Topics • Background: The Cambodian Genocide

• Khyâl attack as one of 9 Cultural Concepts of Distress in the Diagnostic and Statistical Manual-5 (DSM-5) (2013)

• The ethnophysiology of a khyâl attack (triggers, symptoms, and a spectrum of severity)

• Treating a khyâl attack: Coining and “doing the vessels”

• Preventing a khyâl attack: “Doing the vessels”

A Local Nosology of Panic Attack Severity: A spectrum of khyâl severity

Mild khyâl

Moderate khyâl

Severe khyâl (called ripe

khyâl or broken khyâl)

Khyâl overload

• A key way of determining the severity of khyâl by assessing the color and bumpiness revealed by coining

• A key way of removing blockages and restoring flow

• A key way to warm the body

• A key way to remove khyâl from the body

Coining (“stratching khyâl”): Its Role in Healing and Nosology

Image Credit: Gregory Juckett,

MD, MPH

“Coining, or “gaoh khyâl,” literally

“scratching khyâl”

A Spectrum of Khyâl Attack Severity

• Typical symptoms • What coining reveals • Degree of dangerous • Treatment depending on the severity of khyâl

Mild Khyâl

Typical symptoms What coining reveals Degree of dangerousness

Treatment

Slight dizziness, anxiety, nausea, chills,

cold extremities, muscle and joint

soreness, other anxiety-like symptoms, feeling out of energy, and may have slight dizziness

on standing

A red color, or very slightly purple, in the coined area

Not dangerous unless left

untreated; if untreated will

then progress to next stage of khyâl severity

Apply khyâl oil or ointment

under the nose, sniff the khyâl oil dabbed on a

finger, apply and rub in the khyâl oil or ointment at the temples, behind the ears,

on the neck; may eat a sour

food.

Moderate Khyâl

Typical symptoms What coining reveals Degree of dangerousness

Treatment

Symptoms as above, but more and more

severe, and may have moderate dizziness

upon standing

Dark purple streaks where the skin has been coined

May cause loss of the use of arms

and legs (“stroke”), heart arrest, asphyxia, fainting, vision

loss, hearing loss

Do coining and other khyâl treatments

“Severe Khyâl” (called “ripe khyâl” or “broken khyâl”)

Typical symptoms What coining reveals Degree of dangerousness

Treatment

Even more severe symptoms as above,

and special symptoms such as jaw tightness, and the patient may

have great dizziness on standing

Dark purple and even black in the coined area, as well as

bumps

Great chance of the dire events

listed above, with significant risk of

death

Do coining and other khyâl

treatments, may well go to the

emergency room

Khyâl Overload (Khyâl koeu)

Typical symptoms What coining reveals Degree of dangerousness

Treatment

Fainting, loss of consciousness, death,

which often first occurs upon standing

As above, but darker streaks and more prominent bumps

All the events above are in the

process of occurring, death is

imminent

Bite the ankles, pull the vessels

in the arm pit and other areas, and then do coining and other khyâl treatments; may

call an ambulance