"Yu Zhi Zi Wan" (Akebia Pill) for Nourishing the Heart and Calming the Spirit
"Yu Zhi Zi Wan" comes from Taiping Huimin Heji Ju Fang (Prescriptions from the Peaceful Benevolent Dispensary). In Yu Yao Yuan Fang (Formulary of the Imperial Pharmacy) it is also named "Zhen Xin Wan" (Heart-Tranquilizing Pill). It is a formula for nourishing the heart and calming the spirit, indicated for insufficiency of heart-qi, low spirits, distracted mood, confused and erroneous speech and judgment, palpitations with vexation and depression, melancholy and distress, frequent joy, anger, and fear, forgetfulness and little sleep, many disturbing dreams at night, fright terrors on falling asleep, or manic dizziness and sudden loss of consciousness. These are common psychiatric symptoms, mostly seen in patients with panic disorder, mania, bipolar disorder, schizophrenia, and borderline personality disorder.
The composition of Yu Zhi Zi Wan is: Gou Qi Zi (Lycii Fructus, purified), Bai Fu Ling (Poria), Huang Jing (Polygonati Rhizoma, steamed until cooked), Zhu Sha (Cinnabaris, ground and water-floated), Yu Zhi Zi (Akebiae Fructus, peeled), Shi Chang Pu (Acori Tatarinowii Rhizoma), Fu Shen (Poriae Pini Radix, remove the wood), Ren Shen (Ginseng), Bai Zi Ren (Biotae Semen), Di Gu Pi (Lycii Cortex), Yuan Zhi (Polygalae Radix, remove the heart), and Shan Yao (Dioscoreae Rhizoma), each in equal amounts.
Preparation: Grind the above herbs together into a fine powder, refine with honey into pills, and coat again with Cinnabaris; the pills should be the size of a longan pit. Take 1 pill each time, chew finely, and wash down with ginseng decoction, at any time.
This formula is somewhat similar to the "Jianwang Dan" (Forgetfulness Pill) I introduced earlier (see the article "Jianwang Dan for Treating Fright and Forgetfulness"); it is also an ancient TCM prescription for treating emotional disorders. Like Jianwang Dan, this formula also uses Cinnabaris, and I still advise removing Cinnabar and not coating the pills with it. Cinnabaris may be replaced by other equally spirit-calming but side-effect-free herbs such as Suan Zao Ren (Ziziphi Spinosae Semen). Or, after removing Cinnabaris, this formula may be combined with Gan Mai Dazao Tang (Licorice, Wheat and Jujube Decoction) or Dan Zhu Ru Tang (Lophatherum Shoot Decoction) for treatment. Because if Cinnabaris is used in large amounts, patients easily suffer mercury poisoning and become slow to respond. The ancients used Cinnabaris to calm the spirit mainly because of its effect of making patients slow to respond; this is really not advisable.
Psychological or psychiatric disorders have existed since ancient times. Ancient TCM also tried to treat such diseases and left some treatment experience. This experience may have some efficacy for psychiatric patients who are unwilling to rely on Western medicine or for whom Western medicine has failed; family members may wish to give it a try.
Psychiatric patients usually have a certain degree of dysfunction, with disordered cognition and emotion; the ancients had a very deep understanding of this. Among the indications of this formula, "confused and erroneous speech and judgment," "manic dizziness," and "sudden loss of consciousness" are, in today's terms, cognitive disorder—meaning the patient has lost the normal ability to test reality against the objective world. The rest—insufficiency of heart-qi, low spirits, distracted mood, palpitations with vexation and depression, melancholy and distress, frequent joy/anger/fear, forgetfulness and little sleep, many disturbing dreams at night, and fright terrors on falling asleep—are all the patient's emotional dysregulation symptoms and somatic symptoms.
Patients develop such symptoms because they are in a state of over-defense: the amygdala and the hypothalamic-adrenal axis, which govern emotional responses, are over-activated, and many neurotransmitters are in disorder. Today's pharmacological experiments show that TCM spirit-calming herbs or spirit-calming formulas do have some effect in improving these biological mechanisms. But treating such diseases usually requires a combination of medication and cognitive behavioral therapy; while improving the patient's physical condition, one must also provide long-term, targeted psychological counseling to correct the core beliefs the patient formed in childhood. If both approaches are not pursued together, lasting efficacy is hard to achieve.
Psychiatric disorders have a long course and slow onset of effect; treatment requires great patience and realistic psychological expectations from both patients and their families. Sometimes even the family members need help from psychological counselors, because caring for such patients is an emotionally exhausting thing.