Chinese Herbs for PMS/PMDD: Ba Zhen Tang

It has become clear that my girlfriend, B, suffers from a form of depressive disorder linked to her menstrual cycle. The week before her period begins, her mood and energy levels take a nose dive and she crashes hard. Her symptoms include severe fatigue, muscle weakness, constipation, nausea, edema, headache, anger, poor memory, clouded thinking, poor judgement, anxiety, paranoia, and obsessive negative thinking.

The stress of being in a relationship with someone suffering from depression used to be the main reason why she said she felt depressed. Even after I found a working psyche med combination and started to recover, she was unable to feel good about this and refused to see the positive transformation occurring right before her eyes. When her period finally began she would feel much better after about 2-3 days.

As I learned more about using Chinese herbs to treat depression, I wondered whether the formula called Ba Zhen Tang - Eight Treasures Decoction - would be good for B. This formula strongly tonifies the Spleen (capitalized because it represents functions, not the anatomical spleen) and builds blood. Women are at particular risk for blood deficiency. The week or two before her period, a woman must produce extra blood to support the growing uterine lining. A lot of B's symptoms are pretty consistent with the Chinese medical diagnosis of blood deficiency: forgetfulness, poor memory, poor sleep, dizziness, fatigue, and constipation. Her periods were often very short with light flow.

Now that B and I live in a normal apartment with a kitchen (a long, horrible story for later), and since we have a good source for fresh herbs at the local market, I decided to try making Ba Zhen Tang from dried herbs. I knew B wouldn't take herbal extract pills with any consistency. She can be really stubborn about not doing something that could make her feel better. I think this is a symptom of depression and anxiety, to be honest. It's like there is a fundamental inability to accept your limitations and feel compassion for yourself.

I went to the market and tried to explain the situation to the herb lady. I used my limited Mandarin and got my point across. The herb lady has pre-mixed packets of the most common formulas. I bought two packs of Ba Zhen Tang that I could use to make six servings. At two servings a day, $6 worth of herbs would make a three day supply.

A packet of Ba Zhen Tang.

Here is a standard formula for Ba Zhen Tang:

• Dang Shen/Radix Codonopsis
• Bai Zhu/Rhizoma Atractylodis Macrocephalae
• Fu Ling/Poria
• Gan Cao/Radix Glycyrrihizae
• Dang Gui/Radix Angelica Sinensis
• Bai Zhao/Radix Paeoniae Alba
• Chuan Xiong/Rhizoma Chuanxiong
• Shu Di Huang/Radix Rehmannia Preparata

Here's a photo of the herbs inside the packet:

1...2...3...4....9? Nine?

It took me a moment to realize that there were nine different herbs in the packet I'd bought. It turns out that what's missing is Shu Di Huang a.k.a. prepared Rehmannia. Prepared rehmannia is a sticky, glutinous black colored herb that is the result of processing rehmannia root. It nourishes kidney and liver Yin. It is good for blood deficiency and helps with dizziness, insomnia, irregular periods, and heart palpitations. If you are Yin and/or blood deficient, it's like you lack coolant and tend to overheat and dry out.

Yum...Shu Di Huang/prepared Rehmannia
Image Source

In its place, we have Shan Yao/Rhizoma Dioscoreae and Da Zao/Fructus Jujubae a.k.a. Chinese red dates. These two herbs have more to do with tonifying the Spleen, Kidneys and Lung. They do not appear to be a substitute for rehmannia. I need to ask the herb lady why she made this substitution.

The replacements

I used the following traditional method to make an herbal decoction from the raw herbs:

1. After rinsing out the herbs in a colander, I put the herbs in a stainless steel pot and added 4 cups of water. Metal is not really the best material for your cooking vessel, as it can react with certain herbs. Stainless steel is OK and it's all I have right now. I plan to buy a traditional ceramic herb cooker in the near future. You should be able to find one at your local Asian grocery.
2. I heated the water to a boil, lowered the flame, and let the herbs simmer partially covered for about 45 minutes while stirring occasionally to keep the herbs submerged. 
3. When the water had decreased to 2 cups (my pot has handy markings inside), I poured the tea through a strainer into a bowl. That left me with 2 cups of pungent medicine. I had B drink 1 cup immediately. 
4. I put the herbs back in the pot, added 3 cups of water, and repeated the simmering process until I had 1 cup of liquid left. I added that to the remaining tea from the first brew. That made two more servings for the next day, one for before breakfast and one before bed. Herbal medicine is best taken on an empty stomach, say 30 minutes before a meal or 1-2 hours after. Unlike pharmaceuticals, which often upset the stomach, herbs are pretty mild - we're trying to strengthen the digestive system after all.

The results? B seemed to feel better after two days. A few days after finishing her last cup of Ba Zhen Tang she started getting antsy and negative. When her period finally came today (right on schedule, now that I monitor these things), she spent most of the day in bed. We're talking about someone who does not have a diagnosis of depression and is more or less fully functional for 75% of any given month.

I'll be honest, I'm really glad I am writing this blog, if only because it gives me a way to express my frustration. As much as I feel that I don't really have much to complain about, I was in denial about my own frustration with B's situation and how she handles it. It affects me a lot. I guess it's only fair that I get a taste of what it is like to live with a depressed person. It just drains the energy out of the room. At least B is finally starting to admit that she has a problem. That's a start. Next month I'm going to suggest she take the herbs for six days. I think it's definitely worth the small amount of trouble it takes to cook them up.

Pre-Remission Journal: Starting Medication - SSRIs

When I started medication to treat my depression and anxiety, I started a journal in order to keep track of what medications I was taking and whether or not they seemed to be working. I wanted to be as systematic as I could, which was limited to what I could handle at the time, but I still felt that it might help me if I had to switch medications. Looking back on my journal, I see that I can still learn from it by finding healthy patterns and identifying bad combination of medications and herbs. I won't edit the entries too much. My writing patterns may also indicate what state of mind I was in when I wrote a particular entry.


Monday, October 26, 2009
1:08am

It's been about 6 days since upping the dose of Faverin (fluvoxamine, an early SSRI) to 50mg/day. I've been in a stupor since then, but having trouble sleeping as well. Average bedtime: 3-4am, waking up around noon or later. This sucks. I still feel completely apathetic towards everything and the only thing that makes it better is that I've stopped pressuring myself over finding a job for the time being. My appetite is non-existent and I feel I have no coordination or strength in my body.

I have a sloshy, bloated stomach from too much spicy food at B's sister's (not really sister) house. I have no idea how they can eat like that (more likely twice as hot) every day. I popped 8 Strong Wakamoto and will hope for the best. I started developing the strange rash on my left arm this time. I applied 1% hydrocortisone. It should be gone in the morning, but why did it occur in the first place? Milk? Greasy food? Who knows anymore what the hell is going on.

Notes:
Insomnia has been a problem since I was 15 years old. When I first entered treatment, I would have to read or surf the web until I was completely exhausted. I have always had trouble getting up early as a result.

These days I can fall asleep by 10:30 - 11:30pm and wake up as early as 6:30 - 7:30am.

The bloated stomach is a symptom of Spleen deficiency in Chinese medicine. This is probably a symptom I've had for a long time, but never really addressed. I am currently taking herbs to tonify the Spleen and rarely experience bloating or indigestion. As a result of good digestion and absorption of nutrients, I have a lot more energy. Spleen deficiency can also cause obsessive thinking and worrying. It sounds weird, but in a sense obsessive worrying is like never feeling satisfied. You feel like you need more and more...never getting enough. In this sense, treating Spleen deficiency can lead to more calmness and lessening of these symptoms.

I guess I've really come a long way just in terms of my sleep schedule. The ability to get enough quality sleep is not to be underestimated. Chronic sleep deprivation can bring on depression, while problems sleeping through the night are a common symptom of depression. It's a negative spiral that can lead to a daily cycle of dreading both sleep and daytime activities.