桂枝龙骨牡蛎汤

o Hollow (kong-diao/hollow-drum-like) or slightly tight pulse.

3. Tongue and pulse

• Tongue: Pale tongue body with thin white coating.
• Pulse: Floating, large, and forceless pulse, or hollow-drum-like (kong), or slightly tight.

4. Common modifications

• Marked yang deficiency with aversion to cold and cold limbs: add Fu Zi (prepared aconite root) to warm the kidney and assist yang.
• Marked qi deficiency with mental fatigue and lack of strength: add Huang Qi (astragalus root) and Dang Shen (codonopsis root) to boost qi and secure the exterior.
• Severe nocturnal emission or spermatorrhea: add Qian Shi (euryale seed), Jin Ying Zi (fructus rosae laevigatae), and Sha Yuan Zi (flat-stemmed milkvetch seed) to strengthen the effect of securing essence and stopping seminal loss.
• Marked insomnia and palpitations: add Suan Zao Ren (spine date seed) and Yuan Zhi (polygala root) to nourish the heart and calm the spirit.
• Modern applications: This formula is widely used for autonomic nervous dysfunction, sexual neurosis, night terrors in children, night sweating, menopausal syndrome, and unremitting postpartum sweating, when these belong to patterns of dual yin-yang deficiency with an unsettled heart spirit.

5. Cautions and clinical notes

• Contraindications:

o Not to be used for nocturnal emission or insomnia caused by internal exuberance of damp-heat or by effulgent fire disturbing the heart.

o Not to be used in exterior excess patterns due to external contraction.

6. Granule conversion and dose

• Calculation of total raw herb weight in the original formula:

o Gui Zhi (cinnamon twig) 9g + Bai Shao (white peony root) 9g + Long Gu (dragon bone) 15g + Mu Li (oyster shell) 15g + Sheng Jiang (fresh ginger) 9g + Da Zao (jujube) 6g + Zhi Gan Cao (honey-fried licorice root) 6g = 69 g.

• Conversion to 5:1 granules:

o 66 g raw herbs ÷ 5 = 13.8 g granules.

• Recommended dose:

o One dose daily, dissolved in warm water and taken in 3 divided doses, about 4.5 g per dose.

o Or as directed by a physician, who will modify the formula according to the patient's relative yin-yang deficiency and specific symptoms; the total raw herb weight must then be recalculated based on the adjusted formula.