Yáng Does Not Love Yīn
Of Insomnia and Opium
I’ve done a fair bit of nosing through old texts over the last couple of years, and a lot of it has found its way here to the mulch pile. I tend to look more at the late imperial eras (especially the Qīng) and find myself particularly drawn to the physicians of southern Jiāngsū (especially around Sūzhōu). The area produced a lot of well-known doctors and was the cradle of the Warm Disease movement. So we’ve looked at some bits of writing from Yè Tiānshì, Wú Jūtōng, and, most prominently, Wáng Xùgāo. Another whose writing and prescribing style I keep returning to is Hé Yuánzhǎng, who was from Qīngpǔ in western Shànghăi, which is Jiāngsū-adjacent and shares many of the stylistic features – lighter, more mobile - that one might expect to see of medicine in the general region. The Hé family in Qīngpǔ was “a branch of one of the oldest medical lineages in China,” (Scheid, 2007), and Hé’s son, who we will return to in a moment, made perhaps a bigger stamp on Chinese medical history with a single formula. But first let’s look at a few of Hé père’s typically aphoristic case reports.
3 Cases of Insomnia
Chapter 24 of Hé Yuánzhǎng Yī An [何元長醫案] (Hé Yuánzhǎng’s Medical Cases) deals with insomnia (bù mèi):
二十四、不寐門（三方）
24, Insomnia (3 prescriptions)
（案1）陽不交陰，寤不成寐，飲食日減，脈來弦數。暫用半夏瀉心法。
川連 茯神 石決明 生甘草 麥冬 半夏 遠志 竹茹 棗仁 陳皮
1) Yáng not interacting with yīn, awake and unable to sleep, food and drink decrease daily, pulse arrives wiry and rapid. Temporarily use Bàn Xià Xiè Xīn [Pinellia Drain the Heart] method.
Chuān Lián [Rz Coptidis Sichuanensis], Fú Shén [Poria Pararadicis], Shí Jué Míng (Concha Haliotidis), Shēng Gān Cǎo (Rx Glycyrrhizae Cruda), Mài Dōng [Rx Ophiopogonis], Bàn Xià [Rz Pinelliae], Yuǎn Zhì [Rx Polygalae], Zhú Rú [Caulis Bambusae In Taeniam], Zǎo Rén [Sm Zizyphi Spinosae], Chén Pí [Pc Citri Reticulatae].
Mulch comments: Interesting that Hé refers to Bàn Xià Xiè Xīn for this prescription. It looks to me much more like a modification of Huáng Lián Wēn Dǎn Tāng [Coptis Warm the Gallbladder Decoction], which is pretty much what I would start with in this situation.
（案2）夜不能寐，時成驚悸。由深思鬱結，陽不戀陰也。治以苦泄，佐用安神。
炒川連 棗仁 半夏 煅龍齒 麥冬 茯神 陳皮 柏子仁 鬱金 菖蒲
2) Cannot sleep at night, at times turns to fright palpitations, due to deep thoughts depressing and binding, this is yáng not attached to yīn [lit. ‘yáng does not love yīn]. Treat with bitter discharging, assist by using spirit-calming.
Chǎo Chuān Lián, Zǎo Rén, Bàn Xià, Duàn Lóng Chǐ [Dens Draconis Calcinata], Mài Dōng, Fú Shén, Chén Pí, Bǎi Zǐ Rén [Sm Platycadi], Yù Jīn [Rx Curcumae], Shí Chāng Pú [Rhizoma Acori Graminei].
Mulch comments: Similar to the previous prescription, leading off with Coptis (fried this time) accompanied by other agents to clear heat from the heart (Mài Dōng, Bǎi Zǐ Rén), using Dragon’s Tooth as the main heavy settler, then addressing some depressive liver heat with Yù Jīn, and penetrating turbidity with Shí Chāng Pú.
（案3）心煩頭暈，寤不成寐。五火內熾也。左脈弦大，治以苦泄。
川連 橘白 白芍 鬱金 龍膽草 杏仁 黑梔 竹茹 半夏 茯神 石決明
3) Heart vexation and dizziness, awake and unable to sleep. This is the five fires blazing interiorly. The left pulse is wiry and large, treat with bitter discharging.
Chuān Lián, Jú Bái [Pc Citri Reticulatae Album], Bái Sháo [Rx Paeoniae Alba], Yù Jīn, Lóng Dǎn Cǎo [Rx Gentianae], Xìng Rén [Sm Armeniacae], Hēi Zhī [Fr Gardeniae Carbonisatus], Zhú Rú, Bàn Xià, Fú Shén, Shí Jué Míng.
Mulch comments: Similar approach, but more bitter draining medicinals (Coptis, Gentiana, Gardenia) as well as moistening (Peony and Apricot seed) to allay the damage to blood and fluids from both the heat and effects of the bitter cold herbs. As before, Yù Jīn and Lóng Dǎn Cǎo to drain the liver, a core of Huáng Lián Wēn Dǎn (Jú Bái is used in place of Chén Pí as it is less drying), and a heavy settler (Shí Jué Míng).
Three cases is not a large sample size, but we can at least begin to see a common treatment strategy here:
· Clear heat/drain fire from the heart, especially with Huáng Lián. Add more bitter draining if there is more heat.
· Clear depressive heat from the liver if necessary.
· Transform phlegm, starting with the core of Èr Chén (Fú Shén, Bàn Xià, Chén Pí)
· Add some spirit-calming and one heavy settling agent.
18-Flavor Smoking Cessation Pill
As I mentioned above, Hé Yuánzhǎng’s son was the next generation of physicians from the family lineage. His name was Hé Qíwěi何其伟 [1774-1837]. When I was starting to read Hé Yuánzhǎng’s cases, I looked for further information on him and read that his son had written a famous smoking cessation formula.
I’ve been recently reading a book, The Opium War: Drugs, Dreams, and the Making of Modern China by Julia Lovell. Prominently figured in the book is a imperial official named Lín Zéxú, who was ardently opposed to opium smoking and was charged by the Dàoguāng Emperor with stamping it out. Lín is held up as a national hero in China for his efforts, which included burning 20,000 chests of opium belonging to the East India Company - one of the main incidents leading to the First Opium War (Lovell, 2011).
As it turns out, years earlier Hé Qíwěi had treated both Lín and his wife (“Lín Zéxú”, 2019), and with Lín being interested in medicine, they became good friends. Among the burning topics they discussed was opium addiction, Lín no doubt passionately advocating for its prohibition. As a gift to his friend, Hé wrote a book on the effects of opium, and included a formula to treat opium addiction. This was the formula I had read about; it was apparently not for tobacco cessation, as I had thought. I was unable to locate the book in digital format but I was able to find the formula (“Shí bā wèi”, n.d.):
十八味戒烟丸
药物组成：，枣仁3钱，茯苓4钱，法半夏5钱，玉竹2钱，旋覆花2钱，益智仁2钱，罂粟壳2钱，枸杞1钱5分，炮姜1钱5分，炙甘草1钱5分，沉香6分，赤糖4两，红枣10个，烟灰5钱。
处方来源：《饲鹤亭集方》引林文忠公方。
制备方法：熬膏，或为丸。
用法用量：随痛大小，酌量加减。
Shí Bā Wèi Jiè Yān Wán [18-Flavor Smoking Cessation Pill]
Medicinal composition: Zǎo Rén 3 qián, Fú Líng 4 qián, Fǎ Bàn Xià 5 qián, Yù Zhú [Rz Polygonati Odorati] 2 qián, Xuán Fù Huā [Fl Inulae] 2 qián, Yì Zhì Rén [Sm Alpiniae Oxyphyllae] 2 qián, Yīng Sù Ké [Pc Papaveris] 2 qián, Gǒu Qǐ [Fr Lycii] 1 qián 5 fēn, Pào Jiāng [Rz Zingiberis Praeparata] 1 qián 5 fēn, Zhì Gān Cǎo 1 qián 5 fēn, Chén Xiāng [Lignum Aquilariae] 6 fēn, Chì Táng [Jaggery, Cane Sugar] 4 liǎng, Hóng Zǎo [Fr Jujubae] 10 pieces, Yān Huī [ashes from burnt opium] 5 qián.
Prescription source: Collected Prescriptions from the Crane-Feeding Pavillion “Sì Hè Tíng Jí Fāng” citing the fair and upright Lín Wénzhōng.
Preparation method: Boil into a paste or make into pills.
Method of use and dosage: According to the pain, great or slight, consider adding or subtracting [dosage]
Formula analysis
· Zǎo Rén calms the spirit, helps with anxiety, agitation and insomnia of withdrawal
· Fú Líng mildly supplements the spleen, calms spirit
· Yù Zhú supplements yīn without cloying
· Gǒu Qǐ nourishes blood and essence
· Yì Zhì Rén warms the spleen yáng and checks diarrhea
· Yīng Sù Ké, opium poppy husk, relieves pain and checks diarrhea. If the withdrawal symptoms are painful, one can substitute Yán Hú Suǒ [Rz Corydalis], if there is diarrhea, one can substitute Hē Zǐ [Fr Chebulae]
· Bàn Xià, Xuán Fù Huā, Chén Xiāng, Pào Jiāng warm and downbear the stomach qi to check vomiting
· Chì Táng, Hóng Zǎo, Zhì Gān Cǎo, all sweet, harmonize the middle burner and relieve pain
· Yān Huī, ashes from burnt opium, a little hair of the dog, I suppose
Conclusion
We can see some of the family influences come through in the prescription by Hé fils. Light supplementation, much attention paid to the middle burner, Zǎo Rén to calm, nothing heavy, nothing harsh. Was it effective? Maybe, maybe not. Even Lín, who championed the use of the formula just before the first Opium War years later, admitted that he didn’t know if it worked (Lovell, 2011). Given the widespread prevalence of opium in virtually all strata of Qing society, the formula would appear to be more of a gesture than a robust public health response. Given the prevalence of opioid use today, though, it may be worth looking at (and most likely modifying).
That’s all I’ve got for now. As always, thanks for reading.
Note: this publication 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
Hé Yuánzhǎng yī àn. (n.d.). https://jicheng.tw/tcm/book/%E8%91%89%E5%A4%A9%E5%A3%AB%E6%9B%B9%E4%BB%81%E4%BC%AF%E4%BD%95%E5%85%83%E9%95%B7%E9%86%AB%E6%A1%88/index.html . Retrieved November 23, 2022
Lín Zéxú yán zhì jiè yān wán. (2019-07-02). https://www.sohu.com/a/324490110_99904027
Lovell, J. (2011). The Opium War: Drugs, dreams, and the making of modern China. Overlook Press.
Scheid, V. (2007). Currents of tradition in Chinese medicine: 1626-2006. Eastland Press.
Shí bā wèi jiè yān wán. (n.d.). https://baike.baidu.com/item/%E5%8D%81%E5%85%AB%E5%91%B3%E6%88%92%E7%83%9F%E4%B8%B8/4109784 (Retrieved March 29, 2024).
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.