From: Chanchal Cabrera
Case history review, first presented at the case studies conference in Boulder
1998. The greatest irony of this case was that his wife was also a patient,
presenting with insomnia due to shift work as a nurse. In the end I treated them
both successfully using Valerian! I love this case as a teaching device to
illustrate why there are no absolute rules in herbal medicine (Valerian is for
insomnia and puts everyone to sleep - not). Extensive discussion of this case
from the conference is available on audiotape from Herbal Education Services (www.botanicalmedicine.org).
NARCOLEPSY
Chanchal Cabrera, MNIMH, AHG
Male, aged 56. His problem began 6 years prior to first appointment when, in his
job as a firefighter, he was accidentally exposed to a cocktail of toxic fumes.
He passed out at the time and suffered some temporary amnesia.
Since that time he suffered from progressively worsening narcolepsy and this had
severely affected his cognitive functioning to a point that his job was
threatened. He was chronically irritable and had episodes of depression. He had
very low energy and stamina, poor memory and concentration and experienced a lot
of 'brain fog'. He could fall asleep at any time, in the middle of a
conversation, at the dinner table and once while walking the dog, only waking up
as he hit the sidewalk. He had been prescribed Ritalin 20 mg daily but did not
feel it was helping.
After his chemical exposure he had suffered from allergic rhinitis and morning
sinus congestion. He was not aware of the triggers for this. He had mild
diverticulosis causing lower abdominal gas and some rectal soreness, as well as
irritable bowel syndrome causing alternating constipation and looseness. He had
early stages of degenerative joint disease at L4 L5 and occasional twinges of
sciatica. He was also bothered by night time leg cramps.
His diet was not good with lots of dairy products, sweets, cookies and processed
meats. He took supplements sporadically, including garlic, lecithin, royal jelly
and a multivitamin & mineral.
Recommendations
He was asked to reduce all the processed and refined foods and the dairy
products and to increase the fruits and vegetables in his diet. He was also
asked to drink lots of water and no coffee or soft drinks.
Calcium citrate 1000 mg
Magnesium citrate 1000 mg
Coenzyme Q10 90 mg
Vinca major
(Periwinkle) 1:3
15
Ginkgo biloba
(Gingko)
1:3 15
Rosmarinus off. (Rosemary)
1:3 15
Panax ginseng
(Korean ginseng) 1:4 15
Turnera diffusa (Damiana)
1:3 15
Taraxacum off. (Dandelion
root) 1:3 15
Ephedra sinica (Ma huang)
1:4 10
100 mL
5 mL three times daily before meals
Therapeutic rationale
The patient agreed to focus the treatment on the narcolepsy and not to try to
treat all his many and various ailments at once. The aim here was to improve
circulation to the head, hence the Gingko, Rosmarinus and Vinca, improve overall
energy availability, hence the Panax, Turnera and Ephedra, and aid in the
removal of toxic wastes, hence the Taraxacum.
The calcium and magnesium was symptomatic for the leg cramps and the CoQ10 was
prescribed to enhance energy production in the cells.
Outcome
A month later he was still taking the Ritalin but was feeling overall slight
improvement. His memory, concentration and energy were a little better but he
still fell asleep all the time and still felt irritable. His leg cramps had
ceased and the allergy symptoms were much improved. He had made some dietary
changes, most notably reducing the dairy and sweets and drinking more water. I
repeated the tincture formula.
Six weeks later he returned to tell me he was beginning to notice some lessening
of the constant sleepiness and continued improvement in the memory and
concentration. The previous week day his doctor had increased the Ritalin to 30
mg and was considering trying even more even though he noticed no change with
the higher dose. He was maintaining a reasonable diet and the symptoms of
diverticulosis and IBS were greatly reduced.
I adjusted his tincture in the following way:
Centella asiatica (Gotu kola)
1:3 15
Vinca major
(Periwinkle) 1:3
15
Ginkgo biloba (Gingko)
1:3 10
Panax ginseng
(Korean ginseng) 1:4 15
Turnera diffusa (Damiana)
1:3 15
Taraxacum off. (Dandelion
root) 1:3 10
Acorus calamus (Sweet
flag) 1:3 10
Ephedra sinica (Ma huang)
1:4 10
100 mL
5 mL three times daily before meals
Therapeutic rationale:
The Acorus was added as a nourishing tonic to the brain tissue.
Six weeks later he returned and was significantly worse. He had experienced a
flare up of bowel disturbance for which he was prescribed antibiotics and since
then he had a complete loss of energy and stamina along with
headaches, memory and intellectual functions significantly reduced and much
worse sleepiness. He had also been prescribed a steroidal nasal spray for the
sinus congestion. This was causing dryness of the mucous membranes and
hoarseness.
Vega testing at this time revealed multiple food allergies as well as excessive
lead, and a high candida load , and vitamin, mineral, enzyme and endocrine
deficiencies. I prescribed a diet to reduce candida and to avoid the worst
allergens.
The formula was adjusted in the following way:
Allium sativum (Garlic
juice)
10
Urtica dioica
(Nettle)
1:3 15
Taraxacum off. (Dandelion
root) 1:3 15
Acorus calamus (Sweet
flag) 1:3
10
Berberis vulgaris (Barberry)
1:4 10
Rosmarinus off.
(Rosemary)
1:3 15
Hypericum perforatum (St. John's wort) 1:3
15
Ephedra sinica (Ma
huang) 1:4
10
100 mL
5 mL three times daily before meals
Therapeutic rationale
More alteratives were used here in an attempt to rid the body of the toxic
residues that we believed had triggered the problem.
Six weeks later he was feeling no better. He has stopped the Ritalin and noticed
no change with or without it. He continued to have severe sleepiness, poor
memory and cognitive function, low energy and enthusiasm and to be irritable.
The formula was adjusted in the following way:
Valeriana off. (Valerian)
1:3 10
Scutalleria lateriflora (Skullcap)
1:3 10
Acorus calamus (Sweet
flag) 1:3 10
Gingko biloba
(Ginkgo)
1:4 10
Centella asiatica
(Gotu kola) 1:3 10
50 mL
5 mL three times daily before meals.
Therapeutic rationale
The patient was quite corpulent and florid and constitutionally warm - the
opposite type to those best suited to Valerian. In desperation I decided to try
the paradoxical approach
Three weeks later he returned to tell me that he was feeling much better, in
fact the best since the original accident. He was more alert and had more energy
and enthusiasm. He had stopped the steroid inhaler and was controlling the sinus
congestion through his diet.