One of my favorite patent herbal medicines to have on hand in the clinic is the classic Chai Hu Long Gu Mu Li Tang. This formula, created by Zhang Zhong-Jing, is a variation of his own formula, Xiao Chai Hu Tang, with the addition of four herbs: gui zhi, fu ling, long gu, and mu li.
Over my almost 30 years in clinical practice, I have used Chai Hu Long Gu Mu Li Tang extensively for a wide array of clinical presentations ranging from chronic headaches to anxiety, insomnia, and prescription drug withdrawal symptoms if these situations fit the appropriate patterns – all with extremely positive clinical outcomes.
In this article, let’s discuss an interesting case study showcasing the highly effective clinical efficacy of Chai Hu Long Gu Mu Li Tang, and illustrating how seemingly simple formulas can have powerful effects on a patient’s life.
Clinical Actions of Chai Hu Long Gu Mu Li Tang
Chai Hu Long Gu Mu Li Tang has the actions of soothing the liver qi, clearing / cooling liver heat, subduing yang, releasing excess from the tai yang, shao yang, and yang ming meridians, transforming phlegm, and tonifying qi. It’s important to mention that the original version of Chai Hu Long Gu Mu Li Tang contains the herb da huang, a purgative medicinal which also clears heat.
Many modern patent remedies remove this medicinal, so it’s important for clinicians to closely examine the patent formula to evaluate if this herb in included or not. I keep both versions on hand in my clinic and use the original version in cases that call for a purgative to clear heat in the lower jiao; and for patients who fit the specific patterns the formula targets and are also experiencing constipation.
The Case Study: A Patient With Anxiety, Insomnia and Headaches
The patient was a 38-year-old male military veteran suffering from anxiety and insomnia with persistent, low-grade headaches. The patient was taking prescription allopathic sleep medication, anxiety medication, and daily over-the-counter headache medicine.
After taking his prescription medications for three months, he was not happy with the results and notified his primary care physician he was stopping the medicines. It was at this point that the patient sought help with herbal medicine.
At his initial consult, the patient reported his challenges with anxiety, insomnia, and headaches, but also expressed that he “had a tendency to feel hot and constipated.”
The patient’s tongue extremely red with swollen sides, a yellow, greasy coat, no cracks or teethmarks. The pulse was fast and wiry; blood pressure was normal. The pattern was liver qi stagnation with depressive heat / heat in the liver meridian, and potential phlegm.
I chose a patent formula which consisted of the original version of Chai Hu Long Gu Mu Li Tang, and included a small dose of the medicinal da huang. After five days of the patent remedy dosed twice daily (one dose one hour before bed, second dose before sleep), the patient reported a dramatic reduction in nighttime anxiety, less constipation and slightly improved sleep. After the surprisingly swift improvements, the patient stated, “This gives me hope and it helps me calm down and relax; maybe I can sleep now.”
After two weeks on the patent medicine, anxiety was significantly reduced, constipation was resolved, and the patient was sleeping, in his words, “dramatically better.” At this point, I phased the patient to a version of Chai Hu Long Gu Mu Li Tang which did not contain da huang.
The patient expressed concern, stating, “This was working, why should we change it?” This was a wonderful teaching opportunity to explain to him that ideally, formulas should be modified as the symptoms evolve and how we had the option of using the exact formula with only one herb removed. He was actually excited by this concept and continued taking the new formula with the same dosing strategy.
After four weeks on the new version of the formula, anxiety was completely resolved, constipation was resolved, and the patient was sleeping well at least three to four nights a week. After a total of eight weeks on the new version of Chai Hu Long Gu Mu Li Tang, anxiety was completely resolved, sleep was continuing to improve, headaches were resolved, and the patient stated that he was “not as hot.”
At this point, I phased the patient to a dosing schedule of every other night and after four weeks on the lower dose, all symptoms continued to improve. Notably, after two months on these formula variations, there were also significant changes visible on the patient’s tongue: the greasy, yellow coat was cleared and the red, swollen sides were now normal.
The patient was extremely grateful and continued to take the patent remedy as needed based on predictable life stress, with excellent results.
