RESEARCH on TRADITIONAL FORMULAS

BLOOD MANSION FORMULA: Frightful Sleep
by Hu Ji-ming, from“Experience with Decoction for Eliminating Stasis from the Blood Mansion (Xue Fu Zhu Yu Tang) in the Treatment of Frightful Sleep”, The Zhejiang Journal of Traditional Chinese Medicine (Zhejiang Zhongyi Zazhi), #5, 1993

Frightful sleep is characterized by interruptions in the normal course of sleep. During the first phase of sleep, the patient will wake with a scream, sitting bolt upright or falling out of bed. The author has treated this disorder successfully with Decoction for Eliminating Stasis from the Blood Mansion (Xue Fu Zhu Yu Tang) and a representative case history follows.

A 35 year old female was first examined on July 25, 1989. She reported that she would not be asleep for very long before she would suddenly scream and sit up awake with both eyes open wide. This was accompanied by rough respiration and palpitations and tachycardia. The condition would last 10 minutes and then begin to calm down. She would then go back to sleep and the pattern would recur as often as 10 times per night. When she did return to sleep, she rested uneasily as if she were walking on thin ice. Cardiac and neurological examinations revealed nothing abnormal. She had received many therapies previously, including antidepressant medications. However, nothing could control her condition.

When the patient came to see the author, she was restless and had a bitter taste in her mouth. Her pulse was fine and wiry, while her tongue was pale red with a thin, slimy coating. The patient was given Decoction for Eliminating Stasis from the Blood Mansion (Xue Fu Zhu Yu Tang) with additions. This contained: 10g each of Radix Angelicae Sinensis (Dang Gui), Semen Pruni Persicae (Tao Ren), Flos Carthami Tinctorii (Hong Hua), Radix Platycodi Grandi­flori (Jie Geng), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Radix Bupleuri (Chai Hu), Fructus Immaturus Citri Seu Ponciri (Zhi Shi), Rhizoma Ligustici Wallichi (Chuan Xiong), Radix Achyranthis Bidentatae (Niu Xi), Rhizoma Pinelliae Ternatae (Ban Xia), and Caulis In Taeniis Bambusae (Dan Zhu Ru). It also contained: raw Concha Haliotidis (Sheng Jue Ming), 30g, Margaritiferae (Zhen Zhu Mu), 30g, and Pericarpium Citri Reticulatae (Chen Pi), 5g. This was decocted in water and 7 ji were administered.

After this treatment the frequency of the episodes markedly diminished even though she would still wake up suddenly. Nevertheless, she no longer had a frightened expression, her mind became clearer, and she was less obviously anxious. She had some slight soreness and pain in the temporal region, thoracic oppression, vexatious heat in the five hearts, and poor sleep. Her pulse was fine and wiry, and her tongue was red with a thin coating. Therefore, Dang Gui, Platycodon, Caulis In Taeniis Bambusae, and Orange Peel were deleted from the original prescription and raw Radix Rehmanniae (Sheng Di), 10g, Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), 10g, Semen Biotae (Bai Zi Ren) 10g, and Cortex Phellodendri (Chuan Bai), 3g, were added and 7 more ji were administered. At this time, the fright ceased altogether. However, the symptoms returned again in April, 1992. A single dose of the same prescription was administered and this arrested the illness and, up to the present day, it has not returned.

According to Dr. Hu, this illness falls within the scope of fright patterns in Chinese medicine. Typically, gallbladder-warming and heart-nourishing measures are most commonly employed. Heavy use of spirit-calming medicinals is also common based upon the axiom, “If there is fright, level it.” Nonetheless, these approaches had produced little effect in this case. It states in “The Discourse on the True Statements of the Golden Cabinet (Jin Gui Zhen Yen Lun)” in the Su Wen (Simple Questions):

The greenblue hue of the eastern direction enters and unblocks the liver. It opens the portals to the eyes and is stored with the essence in the liver and causes the illness of fright.

“The Discourse on Extraordinary Things (Da Qi Lun)” in the Spiritual Pivot (Ling Shu) states, “When there is an accumulation in the liver, there is fullness in both flanks and lying down causes fright.”

The classical explanation for this illness is typically based on the statement, “The liver stores the hun.” The implications of this statement are that a failure of circulation of the qi and blood in the liver itself, failure of the blood to nourish the liver, or a contraction of a pathogen by the liver may all result in a failure of the liver to store the hun. In the author’s experience, the primary disease mechanism of this illness is a stagnation of qi and blood accompanied by a vacuity of liver blood. The liver itself is yin and utilizes yang. If there is an orderly reaching of the qi and blood of the liver organ, activity and quietude assist one another, yin and yang are in harmony, the blood is effulgent and nourishes the hun, and the spirit is intact and the hun is stored, then how can there be fright?

Therefore, liver is central to a number of disease mechanisms which may produce fright. First, when the qi dynamic fails to course the qi, there is stagnation of liver blood, and when there is blood vacuity, the liver is not nourished. Thus, the liver may directly cause fright. Secondly, the liver has an interior/exterior relationship with the gallbladder. When the liver qi becomes stagnant, this impairs the gallbladder’s capacity for coursing and draining. When there is an insufficiency of liver blood, this often causes an insufficiency of gallbladder qi resulting in fright. Third, there is an intimate connection between the heart and the liver. If there is either a debility or stagnation of liver qi and blood, then the qi and blood cannot ascend to nourish the heart. The spirit is not nourished and protected, resulting in palpitation fright. This is a case of an illness of the mother affecting the son. Fourth, if the liver fails to course and drain the qi and the qi dynamic malfunctions, this causes a loss of proper ascension and descension allowing the liver qi to attack the lungs. Once the lungs lose their function of diffusion and downbearing, this produces difficult respiration, thoracic oppression or pain, and a sense of precordial pressure.

Decoction for Eliminating Stasis from the Blood Mansion (Xue Fu Zhu Yu Tang) was composed by Wang Qing-ren in the Qing dynasty. In his Yi Lin Gao Cuo (Correction of the Errors of the Medical Forest), he states: “When there is nocturnal restless­ness...with throbbing heart and flusteredness, and when Gui Pi (Returning the Spleen [Decoction]) has proven effective, this prescrip­tion (i.e., Xue Fu Zhu Yu Tang) hits the mark one hundred times in one hundred.” In this prescription, raw Rehmannia, Dang Gui, Persica, Carthamus, Red Peony, and Ligusticum to quicken and cool the blood and nourish the blood and yin. Bupleurum, Citrus Immatu­rus, Red Peony, and Licorice are Zhang Zhong-jing’s Four Counterflows Powder (Si Ni San) which enters the liver channel and soothes the qi dynamic of the liver and gallbladder. Platycodon opens the lung qi and smoothes the upper warmer, and Achyranthes guides the blood downward, encouraging the blood stasis to drain from the liver. When these medicinals are all combined, qi and blood are addressed equally, and attack and supplementation are administered simultaneously. This allows the hun to return to the liver and the heart to store the spirit. The gallbladder qi flows, ascension and descension are uninhibited, and fright is cured.

The author has found this prescription quite effective given an appropriate diagnosis. Typically, only 5 ji are necessary to produce a positive result. The additions of raw Abalone Shell and Mother of Pearl enhance the results. If the tongue coating is white and slimy, one may add Pinellia and Orange Peel. If there is vexatious heat in the five hearts, one may add Anemarrhena and Phellodendron. When one tends to awake from sleep easily, Semen Biotae and Salvia may be added.

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