Tianwang Buxin Dan for Treating Cardiac and Cerebrovascular Diseases

Tianwang Buxin Dan (Heavenly Emperor's Heart-Supplementing Pellet) is a famous TCM formula for treating spirit and mind disorders. TCM "spirit disorders" relate to psychiatric and cardiac diseases in modern medicine; in fact, the two often occur comorbidly.

Historically several formulas have borne the name Tianwang Buxin Dan. The best known are the "Tianwang Buxin Dan" in Wei Yilin's Shiyi Dexiao Fang (Yuan dynasty) and the "Tianwang Buxin Dan" in Miao Xiyong's Xianxing Zhiyi Guangbi Ji (Ming dynasty); the two differ little in composition. Modern Chinese patent manufacturers' Tianwang Buxin Dan essentially follows the ancient formulas with only slight modifications.

The Tianwang Buxin Dan in the Shiyi Dexiao Fang is composed of: Shudihuang (prepared Rehmannia, washed and baked) 4 liang (120 g); and Fuling (Poria), Fuishen (Poria with hostwood, wood removed), Danggui (Angelica, washed and baked), Yuanzhi (Polygala, core removed), Shichangpu (Acorus, Rhizoma Acori Graminei), Hei Xuanshen (black Scrophularia), Renshen (Ginseng), Maimendong (Ophiopogon, core removed), Tianmendong (Asparagus, core removed), Jiegeng (Platycodon, rootlet removed), Baibu (Stemona), Baiziren (Biota Seed), Duzhong (Eucommia, stir-fried in ginger juice), Gancao (honey-fried Licorice), Danshen (Salvia, washed), Suanzaoren (Sour Jujube Seed, stir-fried), and Wuweizi (Schisandra), each 1 liang (30 g).

Grind all the above into a fine powder, refine with honey into pills, making 10 pills per liang, and wrap each with gold leaf. The Shiyi Dexiao Fang assigns this formula the effects of quieting the heart and settling the spirit, benefiting blood and securing essence, strengthening power and improving memory. It treats heart-spirit deficiency with severe palpitation and unease, insomnia, fright palpitations, dry throat and parched mouth—symptoms quite similar to depression in modern medicine.

The Tianwang Buxin Dan in the Xianxing Zhiyi Guangbi Ji is composed of: Renshen (Ginseng), Huai Shanyao (Chinese Yam), Maimendong (Ophiopogon, core removed), and Danggui-shen (Angelica body, washed in wine), each 1 liang (30 g); Huai Shengdihuang (Raw Rehmannia) and Tianmendong (Asparagus, core removed), each 1 liang 3 qian (40 g); Danshen (Salvia) 8 qian (24 g); Baibu (Stemona), Bai Fuishen (Poria with hostwood, coarse bark removed, firm white preferred), Shichangpu (Acorus, hairs removed), Baiziren (Biota Seed, the de-oiled kind preferred, ground separately), Gancao (Licorice, moistened with running water and fried), Bei Wuweizi (Northern Schisandra), and Duzhong (Eucommia), each 7 qian (20 g); Yuanzhi (Polygala) 3 qian (10 g); and Bai Fuling (White Poria) 1 liang 6 qian (47 g).

The preparation is to grind all the above into a fine powder, refine with honey into pills the size of a ball, each pill weighing 3 g, and coat with 30 g of Zhusha (Cinnabar) ground to an extreme fineness. Let the pill dissolve in the mouth after meals or before bedtime, then drink an appropriate amount of decocted Dengxincao (Rush Pith). This book records the formula's effects as quieting the heart and settling the spirit, boosting qi and securing essence, strengthening power and improving memory, and clearing heat and resolving phlegm. It treats inherent weakness, overthinking, insufficiency of heart-blood, severe palpitation and forgetfulness—symptoms broadly similar to those recorded in the Shiyi Dexiao Fang.

The Tianwang Buxin Dan produced by contemporary pharmaceutical factories is composed of: Dangshen (Codonopsis), Danshen (Salvia), Danggui (Angelica), Shichangpu (Acorus), Fuling (Poria), Wuweizi (Schisandra), Tiandong (Asparagus), Maidong (Ophiopogon), Dihuang (Rehmannia), Xuanshen (Scrophularia), Yuanzhi (Polygala), Suanzaoren (Sour Jujube Seed), Baiziren (Biota Seed), Jiegeng (Platycodon), Gancao (Licorice), and Zhusha (Cinnabar). Its effect is to nourish yin and blood, tonify the heart and settle the spirit; it treats heart-yin deficiency with palpitations and forgetfulness, insomnia and frequent dreaming, and dry stool.

Tianwang Buxin Dan is now mostly used for intractable insomnia, depression, angina pectoris, tachycardia, and intractable ventricular premature beats. In the author's observation, these symptoms are common in patients with anxiety disorders, depression, bipolar disorder, or schizophrenia, who may also have thyroid dysfunction, headache, vomiting, suspiciousness, and irritability. From the symptom descriptions of Tianwang Buxin Dan we can see that ancient Chinese physicians had already observed the clinical symptoms of some neurasthenic patients and tried to formulate treatment. That Tianwang Buxin Dan, as a famous formula, has been used by physicians through the ages shows that it does indeed play a certain clinical role and is effective in improving patients' symptoms.

But whether this formula is coated with cinnabar or gold leaf, it has certain side effects. Cinnabar is mercury sulfide; even in trace amounts, long-term use causes cumulative mercury poisoning that damages the patient's nervous system. Thus this formula actually badly needs improvement. Tianma (Gastrodia), Mohanlian (Eclipta), and Nuzhenzi (Ligustrum Fruit) also have spirit-settling effects with far fewer side effects than mercury sulfide. Contemporary TCM physicians, whether out of concern for patient safety or their own professional safety, need to find such herbs to replace gold leaf and cinnabar and explore new, more effective and safer compositions.