| Chai Hu Jia Long Gu Mu Li Tang originated from Clause107in Treatise on Cold Damage:Differentiation and Concurrent Treatment of Pulse and Sign in Taiyang Disease states "Shang han for eight or nine days, with purgation, if the chest is full, there is vexation and fright, the urination is not free, there is delirious speech, the whole body feels heavy, so that the patient cannot turn over, Chai Hu Jia Long Gu Mu Li Tang governs." The formula is made due to misuse purgation after shang han for eight or nine days and contains Chai Hu4Hang, Huang Qin11/2liang, Sheng Jiang11/2liang, Qian Dan11/2liang, Ren Shen11/2liang, Gui Zhi11/2liang, Fu Ling11/2liang, Ban Xia21/2ge, Da Huang2liang, Mu Li11/2liang, Long Gu11/2liang, and Da Zao6pieces. Main clinical manifestations present with chest depression, vexation, fright, inhibited urination, delirious speech, heaviness of the whole body with inability to turn over and principal pathogenesis is summarized into falling inward pathogen distributing all over the body leading to disinhibited pivot mechanism of shaoyang. As one of representative formulas in Chai Hu group patterns, Chai Hu Jia Long Gu Mu Li Tang has effect of harmonizing and purging heat, sedating and calming the spirit used to treat disinhibited pivot mechanism of shaoyang. Later practitioners attach great importance to the formula, and express their praise and proceed with extensive research.The formula modified by Xiao Chai Hu Tang contains ingredients of Chai Hu, Long Gu, Mu Li, Huang Qin, Fu Ling, Gui Zhi, Sheng Jiang, Ren Shen, Qian Dan, Da Zao, Ban Xia, and Da Huang. It is mainly applied to treat shaoyang pattern accompanied by vexation, fright, and delirious speech. Xiao Chai Hu Tang harmonizes pivot mechanism, reinforces the healthy qi and dispels the pathogenic qi. Gui Zhi drives falling inward pathogen away; Long Gu, Mu Li, and Qian Dan settle the shen and relieve vexation and fright; Da Huang harmonizes the stomach qi to dissolve phlegm and blood stasis; Fu Ling disinhibits urination. The formula is effective on the treatment of residual pathogen and accumulated heat in the upper, middle and lower jiao, liver depression, qi stagnation, and phlegm bind.Literature related with Chai Hu Jia Long Gu Mu Li Tang has been searched, organized and summed up in recent ten years. It is found that the formula is widely applied to treat epilepsy, insomnia, depression, hysteria, climacteric syndrome, dizziness, cardiac neurosis, coronary heart disease, chronic diarrhea, impotence, spermatorrhea, infantile urinary frequency and tinnitus with remarkable effect.The formula is modified by Xiao Chai Hu Tang omitting Gan Cao and reducing dosage of Xiao Chai Hu Tang into half with addition of Long Gu, Mu Li, Qian Dan, Gui Zhi, Da Huang, and Fu Ling. It is pointed out that among all128cases of the formula, Gan Cao is used in32times accounted for1/4of all cases. The author believes that Gan Cao probably cannot be omitted in clinic to treat emotional diseases. In Chai Hu Jia Long Gu Mu Li Tang, it contains ingredients of Gui Zhi Gan Cao Long Gu Mu Li Tang which can strengthen its effect on treating vexation and fright.Besides herbs in Chai Hu Jia Long Gu Mu Li Tang, there are98additional herbs based on different conditions in all collected cases. These additional98herbs used in368times together, on the average of3.75times for each herb. If the herb used for more than4times, it is named commonly-used additional herb. As the respect of action of the herbs, the most frequently used herbs can be categorized into mind-calming herbs and phlegm-dispelling to calm the mind herbs, all together17kinds, in130times. The rest would be qi-rectifying, wind-extinguishing, blood-invigorating and tonifying.What kind of herbs should be used is based on the specific condition of qi, blood, yin and yang.The way to take decoction is by oral. Decoction is the main preparation, extract used by Japanese doctors. Instructions to take medicine include single dose, several doses, and frequent-taking doses. There are117cases recorded how many packs would be taken. The minimum number is3packs, and the maximum one lasts for half a year, and commonly between10to30packs. The number of packs is closely related with disease subject and duration. For instance, patients suffering from epilepsy or long-time disease will take more packs. Chai Hu Jia Long Gu Mu Li Tang is mainly used to treat complicated emotional diseases, therefore the duration is longer, and more packs need to be taken. When Japanese practitioners use this formula, it is seldom modified, and with lower dosage and long course, which is different from domestic doctors in Chinese medicine.Among128cases, there are52cases with Chinese medicine diagnosis,23subjects of disease, and one case belonging to external contraction and the rest are miscellaneous diseases. Based on frequency recorded in these cases, there in sequence are manic-depressive psychosis, heart palpitation, depression, insomnia, hysteria, tremor, headache, dizziness, up-rushing gas syndrome, spermatorrhea, sleepwalking, and hemiplegia.There are49cases with western medicine diagnosis involving different departments like internal medicine, external medicine, gynecological department, pediatric department, ENT, and psychiatric department and multiple systematic diseases like nervous, circulatory, endocrinal and urinary disorders. According to frequency appeared within these inclusive cases, there are epilepsy, schizophrenia, hysteria, neurosis, hypertension, meniere’s syndrome, baby spasm, huntington’s disease, sinus tachycardia, angina pectoris, paralysis after encephalitis, hyperthyroidism, sequel after concussion and atrioventricular block.Based on statistical results, principles of Chai Hu Jia Long Gu Mu Li Tang are summarized as follows:1. Emotional disease occurs without gender limit, but the female is in the majority. It occurs without age variance, but middle-age people take the predominance. It occurs without season change, but usually in spring and summer.2. There are main pathogenic factors leading to Chai Hu Jia Long Gu Mu Li Tang pattern, but mental stimulation is the principal one. Usually it takes long duration, and duration of the disorder is positively related to treatment course, with little relationship with curative effect.3. The main diagnostic indicators manifest with restlessness or dull expression, insomnia with profuse dreams, fullness and pain in the chest and hypochondriac region, heart palpitation, constipation, red tongue, white or yellow tongue coating, and wiry pulse.4. The main pathogenesis of Chai Hu Jia Long Gu Mu Li Tang pattern is qi stagnation in the liver and gallbladder, deficiency and excess complex. Treatment principle is to soothe the liver and gallbladder, unblock yang and discharge heat, and calm the mind with heavy sedatives. Herbs in Chai Hu Jia Long Gu Mu Li Tang can be modified, but Chai Hu is the essential one.5. Chai Hu Jia Long Gu Mu Li Tang in modern time is applied to treat miscellaneous disorders, especially to emotional and nerve system diseases.To sum up, Chai Hu Jia Long Gu Mu Li Tang with complicated symptolms is widely used both in ancient and modern times. It is one of most commonly-used formula in internal medicine, external medicine, gynecological department, pediatric department, and ENT department. The original clause states due to misuse of purgation after eight or nine days of shang han leading to pathogen falling inward and forming a transmuted pattern with exterior and interior, and deficiency and excess conditions. Golder Mirror of Medical Tradition once stated "Chai Hu Jia Long Gu Mu Li Tang was caused by pathogens with the nature of yin and yang, the formula’s ingredients contained herbs on their properties of both yin and yang. Chai Hu and Gui Zhi addressed unresolved external pathogen; Da Huang purged the interior heat falling inward from outside; Ren Shen, Sheng Jiang and Da Zao tonified deficiency and harmonized the stomach; Fu Ling and Ban Xia disinhibited water and redirected counterflow; Long Gu, Mu Li and Qian Dan with nature of heaviness suppressed fright and calmed the mind. This was so-called complex herbs with the properties of cold and heat to treat complicated disease with dual deficiency and excess, cold and heat." Indications of Chai Hu Jia Long Gu Mu Li Tang mainly refer to emotional and nervous symptoms like depressive psychosis, mania, epilepsy, hyperthyroidism, depression presenting with insomnia, irritation, vertigo, overexcitation, twitch, and qi upsurge. Secondary, they are fullness and depression of chest and hypochondriac region, no appetite which are principal symptoms in shaoyang disease. Besides, numbness and heaviness due to interior exuberant phlegm turbidity also occur. They mostly present with red tongue, slight yellow or yellow and thick or thick greasy tongue coating, and wiry and slippery or wiry and rapid or wiry and thread pulses. A large number of cases related with extensive application of Chai Hu Jia Long Gu Mu Li Tang by ancient and modern practitioners provide basis for us to master its differentiated principle, develop ideas and select the formula to treat certain diseases based on clinical differentiation. |
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