by 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 (i.e., "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).

Male, aged 56. His problem began six 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 with minerals.

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.

I advised him to take the following supplements:

Calcium citrate 1000 mg
Magnesium citrate 1000 mg
Coenzyme Q10 90 mg

And gave him this first formula:

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 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.

Outcome: 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, 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.

Outcome: 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 was still irritable.

The formula was adjusted in the following way:

Valeriana off. (Valerian) 1:3 10
Scutellaria 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.

Outcome: 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.

 

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