Baijin Wan: A TCM Formula for Mental Disorders
"Baijin Wan" (White-Metal Pill) was first recorded in the Song-dynasty physician Xu Shwei's Puji Benshi Fang (Effective Formulas from Universal Aid), which states: "For mania-depression arising from melancholy, with phlegm-saliva blocking the pericardium and the orifices of the heart: 3 liang of alum (baifan), 7 liang of Sichuan turmeric (chuan yujin). Grind the two herbs together into powder, bind with paste into pills the size of a parasol-tree seed (about the size of a soybean, roughly 6mm in diameter). Take 50–60 pills each time with warm water." In this formula, alum is sometimes replaced by dried alum (kufan). The Qing-dynasty Zhao Xuemin's Chuanya Waibian also records this formula, where it is called "Jie Dian Fang" (Epilepsy-Stopping Formula), indicated for mania-depression.
From this passage, the indication of Baijin Wan should correspond to bipolar disorder, schizophrenia, or borderline personality disorder in modern psychiatry: the patient is sometimes in a depressed (melancholic) state and sometimes in a manic (or hypomanic) state, with violent emotional swings, cognitive, affective, and mood disturbance beyond self-control. This is a rare accurate description in ancient Chinese medical texts of the symptoms of such mental illnesses. Traditional TCM holds it to be caused by phlegm clouding the heart orifices, so treatment should open the orifices and scour phlegm.
Alum (baifan) is a crystal refined from alunite, a sulfate mineral of the alum-stone family; its main component is hydrated potassium aluminum sulfate. Dried alum (kufan) is made by dehydrating alum; it is also called calcined alum. The traditional processing is to take sorted alum, place it in a clay pot, heat it until it melts and calcines to dryness. Dried alum appears as irregular crystals of varying size, colorless, transparent or translucent, with a slightly smooth or uneven surface, fine longitudinal ridges, and a glassy luster.
Modern pharmacology shows that alum or dried alum both have good antibacterial effects, anti-trichomonal effects, protein-coagulating effects, and hemostatic and antiperspirant effects. But alum is toxic: animal experiments show that injecting alum injection into rabbits or dogs causes local hemorrhagic coagulative necrosis, followed by anti-collagen scar formation around it, leading to anuria, urinary incontinence, diarrhea, and difficult defecation; experimental animals also developed edema of the anus, perineum, and testicles and scrotum, even perianal tissue necrosis, rectal fistulas, and late rectal stricture. Thus alum or dried alum must not be used in excess or long term.
Traditional TCM holds that alum expels phlegm and opens the orifices; it is often used to treat stroke, epilepsy, throat obstruction, and phlegm-rheum panting and cough. Alum is also frequently used externally for scabies, psoriasis, vitiligo, eczema, carbuncles and swellings, cellulitis, mouth and tongue ulcers, burns and scalds, purulent ear discharge, nasal polyps, hemorrhoid pain, uterine bleeding, traumatic bleeding, epistaxis, vaginal discharge and itching, rectal prolapse, and uterine prolapse.
Alum is one of the most important herbs in TCM treatment of nervous system diseases. Besides Baijin Wan, history also records "Jiusheng San" (from the Shengji Zonglu), also used for nervous system disease. Jiusheng San treats sudden stroke (cerebral hemorrhage or cerebral infarction); it consists of equal parts alum, clear pinellia, and arisaema, made into a powder. To use, take about 3g of powder, mix with wine, then decoct 3 slices of ginger and pour the decoction down the patient to induce vomiting. This was an ancient emergency method for stroke patients; it is rarely used today, and modern stroke patients are generally rescued by neurosurgery.
From these records we can see that in ancient times Chinese physicians found that alum had some therapeutic effect on nervous system diseases. Mental illnesses such as bipolar disorder are also nervous system diseases, so it is not strange that the ancients used alum to treat them.
Sichuan turmeric (yujin) is another Chinese herb commonly used for mental illness; as its name suggests, turmeric treats depression patterns. Sichuan turmeric (Curcuma chuanyujin) is a perennial herb grown in Sichuan, 80–120cm tall, with spindle-shaped tuberous roots that are yellow in cross-section. Modern yujin is the tuberous root of several Curcuma species: Sichuan turmeric, Wen turmeric (from Wenzhou), turmeric (jianghuang), Guangxi zedoary, and zedoary (ezhu) are all used as yujin. To ensure efficacy, the turmeric in Baijin Wan should follow the ancient text and use Sichuan turmeric.
Modern pharmacology shows yujin has some effect on higher nervous activity of the central nervous system; curdione (jianghuang erdong) contained in yujin is one of its main active components. Studies show curdione injection significantly prolongs all sleep stages in cats—slow-wave sleep stage 1, slow-wave sleep stage 2, and REM sleep—and is clearly superior to the traditional sedative Zhusha Anshen Wan. The trial suggests curdione has a marked central nervous depressant effect. Other experiments show curdione significantly inhibits the evoked field potentials of CA1 pyramidal cell clusters in isolated hippocampal slices. Yujin's effect on mental illness has thus been confirmed by modern science.
Inspired by this formula, Academician Tong Xiaolin added bambusae concretio silicea (tianzhuhuang) to Baijin Wan and developed "Tong's Hysteria-Syncope Pill." Its composition: dried alum (kufan) 12g, broad turmeric (guang yujin) 48g, bambusa concretio (tianzhuhuang) 24g. Grind the three into powder, make into honey pills, each 3g. Take one pill each time, twice daily. The formula scours phlegm and opens the orifices, and is indicated for hysterical syncope.
According to Academician Tong Xiaolin's account, in clinical practice a patient once told him that a folk practitioner had used alum and turmeric to treat psychiatric disease with very good effect. Academician Tong then adopted the approach in his own practice and further optimized the formula. He has used it to treat severe mental illnesses such as schizophrenia and bipolar disorder, with cured cases; his writings contain dedicated case records, and interested readers may consult his book New Nineteen Items of Disease Mechanism.
Virtually no psychiatric drug is free of side effects; relatively speaking, Baijin Wan may have somewhat less toxicity than others. Even so, patients should not take it in excess. If long-term use is needed, liver and kidney function and blood count should be checked regularly before and during use, to avoid acute poisoning or chronic cumulative toxicity.