Disrupted cortisol regulation from chronic stress is linked to depression, chronic pain and neurodegenerative disease in research.^[2]

Sleep

Stress and sleep affect each other. In a meta-analysis of 65 trials, interventions that improved sleep quality also reduced stress, as well as anxiety, depression and rumination.^[3] Insomnia affects about half of people with anxiety.^[4]

Mood and anxiety

Prolonged stress raises the risk of anxiety and depression.^[1] Sleep loss can start or worsen anxiety.^[4]

Physical health

Chronic stress increases the risk of cardiovascular disease.^[1] People under stress may also turn to smoking, alcohol or overeating to cope. This is one reason a medical check-up is worthwhile when stress has lasted for months.

Acupuncture for Stress

What the research shows

The evidence for acupuncture for stress is limited. Few trials measure stress itself, so most of the research comes from related outcomes such as anxiety and ear acupuncture.

A 2025 meta-analysis of 12 studies of auriculotherapy (stimulation of points on the ear, by needles or pressure) found it better than control for a subjective stress index, blood pressure and heart rate variability in adults. Ear acupressure appeared to work better than ear acupuncture, and the review did not report on how long the benefit lasted.^[5]

A 2026 meta-analysis of 20 trials in 1,462 people with anxiety found that manual acupuncture reduced anxiety more than sham acupuncture or usual care or a waitlist. The benefit over sham lasted at follow-up but the benefit over usual care did not, and results differed widely between trials.^[6] A 2022 meta-analysis of 27 trials in generalized anxiety disorder found lower anxiety scores with acupuncture, though most trials had unclear risk of bias.^[7] In a meta-analysis of 14 sham-controlled trials in people with generalized anxiety disorder, acupuncture reduced anxiety and cortisol modestly, with certainty rated low to very low for questionnaire outcomes.^[8]

A systematic review of 12 sham-controlled trials found variable results and no clear evidence that acupuncture has a specific effect on heart rate variability, a marker of stress physiology.^[9]

How acupuncture may work

How acupuncture might reduce stress is not settled. Researchers have studied effects on the autonomic nervous system and stress hormones. Heart rate variability results are inconsistent,^[9] while the sham-controlled meta-analysis in generalized anxiety found small reductions in cortisol and ACTH, which are stress-axis hormones.^[8] These findings are suggestive, not proof of a mechanism.

What treatment involves

Treatment uses fine, sterile, single-use needles at points on the body, and sometimes the ear, usually left in place for about 20 to 40 minutes. A course of several visits is followed by reassessment of stress, sleep and tension. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[10] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture).

Ayurvedic medicine for Stress

The Ayurvedic view

Ayurveda describes stress as a disturbance of the mind and nervous system, often linked to aggravated Vata, with Pitta added when stress comes with irritability and overwork. Treatment aims to calm the mind, support sleep and restore a steady daily rhythm. These are traditional categories used to choose care, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• A regular daily routine with consistent meals and sleep times
• Warm oil massage of the body or scalp
• Shirodhara, in which warm oil is poured in a steady stream over the forehead^[11]
• Herbs such as ashwagandha (Withania somnifera), which has been studied for stress^[12]
• Breathing and relaxation practices

Panchakarma procedures are not appropriate during pregnancy, acute illness, frailty or severe depression or anxiety.

What the research shows

The most research is on ashwagandha. A meta-analysis of nine placebo-controlled trials (558 patients) found lower perceived stress, anxiety and serum cortisol with ashwagandha than with placebo, and four trials reported mild to moderate side effects.^[12] A second meta-analysis of 12 trials (1,002 participants) also found lower stress and anxiety but rated the certainty of the evidence as low, with large differences between trials.^[13] A systematic review of nine studies in stressed adults found that short-term supplementation appeared to lower cortisol, while the long-term effects were unknown.^[14] Extracts differ widely between studies, so no single preparation has been established.^[15]

For shirodhara, a small randomized study of 16 healthy women found lower state anxiety and a drop in noradrenaline after a single 30-minute session compared with lying still. It was a single session in a very small group, so it shows a short-term relaxation effect, not a lasting benefit.^[11]

Herbal medicine for Stress

Herbs and formulas that have been studied

Most herbal research concerns anxiety rather than stress itself. A network meta-analysis of 29 trials compared 12 herbs and included silexan (a lavender oil preparation), kava, ginkgo, Withania somnifera, passionflower, saffron, valerian and chamomile.^[16] Chinese herbal medicine has been tested in many trials for anxiety disorders, nearly always against anxiety medicines.^[17]

What the research shows

The evidence is limited and preliminary. In the network meta-analysis, silexan, kava, ginkgo and Withania somnifera lowered anxiety scores, although kava may not help people with generalized anxiety disorder, and the authors called the results preliminary because trials were small. Ginkgo was ranked worst for tolerability.^[16]

A 2025 meta-analysis of 92 trials found Chinese herbal medicine lowered anxiety scores more than anxiety medicines in generalized anxiety disorder, with fewer adverse events, and no low-risk-of-bias trials existed for other anxiety disorders.^[17] Because these trials used medicine rather than placebo as the comparison, they do not show that herbs outperform placebo. We found no trials of Chinese herbal formulas for everyday stress itself.

Safety and herb-drug interactions

Herbs can interact with medicines. Published reports describe a semicomatose state when kava was combined with alprazolam, serotonin syndrome when St John's wort was combined with certain antidepressants, and mania when ginseng was combined with the antidepressant phenelzine.^[18]

Ashwagandha has been linked to liver injury, usually cholestatic hepatitis. Three patients with existing chronic liver disease developed acute-on-chronic liver failure and died.^[19] Tell us about liver disease, pregnancy or breastfeeding, and every medicine and supplement you take. In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic, so products should come from tested sources.^[20] Herbs are prescribed individually by a qualified practitioner.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes stress as stagnation of liver qi, which can disturb the heart and spirit, and treatment aims to move and calm. Ayurveda describes aggravated Vata as restlessness, racing thoughts and poor sleep. Researchers studying these approaches look at the stress hormone axis, the sympathetic nervous system and sleep.^{[3, 15]}

These biological ideas overlap loosely with the traditional pictures, as in the shirodhara study that measured noradrenaline, a sympathetic stress chemical.^[11] No study has shown that a qi pattern or a dosha corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for stress is complementary. Keep working with your physician, therapist or psychiatrist, and do not stop or change prescribed medicines without your prescriber. We do not diagnose anxiety, depression or PTSD, so stress that is severe, long lasting or accompanied by physical symptoms should be medically evaluated.

Please bring your diagnosis if you have one, a full list of medicines and supplements, and details of any counseling you are receiving.

When to seek urgent medical care

Stress can overlap with serious mental and physical problems, and traumatic stress can lead to PTSD.^[1]

• Thoughts of suicide or self-harm; call or text 988 (Suicide and Crisis Lifeline)
• Chest pain, trouble breathing or fainting, which should not be assumed to be stress
• Symptoms after a traumatic event, such as intrusive memories, avoidance and constant alertness, that do not ease
• Feeling unable to eat, sleep, work or care for yourself
• Rising use of alcohol or drugs to cope

If any of these are an emergency, call 911 or go to the nearest emergency department.