CLINICAL APPLICATIONS

* Insomnia with difficulty falling and staying asleep

* Disturbed sleep with excessive dreams and restlessness

* Poor memory with dizziness, weakness, fatigue, and anemia

* Fragile mental state with worries, fear, constant fatigue and tiredness

* Postpartum depression with weakness and anemia

 

WESTERN THERAPEUTIC ACTIONS

* Sedative and hypnotic effects to facilitate falling and staying asleep

* Anxiolytic effect to alleviate stress and anxiety

* Antidepressant effect to lift depression

* Adaptogenic effect to facilitate coping with mental and physical stress

 

CHINESE THERAPEUTIC ACTIONS

* Nourishes the Spleen and the Heart

* Tonifies qi and blood

* Tranquilizes the shen (spirit)

 

DOSAGE

Take 4 capsules three times daily with warm water on an empty stomach. For treatment of insomnia and disturbed sleep, take 8 capsules 30 to 60 minutes before bedtime.

 

INGREDIENTS

Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Chuan Mu Xiang (Radix Vladimiriae)

Da Zao (Fructus Jujubae)

Dang Gui (Radix Angelicae Sinensis)

Fu Shen (Poria Paradicis)

Huang Qi (Radix Astragali)

Long Yan Rou (Arillus Longan)

Ren Shen (Radix et Rhizoma Ginseng)

Sheng Jiang (Rhizoma Zingiberis Recens)

Suan Zao Ren (Semen Ziziphi Spinosae)

Wu Wei Zi (Fructus Schisandrae Chinensis)

Xie Cao (Radix et Rhizoma Valerianae)

Yuan Zhi (Radix Polygalae)

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

 

BACKGROUND

Insomnia is defined as difficulty falling or staying asleep. There are many potential causes of insomnia, including but not limited to poor sleep hygiene (coffee, exercise or excitement near bedtime), psychiatric disorders (stress, depression), physical disorders (chronic pain, arthritis), sleep apnea, narcolepsy, restless leg syndrome, use of drugs (alcohol, stimulants, steroids, thyroid hormones) and withdrawal of drugs (alcohol, certain antidepressants, opioids, barbiturates, sedatives and illicit drugs). Insomnia should be treated as prolonged lack of sleep will adversely affect health and well-being.

 

FORMULA EXPLANATION

Schisandra ZZZ is formulated with herbs to nourish the Spleen and the Heart, tranquilize the shen (spirit), and tonify qi and blood. Clinical applications of Schisandra ZZZ include insomnia, difficulty falling asleep and staying asleep, poor memory, dizziness, weakness, constant fatigue, and postpartum depression due to anemia.

        Wu Wei Zi (Fructus Schisandrae Chinensis) replenishes the vital energy and has a regulatory effect on the central nervous system (CNS). Ren Shen (Radix et Rhizoma Ginseng), Huang Qi (Radix Astragali), Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Fu Shen (Poria Paradicis) tonify the Spleen qi and enable it to generate blood to nourish the shen (spirit) of the Heart. Dang Gui (Radix Angelicae Sinensis) and Long Yan Rou (Arillus Longan) tonify blood and calm the shen (spirit). Suan Zao Ren (Semen Ziziphi Spinosae) and Yuan Zhi (Radix Polygalae) are tranquilizing herbs with sedative and hypnotic effects. Xie Cao (Radix et Rhizoma Valerianae) is an herb that has tranquilizing and calming effects. Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle), Sheng Jiang (Rhizoma Zingiberis Recens) and Da Zao (Fructus Jujubae) improve the appetite, harmonize, and strengthen the gastrointestinal tract. Chuan Mu Xiang (Radix Vladimiriae) revives the Spleen and dispels stagnation.

        In summary, Schisandra ZZZ nourishes the blood and calms the shen (spirit) to treat insomnia and sleeping disorders.

 

CAUTIONS & CONTRAINDICATIONS

* This herbal formula may cause drowsiness in individuals who are sensitive to herbs. Patients are advised not to drive or operate heavy machinery while taking this herbal formula. Similarly, alcohol is not recommended as it may intensify the effect.

* 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 NOTE

* Schisandra ZZZ is excellent to take for a week after each menstrual cycle. It replenishes the blood and qi lost during each period.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Insomnia due to Spleen and Heart yang deficiencies: floating and weak pulse on left cun and right guan

* Insomnia due to blood deficiency: weak pulse on the right cun

 

SUPPLEMENTARY FORMULAS

* For depression, combine with Shine or Shine (DS).

* For Spleen qi deficiency with loose stool and poor appetite, add GI Tonic.

* For Liver qi stagnation manifesting in irritability, restlessness, or PMS, combine with Calm.

* For severe insomnia with disturbed shen (spirit) in excess patients, use Calm (ES).

* For insomnia due to stress in patients with deficiency, combine with Calm ZZZ.

* For menopausal symptoms, combine with Balance (Heat).

* For dysmenorrhea, combine with Mense-Ease.

* For hair loss, dry or brittle hair, combine with Polygonum 14.

* To tonify the overall bodily constitution, combine with Imperial Tonic.

* For forgetfulness, add Enhance Memory.

* For Kidney yang deficiency, add Kidney Tonic (Yang).

* For Kidney yin deficiency, add Kidney Tonic (Yin).

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Shenmen (HT 7), Sanyinjiao (SP 6), Xinshu (BL 15), Pishu (BL 20), Taixi (KI 3), Weishu (BL 21), Zusanli (ST 36)

* Anmian (extra point), Shenmen (HT 7), Baihui (GV 20)

 

Classic Master Tung's Points:

* Insomnia, dreams: 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.

* Weakness and fatigue: Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21), Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Beimian (T 44.07), Sanyan (T 11.21), Zhitong (T 44.13)

* Poor memory: Dizong (T 44.09), Tianhuangfu [Shenguan] (T 77.18), Zhenghui (T 1010.01), Piyi (T 88.35)*, Pier (T 88.36)*

* Dizziness: Linggu (T 22.05), Dabai (T 22.04), Zhenghui (T 1010.01), Wanshunyi (T 22.08), Wanshuner (T 22.09), Luotong (T 44.14), two points on the sides of the first metacarpal joint of the thumb, Fuding (T 44.04), Tongshen (T 88.09), Tongwei (T 88.10), Tongbei (T 88.11), Zhitong (T 44.13)

* Anemia: Shuitong (T 1010.19), Shuijin (T 1010.20), Tongtian (T 88.03), Zusanli (ST 36), Tuling (T 88.46)*. Moxa Huofuhai (T 33.07) and Zusanli (ST 36).

* Depression: Tongguan (T 88.01), Tongshen (T 88.09), Neiguan (PC 6), Tianhuangfu [Shenguan] (T 77.18), Huoying (T 66.03), Huoxi (T 11.16). Bleed the HT and LU areas of the back with cupping. Bleed before needling for best result.

 

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

* Insomnia, excessive worries, pensiveness: Tongtian (T 88.03), Tongshen (T 88.09)

 

Balance Method by Dr. Richard Tan:

* Left side: Yinlingquan (SP 9), Xuehai (SP 10), Sanyinjiao (SP 6), Rangu (KI 2), Dazhong (KI 4), Fuliu (KI 7), Hegu (LI 4), Zhongzhu (TH 3), Zhizheng (SI 7), ear Shenmen

* Right side: Zusanli (ST 36), Jiexi (ST 41), Shaofu (HT 8), Tongli (HT 5), Shaohai (HT 3)

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

 

Ear Acupuncture:

* Insomnia: Heart, Kidney, Parietal Lobe. Place magnetic ear balls or embed ear needles on one or both ears every evening and remove them in the morning. Five days equal one course of treatment.

* Frequent dreams: Heart, Kidney, Frontal Lobe. Embed needles and switch ear every three days. Patient should be instructed to massage those points at least three to four times each day for one to two minutes.

* Anemia: Bone Marrow, Kidney, Spleen, Ovaries or Testis, Adrenal Gland

* Excessive worry or neurasthenia:

¡± Main points: Shenmen, Heart, Subcortex, Brain Stem

¡± Adjunct points: Kidney, Spleen, Liver, Endocrine, Stomach

 

Auricular Medicine by Dr. Li-Chun Huang:

* Dream-disturbed sleep or to improve sleep: Dream-Disturbed Sleep Area, Shenmen, Occiput, Heart, Neurasthenia Area, Neurasthenia Point, Nervous Subcortex. Bleed Ear Apex.

¡± For dream-disturbed sleep due to disharmony between the Heart and Kidney: add Kidney.

¡± For dream-disturbed sleep due to deficiency of both Heart and Spleen: add Spleen.

¡± For dream-disturbed sleep due to Liver qi stagnation: add Liver.

¡± For nightmares: add Gallbladder.

* Replenishing the blood: Spleen, Stomach, Heart, Kidney, San Jiao, Adrenal Gland, Blood, Endocrine

* Neurasthenia: Shenmen, Heart, Occiput, Nervous Subcortex, Neurasthenia Area (front and back), Neurasthenia Point (front and back). Bleed Ear Apex.

* Hypoglycemia: Pancreas, Diabetes, Pituitary, Endocrine, Thalamus, Sympathetic, Duodenum, Digestive Subcortex

* Dizziness from anemia: Dizziness Area, External Sympathetic, Liver, Occiput, Spleen, San Jiao. Bleed Ear Apex.

 

NUTRITION

* Increase consumption of foods that contain high levels of tryptophan such as turkey, bananas, figs, dates, yogurt, milk, tuna, and whole grain crackers as they help promote sleep.

* Avoid foods that contain tyramine near bedtime. Tyramine increases the release of the brain stimulant norepinephrine. Foods with high content of tyramine include bacon, cheese, chocolate, eggplant, ham, potatoes, sugar, sausage, spinach, and tomatoes.

* A glass of warm milk with honey is helpful for mild insomnia.

 

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

* Drink celery and beet tops tea in the evening, two hours prior to bedtime.

* Boil mulberry tea and drink 1/2 cup.

* Toast 1/4 cup amaranth in oven until slightly brown, remove and steep in a cup of hot water for five minutes and sip before bedtime.

* Eat soup for dinner made from lima beans with other calming foods like turkey and sage.

 

LIFESTYLE INSTRUCTIONS

* Especially at night, patients with insomnia should avoid alcohol, caffeine, and tobacco.

* If insomnia is due to overwork, do not 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.

* Patient should be counseled to not worry about things they cannot control or change.

 

CASE STUDIES

* I.G., a 48-year-old female, presented with stress and insomnia. It was noted that the patient¡¦s son was getting married and she was experiencing lots of worries and stress surrounding the wedding. This caused the patient to have difficulty falling asleep at night, waking often, and becoming easily fatigued. Headaches were also present quite often. The patient was given 8 capsules of Schisandra ZZZ 30-60 minutes prior to sleep. With taking the herbs, the patient¡¦s sleep immediately got better. She was able to fall asleep within minutes and often stayed asleep the entire night. If she did wake, falling asleep was quicker and easier. Her headaches also got better. Submitted by L.M., Gresham, Oregon.

* E.E. is a 30-year-old postpartum female who presented difficulty falling and staying asleep, restlessness, overactive mind, difficulty concentrating, fearfulness and anxiousness. The pulse was thin, weak and rapid. The tongue was very red with peeled edges and quivering at the same time. The face, ear and neck were red and flushed. The practitioner diagnosed her with postpartum depression with Heart fire and Spleen and Heart qi and blood deficiencies. Schisandra ZZZ was prescribed at 3 capsules three times daily. Within the first week, the patient noticed reduced anxiety. She was able to fall asleep and the mind was calmer. Submitted by S.S., Topanga, California.

* An 18-year-old patient presented with life-long insomnia. She often needed one hour to fall asleep. Her sleep quality was quite poor, and she remained sluggish throughout the day. The practitioner diagnosed the case as qi and blood deficiency. The patient took 6 capsules of Schisandra ZZZ 30 minutes before bedtime. After three weeks of treatment, the patient was able to fall asleep within 15 minutes and awaken with more energy. Submitted by M.K., Sherman Oaks, California.

* 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.M., a 43-year-old female, presented with infertility. It was noted that the patient had other health concerns of weight gain, irritability due to high stress, and undergoing IVF cycles. She had been experiencing high risk pregnancy, consisting of nine failed IUIs, and was currently taking DHEA hormonal drugs. The TCM diagnosis was Heart qi and blood deficiencies, blood stagnation, Liver and Kidney yin deficiencies, and Spleen deficiency. Her Western diagnosis was undefined infertility, possibly due to old age. For treatment, Blossom (Phases 1-4) was prescribed with the addition of Schisandra ZZZ. After 6 weeks of taking the herbs, she had successful conception implantation. The patient reported she was able to sleep more, moods were more stabilized, less fatigued, and her weight became more stable. As a result, she gave birth to a healthy baby girl. Submitted by N.T., Bethesda, Maryland.

* A tired and exhausted patient presented with general aches and pain in the neck and low back. There was also a history of poor sleep and digestion with no constipation. The practitioner felt the patient had over-worked herself throughout the years and that the condition was due to ¡§wear and tear.¡¨ The diagnosis was qi and blood deficiencies with underlying yin and yang deficiencies. Imperial Tonic, Schisandra ZZZ and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) were given along with acupuncture and massage therapy. The treatment was concluded to be quite effective. Submitted by S.C., La Crescenta, 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.

* 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 within. 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. However, she still complained about the neck and shoulder pain. Submitted by J.C.O., Whittier, California.

* H.G., a 55-year-old female, presented with agitation, anxiety, depression, and insomnia, and stated that she was easily angered. Her tongue was purple, with a thin white coating; her pulse was soft and wiry. The Western diagnosis was depressive-anxiety disorder; the TCM diagnosis was Liver fire rising with Liver qi stagnation. Calm (ES) was prescribed at three capsules, three times daily. Upon follow-up one week later, the patient reported a decrease of anxiety and agitation, but continuing insomnia. Schisandra ZZZ was added to her herbal regimen. One week later, the patient reported the insomnia completely resolved; but said that she experienced somnolence in the morning. She was told to reduce Schisandra ZZZ from three times daily to twice daily, eliminating the morning dose. After the dosage adjustment, the patient reported calm, uninterrupted sleep, and waking feeling energized, without lethargy or grogginess. She continues to take Schisandra ZZZ on an as-needed basis. Submitted by C.L., Chino Hills, California.

* 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 a 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.

* M.P., a 74-year-old female, presented with insomnia. She was prescribed Ambien (zolpidem) by her medical doctor but could not take it because of an allergy to the medication where her tongue would swell and burn. She was then put on Zyprexa (olanzapine) and Paxil (paroxetine). The patient reported she also had an allergic reaction (tongue swelling) to Zyprexa (Olanzapine). The patient, described by the practitioner, was a very anxious, nervous type of person who would hyperventilate when stressed. Her husband also has multiple medical problems and she stated she was worried about him. Her blood pressure was 120/70 mmHg and her heart rate was 70 beats per minute. The TCM diagnosis was Spleen and Heart disharmony with qi and blood deficiencies. Schisandra ZZZ was prescribed at 4 to 6 capsules at night. The patient reported that taking 4 capsules allowed her to sleep for four hours and then she was awake. Dosage was then increased to 6 capsules at night and she reported she was able to sleep five to six hours. The patient is still currently under care and the practitioner is adjusting the dose slowly. Submitted by M.H., West Palm Beach, Florida.

* A 42-year-old female presented with insomnia due to family-related stress. She reported having difficulty falling asleep due to excessive thoughts, thus creating morning fatigue that ¡§feels like a hangover.¡¨ The TCM diagnosis was insomnia due to Spleen and Heart qi deficiencies with shen (spirit) disturbance. After she began taking three capsules of Schisandra ZZZ at bedtime, the patient reported much improved sleep without difficulty falling or staying asleep. Submitted by C.L., Chino Hills, 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 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.

* A 50-year-old female public information specialist who was emotionally labile presented with pain in the shoulder, neck, thoracic, lumbar and foot. Her lumbar discs at L4 and L5 were herniated. In addition to migraines and bouts of constipation, she also complained of anxiety, depression and insomnia, all of which may be attributed to some side effects of taking multiple pharmaceuticals. The practitioner diagnosed her condition as qi and blood stagnation as well as Liver depression. Corydalin (AC) and Schisandra ZZZ were given. Corydalin (AC) significantly reduced her pain. She was able to lessen the use of oxycontin and Duragesic (fentanyl) patches significantly. In fact, the dosages of oxycontin and Duragesic (fentanyl) patches were reduced by as much as 75%. Furthermore, the practitioner observed that Corydalin (AC) was also effective to maintain other patients who suffered from occasional pain. The majority of patients (about 90%) who took Corydalin (AC) responded favorably, especially since most were experiencing digestive side effects with ibuprofen. Submitted by F.G., Sykesville, Maryland.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Schisandra ZZZ is designed to treat insomnia with difficulty falling and staying asleep. It utilizes herbs with sedative and hypnotic effects to directly treat insomnia. Furthermore, since insomnia is frequently associated with emotional and mood disorders, herbs in this formula also have anxiolytic, antidepressant, and adaptogenic functions to enhance the overall effectiveness of the formula.

        Schisandra ZZZ contains many herbs with sedative and hypnotic effects to directly treat insomnia. Suan Zao Ren (Semen Ziziphi Spinosae), Fu Shen (Poria Paradicis), Da Zao (Fructus Jujubae), and Huang Qi (Radix Astragali) all have sedative effects.[4]^,[5],[6],[7] Da Zao (Fructus Jujubae) shows additional benefit to reduce spontaneous motor activities.[8] Da Zao (Fructus Jujubae) has a hypnotic effect to significantly increase the total sleep and non-REM sleep, while it shows no significant effect on REM sleep and slow wave sleep.[9] Xie Cao (Radix et Rhizoma Valerianae) and Suan Zao Ren (Semen Ziziphi Spinosae) have been shown to prolong sleeping time, reverse excitation caused by caffeine, and inhibit hyperactivity induced by morphine.[10]^,[11] Specifically, the clinical effects of Xie Cao (Radix et Rhizoma Valerianae) are thought to be similar to those of short-acting benzodiazepines.[12]

        According to the Merck Manual, 80% of patients with major depression report insomnia, and 40% of patients who suffer chronic insomnia have a mood disorder.[13] Therefore, successful treatment of insomnia often requires use of herbs to address mood disorders. Schisandra ZZZ utilizes many herbs to treat stress, anxiety and depression. Xie Cao (Radix et Rhizoma Valerianae) and Yuan Zhi (Radix Polygalae) both have antidepressant activities. According to one study, administration of various preparations of Xie Cao (Radix et Rhizoma Valerianae) has been associated with pronounced anxiolytic and antidepressant activities.[14] Xie Cao (Radix et Rhizoma Valerianae) and its active valerenic acid exert anxiolytic effects and reduce anxious behavior by interacting with the GABA(A)-ergic system, a mechanism of action similar to the benzodiazepine drugs.[15] According to another study, use of Yuan Zhi (Radix Polygalae) is associated with a marked antidepressant effect to reverse the harmful effects of chronic stress on mood and behaviors. The mechanism of this antidepressant effect is attributed in part to the neuroendocrine and neuropropective activities, as well as involvement of the hypothalamo-pituitary-adrenal system.[16] Furthermore, Yuan Zhi (Radix Polygalae) and Long Yan Rou (Arillus Longan) also showed anxiolytic, sedative and hypnotic activities.[17]^,[18] Lastly, oral administration of Suan Zao Ren (Semen Ziziphi Spinosae) is associated with anxiolytic effects at lower dose and sedative effects at higher dose.[19]

        Schisandra ZZZ also contains many other herbs that offer additional support to treat insomnia and related complications. Ren Shen (Radix et Rhizoma Ginseng) and Bai Zhu (Rhizoma Atractylodis Macrocephalae) have adaptogenic effects to help the patient manage mental and physical stress.[20]^,[21],[22] Da Zao (Fructus Jujubae), Gan Cao (Radix et Rhizoma Glycyrrhizae) and Wu Wei Zi (Fructus Schisandrae Chinensis) have cognitive effects to significantly reduce memory impairment.[23]^,[24],[25] Yuan Zhi (Radix Polygalae), Suan Zao Ren (Semen Ziziphi Spinosae) and Wu Wei Zi (Fructus Schisandrae Chinensis) have neuroprotective effects to inhibit acetylcholinesterase (AChE) activity,[26] protect the neurons from Abeta-induced neuronal damages,[27]^,[28] and prevents neurotoxicity induced by glutamate.[29]^,[30] Lastly, since lack of rest directly leads to fatigue and speeds the aging process, Long Yan Rou (Arillus Longan) is added for its antifatigue effect,[31] and Ren Shen (Radix et Rhizoma Ginseng) is incorporated for its antiaging effect.[32]

        Clinically, many herbs in Schisandra ZZZ have been used with great success to treat insomnia. In a randomized, placebo-controlled, multi-center study, 121 patients were divided into either an herb group or a placebo group. Both groups received pills one hour before bedtime for 28 consecutive days. The subjects in the herb group received 600 mg of 70% alcohol extract of Xie Cao (Radix et Rhizoma Valerianae) standardized to 0.4 to 0.6% valerenic acid. At the end of the trial, the study reported good or very good results in 66% of subjects in the herb group, compared to only 29% in the placebo group.[33] In another double-blind crossover study of 128 participants, it was found that those who took Xie Cao (Radix et Rhizoma Valerianae) had a significant improvement in sleep quality with fewer awakenings and less somnolence the next morning.[34] Lastly, daily intake of 10 grams of Suan Zao Ren (Semen Ziziphi Spinosae) powder at night effectively treated 34 of 39 patients with insomnia within three to ten days. These patients were allowed to drink 15 grams of green tea at 8:00 a.m., but could not take other stimulants throughout the day.[35]

        Overall, Schisandra ZZZ is a great formula to treat insomnia using herbs with sedative, hypnotic, anxiolytic and antidepressant functions.

 

COMPARATIVE ANALYSIS

Though there are many causes of insomnia, there is one overwhelming treatment - sedatives and hypnotics for short term relief. The sleeping pills most frequently used include benzodiazepines such as Halcion (triazolam), Restoril (temazepam), and Dalmane (flurazepam). The main advantages of these drugs are they are extremely potent, and generally induce sedation within 30 to 60 minutes. However, their effect generally lasts for a long period of time, resulting in drowsiness the following morning. Furthermore, if used for a long period of time, they cause tolerance and dependence, making it increasingly difficult to restore normal sleeping patterns. Finally, these drugs are also likely to cause other side effects, such as 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 for short-term treatment of insomnia, and not be relied upon on a long-term basis.

        From a Chinese medical perspective, insomnia [inability to fall or stay asleep] is the direct result of shen (spirit) disturbance. Therefore, the main focus of this formula is to use herbs that calm the shen (spirit) to treat insomnia. Furthermore, lack of sleep over a long period of time contributes to deficiency. Therefore, many tonic herbs are also used to supplement such weakness and deficiencies. It is important to remember that herbs do not ¡§sedate¡¨ the patient to treat insomnia. Rather, they calm the shen (spirit) and nourish the deficiency to restore normal waking / sleeping cycles. Therefore, herbs should be taken continuously for at least one week to restore normal waking / sleeping cycles, as they do not work on an ¡§as needed¡¨ basis like sleeping pills.

        It is important to re-evaluate the patients periodically. Individuals who continue to have insomnia should be examined for secondary causes, such as pain, anxiety, stress, depression, and withdrawal from drug or alcohol. While drugs and herbs are both effective, insomnia can only be treated successfully on a long-term basis when these secondary causes are removed.