Chinese patent medicines for relieving anxiety

Currently, there are three types of Chinese patent medicines that have been evidence-based and widely used for anxiety intervention in domestic clinical practice. The core are Shugan Jieyu Capsules, Wuling Capsules, and Jiuwei Zhenxin Granules. All Chinese patent medicines must be used based on TCM syndrome differentiation. They must not be purchased and taken according to symptoms, nor can they directly replace prescription anti-anxiety Western medicines.

A while ago, I met a 28-year-old Internet operation girl who suffers from mild generalized anxiety. On Monday, she was so flustered that she couldn't hold the mouse. Her chest felt like it was filled with half a sponge that had not been soaked. She was so stuffy that she couldn't cough it out or swallow it. When she lay in bed, her mind could go through the unfinished plan three times last week. She kept her eyes open until two o'clock in the morning. She was afraid that taking western medicine would make her dependent, and she was really uncomfortable. The diagnosis was typical liver stagnation and spleen deficiency, so she was prescribed Shugan Jieyu Capsules, and asked her to take two capsules twice a day with oryzanol. After three weeks of follow-up consultation, she said that the feeling of "wet rag pressed against the chest" had basically disappeared. She stayed up all night to work on a project last week, and she did not panic to search for "precursors of sudden death" in the middle of the night like before. The ingredients of this medicine are Hypericum perforatum and Eleutherococcus senticosus. It is also interesting to talk about it. Hypericum perforatum is the anti-anxiety botanical St. John's wort commonly used in foreign countries. It means that traditional Chinese and Western medicine have just hit the target with this ingredient. Many studies have now confirmed that it has an improvement effect on mild to moderate anxiety, which is similar to that of low-dose buspirone, and has fewer side effects.

But if your anxiety is not chest tightness, but always feels hollow in your heart, like a little rabbit jumping around, your palms and soles are always hot, you sweat all over your body when you fall asleep at night, and your mind is full of bad things that haven’t happened, then taking liver-soothing products will not be the right medicine. In clinical practice, Wuling Capsules are more commonly used for this type of heart-kidney disharmony. Its ingredient is a single Wuling mushroom powder, which is not only used in traditional Chinese medicine to tonify the kidneys and calm the mind, but modern pharmacological research has also found that it can regulate γ-aminobutyric acid receptors, and its action path overlaps with that of many anti-anxiety Western medicines. I have met many students who are preparing for postgraduate entrance examinations and public entrance examinations.

To be honest, I have met many people who search for folk remedies as soon as they detect anxiety, and then ask if Xiaoyao Pills can be taken. This is really controversial. Many people think that "Xiaoyao Pill cures all unhappiness." There are indeed patients in the outpatient clinic who say that they are so irritable before menstruation that they want to throw things. After taking Xiaoyao Pill for two days, they are much better. But it must be made clear: Xiaoyao Pill targets transient anxiety caused by liver stagnation and blood deficiency. Emotions, if you are diagnosed with an anxiety disorder, whether it is generalized anxiety or a panic attack, it is basically impossible to suppress it by just taking Xiaoyao Pills. If it is not symptomatic, it will even aggravate the problems of internal heat and constipation. It can be used as an auxiliary treatment at most, and it cannot be used as the main medicine. Some people think that the anti-anxiety effects of Chinese patent medicines are all placebo effects. This cannot be generalized. In a small-sample controlled study conducted by us in conjunction with the psychiatry department last year, patients with moderate to severe anxiety who took Chinese patent medicines symptomatically had nearly 30% faster resolution of physical symptoms such as headaches, chest tightness, and abdominal distension than those who simply took Western medicines. The patients' medication compliance was also higher. Of course, it is not objective to say that there is no placebo effect at all. The psychological cues of mild to moderate patients themselves will also help relieve symptoms.

I received a 62-year-old elderly patient before. He always felt that something was going to happen at home. He couldn't sit still, stand up, or eat. After a physical examination, there were no problems. The psychiatric test showed that he was moderately anxious. He had a bad stomach and always took western medicine. Nausea was diagnosed as a deficiency of the heart and spleen, so he was prescribed Jiuwei Zhenxin Granules, which he took for more than a month. When his wife came for a follow-up visit, he said that he could finally sit down and watch the news broadcast for half an hour, and no longer kept asking "Is the door locked?" However, this medicine is a bit warm. People with yin deficiency and fire exuberance are prone to dry mouth and constipation after taking it. I usually tell you to drink more warm water in advance. If you still get angry after taking it for three days, you have to come back to adjust the medicine.

To be honest, don’t just think that Chinese patent medicines are “natural medicines” and just increase the dosage. There was a patient who changed Shugan Jieyu Capsules from two capsules twice a day to four times a day. After taking it for a week, the transaminase test doubled, which was not worth the loss. There are also people who take prescription drugs such as paroxetine and escitalopram oxalate and feel the side effects are severe, so they stop switching to Chinese patent medicines. As a result, withdrawal reactions occur, and the anxiety becomes worse than before. This must be avoided - Chinese patent medicines are either used alone for mild to moderate anxiety, or combined with Western medicine to reduce side effects for moderate to severe cases. They are never a substitute. Pregnant women and people with liver and kidney dysfunction must strictly follow the doctor's advice not to touch them.

After all, medicine only helps you turn down the alarm sound of anxiety. I have a patient who takes medicine while hiking twice a week and taking 10 minutes of mindful breathing every day. He feels better nearly twice as fast as the person who only takes medicine. After all, anxiety is essentially your body shouting "I can't take it anymore." If you just take medicine to block the alarm, you will still stay up late every day, get angry with others, and tighten the strings to the point of breaking. No medicine will help.