Jiedan Fang for Acute Manic Episodes (Diankuang)

The Qing-dynasty physician Zhao Xuemin recorded in Chuanya Neiwaibian (Collections from a Wanderer, Inner and Outer Sections) a formula called "Jiedan Fang" (Mania-Cutting Formula). It consists of equal parts of Baifan (Alumen, alum) and Yujin (Curcumae Radix); the two are ground together into powder and made into pills. Take 1 qian (3 g) each time, twice daily. Zhao Xuemin wrote that this formula treats "loss-of-wits mania with godlike effectiveness." What TCM calls "loss-of-wits mania" is also called "peach-blossom mania" or "rape-flower mania," because it tends to break out in season when peach and rapeseed flowers bloom. This condition resembles manic episodes in modern psychiatry and is an important acute manifestation of various psychiatric illnesses. Academician Tong Xiaolin once encountered in his clinical practice a female patient suffering from hysterical syncope; the condition had persisted for years, with episodes one or twice a week. She later obtained some powders from a school physician and, after only one week of taking them, was completely cured. The school physician used the same formula for similar patients with similarly good results; the prescription he used was Jiedan Fang with additions. Inspired by this, Academician Tong Xiaolin, adding Tianzhuhuang (Bambusae Concretio Silicea) to Jiedan Fang, developed "Tong's Hysterical Syncope Pills." The pill composition is: Kufan (dried Alum) 12 g, Guang Yujin (Curcumae Radix) 48 g, Tianzhuhuang 24 g. Grind the three above into powder and make into honey pills, each weighing 3 g. Take 1 pill each time, twice daily. This formula opens the orifices by sweeping out phlegm; it treats hysterical syncope. Jiedan Fang treats not only hysterical syncope but also other psychiatric illnesses, including schizophrenia. Academician Tong himself once treated a schizophrenia patient who, upon presentation, was emotionally low, negative, suicidal, with distending pain in the back and expectoration of large amounts of sticky yellow phlegm; the tongue was red with a yellow greasy coating, and the pulse was slippery and rapid. Western medicine diagnosed schizophrenia. Based on the symptoms, Academician Tong treated the case with Jiedan Fang combined with Xiao Xianxiong Decoction plus additions: Baifan 30 g, Yujin 30 g, Qing Banxia (clear Pinelliae Rhizoma) 30 g, Huanglian 6 g, Gualouren (Trichosanthis Semen) 15 g, Fuling 120 g, Guizhi (Cinnamomi Ramus) 30 g, Sheng Baizhu (raw Atractylodis Macrocephalae Rhizoma) 120 g, Zhigancao (honey-fried Glycyrrhizae Radix) 15 g, Xiyangshen (Panacis Quinquefolii Radix) 6 g. One decoction daily. After 13 doses the patient's mood stabilized, and the sticky phlegm and back pain disappeared; the formula was then changed to pills for consolidation for one month, resulting in clinical cure with no recurrence. Modern medical conditions such as bipolar disorder, mania, borderline personality disorder, hysteria, and schizophrenia all fall under the ancient TCM category of "diankuang" (mania-depression). Their clinical manifestations all include reduced insight, sensitivity and suspiciousness, irritability, irascibility, aggression, and persecutory delusions. TCM holds that the cause of such diseases is mostly phlegm clouding the heart orifices, so treatment should open the orifices by sweeping out phlegm. Baifan is a sulfate-group mineral, alumstone, processed and refined; Kufan is the dehydrated product of Baifan, and their effects are essentially the same. Both may be used externally or internally. Applied externally, they resolve toxin and kill parasites, dry dampness and stop itching, and can kill Gram-positive bacilli, dermatophytes, Candida albicans, and other pathogenic bacteria; Kufan additionally dries dampness and astringes sores, stops pain, and removes putridity to stop bleeding. Baifan and Kufan are used externally for eczema, scabies and tinea, rectal prolapse, hemorrhoids, impetigo, and purulent ear discharge; taken internally they stop bleeding and diarrhea and expel wind-phlegm, treating persistent diarrhea, bloody stool, uterine bleeding, epilepsy, and mania. Yujin (Curcuma Radix), as its name suggests in Chinese, is an essential herb for soothing the liver, moving qi, and resolving constraint. Traditional TCM holds that Yujin activates blood and stops pain, moves qi and resolves constraint, clears the heart and cools blood, and benefits the gallbladder and reduces jaundice. However, Yujin must not be used together with Dingxiang (Caryophylli Flos); the two have side effects when combined. In treating depression and mania, TCM rarely does without Yujin. The Tianzhuhuang added in Academician Tong's formula is a concretion formed by the dried secretions inside the stems of bamboo plants such as Bambusa textilis or Lingnania cerosissima (Gramineae). It clears heat and resolves phlegm, clears the heart and stabilizes fright, and treats such conditions as clouded spirit from heat disease, phlegm coma after stroke, pediatric phlegm-heat, convulsive epilepsy, twitching, and nocturnal crying in children. From these descriptions we can see that ancient TCM mostly used Tianzhuhuang for diseases related to the brain. Jiedan Fang combines Baifan and Yujin: it both opens the orifices by sweeping out phlegm and soothes the liver to resolve constraint. The composition is exquisite, focused, and powerfully effective; Zhao Xuemin's description of its "godlike effectiveness" on loss-of-wits mania is not unfounded—Zhao must have had such clinical experience. Academician Tong's addition of Tianzhuhuang takes the effect a step further. During acute psychiatric episodes, patients briefly lose insight and cannot control their emotions, becoming sensitive and suspicious, with racing thoughts, irritability, and impulsivity. Without treatment this seriously affects the patient's quality of life and that of the family. Some patients are averse to common antipsychotic Western drugs because certain medications cause drowsiness, weight gain, mental dullness, and emotional numbness; such patients may try this formula. If insomnia is severe, it may be used together with the patent medicine Jieyu Anshen Keli (Constraint-Resolving Spirit-Calming Granules).