By Andrew Gaeddert
Everyone experiences fear and anxiety. Fear is a response to an external threat, whereas anxiety can erupt from external events and a person’s own thoughts. Anxiety is a stress response that can either arise suddenly as in a panic, or can occur gradually.
According to the American Heritage Dictionary, anxiety is a state of apprehension, uncertainty, and fear resulting from the anticipation of a realistic or fantasized threatening event or situation, often impairing physical and psychological functioning. Panic is a sudden overpowering terror.
Generalized Anxiety Disorder pertains to persistent daily anxiety or worry that interferes with one’s life. In addition, there may be three or more of the following symptoms: restlessness, fatigue, concentration problems, irritability, muscle tension, and insomnia. Three to five percent of adults have general anxiety disorder during a given year. Women are twice as likely as men to have this disorder. It has not been proven that repressed conflicts or chemical imbalances cause anxiety, although these are popular theories among mental health professionals.
Panic attacks are defined as acute and extreme anxiety in response to a specific situation. Symptoms of panic attack include a sudden appearance of shortness of breath, a feeling of being smothered, or “closed in”, hear t palpitations, shaking, fear of going crazy or losing control, feeling detached from the environment, dizziness, sweating, and chest pain. It is not uncommon for people to worry that they have a dangerous medical problem. Although panic attacks themselves are not dangerous, it makes sense to consult a physician to rule out other disorders.
Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by exposure to an overwhelming traumatic event, often experienced by combat veterans and victims of violent acts, whereby the person repeatedly re-experiences the event. Sometimes a person’s symptoms don’t begin until months or years after the traumatic event took place. Symptoms include intense fear, hopelessness, and horror. The person re-experiences the trauma in nightmares or flashbacks. The person may have difficulty sleeping or be easily startled. Oftentimes PTSD becomes less severe over time.
CONVENTIONAL TREATMENTS
Conventional therapies include behavior modification where the person is exposed to the situation that causes the fear, panic, and worry. Cognitive behavioral therapy, which emphasizes self-help assignments and examining one’s thoughts, can be very effective for anxiety, panic and PTSD. (Beck, Judith. Cognitive Therapy: Basics and Beyond. Guilford Press: New York, NY.) Psychiatrists typically recommend drugs such as SSRI’s, MAO inhibitors, or trycylic anti-depressants alone or in addition to counseling or behavioral therapy. Typical side effects of medications include anxiety, fatigue, gastrointestinal changes, insomnia, headaches or migraine, and sexual dysfunction.
HERBAL APPROACHES
There are several reasons why clients want herbal approaches. Some individuals are afraid of being on anti-depressants and other medications for long periods of time and therefore try herbs first. Other people have not had satisfactory results with typical conventional medications or treatment. Finally, some men and women try conventional drugs but find their side effects intolerable.
The best way to take herbs is to have them administered by a trained herbalist. You may obtain the name of an herbalist from a friend or loved one or you may check your local listing. For example, an herbalist trained in Traditional Chinese Medicine (TCM) will note the symptoms of anxiety and panic but will also determine the other symptoms such as nightmares, sweating during the day and night, mood swings, digestive symptoms, muscle aches, joint pain, and sensations of Hot and Cold. Women may be asked about their period as well as hormonal changes. A TCM practitioner may examine the patient’s face and determine if the client seems especially fearful, timid, or angry. Qualities of the pulse and the tongue are measured. Clinicians may also pay attention to the individual’s body type and speed of movement.
According to TCM, certain lifestyle habits and constitutional factors would predispose one to suffer from panic disorders more than another person. For example, without adequate sleep and mind rest such as Tai Qi and meditation, one might be more likely to suffer from panic attacks. A poor diet may lead to symptoms such as Hot sensations and confusion. Although herbal anti-depressants or sedatives can be administered, well-trained herbalists keep in mind constitutional factors when they select herbs. The following case studies demonstrate how different patients with panic disorder and PTSD are treated by Chinese medicine:
CASE 1
Bob has a Hot energetic pattern. He suffers from Post-traumatic stress disorder. He feels explosive rage at times, which creates Heat. Heat symptoms include his face becoming red, migraine, and headache. Furthermore Bob is always thirsty so he drinks sodas to quench his thirst. However, sodas contain sugar (which is warming) and caffeine (which removes water). Thus he is getting dehydrated over time. In addition, Bob drinks alcohol at night to help him relax and go to sleep. Alcohol is both warming and a diuretic. Alcohol is known to interfere with sleep so that the rest Bob gets is less than satisfactory. No wonder he wakes up irritable and groggy and needs plenty of coffee (which is warming) to get going and the whole cycle begins again. During the day Bob eats fast food, many fried foods, excessive amounts of meats, and sweets. Bob’s pulse was rapid and his tongue was red and peeled. These all contributed to Heat. In addition to drinking more water and fresh vegetables we recommended that Bob reduce his alcohol, sweets and fast food intake. We recommended Coptis Purge Fire (Coptis Root Huang Lian, Lophatherum Herb Dan Zhu Ye, Bupleurum Root Chai Hu, Rehmannia Root Sheng Di Huang, Tang Kuei Root Dang Gui, Peony Root Bai Shao, Akebia Trifoliata Root Mu Tong, Anemar rhena Rhizome Zhi Mu, Phellodendron Bark Huang Bai, Gentiana Root Long Dan Cao, Alisma Rhizome Ze Xie, Plantago Seed Che Qian Zi, Scute Root Huang Qin, Sophora Root Ku Shen, Forsythia Fruit Lian Qiao, Gardenia Fruit Zhi Zi, Licorice Root Gan Cao),
2 capsules QID to clear Heat, and Calm Spirit (3 capsules contain: Magnesium, Taurine Enzymes: – Amylase, Cere Calase, Protease, Catalase, Alpha-Galactosidase, Lipase, Glucoamylase, Cellulase, Malt Diatase, and Herbs – Biota Seed Bai Zi Ren, Peony Seed Bai Shao, Tang-kuei Root Dang Gui, Fu-shen Sclerotium Fu Shen, Polygala Root Yuan Zhi, Zizyphus Seed Suan Zao Ren, Ophiopog on Tuber Mai Men Dong, Codonopsis Root Dang Shen, Succinum Resin Hu Po), 2 capsules QID for its Heart Yin nourishing and stress reducing effects. After two weeks Bob noticed that he was more regular and that he had fewer headaches. His pulse was slightly slower and his tongue less red. We continued on the above mentioned protocol for one month and his Heat signs were alleviated. We eliminated Coptis Purge Fire and had him maintain on Calm Spirit with the addition of Nine Flavor Tea (Rehmannia Root Shu Di Huang & Sheng Di Huang, Dioscorea Rhizome Shan Yao, Poria Sclerotium Fu Ling, Cornus Fruit Shan Zhu Yu, Moutan Root Bark Mu Dan Pi, Alisma Rhizome Ze Xie, Dendrobium Stem Shi Hu, Scrophularia Root Xuan Shen, Ophiopogon Tuber Mai Men Dong), which nourishes Liver and Kidney Yin.
CASE 2
Eleanor suffers from nervous exhaustion. She also suffers from insomnia. She is largely housebound because she is fearful. When she goes outside she is reminded of the time she was mugged. Eleanor is said to have a Cold constitution. She was sickly as a child with bedwetting, asthma, eczema, and frequent bronchial infections. Her body type is thin and she is underweight. Eleanor does not work or do volunteer work. She has only recently been able to go out of the house twice a week to see a counselor. Previously, all trips out of the house resulted in panic attacks. Her pulse is slow and weak, her tongue is pale, and she has pale complexion. We recommended Shen Gem (Ginseng Root Ren Shen, Poria Sclerotium Fu Ling, White Atractylodes Rhizome Bai Zhu, Zizyphus Seed Suan Zao Ren, Astragalus Root Huang Qi, Tang-kuei Root Dang Gui, Salvia Root Dan Shen, Amber Resin Hu Po, Polygala Root Yuan Zhi, Longan Fruit Long Yan Rou, Jurinea Root Mu Xiang, Ginger Rhizome Gan Jiang, Licorice Root Gan Cao, Cardamon Fruit Sha Ren), 3 capsules QID to tonify Qi and Blood, and ginger tea for its warming properties. After two weeks the response was good so we added Rehmannia 8 (Rehmannia Root Shu Di Huang, Poria Sclerotium Fu Ling, Moutan Root Bark Mu Dan Pi, Dioscorea Rhizome Shan Yao, Cornus Fruit Shan Zhu Yu, Alisma Rhizome Ze Xie, Eucommia Bark Du Zhong, Cinnamon Bark Rou Gui), 1capsule QID to tonify her Kidney Qi. After three months Eleanor was able to leave the house on a daily basis to walk and to run errands. She attributes her changes to counseling and herbs.
CASE 3
Jeannette was involved in a serious auto accident which necessitated many surgeries and the almost constant use of pain-killers such as Vicodin and ibuprofen. She is also taking the anti-depressant trazadone. She has panic attacks whenever she has to drive on the freeway. Jeannette uses food to comfort herself and is 50 pounds overweight. She wakes up tired after ten hours of sleep. In fact, bed is one of the places she feels safe. However, once the day gets going she begins to pick up energy. She is a teacher who really enjoys her work. However she has difficulty saying “no” and sometimes feels on the verge of having panic attacks when she thinks of all the things she has to do. Physical symptoms include frequent diarrhea, indigestion, bronchial infections, and urinary tract infections. Her tongue is pale with a red tip and a heavy white coating. Her pulse has a slippery quality. Jeannette is said to have a Damp condition.
At the beginning we recommended Six Gentlemen (Codonopsis Root Dang Shen , Atractylodes Rhizome Bai Zhu, Porea Sclerotium Fu Ling, Baked Licorice Root Zhi Gan Cao, Citrus Rind Chen Pi, Pinellia Tuber Ban Xia, Jurinea Root Mu Xiang, Cardamon Fruit Sha Ren), 3 capsules QID and Quiet Digestion (Poria Sclerotium Fu Ling, Coix Seed Yi Yi Ren, Shen Chu Herb Shen Qu, Magnolia Bark Hou Po, Angelica Root Bai Zhi, Pueraria Root Ge Gen, Red Atractylodes Rhizome Cang Zhu, Jurinea Root Mu Xiang, Pogostemon Herb Huo Xiang, Oryza Sprout Gu Ya, Trichosanthes Root Tian Hua Fen, Chrysanthemum Flower Ju Hua, Halloysite Chi Shi Zhi, Citrus Rind Ju Hong, Mentha Herb Bo He), 1 capsule QID plus 1 capsule with meals. In addition we suggested an elimination of Damp-producing foods such as dairy products and orange juice. Six Gentlemen tonifies Qi, drains Dampness and clears Phlegm. Quiet Digestion removes food stagnation and drains Dampness. After two weeks she reported that her “head felt clearer”, and that she had more energy and less indigestion. At that time we substituted Six Gentlemen for the stronger acting Source Qi. After two months she rarely had diarrhea and she noticed greater energy and a better ability to tolerate stress as her body felt stronger. After six months she was off Vicodin and had lost 10 pounds due to fewer food cravings.
Herbs work best when combined with a general health program that includes a good diet, adequate rest, stress reduction, and daily exercise to one’s constitution. For example, seniors or persons incapacitated by anxiety and other disorders may need gentle exercise such as walking, gardening, swimming, or water aerobics. More robust individuals may find more vigorous activity more effective. Making adequate time to eat or say a prayer of thanks before eating can help promote the calm lacking in so many people’s lives.
Can herbs be combined with drugs? In our clinic in Oakland, California clients frequently take herbs and drugs. For example clients may take sleep medication at night but use herbs during the day for other discomforts caused by anxiety, panic or other symptoms. Some of our clients with anxiety disorders are on various prescribed medicines for hypertension, anxiety, pain, etc. However, if they are having side effects from the medication, we can usually help. If clients and their mental health professionals think it wise, we can incorporate an herbal program to assist them in reducing their medications. Herbalists should be comfortable treating the patient on medication. If your practitioner is reluctant it’s best to seek a referral and find someone who is experienced in this area. To avoid herb/drug interactions it is important to take herbs and drugs 2 hours apart.
In our experience the following popular herbs work best w h e n combined with professionally prescribed constitutional tonic herbs. Like foods, herbs work best when used in combination. The well-known herbal anti-depressant St. John’s Wort has been found to interact with a variety of pharmaceutical drugs, so it is best used by clients who are not taking medications. In a few cases it has also caused a photosensitive skin reaction. Ginkgo leaf is used to promote blood flow. Lately it has been used to help alleviate the side effects of sexual dysfunction caused by anti-depressants. Clients need to take Ginkgo for at least six weeks to observe clinical benefits. It has been reported to interact with blood thinning medications including aspirin and coumadin. Kava Kava has natural sedative and muscle relaxant properties. Clinical studies have demonstrated it to be safe and effective. It should only be used under professional supervision if clients are taking sedating drugs. As a general precaution, it should not be used before driving or operating heavy machinery. Constitutional tonics include Shen Gem, a Qi and Blood tonic for clients with anxiety, fatigue, pallor, and difficulty falling asleep; Calm Spirit for Heart Yin deficiency with anxiety, dryness or Heat, and waking up frequently at night; Source Qi for loose stools, and fatigue; and Rehmannia 8 for fear, coldness, low back pain and frequent urination. Schisandra Dreams or Griffonex 5-HTP can be used to help clients enjoy more restful sleep.
When appropriately used herbal therapy can offer many benefits to clients suffering from anxiety and panic disorders. Botanicals are often more suitable than drugs for highly sensitive patients and individuals who have previous herb experience, and should be combine d with techniques such as cognitive behavioral therapy. Whenever possible, use herbs under the direction of a professional herbalist.
Andrew Gaeddert is an herbalist and author of the books, Healing Digestive Disorders.