Sample Herbal Treatment Strategies
Chinese medical reports on herbal therapies for shen disorders are spread somewhat randomly throughout the Chinese medical literature, most being in obscure journals. One of the areas that has gotten considerable attention is "senile dementia," which involves deterioration of brain function, with symptoms such as depression, confusion, poor memory, and slow responses. The treatment of this problem with Chinese herbs is not substantially different than the treatment of other disorders that affect mental status, particularly in adults. This is because traditional Chinese medicine is based on general principles of treatment rather than unique ways to combat specific diseases. The therapeutic approaches described in chapters 7 and 8 are applicable to this condition. For purposes of contrast, the treatment of attention deficit disorder (ADD) in children will be presented afterward. In both cases, the therapies described were actually used in clinical practice for dozens or even hundreds of patients, not merely recommended on the basis of indications for a traditional formula. Claims for success were presented in the literature, but the frequency of improvement (i.e. "success rate," which was often high) is not conveyed here because the standards of reporting and analysis in the reports differ significantly from what is utilized in Western medical studies. Instead, the main focus here is on the selection of herbs.
Selected information from two large review articles published in the Journal of Traditional Chinese Medicine is presented below in order to summarize a broad range of Chinese medical literature.
In a 1996 review of Chinese herbal therapies for senile dementia (1), doctors at the Chengdu University of Traditional Chinese Medicine and Pharmacy presented the diagnosed syndromes and key herbs used to treat the patients, and these are relayed in Table 1.
Table 1: Modern Differential Diagnosis and Treatment for Senile Dementia.
|Syndrome/Therapeutic Method||Main Symptoms||Key Herbs|
|Deficiency of kidney essence|
|progressive dementia, dizziness, tinnitus, insomnia, poor memory, difficulties in speech, dull eyes, and slow responses||rehmannia, cornus, dioscorea, ho-shou-wu, lycium, eucommia, tang-kuei, zizyphus, polygala|
|Stagnation of phlegm|
|dull expressions, vague mind, depression, poor memory, abnormal behavior, involuntary crying or laughing, dizziness, heavy head or limbs, sleepiness||pinellia, hoelen, acorus, polygala, curcuma, chih-ko, citrus, bamboo, bamboo sap|
|Deficiency of qi and blood|
|dizziness, poor memory, indifferent expression, dreaminess and light sleep, susceptible to fright, pale complexion and listlessness, unable to participate in normal daily activities||ginseng*, astragalus, tang-kuei, atractylodes, fu-shen, rehmannia, ho-shou-wu, polygala, peony, zizyphus |
* codonopsis or pseudostellaria could be substitutes for ginseng
|Cerebral blood stasis|
|dizziness, headache, poor memory, dementia, stiff tongue and incapability of uttering a sound, history of apoplexy||salvia, carthamus, persica, cnidium, astragalus, angelica, musk, tang-kuei, red peony|
The authors suggested that there are two main actions of the herbs in the formulas: to replenish the kidney so as to nourish the brain and to supplement and invigorate both qi and blood to provide adequate circulation in the brain. They translated the means by which these actions affect dementia to a Western idiom as follows:
The authors also suggested that if blood-vitalizing herbs are included with the tonic therapies that the results will be even better than using tonics alone, mainly because of the improved microcirculation.
In a 1999 review from the Ningjin County Hospital of Traditional Chinese Medicine (2), journal reports were divided into four groups: general differentiation using traditional formulas; treatment based on differentiation of regulating and nourishing the kidney and heart; treatment based on differentiation of blood stasis and phlegm obstruction; and treatments based on modern prescriptions. In this presentation, a number of the prescriptions are designated by their traditional names, but many were said to be "modified" without specifying the alterations made.
Several examples of this approach were offered. Following is one giving the diagnostic category and recommended formula for treatment relying on well-known traditional formulations that had been slightly modified:
Here are two other sets of recommendations, the first attributed to Xu Shizhen, the second attributed to the work of Zhao Xiangjun:
|Category||Xu Shizhen's Recommendations|
|Liver/Kidney Yin Deficiency||Modified Bushen Yinao Tang|
|Spleen/Kidney Yang Deficiency||Modified Yougui Wan|
|Accumulation/Obstruction by Phlegm||Modified Erchen Tang|
|Interior Obstruction by Blood Stasis||Modified Fuyuan Huoxue Tang|
|Category||Zhao Xiangjun's Recommendations|
|Failure of Kidney Essence||Modified Yougui Wan|
|Liver/Kidney Yin Deficiency||Modified Zuogui Wan|
|Heart/Spleen Deficiency||Modified Guipi Tang|
|Obstruction by Phlegm and Blood Stasis||Mengshi Guntan Wan plus Xuefu Zhuyu Tang|
This information can be summarized as follows: the primary formulas for deficiency syndromes are modifications of Guipi Tang and the pills for tonifying the left and right kidneys (Zuogui Wan and Yougui Wan; or the related formula for nourishing kidney and marrow Bushen Yisui Tang). For phlegm obstruction, Erchen Tang and related formulas, such as Banxia Baizhu Tianma Tang are used. For blood stasis, formulas comprised of several blood vitalizing (huoxue) herbs were used. Obstruction by phlegm accumulation and blood stasis might be treated together.
Two examples of self-designed base formulas were offered for this category:
Those formulations were derived from Guipi Tang and Tianwang Buxin Dan, respectively. A more extensive differentiation involved these therapeutic categories and formulas:
In these formulations, the most consistent aspect of treatment is use of acorus and polygala to open the orifices and invigorate the brain and use of rehmannia to nourish the kidney.
Two articles were described in this section of the review, one focused on blood stasis and the other focused on phlegm obstruction. The blood stasis formulas are not well known, so they will not be relayed here except for one of the suggestions which was based on standard prescriptions: for qi deficiency and blood stasis the recommendation was to use modified Yiqi Congming Tang (mentioned in Chapter 8 in the tonic section) plus Tao Hong Siwu Tang (this is Si Wu Tang , the most frequently used blood nourishing herbs, with persica and carthamus). For the phlegm accumulation disorders, the basic formula recommended was Banxia Baizhu Tianma Tang (Pinellia and Gastrodia Combination) with acorus added (additional herbs might also be added).
The following information is based on reports in which a single base formula was utilized for numerous cases of senile dementia, rather than relying on differential diagnosis with several corresponding formulas. So, each of these formulas appeared in a separate clinical report. The formulas are presented here according to the therapeutic approach that was utilized. In many cases, the formula was then modified slightly to address the unique symptoms of the patients:
|Therapeutic Category||Formula Ingredients|
|Supplementing qi and activating blood circulation to remove stasis||astragalus, codonopsis, cnidium, red peony, peony, persica, pueraria, millettia, alpinia, curcuma, acorus, polygala|
|Nourishing the kidney and brain||ho-shou-wu, cornus, dioscorea, lycium, cuscuta, red peony, salvia, curcuma|
|Tonifying the kidney, supplementing qi, and activating blood circulation||astragalus, codonopsis, pueraria, salvia, crataegus, lycium, polygonatum, cornus, tang-kuei, gastrodia, acorus|
|Tonifying the kidney, supplementing qi, and activating blood circulation||astragalus, codonopsis, alpinia, lycium, ho-shou-wu, salvia, red peony, cnidium, acorus, polygala|
|Tonifying the kidney and activating blood circulation to remove stasis||cornus, cuscuta, alpinia, placenta, leech, crataegus, curcuma, arisaema, acorus, polygala|
|Tonifying the kidney and activating blood circulation to remove stasis||rehmannia, cistanche, tortoise shell, cornus, polygonatum, tribulus, silkworm, gastrodia, astragalus, curcuma, acorus, arisaema, carthamus|
|Dispelling phlegm and removing blood stasis||pinellia, hoelen, citrus, ginger, bamboo, chih-shih, coptis, zizyphus, silkworm, arisaema, gastrodia, salvia, curcuma, acorus|
|Dispelling phlegm and removing blood stasis||astragalus, red peony, cnidium, persica, earthworm, bamboo, aurantium, pinellia, carthamus, gastrodia, silkworm, scorpion, leech, centipede, curcuma, acorus, polygala|
The authors of the review commented:
TCM holds that while the location of the disease is in the brain, its root cause is insufficiency of vital essence and energy of various zangfu organs in addition to obstruction by stagnation of phlegm and blood stasis. The weak constitution due to old age often leads to weakness and failure of the zangfu organs and deficiency of qi and blood and deficiency of yin and yang. This weakness and failure may give rise to stagnation of qi, causing blood stasis, which, in turn, leads to accumulation of qi to form phlegm that may retain in the five zang organs and obstruct collaterals of the brain to confuse the mind, hence the occurrence of dementia. Its pathogenesis is deficiency in origin and excess in superficiality.
An examination of the formulas presented in these two review articles illustrates the basic approach that has been used and high reliance on a relatively small number of herbs.
Attention Deficit Disorder (ADD) involves difficulty with concentrating on a single task for a sufficient period of time to accomplish the goal at hand. Although excessive movement is commonly observed with this condition, it is not necessarily a component of ADD (when present, the disorder may be termed ADHD, to include the "hyperkinetic" aspect). In some instances, ADD might be a misdiagnosis for behavioral problems that are related to home and social situations without an underlying brain dysfunction.
ADD is usually not diagnosed until lack of concentration at school is deemed a problem, typically in the first or second grades (ages 7 to 8). Males are at least four or five times as likely as females to have this diagnosis. While for many children affected by ADD there is some reduction in the symptoms as the child enters puberty, the disorder will often continue for the rest of the individual's life. Manifestations such as impulsiveness, recklessness, irritability, aggression, and poor emotional development can have a lasting impact. Sometimes, puberty brings about a switch from hyperactivity to persistent sluggishness, depression, and moodiness, which is liable to be equally disruptive. The ADD syndrome has been identified in adults as well.
The primary treatment for ADD is the administration of stimulant drugs. It is postulated that the controlling action of certain mid-brain activities may be deficient in these individuals and therefore a stimulant is able to bring about the desired control. The stimulation of brain function may also enhance alertness and concentration. The primary drug used for this disorder is methylphenidate (Ritalin), a relatively mild derivative of amphetamine. Ritalin is also used in the treatment of depression, emotional withdrawal in the elderly, and narcolepsy. This drug can have side effects, mainly nervousness and insomnia. Ritalin is ineffective in about 30% of cases diagnosed as ADD.
In China, the same attention deficit problem has been noted, and Ritalin has been used as a therapy, but herb formulas may be utilized instead (3). From the traditional Chinese medical viewpoint, ADD is caused by a kidney essence deficiency that affects brain development. Further, the yin aspect of the kidney is most deficient, leading to excessive expression of yang: this is manifest as the hyperactivity and wandering of the mind. The orifices are not clear, and that leads to erratic behavior of the spirit. Accordingly, this syndrome is to be treated by nourishing the kidney yin, opening the heart orifices, and settling the agitated yang. The main herbs used for nourishing the kidney in children with this syndrome are rehmannia, lycium, cornus, deer antler (especially the gelatin, which is more yin nourishing) and tortoise shell; these are the same ingredients used in treating adults with senile dementia. For example, these ingredients are included traditional Zuogui Wan (Left Restoring Pill) used to treat kidney yin deficiency when there are deficiencies of "marrow and essence." Zuogui Wan, which adds some tonification for the kidney yang, was mentioned in the suggested treatments for senile dementia as well.
Phlegm obstruction of the heart orifices usually leads to confusion, inability to concentrate, and poor memory. It occurs for a variety of reasons, but often because of weak digestion and/or poor diet. Among the main herbs for clearing the heart orifices and enhancing the mental function are acorus, polygala, curcuma, and alpinia. To settle the agitated the yang (which may manifest as hyperactivity and insomnia) the so-called "heavy sedating agents" are used. The traditional concept is that these substances bear down on the rising and disordered yang. The main substances given for ADD by Chinese doctors are dragon bone or dragon teeth, oyster shell (or mother of pearl), and succinum. In some cases, herbs to purge deficiency fire that accompanies yin deficiency syndrome might be employed. Phellodendron and anemarrhena are the most commonly used items for this purpose.
The dosages of herbs used in treating the children were often rather high, and so the details will be relayed here when available. The dosage for adults is proportionately higher.
As an example of applying these methods, children with ADD were treated with a syrup made from alpinia, ho-shou-wu, lycium, dragon bone, oyster shell, acorus, curcuma, and salvia for two to four months. Three times per day, the children would take 25 ml of the liquid plus 2 grams of deer antler powder. A similar method was used in a study of children with ADD who were given a decoction of acorus, polygala, dragon bone, and oyster shell, modified by adding 3-6 herbs according to symptoms, and a powder of succinum.
Excellent results were claimed in a small study of children treated with a decoction of ligustrum, peony, lycium, mother-of-pearl, and polygonum stem (each ingredient 10-15 grams), modified with addition of some herbs for specific symptoms, such as blood deficiency (add rehmannia and gelatin), spleen deficiency (add hoelen and atractylodes), or restless sleep (add zizyphus). The total daily dose was about 60 grams of herbs, the decoction taken in three divided doses. Treatment times of 15 to 60 days were used, and no recurrence was noted within six months of follow-up. Another high dosage decoction was made with raw rehmannia, ophiopogon, tortoise shell, peony, pseudostellaria, gelatin, baked licorice, curcuma, cnidium, acorus, polygala, oyster shell, and dragon bone; each ingredient 6-12 grams (except 20 grams oyster shell). This combination, with over 120 grams of crude herbs, was administered as a single dose per day. In a large scale study ADD, three different formulas were used; two were decoctions and the third a large honey bolus (six grams per pill). The pill, as an example, was a kidney tonic, with rehmannia, tortoise shell, dioscorea, cornus, hoelen, phellodendron, anemarrhena, polygala, acorus, and dragon teeth.
Two formulas described in the literature were made in the form of a sugar paste; one comprised mainly of acorus and polygala, and the other contains those two herbs plus tortoise shell, hoelen, dragon bone, alpinia, dioscorea, and lotus seeds. The dose of these pastes was 10-15 ml each time, and they were taken two to three times per day. Treatment time was about one month. It was pointed out that the paste could be encapsulated for purposes of easier administration.
Early in 1993, based on the literature reviewed here, ITM prepared an experimental formulation (Acorus Tablets). The formula contains acorus, polygala, fu-shen, alpinia, curcuma, raw rehmannia, dragon bone, dragon teeth, oyster shell, bamboo sap, tortoise shell, and succinum. It contains no stimulants. The formula has been used by both children and adults since then.
In the section of this chapter devoted to treatments for senile dementia, certain formulas were mentioned repeatedly. Their ingredients are briefly mentioned here for easy reference.
Zuogui Wan: rehmannia, dioscorea, cornus, lycium, achyranthes (or cyathula), cuscuta, deer antler gelatin, tortoise shell gelatin.
Yougui Wan: rehmannia, dioscorea, cornus, lycium, cuscuta, deer antler gelatin, eucommia, tang-kuei, cinnamon bark, aconite.
Erchen Tang: pinellia, citrus, hoelen, fresh ginger, jujube, mume.
Banxia Baizhu Tianma Tang (Pinellia and Gastrodia Combination): pinellia, citrus, hoelen, fresh ginger, jujube, gastrodia, atractylodes.
A traditional acupuncture chart from the Wellcome Trust in London. This chart directs attention to some of the key zones for treatment to be described in Chapter 10, where the methods outlined in this booklet are summarized. At the top of the head and coming down the center of the face is the Governing Vessel, with its important points such as baihui (GV-20) at the top of the head, shenting (GV-24) at the hairline, and renzhong (GV-26) just below the nose. At each wrist, the chart indicates a multiplicity of points (along with the pulse taking positions); especially valuable are the Pericardium points, such as neiguan (PC-6), and the Heart point shenmen (HT-7). At the feet, several valuable points are shown, especially along the liver and kidney channels, of which yingquan (KI-1), taixi (KI-3) and taichong (LV-3) are frequently used for shen disorders.