Se 'bru 5 (Padma Digestin) in Burnout
A case report - an integrative treatment approach
Dr. Cecile Vennos
Burnout syndrome is not a medically-defined diagnosis. Nevertheless, it seems to be an ever-increasing
problem in the West. The state of burnout is usually caused by stress, mostly due to demanding work
situations, resulting in physical and emotional exhaustion.
The treatment of burnout, as it is applied in the increasing number of specialized burnout clinics and
institutions, focuses primarily on two factors. The first focus is on organizational aspects with the aim of
reducing the stress level. Secondly it concentrates on individual characteristics and capabilities of the patient,
especially on their ability to cope with stress. This may include different kinds of psychotherapy, psychopharmaceuticals and relaxation techniques such as meditation, breathing techniques or external therapies
such as massage, or dietary advice. A third factor, which is sometimes neglected in standard burnout therapy,
is the treatment of physical complaints.
Physical symptoms of burnout - the Western perspective
Burnout-related symptoms can include back pain, chest pain, accelerated heart beat, headaches, frequent
infections, and dizziness. Besides these, gastrointestinal disturbances are highly prevalent, such as
abdominal pain and discomfort, early satiation, diarrhoea or constipation, nausea, bloating and loss or
increase of appetite. From a Western scientific point of view, the reason for the close association between
psychological and gastrointestinal function stems from the brain-gut-axis and the autonomic nervous system.
The gut has its own extensive system of nerves which is sometimes described as a ‘second brain‘. It regulates
the gastrointestinal functions, however the two systems are closely connected and influence each other. This
may lead to gastrointestinal dysmotility, hypersensitivity and disturbed accommodation of the stomach,
resulting in functional disorders such as functional dyspepsia and irritable bowel syndrome.
The treatment of physical complaints resulting from burnout is an essential part of an integrative therapy
scheme. Physical complaints together with psychological stress form a feedback loop which negatively
influences the mental state, the capability to perform daily activities as well as impacting upon the individual‘s
social life. In addition, they diminish vitality and the ability to cope with stress, which in turn leads to
psychological exhaustion (fig. 1).
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Figure 1: Psychological disturbances may lead to physical complaints, which in turn induce or aggravate
psychological factors. Therefore psychological as well as physical aspects have to be considered in the
treatment of burnout.
Strengthening the digestive functions - the Tibetan perspective
One of the key elements of digestion - according to Tibetan Medicine - is the digestive heat, Me drod. It is
necessary for all aspects of digestion, breaking down food and absorption of nutrients. It is therefore an
essential factor in the build up and maintenance of a healthy body. If Me drod is diminished, for example
through stress, old age, cold weather or inappropriate food-stuff, not only the digestion is affected but the
reduced inner heat may lead to cold kidney disease, the symptoms of which include a feeling of coolness in
the abdomen and the lumbar region, loss of libido, lower back pain and impaired sexual functions.
In Tibetan Medicine, warming plants - such as are present in the formula Se 'bru 5 - are used to increase a
diminished Me drod. Regarding the negative feedback loop depicted in figure 1, the formula mainly
strengthens the physical side of the circle (fig. 1). However, because of its vitalising and warming qualities, Se
'bru 5 may also have a positive influence on the psychological side.
Towards an integrative treatment approach
Besides treating the causes of burnout, namely reduce stress factors and develop the patients coping abilities
the third pillar of burnout therapy is the treatment of the physical symptoms (fig. 2). From a Tibetan point of
view many burnout related symptoms result from a depleted inner heat and a decreased Me drod (digestive
warmth), which is reflected in the western term "burnout". Here the herbal formula Se 'bru 5 (Padma Digestin)
offers an option. It is composed from pomegranate seeds, cardamom, cassia bark, long pepper and lesser
galangal (fig. 3), which improve the digestive functions by positively influencing gastrointestinal secretion, gut
motility and sensitivity and by having carminative, mucosa protecting and spasmolytic effects [1]. Supporting
Me drod not only enhances quality of life and well-being, it is also essential to support vitality and
psychological strength as well as increasing coping abilities and personal resources. Additionally it diminishes
symptoms of cold-kidney disease, which are often observed in burnout patients.
Other examples for formulas from the Tibetan Medicine System, that may be used in burnout related
symptoms are the formula Srog 'zin 10 (Padma Nervotonin), which is especially helpful in sleep disorders,
nervousness and anxiety [2]. If stress results in an impairment of the immune function, it may lead to
increased susceptibility to infections or to worsening of inflammatory diseases. In this case the preparation
Padma 28 can be recommended, which has anti-inflammatory, antioxidant and blood circulation enhancing
activities [3]. Since it is also a cooling formula in the context of burnout it should preferably not be given in the
evening but at midday as shown in the example of the following case report.
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Figure 2: the three pillars of an integrative burnout therapy, which besides stress reducing organizational
measures and coping mechanisms includes treating physical complaints.
Case Report (the patient was treated by Dr. Simon Feldhaus, Paramed, Baar, Switzerland).
A 39 year-old male patient was suffering from burnout due to excessive challenges in his job as a selfemployed lorry-driver. The symptoms were (subjectively perceived) heart problems with accelerated pulse
rate, joint pains as well as digestive problems with feelings of fullness and bloating.
No previous diseases were known and there was no previous medication. The patient was examined following
a holistic approach and therapy was started using craniosacral therapy (once per month) to reduce the stress
level. The diet was changed to a low carbohydrate diet with reduced intake of raw vegetables. Additionally
Padma Digestin (Se 'bru 5) was given, 2 capsules in the morning and 2 in the evening. Padma 28 was given,
2 capsules at midday.
After four weeks, a significant improvement was seen regarding digestive function. The patient perceived a
pleasant feeling of warmth in the stomach region and generally felt better, stronger and more effective at
performing his daily activities. Nevertheless, he still complained of tiredness and concentration problems. The
medication with Padma Digestin and Padma 28 was continued. Additionally, 15 g of galactose was given,
divided into several doses over the day.
After another 4 weeks, the patient felt much better with regard to the fatigue and brain power. At this stage,
stress-reducing methods such as power naps and breathing therapy were conveyed to the patient and an
evening meal rich in fat was introduced into the diet. The medication was reduced to Padma Digestin 1
capsule in the morning and in the evening, Padma 28 was discontinued.
Conclusions
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Tibetan Medicine offers valuable options within an integrative treatment approach to burnout. Besides external
therapies and dietary advice in order to harmonize the three humours, different herbal formulas based on the
Tibetan Medicine system can be helpful. In particular, the herbal mixture Se 'bru 5 (Padma Digestin) is
suitable. By increasing Me drod - the digestive heat, it not only improves the digestive complaints frequently
observed in burnout patients, it also supports vitality and wellbeing and thus strengthens the ability to cope
with stress.
Figure 3: The formula Se 'bru 5 (Padma Digestin) and its ingredients: cardamom seeds, lesser galangal,
pomegranate seeds, cassia bark and long pepper (from left to right).
References
1 Vennos C. Overcoming regulatory challenges: Se ‘bru becomes Padma Digestin, a new traditional Tibetan
formula for Switzerland. Journal of Traditional Tibetan Medicine 2012:8-11.
2 Vennos C, Schwabl H. Srog’zin 10 a Tibetan formula for times of crisis and unrest- keeping one’s nerve in
spite of high pressure. Journal of Traditional Tibetan Medicine 2010:8-13.
3 Schwabl H, Vennos C. Can Tibetan formulas be explained by Western science? Multi-target drugs and
chronic inflammation: the example of Padma 28. TTM Journal 2008:8-13.
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