Back to the Cover Page

Calm (ES)


CLINICAL APPLICATIONS

* Stress with poor appetite, headache, tension, insomnia, and similar stress responses

* Extreme or severe emotional and psychological disorders, such as hysteria, neurosis, and schizophrenia

* Insomnia with disturbed sleep and night awakenings

* Withdrawal signs and symptoms associated with alcohol, drug, and smoking addiction

 

WESTERN THERAPEUTIC ACTIONS

* Sedative effect to relieve nervousness and irritability

* Anxiolytic function to relieve stress and anxiety

* Tranquilizing effect to alleviate severe emotional and psychological disorders

* Antispasmodic effect to relieve muscle tension and cramping

* Calming effect to ease withdrawal signs and symptoms associated with alcohol, drug, and smoking addiction

 

CHINESE THERAPEUTIC ACTIONS

* Spreads Liver qi, purges excess Liver fire

* Calms the shen (spirit) and tranquilizes the Heart

 

DOSAGE

For stress- and anxiety-related disorders, take 3 to 4 capsules three times daily. For severe emotional and psychological disorders, or patients with withdrawal signs and symptoms because of drug or alcohol addiction, the dosage may be increased to 6 to 8 capsules every four to six hours or as needed. Dosage can then be dropped down to 3 to 4 capsules three times daily when symptoms are stabilized.

 

INGREDIENTS


Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Chai Hu (Radix Bupleuri)

Chuan Xiong (Rhizoma Chuanxiong)

Da Huang (Radix et Rhizoma Rhei)

Da Zao (Fructus Jujubae)

Dang Gui (Radix Angelicae Sinensis)

Fu Ling (Poria)

Gan Cao (Radix et Rhizoma Glycyrrhizae)

Gou Teng (Ramulus Uncariae cum Uncis)

Gui Zhi (Ramulus Cinnamomi)

Huang Qin (Radix Scutellariae)

Long Gu (Os Draconis)

Mu Li (Concha Ostreae)

Sheng Jiang (Rhizoma Zingiberis Recens)

Suan Zao Ren (Semen Ziziphi Spinosae)

Xi Yang Shen (Radix Panacis Quinquefolii)

Xie Cao (Radix et Rhizoma Valerianae)

Zhu Ru (Caulis Bambusae in Taenia)


 

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 constantly stressed state. Over time, constantly living in a stressed state coupled with an absence of relaxed states leads to serious health problems.

 

FORMULA EXPLANATION

Calm (ES) is one of the strongest herbal formulas to treat emotional and psychological disorders. In addition to regulating Liver qi and purging Liver fire, it also calms the shen (spirit) and tranquilizes the Heart. Clinically, it is commonly used for patients with severe emotional distress or mild psychological disorders. Furthermore, it can also be used to treat withdrawal signs and symptoms commonly associated with substance addiction.

        Long Gu (Os Draconis) and Mu Li (Concha Ostreae) are mineral medicinal substances commonly used to anchor the floating shen (spirit). They have tranquilizing and sedative effects, which can subdue the hyperactivity of Liver fire. Gou Teng (Ramulus Uncariae cum Uncis) treats headache associated with a sudden rise of blood pressure. Huang Qin (Radix Scutellariae) and Da Huang (Radix et Rhizoma Rhei) clear heat and relieve irritability. Chai Hu (Radix Bupleuri) disperses stagnant Liver qi and Dang Gui (Radix Angelicae Sinensis) nourishes Liver blood. Xi Yang Shen (Radix Panacis Quinquefolii), Bai Zhu (Rhizoma Atractylodis Macrocephalae), Fu Ling (Poria), Sheng Jiang (Rhizoma Zingiberis Recens), and Da Zao (Fructus Jujubae) strengthen and harmonize the middle jiao and prevent the Liver from overacting on the Spleen. Gui Zhi (Ramulus Cinnamomi) and Chuan Xiong (Rhizoma Chuanxiong) promote qi and blood circulation. Suan Zao Ren (Semen Ziziphi Spinosae) and Xie Cao (Radix et Rhizoma Valerianae) calm the Heart and nourish the shen (spirit). Gan Cao (Radix et Rhizoma Glycyrrhizae) harmonizes all the herbs in the formula and protects the stomach against the harshness of the mineral medicinal substances in this formula.

 

CAUTIONS & CONTRAINDICATIONS

* This formula is contraindicated during pregnancy and nursing.

* Patients with a weak digestive system may experience mild gastrointestinal disturbances. In such cases, reduce the dosage or take this formula with GI Care for nausea, and Gentle Lax (Deficient) for constipation.

* 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]

* The following warning statement is required by the State of California: “This product contains Da Huang (Radix et Rhizoma Rhei). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang (Radix et Rhizoma Rhei) may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.”

 

CLINICAL NOTES

* In addition to using Calm (ES), efforts should be made to identify the underlying cause of illness. Both the symptoms and the cause should be treated concurrently to ensure optimal results.

 

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 moderate amounts of stress and anxiety or PMS, use Calm.

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

* For insomnia arising from blood deficiency, add Schisandra ZZZ.

* For crying spells or depression, add Shine or Shine (DS).

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

* For stress-related irritable bowel syndrome (IBS), add GI Harmony.

* For stress-related ulcerative colitis, add GI Care (UC).

* For chronic, stubborn insomnia with blood stagnation, add Circulation (SJ).

* For menopausal signs, add Balance (Heat).

* For hypertension, add Gentiana Complex or Gastrodia Complex.

* For headache, add Corydalin (AC) or Corydalin (CR).

* For constipation, combine with Gentle Lax (Excess) or Gentle Lax (Deficient).

* If the patient has hyperthyroidism, add Thyrodex.

* For heartburn or gastric ulcers, add GI Care.

* For excess fire in the body, add Gardenia Complex.

* For thirst and dryness, add Nourish (Fluids).

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Yintang (Extra 1), Xingjian (LR 2)

* Shenmen (HT 7), Taichong (LR 3), Ganshu (BL 18), Baihui (GV 20), Xinshu (BL 15), Pishu (BL 20)

 

Classic Master Tung's Points:

* Stress: Dizong (T 44.09), Neiguan (PC 6), Huoying (T 66.03), Tongshan (T 88.02), Tongtian (T 88.03), Tianhuangfu [Shenguan] (T 77.18), Huoxi (T 11.16)

*  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.

* Alcohol, drug, and smoking addiction: Simashang (T 88.18), Simaxia (T 88.19), Simazhong (T 88.17), Tongshan (T 88.02), Tongguan (T 88.01), Tongtian (T 88.03), Tianhuang (T 88.13), Minghuang (T 88.12), Qihuang (T 88.14)

 

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)

 

Balance Method by Dr. Richard Tan:

* Left side: Zulinqi (GB 41), Yanglingquan (GB 34), Shenmen (HT 7), Tongli (HT 5), Shaohai (HT 3), Quze (PC 3), Daling (PC 7)

* Right side: Taichong (LR 3), Ligou (LR 5), Ququan (LR 8), Zhongzhu (TH 3), Waiguan (TH 5), Tianjing (TH 10)

* Yintang (Extra 1), bilateral ear Shenmen, Anmian

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

 

Ear Acupuncture:

* Insomnia: Heart, Kidney, Parietal Lobe. Place magnetic ear balls or embedded ear needles on one or both sides of the ear every evening and remove in the morning. Five days of consecutive therapy equals one treatment course.

* Controlling cigarette smoking urges: Mouth, Bronchi, Lung, Pituitary Gland, Shenmen, Subcortex. Switch ears every five days. Instruct the patient to massage the points for one to two minutes when smoking urges occur.

* Psychiatric disorders: Shenmen, Heart, Subcortex, Brain Stem. Strongly stimulate the points every other day. Fifteen treatments equal one course. Ear seeds can also be used. Alternate ears every week.

* To quit cigarette smoking: Mouth, Bronchi, Lung, Pituitary Gland, Shenmen, Subcortex. Switch ear every five days. Instruct the patient to massage the points for one to two minutes when smoking urges occur.

* Select six points from the following and needle both ears: Stomach, Adrenal Gland, Shenmen, Kidney, Subcortex to Endocrine, Brain Stem, Heart.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Improving depression, anxiety, stress, nervousness: Shenmen, Heart, Nervous Subcortex, Anxious, Be Happy, Liver, Occiput. Bleed Ear Apex.

* Improving sleep: Shenmen, Heart, Kidney, Occiput, Neurasthenia Area, Neurasthenia Point, Nervous Subcortex. Bleed Ear Apex.

* Hysteria: Heart, Liver, Shenmen, Brain Stem, Anxious Point, Forehead, Nervous Subcortex. Bleed Ear Apex.

§ For hysterical paralysis, add Knee Joint, Hip Joint, Lumbosacral

§ For hysterical aphasia, add Mouth, Glottis, San Jiao

§ For hysterical blindness, add Vision 2, Eyes, Occiput

* Psychosis: Forehead, Nervous Subcortex, Heart, Liver, Shenmen, Occiput, Anxious. Bleed Ear Apex.

§ For manic type, add Brain Stem

§ For depressive type, add Be Happy

* Addiction:

§ Smoking addiction (smoking withdrawal): Sympathetic, Shenmen, Mouth, Lower Lung, Nervous Subcortex, Anxious

§ Alcohol addiction: Sympathetic, Shenmen, Drunk Point, Liver, Nervous Subcortex, Anxious Point

§ Drug addiction: Sympathetic, Shenmen, Kidney, Liver, Lower Lung, Anxious Point, Nervous Subcortex. Bleed Ear Apex.

 

NUTRITION

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

* Encourage the consumption of fruits and vegetables such as apricots, asparagus, avocados, bananas and broccoli. Brown rice, dried fruit, figs, salmon, garlic, green leafy vegetables, soy products, and yogurt are also recommended.

* Avoid caffeine (coffee, tea, cola, chocolate), tobacco, alcohol and sugar whenever possible.[4]

* 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:

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

 

LIFESTYLE INSTRUCTIONS

* If insomnia is related to work or stress, advise the patient not to work in the bedroom and remove anything that may be a reminder of the office or work. A warm bath or light snack before bedtime may also be helpful.

* 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 daily routines to do something 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.

* Sleep by 10 p.m. In TCM, 11 p.m. to 1 a.m. is when the yin shifts to yang. It is crucial for the body to be at rest during this time for optimal health.

 

CASE STUDIES

* C.K., a 54-year-old female, presented with obsessive compulsive disorder, anxiety and over thinking. Patient had been taking Celexa (citalopram) and Effexor (venlafaxine) for many years for anxiety and depression. The practitioner diagnosed the condition as disturbance of the shen (spirit). She was treated with Calm (ES), four capsules three times daily based upon her small frame and weight of 120 pounds. She was also recommended to take vitamin B12. After one year of taking the herbs and returning to the Western drugs occasionally, the patient began to handle and recognize her emotions and no longer uses the drugs. In her five-year follow-up treatment, she was only taking two capsules two times daily, doing her spiritual work, breathing properly, and was much happier. Submitted by N.H., Chatsworth, California.

* A 65-year-old female patient, whose husband had recently died and was left to run their business, presented with high blood pressure and was not interested in Western medicine for treatment. Her blood pressure was 160/92 mmHg and her heart rate was 78 beats per minute. She frequently experienced stress at work, sleeping difficulties, and would wake up feeling very anxious during the night. The practitioner diagnosed the condition as Liver qi stagnation and phlegm fire. The patient was treated with Calm (ES) four capsules three times daily. After seeing results from the herbs, her Western doctor stopped pushing her to take the Western drugs. Occasionally the patient experienced an increase in her blood pressure due to stress, and would come in to receive acupuncture treatment. The patient was also encouraged to exercise and lose weight to help with her overall health. Submitted by L.W., Arroyo Grande, California.

* P.I., a 46-year-old female, presented with spotting and uterine bleeding between menstrual cycles, which were irregular short cycles ranging from 15 to 27 days long. She had been experiencing heavy bleeding, no clots during her cycles, night sweats, and chronic anxiety, which was worse before her menses. Her Western diagnosis was perimenopausal syndrome with chronic anxiety; the TCM diagnosis was Liver and Kidney yin deficiencies with deficiency heat, blood stagnation, Liver qi stagnation, and shen (spirit) disturbance. The practitioner prescribed Calm (ES), two grams three times a day and has been taking this formula for anxiety the past two years. In addition, she was also prescribed Nourish and Notoginseng 9, same dosage as the other formula, for six months to stop the uterine bleeding. Notoginseng 9 successfully stopped the irregular bleeding and night sweats, which had been gradually reduced over the six month period. Her periods have returned to normal with light flow and her anxiety is also much better ever since adding Nourish. The patient had excellent wellness and lifestyle habits, including her diet and exercise, and she was very compliant with taking her herbs. Submitted by E.Z., Portland, Oregon.

* J.K., a 35-year-old male, presented with alcoholism, with a constant urge to drink. However, he did not want to attend AA meetings. Other than this, the patient was considered to be healthy. The patient had also just previously quit smoking cold turkey. For treatment the patient was given Calm (ES) and Liver DTX in conjunction with receiving acupuncture. As a result, the patient reported that he no longer had the urge to drink. The practitioner had also counseled the patient that this was not a stand alone treatment for alcoholism and advised the patient to go seek more help. Submitted by B.L., Fort Myers, Florida.

* J.H., a 37-year-old female, presented with anxiety, depression and addiction symptoms. There was also a history of ulcerative colitis. Pulse was weak and wiry, and her tongue had a red tip with a center crack and white coat. The practitioner diagnosed this condition as qi and blood stagnation, Liver qi stagnation, and shen (spirit) disturbance. For treatment the patient was prescribed a combination of Astringent Complex, Calm (ES), and Gui Pi Tang (Restore the Spleen Decoction). The patient had completely changed for the better as she had stopped taking Western medication, quit smoking, and felt stable and happy after two months of treatment. Submitted by T.W., Perrysburg, Ohio.

* M.D., a 41-year-old female, presented with manic depressive disorder. PMS symptoms, constipation and a history of depression and addiction were also noted. Pulse was wiry and her tongue had a red tip. The practitioner diagnosed this condition as Liver qi stagnation with heat disturbing the shen (spirit) and consuming fluids. Upon diagnosis, the patient was given Calm (ES) along with Zhi Zi (Fructus Gardeniae) and Da Huang (Radix et Rhizoma Rhei). With taking the herbs the patient had stated she had never felt this good naturally before. She was very thankful. Submitted by T.W., Perrysburg, Ohio.

* A.D., a 58-year-old female, presented with nervousness, along with worrisome scattered thoughts throughout the day. It was noted that the patient was anorexic as well. Blood pressure was 112/74 mmHg and heart rate was 60 beats per minute. The practitioner diagnosed this condition as Spleen and Heart qi deficiencies with Liver qi stagnation agitating the shen (spirit). The patient was prescribed Calm (ES) to take as she was dealing with her mother’s health condition and their strained relationship as well. During the times she took the Calm (ES), the patient responded very well and continues to use them during times of stress. Submitted by L.H., Chicago, Illinois.

* L.H., a 43-year-old female, presented with anxiety symptoms consisting of restless thoughts, insomnia and waking up at 3 a.m. almost every night. It was noted that the patient’s anxiety was related to a business situation involving traveling and that she felt very overwhelmed at work. Blood pressure was 110/72 mmHg and heart rate was 62 beats per minute. The practitioner diagnosed the condition as Liver qi stagnation with fire harassing the shen (spirit). Upon diagnosis, Calm (ES) was prescribed and she was directed to take it before and during the business trip. After taking the herbs, the patient experienced immediate effect of relief from stress and insomnia. The herbs also gave her a peaceful feeling with her work situation. Submitted by L.H., Chicago, Illinois.

* S.L., a 42-year-old female, presented with a sensation of insanity, grief and sadness. Objective findings were wide-opened eyes and shaking hands. The practitioner diagnosed this condition as disturbance of the shen (spirit). Upon diagnosis the patient was directed to take Calm (ES) as needed. As a result of taking the herbs for four days, the patient noticed herself feeling calmer and less hysterical. However, the patient had noted that in order for Calm (ES) to be effective, she needed to take it several times a day. Submitted by S.L., Yuma, Arizona.

* A.L., a 36-year-old female, presented with PMS symptoms including stomach cramping, moodiness and breast tenderness. Pulse was wiry and the tip and sides of her tongue were both slightly red. The TCM diagnosis was Liver qi stagnation. For treatment, Calm (ES) was prescribed at two capsules two times a day. As a result of taking the herbs, it was noticed one week before her next menstrual cycle that the patient felt more relaxed, with no breast tenderness or cramping. Submitted by M.P., Muskego, Wisconsin.

* W.Y., a 62-year-old male, presented with insomnia due to stress and anxiety, which caused him to wake two to three times per night. Objective findings included red cheeks and purple lips. The TCM diagnosis was blood stagnation with Liver fire. For treatment Circulation was prescribed to treat the blood stagnation as well as Calm (ES) to treat the anxiety. Both were prescribed at a dosage of 2 capsules two times a day. Within the first week of taking the herbs the patient’s sleep had improved to waking up only once during the night. His legs were still blue so the dosage of Circulation was increased. Submitted by M.P., Muskego, Wisconsin.

* A.B., a 22-year-old female, presented with anxiety and fear of failure. Additional symptoms she had been experiencing were depression, insomnia, and poor eating habits. It was noted that her shen (spirit) was not settled and she had dysglycemia. The practitioner diagnosed this condition as Liver qi stagnation and Spleen qi deficiency; Western diagnosis was low self-esteem along with low caloric diet. Calm (ES) was prescribed to take during the day and then Calm ZZZ to take at night. After two weeks she was then instructed to take Schisandra ZZZ at night and Shine during the day. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was taken as well until she began eating at regular intervals. After one month of taking the herbs, the insomnia had resolved and regular sleeping habits were occurring. In addition, her depression was lifted. She started experiencing major changes in attitude, life purpose and direction. Six weeks later she maintained her results by taking Calm. The anxiety had also reduced, only being anxious during stressful situations, which she had been resolving. She had also established regular eating habits, her energy had improved and her menses became regular without pain. Overall, the patient was very pleased with the outcome of taking the herbs. Submitted by N.T., Bethesda, Maryland.

* S.B., a 49-year-old female, presented with mood swings. It was also noted that she had night sweats and ringing in the ears. She was borderline diabetic, which she managed well through her diet. The practitioner diagnosed this condition as Kidney and Liver yin deficiencies with Liver qi stagnation. Calm (ES) was prescribed in combination with Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill). By the end of the first week taking the herbs, she had reported feeling less volatile, a decrease in night sweating, and was sleeping more deeply. Submitted by N.V., Muir Beach, California.

* L.L., a 56-year-old female, presented with frustration, anger and sadness over losing her home in the hurricanes. She was unable to move through these emotions. She was also diagnosed with hypertension, high cholesterol, and post-traumatic stress syndrome recently, and refused to take medications. Her blood pressure was 138/78 mmHg and her heart rate was 82 beats per minute. She also suffered from headaches in the temporal region and the vertex. Other symptoms included twitching of the eyes, agitation, red eyes, and a scalloped tongue with thick yellow tongue coating. The TCM diagnoses were damp-heat in the Liver and Gallbladder, Kidney yin deficiency, and excess fire and wind rising. She was prescribed the following formulas: Calm (ES) at 1 to 3 capsules, as needed, Cholisma at 4 capsules twice daily, and Gentiana Complex at 5 capsules twice daily. The patient gained control of her emotions immediately after taking Calm (ES). Blood pressure gradually reduced over time to 120/72 mmHg. The practitioner commented that the combination of these formulas is phenomenal. Submitted by M.H., West Palm Beach, Florida.

* A 49-year-old female social worker presented with stress, anxiety, dizziness and irregular menses. The patient reported occasional irritability, hot flashes, night sweats and dysmenorrhea. Dry eyes and muscle cramps were also present. The patient was diagnosed with Kidney and Liver yin deficiencies with Liver qi stagnation. With Balance (Heat) and Calm (ES), the patient experienced a reduction of hot flashes and had less irritability, stress, anxiety and dizziness. She also stated that she slept better and her menses were not as painful. The practitioner concluded that Balance (Heat) and Calm (ES) were an excellent combination for the condition. Submitted by D.M., Raton, New Mexico.

* A 44-year-old female police officer presented with chronic headaches located in the occipital/temporal regions. She stated that stress aggravated the problem. There was acute tenderness at the Fengchi (GB 20) area as well as in the cervical spine. She also experienced pain on her zygoma. The practitioner diagnosed the condition as qi and blood stagnation in Gallbladder, Urinary Bladder, and Small Intestine channels in addition to myofascial syndrome, which was stress-induced because of the nature of her job. She was treated with Corydalin (AC), Neck & Shoulder (AC) and Calm (ES), which were all so effective that they subsequently replaced her medication, Imitrex (sumatriptan). The practitioner concluded that a critical aspect in the treatment was to assist the patient in coping with stress, which in turn made the herbal treatment more effective. Submitted by S.C., La Crescenta., California.

* An 18-year-old female presented with vivid visual hallucinations at night, mainly when going alone from her car to the house. The Western diagnosis was paranoia with visual hallucination; the TCM diagnosis was Liver qi stagnation with shen (spirit) disturbance. The practitioner prescribed three capsules of Calm (ES), three times daily for two weeks, and taught the patient to engage in positive visual imagery and mental clarification. After the integrative therapies, the patient reported that her hallucinations and fears had resolved. Submitted by C.L., Chino Hills, California.

* A 40-year-old male presented with severe insomnia, restlessness, and hyperactivity. Tongue body appeared red while his pulse felt rapid and wiry. Western assessment of his condition was schizophrenia. The TCM diagnosis was Heart fire and Liver fire. Within a week of taking Calm (ES), his sleep time increased from 2 to 3 hours a night to 7 to 8 hours a night. His restlessness and hyperactivity also subsided. Submitted by T.G., Albuquerque, New Mexico.

* M.C., a 53-year-old female, presented with anxiety. She was very anxious and fearful of flying. Otherwise healthy, she had to take her son up north to begin college and had to fly, and came to my office for treatment. Her blood pressure was 120/78 mmHg and her heart rate was 76 beats per minute. The TCM diagnosis was Liver fire. Calm (ES) was prescribed at 4 to 6 capsules before the flight. She reported later that she took 4 capsules one hour before her flight, and that her anxiety was under control. She was able to fly out more often to see her son as she felt she could handle the flights when she takes Calm (ES). Submitted by M.H., West Palm Beach, Florida.

* A 53-year-old male miner presented with insomnia, depression, stress, anxiety and fatigue. He had difficulty falling asleep, which was aggravated by relentless worrying. Other symptoms included palpitations and occasional dizziness. A choppy pulse and a pale tongue were present, along with a pale complexion. The practitioner diagnosed the condition as Heart and Spleen blood deficiency. After the initial treatment, his sleep improved from two to three hours per night to five to six hours per night. The patient was no longer fatigued and felt much calmer. Because of his occupation and the nature of his condition, he was unable to take the Western medication since drowsiness was one side effect. The combination of Schisandra ZZZ and Calm (ES) made it possible to manage his condition with no known side effects. The practitioner recommended continuous application of the herbal combination of Schisandra ZZZ and Calm (ES) for his medical condition. Submitted by D.M., Raton, New Mexico.

* A 78-year-old female with a past history of stroke presented with memory loss, insomnia, and nightmares. She was easily frightened and frequently woke up in the middle of the night because of her dreams. Her Western medical diagnosis was dementia. The TCM diagnosis included qi and blood stagnation, Liver and Kidney yin deficiency, and Heart fire. She was given Calm (ES) and Neuro Plus. After taking the herbs for approximately one month, the patient was able to recall the practitioner’s name for the very first time! In addition, her sleep, mood, complexion, and energy level improved greatly. The patient was much calmer and less irritable. Despite the fact that she still did not know the name of her town or the correct month, there were many improvements in all other areas. The practitioner concluded that the combination of Calm (ES) and Neuro Plus has enhanced the patient’s quality of life. Submitted by P.R., Encinitas, California.

* B.B., a 51-year-old female, presented with daily, moderate headaches. She suffered from breast tenderness and a headache that worsened before each period. She also had insomnia and would waken and stay awake for an hour, several times a night. She suffered from irritability that may have arisen from her recent quitting of tobacco smoking. Her tongue was purplish red; her pulse was rapid and wiry. The TCM diagnosis was Liver fire and Liver qi stagnation. Jia Wei Xiao Yao San (Augmented Rambling Powder) and Calm (ES) were prescribed at 2 grams each, daily. After taking the herbs, the patient reported the breast soreness was gone. Her headache began to diminish, especially after she was past nicotine detox. Irritability was also greatly reduced. The patient continued taking the herbs for a year, and noticed that if she stopped taking the herbs, the irritability would return but not the headache or sore breasts. She continues with the formulas at 1 gram per day each, and is very impressed with the results. Submitted by C.D., Phoenix, Oregon.

 

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), muscles (stiffness and pain), stomach (acid reflux, peptic ulcer disease, irritable bowel syndrome), 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 (ES) contains herbs with adaptogenic effects to help the patients cope with nonstop stress. Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Fu Shen (Poria Paradicis) have an adaptogenic effect to help the patients deal with physical stress by enhancing duration and relieving restlessness.[5],[6] Chai Hu (Radix Bupleuri), Gou Teng (Ramulus Uncariae cum Uncis), Suan Zao Ren (Semen Ziziphi Spinosae), Da Zao (Fructus Jujubae), Xie Cao (Radix et Rhizoma Valerianae) and Zhi Zi (Fructus Gardeniae) have calming effects on the brain to help the patients manage mental stress by promoting relaxation and improving sleeping.[7],[8],[9],[10],[11],[12] To improve mental functions and ameliorate memory impairment, herbs are used in this formula for their positive cognitive effect, such as Da Zao (Fructus Jujubae) and Gan Cao (Radix et Rhizoma Glycyrrhizae). [13],[14]

        In addition, herbs with anxiolytic and antidepressant effects are used in this formula to combat stress, anxiety and depression. Suan Zao Ren (Semen Ziziphi Spinosae) and Xi Yang Shen (Radix Panacis Quinquefolii) both have an anxiolytic effect to relieve stress and anxiety.[15],[16] Huang Qin (Radix Scutellariae) exerts its anxiolytic effect through positive allosteric modulation of the GABA(A) receptor complex.[17] Xie Cao (Radix et Rhizoma Valerianae) has both anxiolytic and antidepressant activities.[18] According to neurobiological research, administration of Xie Cao (Radix et Rhizoma Valerianae) and its active valerenic acid is associated with a significant reduction in anxious behavior. The herb and its active compounds exert their anxiolytic effects by interacting with the GABA(A)-ergic system, a mechanism of action similar to the benzodiazepine drugs.[19]

        To restore normal functions of the heart, Calm (ES) has herbs with various cardiovascular and circulatory functions. In one laboratory study, intravenous injection of Dang Gui (Radix Angelicae Sinensis) was 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 in "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.[20],[21],[22],[23] 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.[24] Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) has shown marked effectiveness in treating subjects with palpitations and artificially-induced arrhythmia.[25],[26] Chai Hu (Radix Bupleuri) has an antihyperlipidemic effect, and has been shown to lower total cholesterol, low-density lipoprotein (LDL) and triglyceride levels.[27] Lastly, Gou Teng (Ramulus Uncariae cum Uncis) has a moderate and prolonged antihypertensive effect to treat hypertension by decreasing heart rate and reducing peripheral vascular resistance.[28],[29] Gou Teng (Ramulus Uncariae cum Uncis) also has a cardioprotective effect for prevention and treatment of vascular proliferative disorders, such as atherosclerosis and restenosis after angioplasty.[30]

        Calm (ES) contains many herbs with analgesic and anti-inflammatory effects to help the body cope with muscle aches and pain due to stress. Dang Gui (Radix Angelicae Sinensis) has both analgesic and anti-inflammatory effects with potency comparable to or greater than acetylsalicylic acid.[31],[32] It has been used successfully to treat low back and leg pain,[33] vascular headache,[34] migraine headache,[35] and the general complaint of pain.[36] 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.[37] Lastly, Chai Hu (Radix Bupleuri) demonstrates both analgesic and anti-inflammatory functions,[38],[39] and the saikosaponins appear to be the main compounds for these actions.[40] Huang Qin (Radix Scutellariae) exhibits significant and potent anti-inflammatory activity via inhibition of nitric oxide, cyclo-oxygenase-2, prostaglandin E2, and proinflammatory cytokines.[41] Finally, Chuan Xiong (Rhizoma Chuanxiong) illustrates an anti-inflammatory effect through its inhibitory activity on TNF-α production and bioactivity.[42] Chuan Xiong (Rhizoma Chuanxiong) has been used successfully to treat many different types of headaches.[43],[44],[45]

        To alleviate adverse effect of stress on the digestive system, Calm (ES) contains many herbs with gastroprotective effects. Bai Zhu (Rhizoma Atractylodis Macrocephalae) has a dual effect to regulate the digestive tract,[46] and is effective to treat either constipation or diarrhea.[47],[48] Mu Li (Concha Ostreae) has a significant effect to neutralize gastric acid, and is commonly used to treat gastric and duodenal ulcers.[49],[50] Da Huang (Radix et Rhizoma Rhei) has a remarkable laxative and purgative effect, as it works directly on the large intestine to increase peristalsis and induce bowel movements.[51] Gan Cao (Radix et Rhizoma Glycyrrhizae) has a proven effect to prevent and treat peptic ulcers. The mechanisms of this action include inhibition of gastric acid secretion, binding and deactivation of gastric acid, and promotion of recovery from ulceration.[52] 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.[53] 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.[54]

        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.[55] Dang Gui (Radix Angelicae Sinensis) increases the phagocytic activity of the macrophages.[56] 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.[57],[58]

        In summary, Calm (ES) is an excellent formula to relax the mind and restore 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 treatment for stress and anxiety focuses primarily on the 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.

 



[1] Chan K, Lo AC, Yeung JH, Woo KS. Journal of Pharmacy and Pharmacology 1995 May;47(5):402-6.

[2] Pharmacotherapy 1999 July;19(7):870-876.

[3] European Journal of Drug Metabolism and Pharmacokinetics 1995; 20(1):55-60.

[4] Balch, JF. et al. Prescription for Nutritional Healing. Avery Publishing Group. 1997.

[5] Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1974; 8:13.

[6] Zhong Yao Da Ci Dian (Dictionary of Chinese Herbs), 1977:1596.

[7] Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983; 888.

[8] Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983; 786.

[9] Chang Yong Zhong Yao Xian Dai Yan Jiu Yu Lin Chuan (Recent Study & Clinical Application of Common Traditional Chinese Medicine), 1995; 489:491.

[10] Cao JX, Zhang QY, Cui SY, Cui XY, Zhang J, Zhang YH, Bai YJ, Zhao YY. Hypnotic effect of jujubosides from Semen Ziziphi Spinosae. Department of Pharmacology, Peking University, School of Basic Medical Science, 38 Xueyuan Lu, Beijing 100191, China. J Ethnopharmacol. 2010 Jul 6;130(1):163-6.

[11] Xian Dai Zhong Yao Yao Li Xue (Contemporary Pharmacology of Chinese Herbs), 1997; 1092.

[12] Jiang Su Yi Yao (Jiangsu Journal of Medicine and Herbology), 1976; (1):28.

[13] Heo HJ, Park YJ, Suh YM, Choi SJ, Kim MJ, Cho HY, Chang YJ, Hong B, Kim HK, Kim E, Kim CJ, Kim BG, Shin DH. Effects of oleamide on choline acetyltransferase and cognitive activities. Biosci Biotechnol Biochem. 2003 Jun;67(6):1284-91.

[14] Zhu Z, Li C, Wang X, Yang Z, Chen J, Hu L, Jiang H, Shen X. 2,2',4'-trihydroxychalcone from Glycyrrhiza glabra as a new specific BACE1 inhibitor efficiently ameliorates memory impairment in mice. J Neurochem. 2010 Jul;114(2):374-85.

[15] Peng WH, Hsieh MT, Lee YS, Lin YC, Liao J. Anxiolytic effect of seed of Ziziphus jujuba in mouse models of anxiety. Institute of Chinese Pharmaceutical Sciences, China Medical College, Taichung, Taiwan, PR China. J Ethnopharmacol. 2000 Oct;72(3):435-41.

[16] Wei XY, et al. Anxiolytic effect of saponins from Panax quinquefolium in mice. Department of Pharmacology, Shenyang Pharmaceutical University, Shenyang 110016, PR China. J Ethnopharmacol. 2007 May 22;111(3):613-8.

[17] Hui KM, Huen MS, Wang HY, Zheng H, Sigel E, Baur R, Ren H, Li ZW, Wong JT, Xue H. Anxiolytic effect of wogonin, a benzodiazepine receptor ligand isolated from Scutellaria baicalensis Georgi. Department of Biochemistry, Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, China. Biochem Pharmacol. 2002 Nov 1;64(9):1415-24.

[18] Hattesohl M, Feistel B, Sievers H, Lehnfeld R, Hegger M, Winterhoff H. Extracts of Valeriana officinalis L. s.l. show anxiolytic and antidepressant effects but neither sedative nor myorelaxant properties. Department of Pharmacology and Toxicology, Universitätsklinikum Münster, Westfälische Wilhelms-Universität Münster, Domagkstr. 12, 48149 Münster, Germany. Phytomedicine. 2008 Jan;15(1-2):2-15.

[19] Murphy K, Kubin ZJ, Shepherd JN, Ettinger RH. Valeriana officinalis root extracts have potent anxiolytic effects in laboratory rats. Department of Psychology, Eastern Oregon University, LaGrande, OR 97850, USA. Phytomedicine. 2010 Jul;17(8-9):674-8.

[20] Jiang Su Zhong Yi (Jiangsu Chinese Medicine), 1965; (3):22.

[21] Xue, JX. et al. Effects of the combination of astragalus membranaceus (Fisch.) Bge. (AM), angelica sinensis (Oliv.) Diels (TAS), cyperus rotundus L. (CR), ligusticum chuanxiong Hort (LC) and paeonia veitchii lynch (PV) on the hemorrheological changes in "blood stagnating" rats. Chung Kuo Chung Yao Tsa Chih; 19(2):108-10, 128. Feb 1994.

[22] Lan Zhou Yi Xue Yuan Xue Bao (Journal of Lanzhou University of Medicine), 1989; 15(3):125.

[23] Zhong Cao Yao Tong Xun (Journal of Chinese Herbal Medicine), 1976; (3):30.                                                      

[24] Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983; 934.

[25] Shang Hai Yi Yao Za Zhi (Shanghai Journal of Medicine and Herbology), 1988; (2):12.

[26] Jiang Su Zhong Yi Za Zhi (Jiangsu Journal of Chinese Medicine), 1987; 8(10):688.

[27] Zhong Yao Xue (Chinese Herbology), 1998; 103:106.

[28] Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and Pharmacology of Common Chinese Drugs), 1994; 1419:1423.

[29] Zhong Cao Yao Tong Xun (Journal of Chinese Herbal Medicine), 1976; 7:45.

[30] Kim TJ, Lee JH, Lee JJ, Yu JY, Hwang BY, Ye SK, Shujuan L, Gao L, Pyo MY, Yun YP. Corynoxeine isolated from the hook of Uncaria rhynchophylla inhibits rat aortic vascular smooth muscle cell proliferation through the blocking of extracellular signal regulated kinase 1/2 phosphorylation. Biol Pharm Bull. 2008 Nov;31(11):2073-8.

[31] Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1975; (6):34.

[32] Yao Xue Za Zhi (Journal of Medicinals), 1971; (91):1098.

[33] Xin Zhong Yi (New Chinese Medicine), 1980; 2:34.

[34] Hu Bei Zhong Yi Za Zhi (Hubei Journal of Chinese Medicine), 1993; (2):9.

[35] Bei Jing Yi Xue (Beijing Medicine), 1988; 2:95.

[36] Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1976; 12:26.

[37] Li CQ, He LC, Jin JQ. Atractylenolide I and atractylenolide III inhibit Lipopolysaccharide-induced TNF-alpha and NO production in macrophages. Phytother Res. 2007 Apr;21(4):347-53.

[38] Shen Yang Yi Xue Yuan Xue Bao (Journal of Shenyang University of Medicine), 1984; 1(3):214.

[39] Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983; 888.

[40] Yamamoto M., Kumagai A. & Yamamura Y. () Structure and actions of saikosaponins isolated from Bupleurum falcatum L. I. Anti-inflammatory action of saikosaponins. Arzneim Forsch. 1975, 25: 1021-1023.

[41] Kim EH, Shim B, Kang S, Jeong G, Lee JS, Yu YB, Chun M. Anti-inflammatory effects of Scutellaria baicalensis extract via suppression of immune modulators and MAP kinase signaling molecules. Department of Biological Sciences, Seoul National University, Seoul 151-742, Republic of Korea. J Ethnopharmacol. 2009 Nov 12;126(2):320-31.

[42] Liu L, Ning ZQ, Shan S, Zhang K, Deng T, Lu XP, Cheng YY. Phthalide Lactones from Ligusticum chuanxiong inhibit lipopolysaccharide-induced TNF-alpha production and TNF-alpha-mediated NF-kappaB Activation. Planta Med. 2005 Sep;71(9):808-13.

[43] Zhong Xi Yi Jie He Za Zhi (Journal of Integrated Chinese and Western Medicine), 1991; (1):52.

[44] Shan Xi Zhong Yi Za Zhi (Shanxi Journal Chinese Medicine), 1985; 10:447.

[45] Si Chuan Zhong Yi (Sichuan Chinese Medicine), 1996; (11):27.

[46] Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and Pharmacology of Common Chinese Drugs), 1994; 739:742.

[47] Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1978; 4:9.

[48] Shan Dong Zhong Yi Za Zhi (Shandong Journal of Chinese Medicine), 1982; 2:107.

[49] Zhong Yao Xue (Chinese Herbology), 1998; 686:688.

[50] Zhong Yi Za Zhi (Journal of Chinese Medicine), 1983; 3:36.

[51] Zhong Yao Xue (Chinese Herbology), 1998; 251:256.

[52] Zhong Yao Zhi (Chinese Herbology Journal), 1993; 358.

[53] Zhong Hua Nei Ke Xue Za Zhi (Journal of Chinese Internal Medicine), 1960; 3:226.

[54] Zhong Yao Lin Chuan Xin Yong (New Clinical Applications of Chinese Medicine), 2001; 163.

[55] Shang Hai Yi Ke Da Xue Xue Bao (Journal of Shanghai University of Medicine), 1986; 13(1):20.

[56] Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1978; 17(8):87.

[57] Jun Shi Yi Xue Jian Xun (Military Medicine Notes), 1977; 2:5.

[58] Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1979; 6:60.