CLINICAL APPLICATIONS

* Stress, anxiety, nervousness, restlessness 

* General symptoms associated with stress, such as poor appetite, headache, tension, and insomnia

* Premenstrual syndrome (PMS) with breast distension, irritability and/or mood swings

 

WESTERN THERAPEUTIC ACTIONS

* Calming effect to relieve restlessness and irritability

* Anxiolytic function to relieve stress, nervousness and anxiety

* Analgesic action to relieve pain, headache and muscle tension associated with stress

 

CHINESE THERAPEUTIC ACTIONS

* Spreads Liver qi

* Nourishes Liver blood

* Clears heat

* Harmonizes middle jiao

 

DOSAGE

Take 3 to 4 capsules three times daily on an empty stomach with warm water. Dosage may be increased to 6 to 8 capsules three times daily if necessary to alleviate symptoms for a few days. Once stabilized, reduce dosage back down to 3 to 4 capsules three times daily.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Bo He (Herba Menthae)

Chai Hu (Radix Bupleuri)

Dang Gui (Radix Angelicae Sinensis)

Fu Ling (Poria)

Mu Dan Pi (Cortex Moutan)

Sheng Jiang (Rhizoma Zingiberis Recens)

Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle)

Zhi Zi (Fructus Gardeniae)

 

BACKGROUND

Stress is a normal physical and psychological reaction to demands of life. Most people experience challenges with mental or physical stress on a regular basis. When confronted with stress, the body responds with a burst of hormones to empower the organism to cope and survive – a reaction that is labeled as the "fight-or-flight" response. Once the stress is gone, however, the body is supposed to return to a normal relaxed state. Unfortunately, the nonstop stress of modern life often keeps the body in a constant stressed state. Over time, constantly living in a stressed state coupled with an absence of relaxed states leads to serious health problems. Acute and chronic stress can affect the brain (feelings and emotions), heart (hypertension, arrhythmia, atherosclerosis, coronary artery disease), muscles (stiffness and pain), stomach (acid reflux, peptic ulcer disease, irritable bowel syndrome), and immune system (weakened immune system, frequent infection).

 

FORMULA EXPLANATION

According to the Five-Elements Theory, the Liver is the most sensitive of all organs to emotional distress. Stress and pressure can easily lead to Liver qi stagnation, which can overact on the Spleen and the Stomach. The treatment protocol is to spread the Liver qi, harmonize the middle jiao, and nourish the blood.

        Calm is formulated based on Xiao Yao San (Rambling Powder), a classic Chinese formula for Liver qi stagnation. In this formula, Chai Hu (Radix Bupleuri) enters the Liver and disperses stagnant qi. Bai Shao (Radix Paeoniae Alba) and Dang Gui (Radix Angelicae Sinensis) nourish the blood and soften the Liver. Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Fu Ling (Poria) strengthen the Spleen and the Stomach to prevent the overacting of the Liver (Wood element) on the Spleen and the Stomach (Earth element). The fragrant and acrid properties of Bo He (Herba Menthae) and Sheng Jiang (Rhizoma Zingiberis Recens) help disperse Liver qi stagnation. The combination of Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) and Bai Shao (Radix Paeoniae Alba) produces an analgesic effect to treat hypochondriac distension. Zhi Zi (Fructus Gardeniae) and Mu Dan Pi (Cortex Moutan) clear heat and reduce irritability, anger and other heat signs.

        Overall, Calm is an excellent formula to concurrently treat the excess (Liver qi stagnation) and the deficiency (blood deficiency).

 

CAUTIONS & CONTRAINDICATIONS

* Calm is a qi-regulating formula, and prolonged use (4 to 6 months) may cause qi deficiency in some patients. Such patients with stressful lifestyles or jobs who cannot be without Calm should be advised to take a qi tonic formula, such as GI Tonic or Cordyceps 3 at 1 to 2 capsules daily, to help maintain optimal qi levels in the body.

* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[1]^,[2],[3]

 

CLINICAL NOTES

* Calm is one of the most effective and popular herbal formulas for stress. It relieves Liver qi stagnation, which manifests in a wide range of clinical signs and symptoms, including but not limited to stress, anxiety, nervousness, restlessness, PMS, insomnia, fidgeting, and irritability.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Outward display of emotional conditions (i.e., patients who express how they feel and do not hold their feelings inside): convex and forceful pulse on the left guan

* Internalized emotional conditions (i.e., patients who hold their feelings inside): concave and deep pulse on the left guan

 

SUPPLEMENTARY FORMULAS

* For stomach pain, heartburn, gastric and duodenal ulcers, add GI Care.

* For severe emotional disturbance with anger and neurosis or insomnia, use Calm (ES).

* For stress, anxiety and insomnia in patients with deficiency, use Calm ZZZ.

* For constant worrying with excessive dreams, combine with Schisandra ZZZ.

* For hypertension, combine with Gastrodia Complex or Gentiana Complex.

* With depression, add Shine or Shine (DS).

* For women experiencing hot flashes and night sweating during menopause, add Balance (Heat).

* For lack of vaginal lubrication during menopause, add Balance Spring.

* For infertility due to stress, use Blossom (Phase 1-4).

* In cases of prolonged Liver qi stagnation causing benign breast lumps, breast tumor and/or mastitis, use Resolve (Upper)

* For dysmenorrhea, add Mense-Ease.

* If the patient has hyperthyroidism, add Thyrodex.

* With acute headache, add Corydalin (AC).

* With chronic headache, add Corydalin (CR).

* For ADD/ADHD, add Calm (Jr).

* For irritable bowel syndrome (IBS) due to stress, add GI Harmony.

* For ulcerative colitis due to stress, add GI Care (UC).

* For excess heat, add Gardenia Complex.

* With blood stagnation, add Circulation (SJ).

* For stress- or hormonal-related acne, add Dermatrol (Clear).

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Hegu (LI 4), Taichong (LR 3), Yintang

* Taichong (LR 3), Xingjian (LR 2), Qimen (LR 14), Zhangmen (LR 13), Feishu (BL 13), Shangwan (CV 13), Shanzhong (CV 17)

 

Classic Master Tung's Points:

* Insomnia: Linggu (T 22.05), Xinling (T 33.17)*, Shenjian (T 44.19), Zhenjing (T 1010.08), Zhenghui (T 1010.01), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Huoying (T 66.03), Tianhuangfu [Shenguan] (T 77.18), Shenmen on the ear. Bleed du (governing) channel and back of the knee area. Bleed before needling for best result.

* PMS: Fuke (T 11.24), Xinling (T 33.17)*, Zhenjing (T 1010.08), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Linggu (T 22.05), Sihuashang (T 77.08), Jiemeiyi (T 88.04), Jiemeier (T 88.05), Jiemeisan (T 88.06). Bleed Huobao (T 55.01) or dark veins nearby. Bleed before needling for best result.

* Stress: Zhenjing (T 1010.08), Tianhuangfu [Shenguan] (T 77.18), Huoying (T 66.03), Dizong (T 44.09), Dan (T 11.13)

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Anxiety, stress, irritability, insomnia: Zhenjing (T 1010.08), Tianhuangfu [shenguan] (T 77.18), Zhongjiuli (T 88.25)

* PMS: Zhenghui (T 1010.01), Zhenjing (T 1010.08), Huanchao (T 11.06), Fuke (T 11.24)

 

Balance Method by Dr. Richard Tan:

* Left side: Zhongzhu (TH 3), Tianjing (TH 10), Hegu (LI 4), Taichong (LR 3), Ququan (LR 8), Sanyinjiao (SP 6)

* Right side: Quze (PC 3), Daling (PC 7), Neiguan (PC 6), Shenmen (HT 7), Yanglingquan (GB 34), Zulinqi (GB 41), Xiangu (ST 43)

* Left and right sides can be alternated from treatment to treatment.

 

Ear Acupuncture:

* Shenmen

 

Auricular Medicine by Dr. Li-Chun Huang:

* Liver qi stagnation, stress, anxiety, restlessness: Shenmen, Heart, Nervous Subcortex, Anxious, Be Happy, Liver, Occiput. Bleed Ear Apex.

* Menopause: Uterus, Endocrine, Ovary, Gonadotropin, Pituitary, Sympathetic, Anxious, Kidney, Liver, Heart.

 

NUTRITION

* A diet high in calcium, magnesium, phosphorus, potassium, and vitamins B and E is recommended. These nutrients are easily depleted by stress.

* Encourage the consumption of fruits and vegetables such as apricots, winter melon, asparagus, avocados, bananas and broccoli in addition to brown rice, dried fruit, figs, salmon, garlic, green leafy vegetables, and soy products.

* Avoid any and all foods that contain sugar, such as cake, desserts, candy, chocolate, soda, canned juice, soft drinks, caffeinated drinks, stevia, sugar substitutes, agave, xylitol, and corn syrup.

* Avoid fermented foods like cheese or fermented tofu.

* Do not eat dairy products, such as milk, cream, yogurt, cheese, and ice cream.

* Warm and hot natured foods that damage qi and yin should be avoided, such as:

§ certain fruits like mango and durian that produce heat.

§ stimulants like coffee, alcohol, and energy drinks.

§ spicy/pungent/aromatic vegetables such as pepper, garlic, onions, basil, rosemary, cumin, funnel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, and wasabi.

* Avoid food and drinks with artificial coloring.

* Consume as few meat products as possible. Do not eat processed meats, such as lunch meats, hot dogs and sausages, as they contain nitrites that are associated with inflammation and chronic disease.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Premenstrual syndrome (PMS)

§ At least one week prior to the usual onset of PMS symptoms, consume foods such as ginger, green onions, fennel, orange peel, spinach, walnuts, hawthorn berries, cinnamon, black pepper, and Chinese date.

§ Avoid cold foods, raw foods, excessive consumption of fruits, vinegar, all shellfish, coffee, stimulants, sugar, dairy products, and smoking.

* Restlessness and emotional instability: Make a tea of wheat bran, licorice root, and dates. Drink three times daily until symptoms are relieved.

 

LIFESTYLE INSTRUCTIONS

* Regular exercise, adequate rest, and normal sleep patterns are beneficial for stress reduction.

* Relax the mind and the body through meditation, yoga, breathing exercises, imagery exercises, and other activities such as tai chi chuan [tai ji chuan] and qi gong.

* Get away from the daily routine to do something different and enjoyable to relieve stress whenever possible. Laughter really is the best medicine.

* Noise can be disturbing to mental health and cause stress. Noise greater than 65-decibels can cause psychological disturbance, greater than 90-decibels can cause emotional damages, and greater than 120-decibels can cause nervous system and hearing damages.

* Shift outlook on life and look at changes in a positive way and as challenges rather than threats.

 

CASE STUDIES

* B.C., a 74-year-old female, presented with insomnia, irritability, and neck and shoulder tension. Neck and shoulders were tender and tight upon palpation. The patient was overweight and drank vodka every night which increased the intensity of her condition. This condition was diagnosed as Liver qi stagnation. After taking Calm, four capsules three times daily, she was able to relax and went to sleep easier. Her neck and shoulders felt a lot looser as well. Submitted by A.I., Hilo, Hawaii.

* S.P., a 42-year-old female, presented with insomnia and restlessness. This person had a Type A personality which needed to be calmed down. The TCM diagnosis was Liver depression affecting the Heart. After taking Calm, the restlessness and emotions decreased in intensity. The patient felt more balanced through the day and slept better at night. She was not up at night as often, and had less desire to want to clean the house at night. She has continued to take the herbs as needed. Submitted by L.M., Portland, Oregon.

* S.S., a 55-year-old female, presented with menopause symptoms and experienced hot flashes ten times a day. Additional symptoms included irritability and difficulty staying asleep. The patient also relied heavily on sleeping aids which resulted in grogginess. Furthermore, she had arthritis in her thumbs, a constant need to clear her throat, and acid reflux. Her blood pressure was 120/80 mmHg and her heart rate was 78 beats per minute. The practitioner diagnosed the condition as yin deficiency and Liver qi stagnation. Balance (Heat) was prescribed at three capsules three times daily, along with Calm, three capsules three times daily with warm water. The patient had very positive results. She reported feeling less irritable and was no longer experiencing hot flashes. Her sleep had also improved where she only needed to take sleeping aids occasionally. Lastly, her acid reflux had improved; however, it was still present when taking certain foods and wine. Submitted by L.W., Arroyo Grande, California.

* S.F., a 32-year-old male, presented with stress, anger and irritability. The patient was prescribed Calm, up to eight capsules as needed. After taking two bottles of the herbs, the patient reported being less stressed and a decreased anger. He would forget to take the herbs at times but admitted to being calmer when he took them. The patient was very pleased with the results. Submitted by S.L., Yuma, Arizona.

* J.C., a 57-year-old female, presented with nervousness, insomnia, and anxiety with a desire to stop smoking. Night sweats were also present. Her tongue was red with no coating present. The practitioner diagnosed the condition as Kidney yin deficiency with heat and Liver qi stagnation. Her Western diagnosis was menopause and hypothyroidism. The patient was given a combination of Calm, Shine, and Nourish. Nourish was taken daily while Shine and Calm were taken as needed. After taking the herbs for six months, the patient reported improvement in sleep; she was calmer and more balanced overall with a positive attitude. Submitted by K.F., Honolulu, Hawaii.

* S.T., a 27-year-old female, presented with PMS symptoms consisting of severe cramping and moodiness. Pulse was choppy and the tongue was purple. The practitioner diagnosed this condition as Liver qi and blood stagnation. Mense-Ease was prescribed at 4 to 6 capsules three times a day, along with Calm to take as needed. After taking Mense-Ease for one cycle, the patient reported less menstrual pain and less cramping and moodiness. In addition, she reported that Calm had immediate effectiveness. Submitted by S.L., Yuma, Arizona.

* L.S., a 36-year-old female, presented with tight upper back muscles, tension in the neck, and fatigue. It was also noted that she has a very stressful job, was easily irritated and had no patience at all. Objective findings included knots in the upper back muscles and stiff neck with limited range of motion. The practitioner diagnosed it as Liver qi stagnation. After taking Calm, three capsules a day for a week, the patient reported feeling much more at ease, being able to handle the stress both at home and at work. The overall tension was lifted and her muscles felt more relaxed. She asked for a second bottle of the herbs to continue taking it as needed. Submitted by L.M., Gresham, Oregon.

* S.M., a 52-year-old female, presented with irritability and had a tendency to be easily stressed. Tongue was red with a peeled coating. The practitioner diagnosed this condition as Liver qi stagnation and prescribed the patient to take Calm, three capsules three times a day. After taking the herbs for two days the patient reported being much calmer and not as angry. The patient had also received acupuncture 2 to 3 times a week. Submitted by S.L., Yuma, Arizona.

* S.F., a 42-year-old female, presented with a gastrointestinal disorder with symptoms consisting of diarrhea with extreme urgency, especially worse with stress. Pulse was wiry and thready and her tongue was red with a long center crack. An additional objective finding was dark circles under her eyes. The practitioner diagnosed this condition as Liver overacting on Spleen. Upon diagnosis the patient was given GI Harmony and Calm. Taking the herbs, the patient is doing well, having a bowel movement which is well formed. Additional lifestyle changes she had made were avoiding caffeine and going to bed before 11:00 p.m. Submitted by T.W., Perrysburg, Ohio.

* D.H., an 18-year-old male, presented with stress and anxiety due to feeling overwhelmed by life. Pulse was wiry and his tongue was reddish purple. The practitioner diagnosed this condition as Liver blood and qi stagnation and prescribed the patient Calm at three to eight capsules, three times a day. After one week of taking the herb, the patient reported being less stressed and having less anxiety. The patient had also started counseling at the beginning of treatment as well. Submitted by S.L., Yuma, Arizona.

* A 35-year-old male manager presented with stress, anxiety and anger. His pulse was rapid and face was red. The practitioner diagnosed the condition as Liver qi stagnation and Liver yang rising. When the patient began the initial treatment one year ago, he and his wife noticed a significant improvement. Through the course of the one-year treatment, the patient noticed a regression of his improvement when not taking his dose of Calm and felt as though he had “less control of his life.” The patient was recommended to continue taking Calm at 4 capsules two times a day. Consequently, his condition showed signs of improvement. Submitted by K.S., San Diego, California.

* A new job and concurrent relationship problems had created quite a stressful situation for a 27-year-old female restaurant cook, who was diagnosed with Liver qi stagnation. Her tongue was purple and her pulse was wiry. Constantly thinking about her problems made her unable to relax. Placed on a two week regimen of Calm has improved her condition tremendously. Although the patient reported that her stress has not changed, she felt more relaxed after taking Calm. Submitted by T.G., Albuquerque, New Mexico.

* A 40-year-old housewife presented with migraines, stress, and a lack of sleep. She woke up frequently and had many stress-related headaches for years. The practitioner diagnosed the condition as Liver qi stagnation with heat rising. The practitioner felt the treatment should revolve around calming the shen (spirit). After two weeks of taking Calm, the headaches were less severe and less frequent. However, sleep was still poor. At four weeks, her headaches were very mild and under control. She no longer needed to take any Western medications. The patient appeared more calm and reported sleeping better and feeling less stressful. She was recommended to continue taking Calm for two to three more months. As an adjunct to the treatment, the practitioner also suggested taking Corydalin (AC) for her headaches, as well as reducing her caffeine intake. Submitted by D.S., Flagstaff, Arizona.

* A 38-year-old female administrator presented with insomnia and TMJ. The practitioner diagnosed her as having Liver fire rising, Kidney and Heart not communicating, and depression. When the patient initially came to the office, she had not slept that same night. She was nervous and had jawbone pain, which was caused by sleeping with a clenched jaw. The acupuncture treatment calmed the patient. To reinforce her acupuncture treatment, Calm was also given at a dose of 3 capsules, three times a day. On the second treatment, the patient was much calmer and more relaxed. The same acupuncture treatment was given, with the advice to continue taking Calm. As a result, the practitioner concluded that Calm was effective for her depression, anxiety, and other symptoms of Liver fire. Submitted by A.D., La Crescenta, California.

* S.C., a 42-year-old female, presented with stress due to domestic situations. Clinical manifestations included constipation, bloating, neck tension, insomnia, anorexia, fatigue, tearfulness and sadness. Her tongue was pale and scalloped, with a mid-line crack; her pulse was soft and soggy. The Western diagnosis was depressive disorder; the TCM diagnosis was Liver qi stagnation. After taking Calm at three capsules, three times daily, the patient reported feeling much better. Her voice became more animated, there was more character in her face, and more shine to her eyes. Furthermore, the patient stated that her neck tension, insomnia, constipation, and sadness were gone. Submitted by C.L., Chino Hills, California.

* M.M., a 41-year-old female, presented with “adrenaline-rush” sensations, characterized by heat flushes to her face, associated with mood swings and anxiety. Her tongue was red and purple, and her face was red. The Western diagnosis was stress-related anxiety attack; the TCM diagnosis was Liver stagnation and yin deficiency. After beginning herbal therapy with Calm, two capsules three times daily, and Balance (Heat), two capsules, three times daily, the patient stated that her affect and personality became calmer. Furthermore, she reported “feeling good,” with increased energy levels and sound sleep. Submitted by C.L., Chino Hills, California.

* L.A., a 37-year-old female patient, presented with insomnia, with difficulty falling and staying asleep. Other symptoms included neck and shoulder stiffness, TMJ pain, heavy menstrual flow, and cramping with blood clots. She complained of marital problems and held the stress and sadness inside. She was also seeing a psychotherapist. The blood pressure was 123/86 mmHg and her heart rate was 88 beats per minute. The tongue appeared to be salmon pink in color, moist with numerous fissures from the center to the tip. The tongue was swollen and the tip was red. The pulse was slippery and thin. The TCM diagnosis was Spleen qi and Heart blood deficiencies with Liver qi stagnation. Calm was prescribed. Calm alone eased her tension, but did not help much with her energy. Her sleep improved slightly. The TMJ resolved after eight acupuncture treatments. After two months, Schisandra ZZZ was added. The patient then slept through the night much more soundly. Submitted by J.C.O., Whittier, California.

* A female presented with stress, irritability, premenstrual syndrome (PMS), loose stool, crying for no reason, muscle tension, and nervous trembling in the hands. She stated that she felt overwhelmed in life and worried incessantly. Her blood pressure was 115/75 mmHg and her heart rate was 87 beats per minute. Her tongue was pink with a red tip and a thin white coating. Pulse was wiry on the left side and slippery on the right side. The TCM diagnosis was Spleen qi deficiency with Liver qi stagnation. Calm was prescribed. The patient responded immediately, stating her “nerves” calmed down, stomach settled, and began to feel more “emotionally stable.” She took only 3 capsules three times a day the week before her period. Submitted by J.C., Whittier, California.

* D.S., a 45-year-old female, presented with insomnia, mood swings, cramps and fatigue. The tongue was slightly purplish and pale with teeth marks. The coating was thin and white. The pulse was deep and wiry. She was diagnosed with Spleen qi deficiency and blood deficiency. Nourish, Calm, and Schisandra ZZZ were prescribed. The patient reported her sleep pattern improved, her moods balanced, and her energy level increased. She was very happy with the herbs. Submitted by B.F., Newport Beach, California.

* A 36-year-old female patient presented with a long history of anxiety, irritability, insomnia, mood swings, and dream-disturbed sleep. Her pulse was slow, full and wiry; tongue was red on the tip and sides. The TCM diagnosis was Liver qi stagnation. After taking three capsules of Calm three times daily, the patient reported subtle changes in moods, including that she was not as irritable, and was able to focus on work and maintain higher productivity. She was also able to sleep better, without disturbing dreams. Submitted by C.L., Chino Hills, California.

* J.W., a 44-year-old patient, presented with infertility and a history of miscarriage. She experienced high stress which she “bottled up” inside. Her hands and feet were cold. She also had back pain, low energy, severe menstrual cramps and premenstrual syndrome (PMS). Her tongue was pale and purplish, swollen with teeth marks. The tip was red. Pulse was wiry on both sides and slippery on the right. Her blood pressure was 125/86 mmHg and heart rate was 83 beats per minute. Lab report showed she had low FSH levels. The diagnosis was Spleen and Kidney yang deficiencies with Liver qi and blood stagnation. Menatrol was prescribed. After one month on Menatrol, the patient reported her menstrual cramping “miraculously disappeared” and her estrogen levels increased dramatically. She was afraid the herbs would interfere with her in vitro fertilization (IVF) procedure so she stopped taking them for six weeks. After the IVF was not successful and her tongue color became very purple in the center, the practitioner suggested she take the formula Calm. She was open to it. Within a week, her stress level decreased and her energy level increased. Her tongue color changed from purple to pink and slightly dusky. She is presently continuing to take Calm and is actively trying to conceive naturally. Submitted by J.C.O., Whittier, California.

* E.P., a 32-year-old female, presented with a 2½-year history of vertigo, associated with insomnia, palpitations, anxiety, and nausea. She also suffered from irritable bowel syndrome with alternating diarrhea and constipation. She had an unsteady gait and was unable to drive. For the Western diagnosis of anxiety disorder, the TCM diagnosis was Liver fire. Initially, Calm and Gentiana Complex were prescribed at two capsules each, three times daily, but then the dosage was increased to three capsules of each, three times daily. After three weeks, the signs and symptoms of irritable bowel syndrome were resolved, and Gentiana Complex was discontinued. On the sixth treatment, the patient reported all symptoms improved. However, work-related stress and anxiety remained. On the 15^th visit, Calm was changed to Schisandra ZZZ to help with her insomnia. After taking this formula for nine days, the patient reported much improvement in her sleeping patterns, from five to six hours of interrupted sleep to six to seven hours of uninterrupted sleep. The patient was treated with acupuncture five times throughout the course of herbal treatment. Submitted by C.L., Chino Hills, California.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Nonstop stress in the modern world places a tremendous burden on the mind and the body to always function in a heightened and alarmed state. Over time, the mind and the body are unable to relax, leading to a wide variety of dysfunction throughout the body, including brain (feelings and emotions), heart (hypertension, arrhythmia, atherosclerosis, coronary artery disease), stomach (acid reflux, peptic ulcer disease, irritable bowel syndrome), muscles (stiffness and pain), and immune system (weakened immune system, frequent infection). Therefore, optimal treatment requires use of herbs to rescue the mind from stress and restore the body to its optimal health.

        Calm has herbs with adaptogenic effects to help the patients cope with nonstop stress. Chai Hu (Radix Bupleuri) and Zhi Zi (Fructus Gardeniae) have a calming effect on the brain to help the patients manage mental stress by promoting relaxation and improving sleeping.[4]^,[5] Gan Cao (Radix et Rhizoma Glycyrrhizae) has a positive cognitive effect to improve mental functions and ameliorate memory impairment.[6] Furthermore, Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Fu Shen (Poria Paradicis) have adaptogenic effects to help the patients deal with physical stress by enhancing duration and relieving restlessness.[7]^,[8]

        In addition, Calm has herbs with various cardiovascular and circulatory functions to decrease the adverse effect of stress on the heart. In one laboratory study, intravenous injection of Dang Gui (Radix Angelicae Sinensis) is associated initially with an inhibitory influence on the heart, followed by a negative chronotropic effect and a positive inotropic effect. It improves overall blood circulation by decreasing the whole blood specific viscosity, or improving the hemorrheological changes associated with blood stagnation. It also has an antiarrhythmic effect, especially against arrhythmia induced by epinephrine, cardiac glycosides, aconitine, and barium chloride. Administration of Dang Gui (Radix Angelicae Sinensis) is associated with reduction of plasma cholesterol and triglyceride levels, and a decreased risk of atherosclerosis, as demonstrated in laboratory studies.[9]^{,[10],[11],[12]} Furthermore, Zhi Zi (Fructus Gardeniae) has demonstrated marked antihypertensive action in numerous studies. One proposed mechanism of this hypotensive effect is its stimulation of the parasympathetic nervous system.[13] In addition, Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) has shown marked effectiveness in treating subjects with palpitations and artificially-induced arrhythmia.[14]^,[15] Finally, Bai Shao (Radix Paeoniae Alba) and Chai Hu (Radix Bupleuri) have antihyperlipidemic activities, and have been shown to lower total cholesterol, low-density lipoprotein, and triglyceride levels.[16],[17]

        To alleviate adverse effect of stress on the digestive system, Calm contains many herbs with gastroprotective effects. Gan Cao (Radix et Rhizoma Glycyrrhizae) has a proven effect to prevent and treat gastric and duodenal ulcers. The mechanisms of this action include inhibition of gastric acid secretion, binding and deactivation of gastric acid, and promotion of recovery from ulceration.[18] According to one study, 100 patients with gastric or duodenal ulcers were treated with Gan Cao (Radix et Rhizoma Glycyrrhizae) extract with 90% rate of effectiveness.[19] Another study also reported good results using Gan Cao (Radix et Rhizoma Glycyrrhizae) to treat patients with peptic ulcers. The treatment protocol was to administer 2.5 to 5 grams of powdered Gan Cao (Radix et Rhizoma Glycyrrhizae) three times daily for 3 to 4 weeks.[20] In addition, Zhi Zi (Fructus Gardeniae) has a gastroprotective effect to protect the stomach from gastritis and gastric lesions. Zhi Zi (Fructus Gardeniae) has acid-neutralizing capacities, antioxidant activities, inhibitory effects on the growth of Helicobacter pylori, and reversal of ethanol-induced gastric lesions.[21] Furthermore, Bai Zhu (Rhizoma Atractylodis Macrocephalae) has a dual effect to regulate the digestive tract,[22] and is effective to treat either constipation or diarrhea.[23]^,[24]

        Lastly, Calm contains many herbs with analgesic and anti-inflammatory effects to relieve various aches and pain caused by stress. Dang Gui (Radix Angelicae Sinensis) has both analgesic and anti-inflammatory effects with potency comparable to or greater than acetylsalicylic acid.[25],[26] It has been used successfully to treat low back and leg pain,[27] vascular headache,[28] migraine headache,[29] and the general complaint of pain.[30] Bai Shao (Radix Paeoniae Alba) and Gan Cao (Radix et Rhizoma Glycyrrhizae) have anti-inflammatory and spasmolytic functions.[31]^,[32] Clinically, these two herbs have a marked effect to treat neck pain,[33] acute back pain,[34] sciatica,[35] pain in the lower back and legs,[36] leg cramps in the calf,[37] restless leg syndrome,[38] heel pain,[39] gastric and abdominal pain,[40] intestinal spasm,[41] menstrual cramps and pain,[42] neuralgia,[43] facial spasms and twitching,[44] trigeminal neuralgia,[45]^,[46] and dysmenorrhea.[47] Bai Zhu (Rhizoma Atractylodis Macrocephalae) also has anti-inflammatory activity and its mechanism of action is attributed to the inhibition of tumor necrosis factor-alpha (TNF-α) and nitric oxide production.[48] Zhi Zi (Fructus Gardeniae) also has anti-inflammatory activity, as this herb suppresses vascular inflammation via inhibition of TNF-α.[49] Lastly, Chai Hu (Radix Bupleuri) demonstrates both analgesic and anti-inflammatory functions,[50]^,[51] and the saikosaponins appear to be the main compounds for these actions.[52]

        To enhance the immune system and maintain optimal health, many herbs with immunostimulant effects are used in this formula. Chai Hu (Radix Bupleuri) stimulates both humoral and cellular immunity.[53] Dang Gui (Radix Angelicae Sinensis) increases the phagocytic activity of the macrophages.[54] Lastly, Bai Zhu (Rhizoma Atractylodis Macrocephalae) increases the activity of the macrophages and reticuloendothelial system, and elevates the number of white blood cells, lymphocytes, and IgG.[55]^,[56]

        In summary, Calm is an excellent formula to treat stress and manage its related conditions and complications. Calm relaxes the mind and restores the body to its optimal health.

 

COMPARATIVE ANALYSIS

Stress and anxiety are two of the most common emotional disorders. Clinical signs and symptoms include recurrent and intrusive thoughts, insomnia, disturbed sleep, illusions, hallucinations, difficulty concentrating, hypervigilance, restlessness, anger, and irritability.

        Pharmaceutical drug treatments for stress and anxiety focus primarily on use of sedative and hypnotic drugs, such as Valium (diazepam) and Ativan (lorazepam). Though these drugs are very potent and have an immediate effect to sedate patients, they do not address the underlying conditions. Furthermore, long-term use of these medications are associated with many side effects, including drowsiness, dizziness, tiredness, blurred vision, changes in sex drive or ability, shuffling walk, persistent, fine tremor or inability to sit still, difficulty breathing or swallowing, severe skin rash, yellowing of the skin or eyes, irregular heartbeat, and addiction. Therefore, these drugs should only be used when necessary, and only for a short period of time.

        Use of herbs is extremely effective to treat stress and anxiety. Herbs regulate mood and emotions, and alleviate stress and anxiety by enhancing the body’s own ability to deal with these external factors. Unlike drugs that have an immediate effect to treat stress and anxiety by sedating the mind and decreasing its responsiveness, herbs do not have an immediate effect, and require two or more weeks of continuous use to gradually treat these conditions. In contrast, one of the main advantages of herbs is they are safe and natural, and do not have negative side effects like drugs.

        Stress and anxiety are two very common disorders. While drugs and herbs are both effective, they have contrasting differences of benefits and risks. While drugs are more effective for short-term treatment, herbs are more successful for long-term management. Furthermore, counseling (behavioral and psychotherapy) is extremely important toward the understanding of, and complete recovery from, these conditions.