COMMONLY USED CHINESE HERB FORMULAS FOR THE TREATMENT OF ...

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JOURNAL OF CHINESE MEDICINE NUMBER 48 MAY 1995 
 
COMMONLY USED CHINESE HERB FORMULAS FOR THE TREATMENT OF MENTAL DISORDERS 
By Heiner Fruehauf 
 
The concept of an inseparable bodymind continuum 
is one of the main characteristics of Eastern thought. 
In classical Chinese medicine, therefore, mental 
activity has always been considered to be inseparable from 
bodily functions, and mental diseases were generally not 
treated differently from any other disorder. The Chinese 
term ‘yuzheng’ (depression), for instance, refers to stagnation 
on both a physical and mental plane, and is usually 
addressed with the same diagnostic and therapeutic means 
as diseases that would be considered to have entirely physical 
origins in the West. 
It is perhaps this absence of a body/mind dichotomy that 
is at the core of Chinese medical theory and practice. As 
described in the classic sources of Chinese scientific thought, 
such as the Yijing (Book of Change), the Daodejing, or the 
Neijing (Inner Canon of the Yellow Emperor), ancient Chinese 
observers of life always postulated the existence of a 
primordial One. From this prenatal entity, they thought, 
emerged two polar aspects which interact in a process of 
constant flux. This concept that all differentiation originates 
from a single source is one of the main messages of the 
Daodejing, the Taoist text which first coined the classic 
statement: “The Dao produced the One, the One produced 
the Two, the Two produced the Three, and the Three 
produced the Myriad Things.” 
Every thing and every phenomenon, according to Chinese 
medical theory, can be analysed with this one-two-threemany 
grid of categorisation. In the one space time continuum 
we live in, for instance, there are the two dominant celestial 
bodies sun and moon, surrounded by myriads of other 
stars; there is humankind as a whole, differentiated into 
male and female; and there is the individual human being, 
consisting of material form (body) and immaterial qi which 
in its highest form is called ‘shen’ - the conscious mind. 
Although most scholars and practitioners of Chinese 
Medicine agree that the body (xing) and the mind (shen) are 
interdependent entities, there has been much discussion 
about the concrete nature of this relationship. In the People’s 
Republic of China, discussions of this nature are often 
influenced by political considerations. Most mainland scholars, 
acutely aware of the Marxist agenda of their superiors, 
usually draw a distinct line between religious ‘idealists’ 
and scientific ‘materialists’ when it comes to body/mind 
related topics. Xunzi, the ancient philosopher who had said 
that “when there is a body, there can be a mind,” has been 
hailed in contemporary books as a model of “materialist 
and thus scientific” thinking1. 
This increasing emphasis on the structural aspects of the 
body, however, goes back much further than the establishment 
of the People’s Republic of China in 1949. If we take a 
look at Chinese medical history, it becomes evident that a 
gradual shift from the immaterial yang aspects to the structural 
yin aspects of diagnosis and treatment has been taking 
place throughout the last two millennia. 
In the original source texts of Chinese medicine, represented 
by the Book of Change, the Daodejing, and the Inner 
Canon, yin and yang are depicted as equal forces, yet the 
rising yang stands out as the conceptual landmark from 
which the various phases of the cyclical process of transformation 
are assessed. According to the Inner Canon, for 
instance, the energetic network that is referred to as the 
Heart governs the activities of all other organs: “The Heart 
is the ruler of all the other organ systems, and it is here that 
the power of the conscious mind is created. If the ruler is 
bright, there will be peace below ... If the ruler is dim, 
however, the twelve organ systems will enter a state of 
crisis, resulting in channel obstruction and severe injury to 
the physical body.2”. 
Following the formative period of Chinese medicine, a 
gradual yet obvious shift of attention toward the structural 
(yin jing) aspects of the body occurred. Diagnostic procedure, 
for instance, changed from sensing the shen, i.e. the 
energetic glow of the face and eyes (Inner Canon, c.200 B.C.) 
to the more hands-on yet still qi oriented method of pulse 
palpitation (Shanghan Lun, c.200 A.D.), to a primarily 
structurally oriented system where tongue shape and colour 
(18-19th century) or X-ray pictures (PRC) are the main 
means of diagnosis. The same is true for the therapeutic 
realm where the ancient and entirely qi based modalities of 
qigong and acupuncture were gradually replaced by herbal 
medicine, a system that is based on the administration of 
material substances. Within the developing field of herbal 
medicine moreover, the early emphasis on yang herbs such 
as Rou Gui (Cortex Cinnamomi Cassiae) and Fu Zi (Radix 
Aconiti Carmichaeli Praeparatae) gave way to a growing 
preference for yin herbs such as Di Huang (Radix 
Rehmanniae Glutinosae), or dense jing tonics derived from 
animal materials. 
But no matter what school of thought they adhere to, 
scholars of Chinese medicine usually agree that the mental 
and physical aspects of the human body are engaged in a 
process of constant movement and transformation. Any 
physical process is believed to have mental implications 
and vice versa. The connecting entity is qi, which can be 
differentiated into physical and mental qi only academically. 
In general, mental energy (shen qi) is simply regarded 
as a more refined form of physical energy (jing qi). Traditional 
treatment principles for mental diseases, therefore, 
do not fall outside the realm of standard diagnostic and 
therapeutic procedure. Even in contemporary China, mental 
patients usually visit doctors who specialise in “internal 
medicine,” that is the treatment of organ disorders with 
Chinese herbs, minerals, and animal materials. 
The therapeutic focus tends to be on the restoration of 
uninhibited qi flow, since unbalanced emotions first affect 
the qi before they influence the physical structure of the 
body. Since chronic qi stagnation eventually results in the 
formation of structural pathologies such as blood stasis or 
phlegm coagulation, the modalities of blood moving and 
phlegm purging are standard methods to treat the more 
chronic types of mental disorders. In addition, Chinese 
physicians often address various types of deficiencies. The 
following is a brief overview of traditional and contemporary 
approaches to the most common mental disorders. 
DEPRESSION 
In classic Chinese medical texts, depression is labelled 
yuzheng (depression syndrome) and refers to a wide array 
of symptoms which are usually attributed to stagnant qi. 
Unhappy emotions are generally believed to be the prime 
cause for stagnant qi. This psychosomatic aspect of qi has 
been emphasised in sources that go back at least as far as the 
Inner Canon, which pioneered the classic statement “In a 
patient full of grief and sadness, the qi becomes depressed 
and does not move”3. Later on, the 7th century medical 
compendium, Zhubing Yuanhou Lun (A Discussion of the 
Symptoms and Origins of Disease), devoted an entire 
subchapter to the pathogenesis and treatment of ‘knotted 
qi’, explaining that “the knotted qi disease is caused by grief 
and worry.”4 
The term ‘yu’ describes symptoms of mental depression 
and maybe the beginning stages of physical manifestation, 
such as discomfort in the sides of the body or the sensation 
of a lump in the throat. At a more advanced stage, it can 
incorporate severe symptoms of phlegm and blood stagnation 
such as tumours or other types of accumulations which 
have formed due to a chronic state of imbalance. 
Since the traditional Chinese concept of health is closely 
tied to the presence of an uninterrupted energy flow, depression 
- the manifestation of obstructed or ‘depressed’ qi 
flow - has always been taken very seriously by Chinese 
physicians. Several influential medical scholars even asserted 
that all disease has its origin in the depression of the 
mental and physical flow continuum. The Song dynasty 
physician Chen Yan, in his landmark work, Sanyin Ji Yi 
Bing Zheng Fang Lun (Discussion of Illnesses, Patterns, and 
Formulas Related to the Unification of the Three Aetiologies), 
first singled out the depression of the seven emotional 
affects (joy, anger, anxiety, worry, grief, apprehension, and 
fright) as a major aspect of clinical pathology. This theory 
culminated in the formation of an entire school of medical 
thought, represented by the six depression approach (depression 
of qi, blood, dampness, phlegm, fire, and food) 
authored by the 15th century physician Zhu Danxi. Zhu 
created the influential statement “If qi and blood exist in 
abundance and harmony, a person will not get sick. Once 
there is depression, all kinds of diseases will start to evolve. 
Therefore, all of the body’s diseases are caused by depression5.” 
From this rich tapestry of medical thought and clinical 
experience evolved a prolific reservoir of herbal formulas 
that are frequently used in the treatment of depression. Not 
surprisingly, most of these formulas regulate various aspects 
of the Liver network. The Liver is in charge of the 
harmonious distribution of qi - the flow organ of the human 
body/mind complex; as the Chinese pictogram for Liver 
indicates, it strives to spread upward and outward and 
resents being suppressed. The Liver channel, moreover, 
runs deep through the sexual organs, and another area 
associated with the realm of the subconscious - dream 
activity - is generally attributed to the Liver network. All of 
these factors indicate the close conceptual affinity of the 
Liver system to the hidden realm that Western culture 
accesses through psychotherapy. “All depression,” the 18th 
century primer Zabing Yuanliu Xizhu (Wondrous Lantern 
Peering into the Origin and Development of Miscellaneous 
Diseases) thus declares, “can be classified as a Liver disease. 
The origin of this disorder is excessive worrying.”6 ‘Yu’ 
(depression), in other words, is a general term for diseases 
that have originally been caused by emotional problems. It 
is primarily a qi disorder, and is generally treated as such. 
After a long time, however, ‘qi depression’ may cause a) 
blood stasis, b) fire depression, c) damp depression, d) 
phlegm depression, or e) various levels of deficiency. Treatment 
strategies for chronic depression thus may have to 
take these components into account. Here are some of the 
most common traditional formulas which are still frequently 
used for the treatment of depression in contemporary Chinese 
hospitals and clinics: 
• Xiao Chai Hu Tang (Minor Bupleurum Decoction): relieves 
shaoyang, harmonises the surface and the interior, realigns 
the Liver and Spleen. Typical symptoms include a bitter or 
metallic taste in the mouth, dry throat, blurred vision, 
restlessness, poor appetite, alternating hot and cold sensations, 
intercostal or subcostal distress, nausea, and a fine 
and wiry pulse. 
• Da Chai Hu Tang (Major Bupleurum Decoction): harmonises 
shaoyang, purges internal heat accumulation. Typical 
symptoms include a sensation of alternating cold and heat, 
lateral chest pain, a bitter or metallic taste in the mouth, 
nausea, subcostal fullness and pain, constipation, restlessness, 
a greasy yellow tongue coating, and a deep and wiry 
pulse. 
• Si Ni San (Frigid Extremities Powder): realigns the Liver 
and Spleen. Typical symptoms include distention, pain, or 
a stuck feeling in the Stomach, lower abdominal, or intercostal 
regions; a mild coldness of the hands and feet when 
getting nervous or stressed, constipation or a sensation of 
unsatisfactory bowel movement or diarrhoea accompanied 
by tenesmus, dry or swollen eyes, and a slippery Liver/ 
Gallbladder pulse. 
• Xiao Yao San (Rambling Powder): soothes the Liver and 
relieves stagnation, strengthens the Spleen and nourishes 
blood. Typical symptoms include poor or irregular appetite, 
intercostal distress, menstrual pain and/or pre-menstrual 
breast distention, sensation of fullness in the epigastric 
region, general fatigue, a flushed face, and a fine and wiry 
pulse. 
• Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction): 
disperses stagnant qi and accumulation, dissolves 
phlegm, restores the downward movement of Stomach qi. 
Typical symptoms include plumpit syndrome (a subjective 
feeling of something being stuck in the throat) or a dry 
itching or piercing pain in the throat, a stuffy feeling in the 
chest and epigastric region, digestive symptoms (nausea, 
belching, poor appetite, gurgling sounds in the epigastric 
region); secondary symptoms may include localised swelling, 
insomnia, or coughing. 
• Yue Ju Wan (Escape Restraint Pill): moves qi and resolves 
depression of qi, blood, phlegm, fire, damp, or food. Typical 
symptoms include stuffiness in the chest and diaphragm 
regions, intercostal distress, distention or pain in the 
epigastric or abdominal regions, acid belching, poor appetite, 
irregular bowel movements, a wiry and slippery pulse, 
and possibly nausea or vomiting. 
• Gan Cao Xiao Mai Da Zao Tang (Licorice, Wheat, and Jujube 
Decoction): nourishes the Heart and quietens the spirit, 
relaxes tension and harmonises the Stomach. Typical symptoms 
include frequent crying, hysterical behaviour, loss of 
self-control, unfocused mind, overly self-conscious behaviour. 
Secondary symptoms may include tight abdominal 
muscles, insomnia or restless sleep, frequent yawning, and 
forgetfulness. 
• Bai He Di Huang Tang (Lily and Rehmannia Decoction) or 
Bai He Zhi Mu Tang (Lily Combination): clears yin deficiency 
heat in the Heart and Lung, boosts qi, and quietens 
the spirit. Typical symptoms include an unusually wide 
variety of subjective symptoms, unstable emotions, poor 
focus, unclear goals, unclear sensation of temperature 
(“sometimes I am too hot, but then again, sometimes I really 
feel more cold”), dizziness, a metallic taste in the mouth, red 
tongue, yellow urine, and a rapid pulse. 
At the Institute for National Medicine and Pharmacology 
in Heilongjiang Province, Dr. Ma Longqi used a combination 
of the traditional shaoyang formulas Xiao Chai Hu Tang 
(Minor Bupleurum Decoction), Da Chai Hu Tang (Major 
Bupleurum Decoction) and Chai Hu Jia Long Gu Mu Li Tang 
(Bupleurum plus Dragon Bone and Oyster Shell Decoction), 
to treat 307 patients who had been officially diagnosed 
as suffering from ‘neurasthenia’, a term that is frequently 
used in China to describe depression. The formula 
he used, Ningshen Lingfang (Calm the Spirit Magic Formula) 
consisted of Chai Hu (Radix Bupleuri) 20g, Huang Qin 
(Radix Scutellariae Baicalensis) 15g, Ban Xia (Rhizoma 
Pinelliae Ternatae) 15g, Long Gu (Os Draconis) 20g, Mu Li 
(Concha Ostreae) 20g, Da Huang (Rhizoma Rhei) 7.5g, Gan 
Cao (Radix Glycyrrhizae Uralensis) 10g, and Gui Zhi 
(Ramulus Cinnamomi Cassiae) 15g. The formula was decocted, 
spray dried, and administered in granulated form. 
At the end of the study a general effectiveness rate of 96.7% 
was reported, with a markedly improved rate of 56%7. 
MENTAL DISEASE 
In Western clinical practice, the diagnosis and treatment of 
mental disease tends to be highly differentiated. Chinese 
physicians, however, have often discussed the various 
manifestations of mental disease under the same heading. 
Nonetheless, treatment strategies are complex, mostly consisting 
of the three aggressive methods of purging, flushing 
phlegm, and moving blood. 
Due to the obvious discrepancy between the modern and 
the traditional assessment of mental disease, contemporary 
Chinese researchers appear to be divided about the best 
way of conducting scientific clinical trials in this field. Some 
have opted to set up their trials according to Western 
diagnosis, accepting only cases that have been officially 
diagnosed as suffering from obsessional neurosis, or psychogenic 
psychosis, or schizophrenia. Others have opted to 
conduct their clinical studies according to their own clinical 
experience, using a single “mental formula” for all kinds of 
disorders, including depression or schizophrenia which 
are discussed elsewhere in this article. The following case 
studies all focus on the generic approach to mental disease. 
• Wen Dan Tang (Warm the Gallbladder Decoction): rectifies 
qi flow and dissolves heat phlegm, clears the Gallbladder 
and harmonises the Stomach. Typical symptoms include 
stubborn insomnia, vivid dreaming, occasional palpitations, 
restlessness, stuffy feeling in the chest, bitter taste in 
the mouth, dizziness, a yellow and sticky tongue coating, 
and a slippery pulse. 
This is one of the representative formulas for heat phlegm. 
Since mental diseases are often diagnosed as phlegm obstructing 
the orifice of the Heart, it has evolved into one of 
the prime remedies for the treatment of mental and psycho 
neurotic diseases. In an early study, the formula was prescribed 
to 149 cases diagnosed with “mental disease;” 117 
were reported cured, 2 markedly improved, 24 improved, 
and 6 showed no results8. In a more recent study, Wen Dan 
Tang was administered to 132 patients suffering from neurasthenia, 
menopausal syndrome, schizophrenia, or other 
mental disorders; at the end of the study, 41 were declared 
cured, 74 improved, while 17 showed no results. The overall 
effectiveness rate was assessed at 87%9. 
• Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon 
Bone and Oyster Shell Decoction): courses the Liver and 
relieves depression, clears heat and purges fire. Typical 
symptoms include a stuffy feeling in the chest, a heavy and 
sinking feeling in the body, depression, insomnia, utterance 
of non-sensical gibberish, inhibited urination and digestive 
disturbances. 
This is a famous ‘mental’ formula which is particularly 
popular in Japan. In a relatively recent study, it was given 
to 35 cases with depression; 15 were reported cured, 10 
markedly improved, 9 improved, and 1 showed no result10. 
In another study, the formula was prescribed to 54 cases 
with depression, and 36 cases with epilepsy; of the depressed 
patients, 32 were reported cured, 19 improved, and 
3 showed no results; of the epileptic patients, 18 were 
declared cured, 11 improved, and 7 without results11. In a 
much earlier trial, the formula was combined with Diankuang 
Mengxing Tang (Awaken from the Dream of Mania Decoction) 
and administered to 40 schizophrenia patients; 10 
were reported cured, 10 improved, and 20 showed no 
improvement12. 
• Jieyu San (Relieve Depression Powder): This is a modern 
formula containing Chen Pi (Pericarpium Citri Reticulatae), 
Ban Xia (Rhizoma Pinelliae Ternatae), Zhi Qiao (Fructus 
Citri seu Ponciri), Zhu Ru (Caulis Bambusae in Taeniis), Zhi 
Zi (Fructus Gardeniae Jasminoidis), Hong Hua (Flos 
Carthami Tinctorii), Xiang Fu (Rhizoma Cyperi Rotundi), 
Shi Chang Pu (Rhizoma Acori Graminei), Shan Zha (Fructus 
Crataegi), Cang Zhu (Rhizoma Atractylodis), Sha Ren 
(Fructus seu Semen Amomi), Su He Xiang (Styrax), and 
Peng Sha (Borax). Ingredients are ground into a fine powder, 
and put into capsules containing 0.45g of herbal powder; 
patients are usually advised to take 4-8 capsules twice 
daily. This formula is primarily designed to treat the (excess) 
stasis aspect that is often present in mental disorders. 
It is said to be applicable for all kinds of mental diseases, 
including psycho neurosis, depression, schizophrenia, anxiety 
neurosis, psychogenic psychosis, obsessional neurosis, 
etc. In an experimental case study with 50 patients suffering 
from a variety of mental disorders, 16 were reported cured, 
27 markedly improved, 6 improved, and 1 showed no 
result13. 
• Xiao Yao San (Rambling Powder) : This formula 
is one of the most frequently prescribed formulas for milder 
degrees of mental disorder, including depression. Like the 
two previous formulas, it addresses the stasis aspect, but it 
also considers the beginning stages of deficiency. In one 
clinical trial, the formula was prescribed to 26 cases with 
affective psychosis; 16 were reported markedly improved, 
7 improved, and 3 without result14 . There are many reports 
on the successful use of Xiao Yao San for the treatment of 
hysteria, including hysteric loss of voice15, hysteric blindness16 
, and hysteric seizures17. Another study reported 
satisfying results for insomnia in neurasthenic patients18. 
Japanese physicians often use Jia Wei Xiao Yao San (Augmented 
Rambling Powder),the famous modification of the 
mother formula with Zhi Zi (Fructus Gardeniae Jasminoidis) 
and Mu Dan Pi (Cortex Moutan Radicis) added, to treat 
depression19. In Japan, it is also used as the standard formula 
for gastrointestinal neurosis, often in combination 
with Ban Xia Hou Po Tang (Pinellia and Magnolia Bark 
Decoction)20. A Chinese study reports that Jia Wei Xiao Yao 
San was prescribed successfully to patients with auditory 
hallucinations21. 
• Gan Cao Xiao Mai Da Zao Tang (Licorice, Wheat, and Jujube 
Decoction), : Due to its safety and high effectiveness, 
this classic formula has remained a favourite for the 
treatment of less serious mental disturbances, particularly 
if a soothing and nourishing rather than a dispersing effect 
is desired. Prime symptoms are crying and signs of mental 
aggravation. A study conducted in 1960 reports that the 
original formula was administered to 25 patients with an 
acute outbreak of hysteria; all 25 were reportedly cured22 . 
Due to an avalanche of successful trials conducted between 
1958-60, Gan Cao Xiao Mai Da Zao Tang has become the first 
choice for the treatment of hysteria in contemporary PRC 
clinics. Since the amount of Gan Cao (Radix Glycyrrhizae 
Uralensis) is usually high (15g/day), side effects of oedema 
have been observed after prolonged intake; one study 
suggested counteracting this undesired affect by adding Fu 
Ling (Sclerotium Poriae Cocos) and He Huan Pi (Cortex 
Albizziae Julibrissin)23. 
The broad symptom complex referred to as ‘neurasthenia’ 
is another common indication for this formula. One 
trial used the original three food herbs licorice, jujube, and 
wheat to treat 34 cases with neurasthenia, and reported 
good results in 30 patients, while 3 patients failed to improve24. 
In another study, Gan Cao Xiao Mai Da Zao Tang 
plus Bai He (Bulbus Lilii) and Zhi Mu (Radix Anemarrhenae 
Asphodeloidis) was prescribed to 100 cases with neurasthenia; 
28 patients reported that their headache and insomnia 
were cured, and 64 reported improvement25. Another trial 
added Bai He (Bulbus Lilii), Sheng Di Huang (Radix 
Rehmanniae Glutinosae) and Shou Wu Teng (Caulis 
Polygoni Multiflori) to the base formula and administered 
it to 110 cases; 12 were reported cured, 32 markedly improved, 
and 60 improved. Best results were reported for the 
insomnia symptoms (74.2%), while the total effectiveness 
rate was assessed at 100%26. Other modifications of the 
formula include the addition of Bai He (Bulbus Lilii), Dang 
Shen (Radix Codonopsis Pilosulae), Long Chi (Dens 
Draconis), Hu Po (Succinum) and Wu Wei Zi (Fructus 
Schisandrae Chinensis), which was given to 94 cases with 
neurasthenic insomnia; 87 patients reported good results. 
The author of the study recommends that this modified 
version of the formula can be used for all kinds of deficiency 
related insomnia or other symptoms of yang flare-up, particularly 
if accompanied by symptoms of dizziness, palpitations, 
or memory loss27. 
Since 1959, there have been at least 8 reports in major 
Chinese medical journals concerning the use of Gan Cao 
Xiao Mai Da Zao Tang for schizophrenia28. In combination 
with Long Gu (Os Draconis) and Mu Li (Concha Ostreae), 
for instance, the formula was used to treat 79 cases with 
different types of schizophrenia who were not responding 
to any other medication. After taking the formula for 7-70 
days, along with small amounts of chlorpromazine (maximum 
of 200 mg/day), 5 were reported cured, 23 markedly 
improved, 34 improved, and 17 without results. The markedly 
improved rate was assessed at 35.5%29. In another 
study, Dr. Cheng Menxue combined Gan Cao Xiao Mai Da 
Zao Tang with Bai He Gu Jin Tang (Lily Bulb Decoction to 
Preserve the Metal) to treat 146 schizophrenia patients who 
were not responding to Western psychopharmacopoeia 
(117 of the patients also took 200mg of chlorpromazine per 
day); after taking the formula for 7-98 days, with an average 
of 16.8 days, 11 were reportedly cured, 44 markedly improved, 
and 64 improved. The general effectiveness rate 
was assessed at 81.4%30. 
In two other recent trials, the formula was successfully 
used to treat 133 cases suffering from menopausal syndrome; 
hot flashes were reduced in 94.4% of patients, 
sweating in 84.1%, insomnia in 92.7%, headaches in 86.8%, 
dizziness in 67.8%, restlessness in 70.2%, and abdominal 
distention in 75%31. There have also been several reports 
about the use of this formula for the treatment of epilepsy 
in children32 . Other trials reported that the formulas was 
useful in the treatment of somnambulism and globus 
hystericus (plumpit syndrome). 
SCHIZOPHRENIA 
Schizophrenia has always been looked upon as a ‘strange’ 
disease by Chinese physicians. Over the last hundred years, 
many self-declared masters of difficult diseases have taken 
up the challenge. Among them were Wang Qingren, the 
19th century renegade physician and representative of the 
clinically extremely important blood moving school, and 
Zhang Xichun, the eminent 1920’s physician who was known 
for his phlegm oriented approach to difficult diseases. 
Wang designed yet another blood moving formula for the 
treatment of schizophrenia, namely Dian Kuang Meng Xing 
Tang (Awaken from the Dream of Madness Decoction), 
while Zhang created Dang Tan Tang (Flushing the Phlegm 
Decoction). By primarily addressing phlegm and blood 
stasis, both of these approaches are representative of the 
traditional treatment of schizophrenia and ‘strange disorders’ 
in general. 
In traditional texts, schizophrenia is usually referred to as 
‘madness syndrome’ (dian kuang). This term is ambiguous, 
since it really includes two opposite conditions, namely 
dian (depression) and kuang (mania, wild and crazy behaviour). 
Kuang often refers to the violent eruption of a mental 
condition, which usually can be controlled rapidly by the 
application of purging methods33. The high status of purging 
methods among the therapeutic modalities of Chinese 
medicine reflects the ancient concept of an evil spirit possessing 
the patient, which needs to be aggressively expelled 
from the body. Schizophrenia, however, is a complex disorder 
which can have a multiplicity of causes. Prolonged 
purging, favoured in many contemporary Chinese case 
studies, is thus not necessarily the correct treatment for 
patients who have been diagnosed with schizophrenia by a 
Western physician. The contemporary manual, Xiandai 
Zhongyi Neike Xue (A Modern Handbook of TCM Internal 
Medicine), appropriately emphasises the necessity of 
broadly distinguishing between the categories of yang type 
schizophrenia and yin type schizophrenia, that is between 
the ‘wild’ manic type and the depressed type. 
Yang type schizophrenia is characterised by symptoms of 
hallucinations (auditory, olfactory, or visual hallucinations; 
discussions with imaginary partners), delusions (paranoia, 
jealousy, hate, guilt, religious delusions etc.), bizarre behaviour 
(strange clothing, strange movements, tendency to 
attack others, repetitious speech or actions), and irregular 
thought patterns (answers do not match questions, sentences 
are not logically connected, constant change of topics, 
etc.). The base formula suggested in the manual is a 
modified version of Chai Hu Jia Long Gu Mu Li Tang 
(Bupleurum plus Dragon Bone and Oyster Shell Decoction) 
consisting of Chai Hu (Radix Bupleuri) 15g, Long Gu (Os 
Draconis) 60g, Mu Li (Concha Ostreae) 60g, Ban Xia 
(Rhizoma Pinelliae Ternatae) 15g, Tao Ren (Semen Persicae) 
30g, Hong Hua (Flos Carthami Tinctorii) 15g, Chi Shao 
(Radix Paeoniae Rubrae) 30g and Da Huang (Rhizoma 
Rhei) 30g, to be taken daily for 60-90 days. 
Yin type schizophrenia is characterised by symptoms of 
dull emotional expression (no change in facial expression, 
dull eyes, decrease in self-initiated movements, inability to 
love etc.), reduced intellectual activity (talks little, sentences 
have little content or are unfinished, slow response), 
and decrease of general awareness (lack of hygiene, loss of 
concentration, decreased sex drive, loner behaviour, low 
excitability, disregard of social codes). The suggested base 
formula is a modified version of Si Ni Jia Gui Tang (Frigid 
Extremities Decoction plus Cinnamon Twig), consisting of 
Fu Zi (Radix Aconiti Carmichaeli Praeparatae) 60g, Gan 
Jiang (Rhizoma Zingiberis Officinalis) 30g, Rou Gui (Cortex 
Cinnamomi Cassiae) 15g, and Gan Cao (Radix Glycyrrhizae 
Uralensis) 15g, to be taken for 60-90 days. Despite the high 
dose of Fu Zi (Radix Aconiti Carmichaeli Praeparatae), no 
side effects were observed in extended clinical trials34. 
Both of these approaches are characterised by their heavy 
usage of either Fu Zi (Radix Aconiti Carmichaeli Praeparatae) 
or Da Huang (Rhizoma Rhei), both of which, due to their 
pharmacological force, are otherwise rarely used in amounts 
exceeding 10g. Due to the traditional proverb that “special 
diseases should be addressed with special methods”, this 
tendency of shocking both body and mind out of their 
highly disturbed state is quite common in contemporary 
clinical practice. One of China’s leading schizophrenia specialists, 
Dr. Qiao Yuchuan, prescribed the following formula 
to 415 schizophrenia patients: Shi Gao (Gypsum) 
155g, Da Huang (Rhizoma Rhei) 62g, Sheng Tie Luo (Frusta 
Ferri) 31g, Meng Shi (Lapis) 31g, Ye Jiao Teng (Caulis 
Polygoni Multiflori) 31g, Huang Qin (Radix Scutellariae 
Baicalensis) 24g, Huang Bai (Cortex Phellodendri) 24g. The 
herbs were boiled three times to yield a total of 2,000 ml of 
medicinal fluid which, divided into six portions, was imbibed 
at two hour intervals. The standard treatment time 
was two weeks, with an expected occurrence of diarrhoea 
that was not to be treated. After two weeks, the prescription 
Gui Pi Tang (Restore the Spleen Decoction) or other harmonising 
formulas was advised. Of 415 participating patients, 
330 were reported cured, 42 improved, 2 without result, 
and 41 stopped the treatment before completion. The overall 
effectiveness rate was 98.6%35. In a consecutive study 
conducted by the same research team employing three 
differentiations of this formula (Schizophrenia Formula 
No.1 for depressed Liver qi and fire flare-up, Schizophrenia 
Formula No.2 for blood deficiency and phlegm fire, and 
Schizophrenia Formula No.3 for excess heat in the yangming 
channels), similar results were achieved. Of 500 patients 
(229 males, 271 females, all ages, disease histories ranging 
from several months to 30 years), 401 were reported cured, 
93 improved, and 6 without result36 . 
ANXIETY DISORDERS 
The modern term anxiety disorders encompasses a group 
of mental illnesses in which symptoms of anxiety prevail. 
Anxiety disorders are fairly common, affecting roughly 
four percent of the population in North America. Western 
medicine distinguishes between generalised anxiety disorder 
(anxiety neurosis), panic disorder, phobia, post-traumatic 
stress disorder, and obsessive-compulsive behaviour. 
All of these disorders involve the vegetative nervous 
system in an obvious manner. Patients tend to be extremely 
tense and nervous. During acute attacks involving fear 
and/or panic there may be breathing difficulties, palpitations, 
dizziness, nausea, abdominal distention, or a variety 
of other symptoms. Anxiety disorders are frequently accompanied 
by sleep disturbances such as insomnia or excessive 
sleeping. 
From a Chinese perspective, symptoms of anxiety always 
call for methods that ‘quieten the spirit’ (anshen, dingshen, 
ningshen). Almost all formulas designed for this disorder 
thus employ sedating materials, such as the downbearing 
minerals Ci Shi (Magnetitum) and Long Gu (Os Draconis). 
In addition, differentiated approaches are used to address 
the underlying cause for spirit unrest, such as blood deficiency 
or phlegm obstruction. 
Ning Shen Jie Lui Tang (Calm the Spirit and Resolve 
Anxiety Decoction), an experimental formula devised by 
Dr. Ding Fouting that was recently tried in a large scale 
study, illustrates the typical approach to anxiety neurosis in 
contemporary clinical practice. Note again the heavy dosages 
which are typical for the treatment of mental disorders. 
The base formula consists of Long Chi (Dens Draconis) 
30g, Ci Shi (Magnetitum) 30g, Suan Zao Ren (Semen Ziziphi 
Spinosae) 15g, Yuan Zhi (Radix Polygalae Tenuifoliae) 15g, 
Shi Chang Pu (Rhizoma Acori Graminei) 15g, Yu Jin (Tuber 
Curcumae) 24g, Gan Song (Rhizoma Nardostachytis) 12g, 
He Huan Pi (Cortex Albizziae Julibrissin) 9g, Gan Cao 
(Radix Glycyrrhizae Uralensis) 9g, Hu Po (Succinum) 3g 
and Zhu Sha (Cinnabaris) 3g (the last two ingredients to be 
taken in powdered form). The base acupuncture point 
prescription accompanying the herbal treatment was Fengfu 
DU-16, Baihui DU-20, Tongli HE-5, Shenmen HE-7, and 
Neiguan P-6. Common differentiations addressing the underlying 
constitutional imbalance included the following: 
• Liver qi stagnation: plus Bai Shao (Radix Paeoniae 
Lactiflorae) 24g, Xiang Fu (Rhizoma Cyperi Rotundi) 24g, 
Chai Hu (Radix Bupleuri) 18g, Qing Pi (Pericarpium Citri 
Reticulatae Viride) 12g and Gan Cao (Radix Glycyrrhizae 
Uralensis) 9g. Acupuncture therapy: plus Ganshu BL-18 
and Xingjian LIV-2. 
•Phlegm obstruction: plus Zhi Shi (Fructus Citri seu Ponciri 
Immaturus) 12g, Sheng Jiang (Rhizoma Zingiberis Officinalis 
Recens) 12g, Xiang Fu (Rhizoma Cyperi Rotundi) 12g, Dan 
Nan Xing (Rhizoma Arisaematis cum Felle Bovis) 9g, Fu 
Ling (Sclerotium Poriae Cocos) 15g, Ban Xia (Rhizoma 
Pinelliae Ternatae) 15g, Fu Hai Shi (Pumice) 30g, Meng Shi 
(Lapis) 30g, and Su Ye (Folium Perillae Frutescentis) 5g. 
Acupuncture therapy: plus Feishu BL-13, Hegu L.I.-4, Lieque 
LU-7, Tiantu REN-22 and Fenglong ST-40. 
•Heart blood deficiency: Yuan Zhi (Radix Polygalae 
Tenuifoliae), Shi Chang Pu (Rhizoma Acori Graminei) and 
Yu Jin (Tuber Curcumae) were decreased to 9g each, Suan 
Zao Ren (Semen Ziziphi Spinosae) was increased to 30g 
plus Dang Shen (Radix Codonopsis Pilosulae) 30g, Dang 
Gui (Radix Angelicae Sinensis) 30g, Wu Wei Zi (Fructus 
Schisandrae Chinensis) 30g, Long Yan Rou (Arillus 
Euphoriae Longanae) 30g, Fu Shen (Poriae Cocos Pararadicis 
Sclerotium) 15g, Mai Men Dong (Tuber Ophiopogonis 
Japonici) 15g, and Da Zao (Fructus Zizyphi Jujubae) 15g. 
Acupuncture therapy: plus Xinshu BL-15 and Pishu BL-20. 
•Blood stasis: plus Dan Shen (Radix Salviae Miltiorrhizae) 
30g, Tao Ren (Semen Persicae) 15g, Hong Hua (Flos Carthami 
Tinctorii) 15g, Chi Shao (Radix Paeoniae Rubrae) 15g, and 
Shui Zhi (Hirudo seu Whitmaniae) 15g. Acupuncture 
therapy: plus Xuehai SP-10 and Geshu BL-17. 
Of the 266 cases participating in the study, all were 
reported cured. After one year, 211 remained without 
reoccurrence, 31 reported reoccurences and had to repeat 
the treatment, and 24 died of unrelated diseases37. 
NEUROTIC INSOMNIA 
Insomnia is probably the most frequent symptom accompanying 
neurotic disorders. In Chinese medicine, it is again 
the sedating aspect which plays a predominant role in 
clinical therapy. A modern formula, Zhen Xin An Shen Tang 
(Sedate the Heart and Calm the Spirit Decoction), was used 
for 157 cases with sleeping disorders. All participating 
patients reported one of the following symptom complexes: 
Margaritaferae) 25-40g; for schizophrenia, plus Meng Shi 
(Lapis) 30-50g, Mu Li (Concha Ostreae) 30-50g, Long Gu 
(Os Draconis) 30-50g, and Hu Po (Succinum) 6-15g; for 
obvious headache, plus Chuan Xiong (Radix Ligustici 
Wallichii)10-20g and Chai Hu (Radix Bupleuri) 10-15g; for 
general deficiency, plus Dang Shen (Radix Codonopsis 
Pilosulae) and Huang Qi (Radix Astragali). Of 240 cases 
(115 males, 125 females; 120 neurosis patients, 120 schizophrenia 
patients; disease histories ranging from 3 months to 
15 years, with an average of 3 years), 81 were reported 
markedly improved, 87 improved, and 72 without satisfying 
results. The treatment period was 20 days. The best 
effects were observed in neurasthenic patients40. 
Another example for this approach is the experimental 
research formula, Huo Xue Mian Tong Tang (Move the Blood 
and Bring About Sleep Formula). It contains San Leng 
(Rhizoma Sparganii) 10g, E Zhu (Rhizoma Curcumae 
Zedoariae) 10g, Chai Hu (Radix Bupleuri) 10g, Zhi Gan Cao 
(Radix Glycyrrhizae Praeparatae) 10g, Bai Shao (Radix 
Paeoniae Lactiflorae) 10g, Bai Zhu (Rhizoma Atractylodis 
Macrocephalae) 10g, Suan Zao Ren (Semen Ziziphi Spinosae) 
12g, Dang Gui (Radix Angelicae Sinensis) 15g, Dan Shen 
(Radix Salviae Miltiorrhizae) 15g, Fu Ling (Sclerotium Poriae 
Cocos) 18g, Ye Jiao Teng (Caulis Polygoni Multiflori) 24g, 
and Zhen Zhu Mu (Concha Margaritaferae) 30g. The remedy 
was tried on 112 patients suffering from severe insomnia, 
which was defined as only 1-3 hours of sleep per night, 
accompanied by symptoms of dizziness/headache, memory 
loss, panicky emotional state, shortness of breath or fatigue. 
At the end of the study, 30 were reported cured, 45 markedly 
improved, 29 improved, and 8 without result. The 
general effectiveness rate was assessed at 93%. The shortest 
treatment time was 1 week, the longest 8 weeks, with an 
average of 3 weeks41. 
APPENDIX 
The following is a more detailed discussion of many of the 
formulas discussed in the article above. The focus is on their 
application and modifications in the treatment of mental 
disorders, and their many other applications are not discussed. 
Chai Hu Jia Long Gu Mu Li Tang 
(Bupleurum plus Dragon Bone and Oyster Shell Decoction) 
Ingredients 
Chai Hu (Radix Bupleuri) 12g 
Huang Qin (Radix Scutellariae Baicalensis) 5g 
Da Huang (Rhizoma Rhei) 6g 
Ban Xia (Rhizoma Pinelliae Ternatae) 9g 
Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) 5g 
Ren Shen (Radix Ginseng) 5g 
Da Zao (Fructus Zizyphi Jujubae) 5g 
Gui Zhi (Ramulus Cinnamomi Cassiae) 5g 
Fu Ling (Sclerotium Poriae Cocos) 5g 
Long Gu (Os Draconis) 5g 
Mu Li (Concha Ostreae) 5g 
extreme difficulty in falling asleep, less than three hours of 
sleep per night, loss of effectiveness of sleeping pills; or 
waking up early without being able to go back to sleep, 
sleeping only 2-3 hours a night, or inability to fall asleep at 
all during the night. The formula used was a combination of 
ingredients that are primarily known for their sedating 
affect: Long Gu (Os Draconis) 10-30g, Mu Li (Concha 
Ostreae) 30g, Fu Ling (Sclerotium Poriae Cocos) 12g, Ye Jiao 
Teng (Caulis Polygoni Multiflori) 30g, Dan Shen (Radix 
Salviae Miltiorrhizae) 30g, Chao Suan Zao Ren (Fried Semen 
Ziziphi Spinosae) 30g, He Huan Pi (Cortex Albizziae 
Julibrissin) 12g. Patients were instructed to boil the materials 
twice, take the weaker medicinal liquid obtained from 
the second boiling in the afternoon or in the evening, and 
drink the first boiling right before going to bed. If there was 
a tendency to wake up early, patients were advised to take 
the first boiling before going to bed, and the second boiling 
after waking up. After 3 days of treatment, progress in the 
157 participants was evaluated in the following way: 98 
markedly improved, 55 improved, and 4 without results38. 
A similar approach was employed by the designers of a 
herbal sleeping pill, which was formulated at the height of 
Chinese-Western combination therapy during the late 
1970’s. The experimental Anmian Wan (Sleeping Pills) contained 
equal amounts of Chuan Xiong (Radix Ligustici 
Wallichii), Suan Zao Ren (Semen Ziziphi Spinosae), Zhi Mu 
(Radix Anemarrhenae Asphodeloidis), Hu Po (Succinum), 
Bai Shao (Radix Paeoniae Lactiflorae), He Huan Hua (Flos 
Albizziae Julibrissin), Mu Li (Concha Ostreae), Long Gu 
(Os Draconis), Bai He (Bulbus Lilii) and Zi Su Ye (Folium 
Perillae Frutescentis). Ingredients were ground into a fine 
powder and manufactured into honey pills weighing 3g 
each. Patients were advised to take 2-3 pills one hour before 
going to sleep. Of 453 cases, the treatment was considered 
effective (the patient could sleep within 30-60 minutes of 
taking the pills) in 361 patients, and not effective in 92 
patients39. 
Since Wang Qingren’s contribution to Chinese medicine, 
there has been a heightened awareness of the role of blood 
stasis in chronic diseases. Contemporary Chinese clinicians 
thus put great emphasis on blood moving herbs such as 
Dan Shen (Radix Salviae Miltiorrhizae) and formulas such 
as Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of 
Blood Decoction) in the treatment of insomnia. In 1986, Dr. 
Xie Yong et. al. published his experience with the blood 
moving approach to insomnia in the article, ‘A Report of 
Treating 240 Insomnia Cases With Blood Movers.’ The base 
formula tested consisted of Dan Shen (Radix Salviae 
Miltiorrhizae) 20-45g, San Leng (Rhizoma Sparganii) 20-45g, 
Xiang Fu (Rhizoma Cyperi Rotundi) 10-25g, Mu Xiang 
(Radix Saussureae seu Vladimirae) 10-25g, Dang Gui (Radix 
Angelicae Sinensis) 10-25g, and Zhi Zi (Fructus 
Gardeniae Jasminoidis) 10-20g. 
Typical modifications were: for neurosis, plus He Huan 
Pi (Cortex Albizziae Julibrissin) 10-20g, Ye Jiao Teng (Caulis 
Polygoni Multiflori) 10-20g, and Zhen Zhu Mu (Concha 
Therapeutic principles: courses the Liver and relieves depression, 
clears heat and purges fire. 
Symptoms and signs: stuffy feeling in the chest, heavy and 
sinking feeling in the body; depression, easily startled, 
insomnia, utterance of non-sensical gibberish; inhibited 
urination; digestive disturbances (constipation, subcostal 
pressure and bloating, etc.). 
Pulse: wiry and rapid, possibly deep and forceful. 
Tongue: tends to be reddish, with no or yellow coating 
(especially towards the back). 
Indications: epilepsy, depression, schizophrenia, neurotic 
insomnia; cardiac neurosis; drug withdrawal syndrome 
(nicotine, caffeine, valium, etc.); baldness. 
Discussion of ingredients: Chai Hu disperses shaoyang pathogens 
(located between interior and surface); Huang Qin 
clears internal heat, particularly Gallbladder heat and upper 
burner heat; Da Huang purges internal fire and relieves 
constipation; Ren Shen and Da Zao strengthen and protect 
the Spleen; Ban Xia, Fu Ling and Sheng Jiang eliminate 
nausea by harmonising the Stomach and drying dampness 
and phlegm; Gui Zhi and Fu Ling stimulate water metabolism 
and disinhibit urination; Mu Li and Long Gu sedate the 
shen. 
Discussion: this prescription first appeared in the classic 
formula source book, Shanghan Lun. It is a famous modification 
of Xiao Chai Hu Tang (Minor Bupleurum Decoction), 
with a specific focus on mental disorders such as epilepsy, 
schizophrenia, or severe depression. Since the original formula 
includes lead, a potent yet toxic sedating agent, the 
formula is now rarely used in China. In Japan, however, 
where a no-lead version of Chai Hu Jia Long Gu Mu Li Tang 
has been approved by the Ministry of Health, the formula 
is prescribed very frequently. A variety of modern usages 
have been reported by Japanese doctors, including the 
stimulation of hair growth in bald people (treatment periods 
ranging from two to six months). 
Da Chai Hu Tang 
(Major Bupleurum Decoction) 
Ingredients 
Chai Hu (Radix Bupleuri) 15-24g 
Huang Qin (Radix Scutellariae Baicalensis) 9g 
Bai Shao (Radix Paeoniae Lactiflorae) 9g 
Zhi Shi (Fructus Citri seu Ponciri Immaturus) 9g 
Da Huang (Rhizoma Rhei) 6g 
Ban Xia (Rhizoma Pinelliae Ternatae) 9-15g 
Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) 12-15g 
Da Zao (Fructus Zizyphi Jujubae) 9g 
Preparation: the herbs are decocted; the time at which the Da 
Huang is added, as well as its dosage (see modifications), 
will influence the potential laxative action of this formula. 
Therapeutic principles: harmonises shaoyang (the region between 
the surface and the interior); purges internal heat 
accumulation. 
Symptoms and signs: 
• Shaoyang (Liver/Gallbladder) pattern, with sensation of 
alternating cold and heat, stuffy or painful feeling along the 
sides of chest, bitter taste in the mouth, incessant nausea 
and vomiting. 
• Yangming (gastrointestinal) excess syndrome, with 
subcostal fullness and pain that resists palpation, constipation 
or extremely putrid diarrhoea, asthmatic breathing, 
restlessness. 
Tongue: yellow or grey coating (may be greasy). 
Pulse: sunken, wiry, and forceful. 
Discussion of ingredients: Chai Hu and Huang Qin harmonise 
the shaoyang; Da Huang and Zhi Shi purge internal 
heat accumulation; Bai Shao counteracts pain, and in combination 
with Chai Hu realigns the Liver; Ban Xia and 
Sheng Jiang harmonise the Stomach and ease vomiting; Da 
Zao moderates the formula’s purgative action. 
Indications and adjustments: 
Mental diseases, such as depression, neurasthenia, 
psychoneurosis, insomnia. 
• For mental diseases with obvious phlegm symptoms, add 
Yu Jin (Tuber Curcumae) and Ming Fan (Alum). 
• For mental diseases with symptoms of stagnant blood, 
add Tao Ren (Semen Persicae) and Gui Zhi (Ramulus 
Cinnamomi Cassiae). 
• If constipated, use Da Huang heavily (6-10g); if not 
constipated, use Da Huang lightly (3-6g). 
Cautions: This formula is indicated for use in persons of 
strong constitution. Da Huang may cause abdominal cramping 
or diarrhoea in some individuals. When the primary 
symptoms have been resolved, the formula may be changed 
to complete the therapy, or discontinued. 
Discussion: Da Chai Hu Tang was first recorded in the classic 
Han Dynasty compendium Shanghan Lun. It was specifically 
designed for patients suffering from both shaoyang 
(Liver/Gallbladder) and yangming (gastrointestinal) symptoms. 
Therefore, the formula is essentially a combination of 
the representative remedies for shaoyang syndrome (Xiao 
Chai Hu Tang) and yangming syndrome (Xiao Cheng Qi 
Tang). The formula is usually administered for intense 
abdominal pain caused by acute problems of the Gallbladder 
or pancreas. The range of its applications, however, is quite 
wide, making it a general formula for digestive system 
diseases. In Japan, physicians are known to prescribe considerably 
less Da Huang than their Chinese colleagues. The 
moderated version of the formula has broadened the general 
indications of Da Chai Hu Tang to include obesity, 
atherosclerosis, herpes, infertility, diabetes, and a variety of 
other diseases. However, even in Japanese usage, the typical 
patient profile requires a strong constitution. 
Ban Xia Hou Po Tang 
(Pinellia and Magnolia Bark Decoction) 
Ingredients 
Ban Xia (Rhizoma Pinelliae Ternatae) 12-15g 
Hou Po (Cortex Magnoliae Officinalis) 9g 
Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) 9-15g 
Zi Su Ye (Folium Perillae Frutescentis) 6g 
Fu Ling (Sclerotium Poriae Cocos) 12g 
Preparation: The herbs are decocted; Zi Su Ye should be 
added late to avoid loss of essential oils. 
Therapeutic principles: Disperses stagnant qi and accumulation, 
dissolves phlegm, restores the downward movement 
of Stomach qi. 
Symptoms and signs: Subjective feeling of something being 
stuck in the throat (“can’t spit it out, can’t swallow it down”) 
or dry itching or piercing pain in the throat. Agitation 
symptoms such as nervousness, anxiety, depression, insomnia. 
Stuffy feeling in the chest and epigastric region; 
coughing. Digestive symptoms such as nausea, belching, 
poor appetite, gurgling sounds in the epigastric region. 
Localised swelling; soft, non-painful. 
Tongue: swollen, with moist white or thick white coating. 
Pulse: sunken and weak. 
Discussion of ingredients: Ban Xia restores the downward 
movement of digestive qi, dries phlegm, and resolves accumulation. 
Hou Po restores the downward movement of 
digestive qi and dries dampness. Zi Su Ye perfuses Lung qi 
and eases the Liver by moving depressed qi. Sheng Jiang 
disperses stagnated water, and in combination with Ban Xia 
counteracts nausea. Fu Ling leeches out moisture and 
strengthens the Spleen. 
Indications and adjustments: 
• For plumpit syndrome accompanied by general depression, 
combine with Xiao Yao San (Rambling Powder); for 
structural changes in the throat, add She Gan (Rhizoma 
Belamcandae Chinensis) and Shan Ci Gu (Bulbus Shancigu); 
for polyp of vocal cord, combine with Mai Men Dong Tang 
(Ophiopogonis Decoction). 
• Mental disorders, such as anxiety, neurosis, hysteria, 
depression, schizophrenia (if accompanied by throat discomfort); 
for nerve related problems without productive 
coughing, add Da Zao (Fructus Zizyphi Jujubae); this will 
produce Si Qi Tang (Four-Ingredient Decoction for the 
Seven Emotions). 
• Non-specific disorders, including chronic fatigue, dizziness, 
vertigo, palpitations, stuffiness in the chest, cold feet, 
gurgling sounds in the digestive tract; gastrointestinal neurosis. 
• Hyperthyroidism; may add Xia Ku Cao (Spica Prunellae 
Vulgaris), Bai Shao (Radix Paeoniae Lactiflorae) and Xiang 
Fu (Rhizoma Cyperi Rotundi). 
Typical modifications 
• For deficiency conditions, add Ren Shen (Radix Ginseng), 
Gui Zhi (Ramulus Cinnamomi Cassiae), Huang Qin (Radix 
Scutellariae Baicalensis) and Gan Cao (Radix Glycyrrhizae 
Uralensis), or add only Ren Shen (Radix Ginseng) and Gan 
Cao (Radix Glycyrrhizae Uralensis). This will produce Hou 
Po Sheng Jiang Ban Xia Gan Cao Ren Shen Tang (Magnolia 
Five Combination) with Zi Su Ye (Folium Perillae 
Frutescentis) and Fu Ling (Sclerotium Poriae Cocos) added. 
Cautions: In some texts, both Ban Xia and Hou Po are said to 
be contraindicated during pregnancy; however, this refers 
to raw Ban Xia and a high dosage of Hou Po. 
Discussion: Ban Xia Hou Po Tang first appeared in the classic 
formula compendium, Essentials from the Golden Cabinet 
(Jingui Yaolue). It was listed in the chapter on gynaecological 
disorders, and specifically recommended for “women 
who feel like there is a lump of baked meat stuck in their 
throat.” Later generations have labelled this disorder 
‘plumpit syndrome’ (meihe qi), a term that specifically 
refers to a lump-in-throat sensation which typically worsens 
when unhappy or depressed. Historical commentators 
have remarked that this enigmatic yet common problem is 
by no means limited to women, although clinical reports 
reveal that it is mostly female patients who seek therapy. 
Some scholars speculate that it might have been the repressed 
state of women in feudal Chinese society which 
fostered a disproportionately high occurrence of female 
laryngopharyngeal paresthesia at the time. Ban Xia Hou Po 
Tang has been the representative remedy for non-structural 
lumps in the throat since the 10th century, when the source 
book - originally part of the 1800 year old Shanghan Zabing 
Lun - was rediscovered in the imperial library. 
Xiao Chai Hu Tang 
(Minor Bupleurum Decoction) 
Ingredients 
Chai Hu (Radix Bupleuri) 15-24g 
Huang Qin (Radix Scutellariae Baicalensis) 9g 
Ren Shen (Radix Ginseng) 9g 
Gan Cao (Radix Glycyrrhizae Uralensis) 6g 
Da Zao (Fructus Zizyphi Jujubae) 9g 
Ban Xia (Rhizoma Pinelliae Ternatae) 9g 
Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) 6g 
Therapeutic principles: relieves shaoyang, harmonises the 
surface and the interior, realigns the Liver and Spleen. 
Symptoms and signs: shaoyang symptom complex (bitter 
taste in the mouth, dry throat, blurred vision); restlessness; 
depression and poor appetite; distention in the sides of the 
body; alternating hot and cold spells; intercostal and 
subcostal distress; nausea; cyclic onset of symptoms. 
Pulse: fine and wiry (particularly on the left hand), possibly 
deep, but never strong. 
Tongue: thin white tongue coating or no coating. 
Indications: nervousness, irritability, depression, insomnia, 
and other mental disorders (particularly if related to the 
female menstrual cycle); pre-menstrual syndrome; narcotic 
analgetic withdrawal syndrome; epilepsy. 
Discussion of ingredients: Chai Hu disperses shaoyang pathogens 
(located between the interior and the surface); Huang 
Qin clears internal heat, particularly Gallbladder and upper 
burner heat; Ren Shen, Da Zao, and Gan Cao strengthen and 
protect the Spleen; Ban Xia and Sheng Jiang eliminate 
nausea by harmonising the Stomach and drying dampness 
and phlegm; Gan Cao co-ordinates the effects of cooling 
and warming herbs. 
Discussion: Xiao Chai Hu Tang (Minor Bupleurum Decoction) 
has traditionally been regarded as the representative 
formula of the so called harmonising method. It was first 
introduced in the Shanghan Lun as the definitive treatment 
for shaoyang disorders, but has since evolved to become 
one of the most frequently prescribed Chinese formulas of 
all times. Shaoyang disorders are said to occur in the 
dividing space between the surface and the interior, and are 
generally recognised by the signs outlined in the rubrics. 
Since the (shaoyang) triple burner meridian governs the 
circulation of fluids throughout the entire body, the symptom 
complex associated with this formula is very wide and 
can involve all of the three burning spaces. Modern scholars 
have linked the ‘half inside/half outside’ nature of shaoyang 
diseases to the lymph system, while others have related it to 
the fluid-containing layer of protective tissue surrounding 
the internal organs. Typically, symptoms occur along the 
(shaoyang) Gallbladder channel, and at pivotal body positions 
such as the throat, the subcostal region, or the inguinal 
region. Although the popularity of Xiao Chai Hu Tang is in 
part related to its reputation as a safe and ‘harmless’ remedy, 
many doctors have warned that it should only be 
prescribed when there is clear evidence of a shaoyang 
symptom complex. However, Zhang Zhongjing, the original 
author of the formula, pointed out that “not all of the 
defining symptoms have to be there at the same time; one of 
them will suffice.” 
Si Ni San 
(Frigid Extremities Powder) 
Ingredients 
Chai Hu (Radix Bupleuri) 18 
Bai Shao (Radix Paeoniae Lactiflorae) 15g 
Zhi Shi (Fructus Citri seu Ponciri Immaturus) 15g 
Gan Cao (Radix Glycyrrhizae Uralensis) 6g 
Therapeutic principles: realigns the Liver and Spleen. 
Symptoms and signs: distention, pain, or a stuck feeling in the 
Stomach, lower abdominal, or intercostal regions; a mild 
coldness of the hands and feet; constipation or a sensation 
of unsatisfactory bowel movement, diarrhoea accompanied 
by tenesmus; dry, swollen eyes. 
Tongue: thin white coating, or white/yellow and greasy 
coating. 
Pulse: wiry and slippery, particularly in Liver/Gallbladder 
position on the left hand. 
Indications: disturbance of the vegetative nerve system, 
depression, mental diseases. 
Discussion of ingredients: Chai Hu and Bai Shao relieve the 
Liver (Chai Hu disperses stagnant Liver qi, Bai Shao nourishes 
Liver blood); Chai Hu and Zhi Shi realign the Liver 
and Spleen by harmonising the physiological movements 
of ascending and descending qi (Chai Hu aids the ascent of 
Liver qi, Zhi Shi aids the descent of Spleen/Stomach qi); Bai 
Shao and Zhi Shi eliminate abdominal pain; Bai Shao and 
Gan Cao relax abdominal muscle spasms; Gan Cao strengthens 
the Spleen and harmonises the different effects of the 
herbs. 
Typical modifications: 
• For severe intercostal or abdominal pain, add Xiang Fu 
(Rhizoma Cyperi Rotundi), Qing Pi (Pericarpium Citri 
Reticulatae Viride) and Chuan Xiong (Radix Ligustici 
Wallichii). This will produce Chai Hu Shu Gan Tang. 
• For greasy tongue coat accompanied by Stomach disorders, 
combine with Ping Wei San (Pacify the Stomach Powder). 
• For expectoration of thick phlegm, add Gua Lou (Fructus 
Trichosanthis). 
Discussion: Si Ni San (Frigid Extremities Powder) was first 
introduced in the Shanghan Lun. Although most of the 
herbs used are cooling in nature, it was originally listed in 
the chapter on shaoyin (Kidney cold) syndrome. The remedy, 
therefore, should be understood as a footnote to the 
Kidney yang booster Si Ni Tang (Frigid Extremities Decoction), 
which essentially implies the warning that “Not every 
condition involving cold limbs (sini) is caused by an exhaustion 
of Kidney yang; this symptom can also be caused 
by damp heat obstructing the Liver/Gallbladder channels, 
in which case the condition should be treated with Si Ni 
San.”. This is a good example of the classic approach of 
Chinese formula design, tackling serious diseases with a 
minimal and concise herbal arrow. Like other Chai Hu 
based remedies, Si Ni San can address a wide range of 
disorders involving all five organ networks, a fact which 
had already been stressed in the original text. Later generations 
of clinicians valued it as a versatile base formula that 
can be used as the core of a more complex prescription; 
some variations, such as Chai Hu Shu Gan San (Bupleurum 
Powder to Spread the Liver) or Xue Fu Zhu Yu Tang (Drive 
Out Stasis from the Mansion of Blood Decoction) have 
become famous in their own right. For acute conditions all 
ingredients except Gan Cao should be used heavily, particularly 
if the formula is used in unmodified form. 
Xiao Yao San 
(Rambling Powder) 
Ingredients 
Chai Hu (Radix Bupleuri) 9g 
Bai Shao (Radix Paeoniae Lactiflorae) 9g 
Dang Gui (Radix Angelicae Sinensis) 9g 
Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) 3g 
Bai Zhu (Rhizoma Atractylodis Macrocephalae) 9g 
Fu Ling (Sclerotium Poriae Cocos) 9g 
Bo He (Herba Menthae) 3-6g 
Gan Cao (Radix Glycyrrhizae Uralensis) 6g 
Therapeutic principles: soothes the Liver and relieves stagnation, 
strengthens the Spleen and nourishes the blood. 
Symptoms and signs: discomfort in the sides of the chest, 
depression, menstrual cramping and/or pre-menstrual 
breast distention, poor appetite, sensation of fullness in the 
epigastric region, general fatigue, flushed face. 
Pulse: fine and wiry. 
Tongue: thin white coating or no coating. 
Indications: hormonal imbalances; neurasthenia, insomnia, 
depression, thymogenic mental disease; migraine; pre-menstrual 
breast tenderness and other PMS symptoms. 
Discussion of ingredients: Chai Hu and Bo He restore the 
uninhibited movement of Liver qi and prevent heat buildup; 
Chai Hu and Bai Shao regulate Liver functions; Dang 
Gui relieves stagnant Liver blood; Dang Gui and Bai Shao 
nourish Liver blood; Bai Zhu, Fu Ling, and Sheng Jiang 
protect the Spleen and ensure proper fluid metabolism; 
Gan Cao tonifies the Spleen and harmonises herbal functions. 
Typical modifications: 
• For obvious Liver heat (red face, temper tantrums, dizziness, 
rapid pulse, heavy menstrual bleeding, pre-menstrual 
acne), add Zhi Zi (Fructus Gardeniae Jasminoidis) and Mu 
Dan Pi (Cortex Moutan Radicis). This will produce Jia Wei 
Xiao Yao San (Augmented Rambling Powder). 
Discussion: Xiao Yao San (Rambling Powder) is an extremely 
popular modification of the two classic Shanghan Lun 
formulas, Si Ni San (Frigid Extremities Powder) and Dang 
Gui Shao Yao San (Tangkuei and Peony Formula). It first 
appeared in the influential 11th century compendium, Imperial 
Grace Formulary of the Taiping Era (Taiping Huimin 
Heji Jufang). Commissioned by the Song dynasty ministry 
of health, the work was specifically designed for clinicians 
and is thus more concise than other important formula 
compendia. Rather than being a complete catalogue listing 
all Song prescriptions, it focuses on 800 formulas that were 
considered outstanding by most eminent physicians of the 
time. Xiao Yao San can be considered to be the most famous 
remedy listed in this work. Along with Xiao Chai Hu Tang 
(Minor Bupleurum Decoction), it is also the representative 
remedy of the so called harmonising method. Xiao Yao San 
is extremely safe to use, but treatment usually needs to be 
administered over long periods of time. In fact, the name of 
the formula alludes to the action of melting (xiao) structural 
signs of stagnation without harming the blood, much like 
the sun melts ice without diminishing the essence of water; 
it further refers to the effect of moving (yao) the qi without 
dispersing it, like an oar stirs up ripples in the water without 
harming its basic substance. Through this bilateral action of 
both tonifying and moving qi and blood, Xiao Yao San 
‘eases’ the distressed Liver - the functional organ network 
which is responsible for so many everyday problems like 
depression, menstrual tension and pain, or stress related 
disorders. 
Wen Dan Tang 
(Warm the Gallbladder Decoction) 
Ingredients: 
Ban Xia (Rhizoma Pinelliae Ternatae) 9g 
Chen Pi (Pericarpium Citri Reticulatae) 9g 
Fu Ling (Sclerotium Poriae Cocos) 9g 
Zhu Ru (Caulis Bambusae in Taeniis) 15-18g 
Zhi Shi (Fructus Citri seu Ponciri Immaturus) 9g 
Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) 6g 
Gan Cao (Radix Glycyrrhizae Uralensis) 6g 
Da Zao (Fructus Zizyphi Jujubae) 3g 
Therapeutic principles: rectifies qi flow and dissolves heat 
phlegm, clears the Gallbladder and harmonises the Stomach. 
Symptoms and signs: stubborn insomnia, vivid dreaming; 
occasional Heart palpitations; restlessness; stuffy feeling in 
the chest; bitter taste in the mouth or frequent regurgitation 
of phlegm or turbid sputum; dizziness. 
Tongue: red with yellow and sticky coating. 
Pulse: slippery. 
Indications: mental diseases (schizophrenia, manic depressive 
psychosis, reactive psychosis, involutional psychosis, 
obsessional neurosis, neurasthenia, dementia, including 
those involving hereditary factors); nervous system disorders 
(functional disturbance of vegetative nervous system, 
menopausal syndrome, epilepsy, migraine). 
Discussion of ingredients: this formula is made from the 
representative phlegm dissolving remedy, Er Chen Tang 
(Two Cured Decoction), by adding qi dispersing and heat 
clearing herbs. Ban Xia and Chen Pi dry dampness and 
dissolve phlegm. Ban Xia and Fu Ling dry dampness and 
move turbid materials downwards. Ban Xia and Sheng 
Jiang warm and harmonise the Stomach. Chen Pi and Zhi 
Shi disperse stagnant qi and dissolve phlegm. Zhu Ru clears 
heat and dissolves phlegm. Sheng Jiang, Da Zao, and Gan 
Cao fortify the Spleen and Stomach and harmonise the 
effect of the other herbs. 
Typical modifications: 
• For obvious heat symptoms, add Huang Lian (Rhizoma 
Coptidis). This will produce Huang Lian Wen Dan Tang 
(Coptis Decoction to Warm the Gallbladder). 
• For insomnia and palpitations, add Suan Zao Ren (Semen 
Ziziphi Spinosae) and Huang Lian (Rhizoma Coptidis). 
This will produce Wen Dan Tang (Bamboo and Hoelen 
Combination)42. 
• For stubborn cases, further add Yuan Zhi (Radix Polygalae 
Tenuifoliae). 
• For additional qi dispersing, phlegm resolving, heat 
clearing, and a mildly tonic effect, add Chai Hu (Radix 
Bupleuri), Xiang Fu (Rhizoma Cyperi Rotundi), Jie Geng 
(Radix Platycodi Grandiflori), Huang Lian (Rhizoma 
Coptidis), and Ren Shen (Radix Ginseng). This will produce 
Zhu Ru Wen Dan Tang (Bamboo and Ginseng Combination). 
• For mental or nerve related symptoms related to phlegm 
(clogging the orifice of the Heart), add Ming Fan (Alum), Yu 
Jin (Tuber Curcumae), and a heavy dose of Shi Chang Pu 
(Rhizoma Acori Graminei). 
• For stroke in obese individuals (slurred speech, no loss of 
consciousness), or epilepsy (if foaming, but no dark lips and 
cold extremities), add Dan Nan Xing (Rhizoma Arisaematis 
cum Felle Bovis), Ren Shen (Radix Ginseng), and Shi Chang 
Pu (Rhizoma Acori Graminei). This will produce Di Tan 
Tang (Scour Phlegm Decoction). 
• For hysteria, neurasthenia, or psycho neurosis with 
Gallbladder fire, add Chai Hu (Radix Bupleuri) and Huang 
Qin (Radix Scutellariae Baicalensis). 
Discussion: The earliest version of Wen Dan Tang was recorded 
by the famous 7th century scholar-physician Sun 
Simiao in his prolific compendium, Thousand Ducat Formulas 
(Qianjin Yaofang). It was not until five centuries 
later, however, that the formula appeared in its present 
form in the influential Song dynasty medical treatise, Discussion 
of Illnesses, Patterns, and Formulas Related to the 
Unification of the Three Aetiologies (Sanyin Jiyi Bingzheng 
Fanglun). The formula is widely regarded as the representative 
remedy for resolving heat phlegm, yet its enigmatic 
label - Warm the Gallbladder Decoction - has caused 
some misunderstandings. Many commentators have remarked 
that considering its action, the formula should 
really be called Qing Dan Tang (Clear the Gallbladder 
Decoction). ‘Warming,’ rather than referring to an elevation 
of physical temperature, here primarily seeks to evoke the 
philosophical connotations of the Chinese term, ‘wen.’ 
According to traditional theory, ‘wen’ is the most balanced, 
neutral, and harmonious energetic state, referring to warm 
weather and foods/herbs with mildly warming properties 
alike. By clearing heat and turbidity from the ‘store house of 
pure fluids

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COMMONLY USED CHINESE HERB FORMULAS FOR THE TREATMENT OF ...