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I have a patient who, during the hot summer, did not dry off after a cold shower and felt discomfort in the lower abdomen the next day, with frequent and intermittent urination, and a sensation of incomplete urination. Drinking hot water provided slight relief.
The tongue was pale red, swollen, with tooth marks on the edges, little coating, and a thin pulse. He had been affected by cold evil, with a tense lower abdomen and difficulty urinating, indicating an imbalance of Yin and Yang. The symptoms also matched the original text of the “Jin Gui Yao Lue,” so I prescribed Gui Zhi Jia Long Gu Mu Li Tang (Cinnamon Twig Decoction with Dragon Bone and Oyster) to secure Yang Qi and converge Yin Qi, resulting in significant improvement of symptoms.
In the above case, after the patient was affected by cold evil, the cold evil invaded the body, disrupting the accompanying Ying and Wei (Nutritional and Defensive Qi). Ying Qi, as a component of blood, belongs to Yin, while Wei Qi belongs to Yang.
The damage to Ying and Wei led to a weakened warming effect of Yang Qi, and the Yin fluids could not be converged, resulting in symptoms such as tense lower abdomen, frequent urination, and a sensation of incomplete urination.
The pale red tongue, swollen with tooth marks, little coating, and thin pulse indicate that the patient has Qi and Blood Deficiency. Using Gui Zhi Jia Long Gu Mu Li Tang can harmonize Yin and Yang, leading to symptom improvement.
Gui Zhi Jia Long Gu Mu Li Tang
Gui Zhi Jia Long Gu Mu Li Tang is a formula from the medical sage Zhang Zhongjing’s “Jin Gui Yao Lue: Blood Bi and Xu Lao Disease Pulse Diagnosis and Treatment,” which states: “If a man has lost essence and has a tense lower abdomen, cold in the Yin area, and dizziness (or pain in the eye socket), hair loss, and a pulse that is extremely weak and thin, it indicates loss of blood and essence. If the pulse is slightly tight and moving, it indicates loss of essence in men and dream intercourse in women; Gui Zhi Jia Long Gu Mu Li Tang is the main treatment.” Those who lose essence refer to individuals with Essence and Blood Deficiency. This group experiences symptoms such as tense lower abdomen, dizziness, and hair loss due to deficiency of Yin and Yang. The usual dosage is: Gui Zhi (Cinnamon Twig), Shao Yao (Peony), and Sheng Jiang (Fresh Ginger) each 15g, Gan Cao (Licorice) 10g, Da Zao (Jujube) 4 pieces, Long Gu (Dragon Bone) and Mu Li (Oyster) each 15g, decocted in water, taken three times a day.
The book records that Gui Zhi Jia Long Gu Mu Li Tang treats nocturnal emissions, dream intercourse, tense lower abdomen, dizziness, hair loss, and palpitations caused by the inability of Yang to secure and Yin to guard internally. It harmonizes Ying and Wei and facilitates the interaction of Yin and Yang. The Qi of Ying and Wei comes from the nutrients in our daily diet. Ying Qi circulates internally, maintaining the normal physiological functions of the organs, while Wei Qi circulates externally, serving as a barrier against external evils. From the perspective of Yin and Yang, Ying Qi belongs to Yin, and Wei Qi belongs to Yang. The Yin and Yang in the body exist in a state of mutual dependence; when this balance is disrupted, it leads to an imbalance of Yin and Yang, resulting in symptoms such as nocturnal emissions, dream intercourse, tense lower abdomen, insomnia, vivid dreams, dizziness, and palpitations.
Analysis
This formula consists of Gui Zhi Tang (Cinnamon Twig Decoction) with added Long Gu (Dragon Bone) and Mu Li (Oyster). Gui Zhi, as the tender branches of cinnamon, is a warming herb that can warm the meridians and assist Yang Qi transformation; Sheng Jiang enhances Gui Zhi’s ability to warm and promote Yang Qi. Together, they secure Yang Qi, preventing it from floating outward, thus ensuring the function of Yang Qi’s securing ability. Shao Yao is sour and slightly cold, with the ability to converge Yin fluids. Da Zao, Shao Yao, and Gan Cao nourish Yin and Ying, harmonizing Ying and Wei externally and Yin and Yang internally. Long Gu and Mu Li, as products of blood and flesh, have the effect of calming floating Yang and converging Yin fluids, enhancing the ability to harmonize Yin and Yang. Therefore, this formula can treat nocturnal emissions and dream intercourse.
Imbalance of Yin and Yang: The Source of All Diseases
From the perspective of TCM, Yin and Yang not only constitute the human body but also maintain the basic substances of life activities. The essence, blood, and fluids in the body are relatively static and belong to Yin, while Qi, being relatively dynamic, belongs to Yang. Yin is static, guarding Yang internally; Yang is dynamic, acting as Yin externally. Essence, blood, and fluids are Yin and guard internally, while Qi is Yang and operates externally. Yang relies on Yin for external defense, and Yin relies on Yang for internal guarding. Therefore, if Yang Qi is insufficient, Yin fluids cannot guard internally and leak outward, leading to symptoms such as spontaneous sweating and nocturnal emissions. Treatment should focus on converging Yin and warming Yang.
Clinical Applications
▋InsomniaInsomnia refers to insufficient sleep time, including difficulty falling asleep, waking easily after sleeping, difficulty falling back asleep, or even sleeplessness throughout the night, severely affecting our daily life. In TCM, it is called “Bu Mei,” with the pathogenesis being “Yang not entering Yin.” The characteristics of Yin Qi are quiet and convergent, and at night, Yin Qi is relatively heavy. Under normal circumstances, the body should be in a quiet state, but when the body’s Yang Qi is overly strong and excessively active at night, it can lead to Yin Qi deficiency, causing mental excitement and resulting in insomnia. Additionally, if the body’s Yin Qi is deficient, the Yang Qi will appear relatively excessive, and the ability of Yin Qi to converge will decrease, also leading to insomnia and vivid dreams. Whether it is excessive Yang Qi or deficient Yin Qi, they mutually influence each other, resulting in a state of Yin deficiency and Yang excess. Therefore, Gui Zhi Jia Long Gu Mu Li Tang, which can secure Yang Qi and converge Yin Qi, can be used for treatment. Among them, Long Gu and Mu Li have the effect of calming the spirit. Clinically, for patients with severe insomnia, 10g of Fu Shen (Poria) and 6g of Suan Zao Ren (Sour Jujube Seed) can be added. For patients with dry mouth and bitter taste, add 3g of Zhi Zi (Gardenia) and 9g of Long Dan Cao (Gentian). For patients with fatigue and abdominal distension, add 15g of Huang Qi (Astragalus), 10g of Dang Gui (Angelica), and 6g of Mu Xiang (Aucklandia). For patients with vivid dreams, add 6g of Shan Yu Rou (Cornelian Cherry) and 9g of Mu Dan Pi (Moutan Root).
▋Palpitations
Palpitations refer to the patient’s subjective feeling of intense heartbeats and anxiety, commonly known as heart palpitations. When the body’s Yin essence is insufficient, blood is deficient, and Yang Qi is inadequate, blood circulation becomes sluggish, leading to insufficient blood supply to the brain. This triggers signals of ischemia, prompting the body to accelerate blood pumping to restore circulation and maintain normal physiological activities, resulting in palpitations. Therefore, Gui Zhi Jia Long Gu Mu Li Tang can be used with 10g of Dang Gui and 12g of Sheng Di Huang (Rehmannia) to treat palpitations.
Gui Zhi and Gan Cao have a strong heart-enhancing effect, and Gui Zhi Jia Long Gu Mu Li Tang has calming properties, improves cardiovascular function, and increases blood circulation. Clinically, for patients with chest tightness and shortness of breath, a purple and dark tongue, and internal blood stasis, add 10g of Dan Shen (Salvia) and 10g of Chuan Xiong (Ligusticum). For patients with chest tightness, abdominal distension, lower limb edema, a swollen tongue, and a white greasy coating, indicating poor circulation of Qi and blood with phlegm accumulation, add 15g of Fu Ling (Poria) and 15g of Bai Zhu (Atractylodes).
▋Nocturnal Emissions
Nocturnal emissions refer to the involuntary discharge of semen in men without sexual activity or masturbation, occurring during sleep, which is referred to as “dream intercourse” in the original text. This is often due to kidney Qi deficiency, insecure Yang Qi, and Yin essence deficiency leading to semen leakage. Patients with frequent nocturnal emissions experience excessive loss of semen, damaging both Yin and Yang, resulting in deficiency of both. Therefore, Gui Zhi Jia Long Gu Mu Li Tang can be used with modifications for treatment. If accompanied by dream intercourse, 10g of Shan Yu Rou, 6g of Wu Wei Zi (Schisandra), and 10g of Qian Shi (Euryale) can be added to secure and astringe.
▋Precautions
1. Avoid eating seaweed, raw scallions, and pork. 2. Avoid raw, cold, and greasy foods, and avoid drinking cold water. 3. Pregnant women and women during menstruation should use with caution.
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