One of the most common trends to see in clinical medical practice and public health is the cycles of health "buzzwords." These come and go depending upon the current cultural zeitgeist. One year, "parasites" are causing all the issues, and the next year it's "candida." Currently, the ones I see most commonly from patients and practitioners alike is "inflammation" and "adrenal fatigue." The concept of systemic inflammatory issues and its relation to chronic and acute disease is a vast topic and one which I will not address in this installment.
The main issue I would like to explore here is the current trend for TCM practitioners to use the diagnostic idea of "adrenal fatigue" in lieu of using standard TCM pattern differentiation. Why is this occurring? Why do qualified TCM practitioners with advanced and effective diagnostic systems resort to using trendy buzzwords such as "adrenal fatigue" as a catch-all phrase for a patient's complex presentations? In my opinion, it is a lazy and unprofessional approach to using the complex system of TCM and it's my hope that TCM practitioners can instead use TCM pattern differentiation instead of simply resorting to a nebulous concept of nervous system deficiency.
It is not uncommon for patients to arrive at my clinic with the diagnosis of "adrenal fatigue." The patient in this case typically brings along a literal bag of supplements filled with the usual suspects: pantothenic acid, "adaptogenic herbs," glandulars, and the ubiquitous "proprietary herbal blend" formulas from naturopathic companies who heavily target TCM practitioners. No tongue diagnosis, no pulse diagnosis, and not even much questioning; just simple "one-size-fits-all" formulas which "heal the adrenals." What does this even mean? Yes, we can discuss complex ideas of the HPA axis, but what does this mean according to TCM? Chinese medicine has a complex system of pattern differentiation and literally hundreds of formulas which, to use the buzz words of the day, can "heal the adrenals." And by this I refer to returning the patient to a state of balance in relation to the respective presenting pattern of disharmony. This is not a complex idea of functional medicine, but rather a foundational idea of basic traditional Chinese medicine. Why is this being ignored?
The following is a list of the most common TCM patterns/formulas I use for patients presenting with the current trendy diagnosis of "adrenal fatigue." This is far from an exhaustive list, but rather just a streamlined one which presents the most common formulas I have on hand to effectively treat the condition of nervous system imbalance. This topic is vast and could literally be expanded into a book format, however the most common three symptoms I see in cases of "adrenal fatigue" are: fatigue, insomnia, and digestive disturbances. The following are the most common formulas I have on hand to effectively treat the TCM pattern diagnosis of these presenting complaints.
Fatigue
Qi and Blood Vacuity: The most common formulas I use in these cases are: Ba Zhen Tang, Ren Shen Yang Rong Tang, Ren Shen Shou Wu Wan, Shi Quan Da Bu Tang. These are common and effective formulas for the fatigue which presents with the standard tongue and pulse signs of qi and blood vacuity. These are base formulas and I often combine these with qi/blood stagnation formulas in cases of chronic fatigue and overall recalcitrant chronic issues.
Yin Vacuity: The most common formulas I use for fatigue with significant underlying yin vacuity are: Liu Wei Di Huang Wan, Zuo Gui Wan. If the yin vacuity presents with vacuity heat, I use: Da Bu Yin Wan and Zhi Bai Di Huang Wan. My personal favorite formula to have on hand for combined yin and yang vacuity is Wu Zi Yan Zong Wan. These are basic formulas and if the yin vacuity is centered on specific organs such as the heart, lungs, or liver, then these can and should be modified as needed to target these specific issues.
Insomnia
In many ways, this is the most important symptom to address as chronic sleep disturbances will cause deep systemic vacuity of qi, blood, yin, yang, and eventually jing. Therefore, addressing chronic sleep issues of vital importance. The following are the most common patterns/formulas.
Heart Blood/Yin Vacuity: The most common formulas I use in these patterns are: Bai Zi Yang Xin Tang, Suan Zao Ren Tang, and Tian Wang Bu Xin Dan. I also use An Shen Bu Xin Wan and Bu Nao Wan, both considered "modern" patent formulas for many cases of hard to treat insomnia and it is not uncommon for me to combine two of these respective formulas in recalcitrant cases as well. Sleep quality is in many ways the ultimate "medicine" for the vague diagnosis of "adrenal fatigue" as in deep restorative sleep the body can regenerate and restore qi, blood, yin, and yang. Therefore, it is imperative for clinicians to focus on resolving this issue and educating patients on appropriate stress reduction and "sleep hygiene" protocols.
Digestive Disturbances
This is a complex category and could also be given the length of a book in a complete discussion. However, the most common TCM patterns I see in cases of supposed "adrenal fatigue" presenting with a complex array of digestive complaints are: liver/spleen disharmony, and food stagnation. This is most likely due to the large amount of food sensitivities/food allergies so common in today's clinical milieu, as well as the poor compliance of patients dealing with these issues.
Liver/Spleen Disharmony: The most common formulas in this presentation is: Xiao Yao Wan, and Jia Wei Xiao Yao Wan. I use these extensively with the formula Bu Zhong Yi Qi Tang in cases of significant spleen vacuity and depressive heat. Food Stagnation: The most common formulas I use are: Bao He Wan, Zi Sheng Wan, and Kang Ning Wan. I am often shocked at how little food stagnation formulas are used in the modern clinic as they are highly effective at resolving digestive issues, particularly when combined with formulas to harmonize the liver and the spleen. I use these much more often than simply resorting to using digestive enzymes as a "quick fix" solution to chronic digestive maladies.
This is a quick overview of the most basic categories which cover the most common issues seen when patients present with infamous "adrenal fatigue." Before resorting to using one-size-fits-all generic supplements, I encourage TCM practitioners to not abandon the use of TCM pattern differentiation! Not only is it effective but it is also important for TCM practitioners to stay within their legal scope of practice. The roots of TCM are strong and fertile and provide endless nourishment to patients, but only if the TCM practitioner provides these doorways. Rather than jumping on trendy standardized buzz-words marketed by supplement companies, remember your roots and treat the root. This is the true secret of the effectiveness of traditional Chinese medicine.
