Q: Hi. I am definitely addicted to tramadol (Ultram). I have tried to stop drug several times, but withdrawal symptoms are so unbearable (depression; diarrhea; lethargy; sweats; aching body much more worse than ever before taking drug, especially upon wakng up in morning; irritability; increase in tremor), that I get through a day or two and then I know that just "one" will take withdrawal symptoms away, so back on drug again!!! I know I am addicted (been buying drug over net from Thailand). I started taking drug for aches and pains because it was "non-narcotic" and "non-habit forming - yeah right!!!!! (I have no medical insurance at this time). Well, for me, it also produces a "euphoric" type of feeling, like I can get more accomplished when I take it. However, I had no problem getting things done before I ever took drug!!! I noticed you have "Ultram" listed under "Treatment" heading (first paragraph), and so now I know I am not abnormal (I guess this must be addictive for many people!!!). At any rate, I really do want to quit taking this drug. I also have essential tremor (familial - mother had it) and am taking diazepam for tremor (about 10 mg/day, no more than 20 mg/day, and that's only if I am going to be in a very uncomfortable social situation). I can even go without diazepam. When I have tried to stop using tramadol (Ultram), my head tremor gets worse. If I could, I would just hide at home for a week or so and detox; I would have no problem doing that, but I have to function for work, day-to-day LIFE, etcetera (no vacation time, and Monday comes around pretty quickly, hence me only getting through two days of trying to detox). Please............Do you have any suggestions on herbs, etcetera to help ease withdrawal from tramadol?.......just so I can function somewhat during detox/withdrawal period. Also, do you have any experience with other cases of withdrawal from this drug, and if so.........how long do extreme symptoms last? Thank you so much for your time. T.S.

Drug-drug interactions are a much more serious problem than either herb-drug or herb-herb interactions. This is because drugs are high doses of single, active, unstable chemicals, while herbs contain multiple ingredients, some of which are natural buffers.

Chinese herbal formulas are even more broad, comprehensive, and balanced than single western herbs. (When I talk about western herbs, I mean many of single herbs you can buy in stores which are part of western herbal tradition... and were not part of chinese herbal tradition.)

Which is Safer - Single Herbs or Herb Formulas?

Herbal formulas are safer. The more singular a substance is, more likely it is to cause side effects and interact with other substances. Studies bear this out- a number of them indicate that drugs negatively interact more with single herbs than they do with herbal formulas.

From most dangerous to safest (in order) are these cominations:

Type of Combination Situation and Results

1. Multiple drugs: The result of one or more physicians prescribing you one or more drug; interaction range from discomfort to life-threatening. 2. Drugs + single western herbs: 1 or more physician-prescribed drugs + you buy yourself 1 or more single herbs 3. One drug alone: Can still have mild to strong side effects 4. One herb alone: Mild side effects are possible 5. Multiple single western herbs: You buy several herbs for yourself and they may interact, especially if combination is not based on tradition or research 6. Drug + herb formula: Prescribed by both a western and Chinese-style physicians; based on research and guesswork. The results of such studies have been positive. The appropriate formula is often able to balance out drug's side effects and/or boost its effectiveness 7. Single western herb + chinese herb formula: Again based partly on tradition and partly guesswork. Some unexpected interactions are possible but should be mild. 8. Personalized chinese herbal formula alone: Based on diagnosis, tradition, and research. There should be little or no unexpected interactions or side effects, and if there are, physician can modify formula to better suit you.

Our current habit of purchasing single herbs like ginseng and gingko (amateur self-prescription) is more dangerous than seeing an acupuncturist for a personalized chinese herbal formula. Did you know that at least 6 million people in U.S. take ginseng singly? (Read more on ginseng) Also read number 10 in next section...

In addition, when you take several drugs and several single herbs, there are many more potential interactions... that real-world situation is more complex than any of our research has investigated. So, it's a good rule of thumb to take as few drugs and single herbs as possible.

The safest therapy options are just about reverse order of list above.

These are not hard and fast rules. In some situations, multiple drug therapy is best choice... I urge you to review your options with your western and chinese-style physicians, and together you can all make best decision.