Application of Chaihu plus Longgu Muli Decoction in Treatment of Physical and Mental Diseases

Bochao SU, Yingfeng LIU

Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, China

Abstract Chaihu plus Longgu Muli Decoction is the representative treatment method of harmonizing and releasing combined with easing for lesser yang disease proposed by famous physician Zhang Zhongjing. Through clinical cases, this paper firstly introduced the main framework of Chaihu plus Longgu Muli Decoction, to make the treatment method of harmonizing and releasing become more flexible in clinical application. Besides, it introduced the common changes in the learning and application of the decoction, to respond to various changes in the clinical diseases.

Key words Chaihu plus Longgu Muli Decoction, Harmonizing and releasing combined with easing, Physical and mental diseases, Knowing the unchanging rule to make changes

1 Background of Chaihu plus Longgu Muli Decoction

Initially recorded inTreatiseonFebrileDiseases, written by Zhang Zhongjing, famous physician in East Han Dynasty, Chaihu plus Longgu Muli Decoction has functions of harmonizing and releasing the lesser yang disease, settling fright and tranquilizing, unblocking yang and discharging heat. According to the original text of Article 107, it was used for treating febrile diseases, but was wrongly prescribed, the lesser yang pathogen was not released (chest fullness still existed); instead, there appeared unbalanced triple energizers, inhibited urine, inward invasion of heat evil, and internal harassment of phlegm-heat, such as fright, and delirious speech[1]. Because Chaihu plus Longgu Muli Decoction has functions of removing depression and clearing heat, tranquillizing and dispelling vexation, later generations of doctors used it in exogenous fever and in internal trauma and miscellaneous diseases, especially for some psychiatric disorders[1].

2 Decomposition of the treatment method

In order to make clear the treatment method of Zhang Zhongjing and not lose the efficacy of Chaihu plus Longgu Muli Decoction, and grasp key points of Chaihu plus Longgu Muli Decoction, we divided the ingredients into four groups: (i) Bupleuri Radix, Scutellariae Radix, Pinelliae Rhizoma, Ginseng Radix Et Rhizoma, Zingiberis Rhizoma Recens, and Jujubae Fructus; (ii) Dragon’s Bone, Ostreae Concha, and Red Lead; (iii) Cinnamomi Ramulus and Poria; (iv) Rhei Radix Et Rhizoma. The combinations of functions include harmonizing and releasing the lesser yang disease, settling fright and tranquilizing, moving water to unblock yang, and purging fire and lowering heat. Through the four groups of function combinations, it is easy to know that the key of Chaihu plus Longgu Muli Decoction is based on the harmonizing and releasing the lesser yang and triple energizers, combined with Cinnamomi Ramulus plus Dragon’s Bone and Ostreae Concha Decoction to pericardium derangement. Thus, dispersing qi movement and tranquilizing by heavy settling are unique points of Chaihu plus Longgu Muli Decoction. Professor Liu Yingfeng summarized the experience of famous expert Chen Ruichun: Chaihu plus Longgu Muli Decoction is a best choice for treatment of patients with lesser yang and reverting yin combined with depression and hyperactivity.

In our opinion, to flexibly use Chaihu plus Longgu Muli Decoction, it is necessary to deal with the organically unified relationship between “dispersing qi and removing depression” and “tranquilizing by heavy settling”. Bupleuri Radix, Scutellariae Radix, Pinelliae Rhizoma and Dragonds Bone, Ostreae Concha are core framework of Chaihu plus Longgu Muli Decoction. The drug dose is adjusted according to the degree of “depression” and “hyperactivity”, to achieve the objective of making clear key points (highlighting the dispersing qi or focusing on tranquilizing). For patients with serious depression and qi stagnation, the the dose of Bupleuri Radix could be increased, combined with drugs for dispersing qi such as Curcumae Radix, Albiziae Cortex, and Toosendan Fructus; for patients with serious fright and vexation, it is recommended to increase the dose of Dragon’s Bone and Ostreae Concha, and add Margaritifera Concha, Magnetitum, and Iron Chippings (because Red Lead is poisonous and often replaced with the above mentioned drugs)[1]; for patients with miscellaneous diseases combined with serious phlegm-heat, it is recommended to use Pinelliae Rhizoma and Scutellariae Radix, supplemented with Wendan Decoction to achieve the optimum effect. Other drugs in the original prescription can be added or subtracted according to specific conditions. For patients with fluid retention syndrome and heavy body and palpitations, it is able to add Poria and Cinnamomi Ramulus; for patients with vexation due to fire counterflow, it is able to add Rhei Radix Et Rhizoma. If no the above symptoms, the mentioned drugs can be omitted. In this way, it still conforms to the overall purpose of harmonizing and releasing combined with easing, and not lose its gist.

3 Representative examples

In this paper, we listed two representative clinical cases and analyzed the unique treatment method of Chaihu plus Longgu Muli Decoction.

3.1 Case of insomnia due to depression and vexation: routine treatment, learning the method and using the drugsMs. Fan, 56 years old, complained about more than 10 years of insomnia, easily occurred in the event of worry or angry. The patient frowned all the time and spoke in a hurry, and said that she took drugs intermittently. And after taking drugs, the insomnia could be alleviated. Three years ago, she was unable to fall asleep because she was anxious and angry. During the two years of taking western medicine, she could fall asleep but had more dreams. Later, she discontinued taking medicine due to the obvious stomach pain caused by taking western medicine. In these days, she fell asleep with troubled thoughts, but anxiety and aggravation worsened, the next day, she had poor spirit, dizziness, pain around the eyes; poor appetite, sometimes bitter in mouth, liked to eat vegetarian foods but not liked meats, hard to defecate, hands and feet were hot at night and needed to be rinsed with cold water to alleviate, while the hands and feet were cold during the day. Tongue fur was light red and thick, the pulse was thin, sunk in the left and taut in the right. Diagnosis: yin deficiency with hot body, seriously disturbed by qi stagnation with serious phlegm-heat. Proposed prescription: Chaihu plus Longgu Muli Decoction + Modified Baihe Zhimu Decoction: 10 g of Bupleuri Radix, 10 g of Scutellariae Radix, 20 g of Dragon’s Bone (decocted firstly), 20 g of Ostreae Concha (decocted firstly), 15 g of Pinelliae Rhizoma, 10 g of Aurantii Fructus, 15 g of Bambusae Caulis In Taenias, 15 g of Cannabis Fructus, 10 g of Anemarrhenae Rhizoma, 10 g of Rehmanniae Radix, 10 g of Paeoniae Radix Alba, and 6 g of Glycyrrhizae Radix Et Rhizoma Praeparata Cum Melle, 14 kinds of medicines, taking after decocting, modified properly, and the sleep gradually became better.

Notes: the patient always frowned and the symptoms appeared in the event of anxiety and angry, poor appetite, not liked to eat meats, bitter in the mouth, vexed, bloating, hard stool, string like pulse, slimy tongue fur, liver and gallbladder depressed with heat, combined with yang brightness, phlegm-dampness. In the next day, the patient felt dizziness, pulse was sunk in the left, indicating that weak upbearing and effusion of liver and gallbladder. Such kind of disease should be treated with Bupleuri Radix to raise qi combined with Scutellariae Radix to outthrust pathogenic heat, and Pinelliae Rhizoma, Aurantii Fructus, and Bambusae Caulis In Taenias to regulate qi and resolve phlegm and remove dampness. Besides, because the patient was not able to sleep, and could not help stopping vexing, this is the syndrome of yang not moving to yin and spirit and soul not kept, it is required to use Dragon’s Bone and Ostreae Concha to secure and tranquilize the soul. The above two symptoms obviously conform to the treatment method of Chaihu plus Longgu Muli Decoction. The method of regulating qi and tranquilizing is clear. In addition, the patient was in the menopause, vexation, mucous stool, hot hands and feet during night, thin pulse, yin deficiency, so we added Cannabis Fructus, Anemarrhenae Rhizoma, Rehmanniae Radix, Paeoniae Radix Alba, and Glycyrrhizae Radix Et Rhizoma Praeparata Cum Melle to nourish yin and clear heat, and moisten the stool. This case is the routine method of Chaihu plus Longgu Muli Decoction. Beginners could understand the rules through a brief analysis.

3.2 Neurasthenia and fear: flexible application of the treatment method, not adhering rigidly to medicinesMr. Jin, middle-aged, dark face, rapid speech. 17 years ago, his parents frequently quarreled. As a result, he always felt not safe. At that time, the pressure of college entrance examination was high, so he suffered neurasthenia and sometimes felt not comfortable in the whole body. However, after diarrhoea, he felt comfortable. He had taken many kinds of traditional Chinese medicines, but the efficacy was not satisfactory. In recent three months, due to death of family member, he was very anxious, fear death, and had the feeling of soul separating his body. He felt his back was paralyzed and obstructed, which was not connected with weather changes. Besides, he was sleepless. Sometimes, he felt bitter in the mouth, the appetite was poor, had sense of obstruction in stomach duct. The stool was little and hard. Through examination, there was hyperplasia on the throat wall. The tongue nature was dark and tongue fur was white and slimy, the pulse was slippery, slightly thin in the left and strong in the right. Diagnosis: blood depletion, qi movement was not smooth, phlegm-dampness, depressed with heat, disturbing the spirit. The proposed prescription was Changyu Wendan Decoction with reference to the method of Chaihu plus Longgu Muli Decoction: 10 g of Acori Tatarinowii Rhizoma, 20 g of Curcumae Radix, 15 g of Dragon’s Bone (firstly decocted), 15 g of Ostreae Concha, 15 g of Bambusae Caulis In Taenias, 15 g of Aurantii Fructus, 10 g of Citri Reticulatae Pericarpium, 15 g of Poria, 10 g of Forsythiae Fructus, 10 g of Moutan Cortex, 15 g of Arisaema Cum Bile, and 10 g of Polygoni Cuspidati Rhizoma Et Radix, 14 kinds of medicines, taking after decocting. After taking medicine: the symptoms of the body impediment and sunk, anxiety and fear reduced half, stool was smooth, 3-4 times of stool, fecal qi became more, sleep became better, and tongue fur became thinner. We kept the above prescription and deleted Polygoni Cuspidati Rhizoma Et Radix, the patient took 20 doses in total. Later, the patient continued taking the medicines to strengthen the blood nourishment. Three months later, the symptoms changed better.

Notes: at first glance of the prescription for this case, readers may think Chaihu plus Longgu Muli Decoction. But after detailed analysis of the reasons and mechanism, we could see the flexible application of treatment method of Chaihu plus Longgu Muli Decoction. The patient always speak rapidly. He suffered neurasthenia, the pulse was thin in the left, belonging to liver blood deficiency and easy angry physique. In insecure environment, he was often anxious, which occurred at the death of a loved family member, poor appetite, obstruction in stomach duct, little and hard stool, sometimes bitter in the mouth, string-like pulse. All these symptoms belong to liver and gallbladder depressed with qi stagnation, it is required to regulate qi to resolve liver depression. Bupleuri Radix may raise and deteriorate qi movement, so we used Curcumae Radix to regulate qi and dispel yin dampness heat. In addition, the patient often thought without specific theme, got sleepless, and had sense of soul separating his body, thus we used Dragon’s Bone and Ostreae Concha to secure and tranquilize the soul. In this way, the prescription prepared with reference to Chaihu plus Longgu Muli Decoction reflects the flexible application. For the poor sleep, obstruction in stomach and duct, hard stool, and obstructed body movement, follicular throat, slippery pulse, white and thick and slimy tongue fur. All these symptoms were resulted from phlegm-dampness. Thus, we used Wendan Decoction with addition of Forsythiae Fructus and Moutan Cortex to resolve and eliminate dampness and obstruction.

4 Conclusions

Through the cases of routine and flexible application of Chaihu plus Longgu Muli Decoction in clinics, we should make clear the main framework of treatment prescription, grasp the soul and gist. Many prescription and medicines are made or prepared in specific condition and time, the efficacy is specific, we should make a deep exploration. Instead, we should not separate from the actual realities, and should not be rigid to the original prescription and medicines. We should make flexible changes, to respond to various changes in clinical diseases.

This paper has been published in Issue 9 ofJiangxiJournalofTraditionalChineseMedicine, 2019 (in Chinese).