Discussion of Detox Program for Opium Users
Dr. Ian Zhu
October 2006
For five years, TCM Health Care Centre has participated in a community "counter drug abuse" workshop. We made a presentation on how Chinese herbs are used to help opium users recover. Based on the clinical data, we found that during different detox stages, patients had shown encouraging responses to Chinese herbs. The following formulae are the most significant after our study over the course of five years.
We advise herbal practitioners to be aware of the fact that opium users are individually different, and always appear in unstable conditions. It is highly recommended that patients are provided with close attention. Long term follow up is crucial.
Differentiation
Modification
Close Attention
Long Term Follow Up
There are three major stages of treatment:
1. The invasion of the pathogenic factors to the Meridians (Jing Luo):
Onset 8-12 Hours
Physically: Watery eyes, runny nose, perspiration, dilated pupils, and muscle pain, loss of appetite, nausea, vomiting, diarrhea or constipation.
Mentally: Restlessness, palpitation and insomnia.
TCM Diagnosis: A pale tongue with white coating; a deep and thready pulse.
Herbal Remedy Suggested:
Modified Wu Hu Tan (Five -Tiger)
· Gypsum Fibrosum (Calcium Sulfate) - Shi Gao
· Ephedrae Radix (Chinese Ephedra) - Ma Huang
· Armeniacae Semen (Apricot Seed) - Xing Ren
· Glycyrrhizae Radix (Licorice) - Gan Cao
· Trichosanthis Radix (Snakegourd Root) - Tian Hua Fen
· Ledebouriellae Radix - Fang Feng
· Cicadae Periostracum (Cicada Slough) - Chan Tui
· Forsythiae Fructus (Forsythia) - Lian Qiao
2. Type of heat-toxin attacking the qi/ying system:
Peak 36-72 hours. It usually lasts 7-10 days.
Physically: Gooseflesh, vomiting, diarrhea, blood pressure/increased heartbeat.
Additional symptoms include tremors, spasms, nausea, thirst, chill, and fever.
Mentally: Listlessness, mania and delirium (alert: coma may occur).
TCM Diagnosis: A red tongue with/without yellow coating; a rapid and thready pulse.
Herbal Remedy Suggested:
Modified Qing Wen Bai Du Yin
· Gypsum Fibrosum (Calcium Sulfate - Shi Gao
· Rhizoma (Anemarrhena) - Zhi Mu
· Coptidis Rhizoma (Coptis) - Huang Lian
· Antelopis Cornu (Antelope Horn) - Ling Yang Jiao
· Paeoniae Radix (Peony) - Chi Shao
· Moutan Radicis Cortex (Moutan) - Mu Dan Pi
· Trichosanthis Radix (Snakegourd Root) - Tian Hua Fen
· Rehmanniae Radix (Rehmannia) - Sheng Di Huang
· Scrophulariae Radix (Scrophularia) - Xuan Shen
· Oldenlandiae Herba (Spreading Hedyotis) - Bai Hua She She Cao
· Bezoar Bovis (Cow Gallstone) - Niu Huang
· Glycyrrhizae Radix (Licorice) - Gan Cao
For stomachache and constipation, add:
Rhei Rhizoma (Rhubarb) - Da Huang
Sticky phlegm/sputum, mania/delirium,
Herbal Remedy Suggested:
An Gong Niu Huang Wan: (clear heat, remove phlegm for resuscitation)
· Bezoar Bovis (Cow Gallstone) - Niu Huang
· Rhinocerotis Cornu (Rhinoceros Horn) - Xi Jiao
· Coptidis Rhizoma (Coptis) - Huang Lian
· Gardeniae Fructus (Gardenia) - Shan Zhi Zi
· Borneol (Bornea Camphor) - Bing Pian
· Margarita (Peal) - Zhen Zhu
· Curcumae Tuber (Turmeric) - Yu Jin
· Astragali Radix (Astragalus) - Huang Qi
· Realgar (Arsenic sulphide) - Xiong Huang
· Cinnabaris (Cinnabar) - Zhu Sha
· Moschus (Musk) - She Xiang
Serious vomiting,
Herbal Remedy Suggested:
Wen Dan Tang: (removing phlegm, stopping vomiting by regulating the function of stomach).
· Pinelliae Tuber (Pinellia) - Ban Xia
· Citri Exocarpium Rubrum (Red Citrus) - Ju Hong
· Poria (Hoelen) - Fu Ling
· Glycyrrhizae Radix (Licorice) - Gan Cao
· Zingiberis Rhizoma (Fresh Ginger) - Sheng Jiang
· Bambusae Caulis in Taeniis (Bamboo Shavings) - Zhu Ru
· Aurantii Fructus Immaturus (Immature Bitter Orange) - Zhi Shi
· Zizyphi Fructus (Jujube) - Da Zao
3. Impairment of both qi and yin:
It lasts 3-6 months or even longer.
Physically: Profuse sweating, muscle spasms, shivering, and tremors and exhausted;
Mentally: Severe anxiety, insomnia;
TCM Diagnosis: A pale and dry tongue; a weak/deficient type pulse.
Herbal Remedy Suggested:
Modified Sheng Mai San/Lian Zi Bai He Ding Sheng Tang: (Replenishing yin, rejuvenating qi and calming the mind)
· Ginseng Radix (Ginseng) - Ren Shen
· Ophiopogonis Tuber (Ophiopogon) - Mai Men Dong
· Schizandrae Fructus (Schizandra) - Wu Wei Zi
· Nelumbinis Embryo (Lotus Embryo) - Lian Zi Xin
· Lilii Bulbus (Lily) - Bai He
· Ostreae Testa (Oyster Shell) - Mu Li
· Grassleaf Sweetflag Rhizoma - Shi Chang Pu
· Longanae Arillus (Longan) - Long Yan Rou
· Polygalae Radix (Polygala) - Yuan Zhi
· Thujae Orientalis Semen (Biotae Semen) - Bai Zi Ren
· Poria (Hoelen) - Fu Ling
· Glycyrrhizae Radix (Licorice) - Gan Cao
Deficiency of heart yin: Restlessness, dry mouth, heat sensation in the palms/ soles, tidal fever, night sweating, insomnia. Diagnosis includes a red tongue and a thready/rapid pulse.
Herbal Remedy Suggested:
Zhu Sha An Sheng Wan:
· Cinnabaris (Cinnabar) - Zhu Sha
· Coptidis Rhizoma (Coptis) - Huang Lian
· Rehmanniae Radix (Rehmannia) - Sheng Di Huang
· Angelicae Radix (Angelica) - Dang Gui
· Glycyrrhizae Radix (Licorice) - Gan Cao
Deficiency of kidney yin: Dizziness, tinnitus, insomnia, poor memory, soreness/weakness of the lumbar region and knee joints, nocturnal emission, dry mouth, afternoon fever, malar flush, night sweating, yellow urine, constipation. Diagnosis includes a red tongue with little coating and a thready/rapid pulse.
Herbal Remedy Suggested:
Liu Wei Di Huang Wan:
· Rehmanniae Radix (Prepared Rehmannia) - Shu Di Huang
· Corni Fructus (Dogwood Fruit) - Shan Zhu Yu
· Batatatis Rhizoma (Chinese Yam) - Shan Yao
· Alismatis Rhizoma (Alisma) - Ze Xie
· Poria (Hoelen) - Fu Ling
· Moutan Radicis Cortex (Moutan) - Mu Dan Pi
Symptoms include hectic fever (Steaming of bone), afternoon fever or night sweating.
Herbal Remedy Suggested:
Qing Hao Bie Jia Tang:
· Artemisiae Herba (Sweet Wormwood) - Qing Hao
· Amydae Carapax (Turtle Shell) - Bie Jia
· Rehmanniae Radix (Rehmannia) - Sheng Di Huang
· Anemarrhenae Rhizoma (Anemarrhena) - Zhi Mu
· Moutan Radicis Cortex (Moutan) - Mu Dan Pi
Deficiency of spleen qi: Sallow complexion, emaciation, lassitude, dislike of speaking, reduced appetite, abdominal dissension, loose stool, fatigue; a pale tongue with a thin, white coating; a slowing-down, weak or soft, thready pulse.
Herbal Remedy Suggested:
Gui Pi Tang:
· Atractylodis Rhizoma (Atractylodes) - Bai Zhu
· Poria with Hostwood - Fu Shen
· Astragali Radix (Astragalus) - Huang Qi
· Longanae Arillus (Longan - Long Yan Rou
· Zizyphi Spinosi Semen (Jujube Seed) - Suan Zao Ren
· Codonopsitis Radix - Dang Shen
· Saussureae Radix (Costus Root) - Mu Xiang
· Glycyrrhizae Radix (Licorice) - Gan Cao
· Angelicae Radix (Angelica) - Dang Gui
· Polygalae Radix (Polygala) - Yuan Zhi
· Zingiberis Rhizoma (Fresh Ginger) - Sheng Jiang
· Zizyphi Fructus (Jujube) - Da Zao
4. Long term follow up
Four Mild Drugs Decoction
(from Prescriptions of People's Welfare Pharmacy)
Composition:
· Radix Codonopsis Pilosulae - Dang Shen - 10g
· Rhizoma Atractylodis Macrocephalae - Bai Zhu - 10g
· Poria - Fu Ling - 10g
· Radix Glycyrrhizae Praeparata - Gan Cao
Action: Strengthening the middle jiao and benefiting vital energy, invigorating the spleen and eliminating dampness evil; mainly for cases of deficiency of spleen and stomach-energy and disorder of the transporting and digestive functions manifested as poor appetite, watery stools or diarrhea, weakness of four limbs, pale complexion, pale tongue with white fur, empty and weak pulse.
Clinical Application:
1. By adding Pericarpium Citri Reticulatae another prescription named Outstanding Effective Powder (from Key to Differentiation and Treatment of Diseases in Children) is formed. It has the effects of invigorating the spleen and regulating vital energy and is indicated for cases due to deficiency of both spleen-energy and stomach-energy and stagnation of vital energy, which are manifested as poor appetite, loose stools, chest and epigastric upset.
2. By adding Citri Reticulate, Rhizoma Pinelliae, Rhizoma Zingiberis, Recens and Fructus Ziziphi Jujubae, a prescription named Six Mild Drugs Decoction (from Orthodox Medical Records) is formed. It has the effects of invigorating the spleen and stomach and eliminating the phlegm-dampness evil, and is indicated for cases due to hypofunction of spleen and stomach complicated by attacking of phlegm-dampness evil, which are manifested as poor appetite, loose stools, productive cough, with profuse thin and clear sputum, shortness of breath and fullness over the abdomen.
3. By adding Citri Reticulatae, Pinilliae, Radix Aucklandiae, Fructus Amomi and Zingiberis Recens, a prescription named Six Drugs with Auclandiae and Amomi Decoction (from a Dictionary of Chinese Medicine) is formed. It has the effects of invigorating the spleen and stomach, regulating vital energy and stopping vomiting, and is indicated for cases due to hypofunction if spleen and retention of phlegm, which are manifested as vomiting of phlegm and saliva, eructation, abdominal fullness, pale tongue and smooth fur.
4. Applicable to cases of chronic gastritis, gastroduodenal ulcer, etc. attributed to hypofunction of the spleen with manifestation of anorexia, loose stools, or vomiting and fullness of abdomen.
Powder of Ginseng and Astragali seu Hedysari (from Main Rules in Medical and Health Service)
Composition:
· Radix Codonopsis Pilosulae - Dang Shen - 15g
· Radix Astragali seu Hedysari - Huang Qi - 15g
· Randix Rehmannieae (crude) - Shen Di Huang - 15g
· Radix Gentianae Macrophyllae - Qin Jiu - 15g
· Cortex Lycii Radicis - Di Gu Pi - 15g
· Radix Asparagi - Tan Men Dong - 15g
· Poria - Fu Ling - 10g
· Rhizoma Anemrrhennae - Zhi Mu - 10g
· Cortex Mori Radicis - Sang Bai Pi - 10g
· Radix Paeoniae Robra - Chi Shao - 10g
· Rhizoma Caparax Trionycis (fried) - Bie Jia - 20g
· Radix Platycodi - Jie Gen - 6g
· Radix Asteris - Zi Yuan - 6g
· Radix Bupleuri - Cai Hu - 6g
· Rhizoma Pinalliae Praeparata - Ban Xia - 6g
· Radix Glycyrrhizae Praeparata - Gan Cao - 3g
Action: Benefiting vital energy, promoting the production of body fluid, nourishing yin, lowering fever, dispersing phlegm and stopping cough; mainly for consumptive diseases manifested as prolonged low fever, fatigue, shortness of breath, poor appetite, feverish sensation over the precordial region, soles and palms, night sweating, emaciation, pale complexion, cough with thick sputum, tender and red tongue, weak and rapid pulse, which are attributive to impairment of vital energy andyin and attack of the lung by asthenic fire.
Clinical Application:
1.Applicable to cases of pulmonary abscess manifested as cough with purulent and foul sputum, lusterless complexion, emaciation, afternoon fever, fatigue and dyspnea.
2. Also indicated for cases with hemoptysis. Irritability, shortness of breath, fatigue, pale complexion, spontaneous sweating, night sweating, tender and red tongue, wiry and small pulse, which are attribute to impairment of lung-energy and attack of the lung by liver-fire.
3. Also applicable to cases of pulmonary tuberculosis and lupus pneumonia with low fever attribute to impairment of vital energy and yin and attack of the lung by asthenic fire, and cases of bronchiectasis and pulmonary congestion with hemoptysis attributive to impairment of lung-energy and attack of the lung by liver-fire.
Powder for Restoring Pulse Beating
(Decoction of Restoring Pulse Beating from Discourse on the Differentiation
of Exogenous and Endogenous Diseases)
Composition:
· Radix Ginseng - Ren Shen - 10g
· Radix Ophiopogonis - Mai Men Dong - 15g
· Fructus Shsiandrae - Wu Wei Zi - 6g
Action: Supplementing vital energy, promoting body fluid production, astringing yin and stopping excessive perspiration; mainly for the cases with deficiency of both vital energy and yin manifested as hyperhidrosis, thirst, shortness of breath, tiredness and small weak pulse, and the cases of spontaneous perspiration and shortness of breath due to damage of the lung caused by chronic cough and damage of both vital energy and yin.
Clinical Application:
1. Applicable for the cases of consumption of vital energy and yin by profuse sweating with tiredness and thirst during hot summer time
2. Ginseng of high-grade should be used in this prescription, such as Radix Panacis Quinquefolii, Radix Ginseng Koreae or Radix Ginseng Jilin. The former one is especially suitable for the case of consumption of vital energy and yin by summer-heat evils.
3. Also applicable for cardiogenic shock and arrhythmia with manifestations of consumption of vital energy and yin
Decoction of Ginseng and Aconiti (from Annotated Effective Prescriptions for Women)
Composition:
· Radix Ginseng - Ren Shen - 12g
· Radix Aconiti Praeparata - Fu Zi - 9g
· Rhizoma Zingiberis Recens - Sheng Jiang - 4 Pcs
· Fructus Ziziphi Jujubae - Da Zao
Action: Benefiting vital energy, recuperating the depleted yang-energy and rescuing the patient from danger; mainly for cases of exhaustion of primordial energy and yang-energy, who are manifested as cold limbs, spontaneous perspiration, dypsnea, shortness of breath, sunken and small pulse.
Clinical Application:
1. Applicable to cases of hypovolumic and cardiogenic shock which are attributed to exhaustion of primordial energy and yang energy.
2. Also applicable to cases of hemorrhagic shock attributed to yang depletion.
Powder of Ginseng, Poris and Atractylodis Macroephalae
(from Prescriptions of People�s Welfare Pharmacy)
Composition:
· Radix Codonopsis Pilosulae - Dang Shen - 5g
· Rhizoma Dioscoreae - Shan Yao - 15g
· Semen Dolichoris Album - Bai Bian Dou - 15g
· Semen Coicis - Yi Yi Ren - 15g
· Semen Nelumbinis - Lian Zi - 20g
· Rhizoma Atractylodis Macrocephalae - Bai Zhu - 10g
· Poriae Alba - Fu Ling - 10g
· Radix Glycyrrhizae Praeparata - Gan Cao - 6g
· Fructus Amomi - Sha Ren - 3g
· Radix Platycodi - Jie Gen - 3g
· Fructus Ziziphi Jujubae - Da Zao - 6Pcs
Action:
Strengthening the spleen and benefiting vital energy, regulating the stomach and eliminating the dampness evil; mainly for cases due to deficiency of spleen-energy and stomach-energy complicated by affection of dampness evil, which are manifested diarrhea, poor appetite, feeling of oppression in the chest, emaciation, white and greasy fur on the tongue, empty and slow pulse.
Clinical Application:
1. For cases with vomiting, increase the dosage of Amomi (up to 6g) but subtract Glycyrrhizae and Platycodi from this prescription to strengthen the spleen and stop vomiting; for cases with abdominal fullness due to stagnation of dampness evil and vital energy, subtract Glycyhizae and add Pericarpium Arecae to promote the circulation of vital energy and promote diuresis.
2. Applicable to gynecological cases resulting from hypofunction of spleen and overabundance of dampness evil with manifestations if leucorrhagia with whitish discharge, pallor, obesity and loose stools.
3. Also applicable to cases of chronic gastritis, ulcerative enterophtisis and chronic pancreatitis with diarrhea attributed to hypofunction of spleen and overabundance of dampness evil. Recently also used for cases of chronic nephritis with persistence of proteinuria attributed to hypofunction of spleen.