If Juéyīn is Harmonized, the Bind will be Dispersed
On Suān Zǎo Rén
This week, let’s return to the materia medica and take another look at a familiar herb and its namesake formula.
I’ve been delving into the Běncǎo Jīng Jiě (Materia Medica Explanation), attributed to Yè Tiānshì in 1724. Yè Tiānshì is the architect of the Four Levels pattern differentiation and a major medical figure of the Qing era. The herbs in the text are all in common use today, but it can be useful to read these entries because many times they offer something that has been left out of the modern textbooks, but which can help us to expand our knowledge of the applications of the materia medica and formulas.
The entry below is on Suān Zǎo Rén (Ziziphi Spinosae Semen). It is always remarkable how, even into the early modern period, Chinese physicians would return to the canonical texts from the very beginnings of the stream of medical knowledge. The first paragraph comes directly from Shén Nóng Bӗn Cӑo Jīng (Divine Farmer’s Materia Medica Classic), and the second is devoted to explaining the pathomechanisms behind the classic quote. (Note: any errors in translation are mine alone)
【酸棗仁】
氣平。味酸。無毒。主心腹寒熱。邪結氣聚。四肢痠痛。濕痹。久服安五臟。輕身延年。（炒研）
棗仁氣平。稟天秋斂之金氣。入手太陰肺經。味酸無毒。得地東方之木味。入足厥陰肝經、手厥陰風木心包絡經。氣味俱降。陰也。心者胸臆之分。手厥陰心包絡脈起之處。腹者中脘之分。足厥陰肝經行之地。心包絡主熱。肝主寒。厥陰主散。不能散則寒熱邪結氣聚矣。棗仁味酸。入厥陰。厥陰和。則結者散也。四肢者手足也。兩厥陰經行之地也。痠痛濕痹。風濕在厥陰絡也。棗仁味酸益血。血行風息。氣平益肺。肺理濕行。所以主之也。心包絡者。心之臣使也。代君行事之經也。肝者生生之臟。發榮之主也。久服棗仁。則厥陰陰足。所以五臟皆安。氣平益肺。所以輕身延年也。
Suān Zǎo Rén
Its qì is balanced, its taste is sour, it is non-toxic. Mainly treats cold and heat in the heart and abdomen, pathogens binding (leading to) qì accumulation, aching pain of the four limbs, and damp bì obstruction. Take for a long time to calm the five Yīn organs, lighten the body and prolong one's life. (Roast and grind)
Zǎo Rén's qì is balanced. It receives the restraining metal qì of autumn, and enters the Hand Taiyin Lung channel. Its taste is sour and non-toxic; this is the taste of Wood and the East. It enters the Foot Juéyīn Liver channel and the Hand Juéyīn Pericardium network channel of wind and Wood. Its nature and flavor all descend and are Yīn. The Heart is the part of the innermost feelings. It is the place where the Hand Jueyin Pericardium network vessel arises. The abdomen is the part of the central cavity [zhōng wǎn, also the name for CV12]. The Liver channel of Foot Juéyīn travels there. The Pericardium network governs heat. The Liver governs cold. Juéyīn governs dispersing. If they cannot be dispersed, the pathogenic cold and heat will bind the qì and mass together. Zǎo Rén's taste is sour; it enters Juéyīn. If Juéyīn is harmonized, then the bind will be dispersed. The four limbs are the arms and legs. The two Juéyīn channels travel there. Aching pain from damp bì obstruction is wind and dampness in the Juéyīn network vessels. Zǎo Rén's sour taste benefits the blood. Move blood and the wind will cease. Balanced qì benefits the Lung. When the Lung is regulated, the dampness will move. So it masters that also. The Pericardium network is the minister and envoy of the Heart. The classic says it acts on behalf of the monarch to carry out its orders. The Liver is the organ of generating life and governs flourishing. Take Zǎo Rén for a long time, and the Juéyīn will have ample Yīn. Therefore all the five Yīn organs will be calm and healthy. Balanced qì benefits the Lung, lightens the body, and prolongs life.
The entry goes on to give combinations with other herbs to treat the familiar symptoms we all associate with Suān Zǎo Rén: insomnia, vexation, palpitations, and sweating. But the explanation of the passage from the Shén Nóng holds other possibilities: qì stagnation, wind-damp bì, even life extension.
Zizyphus Decoction
We all know Suān Zǎo Rén Tāng (Zizyphus Decoction), of course. It is from Jīn Guì Yào Lüè (Essential Prescriptions of the Golden Cabinet), where it is indicated for “vacuity taxation with vacuity vexation and inability to sleep.” (Wiseman & Wilms, 2013) Essentially it is used as a formula for anxiety and insomnia. It is, as we know, a reliable formula for these indications.
A common dosage is something like:
Suān Zǎo Rén (roasted) 15g;
Zhī Mǔ (Anemarrhenae Rhizoma), 6g;
Fú Líng (Poriae Sclerotium), 6g;
Chuān Xiōng (Ligustici chuanxiong Rhizoma), 6g;
Gān Cǎo (Glycirrhizae Radix), 3g.
Happy baby tea
There is a sort of “off-label” use of Suān Zǎo Rén Tāng that has been in use in my practice for many years: pain in teething infants. This is an application I first encountered in taking a TCM pediatrics course from Bob Flaws (Flaws, 1997). As fate would have it, I had a teething infant at home. I put together some granules of the formula, adding some extra Chuān Xiōng, stirred it into some water and administered it with an oral syringe. I called it “happy baby tea.” It worked quite well. I would prescribe the granules for other infants until Blue Poppy came out with a fluid extract of the formula, called “Tender Teeth.” It has been a consistent seller at the clinic over the years.
An adjunct for chronic pain?
Reading the entry from Yè Tiānshì, though, got me to thinking about how the formula might be a useful adjunct for chronic primary pain (CPP). In my early years of practice (the 1990s), I was employed at a rheumatology practice and saw many fibromyalgia syndrome (FMS) patients. Almost all of them were on serotonin reuptake inhibitors (serotonin regulation is used to modify pain signals, and is the subject of ongoing research for CPP, see for example Tao et al., 2019) and various medications to help them sleep. Suān Zǎo Rén exerts at least some of its clinical effects through the regulation of the serotonergic system (Bian et al., 2021).
The indications given for the herb in the old texts include wind-damp bì causing aching in the four limbs (a common clinical feature of FMS), and to that end Chuān Xiōng and Fú Líng in the formula would augment that capacity. The formula could be easily modified as well, for example by adding Yi Yi Ren (Coicis Semen) for wind damp and/or Yán Hú Suǒ (Corydalis Rhizoma) for pain. Suān Zǎo Rén Tāng seems a reasonable formula option for cases of chronic pain also exhibiting the other key features of exhaustion, sleep disturbance, and deficiency vexation.
Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Bian, Z., Zhang, W., Tang, J., Fei, Q., Hu, M., Chen, X., Su, L., Fei, C., Ji, D., Mao, C., Tong, H., Yuan, X., & Lu. T. (2021). Mechanisms underlying the action of Ziziphi Spinosae Semen in the treatment of insomnia: A study involving network pharmacology and experimental validation. Frontiers in Pharmacology, 12. DOI: https://doi.org/10.3389/fphar.2021.752211
Flaws, B. (1997). A handbook of TCM pediatrics: A practitioner's guide to the care and treatment of common childhood diseases. Blue Poppy Press.
Tao, Z.Y., Wang, P.X., Wei, S.Q., Traub, R.J., Li, J.F., & Cao, D.Y. (2019). The role of descending pain modulation in chronic primary pain: Potential application of drugs targeting serotonergic system. Neural Plasticity, 2019. DOI: https://doi.org/10.1155/2019/1389296
Wilms, S. (2017). Shén Nóng bӗn cӑo jīng: The divine farmer’s classic of materia medica. Happy Goat Productions.
Wiseman, N. & Wilms, S. (2013). Jīn Guì Yào Lüè (Essential Prescriptions of the Golden Cabinet). Paradigm Publications.
Yáo, Q. (1926). Jīng xiào Yè Tiānshì běn cǎo jīng jiě. Guǎng Yì Book Company. Retrieved December 14, 2022, from https://jicheng.tw/tcm/book/%E6%9C%AC%E8%8D%89%E7%B6%93%E8%A7%A3/index.html