The Spirit’s Appointees
On Tiān Wáng Bǔ Xīn Dān
As summer approaches, I thought I would take a look at some of the aspects of treating the heart and fire phase in general.
It seems proper to start this discussion with the Celestial Emperor’s Heart Supplementing Elixir, or Tiān Wáng Bǔ Xīn Dān. This is a well-known formula for heart yīn vacuity with effulgent fire. It is most commonly prescribed for insomnia, but I have found it useful for other conditions as long as the pattern fits.
Origins and traditional views
There are a few different versions of the formula available. The one that I am most familiar with comes from Shè Shēng Mì Pōu (Investigating the Secrets to Preserving Life), written in the Míng era by Hóng Jī. According to the source text,
治心血不足，神志不寧，津液枯竭，健忘怔忡，大便不利，口舌生瘡等証。
Treats patterns of heart blood insufficiency, disquieted shén (spirit) and zhì (will), dessication of fluid and humor, forgetfulness and fearful throbbing, inhibited defecation, mouth and tongue sores and so forth.
The pathomechanisms are enumerated by Hóng Jī thus:
心者，神明之官也。憂愁思慮則傷心。神明受傷，則主不明而十二官危，故健忘怔忡。心主血，血燥則津枯，故大便不利。舌為心之外候，心火炎上，故口舌生瘡。
The heart is the official of the bright spirit (shén ming). Worry, anxiety, thought and preoccupation result in damage to the heart. The bright spirit sustains damage, thus the master is not enlightened and the twelve officials are endangered, causing forgetfulness and fearful throbbing. The heart governs blood, and blood dryness results in parched fluids, therefore defecation is difficult. The tongue serves as the exterior sign of the heart, so if heart fire flares upward, it will engender sores of the mouth and tongue.
Wáng Xùgāo, in his Yī Fāng Zhèng Zhì Huì Biān Gē Jué (Compilation of Medical Formulas, Patterns and Treatments) gives an interesting take on the spiritual functions of the formula:
《道藏》天王補心丹《其方有四，惟此《道藏》者通。）補心之用神自安，（補心者，補心之用也。心藏神，而神之所用者，魂魄意智精志也。補其用而心能任物矣。）靜寧補魄味（五味子）天（冬）麥，（麥冬各一兩）流動補魂歸（當歸一兩）柏（子仁一兩）丹，（丹參五錢）參（人參五錢）茯（苓神五錢）調中補意餒，地（生地四兩）玄（參五錢）填下補精殘，遠（志肉五錢）桔（梗五錢）補志棗（仁一兩）補智，補心之義如斯觀，（此補心之主方）怔忡（思慮過度，心血不足。）盜汗（汗為心液，心虛有火，故多盜汗。）宜常服，（多服常服見效）便秘時溏一例看。（心血虛而有火，故大便燥秘；或時溏者，心火乘脾，熱迫下泄也。）或益菖蒲（一方有菖蒲，通竅豁痰。）或連（川連）草（甘草），（一方有上二味，瀉心火。）
“Dào zàng” [Daoist canon] Tiān Wáng Bǔ Xīn Dān (there are four versions of this formula, but only this one is connected with the Daoist canon.)
By use of heart-supplementing the spirit is tranquil in itself. Supplementing the heart means supplementing the heart’s purpose. The heart stores the spirit (shén) and the spirit’s appointees are the hún (ethereal soul), pò (corporeal soul), yì (intention), zhì (wisdom), jīng (essence), and zhì (will). Supplementation gives the heart the ability to confer responsibility for matters to each.
To make quiet and tranquil, supplement the pò with Wǔ Wèi Zi (Fr Schisandrae), Tiān Dōng (Rx Asparagi), and Mài Dōng (Rx Ophiopogonis), 30 grams (1 liǎng) each.
To discharge and move, supplement the hún with Dāng Guī (Rx Angelicae Sinensis 30g), Bǎi Zi Rén (Sm Biotae 30g), Dān Shēn (Rx Salviae Militiorrhizae 15g), Rén Shēn (Rx Ginseng 15g), and Fú Líng Shén (Scl Poriae Pararadicis 15g).
To harmonize the center, supplement the disheartened yì with Shēng Dì (Rx Rehmanniae 120g), and Xuán Shēn (Rx Scrophulariae 15g).
To replenish the lower, supplement essence with Yuǎn Zhì Ròu (Rx Polygalae 15g), and Jie Gěng (Rx Platycodi 15g).
Supplement the zhì (will) with Zǎo Rén (Sm Ziziphi Spinosae 30g).
The meaning of supplementing the zhì (wisdom) and supplementing the heart is like this. This is the main formula for supplementing the heart. There is fearful throbbing (from excessive thought and preoccupation and insufficiency of heart blood), thief (night) sweats (sweat is the humor of the heart, and there is fire from heart vacuity, so the result is copious night sweats.)
It is suitable to take regularly (take large doses regularly to get the desired effect).
There may be constipation or sometimes sloppy stool (there is heart blood vacuity as well as fire, so the stool is dry and dense; or when it is sloppy, the heart fire encroaches on the spleen, and the heat forces it to drain downward.). Or add Chāng Pú (Rz Acori Graminei) (one version of the prescription has Chāng Pú to unblock the orifices and sweep phlegm) or Chuān Lián (Rz Coptidis), and Gān Cǎo (Rx Glycyrrhizae), (one version of the prescription has the above two flavors, to drain heart fire).
As mentioned above, the composition of the formula can vary depending on the source. The KPC version, for example, uses a much smaller dose of Dì Huáng and includes Dù Zhòng (Cx Eucommiae) and Bǎi Bù (Rx Stemonae) (Ellis, 2003).
Clinical applications
Generally the formula is used for sleep difficulties, anxiety and palpitations as well as menopausal complaints such as night sweats. Maclean (2019) mentions that the formula is useful in patients who have developed a tolerance to prescription sedatives and anxiolytics, as well as those with a history of chronic stimulant use. The Clinical Handbook of Internal Medicine by Maclean et al. (2018) additionally lists the formula under treatments for diabetes, epistaxis, fainting, chronic fever, hyperthyroid, oral ulcers, seizures, tics, and fatigue.
I have found the formula surprisingly versatile over the years. A brief clinic story/case report can illustrate one such off-label application.
A clinic story
Many years ago a patient of mine suffered from a chronic inflammatory arthritic condition, mainly affecting the joints of her upper limbs including wrists and hands. She was very talkative, quick and witty, always joking about her life and her job, even about her illness. The acupuncture was helpful in the short term, but the condition was resistant to resolution and the symptoms would return by the next weekly treatment. She was taking prescription medications for the condition which did not prove effective.
I had a granule pharmacy at the time, and decided to undertake a custom formula for her. I included all manner of wind-damp, heat-clearing, channel conductors, and so on; each iteration of the formula failed miserably, with virtually no effect. Eventually I gave up on the herbs.
Her condition ground on for month after month, and secondary to the inflammation, she developed painful sores on her tongue. More medication was prescribed for this new symptom to no avail, and using points like CV23 didn’t really help much. At one point, she told me that she had grown used to the pain and swelling in her upper limb and finger joints, but she would just be happy if there was anything I could do for the sores on her tongue. I went in the dispensary and had a look around. I found a bottle of Tiān Wáng Bǔ Xīn Dān teapills, and figured, okay I guess we’ll try this.
By the following week, everything had gone into remission. I mean everything: the tongue sores, the pain, the inflamed joints, everything had cooled down. She continued to take the formula and her condition continued to improve for a few months; she came in less and less frequently and eventually moved on.
Takeaways
I learned some valuable lessons from that case: 1) if the pattern fits, don’t feel bound by the usual indications of the formula, and 2) don’t sleep on patents – the teapills smoked my super-over-engineered custom granule formula.
It would seem that mine is not an isolated case. Williams (2023) wrote of a similar experience in Acupuncture Today. I’ve had other occasions to use the formula for chief complaints such as low back pain, but again only when the pattern fit.
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
Ellis, A. (2003). Notes from South Mountain. Thin Moon Publishing.
Hong, J. (n.d.). Shè shēng mì pōu. https://ctext.org/wiki.pl?if=gb&chapter=467679 . Retrieved June 6, 2023.
Maclean, W., Lyttleton, J., Bayley, M., & Taylor, K. (2018). Clinical handbook of internal medicine: The treatment of disease with traditional Chinese medicine. Eastland Press.
Maclean, W. (2019) Clinical manual of Chinese herbal prepared medicines (3rd ed). Eastland Press.
Wang, X. (1897). Yī fāng zhèng zhì huì biān gē jué. https://jicheng.tw/tcm/book/%E9%86%AB%E6%96%B9%E8%AD%89%E6%B2%BB%E5%BD%99%E7%B7%A8%E6%AD%8C%E8%A8%A3/index.html . Retrieved 5-3-2023.
Williams, C. (2023). Joint pain: Think outside the box. Acupuncture Today, 24(2). https://acupuncturetoday.com/article/34307-joint-pain-think-outside-the-box