Ms. Wei, 56 years old

1st consult, October 10th, 2013

The patient suffered from depression and nervousness episodes for 3 years, which disrupted her sleep and worsened over the month prior to consultation. Western medicine diagnosed her with severe depression, prescribing her with Zopiclone and other sleeping medication, however even with the medication she could only sleep lightly for about 2 hours, waking up 12 times a night, with fever and sweat. She had an aversion to wind and cold, left-sided headaches, toothache, vexation, dry mouth, bitter taste, palpitations, borborygmus, fatigue, coldness in both calves, poor appetite, over the 3 year period she had lost more than 30 pounds, regular stools, pink tongue with white coating which was greasy at the root and a wiry pulse.

Six syndrome: Tai yang Shao yang Yang ming Tai yin concurrent

Formula pattern: Chai Hu Jia Long Gu Mu Li Qu Da Huang Qian Dan Jia Hua Fen Yuan Zhi Chang Pu Tang pattern

2nd consult, October 17th, 2013: After one week of the formula, her sleep improved significantly and she had stopped taking sleeping medication. She could sleep 5-6 hours a night, her tinnitus reduced and she no longer suffered from cold feet or bitter taste.

However she still had palpitations, dry mouth, left-sided migraines, frequent urination, nocturia 1-2 times a night, red tongue with white coating which was greasy at the root and a thready pulse. She was prescribed the same formula with the addition of Cang Zhu 15g and Jiang Ban Xia was raised to 30g.

3rd consult, October 31st, 2013: Her sleep was regular, the palpitations reduced, the dry mouth subsided, nocturia once a night, no evident frequent urination, the migraines have alleviated, a tingling sensation in the occipital region, low appetite, a subjective burning sensation in the tongue, which was evidently worse at night, no sweating, pale tongue with a white, greasy coating and a thready pulse. She was prescribed the same formula with Jiang Ban Xia substituted for Qing Ban Xia 15g, Bai Shao 10g, Wu Zhu Yu 10g and Sheng Shi Gao 45g.

Result: In a follow up consultation, the patient said she continued taking the formula for another week until her syndrome resolved completely.

Analysis: The symptoms of aversion to wind and cold, fever, sweating and headaches, all indicate a Tai yang exterior syndrome.

Tinnitus can occur either due to Shao yang stagnated heat or water qi surging upwards, when combined with poor appetite, toothaches, irritability, dry mouth and bitter taste, these symptoms fit a Chai Hu Jia Long Gu Mu Li Tang pattern.

Fatigue, cold calves and palpitation signify a Tai yang Tai yin concurrent exterior pathogens with internal rheum syndrome, fitting a Ling Gui Zhu Gan Tang pattern.

Analysis:   Insomnia, anxiety, depression, fever and sweating mark a Gui Zhi Gan Cao Long Gu Mu Li Tang pattern. Hua Fen was added to clear Yang ming heat and resolve thirst.

Chang Pu and Yuan Zhi were added to calm the spirit, stabilize the mind and resolve depression.

We can see that the full presentation of symptoms and so the presented formula pattern was Chai Hu jia Long Gu Mu Li qu Da Huang Qian Dan jia Hua Fen Yuan Zhi Chang Pu Tang pattern.

The patient was advised to stop taking western drugs for 2 main reasons, the first being to avoid drug interactions and reduce the effect of the formula and the second being to avoid the multiple side effects.

On the 2nd consult her symptoms improved greatly, proving the accuracy of the diagnosis. She still suffered from palpitations, dry mouth and frequent urination, meaning there were still abundant rheums causing qi to rush upwards, therefore Cang Zhu was added to expel dampness due to the obvious Tai yin syndrome. When combined with the headache, we can deduce there was still an unresolved exterior pathogen, which is why Ling Gui Zhu Gan Tang was added to resolve the exterior and transform fluids. The dosage of Ban Xia was increased to strengthen the reversal descending and rheum transforming functions.

On the 3rd consult all of her symptoms reduced however she still suffered from headaches. Stubborn migraines mostly fall under the category of external pathogens with internal rheum, which in turn rush upwards, therefore Bai Shao was added. When coupled with Gui Zhi, they can resolve exterior syndromes as well as harmonize ying-wei.

Wu Zhu Yu was added to warm and transform cold rheum and Sheng Shi Gao was added to clear Yang ming heat and simultaneously counter the hot properties of Wu Zhu Yu. Based on their opposite temperatures, prof. Hu often prescribed Wu Zhu Yu and Sheng Shi Gao together when treating persistent headaches and migraines with great clinical results when the cause is a Tai yin Yang ming concurrent syndrome.

Clause 107: “Shang han for 8-9 days, after purgation was applied, if there is chest fullness, vexation, inhibited urination, delirious speech, diffused heaviness of the body with an inability to turn over in bed, Chai Hu Jia Long Gu Mu Li Tang governs.”

第107条：伤寒八九日，下之，胸满、烦惊、小便不利、谵语、一身尽重、不可转侧者，柴胡加龙骨牡蛎汤主之。

If a shang han pattern lasts for 8-9 days, it has already progressed to a Shao yang syndrome. If the doctor has erroneously applied purgation therapy, it will cause symptoms such as chest fullness, as the Chai Hu pattern had not yet resolved.

Since there is an internal phlegm and heat binding, there will be vexation and inhibited urination. Abdominal discomfort and delirious speech are the result of pathogenic heat affecting the spirit.

Because there is abundant water qi in the exterior, namely pathogens in the exterior and rheum in the interior, there will be whole body heaviness and an inability to turn over in bed.

This formula can treat Xiao Chai Hu Tang Qu Gan Cao patterns by reinforcing the immunity, expelling pathogens, harmonizing and clearing heat. Gui Zhi is added to descend up surge, Fu Ling can promote fluid circulation, Da Huang clears by purging, Long Gu, Mu Li and Qian Dan calm the mind and spirit, therefore designating this formula to treat Xiao Chai Hu Tang patterns with upsurge of qi causing palpitations, unsmooth defecation, vexation, fright and restlessness.

This pattern is classified as a Tai yang Shao yang Yang ming Tai yin concurrent syndrome. Since the indications include “vexation, fright and delirious speech”, this formula can be used freely to treat restlessness, anxiety, epilepsy and similar depressive disorders. We often add Cang Zhu or Ling Gui Zhu Gan Tang in case of a simultaneous external pathogen and internal rheum pattern; or Da Huang and Sheng Shi Gao in case of a Yang ming internal excess.

Many patients with depression, anxiety and neurosis are often prescribed western medicine without any effect, sleeping only 2 -3 hours a night. After only taking 7 packs of the formula, the patient demonstrated significant improvement, showing its true value. However, this does not designate this formula as a dedicated “depression treating formula”, the key to its efficacy lies in understanding the Jing Fang diagnostic of the Six syndrome system.

Relying on the academic notions of prof. Hu, we have inherited the following: “Chinese medicine diagnosis and treatment mainly emphasizes to promote the body’s natural defense against diseases, while Jing Fang targets diseases through diagnosis the affected syndromes. When there are symptoms, there is a corresponding formula; where there are symptoms, there are corresponding medicinals.”