In my last column, I discussed variations on formulas found within the classic TCM text "Jin Gui Yao Lue" (Essentials from the Golden Cabinet). I will continue this theme in this installment and present two case studies using formulas from this classic text as well as another classic TCM text, "Shang Han Lun" (Treatise on Cold Damage).
Case 1
Patient was a 32-year-old Caucasian male. He was suffering from chronic insomnia, which had been present for over one year. He was able to fall asleep, but would wake up frequently feeling hot and agitated. He also complained of dry mouth at night with excessive thirst. There were no other presenting symptoms. His tongue appeared red with a particularly red tip, normal body shape with normal coating and sublingual veins were normal. His pulse was wiry and rapid. The pattern differentiation was Liver Yin / Blood Vacuity with depressive heat. The following formula modification was administered in tea form:
Modified "Suan Zao Ren Tang"
Suan Zao Ren 20gr
Nu Zhen Zi 15gr
Han Lian Cao 15gr
Zhi Mu 12gr
Fu Ling 6gr
Chuan Xiong 6gr
Bai Shao 6gr
Zhi Zi 6gr
Patient was instructed to drink one cup two hours before bed and one cup right at bedtime. After two weeks on the modified formula the patient described that he was now only occasionally waking up during the night. Since he was beginning to see positive changes, another two weeks of the formula was administered. After a total of four weeks on the above formula, the patient was now only occasionally waking up during the night and was no longer experiencing a dry mouth or excessive thirst. At the four week follow-up, patient's tongue was a normal red color, the tip was no longer extremely red, and the coating was normal. His pulse was slippery and regular. At six-week follow-up, patient was sleeping soundly with only occasional bouts of waking.
This was a simple modification of the formula "Suan Zao Ren Tang" from the classic text Essentials from the Golden Cabinet. I added the two herb formula "Er Zhi Wan" for Liver Yin Vacuity and added Bai Shao/Zhi zi to course the qi and clear heat in order to resolve the depressive heat. The addition of these simple modifications allowed the formula to work much more effectively to quickly resolve the patient's stubborn insomnia and targeted the underlying pathological issues rather than just administering a "sedative" formula per se.
Case 2
Patient was a 54-year-old Caucasian female presenting with menopausal "hot flashes," irritability and insomnia as the main complaints. She had no other complaints. Patient's tongue was red with scarlet red tip and dry coating; sublingual veins were normal. Pulse was wiry and rapid. The pattern differentiation was Heart Yin/ Liver Blood Vacuity with depressive heat. The following formula modification was used:
Modified "Suan Zao Ren Tang"
Suan Zao Ren 20gr
Sheng Di Huang 10gr
Zhi Mu 10gr
Fu Ling 6gr
Chuan Xiong 6gr
Yu Jin 6gr
Hou Po 6gr
Zhi Zi 6gr
Zhi Shi 6gr
Gan cao 3gr
The patient was instructed to drink two cups daily, one AM and one PM. After two weeks on the formula modification, the patient was no longer feeling irritable and noticed a slight reduction in hot flashes, sleep was slightly improved. After four weeks on the formula modification, the patient reported a 50 percent reduction in hot flashes, less irritability and was experiencing an improvement in sleep quality. After eight weeks on formula modification, patient was experiencing only occasional hot flashes and was sleeping soundly with no complaints of irritability. Patient's tongue was normal color with a thin coating, sublingual veins were normal; pulse was slippery and rapid. At this point, the formula modification was stopped. Patient was administered a pill formula of Suan Zao Ren Tang to use as needed.
This formula modification was a combination of two formulas: Suan Zao Ren Tang from the Essentials from the Golden Cabinet and Zhi Zi Hou Po Tang from the Treatise on Cold Damage with slight modification. The combination of these two classic formulas efficiently targeted the Heart Yin/Liver Blood Vacuity with depressive heat. I added Sheng Di Huang to more effectively clear vacuity and depressive heat and nourish blood. I added Yu Jin to course the qi mechanism in order to more efficiently clear the depressive heat.
I hope these simple case studies will stimulate practitioners and students alike to dive into the classics texts in search of clinical pearls. The Jin Gui Yao Lue and Shang Han Lun are veritable treasures and any serious practitioner or student of TCM should examine these texts in order to broaden and enrich their clinical acumen for herbal medicine.
