Clinical Experience Introduction of Combined Zao Ren Si Wu Tang in Treating Insomnia

In the book Synopsis of Prescriptions ofthe Golden Chamber: The Pulses, Symptoms and Treatment of Blood-Bi Disease and Consumptive Debility Disease, it says,“Insomnia caused by consumptive debility or vacuity vexation could be treated with SuanZao Ren Tang.”Zao Ren Si Wu Tang is the combination of SuanZao Ren Tang and Si Wu Tang.It supplements the body of the liver, regulates the liverand relieves the urgency, which is a good formula for blood deficiency insomnia. In clinic, insomnia appears to be sleeplessness, full of dream, lightand easily awake sleep. If a patienthas insomnia witha yellow complexion, pale lips and nails, dry-scaly skin, dry-white hair, dizziness and fatigue, it is the so called “liver blood deficiency” in TCM, then ModifiedZao Ren Si Wu Tang can be used. The caseis as follows.

Mr. Zou, 27-year-old, first visit on March 2nd, 2018

Mr. Zou had trouble in sleep for 4 years with symptoms as having difficulty in fallingasleep, full of dream, lightsleep and easy to wake up;thirst with desire to drink, dry eyes and hair, tense and anxious, as well as dry stool like sheep excrement for once a day. Sometimes he had lumbar soreness and was easily fatigued. Appetitewas good. He had a pale-red tongue with thin coating and slow pulse.

Western diagnosis: Sleeping disorder

TCM diagnosis: Sleeplessness (liver blood deficiency)

Principle: ModifiedZao Ren Si Wu Tang to nourish blood, calm the mind, clear heat and eliminate the irritability.

SuanZaoRen 30g, ZhiMu 10g, FuLin 12g, ChuanXiong 12g,ZhiGanCao12g, Shu Di Huang 24g, Dang Gui 12g, Bai Shao 18g, XiaoMai 30g, Da Zao 30g, and WuWeiZi 6g, 7 dosages.

Second visit on March 16th, 2018

After 7-day treatment, lumbago wascured and the spirit wasimproved. The symptoms as dry mouth, dry eyes, dry hair and anxiety werealso improved.Bowel movement became smooth, once a day. Appetitewas good. He had a pale-red tongue with thin coating and slow pulse.The therapeutic methods and the formula continued to be applied, but the dosage of WuWeiZi was increased to 9g, 7 dosages.

Formula analysis: The patienthad thirst with desire to drink, dry eyes and hair, as well as sheep excrement-like dry stool, which appeared to be fluid and blood deficiency. When one has fluid and blood deficiency, then the orifices, hair and stool cannot be moistened and nourished, thus the patient had the symptoms above. Moreover, fluid and blood deficiency can lead to deficient fire harassingspirit, therefore, the patient had difficulty in fallingasleep, full of dreamwithshallow sleep and easy to be anxious.The longer he suffered from poor sleep, the worse fluid and blood deficiency he got, and meanwhile kidney yin was consumed gradually, so, he sometimes had lumbar soreness and easily fatigued. Thus, Zao Ren Si Wu Tang was applicable for this case to nourish blood, calm the spirit, clear heat and tranquilize irritability.

In this formula, a big dose of SuanZaoRen is used as the chief medicinal to nourish blood, supplement the liver, tranquilize the heart and calmthe spirit, for its sweet-sour flavor and moistening characterwhich entersheart and liver meridians. Fu Ling also tranquilizes the heart and calm the spirit.Together with ZhiMu, which is bitter-cold and moistening, asdeputy medicinals to enrich yin and moisten dryness, clear heat and eliminate irritability.The chief medicinal combines the deputy medicinals to reinforce the effect of calming spirit and eliminating irritability. Assistedwith ChuanXiong, which has an acrid flavor and dispersing character, to regulate liver blood and soothe liver qi. The acrid-dispersing ChuanXiong combined with a large amount of sour-astringent SuanZaoRen, gains magical effects ofsupplementing blood, moving blood, nourishing blood and regulating liver.

Si Wu Tang contains 2big dose yin supplementing herbs of Shu Di Huang and Bai Shao. Shu Di Huang, also known as Di Sui, is sweet, slight warm, heavy and soft with yin nature.It specializes in replenishing kidney and supplementing essence, as well as nourishing blood and tonifying yin. Bai Shao combines ZhiGanCao, forming Shao Yao Gan Cao Tang.It supplements fluids and blood, as it has sour and sweet flavors, which transforms and boostsbody yin. What’s more, Dang Guiis sweet andwarm with moistening, acrid-aromatic andmobile characters, which not only supplement blood but also invigorate blood, thus, it harmonizes blood and is an essential medicinal in treating blood disorders.

In order to reinforce the effects of nourishing blood and supplementing fluids of Si Wu SuanZao Ren Tang, we also added Gan Mai Da Zao Tang and WuWeiZi in the formula. Gan Mai Da Zao Tang is sweet and moistening.It supplements blood, promotes body fluid, nourishes theheartand calmthe spirit. Wu Wei Zi, which is sweet and warm, has the effect of supplementing kidney and benefiting yin, as well as tranquilizing heart and calming spirit.