Anshen Pill: Treating Insomnia Due to Yin Deficiency
In *Records of Pattern Differentiation* (Bianzheng Lu) by the Qing-dynasty physician Chen Shiduo, there is a formula named "Anshen Dan" (Spirit-Pacifying Pill). Its composition is: 15g each (5 qian) of white peony root (Baishao), unprocessed rehmannia root (Shengdihuang), and Chinese angelica (Danggui); 3g of licorice (Gancao, 1 qian); 30g of processed rehmannia root (Shudihuang, 1 liang); 6g each (2 qian) of Cornus fruit (Shanzhuyu) and goji berry (Gouqizi); and 9g of chrysanthemum (Ganjuhua, 3 qian). Decoct in water; take one dose daily, strain, and divide into three warm servings.
According to traditional TCM theory, this formula has the effects of tonifying liver blood and benefiting kidney water. It is mainly indicated for liver-kidney yin deficiency with liver qi too dry; after sorrow and worry, the patient is drowsy all day but at night cannot close the eyes, and longs to close them but cannot. From a modern medical perspective, these are symptoms of depression or anxiety. The patient is depressed all day, anxious and depressed, fatigued and weak, yet suffers insomnia all night. There are both psychiatric symptoms and somatic symptoms.
The composition of Anshen Dan is very similar to the patent medicine Qiju Dihuang Wan, which is composed of processed rehmannia, prepared Cornus fruit, Dioscorea (Shanyao), Moutan bark (Mudanpi), Poria (Fuling), Alisma (Zexie), goji berry, and chrysanthemum. Anshen Dan is based on Qiju Dihuang Wan, removing Moutan bark, Dioscorea, Poria, and Alisma, and adding white peony, Chinese angelica, unprocessed rehmannia, and licorice.
Moutan bark cools blood and drains heat; Alisma and Poria have diuretic effects. The ancients considered the combination of Moutan, Alisma, and Poria to clear kidney fire and drain kidney turbidity. Chen Shiduo attributed the cause in such patients to deficiency of yin-blood, not yin deficiency with internal heat, so he did not use kidney-fire-clearing or turbidity-draining herbs; instead he added white peony, Chinese angelica, and unprocessed rehmannia—all blood-tonifying herbs, essentially the famous blood-tonifying formula Siwu Tang minus the warm-drying Sichuan lovage.
After this adjustment, the formula becomes a purely yin-nourishing, tonifying prescription, suitable for patients with depression or anxiety who are constitutionally frail and have been overworked. It improves the patient's physical condition and also improves sleep.
Not one herb in this formula is a spirit-calming or sleep-promoting drug, yet the formula has that effect. This composition embodies precisely the TCM idea of treating the root cause of disease.
In my experience, adding 12g of Eclipta (Mohanlian) and 12g of Ligustrum (Nüzhenzi) improves the anti-anxiety and sleep-promoting effect. In addition, this formula may cause loose stools, so patients with poor digestion and loose, watery stools should use it cautiously.