My Modified Yangxin Tang for Post-COVID Insomnia and Tachycardia

In the Gu Jin Yi Tong Daquan there is a formula called Yangxin Tang, composed of: Angelicae Sinensis Radix (Danggui), Rehmanniae Radix (Shengdi), Rehmanniae preparata (Shudi), and Poriae Sclerotium Pararadicis (Fushen), each 1 qian (3 g); Ginseng and Ophiopogon, each 1.5 qian (4.5 g); Schisandrae Fructus (Wuweizi) 1.3 qian (4 g); Platycladi Semen (Baiziren) and Zizipphi Spinosae Semen (Suanzaoren), each 1 qian (3 g); prepared Licorice 0.5 qian (1.5 g). Decoct in water for oral use.

This formula nourishes blood and yin, calms the heart and settles the spirit; it is used for the pattern of blood failing to nourish the heart, presenting palpitations and severe palpitation, insomnia and forgetfulness, restless dreams at night, five-pronged heat, dizziness, fatigue and lassitude, a pale tongue, and a scorched coating. Today it is commonly used for insomnia, senile dementia, menopausal syndrome, neurosis, coronary heart disease, viral myocarditis, congestive heart failure, and arrhythmia belonging to heart-blood insufficiency.

After COVID-19 many patients present insomnia and tachycardia, belonging to the pattern of phlegm-heat harassing the heart with yin deficiency and qi deficiency; Yangxin Tang can relieve these symptoms. But post-COVID sequelae are complex: patients with insomnia usually also have tachycardia, night sweats, easy sweating, and dry mouth, so this formula alone is not strong enough. It should be combined with Danzhuru Tang. The author’s empirical formula is as follows:

Angelica 12 g, white Paeonia 12 g, raw Rehmannia 12 g, prepared Rehmannia 12 g, Fushen 12 g, Codonopsis (Dangshen) 15 g, Ophiopogon 15 g, Schisandra 12 g, light wheat (Fuxi Xiaomai) 30 g, Platycladi seed 10 g, Zizyphi spinosae seed 10 g, Polygala (Yuanzhi) 10 g, bamboo shavings (Zhuru) 10 g, artificial Tianzhuhuang (Bambusae concretio silicea) 10 g, Poria 10 g, Arisaema cum Bile (Dannanxing) 6 g, processed Pinellia (Fabanxia) 6 g, prepared Licorice 6 g, Albiziae Flos (Hehuanhua) 6 g, Polygoni multiflori Caulis (Yejiaoteng) 12 g, amber powder (Hupo) 6 g, Gastrodia (Tianma) 6 g, and Acori Rhizoma (Shichangpu) 6 g.

For night sweats add prepared Trionyx shell (Zhibiejia) 15 g, Cortex Lycii 15 g, Anemarrhena (Zhimu) 6 g, Phellodendron 6 g, or take Zhibai Dihuang Wan concurrently; for qi deficiency and weakness add raw Astragalus (Sheng Huangqi) 30 g, Polygonatum (Huangjing) 15 g, or take Buzhong Yiqi Wan concurrently; for dry mouth and tongue add Trichosanthes root (Tianhuafen) 10 g, Gynostemma (Jiaogulan) 15 g, Glehnia (Beishashen) 15 g; for chest tightness and stabbing pain add Allii macrostemi Bulbus (Xiebai) 10 g, Trichosanthes fruit (Gualou) 15 g, earthworm (Dilong) 10 g, Curcuma (Yujin) 10 g, Salvia (Danshen) 10 g, Cinnamomi Ramulus (Guizhi) 10 g; for agitated mood add Coptis (Huanglian) 3 g, donkey-hide gelatin (Ejiao) 12 g; for stomach pain and acid reflux cuttlefish bone (Wuzeigu) 10 g, Bletilla (Baiji) 10 g, Corydalis (Yuanhu) 10 g; for constipation add Cistanche (Roucongrong) 10–30 g, Cannabis seed (Huomaren) 10–30 g.

The above are adult daily doses: 1 dose daily, decocted in water and taken in 2–3 portions, reduced for children. Patients with these symptoms are usually constitutionally weak, with underlying disease or a family history of cardiovascular or cerebrovascular disease; though they improve with medication, the course is long and the condition fluctuates. If the formula works well, it may be made into pills for long-term use.