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abstracted & translated by
Bob Flaws, Dipl. Ac. & C.H., Lic. Ac., FNAAOM, FRCHM
Xiao Yao San (Rambling Powder) is one of the most commonly prescribed of all Chinese medicinal formulas, especially in the West. However, in China, this formula is rarely used in its textbook form. Rather it is prescribed with various additions and subtractions depending on the patient’s major complaint and exact combination of presenting patterns. Xiao Yao San is a harmonizing formula which courses the liver and rectifies the qi, fortifies the spleen and supplements the qi, and nourishes the blood. In issue #6, 2002 of Si Chuan Zhong Yi (Sichuan Chinese Medicine), He Li-hua published an article titled, “The Treatment of 62 Cases of Insomnia with Xiao Yao San Jia Wei (Rambling Powder with Added Flavors).” This article appeared on page 42 of that journal. A precis of it is given below as an interesting modification of this often-used formula.
Cohort description:
Sixty-two patients, 22 males and 40 females, were enrolled in the so-called treatment group of this study. Among these, the youngest was 18 and the oldest was 75 years old. Twelve cases were 16-25 years, 15 cases were 26-35, 14 cases were 36-45, 11 cases were 46-55, seven cases were 56-65, and three cases were 66 years old or older. The longest duration of insomnia in this group was four years and the shortest was one month. Another 58 patients comprised the comparison group. Of these, 19 were male and 39 were female aged 17-73 years of age. Ten of these were 16-25, 14 were 26-35, 13 were 36-45, 11 were 46-55, eight were 56-65, and two were 66 years or older. The longest duration of insomnia in this group was three years and the shortest was two months. Therefore, there was no marked statistical difference between these two groups in terms of sex, age, or duration of insomnia. All these patients suffered from difficulty going to sleep, easily being awoken, and inability to go back to sleep after being awoken for three weeks continuously or more. These symptoms were commonly accompanied by headache, dizziness, heart palpitations, impaired memory, lassitude of the spirit, lack of strength, restlessness of the heart-mind, profuse dreams, etc. Patients were excluded if there was any organic basis for their insomnia.
Treatment method:
The members of the comparison group were administered 20mg of a multivitamin orally three times per day, 20mg of vitamin B1 orally three times per day, and 5mg of Valium before going to bed at night. Members of the treatment group received: Radix Bupleuri (Chai Hu), Radix Angelicae Sinensis (Dang Gui), Sclerotium Poriae Cocos (Fu Ling), and Radix Polygalae Tenuifoliae (Yuan Zhi), 15g each, Radix Albus Paeoniae Lactiflorae (Bai Shao), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Semen Zizyphi Spinosae (Suan Zao Ren), and Arillus Euphoriae Longanae (Long Yan Rou), 12g each, Radix Glycyrrhizae (Gan Cao), 9g, blast-fried Rhizoma Zingiberis (Pao Jiang) and Herba Menthae Haplocalycis (Bo He), 3g each, and Caulis Polygoni Multiflori (Ye Jiao Teng), 30g. If there was liver depression transforming fire, Cortex Radicis Moutan (Dan Pi), Fructus Gardeniae Jasminoidis (Zhi Zi), and Radix Gentianae Scabrae (Long Dan Cao) were added. If there was heart fire effulgence and exuberance, Rhizoma Coptidis Chinensis (Huang Lian) and Herba Lophatheri Gracilis (Dan Zhu Ye) were added. If there was torpid intake and abdominal distention, Pericarpium Citri Reticulatae (Chen Pi), Massa Medica Fermentata (Shen Qu), and Fructus Crataegi (Shan Zha) were added. If there was chest oppression and ribside distention with a tendency to great sighing, Rhizoma Cyperi Rotundi (Xiang Fu) and Tuber Curcumae (Yu Jin) were added. If there were heart palpitations and fearful throbbing, uncooked Os Draconis (Long Gu) and Concha Ostreae (Mu Li) were added. If there were heart palpitations, shortness of breath, and a lusterless facial complexion, Radix Codonopsitis Pilosulae (Dang Shen), Radix Astragali Membranacei (Huang Qi), cooked Radix Rehmanniae (Shu Di), and Gelatinum Corii Asini (E Jiao) were added. If the heart and kidneys were not interconnected, Rhizoma Coptidis Chinensis (Huang Lian) and Cortex Cinnamomi Cassiae (Rou Gui) were added. One packet of these medicinals was decocted in water two times and adminstered orally in two divided doses, morning and evening. Fifteen days equaled one course of treatment, and outcomes were assessed after 1-3 courses.
Treatment outcomes:
Cure was defined as disappearance of clinical symptoms after 1-3 courses of treatment and an ability to sleep soundly at night. Marked effect meant that the patient could go to sleep after one course of treatment. However, they still had profuse dreams and were still easily awoken. It also meant that, after three courses of therapy, the patient was able to go to sleep at night, but there were profuse dreams and the amount of sleep was not increased. However, there was marked improvement in accompanying symptoms. Some effect was defined as the ability to go to sleep after three months of treatment but no stable improvement in overall symptoms. No effect meant that, after three months of treatment, there was no improvement in the patient’s ability to go to sleep or their other symptoms. Based on these criteria, in the treatment group, 20 patients were judged cured, 32 got a marked effect, seven got some effect, and three got no effect, for a total amelioration rate of 90.5%. In the comparison group, two cases were judged cured, 12 got a marked effect, 20 got some effect, and 24 got no effect, for a total amelioration rate of 58.6%.
Discussion:
It is the Chinese author’s opinion that most cases of insomnia are due to over-thinking and too much worry which tax and damage the heart and spleen. Thus the heart spirit loses its nourishment. It is also possible for earth to be assailed by wood depression. If qi depression transform fire, evil fire may harass and stir the heart spirit. In either case, the heart spirit becomes disquieted and there is insomnia at night. Therefore, Dr. He has chosen to course the liver and resolve depression as the root. This assisted by fortifying the spleen, nourishing the heart, and quieting the spirit. Within Xiao Yao San, Chai Hu and Bo He course the liver and rectify the qi. Dang Gui and Bai Shao nourish the blood and emolliate the liver. Bai Zhu, Fu Ling, mix-fried Gan Cao, and blast-fried Jiang fortify the spleen and warm the center. These are then combined with Yuan Zhi, Suan Zao Ren, Long Yan Rou, and Ye Jiao Teng to nourish heart blood and quiet the heart spirit. When all these medicinals are used together, their effect is to soothe the liver and resolve depression, fortify the spleen and nourish the blood, boost the qi and quiet the spirit.
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