Da Qing Long Tang to treat Insomnia

Clinical case reviewed in 2015 SHL webinar 2 with Dr. Feng

Mr. Lu, 36 years old

1st consultation on November 7th, 2010

The patient had suffered from severe insomnia due family and work related stress for over 6 months. Western medicine doctors diagnosed him with depression. He was administered various western and Chinese medicine such as Suan Zao Ren Liquid, Zhu Sha An Shen Wan, Tian Wang Bu Xin Dan regularly and various blood nourishing, spirit calming, heart tonifying and kidney nourishing decoctions without any effect.

 

Symptoms at consultation: Difficulty in falling asleep, even after taking 2 tablets of Estazolam, he could not sleep more than 2-3 hours, his sleep quality was very light, and on the next day he would feel dizzy and sleepy, whole body fatigue and heaviness, frequent headaches, chest oppression, vexation, his expression was very gloomy and he was struggling to stay focused at work. Thorough inquiry of his symptoms also revealed he often suffered from nasal congestion causing headaches, laryngitis, white and greasy tongue coating which was thick at the root and a wiry, slippery pulse which was floating at the left cun position.

 

Symptom analysis:

  • Nasal congestion, body heaviness and headaches reflect an unresolved Tai Yang Syndrome accompanied by internal dampness retention of the Tai Yin Syndrome.
  • Chest oppression, vexation and difficulty falling asleep reflect the internal heat retention of the Yang Ming Syndrome.
  • The simultaneous occurrence of body heaviness, white and greasy tongue which is thicker at the root and throat inflammation are the result of the internal rheum retention of the Tai Yin Syndrome.

 

Six syndrome: Tai Yang Yang Ming Tai Yin Concurrent Syndrome

Formula pattern: Da Qing Long Jia Jie Geng Yi Yi Bai Jiang Cang Zhu Tang pattern

Ma Huang 18g Gui Zhi 10g Xing Ren 10g
Zhi Gan Cao 6g Da Zao 4 pcs Sheng Jiang 15g
Sheng Shi Gao 45g Sheng Yi Ren 18g Bai Jiang Cao 18g
Jie Geng 10g Cang Zhu 18g

1 day dosage.

He boiled the formula and took it the next day at 9:00am and 4:00pm.

The patient was convinced that due to the chronic nature of the disease, the treatment must include many herbs and combine many formulas, however Dr. Feng explained that Jing Fang offers symptom-correspondent treatment and how modifications have their own limitations, urging the patient to return the next day for consultation.

 

Result: The patient returned the day after taking his medicine on November 9th and as soon as he came through the door he started shouting: “you are truly a gifted doctor, yesterday I slept very deep!”. Further questioning revealed he no longer suffered from headaches, his body felt lighter and his spirit was calmer.

 

Since his nose was still congested and his throat was still painful, despite the improvement of his condition his syndrome had not yet resolved, so he continued taking the same formula with the dosage of Ma Huang reduced to 10g for 1 week. After 2 more weeks of the same formula with symptom-based modifications, the syndrome subsided entirely.

 

Note: This patient did not respond to sedatives and spirit calming medicinals. However he responded very well to Jing Fang treatment, which did not target the sleep disorder or restlessness but rather the presented symptoms.

 

To understand these amazingly fast results, we must analyse the formula pattern according to the Six Syndrome System. Da Qing Long Tang can treat insomnia since the patient presented with the accompanied symptoms fitting the Da Qing Long Tang pattern.

Clause 38: “ Tai yang Zhong feng, if the pulse is floating and tight and there are hot sensations, aversion to cold, body aches, absence of sweating and vexation, Da Qing Long Tang governs. ”

 

《伤寒论》38:太阳中风,脉浮紧,发热恶寒,身疼痛,不汗出而烦躁者,大青龙汤主之。

 

This formula pattern addresses Tai Yang Syndrome with symptoms of aversion to cold, nasal congestion and diffused body heaviness and pains along with Yang Ming Syndrome with internal heat symptoms of insomnia and vexation. Since the patient also suffered from severe throat pain, Jie Geng was added. The added Sheng Yi Ren, Cang Zhu, Bai Jiang Cao addressed the internal rheum retention of the Tai Yin Syndrome. Since the full presentation of the pattern was addressed the patient’s chronic insomnia was successfully resolved.