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The Diagnosis & Treatmentof Adrenal Fatigue Syndrome According toTraditional Chinese Medicine (TCM)byDr. Sam C. LiangGolden Needle Acupuncture, Inc.(This article is adapted from the contents of Dr. Sam C. Liang's presentation delivered atthe seminar "Traditional Chinese Medicine for Adrenal Fatigue" hosted bythe Oriental Healing Arts Institute (OHAI) in Irvine, CA on June 13th, 2010.)to as non-Addison hypadrenia, sub-clinicalIntroductionAdrenal fatigue is a type of syndrome causedby the decreased function of the adrenal glands.This syndrome is caused by prolonged periodsneurasthenia, and adrenal apathy. Millions ofpeople in the United States and throughout theworld suffer adrenal fatigue.of overwork, nervousness, stress, and pressureThere are eight types of differential diagnosisfrom daily life. It may also be triggered by acutefor "Adrenal Fatigue Syndrome" according toor chronic infections, including respiratoryTCM:disorders, such as the common cold, bronchitis,1. Kidney Yin deficiencyor pneumonia. This type of fatigue persists even2. Kidney Yang deficiencywith rest or sleep.3. Kidney Yin & Yang deficiencyAdrenal fatigue patients will feel like theyare in a constant state of illness, lethargicor "feeling gray". Suffering this type oflistlessness, they become dependent on coffee,caffeine or other stimulants to get through theday. Adrenal fatigue syndrome is also referredAdrenal Glands4. Kidney Qi deficiency5. Miscommunication between Heart andKidneys6. Liver & Kidney Yin deficiency7. Spleen & Kidney Yang deficiency8. Lung and Kidney Yin deficiencyThe TCM Diagnosis & Treatmentof Adrenal Fatigue Syndrome1. Kidney Yin DeficiencyKidney Yin becomes injured by overwork,chronic illness, late-stage Kidney patterns, orfollowing febrile diseasel. As a result, deficientKidney fire flares and the excessive heatdamages Kidney Yin and fluids.Clinical signs and symptoms include fivecenter heat, insomnia with night sweats,dry mouth, sore throat, heel pain, low backsoreness, beng luo2, a red tongue body, and athin, rapid pulse.1
1.1 Treatment of Kidney Yin Deficiency with InsomniaSigns & SymptomsThis pattern is caused by over-thinking.Excessive over-thinking leads to Kidney Yin/Essence deficiency and flaring of Heart fire. Thesigns and symptoms are palpitation, insomnia,random/bizarre dreams, five-center heat,dizziness, and tinnitus.Treatment PrincipleBecause the kidney is deficient, its water isunable to nourish the Heart's fire and insomniaresults. Treatment includes replenishing Kidneywater to subdue the deficiency fire and, calmingand stabilizing the spirit3.Recommended Herbal Formulas:The following formulas are combined together and taken 3 times during a day after each meal with warm water.ChineseEnglishPin-yin左歸丸Achyranthes & Rehmannia FormulaZuo Gui Wan還少丹Lycium FormulaHuan Shao Dan知柏地黃丸Anemarrhena, Phellodendron & Rehmannia FormulaZhi Bo Di Huang WanThe following formulas are combined together and taken 2 hours before bed or immediately after dinner with warm a Six FormulaLiu Wei Di Huang Wan黃連阿膠湯Coptis & Gelatin CombinationHuang Lian E Jiao Tang1.2 Treatment of Kidney Yin Deficiency with FatigueSigns & SymptomsTreatment PrincipleThe body is thin and emaciated, low-gradeTonify and nourish Kidney Yin.fever, dizziness with tinnitus and deafness,weakness in the legs, and lusterless facial color.Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm water.2ChineseEnglishPin-yin左歸丸Achyranthes & Rehmannia FormulaZuo Gui Wan益氣聰明湯Ginseng, Astragalus & Pueraria CombinationYi Qi Cong Ming Tang人參養榮湯Ginseng Nutritive CombinationRen Shen Yang Rong Tang
2. Kidney Yang DeficiencyThe body is unable to warm up the Zang-fuorgan because of deficiency of the primordialyang 4 which results in dampness and waterretention in the body as well as decreasedfunction of the reproductive system. This is dueto overwork, aging-induced Kidney deficiency,or chronic diseases.Clinical signs and symptoms include coldsigns such as white and pale face, cold andsoreness of the low back, abundant clear urineor retention of urine, edema (especially belowthe waist), erectile dysfunction, prematureejaculation, excessive vaginal discharge,infertility due to coldness in the uterus, paletongue body with a white coat, deep thin pulseat the Chi position or a deep hesitant pulse.2.1 Treatment of Kidney Yang Deficiency with FatigueSigns & SymptomsTreatment PrincipleInterior cold causes watery diarrhea withWarm Shen Men (神門), tonify the essenceundigested food, abundant clear urine, soreand blood.upper and low back, premature ejaculation,erectile dysfunction, and weight gain, especiallyaround the waist, that is hard to lose.Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm water.ChineseEnglishPin-yin右歸丸Eucommia & Rehmannia FormulaYou Gui Wan龜鹿二仙膠Tortoise Shell & Deer Horn FormulaGui Lu Er Xian Jiao還少丹Lycium FormulaHuan Shao Dan鹿茸Deer AntlerLu Rong2.2 Treatment of Kidney Yang Deficiency with Water Retention/SwellingSigns & SymptomsTreatment PrincipleEdema of the whole body, pitting edemaWarm the Kidneys, move the Qi and promoteespecially below the waist, scanty urine, lowwater movement.back pain, cold stagnation affecting the limbs,and a pale flabby tongue body with teeth marks.Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm ality CombinationWen Fu Tang (Zhen Wu Tang)導水茯苓湯Hoelen, Atractylodes & Areca CombinationDao Shui Fu Ling Tang3
3. Kidney Yin & Yang DeficiencyThe body to be unable to nourish the organsand meridians due to and insufficiency ofKidney Yang complicated with injured Yin andessence. Both internal and external factorssuch as overwork, late or end-stage of chronicdisease which affects the Kidneys contribute tothis condition.Clinical signs and symptoms include “shrimpsleeping”5, hot palms and soles, dry mouth andthroat, favoring hot or warm drinks, vertigo,tinnitus, low back soreness and weakness,abundant clear urination, urine retention,erectile dysfunction and premature ejaculatingin males, infertility and increase of vaginaldischarge in females, a flabby red tongue bodywith a white coating, and a thin and weak pulsein the Chi position.3.1 Kidney Yang and Yin Deficiency with Guan Ge Disorder6Signs & SymptomsRehmannia(Di Huang)Nausea and vomiting, scanty urine or urinarydifficulties, edema, dark facial hue, extremelack of energy, listlessness, dry mouth, a flabbypale red tongue body, and a white coating.Treatment PrincipleTo tonify and soothe Yang, dissipate turbidity,nourish Yin and benefit the water.Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm hes & Plantago FormulaJi Sheng Shen Qi Wan豬苓湯Polyporus CombinationZhu Ling Tang3.2 Treatment of Kidney Yang and Yin Deficiency with FatigueSigns & SymptomsTreatment PrincipleAversion to cold, hot palms and soles, dryTo tonify and nourish both Yang and Yin.throat, preference for warm drinks, vertigo,tinnitus, soreness and weakness of thelower back, erectile dysfunction, prematureejaculation, infertility, low blood pressure,low blood sugar, constantly tired or in asemiconscious state, uncontrollable craving forsalty or sweet foods.4Astragalus(Huang Qi)
Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm water.ChineseEnglishPin-yin右歸丸Eucommia & Rehmannia FormulaYou Gui Wan左歸丸Achyranthes & Rehmannia FormulaZuo Gui Wan鹿茸Deer AntlerLu RongOr the following formulas are combined together and taken 3 times a day after each meal with warm water.ChineseEnglishPin-yin參茸固本丸Ginseng & Antler PillsShen Rong Gu Ben Wan還少丹Lycium FormulaHuan Shao Dan補中益氣湯Ginseng & Astragalus CombinationBu Zhong Yi Qi Tang4. Kidney Qi DeficiencyKidney Qi deficiency is mostly due todeficient pre-heaven Qi, overwork, or chronicdisease. This is due to severe depletion ofthe Kidney Qi, leading to decreased Kidneyfunction.Clinical signs and symptoms includedecreased hearing acuity, day-dreaming,deafness, dizziness, lightheadedness, blurredvision, soreness and weakness of the low back,nocturia, premature ejaculation, pale tonguebody with a white coating, and a thin, weakpulse.4.1 Treatment of Kidney Qi Deficiency with FatigueSigns & SymptomsGinseng(Ren Shen)Dizziness, tinnitus, decrease in hearingacuity, soreness and weakness of the low back,mild depression and decrease in sex drive,constantly feeling unhealthy, and a prolongedrecovery time from infections.Treatment PrincipleTo tonify Kidneys.Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm water.ChineseEnglishPin-yin滋腎通耳湯Scute Ear CombinationZhi Shen Tong Er Tang右歸丸Eucommia & Rehmannia FormulaYou Gui Wan補中益氣湯Ginseng & Astragalus CombinationBu Zhong Yi Qi Tang大防風湯Major Siler CombinationDa Fang Feng Tang5
5. Miscommunication betweenKidneys & HeartClinical signs and symptoms includeirritability, insomnia, upper back and neck painThis is due to chronic disease, overwork,of unknown origin, lots of dreams, prematureover indulgence in sexual activity, or extremeejaculation, soreness of the lower back, legemotions leading to depletion of Kidneyweakness, hot flashes with spontaneouswater. Insufficient water fails to control Heartsweating, vertigo, tinnitus, palpitation, dryfire. Heart Yin becomes deficient leading tothroat, nocturia, red tongue body with scanty orthe flaring up of Heart deficiency fire. Thisno coating, pulse is thin and rapid.along with Kidney water deficiency results inmiscommunication between Kidneys and Heart.5.1 Treatment of Miscommunication between Heart & Kidneys with InsomniaSigns & SymptomsPueraria(Ge gen)This pattern is due to overwork which causesdeficiency with insufficient Kidney waterthat leads to Heart fire blazing. The signs andsymptoms include deficiency induced irritabilityand insomnia, excessive dreaming, 5-centerheat, dry mouth, insufficient saliva, upper backor neck pain along with dizziness, tinnitus, andpalpitation.Treatment PrincipleTo benefit and strengthen water to controlfire, nourish Yin, and clear heat.Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm water.ChineseEnglishPin-yin黃連阿膠湯Coptis & Gelatin CombinationHuang Lian E Jiao Tang葛根湯Pueraria CombinationGe Gen Tang養心湯Astragalus & Zizyphus CombinationYang Xin TangThe following formulas are combined together and taken after dinner with warm water.6ChineseEnglishPin-yin葛根湯Pueraria CombinationGe Gen Tang酸棗仁湯Zizyphus CombinationSuan Zao Ren Tang補中益氣湯Ginseng & Astragalus CombinationBu Zhong Yi Qi Tang六味地黃丸Rehmannia Six FormulaLiu Wei Di Huang Wan
6. Liver & Kidney Yin DeficiencyThis is due to “Kidney Yin deficiency leadingto Liver Yin deficiency” or “Liver Yin deficiencyleading to depletion of Kidney Yin”. In clinicalpractice Kidney and Liver Yin are often bothseverely deficient. This condition is mostly dueto chronic illness, overwork, or warm febriledisease injuring Liver and Kidney Yin. Clinicalsigns and symptoms include blurred vision,numbness, dry and brittle nails, flank pain,vertigo, tinnitus, brittle hair with split ends,thin and emaciated body, dry throat and mouth,deficient-induced irritability with inability tostay still (especially in the morning or between3-5 pm, along with a feeling of weakness of theentire body, frequently feeling of listlessnessand fatigue around 9-10 pm but is unable to fallasleep or willing to go to bed), yellow urine,dry stool, red tongue body with scanty coatingor no coating, deep, wiry, thin and rapid pulse.6.1 Liver & Kidney Yin Deficiency with Fatigue & VertigoSigns & SymptomsSoreness and weakness of the low back,vertigo, tinnitus, blurred vision, decreasedvisual acuity, loose teeth, brittle hair, and Qi andBlood deficiency symptoms of all other Zang-fuorgans in the body.Treatment PrincipleTo benefit, nourish,and tonify Liver andKidneys.Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm rum & Lycium FormulaQi Bao Mei Ran Dan葛根湯Pueraria CombinationGe Gen Tang龜鹿二仙膠Tortoise Shell & Deer Horn FormulaGui Lu Er Xian Jiao6.2 Treatment of Liver & Kidney Deficiency with VertigoSigns & SymptomsMild vertigo due to deficiency that canbe relieved by laying down and closing theeyes and is accompanied by other Liver andKidney deficiency symptoms. This is mostlydue to deficiency of Kidney water since thewater cannot nourish wood. Liver Yang risesand creates wind, which causes vertigo anddizziness. Another problem is Liver andKidney Yin/Essence depletion that is unable toregenerate fluids.Treatment PrincipleTo benefit, and regulate Liver and Kidneys,nourish the blood andregulate menses.Gastrodia(Tian Ma)Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm water.ChineseEnglishPin-yin杞菊地黃丸Lycium, Chrysanthemum & Rehmannia FormulaQi Ju Di Huang Wan天麻鈎藤飲Gastrodia & Uncaria CombinationTian Ma Gou Teng Yin龜鹿二仙膠Tortoise Shell & Deer Horn FormulaGui Lu Er Xian Jiao7
6.3 Treatment of Kidney & Liver Yin Deficiency Related to the Menses in FemalesSigns & SymptomsBupleurum(Chai Hu)This is due to Liver and Kidney Yin deficiency,unable to control Liver Yang. Liver Yang thenrises to the head, causing distending headaches,red face, irritability, anxious, increased PMSsigns and symptoms (heavy menstrual flow upuntil Day 4 and stops or the flow pauses andstarts up again for 1 day on Day 5 or 6).Treatment PrincipleTo benefit, and regulate Liver and Kidneys,nourish the blood and regulate menses.Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm m & Peony FormulaJia Wei Xiao Yao San芎歸膠艾湯Dang Gui & Gelatin CombinationXiong Gui Jiao Ai Tang吳茱萸湯Evodia CombinationWu Zhu Yu TangOr the following formulas are combined together and taken 3 times a day after each meal with warm water.ChineseEnglishPin-yin吳茱萸湯Evodia CombinationWu Zhu Yu Tang知柏地黃丸Anemarrhena, Phellodendron & Rehmannia FormulaZhi Bo Di Huang Wan逍遙散Dang Gui & Bupleurum FormulaXiao Yao San7. Spleen & Kidney Yang DeficiencyThis is due to the combination of SpleenClinical signs and symptoms include coldYang insufficiency and Kidney Yang deficiency.limbs, pale face, thin and emaciated body, tiredIf the disorder is due to the diseases of thespirit, coldness and pain in the lower abdomen,Spleen with Kidney deficiency, signs andintermittent constipation and diarrhea withsymptoms of Spleen Yang deficiency would beundigested food, diarrhea, lower back soreness,more prominent. Moreover, if the disorder iscold knees, abundant clear urination, nocturia ordue to the diseases of the Kidney and Spleenunsmooth urination, edema/swelling of the facedeficiency, signs and symptoms of Kidneyand the limbs, erectile dysfunction, prematureYang deficiency would be more prominent. Inejaculation, coldness in the uterus in femalesthis scenario, we are talking about “the diseaseleading to infertility, excessive clear vaginalof the Spleen with Kidney deficiency”, whichdischarge, pale, flabby tongue body with teethleads to internal cold and decrease of themarks, pulse is deep, slow, thin, and weak.Spleen’s transformation function causing water8retention.
7.1 Treatment of Spleen & Kidney Yang Deficiency with FatigueSigns & Symptomstransformation function to become impaired.This is due to a decrease of the transformationThis will lead to symptoms of low appetite,function of spleen leading to poor appetite,loose stool or diarrhea, or intermittent diarrheawith constipation. Long term diarrhea will drainthe body and the patient will become weak andfatigued. If Kidney Yang deficiency is due toinsufficient pre-heaven energy or irregularityemaciation, and tired spirit.Treatment PrincipleTo benefit, warm and tonify Spleen andKidneys. If Spleen deficiency is predominant,emphasize tonifying the Spleen. If Kidneyin diets and activities leading to deficient post-deficiency is more predominant, emphasizeheaven energy, Kidney Yang will be unable toapply tonification both the Spleen and Kidneys.rise and warm Spleen Yang, causing Spleen’stonifying the Kidneys. In either circumstanceRecommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm water.(Indication: Diarrhea or intermittent te, Ginseng & Ginger CombinationFu Zi Li Zhong Tang右歸丸Eucommia & Rehmannia FormulaYou Gui Wan四神丸Psoralea & Nutmeg FormulaSi Shen WanOr the following formulas are combined together and taken 3 times a day after each meal with warm water.(Indication: Diarrhea or intermittent ng & Atractylodes FormulaShen Ling Bai Zhu San右歸丸Eucommia & Rehmannia FormulaYou Gui Wan四神丸Psoralea & Nutmeg FormulaSi Shen WanThe following formulas are combined together and taken 3 times a day after each meal with warm water.(Indication: Intermittent a & Rehmannia FormulaYou Gui Wan麻子仁丸Apricot Seed & Linum FormulaMa Zi Ren Wan潤腸丸Linum & Rhubarb CombinationRun Chang Wan八珍湯Dang Gui & Ginseng Eight CombinationBa Zhen TangWhite Atractylodes(Bai Zhu)Chinese Angelica(Dang Gui)9
8. Lung & Kidney Yin DeficiencyLung Yin is deficient due to overtirednessalong with Kidney Yin deficiency leading toLung and Kidney Yin and fluids insufficiency.As water becomes deficient there is flaring up ofdeficient fire.Clinical signs and symptoms include frequentcolds or other respiratory infections that tendto linger, cough with scanty sputum or bloodtinged sputum, dry mouth and throat, hoarsevoice, irritability, restlessness, red tongue body,and thin, rapid pulse.8.1 Treatment of Lung & Kidney Yin Deficiency with Cough DisordersSigns & SymptomsSchisandra Fruit(Wu Wei Zi)Prolonged pathogenic heat injuring the Lungsleading to Kidney Yin deficiency, especially dueto frequent colds or other respiratory infectionsthat lingers, cough with scanty sputum or bloodtinged sputum especially at night, dryness of themouth and throat, red tongue body with scantycoating, and a thin pulse.Treatment PrincipleBenefit, nourish, and tonify Kidney Yin,moisten the Lungs, and stop cough.Recommended Herbal Formulas:The following formulas are combined together and taken 3 times a day after each meal with warm a & Schizandra FormulaQi Wei Du Qi Wan玉屏風散Siler & Astragalus FormulaYu Ping Feng San百合固金湯Lily CombinationBai He Gu Jin Tang清燥救肺湯Eriobotrya & Ophiopogon CombinationQing Zao Jui Fei TangThe following formulas are combined together and taken 3 times a day after each meal with warm water.(Indication: For Lung deficiency with chronic cough and blood-tinged sputum)ChineseEnglishPin-yin生脈散Ginseng, Schizandra & Ophiopogon FormulaSheng Mai San金水六君子煎Six-Gentleman of Metal & Water DecoctionJin Shui Liu Jun Zi Jian紫菀湯Aster CombinationZi Wan TangFootnotes1. 溫病, Wen Bing2. 崩漏, gushing-leaking syndrome3. 神, Shen4. 元陽, Yuan Yang5. Sleeping with the body curled up in the fetal position6. 關格, Guan Ge Disorder10
day. Adrenal fatigue syndrome is also referred to as non-Addison hypadrenia, sub-clinical neurasthenia, and adrenal apathy. Millions of people in the United States and throughout the world suffer adrenal fatigue. There are eight types of differential diagnosis for "Adrenal Fatigue Syndrome" according to TCM: Kidney Yin deficiency Kidney Yang .
