柴胡龙骨牡蛎汤

3. Tongue and pulse

• Tongue: Red tongue body, with a yellow greasy or white greasy coating.
• Pulse: Wiry and rapid, or wiry and slippery.

4. Common modifications

• Phlegm-heat disturbing the heart, with severe insomnia: Add Huang Lian (coptis rhizome) and Zhu Ru (bamboo shavings) to clear the heart and resolve phlegm.
• Liver yang rising, with severe dizziness: Add Tian Ma (gastrodia rhizome) and Gou Teng (uncaria stem) to calm the liver and subdue yang.
• Marked palpitations and fearful throbbing: Add Zhu Sha (cinnabar) (in minute amount, discontinue once the condition resolves, use with caution) and Yuan Zhi (polygala root) to strengthen the effect of calming the spirit and settling palpitations.
• Internal blood stasis: Add Tao Ren (peach kernel) and Dan Shen (salvia root) to invigorate blood and dispel stasis.
• Modern applications: This formula is widely used for psychiatric and neurological conditions such as anxiety disorder, depression, insomnia, epilepsy, schizophrenia, menopausal syndrome, and cardiac neurosis, and is effective in any case involving impaired Shaoyang pivot function with heat disturbing the heart spirit.

5. Cautions and clinical notes

• Contraindications:
  • This formula combines cold and heat, and both attacking and tonifying methods; it is not suitable for cases of pure deficiency or pure excess.
  • Qian Dan (lead oxide) in the original formula is highly toxic and must never be used.
  • Da Huang (rhubarb root and rhizome) in the formula is a purgative; use with caution in cases of Spleen-Stomach deficiency cold with loose stools, or substitute with prepared (processed) Da Huang.

6. Granule conversion and dose (Qian Dan removed)

• Calculation of total raw herb weight in the original formula (Qian Dan removed):
  • Chai Hu (bupleurum root) 12 g + Huang Qin (scutellaria root) 4.5 g + Ban Xia (pinellia rhizome) 6 g + Long Gu (dragon bone) 4.5 g + Mu Li (oyster shell) 4.5 g + Gui Zhi (cinnamon twig) 4.5 g + Fu Ling (poria) 4.5 g + Ren Shen (ginseng) 4.5 g + Da Huang (rhubarb root and rhizome) 6 g + Sheng Jiang (fresh ginger) 4.5 g + Da Zao (jujube fruit) 3 g = 59 g.
• Conversion to 5:1 granules:
  • 59 g raw herb ÷ 5 = 11.8 g granules.
• Recommended dose:
  • One dose daily, dissolved in warm water and taken in two portions, morning and evening, about 6 g per portion.
  • Or as directed by a physician. When this formula is used for psychiatric and emotional conditions, the duration of use tends to be longer; the physician's prescription must be strictly followed, with dosage and composition adjusted according to changes in the condition.