(248) Tian Ma (Rhizoma Gastrodia)

[HB KIM]

Tian Ma (Rhizoma Gastrodia)

Tian Ma can treat the root of many problems in the brain, such as cerebrovascular disease and neural conduction disorders.  The importance of this herb is increasing as the baby boomer generation is reaching retirement age.  One of the most common diseases in the elderly is dementia.  Not limited to use for the elderly, Tian Ma can help people of any age with epilepsy, or any circulation problem in the brain including tinnitus, headache and dizziness.  A very unique characteristic of Tian Ma is that it crosses the blood-brain barrier, which allows it to help cerebrovascular circulation and improve neurotransmitter function. 

Imagine a rusty old light socket with a bulb that intermittently blinks on and then off, on and then off.  When that light socket is cleaned up or changed, the very same bulb will glow brightly and consistently.  Tian Ma has the power to physically restore the "hardware" in the brain, allowing the spirit to shine through, like replacing the rusty socket so the bulb glows brightly and consistently.

Although Tian Ma is the king herb in some formulas, I like to use it as a deputy.   In cases of deficiency, use it with herbs to tonify Liver Blood (Shu Di Huang, He Shou Wu, Dang Gui) or tonify Liver Yin (Gou Qi Zi).  In cases of excess,  use Tian Ma with herbs that open the orifices and move the Qi (Shi Chang Pu, Mu Xiang, Wu Yao).


1. DEMENTIA
Elderly patients may present with symptoms of poor memory, decreased analytical capability, affected cognition, attention difficulty, language difficulty, short-term memory loss, or progressive decline of cognitive function.  In these kinds of cases, the treatment principle of TCM is to open the channels and extinguish Wind.  For thin patients whose CT or MRI reports indicate clear brain cell damage, tonify the Liver Blood and Kidney Yin, and use about 4-6 grams of Tian Ma.   

Shu Di Huang 16g
He Shou Wu 8g
Gou Qi Zi 8g
Shan Zhu Yu 8g
Tian Ma 6g
Dang Gui 4g
Lu Rong 2g

For a slightly chubby or heavier patient with a lot of Damp-Phlegm, the following herbs expel Phlegm and open the orifices. Mu Xiang is used instead of She Xiang because She Xiang is so expensive and rare.  Mu Xiang is a suitable replacement.  This formula can be used not only for dementia, but also for post-stroke if the patient has an obese body type and still remains drowsy 2-3 months after the incident.

Tian Ma 8g
Dan Nan Xing 6g
Shi Chang Pu 6g
Mu Xiang 4g(instead of She Xiang)


2. SEIZURES
According to TCM seizures are classified as internal Liver Wind, and they are mainly related to stress.  A person who tends to be more stressed and exhibits symptoms of Liver Wind has a higher risk than others for seizures or tremors.  Tian Ma can be used in that case.

Another profile for seizures occurs in children who experience overwhelming emotion, especially anger.  Seizures can occur even in the absence of a physical brain problem or any EEG abnormality.  This type of case can be referred to as "functional epilepsy," in which there is just a temporary neurotransmitter problem and temporary ischemia, but no sustained physical or electrical problems in the brain.  In this case, Tian Ma can help to open the channels, extinguish Wind, increase blood flow to the brain, and improve neurotransmitter activity.  These types of seizures are called Hysterical Seizures.  Another good herb to be used is Xiang Fu.  Treatment with the following formula can reduce the occurrence of Hysterical seizures in just one to two months.  A longer course of treatment will be required if the patient must also be weaned off of pharmaceutical drugs.

Tian Ma 8g
Xiang Fu 6g
Chen Pi 6g
Mu Xiang 4g
Wu Yao 4g


3. HEAD (Heaviness, Tinnitus, Dizziness)

(a) Heavy Head Pain
If the head feels heavy and foggy like it's not receiving enough oxygen, this can be a pre-stroke symptom that results from poor circulation. Combine herbs to activate both the Blood and the Qi.  The following combination increases blood flow in the brain to get rid of that foggy, heavy feeling: Chuan Xiong + Gao Ben or Bai Zhi.  Chuan Xiong activates the Blood and Gao Ben and Bai Zhi guide to the head. 

(b) Brain Noise
There is a condition called Brain Noise, or Phantom Noise, in which someone experiences a heavy and painful sensation in the head accompanied by white noise which is not experienced in the ear, but from inside the head.  In the simplest terms, this situation can be explained as something like a bruit in the cerebral vasculature.  Some cases of Brain Noise may require surgery, but if surgery is not required then Tian Ma is effective for this condition.  Tian Ma is like aspirin for the brain.  The basic formula is listed below.  Other herbs should be added based on the pattern, for example Yin tonifying herbs for Liver and Kidney Yin deficiency, but the basic formula is:   

Chen Pi 12g
Chuan Xiong 8g
Tian Ma 6-8g
Fang Feng 4g

Q: If Tian Ma is like brain aspirin, then why is Chen Pi the king herb in the formula for Brain Noise?

A: According to the OM differential diagnosis, this problem stems from a lack of Qi and Blood circulation.  Therefore the main treatment principle is to move Qi and Blood, giving Chen Pi and Chuan Xiong a higher position in the formula's hierarchy while Tian Ma serves as the deputy with the function of increasing Blood circulation in the brain.  Chen Pi is the king since it can move Qi.  Since Qi moves the Blood, Chen Pi is given credit for helping to move the Qi and improve the Blood circulation of the whole body.  After 15 days of treatment with the original formula, the treatment principle can be changed to focus more on tonification and Shu Di Huang can be added.

(c) Dizziness due to Phlegm
For a patient with a weak digestive system that feels dizziness, Tian Ma makes a good deputy.  Ban Xia Bai Zhu Tian Ma Tang is a famous formula used for this type of case, but smaller, simpler formulas can be just as effective.  If the chief complaint is dizziness, plus the sensation of being on a boat, nausea, and darkness below the eyes, these are Phlegm-Fluid symptoms and the following formula is good:

Bai Zhu (fried) 12g
Fu Ling 8g
Ren Shen 6g
Tian Ma 4g
Ban Xia (ginger prepared) 4g
Sheng Jiang 8g


CLINICAL CASES

CASE 1.
A thin, 63 year old female had the chief complaint of dizziness and vertigo.  She also had indigestion.  She's never been able to eat very much at one sitting ever since childhood.  The dizziness set in six months ago when she was taking care of her young, energetic grandson and she got exhausted.  She has been feeling dizzy almost continuously since then.  She also feels nauseated and has the sensation like she's on a boat.  Her MD couldn't find any problem based on the exams and lab work, and gave her instructions just to rest.  So for a few weeks she stayed at home and ate noodle soup and got lots of sleep.  Now she's noticed that eating noodles makes her dizziness more severe.  She's developed dark circles below her eyes, and when she wakes up her eyes and hands feel swollen.  She was given this formula for two weeks: 

Bai Zhu (fried) 12g
Fu Ling 8g
Ren Shen 6g
Huang Qi 6g
Tian Ma 4g
Ban Xia (ginger prepared) 4g
Lu Rong 2g
Sheng Jiang 5pcs

At her follow-up appointment 15 days later, she reported her dizziness, digestive problems, edema, and dark circles all improved.  She sometimes still felt a little dizzy, but overall claimed to be 70-80% better and wanted more herbs.  She was given the above formula with the following modifications:
   
Fu Ling 8g
Bai Zhu 8g (reduced)
Shan Yao 10g             

CASE 2. 
A 57 year old woman had the chief complaint of brain noise.  Her body shape was thin in the arms and legs but with a disproportionately large abdomen.  She said there's been the sound of insects singing in her brain, not in her ears, for six months now.  It started out just at night, but now it is there all night and day.  There is no abnormal finding on her CT or MRI.  She has been taking medication for diabetes for three years, and medication for hypertension for seven years.  Her MD attributes her symptom to stress.  Sometimes at night she has muscle spasms and a dry mouth.  She also sometimes feels a heavy sensation in her body or in her head, so she thinks she has a lack of circulation and is worried about stroke.  She had a hysterectomy 15 years before.  She took this formula:

Chen Pi 12g
Gou Qi Zi 8g
Tian Hua Fen 8g
Chuan Xiong 4g
Fang Feng 4g
Tian Ma 4g
Hong Hua 2g

At her follow-up appointment 15 days later, the patient was happy to report that the brain noise had reduced by 50-60%.  It was mostly gone during the day time, and now only bothered her at night and early in the morning.  She was given the formula above with the following modifications for the next two weeks: 

Shu Di 12g
Chen Pi 8g (reduced)   

CASE 3. 
A 24 year old female had the chief complaint of seizures (grand mal type).  Her emotional state was very anxious and sensitive.  When she was 19, her parents divorced.  She lives with her mother.  She was having seizures 1-3 times per month.  She was prescribed Topamax to take twice daily, which helped.  She has been stressed about finding a job and hasn't been sleeping well at all.  A few days ago after she got into an argument with her mother, she had another grand mal.  Her MD wants to increase the dosage of Topamax and prescribe a sedative, but she is concerned about the price and the side effects of the drugs and really wants to try herbs instead.  She was given:

Long Yan Rou 12g
Suan Zao Ren 8g
Dang Gui 6g
Tian Ma 6g
Chen Pi 4g
Xiang Fu 4g
Mu Xiang 3g
Huang Lian (fried) 3g

At her follow-up 15 days later, the patient reported that no seizures had occurred and she had reduced her prescription use by about 20%.  After three months of herbal treatment she was able to quit taking the Topamax altogether.  The patient was taught some Qi Gong exercises and instructed to use Qi Gong for maintenance to help keep her anxiety in check.

CASE 4.
A 72 year old female patient with a very small stature and dentures has been experiencing severe memory loss for the last 3-4 years.  Her MD diagnosed senile dementia and presbyophrenia syndrome.  Sometimes she cannot even recognize some familiar objects in her home.  She lives alone and her daughter drives her to appointments.  She has a good appetite.  Her hair is notably brittle and thin.  She was around 50 when she lost her teeth.

She was recommended a treatment course of at least three months due to her condition of Yin, Blood and Essence deficiency.  The principle was to nourish the brain to treat the memory.  Upon visiting every month her progression was easy to see: improved cognition, reduced dementia, improved hair texture, and her appetite reduced to normal.  This was the formula she took:   

Shu Di Huang 16g
Gou Qi Zi 8g
Shan Zhu Yu 8g
Tian Ma 6g
Fu Shen 6g
Yuan Zhi 4g
Shi Chang Pu 3g
Lu Rong 2g