Huanglian Ejiao Decoction for Irritability and Insomnia Caused by Stomach Problems

Huanglian Ejiao Tang comes from Zhang Zhongjing's Shanghan Lun. In the chapter on Shaoyin disease pattern differentiation and treatment, a line reads: "In Shaoyin disease, after two or more days, if there is vexation in the heart and inability to lie down, Huanglian Ejiao Tang governs."

The formula's composition: Huanglian (Coptis) 4 liang, Huangqin (Scutellaria) 2 liang, Shaoyao (peony) 2 liang, Jizihuang (chicken egg yolk) 2 pieces, Ejiao (donkey-hide gelatin) 3 liang. Modern practitioners commonly use: Huanglian 12 g, Huangqin 6 g, Baishao (white peony) 6 g, Ejiao 10 g, egg yolk 2 pieces.

Later scholars call the Huanglian Ejiao Tang pattern the Shaoyin heat-transformation pattern or the pattern of non-communication between heart and kidney. The Shaoyin pulse is mostly deep—deep fine or deep faint. The typical Shaoyin symptom is "but desire to sleep" (somnolence), yet the Huanglian Ejiao Tang pattern shows vexation and insomnia, showing Shaoyin disease has a bidirectional effect on sleep.

Cold Shaoyin patterns usually show "but desire to sleep," with a deep moderate or deep slow pulse, and are treated with formulas such as Sini Tang, Mahuang Fuzi Xixin Tang, or Mahuang Fuzi Gancao Tang according to the patient. Heat Shaoyin patterns show vexation and insomnia, with a deep faint and rapid pulse, and are treated with Huanglian Ejiao Tang. Both cold and heat Shaoyin patterns commonly also show fatigue.

There are many types of insomnia and many formulas treat it, such as Suanzaoren Tang and Guipi Tang. One must choose according to the patient's specific condition; a wrong formula will not work.

I believe Huanglian Ejiao Tang can treat insomnia caused by various stomach diseases of modern medicine. Besides a deep, fine, rapid pulse, such patients tend to have dry mouth and tongue and chapped lips. Among the formula's herbs, Huanglian, Huangqin, and Baishao are all common stomach medicines. Egg yolk is rich in vitamin B2; vitamin B2 deficiency commonly causes cracked corners of the mouth, glossitis, and painful chapped lips—symptoms frequent in stomach patients. In Chinese medicine these mostly belong to yin deficiency with effulgent fire, a Shaoyin heat pattern.

These stomach problems most often arise from staying up late and anxiety; some patients also have heartburn and a craving for ice-cold drinks. The several patients I myself treated by this pattern differentiation—with restless stomach and vexed insomnia—responded remarkably.

I also recall Professor Liu Duzhou treating a patient who habitually stayed up late, drinking strong coffee while doing so, and then developed chronic insomnia. At night his vexation was so great he had to go out into the open fields and shout loudly to feel relief; his tongue was strawberry-red. Professor Liu judged it a Huanglian Ejiao Tang pattern and prescribed the formula. After three doses he could sleep peacefully and the vexation ceased; after three more doses, the insomnia was cured.

I believe this patient's root cause was actually long-standing bad habits—staying up late plus strong coffee, which heavily irritate the stomach.

These modest observations are offered for readers' reference.