A formula suitable for the treatment of depression and anxiety – Xiao Ding Zhi Wan
[Composition] Ginseng, Poria, Acorus calamus, Yuan Zhi.
Functions】Benefiting Qi, tonifying deficiency, and communicating with the heart and kidney.
Indications】Disturbance of the mind and kidney caused by disconnection of the heart and kidney, including depressed mood, nervousness and fear, forgetfulness, abnormal speech and behavior, seminal emission, etc.
Application Notes
Kaixin San is from “Qianjin Essentials” and is used to treat “good forgetfulness”. The same composition, but with a slight change in the proportion of drugs, “Ancient and Modern Recorded Experimentation Formula” Ding Zhi Wan, “Hodong Bureau Formula” Ding Zhi Xiao Wan is the main treatment of “uncertainty in the heart, the five organs are not enough, and even worry and worry, and forgetfulness, the morning and the evening, the evening and the morning, and because of things have a big fright, dreaming and sleeping unknown, climbing high and involved in danger, resulting in the restlessness of the soul, palpitation and fear”. We have investigated the effects of XieXiShan and its analogues. We have examined the literature of Kaixin San and similar prescriptions through the ages and found that.
(1) All the drugs in the formula have the effects of benefiting qi, tonifying deficiency, calming the mind, calming panic, educating the mind and transporting the heart and kidneys;
(2) Anxiety, depression, forgetfulness, abnormal speech and behavior, spermatorrhea, and decreased vision are the target symptoms of their treatment;
(3) Yang Qi deficiency is the pathological basis for the use of Kaixin San and its analogues. The non-interaction between the heart and kidney is the “Yang Qi” between the heart and kidney.
In modern Chinese medicine, there have been a lot of experimental and clinical studies on the treatment of depression with Kaixin San (including Dingzhi Xiaowan), and its antidepressant mechanism has been partially elucidated. Our preliminary study found that the efficacy of Kaixin San in the treatment of mild to moderate depression was comparable to that of fluoxetine and could improve endogenous melatonin in depressed patients. We often use this formula clinically as a basic formula for the treatment of mixed depressive and anxiety disorders, which are identified by TCM as heart and gallbladder qi deficiency or heart and kidney (yang qi) non-interaction, with prominent symptoms of depressed mood, nervousness and fear, forgetfulness and palpitations.
For those with obvious symptoms of Qi deficiency, with fatigue, shortness of breath and spontaneous sweating, add Astragalus, Atractylodes and Glycyrrhiza glabra; for those with obvious symptoms of insomnia and nervousness and fear, add sour date palm, cypress kernel, calcined magnet and raw oyster; for those with internal heat of yin deficiency, with five heart troubles, hot flashes and night sweats, and dry mouth and throat, add asparagus and Radix et Rhizoma; for those with spleen deficiency and dampness, with distention and stuffiness, loose stools and decreased appetite, add Mu Xiang, fried Atractylodes, Job’s Tears and Pian Dou; for those with phlegm and dampness, add Mucuna Pruriens, fried Atractylodes, Job’s Tears and Pian Dou. For those with internal disturbance of phlegm and heat, irritability and yellowish coating, combining with Huanglian Wenzhi Tang (Huanglian, Zhushu, Citrus aurantium, Chen Pi, Fuxianxia, Poria, Licorice, Ginger).
Experimental case
Ye, female, 38 years old, with undergraduate education, is an employee. She was first diagnosed on April 15, 2008 due to heartburn, poor sleep and forgetfulness for more than half a year, aggravated in February. Six months ago, she was anxious and worried about her husband’s business loss, and she had distress and poor sleep, mainly difficulty in falling asleep, but after she fell asleep, she was dreamy, panic-stricken, timid, easily sad and worried, reluctant to interact with others, often dazed when she had nothing to do in the office, short-tempered, poor memory, often misplacing things, and forgetting what she just said in a few minutes. He has been seen in the local internal medicine department for several times, and his blood tests such as routine blood count, sedimentation, blood biochemistry, thyroid function and electrocardiogram are normal.
In the past 2 months, his symptoms have worsened, he often has difficulty sleeping, wakes up easily, has nightmares, does not want to do anything at home, feels fatigued when he works a little, feels like he is in trouble all day, gets nervous and panicky when he hears a phone call (his heart beats like it is about to jump out of his throat), is irritable, walks back and forth in the house from time to time, may drop things at the slightest thing, regrets afterwards, feels no point in being human, but has no suicidal ideas She was referred to the Department of Mental Health for treatment of her symptoms, including loss of appetite, decreased and delayed menstruation. Mental examination: clear consciousness, neat instrumentation, complete orientation, anxious expression, irritable, rubbing her hands and feet from time to time, depressed mood, tearing from time to time, seemingly inattentive, normal memory coarse measurements, sensitive and suspicious, feeling that colleagues and neighbors look down on her, no exact psychotic symptoms, reduced volitional activity, self-knowledge present. The tongue is pale, the coating is thin and white, and the pulse is thin and weak. Hamilton depression scale (HAMD) score of 24, Hamilton anxiety scale (HAMA) score of 22.
Diagnosis: Mixed depressive-anxiety disorder.
Treatment: The patient complained that he was allergic and had been treated with herbal medicine. He requested a trial of herbal treatment first and was willing to receive psychotherapy. The patient was given Happy San Plus with the following herbs: Ginseng Slices 20g, Poria 30g, Acorus Calamus 20g, Yuan Zhi 10g, Raw Dragon Bone (first decoction) 30g, Raw Oyster (first decoction) 30g, Calcined Magnet (first decoction) 30g, Sour Date Palm 50g, Shou Wu Vine 30g, Licorice 10g, Lily 60g, Radix et Rhizoma Dioscoreae 15g, Radix Aromaticus 10g. 7 doses were taken with water decoction, 1 dose daily, divided into 2 doses in the morning and afternoon. And sleep hygiene education, progressive relaxation training 2 times/day and exercise 30 minutes/day.
After 1 week of follow-up, there was some improvement in agitation, sleep and tension, and no significant adverse effects were seen with Chinese medicine. 21 more doses of the above were given, with the same progressive relaxation training and exercise program as before, and cognitive behavioral therapy was started once a week.
After 3 weeks of follow-up, he felt that his symptoms had improved by more than 6/10, and now he felt that his back was sore, so he was given the following adjustments to the Chinese herbal formula: Ginseng slices 15g, Poria 30g, Calamus 15g, Yuan Zhi 10g, raw oyster (first decoction) 30g, calcined magnet (first decoction) 30g, sour date palm 30g, Shou Wu Vine 30g, licorice 10g, lily 60g, Lycium barbarum 20g, Epimedium 15g, Eucommia 20g. 28 doses. Psychotherapy is still in progress.
After 4 weeks, various symptoms were basically relieved, and the HAMD score was checked at 10 and HAMA score at 8. The above herbal and cognitive-behavioral treatments were continued, and the practice of internal breathing and somatic scanning was started. After a total of 14 months of treatment, the medication was discontinued. Since then, he insisted on progressive relaxation training once/day, exercise for 30 minutes/day, and torso scan once/day. The condition was stable at one year follow-up.
[Note] This patient has depressive co-morbid anxiety disorder, with prominent clinical manifestations of “depressed mood”, “nervousness and fear”, “forgetfulness”, and The prominent clinical manifestations of “depressed mood”, “nervousness and fear”, “forgetfulness” and “panic and palpitation” are similar to the “Kaixin San formula”, so Kaixin San with added flavor is used for treatment. Since the patient’s symptoms of insomnia, irritability and agitation were obvious, we combined it with Baihe Dihuang Tang and increased the dose of tranquilizers such as sour date palm, oyster and magnetic stone. We experienced that herbal medicine combined with psychotherapy has good efficacy for mixed depressive-anxiety disorder and is a good choice for patients who do not want to receive western antidepressant treatment.