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Herbal DRX


CLINICAL APPLICATIONS

* Edema and generalized water accumulation

* Swelling due to water accumulation

* Feeling of heaviness or sluggishness in the body, preference to lay down or sleep all day

* Tan yin (phlegm retention) syndrome

 

WESTERN THERAPEUTIC ACTIONS

* Diuretic effect to eliminate water and treat edema

 

CHINESE THERAPEUTIC ACTIONS

* Strengthens the Spleen

* Resolves dampness

* Promotes urination and treats edema

 

DOSAGE

Take 3 to 4 capsules three times daily. For maximum effectiveness, take the herbs on an empty stomach.

 

INGREDIENTS


Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Chen Pi (Pericarpium Citri Reticulatae)

Chi Fu Ling (Poria Rubra)

Chuan Mu Xiang (Radix Vladimiriae)

Fu Ling (Poria)

He Zi (Fructus Chebulae)

Hua Shi (Talcum)

Sheng Jiang Pi (Pericarpium Zingiberis Recens)

Wu Bei Zi (Galla Chinensis)

Yi Yi Ren (Semen Coicis)

Ze Xie (Rhizoma Alismatis)

Zhu Ling (Polyporus)


 

BACKGROUND

Edema is the swelling of soft tissues due to increased accumulation of water and fluids. Edema may be localized or generalized. Localized edema is usually caused by venous obstruction, lymphatic obstruction, or infection. Generalized edema is commonly due to heart failure, liver failure or kidney failure. In addition to water and fluid retention, other symptoms of edema may include feeling of tightness or fullness in the chest, feeling of heaviness or sluggishness in the body, and preference to lay down or sleep all day. Optimal treatment requires use of herbs to treat the cause and the symptoms.

 

FORMULA EXPLANATION

Herbal DRX is designed specifically to treat edema, water retention and swelling. It treats the cause of edema by strengthening the Spleen and resolving dampness. It treats the symptoms of edema by clearing damp-heat and draining water through urination.

        In this formula, Fu Ling (Poria), Bai Zhu (Rhizoma Atractylodis Macrocephalae), and Yi Yi Ren (Semen Coicis) strengthen the Spleen to resolve dampness. Fu Ling (Poria), Zhu Ling (Polyporus), Ze Xie (Rhizoma Alismatis), and Sheng Jiang Pi (Pericarpium Zingiberis Recens) resolve dampness, regulate water circulation, and drain water accumulation. Sheng Jiang Pi (Pericarpium Zingiberis Recens) is especially good for water trapped in the superficial parts of the skin. Hua Shi (Talcum) and Chi Fu Ling (Poria Rubra) clear damp-heat to promote normal urination. Chuan Mu Xiang (Radix Vladimiriae) and Chen Pi (Pericarpium Citri Reticulatae) activate qi circulation, which is often stagnant in cases of water and damp accumulation. Lastly, Wu Bei Zi (Galla Chinensis) and He Zi (Fructus Chebulae) are astringent herbs that reduce swelling, and constrict and push the excess fluids out of the body.

        In summary, Herbal DRX is an excellent formula to treat both the cause and symptoms of edema. This formula may be used individually, or in combination with others to treat the cause and/or complications of edema.

 

CAUTIONS & CONTRAINDICATIONS

* Herbal DRX is an excellent formula to eliminate accumulation of water and treat edema. However, in addition to elimination of excessive water, diuretic herbs may lead to excretion of some electrolytes. Therefore, if the formula is to be taken for more than two weeks, it is important to receive supplementation of additional electrolytes to prevent imbalance. Symptoms of electrolyte imbalance include muscle spasms and cramps. Common supplements include bananas, orange juice, multivitamins and minerals, and sports drinks.

* Concurrent use of diuretic herbs and diuretic drugs is not recommended as they have the same functions to eliminate water and electrolytes. Concurrent use may contribute to dehydration and electrolyte imbalance.

* This formula is contraindicated during pregnancy.

 

CLINICAL NOTES

* In comparison with pharmaceutical drugs, diuretic herbs have a moderate potency and a slower onset of action. Therefore, most patients will experience noticeable diuretic effect only after two to four weeks. This formula is designed as a long-term therapy for treatment and prevention of edema-related disorders. Acute conditions, such as acute nephritis with edema, should be treated with other methods and formulas.

* In addition to eliminating excessive water, some herbs in this formula have also shown a marked effect to reduce blood pressure, blood glucose levels, and cholesterol levels, and improve kidney functions.

* Severity of water retention can be easily checked by pressing the patient’s shin bone [around the area of Ligou (LR 5)]. The deeper the indentation and the longer it stays without bouncing back, the more severe the condition is.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Deep pulse on all three positions on both hands

 

SUPPLEMENTARY FORMULAS

* With excessive damp and phlegm, add Pinellia Complex.

* For deficient types of hypertension with edema, add Gastrodia Complex.

* For excess types of hypertension with edema, add Gentiana Complex.

* For edema due to compromised kidney functions, add Kidney DTX.

* For obesity with edema, add Herbalite.

* For Spleen deficiency with edema, add GI Tonic.

* For high cholesterol with excessive dampness, add Cholisma or Cholisma (ES).

* For gallstones, add Dissolve (GS).

* For kidney stones, add Dissolve (KS).

* For cysts or fibroids in the uterus or ovaries, add Resolve (Lower).

* For fibroids in the breast with excessive dampness, add Resolve (Upper).

* For excessive dampness in conditions such as dysuria, vaginitis, yellow vaginal discharge, add V-Support.

* For yang deficiency type of edema with coldness and possible low back pain, add Zhen Wu Tang (True Warrior Decoction).

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Lieque (LU 7), Hegu (LI 4), Piani (LI 6), Yinlingquan (SP 9), Weiyang (BL 39), Pishu (BL 20), Shenshu (BL 23), Shuifen (CV 9), Ciliao (BL 32), Guanyuan (CV 4), Shangqiu (SP 5), Fenglong (ST 40)

 

Classic Master Tung's Points:

* Edema (general): Dihuang (T 77.19), Tongshen (T 88.09), Tongwei (T 88.10), Shuiqu (T 66.09), Tongbei (T 88.11)  

* Edema (face): Dihuang (T 77.19), Tianhuangfu [Shenguan] (T 77.18), Tongshen (T 88.09), Tongwei (T 88.10), Tongbei (T 88.11), Huoying (T 66.03), Shuijin (T 1010.20) towards Shuitong (T 1010.19), Xinling (T 33.17)*

  *   Edema (lower body): Fuchang (T 77.12), Shuiqu (T 66.09)
  *   Edema (pulmonary): Chongzi (T 22.01), Chongxian (T 22.02), Simazhong (T 88.17), Neiguan (PC 6). Bleed the LU and HT area below the knee. Bleed before needling for best result. 
 

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

* Edema: Shuiqu (T 66.09), Tongshen (T 88.09)

 

Balance Method by Dr. Richard Tan:

* Left side: Hegu (LI 4), Shaoze (SI 1), Wangu (SI 4),Yinlingquan (SP 9), Yinbai (SP 1), Gongsun (SP 4)

* Right side: Chize (LU 5), Jingqu (LU 8), Shaoshang (LU 11), Fenglong (ST 40), Weizhong (BL 40), Kunlun (BL 60)

* Alternate sides in between treatments.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Kidney, Spleen, Heart, Sanjiao, Endocrine, Ascites Point

 

NUTRITION

* A low-sodium diet is recommended, as sodium may cause fluid retention.

* Consume an adequate amount of vitamin B complex, which helps to reduce water retention.

* Consume a sufficient amount of free-form amino acid complex, as edema is sometimes caused by inadequate protein assimilation.

* Increase the consumption of foods that have natural diuretic effects, such as Lu Dou (Semen Phaseoli Radiati) and Yi Yi Ren (Semen Coicis).

* Avoid drinking ice, cold beverages or eating cold or raw foods.

* Avoid citrus and other foods that are cold in nature such as watermelon, salads, tomatoes, and cucumbers.

* Avoid eating fried, greasy or food high in fat content.

* Reduce the intake of dairy and sugar.

 

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

* Edema and swelling

§ Recommendations: red (azuki) beans, corn, ginger skin, winter melon, winter melon skin, squash, apples, mulberries, peaches, tangerines, coconuts, seaweeds, fish, celery, green onions, garlic, bamboo shoots, spinach, water chestnuts, millet, wheat, black beans, pearl barley, carrots, watermelon, oats, and beef.

§ Avoid rich foods, salty foods, lamb, stimulating foods, wine, pepper, shellfish, fatty foods, and greasy foods.

 

LIFESTYLE INSTRUCTIONS

* Individuals with swelling and edema of legs and feet should sit with their legs up as much as possible. Wearing support hose will also reduce swelling in the legs.

* Exercise daily to help push fluids away from the legs and lower body.

* Avoid exposure to the rain. Do not engage in water sport activities while under treatment.

 

CASE STUDY

* S.S., a 31-year-old male patient, presented with a desire to lose weight, preferably 20 pounds. Symptoms included generalized weight gain and considerable swelling on his face and limbs. Pitting edema was seen upon inspection of the lower legs and hands. The practitioner diagnosed his condition as Spleen qi deficiency with dampness and food accumulation. Herbal DRX was prescribed at 4 capsules three times daily for two weeks and Herbalite at 4 capsules three times daily following the completion of Herbal DRX. After taking Herbal DRX for two weeks, the patient noticed significant reduction in edema of the hands and legs as well as reduction in weight of six pounds. Submitted by A.G., Solana Beach, California.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Herbal DRX is designed to treat edema. To treat the symptom of edema, herbs with diuretic functions are used to increase urine output and water elimination. To manage the cause of edema, many herbs with beneficial effect for the heart, liver, and kidney are used to enhance their functions.

        To treat the symptom of edema, many herbs with diuretic effects are used in Herbal DRX to eliminate excess water. According to one study, use of Fu Ling (Poria) is associated with a marked diuretic effect and a significant increase in urine output.[1] According to another study, use of Fu Ling (Poria) in an herbal formula is associated with marked effectiveness in treating 23 of 30 patients with edema.[2] Zhu Ling (Polyporus) and Ze Xie (Rhizoma Alismatis) also have a marked diuretic effect, and they increase the excretion of water, sodium, chloride, and potassium.[3],[4] In fact, it has been shown that use of Zhu Ling (Polyporus) and Lasix (furosemide) for eight days have similar effect on diuresis, natriuresis and chloriuresis.[5] Bai Zhu (Rhizoma Atractylodis Macrocephalae) is also used frequently for its diuretic effect to treat edema. The mechanism of action for Bai Zhu (Rhizoma Atractylodis Macrocephalae) has been attributed to the inhibition of sodium re-absorption leading to increased diuresis.[6] Lastly, the use of Shi Gao (Gypsum Fibrosum) in an herbal formula has been shown to promote normal urination among 10 patients with urinary tract infection and dysuria.[7]

        To manage the cause of edema, many herbs are used in Herbal DRX to treat heart, liver, and kidney dysfunctions. For heart disorders, Chen Pi (Pericarpium Citri Reticulatae), Chuan Mu Xiang (Radix Vladimiriae) and Sheng Jiang (Rhizoma Zingiberis Recens) are three herbs with beneficial cardiovascular effects.[8],[9],[10],[11] For liver disorders, Bai Zhu (Rhizoma Atractylodis Macrocephalae), Chuan Mu Xiang (Radix Vladimiriae), Ze Xie (Rhizoma Alismatis) and Zhu Ling (Polyporus) are herbs with hepatoprotective effects. Furthermore, Bai Zhu (Rhizoma Atractylodis Macrocephalae) has been shown to treat specific liver disorders, such as ascites due to liver cirrhosis, hepatitis B, and liver damage caused by Tylenol (acetaminophen).[12],[13],[14] For kidney disorders, He Zi (Fructus Chebulae) has shown both hepatoprotective and nephroprotective effects. According to one study, use of He Zi (Fructus Chebulae) is associated with significantly lowered serum levels of the hepatic enzyme markers (AST and ALT) and reduced the indicators of oxidative stress in the liver, such as the glutathione disulfide content and lipid peroxidation, in a dose-dependent manner. In addition, He Zi (Fructus Chebulae) is effective to reduce the incidence of liver lesions, including hepatocyte swelling and neutrophilic infiltration. He Zi (Fructus Chebulae) can also repair necrosis induced by tert-butyl hydroperoxide.[15] According to another study, administration of He Zi (Fructus Chebulae) (125 mg/kg) and/or silymarin (25 mg/kg) offers significant protection for the liver and the kidneys by lowering the serum triglycerides, total cholesterol, blood urea nitrogen, serum creatinine, and aspartate transaminase activity.[16]

        In summary, Herbal DRX is an effective formula to treat and prevent edema and its complications. Most herbs have direct diuretic functions to eliminate the accumulation of water. Others have cardiovascular, hepatoprotective, and nephroprotective effects to manage the cause of edema.

 

COMPARATIVE ANALYSIS

Water accumulation, as in edema, is a symptom that occurs in various diseases, such as hypertension, congestive heart failure, and nephropathy. This condition is usually treated in part with diuretic drugs, such as Lasix (furosemide), Aldactone (spironolactone), and Dyazide (HCTZ/triamterene). While these drugs all have diuretic effect to eliminate water, their risks include dizziness, vertigo, orthostatic hypotension, electrolyte imbalance, and in severe cases, agranulocytosis, leukopenia and thrombopenia. Furthermore, long-term use of these drugs may increase plasma levels of glucose and cholesterol level, thereby complicating overall management of cardiovascular and circulatory disorders. In short, diuretic drugs must be used carefully, as there are many potential side effects and adverse reactions.

        In TCM, water accumulation is treated with herbs that treat both the symptoms and the causes. Diuretic herbs, known as herbs that regulate water and resolve dampness, have an excellent effect to facilitate elimination of water through urination. Furthermore, herbs are also used to strengthen the body and increase its own ability to regulate water circulation in and out of the body. Thus, the use of herbs is effective and achieves both short- and long-term benefits.

        Drugs and herbs are both effective to drain water and treat edema. Drugs are more potent, and in severe cases, have a stronger and immediate onset of effect (especially with intravenous injection). However, diuretic drugs must be used and monitored carefully to ensure safe and effective use. Herbs, on the other hand, are gentle and effective. Though they are not as potent, they exert consistent and moderate diuretic effect over the course of therapy. Furthermore, herbs have a much better safety profile in comparison with drugs. In conclusion, selection of optimal treatment depends on the severity of the condition and the patient’s risk tolerance.

 



[1] Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and Pharmacology of Common Chinese Drugs), 1994; 1383:1391.

[2] Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology), 1986; 8:25.

[3] Yao Xue Xue Bao (Journal of Herbology), 1964; 11(12):815.

[4] Sheng Yao Xue Za Zhi (Journal of Raw Herbology), 1982; 36(2):150.

[5] Zhang G, Zeng X, Han L, Wei JA, Huang H. Diuretic activity and kidney medulla AQP1, AQP2, AQP3, V2R expression of the aqueous extract of sclerotia of Polyporus umbellatus FRIES in normal rats. J Ethnopharmacol. 2010 Mar 24;128(2):433-7.

[6] Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 1961; 47(1):7.

[7] Liao Ning Yi Yao (Liaoning Medicine and Herbology), 1976; (2):69.

[8] Journal of Pharmacol Exp Ther, 1940; 69:309.

[9] Jiang Su Zhong Yi Za Zhi (Jiangsu Journal of Chinese Medicine), 1981; (3):61.

[10] Zhong Yao Yao Li Yu Ying Yong (Pharmacology and Applications of Chinese Herbs), 1983: 169.

[11] Zhong Yao Xue (Chinese Herbology), 1998; 69:72.

[12] An Hui Zhong Yi Xue Yuan Xue Bao (Journal of Anhui University School of Medicine), 1984; 2:25.

[13] Gan Su Zhong Yi (Gansu Chinese Medicine), 1995; (1):19.

[14] Xiong LL. Therapeutic effect of combined therapy of Salvia miltiorrhizae and Polyporus umbellatus polysaccharide in the treatment of chronic hepatitis B. Zhongguo Zhong Xi Yi Jie He Za Zhi. 1993 Sep;13(9):533-5, 516-7.

[15] Lee HS, Won NH, Kim KH, Lee H, Jun W, Lee KW. Antioxidant effects of aqueous extract of Terminalia chebula in vivo and in vitro. Department of Food Science, College of Life & Environmental Sciences, Korea University, Seoul, Korea. Biol Pharm Bull. 2005 Sep;28(9):1639-44.

[16] Gopi KS, Reddy AG, Jyothi K, Kumar BA. Acetaminophen-induced Hepato- and Nephrotoxicity and Amelioration by Silymarin and Terminalia chebula in Rats. Department of Pharmacology and Toxicology, College of Veterinary Science, Hyderabad - 500030, Andhra Pradesh, India. Toxicol Int. 2010 Jul;17(2):64-6.