ACUPUNCTURE AND HERBS
FOR MIND AND BRAIN DISORDERS

II. Herbs

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

In many cases, disorders that involve a defect in brain function require continuous therapy. In modern medical practice, patients with mind-brain disorders may be given drugs that are taken for years or for life. It is rarely practical to utilize acupuncture over such an extended period of time, so herbal therapies become an important consideration. Since some people live far from a site where acupuncture is offered, herbal remedies may be the only viable method of traditional medicine to be prescribed, other than simple exercises that can be done daily, such as those derived from the practices of taiji and qigong.

BASIC THERAPEUTIC APPROACHES

The Chinese literature includes numerous reports about the treatment of mind and brain disorders with herbs, the most common subject by far being the treatment of senile dementia. This will be the focus of the current presentation (see also: Alzheimer’s disease: treatment with Chinese herbs). For mind/brain disorders that occur earlier in life, the treatment method for attention deficit disorder serves as a model (see: Chinese herbal treatment for attention deficit disorder); also, the book Treatment of Difficult and Recalcitrant Diseases with Chinese Herbs (1) provides information on herbal therapy for schizophrenia and several other mental disorders.

In general, it can be said that there are three component therapeutic approaches that have long been relied upon in traditional Chinese medicine to address the problems characteristic of senile dementia:

1. Tonification therapy. The brain is described as an extension of the marrow which belongs to the kidney system, so herbs that nourish the kidney are understood to nourish the brain. Lack of nourishment of any organ can lead to mental distress, due to the fact that the internal spirits cannot rest if their associated internal organs are “empty,” that is, deficient in essential fluids. In particular, deficiency of liver and heart can easily cause disturbance of the mind. Weakness of spleen qi is often ultimately responsible for lack of nourishment; the spleen must also promote upward circulation of qi to reach the brain.

2. Clearing orifices of phlegm-mist. The connection between the heart and mind (or body and brain) is made by channels (orifices) that can become obstructed; the source of obstruction may be weak stomach/spleen function leading to accumulation of phlegm or fire syndrome damaging fluids and transforming them to pathological phlegm. Aromatic and penetrating herbs can clear the obstruction and phlegm-resolving herbs can help prevent the orifices from becoming obstructed again.

3. Calming agitation. Aside from the problem of deficiency that leads to unsettling of the spirit, the mind can be agitated as a result of heat, wind, or uprushing qi and yang, disorders that may be secondary to deficiency (e.g., yin deficiency of the liver yields liver fire and internal wind) or may be an excess pattern. Herbs are used to clear the heat, sedate the wind, and settle the upward rising of qi and yang.

It is common to combine all these therapies in a single formulation because each of the pathological conditions will often be present to a certain extent in elderly patients. Throughout the history of Chinese medicine, several mental disorders, including loss of consciousness, mania, and emotional agitation, were understood to occur as the direct result of feverish diseases. Thus, herbs that purge fire, including rhino horn, raw rehmannia, coptis, gardenia, and scute, were sometimes key ingredients in the prescriptions. In modern times, most of these feverish conditions can be controlled with antibiotics, antipyretic drugs, and other modern therapies so that the mind and brain disorders that are the subject of potential Chinese-herbal treatment today are rarely associated with febrile disease. While these same fire-purging herbs have some sedative effects, it is clear from the ancient formula descriptions that they were included mainly for their role in treating a febrile condition. This fire-purging aspect of treatment is not discussed further in this article.

As is the case with many other diseases, modern Chinese practitioners have added to the traditionally employed methods the principle of treating blood stasis as a means of resolving mind-brain disorders. Frequently used herbs, such as red peony, cnidium, persica, carthamus, and salvia are the most frequent additions for this purpose. Since blood-vitalizing therapy is a new method for treating mental disorders (except in the syndrome xue dao zheng, see: Complex disease patterns), it will only be noted later in this article in the section devoted to modern journal reports. A Chinese herb adopted into the practice of Western herbal medicine, ginkgo leaf, has become well-known for promoting circulation to the brain. The circulation improvement may restore some of the affected mental functions (see: Ginkgo). Presumably, the blood vitalizing herbs have a similar action.

Tables 1–3 list some sample herbs in each of the three therapeutic areas of primary concern. The herbs were selected for inclusion on the basis of high frequency of use in treating mind and brain disorders as described in both the traditional and modern literature. Within each category, the herbs are listed alphabetically by common name (followed by pinyin for clear identification). In the section of “main actions,” the information is derived from Oriental Materia Medica (2), with only those actions that are somewhat relevant to treatment of mental disorders included in the table.

Table 1: Tonic Therapies Frequently Used for Mind and Brain Disorders.

Herb	Main Actions	Comments
Alpinia yizhiren	supplements spleen, warms the kidney, astringes essence, strengthens the stomach, fortifies qi	The Chinese name for the herb means to enhance the disposition of the individual (increase wisdom, is one translation). It is thought to improve the thinking function associated with the spleen and the will associated with the kidney.
Asparagus tianmendong	nourishes yin, moistens dryness	Asparagus is considered similar in nature, taste, and function to ophiopogon and is commonly used in combination with it to nourish the yin.
Astragalus huangqi	supplements qi, increases yang	Astragalus helps the spleen generate a pure and clear qi that rises upward to nourish the heart and brain
Atractylodes baizhu	supplements spleen, tonifies qi	This aromatic tonic for the spleen disperses stagnated fluids that can obscure the heart orifices.
Cistanche roucongrong	nourishes kidney essence, supplements yang	The soft, black, salty herb is thought to quickly nourish the deficient kidney essence.
Codonopsis dangshen	invigorates the spleen and stomach, replenishes qi	In China, codonopsis is almost always used as a substitute for ginseng in modern practice; its action is more focused on rectifying stomach/spleen weakness, but it lacks the sedative qualities of ginseng.
Cornus wuzhuyu	supplements liver and kidney, astringes essence	The sour fruit is frequently used to astringe the essence and help prevent deterioration of health.
Cuscuta tusizi	supplements kidney essence, clears vision	The seed is thought to help prevent leakage of essence (like the astringent herbs), therefore it is used to prevent deterioration.
Dioscorea shanyao	supplements spleen and stomach, tonifies lungs and kidneys, astringes essence	Dioscorea is used in many treatments for weakening of the kidney essence; its ability to benefit the spleen at the same time is unusual among the Chinese herbs used for that purpose.
Ginseng renshen	replenishes and supplements original qi, benefits the five viscera, pacifies the spirit, soothes the soul, increases wisdom, opens the cleverness of the heart, clears vision	Ginseng is one of the original remedies for mental disorders used in Chinese medicine; it has a calming nature and replenishes all deficiencies. In the West, ginseng has taken on the connotation of an energy stimulant, partly due to the erroneous translation of qi as energy. As a result, practitioners and patients often worry about the stimulant action of this herb.
Ho-shou-wu heshouwu	nourishes yin, replenishes essence and blood, tonifies liver and kidneys	Ho-shou-wu is a famous “anti-aging” herb that is reputed to keep the body and mind young and active. By nourishing the kidney and liver, it nourishes the brain.
Hoelen fuling	strengthens spleen, harmonizes middle warmer, tranquilizes the heart, soothes the nerves, and pacifies the spirit	Hoelen is favored as a sedative, especially when there is weakness of the stomach/spleen system. It has a mild action.
Longan longyanrou	supplements the heart, stabilizes the spirit, tonifies spleen, nourishes blood	This sedative tonic has properties that imitate the actions of ginseng plus tang-kuei. It is primarily used in Ginseng and Longan Combination (Guipi Tang).
Lycium gouqizi	supplements liver and kidneys, promotes production of jing and blood	Lycium is commonly used in cases of jing deficiency and is considered especially useful because of its mild nature, not producing any adverse effects even in large dosage.
Ophiopogon maimendong	nourishes yin, moistens dryness, removes heat, resolves phlegm	This yin-nourishing herb is especially relied upon when there is phlegm accumulation and heart agitation, as it has both phlegm-resolving and calming properties; sometimes asparagus is added to enhance the heat clearing action.
Peony baishao	supplements blood	Peony is frequently used in formulas that tonify spleen qi and nourish liver blood; it has an affinity for the spleen and liver, where it can enhance the action of the other herbs.
Rehmannia shoudihuang	nourishes blood and essence, supplements kidney and liver	This rich, black processed root is considered one of the most important herbs to nourish the liver and kidney. It is used to prevent and even reverse the deterioration associated with aging.
Schizandra wuweizi	nourishes the kidneys, astringes essence	Like cornus, it is relied upon to astringe essence and prevent deterioration of health; modern research has shown that it normalizes cerebral electrical discharges and is thus used in treatments for brain disorders, especially those involving insomnia and poor memory.
Tang-kuei danggui	supplements and moves blood	This herb is used for nourishing the blood of the liver and heart, which has the effects of controlling emotional distress and relieving spasms.

Table 2: Sedative Herbs Commonly Used for Mind and Brain Disorders. For a more comprehensive list of herbs that calm mental agitation see: Emotions and health. Polygala, listed in the Materia Medica among the heart-nourishing herbs, has been moved to the category of herbs to help resolve phlegm mist, because of its well-known phlegm-resolving action (see Table 3).

Herbs (Pinyin)	Main Actions	Comments
Biota baiziren	nourishes heart and calms mind	This seed is very oily, so it is used only moderately or left out if there is a spleen-damp syndrome, but is favored for constipation and dryness.
Cinnabar zhusha	sedates the heart and calms the mind	This is the premier sedative of the Chinese tradition and mentioned in numerous ancient and modern formulas; however, it is avoided in the West due to its content of mercury, the active constituent.
Dragon bone longgu	pacifies the liver, restrains floating yang, sedates and calms the mind	These are fossilized bones, comprised mainly of soluble minerals, such as calcium carbonate. It has a nutritive and calming action.
Dragon teeth longchi	sedates and calms the spirit	Like dragon bones, dragon teeth are fossilized; they are the huge teeth of mastodons and other creatures that have long since disappeared. Chinese doctors regard them as especially useful for fright-induced mental disorders.
Fu-shen fushen	sedative	Fu-shen is mostly the same material as hoelen (see Tonics) but includes portions of pine root; the pine confers a sedative effect.
Oyster shell muli	pacifies the liver and restrains the floating yang	Oyster shell is the principal ocean shell used in Chinese medicine, though several others are also used and have similar actions; they contain calcium carbonates and are used to calm agitation. They also are used to reduce excess stomach acid.
Succinum hupo	sedates and calms spirit	This is the aged resin of pine; the Chinese say that this material is actually the soul of tigers that have died, and it has a sedating quality that still imparts the tiger’s power.
Zizyphus suanzaoren	nourishes heart and calms spirit	The most commonly-used liver-nourishing sedative in Chinese medicine, it treats most mental disorders characterized by insomnia and agitation.

Table 3. Herbs that Clear Phlegm Mist and Open the Orifices. This table includes herbs found in the Materia Medica categories of opening orifices and of resolving phlegm. One herb, curcuma, is usually categorized as vitalizing blood, but it is included in formulas for brain disorders because of a cooling, phlegm-resolving action.

Herb (Pinyin)	Main Actions	Comments
Acorus changpu	opens orifices, expels phlegm and turbidity, replenishes intelligence	This is the most commonly-used Chinese herb (of plant origin) for treatment of mental disorders. It was listed in the Shennong Bencao Jing as a superior herb and it also has symbolic value as a dispeller of evil spirits.
Arisaema tiannanxing	dispels wind to relieve convulsions, dries dampness to resolve phlegm, disperses lumps and accumulations	Arisaema is described as having the power to vaporize phlegm accumulations; it is mainly used when the herbal formula is aimed at treating phlegm obstruction of the orifices. The bile processed arisaema, known as dannanxing, has a cooling rather than warming nature.
Bamboo zhuru, zhuli, tianzhuhuang	removes heat, transforms phlegm, calms fright	Bamboo leaves, juice, or dried secretion are all used to treat irritability, fidgets, and convulsions. They are particularly favored in treatment of children’s disorders.
Borneol longnao	opens orifices, moves qi, clears vision	Borneol is usually used as an adjunct ingredient in formulas for resolving phlegm that causes brain disorders; it is often combined with musk and/or acorus to open orifices.
Curcuma yujin	regulates flow of qi, dissolves qi stagnation, disperses stagnant blood	Although curcuma is best known for its ability to vitalize circulation of qi and blood, it enters into several formulas for brain disorders because it is also considered useful in treating phlegm accumulation disorders, especially when there is a heat syndrome.
Musk shexiang	opens orifices	Musk, with its penetrating aroma and stimulating quality, is mostly used for the very severe cases of brain disorder, especially when the person is losing consciousness or suffering from severe delirium.
Ox gallstone niuhuang	opens orifices, transforms phlegm, clears heat, removes toxin, calms fright	Ox gallstone is utilized to correct gallbladder disorders that result in hot phlegm moving upward to cloud the consciousness. A mixture of bile acids and minerals is used today to make synthetic ox gallstone to replace the extremely rare and expensive original compound.
Pinellia banxia	harmonizes stomach, dries dampness, removes phlegm, disperses accumulation	Pinellia is the most commonly-used phlegm-resolving herb in Chinese medicine and it enters into formulas for treating brain and mind disorders that involve phlegm accumulation due to stomach/spleen weakness.
Platycodon jiegeng	resolves phlegm	Platycodon is thought to direct the action of other herbs to the upper body, and it is, therefore, useful in treating brain disorders; in addition, it helps to resolve phlegm accumulation that is often associated with diseases of the brain.
Polygala yuanzhi	stabilize the heart and calm the mind	Polygala is often used as an adjunct to acorus for resolving phlegm that obstructs the orifices of the heart. In addition, it is used as a sedative, often along with zizyphus.

SAMPLE FORMULAS: TRADITIONAL PRESCRIPTIONS AND PATENT REMEDIES

The formulas described below were designed for mind and brain disorders that arise from a nutritional and functional deficiency of the internal organs. The herb ingredients are divided according to the three categories of therapy outlined above; most of the formulas have additional ingredients that do not fit into these categories and are not listed here. For complete ingredients listings, please see the reference texts (3, 4). Descriptions of modern patents may involve partial ingredients lists and should be interpreted with some reservations. After each presentation of the formula ingredients by therapeutic category, there is a very brief description of the formula. For problems in mind/brain function that are associated with imbalances in the seven emotions, stagnation of qi and blood, and accumulation of moisture, see the article: Complex disease patterns, which presents a different selection of herbal formulas.

Niuhuang Qingxin Wan (Bos and Musk Formula)
Tonics	Sedatives	Orifice-clearing Herbs
Atractylodes	Cinnabar	Musk
Tang-kuei		Borneol
Peony		Ox gallstone
Ginseng		Platycodon
Hoelen		Curcuma
Dioscorea
Ophiopogon

Bos and Musk Formula is used for loss of consciousness, stroke, extreme emotions (anxiety, fright, grief), irritability, insomnia, abnormal mood swings, and mental confusion. An older version of this formula has a large number of tonic herbs, probably to help restore fluids damaged by a prolonged febrile disease (treated by ingredients such as coptis, scute, and gardenia).

Tianwang Buxin Dan (Ginseng and Zizyphus Formula)
Tonics	Sedatives	Orifice-clearing Herbs
Schizandra	Zizyphus	Platycodon
Tang-kuei	Biota	Polygala
Rehmannia	Cinnabar
Ophiopogon
Asparagus
Ginseng
Hoelen

Ginseng and Zizyphus Formula, probably the best known of the prescriptions in this group, is used for poor memory and insomnia. Cinnabar is used only to coat the outside of the traditional pills. This prescription is commonly prescribed in the West (cinnabar is usually deleted). It is considered suitable for long-term therapy in treating chronic brain disorders, such as occur with aging. The main emphasis of this formula is tonification of yin and blood. A formula originally developed to tonify the spleen, Guipi Tang (Ginseng and Longan Combination), has been adopted to a similar application. It has ginseng, hoelen, tang-kuei, zizyphus, and polygala in common, but includes several other qi tonics (astragalus, jujube, atractylodes, licorice) in place of the yin-nourishing herbs of Ginseng and Zizyphus Formula.

Bu Nao Wan (Cerebral Tonic Pills)
Tonics	Sedatives	Orifice-clearing Herbs
Schizandra	Zizyphus	Acorus
Tang-kuei	Biota	Arisaema
Cistanche	Succinum	Polygala
Lycium	Dragon teeth

Cerebral Tonic Pills is a modern patent remedy indicated mainly for poor memory and insomnia. The emphasis of this formula is sedative effects, useful for anxiety, heart palpitations, and being easily frightened.

Jian Nao Wan (Healthy Brain Pills)
Tonics	Sedatives	Orifice-clearing Herbs
Schizandra	Zizyphus	Acorus
Tang-kuei	Biota	Bamboo
Cistanche	Cinnabar	Polygala
Ginseng	Succinum
Alpinia	Dragon teeth
Lycium
Dioscorea

Healthy Brain Pills is a modern patent designed along the same lines as Cerebral Tonic Pills, and for the same indications. The acorus used is known as altaica (jiujie changpu), from a different plant. This formula includes gastrodia (see section on gastrodia below).

Baizi Yangxin Wan (Biota Heart Nourishing Pills)
Tonics	Sedatives	Orifice-clearing Herbs
Schizandra	Zizyphus	Pinellia
Tang-kuei