Chapter Thirteen. Syndrome of disturbance of Heart-shen and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that can sedate the Heart-shen (which is often translated as spirit or psyche) and calm the mind. They are used to treat anxiety, restlessness and insomnia due to disturbance of the Heart-shen.
Heart
The Heart is the most important organ among the five. It decides the emotional features and cognitive ability of the individual. It houses the Shen (psyche) and dominates all mental activities in the conscious state. It concerns the ability to know the external world through sensory organs. All information or stimuli, including introspection and insight into oneself and the ability to feel emotions, are first received by the Heart and are further felt and evaluated with the cooperation of different internal organs. The Heart is then able to formulate the information intelligently at emotional and cognitive levels, and enables one to respond based on a proper evaluation of the stimuli. The emotional attribute of the Heart is joy, which makes the Qi relax and move without clear direction and boundary. A healthy and positive attitude towards life makes the Heart strong. Having too little joy in life or, conversely, an overindulgence in joy, may weaken the Heart.
The Heart-Qi and Heart-Yang, as the functional aspects of the body, are constantly active in all mental activities. The blood and the Yin of the Heart, as the material aspects of this organ, are responsible for supplementing and nourishing the Heart in order to sustain the mental activities. The main physiological function of the Heart is governing the blood and dominating blood circulation. If this function is impaired, the Shen loses nourishment and control of the Heart, and mental confusion, anxiety, palpitations and difficulty falling asleep may occur.
The balance between the Kidney-Yin (water) and Heart-fire provides another indicator of mental state. In an acutely stressful situation, such as being frightened or shocked, Heart-fire becomes hyperactive and easily loses connection with the Kidney-water; this may directly cause anxiety, restlessness and sleep disorders.
Liver
The Liver houses the Hun and has its main influence on the sleeping process, dreams and all activities in the subconscious state. Flexibility in one’s temperament and in how one deals with things is a sign of a strong and properly functioning Liver. The emotional attribute of the Liver is anger, which can easily push the Qi upwards. Relaxation and flexibility in temperament make the Liver strong and allow the Liver-Qi to flow freely; anger and frustration make the Liver-Qi stagnate (even move upwards) and eventually weaken this organ.
The Liver-Yin and blood are very important in maintaining the function of the Liver. When they are strong, the person sleeps well, feels calm and satisfied, has a sense of humor and moves in a quick and harmonious manner. When the blood and Yin are deficient, the Liver-Qi stagnates and the sleep becomes restless and disturbed by dreams, the person easily feels irritation, anger and frustration, or loses relaxation and flexibility in character. Moreover, Liver is the mother organ of the Heart. Liver-Qi stagnation and up-flaring of Liver-fire can quickly influence the Heart and cause restlessness of the Heart-shen.
Kidney
The Kidney is often called the root of life. This is because it stores the Kidney-Qi ( Source-Qi or Yuan-Qi) which is the initial life force inherited from one’s parents. It determines the vitality of each individual and is the source of the Qi of the other organs. The Kidney houses the Zhi (will-power) which relates to an individual’s ambitions and goals in life. It derives from the biological drive for survival. The emotional attribute of the Kidney is fear, which concerns the well-being of the individual and which serves to safeguard the individual from dangerous situations. Fear leads the Qi downwards. Having both short- and long-term goals, and leading a life with appropriate challenges but without threat, make the Kidney strong and Kidney-Qi firm. It is particularly important to create these conditions for the physical and mental development of children and young people.
Spleen
The function of the Spleen is also very important. The Spleen transforms food and drink into Qi and blood. These supplement the Qi and blood of the whole body and are also transformed into essence, which supplements the Kidney-essence; a strong Spleen thus sustains the vitality of the individual in the long run. The Spleen houses the Yi (intention) and this determines the ability and profundity of feeling, thinking, studying, planning and memorizing things, and directly influences these processes. It determines the level of an individual’s intelligence. The emotional attributes of the Spleen are empathy, sympathy, care and worry. These feelings slow down the movement of the Qi and may even make it stagnate.
When the function of the Spleen is too weak or is disturbed, the person may lose the ability to study, understand, plan, concentrate and memorize things. If the function of the Spleen is too weak to generate the Qi and blood, the person may get worried easily and feel gloomy and tired. When the Spleen-Qi is weak or blocked, a person may lose the feeling of sympathy and care.
The Spleen is also important for maintaining balance in the functions of the internal organs. Located in the middle of the body, it is like a turbine, controlling the upward and downward movement of the Qi. It can therefore connect the Lung and Heart, which are located in the upper part of the body, and the Kidney and Liver, which are located in the lower part of the body. (See Figures 13.1 and 13.2 on page 311.)
Phlegm and blood
Besides the disorders of the internal organs, phlegm and congealed blood can also be causative factors in mental disorders. When the dietary habit of the patient is inappropriate or the function of the Spleen is too weak, phlegm is easily formed. It can be pushed by Qi moving in the body, covering the mind and blocking the meridians, and cause disorders of the Heart-shen. The congealed blood is a pathological product, which is formed when the Qi stagnates over a long period of time. It can block the Heart orifice and also cause disorders of the Heart-shen.
The Lung
The Lung houses the Po. It relates to the boldness, courage, realistic self-confidence and self-esteem of the individual. The emotional attribute of the Lung relates to the change from optimism and courage to pessimism and sadness. The Lung gathers the Qi, which is mixed from the air from inhalation and the Qi that is generated from food and drink. The Lung is also responsible for distributing the Qi throughout the body in order to carry out all physical and mental activities. This function directly influences the intensity and changes of mental activities and emotions.
When the Qi is strong and disperses properly, the person is optimistic, stable in mood and behaviour, is courageous and dares to take on challenges and responsibilities. When the Lung-Qi is deficient, it is too weak to spread out and the person is prone to sadness, negative and dissatisfied feelings, is unable to take responsibility and does not manage to reach one’s goals in life. When the Lung-Qi descends too much, the person may feel depressed, is often self-critical and feels guilty. On the contrary, when the Lung-Qi ascends too much, a person is conceited and often takes a dominating position. If the Lung-Qi moves upwards and downwards intensely and rapidly, the person may switch quickly from being conceited to having low self-esteem. Moreover, the proper function of the Lung is very closely related with the Heart and Liver, as the Heart governs the blood and directly influences Qi movement; and the proper movement of Liver-Qi may smooth the dispersing and descending functions of the Lung-Qi. In acute stress conditions, the Liver-Qi disturbs the Lung-Qi and Heart-Qi; shortness of breath, restlessness, even hyperventilation and panic attack may occur. (See Figure 13.3 on page 312.)
Syndrome of disturbance of Heart-shen
Manifestations
Main symptoms
Restlessness, anxiety, palpitations, irritability, insomnia, stress, inability to concentrate, anticipation of misfortune, being afraid of losing control. In severe cases, panic attacks or hyperventilation.
Secondary symptoms
Shakiness, stiffness of muscles, dry mouth, indigestion, vigilance, quick breathing, night sweats, tiring easily and quickly.
Tongue
Red, purple or pale, trembling; may have a yellow or sticky coating.
Pulse
Wiry, rapid, irregular; forceful in an excess condition, thready and restless in a deficiency condition.
Associated disorders in western medicine
Anxiety, depression, insomnia, different types of phobia, obsessive–compulsive disorder, post-traumatic stress disorder, panic attacks, acute stress disorder. It is also related to chronic diseases, such as anemia, and diseases of the heart and lung.
Analysis of the syndrome
In an acute and excess condition, the stress is severe and has an obvious cause, but the physical condition of the patient is good.
• The Heart-fire and Liver-fire are intensively stimulated by stress and flare-up, and the Heart-Qi and Lung-Qi are hyperactive and dispersed. These result in restlessness, palpitations, dry mouth, sweating, shakiness and stiffness of muscles. These changes can be traced back to humans’ fight-or-flight survival response in dangerous situations: the heart beats more rapidly to supply more blood to the muscles; breathing becomes faster to obtain more oxygen for the physiological need. Nowadays, these coping reactions still present in stressful situations when the individual is worried, frustrated and frightened.
• At the same time, the Kidney-Qi descends due to fear and shock, and the connection between the Kidney and the Heart is broken. The Liver-Qi overacts on the Spleen and the Qi in the Middle-Jiao is blocked. The Liver-fire and Heart-fire often flare up attacking the lung. These result in anxiety, rapid breathing, vigilance, night sweats, insomnia and poor concentration – even panic attacks and hyperventilation.
• These physical and mental reactions strongly consume the Qi, and the patient easily and quickly feels tired.
• A red tongue and a wiry, forceful and rapid pulse indicate the existence of fire.
• If this situation continues for a fairly long period of time, the Heart-Yin is injured by the fire and causes further severe disturbance of Heart-fire. When the Heart-shen is unable to stay in the Heart, persistent restlessness, palpitations, reduced ability to concentrate and insomnia arise, even without an obvious reason.
In a chronic condition:
• The persistent anxiety, palpitations and insomnia often occur without an obvious reason. These are mainly caused by blood and Yin deficiency of the Heart and Liver.
• If there is only Qi and blood deficiency, the tongue body is usually pale or delicate red with a thin white coating and the pulse is thready, weak and restless.
• If there is Yin deficiency, the patient may have night sweats, vigilance, irritability, a red tongue without coating and a rapid, thready and wiry pulse.
• Phlegm is frequently formed due to poor digestion and Qi stagnation. It covers the Heart and causes cognitive impairment, poor memory and poor concentration, as well as restlessness and palpitations. In this case, a sticky tongue coating and a slippery pulse are present.
• The congealed blood can also be formed by Qi disturbance of the internal organs and by chronic illness. It can block the Heart and cause stubborn pain, restlessness and palpitations. In this case, a purple tongue and a choppy pulse are present.
Treatment principle
• In an acute and excess condition: Sedate the Heart-Yang and Liver-Yang, clear the Heart-fire and Liver-fire, regulate the Liver-Qi and descend the Lung-Qi to calm the mind.
• In a chronic and deficiency condition: Nourish the Heart-blood and Heart-Yin, tonify the Heart-Qi, harmonize the Qi and blood and calm the mind.
• In a deficiency condition with acute stress: Sedate the Heart-shen, reduce fire or descend the Liver-Yang, regulate Qi and blood, and tonify the blood and Yin.
Herb selection principles and formula composition strategies
First priority
• In an acute, severe and excess condition, mineral substances are chosen to directly and quickly sedate the Heart-shen and descend the Liver-Yang. These herbs are salty and cold, and enter the Heart, Liver and Kidney meridians.
• In a chronic condition due to Yin deficiency, herbs that nourish the Yin of the Heart and Kidney and calm the mind are selected. These herbs are sweet and cold, and enter the Heart, Liver and Kidney meridians.
• In a chronic condition due to blood and Qi deficiency of the Heart, herbs that can nourish the blood and tonify the Heart-Qi are used. These herbs enter the Heart, Spleen and Liver meridians.
Second priority
• In an acute and severe condition, herbs that enter the Heart and Liver meridians, and can clear heat and nourish the Yin are selected.
• In a chronic condition, herbs that calm the mind, and tonify the Qi and blood are selected.
Third priority
• Herbs that are pungent, enter the Heart, Pericardium, Liver and Gall Bladder meridians, and can promote the Qi movement and blood circulation are used.
• Herbs that are pungent and bitter, can remove phlegm so as to connect the Heart and Kidney, and calm the mind are often used.
• Herbs that tonify the Spleen and protect the Stomach so as to reduce the side effect of herbs with strong sedating effects are often chosen in the same formula.
CAUTIONS
1. Determine the treatment order:
The treatment order is to sedate the Shen and to treat the manifestations in an acute and severe condition primarily, and to treat the cause and manifestations secondly.
2. Caution when using mineral substances:
Mineral substances can strongly sedate the Shen and descend the fire and Qi, thus suppressing Qi and causing an uneasy sensation in the chest. For these reasons they should not be used in a large dosage for a long period of time. When the condition of the patient improves, gentle herbs that calm the mind should be used instead of mineral substances.
3. Protect the Stomach:
As mineral substances are heavy for the stomach and may cause a heavy sensation in the stomach, stomach pain and constipation, they should be used with other herbs that protect the stomach. When the condition of the patient improves, gentle herbs that calm the mind should be used instead of mineral substances.
4. Influence on concentration:
The formulas that strongly sedate the Shen can cause a sleepy sensation and decrease the ability to concentrate if they are used in an inappropriate dosage. If these signs are present during the day, one should reduce the dosage of the formula or only use it before going to bed at night.
5. Caution in pregnancy:
The substances that sedate the Shen have a strong descending tendency. Pregnant women should not use them or use them with caution.
Structure of the formula and selection of herbs
Chief: Sedate the Heart-shen in an acute and a severe condition; tonify the Heart and calm the mind in a chronic and a mild condition
Ci Shi ( Magnetitum), Zhen Zhu ( Margarita usta) and Zhen Zhu Mu ( Concha margaritifera usta)
All of these substances are minerals. They can directly and strongly sedate the Heart-shen and are effective in treating acute and excess conditions of restlessness, palpitations, anxiety and insomnia. They are often chosen as chief substances in the formula.
Ci Shi is a heavy and solid mineral. It is pungent, salty and cold, and is the strongest of the three in sedating the Heart-shen. Since it enters the Liver and Kidney meridians, it is more suitable for treating Heart-shen disturbance caused by Liver and Kidney disturbance. This manifests as palpitations, restlessness with fear, dream-disturbed sleep and easily waking up in the night. There may be a wiry and restless pulse, particularly in the second position on the left side. Ci Shi is also able to stabilize the Kidney-Qi and Kidney-essence, and descend the Liver-Yang.
Zhen Zhu is sweet, salty and cold. Its function of sedating the Heart-shen is more moderate than that of Ci Shi. Its principal focus is on disorders of the Heart as it enters the Heart and Liver meridians directly. As well as sedating the Heart-shen, its sweet nature can ease the tension of conflict, calm the mind and slow down the pathological process of anxiety. It is also effective in clearing fire of the Heart and Liver, and treats restlessness, palpitations, irritability and difficulty falling asleep. In this condition, patients may have a rapid, active and restless pulse, particularly in the first position on the left side.
Zhen Zhu Mu has a similar function to Zhen Zhu, is also cold and salty, and enters the Heart and Liver meridians. Its function of sedating the Heart-shen and calming the mind is weaker than that of Zhen Zhu, but it is stronger in descending the Liver-Yang. It is more suitable for use in the condition where the Liver-Yang ascends and the Heart is disturbed. This manifests as dizziness, headache, tinnitus, palpitations, irritability and insomnia.
Long Chi ( Mastodi fossilia dentis) and Long Gu ( Mastodi fossilium ossis)
Long Chi and Long Gu are different parts of fossil fragments. Both have the function of sedating the Heart-shen.
Long Chi is cold in nature and enters the Heart and Liver meridians. It is heavier than Long Gu and its descending action is stronger and quicker. Long Chi is very effective for sedating the Heart-shen and calming the mind. It is used to treat severe restlessness, agitation, insomnia and night sweats.
Long Gu is sweet, neutral and astringent, and enters the Heart, Liver and Kidney meridians. Its function of sedating the Shen is not as strong as that of Long Chi but it controls fear as it can stabilize the Kidney-Qi. It can also stabilize the essence and body fluids, and treats night sweats, nocturnal emissions and enuresis. In addition, it can anchor the Liver-Yang and treat the Liver-Yang ascending that manifests as dizziness, tinnitus, headache and dream-disturbed sleep. It is often chosen in a formula as chief if anxiety is caused by Liver-Yang ascending, disturbance of the Heart-shen and weakness of the Kidney-Qi.
Zhu Sha ( Cinnabaris)*
Zhu Sha is sweet, salty and slightly cold, and enters the Heart meridian. It is considered the strongest substance for calming the mind and reducing Heart-fire in acute and severe conditions of anxiety and insomnia. Zhu Sha contains mercury, a very poisonous mineral, and it can act directly against the aggressive heat-toxin that is generated by the vigorously blazing fire when Qi and blood are suddenly obstructed. Since mercury is poisonous and can accumulate in the body, Zhu Sha is traditionally only used for a very short time and in a very small dosage as a coating for herbal pills. Nowadays, use of Zhu Sha is forbidden in many countries; however, it can be replaced by a combination of Long Chi ( Mastodi fossilia dentis), Zhen Zhu ( Margarita usta) and Huang Lian ( Coptidis rhizoma).
Sheng Di Huang ( Rehmanniae radix), Xuan Shen ( Scrophulariae radix) and Bai Shao Yao ( Paeoniae radix lactiflora)
These three herbs are cold in nature. They can nourish Yin and reduce heat. They are often used as a part of chief substances together with minerals in a formula to sedate the Heart-shen and calm the mind in an acute and severe condition of anxiety caused by excess heat or empty-heat. They can also be used as chief herbs to treat moderate or chronic cases of anxiety and insomnia via the approach of reducing the excess fire or empty-fire of the Heart, Liver and Kidney.
Sheng Di Huang is sweet, bitter and cold, and enters the Heart, Liver and Kidney meridians. As it can directly clear excess heat or empty-heat in the Heart, Liver and Kidney, it can calm the mind and relieve irritability and restlessness. It can cool the blood, thus the function of calming the mind is even stronger. It is frequently used as chief in the formula for treating excess or deficiency syndromes.
Bai Shao Yao is sour and cold, and enters the Liver meridian. It can generate Liver-Yin and reduce heat, and thus treat vigilance, irritability, night sweats, insomnia and dream-disturbed sleep. Since it can nourish the Liver-blood and soften the Liver, it can ease the tendons and relieve trembling and stiffness of the muscles. It is an import herb for use in acute and chronic conditions of anxiety and insomnia caused by disorders of the Liver.
Suan Zao Ren ( Ziziphi spinosae semen) and Bai Zi Ren ( Platycladi semen)
These herbs are commonly used to calm the mind and improve sleep. They are often selected as chief in a mild or chronic condition of disturbance of the mind.
Suan Zao Ren is sweet and sour; it enters the Liver meridian primarily and the Heart meridian secondly. It can tonify the Liver and Heart blood, and stabilize the blood and the Qi. It is the most commonly used herb to tonify the Liver-blood and calm the mind. It is particularly effective for treating restlessness and irritability without an obvious cause, dream-disturbed sleep and nightmares.
Bai Zi Ren enters the Heart meridian primarily and the Liver meridian secondly. It is sweet and has a moistening nature. It is an excellent herb to nourish the Heart blood and calm the mind. It also has the function of stopping sweating and is suitable for treating such symptoms as difficulty falling asleep, restlessness and palpitations, becoming nervous easily and sweating.
Since mental state and sleep relate to the Heart and Liver, Suan Zao Ren and Bai Zhi Ren are often used together.
Ren Shen ( Ginseng radix) and Zhi Gan Cao ( Glycyrrhizae radix preparata)
Ren Shen is sweet and slightly warm. Not only is it a very strong herb to tonify the Qi in general, it is also an effective herb to stabilize the Qi and calm the mind. Since it directly tonifies the Source-Qi and stabilizes the Heart-Qi, it is used in acute or chronic conditions of anxiety due to Heart-Qi and Kidney-Qi deficiency. However, because it can strongly tonify the Qi, it may stimulate the Qi too much and too quickly so that the patient may feel more restless and has difficulty falling asleep, especially at the start of treatment with Ren Shen. To prevent this side effect, this herb should be used with small dosages initially, and the dosage increased gradually thereafter.
Zhi Gan Cao is sweet in nature and enters all 12 regular meridians; however, it primarily enters the Spleen meridian. If it is used in a reasonably large dosage (i.e. above 9 g as a crude herb) it can sufficiently tonify and smooth the Qi. Unlike Ren Shen, it does not cause restlessness and insomnia, and is particularly useful in an acute or persistent condition of anxiety. This is because its sweet taste can reduce the tension from the conflict between the body’s resistance and the pathogenic factors, slow down the pathological process, ease the tendons and muscles, and thus calm the mind in a stable, gentle and pleasant way.
Gui Zhi ( Cinnamomi cassiae ramulus) and Rou Gui ( Cinnamomi cassiae cortex)
These two herbs are sweet, pungent and warm. They can stimulate the Yang and treat anxiety, restlessness and palpitations due to Yang deficiency. However, since Gui Zhi enters the Heart meridian and Rou Gui enters the Kidney meridian, they calm the mind from different approaches.
Gui Zhi is more pungent and has a strong moving ability. It can stimulate the Heart-Yang, expel cold and promote the blood circulation, thereby treating restlessness and palpitations due to Yang and Qi deficiency and cold in the chest. Its effect is quite quick.
Rou Gui is warmer and sweeter than Gui Zhi but is not as pungent. It can strengthen the vital gate fire, the Kidney-Yang, and treat restlessness, becoming nervous easily, frightened or shocked due to Kidney-Yang deficiency.
Both Gui Zhi and Rou Gui can be used as chief in formulas for calming the mind due to Yang deficiency. They are often used with herbs that tonify the Qi such as Ren Shen ( Ginseng radix) and Zhi Gan Cao ( Glycyrrhizae radix preparata) to enhance and stabilize their functions.
Deputy: In acute and excess conditions, descend fire, nourish the Yin, cool the blood and remove congealed blood so as to calm the mind; in chronic and deficiency conditions, tonify the Yin, blood and Qi so as to calm the mind
Mu Li (Concha Ostreae)
Mu Li is salty, astringent and slightly cold, and enters the Kidney, Liver and Gall Bladder meridians. It has the function of descending the heat of the Kidney, anchoring the Liver-Yang and stabilizing the body fluids. It is often chosen as deputy for treating night sweats, hot flushes, restlessness and anxiety.
Huang Lian ( Coptidis rhizoma), Zhi Zi ( Gardeniae fructus) and Mu Tong ( Mutong caulis)*
These herbs can be used as deputies in the formula to treat acute and excess conditions where excess heat is blazing in the Heart. They are all bitter and cold, and enter the Heart and Liver meridians. They can strongly reduce the excess fire from the Heart and Liver, and therefore calm the mind. Zhi Zi and Mu Tong can also drain heat by promoting urination. These herbs can be used to treat agitation, difficulty falling asleep, a bitter taste in the mouth, mouth ulcers and scanty and difficult urination.
Since Mu Tong is a poisonous herb and its use is forbidden in many countries, it can be substituted by Ku Zhu Ye ( Bambusae amarae folium) or Tong Cao ( Tetrapanacis medulla) with Huang Lian ( Coptidis rhizoma) or Long Dan Cao ( Gentianae radix).
Hu Po ( Succinum), Dan Shen ( Salviae miltiorrhizae radix) and Yu Jin ( Curcumae radix)
Hu Po, Dan Shen and Yu Jin enter the Heart and Liver meridians. They can promote blood circulation, thus calming the mind in acute and chronic conditions. They treat palpitations, irritability, chest pain and hypochondriac pain due to blood stagnation.
Hu Po is sweet and neutral, and enters the blood level of the Heart and Liver. It is particularly effective in sedating the Shen and removing congealed blood. It treats palpitations and restlessness due to blood stagnation. It is used in treating severe and persistent heart and mental disorders such as coronary heart disease, phobia, obsessive–compulsive disorder and manic depression.
Dan Shen is bitter and cold. It enters the Heart meridian primarily and the Liver meridian secondly. Its function focuses on the Heart rather than the Liver and it can directly clear heat of the Heart, cool the blood, and relieve irritability and restlessness. In this way it can calm the mind.
Yu Jin enters the Liver meridian primarily and the Heart meridian secondly. It is not only bitter and cold, but also pungent. Its function focuses on the Liver rather than the Heart. Its functions of promoting blood circulation and removing congealed blood are also stronger than those of Dan Shen. Moreover, Yu Jin can spread the Liver-Qi and clear Liver-heat. As an aromatic herb, it can also clear damp-heat and remove damp-heat obstruction in the Upper- and Middle-Jiao. It is an appropriate choice in a formula if there are symptoms of irritability, headache, a tight sensation in the chest, agitation, and a bitter and sticky taste in the mouth.
Mai Men Dong ( Ophiopogonis radix), Sheng Di Huang ( Rehmanniae radix), Zhi Mu ( Anemarrhenae rhizoma) and Xuan Shen ( Scrophulariae radix)
These herbs are all cold in nature. The first three herbs enter the Heart meridian. They can nourish the Heart-Yin, reduce heat and thus calm the mind. They are often used as deputies in the formula to treat acute and chronic anxiety, restlessness and insomnia due to excess heat or empty-heat in the Heart.
Sheng Di Huang, Zhi Mu and Xuan Shen also enter the Kidney meridian. Sheng Di Huang can nourish the Kidney-Yin and reduce the empty-heat; Zhi Mu and Xuan Shen can clear heat there. They are often used as deputies in the formula to treat acute and chronic imbalance between the Heart and Kidney, which manifests as restlessness, hot flushes, night sweats, anxiousness, anxiety and agitation.
Fu Shen ( Poriae cocos pararadicis), Ye Jiao Teng ( Polygoni multiflori caulis), He Huan Pi ( Albiziae cortex) and Bai He ( Lilii bulbus)
These herbs calm the mind and improve sleep, and are often used as deputies in formulas that treat chronic conditions of restlessness and insomnia.
Fu Shen is sweet and neutral, and enters the Heart and Spleen meridians. It has the function of tonifying the Spleen-Qi and Heart-Qi and can calm the mind. It treats palpitations, forgetfulness, restless sleep and early waking. Its function is gentle but sufficient for a mild or moderate case.
Ye Jiao Teng is sweet and neutral, and enters the Heart and Liver meridians. It nourishes the Heart-blood and benefits the Yin, calms the mind and improves sleep. Since it is a vine, which can open the collaterals and activate blood circulation, it can treat pain, stiffness and restlessness of the body and limbs in conditions of blood deficiency. It is often selected specifically to treat a sensation of discomfort in the muscles and restless legs in sleep.
He Huan Pi is sweet and neutral, and enters the Heart, Spleen and Lung meridians. It regulates the Qi in the chest and calms the mind. It is particularly suitable for treating insomnia in depression due to Lung-Yin and Heart-Yin deficiency and Liver-Qi stagnation. The accompanying symptoms are sadness, a tight sensation in the chest and reduced appetite.
Bai He is sweet, bland and slightly cold, and enters the Lung and Heart meridians. It is particularly effective for moistening the Lung-Yin and nourishing the Heart-Yin. It is able to calm the mind, and relieve sadness and irritability. Bai He is often used with He Huan Pi to treat insomnia in depression due to Lung-Yin and Heart-Yin deficiency and Liver-Qi stagnation.
E Jiao ( Asini corii colla), Dang Gui ( Angelicae sinensis radix) and Bai Shao Yao ( Paeoniae radix lactiflora)
E Jiao is sweet and warm, and has the function of tonifying the Yin, essence and blood, and moistening the dryness. Since persistent palpitations, agitation and sweating consume the Yin and blood, hasten and exhaust the Qi, these symptoms are considered as dryness of the Heart in traditional Chinese medicine. E Jiao is an appropriate choice for treating these disorders because it can moisten the dryness.
Dang Gui and Bai Shao Yao are often used together to treat blood deficiency. Dang Gui can tonify the blood and promote blood circulation; Bai Shao Yao can nourish the Yin and reduce heat. Although they do not have a direct function of calming the mind, they are effective in nourishing the blood of the Liver. As they provide the residence of Heart-shen and Liver-hun, and can smooth the flow of Liver-Qi, they are often used to assist herbs that treat insomnia due to blood deficiency.
Zhi Gan Cao ( Glycyrrhizae radix preparata)
Zhi Gan Cao is sweet in nature and primarily enters the Spleen meridian. Sweet holds a capacity of moderating, tonifying and moistening. In acute and severe cases, the sweet taste of Zhi Gan Cao can reduce the tension from conflict between body resistance and pathogenic factors, slow down the pathological process, ease the tendons and muscles and thus assist the herbs that sedate the Heart-shen. In a chronic condition, it can tonify and moderate the Qi so as to calm the mind in a stable, gentle and pleasant way.
Assistant: Remove the phlegm; regulate the Qi, promote blood circulation and therefore calm the mind; strengthen and stabilize the weak organs and calm the mind; strengthen the Middle-Jiao and protect the Stomach so as to reduce the side effect of the herbs that strongly sedate the Shen
Meng Shi ( Lapis micae seu chloriti)*
Meng Shi is a mineral substance and is used to remove phlegm-heat. It has a very strong descending ability and can eliminate phlegm and reduce heat. It is used in a syndrome where phlegm-heat covers the Heart and obstructs the Heart meridian. The manifestations are mental confusion, anxiety and restlessness, such as in schizophrenia. It is only used for a short period of time as it can cause uneasy sensations in the stomach and intestines.
Tian Zhu Huang ( Bambusae concretio silicea), Zhu Li ( Bambusae succus), Zhu Ru ( Bambusae caulis in taeniam), Dan Nan Xing ( Pulvis arisaemae cum felle bovis) and Yu Jin ( Curcumae radix)
These cold herbs are selected to remove phlegm-heat. In the syndrome of disturbance of the Heart-shen, these herbs are selected to remove phlegm from the Heart, Stomach, Liver and Gall Bladder meridians; they can also prevent the phlegm covering and blocking the Heart in the process of calming the mind. When phlegm covers the Heart, the Heart disconnects from the Kidney, as well as from the other organs and meridians, and symptoms such as mental confusion, palpitations, restlessness, insomnia, headache, and fullness in the chest, hypochondria and stomach may arise. In this case, a red tongue with a yellow sticky coating and a slippery and rapid pulse are present. To treat this condition, the appropriate herbs in this group can be selected in the formula according to their characteristics.
Tian Zhu Huang, Zhu Li and Zhu Ru all come from bamboo. Tian Zhu Huang enters the Heart and Liver meridians, and is effective in dislodging phlegm, clearing heat, cooling the Heart and controlling convulsions. It is often used for disturbance of the Heart and Liver by phlegm-heat when there is high fever, irritability and restless sleep. It is also often used in infant convulsions and night crying.
Zhu Li is the coldest of these three herbs. It enters the Heart, Lung and Stomach meridians. It has a lubricating nature, can strongly eliminate phlegm-heat from the Heart, open the Heart orifice and unblock the meridians and collaterals so as to treat mental confusion, numbness and tingling of the limbs.
Zhu Ru is slightly cold in nature and enters the Lung, Stomach and Gall Bladder meridians. As well as clearing heat and transforming phlegm, it is effective in dispersing the constrained Qi, eliminating irritability and calming the mind. It is mainly used for treating restlessness, palpitations, restless sleep and depression, especially after febrile disease or in chronic diseases.
Dang Nan Xing is bitter and cold, and is characterized by clearing heat, expelling phlegm, extinguishing wind and calming spasm. It is able to eliminate the phlegm-heat that covers the Heart and treats headache, irritability and heaviness or numbness of the limbs.
Yu Jin is cold, aromatic and pungent, and enters the Liver meridian. Yu Jin can spread the Liver-Qi, clear the Liver-heat and treat irritability, restlessness, headache and fullness in the chest caused by damp-heat obstruction. It can also cool the blood and promote blood circulation. It is often selected in the formula to treat phlegm-heat obstructing the Liver, Gall Bladder and Heart meridians.
Yuan Zhi ( Polygalae radix) and Shi Chang Pu ( Acori graminei rhizoma)
These herbs are used together as their functions enhance each other. Yuan Zhi is pungent and bitter, and enters the Heart and Kidney meridians; Shi Chang Pu is pungent, aromatic, bitter and warm, and enters the Heart and Stomach meridians. They can remove phlegm from the Heart meridian, connect the Qi of the Heart with the Kidney and open the Heart orifice, thereby improving the functions of the Heart and calming the mind. They can be used in acute and chronic conditions of restlessness, palpitations, forgetfulness, poor concentration, insomnia, depression, anxiety and psychotic disorders.
In clinical practice, Yuan Zhi should be used with caution, because too high a dose can irritate the gastric mucosa, cause nausea and increase the secretion of the respiratory tract.
She Xiang ( Moschus)**, Bing Pian ( Borneol) and Jiang Zhen Xiang ( Dalbergiae odoriferae lignum)
These herbs are selected to regulate the Qi and therefore calm the mind. They are pungent and aromatic, and have a strong dispersing and moving ability. They are especially used to promote Qi movement, penetrate into dampness or phlegm and open the Heart orifice so as to treat chest pain, palpitations and restlessness.
Lian Qiao ( Forsythiae fructus), Chai Hu ( Bupleuri radix), Jie Geng ( Platycodi radix) and Mai Ya ( Hordei fructus germinatus)
These herbs have dispersing and ascending properties. They release the constrained Qi in different organs caused by emotions, especially frustration and resentment. Constrained Qi can also be caused by accumulation of food, or from the strong and quick descending action of the sedating substances, especially minerals.
Lian Qiao can particularly disperse the constrained Qi of the Heart; Chai Hu is able to disperse the constrained Qi of the Liver and Gall Bladder; Jie Geng can disperse the Lung-Qi and remove phlegm; Mai Ya can ascend the Stomach-Qi and protect the function of the Spleen. They are often selected as corrective assistants in the formula to open obstructions and promote Qi movement.
Ban Xia ( Pinelliae rhizoma), Chen Pi ( Citri reticulatae pericarpium), Xiang Yuan ( Citri fructus), Fo Shou ( Citri sarcodactylis fructus) and Xiang Fu ( Cyperi rhizoma)
These herbs are often used to regulate the Stomach-Qi and Liver-Qi, and to treat Qi stagnation, which always exists in the syndrome of disturbance of Heart-shen. Qi stagnation can also be caused by the strong and quick descending action of the sedating substances, especially the minerals, which suppress the Stomach-Qi. Moreover, the sweet, sour and astringent herbs that are selected to slow down the Qi movement also cause stagnation.
Among these herbs, Ban Xia can soothe the Stomach-Qi and Chen Pi can promote the Qi movement in the Upper- and Middle-Jiao. Both can remove the dampness, phlegm and food accumulation that often arises in the same syndrome. Xiang Yuan and Fo Shou are able to harmonize the Qi of the Liver and Stomach, and are particularly used in the condition where the Liver overacts on the Stomach. Xiang Fu is the most commonly used herb to promote Liver-Qi movement and it is widely used in all types of syndrome. As all of these herbs are pungent and warm, they consume the Yin and increase heat, especially in a syndrome where heat already exists. They should be used with caution.
Chuan Xiong ( Chuanxiong rhizoma), Dan Shen ( Salviae miltiorrhizae radix) and Yu Jin ( Curcumae radix)
These herbs are often selected as assistants to help the chief and deputies to promote blood circulation and remove congealed blood.
Chuan Xiong, Dan Shen and Yu Jin are the commonly used herbs to promote blood circulation. They have high speed and are often called the Qi-moving herbs in the blood. Chuan Xiong is warm and Dan Shen and Yu Jin are cold. Chuan Xiong is able to reach all parts of the body and stop pain; Dan Shen particularly regulates blood circulation of the Heart and relieves chest pain and anxiety; Yu Jin particularly promotes the Liver blood circulation and relieves irritability.
Wu Wei Zi ( Schisandrae fructus), Lian Zi ( Nelumbinis semen) and Long Yan Rou ( Longanae arillus)
These herbs can stabilize the Qi and Yin of the Heart and therefore calm the mind.
Wu Wei Zi is sour and warm, and enters the Heart meridian. It can stabilize the Qi and Yin of the Heart and therefore calm the mind. Because it can strongly enhance the ability of the herbs that tonify the Qi and Yin of the Heart, it is often used as a helping assistant in the formula to treat anxiety, palpitations, restlessness and sweating. However, as this function can cause restless sleep or difficulty falling asleep in some patients, it is better to use it several hours before sleep.
Lian Zi is sweet, astringent and neutral, and enters the Spleen, Kidney and Heart meridians. This herb is able to tonify the Spleen-Qi, Kidney-Qi and Heart-Qi. Its astringent property may stabilize the Qi, essence and fluid. It is often used as assistant in the formula to treat chronic, persistent restlessness, palpitations and anxiety due to weakness of the Heart, Spleen and Kidney.
Long Yan Rou is sweet and warm, and enters the Heart and Spleen meridians. It can tonify the Qi and blood, and is often used as assistant in the formula to treat a chronic condition of restlessness, poor concentration and forgetfulness due to deficiency of Qi and blood of the Spleen and Heart.
In addition, Lian Zi and Long Yan Rou are often used in dietary formulas for strengthening the Heart and Spleen and improving memory.
Sheng Jiang ( Zingiberis rhizoma recens), Da Zao ( Jujubae fructus), Mai Ya ( Hordei fructus germinatus) and Zhi Gan Cao ( Glycyrrhizae radix preparata)
These herbs are often used as assistants in a formula to protect the Middle-Jiao because the herbs that sedate the Heart-shen are heavy and move downwards, can injure the Stomach and Spleen, suppress the Qi in the Middle-Jiao, and cause nausea, fullness or pain of the stomach.
Sheng Jiang can soothe the Stomach-Qi; Da Zao can tonify the Qi and blood. They are often used together to strengthen the function of the Stomach and Spleen and promote digestion, thus protecting the Middle-Jiao from the heavy herbs and minerals.
Mai Ya is able to slightly ascend the Stomach-Qi and promote digestion. It is often used to protect the Stomach-Qi from suppression by the minerals.
Zhi Gan Cao can tonify the Spleen-Qi and moderate the harsh action of the minerals. As it reduces the tension caused by constrained Qi in the Stomach, it is often used to protect the Stomach and Spleen.
Envoy: Harmonize the formula
Zhi Gan Cao ( Glycyrrhizae radix preparata)
As the most commonly used herb, Zhi Gan Cao can integrate the actions and properties of herbs and minerals in a formula.
Examples of classical formulas
An Shen Wan (Pill to Calm the Shen) 
Source: Yi Xue Fa Ming 
Composition
Zhu Sha ( Cinnabaris)* 15 g
Huang Lian ( Coptidis rhizoma) 18 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 16 g
Sheng Di Huang ( Rehmanniae radix) 8 g
Dang Gui ( Angelicae sinensis radix) 6 g
Analysis of the formula
This formula can directly descend Heart-fire and sedate the Heart-shen. It is used for a short period of time to treat acute anxiety caused by sudden uprising of Heart-fire. It can also nourish the Heart-Yin, which is injured by excess fire.
In this formula:
• Zhu Sha is used as chief. It is cold and heavy, enters the Heart meridian, can act powerfully and directly against the excess Heart-fire and sedate the Heart-shen.
• Huang Lian is used as deputy. It is very bitter and cold, and enters the Heart meridian. It can descend Heart-fire, relieve irritability and therefore enhance the ability of Zhu Sha to sedate the Heart-shen.
• The sweet Zhi Gan Cao is also used as deputy. As it moderates and smoothes the Heart-Qi, it stabilizes the function of the Heart-shen and calms the mind.
• Sheng Di Huang and Dang Gui are used as assistants. Sheng Di Huang can nourish the Yin of the Heart and Kidney, which are injured by excess Heart-fire. It can also reduce the fire from the Heart and enhance the ability of Zhu Sha and Huang Lian to sedate the Shen. Dang Gui can tonify the blood, which is also injured by the excess fire. In addition, Dang Gui is used as corrective assistant in the formula to prevent blood stagnation caused by herbs with a cold nature and a downward-moving tendency.
• Zhi Gan Cao also serves as assistant to protect the Stomach from the heaviness of Zhu Sha and the bitterness of Huang Lian.
Commentary on strategies
In this formula, several procedures are carried out to produce a quick and strong action of calming the mind.
• First, all the ingredients enter the Heart meridian and work directly on the Heart.
• Second, a strong mineral substance is used to intensively descend the fire, remove the fire-toxin and sedate the Heart-shen.
• Third, herbs that directly reduce excess fire and empty-fire of the Heart are used to calm the mind.
• Fourth, a large dosage of Zhi Gan Cao is used to smooth Qi movement and moderate the blood circulation, thus reducing tension and calming the mind.
• Finally, the conditions of the Yin and blood are considered in the pathological conditions.
It should be mentioned that processing of Zhu Sha is essential. It is ground with a lot of water, and only the finest powder that floats on the surface of the water is collected. After several repeated grindings and collection, the finest powder is used as a very thin coating on the herbal pills. Since the use of Zhu Sha in any form is forbidden nowadays, it can be substituted by Long Chi ( Mastodi fossilia dentis), Zhen Zhu ( Margarita usta) and Huang Lian ( Coptidis rhizoma); however, the formula is no longer as strong and as quick.
Tian Wang Bu Xin Dan (Emperor of Heaven’s Special Pill to Tonify the Heart) 
Source: She Sheng Mi Pou 
Composition
Sheng Di Huang ( Rehmanniae radix) 120 g
Mai Men Dong ( Ophiopogonis radix) 60 g
Tian Men Dong ( Asparagi radix) 60 g
Xuan Shen ( Scrophulariae radix) 15 g
Dan Shen ( Salviae miltiorrhizae radix) 15 g
Dang Gui ( Angelicae sinensis radix) 60 g
Ren Shen ( Ginseng radix) 15 g
Suan Zao Ren ( Ziziphi spinosae semen) 60 g
Bai Zi Ren ( Platycladi semen) 60 g
Wu Wei Zi ( Schisandrae fructus) 15 g
Fu Ling ( Poria) 15 g
Jie Geng ( Platycodi radix) 15 g
Yuan Zhi ( Polygalae radix) 15 g
Zhu Sha ( Cinnabaris)* (as coating of the pills; see above)
Analysis of the formula
This formula can nourish the Yin of the Heart and calm the mind. It is used for treating restlessness and insomnia due to Heart-Yin and Kidney-Yin deficiency and empty-fire. Besides restlessness and insomnia, symptoms such as palpitations, forgetfulness, mental tiredness, constipation and ulcers in the mouth occur. A red tongue without coating and a thready, rapid pulse are also present.
When all the herbs are used together, the Yin and blood are nourished, the Heart-Qi becomes firm and the mental state is stable again.
Commentary on strategies
In this formula, some features in addition to the points analyzed above are shown.
• A group of herbs that enters both the Heart and Kidney meridians is selected to directly treat the disorders of these two organs; it is formed by Sheng Di Huang, Ren Shen, Yuan Zhi, Fu Ling and Wu Wei Zi.
• A second group of herbs enters the Heart meridian and works directly on the disorder of the Heart; it is formed by Mai Men Dong, Dan Shen, Bai Zi Ren and Zhu Sha.
• The third group works on the Kidney; it is formed by Tian Men Dong and Xuan Shen.
• The final group is composed of sour herbs that are selected for stabilizing the Qi and Yin of the Heart in order to settle the mind; it is formed by Suan Zao Ren and Wu Wei Zi.
All these procedures work together to fulfill the purpose of calming the mind.
Suan Zao Ren Tang (Sour Jujube Decoction) 
Source: Jin Gui Yao Lue 
Composition
Suan Zao Ren ( Ziziphi spinosae semen) 15–18 g
Fu Ling ( Poria) 6 g
Zhi Mu ( Anemarrhenae rhizoma) 6 g
Chuan Xiong ( Chuanxiong rhizoma) 6 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 3 g
Analysis of the formula
This formula can nourish the blood and calm the mind. It is used for treating a chronic condition of palpitations, irritability, restlessness, insomnia, night sweats, dizziness, and dry mouth and throat. The tongue coating is dry and the pulse is thready and wiry. These symptoms and signs are caused by blood deficiency of the Heart and Liver and the Shen of the Heart and the Hun of the Liver are unable reside there firmly.
In this formula:
• Suan Zao Ren is used as chief in a relatively large dosage. It can directly calm the mind and improve sleep. Since its sour taste can nourish and stabilize the Yin and Qi, it can reduce anxiousness, palpitations and night sweats.
• Fu Ling, as deputy, enhances the function of Suan Zao Ren to tonify the Heart-Qi and calm the mind; Zhi Mu, another deputy, enhances the function of Suan Zao Ren to nourish the Yin and reduce heat, which is generated by long-term blood consumption in the Heart and Liver.
• Chuan Xiong is used as assistant. It can activate the blood circulation, which stagnates or has the tendency to stagnate in the condition of disturbance of the Heart-shen. It also brings balance to the formula where many downward-moving herbs are used.
• Zhi Gan Cao serves as assistant as well as envoy to enhance the ability of Fu Ling to tonify the Qi of the Heart. It can moderate and integrate the functions of all the herbs in this formula.
Commentary on strategies
This is a small formula containing only five herbs, but behind the herbs the formula is devised with a profound understanding of the pathology.
• Second, the combination of cold herbs and warm herbs can treat the imbalance between heat and cold in longstanding mental disorders.
• Third, the combination of using downward-moving herbs and upward-moving herbs indicates that it is important to harmonize the conflicted moving tendency of Qi and blood in chronic mental disorders.
In chronic insomnia, disorders of blood deficiency of the Heart and Liver and stagnation of the Qi and blood, as well as empty-heat, often exist in one syndrome. This small formula matches the pathological condition and can therefore bring an effective result in clinical practice.
An Shen Ding Zhi Wan (Calm the Shen and Settle the Will Pill) 
Source: Yi Xue Xin Wu 
Composition
Ren Shen ( Ginseng radix) 6 g
Shi Chang Pu ( Acori graminei rhizoma) 6 g
Yuan Zhi ( Polygalae radix) 6 g
Long Chi ( Mastodi fossilia dentis) 6 g
Fu Ling ( Poria) 9 g
Fu Shen ( Poriae cocos pararadicis) 9 g
Analysis of the formula
This formula can tonify the Qi of the Heart and Kidney, and promote a better connection of these two organs so as to calm the mind. It is used for treating a chronic condition of palpitations, restlessness, dizziness, mental confusion and tiredness due to Qi deficiency of the Heart and Kidney and obstruction of the Heart meridian. A rapid, rootless pulse is often palpable and a pale tongue is often observed.
In this formula:
• Ren Shen is chief. As it tonifies the Qi of the Heart and Kidney, it can calm the Heart-shen and settle the Kidney-zhi. It is used for treating the cause of restlessness and fear.
• The heavy and cold Long Chi is also chief in the formula. Since it enters both the Heart and Kidney meridians, can strongly descend the Qi and reduce heat, it can sedate the Heart-shen and settle the Kidney-zhi. It directly treats the manifestations.
• Fu Shen serves as assistant. It strengthens the Qi of the Heart and enhances the function of Ren Shen. Moreover, it can directly calm the Heart-shen in a gentle and effective way.
• Shi Chang Pu and Yuan Zhi are also used as assistants. They can remove the damp-phlegm that blocks the Heart meridian and thus improve the possibility of reconstructing the relationship between the Heart and Kidney.
• Fu Ling is another assistant. First of all, it enhances the function of Ren Shen and Fu Shen to tonify the Qi of the Heart and calm the Heart-shen. Second, it enhances the function of Long Chi in descending the Qi as it moves downward. Third, it helps Shi Chang Pu and Yuan Zhi to dissolve the dampness.
Commentary on strategies
This formula shows smart composition skill in treating the cause and the manifestations together in sub-acute and chronic conditions of restlessness.
• It is gentle, but steady and effective, and does not have an extreme temperature feature.
• In the formula, the tonifying and sedating substances are used together. Since Fu Ling and Fu Shen bring gentle actions among the strong herbs, the formula has no side effects of increasing restlessness from strong tonification or patients becoming sleepy from strong sedation.
• Upward- and downward-moving herbs are used together with herbs that remove phlegm. They can sufficiently regulate and harmonize the Qi. In this way, the Heart and Kidney are connected in a very balanced way.
This formula is not only a good example for study, but also an effective and commonly used formula in clinical practice.
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| Figure 13.1 •. |
| Heart and Kidney in mental state. |
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| Figure 13.2 •. |
| Liver and Spleen in mental state. |
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| Figure 13.3 •. |
| Lung in mental state. |
