Calm ZZZ™

TCM herbal formula for chronic stress, anxiety, insomnia, and overactive mind in patients with underlying deficiency — calms the shen (spirit); regulates Liver qi; sedates Liver fire; tonifies deficiencies; anxiolytic; antidepressant; sedative and hypnotic; muscle-relaxant

⚠️ This formula may cause drowsiness in individuals who are sensitive to herbs — do not drive or operate heavy machinery while taking this formula. Alcohol is not recommended as it may intensify the effect. Do NOT use as "sleeping pills" — do not ingest a large amount as this increases the risk of drowsiness. Allergy warning: Xiao Mai (Fructus Tritici) contains wheat — persons with wheat allergy should not take this product. This formula generally takes a few days before it nourishes the underlying deficiency and restores normal sleeping patterns. Safe for long-term use.

CLINICAL APPLICATIONS

* Chronic and constant stress, anxiety, and depression with underlying deficiency

* Insomnia with difficulty falling or staying asleep in patients who are stressed or have things on their minds

* Type A personality with excessive competitive drive, impatience, and sense of urgency without the body strength and constitution to cope with their stress

Background: Nonstop stress in the modern world places a tremendous burden on the mind and body to always function in a heightened and alarmed state. Over time, the mind and body are unable to relax, leading to dysfunction throughout the body — brain (feelings and emotions), heart (hypertension, arrhythmia, atherosclerosis, coronary artery disease), muscles (stiffness and pain), stomach (acid reflux, peptic ulcer disease, IBS), and immune system (weakened immunity, frequent infection). Calm ZZZ is designed for individuals who are under constant stress but also have a deficient constitution. Shen (spirit) disturbance during the day manifests as stress, anxiety, and emotional instability; at night it manifests as insomnia with difficulty falling and/or staying asleep. Many of these patients have underlying deficiencies from Liver excess consuming yin and body fluids long-term. Optimal treatment requires herbs to calm the shen, regulate Liver qi, sedate Liver fire, and tonify the deficiencies.

Key herb-level clinical data:

— Chai Hu (Radix Bupleuri): regulates qi circulation; relieves Liver qi stagnation; calming effect on the brain — promotes relaxation and improves sleep; analgesic and anti-inflammatory via saikosaponins

— Xiang Fu (Rhizoma Cyperi): regulates qi circulation; relieves Liver qi stagnation; anti-inflammatory — inhibits nitric oxide and superoxide (O2-) production in dose- and time-dependent manners

— Gou Teng (Ramulus Uncariae cum Uncis): calms Liver yang; antihypertensive

— Deng Xin Cao (Medulla Junci): sedates Heart fire; relieves irritability

— Zhi Mu (Rhizoma Anemarrhenae): clears deficiency fire; significant antidepressant activity — sarsasapogenin markedly increases noradrenaline and serotonin levels in both the hypothalamus and hippocampus; anti-inflammatory — nyasol inhibits COX-2, inducible nitric oxide synthase, and 5-lipoxygenase

— Bai Shao (Radix Paeoniae Alba): calms the shen; nourishes the Heart; anti-inflammatory and muscle-relaxant — total glucosides suppress adjuvant arthritis and intervene cytokine signaling between synoviocytes; inhibits MCP-1 and MCP-3 secretion; clinically with Gan Cao: neck pain, acute back pain, sciatica, lower back and leg pain, leg cramps in the calf, restless leg syndrome, heel pain, gastric and abdominal pain, intestinal spasm, menstrual cramps, neuralgia, facial spasms and twitching, trigeminal neuralgia, and dysmenorrhea

— Suan Zao Ren (Semen Ziziphi Spinosae): calms the Heart; nourishes the shen; anxiolytic; hypnotic — jujubosides promote sleep; clinically used in multiple studies to successfully treat insomnia

— He Huan Hua (Flos Albiziae): calms the shen; nourishes the Heart; relieves stress and anxiety

— Shou Wu Teng (Caulis Polygoni Multiflori): calms the shen; nourishes the Heart; relieves stress and anxiety

— Fu Shen (Poria Paradicis): calms the shen; nourishes the Heart; adaptogenic

— Xiao Mai (Fructus Tritici): calms the shen; controls emotional instability; prevents drastic shifting of moods

— Gan Cao (Radix et Rhizoma Glycyrrhizae): calms the shen; controls emotional instability; gastroprotective — prevents and treats peptic ulcers via gastric acid inhibition; 100 patients with gastric or duodenal ulcers — 90% effective; positive cognitive effect — ameliorates memory impairment; clinically with Xiao Mai + Da Zao: neurasthenia — 92 of 100 patients effectively treated; hysteria — 60 patients all resolved with no recurrence at 6-month follow-up (concurrent acupuncture); insomnia — 110 patients with 74.2% overall effectiveness

— Da Zao (Fructus Jujubae): calms the shen; controls emotional instability; prevents drastic mood shifts; calming effect on the brain — promotes relaxation and sleep; positive cognitive effect — improves memory

WESTERN THERAPEUTIC ACTIONS

* Anxiolytic — Suan Zao Ren (anxiolytic); Gan Cao + Xiao Mai + Da Zao (neurasthenia 92/100, hysteria 60/60, insomnia 74.2%)

* Antidepressant — Zhi Mu (sarsasapogenin, noradrenaline↑, serotonin↑ in hypothalamus and hippocampus)

* Sedative / hypnotic — Suan Zao Ren (jujubosides, hypnotic, insomnia clinical success); Chai Hu, Gou Teng, Da Zao (calming brain, relaxation, sleep)

* Muscle-relaxant / analgesic / anti-inflammatory — Bai Shao + Gan Cao (neck pain, back pain, sciatica, leg cramps, menstrual cramps, neuralgia, trigeminal neuralgia, dysmenorrhea); Xiang Fu (nitric oxide↓, superoxide↓); Zhi Mu (COX-2↓, nitric oxide synthase↓, 5-lipoxygenase↓); Chai Hu (saikosaponins)

* Gastroprotective — Gan Cao (peptic ulcer prevention and treatment, gastric acid inhibition, 90% effective)

CHINESE THERAPEUTIC ACTIONS

* Calms the shen (spirit) (Suan Zao Ren, He Huan Hua, Shou Wu Teng, Fu Shen, Bai Shao, Xiao Mai, Gan Cao, Da Zao)

* Regulates Liver qi; relieves Liver qi stagnation (Chai Hu, Xiang Fu)

* Sedates Liver fire; calms Liver yang; clears deficiency fire (Gou Teng, Deng Xin Cao, Zhi Mu)

* Tonifies deficiencies; nourishes Heart (Fu Shen, Bai Shao, Suan Zao Ren, He Huan Hua, Shou Wu Teng)

* Controls emotional instability; prevents mood shifts (Xiao Mai, Gan Cao, Da Zao)

DOSAGE

Standard: 3–4 capsules three times daily for stress, anxiety, emotional instability, and similar mental disorders. For insomnia, take an additional dose 30 minutes before bedtime. Safe for long-term use.

Supplementary formulas: Mild to moderate stress and anxiety — combine with Calm. Moderate to severe stress and anxiety — combine with Calm (ES). Severe insomnia — combine with Schisandra ZZZ. Headache — add Corydalin (AC) or Corydalin (CR). Heartburn or gastric ulcers — add GI Care. Depression — add Shine or Shine (DS). Constipation — combine with Gentle Lax (Deficient) or Gentle Lax (Excess). IBS from stress — add GI Harmony. Ulcerative colitis from stress — add GI Care (UC). Menopausal symptoms — combine with Balance (Heat). Forgetfulness — add Enhance Memory. Hypertension — combine with Gastrodia Complex or Gentiana Complex. Tonify overall body constitution — combine with Imperial Tonic.

Nutrition: A diet high in calcium, magnesium, phosphorus, potassium, and vitamins B and E is recommended — these are easily depleted by stress. Recommended foods: apricots, winter melon, asparagus, avocados, bananas, broccoli, brown rice, dried fruit, figs, salmon, garlic, green leafy vegetables, soy products, and yogurt. A glass of warm milk with honey before bedtime is helpful for mild insomnia. Avoid foods high in tyramine near bedtime — tyramine increases release of the brain stimulant norepinephrine; high-tyramine foods include: bacon, cheese, chocolate, eggplant, ham, potatoes, sugar, sausage, spinach, and tomatoes. Avoid caffeine (coffee, tea, cola, chocolate), tobacco, alcohol, and sugar. Avoid warm and hot-natured foods that damage qi and yin: heat-producing fruits (mango, durian), stimulants (coffee, alcohol, energy drinks), and spicy/pungent/aromatic vegetables (pepper, garlic, onions, basil, rosemary, cumin, fennel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili, wasabi). Avoid artificial coloring. Minimize meat — no processed meats (lunch meats, hot dogs, sausages) as nitrites are linked to inflammation and chronic disease.

Tao of Nutrition (Dr. Maoshing Ni and Cathy McNease):

— Restlessness and emotional instability: Make a tea of wheat bran, licorice root, and dates. Drink three times daily until symptoms are relieved.

— Insomnia: Boil mulberry tea and drink 1/2 cup.

— Anxiety and/or insomnia: Toast 1/4 cup amaranth in the oven until slightly brown, remove and steep in a cup of hot water for 5 minutes — sip for immediate relief of anxiety or before bedtime for insomnia.

Lifestyle: Regular exercise, adequate rest, and normal sleep patterns are beneficial for stress reduction. Relax the mind and body through meditation, yoga, breathing exercises, imagery exercises, tai chi chuan, and qi gong. Get away from the daily routine to do something different and enjoyable — laughter really is the best medicine. Minimize noise exposure — noise is disturbing to mental health and causes stress. If insomnia is due to overwork, do not work in the bedroom and remove anything that reminds you of the office. A warm bath or light snack before bedtime may also be helpful. Do not worry — prepare for upcoming stressful events and ask for help from friends, family, and colleagues when stress becomes intolerable. Shift your outlook and look at changes positively as challenges rather than threats. Sleep by 10 p.m. — in TCM, 11 p.m. to 1 a.m. is when yin shifts to yang; the body must be at rest during this time for optimal health.

CASE STUDIES

— 39-year-old female (C.W.): Difficulty falling and staying asleep due to stress; Liver qi stagnation and shen disturbance; Western diagnosis: insomnia. Calm ZZZ 3 capsules 3x/day. Result after 2 weeks: sleeping 4–6 hours undisturbed; also reported better personal relationships.

— 49-year-old female (M.S.): Severe muscle spasms on the side of neck and shoulder, limited ROM; high stress and difficulty sleeping; pale face, low voice, trapezius tension; qi and blood deficiencies with qi and blood stagnation. Calm ZZZ prescribed. Result after 1 week: dramatic improvement — ROM 90% normal, other symptoms almost diminished.

— 22-year-old female (A.B.): Anxiety, fear of failure, depression, insomnia, poor eating habits; shen not settled, dysglycemia; Liver qi stagnation and Spleen qi deficiency. Calm (ES) daytime + Calm ZZZ nighttime → Schisandra ZZZ nighttime + Shine daytime + Bu Zhong Yi Qi Tang. Result after 1 month: insomnia resolved, depression lifted, major attitude and life changes. At 6 weeks: maintained with Calm; anxiety reduced to only stressful situations; regular eating habits, improved energy, regular painless menses.

— 62-year-old female (S.C.): Right wrist pain from yoga, high stress, insomnia; qi and blood stagnation in Lung, Pericardium, and Heart channels. Arm Support + Calm ZZZ 3–4 capsules 3x/day. Result after 1 week: wrist pain completely resolved. Stress and sleep improved over following 2 weeks. Discontinued Arm Support; continued Calm ZZZ only.

— 55-year-old female (R.K.): Insomnia from low back pain and stress; qi and blood stagnation in Urinary Bladder channel and Liver qi stagnation. Calm ZZZ + Back Support (AC). Result after 2 weeks: back pain resolved temporarily; sleep improved as back pain improved over time.

— 38-year-old female (J.F.): Sleep issues — difficulty falling and staying asleep; premenstrual irritability, mood swings, anxiety; palpitations and racing heartbeat at night; BP 100/62 mmHg, HR 70 bpm; pale face, jitteriness; Liver blood and yin deficiencies and Heart blood and yin deficiencies. Calm ZZZ 3 capsules 3x/day + Jia Wei Xiao Yao San at PMS onset through day 3 of period. Result: sleeping 7 hours consistently (some nights 8–10 hours); falling asleep in 20 minutes vs. 1–2 hours before; PMS symptoms dramatically improved with much more even emotions.

Related Reading

Also see: Calm – for mild to moderate stress and anxiety | Calm (ES) – for moderate to severe stress and anxiety | Schisandra ZZZ – for severe insomnia | Corydalin (AC) – for headache | Corydalin (CR) – for headache | GI Care – for heartburn or gastric ulcers | Shine – for depression | Shine (DS) – for depression | Gentle Lax (Deficient) – for constipation | Gentle Lax (Excess) – for constipation | GI Harmony – for stress-related IBS | GI Care (UC) – for stress-related ulcerative colitis | Balance (Heat) – for menopausal symptoms | Enhance Memory – for forgetfulness | Gastrodia Complex – for hypertension | Gentiana Complex – for hypertension | Imperial Tonic – to tonify overall body constitution | Stress & Sleep Collection.