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.

Rhodiola rosea and Depression: Update I

Herbalgram report on Rhodiola rosea: read and download from Scribd.com

I've been taking Rhodiola rosea extract for the past few days and I have definitely noticed a positive effect in terms of mood and energy. I actually noticed an effect after the first dose, but couldn't be sure if it was solely due to the rhodiola. I took one day off, then decided to that I should take it every day in order to form a fair opinion of its effects. The second time I took it I again noticed greater energy and a brightening effect in my visual field. I made sure to take it apart from my usual morning cocktail of vitamins and herbs. There was no mistaking the effects this time.

I purchased bulk Rhodiola rosea extract powder and made my own capsules. Pictured above is 500mg of extract in a "OO" sized capsule.

I had ordered Rhodiola rosea extract powder from Beyond a Century a few months ago, but was hesitant to try it because I knew it could affect neurotransmitters. My experiences with niacin and folic acid have taught me that supplements and herbs that affect neurotransmitter production and reuptake could potentially interact with my meds in a negative way. In the case of niacin and folic acid, I tend to feel tired and sluggish. I attribute this to an overproduction or lessening of the reuptake of serotonin. I do not get this effect with rhodiola. In fact, I feel more alert and my mind moves faster.

The Rhodiola rosea I purchased is standardized to 3% Rosavins. I do not know the concentration of Salidrosides. I have heard that the ideal ratio of Rosavins to Salidrosides is 3:1. The extract powder is very resinous and is quite bitter. It also seems to be somewhat hydrophobic and coats your tongue and the inside of your mouth. I have a pretty good tolerance for the taste of bitter herbs, but rhodiola is a bit too much for my liking. I decided it'd be easier to make my own capsules using OO-sized gelatin capsules and my Cap-M-Quik capsule machine that I purchased from the guys at Purebulk.com. If you do decide to take the powder raw, have a sweet drink or candy ready as a chaser.

My curiosity piqued, I went to the library and read through a copy of The Rhodiola Revolution by Richard P. Brown M.D., Patricia L. Gerbarg M.D. and Barbara Graham. Both Brown and Gerbarg are practicing psychiatrists and take rhodiola for certain health conditions and as an energy booster. They also recommend rhodiola to some of their psychiatric patients and report little to no adverse reactions with any medications including antidepressants and mood stabilizers (see Important below). The book also contains a good summary of the physiology of stress and how rhodiola might help to build a tolerance to its deleterious effects.

As doctors with a healthy dose of scientific skepticism, Brown and Gerbarg went straight to the source, literally, by contacting Dr. Zakir Ramazanov, a Russian plant biochemist and molecular biologist that participated in formerly classified research on adaptogens. He discovered the power of Rhodiola rosea after taking it while serving in the military and later used the herb to cure his Post Traumatic Stress Disorder (PTSD). Dr. Ramazanov shared his extensive findings with the authors and even took them to one of remote mountainous regions in Siberia where Rhodiola rosea grows naturally. It is believed that the difficult conditions in which the plant grows may be the stimulus for the plant to produce its adaptogenic substances.

I plan to continue taking Rhodiola rosea for the time being as part of my daily blend of herbs and supplements. I have heard that rhodiola can lose its effect over time and is best cycled. If I find this to be the case, I will report back with my experience. If anything, my positive results from taking rhodiola remind me to keep an open mind and to be continually humbled by the healing nature of herbs. I urge you to cultivate your belief in the possibility of healing from depression and anxiety and to remain steadfast for as long as it takes to find relief. I know what it's like to suffer deeply and I also know that there is always hope.

For more information on Rhodiola rosea, the author's of the book The Rhodiola Revolution along with Dr. Zakir Ramazanov have published a nice report in the publication Herbalgram. Click here to read and download from Scribd.com.


Important: The authors are clear to highlight a slight risk when taking rhodiola for activating mania in bipolar individuals who are not currently on mood stabilizers or in a stable condition. If you are prone to manic or hypomanic states, take a small dose of rhodiola to see if it affects you in a negative way. Do not mix rhodiola with other stimulants and take your dose in the morning if you are prone to insomnia.



*As you should know, the purpose of this blog is not to make recommendations for treatment. I am not a doctor nor do I pretend to be. You are responsible for your own health and you should always consult with your doctor before trying any medications, supplements or herbs. I tell my doctor about any supplements that I take and I have her approval as long as they are helping and not hurting my recovery.*

Rhodiola Rosea and Depression

September 18, 2010

I'm taking a number of herbs for depression, energy and anxiety. But I won't go into those right now. I going to try taking Rhodiola rosea extract for a few days to see if it affects my mood and energy.

[Rhodiola appears to have noticeable effect! See Update I on Rhodiola Rosea and Depression]

I am going through a difficult time right now in my recovery. I am in a new living space, I'm able to cook, and overall the environment is much better than it was before. Nonetheless, my relationship with B is not doing so well. I know I have to find positive strategies to deal with this frustration. Until now, my go-to stress relief has been smoking. This is pretty much the worst thing I could be doing since it steals my energy and brings my mood down. I also tend to procrastinate horribly when smoking. I'd rather smoke than take positive action.

I won't say I've been perfect in terms of quitting smoking*, but I have made some changes:

• I'm making nutritious food and making sure to eat enough
• I'm going to the library in the afternoon and reading/taking notes
• I've polished a basic version of my resume and I am ready to send it out to some jobs that I think I am more than qualified for
• I'm trying to remember the importance of meditation and calming in the overall picture of regulating my mind and energy
• I'm trying to invest in my own future outside of the relationship; what I mean is that I am trying to not let my relationship problems make me feel like my future is hopeless. It is not.

I just took about ~500ml of Beyond a Century's Rhodiola extract. It tasted a little bitter and sweet and coated my tongue with an astringent powder. It is not unpalatable like, say, eurycoma longifolia.

We'll see how it goes.

Addendum: I felt frustrated last night when B came home. She had an extremely long day, and her habit is to pretty much ignore me and act pretty ungracious. Earlier in the day, I'd made a large quantity of Indian food (dahl, potatoes) so we'd have some good food to eat. When she came home, I asked B is she was hungry. She said she didn't want to eat. Without any further conversation she changed clothes and went straight to bed. After half an hour, I wrapped up what I was doing and got ready for bed. After about ten minutes she got up and said she was hungry. I was going to warm up the food, but she didn't show any signs of getting up, like she wanted me to bring the food to her in bed. I wasn't in the mood to do that, and plus I don't think we want to eat food in the bedroom and have it smell like oil and curry. She finally got up and I heard her heating up some food. I thought I'd go out and hang out with her while she ate. I heard the TV come on and knew that she didn't want to interact with me at all. I peeked out and saw a bowl of lentils sitting untouched on the dining room table. She was eating a bowl of rice and some preserved mushrooms we received from her relatives. 


This morning was more of the same. Today (Saturday) was unusual in that B needed to go to work for the morning. Before we got up, I asked B if she wanted to eat breakfast. She said yes, but rolled over in bed. I got up and made scrambled eggs, toast and coffee. When it was ready, I told her it was time to eat. I hate it when I make food for her and she waits a long time to sit down to eat - when the food is already cold. After a few minutes she came over to me and said in her fake-cheerful voice, "Thank you, Billy!". I was feeling a bit pissed off because she hadn't said anything else to me otherwise. No 'good morning', nothing about her previous day. Nothing. I also asked her, "Did you even try the beans last night or did you just throw them away?" She said she tried them and put them back in with the rest of the leftovers. I wasn't really feeling too cheerful by this point and she finally noticed after eating a few bites of egg and toast. She asked me why I was upset, but I didn't say anything. "Try the cinnamon-sugar--it's good," was all I could say. She got up, took out a Ziploc bag and put the rest of her breakfast inside to take to work. Now she was going to punish me for being upset, and rightly so in my opinion, by not talking to me. As she locked the gate to leave for work I asked her what time she'd be coming back. That's something I'd like to know, especially since she expected me to make her lunch or dinner. "After lunch," she said with some contempt and just left.


I finished off that smoke and had one more. I walked back to the apartment wondering what I was going to do. I don't want to go back to sitting around the apartment not doing anything. I will still go to the library this afternoon. I do feel very depressed, however, not only because I broke my self-imposed smoking ban, but because I felt weak, ineffectual, hopeless, and above all else, sad. Sad about my condition, sad about my relationship, and sad that there seems to be very little joy these days no matter what I do or how hard I try to maintain a positive attitude.

Quitting Smoking (Again) and Herbal Chicken Soup

September 13, 2010

It's day three of not smoking. As usual, I reached well beyond the point where smoking was enjoyable and had to face the fact that I was chasing something that wasn't real. The more I smoked, the more I smoked. There was no end in sight. As usual, I had to chuck an unfinished pack in the trash. The act of voluntarily getting rid of perfectly good smokes is the symbolic gesture that begins the ritual transformation of kicking the habit. Finishing a pack just won't go it; that's just a natural pause in the game of smoking. But throwing away smokes is sacrilege; only a non-smoker can do that. In order to quit smoking I must become a non-smoker. There is no other way.

I had a very hard time waking up this morning. Still tired even after eight hours in bed. I guess I didn't eat enough last night. This is becoming an issue. I am not used to having to eat more food just to be able to feel normal. I am very wary of not overeating, but I think my metabolism is speeding up from the weight training. Other than that, I've been getting very little exercise as of late. That was because of the smoking. As a smoker, I didn't exercise that much. As a non-smoker, I can exercise all I want. I might as well, since that's one of the best reason's not to smoke, to embrace health. I don't feel too healthy today, however, despite going to the gym yesterday. That's why I went to the market to get myself some herbs.

I bought this pre-mixed package of herbs for less than $3

I went to check on the chicken soup and it is looking good. Absolutely no scum, just some yellow fat/oil that I skimmed off. I bought a free-range chicken and a packet of herbs from the herb lady. I told her I was making chicken soup and I wanted some herbs to "boost qi". She reached up and pulled a packet out of one of the bags hanging from the frame of her stall. I asked her what it was called, but she just told me how many herbs were in the packet. Thanks. I guess I understand that most people don't know anything about Chinese herbs, so it's pointless to try to explain what the individual herbs are much less what they do. I hope I can slowly show her that I know a thing or two and that I'm interested in learning whatever she has to share.

There were nine different herbs in the packet, all very fresh. 

Based on some experience and several online resources, I think I've identified the herbs. Following a counterclockwise spiral from the top left their Chinese Pin Yin and Latin pharmaceutical names are:
 

• Shan Yao/Rhizoma Dioscoreae
• Huang Qi/Radix Astragali
• Dang Shen/Radix Codonopsis pilosulae
• Yu Zhu/Rhizoma Polygonati Odorati
• Da Zao/Fructus Jujubae
• Gou Qi Zi/Fructus Lycii
• Gai Ben.Rhizoma Ligustic
• Bai Zhu/Rhizoma Atractylodis macrocephalae
• Gan Cao/Radix Glycyrrhizae

Most of these herbs tonify the Spleen and Qi and remove dampness. This means that they make your digestion stronger and prevent bloating and undigested food sitting in your gut. They also enhance your metabolism and boost energy production. The Gou Qi Zi a.k.a. Goji Berries or Chinese Wolfberries add some Yin to the mix, to balance out all the dry, warm herbs. The Yu Zhu a.k.a. Solomon's Seal also helps to moisten and nourish Yin. Gan Cao a.k.a. Licorice Root is added to many formulas to harmonize the actions of the other herbs and to shore up digestion as well.

The aroma of the herbs and chicken is so good. Note the yellow fat. The leftovers turned to a thick, collagen-rich gelatin in the fridge.

The soup is a bit tart and sweet. I added some salt and I think it'll be ready to eat in about 10 minutes. Oops, I forgot to make rice. Stupid.

Why am I so absent-minded these days? Is it because of the smoking? Is it the depression coming back? Is it "normal"? Will I ever be able to know if the way I feel is normal, is justified and I don't have to worry about it?

Well, when my mind starts going a little too fast or in a negative direction, it's usually time to eat. I guess adults can be like cranky babies before they get their bottle. I sure hope babies don't have existential crises every time they get hungry.

The soup is delicious and nourishing. I'm very fortunate that I can walk 10 minutes to the market to buy fresh meat and herbs. Food truly is the first medicine.