Xingmi Zhibao Pills for Dementia and Mania Caused by Phlegm Confusing the Heart Orifice

"Xingmi Zhibao Dan" (Waking from Confusion Precious Pills) comes from the Qing-dynasty Yifang Yijian (Simple Medical Formulas) compiled by Wang Jinfu and his son Wang Pengshou. The formula is composed as follows: Dannannan (Bile Arisaema) 3 qian (9 g), raw Suanzaoren (Semen Ziziphi Spinosae) 3 qian (9 g), Yuanzhipou (Radix Polygalae, peeled) 3 qian (9 g), Fushen (Poria with Hostwood) 3 qian (9 g), Chaihu (Radix Bupleuri) 3 qian (9 g), Chuanbeimu (Bulbus Fritillariae Cirrhosae) 2 qian (6 g), Banxiaqu (Massa Pinelliae Fermentata) 2 qian (6 g), Chenpi (Pericarpium Citri Reticulatae) 1 qian (3 g), Gancao (Radix Glycyrrhizae) 1 qian (3 g), Guangmuxiang (Radix Aucklandiae) 1 qian (3 g), and Sharen (Fructus Amomi) 1 qian (3 g).

Grind all the above herbs into a fine powder; use refined honey as a binder to make pills the size of a phoenix-tree seed (about the size of a soybean), coating 3 qian (9 g) of Zhusha (Cinnabaris) on the outside. Take 30-40 pills each time with warm water, 2-3 times daily. The main action of this formula is to scour phlegm and open the orifices. It is indicated for phlegm confusing the heart orifice with dementia and mania—a condition seen in modern medicine in patients with psychiatric disorders such as schizophrenia.

Because Zhusha (cinnabar) in this formula is toxic and has toxic side effects on the nervous system, long-term use can easily cause cumulative poisoning. I therefore suggest omitting Zhusha and instead adding Shichangpu (Rhizoma Acori Tatarinowii) 9 g and Tianzhuhuang (Concretio Silicea Bambusae) 6 g, and preparing the mixture as pills. Alternatively, decoct the above amounts in water as a decoction; the above amounts constitute one adult day's dose, to be decocted twice and divided into two doses.

In this formula, Dannannan, Chuanbeimu, and Banxiaqu are phlegm-resolving herbs; Suanzaoren, Yuanzhi, and Fushen all calm the spirit; Chaihu soothes the liver and resolves depression; Chenpi, Muxiang, and Sharen regulate qi; Gancao harmonizes the other herbs. Adding Shichangpu has the effect of waking and opening the orifices; Tianzhuhuang assists Banxiaqu, Dannannan, and Chuanbeimu in resolving phlegm. If the stool is constipated, Dahuang (Radix et Rhizoma Rhei) and Mangxiao (Natrii Sulfas) may be added; if liver depression and qi stagnation are severe, Xiangfu (Rhizoma Cyperi) and Yujin (Radix Curcumae) may be added.