Adrenal Support: Important for Coping With Prolonged Stress

Active Hydrogen Adrenal Extracts Alanine Alpha-Linolenic Acid Alpha-Lipoic Acid AMP Amylase Inhibitors Arginine Bee Pollen Beta Carotene Beta-glucan Betaine Beta-Sitosterol Biotin Borage Oil Boron Bovine Cartilage Bovine Colostrum Brewer's Yeast Bromelain Calcium Capsaicin Carnitine Carnosine Chitosan Chloride Chlorophyll Chondroitin Chromium CLA Cobalt Coenzyme Q10 Copper Creatine Cysteine DHA DHEA DMAE EGCG Evening Primrose Oil 5-HTP Fiber (Insoluble) Fiber (Soluble) Fish Oil Flavonoids Fluoride Folate Fumaric Acid GABA Gamma-Linolenic Acid Glucomannan Glucosamine Glutamic Acid Glutamine Glutathione Glycine Grape Seed Extract Histidine HMB Hydroxycitric Acid Indole Inosine Inositol Iodine Ipriflavone Iron Isoleucine Lactase Lecithin Leucine Lipase Lutein Lycopene Lysine Magnesium Malic Acid Manganese Mannose Melatonin Methionine Methoxyisoflavone Molybdenum MSM N-Acetyl Cysteine NADH Naringin Niacin Octacosanol Oligosaccharides Olive Leaf Extract Ornithine Oryzanol PABA Pancreatic Enzymes Pantothenic Acid Phenylalanine Phosphatidylserine Phosphorus Phytic Acid Policosanol Potassium Pregnenolone Probiotics Propolis Psyllium Pyridoxine Pyruvate Quercetin Resveratrol Retinol Riboflavin Ribose Royal Jelly SAMe Selenium Shark Cartilage Silicon Sodium Spirulina Spleen Extracts St. John's Wort Strontium Sulforaphane Sulfur Taurine Thiamine Tocopherol Tea Tree Oil Tyrosine Usnic Acid Valine Vanadium Vinpocetine Vitamin A Vitamin B1 Vitamin B2 Vitamin B3 Vitamin B5 Vitamin B6 Vitamin B9 Vitamin B12 Vitamin C Vitamin D Vitamin H Vitamin K Whey Protein Xylitol Zinc

Abalone Shell (shi jue ming)
Abutilon Seed (dong kui zi)
Acanthopanax Bark (wu jia pi)
Achyranthes (niu xi)
Aconite (fu zi)
Acorus (shi chang pu)
Adenophora Root (nan sha shen)
Agkistrodon (bai hua she)
Agrimony (xian he cao)
Ailanthus Bark (chun pi)
Akebia Fruit (ba yue zha)
Albizzia Bark (he huan pi)
Albizzia Flower (he huan hua)
Alfalfa (medicago sativa)
Alisma (ze xie)
Aloe (lu hui)
Alum (bai fan)
Amber (hu po)
Ampelopsis (bai lian)
Andrographis (chuan xin lian)
Anemarrhena (zhi mu)
Antelope's Horn (ling yang jiao)
Apricot Seed (xing ren)
Areca Peel (da fu pi)
Areca Seed (bing lang)
Arisaema (tian nan xing)
Ark Shell (wa leng zi)
Arnebia (zi cao or ying zi cao)
Arnica (arnica montana)
Artichoke Leaves (Cynara scolymus)
Ash bark (qin pi)
Ashwagandha (withania somniferum)
Aster (zi wan)
Astragalus (huang qi)
Aurantium (zhi ke [qiao])
Bamboo Juice (zhu li)
Bamboo Shavings (zhu ru)
Belamcanda Rhizome (she gan)
Benincasa Peel (dong gua pi)
Benincasa Seed (dong gua xi/ren)
Benzoin (an xi xiang)
Bilberry (yue ju)
Biota Leaf (ce bai ye)
Biota Seed (bai zi ren)
Bitter Melon (ku gua)
Bitter Orange Peel (ju hong)
Black Cohosh (sheng ma)
Black Plum (wu mei)
Black Sesame Seed (hei zhi ma)
Bletilla (bai ji)
Boneset (ze lan)
Borax (peng sha)
Borneol (bing pian)
Bottle Brush (mu zei)
Buddleia (mi meng hua)
Buffalo Horn (shui niu jiao)
Bulrush (pu huang)
Bupleurum (chai hu)
Burdock (niu bang zi)
Camphor (zhang nao)
Capillaris (yin chen hao)
Cardamon Seed (sha ren)
Carpesium (he shi)
Cassia Seed (jue ming zi)
Catechu (er cha)
Cat's Claw (uncaria tomentosa)
Cephalanoplos (xiao ji)
Celosia Seed (qing xiang zi)
Centipede (wu gong)
Chaenomeles Fruit(mu gua)
Chalcanthite (dan fan)
Chebula Fruit (he zi)
Chinese Gall (wu bei zi)
Chinese Raspberry (fu pen zi)
Chrysanthemum (ju hua)
Cibotium (gou ji)
Cinnabar (zhu sha)
Cinnamon (rou gui or gui zhi)
Cistanche (rou cong rong)
Citron (xiang yuan)
Citrus Peel (chen pi)
Clam Shell (hai ge ke/qiao)
Clematis (wei ling xian)
Cloves (ding xiang)
Cnidium Seed (she chuang zi)
Codonopsis (dang shen)
Coix Seed (yi yi ren)
Coptis (huang lian)
Cordyceps (dong chong)
Coriander (hu sui)
Corn Silk (yu mi xu)
Cornus (shan zhu yu)
Corydalis (yan hu suo)
Costus (mu xiang)
Cranberry (vaccinium macrocarpon)
Cremastra (shan ci gu)
Croton Seed (ba dou)
Curculigo (xian mao)
Cuscuta (tu si zi)
Cuttlefish Bone (hai piao xiao)
Cymbopogon (xiang mao)
Cynanchum (bai qian)
Cynomorium (suo yang)
Cyperus (xiang fu)
Dalbergia (jiang xiang)
Damiana (turnera diffusa)
Dandelion (pu gong ying)
Deer Antler (lu rong)
Dendrobium (shi hu)
Devil's Claw (harpagophytum procumbens)
Dianthus (qu mai)
Dichroa Root (chang shan)
Dittany Bark (bai xian pi)
Dong Quai (tang kuei)
Dragon Bone (long gu)
Dragon's Blood (xue jie)
Drynaria (gu sui bu)
Dryopteris (guan zhong)
Earthworm (di long)
Eclipta (han lian cao)
Elder (sambucus nigra or sambucus canadensis)
Elsholtzia (xiang ru)
Ephedra (ma huang)
Epimedium (yin yang huo)
Erythrina Bark (hai tong pi)
Eucalyptus (eucalyptus globulus)
Eucommia Bark (du zhong)
Eupatorium (pei lan)
Euphorbia Root (gan sui or kan sui)
Euryale Seed (qian shi)
Evodia (wu zhu yu)
Fennel (xiao hui xiang)
Fenugreek (hu lu ba)
Fermented Soybeans (dan dou chi)
Flaxseed (ya ma zi)
Fo Ti (he shou wu)
Forsythia (lian qiao)
Frankincense (ru xiang)
Fritillaria (chuan bei mu)
Gadfly (meng chong)
Galanga (gao liang jiang)
Galena (mi tuo seng)
Gambir (gou teng)
Gardenia (zhi zi)
Garlic (da suan)
Gastrodia (tian ma)
Gecko (ge jie)
Gelatin (e jiao)
Genkwa (yuan hua)
Germinated Barley (mai ya)
Ginger (gan [sheng] jiang)
Ginkgo Biloba (yin xing yi)
Ginseng, American (xi yang shen)
Ginseng, Asian (dong yang shen)
Ginseng, Siberian (wu jia shen)
Glehnia (sha shen)
Glorybower (chou wu tong)
Goldenseal (bai mao liang)
Gotu Kola (luei gong gen)
Green Tea (lu cha)
Gymnema (gymnema sylvestre)
Gynostemma (jiao gu lan)
Gypsum (shi gao)
Halloysite (chi shi zhi)
Hawthorn (shan zha)
Hemp Seed (huo ma ren)
Homalomena (qian nian jian)
Honey (feng mi)
Honeysuckle Flower (jin yin hua)
Honeysuckle Stem (ren dong teng)
Houttuynia (yu xing cao)
Huperzia (qian ceng ta)
Hyacinth Bean (bai bian dou)
Hyssop (huo xiang)
Ilex (mao dong qing)
Imperata (bai mao gen)
Indigo (qing dai)
Inula (xuan fu hua)
Isatis Leaf (da qing ye)
Isatis Root (ban lan gen)
Java Brucea (ya dan zi)
Jujube (da zao)
Juncus (deng xin cao)
Kadsura Stem (hai feng teng)
Katsumadai Seed (cao dou kou)
Kelp (kun bu)
Knotweed (bian xu)
Knoxia root (hong da ji)
Kochia (di fu zi)
Lapis (meng shi)
Leech (shui zhi)
Leechee Nut (li zhi he)
Leonorus (yi mu cao)
Lepidium Seed (ting li zi)
Licorice (gan cao)
Ligusticum (chuan xiong)
Ligustrum (nŸ zhen zi)
Lily Bulb (bai he)
Limonite (yu liang shi)
Lindera (wu yao)
Litsea (bi cheng qie)
Lobelia (ban bian lian)
Longan (long yan hua [rou])
Lophatherum (dan zhu ye)
Loquat Leaf (pi pa ye)
Lotus Leaf (he ye)
Lotus Node (ou jie)
Lotus Seed (lian zi)
Lotus Stamen (lian xu)
Luffa (si gua luo)
Lycium Bark (di gu pi)
Lycium Fruit (gou qi zi)
Lygodium (hai jin sha)
Lysimachia (jin qian cao)
Magnetite (ci shi)
Magnolia Bark (hou po)
Magnolia Flower (xin yi hua)
Maitake (grifola frondosa)
Marigold (c. officinalis)
Massa Fermentata (shen qu)
Milk Thistle (silybum marianum)
Millettia (ji xue teng)
Mint (bo he)
Mirabilite (mang xiao)
Morinda Root (ba ji tian)
Mugwort Leaf (ai ye)
Mulberry Bark (sang bai pi)
Mulberry Leaf (sang ye)
Mulberry Twig (sang zhi)
Mullein (jia yan ye)
Musk (she xiang)
Myrrh (mo yao)
Notoginseng (san qi)
Notopterygium (qiang huo)
Nutmeg (rou dou kou)
Oldenlandia (bai hua she she cao)
Omphalia (lei wan)
Onion (yang cong)
Ophicalcite (hua rui shi)
Ophiopogon (mai dong)
Oroxylum Seed (mu hu die)
Oryza (gu ya)
Oyster Shell (mu li)
Passion Flower (passiflora incarnata)
Patrinia (bai jiang cao)
Pau D'Arco (tabebuia avellanedae)
Peach Seed (tao ren)
Pearl (zhen zhu [mu])
Perilla Leaf (su ye)
Perilla Seed (su zi)
Perilla Stem (su geng)
Persimmon (shi di)
Pharbitis Seed (qian niu zi)
Phaseolus (chi xiao dou)
Phellodendron (huang bai)
Phragmites (lu gen)
Picrorhiza (hu huang lian)
Pinellia (ban xia)
Pine Knots (song jie)
Pipe Fish (hai long)
Plantain Seed (che qian zi)
Platycodon (jie geng)
Polygala (yuan zhi)
Polygonatum (huang jing)
Polyporus (zhu ling)
Poppy Capsule (ying su qiao)
Poria (fu ling)
Prickly Ash Peel (hua jiao)
Prinsepia Seed (rui ren/zi)
Prunella (xia ku cao)
Prunus Seed (yu li ren)
Pseudostellaria (tai zi shen)
Psoralea (bu gu zhi)
Pueraria (ge gen)
Pulsatilla (bai tou weng)
Pumice (fu hai shi)
Pumpkin Seed (nan gua zi)
Purslane (ma chi xian)
Pyrite (zi ran tong)
Pyrrosia Leaf (shi wei)
Quisqualis (shi jun zi)
Radish (lai fu zi)
Realgar (xiong huang)
Red Atractylodes (cang zhu)
Red Clover (trifolium pratense)
Red Ochre (dai zhe shi)
Red Peony (chi shao)
Red Sage Root (dan shen)
Rehmannia (shu di huang)
Reishi (ling zhi)
Rhubarb (da huang)
Rice Paper Pith (tong cao)
Rose (mei gui hua)
Rosemary (mi die xiang)
Safflower (hong hua)
Saffron (fan hong hua)
Sandalwood (tan xiang)
Sanguisorba Root (di yu)
Sappan Wood (su mu)
Sargent Gloryvine (hong teng)
Saw Palmetto (ju zong lu)
Schefflera (qi ye lian)
Schisandra (wu wei zi)
Schizonepeta (jing jie)
Scirpus (san leng)
Scopolia (S. carniolica Jacq.)
Scorpion (quan xie)
Scrophularia (xuan shen)
Scutellaria (huang qin)
Sea Cucumber (hai shen)
Sea Horse (hai ma)
Seaweed (hai zao)
Selaginella (shi shang bai)
Senna (fan xie ye)
Shiitake (hua gu)
Siegesbeckia (xi xian cao)
Siler Root (fang feng)
Slippery Elm (ulmus fulva)
Smilax (tu fu ling)
Smithsonite (lu gan shi)
Sophora Flower (huai hua mi)
Sophora Root (ku shen)
Spirodela (fu ping)
Stellaria (yin chai hu)
Stemona (bai bu)
Stephania (fang ji [han])
Sweet Annie (qing hao)
Teasel Root (xu duan)
Tiger Bone (hu gu)
Torreya Seed (fei zi)
Tortoise Plastron (gui ban)
Tremella (bai mu er)
Trichosanthes Fruit (gua lou)
Trichosanthes Root (tian hua fen)
Trichosanthes Seed (gua lou ren)
Tsaoko Fruit (cao guo)
Turmeric (jiang huang)
Turtle Shell (bie jia)
Tussilago (kuan dong hua)
Urtica (xun ma)
Uva ursi (arctostaphylos uva-ursi)
Vaccaria Seed (wang bu lui xing)
Valerian (jie cao)
Veratrum (li lu)
Viola (zi hua di ding)
Vitex (man jing zi)
Walnut (hu tao ren)
Watermelon (xi gua)
White Atractylodes (bai zhu)
White Mustard Seed (bai jie ze)
White Peony (bai shao)
Wild Asparagus (tian men dong)
Windmill Palm (zong lu pi/tan)
Xanthium (cang er zi)
Zedoary (e zhu)

By Kerry Bone, BSc (hons), Dipl. Phyto.

When the famous physiologist Hans Selye was conducting his original research on the stress response in the 1930s, he observed that prolonged and sustained stress eventually attacked the adrenal glands themselves. The end stage of maladaption to stress was the exhaustion phase, during which levels of cortisol production declined to below those needed to sustain health because of the atrophy of the adrenals.

This is not unlike the situation with type 2 diabetes. At first, there is a state of insulin resistance whereby the pancreatic cells overproduce insulin to compensate, but after a period of time this overproduction takes its toll and the insulin-producing cells become spent, with insulin levels falling rapidly. Likewise, in a stressed individual there is overproduction of cortisol that overtaxes the capacity of the adrenal glands, especially the adrenal cortex. This can eventually lead to a weakening of the adrenals with correspondingly lower levels of cortisol.

In the popular literature we often hear the term adrenal exhaustion used, but this is misleading since genuine adrenal exhaustion is life-threatening. Only in severe cases does chronic stress eventually lead to a dangerously pronounced underproduction of cortisol. A better term to use is adrenal depletion, meaning the adrenal glands temporarily underfunction because of the high demands placed on them.

However, all of this does highlight that stressed individuals will benefit if their adrenal glands are supported, irrespective of whether cortisol is high or low, but especially for adrenal depletion. The herbs that can do this are known as the adrenal restorative or adrenal tonic herbs.

Typical Signs and Symptoms of Adrenal Depletion¹

• Constant fatigue and need for extra sleep
• Inability to cope with stress, irritability, anxiety
• Reduced libido, sighing, yawning
• Low back pain in the adrenal area
• Recurrent and often prolonged colds or flu
• Sweet craving and reactive dysglycaemia
• Sensitive to cold and heat; low core temperature
• Possible pigmentation in skin creases and loss of body hair
• Poor digestion and assimilation; IBS
• Postural hypotension (Raglan's sign) and an unstable pupillary reflex

The key herbs that support adrenal function are licorice (Glycyrrhiza glabra) and uncured Rehmannia (Rehmannia glutinosa). The information that backs up their use in this context comes largely from pharmacological models, but there is also some support from traditional use and clinical studies. These adrenal restorative herbs work best in conjunction with adaptogens. On the other hand, giving adaptogens to someone who is chronically stressed may not be enough without these herbs to also support the adrenals.

Licorice

In the British Herbal Pharmacopoeia and the British Herbal Compendium, licorice is described as an adrenal agent and adrenocorticotropic (which herbalists now regard as adrenal supportive) and indicated for primary adrenocortical insufficiency and autoimmune Addison's disease.^2-3 (Addison's disease is an adrenal disease characterized by the progressive destruction of the adrenal cortex, resulting in insufficient production of aldosterone and hydrocortisone.)

Glycyrrhizin from licorice has reduced the suppressive effect of cortisol on adrenocorticotropic hormone (ACTH) secretion and adrenal weight. ACTH from the pituitary stimulates and maintains the adrenal glands. In a clinical study, oral administration of glycyrrhizin (150-300 mg/day) blocked the effect of the steroid drug dexamethasone in lowering the amount of urinary metabolites of cortisol as the result of pituitary (ACTH) inhibition.⁴

In the 1950s, licorice extract was found to be a successful medical treatment for some cases of Addison's disease. Patients could be maintained on 3-60 g/day of extract; the lower dosage was used when the disease was controlled.⁵ In one case treated with an initial high dose of licorice extract, the dosage was dropped to a low maintenance dose. The doctor noted an increased sensitivity and cumulative action from licorice.⁶ This suggests licorice may assist in the recuperation of the adrenal cortex.⁷

If you recommend licorice to patients, there are some precautions that should be observed. It can cause high blood pressure and thus is contraindicated in hypertension and edema. Caution is advised if patients are taking cortisol or prednisolone, and in the elderly and those with cardiac, renal or hepatic disease. Do not recommend licorice if the patient is taking potassium-depleting diuretics. So, licorice needs to be taken cautiously - and please avoid excessive doses. When taken for prolonged periods, it should be in conjunction with a high-potassium and low-sodium diet, and keep an eye on blood pressure.

Rehmannia

In Western herbal medicine, Rehmannia is regarded as an adrenal tonic or supportive herb, due mainly to the activity demonstrated in experimental studies. Oral administration of uncured Rehmannia (3 g/kg) for two weeks to rabbits chronically treated with the glucocorticoid dexamethasone significantly raised serum corticosterone levels. (This is a model of adrenal depletion.) Continuation of treatment resulted in further increases. Rehmannia treatment also prevented or reversed changes in the pituitary and adrenal cortex, appearing to antagonize the suppressive effect of glucocorticoids on the hypothalamic-pituitary-adrenal (HPA) axis.8 Rehmannia may work by inhibiting the negative feedback from the steroid drug to the pituitary gland.⁹ These results also suggest that Rehmannia supports the cells of the adrenal cortex and pituitary during times of prolonged stress.

Typical useful doses for adrenal support are about 2-4 g per day for licorice root and around 2-4 g per day for Rehmannia.

References

Durrant-Peatfield B. Your Thyroid and How to Keep It Healthy. Hammersmith Press, London, 2007.
British Herbal Pharmacopoeia. BHMA, Bournemouth, 1983.
British Herbal Compendium. BHMA, Bournemouth, 1992.
Kumagai A, Asanuma Y, Yano S et al. Effect of glycyrrhizin on the suppressive action of cortisone on the pituitary adrenal axis. Endocrinol Jpn, 1966;13(3):234-244.
Knowles JP. Addison's disease with glycyrrhizophilia. Proc R Soc Med, 1958;51(3):178.
Calvert RJ. Liquorice extract in Addison's disease; successful, long-term therapy. Lancet, 1954;266(6816):805-807.
Mills SY. The Essential Book of Herbal Medicine. Penguin Arkana (Penguin), London, 1991.
Cha LL, Shen ZY, Zhang XF, et al. Effects of Rehmannia glutinosa in rabbits chronically treated with glucocorticoids. Chin J Integr Trad West Med, 1988;8(2):95-97.
Chen JK, Chen TT, Crampton L. Chinese Medical Herbology and Pharmacology. Art of Medicine Press, California, 2004.

Kerry Bone is a practicing herbalist; co-founder and head of research and development at MediHerb; and principal of the Australian College of Phytotherapy. He also is the author of several books on herbs and herbal therapy, including Principles and Practice of Phytotherapy and The Essential Guide to Herbal Safety.