甘麦大枣汤

3. Tongue and pulse

• Tongue: Pale red tongue body with scanty coating.
• Pulse: Thin and rapid, or wiry and thin.

4. Common modifications

• Severe restlessness and insomnia: Add Suan Zao Ren (spine date seed), Bai Zi Ren (arborvitae seed), and Ye Jiao Teng (tuber fleeceflower stem) to strengthen the nourishing of the heart and calming of the spirit.
• Liver qi stagnation with distension and pain in the hypochondrium: Add He Huan Pi (silktree bark), Mei Gui Hua (rose flower), and Chai Hu (bupleurum root) to course the Liver and relieve stagnation.
• Yin deficiency with internal heat, heat in the palms and soles: Add Bai He (lily bulb) and Sheng Di (fresh rehmannia root) to nourish yin and clear heat.
• Palpitations: Add Long Gu (dragon bone) and Mu Li (oyster shell) to heavily settle and calm the spirit.
• Modern applications: This formula is a base formula for hysteria, menopausal syndrome, neurasthenia, anxiety disorder, attention-deficit/hyperactivity disorder in children, and night crying in infants, when these conditions belong to the pattern of Heart yin insufficiency with disharmony of Liver qi.

5. Cautions and clinical notes

• Contraindications:
  • Not suitable for mental disturbance caused by phlegm-fire exuberance, presenting with mania and restlessness, red face and eyes, and yellow greasy tongue coating.
  • Although the ingredients are foods as well as medicinals, because the formula is sweet and relaxing in nature, it should be used with caution in those with abdominal fullness and distension (zhong man).

6. Granule conversion and dose

• Calculation of total raw herb weight in the original formula:
  • Xiao Mai (wheat) 15 g + Gan Cao (licorice root) 9 g + Da Zao (jujube, 10 pieces, about 30 g) = 54 g.
• Conversion to 5:1 granules:
  • 54 g raw herbs ÷ 5 = 10.8 g granules.
• Recommended dose:
  • One dose daily, taken in 2 divided doses (morning and evening) dissolved in warm water, about 5.5 g per dose.
  • Or as directed by a practitioner; the formula is mild and balanced in nature, and for chronic emotional conditions may be taken over a long period for gradual resolution.