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

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) [see above]: 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), [see above]: 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