TCM Diagnosis: Heart Blood and/or Yin deficiency with Shen disturbance. (Also used for Heart and Kidney not communicating with Shen disturbance.)
Presentation: mild disorientation, occasional insomnia, vivid or disturbing dreams, nightmares or dream disturbed sleep. May also present with occasional anxiety or agitation, racing heart, forgetfulness, difficulty concentrating or mental fatigue; nocturnal emissions, night sweats, occasional constipation or dry stools.
Tongue: pale with a red tip if Blood deficiency is prominent, red if Yin deficiency is predominant, and may look normal if Yin and Blood are both deficient.
Pulse: thin, weak, rapid.
Formula: Bai zi ren 25.8%, Gou qi zi 19.4%, Xuan shen 12.9%, Shu di huang 12.9%, Mai men dong 6.5%, Dang gui 6.5%, Fu ling 6.4%, Shi chang pu 6.4%, Gan cao 3.2%.
Dosage & Administration: The standard dosage is 8 pills, 3 x day. In severe cases or in the initial phases of treatment, dosage may be increased to 10-12 pills 3 times per day, then reduced to a maintenance dose as the treatment takes effect. To help maintain normal sleep patterns, 8-16 pills before bed. Administer 1/2 hour before or one hour after eating for optimal digestion and absorption. May be used long-term for several months. Repeat courses of treatment may be administered over several years.
Cautions & Contraindications: Contraindicated during early stages of acute infection or illness, such as cold or flu. Use with caution in Spleen deficient patients with a tendency to loose stools, diarrhea, poor appetite or chronic digestive weakness.
Clinical Comments: From Peng Yong-Guan’s 1549 A.D. formula book, Compilations of Materials of Benevolence for the Body, Bai Zi Yang Xin Wan is a variation on Tian Wang Bu Xin Dan that focuses more on tonifying Blood than Yin. It strongly supports emotional and mental stability, making it very useful for Shen disturbance patterns when due to Blood and Yin deficiency.
In comparison with the more well-known An Shen Bu Xin Wan to calm the Shen, this formula was designed to primarily treat the underlying cause of the Shen disturbance, in this case Heart, Liver and Kidney Blood and Yin deficiency, while only secondarily focusing on calming the Shen. Bai Zi Yang Xin Wan is a good choice for a constitutional treatment and is well-paired with An Shen Bu Xin Wan for short periods of time when relatively quickly sedating and calming the Shen is necessary.
The chief herb, Bai zi ren nourishes the Heart to support restful sleep, reduce irritability and calm anxiousness. It is particularly good at treating sleeplessness and forgetfulness due to excessive worry damaging the Heart and Spleen and useful to help the body maintain a normal heart rhythm. The deputy, Gou qi zi nourishes Liver and Kidney Yin and Blood to cool the Heart. Xuan shen, Shu di huang and Mai men dong aid Bai zi ren in deeply nourishing the Yin of the Heart, Liver and Kidneys, cooling the Blood and clearing any buildup of Yin deficient heat. Shu di huang combines with Gou qi zi and Dang gui to aid Bai zi ren in strongly nourishing Heart and Liver Blood. Shu di huang tonifies the Jing-essence and fills the Marrow to diminish the mental and physical signs of premature aging. Fu ling and Shi chang pu combine to clear phlegm that may block the connection between the Heart and Kidneys, open the orifices and calm the Shen, which benefits memory and cognitive function, sleep, and regular heart rhythm. Fu ling also strengthens the Spleen, increases its ability to regulate the movement of fluids, and prevents the heavy tonics from damaging the Spleen and Stomach’s digestive functions. Gan cao benefits Qi, promotes normal heart rhythm, and harmonizes the actions of the herbs in the formula.
Since 1/4 of the formula is the oily seed Bai zi ren and is rich in additional herbs to nourish Yin and Blood, Bai Zi Yang Xin Wan also moistens the Intestines and unblocks the bowels. This makes it ideal for cases of occasional sleeplessness in older patients and postpartum patients where a tendency to constipation due to Blood or Yin deficiency may also be an issue.
Combinations: for marked Qi and Blood deficiency with stronger signs of forgetfulness or difficulty concentrating, combine with Bu Nao Pian or Gui Pi Wan. For stronger signs of Shen disturbance, combine with An Shen Bu Xin Wan. For stronger signs of sleeplessness and night sweats due to Yin deficient heat, combine with Zhi Bai Di Huang Wan.
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