Huanglian Wendan Decoction for Insomnia Due to Digestive Tract Disease

Huanglian Wendan Decoction comes from Liuyin Tiaobian (Systematic Identification According to the Six Causes) by the Qing physician Lu Zixian. Its composition is: Huanglian (Coptidis Rhizoma), 2 qian (6 g); Zhuru (Bambusae Caulis in Taeniam), 4 qian (12 g); Zhishi (Aurantii Fructus Immaturus), 2 qian (6 g); Banxia (Pinelliae Rhizoma), 2 qian (6 g); Chenpi (Citri Reticulatae Pericarpium), 2 qian (6 g); Gancao (Glycyrrhizae Radix), 1 qian (3 g); Shengjiang (Zingiberis Rhizoma Recens), 2 qian (6 g); Fuling (Poria), 3 qian (9 g). This is an effective, proven formula for insomnia due to phlegm-fire harassing the heart. Its indications are: insomnia with vexation and tossing and turning, gastric and epigastric fullness and oppression with dull pain, a yellow, thick, rotten, greasy tongue coating, heavy breath, and a slippery, rapid pulse. These symptoms are common in patients with various chronic gastrointestinal diseases; patients with Helicobacter pylori infection, gastric ulcer, gastritis, reflux esophagitis, chronic enteritis, cholecystitis, gastric cancer, liver cancer, and gallbladder cancer often present with such symptoms. This formula combines Huanglian with Wendan Decoction because, according to traditional TCM theory, Huanglian clears heat and dries dampness, drains fire and resolves toxin. Modern pharmacological research shows that the berberine (huangliansu) contained in Huanglian is a broad-spectrum antibacterial active agent that treats gastritis, enteritis, esophagitis, cholecystitis, and related conditions. However, Huanglian is bitter and cold and easily irritates the stomach, so it is advisable to take it with egg white, milk, or soy milk to protect the stomach. TCM holds that "when the stomach is not harmonized, sleep is restless"; here "stomach not harmonized" refers in a broad sense to digestive tract disease, and chronic digestive disease indeed causes insomnia. Apart from the single herb Huanglian, the remaining herbs in this formula constitute Wendan Decoction. Wendan Decoction is a famous TCM phlegm-resolving formula that moves qi and resolves phlegm, harmonizes the stomach and benefits the gallbladder. It treats the syndrome of gallbladder constraint with phlegm disturbance. Its indications are: timidity and susceptibility to fright, dizziness and palpitations, vexation and insomnia, many disturbed dreams at night; or nausea and belching, vertigo, and epilepsy; a white greasy tongue coating and a wiry, slippery pulse. Clinically it is often used for neurasthenia, acute and chronic gastritis, peptic ulcer, chronic bronchitis, Meniere's disease, menopausal syndrome, and epilepsy belonging to the gallbladder-constraint-with-phlegm-disturbance pattern. Huanglian Wendan Decoction is a typical formula combining disease differentiation with syndrome differentiation. One may add Xiaomai (Tritici Fructus) 30 g and Dazao (Jujubae Fructus) 5 pieces, combining it with Ganmai Dazao Decoction to enhance the effect of resolving constraint and calming the spirit, while also better protecting the stomach from Huanglian's irritation. In addition, one may appropriately add spirit-calming, sleep-promoting herbs such as Yejiaoteng (Polygoni Multiflori Caulis), Hehuanhua (Albiziae Flos), Suanzaoren (Ziziphi Spinosae Semen), and Baiziren (Biotae Semen). With accompanying anxiety and constipation, it may be combined with Erzhi Wan; with acid regurgitation and heartburn, with Wuji San (equal parts of Wuzeigu (Sepiae Endoconcha) and Baiji (Bletillae Rhizoma)); with a feeling of distress in the heart and generalized heat, with Zhizi Dadouchi Tang (Zhizi (Gardeniae Fructus) 10 g, Dadouchi (Sojae Semen Praeparatum) 10 g).