Shangxia Liangji Dan for Day-and-Night Vexation and Sleeplessness

"Shangxia Liangji Dan" (Upper-and-Lower Mutual-Support Pellets) comes from Bianzheng Lu (Records of Pattern Differentiation) by the Qing physician Chen Shiduo. Its composition is: Renshen (Ginseng Radix et Rhizoma), 5 qian (15 g); Shudihuang (processed Rehmanniae Radix), 1 liang (30 g); Baizhu (Atractylodis Macrocephalae Rhizoma), 5 qian (15 g); Shanzhuyu (Corni Fructus), 3 qian (9 g); Rougui (Cinnamomi Cortex), 5 fen (1.5 g); Huanglian (Coptidis Rhizoma), 5 fen (1.5 g). One dose daily, decocted in water, strained, and divided into two warm doses. This formula boosts qi and nourishes yin, and communicates the heart and kidney. It treats non-interaction between heart and kidney: inability to sleep day or night, with extreme vexation and restlessness. Judging from these symptom descriptions, the indications of this formula resemble anxiety and depression in modern medicine; patients with moderate-to-severe depression and bipolar disorder may present these symptoms during the depressive phase. This formula is mainly tonifying, matching the disease mechanism of depressed willpower and weakness in depression patients. In it, Renshen greatly supplements original qi, Shudihuang nourishes yin and blood, Baizhu fortifies the spleen and boosts qi, and Shanzhuyu supplements the kidney and secures collapse; all four are used in relatively large amounts, so the emphasis of this formula is on supporting the righteous qi. The combination of these four has the effect of greatly supplementing original qi and supplementing the kidney and nourishing yin, restoring the patient's vitality. Those with depressed willpower and low vitality may appropriately add Bajitian (Morindae Officinalis Radix) 15 g and Tusizi (Cuscutae Semen) 15 g; those with prominent anxiety may add Mohanlian (Ecliptae Herba) 15 g and Nüzhenzi (Ligustri Lucidi Fructus) 9 g. The combination of Rougui and Huanglian is the famous TCM formula Jiaotai Wan. Jiaotai Wan treats glomus and discomfort in the chest—when the stool is loose the chest feels rather relieved, when the stool is hard the glomus becomes unbearable—lack of appetite, hyperactivity of heart fire, non-interaction between heart and kidney, palpitations, and insomnia. TCM holds that "when the stomach is not harmonized, sleep is restless"; anxious, insomniac patients usually have gastrointestinal discomfort—acid regurgitation and heartburn, belching with putrid odor, or gastric gnawing—and irregular bowels, whether constipation or loose stools, often accompanied by irritable bowel syndrome. These are precisely the indications of Jiaotai Wan. Overall, this formula emphasizes tonification while also addressing symptoms. The depression patients I see clinically often have a history of being frail and sickly since childhood, with stamina below the ordinary; some even had mothers who were in poor health and dependent on medication at the time of conception. Such patients frequently have digestive problems. The ancients' composition of this formula shows how thoroughly they understood the patients' clinical symptoms.