abstracted & translated by
Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, Chinese herbal medicine, psychiatry, generalized anxiety disorder (GAD), Wen Dan Tang

On page 66 of issue #12, 2006 of Xin Zhong Yi (New Chinese Medicine), Zhou Ren-yi published an article titled, “The Treatment of 34 Cases of Anxiety Disorder with Wen Dan Tang (Warm the Gallbladder Decoction).” Because Wen Dan Tang is one of my favorite formulas and psychiatric conditions are a perennial interest to Western practitioners of Chinese medicine, a summary of this article is presented below.

Cohort description:

A total of 68 cases were randomly divided by sequence into two groups of 34 cases each, a treatment group and a comparison group. All 68 cases met the CCMD-3 diagnostic criteria for GAD. Patients with hyperthyroidism, high blood pressure, coronary heart disease, or other organic diseases which might causes secondary anxiety were eliminated from this study as well as anyone whose onset of anxiety was coincident with taking a variety of medications. All had a Hamilton anxiety (HAMA) score of 14 points or more. In the treatment group, there were 20 males and 14 females with a median age of 28.8 ± 5.8 years and a median disease duration of 2.5 ± 2.1 years. In the comparison group, there were 18 males and 16 females with a median age of 29.2 ± 6.1 years and a median disease duration of 2.7 ± 2.0 years.

Treatment method:

Treatment was begun in both groups only after a week of gradual withdrawal from any other anti-anxiety medications. The basic formula administered to those in the treatment group consisted of:

Zhu Ru (Caulis Bambusae In Taeniam)
Ban Xia (Rhizoma Pinelliae), 12g each
Fu Ling (Poria)
Yu Jin (Tuber Curcumae)
Dan Shen (Radix Salviae Miltiorrhizae)
Suan Zao Ren (Semen Zizyphi Spinosae), 15g each
Dan Nan Xing (bile-processed Rhizoma Arisaematis), 10g
uncooked Long Gu (Os Draconis)
uncooked Mu Li (Concha Ostreae), 30g each
Shi Chang Pu (Rhizoma Acori Tatarinowii)
Zhi Shi (Fructus Immaturus Aurantii), 9g each
Gan Cao (Radix Glycyrrhizae), 6g

If there was constipation, Gua Lou Ren (Semen Trichosanthis) and Jue Ming Zi (Semen Cassiae) were added.

If liver fire was blazing upward, Long Dan Cao (Radix Gentianae) and Zhi Zi (Fructus Gardeniae) were added.

If there was yin vacuity fire effulgence, Zhi Mu (Rhizoma Anemarrhenae) and Huang Bai (Cortex Phellodendri) were added.

If there was dizziness, Bai Shao (Radix Alba Paeoniae) and Dai Zhe Shi (Haemititum) were added.

If there was vomiting, Huang Lian (Rhizoma Coptidis) and Zi Su Ye (Folium Perillae) were added.

If there was torpid intake, Shen Qu (Massa Medica Fermentata) and Mai Ya (Fructus Germinatus Hordei) were added.

If insomnia was severe, He Huan Pi (Cortex Albiziae) and Ye Jiao Teng (Caulis Polygoni Multiflori) were added.

One packet of these medicinals was decocted in water and administered per day.

Members of the comparison group were administered fluoxetine beginning at a dose of 25mg per day and increasing this dose over 10 days to 100-250mg given in two divided doses per day. All patients were forbidden to take any other psychiatric medications during the course of this study which lasted a total of six weeks for both groups.

Study outcomes:

Cure was defined as a decrease in HAMA score from before to after treatment equal to or more than 75%. A decrease of 50-74% was labeled as marked improvement. A decrease of 25-49% was labeled as some improvement, while a decrease of less than 25% was labeled as no effect. The following table shows the outcomes of the two groups based on these criteria.

Thus there was no significant difference in total effectiveness rate between these two groups (P > 0.05). However, there were differences in the severity and number of adverse reactions to treatment between these two groups. In the treatment group, there were only extremely mild or faint adverse reactions which all gradually disappeared after treatment. In the comparison group, there were eight cases of visual disturbances, six cases of dry mouth and difficulty urinating, four cases of electrocardiogram abnormalities, and three cases of constipation. However, none of these caused the patient to discontinue treatment. Nevertheless, the Chinese medical protocol was as effective as the Western drug therapy and with considerably less side effects.

Discussion:

According to Dr. Zhou, anxiety disorder falls under the Chinese medical disease categories of depression and fright and fear. Patients mostly have a dry mouth, a red tongue with yellow fur, and a bowstring pulse. The disease causes and mechanisms are mostly evils entering the shao yang with liver loss of coursing and discharge. Thus the gallbladder’s function of decision. The qi becomes depressed and transforms phlegm. This depression also results in the transformation of heat. Phlegm heat then harass above. If the spirit brightness suffers harassment, then one sees anxiety disorder. Wen Dan Tang comes from Sun si-miao’s Qian Jin Fang (Formulas [Worth] a Thousand [pieces of] Gold). Its effects as written in this protocol are that it transforms phlegm and clears heat, heavily settles and quiets the spirit. Within this formula, Zhi Shi moves the qi and abducts stagnation, soothes and vitalizes the qi mechanism. Ban Xia dries dampness and expels phlegm, scatters binding and disperses glomus. Zhu Ru clears heat and eliminates vexation, regulates and eases the qi mechanism. Shi Chang Pu and Yu Jin move the qi, resolve depression, and quiet the spirit. Long Gu and Mu Li heavily settle and quiet the spirit. Fu Ling seeps and disinhibits urination. Combined with Suan Zao Ren, these two nourish the heart and quiet the spirit. Dan Nan Xing clears heat and transforms phlegm. Gan Cao harmonizes the center and nourishes the heart. When all these medicinals are used together, their effect is to transform phlegm and clear heat, heavily settle and quiet the spirit.