Dr. Féng Xué-Gōng
Case taken from ‘Forum on Classical Formulas from Throughout the Country’ (全国经方论坛)
A seventy-one year old
female was first seen on June 24, 2010 suffering with insomnia for over forty
years, which has been quite severe over the last 3 years. When the condition
had first started many years ago, she never paid much attention to it or
received any kind of treatments. Over the last three years the insomnia has
gotten quite bad. She has great
difficulty falling asleep, and although she typically goes to bed around nine
o’clock every night, she doesn’t actually fall asleep until at least midnight
or one o’clock. Her sleep is very short,
and she wakes very easily. If she takes a sleeping pill, she is able to sleep
up to three or four hours. In addition, she experiences heart vexation, and has
two to three dry bowel movements per day.
Her appetite is good and urination is normal. Tongue is pale red with a white coat, and
pulse is wiry.
In my experience, cases of
insomnia accompanied by heart vexation are typically due to Shào Yáng depressed
heat, and are treated as such.
Formula:
A modified version of Chái
Hú Jiā Lóng Gǔ Mǔ Lì Tāng (Bupleurum plus Dragon Bone and Oyster Shell
Decoction)
chái hú (Bupleuri Radix)
12g
guì zhī (Cinnamomi Ramulus)
10g
huáng qín (Scutellariae
Radix) 10g
dǎng shēn (Codonopsis
Radix) 10g
bàn xià (Pinelliae Rhizoma
preparatum) 12g
fú líng (Poria) 30g
dà huáng (Rhei Radix et
Rhizoma) 10g
shēng lóng gǔ (Fossilia
Ossis Mastodi) 30g
shēng mǔ lì (Ostreae
Concha) 30g
hé huān pí (Albizziae
Cortex) 30g
zhì gān cǎo (Glycyrrhizae
Radix preparata) 6g
shēng jiāng (Zingiberis
Rhizoma recens) 10g
dà zǎo (Jujubae Fructus)
10g
Follow up on July 1, 2010: After
taking the seven packages, none of her symptoms improved and she was still experiencing
insomnia. Her tongue was pale red with a white coat, and the pulse was (still)
wiry.
Since this woman was older,
and had been suffering from insomnia for many years, I tried treating her from
the perspective of a kidney yáng insufficiency with ministerial fire being unable
to return to its residence.
Formula:
shā rén (Amomi fructus) 15g
guī bǎn (Tortoise plastron)
10g
huáng bǎi (Phellodendri
Cortex) 10g
ròu guì (Cinnamomi Cortex)
6g
shēng lóng gǔ (Fossilia
Ossis Mastodi) 30g
shēng mǔ lì (Ostreae
Concha) 30g
fú líng (Poria) 30g
zhì gān cǎo (Glycyrrhizae
Radix preparata) 6g
Seven packages were administered,
and to be cooked as a water decoction, taking one pack per day.
Third consultation on July 8, 2010: Her insomnia was definitely improving, as she was
now able to fall asleep easier, wasn’t waking up easily, and was also able to
avoid taking any sleeping pills. Tongue was pale red with a white coat, and
pulse was wiry.
The strategy of warming the
yáng was effective so this is where the emphasis would remain. To the previous formula (July 1st),
ròu guì was increased to 10g, and 30g of cí shí was added. She was given fourteen
more packages, to be cooked as a water decoction, taking one pack per day.
Fourth consultation on July 22, 2010: The insomnia had now clearly improved, and she
completely stopped taking any kind of sleeping pills. It now took her only ten
minutes to fall asleep; she was not waking easily, and slept for five hour
stretches at a time. Her bowel movements were now much easier occurring once
per day. Her tongue was pale red, and her pulse was wiry. To her previous
formula páo fù zǐ was increased to 15g and the other medicinals were left as
is. She was given another fourteen packages.
Commentary: In clinical practice, insomnia
is typically diagnosed and treated as either a yīn-blood insufficiency, heart
spirit deprived of nourishment, internal brewing of fire, or hyperactivity of
the heart spirit, and is rarely identified and treated as yáng vacuity. In
actual fact, yáng vacuity insomnia is very common, and many cases are due to
yáng vacuity insecurity with ministerial fire being unable to return to its
residence and producing false heat, which can be erroneously regarded as true
heat. This case clearly exemplifies this concept.
Qián Yáng Dān (Yáng
Descending Elixir) is a fire spirit school formula created by Zhèng Qīn-Ān. It
contains shā rén (Amomi
fructus), páo fù zǐ (Aconiti Radix lateralis tosta), guī
bǎn (Tortoise plastron), and gān cǎo (Glycyrrhizae Radix). Fēng Suǐ
Dān (Marrow Sealing Elixir) is a formula from the Golden Mirror of Medicine (医宗金鉴), which
contains huáng bǎi (Phellodendri Cortex), shā rén (Amomi fructus), and gān cǎo
(Glycyrrhizae Radix). In clinical practice when treating floating and ascending
vacuous yáng, master Zhèng would commonly combine these two formulas, achieving
miraculous results. Later generations of physicians commonly utilized master
Zhèngs methods, including Wú Péi-Héng (吴佩衡) from Yúnnán province, who renamed the combination of these two formulas
Qián Yáng Fēng Suǐ Dān (Yáng Descending Marrow Sealing Elixir). Within the
formula Zhèng Qīn-Ān believed that guī bǎn was able to generate the essence
within water, not for the purpose of nourishing yīn, but for freeing yīn in
order to assist yáng. Shā rén is generally thought of as a medicinal, that moves
qì, transforms turbidity, and harmonizes the stomach. However, in the Běn Cǎo it is said to be able
to absorb qì and return it to the kidneys thereby treating and guiding qì,
which is unable to return to its source.
This patients’ insomnia had
lasted for many years, and was first treated as a pattern of Shào Yáng
depressed heat but with no effect. After some contemplation, I figured due to
the patients’ age, and the fact that this was an enduring disease, there (must
have) initially (been) a yīn vacuity, which eventually affected the yáng. Moreover, all enduring conditions (eventually)
reach the kidneys. With kidney yáng insufficiency, (the kidneys) lose their ability
to secure and contain, which then leaves the ministerial fire unable to return
to its residence; floating yáng will then ascend disturbing the heart spirit resulting
in insomnia. Therefore, the root of the insomnia here lies in yáng vacuity.
After using Qián Yáng Fēng Suǐ Dān (Yáng Descending Marrow Sealing Elixir),
vacuous fire is able to descend, ministerial fire will return to its residence,
and the heart spirit will be tranquil, thereby eliminating insomnia. This case
illustrates the importance of paying close attention to recognizing yáng
vacuity insomnia and serves to increase and improve our overall clinical
efficacy.
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