Modified Wenden Decoction for the Treatment of Generalized Anxiety Disorder: a Case Report
Wendan decoction (WDD), a classical Chinese herbal medicine (CHM) formula consisting of six ingredients (Xu, 2015): Pinelliae (ban xia, 6 g), Ginger (sheng jiang,12 g), Citri Exocarpium (ju pi, 6 g), Aursntii Fructus Immaturus (zhi shi, 9 g), Bambusae caulis (zhu ru, 6 g), and Glycyrrhizae (gan cao, 3 g), has been used since 500 AD. WDD exerts multiple actions in regulating phlegm-associated problems (Gao, 2000). In traditional Chinese Medicine (TCM), the “phlegm” refers to pathological states of stasis and dampness in circulation, digestion, emotion, exhaustion, and respiration. Therefore, WDD is widely used in cardiology, gastroenterology, neuropsychiatry and breathing disorders (Liu, 2009).
For neuropsychiatry area treatments, WDD was modified as following: Pinellia, Zhuru, Zhishi, Orange peel, Licorice, Poria, Ginger and Jujube by Chen Wuzhe from South Song Dynasty. Its targeted TCM pattern was disharmony between gallbladder and stomach, phlegm-heat harassing the inner body. Today, modified WDD is one of core CHM formulas for the treatment of anxiety disorders.
A TCM physician, Dr. Zheng, introduced her successful experience on treating a patient with generalized anxiety disorder by prescribing modified WDD (Zheng, 2016).
Patient: male, 59 years old, had been nervous and worried about little things in life, such as turning off the gas, or locking the door, since retirement in November 2013. Since Jun 2014, the patient had gotten less sleep and been worried about more little things. At the end of November 2014, the patient got sudden rapid heart rate, palpitations, increased blood pressure, and thought he would die. After he was sent to emergency room, all the test results were normal. Since then he always felt that he had some disease, bursts of flustered feelings, panic-attacks, got upset, unwilling to go to places where there was crowd of people, did not speak to others or watch TV, did not answer mobile phone, afraid that others would laugh at him if they knew his sickness, and lost appetite. Since Jan 2015, he occasionally took Estazolam 1mg at bedtime, and his sleep was slightly improved. But he still got annoyed, worries, and stopped conversations. He later took Zoloft 50mg every morning by himself, thus his condition was slightly improved. However, he self-discontinued the medicine because of dry mouth and nausea. Recently, his condition became worse and exhibited tension and fear, severe insomnia, panic attack, bursts of sweat, and trembling. However, he couldn’t have a logical explanation or reason to his own fear.
On 22 Mar 2016, the patient visited Dr. Zheng.
Mental examination: Consciousness was clear, questions were answered, facial expressions were tense; orientations of time, place, and person were complete. He exhibited hyperesthesia, sensitive to voice and light, anxious and worrying, feared bad things would happen. Tongue was red, with mild yellow and greasy coating. The pulse was slippery.
Auxiliary examination: The Hamilton Anxiety Scale scored 30 points; EEG, biochemical items, thyroid function, and ECG did not show obvious abnormalities.
Western medicine diagnosis: generalized anxiety disorder;
TCM diagnosis: Yu zheng (depression pattern) – disharmony between gallbladder and stomach, phlegm-heat harassing the inner body.
The patient insisted on not taking western medicine, so he was treated by modified WDD treatment. Medicinal formula was: Pinellia 20g, Zhuru 20g, Zhishi 15g, orange peel 10g, Guizhi 5g, raw white peony root 25g, cooked Yuanzhi 15g, Ciwujia 50g, lily 30g, raw keel 30g, oyster 30g, Poria 20g. Dosage: 1 dose /d, divided in 2 times, taken warm.
Effects: After taking the modified WDD for 7 days, the feeling of worriedness and fear was obviously relieved, and his sleep was improved. After 1 month of treatment, the patient was in good mood, and all symptoms disappeared. The patient was asked to stop the treatment and self-adjust emotions. His anxiety did not relapse after following-up for 2 months.
Modified WDD is based on the original WDD. In this modified formula, Pinellia dries dampness and transforms phlegm, downbears counterblow and harmonizes the stomach; Zhuru clears gallbladder and benefit liver, checks vomiting and relieves fidgetiness; Zhishi rectifies qi and transforms phlegm; Guizhi coupled with Poria smooths Qi through three cavities; Guizhi coupled with raw white peony root harmonizes the spleen and stomach, transform Qin in center burner; raw keel and oyster settle fright and quiet the spirit; Cooked Yuanzhi and Ciwujia calm spirit and help sleep; Lily quiets the heart spirit. By working together, this modified WDD reached the aim of draining the fire and expelling the phlegm, thus cured the generalized anxiety disorder of this patient.
Besides modified WDD, there are dozens of other CHM formulae for anxiety disorder in terms of different TCM patterns. For the pattern of effulgent heart fire, modified Daochi Powder is the right formula to achieve the purpose of clearing the heart and draining fire. For the pattern of disquieted heart spirit, Neutral Supplementing Heart-Settling Elixir is the right herbal treatment in order to benefit qi and settle fright, quiet the spirit and stabilize the mind. For the pattern of heart- gallbladder qi vacuity, Four Gentlemen decoction combined with Wendan decoction can benefit qi, warm gallbladder, and transform phlegm. For the pattern of liver depression and blood vacuity, modified Danzhi Xiaoyao San is good at coursing the liver and rectify qi, nourishing blood and calming spirit. For the pattern of insufficiency of kidney essence, modified Six-Ingredient Rehmannia Pill can supplement the kidney, boost essence and stabilize the mind (He, 2013).
The holistic theory of TCM brought more accurate treatment for the patient, while fewer side effects than western medicine.
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Zheng W, Gao S, Zhao YM, et al. Modi?ed Wendan Decoction in Treating Generalized Anxiety Disorder. Clinical journal of traditional Chinese medicine, Dec. 2016, 28(12):1704-5 (in Chinese).