Wan Mi-zhais Zhu Ru Tang (Caulis Bambusae Decoction) &

Fear and Fright

by

Bob Flaws,

with less than normal heart qi tend to be fearful

and easily frightened.

Dipl. Ac. & C.H., FNAAOM,

FRCHM

However, while a tendency to fear and fright is

mostly due to qi vacuity, in real, live patients suffering from anxiety disorders, panic disorders,
paranoia, obsessive-compulsive disorder, and
other such psychiatric disorders characterized by
more than normal levels of fear and fright, qi
vacuity is commonly complicated by phlegm
and/or heat. In the former case, phlegm obstructs
the free flow of the heart qi and thus disrupts the
normal connection of the heart spirit internally
with the external world. In the later case, evil
heat causes the heart qi or spirit to stir excessively or too easily. Because the heart spirit is nothing other than the heart qi when discussed from
the point of view of consciousness and thinkingfeeling and because movement is an inherent
characteristic of qi, movement is also an inherent
characteristic of that spirit. Because the notion of
health in Chinese medicine is based on the
Confucian doctrine of the mean (nothing too
much, nothing too little), when it is healthy, the
spirit moves freely but does not stir frenetically.
Therefore, besides nonconstruction (by qi) and
malnourishment (by blood and essence), anything which either inhibits the free flow of the
heart qi or spirit or causes it to stir hyperactively
may result in the spirit becoming disquieted
(shen bu an).

Keywords: Chinese medicine, Chinese herbal

medicine, Chinese medical psychiatry, fear and
fright, heart-gallbladder qi timidity, Zhu Ru
Tang, Gan Mai Da Zao Tang
The three main mechanisms of psychiatric disorders
In Chinese medical psychiatry, there are three
main disease mechanisms: 1) nonconstruction
and malnourishment of the heart spirit, 2) harassment of the heart spirit by evil heat, and 3) blockage and obstruction of the heart qi, i.e., spirit by
phlegm and/or blood stasis. In addition, the disease mechanism of liver depression qi stagnation
often underlies and is the ultimate cause of any
and all of the above three mechanisms. Fear
(kong) and fright (jing) are two of the seven
affects of Chinese medicine. In terms of viscera
and bowel correspondences, fear damages the
kidneys and fright damages the heart. Fear is fear
of a future potential danger, while fright is
caused by an immediately perceived threat. In
other words, while I may fear death even when
there is no present danger to my life, I am frightened by the man holding the gun to my head.
Although these two affects cause different disruptions in the flow of qi (fear causes the qi to
descend; fright causes the qi to become chaotic),
since their disease mechanisms tend to be the
same, many Chinese medical books lump these
two together. In Chinese medicine, a tendency to
fear or fright is associated with a lack of sufficient heart qi or spirit. People with lots of heart
qi tend to be courageous, i.e., have heart. People

Heart-gallbladder qi timidity
At this point, some may ask about the role of the
Chinese medical concept of the gallbladder in
fear and fright. Sometimes, Chinese talk about
courage as a function of the gallbladder and
excessive fear and fright as gallbladder timidity. In this case, it is a gallbladder qi vacuity

which results in fear and fright. For instance, in

Chinese medical texts, gallbladder qi timidity is
synonymous with gallbladder qi vacuity.
However, in contemporary Chinese medicine,
gallbladder qi vacuity is only a shorthand name
for a more complex, multi-pattern presentation.
That multi-pattern presentation consists of liver
depression and spleen vacuity resulting in heart
vacuity complicated by phlegm. Therefore, in
contemporary Chinese texts, this pattern is also
commonly referred to as heart-gallbladder qi
timidity or heart-gallbladder qi vacuity. Within
this context, the term gallbladder is a rhetorical
device standing in for the liver.

theory of similar transformation and Zhu Danxis theory of the six depressions, both qi stagnation and phlegm obstruction tend to become
complicated by heat. Because qi is yang and,
therefore, inherently warm, if the qi becomes
stagnant due to liver depression, qi stagnation
will transform depressive heat. Similarly, if the
qi becomes stagnant due to blockage and
obstruction by phlegm, it may also transform
depressive heat. If liver depression transforms
heat, this may not only cause heat in the liver and
gallbladder but also in the stomach. The liver,
gallbladder, and stomach have especially close
interrelationships. In addition, all have especially close relationships to lifegate or ministerial
fire. Therefore, heat in the liver may inflame the
stomach and heat in the stomach may inflame the
liver. The practical import of this is that, in real,
live patients, we often find depressive heat in
both the liver and stomach and we often find
phlegm and heat mixed together to form phlegm
heat. Further, because heat is yang in nature, it
has an innate tendency to ascend, and the heart is
in the upper burner. Therefore, any evil heat in
the body tends to accumulate in the heart where
it may harass the spirit, forcing it to stir or move
frenetically. In addition, because heat is a yang
evil, if it is either exuberant or endures, it may
damage yin. In that case, vacuous yin may fail to
control yang which then stirs even more hyperactively. Thus, it is common to find patients with
excessive fear and fright who not only manifest
the patterns of liver-spleen disharmony with
nonconstruction and malnourishment of the heart
spirit but also phlegm and heat.

Because the spleen is the latter heaven root of qi

and blood engenderment and transformation as
well as governs the upbearing of the clear, spleen
vacuity may result in nonconstruction and malnourishment of the heart spirit. Because the qi
moves and transforms water fluids and phlegm is
nothing other than congealed water dampness, qi
stagnation is commonly complicated by phlegm.
On the other hand, since the spleen rules the
movement and transformation of water fluids,
spleen vacuity also commonly results in damp
evils which, over time, may also congeal into
phlegm. Therefore, both liver depression and
spleen vacuity tend to result in the internal
engenderment of phlegm. To make matters
worse, the spleen is averse to dampness. So
phlegm, dampness, and turbidity further damage
the spleen, while phlegm obstructs the free flow
of qi, thus further damaging the livers coursing
and discharging. Hence, it is easy to see how, in
certain patients, liver depression, spleen vacuity,
and phlegm obstruction mutually engender each
other.

Gan Mai Da Zao Tang

In Chinese medical psychiatry, one of the most
commonly prescribed formulas for nonconstruction and malnourishment of the spirit resulting in
disquietude is Gan Mai Da Zao Tang (Licorice,
Wheat & Red Dates Decoction). This formula
consists of mix-fried Radix Glycyrrhizae (Gan
Cao), Fructus Tritici Aestivi (Xiao Mai), and
Fructus Zizyphi Jujubae (Da Zao). According to

Depression & phlegm heat

Although heart qi vacuity and phlegm obstruction are enough on their own to make the spirit
disquieted, heat causing the heart qi to stir hyperactively adds yet another disease mechanism of
spirit disquietude. According to Liu Wan-sus

most contemporary Chinese sources, this formula nourishes the heart and quiets the spirit, harmonizes the center and relaxes tension. It is indicated for a combination of heart qi, blood, and
yin vacuity with liver depression and spleen
vacuity, although the symptoms of heart vacuity
are more prominent than the symptoms of spleen
vacuity. Nonetheless, it is spleen vacuity associated with liver depression (i.e., liver repletion
horizontally counterflowing and assailing spleen
earth) that is responsible for the heart vacuity,
and it is liver depression transforming heat that is
responsible for any heat. In this case, there is
essence spirit abstraction, alternating crying and
laughing for no good reason, inability to control
onself, restless sleep, and, if severe, abnormal
speech and behavior. Classically, frequent,
repeated yawning and stretching are emphasized
as symptoms as are fright and watchfulness (i.e.,
paranoia). The patients tongue is red with scanty
fur or may even be peeled and have cracks and
fissures, and their pulse is fine and rapid or bowstring and rapid. This constellation of signs and
symptoms is often referred to as visceral agitation (zang zao).

Within this formula, Gan Cao is sweet and,

therefore, relaxes and harmonizes the center. In
this case, harmonization of the center means harmonization of the liver and spleen. In the Nei
Jing (Inner Classic), it says that, [When there
is] depression, use sweetness to relax it. Gan
Cao also supplements and nourishes the heart.
Xiao Mai is slightly cold. It supplements and
nourishes the heart qi and yin, clears heat evils
from the heart, and therefore, quiets the spirit.
Da Zao supplements and boost the spleen qi as
well as relaxes liver tension. Hence, when all
three of these sweet-flavored medicinals are used
together, they sweetly relax, enrich, and supplement. They emolliate the liver and relax tension,
calm the heart and quiet the spirit.
Zhu Ru Tang
However, Gan Mai Da Zao Tangs ability to
clear heat from the heart is not very strong.
Instead of bitterly and coldly clearing and draining, it uses Li Dong-yuans sweet, warm method
of upbearing the clear and, therefore, out-thrusting and scattering heat. In addition, it does not
address phlegm at all. Thus, when visceral agitation is complicated by phlegm heat, a formula to
keep in mind is Wan Mi-zhais Zhu Ru Tang
(Caulis Bambusae Decoction). This formula is
found in the second juan of Wan Shi Nu Ke
(Master Wans Gynecology). It consists of the
ingredients of Gan Mai Da Zao Tang plus Radix
Panacis Ginseng (Ren
Shen),
Tuber
Ophiopogonis Japonici (Mai Men Dong),
Sclerotium Poriae Cocos (Fu Ling), Caulis
Bambusae In Taeniis (Zhu Ru), and uncooked
Rhizoma Zingiberis (Sheng Jiang). This formula
is indicated for heart vacuity fright and fear, visceral agitation, and weeping with grief.

Profs. Song and Yu of the Zhejiang College of

Chinese Medicine describe the disease mechanisms of visceral agitation in A Handbook of
Traditional Chinese Gynecology (Blue Poppy
Press, 1995, p. 227):
The cause of this disease is mainly
heart construction insufficiency and
heart fire upward dazzling lung
metal. the heart rules joy and the
lungs rule sorrow. The heart produces smiles and the lungs produce
crying. Therefore, there is distress
due to sorrow and deep grief, crying
and smiling with no constancy. The
kidneys rule yawning. If heart yin is
already vacuous, heart fire is hyperactive above and is not able to
descend and join with the kidneys.
Thus there is much yawning and
stretching.

Within this formula, Ren Shen supplements the

qi, engenders fluids, and quiets the spirit. Fu
Ling fortifies the spleen, supplements the heart,
quiets the spirit, and transforms phlegm. Mai
Men Dong engenders fluids and enriches yin,

clears heat from the heart and stomach, and

transforms phlegm. Zhu Ru clears and transforms
phlegm heat and harmonizes the center. In this
case, harmonization of the center means harmonization of the liver and stomach. Sheng Jiang
harmonizes the rest of the medicinals in the formula as well as aids in the both the rectification
of the qi and the transformation of phlegm.

three or four patterns simultaneously. Either

other patterns complicate the core set of patterns
or one or more of the patterns is more pronounced than that which the original formula is
designed to treat. Therefore, learning the most
important additions and subtractions to a formula is just as important as learning the core formula itself. Thus, Ren Shen may be substituted by
Radix Codonopsitis Pilosulae (Dang Shen) or
Radix Pseudostellariae Heterophyllae (Tai Zi
Shen) if either Ren Shen is too dear in price or
contraindicated, for instance in the case of hypertension. If qi vacuity with fatigue and lack of
strength is more pronounced, one can also add
Radix Astragali Membranacei (Huang Qi). To
further quiet the spirit and transform phlegm, one
can add Rhizoma Acori Graminei (Shi Chang
Pu) and/or Radix Polygalae Tenuifoliae (Yuan
Zhi). Yuan Zhi also promotes the descension of
the heart qi and, therefore, the reintegration of
the heart fire and kidney water. If there is profuse
phlegm, one can also or alternately add Rhizoma
Pinelliae Ternatae (Ban Xia) and possibly
Pericarpium Citri Reticulatae (Chen Pi). The
author of Chan Ke Xin Fa (Obstetrical Heart
Methods) gives a formula called Dan Zhu Ru
Tang (Bland Caulis Bambusae Decoction) which
is the same as Zhu Ru Tang plus Ban Xia and
minus Xiao Mai. Profs. Song and Yu say that
Gan Mai Da Zao Tang and Dan Zhu Ru Tang
may be combined together, thus resulting in Zhu
Ru Tang plus Ban Xia.

Zhu Ru Tang is named after the ingredient Zhu

Ru. Personally, I find this a very useful medicinal
which many practitioners tend to overlook. Zhu
Ru is sweet and cool (some sources also say it is
bitter and acrid) and collects in the heart, lungs,
stomach, and gallbladder. It clears heat, cools the
blood, transforms phlegm, and stops vomiting. It
is indicated for the treatment of vexatious heat
vomiting, hiccup, phlegm heat coughing and
panting, spitting blood, spontaneous ejection of
blood (i.e., epistaxis), flooding and leaking, nausea in pregnancy, fetal stirring, and fright epilepsy. According to the Ben Cao Zai Xin (Materia
Medica Renewed), this medicinal drains fire
and eliminates vexation, moistens the lungs and
opens depression, transforms phlegm and cools
the blood, stops vomiting of blood, transforms
static blood, disperses welling abscesses,
swellings, and toxins. Therefore, it is also used
to treat insomnia, heart palpitations, and irritability due to phlegm heat. Because of this, it is an
important ingredient in Chinese medical psychiatry where phlegm heat plays such a prominent
part. For instance, Zhu Ru is a main ingredient in
the Wen Dan Tang (Warm the Gallbladder
Decoction) family of formulas, all of which are
commonly used for the treatment of psychiatric
disturbances and especially when those disturbances are associated with fear and fright.

If there are heart palpitations, one may add

Semen Zizyphi Spinosae (Suan Zao Ren) and
either Os Draconis (Long Gu), Dens Draconis
(Long Chi), or Concha Ostreae (Mu Li). For heart
palpitations and insomnia, one may also consider Suan Zao Ren and Caulis Polygoni Multiflori
(Ye Jiao Teng). If there are night sweats, add
Fructus Schisandrae Chinensis (Wu Wei Zi) and
Mu Li. If heart blood vacuity is marked, one can
add Radix Angelicae Sinensis (Dan Gui) and
Arillus Euphoriae Longanae (Long Yan Rou). If
there is marked qi stagnation, one may choose
between Fructus Citri Aurantii (Zhi Ke) and

Additions & subtractions

While this formula is, I believe, a useful one to
add to ones repertoire, in real life, such formulas
are rarely prescribed in their standard or original
form. This is because, patients with chronic,
enduring conditions rarely present with even just

Fructus Immaturus Citri Aurantii (Zhi Shi). If

there is more marked heart yin vacuity, one can
add Semen Biotae Orientalis (Bai Zi Ren) and
Bulbus Lilii (Bai He). If there is heat in the blood
associated with bleeding gums or epistaxis, one
can add Folium Eriobotryae Japonicae (Pi Pa
Ye), and uncooked Radix Rehmanniae (Sheng
Di). If there is blood stasis, one can add Radix
Salviae Miltiorrhizae (Dan Shen), Radix
Ligustici Wallichii (Chuan Xiong), and/or Sheng
Di. If heat is more pronounced, one may choose
between Radix Scutellariae Baicalensis (Huang
Qin) and Rhizoma Coptidis Chinensis (Huang
Lian), and if there is hypertension, one can delete
Sheng Jiang, reduce or delete Gan Cao, and add
Ramulus Uncariae Cum Uncis (Gou Teng) and
Semen Cassiae Torae (Jue Ming Zi) if there is
concomitant constipation or Gou Teng and Flos
Chrysanthemi Morifolii (Jue Hua) if there is not.

titioners forget about or overlook Zhu Ru and the

formulas within which Zhu Ru is a main or ruling ingredient. Although this ingredient effectively treats a number of somatic complaints,
such as nausea and vomiting, it also has a pronounced psychotropic effect. When correctly
prescribed on the basis of the patients pattern
discrimination, formulas containing this medicinal are especially effective for the treatment of
psychiatric disorders. This ingredient may not be
precious in terms of cost, but it is precious in
terms of effectiveness for mental-emotional
complaints associated with fear and fright,
phlegm and heat.
Copyright Blue Poppy Press, 2002. All
rights reserved.

For more information on the Chinese medical

treatment of psychiatric disorders, see Bob Flaws
& James Lakes Chinese Medical Psychiatry
and/or Bob Flawss Distance Learning program,
Treating Mental-emotional Conditions with
Chinese Medicine, both available from Blue
Poppy.

Conclusion
It is possible that one may have gotten to the
above formula, Zhu Ru Tang, simply by modifying Gan Mai Da Zao Tang. However, as mentioned above, it is my experience that many prac-

Copyright Blue Poppy Press, 2002

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