By Andrew Gaeddert
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 ingredi- ents 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, Cardamon Sha Ren); are for dampness, Qi stagnation, blood stagnation, and blood deficiency. The pulse would be thin and weak, and the tongue pale. A specific formula, St. John’s Seng, 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 who are 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 antidepressants. 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 Since the attack one year ago he suffered from insomnia, constant headaches, fear (he became withdrawn) and chronic muscle pain especially shoulder and neck pain.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 Ease Plus (Chai Hu Mu Li Long Gu Tang) 3 capsules QID, to relieve liver Qi stagnation and to treat headache, shoulder and neck pain; and Shen-Gem, 3 capsules QID, to nourish blood and treat anxiety and insomnia from Qi and blood deficiency. He was instructed to take herbs and drugs 2 hours apart. After two weeks Gus saw a slight lessening of his insomnia and headaches. As he reduced his Percodan dosage 50 percent, he also noticed his mind felt clearer. Gus maintained the above mentioned herb recommendations for 3 months. He was able to reduce his Percodan dosage ninety percent and he was able to discontinue the Flexeril. Headaches, insomnia, and muscle pain were reduced substantially.
CASE 2
Allen was a 47-year-old accountant who had been diagnosed and treated for Hodgkin’s lymphoma with chemotherapy treatments six months before visiting our clinic. He complained of fatigue, depression, and nighttime 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 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 recommend Astra Essence which contains: (Astragalus root and seed Huang Qi and Sha Yuan Ji Zi, Ligustrum Nu Zhen Zi, Ho- shou-wu He ShouWu, Lycium fruit Gou Qi Zi, Rehmannia Shu Di Huang, Eucommia Du Zhong, Cuscuta Tu Si Zi Ginseng Ren Shen, Tang-kuei Dang Gui, Cornus Shan Zhu Yu); 3 capsules QID, to tonify his body and stop night-time urination; and Aspiration which contains: (Polygala Yuan Zhi, 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 Dang Gui, Pinellia Ban Xia, Poria Fu Ling Aquilaria Chen Xiang); 2 capsules QID, for depression. After being on the herbs for one month, he reported better energy, less nighttime 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 ofcapsules two times per day. Gradually, we tapered down the dosage, so he was taking Astra Essence, 3 capsules BID, plus Aspiration, 2 capsules BID. 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.
DISCUSSION
Bipolar disorder is characterized by major depression alternating with mania or excitement. The standard treatment, Lithium, was prescribed for 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, Ease Plus and Ecliptex, 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, and during the time we treated her she also did a course of ten 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.
This is the final part of a three-part article addressing herbs and depression.
Andrew Gaeddert is an herbalist and author of the books, Healing Digestive Disorders and Chinese Herbs in the Western Clinic.