A Liver-based Protocol for the Treatment of Generalized Anxiety Disorder

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

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

On pages 5-8 of issue #11, 2006 of Bei Jing Zhong Yi Yao Da Xue Xue Bao (Academic Journal of Beijing University of Chinese Medicine & Pharmacology), Guo Rong-juan et al. of the Dongfang Hospital associated with Beijing University of Chinese Medicine published an article titled, “Clinical Observations on the Treatment of Generalized Anxiety Disorder with the Methods of Coursing the Liver & Draining Fire, Nourishing the Blood & Quieting the Spirit).” A summary of this study is presented below.

Cohort description:

A total of 60 patients with a confirmed diagnosis of GAD were randomly divided into two groups of 30 patients each. In the treatment group, there were 13 males and 17 females aged 17-77 years with a median age of 47 ± 12 years. All of these patients had a Hamilton anxiety score (HAMA) of 14-29 points, with a median score of 20.90 ± 3.52 points. Twelve cases had a score of 14-20 points, 17 had a score of 21-28 points, and one patient had a score of 29 points. In addition, all patients had a Hamilton depression score (HAMD) of 7-17 points, with a median score of 13 ± 3 points. The median course of disease of these patients was 17 ± 5 months.

In the comparison group, there were 12 males and 18 females aged 23-85 years with a median age of 49 ± 12 years. These patients all had a HAMA score of 14-28 points. Ten patients had a score of 14-20 points, and 20 patients had a score of 21-28 points. Similarly, all these patients had a HAMD score of 9-17 points, with a mean score of 14 ± 3 points. These patients’ median disease duration was 16 ± 6 months.

Treatment method:

All patients in the treatment group were orally administered Jing Xin An Shen Tang (Tranquilize the Heart & Quiet the Spirit) which consisted of undisclosed doses of the following medicinals:

Xia Ku Cao (Spica Prunellae)
vinegar stir-fried Chai Hu (Radix Bupleuri)
Huang Qin (Radix Scutellariae)
Chi Shao (Radix Rubra Paeoniae)
Bai Shao (Radix Alba Paeoniae)
stir-fried Suan Zao Ren (Semen Zizyphi Spinosae)
Yuan Zhi (Radix Polygalae)
He Huan Pi (Cortex Albiziae)
Ye Jiao Teng (Caulis Polygoni Multiflori)
mix-fried Gan Cao (Radix Glycyrrhizae)

One packet of these medicinals was administered per day divided into morning and evening doses. Four weeks equaled a course of treatment.

All members of the comparison group were orally administered Deanxit, a combination of two tricyclic antidepressants. Each morning these received one tablet weighing 10.5mg. These patients were also treated for four weeks.

Both groups’ heart rate, blood pressure, respiration, and pulse beats were checked before and after  treatment as were blood, urine, and fecal examinations. Similarly, liver and kidney function and electrocardiograms were done both before and after treatment.

Study outcomes:

To determine effectiveness rates, the HAMA score before treatment was divided into the score after treatment and then multiplied by 100%. Clinical remission defined as a decrease of 80% or more. Marked effect was defined as a decrease of 50% or more. Some effect was defined as a decrease of 30% or more, and no effect meant that any decrease was less than 30%. The following chart shows these outcomes in the two groups.

These outcomes show that both groups got a statistically significant therapeutic effect (P 〈 0.01). However, there was no markedly significant difference in total effectiveness between the two groups (P 〉 0.05). In other words, in terms of total effectiveness, the two groups faired about the same.

The following chart shows mean HAMA scores in both groups before, during, and at the end of treatment.

This shows that the decrease in HAMA scores was significantly better after two weeks in the treatment group compared to the comparison group (P 〈 0.01) and after four weeks (P 〈 0.05). In addition, at the end of four weeks, no marked adverse reactions were seen in either group. In the comparison group, there were two cases of slight dry mouth, one case of moderate sweating, one case of slight tremors, and one case of slight urinary urgency.

Discussion:

According to the Chinese authors, the Chinese medicinal protocol used in this study is based on Dan Zhi Xiao Yao San (Moutan & Gardenia Rambling Powder) with modifications based on empirical experience. Within it, Xia Ku Cao’s nature is cold, its flavor is bitter, and it enters the liver and gallbladder channels. It can clear the liver and drain fire, resolve depression and scatter binding. Chai Hu’s nature is slightly cold and its flavor is bitter. It enters the liver and gallbladder channels. It assists Xia Ku Cao in coursing the liver and resolving depression. Huang Qin’s flavor and nature are bitter and cold. It drains fire and resolves toxins. It is added to strengthen Xia Ku Cao’s clearing and draining of shao yang heat. When Huang Qin and Chai Hu are used together, as they are in Xiao Chai Hu Tang (Minor Bupleurum Decoction), they course the liver and resolve depression. Chi Shao’s flavor is bitter and its nature is slightly cold. It too enters the liver channel. It clears heat and cools the blood. Bai Shao’s flavor is bitter and sour and its nature is also slightly cold. Combined with Chi Shao, it cools and nourishes the blood and contains yin, emolliates the liver and relaxes urgency. Stir-fried Suan Zao Ren nourishes the liver, boosts the heart, and quiets the spirit. Yuan Zhi calms the heart and quiets the spirit, transforms phlegm and scatters binding. He Huan Pi and Ye Jiao Teng resolve depression, nourish the blood, and quiet the spirit. These last four medicinals all have the ability to nourish the blood and quiet the spirit. When taken as a whole, this formula courses the liver and drains fire, transforms phlegm, nourishes the blood and quiets the spirit.

Copyright © Blue Poppy Press, 2007. All rights reserved.