In my previous column, I presented two case studies using modification of Golden Chamber (Jin Gui Yao Lue) formulas to assuage physical pain. I will continue this exploration of classical formula modifications by using a Golden Chamber formula modification to treat emotional/psychological "pain." The unique feature of both case studies is that both patients received substantial benefit from a simple modification of a classical formula after having minimal clinical benefit from a common TCM patent formula.
Case One
Patient was a 28-year-old Caucasian female suffering from severe anxiety and insomnia for one year. Her blood work was normal and she had no other complaints besides dry mouth. Her pulse was wiry and fast, tongue was shrunken, scarlet red, with no coat. She was currently taking a patent formulas of "Jia Wei Xiao Yao Wan", three tabs Bid. Patient experienced mild relief from herbal formula, yet her symptoms were not resolved after two months of administration. The following formulas modification was used: Bai He Zhi Mu Tang modification: Bai He 20 gr, Zhi Mu 10 gr, Zhi Zi 10 gr.
Patient was instructed to take three tabs of previously prescribed patent formula with one cup of new formula. After seven days, patient experienced a significant improvement in quality of sleep. Anxiety level was described as "manageable." I continued above protocol for two more weeks. After three weeks total, patient experienced a complete resolution of anxiety and insomnia. Her pulse was now slippery and rapid and her tongue was red/pink color. After four weeks total of above protocol, patient continued to have no reportable levels of anxiety and was able to sleep 7-9 hours a night without interruption. At this point I discontinued medicinals. At three-month follow-up, patient was still sleeping 7-9 hours nightly and only experienced fatigue when "under extreme stress."
This was a simple case of chronic Liver Depression damaging Yin fluids resulting in Heart/Kidney Yin Vacuity. The combination of formulas targeting both aspects of pattern evolution resulted in substantial clinical outcomes. Bai He and Zhi Mu nourish Yin, moisten fluids and clear heat. Zhi Zi was added to clear both depressive and vacuity heat more effectively particularly when combined with Jia Wei Xiao Yao Wan.
Case Two
Patient was a 53-year-old Caucasian female suffering from night sweats, anxiety and palpitations. Her primary care physician classified her as "menopausal" based upon blood work and suggested HRT (hormone replacement therapy) or a natural alternative. She was referred after two months of TCM herbal therapy and was experiencing no change in her symptoms. He tongue was red with no coat, extremely dry. Her pulse was thready and rapid. The patient had no other complaints. She was currently taking a patent formula of Zhi Bai Di Huang Wan, dosed at three tabs BID. The following formula medication was added to her protocol: Bai He Zhi Mu Tang modification: Bai He 20 gr, Zhi Mu 15 gr, Mai Meng Dong 10 gr, Wu Wei Zi 10 gr.
The above tea was taken along with the previously prescribed patent medicine. After three weeks of new protocol, patient experienced a 50 percent reduction in night sweats and was experiencing only "occasional" anxiety and palpitations when extremely fatigued. After two months on above protocol, patient was experiencing night sweats once or twice and month and palpitations and anxiety had completely resolved. I continued patient on new protocol for another month and upon follow-up, she was still experiencing only one to two night sweat a month with no palpitations. At this point, patient was instructed to continue patent medicine for two months. Upon two month follow-up, patient was no longer experiencing night sweats or anxiety or palpitations.
This case was also an excellent example of a slight modification providing substantial clinical results. Bai He Zhi Mu Tang is a popular formula for treating complex and hard to treat mental and emotional disorders and being a simple two herb formula is easily combined with patent medicines to more efficiently effect clinical outcomes. I hope these two articles on ancient solutions for modern pain will inspire students and practitioners to continue to utilize classical formulas in the modern clinic.
