Shen gem (gui pi wan) is indicated for heart blood deficiency. This formula is best suited for someone with a pale complexion, who has difficulty falling asleep, withdrawal, forgetfulness and palpitations. The chief herbs in this formula are ginseng (ren shen) and astragalus (huang qi), which are among the strongest Chinese herbs for improving the spleen. Longan (long gan rou) and zizyphus (suan zao ren) are specific ingredients having calming effects. The remaining herbs (poria [fu ling]; white atractylodes [bai zhu]; tang-kuei [dang gui]; salvia [dan shen]; amber [hu po]; polygala [yuan zhi]; saussurea [mu xiang]; ginger [gan jiang]; licorice [gan cao]; and cardamon [sha ren]) are for dampness, qi stagnation, blood stagnation and blood deficiency. The pulse would be thin and weak, and the tongue pale. Another specific formula combines the classical gui pi wan formula with the well-known antidepressant St. John's wort.
These formulas can be taken with pharmaceutical medications and are best used with counseling, daily stress reduction and exercise programs. Herbs should be considered for at least three months as they address long-standing patterns. Individuals on multiple medications should be advised to take herbs at least two hours apart from pharmaceuticals in order to minimize potential interactions. Practitioners should also advise clients to watch for untoward signs and symptoms, and to notify them immediately if such effects appear. Clearly many patients who have been on pharmaceuticals for a long period cannot and should not stop abruptly, lest withdrawal symptoms set in. Many antidepressant medications are highly addictive. Therefore, when individuals do wish to reduce or discontinue their medications, it should be done slowly by tapering the dosage after consulting with their prescribing physician.
The following cases demonstrate the use of Chinese herbs with anti depressants. Future articles will include case studies using herbs alone.
Case #1: Gus, a 45-year old prison guard, was brutally attacked while at work. Since the attack one year ago, he suffered from insomnia, constant headaches, fear (he became withdrawn) and chronic muscle pain, especially shoulder and neck pain. His medications included Percodan (oxycodone hydrochloride) for pain, Flexeril (cyclobenzaprine hydrochloride) for muscle pain and spasm, and Effexor (venlafaxine), an antidepressant. Gus was in weekly counseling. His pulse was thin and wiry; his tongue was slightly pale and red around the edges.
Gus's goals for herbal therapy were to minimize his medication, reduce headaches, and relieve chronic pain. We suggested three tablets QID of an easing formula (chai hu mu li long gu tang) to relieve liver qi stagnation and treat headache, shoulder and neck pain; and three tablets QID of shen gem to nourish blood and treat anxiety and insomnia from qi and blood deficiency. He was instructed to take herbs and drugs two hours apart. After two weeks, Gus saw a slight lessening of his insomnia and headaches. As he reduced his Percodan dosage by 50%, he also noticed his mind felt clearer. Gus maintained the above mentioned herb recommendations for three months. He was able to reduce his Percodan dosage 90% and he was able to discontinue the Flexeril. Headaches, insomnia and muscle pain were reduced substantially.
Case #2: Allen, a 47-year old accountant, had been diagnosed and treated for Hodgkin's lymphoma with chemotherapy treatments six months before visiting our clinic. He complained of fatigue, depression and night-time urination, which woke him up and made it difficult to go back to sleep, as he would think about his worries. He was depressed because his father, uncle and grandmother had all died of cancer, and he was going through a divorce. Allen was also being treated with acupuncture and was taking antioxidant vitamins to help his immune system. Allen's pulse was thin and weak; his tongue was red with a thin yellow coating.
We recommended three tablets QID of an astragalus formula, containing astragalus root and seed (huang qi and sha yuan ji zi); ligustrum (nu zhen zi); ho-shou-wu (he shou wu); lycium fruit (gou qi zi); rehmannia (shu di huang); eucommia (du zhong); cuscuta (tu si zi); ginseng; tang-kuei; and cornus (shan zhu yu) to tonify his body and stop night-time urination; and two tablets QID of an aspiration formula containing polygala; vervain (herba verbenae officinalis); uncaria (gou teng); gardenia (zhi zi); albizzia flowers (he huan hua); damiana (folium turnerae aphrodisiaciae); white peony (bai shao); tang-kuei; pinellia (ban xia); poria; and aquilaria (chen xiang) for depression. After being on the herbs for one month, he reported better energy and less night-time urination, although he was still depressed. Shortly after starting the herbs he saw a psychiatrist and was prescribed Serzone (nefazodone), an antidepressant. His pulse and tongue were unchanged.
We kept Allen on the same protocol of herbs, suggesting that he take the herbs and the antidepressant two hours apart. As Allen had a great deal of trouble taking the herbs four times a day, he took the same number of tablets two times per day. Gradually, we tapered down the dosage, so he was taking three tablets BID of the astragalus formula, plus two tablets BID of the aspiration formula. After another month on the herbs and the antidepressant, Allen was no longer depressed, although he still felt sad about his divorce and fearful about the return of cancer. Allen remained on the protocol for over a year. Tests showed the cancer was not growing.
Case #3: Bipolar disorder is characterized by major depression alternating with mania or excitement. The standard treatment, lithium, was prescribed for a patient of ours named Margret, but she did not like taking the drug, and through a good deal of trial and error, including combinations of antidepressants and anti-anxiety agents, Tegretol was selected. A common side-effect of Tegretol is abnormal liver function. Although standard tests revealed only slightly abnormal liver function, her symptoms, as well as her wiry pulse, indicated liver imbalance according to TCM. Therefore the herbs we selected, chai hu mu li long gu tang and an eclipta formula, were aimed at improving her liver. Valerian was selected because she had previously had an unusual reaction to kava kava; flaxseed was selected as it treats constipation. Margret was very eager to try natural therapies. During the time we treated her, she also did a course of 10 acupuncture treatments which probably helped improve her results. As she seemed responsible and was under the care of a psychiatrist, we saw no reason not to try herbs as an adjunctive therapy to medication and counseling.
