Three Proven Formulas for Mania Recorded in Lu Fu Jin Fang
Lu Fu Jin Fang (Imperial Prescriptions of the Lu Prince) is a work by the famous Ming-dynasty physician Gong Tingxian. Gong Tingxian was renowned in his day for his outstanding therapeutic results and was hailed as the “Zhuangyuan of the Medical World.” The proven formulas he commonly used had definite efficacy and are of considerable research value.
This article introduces three proven formulas for mania recorded in Lu Fu Jin Fang. Gong Tingxian had quite a number of formulas for treating mania, but some of them used mercury preparations or lead-containing Chinese herbs, which easily cause toxic reactions; these formulas are no longer safe for modern use, so the author does not discuss them here. The three formulas introduced in this article are all relatively safe.
Formula 1: Sanhuang Jusheng Decoction
Original text: It treats yang-toxin mania with raving and confused speech, climbing to heights and singing, throwing off clothing and running about, a red face and large forceful pulse, eruptive spots and jaundice, great thirst, and constipation with a retracted scrotum; these are difficult to treat, as the toxin has entered the zang-fu organs. Ingredients: Shigao (Gypsum), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Dahuang (Rhei Radix et Rhizoma), Mangxiao (Natrii Sulfas), Zhishi (Aurantii Fructus Immaturus), Shanzhi (Gardeniae Fructus), Gancao (Glycyrrhizae Radix et Rhizoma); decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus), and take warm.
This formula is based on Zhang Zhongjing’s Sanhuang Xiexin Decoction (composed of Huanglian, Huangqin, Huangbai, and Dahuang) and Xiaochengqi Decoction (composed of Dahuang, Mangxiao, and Gancao), with added Shigao, Zhizi, Zhishi, Shengjiang, and Dazao.
The symptoms recorded by Gong—raving and confused speech, climbing to heights and singing, throwing off clothing and running about—are typical of a manic episode, commonly seen in mania, bipolar disorder, or the manic phase of schizophrenia. Most such patients also suffer from constipation; in severe cases they may not have a bowel movement for one to two weeks.
TCM regards this as a Yangming excess pattern. In the Shanghan Lun and Jingui Yaolüe, the Chengqi Decoction series is commonly used for this, and Tiaowei Chengqi Decoction is indicated for mania. Gong’s Sanhuang Jusheng Decoction builds on Tiaowei Chengqi Decoction while strengthening the heat-clearing and fire-purgating action, so its efficacy should be even more pronounced.
Formula 2: Sanhuang Shigao Decoction
Original text: It treats yang-toxin eruption with the body as red as if painted cinnabar, eyeballs like fire, raving and wanting to run, all six pulses surging and rapid, dry agitation and thirst as if dying, dry nose, red face, yellow teeth; the condition has not resolved after passing through the channels and has become a dysentery-like disorder. There is heat both in the exterior and interior; trying to sweat it out does not resolve the fever, and then purging is used, leading to frequent stools and difficult urination. It also treats cases where a warm disease was mistreated and led to this condition. It further treats, after sweating and purging, heat engendered in the triple burner, a surging pulse and delirious speech, panting day and night, occasional nosebleeds, and raving with a desire to run. Ingredients: Huanglian, Huangqin, Huangbai, Shanzhi, Mahuang (Ephedrae Herba), Shigao, Douchi (Sojae Semen Praeparatum), Shengjiang; decoct with a little fine tea and take.
This formula combines Huanglian Jiedu Decoction (Huanglian, Huangqin, Huangbai, Zhizi) with Zhizi Chi Tang (Zhizi and Dandouchi), and also incorporates half of a Mahixing Shigan Decoction (Mahuang, Xingren, Shigao, Gancao). Huanglian Jiedu Decoction treats exuberant fire in the triple burner; Zhizi Chi Tang treats oppressive discomfort in the chest; Mahixing Shigan Decoction treats lingering heat in warm disease.
Thus from a TCM theoretical standpoint, this is a fire-purging and annoyance-relieving formula. Gong used it to treat yang-toxin presenting as “eyeballs like fire, raving and wanting to run, surging rapid pulses, dry agitation and thirst,” which is highly appropriate.
The difference in medication between Sanhuang Shigao Decoction and Sanhuang Jusheng Decoction is that the former is suitable for patients with difficult urination, while the latter is more suitable for patients who also have constipation.
Formula 3: Taoren Chengqi Decoction
Original text: It treats heat evil transmitting to the interior, heat accumulating in the bladder, with the person behaving as if manic, normal urination, black stool, fullness and pain in the lower abdomen, and yellow body and eyes—this is blood accumulation syndrome, with a deep, forceful pulse; use this to purge out the black matter and recovery follows. If blood passes before taking the formula, recovery is imminent and Taoren need not be taken. Ingredients: Guizhi (Cinnamomi Ramulus), Dahuang, Mangxiao, Gancao, Chaihu (Bupleuri Radix), Qingpi (Citri Reticulatae Pericarpium Viride), Zhishi, Baishao (Paeoniae Alba Radix), Danggui; add Sumu (Sappan Lignum) 2 qian; boil briefly and take warm.
Tao Ren Chengqi Decoction is a representative formula for treating mania accompanied by blood stasis. The patient’s typical symptoms are “black stool and fullness/pain in the lower abdomen.” This formula is derived from a modification of Da Chaihu Tang and Taohe Chengqi Tang, with a strong blood-activating and stasis-resolving action.
These three formulas collected by Gong Tingxian comprehensively cover the three aspects of mania accompanied by bowel or bladder problems. When using Gong’s formulas for pattern differentiation, as long as one takes a detailed history of the patient’s bowel and urination patterns—the main issue—one knows how to medicate. If a TCM practitioner needs to see psychiatric patients frequently, it is well worth studying these formulas carefully. Only by understanding the principles behind their medication can one achieve good clinical results.