Dangtan Tang: Zhang Xichun's Decoction for Sweating Away Phlegm in Manic Episodes
Dangtan Tang comes from Zhang Xichun's Yixue Zhongzhong Canxi Lu (Records of Integrating Chinese and Western Medicine). Its composition is: unprocessed ochre (Daizheshi, crushed fine) 60 g, rhubarb (Dahuang) 30 g, mirabilite (Poxiao) 18 g, cleared Pinellia (Qing Banxia) 9 g, and Curcuma (Yujin) 9 g. Decoct in water and strain. Take warm, twice daily.
Dangtan Tang drains fire and pacifies the liver, resolves phlegm and opens stagnation. It is indicated for dian-kuang with loss of reason and a slippery, forceful pulse. The TCM condition dian-kuang with loss of reason corresponds in modern medicine to manic episodes, the typical symptoms seen during acute phases of mania, the manic phase of bipolar disorder, schizophrenia, and borderline personality disorder. The patient's behavior differs greatly not only from that of ordinary people but also from his own state when calm, which is why in the past the condition was also called "loss-of-reason madness."
Usually such patients also have constipation during an episode; the more severe the constipation, the higher the degree of mania. That is why Zhang Xichun's formula uses rhubarb and mirabilite, and uses rhubarb in a large dose. TCM holds that a manic episode arises from flaring fire in the liver channel with phlegm confusing the heart's orifices, so treatment focuses on pacifying the liver, scourging phlegm, and draining heat. This formula uses a large dose of unprocessed ochre because ochre pacifies the liver and drains fire; cleared Pinellia resolves phlegm; Curcuma clears the heart and cools the blood, and soothes the liver and resolves stagnation—its name Yujin ("golden moderation") reflects its action of relieving emotional depression. Pinellia and Curcuma assist the ochre (which drains liver fire) and the rhubarb and mirabilite (which drain heat and unblock the bowels), thereby rapidly relieving the patient's manic symptoms.
The causes of manic episodes are extremely complex; essentially all six major psychiatric illnesses can at times present with mania, and patients with depression, when protracted and unrelieved, may also develop manic symptoms. During a manic episode, psychological and somatic symptoms may appear together; severe cases also have auditory and visual hallucinations, cognitive impairment, refusal to acknowledge illness, and very poor treatment adherence, making caregiving very difficult for the family. Treatment must therefore be started at the first sign of an episode, to block a severe attack.
Dangtan Tang cannot radically cure the six major psychiatric illnesses, so patients and their families should not harbor unrealistic expectations of a curative effect. But during a manic episode, this formula can be used to relieve the patient's symptoms and lessen the suffering of both patient and family.