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 2            Traditional Chinese Medicine       6                       Integrated Traditional & Western Medicine
     Low Mood – A Chinese Medicine Perspective       Stress and Mood Disorders - Taking a Deeper Look

 8                   Product Announcements
     Returning Formulas
                                         TRADITIONAL CHINESE MEDICINE
                                      Low Mood – A Chinese Medicine Perspective*
WHEN IT’S MORE THAN JUST                       Re-establishing emotional stability and         Typical Formula: Chai Hu Shu Gan Tang
“FEELING DOWN”                                 balance is vital for overall health. In this    [Bupleurum & Cyperus Formula]
Sadness and low mood are common                article we will review strategies you can
clinical presentations today. There are        use to help patients with mood disorders.       Formula Discussion: This is a variation of Si
many patients who have chosen to manage                                                        Ni San [Bupleurum & Zhi Shi Combination],
their mood disorder using traditional                                                          mentioned in the Zheng Zhi Zhun Sheng
Chinese medicine instead of, or in             TCM MANAGEMENT OF                               (Guidelines for Pattern Identification and
addition to, conventional pharmaceutical       MOOD DISORDERS                                  Treatment). This formula courses the liver,
medicines. For these patients there are        Sadness and low mood in traditional             rectifies qi, quickens blood, relieves pain.
many formulas that can help them regain        Chinese medicine is categorised as one of       This formula is less blood nourishing
emotional balance and restore joy to their     the following:                                  than Xiao Yao San [Bupleurum & Dang Gui
lives.                                                                                         Formula] but is more effective in rectifying
                                                   1. Depressive condition – yu zheng
                                                                                               central burner qi.
                                                   2. Withdrawal – dian
An enduring tendency in Chinese thinking
                                                   3. Vacuity taxation – xu lao                Common Modifications:
is to see motion and change (dòng )
                                                   4. Insomnia – bu mian                       • In cases of liver qi invading the
as an essential part of our existence.
In this world of ceaseless change and              5. Vexation and agitation – fan zao           stomach with signs such as belching,
transformation, we maintain health                 6. Visceral agitation – zang zao              add Fo Shou [Finger Citrus].
through the orderly flow and exchange                                                          • In cases of strong menstrual pain, add
of jïng    , qì , and xuè    . When the                                                          Yu Jin [Curcuma aromatica] and Pu
orderliness of functional processes is         CHINESE PATTERN                                   Huang [Pollen typhae].
upset (for example when what should go         DIFFERENTIATION:                                • For stomach pain, add Hai Piao Xiao
up goes down, or vice versa), the various      REPLETION PATTERNS                                [Cuttlebone].
circulations become obstructed and             Sadness and low mood can be
health problems may arise.                     differentiated into five repletion patterns,    2. Liver depression transforming into fire
                                               including liver qi depression, liver            Clinical Manifestation:
As we can see below, there are frequent        depression transforming into fire, blood            • the above signs and symptoms, plus
textual references describing the process      movement depression (blood stagnation),             • not just irritable, but angry
of unskillful emotional reactions leading      phlegm and qi depression and stagnation,            • shouting, cursing
to the loss of flow and depression of          and phlegm fire obstruction.                        • speaking inappropriately
circulation.                                                                                       • bitter taste in the mouth, often
• Nei Jing Su Wen: “When thinking              1. Liver qi depression                                on waking
    excessively, thoughts are stored in        Clinical Manifestation:                             • possible sour regurgitation
    the heart, concentrated in one place,           • irritability                                 • headache
    whereby the qi stops moving and                 • passive aggressive behaviour                 • red eyes
    becomes depressed. That is why qi               • resistance                                   • tinnitus
    congeals jié .”                                 • stubbornness                                 • dry stool
• Nei Jing Ling Shu: “When sad and                  • tendency to sigh                             • dark, yellow concentrated urine
  worried, the passage of qi slows and              • chest and hypochondriac oppression           • T: red, body, yellow coat
  its movement is depressed.”                       • lower abdominal distension and pain          • P: wiry
• Zhu Bin Yuan Hou Lun: “Qi                         • diminished appetite
  accumulation illness, jie qi bing                 • discomfort in the epigastrium            Typical Formula: Jia Wei Xiao Yao San
    , is produced by sadness and worry.             • possible delayed menses                  [Bupleurum & Peony Formula].
  When thoughts are heavy in the heart,             • darkish, stagnant menstrual blood
  the shen slows, qi gets depressed and             • menses unable to come easily             Formula Discussion: There are a number
  congealed inside.”                                • premenstrual breast distension           of commonly used variations of Xiao Yao
                                                    • T: normal, or slightly darkish body,     San. This is one of the most commonly
                                                      thin, white coat                         used. This particular formula is from the
                                                    • P: tight                                 Nei Ke Zhai Yao, or Summary of Internal

               *Material adapted from the 2005 Greg Bantick Seminar on depression - Greg Bantick is also the presenter of the
                                      February 2009 Seminar on Stress, Anxiety and Mood Disorders.

2     Sun Ten Newsletter   Autumn 2009
Medicine. It is Xiao Yao San with the        3. Blood movement depression                    • For general deficiency: add Dang
addition of Mu Dan Pi and Zhi Zi and is      (blood stagnation)                                Shen (Codonopsis) and Huang Qi
used where there is constrained liver qi     Clinical Manifestation:                           (Astragalus).
generating heat, and the constraint is           • emotional depression
invading the spleen. This formula courses        • restlessness and agitation
the liver, rectifies the qi, clears heat,        • feeling vulnerable
resolves depression, nourishes the spleen,       • easily upset
drains damp, nourishes and harmonises            • dark facial colour
the blood.                                       • rib side and flank distension
                                                   and pain
Modern Research:                                 • suicidal thoughts
• Effects on GABA: Jia Wei Xiao Yao San          • possible amenorrhoea
  [Bupleurum & Peony Formula] activates          • possible painful menses
  GABA receptors: Jia Wei Xiao Yao San           • T: dark, purplish, or with
  has an anxiolytic action through binding         purplish spots
  to, and activating, GABA receptors.            • P: deep, wiry and or choppy
  A secondary effect is that the formula
  promotes synthesis of chemicals which      Typical Formula: Xue Fu Zhu Yu Tang
  decrease anxiety. This formula has a       [Persica & Achyranthes Combination].
  GABAergic effect. GABA binds to the        Alternatively Si Wu Tang [Dang Gui Four
  body’s benzodiazepine receptors, which     Combination] and Si Ni San [Bupleurum           4. Phlegm and qi depression
  prevents nerve impulses associated         & Zhi Shi Formula] and Tao Ren [Persica]        and stagnation
  with stress and anxiety from reaching      and Hong Hua [Carthamus].                       Clinical Manifestation:
  the motor centres of the brain and                                                             • plum pit qi
  sedates the central nervous system.1       Formula Discussion: Xue Fu Zhu Yu Tang              • feeling overwhelmed
• Jia Wei Xiao Yao San [Bupleurum &          first appeared in the 19th century treatise,        • pressured to make decisions
  Peony Formula] may reduce low mood:        Yi Lin Gai Cuo, or Corrections of Errors            • possible oppressed feeling in
  In a 12 week study, 124 patients with      Among Physicians. This formula is a                   the chest
  mood disorders were given Jia Wei          combination of the blood invigorating               • possible rib side pain
  Xiao Yao San concommitantly with an        formula, Tao Hong Si Wu Tang [Persica,              • T: greasy, white coat
  anticonvulsant and showed beneficial       Carthamus and Dang Gui Combination],                • P: wiry, slippery
  effects.2                                  with the qi regulating formula, Si Ni San
                                             [Bupleurum & Zhi Shi Formula]. It is used       Typical Formula: Ban Xia Hou Po Tang
• Jia Wei Xiao Yao San [Bupleurum &
                                             for a variety of complaints in the upper        [Pinellia & Magnolia Combination].
  Peony Formula] increases dopamine
                                             body that share fixed, sharp, stabbing pain
  levels: Jia Wei Xiao Yao San contains                                                      Formula Discussion:          This formula
                                             together with tongue and pulse signs of
  an active ingredient that increases                                                        disperses stagnant qi and accumulation by
                                             blood stasis. This formula invigorates the
  dopamine levels. This action will                                                          promoting the movement of qi, dissipates
                                             blood and dispels blood stasis, unblocks
  contribute to the formula’s well known                                                     clumps, dissolves phlegm, directs
                                             the channels and spreads the qi of the
  mood lifting effect as dopamine activity                                                   rebellious qi downward, and restores
                                             liver, and stops pain. This formula not only
  decreases apathy, improves mood and                                                        the downward movement of stomach
                                             invigorates blood and transforms stasis in
  feelings of wellbeing; inducing euphoria                                                   qi. Ban Xia Hou Po Tang first appeared in
                                             the blood level, it also relieves depression
  and increases assertiveness.3                                                              the Jingui Yaolue, or Essentials from the
                                             and constraint in the qi level. This is using
                                             qi to promote the movement of blood by          Golden Cabinet. It was listed in one of the
                                             ensuring that lung qi properly diffused         chapters on gynaecological disorders, and
                                             and that liver qi is smoothly spread. It has    specifically recommended for “women
                                             the effect of invigorating the blood without    who feel like there is a lump of baked meat
                                             consuming it, and overcoming blood              stuck in their throat.” This condition is by
                                             stasis while promoting the production of        no means limited to women. It has come
                                             new blood.                                      to be referred to as “plum pit syndrome”
                                                                                             (mei he qi), a term that specifically refers
                                             Common Modifications:                           to a lump-in-throat sensation that typically
                                             All quantities in raw herbs.                    worsens when unhappy or depressed,
                                                                                             and is due to circumstances which the
                                             • For neurosis: add He Huan Pi (Albizzia)
• Jia Wei Xiao Yao San and Ban Xia                                                           patient figuratively feels they cannot
                                               10-20g, Ye Jiao Teng (Polygonum Stem)
  Hou Po Tang relieve panic disorder:                                                        swallow. This leads to qi constraint,
                                               10-20g, and Zhen Zhu Mu (Concha
  Four patients with panic disorder and                                                      affecting the lung and stomachs ability to
                                               Margaritaferae) 25-40g.
  agoraphobia were given Jia Wei Xiao San,                                                   move qi downwards. This, in turn, leads
                                             • For schizophrenia: add Meng Shi (Lapis)       to problems with the transformation and
  followed by Ban Xia Hou Po Tang. Both
                                               30-50g, Mu Li (Oyster Shell) 30-50g,          transportation of fluids, leading to the
  formulas relieved the panic attacks,
                                               Long Gu (Dragon Bone) 30-50g, and Hu          accumulation of phlegm. This interference
  anticipatory anxiety and agoraphobia. It
                                               Po (Succinum) 6-15g.                          of the qi mechanism by phlegm also leads
  was noted that Jia Wei Xiao San was more
  effective in the more severe cases.4       • For obvious headache: add Man Jing Zi         to the stuffy feeling in the chest and
                                               (Vitex), and Bai Ji Li (Tribulus).            epigastrium.

                                                                                                 Sun Ten Newsletter   Autumn 2009      3
Common Modifications:                           5. Phlegm fire obstruction                     kids, hates his job, can feel dizzy and
• For severe qi stagnation: add Chai            Clinical Manifestation:                        disoriented, sometimes when he is walking
  Hu (Bupleurum), Yu Jin (Curcuma               • both apathetic and tired, and restless       he feels like he is leaning sideways. P:
  aromatica), Xiang Fu (Cyperus) and                and anxious, possibly alternating          rapid slippery T: yellow greasy.
  Qing Pi (Blue Citrus).                            between the two
• For severe stifling sensation in the chest:   • heavy feeling in the head
  add Yu Jin (Curcuma aromatica), and           • profuse phlegm
                                                                                               CHINESE PATTERN
  Zhi Ke (ripe Citrus).                                                                        DIFFERENTIATION:
                                                • poor sleep
• For mood disorders, if accompanied by                                                        VACUITY PATTERNS
                                                • chest oppression                             Depression can be differentiated into
  throat discomfort: add Da Zao (Jujube),
  this will produce Si Qi Tang (Four-           • reduced appetite                             four vacuity patterns: Depression of heart
  Ingredient Decoction for the Seven            • burping                                      qi, heart and spleen vacuity, spleen and
  Emotions).                                                                                   kidney vacuity, and yin vacuity with fire
                                                • sour regurgitation
                                                • T: greasy yellow
Modern Research:
                                                • P: slippery, rapid                           1. Depression of heart qi
• Ban Xia Hou Po Tang [Pinellia and
                                                                                               Clinical Manifestation:
   Magnolia Combination] modulates
                                                Typical Formula: Huang Lian Wen Dan            • easily distracted, absent minded
   neurotransmitters: Brain monoamines
   like serotonin and dopamine play             Tang [Coptis Decoction To Warm The Gall        • fearful
   important roles in various psychiatric       Bladder]. Or alternatively Wen Dan Tang
                                                                                               • anxious
   and neurological diseases, such as           [Bamboo & Hoelen Combination] and
                                                Huang Lian [Coptis].                           • restless
   sadness and anxiety. Ban Xia Hou Po
                                                                                               • sorrowful
   Tang increases serotonin, dopamine
   and noradrenaline and reduces their          Formula Discussion: The base formula,          • tendency to cry easily
   breakdown. This explains why this            Wen Dan Tang [Bamboo & Hoelen
                                                                                               • frequent yawning
   formula works so well for these types        Combination], is an important remedy for
                                                                                               • T: pale, thin white coat
   of disorders.5                               resolving heat phlegm. In the treatment
                                                of mood disorders, a key component of          • P: wiry, fine
• Honokiol from magnolia reduces
                                                this formula is disharmony between the
  anxiety: Honokiol is strongly anxiolytic.
                                                stomach and gall bladder with phlegm           Typical Formula: Gan Mai Da Zao Tang
  Magnolia-free preparations of Ban Xia
                                                heat. The phlegm heat interferes with the      [Licorice & Jujube Combination].
  Hou Po Tang [Pinellia and Magnolia
                                                rising of clear yang, and disturbs the chest
  Combination] do not have the anxiolytic
                                                and heart, clouding the heart orifices.        Formula       Discussion: This formula
  effect associated with preparations
                                                                                               nourishes the heart and quietens the
  that contain the magnolia.6
                                                Common Modifications:                          spirit, relaxes tension and harmonises
• Ban Xia Hou Po Tang [Pinellia                 • For stubborn insomnia due to heart           middle burner. Gan Mai Da Zao Tang
  and Mangolia Combination] reduces               and gall bladder deficiency: add Shi         first appeared in the classic formula
  stress markers: Stress upregulates              Gao (Gypsum), Ren Shen (Ginseng),            compendium the Jing Gui Yao Lue, or
  expression of certain proteins in the           Long Yan Rou (Arillus Euphoriae              Essentials from the Golden Cabinet,
  brain. Ban Xia Hou Po Tang significantly        Longanae), Suan Zao Ren (Zizyphus),          Chapter 22, clause 6. It was originally
  reduces the expression of these                 and Mai Men Dong (Ophiopogon).               mentioned in the chapter on women’s
  proteins in stressed rats; however, there                                                    disorders and was recommended for use
                                                • For hysteria, fearfulness and great
  is no reduction in unstressed animals.7                                                      in zang zao, restless organ syndrome.
                                                  agitation: add Chai Hu (Bupleurum)
• Ban Xia Hou Po Tang [Pinellia and               and Huang Qin (Scute).                       This is an emotional syndrome attributed
  Magnolia      Combination]    reduces                                                        to excessive anxiety and worry. This
  stress-related diseases: Neuropeptide                                                        damages the heart yin, constrains the flow
                                                Case Example: Male late 40’s. Chief
  Y is involved in regulation of the                                                           of liver qi, and damages spleen qi. There
                                                complaint of sinus congestion and feeling
  hypothalamic-pituitary-adrenal (HPA)                                                         is some confusion about what is meant
                                                blocked and “fuzzy” in the head. On
  axis    and      stress   responsivity.                                                      by the term organ. Some authors feel it
                                                questioning reveals he has a stuffy feeling
  Neuropeptide Y increases under stress                                                        means the uterus. However, men also
                                                in the chest and often feels he cannot
  and is used as a marker of stress.                                                           experience the syndrome. Other authors
                                                get a deep breath. Is depressed, short
  Administration of Ban Xia Hou Po Tang                                                        feel it refers to the heart and addresses
                                                tempered, impatient, eats poor quality
  prevents the rise in neuropeptide Y,                                                         where the heart loses its tranquility, the
                                                and excessively, drinks moderately, has
  indicating the formula is beneficial in                                                      spirit becomes restless. This seems to fit
                                                a strained relationship with his wife and
  stress-related diseases.8                                                                    with the focus of the formula. In clinic, all
                                                                                               the yin organs could be involved. Another
                                                                                               idea in the formula is liver constraint. This
                                                                                               sweet formula was apparently inspired by
                                                                                               the treatment principle found in chapter
                                                                                               22 of the Su Wen, that “When the liver is
                                                                                               in a bitter and restless state, quickly eat
                                                                                               sweet flavours to emolliate it.” Despite its
                                                                                               simple food based design, the formula

4     Sun Ten Newsletter   Autumn 2009
has been found to be highly effective in       2. Heart and spleen vacuity                Typical Formula: Ji Sheng Shen Qi Wan
the treatment of various mental disorders.     Clinical Manifestations:                   [Kidney Qi Pill from Formulas To Aid The
It is frequently combined with other mood      • palpitations                             Living]. Alternatively (number of grams
disorder formulas.                             • busy thinking                            of granules for one dose) Liu Wei Di
                                                                                          Huang Wan [Rehmannia Six Formula] 3g
                                               • worrying
Common Modifications:                                                                     and Huai Niu Xi [Achyranthes] 1g and
• For heart yin deficiency: add Bai He         • confusion                                Che Qian Zi [Plantago] 1g and Rou Gui
  (Lily) and Bo Zi Ren (Biota).                • inability to concentrate                 [Cinnamon] 0.3g.
• For qi deficiency: add Dang Shen             • feeling overwhelmed
  (Codonopsis)    and    Huang  Qi             • loss of strength and heaviness in        4. Yin vacuity with fire effulgence
  (Astragalus).                                  the limbs                                Clinical Manifestations:
                                                                                          • depression
• For schizophrenia: add Gui Zhi               • timidity, overly compliant behaviour
  (Cinnamon Twigs), Long Gu (Dragon                                                       • high anxiety
                                               • poor sleep
  Bone) and Mu Li (Oyster Shell).                                                         • possible panic attacks
                                               • poor memory
• For instability and restlessness of heart                                               • palpitations
  qi: add Suan Zao Ren (Zizyphus), Yuan        • light headedness
                                                                                          • insomnia
  Zhi (Polygala), Fu Shen (Poria cocos)        • fatigue
                                                                                          • dream disturbed sleep
  and Wu Wei Zi (Schizandra).                  • no enthusiasm
                                                                                          • dizziness
• For insomnia: add Bai He (Lily), Dang        • taking little delight in food or drink
  Shen (Codonopsis), Suan Zao Ren                                                         • heart agitation
                                               • T: pale
  (Zizyphus), Long Chi (Dens Draconis),                                                   • heat in the five hearts
                                               • P: fine, weak
  Wu Wei Zi (Schizandra) and Mai Men                                                      • irritability
  Dong (Ophiopogon).
                                               Typical Formula: Gui Pi Tang [Ginseng &    • easily angered
• Above symptoms and liver constraint,
                                               Longan Combination].                       • wanting to be alone
  depression, irritability and anger,
  chest and hypochondriac distention                                                      • possible suicidal ideation
                                               Formula Discussion: Source: Fu Ren Liang   • T: red, no coat
  and pain: combine with Xiao Yao San
                                               Fang. The formula supplements qi and
  [Bupleurum & Dang Gui Formula].                                                         • P: fine, rapid
                                               blood, strengthens the spleen, nourishes
• Above    symptoms       and    anxiety,      the heart and quiets the spirit.
  schizophrenia, manic depression,                                                        Typical Formula: Liu Wei Di Huang Wan
  psychosis, obsessional neurosis,             Common Modifications:                      [Rehmannia Six Formula].
  neurasthenia, dementia, menopausal           • Pronounced insomnia: add Ye Jiao
  syndrome,     epilepsy,      migraine,         Teng (Polygonum Stem).                   Formula Discussion: This formula is
  auditory and visual hallucinations,          • Pronounced blood vacuity, night          derived from Shen Qi Wan from the Jing
  stubborn inability to listen: combine          sweats:    add     Shu  Di   Huang       Gui Yao Lue (Essentials from the Golden
  with Wen Dan Tang [Bamboo & Hoelen             (Rehmannia, raw), this produces the      Cabinet). The formula’s creator, Qian Yi,
  Combination].                                  formula Hei Gui Pi Wan.                  removed the yang tonifying herbs from
                                               • Concurrent liver qi depression with      the original formula, leaving an elegant
Case Example: Female, late 40’s.                 heat: add Chai Hu (Bupleurum) and        and well balanced formula to supplement
Professional appearance, articulate, well        Shan Zhi Zi (Gardenia).                  kidney yin in children with symptoms
spoken. Chief complaint of frequent                                                       such as failure to thrive, a shiny, pale
urination, especially at night, leaving her    3. Spleen and kidney vacuity               complexion, dispiritedness and so
tired and lethargic the next day. On inquiry   Clinical Manifestation:                    on. This formula has since become
she is suffering depression and probably       • lack of enthusiasm                       the most commonly used formula for
post-traumatic stress disorder (PTSD)                                                     supplementing and enriching kidney yin
                                               • apathy
following the violent stabbing death of                                                   deficiency. Because the liver and kidney
her eldest son. She is very anxious, easily    • procrastination                          are of the same source, it also nurtures
frightened, irritable, cries easily, sleeps    • depression                               liver yin.
only a couple of hours each night and is       • wants to lie down
very tense physically. P: deep fine weak.                                                 Common Modifications:
                                               • a still body, little gesticulation
                                                                                          • Insomnia: add Suan Zao Ren [Zizyphus]
                                               • a monotonous, flat voice                   and Ye Jiao Teng [Polygonum Stem].
                                               • feeling easily frightened,               • Lower back pain and weakness: add
                                                 and apprehensive                           Du Zhong [Eucommia] and Huai Niu
                                               • sexual dysfunction                         Xi [Achyranthes].
                                               • poor libido
                                               • weakness of low back and knees
                                                                                                      References available on request.
                                               • T: large, pale, possible teeth marks,
                                                 white coat
                                               • P: deep, fine

                                                                                                  Ten Newsletter
                                                                                              Sun Ten Newsletter   Autumn 2009      5
                                              INTEGRATED TRADITIONAL &
                                              WESTERN MEDICINE
                      Stress and Mood Disorders - Taking a Deeper Look
                                 By Angela Carroll Adv. Dip. H.Sc. (Nat.), Adv. Dip. H.Sc. (Acu.), Adv. Dip. H.M.

Drivers of Stress and                           The Role of Inflammation in                          generation of certain mood disorders
Mood Disorders                                  Stress and Mood Disorders                            – particularly conditions characterised
It is well known that dysregulation of the      Inflammation and mood disorders are                  by lowered serotonin levels.1 In fact,
hypothalamic–pituitary–adrenal (HPA)            often seen together. Inflammation is the             there is some evidence that mood
axis, the core physiological stress-coping      direct result of immune activation. Any              disorders, insomnia and anxiety are
mechanism, affects the delicate balance         process that activates the immune system             often accompanied by activation of the
of cytokines, neurotransmitters and             (such as those listed in Table 1) triggers           inflammatory response.2 Interestingly,
hormones within the body. This, in turn,        an adrenal response, eliciting an increase           inadequate rest or sleep may actually
can detrimentally affect mood, causing          in cortisol production to help control               generate inflammation, contributing to a
low mood, irritability, anxiety and sleep       the inflammation and enable a return to              vicious cycle of inflammation, stress and
disturbances. Restoring health to your          homeostasis.                                         further sleep disturbance. Sleep loss
stressed, sad, anxious and/or insomniac                                                              increases levels of TNF-alpha and IL-6
patients requires that balance be restored.                                                          and thus contributes to the inflammatory
In addition to addressing the delicate                                                               response and HPA activation.3
balance of cytokines, neurotransmitters
and hormones with herbal formulas,                                                                   Inflammation can be a significant driver of
such as those mentioned in the article                                                               stress and mood disorders, and research
“Low Mood – A Chinese Medicine                                                                       indicates that reducing inflammatory
Perspective” on page 2, we also need to                                                              mediators in the body can improve HPA
assess and resolve driving factors that                                                              activity and reduce stress and mood
may be reducing that patient’s stress                                                                disorders. Managing inflammation in
tolerance and influencing their overall
                                                                                                     TCM involves the use of herbal formulas
health. Underlying driving factors that can
                                                                                                     that primarily clear damp and certain heat
accelerate the development of stress and
                                                                                                     patterns. For herbal recommendations
mood disorders include:
                                                                                                     see Integrated Traditional and Western
1. Inflammation
                                                                                                     Medicine. Sun Ten Newsletter; Jan/Feb,
2. Insulin resistance                                                                                2005: 8-11 and Integrated Traditional and
                                                Long-term production of pro-inflammatory
3. Sex hormones and                                                                                  Western Medicine. Sun Ten Newsletter;
                                                cytokines, such as, tumour necrosis
   gonadal dysfunction                                                                               Winter, 2007: 6-7.
                                                factor-alpha (TNF-alpha), interleukin-1
4. Impaired thyroid function                    (IL-1) and interleukin-6 (IL-6), cause HPA
5. Toxicity                                     dysregulation. Raised levels of IL-1, IL-6
                                                and TNF-alpha are implicated in the                  The Role of Insulin Resistance in
                                                                                                     Stress and Mood Disorders
                                                                                                     Inflammation and insulin resistance
                TABLE 1: MAJOR CAUSES OF INFLAMMATION                                                are intimately linked. Insulin resistance
 Allergens – environmental allergens, food allergens, pollens, dust, mould, animals, etc.            increases inflammation and, to compound
                                                                                                     this, insulin resistance is driven by
 Dysglycaemia and insulin resistance                                                                 inflammation. In order to improve stress
 External (exogenous) toxins – pollutants, drugs, toxic metals                                       tolerance, it is necessary to reduce both
                                                                                                     inflammation and insulin resistance
 Infection – acute or chronic
                                                                                                     because both these metabolic conditions
 Internal toxins – gut-derived                                                                       exacerbate stress and mood disorders.
                                                                                                     Insulin resistance is frequently associated
 Lack of blood flow
                                                                                                     with greater body fat stores. Essentially,
 Malnutrition                                                                                        adipocytes produce pro-inflammatory
 Nutritional deficiencies                                                                            cytokines (e.g. IL-1, IL-6 and TNF-alpha)
                                                                                                     and raised levels of IL-1, IL-6 and TNF-
 Oxidative stress                                                                                    alpha are implicated in the generation of
 Physical injury or trauma                                                                           anxiety and mood disorders. Therefore,
                                                                                                     maintaining weight within a healthy range
 Psychological stress
                                                                                                     is vital for assisting patients to improve
                                                                                                     their stress-tolerance and to reduce
                                                                                                     symptoms of stress.

6     Sun Ten Newsletter    Autumn 2009
                                                                                               “ improve stress tolerance,
                                                                                               it is necessary to reduce both
                                                                                                   inflammation and insulin

                                                                                               However, chronic stress has an inhibitory
                                                                                               effect on thyroid activity. Chronically
                                                                                               raised levels of corticotropin releasing
Fat loss and improved insulin sensitivity      Oestrogen, on the other hand, upregulates       hormone (CRH) and cortisol reduce the
are, therefore, essential for stressed         HPA responses.8 Women are, therefore,           levels of the active thyroid hormone tri-
patients. In the management of insulin         inherently more reactive to stress and          iodo-thyronine (T3). Hence, ongoing
resistance and obesity, your patient’s fat     more prone to mood disorders. Women’s           stress has a detrimental affect on
to muscle ratio must be improved by both       increased vulnerability to mood disorders       thyroid function, which subsequently
diet and exercise. Consistently, research      occurs post-pubertally, with the beginning      affects energy, vitality and mood. In fact,
is finding the most effective dietary          of cyclical changes in oestradiol (E2)          hypothyroidism is common in patients
program for increasing insulin sensitivity,    secretion from the ovaries. It is postulated    with HPA dysfunction, and is associated
                                                                                               with reduced serotonin activity and
reducing fat mass and improving mood,          that the changes in E2 levels may increase
                                                                                               reduced serotonin receptor sensitivity.
is a carbohydrate-restricted, adequate         women’s susceptibility to anxiety and
protein diet.                                  mood disorders.
                                                                                               If hypothyroidism is contributing to a
                                                                                               patient’s mood disorder, you must support
Supporting insulin signalling pathways is      For herbal recommendations on improving
                                                                                               thyroid function by providing adequate
important for insulin resistant, stressed      oestrogen     balance    see    Integrated
                                                                                               nutrition for thyroid hormone production
patients. Powerful insulin sensitising         Traditional and Western Medicine and TCM        and function – i.e. use a high iodine and
herbs such as cinnamon (Rou Gui), and          Principles. Sun Ten Newsletter; May/June,       tyrosine supplement with the addition of
Panax ginseng (Ren Shen) may support           2005: 7-8.                                      adequate zinc and selenium, as a base
healthy blood sugar metabolism.4,5                                                             for thyroid hormone structure. These
Additionally, the use of anti-inflammatory                                                     nutrients will also assist to improve
herbs, through reducing the levels of                                                          the conversion of thyroxine (T4) to T3.
circulating pro-inflammatory cytokines,                                                        Selenium and zinc additionally support
not only improves insulin signalling, may                                                      adrenal function in cases where cortisol
also improve mood and sleep disorders.                                                         production is altered. Performing the
For herbal recommendations to support                                                          simple Zinc Taste Test on all patients is a
insulin signalling and fat loss see Sun Ten                                                    wise practice to help identify if suboptimal
Newsletter; Spring, 2007.                                                                      zinc levels are a potential problem.

                                                                                               Hyperthyroidism can cause significant
The Role of Sex Hormones                                                                       anxiety, and conversely, acute stress
and Impaired Gonadal Function                                                                  may cause hyperthyroidism. In these
                                                                                               circumstances, a calming nourishing
in Stress and Mood Disorders
                                                                                               approach achieves the best clinical
As well as inflammation, obesity and
                                                                                               outcomes. Rehmannia glutinosa (Sheng Di
insulin resistance, the state of a patient’s
                                                                                               Huang) is a herb that has been traditionally
sex hormone balance and gonadal function
                                                                                               used in TCM for the management of those
can also affect their stress response and
                                                                                               with hyperthyroid, anxiety and fatigue
mood. For example, testosterone reduces
                                                                                               patterns. Recent research has found
HPA responses, suggesting that males
                                               The Role of Impaired Thyroid                    Rehmannia favourably alters thyroid
are better adapted to dealing with stress.
                                               Function in Stress and                          hormone levels in hyperthyroid patients,9
Clinical studies show that hypogonadal
                                                                                               with the additional benefit of reducing
males are more susceptible to stress           Mood Disorders
and mood disorders and that androgen           Stress has a significant impact on
replacement can reduce depressive              thyroid activity, and thyroid function can
symptomology.6 For hypogonadal men,            exacerbate anxiety and low mood. There is
the herb Tribulus terrestris (Bai Ji Li)                                                       The Role of Toxicity in Stress
                                               a positive feedback loop that runs from the
may increase serum testosterone levels.        sympathetic nervous system (SNS) to the
                                                                                               and Mood Disorders
Tribulus is traditionally used to support                                                      The final driver of stress and mood disorders
                                               thyroid via the adrenals. The activation of
reproductive health and sexual vitality,                                                       that must be addressed is toxicity. Toxins
                                               the SNS during acute stress upregulates
due to its effects on testosterone levels.7                                                    can initiate a stress response from the
                                               noradrenaline and adrenaline production;
This herb, although traditionally used in                                                      HPA and/or may exacerbate existing mood
                                               this, in turn, excites the thyroid, releasing
TCM for different purposes, is gaining a                                                       disorders. This can include exotoxins
                                               more thyroid hormone, leading to stress-        (i.e. toxins from external sources), such
strong fellowship among TCM herbalists
                                               induced hyperthyroidism.                        as alcohol, heavy metals and organic
for male reproductive health.

                                                                                                   Sun Ten Newsletter   Autumn 2009       7
chemicals, as well as endotoxins (i.e.        Endotoxins can also affect HPA function.
toxins from within us), such as bacterial     LPS is the major endotoxin to be aware of.
lipopolysaccharide (LPS).                     This constituent of the cell walls of gram-
                                              negative bacteria is a well-known inducer
One particular study found that acute         of the inflammatory response and strongly
administration of alcohol induces             activates IL-6. Dysbiosis (an overgrowth
dose-related     increases    in   plasma     of the wrong type of bacteria in the gut
adrenocorticotropic hormone (ACTH)            that produces excessive amounts of LPS)
and cortisol levels in an animal model. In    is one of the most common sources of
contrast, chronic alcohol intake results in   chronic HPA dysfunction.12                    The elements that need to be considered
blunted HPA activity. This study revealed                                                   with detoxification are all addressed in the
both hypothalamic and pituitary mediated          “Stress has a significant                  recently updated Metagenics’ Key Clinical
HPA dysfunction in chronic alcohol               impact on thyroid activity,                Concepts Practitioner Guide to Detox. This
exposure.10 Other examples of the effects                                                   program provides an effective elimination
                                                  and thyroid function can
of exotoxicity on stress responses include                                                  and repair program for patients with gut
findings that occupational toxin exposure          exacerbate anxiety and
                                                                                            and/or liver toxicity issues.
may cause stress-related symptoms.                      low mood. “
In workers performing confined space
welding without adequate protection,
                                                                                            Drivers of Stress and Mood
significant inverse toxin dose-effect
                                                                                            Disorders – Improved
relationships were found for IQ, executive
function, sustaining concentration and
                                                                                            Clinical Awareness
                                                                                            These HPA activators enhance the effects
sequencing, verbal learning, working and
                                                                                            of stress on the HPA axis and predispose
immediate memory. Other symptoms
                                                                                            patients to the development of stress-
reported by the welders while working
                                                                                            related mood disorders. It is important
were as follows:
                                                                                            to understand the role these factors
• Tremors (41.9%),                                                                          play in stress and mood disorders, to
• Numbness (60.5%),                                                                         increase your awareness in your practice
• Excessive fatigue (65.1%),                                                                of considerations that may need to be
                                                                                            addressed when assisting patients with
• Sleep disturbance (79.1%),
                                                                                            stress and mood disorders.
• Sexual dysfunction (58.1%),
• Toxic hallucinations (18.6%),                                                                         References available on request.

• Depression (53.5%), and
• Anxiety (39.5%).11

               Product Announcements
Health World are excited to announce          In Australia all species of Aristolochia      Sun Ten products are manufactured in a
the return of several formulas which          are prohibited for supply, sale or use        TGA compliant manufacturing plant and
have passed stringent TGA (Therapeutic        under the Scheduling of Drugs and             their raw material, testing and quality all
Goods Administration) approved testing to     Poisons Act. Formulas that commonly           exceed the stringent TGA standards.
ensure they contain no aristolochic acids.    contain aristolochic acids (including
Aristolochic acids have been associated       the listed formulas) need to be tested                    References available on request.
with severe kidney damage1 and urinary        for aristolochic acid content before they
tract cancer2.                                can be sold as therapeutic goods on the
                                              Australian market.
The formulas that are returning are;
• #438 - Xiang Sha Liu Jun Zi Tang

•   #244 - Shu Jing Huo Xue Tang                     How do I know if a formula
    CLEMATIS & STEPHANIA                             contains aristolochic acids?
                                                     TGA compliant formulas contain an Aust L (listable)
•   #350 - Gui Pi Tang                               number displayed on the container. This ensures
    GINSENG & LONGAN COMBINATION                     that the herbs are correctly identified (haven’t
                                                     been substituted), safe (e.g. no aristolochic acids)
•   #1607 - Long Dan Xie Gan Tang                    and comply with a number of safety and efficacy

8     Sun Ten Newsletter   Autumn 2009
                                                  FSH      LH



         (E2)     (P)

                (FSH)        40-80pg/ml                         80-40pg/
(LH)                    ml                               100-150pg/ml
                                        40pg/ml                      E2
                                  60-80pg/ml                    E2
                        (T)0.8nmo/L        FSH      LH


                             CD3     CD4

  (ER)                                                           (IL      2)

                              Sun Ten Newsletter    Autumn 2009           9
                                                           (hormone replacement
                                        therapy, HRT)




10   Su Te
     Sun Ten Newsletter
     Sun Ten Newsletter
              ewsle ter
               ws ette
                  e er    Autumn
                           u um
                          Autumn 2009
Sun Ten Newsletter   Autumn 2009   11
12   Sun Ten Newsletter   Autumn 2009

 pH:7.2    8.0

                 40 x 106⁄ml



  Sun Ten Newsletter     Autumn 2009   13



  (oligoasthenoteratozoospermia,      OTA



14     Sun Ten Newsletter   Autumn 2009





                           (pelvic inflammatory
disease, PID)

                                                    Sun Ten Newsletter   Autumn 2009   15
Distributed by Health World Limited
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Northgate, Queensland, Australia 4013              PO Box 35383, Browns Bay
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Telephone: (07) 3117 3300               Telephone: (09) 478 2540 or 0508 227 744
Facsimile: (07) 3117 3399                   Facsimile: (09) 478 2740 or 0508 227 733
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