Suan Zao Ren Tang (Sour Jujube Seed Decoction) for Deficiency-Heat Insomnia
The Tangtou Gejue (Song of Decoction Rhymes) says: "Suan Zao Ren Tang treats insomnia; with Chuanxiong, Zhimu, Gancao, and Fuling decocted; it nourishes blood and removes vexation, clears deficiency heat, and one sleeps peacefully with sweet dreams." The Suan Zao Ren Tang mentioned in this verse is a classic famous prescription for treating insomnia from Zhang Zhongjing's Jingui Yaolue (Essentials from the Golden Coffer) of the Han Dynasty. The Jingui Yaolue records: "For deficiency vexation and deficiency exhaustion with inability to sleep, Suan Zao Ren Tang governs it." This record clearly points out that the main effect of this formula is treating insomnia, so physicians of all dynasties have used it to treat deficiency-vexation insomnia caused by heart yin insufficiency.
The composition of Suan Zao Ren Tang is: Suanzaoren (Ziziphi Spinosae Semen) 12 g; Fuling (Poria) 6 g; Chuanxiong (Chuanxiong Rhizoma) 6 g; Zhimu (Anemarrhenae Rhizoma) 6 g; Sheng Gancao (raw Glycyrrhizae Radix) 3 g; decocted in water for oral use. The above doses have all been converted to modern doses; in the Han Dynasty, the doses Zhang Zhongjing used were much larger, but nowadays they are no longer used as in Han times. Modern pharmacological research has found that Suanzaoren in this formula indeed has a very good spirit-calming and sleep-promoting effect. But the effect of using Suanzaoren alone to treat insomnia is not as good as Zhang Zhongjing's formula, especially for deficiency-vexation insomnia.
Traditional TCM holds that Suan Zao Ren Tang has the effects of nourishing blood and calming the spirit, clearing the heart and removing vexation. It can be used for deficiency-vexation insomnia due to liver blood deficiency and heart yin insufficiency. The common symptoms of this pattern are irritability and insomnia, palpitations and night sweats, dizziness and vertigo, dry mouth and parched tongue.
Nowadays it is often used for insomnia caused by neurasthenia, intractable insomnia, cardiac neurosis, coronary heart disease, paroxysmal tachycardia, ventricular premature beats, menopausal syndrome, Sjogren's syndrome, schizophrenia, somnambulism, and hepatolenticular degeneration with mental disorders. It can also be used for hypertension, infertility, and other conditions belonging to the pattern of deficiency heat harassing internally. But this formula is not very effective for insomnia caused by cerebrovascular diseases (such as cerebral infarction, lacunar infarction, etc.).
This formula is a Zhang Zhongjing classical prescription; Zhang's classical formulas have always been valued, so there are very many historical medical cases in which this formula was used to treat insomnia with good results. Even in modern times, countries that value TCM such as China and Japan still have Chinese patent medicines made according to Suan Zao Ren Tang's composition circulating on the market, such as the Kampo medicine Suanzaoren-to in Japan, and Chinese patent medicines like Suanzaoren Keli (Sour Jujube Granules) and Zaoren Anshen Jiaonang (Jujube Seed Spirit-Calming Capsules).
This formula also has many derived formulas, all formed by adding or subtracting herbs according to the patient's specific symptoms. If the patient has severe deficiency vexation, with restless heart, malar flush and night sweats, add Wuweizi, Baishao, and Fuxiaomai to calm the spirit and astringe sweat; if the patient has heart-gallbladder qi deficiency with palpitations and many dreams, add Huangqi, Dangshen, and Longchi to boost qi and settle fright; if liver-kidney yin deficiency with dizziness, blurred vision, and dry eyes, this formula can be used together with Qi Ju Dihuang Wan; for neurasthenia with severe insomnia, add Baihe, Hehuanpi, Jiaoteng, Danggui, Shudi, Baishao, Cishi, Hupo, Yuanzhi, and Baiziren to strengthen the spirit-calming and sleep-promoting effect; for yin deficiency with effulgent fire and constipation, add Baiziren, Huomaren, and Roucongrong to moisten dryness and free the stool.