Ann Fritts

Summer 2004

Author: Chen Rui-Chun

This is a collection of famous Doctors’ cases where they treated patients using Shan Han Lun formulae.  Included are two cases where the formula Chai hu long gu mu li tang was used to treat two separate gynecological cases.  The first being pre-menstrual anxiety, where there is Liver depression transforming into fire.  This fire influences the mind to become irrational, for one to become vexed and agitated, and depressed.  The second is for peri-menopausal emotional fluctuation.  The main symptoms given were agitation and vexation, unsettled spirit, and easy to anger, and dream disturbed sleep.  The syndrome occurs when a woman is in her forties and her period becomes irregular.

In the first case Chai hu long gu mu li tang was prescribed to a woman suffering from pre menstrual anxiety.  Each month, one week prior to the onset of her menstrual period, the patient, a 37 year old female, become vexed and agitated.  At night she would have dream disturbed sleep.  She was on edge and would look for someone to quarrel with, often arguing with family members.  Her eating and drinking were normal, bowel movements were not smooth. These symptoms would continue until her period arrived, then subside. 

The patient’s pulse was thin, rapid and string-like, and she had a thin, yellow tongue coat on a slightly red tongue body. 

She was given a modification of Chai hu long gu mu li tang with a milder purgative, hu zhang substituted for da huang.  Ci shi, Lian qiao, and Yu jin were also added to clear heat from constraint.  A full list of ingredients follow:

Chai hu 10g, Tai zi shen 15g, Huang qin 10g, Fa ban xia 10g, Hu zhang 15g, Chao hei zhi zi 10g, Sheng mu li 15g, Yu jin 10g, Ling ci shi 15g, Lian qiao10g

The patient was advised to take 3 packets, 1 packet each day in decoction form. 

Five days later the patient returned to the clinic and reported feeling more calm.  She was able to sleep peacefully.  Bowel movements were smooth.  Her menstrual period had started the day before and the amount of blood was not profuse, and the color of the blood was very dark/ black.  Her pulse was moderate and had strength.  This time she was prescribed Su wu tang modified (again with herbs to help relieve liver constraint) : Sheng di 15g, Shu di 15g, Chi shao 10g, bai shao 10g, dan shen 15g, Chuan xiong 5g, Chai hu 10g, Yu jin 10g, Yi mu cao 15g, Han lian cao 10g.  She was advised to take 5 packets. Once her period finished, she was to stop. 

The patient continued the pattern of taking Chai hu long gum u li tang before her period and Si wu tang during her period for 3 cycles.  Afterward her pre-menstrual anxiety resolved. 

The second case was an account of a woman in her forties who was experiencing irregular periods.  Her disposition became more disagreeable around her periods.  Her Bowel movements were often dry, her mouth and throat were also dry.  Her pulse was string-like and slightly rapid.  Her tongue was red with a thin yellow coating.  She was prescribed a combination of Chai hu long gu mu li tang and gan mai da zao tang:

Chai hu 10g, Tai zi shen 15g, Fa ban xia 10g, Ku qin 10g, Suan zao ren 15g, Fu ling 15g, Zhi mu 10g, Chuan xiong 5g, Zhi gan cao 5g, Mai men dong 10g, Fu xiao mai 30g, Sheng long gu 15g, Long gu 15g.

The herbs were taken in decoction form at the dose of 1 packet per day for 10 days.  After the patient took the above herbs she was completely calm.  She was able to work normally.  Her mouth was no longer dry , her urination and bowels functions were normal  Before and after her period here emotions still took a turn for the worse, so she was advised to continue taking the herbs (same formula with dan shen and Er zhi wan added) before and after her period to regulate her emotions.