Journal of Chinese Medicine | Issue123 | June 2020

Using Herbs That Clear Heat to Calm the Spirit

Using Herbs That Clear Heat

to Calm the Spirit
Cara O. Frank

Abstract

When confronted by patients presenting with anxiety, agitation,

depression or insomnia, practitioners of traditional East Asian medicine
often focus on the ‘calm spirit’ category of medicinals. However, this
represents a limited perspective on the treatment of such conditions.
This article documents the use of herbs and formulas that clear heat to
effectively treat these problems. The traditional descriptors of xīn fán (heart
vexation) and fán zào (vexation and agitation) are discussed, along with
an introduction to a constitutional approach to herbal prescribing. Finally,
the role of the herbs Huáng Lián (Coptidis Rhizoma), Shí Gāo (Gypsum
fibrosum), Gé Gēn (Puerariae Radix), Zhī Zǐ (Gardeniae Fructus) and Lián
Qiào (Forsythiae Fructus) are discussed in detail with regard to their spirit-
calming actions and associated formulas.

Keywords
Chinese medicine, herbal medicine, anxiety, depression, fan zao, xin fan, constitution, calm spirit, shen.

Introduction

Practitioners of traditional East Asian medicine are
often unfamiliar with or else underestimate the
impact that heat-clearing herbs and formulas can have on
the mind/spirit (shén). Although these medicinals are not
typically defined as ‘spirit calming’, there are numerous
historical references for their clinical use in this way. This
article presents the practical application of heat-clearing
herbs and their formula families to quiet the mind and ease
suffering, in order to improve practitioners’ clinical
precision and expand their repertoire of methods.
When diagnosing and treating psycho-emotional
disorders such as anxiety and depression, practitioners
often rely on medicinals and formulas from two broad
categories: the ‘calm the spirit’ category and the ‘regulate qi’
category. Formulas that calm the spirit are primarily tonics
used to nourish Heart blood and yin, tonify Kidney yin and
strengthen Spleen qi. With patterns of deficiency causing
emotional distress, the spirit (shén) will become calm
when it is properly nourished. Formulas that regulate the
qi treat depression by moving stagnation. However, if we
limit our herbal vocabulary when treating the spirit to only
these medicinals, we neglect to honour our traditional East
Asian medicine (TEAM) heritage and do ourselves and our
patients a disservice. Such a perspective - essentially seeing
the spirit as something separate from the body - might
be seen to reflect something of a Western reductionist
way of thinking. In fact, if the diagnosis is appropriate,
heat-clearing herbs and formulas can deliver a genuinely
constitutional treatment that deals with emotional
suffering by treating the whole person - not merely treating
symptoms of emotional distress.
Similarly, the clinical importance of the six fǔ bowels is

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Journal of Chinese Medicine | Issue123 | June 2020
Using Herbs That Clear Heat to Calm the Spirit
often devalued. The five zang viscera are often considered
more precious than than fǔ. However, the fǔ have a critical
role in the generation and distribution of yin, blood and jīn
yè fluids throughout the body. Without the fǔ, we would
die of malnutrition. Fǔ heat patterns can also cause severe
psycho-emotional disturbance, especially those centred
on yánɡ mínɡ heat. Bitter heat-clearing herbs can balance
and promote digestive qi, and simultaneously create space
for quiet yin reflection. To illustrate this point, we can look
to the description of Dà Huáng in the Shén Nóng Bĕn Căo
Jīng (Divine Husbandman’s Classic of Materia Medica): ‘…
scouring and flushing the intestines and stomach; pushing
out the old and making the new arrive … calming and
harmonizing the five zang organs.’1 The clinical strategies
of clearing, draining or purging stagnant heat to reset the
body and mind and facilitate ‘renewal’ have been tried and
tested by numerous physicians throughout history.
Constitution
References to the spirit-calming effects of medicinals
stretch back as far as
the Shén Nóng Bĕn Căo
Jīng. When using herbs
to calm the spirit, it is
Xīn fán can progress to a pattern that
important to be aware of involves actual physical agitation
the constitutional aspect
of herb prescribing. Just
of the limbs called fán zào 烦躁
as one might diagnose a (vexation and agitation).
person in terms of the five
phases as having a wood
or fire constitution, the Shāng Hán Lùn (Treatise on Cold
Damage) offers a path to constitutional treatment rooted
in medicinals and formulas. Using this system, a herb
reflects a type of person and their way of being in the
world, as well as a predisposition towards developing
certain diseases. No one has championed these theories
more than Dr. Huang Huang of Nanjing. Huang’s system
presents constitutional patterns that are reflected in the
character of specific herbs, their associated formulas and
the diseases treated by them. Therefore, we might say
that the behaviour of a person with a Chái Hú (Bupleuri
Radix) constitution reflects a Chái Hú imbalance and
predisposes them to develop Chái Hú diseases. Moreover,
they will be treated with Chái Hú formulas. Understanding
the patterns and formulas presented in the Shāng Hán
Lùn and Jīn Guì Yào Lüè (Essentials from the Golden
Cabinet) in this way creates clarity, simplifying the most
complex cases to their fundamental component: the qi
dynamic. In this way, for the right person at the right time,
heat-clearing medicinals can be profoundly spiritually
nourishing. The key to clinical success is to understand
52
the constitution of the patient, the nature of each herb and
its formula family, and the disease pattern treated by it.
Xīn fán, fán zào and anxiety
When investigating the effect of herbal medicine on
psycho-emotional imbalance, it is important to be aware
of the traditional Chinese medical concept of fán 烦
(vexation or irritability). According to the Practical
Dictionary of Chinese Medicine,2 there are approximately 90
references to fán in the Shāng Hán Lùn. Thirteen variations
of fán are listed, including fán jīng bù ān (vexation and
susceptibility to fright), fán yuan (vexation and low spirits)
and fán zào yì nù (vexation, agitation and irascibility). Xīn
fán 心烦 (heart vexation) refers to a feeling of unrest
or irritability focused in the heart or chest region. Xīn
fán is often observed in patterns of excess or deficiency
heat. With increasing heat, xīn fán can progress to a
pattern that involves actual physical agitation of the limbs
called fán zào 烦躁 (vexation and agitation). The former is
a subjective symptom, while the latter is an objective sign.
Although they are different, they are often considered as
one, as they usually occur
in tandem and share the
same disease mechanisms.
In clinical practice, we
might encounter a patient
who is unable to settle
down, feels nervous and
tense, and tends to be
reactive. They experience
an inability to concentrate
and are forgetful. Western diagnoses that fall under the
category of fán zào include anxiety, attention deficit
hyperactivity disorder (ADHD), bipolar disorder, even
post-traumatic stress disorder (PTSD) can fall under
this umbrella term. Fán zào can also be associated with
neurological diseases such as Parkinson’s disease and
hyperthyroidism. Finally, drug and alcohol withdrawal
can result in fán zào.3
It is easy to overlook the importance of fán in the clinic.
After years of clinical practice, I felt dissatisfied with the
results I was achieving treating anxiety, depression and
insomnia using the formulas I had been taught as a student.
In those days, Chinese herbal education did not focus
much on the classics, as is common now. When I began
to study the herbs, formulas and pattern presentations of
the Shang Han Lun, which introduced me to the concept
of fán, I had a decisive paradigm shift that clarified
my understanding of how to diagnose and treat these
disorders. Since then, I have effectively applied these
concepts to many of my treatment strategies to alleviate
anxiety.
 Journal of Chinese Medicine | Issue123 | June 2020
Using Herbs That Clear Heat to Calm the Spirit

through the body. When it becomes impeded (by any

Anxiety
SOMATIC: Headaches,
dizziness or lightheadedness,
nausea and/or vomiting,
diarrhoea, tingling, pale
complexion, sweating,
numbness, difficulty in
breathing, and sensations of
tightness in the chest, neck,
shoulders or hands.
BEHAVIOURAL: Pacing,
trembling, general restlessness,
hyperventilation, pressured
speech, hand wringing, finger
tapping.
Fán Zào
SOMATIC: A subjective feeling
of heat and disquietude in the
chest (vexation).
BEHAVIOURAL: An objective
fidgetiness of the limbs
(agitation).
number of physical or emotional pathogenic factors) the
resultant stagnation will generate heat. The term yù 郁
(depression) refers both to inhibited physiological function
and inhibited emotional expression, as well as describing
the expression of frustration or irascibility. The Liver and
the wood phase are associated with yù. Liver patterns
like gān yù huà huǒ (Liver depression transforming into fire)
refer to heat that develops because of long-term stagnation.
Just like a car engine in heavy traffic, when there is long-
term qi stagnation the body overheats. When the car starts
moving again the engine cools; similarly when qi stagnation
is resolved, heat often clears naturally.

COGNITIVE: Recurrent or Medicinals and formulas

obsessive thoughts, feelings of
doom, morbid or fear-inducing
thoughts or ideas, confusion, This article discusses five medicinals that appear in the Shén
inability to concentrate. Nóng Bĕn Căo Jīng and the Shāng Hán Lùn. Whilst there are
EMOTIONAL: Feeling states many others that can clear heat to alleviate vexation, the
associated with anxiety include scope of the discussion here is limited to those discussed
tension or nervousness, feeling in the earliest historical literature. The herbs discussed are:
‘hyper’ or ‘keyed up’, feelings
of unreality, panic, or terror. • Huáng Lián (Coptidis Rhizoma)
• Shí Gāo (Gypsum fibrosum)
Table 1: Anxiety and fán zào4,5 • Gé Gēn (Puerariae Radix)
• Zhī Zĭ (Gardeniae Fructus)
Anxiety is the medical disease label that most closely • Lián Qiào (Forsythiae Fructus)
matches the pattern of fán zào. They are similar, but not
identical human experiences. They are compared in Table 1. Huáng Lián
Huáng Lián is bitter and cold and enters the Heart and
Both anxiety and fán zào include symptoms of restlessness. Stomach channels. It drains Stomach fire, clears heat
Both can include symptoms that involve the upper body, and dries dampness. It can stop bleeding and treats
particularly describe a sensation of tightness, fullness boils, infections and sore throat. Huáng Lián can have a
or disquietude in the chest. Anxiety can also include profoundly calming effect on the spirit. The key symptom
hyperventilation and catastrophic thoughts, which may or treated by Huáng Lián is xīn fán. Thus, one might argue,
may not be part of in the scope of fán zào. this herb is one that primarily treats the spirit. Because it
drains Heart fire, Huáng Lián can treat irritability, agitation,
anxiety, obsessive-compulsive disorder, ADHD, headache,
Heat, stagnation and insomnia, profuse
the shén dreaming, delirium
The key symptom treated by Huáng and disorientation.
General signs and
symptoms of heat include
Lián is xīn fán. In the
Lián presentation, the
Huáng

fever, red eyes, a bitter taste person is unable to

in the mouth, bleeding disorders, a red tongue and a rapid
pulse. Heat tends to rise, thereby agitating the body and
the emotions. Heat that affects the physical body will often
affect the heart-spirit. When heat affects the shén, the mind
lacks stillness, reflectiveness and quiescence. The person
is uncomfortable in his or her body; nothing feels at ease.
Anxiety, insomnia and restlessness can ensue.
Pathogenic heat can be both the cause and the result
of emotional distress. In a state of health, qi moves freely
settle down: they are worried, anxious, nervous and are
easily awakened. The entire constellation of these signs
and symptoms form a pattern that can be called Huáng
Lián disease. The three symptoms that call for using Huáng
Lián are:
• Xīn fán
• Focal distention (glomus)
• Diarrhoea.

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Journal of Chinese Medicine | Issue123 | June 2020
Using Herbs That Clear Heat to Calm the Spirit

The pulse that indicates that Huáng Lián should be used the mind is Huáng Lián Ē Jiāo Tāng (Coptis and Ass Hide
is typically slippery and rapid. The tongue is red with a Gelatin Decoction):
firm or tough appearance. There may be red prickles and
a thick yellow, dry coating. If the tongue is not coated, or Huáng Lián 黄连 Coptidis Rhizoma 12g
the tongue body pale, then either Huáng Lián should only
be used cautiously in a harmonising formula, or not at all. Huáng Qín 黄芩 Scutellariae Radix 6g
In comparison, in a Shí Gāo presentation the face will be Bái Sháo 白芍 Paeoniae Radix Alba 6g
red. The Huáng Lián complexion may be pale, but the lips,
tongue and throat are red. Ē Jiāo 阿胶 Asini Corii Colla 9g
Two key Huáng Lián formulas treat patterns of heat above Jī Zǐ Huáng 鸡子黄 Vitellus Galli 2 yolks
and cold below. Bàn Xià Xiè Xīn Tāng (Pinellia Decoction to
Drain the Epigastrium) being the most important example: Huáng Lián Ē Jiāo Tāng (Coptis and Ass Hide Gelatin Decoction)7

Huáng lián 黄连 Coptidis Rhizoma 3g This formula treats xū fán (deficiency vexation). This
pattern can be diagnosed by palpating the epigastrium,
Huáng qín 黄芩 Scutellariae Radix 6g inferior to the sternum. The patient will feel discomfort on
Rén shēn 人参 Ginseng Radix 6g palpation, although the practitioner will not feel resistance.
In contrast, when the epigastrium of the Bàn Xià Xiè Xīn
Bàn xià 半夏 Pinelliae Rhizoma 9g Tang patient is palpated, it will feel painful to the patient and
Gān jiāng 干姜 Zingiberis Rhizoma 6g the practitioner will also feel resistance. Symptoms of xū fán
include irritability and anxiety, with a sensation of fullness
Zhì gān căo 炙甘草 Glycyrrhizae Radix praeparata 2g in the chest that prevents the patient from lying down. Their
Dà zăo Z大枣 Jujubae Fructus 4pc complexion is often pale (reflecting blood deficiency) with
red or dark lips (reflecting heat). The formula employs
Bàn Xià Xiè Xīn Tāng (Pinellia Decoction to Drain the Epigastrium) a sophisticated pairing of Huáng Lián and Ē Jiāo. Huáng
Lián drains Heart fire to eliminate vexation but is drying. Ē
A related formula is Huáng Lián Tāng (Coptis Decoction): Jiāo enriches Kidney water, yet it is cloying. When water is
nourished, it can ascend to the Heart. When fire is directed
Huáng Lián 黄连 Coptidis Rhizoma 6g downwards, the Kidneys are warmed. Thus, the formula
treats the pattern of Heart and Kidneys not communicating.
Gān Jiāng 干姜 Zingiberis Rhizoma 6g The final formula discussed here that uses Huáng Lián
Guì Zhī 桂枝 Cinnamomi Ramulus 6g to calm the spirit is Huáng Lián Wēn Dǎn Tāng (Warm Gall
Bladder Decoction with Coptis):
Bàn Xià 半夏 Pinelliae Rhizoma 9g

Rén Shēn 人参 Ginseng Radix 3g Huáng Lián 黄连 Coptidis Rhizoma 6g

Zhì Gān 炙甘草 Glycyrrhizae Radix praeparata 6g Bàn Xià 半夏 Pinelliae Rhizoma 6g
Căo
Fú Líng 茯苓 Poria 6g
Dà Zăo 大枣 Jujubae Fructus 4pc
Chén Pí 陈皮 Citri reticulatae Pericarpium 9g
Huáng Lián Tāng (Coptis Decoction)
Zhú Rú 竹茹 Bambusae Caulis in taeniam 6g

These formulas use a similarly sophisticated combination Zhǐ Shí 枳实 Aurantii Fructus immaturus 6g
of warm and cold ingredients to correct the ascending Gān Căo 炙甘草 Glycyrrhizae Radix 3g
and descending of the qi mechanism, so that yin and yang
are harmonised. By clearing heat from the Heart, Huáng Dà Zăo 大枣 Jujubae Fructus 3 pcs
Lián allows the spirit to become calm, settled and focused. Shēng 生姜 Zingiberis Rhizoma recens 5 slices
The Shén Nóng Bĕn Căo Jīng states, ‘Consumed over a long Jiāng
time, it staves off forgetfulness.’6 For this reason, Huang
Huáng Lián Wēn Dăn Tāng (Warm Gall Bladder Decoction with Coptis)
Huang suggests that Huáng Lián can be used to improve
memory.
One of the best examples of the use of Huáng Lián to calm The actions of this formula are to clear phlegm-heat,

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 Journal of Chinese Medicine | Issue123 | June 2020
Using Herbs That Clear Heat to Calm the Spirit

harmonise the Stomach, quell nausea and vomiting, with attention deficit hyperactivity disorder (ADHD). Dr.
clear the Gall Bladder and regulate qi. The indications Hsu writes that Shí Gāo and its representative formula, Bái
include dizziness, nausea, dream-disturbed sleep, glomus, Hŭ Tāng (White Tiger Decoction), can be used for delusions.8
restlessness, being easily startled, irritability and bitter taste There are three key aspects to a Shí Gāo presentation:
in the mouth. The tongue is red with a thick yellow coat, • The complexion of the patient is red or ruddy; they may
and the pulse is slippery or wiry. look haggard.
Although Bàn Xià is discussed in textbooks as being • Because heat has injured the fluids, the tongue is dry with
primarily used to treat phlegm and alleviate nausea, a thin coating. The pulse will be flooding and big.
its use is actually much broader than this and includes • The patient looks robust, tends to be sweaty and their
anxiety. This is evidenced by the actions and indications voice may be loud.
of Wēn Dǎn Tāng (Warm Gall Bladder Decoction). When
combined with Huáng To further expand on
Lián, it is especially useful the Shí Gāo tongue, even
for treating anxiety and ... the patient not only experiences though there is great heat,
irritability. When I studied vexation and agitation but also - the tongue does not have
at the Xi Yuan Hospital in a coating because there is
Beijing, Wēn Dǎn Tāng was because this is a syndrome of not substantial material
the most commonly used great heat - incoherent speech accumulation in the body.
formula in the psychiatry- If the tongue is coated
neurology department. or mania. and the abdomen is firm
A person with a Wēn upon palpation, then the
Dǎn Tāng presentation was often simply diagnosed as focus moves towards a Dà Huáng presentation, as this
being ‘neurotic’. This was not the pejorative declaration is indicated to treat yánɡ mínɡ patterns ‘with form’ (i.e.
that is understood in the West, but merely a statement material accumulation). Shí Gāo formulas are inappropriate
that the disease has affected the patient’s nervous system. if the pulse is thready, wiry or deep, there is no thirst and
The formula’s actions hinge on the application of bitter, the patient is not sweaty.
descending herbs that clear heat from the Gall Bladder. Shí Gāo is included in several formulas that treat
It may seem that there are no spirit-calming herbs in the wheezing due to Lung heat, most notably Má Xìng Shí Gān
formula. However, the formula deals with the core pathology Tāng (Ephedra, Apricot Kernel, Gypsum and Licorice
of phlegm-heat as it impacts the mind. The Bàn Xià person is Decoction) and Dà Qīng Lóng Tāng (Major Green Dragon
wide-eyed, anxious, easily startled, fearful and nervous. Bàn Decoction). The Shén Nóng Bĕn Căo Jīng states that it treats
Xià presentations might be part of post-traumatic stress counterflow qi below the Heart, fright and panting, dry
disorder. According to Dr. Huang, when using Bàn Xià for mouth and tongue, hardness and pain in the abdomen,
psycho-spiritual disorders we should use large doses, up to and eliminates evil ghosts. In terms of specific illnesses, this
30 grams daily. Smaller, more standard doses are used to paints a vivid picture of both asthma as well as the shortness
harmonise the Stomach and quell nausea. of breath associated with extreme anxiety, amongst others.
An excellent formula example of the use of Shí Gāo to
Shí Gāo treat the spirit can be found by studying Zhú Yè Shí Gāo
Shí Gāo is the primary medicinal for treating yánɡ mínɡ Tāng (Lophatherum and Gypsum Decoction):
disorders. Symptoms include what is colloquially referred
to as the ‘the big four’: big fever, big sweat, big thirst and Dàn Zhú Yè 淡竹叶 Lophatheri Herba 12g
big pulse. The person feels subjectively hot and prefers cold
food and drinks - essentially mirroring the experience of a Shí Gāo 石膏 Gypsum Fibrosum 30g
heatwave in the summer. Encountering a Shí Gāo type is to Bàn Xià 半夏 Pinelliae Rhizoma 10g
meet a loud, boisterous, short-tempered, red-faced person.
When the Stomach fǔ is affected, there may be symptoms of Mài Mén Dōng 麦门冬 Ophiopogonis Radix 18g
Stomach fire, such as reflux and thirst. When the channel is Rén Shēn 人参 Ginseng Radix 6g
affected, we might see frontal headache, toothache, bleeding
gums and inflammation. Furthermore, the patient not only Gān Căo 甘草 Glycyrrhizae Radix 6g
experiences vexation and agitation but also - because this is a Gēng Mǐ 粳米 Oryzae sativae Semen 15g
syndrome of great heat - there may be incoherent speech or
mania. Milder Shí Gāo presentations are encountered in those Zhú Yè Shí Gāo Tāng (Lophatherum and Gypsum Decoction)

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Journal of Chinese Medicine | Issue123 | June 2020
Using Herbs That Clear Heat to Calm the Spirit
Indications for this formula include insomnia, nervous
exhaustion, oppression of the chest, parched lips,
restlessness, stifling sensation, a dry, red tongue with a
thin coating, and a rapid-empty pulse. The formula treats
the sequelae of fever with insomnia and irritability. The
patient looks thin, dry and anxious, and may be suffering
from chronic illness. It can also be used to treat the side
effects of chemotherapy. The chief herb is Dàn Zhú Yè,
which enters the Heart channel to clear vexation. Shí
Gāo’s sweet and acrid properties vent the heat and re-order
the qi dynamic. Bàn Xià clears heat from the Gall Bladder,
relieves anxiety and harmonises the Stomach. Mài Mén
Dōng generates fluids, nourishes the yin, and calms the
spirit. Rén Shēn and Gān Căo tonify the qi and generate
fluids, while Gēng Mǐ protects the stomach. This formula
uses 30 grams of Shí Gāo, which is a lower dose than one
would use when treating a yánɡ mínɡ fever, suggesting that
this formula does not address full heat. In contrast, Bái Hŭ
Tāng White Tiger Decoction can use up to 90 grams. By
using a smaller dose of Shí Gāo combined with Mài Mén
Dōng, the actions are redirected towards nourishing yin
fluids and clearing lingering heat. When I use this formula,
I tend reduce the dose further, usually to 15-18 grams. Of
course, lingering emotions can also generate heat that,
given the right constitution, might be treated with this
formula.
Gé Gēn Gé Gēn can be understood in
Gé Gēn is one of the more
compelling herbs to terms of its opening, mobilising and
learn, both as a Chinese softening actions.
medicinal as well as for its
biochemistry. There is a
large body of research showing that the major bioactive
ingredients in Gé Gēn are the isoflavones puerarin,
daidzein and genistein. The herb is cardioprotective,
antihypertensive, antipyretic, neuroprotective,
antispasmodic, and more.9 Gé Gēn is sweet, acrid and
cool. It enters the Spleen and Stomach channels. Its chief
actions are to raise the clear yang qi of the Stomach,
release the muscles and generate fluids to alleviate thirst.
Furthermore, Gé Gēn can lower blood pressure and treat
headaches and dizziness.10
A key to understanding a Gé Gēn constitution lies in
its ability to treat alcohol toxicity. If we extrapolate on
this idea of intoxication, we can expand it to include
symptoms of dizziness, confusion and clouded thinking.
Therefore, Gé Gēn can be used when people experience
a lack of grounding or clarity. Gé Gēn allows clear yang to
reach the head and is one of the best medicinals for clearing
the mind. Gé Gēn can be understood in terms of its opening,
mobilising and softening actions. The typical Gé Gēn body
56
type is that of a robust, muscular person who enjoys alcohol.
Since Gé Gēn releases the muscle layer, it treats muscular
tension, especially in the neck and shoulders. There may
also be thirst, diarrhoea and acne.
An excellent example of a Gé Gēn formula that can treat
the spirit can be found in the formula Gé Gēn Qín Lián Tāng
(Kudzu, Scutellaria and Coptis Decoction):
Gé Gēn 葛根 Puerariae Radix 24g
Huáng Lián 黄连 Coptidis Rhizoma 9g
Huáng Qín 黄芩 Scutellariae Radix 9g
Zhì Gān Căo 炙甘草 Glycyrrhizae Radix praeparata 6g
Gé Gēn Qín Lián Tāng (Kudzu, Scutellaria and Coptis Decoction)
This formula releases the exterior and clears yánɡ
mínɡ interior heat to treat foul-smelling or explosive
diarrhoea, burning sensation of the anus after defecation,
irritability with a feverish sensation in the chest and
epigastrium and thirst, with a yellow tongue coating
and a rapid pulse. It is thus often used to treat hot-type
acute gastroenteritis and ulcerative colitis. In addition to
these traditional applications, the formula is an effective
method for treating
vexation and agitation,
headache, muscle spasms,
dizziness and anxiety with
heat. Because Gé Gēn also
lowers blood pressure
and improves cerebral
circulation, the formula
might be used to address the cognitive and behavioural
changes caused by hardening of the arteries and related
cerebral-vascular disorders. In clinical practice, I have used
this formula for the agitation and outbursts that occur in
people with Alzheimer’s disease. For this situation, we
can modify the formula with medicinals to invigorate the
blood, such as Chì Sháo (Paeoniae Rubra Radix), Mŭ Dān
Pí (Moutan Cortex) and Táo Rén (Persicae Semen).
Zhī Zǐ
Zhī Zĭ is bitter and cold. It enters the Heart, Lungs,
Stomach, Liver and Triple Burner. It clears heat from all
three burners, draining it through urination. Additionally,
it clears damp-heat jaundice and is used to treat damp-
heat lìn syndrome. It cools the blood and relieves toxicity
and thus can be used when heat causes blood to move
recklessly. Zhī Zĭ neither clears exterior heat, nor does
it clear hard, clumped heat. Zhī Zĭ particularly treats
constrained heat - often causing stifling oppression in the
 Journal of Chinese Medicine | Issue123 | June 2020
Using Herbs That Clear Heat to Calm the Spirit

chest - by draining it through urination. Zhāng Zhòng-jǐng When other signs and symptoms match, I often modify this
says that Zhī Zĭ ‘resolves anguish and vexation in the heart formula to treat children with difficulty sleeping.
and depressed heat bind’.11 When Zhāng uses the term A widely used formula that uses Zhī Zĭ to calm the spirit
'anguish', he means a feeling of harassment to the point is Jiā Wèi Xiāo Yáo Săn (Modified Rambling Powder)
where the patient cannot calm down, along with shallow
and rapid breathing. Chái Hú 柴胡 Bupleuri Radix 9g
In addition to obvious signs of heat such as red eyes,
being easily angered and a bitter taste in the mouth, Dāng Guī 当归 Angelicae sinensis Radix 9g
there are other important signs and symptoms of a Zhī Bái Sháo 白芍 Paeonia Radix alba 9g
Zĭ presentation. When palpating the abdomen, there is
often pain and discomfort under the sternum. Look for Bái Zhú 白术 Atractylodis 9g
macrocephalae Rhizoma
tightness, rigidity and a lack of yielding below the heart,
as well as a subjective sensation of fullness in the chest and Fú Líng 茯苓 Poria 9g
epigastrium. A hallmark sign of a Zhī Zĭ pattern is revealed
Zhì Gān 炙甘 Glycyrrhizae Radix 3g
if the practitioner quickly and firmly palpates just below Căo 草 praeparata
the sternum; if this elicits pain or discomfort that startles
the patient, then this strongly suggests a Zhī Zĭ pattern Bò Hé 薄荷 Menthae haplocalycis 6g
Herba
presentation.
Shēng Jiāng 生姜 Zingiberis Rhizoma 3-5 slices
recens
Zhī Zǐ 栀子 Gardeniae Fructus 9g
Mŭ Dān Pí 牡丹 Moutan Cortex 6g
Dàn Dòu Chǐ 淡豆豉 Sojae Semen praeparatum 9g 皮

Zhī Zǐ Chǐ Tāng (Gardenia and Prepared Soybean Decoction) Zhī Zǐ 栀子 Gardeniae Fructus 6g

Jiā Wèi Xiāo Yáo Săn (Modified Rambling Powder)

This formula clears heat due to constraint in the chest and
diaphragm. It also treats the lingering heat following a
febrile illness that causes insomnia with tossing and turning,
and ‘anguish in the Heart’.12 This pattern is referred to as xū
fán (see above). Huáng Lián Ē Jiāo Tāng also treats this
pattern, although the appearance of the person and the
accompanying signs and symptoms will differ. Huáng Lián
Ē Jiāo Tāng nourishes the blood and yin and clears heat, so
the patient’s complexion will be pale or white with red lips.
There may also be heavy
menstrual or intestinal
bleeding. The tongue will Zhī Zǐ Chǐ Tāng is vital for treating
be red with a dry yellow
coating, and the pulse will restless sleep patterns that appear
be thready and rapid. In the following emotional upset.
case of Zhī Zĭ Chĭ Táng, the
heat is at the qi level. The
patient may or may not have a low-grade fever but is unable
to settle down; sleep is characterised by tossing and turning.
The tongue is red, but with a pale yellow coating, and the
pulse is floating, forceful and rapid. Zhī Zĭ Chĭ Tāng is vital
for treating restless sleep patterns that appear following
emotional upset. Dr. Huang teaches that this formula can
be used when the patient is troubled but unable to explain
what is wrong. Using this formula can help them to express
themselves clearly. In this case, clearing heat creates space
in which to reflect and to gain insight into one’s feelings.
This modification of the iconic formula Xiāo Yáo Săn is used
to regulate the Liver qi, nourish the blood and harmonise
the Liver and Spleen. Symptoms can include sweating, a
feeling of heat rising, red ears, red eyes, breast distention
and menstrual irregularities. It can treat what is generally
referred to as premenstrual syndrome. The pulse is wiry
and the tongue is reddish. Zhī Zĭ and Mŭ Dān Pí are added
to clear heat that causes restlessness and irritability.
Lián Qiào
Bitter and light, Lián
Qiào is a medicinal that
we rarely think about
for calming the spirit.
The Materia Medica
3rd edition states that it
‘Clears heat and resolves toxicity … Reduces abscesses
and dissipates clumps.’13 Easily overlooked in the list
of its actions is that it clears heat that has entered the
Pericardium causing fever and impairing consciousness.
Based only on this commentary, one might never grasp
the full impact this herb can have on the spirit. Jiao Shu-de
states that it treats warm-heat evil entering the Heart.
Symptoms include clouded consciousness, delirious
speech, and vexation and agitation. Huang says that Lián
Qiào can be used to clear the emotions and get rid of

57
Journal of Chinese Medicine | Issue123 | June 2020
Using Herbs That Clear Heat to Calm the Spirit
agitation. He uses it to treat insomnia and irritability. He
likes to combine it with Zhī Zĭ for this purpose.14 Huang
created the formula the formula Bā Wèi Chū Fán Tāng
(Eight Flavor to Eliminate Vexation Decoction), which
uses it in this way to great effect:15
Hòu Pò 厚朴 Magnoliae Officinalis Cortex
Bàn Xià 半夏 Pinelliae Rhizoma
Fú Líng 茯苓 Poria
Zǐ Sū 紫苏梗 Perillae Caulis
Gěng
Lián Qiào 连翘 Forsythiae Fructus
Huáng 黄芩 Scutellariae Radix
Qín
Zhī Zǐ 栀子 Gardeniae Fructus
Zhǐ Qiào 枳壳 Aurantii Fructus
Bā Wèi Chū Fán Tāng (Eight Flavor to Eliminate Vexation Decoction)
This formula is a modification of Bàn Xià Hòu Pò
Tāng (Pinellia and Magnolia Bark Decoction), the
iconic formula that treats plum pit qi (the sensation of
having something lodged in the throat although there is
nothing actually there). It is a pattern associated with
constrained emotions. Zhī Zĭ, Lián Qiào and Huáng
Qín clear heat from the Heart to calm the mind. Hòu
Pò, Zhĭ Qiào, and Zĭ Sū Gĕng reduce bloating and
distention and regulate qi to relieve depression. Bàn
Xià and Fú Líng resolve phlegm. Bàn Xià is also specific
for relieving anxiety. One appealing part of the formula’s
construction is that it relaxes the nervous system without
being overly sedating. Because there are no obvious
spirit-calming herbs in this formula, one may not at first
glance think that it was constructed to deal with anxiety.
The formula works because it rectifies the fundamental
qi mechanisms of regulating and opening. In this way, the
patient feels clear and calm but not sedated.
Conclusion
Using herbs that clear heat to calm the spirit and settle the
mind has significantly improved my therapeutic results,
whether the chief complaint is anxiety or depression, or
associated symptoms such as an inability to concentrate
or insomnia. With conscientious treatment, immediate
and lasting results can be achieved. When the heat that has
caused the spirit to be unsettled clears, the mind is left
calm and focused. The patient feels centred, cooled and
present. Thus, treatment can cultivate a clear, still and
58
reflective space within the patient, allowing them to grow
and flourish.
Cara O. Frank, L.O.M., Dipl. O.M., is an acupuncturist,
herbalist and educator who has been in practice since 1983.
10g She is also the founder of China Herb Company, created
in 1991 to meet the need for high quality custom Chinese
10g herbal formulas. She has also founded and directed Chinese
10g herb departments at two acupuncture schools. Cara is the
author of TCM Case Studies: Eye, Ear, Nose and Throat
10g Disorders. She lives and practises in Philadelphia, where
she runs Six Fishes Healing Arts, with two locations and a
15g special focus on Chinese herbal medicine. She is the creator
of many Chinese herbal products, including her signature
10g
‘Little Fishes’ formulas for children.
10g
Notes
10g 1. Wilms, S. (trans.) (2016). Shen Nong Ben Cao Jing. The Divine Farmers
Classic of Materia Medica, 2nd edition. Happy Goat Productions: Corbett
2. Wiseman, N. & Feng, Y.. (1998). A Practical Dictionary of Chinese
Medicine. Paradigm Publications: Brookline, MA, p.273
3. Flaws, B. & Lake, J. (2001). Chinese Medical Psychiatry. Blue Poppy
Press: Boulder, p.136
4. American Psychiatric Association (2013). The Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric
Association: Arlington, VA
5. See National Institute of Mental Health: Anxiety Disorders at <https://
www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml>
6. Wilms, S. (trans.) (2016). Shen Nong Ben Cao Jing. The Divine Farmers
Classic of Materia Medica, 2nd edition. Happy Goat Productions:
Corbett, p.214.
7. For practical and aesthetic purposes, we usually do not tend to add
egg yolks to the decoction - the patient can simply be advised to eat
soft-boiled eggs while taking the decoction.
8. Hsu, Hong-Yen (1980). Commonly Used Chinese Herb Formulas with
Illustrations. Oriental Healing Arts Press, p. 185
9. Chen, J. & Chen, T. ( 2004). Chinese Medical Herbology and
Pharmacology. Art of Medicine Press: City of Industry, CA, p. 82
10. Wing Ming Keung (2002). Pueraria: The Genus Pueraria. Taylor &
Francis: Oxford, p.156.
11. Mitchell, C., Feng, Y. & Wiseman, N. (1999). Shang Han Lun. Paradigm
Publications: Brookline, MA, Line 261
12. Ibid., line 76b.
13. Bensky, D., Clavey, S. & Stoger, E. (2004). Chinese Herbal Materia
Medica, 3rd Edition. Eastland Press: Seattle
14. Max, M. (2007). Person… Illness… Prescription. An interview with Dr.
Huang Huang, The Lantern, 4-2
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