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Jie Yu Ding Mian Fang

This formula was designed by Dr. Gao Tian-jun of the No. 1 Long Hai Municipal Hospital in Long Hai, Fujian. It is for the treatment of recalcitrant, nonhealing insomnia. Our version is a 10:1 extract.

Rx

Dan Shen (Radix Salviae Miltiorrhizae)
stir-fried Suan Zao Ren (Semen Zizyphi Spinosae)
He Huan Pi (Cortex Albiziae)
precooked Long Gu (Os Draconis)
Xia Gu Cao (Spica Prunellae Vulgaris)
Chai Hu (Radix Bupleuri)
Zhi Ke (Fructus Aurantii)
Chuan Xiong (Rhizoma Chuanxiong)
Chuan Niu Xi (Radix Cyathulae)
Ban Xia (Rhizoma Pinelliae)
E Jiao (Gelatinum Corii Asini)
Hu Po (Succinum)
uncooked Gan Cao (Radix Glycyrrhizae)

Indications:
This formula is for the treatment of recalcitrant insomnia which has lasted for more than three months due to a combination of liver depression qi stagnation (with possible depressive heat) and blood stasis with malnourishment and disquietude of the heart spirit. It can be used when other, more conventional Chinese therapies for insomnia have failed. Patients may not be able to sleep at all or only 1-2 hours per night.

Formula explanation:
According to Dr. Gao, most recalcitrant insomnia involves blood stasis which has not be addressed in previous therapy. Liver depression (with possible depressive heat) results in qi stagnation, and, if the qi moves, the blood moves; if the qi stops, the blood stops. Since static blood hinders and obstructs the engenderment of new or fresh blood, qi stagnation and blood stasis are commonly complicated by blood vacuity. In that case, there may be insufficient blood to construct and nourish the heart spirit which thus becomes disquieted or restless. If liver depression transforms heat, depressive heat may also ascend to harass the spirit, thus further disquieting it.

Within this formula, Chuan Xiong, Dan Shen, and Chuan Niu Xi quicken the blood and transform stasis. Chai Hu, Zhi Ke, and Chuan Xiong course the liver and resolve depression. Thus the qi and blood are regulated and the qi mechanism is harmonized. Chuan Xiong and Zhi Ke promote the upbearing of yang, while Chuan Niu Xi downbears yin. The combination of these three regulates and harmonizes yin and yang. Ban Xia and Xia Gu Cao are a little known but extremely effective empirical combination for the treatment of insomnia that come from the Yi Xue Mi Zhi (The Secret Purport of the Study of Medicine). Ban Xia harmonizes the stomach, downbears counterflow, and transforms phlegm. Xia Gu Cao clears liver heat. Dan Shen, Suan Zao Ren, and E Jiao supplement liver blood and quiet the heart spirit, while Long Gu and Hu Po heavily settle and still. In addition, He Huan Pi moves the qi and quickens the blood, resolves depression and quiets the spirit. Gan Cao harmonizes all the other medicinals in this formula.

Combinations:
If there is definite depressive heat with heart vexation, agitation, easy anger, a bitter taste in the mouth, a red tongue, and a bowstring, rapid pulse, combine with Rhizoma Coptidis Chinensis (Huang Lian) and Fructus Gardeniae Jasminoidis (Zhi Zi) in powdered extract form. If there is phlegm heat with profuse phlegm, a bitter taste in the mouth, slimy yellow tongue fur, and a slippery, bowstring, rapid pulse, combine with Eleven Flavors Warm the Gallbladder. If there is heart qi vacuity with easy fright and heart palpitations, combine with Radix Codonopsitis Pilosulae (Dang Shen), Radix Polygalae Tenuifoliae (Yuan Zhi), and Fructus Schisandrae Chinensis (Wu Wei Zi) in powdered extract form. If there is dual qi and blood vacuity with a sallow yellow or pale facial complexion, dizziness, fatigue, and lack of strength, combine with Ba Zhen Wan (Eight Pearls Pills). If there is perimenopausal insomnia with liver blood-kidney yin vacuity, spleen qi-kidney yang vacuity and vacuity heat, combine with Ultimate Immortals.

Research outcomes:
In 38 patients with recalcitrant insomnia lasting for more than three months, 23 were cured, 12 improved, and only three got no effect, for a total amelioration rate of 92.1%. The shortest course of treatment was 10 days, the longest was 49 days, and the average duration was 18.6.1

Signs & symptoms of liver depression:

• Irritability

• Emotional depression

• Chest oppression

• Frequent sighing

• Breat, epigastric, rib-side and/or lower abdominal distention and pain

• A bowstring pulse

• PMS and/or menstrual irregularities in women

Signs & symptoms of blood stasis:

• A sooty, dark facial complexion

• Dark, purplish lips

• A dark, purple tongue and/or possible static spots or macules

• Spider nevi

• Varicosities

• Cherry hemangiomas

• Dry, scaly skin

• Severe, fixed, and/or piercing pain

• A history of recalcitrant, enduring disease

Dosage:
Three capsules two times per day. This formula is made from a 10:1 extract. That means the above dosage is equivalent to not less than 30 grams of raw herbs. However, because our extraction process is so much more efficient than stovetop decoction, we believe this amount it is actually more like the equivalent to 45-60 grams of bulk-dispensed herbs.

Note: In actual fact, the overt signs and symptoms of blood stasis may be minimal. In that case, this formula may be tried based on this condition’s not responding to more standard previous Chinese medical approaches.

My patient does have:

Recalcitrant insomnia Yes No
Liver depression Yes No
Depressive heat Yes No
(Not absolutely necessary)
Blood stasis Yes No

1 Gao Tian-jun, “The Treatment of 38 Cases of Recalcitrant Insomnia with Jie Yu Ding Mian Fang (Resolve Depression & Stabilize the Sleep Formula), Fu Jian Zhong Yi Yao (Fujian Chinese Medicine & Medicinals), #5, 2000, p. 35

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