Author: Deng Tietao

 Ganmai Dazao Tang is a formula from the book "Golden Chamber" of the Han Dynasty. It is composed of licorice, wheat, and jujube. It can treat women's internal irritability, sadness, crying, and yawning as if they were impacted by spirits. Because the formula is old, simple, and it is composed of ingredients are people consume in daily life, some people doubt its efficacy. But I think it is a good formula that is effective, convenient, and cheap. According to clinical experience, this formula is not only effective for women's internal irritability, but also for men, women, old and young (such as children crying at night).

In addition to using this formula to treat internal irritability and insomnia caused by insufficient heart and spleen, I often like to use this formula or combine it with other formulas for some special conditions that are not easy to explain with general syndrome differentiation theory and have symptoms of heart and spleen deficiency. From the perspective of Western medicine diagnosis, this formula has a certain effect on neurosis. Here are a few case studies to illustrate this.

1. Zangzao

Before the founding of New China, I treated a woman who said that she saw something scary, had palpitations and panic, and wanted someone to accompany her all day. Her face was blue, her tongue color was normal, and her pulse was stringy. She was treated with Ganmai Dazao Decoction and recovered after two doses.

In 1968, I treated a female cadre who had palpitations and panic. One night, her family went out and she sat in the corridor and did not dare to return to her room. Her tongue was tender and white, and her pulse was weak. Prescription: 9 grams of licorice, 5 jujubes, 1 tablespoon of flour (cooked and taken). She recovered after one dose.

Regarding the pathology of Zangzao, it cannot be explained as uterine blood deficiency as general commentators do. Some scholars believe that the cause of Zangzao is mostly due to emotional depression or excessive thinking, which leads to damage to the heart and spleen and insufficient Zangyin, which is more reasonable. After the preparation method of Ganmai Dazao Decoction in "Golden Chamber", there is a sentence "It also replenishes the spleen qi". Some commentators believe that it was added by later generations and advocate deletion. This consideration seems to be out of practice. The heart governs the mind, and sadness and crying are like the work of the spirits. This is because the disease is related to the heart. However, the heart and spleen are closely related. The emotional diseases treated by Ganmai Dazao Decoction often have symptoms of spleen deficiency. Licorice, wheat, and jujube do have the effect of nourishing the heart and spleen.

2. Insomnia

The patient is a 42-year-old male. Due to mental stimulation, he could not fall asleep for five consecutive days and nights, and then he felt dizzy and had a headache. He continued to suffer from insomnia (he only slept for about three hours every night after taking sleeping pills). He has been ill for three months and has not been cured after hospitalization. The tongue quality is normal, the tongue coating is white and moist, the pulse is stringy and slippery, and the blood pressure is 21.5/15.5kPa.

Prescription: 15 grams of floating wheat, 3 grams of licorice, 24 grams of cooked jujube kernel, 15 grams of Poria, 9 grams of French Pinellia, 4.5 grams of orange peel, 10 grams of bamboo shavings, and 30 grams of magnetite (cook first). After taking six doses of medicine (one dose of medicine was decocted twice for two days), blood pressure dropped to 21/10, 5kPa, and sleep was normal.

This syndrome is caused by liver depression and hyperactivity of liver yang, high blood pressure and dizziness and headache. However, the cause of the disease is mental stimulation, and the main symptom is insomnia, so Ganmai Dazao Decoction with cooked jujube kernel is used to nourish the heart and spleen and treat insomnia. White and moist tongue coating and stringy and slippery pulse indicate phlegm, so Yunling, Banxia, Tangerine peel, and Zhuru are used to remove phlegm; ochre and stone cassia are used to calm the liver. It is not suitable to use licorice for hypertension, so only 3 grams is used, and cooked jujube kernel is added as an auxiliary.

3. Vertigo

Patient, female, worker, 38 years old. Two years ago, she felt dizzy and had poor sleep, sore and weak lower limbs, good appetite, and normal bowel movements. After getting sick, she repeatedly used methods such as replenishing qi and blood, nourishing the liver and suppressing yang, removing phlegm and calming wind, and warming and nourishing to treat the disease, but to no avail. When she came to the clinic, the symptoms worsened, the dizziness continued, and she dared not go out. If she walked about 60 to 70 meters to 100 meters, the dizziness would worsen, and she had to sit down and rest for a while before she could continue walking. The dizziness was not rotational, there was no nausea, vomiting, tinnitus. Patient sometimes felt numbness in the head. In addition, she sweated on her back, felt cold on her back after sweating, and had insomnia and many dreams. Her appetite was average, her bowel movements were normal, her menstruation was on time but small, and she had waist and abdominal pain before and after her menstruation. Her complexion was normal, her lips were normal, her tongue tip was red, her tongue coating was white and slightly dry, and her pulse was slightly floating. Examination: normal body temperature, normal blood pressure, normal hearing, no abnormalities in blood count and urine routine, and normal heart and lung X-ray chest radiography.

From the syndrome differentiation, dizziness, insomnia, dreaminess, and stringy pulse, which is the so-called "all wind-induced dizziness, all belong to the liver", seem to be dizziness caused by internal liver wind, but the prescriptions and medicines such as nourishing the liver and suppressing yang, and stopping wind are ineffective. It can be seen that although this disease is related to the liver, it is not the main aspect of the contradiction. According to the fact that she gets dizzy every time she walks a little farther, and can get up after resting, it is closely related to her mind, so I gave Ganmai Dazao Decoction with a little liver-soothing and spleen-strengthening herbs.

Prescription: 9 grams of licorice, 24 grams of malt, 3 jujubes, 15 grams of Uncaria rhynchophylla, 6 grams of jasmine flowers, 9 grams of lentil flowers, and 12 grams of Poria. 2 doses. Uncaria rhynchophylla and jasmine flowers soothe the liver to treat flank pain, and malt also has the effect of soothing the liver, so malt is used instead of wheat.

Second visit: The symptoms are roughly the same as before, chest and flank pain has been eliminated. Patient had abdominal pain, the tongue is red, the tongue coating is white and moist, and the pulse is stringy. The prescription was changed to: 9 grams of licorice, 6 jujubes, 12 grams of white peony, 12 grams of malt, and 1 spoon of flour (taken with water). After taking 3 doses, the dizziness was greatly relieved. Later, Ganmai Dazao Decoction was added with dragon bone, oyster or glutinous rice root, white peony, and Polygonum multiflorum to nourish the liver and kidney, or with ginseng and Atractylodes to strengthen the spleen. It was cured after four months of treatment and has not recurred in four years of follow-up.

4. Pregnancy headache

The patient, female, 36 years old. She was already 3 months pregnant, with symptoms of headache, restless pulsation of blood vessels in the head, dizziness, palpitations, numbness of hands and feet, insomnia, occasional pain in the left rib, aversion to wind and cold, decreased appetite, and loose stools. After examination by the neurology department, no abnormal signs were found and it was diagnosed as neurosis. The patient had a heavy mental burden and could not work or do housework. The patient's complexion and lip color were normal, the tongue was tender and the coating was thin and white, and the pulse was stringy. The treatment method is to nourish the heart and spleen, and harmonize the liver and gallbladder, using Ganmai Dazao Decoction combined with Wendan Decoction.

Prescription: 9 grams of licorice, 30 grams of floating wheat, 3 jujubes, 9 grams of bamboo shavings, 4-5 grams of Citrus aurantium, 4-5 grams of orange peel, 4-5 grams of French Pinellia, and 9 grams of Poria. After 3 doses, all symptoms improved, palpitations and heart palpitations decreased, the pulse string decreased and the inch pulse was slightly weak. According to the above, remove the French Pinellia and add 12 grams of Radix Pseudostellariae to replenish qi. After taking 15 doses, the spirit improved, sleep was good, appetite increased, forehead and back of the head still had occasional pain, sometimes forehead and back of the head were itchy, and felt comfortable when it itched. The pulsation of blood vessels in the head was greatly reduced, the heart was not panicked, the hands and feet were not numb, and the left side still had occasional pain at night. Take it according to the above for one month, and it has been basically cured. In order to completely cure and consolidate the therapeutic effect, continue to nourish the heart and spleen as the main treatment and slightly nourish the liver as the auxiliary treatment. Use Ganmai Dazao Decoction combined with Sijunzi Decoction with jujube seeds and Shouwu, or remove Baizhu (in case of constipation) and add glutinous rice root. Take one dose a day or every other day, and take the medicine for another two months. After that, a baby was born.

5. Joint pain

The patient, female, 45 years old, cadre. She suffered from pain in the left wrist joint in July 1973. She was afraid of wind. The whole body ached when the wind blew, especially the shoulder joint. It further developed into pain in large and small joints and difficulty walking. By 1975, in addition to joint pain, the skin of the whole body felt like ants crawling, painful and numb, restless, uncomfortable all day, and panic. The antistreptococcal hemolysin "O" and erythrocyte sedimentation rate were normal. She came to the clinic in September 1975. The symptoms were as mentioned above, the tongue was dark, the tongue coating was white and thin, and the pulse was thin. The treatment was Ganmai Dazao Decoction combined with Yupingfeng Powder.

Prescription: 9 grams of licorice, 6 jujubes, 1 spoon of flour (cooked), 12 grams of Astragalus, 4-5 grams of Saposhnikovia divaricata, and 15 grams of Atractylodes macrocephala. Because she was afraid of wind and felt severe pain when the wind blew, in addition to using Ganmai Dazao Decoction to nourish the heart and spleen, Yupingfeng Powder was also used to consolidate the exterior. A total of 60 doses of medicine were taken. On December 5, 1975, the patient was diagnosed again. The crawling ant-like feeling had disappeared, but there was still wandering skin pain, and there was mild pain in the joints. The patient was still afraid of wind and cold, with a dark tongue, thin white fur, and a thin and slightly astringent pulse. 30 grams of Millettia reticulata was added to the above formula to nourish blood and calm wind. A total of more than 50 doses were taken. After taking the medicine, the patient sometimes felt that there was wind coming out of the skin, and the disease was basically cured. Continue to take the previous medicine for 10 doses to follow up, and there was no recurrence after more than a year of follow-up.

6. Spontaneous sweating

The patient was a 42-year-old male officer. Symptoms included spontaneous sweating, aversion to wind and cold, cold sweating when the wind blew, palpitations and fatigue, dizziness, sore waist and legs, abdominal distension, poor appetite, short and yellow urine, and constipation. The patient had been ill for a year and was admitted to the military hospital. He was diagnosed with autonomic dysfunction. The tongue was slightly red, the coating was white, the pulse was stringy, and the Cun pulse on both sides was weak. The treatment was Ganmai Dazao Decoction with added ingredients.

Prescription: 45g floating wheat, 9g licorice, 4 jujubes, 30g glutinous rice root, 12g astragalus, 15g Pseudostellariae Radix, 15g Poria, 15g white peony. Take 20 doses of the above prescription. When the patient was re-examined, all symptoms improved, the patient's aversion to wind and sweating were less, his spirit and physical strength improved, his tongue was red with tooth marks, his tongue coating was slightly thick, his pulse was weak at the two Cun spots, and his pulse was slightly stringy at the Guan and Chi. Add 6g of Atractylodes macrocephala to the above prescription. After taking seven doses, except for a small amount of sweating in the face of wind and poor sleep, all other symptoms disappeared. Take another 15 doses of the prescription and he recovered. There was no recurrence after two and a half years of follow-up.

This disease is characterized by spontaneous sweating as the main symptom. Sweat is the fluid of the heart. Palpitations, abdominal distension, and poor appetite are all due to deficiency of both the heart and spleen. Therefore, floating wheat is used in Ganmai Dazao Decoction because it can astringe sweat. The reason why Sijunzi Decoction did not use Atractylodes macrocephala but added white peony was because of its red tongue and constipation. The use of glutinous rice root and Astragalus is intended to strengthen the consolidation of the exterior and astringency of sweat.

Notes:

This is an effective formula for treating zangzao. Licorice is sweet and soothing, wheat nourishes the heart, and jujube strengthens the spleen and nourishes the middle. Although there are three ingredients in the formula, they can nourish both the heart and spleen. The "Compendium of Materia Medica" discusses wheat and believes that in addition to nourishing the heart, "the liver and heart are the organs of the child and the mother. The child can make the mother full, so it mainly nourishes the liver qi." Because the pharmacy is often short of wheat, I like to use flour instead. The amount is generally one tablespoon. You can first use a small amount of cold boiled water to make a thick paste, and then use the hot liquid from boiling the herbs to mix it well. "Suwen·Zangqi Fashilun" says: "The liver is bitter and urgent, and eating sweet food can relieve it." Licorice can also relieve the liver's urgency, so Ganmai Dazao Decoction not only nourishes the heart and spleen, but also treats the liver. The above two cases of zangzao syndrome were treated with Ganmai Dazao Decoction, and the effect was very quick. This experience is valuable and worth inheriting and carrying forward.

For other cases, although the main symptoms are different, Ganmai Dazao Decoction is used as the main treatment, or it can also treat the liver, or it can also replenish qi and consolidate the exterior, or it can also harmonize the stomach and remove phlegm. Although the treatment takes a little time, it can be effective. This is a modification of Ganmai Dazao Decoction. The so-called modification is also inseparable from the pathogenesis, syndrome differentiation and treatment, that is, grasping the deficiency of the heart and spleen, and distinguishing the priority of the relevant organs and using other prescriptions and medicines for those with special symptoms and related to consciousness. It seems that this type of disease is not only a functional disorder problem, but the organs themselves are first deficient, and then damaged, which makes it difficult for the organs to recover, so the treatment is time-consuming.

Using Ganmai Dazao Decoction as the main treatment, it can be seen that the role of this formula is not limited to nourishing the heart and calming the mind, and it is sweet and mild. I think this formula has the effect of regulating yin and yang, and harmonizing the Ying and Wei, but in treatment, it is necessary to grasp the priority of the contradictions between the heart, spleen, liver and other organs according to the theory of the five internal organs of the Zang-Xiang theory, and strive to achieve the purpose of nourishing the heart and spleen to invigorate the vital energy and regulate yin and yang.

Source: "China's 100 Years of 100 Chinese Medicine Clinicians Series·Deng Tietao" pp. 205-209, China Traditional Chinese Medicine Press.