Beating the Blues: Health Tips for Living a Joy-filled Life Successfully Alleviating Depression with Lifestyle, Diet, Supplement and Herbal Therapies by Lesley Tierra, L. Ac. and Michael Tierra, O.M.D. TABLE OF CONTENTS Introduction 3 I: OVERVIEW OF DEPRESSION Symptoms of Depression Forms of Clinical Depression Depression, Stress and the Marketing of Antidepressants Causes for Depression 4 4 5 6 II: TREATMENT FOR DEPRESSION Lifestyle Therapy for Depression Food Therapy for Depression Supplement Therapy for Depression Herbal Therapy for Depression Determining Your Type(s) of Depression Herbal Remedies for Depression Taking the Proper Herbal Dosage Guidelines for Taking Herbs with Medications 8 10 13 16 17 21 25 25 III: ADDENDA Addendum I: TCM Organs Addendum II: Omega 3 and 6 Folic Acid Studies 27 31 Note: Anyone seeking to treat themselves – especially for severe, intractable depression – should seek appropriate medical health care to determine whether such complementary or alternative modalities are appropriate for their particular condition. Under no circumstances should one suddenly stop taking prescribed drugs for depression, or substitute more natural approaches without seeking the assistance of their qualified health provider. 2 INTRODUCTION “But when the melancholy fit shall fall Sudden from heaven like a weeping cloud, That fosters the droop-headed flowers all, And hides the green hill in an April shroud – She dwells with Beauty – Beauty that must die; And joy, whose hand is ever at his lips Bidding adieu; and aching Pleasure nigh, Turning to poison while the bee-mouth sips: Ay, in the very temple of Delight Veil’d Melancholy has her sovran shrine.” From Ode to Melancholy by John Keats (1795-1821) What exactly is this dreaded “melancholy” that inspired Keats’ ode? In early Arabic and medieval medicine, melas meant “black” and chole meant “bile.” Together, as “melancholy,” they refer to “black bile,” one of the four humors of the medicine of classical antiquity. When imbalanced, “black bile” was considered to be the psycho-physiological cause of depression, and it was said to emanate from the liver and spleen. Today, we describe what our ancestors called “black bile” with another color: “Feeling blue” is the colloquial term for used to describe the dark, depressed mood previously associated with the term “melancholy.” It’s no wonder that since W.C. Handy’s publication of Memphis Blues in 1912, the blues has become the basis of Western popular music. Rather than sing the blues, why not use many of the available and successfully tested options that exist for treating and alleviating depression? Here we will first look at the symptoms, types and causes of depression and then we will explore lifestyle, dietary, supplement and herbal treatment approaches to managing this condition. 3 I: OVERVIEW OF DEPRESSION SYMPTOMS OF DEPRESSION The following is a list of symptoms that define depression according to the American Psychiatric Association: • • • • • • • • • • Loss of interest or pleasure in usual activities and pastimes Increased or decreased appetite with noticeable weight change Excessive sleepiness or sleeplessness (insomnia) Hyperactivity or slowed activity No interest or pleasure in normal activities, with possible inability to get out of bed in the morning Reduced sex drive Fatigue or lack of energy Feelings of guilt, self-reproach, or lack of personal worth Impaired mental abilities Preoccupation with thoughts of death or suicide; attempted suicide The symptoms of depression may be also be expressed as the following: increased irritability and dissatisfaction, withdrawal from others, crying spells, moodiness, nervousness, anxiety, headaches, muscle aches and pains and/or palpitations. It may also manifest as sudden anger and aggressive behavior, especially in boys and men (because of the Western “boy code” – “Keep your chin up, don’t be a crybaby” - males are more often taught to hide their emotions). FORMS OF CLINICAL DEPRESSION There are many types of depression and it is possible to experience one type, or a combination of types. Further, individuals who have had one episode of major depression are more likely to have another at some point in their lives. Sometimes this is separated by several years, or there may be several episodes over a shorter period alternating with periods of normal functioning. In general, it is estimated that 20 to 35 percent of victims suffer chronic depression that prevents them from living a normal daily routine. • • • • Major Depressive Episode: This is a state of depression with all the classic symptoms – lethargy, sleep disturbance, despondency, morbid thoughts, inability to feel pleasure, feelings of worthlessness and sometimes attempted suicide. Agitated Depression: This is a clinical depressive state where the individual exhibits irritability and restlessness. Dysthymia, or Dysthymic, Depression: This type of depression occurs when someone feels in a bad mood for months to years. Retarded Depression: This is a state of clinical depression where an individual is lethargic and slow to initiate action. 4 • • • • • • • • • Clinical Depression: This is characterized by a dominant state of an inability to derive pleasure from life (anhedonia). It is so severe that it requires clinical intervention. Affective Disorder, Emotional Disorder, Emotional Disturbance, Major Affective Disorder: These types of depression are caused by physiological abnormalities of the brain when the person is emotionally disturbed. Endogenous Depression: This is a state of depression in which there is no apparent external cause. Exogenous Depression, or Reactive Depression: This occurs in response to events in one’s life, such as the loss of a loved one, job, or something else of value. Manic Depression: This is a distinct period of an abnormally and persistently elevated or irritable mood that lasts at least one week (or is of any duration where hospitalization may be necessary). Manic depression can take many forms, including a decreased need for sleep, extreme talkativeness, racing thoughts, easily distracted, increased goaldirected activity and/or excessive involvement with pleasurable activities that have a high potential for adverse consequences such as buying sprees, sexual over-indulgence, or foolish business investments. These episodes of mania are alternated with “down” times more easily identifiable as classic depression. Psychotic Depression: This is a severe depressed state where a person loses contact with reality and suffers a variety of functional impairments. Neurotic Depression: This describes a state of depression that is not psychotic or involves any other type of disassociation behavior. Post Partum Depression: Usually resulting from a sudden hormone shift in the mother, post partum depression occurs after childbirth where there is a radical downward swing in mood. Anaclitic Depression: This is severe progressive depression in infants who either lose their mother, or for various reasons are unable to form a dependent bond through the early years. DEPRESSION, STRESS AND THE MARKETING OF ANTIDEPRESSANTS Either with the prevalence of stress in Western societies, or because of its increased recognition (as much as 10 to 20 percent of the population worldwide is taking or has taken some form of psychoactive drug for depression, anxiety, stress or other nervous system disorders), the World Health Organization (WHO) has projected depression to become the second leading cause of premature death by 2020. In fact, depression has become so widespread, particularly in the U.S., that Europeans call this country the “Prozac Nation.” Indeed, it is very common for adults to use antidepressants, and antidepressant use is becoming more and more widespread amongst children and teenagers as well. Further, it is not unusual for women to experience mild depression before or during menses, after childbirth or through the peri/menopausal years. Severe depression and depression due to inherited causes or childhood factors usually need professional guidance and counseling. However, such treatment may be coupled with herbs and diet for more efficient results. 5 It is certainly appropriate for people who are at risk of suicide, or of doing personal harm to themselves or others, to use strong antidepressant drugs. (Any threats or thoughts of violence or suicide should be taken at face value when dealing with anyone who suffers from depression.) However, for those who are not suicidal or violent, or whose depression is identified as ‘mild,’ the use of herbs, nutrition and lifestyle modifications can be extremely valuable. This means that as many as 80 percent of the population taking prescribed antidepressant medication can seek less invasive, more natural means of treatment. There are actual physiological causes for most types of depression that can be treated and improved. This is a tremendous boon since medications only mask the underlying causes. Of course antidepressants may be important in intractable cases, or to help someone get over an extremely difficult time in life. However, the underlying causes and imbalances for the depression still need correcting, and when they are, medications are usually no longer needed. CAUSES FOR DEPRESSION While a period of grief and sadness over a loss is normal, it can also trigger a depressive episode. Similarly, environmental changes can trigger a downward swing in mood. For obvious reasons, many poor single working mothers of young children are prone to depression. These women often live with loneliness, financial stress and lack assistance with rearing children or maintaining a household. Similarly, men who are unable to find gainful employment are laid off from work and/or experience a major financial loss, also have a tendency towards depression. Most depression results from a combination of the following (the first listing is the commonly acknowledged Western causes while the ones in parentheses are the causes according to Traditional Chinese Medicine (TCM) 1 : • • • • • • • Hypothyroidism Suppressed, unexpressed and unreleased emotions, particularly anger, frustration and resentment, although it can be any long-term repressed emotion (congests the Liver) Sudden emotional extremes, such as those from shock or crisis (depletes the TCM Kidneys and Heart) Genetic predisposition or inherited weak nervous system (weakened TCM Kidneys and/or Liver) Difficult childhood, such as abuse, deprivation or neglect (congests the TCM Liver) Extreme stress, especially if feeling an inability to cope, such as the death of a loved one, divorce, loss of job, abuse, neglect, financial collapse, mid-life crisis (weakens the TCM Kidneys and congests the TCM Liver). 1 TCM Organs are capitalized. They have different functions than those attributed by Western medicine. See Addendum I for a full definition of the TCM Organs. 6 • • • • • • • • • • • • • • Excessive use of alcohol, caffeine and caffeine-like stimulants (coffee, black tea, colas, mate, cocoa and chocolate) or drugs (recreational or medical) – (weakens the TCM Kidneys and congests the TCM Liver) Excessive intake of dairy, nuts and nut butters, turkey, avocados, fried and fatty foods, chips, vinegar and oily, greasy foods (congests the TCM Liver) Long-term chemical exposure, such as herbicide sprays or metalworking (congests the TCM Liver) Suppressed creativity (congests the TCM Liver) Suppressed desires and dreams for one’s life (congests the TCM Liver and depletes the TCM Heart) Overworking combined with irregular diet and excessive activity or sex (weakens the TCM Kidneys) Lack of exercise (congests the TCM Liver) Not liking one’s work or job (congests the TCM Liver and weakens the TCM Heart) Long-term chronic disease (weakens the TCM Kidneys and digestion) Birthing too many children too close together (weakens the Kidneys) Low or imbalanced blood sugar levels (weakens the digestion) Low energy, tiredness (weakens the TCM Kidneys and digestion, congests the TCM Liver) Unresolved stress (congests the TCM Liver) Unhappy or unfulfilling relationships (congests the TCM Liver and weakens the TCM Heart) 7 II: TREATMENTS FOR DEPRESSION There are three ways to treat depression naturally: lifestyle, food, and supplement and herbal therapies. LIFESTYLE THERAPY FOR DEPRESSION: The following lifestyle recommendations are beneficial for both alleviating and preventing depression. Many of them have cumulative effects, so it is important to do them daily for best results, or at least several times a week. Some people only need to follow these suggestions along with the dietary recommendations in order to manage or prevent depression. 1) Daily exercise: Movement is most beneficial for preventing and treating depression, as it stimulates the production of endorphins, or natural mood-elevating chemicals. Having little need for natural exercise in our modern lives, we substitute with gyms, exercise equipment and video tapes, yet this does not compare to the amount of walking, lifting and carrying that was a normal part of life before motor vehicles and appliances. In fact, one of the best expressions for frustration, anger and resentment is constructive physical activity. Depression is often suppressed anger, so use that energy to clean up the kitchen, unload old drawers/closets, or run around the block – all help to express and release this energy in healthy ways. At the first signs of depression, physically move your body. While this may be the last thing you feel like doing, it is the easiest and most efficient way to change your emotions. As well, movement increases energy, stimulates metabolism, aids sleep, rejuvenates bodily functions and improves digestion and elimination. Movement may be any activity that physically moves your body. Putting on music and dancing while performing chores, walking, swimming, bicycling, wrestling with kids and other such activities that physically move your body will free congested energy in TCM Liver. An important note here is to make sure the exercise and movement you choose is FUN. Let it express your unique being; otherwise it defeats the purpose. So do whatever is easiest and most satisfying – walk, run, dance, pound pillows, garden, or do yoga, Qi Gong, Tai Chi or some other martial art – just so you move your body. After five or 10 minutes, you’ll feel better. Then move some more. A half-hour is ideal, but if five minutes is all you can do, even that makes a difference. Moving in nature is even better, as nature is powerfully healing. Some research shows that blood types may make a difference as to how much exercise is needed. “O” blood types especially need abundant and strenuous exercise such as aerobics three times weekly (your ancestors walked 10-15 miles a day carrying extremely heavy loads!). “A” blood types need less and more relaxed exercise, such as tai chi or yoga. “B” blood types need something in between. Find what works best for you and stick to it. 2) Uncover Emotional Issues: Any long-term suppressed or repressed emotion causes depression. Rather than suppression, repressing or stuffing that emotion, now is the time to discover its 8 underlying cause and outlet. Above all, do not repress or stuff any emotion, as this creates more depression. Long-term suppressed emotions may be moved through many ways: a) Exercise or move (see 1 above). b) Appropriately express and release emotions. Examples include pounding pillow, talking to a friend or seeking professional assistance. c) Express yourself creatively (see 3 below). d) Take time off. Consider going on a meditative retreat or vision quest. Or examine what is “wrong” in your life, be it unfulfilling work, relationships, and/or living locations, and come up with a plan for change. Identify stressful factors in your home and work environment and modify them. e) Write in a journal. This helps unload repressed feelings, moves blocked energy and invites insights, solutions and ideas that may help sort through painful emotions and clarify decisions. When emotions are blocked or hidden they fester, congesting the Liver and in turn create depression and mood swings. Writing your feelings is quite different than just thinking about them, a process that only creates an endless mental loop. Instead, writing creates an outlet for thoughts and feelings to freely travel between your conscious, subconscious and super-conscious minds. This process not only releases trapped emotions, but also reveals inner connections, new ideas, past experiences, or hidden thoughts and feelings, all of which often form new meanings and awareness of your self. To help you write more openly, imagine you’re talking with a good and trusted friend (you might even write that person’s imagined “responses” too). It is also useful to “dialogue” or “talk” with your Heart and/or Liver (where most emotions are stuffed or felt), writing down your words and recording any imagined response. (This may sound odd, but it can be quite revealing and helpful). 3) Put energy into creative outlets. Creativity opens doors to your subconscious mind, allowing energy to flow again. It doesn’t have to be a big or “important” project - simple activities such as rearranging furniture, decorating, building a carpentry project, planning a new garden area, playing a musical instrument, or singing are all beneficial. It doesn’t matter what you choose to do, just so it creatively expresses your energy. Creative expression is an essential element in freeing a congested Liver, helping energy to flow smoothly and evenly. This in turn treats as well as prevents myriad problems from chest and rib pain, to mood swings, menstrual, digestive and eliminative irregularities, feelings of unhappiness, irritability, frustration, anger, loss of life direction, PMS, nausea, acid regurgitation, abdominal pain, abdominal distension and lumps (or masses) in the neck, breast, groin or flank. 9 4) Go to sleep by 11 p.m. The body’s energy shifts at this time so the liver focuses on storing and cleansing the blood. If you aren’t asleep during the 11pm – 3 am time period, it puts an extra stress on the liver, leading to further depression. Even if you get the same amount of sleep hours when going to bed after 11 PM, the quality of sleep is very different and can affect how quickly you clear depression from your life. 5) Laugh often. Doing so not only substantially boosts immunity and enhances all bodily functions, but it also improves blood circulation, mental functions (memory, articulation), sleep, anxiety, palpitations, mood swings and uplifts your spirit, treating lack of joy, sadness, grief, anxiety and depression. 6) Moderate your habits. Watch that you do not over indulge in excessive activity, exercise, sex and work as doing so depletes the body’s energy and leads to depression. The key word here is excessive – anything that is out of the norm or depleting is excessive. Instead, alternate work with rest and play. FOOD THERAPY FOR DEPRESSION: There are beneficial foods for treating and preventing depression as well as foods which, in excess over time, can actually cause depression. It is best to tailor your diet so it includes all the beneficial foods and little to none of the detrimental ones. Beneficial Foods Eat plenty of the beneficial foods: • cooked vegetables (especially carrots, beets, celery, green beans, shitake mushrooms and artichokes) • some vegetable juices • lemons • dark leafy greens (kale, collards, dandelion, mustard, beet and mustard greens) • bitter foods • mung, aduki and garbanzo beans • some whole grains • fresh fruit • adequate amounts of protein for your body’s needs, primarily derived from animal sources Kicharee This is one of the best foods to rebalance the body, support Liver and blood function and detoxify all at the same time. It makes a good fast for all body types, though it may be eaten as a meal any time. Vegetables may be added or eaten on the side. Vegetarians and O Blood types benefit from cooking the rice and mung beans in meat stock, or adding a little fish or chicken to the meal. 10 To make: soak and cook 1 cup rice and 1/3 cup mung beans separately. Brown ½ tsp. turmeric powder, 1 tsp. cumin seed and 1/2 tsp. coriander powder in 2 Tblsp. ghee (or sesame oil). Mix all together. Add water to make soupier, if desired. Detrimental Foods: Many foods may actually cause depression, and it is recommended you limit these foods as much as possible. In Lesley’s experience, many times a client has only needed to change the diet for the health condition to change. Further, not eliminating these foods from your diet may make any herbs or supplements you take less effective, or even ineffective. While these foods aren’t recognized by Western medicine as having any adverse affects, in Traditional Chinese Medicine the energy of any food is known to have either beneficial or adverse effects on the body. Regardless of your belief or disbelief in whether any foods can contribute to depression, it is valuable to eliminate them for a period of two to four weeks to see if you experience any beneficial results. If you do, it was well worth finding this out. If not, there’s no loss for trying. Foods that cause depression are, unfortunately, very prevalent in the Western diet. On the other hand, it may help explain why depression occurs so often. Further, when these foods are removed it helps the body to regain balance more quickly. To resolve depression and get best results, it is highly recommended that you reduce or completely eliminate the following foods: • • • • • • • • • • • fried, greasy and fatty foods and excessive intake of oils (except omega-3 and -6 fatty acids) nuts and nut butters (an exception would be a few walnuts eaten periodically as these support the Kidneys, which in turn, help the Liver) cheese and dairy (some periodic feta or mozzarella, or sprinkling of parmesan may be fine) chips of all kinds alcohol caffeinated and caffeine-like foods and drinks (coffee, black tea, mate, cocoa, colas and chocolate recreational drugs, including marijuana avocados turkey red meat for best results, eliminate raw foods, refrigerated/iced foods and drinks (including ice cream, frozen yogurt and popsicles), excessive intake of fruit, fruit juices, sugar and sweets 11 Omega-3 and -6 Fatty Acids 2 A healthy diet should provide for at least five grams daily of essential fatty acids, divided between omega-3 and omega-6. This includes a diet of fish, sesame and olive oils, walnuts and flax and pumpkin seeds. Most would benefit from a regular daily supplement of good quality fish oil, high in omega-3 fatty acids. Many compelling studies show that symptoms of depression are much higher among those with a depletion of omega-3 fats. This is true cross-culturally comparing those who eat high amounts of fish with those who don’t. Those who don’t eat much fish have higher incidences of depression. Several studies have been conducted on the effects of omega-3 on depression and bi-polar conditions. Some of the results concluded that the ideal ratio of omega-6 to omega-3 is one to one, and it is recommended that as well, omega-3 be taken with vitamins C and E. The two active ingredients of omega-3 fish oil are EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) The active ingredient in flax oil is alpha-linolenic acid, which is converted to EPA and DHA in the body. A pilot study of EPA on depressed patients produced a beneficial effect while in another study, DHA alone had no beneficial effect (thus, buy an omega-3 that contains more EPA than DHA 3 ). Fish oil has also been highly touted as a preventative for heart disease and a host of other ills, so there was a ready-made supply on the market long before these studies showed the benefit of omega-3 on depression. Ground flax seed can be mixed in with cereal, fruit juice or sprinkled on yogurt. Because flax oil is subject to rapid oxidation and rancidity, it is best to use freshly ground flax seed rather than the oil. If using the oil be sure to only buy it in a dark container, keep it refrigerated and use it within a short period of time. Most capsules contain 1,000 mg of flax oil, although it is not yet clear how much flax the body needs. Flax seed is also a rich source in ligands (which may prevent some hormonally-related cancers) and fibers (the oil alone does not have ligands or fiber). If you buy flax seeds, be sure they are ground, or that you grind them, as the body cannot digest the seed's outer hull. Whether as fish or flax oil, omega-3 fatty acid has a blood thinning effect, though it is weaker than aspirin. It is essential that you take any pharmaceutical drug thinner, you must tell your doctor that you are taking omega-3 fatty acid so your blood-thinning medication may be moderated. 2 See Addendum II for detailed information and studies on omega-3 and -6 fatty acids. 3 There are many quality fish oil and omega-3 products on the market. Three that we recommend are: Carlson Brand (http://www.carlsonlabs.com/product), Nordic Naturals (http://www.nordicnaturals.com/), Krill Oil (http://www.nordicnaturals.com/). Dakota Flax Gold has a wonderfully light nutty flavor. This is available in many natural food stores, or directly from Heintzman farms (http://www.heintzmanfarms.com/). 12 Finally, keep in mind that although omega-3 looks like a promising way to treat depression and bipolar disorder, there are no major clinical trials to guide us. At least at this stage, their use should be considered a complement to other therapies rather than as a medication replacement, and, as always, it is best to consult with your doctor or psychiatrist before starting it. Regardless of any recommended herbal program, the nutritional aspect and the inclusion of quality omega3 and omega-6 EFAs seems to be a prudent addition to any comprehensive program for the treatment of depression. SUPPLEMENT THERAPY FOR DEPRESSION Several different vitamins and minerals have a beneficial effect in alleviating depression. In fact, depression often signals a depletion of vitamins and/or minerals in the body, particularly the B vitamins, vitamin C and certain minerals. The specific ones which follow are important to supplement in order to treat or prevent depression. It is advisable to see your health practitioner and get a blood test or hair analysis to determine your levels of vitamins and minerals. If you test low, you know which ones to focus on. If you test normal, a good multi-vitamin containing the vitamins and minerals listed here can still be beneficial for you. An abundance of natural vitamins and minerals are found in organic vegetables and fruit. Minerals are also found in high quantities in edible seaweeds such as kelp and nori (used to make sushi). The addition of these foods to your diet can be most beneficial. B-Complex Vitamins and Depression The B-complex vitamins are essential to overcome that run-down feeling accompanying negative mental and emotional states. Since B vitamins don’t store in the body, we must rely entirely on a daily diet to replenish them. A variety of foods such as whole grains, beans, eggs and meat serve as a source for various B vitamins while animal protein is regarded as the only significant, reliable source of vitamin B12, the “pep” vitamin. Because B vitamins are destroyed by alcohol, refined sugars, nicotine, and caffeine, it is no surprise that many people are deficient in them, another reason to eliminate these substances from your diet. If you supplement any B vitamins, it is best to take them together in a complete B vitamin complex. Following is a rundown of recent findings about the relationship of B-complex vitamins to depression: • Vitamin B1 (thiamine): The brain uses this vitamin to help convert glucose, or blood sugar, into fuel, and without it the brain rapidly runs out of energy. This can lead to fatigue, depression, irritability, anxiety, and even thoughts of suicide. Deficiencies can also cause memory problems, loss of appetite, insomnia, and gastrointestinal disorders. The consumption of refined carbohydrates, such as simple sugars, drains the body's B1 supply. • Vitamin B3 (niacin): A niacin deficiency causes a condition of pellagra, a disease characterized by symptoms of diarrhea, dermatitis and dementia. Many commercial food products now contain niacin, and pellagra has virtually disappeared. However, subclinical deficiencies of vitamin B3 can produce agitation and anxiety, as well as mental and physical slowness. 13 • Vitamin B5 (pantothenic acid): Symptoms of deficiency are fatigue, chronic stress, and depression. Vitamin B5 is needed for hormone formation and the uptake of amino acids and the brain chemical acetylcholine, which combine to prevent certain types of depression. • Vitamin B6 (pyridoxine): This vitamin aids in the processing of amino acids, which are the building blocks of all proteins and some hormones. It is needed in the manufacture of serotonin, melatonin and dopamine. Vitamin B6 deficiencies, although very rare, cause impaired immunity, skin lesions, and mental confusion. A marginal deficiency sometimes occurs in alcoholics, patients with kidney failure and women using oral contraceptives. Ironically, the class of antidepressant drugs known as MAO-inhibitors may also lead to a shortage of this vitamin. Many nutritionally oriented doctors believe that most diets do not provide optimal amounts of this vitamin. • Vitamin B12: Because vitamin B12 is important to red blood cell formation, deficiency leads to an oxygen-transport problem known as pernicious anemia. This disorder can cause mood swings, paranoia, irritability, confusion, dementia, hallucinations, or mania, eventually followed by appetite loss, dizziness, weakness, shortage of breath, heart palpitations, diarrhea, and tingling sensations in the extremities. Deficiencies take a long time to develop, since the body stores a three to five year supply in the liver. When shortages do occur, they are often due to a lack of “intrinsic factor,” an enzyme that allows vitamin B12 to be absorbed in the intestinal tract. Since intrinsic factor diminishes with age, older people are more prone to B12 deficiencies. 4 • Folic acid: This B vitamin is needed for DNA synthesis and the production of SAM (Sadenosyl methionine). Poor dietary habits contribute to folic acid deficiencies, as do illness, alcoholism and various drugs, including aspirin, birth control pills, barbiturates and anticonvulsants. It is usually administered along with vitamin B12, since a B12 deficiency can mask a folic acid deficiency. Pregnant women are often advised to take this vitamin to prevent neural tube defects in the developing fetus. Studies on the Relationship between B Vitamins and Depression Research conducted over a period of six months at Kuopio University in Finland, published in the journal BMC Psychiatry, showed that people who maintained high levels of B12 in their blood, both at the start and finish of the study, resulted in less episodes of depression and greater response to drugs and other treatments. The association remained significant even after other factors were taken into consideration, such as smoking and drinking habits, type of treatment received and family history of depression. Lead researcher Jukka Hintikka noted that the results were potentially significant, as many people do not respond to anti-depression treatments. 4 Jukka Hintikka, Tommi Tolmunen, Antti Tanskanen and Heimo Viinamäki High vitamin B12 level and good treatment outcome may be associated in major depressive disorder. Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland, BMC Psychiatry 2003, 3:17 doi:10.1186/1471-244X-3-17 14 A previous study showed that elderly patients with depression responded better to treatment if they took a supplement containing vitamins B1, B2 and B6. This supplement indirectly increased the level of vitamin B12 in these patients' blood. This new study supports the idea that taking vitamin B supplements may help people respond positively to antidepressants. Vitamin C and Depression In 1990, a German study involving 1,000 men revealed that even a slight deficiency of 150 mg vitamin C (approximately the amount found in two oranges) resulted in nervousness, irritability and depression. Vitamin C is another vitamin that is not manufactured or stored in the body and must be supplied in the daily diet. Researchers have found that vitamin C is important for boosting levels of energizing norepinephrine. It is also important to help the body assimilate B vitamins, iron and other minerals. Stress, pregnancy, lactation, surgery, trauma, inflammatory disease, and taking aspirin, tetracycline or birth control pills are only a few causes that deplete and create a subsequent need for vitamin C. This must be provided through an increase in fresh fruits and vegetables, or the supplemental intake of vitamin C. For best absorption, use vitamin C ascorbate. Minerals and Depression Along with vitamin deficiency, there are a number of minerals that can also cause depression. These are as follows: • Magnesium: Magnesium deficiency or imbalance plays a crucial role in symptoms of mood disorders. A deficiency of magnesium can result in depressive symptoms, along with confusion, agitation, anxiety and hallucinations, as well as a variety of physical problems. 5 Magnesium deficiency increases susceptibility to stress, while stress depletes magnesium stores in the body. 6 Most diets do not include enough of this essential mineral. • Calcium: A calcium depletion affects the central nervous system and low levels cause nervousness, apprehension, irritability and numbness. 5 Paul Mason of www.mgwater.com says, “Magnesium deficiency causes serotonin-deficiency with possible resultant aberrant behaviors, including depression, suicide or irrational violence.” Mark Sircus, Ac., O.M.D., Transdermal Magnesium Therapy (Phaelos Books, 2007), p. 172. 6 “Most depressive episodes are triggered by a stressful personal event such as loss of a loved one or change of circumstances, and depression over a short period is a normal coping mechanism. Long-term stress-induced depression often results when magnesium falls to dangerously low levels in the body. One of the reasons it does this is because the stress itself depletes already meager cellular magnesium stores.” Sircus book cited above. 15 • Zinc: Inadequacies of zinc result in apathy, lack of appetite and lethargy. When zinc is low, copper in the body can increase to toxic levels, resulting in paranoia and fearfulness. 7 • Iron: Depression is often a symptom of chronic iron deficiency. Other symptoms include general weakness, listlessness, exhaustion, lack of appetite and headaches. • Manganese: This metal is needed for proper use of the B-complex vitamins and vitamin C. Since it also plays a role in amino-acid formation, a deficiency may contribute to depression stemming from low levels of the neurotransmitters, serotonin and norepinephrine. Manganese also helps stabilize blood sugar and prevents hypoglycemic mood swings. • Potassium: A depletion of potassium is frequently associated with depression, tearfulness, weakness and fatigue. HERBAL THERAPIES FOR DEPRESSION For herbs to work best, it is extremely important to adjust the lifestyle and dietary habits as well, or else it may render the herbal treatment ineffective. There are many herbs, both Western and Chinese, which are used to alleviate depression. Traditional herbal medicine states most cases of depression are treatable through lifestyle, nutritional and herbal therapies. For example, lemon balm (Melissa officinalis) was described by 16th-century English physician Nicholas Culpeper,as an herb that “causeth the mind and heart to become merry and driveth away all troublesome cares and thoughts our of the mind, arising from melancholy and black choler.” Similarly Culpeper described the now famous herb St. John’s wort (Hypericum perforatum) as useful “against melancholy and madness.” Today, St. John’s wort is touted as the main treatment for mild depression, and its use for this condition has been researched and scientifically confirmed. As such, it is one of the top selling herbs on the market. In truth, there are many effective herbs for treating depression. The Polynesian herb kava kava (Piper methysticum) has a special application for anxiety accompanying depression. The Chinese botanical albizzia (Albizzia julibrissin, also known as mimosa tree bark and flower, or the “happiness tree”) may well be the oldest and most potent antidepressant herb known. In 500 year old herbal texts it is recommended for use when suffering from sadness or grief as a result of severe disappointment or loss. Today many Western health providers refer to this 7 Zinc is involved with psychiatric disorders – “Over 90 metallo-enzymes require zinc and the functioning of the brain is dependent on adequate levels of zinc. Deficiency can cause amnesia, apathy, depression, irritability, lethargy, mental retardation and paranoia.” Mark Sircus 16 remarkable herb as “herbal Prozac,” but with the added benefit of not having the side effects of antidepressant drugs. DETERMINING YOUR TYPE(S) OF DEPRESSION Because there are many causes for depression, the most effective treatment occurs when the herbal treatment is individualized. If you just take any herb for depression, it may or may not help. To help find the treatment most suited to you, first determine your type of depression by checking the following numbers with the most symptoms applicable to you. Afterward, locate the numbers you checked in the following table and find the remedies indicated. Next, read the information listed about each remedy and then take the ones indicated for you. For best results, follow the diet, lifestyle and supplement guidelines given above along with taking the herbal remedies indicated for your symptoms. Check the box next to symptoms you most frequently experience, in addition to depression: 1) Moodiness mental confusion PMS frustration annoyance impatience sighing belching tiredness feeling of a lump in the throat pain in the ribs or side feeling of tightness in the ches irregular periods clumsiness breast distension Palpitations Insomnia Nightmares suffocating sensation in the chest irritability mood swings excitability in extreme cases, psychosis 2) 17 3) extreme depression severe mood swings intense irritability propensity to be violent obsessive jealousy outbursts of anger manic-depressive depression alternating with confusion and elation manic depressive lack of mental clarity anxious agitated weeping tendency toward suicide dizziness dull headache nausea desire to lie down feeling of oppression in the chest poor appetite tiredness poor concentration extreme tiredness no desire to talk lack of motivation no appetite restless sleep unpleasant dreams loose stools slight breathlessness weak voice pale, shiny face obsessive thinking poor concentration vaguely depressed tiredness anxious easily startled palpitations 4) 5) 6) 18 pale, dull complexion dull eyes dizziness blurry vision numbness in limbs hard to fall asleep poor memory timid feelings of coldness mentally and physically exhausted lack of will power loss of interest in life loss of initiative feeling that everything takes too much effort hopelessness low back ache weak knees poor memory cold legs and back frequent and pale urination nighttime urination very anxious restlessness palpitations dispirited dry eyes Lack of sense of direction in life mentally restless wakes up frequently during the night restless dreams tiredness burning sensations in palms, soles and/or chest spurts of energy followed by exhaustion very anxious mentally restless low back pain fitful sleep lack of willpower 7) 8) 9) 10) 19 11) hyperactive child with symptoms of Attention Deficit Disorder (ADD), or Attention Deficit Hyperactive Disorder (ADHD) 12) nervous exhaustion tension stress insomnia jitteriness drug or alcohol withdrawal inability to focus and concentrate low back pain Review your checklists for the numbers that represent most of your symptoms. Now look up your numbers on the following table. These are the herbs, products and formulas recommended for your type(s) of depression. 1 2 3 4 5 6 7 8 9 10 11 12 RECOMMENDED PRODUCT (S) FOR YOUR SYMPTOMS Albizzia Plus, St. Johnswort, Bupleurum Calmative Albizzia Plus, Salvia, Kava EZ, Bupleurum Calmative Albizzia Plus, Salvia, Kava EZ, bupleurum Calmative Rising Courage (Wen Dan Tang), Kava EZ, Bupleurum Calmative Albizzia, Ginseng Classic, Calm Spirit Teapills Albizzia, Women’s Treasure, Bupleurum Calmative Albizzia, Rehmannia Vitalizer, Kava EZ Albizzia, Emperor’s Teapills, Kava EZ Albizzia, Emperor’s Teapills, Linking Decoction (Yi Guan Jian) Albizzia, Emperor’s Teapills, Rehmannia Endurance, Kava EZ Calm Child, Kava EZ Stress Free, Schizandra Adrenal In addition to your individually recommended formulas, it is recommended to take TRIPHALA, a gentle Ayurvedic detoxification formula. 20 HERBAL FORMULAS FOR DEPRESSION Each remedy is described below along with its recommended dosage. Find the one(s) indicated for you and follow those directions. ALBIZZIA (available both as a Planetary Product and as an East West Herb Product) Ingredients: Albizziae julibrissan Actions: Both albizzia bark and flower are used to calm the spirit. Called the “tree of happiness” by the Chinese, it is specific for depression, sadness and unhappiness as well as prolonged grief. It is certainly the primary herbal candidate for the treatment of depression, melancholy, insomnia, nervousness, anxiety and irritability, all conditions regarded in Traditional Chinese Medicine as ‘spirit disorders.’ It will not affect libido and, in fact, for those whose sexual dysfunction is emotionally related, albizzia can be effective. Dose: 30 to 60 drops, 2 or 3 times daily; between meals or as often as needed ALBIZZIA PLUS (an exclusive East West Herbs product) Ingredients: Albizzia, bupleurum, white peony, dong quai, white atractylodes, poria, fresh ginger, licorice, lemon balm. Actions: Soothes the Liver and clears Liver congestion, harmonizes digestion, moves energy and blood, regulates menses; use for PMS, irregular menstruation, irritability, anxiety, depression, headache, breast distension, poor appetite, chronic hepatitis, malaria and peri/menopausal disorders. Dose: 1 dropper full (40 drops), 3 times daily BUPLEURUM CALMATIVE (Planetary Formula based on the traditional Chinese formula, Xiao Yao San or try the Plum Flower brand of patent, Free and Easy Wanderer or Free and Easy Wanderer Plus, or the Min Shan patent brand, Xiao Yao Wan.) Ingredients: Bupleurum root, dong quai, atractylodes rhizome, peony root, ginger root, poria, licorice root and Chinese mint. Actions: The Chinese name, “Relaxed or Free and Easy Wander,” describes this formula perfectly. Rather than a single herb responsible for its calming action, the combination treats Liver congestion with symptoms of mood swings, premenstrual tension, depression, anxiety, headache, irregular menses, PMS, irritability, breast distension and chronic hepatitis. Dose: 2 to 3 tablets 3 times daily Note: If you are also in your peri/menopausal years and experience hot flashes, heart palpitations, mood swings, depression and/or irregular menses, try the Planetary Formula MENOCHANGE. This formula includes the traditional Chinese Xiao Yao San formula plus added several herbs to treat hormonal imbalance and heart palpitations. CALM CHILD: (Planetary Formula available as a flavored syrup or tablet) Ingredients: Chamomile, lemon balm, catnip, hawthorn, zizyphus seed, gotu kola, long pepper, anise, clove and cassia bark. Actions: Especially suited for children but many adults find great benefit from its use. It calms as well as treats stress, hyperactivity, headaches and colds. Dose: 2 tablets 2 times daily, or ¼ to ½ tsp. 2 to 3 times daily 21 CALM SPIRIT TEAPILLS: Ingredients: Polygonum multiflorum vine, sprouted wheat, jujube dates, poria, lily bulb, licorice and albizzia bark Actions: Nourishes the Heart, calms and aids digestion; use for excessive worrying, anxiety, crying spells, inability to control one’s self, restless sleep, frequent bouts of yawning, depression, insomnia, anxiety, clouded mind, vivid dreaming, PMS and peri/menopausal disorders. Dose: 8 pills, 3 times daily EMPEROR’S TEAPILLS: Ingredients: Raw rehmannia, dong quai, schisandra, zizyphus, biota, asparagus root, ophiopogon, scrophularia , salvia, codonopsis, poria, platycodon and polygala. Actions: Cools, nourishes Heart blood and yin, calms; use for insomnia, palpitations, anxiety, restlessness, restless leg syndrome, poor memory, mental fatigue, tongue or mouth sores, nocturnal emission, constipation, hyperthyroidism and peri/menopausal disorder due to deficient Heart yin. Dose: 8 pills, 3 times daily GINSENG CLASSIC (Planetary Formula) Ingredients: Asian ginseng, white atractylodes, poria and licorice. Actions: Strengthens energy, helps digestion; use for poor appetite, energy and digestion. Dose: 2 tablets, 2 times a day; if sleep is affected, don’t take past 4 p.m. KAVA KAVA (an exclusive East West Herbs product) Ingredients: Piper methysticum Actions: For anxiety, nervousness, panic attacks, insomnia, stress, restlessness, muscle spasms, asthma, fibromyalgia, ureter spasms, interstitial cystitis pain and spasms, irritable bladder, hyperactivity, ADD, tension headaches and performance anxiety. Precautions: do not use if taking antidepressants, such as Xanax; as Kava potentiates the effects of barbiturates and benzodiazepines Note: While in Europe there are reports of kava causing hepato-toxicity, a closer look reveals that most all cases are due to other causes, such as accompanying alcohol and drug abuse, a history of Hepatitis, taking medications with known liver disease-causing side effects, or driving with an illegal level of alcohol in the blood but having a bottle of kava in the car (so the accident was attributed to kava). Because the use of kava has a centuries-long history of recreational and ritualized use by the Polynesians that extends to the present without associated liver disease, World Health Organization (WHO)-appointed researcher Dr. Subramaniam Sotheeswaran investigated the safety of this herb. He makes the distinction that the normal Fijian use of kava is a water extract containing only about four to six percent of the biologically active compounds (kava lactones and other organic compounds) while the European products extracted with heavy and toxic compounds contained up to 30 to 50 percent of these compounds. As a result of the 30 or so cases (mostly from Germany) of reported liver toxicity kava, it is no longer available as an over-the-counter herb in that country. It may continue to be widely prescribed by German physicians for the treatment of anxiety and depression, however. Other European countries, including France, Switzerland and the UK, have followed suit with Germany, banning the sales of kava to the general public. The U.S. Food and Drug 22 Administration, obviously finding the evidence against the use of kava inconclusive, allow its sale with the provision that a warning label accompany the sale of each product. Dose: 1 dropper full (40 drops), 3 times daily KAVA EZ (an exclusive East West Herbs product) Ingredients: Kava kava, albizzia bark, jujube seed, oyster shell and dragon bone. Actions: Relieves nervousness, anxiety and symptoms of stress. Dose: Take 1 dropper full (40 drops), 3 times daily LINKING DECOCTION: (Traditional Chinese formula) Ingredients: Raw rehmannia, lycii, glehnia, ophiopogon, dong quai, and chinaberry (Melia toosendan). Actions: Regulates energy and tonifies Liver and Kidney yin (depleted yin is similar to a dry, burnout condition, like running a car low on oil). Use for chest fullness and pains, dryness of throat and mouth, a bitter taste in the mouth, peri/menopausal symptoms, insomnia, chronic hepatitis, nervous gastrointestinal tract, gastric and duodenal ulcers and nervous exhaustion, diabetes, herpes zoster, liver cirrhosis, stomatitis, chronic gastritis, chronic hepatitis, neurosis and PMS, all from dryness in the body. Dose: 8 pills, 3 times daily with meals, if possible REHMANNIA ENDURANCE (Planetary Formula) Ingredients: Rehmannia, cornus, lycii, alisma, dioscorea, poria, moutan peony, Polygonum multiflorum, chrysanthemum, ligustrum and saw palmetto. Actions: Strengthens the Kidney yin (depleted yin is similar to a dry, burnout condition, like running a car low on oil); use for dry eyes, mouth, throat or vagina, weak lower back, headache, dizziness, tinnitus, hypertension, insomnia, night sweats, anxiety, fatigue and peri/menopausal disorders Dose: 2 tablets, 3 times daily with meals, if possible. REHMANNIA VITALIZER (Planetary Formula) Ingredients: Morinda, cistanche, cuscuta, rehmannia, psoralea, cornus, dioscorea, moutan peony, alisma, Asian ginseng, dong quai, epimedium, poria, schisandra, saw palmetto, cinnamon bark and lycii. Actions: Strengthens the Kidney yang (yang is the heating, metabolizing energy in the body); use for low back pain or weakness, weak knees, frequent urination, impotence, infertility, cold limbs, edema (especially of ankles), chronic nephritis, nighttime urination, chronic prostatitis and as a geriatric tonic. Dose: 2 tablets, 3 times a day RISING COURAGE TEAPILLS Ingredients: Bamboo shavings, green citrus, pinellia, citrus, poria, licorice, fresh ginger, jujube dates Actions: Regulates energy and transforms phlegm; use for dizziness, vertigo, headache, nausea, vomiting, poor appetite or digestion, anxiety, insomnia (especially awake 5-7 a.m.), irritability, depression, palpitations, seizures, hepatitis, gastritis, chronic gallbladder inflammation, obesity. Dose: 8 pills, 3 times daily 23 SALVIA Salvia miltiorrhiza (Planetary herb product) Ingredients: Salvia miltiorrhiza Actions: supports a healthy cardiovascular system; use for blood clots, angina pectoris, coronary heart disease, chest or epigastric pain, soreness in the ribs, palpitations, irritability, insomnia, painful menstruation, amenorrhea, endometriosis, abdominal masses, fibroids, cysts, sharp, stabbing pains, soreness in the ribs, irritability, insomnia. Dose: 1 tablet, 2 times daily with meals; or take 1 dropper full (40 drops) 3 times daily SCHISANDRA ADRENAL COMPLEX (Planetary Formula) Ingredients: Schisandra fruit, dioscorea, poria, water plantain, prepared rehmannia, cuscuta seeds, psyllium seed, palm-leaf raspberry fruit, lycium fruit and cornus berries. Actions: Relieves depression along with adrenal fatigue or burnout due to overwork, excessive stress and inadequate rest. This formula balances the sympathetic and parasympathetic nervous systems and hormones. Dose: 2 tablets 3 times daily between meals ST. JOHN’S WORT (Planetary herb product) Ingredients: Hypericum perforatum Actions: Resolves depression for those with heat in the Liver; depression, nervous conditions, nervousness, nervous irritability, nervous tension, chronic tension headaches, menopausal tension, insomnia from restlessness, nerve pains, trigeminal neuralgia, sciatica, surgical trauma, rheumatism, wounds, burns, ulcers, skin irritations. Precautions: Avoid if using MAO inhibitors, protease inhibitors (used for HIV and AIDS), or cyclosporine, Theophylline, Warfarin, Digoxin, or if having anesthesia (must be off herb for five days before undergoing surgery); use cautiously in anxiety, or when taking pharmaceutical drugs (because it may lower their effects); it can create sun sensitivity and burning in fairskinned people when taken internally for prolonged periods Dose: 1 dropperful (40 drops), 3 times daily; or 1 tablet, 2 times daily STRESS FREE (Planetary Formula) Ingredients: Jujube seed, skullcap, hops, wood betony, valerian, American ginseng, hawthorn berry, licorice, chamomile, black cohosh and eleuthero root. Actions: Herbal food for the nervous system; calms and supports the nervous system; treats extreme acute nervousness, insomnia and addictions. Dose: The suggested maintenance dose is appropriate for most chronic conditions but two tablets can be taken every half hour for acute conditions of nervousness, stress and anxiety. WOMEN’S DONG QUAI TREASURE (Planetary Formula) Ingredients: Dong quai extract, cramp bark, false unicorn root, cooked rehmannia, dong quai, white atractylodes, white peony, ligusticum, moutan peony, blue cohosh, ginger, poria Actions: Use for signs of blood depletion - dizziness, blurry vision, numbness, restlessness, anxiety, slight irritability, insomnia, scanty menses or amenorrhea, thinness or emaciation, dark spots in the visual field, dry skin, hair or eyes, lusterless, pale face and lips, tiredness, easily startled or overwhelmed, poor memory – and menstrual pain or abdominal masses. Dose: Take 2 tablets, 3 times a day. 24 TAKING THE PROPER HERBAL DOSAGE The proper dosage of herbs is very important. First, it’s necessary to take a sufficient quantity of herbs for them to be effective. Quite often people take the right herbs or formulas but don’t experience results simply because they didn’t take enough of them. On the other hand, it’s possible to take too many herbs (and supplements) and, over a long period of time, injure your digestion, eventually impairing the body’s ability to metabolize food. At other times, a low dose of a formula over time can give results without any aggravating effects, especially if it contains strong acting herbs. How do you know which dose to use? Once you’ve chosen an herbal treatment plan, take the herbs for three days. If after this time you experience a positive reaction, continue your plan until your symptoms are relieved. If you don’t experience any changes, increase the dose and continue for another week, then re-evaluate your condition. Sometimes subtle changes occur slowly, which take time to experience. Other times you have the right herbs but need to take a higher dose for better results. Sometimes it’s necessary to take an herb/herbal formula for several weeks before experiencing results. If you experience a mild negative reaction, cut down to a minimal dose (1 tablet or 10 drops tincture, 2 times/day) and continue for another 3 days. If the reaction continues, or if you experience a marked negative reaction, stop the herbs until the reactions disappear, then restart at a lower dose. If reactions recur again, you definitely know that it’s the wrong herbal approach and needs re-evaluation. Don’t be discouraged if this occurs. Herbal medicine is a matter of strategy, and if an adverse reaction occurs, this may be used diagnostically to help reveal the correct treatment plan. General dosages are calculated for a person weighing about 150 pounds. However, even if weighing this, each body responds differently to herbs and therefore, a particular dosage may be too high or too low for your own needs and sensitivities. As a guideline, start with the given dosage, then increase or decrease according to your body’s response. GUIDELINES FOR TAKING HERBS WITH MEDICATIONS If you are taking medications for depression and/or anxiety, there are certain important guidelines to follow when adding in herbs. These are as follows: • • • • • • Inform your doctor of any herbs or supplements you may be taking. Have you doctor monitor your body’s response and reduce medication doses as appropriate. Monitor your body’s response for any adverse reactions after taking herbs. Take herbs in formulas rather than alone. Begin herbs at low doses and then gradually increase. Take herbs and medications separately, about 3-4 hours apart. 25 • • • If you have any questions, consult a professional herbalist for guidance. Pay close attention to contraindications and drug interactions noted on the herb bottle as well as prescription literature. Buy herbs from a reputable company. Never take an herb if you are not sure what it is. Taking Herbs with Tranquilizers and/or Antidepressants Certain herbs can interact with tranquilizers and antidepressants, increasing or decreasing their actions, such as St. John’s wort or kava kava. On the other hand, these herbs can be extremely useful alternatives after eliminating medications. Any herb with MAO-inhibitors can also interfere with certain antidepressants as well as anesthesia, so be sure to consult with your doctor before starting these herbs if you are taking any tranquilizers and/or antidepressant medication. 26 ADDENDUM I: TRADITIONAL CHINESE MEDICINE (TCM) ORGANS THE ORGANS The Chinese view the Organs according to energetic, rather than physical, functions. They are seen as dynamic interrelated processes that occur throughout every level and cell of the body, rather than as discrete, local organs with specialized functions. In fact, some of the Chinese Organs don’t have physical counterparts, or aren’t considered “organs” at all, in Western medicine. The Organs are divided into two types: the solid, or Yin, Organs that store; and the hollow, or Yang, Organs that transport. The Yin Organs are vital while the Yang Organs are functional. Each Yin and Yang Organ is paired together in a system (called “HusbandWife”) where each interdependently performs its functions, yet mutually communicates and provides the other with energy. Because the Yin Organs are the vital ones, they are generally referred to in TCM symptom assessment rather than the Yang ones. YIN ORGANS HEART The Heart is the supreme master of the Organs, as the Emperor is of the people. And like the Emperor, the Heart links Heaven (the Spirit) and Earth (the body). It governs Blood and its vessels and smooth blood circulation throughout the body. It also houses the Spirit – the power to exude joy, charisma, and enthusiasm; and the Mind – the capacity to clearly think, remember, comprehend and respond. Thinking, long-term memory, sleeping and dreaming are all part of the Heart’s function. The Heart produces sweat, appears as a bright sheen on the face, opens to the tongue and loathes Heat (since it’s already a “warm” Organ from its Blood content). When imbalanced, the Heart manifests symptoms of palpitations, chest pains, poor circulation, poor memory, insomnia, forgetfulness, poor long term memory, dreamdisturbed sleep or excessive dreaming, tongue sores and ulcers, excessive talking, inability to speak, incoherent speech, anxiety, mental restlessness, inappropriate behaviors; unclear thinking, unhappiness, lack of joy and mental disorders. Bitter herbs that help clear cholesterol from the veins and arteries affect the Heart Organ. Other herbs, such as zizyphus and biota, calm the Spirit and nurture the Heart. SPLEEN The Spleen is responsible for assimilation and transportation of nutrients throughout the body (metabolism). As this occurs on all levels, Spleen Qi not only controls food and fluid 27 metabolism, but also cell respiration and other similar metabolic functions. The Spleen rules the muscles, flesh and limbs, keeps the Organs in place and the Blood in vessels, opens to the mouth and manifests in the lips. The Spleen hates to be Damp, as this interferes with its ability to transform and transport food and fluids. A weak Spleen causes poor digestion, low appetite, gas, bloatedness, acid regurgitation, loose stools, undigested food in the stools, malnutrition, weakness in arms and legs, fatigue, poor muscle development, edema of abdomen, hips and thighs, blood spots under the skin, easy bruising, lack of sensation of taste, prolapsed organs, frequent bleeding, abdominal distension, obsession, worry, and anemia. Herbs that tonify Spleen Qi such as ginseng and dioscorea (Chinese wild yam), warm or tonify Spleen Yang such as psoralea or dried ginger; or transform Spleen Dampness such as agastache or cardamom, are used. . LUNGS The Lungs govern respiration, receiving air and dispersing it throughout the body. They rule the skin and body hair, regulate the opening and closing of pores, control sweating, govern the voice and open to the nose. It is the only vital Organ with a direct link to the external environment and thus is quite sensitive. The Lungs loathe Dryness. Disorders of the Lungs cause symptoms of shortness of breath, cough, difficulty breathing, breathlessness, asthma, bronchitis, mucus, sore throat, colds, flu, lowered immunity, spontaneous sweating, allergies, rhinitis, soft, unclear or weak voice, grief, inability to give and/or receive, sadness and skin conditions. Warming or Cooling expectorants such as mullein, coltsfoot or apricot seed, Lung Qi tonics, such as astragalus, ginseng or dioscorea, or Lung Yin tonics such as ophiopogon, are used. KIDNEYS The root of Yin and Yang in the body, the Kidneys store Essence, regulate fluid metabolism, dominate the hormonal (endocrine) system and open to the ears. As well, the Kidneys rule the bones, teeth and brain, produce bone marrow, manifest in the head hair and control the lower orifices (anus, vagina, urethra, sperm ducts). The Kidneys promote growth, development, reproduction and the deep underlying immune system. The Kidneys loathe Coldness. Issues concerning fertility, sexuality, the urinary system, weakness, low back pain, night time urination, poor memory (especially short-term), weak knees, joint problems, swollen ankles, leg edema, early morning diarrhea, teeth problems, brittle bones, senility, fear, paranoia, hormonal issues, thinning hair or loss of head hair, lack of will power, ear and hearing problems and premature aging all signal Kidney imbalance. Salty and mineral-rich herbs (nettles and seaweeds) and diuretics (uva ursi, parsley) are used along with Kidney Yin tonics such as Chinese asparagus root, marshmallow root, ligustrum (privet) and 28 eclipta, and/or Kidney Yang tonics such as fenugreek, damiana, ashwagandha, or dipsacus, depending on the condition. LIVER The Liver stores Blood and maintains the smooth flow of Qi in the body. It also opens to the eyes, controls the tendons and ligaments, manifests in the nails and harmonizes the emotions. The Liver directly links with the ribs, lower abdomen, external genitals and breasts. Pressure and emotional stress adversely affect the Liver, and it loathes Wind since that disrupts its smooth flow of energy. Liver imbalances include muscle spasms, cramps and tics, eye ailments, muscle tension, irregular menses and other menstrual problems, depression, mood swings, PMS, pain in the ribs, sighing, hiccuping, feeling of a lump in the throat, lumps, cysts, fibroids, especially in breasts and abdomen, splitting headaches and migraines, difficulty falling asleep, tight neck and shoulders, poor nail health, numb extremities, sluggish joint movements, difficulty in bending or stretching, alternating constipation and diarrhea, suppressed creative expression, lack of drive, anger, irritability, frustration and hypertension. Sour herbs assist the Liver, while bitter ones stimulate the release of bile. Use herbs that regulate Liver Qi such as bupleurum, cyperus or rose petals; tonify Liver Blood such as lycii berries, white peony or blackstrap molasses; tonify Liver Yin such as raw rehmannia, ligustrum or eclipta; or clear Liver Heat such as dandelion, yellow dock or burdock root. YANG ORGANS SMALL INTESTINE The Small Intestine partners with the Heart. It assists digestion by receiving food from the Stomach, separates the pure Fluids from the impure ones, transports them to various parts of the body and sends the residue on to the Large Intestine. Disorders of the Small Intestine include constipation, diarrhea and some urinary disorders. STOMACH The counterpart of the Spleen, the Stomach receives food and drink and breaks them down, thus governing digestion. Imbalances result in lack of appetite, indigestion, vomiting, nausea, bleeding gums, bad breath, mouth sores and headaches across the forehead. 29 LARGE INTESTINE The Large Intestine pairs with the Lungs and is responsible for transporting waste products out of the body and governs the rectum. Constipation, dysentery, diarrhea and hemorrhoids are manifestations of Large Intestine disharmony. URINARY BLADDER The Urinary Bladder, the Kidney’s partner, stores and excretes waste water. Disharmonies of the Bladder result in edema and urinary disorders. GALLBLADDER The paired Organ to the Liver, the Gallbladder is in charge of storing and secreting bile. Because bile is the only pure substance in the body, it is considered responsible for a person’s ability to make decisions. Imbalances manifest as digestive upset, timidity, indecisiveness, nausea and belching. 30 ADDENDUM II: OMEGA-3 and -6 STUDIES In 1996, the Journal of the American Medical Association published a study comparing the prevalence of depression across 10 nations. The survey yielded eye-opening results in showing how the lifetime and annual rates for depression varied widely from country to country (e.g., 1.5 in every 100 adults in Taiwan experience depression in their lifetimes while the figure is 19 for every 100 adults in Beirut). A 1998 study published in The Lancet compared this data with fish consumption, finding the higher consuming populations experienced less depression. One study in 2001, by A. Tanskanen, evaluated 3,204 Finnish adults with depressive symptoms along with measuring their fish consumption. They found the likelihood of having depressive symptoms significantly higher among infrequent fish consumers as compared with more frequent consumers. A 2003 study published in the American Journal of Psychiatry compared similar cross-national epidemiological data, this time involving bipolar disorder and seafood consumption, and again found a strong correlation. The working ingredient of fish oil is omega-3, a polyunsaturated fatty acid which is also found in certain plant parts such as flaxseeds, pumpkin seeds and walnuts. According to Joseph Hibbeln, M.D. of the National Institutes of Health, who authored the two fish-consumption studies: "In the last century, [Western] diets have radically changed and we eat grossly fewer omega-3 fatty acids now. We also know that rates of depression have radically increased by perhaps a hundred-fold." In a NY Times article, Dr. Hibbeln noted the following correlations: • Infant monkeys fed baby formula supplemented with omega-3 are stronger and more alert even at less than a week than monkeys given standard baby formula. • Depression is 60 times higher in New Zealand, where the average consumption of seafood is 40 pounds a year compared to Japan, where a person consumes nearly 150 pounds of seafood a year. • Postpartum depression is 50 times more common in countries with low levels of seafood consumption. During pregnancy, a woman’s body becomes depleted of fatty acids, which are transferred to the fetus. • Omega-3 seems to be critical to the growth and maintenance of brain cells, especially cell membranes. • When omega-3 is not available, the body uses omega-6, which produces cell membranes less able to cope with neurotransmitter traffic. The Omega-3 Bipolar Disorder Study One exciting breakthrough study in the treatment of bipolar disorders, including manic depression, was the 1999 Harvard study conducted on 30 patients with bipolar disorder, generally in stable condition but with a history of relapses (all had experienced bipolar episodes 31 over the past year). All but eight of the subjects were on medications, which were left unchanged. Half the subjects were given 9.6 grams of fish oil capsules, the other half received olive oil. The trial was supposed to go on for nine months, but was stopped after only four due to its outstanding results, with the omega-3 group staying in remission significantly longer than the placebo patients. By two months, half of the placebo group had dropped out compared to only two people in the fish oil group. The omega-3 group actually did less well in lowering their mania scores than those taking placebos, but fared much better getting their depression down. Some patients experienced nausea, diarrhea, and fishy aftertaste, which was not surprising considering the high doses. Currently Dr. Stoll is conducting a much larger and longer (three year) study that should conclude fairly soon. At a seminar at the May 2004 American Psychiatric Association’s annual meeting, Jerry Cott, PhD (an FDA researcher), had this to say about omega-3 (the following is paraphrased): Omega-3 is a fatty acid that appears to work much like a calcium channel blocker. Not uncoincidentally, Joseph Hibbeln MD of the NIH, who has led the way in omega-3 research, had been working on a calcium channel blocker study. Omega3 competes with its sister fatty acid, omega-6, for the same enzyme chain. From there, omega-3 and omega-6 are metabolized, then stored as highly unsaturated fatty acid in tissue phospholipids. The ideal ratio of omega-6 to omega-3 is one to one, but with modern diets favoring omega-6 at 20 to one, it’s fairly obvious which fatty acid is going to win the battle of the enzyme chain. With omega-3 less may be more; large doses may result in oxidative stress as omega-3 is being metabolized. This may explain why some studies using omega-3 (EPA) failed at higher doses. Accordingly, Dr. Cott recommends omega-3 be taken with vitamins C and E. Dr. Stoll also recommends taking vitamins C and E with omega-3 (1.5 to 3.5 grams of omega-3 a day, taken with food). He does not suggest using cod liver oil, as high amounts can lead to hyper-vitaminosis A. In buying fish oil, make sure you receive a 90 percent concentration (in the past only 30 percent was available.) Be sure it contains more EPA (omega-3) than DHA (omega-6), and that it has no heavy metal concentrations. Dr. Stoll recommends fish oil capsules over a diet of cold water fish such as salmon or tuna, citing toxic ingredients as a reason for not going with fish. Even one can of tuna a week is too much, he asserts. Andrew Weil, M.D., the natural health guru, recommends eating fish twice or three times a week, and cautions against capsules that may contain toxic contaminants. Both doctors agree that any fish you eat should be ocean fish rather than farm-raised fish. This is because omega-3 travels up the food chain from algae, while farm-raised fished are fed grains, which do not contain omega-3. Recently Krill oil has been made available because it is a more primal source high in omega-3 fatty acids and is also a potent natural antioxidant. Dr. Stoll also favors fish oil over flaxseed oil, as fish oil is more proven at this point. However, Dr. Weil says it's okay to go with flaxseed oil, which will make vegetarians happy. 32
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