Dr. Bob Scott in his lecture at ANM (Oct 2018) encouraged the use of the term HPA Axis support rather than adrenal insufficiency. The adrenal gland produces 20mg of cortisol per day and is important for the following: metabolism of insulin, thyroid hormones and DHEA, balancing blood glucose, immune system response (NK cytotoxicity) Secretory IgA, microbiota, bone turn-over rate, mood and thought, REM versus delta wave sleep and protein catabolism.

Some common herbal adaptogens and nervines to consider include ashwagandha (withania) Korean ginseng, rhodiola, schisandra, astragalus, bacopa, saffron, skullcap and St. John’s wort.

Adaptogenic herbs are those that conserve adaptation reserve and work overtime. The promote regeneration, improve mental capacity, sensitizes the HPA axiS making the stress response more efficient and increase glucocorticoid action. These herbs include Eleutherococcus, ashwagandha, (withania), rhodiola and tribulus and can be taken over long periods of time for the best effect. I suggest rotating them in combination every month or two over the period of a year or more depending on the pathology. For example asthma, autoimmune disease and those with PTSD benefit from long term HPA axis support.

Mediherb supplies Withania Complex which contains Withania extract 950mg, Glycyrrhiza dry root 750mg, Scutellaria lateriflora dry herb 470mg and Panax ginseng dry root 100mg.
This formula is for the wired but tired patient. It helps support cognitive function, learning and memory retrieval, Reduces mental fatigue, helps enhance physical performance, promotes vitality and nervous system health when experiencing temporary stress, works as a tonic to benefit the entire body and increases production of T4. Take 3-6 per day. Monitor blood pressure and thyroid function.

• Postpartum fatigue and stress
  (some controversy regarding licorice in breastfeeding)
• monitor mom for BP and potassium
• licorice can be helpful for improving infant weight
• Overwhelmed feelings
• Promotes restful sleep
• Mild anxiety and depression

Withania somnifera:

• Improves growth in children age 8-12
• Improves Hgb and RBC counts in men aged 50-59 (3 grams per day)
• Improved stamina of mountaineers at 1g/OD
• Improved semen quality in men 5g/OD
• Improves cognition 0.5g/OD in healthy volunteers
• Similar potency to Korean Ginseng

 Skullcap (Scutellaria lateriflora)

• Traditionally used to treat nervous tension and epilepsy
• Disorders arising from physical and mental overwork
• Insomnia and depression
• Tonic, nervine and antispasmodic
• Neuralgias, muscle twitching, tremors and restlessness
• Watch for adulterations Mediherb supplies Skullcap (Scutellaria lateriflora)

Korean Ginseng (Panax ginseng)

• Tonifies vital energy and spleen
• Calms the nerves
• Chronic general weakness with irritability and insomnia
• HPA axis adaptogen
• Improves mental health and social functioning
• Improves well-being in post-menopausal women
• Improved symptoms of COPD with an anti-fatigue effect on respiratory muscles

 Licorice

• Anti-inflammatory
• Mucoprotective and expectorant
• Demulcent
• Antiulcer
• Antitussent
• Mild laxative
• May lower testosterone at high doses
• Licorice extract exhibits evident anti-inflammatory properties mainly by decreasing TNF, MMPs (matrix metalloproteinase enzymes), PGE2 and free radicals,
• Indicated for primary adrenocortical insufficiency and Addison’s Disease (in doses of 10-45g of extract OD
• Synergistic with cortisone in Addison’s extending the effects of steroids and may aid the withdrawal early in onset.
• Study found that 262mg OD increased cortisol levels by 20%.
• It is a traditional Chinese medicine that tonifies the QI
• Spleen weakness: decreased appetite and weight loss
• Harmonizes and moderates other herbs
• (monitor blood pressure!)

AdrenoCo (consider alternating with Withania Complex)
Contains Licorice root 1.75grams and Rehmannia 750mg.
Take one tablet twice per day –

• Ideal in Phase 2 ( adrenal stress) or 3 (adrenal exhaustion)
• These adrenal tonics (used more short term) preserve, protect and restore adrenal cortex function
• Licorice neither stimulates nor inhibits the production of cortisol, but rather preserves, protects and restores the cortisol producing machinery (adrenal cortex). See above.
• Rehmannia in TCM reduces heat in the blood, nourishes yin and promotes the production of body fluid, in Western medicine it is used as an adrenal tonic (ie curcumin can be too hot for some patients).
• Rehmannia may lower blood pressure
• Promotes the production of body fluids
• General debility
• Prevents senility
• Adrenal and pituitary tonic
• Inhibits the breakdown of cortisone products thereby extending their effects.
• Autoimmune diseases such as RA
• Boosts resistance to colds and flus.

Note: if patients cannot tolerate licorice refer to Rehmannia Complex and Rhodiola and Ginseng formulas below.

Rhodiola and Ginseng

• Contains Rhodiola rosea 3.6grams and Panax ginseng 500mg.
• Take 2-4 tablets per day. 2 tablets upon waking works within one week to improve energy and resilience. Alternate with Rehmannia Complex.
• Rhodiola & Korean Ginseng are powerful tonic and adaptogenic herbs which help the body cope with stress
• In clinical studies both Rhodiola & Korean Ginseng have been shown to increase physical and mental efficiency and produced significant improvement in physical fitness particularly when under stress
• Fatigue, mental and/or physical exhaustion
• Improving mental performance, concentration and memory, especially when under stress
• Improving physical performance and endurance
• Improving mood in mild to moderate depression
• Promotion of healthy glucose levels

Rhodiola

• Combines with other adaptogens well
• reduced the frequency of recurrence of superficial cancer of the bladder,
• improved sleep in 67% of patients with chronic sleep- related problems;
• improved sexual function in men with erectile dysfunction and/or premature ejaculation
• produced normal menstruation in over 60% of women with amenorrhoea
• sped up the recovery of patients with acute infections of the mouth (as adjunctive treatment)

Korean Ginseng (see above effects)

Rehmannia Complex

Rehmannia glutinosa (Rehmannia) dry root          350 mg
Bupleurum falcatum (Bupleurum) dry root            700 mg
Hemidesmus indicus (Hemidesmus) dry root        500 mg
Tanacetum parthenium (Feverfew) dry herb          165 mg

This formula is recommended for, Chronic inflammation, Autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, anklosing spondylitis, Graves’ disease, Hashimoto’s thyroiditis, Migraine or headache, especially where there is liver involvement.

• Rehmannia is an anti inflammatory which acts via the adrenal glands through antagonizing the depression of the adrenals caused by exogenous steroid hormones. It also inhibits the breakdown of cortisone products in the body, thereby extending their effects
• Feverfew’s MOA includes the inhibition of granule secretion from platelets (antimigraine effect) and polymorphs (anti-arthritic effect). More recent traditional uses include headache, common cold, coughs, difficult breathing, to stimulate digestion and to relieve facial and ear pain in dyspeptic and rheumatic patients.
• Bupleurum falcatum Chinese herb used for liver disharmony, it is anti-inflammatory, adaptogenic, hepatoprotective and a mild sedative
• Hemidesmus indicus Ayurvedic root used as a depurative (purifying and detoxifying) and tonic, used to treat chronic rheumatism, kidney, skin disorders and constitutional debility

Tribulus Forte

Tribulus terrestris (Tribulus) dry herb (aerial parts) 9g standardised to contain furostanol saponins as protodioscin 110 mg

• Improves sperm and semen parameters in men with infertility
• Improves libido in men
• Improves ovulation in some women with infertility
• Relieves menopausal symptoms
• Possibly enhances the body’s natural production of sex hormones, especially when at low levels (DHEA) but is unlikely to increase beyond normal range
• Male infertility, impotence, lowered libido
• Female infertility, menopause
• Suboptimal physical performance
• Recovery of vitality after convalescence or surgery
• Elevated stress

Tribulus terrestris might be a safe alternative for the treatment of premenopausal women with Hypoactive Sexual Desire Disorder as it was effective in reducing the symptoms (desire, sexual arousal, orgasm and satisfaction), probably due to an increase in the serum levels of free and bioavailable testosterone.

When fatigue presents with a decrease in libido or athletic performance, I often prescribe this formula. I also use it for my menopausal hot flash patients along with Wild Yam Complex, at a dose of 2 bid of each. Most hot flashes are greatly diminished within one week, then we adjust the dose to support long term improvement.”

Reishi Referred to as the Ten Thousand-Year Mushroom, Medicine of Kings, The Sacred Mushroom or Mushroom of Immortality
It has been used for over 2000 years in China
Best mushroom for general tonic to improve overall health and increase longevity
It is considered an adaptogen.

This mushroom as much of a reputation as Korean Ginseng for the treatment of chronic diseases.(consider alternating them)

• Inhibits histamine release
• Anti-inflammatory via suppression of TNF-α, IL-6, nitric oxide and PG E2, shifts immune dominance from TH2 (allergies, inflammation) to TH1
• Anti-microbial to help treat and avoid dysbiosis
• Anti-oxidant
• Anti-cancer via reducing cell adhesion due to Beta D Glucans
• Anti-Allergic /Anti-Inflammatory Activity
• Immune system support
• Increases T helper cells, interferon gamma, TNF-alpha, and interleukin-2(IL2) in mice studies.
• Decreases CD8 counts
• Reduced side effects of nausea and vomiting from chemotherapy and radiation (4-8 grams per day).
• Improved postoperative recovery
• Anti-tumor activity in animal studies
• In a Chinese study of 2000 patients with chronic bronchitis there was 60-90% improvement within two weeks of taking reishi syrup.
• Hepatoprotective
• triterpenes block PDGF beta R
• Small study showed improvement of GGT and GST in hepatitis B within 3 months of taking 6 grams of Reishi per day
• Used daily to treat Hepatitis C and liver failure
• Cardiovascular effects
• Lowers cholesterol by inhibiting HMG-CoA reductase
• Inhibits absorption of cholesterol from food
• Lowers blood pressure
• Inhibits platelet aggregation
• Altitude Sickness
• It is used for altitude sickness and by Chinese athletes
• Works by oxygenating the blood at higher altitudes
• Daily use for 10-14 days prior to a climb as high as 17,000 feet
• Hypoglycemic Effect
• Polysaccharide effect of Ganoderans A, B, and C
• Elevates plasma insulin
• Enhances peripheral tissue utilization of glucose
• Enhances liver metabolism of glucose

Over the years of clinical practice adrenal support is an underlying therapy in many of my protocols for chronic stress, anxiety, PTSD, insomnia, fatigue, hormonal imbalances including hypothyroid, autoimmune diseases and allergy. I will alternate the most efficacious formulas over 1-3 months for one to two years and have the patient take the remedy at least 5 days per week. I explain that the HPA axis can take a long time to regulate, to help the patient build up their reserves in order they may handle future stresses much better. Once they understand this they are very compliant with the alternating or formulas.

• A few favorites include ADR adrenal glandular from Physica that I alternate with a formula I devised that I call Female Adrenal Tonic. This contains equal amounts of Ashwagandha, Astragalus, Siberian Ginseng, Reishi, Shatavari, Rehmannia. Whenever possible I used Mediherb liquid tonics so I used Mediherb Ashwagandha in this. Patients often prefer to vary taking liquids versus tablets or capsules and this formula is pleasant tasting. Sometimes I will use both at the same time if the stress is severe. The ADR could also be alternated with Rhodiola and Ginseng or Withania Complex or Adrenoco if there is no sensitivity to licorice.
• I also have a Male Adrenal Tonic: Panex Ginseng, Ashwagandha, Astragalus which is effective for fatigue and low libido in males
• I love Siberian Ginseng (Eleutherococcus) and have used it in formulas such as Astragalus Combination (liquid tincture) Astragalus, Codonopsis, Reishi Mushroom, Siberian Ginseng, Ligustrum, Schizandra, White Atractylodes;or Astragalus Complex. I do not hesitate to use these formulas for months at a time to improve HPA axis health as well as the immune system.
• Always evaluate and support the thyroid in these cases. Hypothyroid consider: Withania Complex or Rehmannia Complex. If hyperthyroid consider Nevaton, Valerian complex, Astragalus complex. A hyperthyroid tonic I use contains: skullcap, eleutherococcus, astragalus, bugleweed, motherwort, valerian,
• Reishi or Cordyceps: Medicinal mushrooms add wonderful adaptogenic effects that can be taken long term and have few contraindications.
• Sleep remedies such as Nevaton can be added to other sleep aids such as Magnesium SRT, Kava Forte, St. John’s Wort and Valerian Complex, Reishi and Withania Complex.
• The liquid herbs that Mediherb does supply makes a lovely nervine to be taken at bedtime: (Withania, Skullcap, Licorice, St. John’s wort) (I avoid usage of St. John’s wort in summer months due to sun sensitivity)
• For PTSD (See Phytotherapist Dec 2001) consider the following:
• Nevaton: Saffron, St. John’s wort, Schisandra and Skullcap
• Valerian complex: Zizyphus, Valerian, Passiflora
• Withania Complex: Scuttelaria lateriflora, Licorice, Withania, Korean ginseng
• Kava kava
• Licorice
• Others: Chamomile, lavender,

In Summary Consider the Following in your HPA Axis cases:

• Cardiovascular support
  • Cordyceps, Reishi and Nevaton, Astragalus (palp, SOB).
• Diabetes
  • Reishi, Cordyceps, Rhodiola and Korean Ginseng, Eleutherococcus (Astragalus Complex)
• Male health
  • Tribulus, saffron,
• Cognition
  • Saffron, rhodiola, Nevaton, Astragalus Complex (Eleutherococcus)
• Immune
  • Reishi, Astragalus, Cordyceps, licorice
• Liver support
  • Nevaton (Schisandra), Reishi, Astragalus complex, cordyceps
• Chemo and radiation
  • Eleutherococcus, Reishi, Cordyceps
• Sleep
  • Eleutherococcus, Reishi, Withania complex
• COPD
  • Reishi, Rhodiola and Korean Ginseng, Rehmannia Complex, Astragalus Complex,
• Altitude sickness
  • Rhodiola, reishi and gingko