恐懼者，神蕩憚而不收。
When one experiences fear and fright, the Shen shakes with dread; it can no longer be gathered.

—Neijing lingshu, Chapter 8

驚則心無所倚，神無所歸，慮無所定，故氣亂矣。
When fright arises, the Heart has nowhere to rest, the Shen has nowhere to return to, and one’s worries have nowhere to settle. Thus, the Qi becomes chaotic.

—Neijing suwen, Chapter 39

師曰：奔豚病，從少腹起，上衝咽喉，發作欲死。
The master says: Running Piglet Disease features a surging upward from the lower abdomen to the throat, such that one feels as if one is about to die.

—Jingui yaolue, Chapter 8

Instinctively, pigs are herd animals and prey animals, so when they’re scared, they run and when I say run, they run fast to get as far away as possible from whatever has frightened them.

—From the blog post “New Pig Parents”

***

The Han Dynasty Chinese used a memorable term to encapsulate the chaotic upward rush characterizing states of anxiety and panic: Running Piglet Qi. The ascending flood of energy is like a stampede of rowdy piglets charging up the Chongmai (Penetrating Vessel).

Below, I will provide ways in which the Classical Chinese herbalist can help “tame” these little piggies. Zhang Zhongjing, author of the Shanghan zabing lun (“Treatise on Cold Damage and Miscellaneous Diseases”), included only three of these formulas in his Running Piglet chapter; I’m taking the liberty of stretching the scope of the syndrome, so as to include a wider variety of anxiety and panic presentations (and thus a greater number of his herbal remedies).

The primary effect of these Shanghan zabing lun formulas is to create a safe inner space for the person to inhabit. The panicked person does not feel safe in his or her body, so the herbalist seeks the best method of restoring a calm, grounded inner atmosphere for the person to feel at home in.

I’ve categorized the herbal remedies we’ll explore in this article according to the following diagnostic themes. (Please be aware that these themes are a convenient, if inexact, way to present the formulas.)

• Heart Yang deficiency
• Shaoyang and Jueyin Diseases
• Deficiency of Yingqi and Blood
• Yin deficiency
• Heat harassing the Heart
• Cold abundance
• Phlegm-rheum

These formulas are at least a couple millennia old, yet they remain so very relevant. Even if we, as practitioners, choose not to employ them in their original forms, the study of their composition and application can guide us in our herbal thinking when treating states of mental-emotional chaos.

Each of the formulas is presented with its ingredients, their amounts, and a representative line from the Shanghan zabing lun (with Shanghan lun quotations abbreviated as SHL and Jingui yaolue passages as JGYL). In addition, brief notes are provided for each formula. These notes primarily derive from the teachings of Joon Hee Lee, Shanghan scholar and practitioner.

Tonifying Heart Yang: Cinnamon

Zhang Zhongjing’s presentation of the treatment of panic centers around Guizhi, cinnamon. Before we get into the formulas themselves, let’s explore this herb a bit.

In line 15 of the Shanghan lun, Zhang asserts that the presentation of “upward surging”—a particular form of counterflow—is a prerequisite for the use of Guizhi Tang, cinnamon’s representative formula:

太陽病，下之後，其氣上衝者，可與桂枝湯，方用前法。若不上衝者，不得與之。
If, in a Taiyang Disease, after purgation is used, Qi surges upward: one can give Guizhi Tang, according to the previously-mentioned method. If there is no upward surging: one cannot give it.

In a similar vein, Zhang advocates for the addition of Guizhi as a single-herb modification in cases of upward surging. In chapter 2, line 22 of the Jingui yaolue, after presenting Fangji Huangqi Tang, Zhang writes:

氣上衝者加桂枝三分 。
For upward-surging Qi: add three fen of Guizhi.

Thus, both the single herb and its namesake formula are recommended in the treatment of upward surging. Building on this theme, Shanghan lun line 117 (which calls for Guizhi jia Gui Tang) directly links the herb to Running Piglet:

所以加桂者，以泄奔豚氣也。
The reason for additional Gui[zhi] is to discharge Running Piglet Qi.

So, through his instructions, Zhang is unequivocally proclaiming Guizhi to be the preeminent herb for the counterflow of anxiety and panic.

This particular class of counterflow manifests with anxiety, chest tightness, headache, palpitations, flushing, perspiration, and cold extremities. To 18th-century Shanghan zabing lun scholar Yoshimasu Todo, Guizhi-type counterflow is due to Heart Yang deficiency—the physiological Fire of the Heart fails to descend and penetrate the Water realm, instead leaking upward and outward.

Heart Yang provides the motive and rhythmic force behind vascular flow, and Guizhi is helping to promote this pumping power. When Heart Yang is deficient, its warmth drifts upward, which provides a “false” heat to the chest and head and a coolness to the lower body and extremities. But when Heart Yang is sufficiently strong, it evenly warms and vitalizes the entire body, including the abdomen, pelvis, legs, and the hands and feet. This makes the person feel integrated, whole, secure.

Now, it might be counterintuitive to use a pungent, warming herb to encourage descent. Here’s a metaphor that might help: Guizhi stimulates a full and complete sunrise (awakening the body and mind, expanding the vessels, opening the pores, moving the Qi outward and upward) so that there might be an equally full and complete sunset (resting the body and mind, closing the pores, contracting the vessels, sending the Qi downward and inward). Cinnamon helps to “open” the body with appropriate force so that it can then “close” with corresponding integrity. This grounds the person in a healthy rhythm.

We might also benefit from considering how Guizhi affects the Bladder. Given the herb’s ubiquity in Taiyang formulas, we know that Guizhi possesses a Taiyang affinity. The Taiyang Bladder channel governs our outer boundary, sealing and warming the periphery. By invigorating the Bladder, Guizhi is providing support in defending against Cold Invasion. “Cold” here includes traumatic influences that pierce our defenses and cause emotional turmoil. Guizhi helps the Bladder to summon protective Qi and thaw any freezing on the surface. So, we can say that Guizhi addresses both the Shaoyin (Heart-Kidney) layer and its partner conformation, the Taiyang (Bladder-Small Intestine).

If we were desiring to shepherd the warming effects of cinnamon directly to the Kidney, we could substitute Rougui for Guizhi. In fact, at times Zhang simply calls for “Gui,” without specifying whether he is recommending the twig or bark. (See, for instance SHL 96 or JGYL 3.14.) In his book on the Shanghan lun, Guohui Liu cites studies claiming that the Guizhi of Zhang’s time was larger and more bark-laden than the modern version, similar to the Rougui we use today. So, perhaps Zhang’s Guizhi had more of a Kidney-focused effect than is commonly thought.

Cinnamon is a sensitive plant, and it resonates with the sensitive person—those who are timid, frail, prone to sickness, thin, anxious, cold. This is not a Mahuang presentation; that herb would be far too strong for this type of person. Instead, we need Guizhi to gently warm and reinforce the Heart (and, by extension, all the body’s vasculature); to expand outward with proper cadence and boundary (which naturally gives way to contraction and descent); and to energize the defensive Qi on the surface via the Bladder (which creates a feeling of security).

Let’s take a look at some of Guizhi’s formulas. Each of the following cinnamon-centric decoctions can specifically address anxiety and panic:

• Guizhi jia Gui Tang
• Guizhi jia Longgu Muli Tang
• Guizhi qu Shaoyao Tang
• Guizhi qu Shaoyao jia Shuqi Longgu Muli Tang

• Guizhi Gancao Tang
• Guizhi Gancao Longgu Muli Tang

• Fuling Guizhi Gancao Dazao Tang
• Fuling Guizhi Baizhu Gancao Tang
• Fuling Guizhi Wuwei Gancao Tang
• Fuling Gancao Tang

The first four formulas derive from Guizhi Tang; the core of the middle two formulas is the pairing of Guizhi and Gancao; and the latter four formulas revolve around the important triad of Guizhi, Gancao, and Fuling. Let’s begin!

桂枝加桂湯
Guizhi jia Gui Tang
Cinnamon Twig Decoction, with Cinnamon Twig Added

桂枝 Guizhi (cinnamon twig) 5 liang
芍藥 Shaoyao (peony root) 3 liang
生薑 Sheng Jiang (fresh ginger rhizome) 3 liang
甘草 Gancao (licorice root) 2 liang
大棗 Dazao (jujube fruit) 12 pieces

JGYL 8.3
發汗後，燒針令其汗，針處被寒，核起而赤者，必發奔豚，氣從少腹上至心，灸其核上各一壯，與桂枝加桂湯主之。
After the promotion of diaphoresis, fire-needling has caused the patient to perspire [again]. If the needling sites then contract cold, [leading to the formation of] nodules that rise and redden: [this means] Running Piglet will surely develop. For Qi rushing upward from the lower abdomen to the heart: burn one zhuang of moxa atop each of the nodules; giving Guizhi jia Gui Tang governs.

*Line 117 of the Shanghan lun offers an almost identical passage.

Notes:
In the above line, a mistreatment using fire has drained the Heart. Heart Yang deficiency paves the way for upward-surging cold water. Furthermore, the introduction of heat has either (a) allowed for the invasion of exogenous cold, or (b) stirred endogenous cold without properly eradicating it; either way, the patient experiences cold at the surface.

This formula seeks to rectify Running Piglet Qi (and simultaneously release the exterior, although moxibustion might accomplish this function on it own) by increasing the amount of Guizhi in Guizhi Tang from 3 to 5 liang. We can employ Guizhi jia Gui Tang in cases of panic attacks featuring severe upward counterflow—headaches, flushing, palpitations, and aortic pulsation. The patient will typically have weak, floating pulse and a thin build. There might be a history of severe burns or drug abuse.

桂枝加龍骨牡蠣湯
Guizhi jia Longgu Muli Tang
Cinnamon Twig Decoction, with the Addition of Fossilized Mammal Bone and Oyster Shell

桂枝 Guizhi (cinnamon twig) 3 liang
芍藥 Shaoyao (peony root) 3 liang
生薑 Sheng Jiang (fresh ginger rhizome) 3 liang
甘草 Gancao (licorice root) 2 liang
大棗 Dazao (jujube fruit) 12 pieces
龍骨 Longgu (fossilized mammal bone) 3 liang
牡蠣 Muli (oyster shell) 3 liang

JGYL 6.8
夫失精家，少腹弦急，陰頭寒，目眩髮落，脈極虛芤遲，為清穀，亡血，失精。脈得諸芤動微緊，男子失精，女子夢交，桂枝加龍骨牡蠣湯主之。
Patients suffering from seminal emission will experience wiry tension in the lower abdomen; cold of the genital-head; dizziness; and hair loss. If the pulse is extremely deficient, hollow, and slow: this signals [diarrhea with] undigested food, Blood collapse, and seminal emission. In all cases where the pulse is hollow and stirring, or faint and tight: [one can expect] men to experience seminal emission and women to have sexual dreams; Guizhi jia Longgu Muli Tang governs.

Notes:
Guizhi jia Longgu Muli is the first of four formulas that combine cinnamon with the two mineral substances Longgu (“dragon bone”) and Muli (oyster shell). Here, we are simply adding the minerals to the base of Guizhi Tang.

The Jingui line focuses on the formula’s application in cases of severe deficiency: we are able to draw upon the minerals’ astringency to secure “leakage” in the form of seminal emission, dizziness, alopecia, and diarrhea. (We might also see excessive perspiration and urinary incontinence.) We can recruit this capacity for astringency to draw back the spirit in cases of panic; then, once the Shen is returned to its proper abode, the minerals’ heaviness anchors it in place. Thus, Guizhi Tang tonifies Heart Yang, while Longgu and Muli settle and secure.

桂枝去芍藥湯
Guizhi qu Shaoyao Tang
Cinnamon Twig Decoction, with Peony Root Removed

桂枝 Guizhi (cinnamon twig) 3 liang
甘草 Gancao (licorice root) 2 liang
生薑 Sheng Jiang (fresh ginger rhizome) 3 liang
大棗 Dazao (jujube fruit) 12 pieces

SHL 21
太陽病，下之後，脈促， 胸滿者，桂枝去芍藥湯主之。
If, after purgation has been used, a Taiyang Disease features a hurried pulse and fullness in the chest: Guizhi qu Shaoyao Tang governs.

Notes:
By removing Shaoyao from Guizhi Tang, this formula is able to lift the therapeutic focus to the chest. Without the sour, astringent peony, the expansion-contraction balance of Guizhi Tang becomes heavily favored toward expansion. A deficiency of Heart Yang is preventing the Heart from expressing outwardly, creating a milieu of excessive interiorization, in the form of panic manifesting with palpitation, tachycardia, tightness and fullness of the chest and neck, and headache.

Compared with the first formula we discussed in this section, Guizhi qu Shaoyao Tang is more chest-focused, while Guizhi jia Gui Tang is more appropriate for severe counterflow.

(Note that if this formula pattern occurs in the midst of Kidney Yang deficiency, the subsequent line tells us to add Fuzi.)

桂枝去芍藥加蜀漆牡蠣龍骨救逆湯
Guizhi qu Shaoyao jia Shuqi Muli Longgu Jiuni Tang
Cinnamon Twig Decoction for Relieving Counterflow, with Peony Root Removed, and Dichroa Leaf, Fossilized Mammal Bone, and Oyster Shell Added

桂枝 Guizhi (cinnamon twig) 3 liang
甘草 Gancao (licorice root) 2 liang
生薑 Sheng Jiang (fresh ginger rhizome) 3 liang
大棗 Dazao (jujube fruit) 12 pieces
牡蠣 Muli (oyster shell) 5 liang
蜀漆 Shuqi (dichroa leaf) 3 liang
龍骨 Longgu (fossilized mammal bone) 4 liang

SHL 112
傷寒脈浮，醫以火迫劫之，亡陽，必驚狂，起臥不安者，桂枝去芍藥加蜀漆牡蠣龍骨救逆湯主之。
If, in a case of Cold Damage featuring a floating pulse, the physician uses fire to force [diaphoresis], [causing] Yang to collapse: there will be fright and mania, and disquiet whether one is upright or recumbent; Gui Zhi qu Shao Yao jia Shu Qi Mu Li Long Gu Jiu Ni Tang governs.

*This formula is also featured in Jingui yaolue 16, line 12.

Notes:
Here, we are building upon Guizhi qu Shaoyao Tang, adding the herbs Muli, Longgu, and Shuqi. Again the focus is the chest, but this pattern features a more extreme mental-emotional imbalance. Fire has severely disturbed the flow of Qi and Blood, “collapsing” Yang. Weak Yang floats upward, causing fright, mania, and insomnia.

Note the increased dosage of Longgu and Muli, which settle the mind, astringe the spirit, and calm abdominal pulsations. Shuqi is a phlegm-rheum herb; its presence helpfully points to the role of phlegm in Heart disturbances. The herb is commonly omitted by modern practitioners due to its lack of availability, but we can learn from Zhang’s decision to include it.

桂枝甘草湯
Guizhi Gancao Tang
Cinnamon Twig and Licorice Root Decoction

桂枝 Guizhi (cinnamon twig) 4 liang
甘草 Gancao (licorice root) 2 liang

SHL 64
發汗過多，其人叉手自冒心，心下悸，欲得按者，桂枝甘草湯主之。
After diaphoresis has been strongly induced, the patient’s hands are crossed over the heart. If there are pulsations below the heart, with a desire for pressure: Guizhi Gancao Tang governs.

Notes:
One of the simplest of the classical formulas, Guizhi Gancao Tang treats Heart Yang deficiency manifesting with palpitations/pulsations. In the line above, the patient’s desire for pressure on their chest suggests a need for external containment in the absence of adequate Heart Yang. There might be chest tightness, sensitivity to stimulation, and a tendency toward constipation.

Note that the Guizhi:Gancao ratio in this formula is 4:2, compared with Guizhi Tang’s 3:2, reflecting a heightened need for Yang tonification (but not as drastic as Guizhi jia Gui Tang’s 5:2 ratio). Gancao is adept at treating mental urgency, and this function is magnified when the other three Guizhi Tang herbs are removed.

桂枝甘草龍骨牡蠣湯
Guizhi Gancao Longgu Muli Tang
Cinnamon Twig, Licorice Root, Fossilized Mammal Bone, and Oyster Shell Decoction

桂枝 Guizhi (cinnamon twig) 1 liang
甘草 Gancao (licorice root) 2 liang
牡蠣 Muli (oyster shell) 2 liang
龍骨 Longgu (fossilized mammal bone) 2 liang

SHL 118
火逆下之，因燒針煩躁者，桂枝甘草龍骨牡蠣湯主之。
If, after an adverse fire treatment has been administered and purgation has been induced, there is vexation and restlessness due to the fire-needling: Guizhi Gancao Longgu Muli Tang governs.

Notes:
Just as Guizhi Tang and Guizhi qu Shaoyao Tang add Longgu and Muli in cases of increased mental-emotional imbalance, so here we add this pair to the Guizhi Gancao Tang base. As Liu writes, “Clinically, this formula is widely applied to fear and fright” (370). There is a Heart Yang deficiency with floating Yang which requires heavy, astringent herbs to harness and anchor the Shen. We can look for palpitations and abdominal stirring. Note the smaller dosage of Guizhi in this line, suggesting milder Yang deficiency.

茯苓桂枝甘草大棗湯
Fuling Guizhi Gancao Dazao Tang
Poria, Cinnamon Twig, Licorice Root, and Jujube Fruit Decoction

茯苓 Fuling (poria) ½ jin
桂枝 Guizhi (cinnamon twig) 4 liang
甘草 Gancao (licorice root) 2 liang
大棗 Dazao (jujube fruit) 15 pieces

*The preparation instructions direct the reader to use 甘瀾水 Ganlanshui (“sweet rippling water”), which is water that has been continuously churned with a ladle.

SHL 65
發汗後，其人臍下悸者，欲作奔豚， 茯苓桂枝甘草大棗湯主之。
If, after the promotion of diaphoresis, the patient has pulsations below the navel: [it signals] the imminence of Running Piglet; Fuling Guizhi Gancao Dazao Tang governs.

*An almost identical passage is found in the fourth line of Jingui 8.

Notes:
The triad of Guizhi, Gancao, and Fuling is the theme for the final four formulas in this section. These herbs combine to treat weak Heart Yang manifesting with a disturbance in water metabolism.

In this formula (also known as Ling Gui Cao Zao Tang), Guizhi and Gancao are recommended in the same ratio as Guizhi Gancao Tang (4:2); they combine to tonify Heart Yang and moderate urgency. Dazao helps to relax hypertonicity by boosting Spleen Qi—the Earth realm is strengthened so as to control Water.

I think we can safely consider Fuling to be the formula’s primary herb, given that it is placed first in the formula name and is recommended in such a large dosage. Its percolative power drains excess water downward, relieving the Heart. The formula pattern might feature abnormal urination and, as the line informs us, abdominal pulsation, in addition to the typical Heart Yang deficiency presentation.

茯苓桂枝五味甘草湯
Fuling Guizhi Wuwei Gancao Tang
Poria, Cinnamon Twig, Schizandra Fruit, and Licorice Root Decoction

茯苓 Fuling (poria) 4 liang
桂枝 Guizhi (cinnamon twig) 4 liang
甘草 Gancao (licorice root) 3 liang
五味子 Wuweizi (schizandra fruit) ½ sheng

JGYL 12.36
青龍湯下已，多唾口燥，寸脈沉，尺脈微，手足厥逆，氣從小腹上衝胸咽，手足痺，其面翕然熱如醉狀，因復下流陰股，小便難，時復冒者，與茯苓桂枝五味甘草湯，治其氣衝。
When, after ingesting Qinglong Tang, there is copious sputum; a dry mouth; a submerged cun-pulse and faint chi-pulse; reversal-counterflow of the hands and feet; Qi surging upward from the lower abdomen to the chest and throat; bi-impediment of the hands and feet; gentle warmth of the face, as is found in the inebriated; and, as a result of flow returning downward into the Yin region, difficult urination and episodic foggy-headedness: give Fuling Guizhi Wuwei Gancao Tang to treat the surging of Qi.

Notes:
In Fuling Guizhi Wuwei Gancao Tang, Fuling and Guizhi are recommended in equal and ample amounts. Qi and water are surging upward, requiring Heart Yang tonification and disinhibition of water. Sour Wuweizi helps to rectify counterflow (especially of the Lung) by gathering inward.

The patient might present with cold of the extremities but warmth of the face; coughing and wheezing; allergies; headache; neck tightness; and brain fog. There might also be urinary dysfunction and abdominal pulsation.

There are several modifications of this formula in the subsequent lines; see JGYL 12.37-40 for these.

苓桂朮甘湯
Ling Gui Zhu Gan Tang
Poria, Cinnamon Twig, White Atractylodes Rhizome, and Licorice Root Decoction

茯苓 Fuling (poria) 4 liang
桂枝 Guizhi (cinnamon twig) 3 liang
白朮 Baizhu (white atractylodes rhizome) 2 liang
甘草 Gancao (licorice root) 2 liang

SHL 67
傷寒，若吐若下後，心下逆滿，氣上衝胸，起則頭眩，脈沉 緊，發汗則動經，身為振振搖者，茯苓桂枝白朮甘草湯主之。
If emesis or purgation has already been used in a case of Cold Damage, and there is counterflow-fullness below the heart; Qi surging upward to the chest; dizziness upon rising; and a pulse that is submerged and tight: Fuling Guizhi Baizhu Gancao Tang governs. If diaphoresis were promoted [instead]: the channels would be stirred and the body would tremble.

*This formula is also found in lines 16 and 17 of chapter 12 of the Jingui yaolue. It warrants mentioning that line 16 calls for 3 liang of Baizhu, while SHL 67 recommends 2 liang of the herb.

Notes:
Ling Gui Zhu Gan Tang is renowned for treating dizziness due to phlegm-rheum collecting in the epigastrium. The pattern features epigastric pi-glomus, abdominal fullness and bloating, aortic pulsation, palpitations, shortness of breath, urinary issues, and, of course, upward surging. The formula strengthens Heart Yang, dries the Spleen, and percolates dampness.

茯苓甘草湯
Fuling Gancao Tang
Poria and Licorice Root Decoction

茯苓 Fuling (poria) 2 liang
桂枝 Guizhi (cinnamon twig) 2 liang
甘草 Gancao (licorice root) 1 liang
生薑 Sheng Jiang (fresh ginger rhizome) 3 liang

SHL 356
傷寒，厥而心下悸，宜先治水，當服茯苓甘草湯，卻治其厥。不爾，水漬入胃，必作利也。
When a case of Cold Damage features reversal and pulsations below the heart: it is appropriate to first treat the water; one should give Fuling Gancao Tang. Only then can one treat the reversal. Otherwise, the water will inundate the stomach, causing diarrhea.

*This formula is also found in line 73 of the Shanghan lun.

Notes:
Fuling Gancao Tang combines our triad of Guizhi, Gancao, and Fuling with a relatively large dose of fresh ginger. This formula treats cold-rheum accumulating in the Middle Jiao due to Heart and Spleen Yang deficiency. Employing this formula in cases of panic would require the presentation of digestive reversal, in the form of nausea, vomiting, and/or belching. We can also look for abdominal distention, aortic pulsation, palpitations, anxiety, and an absence of thirst.

Strengthening & Clearing: Shaoyang and Jueyin

Shaoyang and Jueyin Disease both assume some combination of deficiency and excess. Let’s explore the Shaoyang layer first.

In Shaoyang disharmony, Qi and Blood are weak, which leads to sluggishness of circulation and ultimately to a congestion that combusts into flames. This combination of Xu and Shi is implied by the constituents of Shaoyang’s representative formula, Xiao Chaihu Tang, which features a medley of clearing and tonifying herbs.

In Shaoyang Disease, stagnation occurs in the lateral zones of the body (along the Gallbladder and Sanjiao channels), affecting the body’s “pivot mechanism,” resulting in temperature dysregulation, rib-side distress, digestive disturbances, lymphatic congestion, and a scorching of the orifices of the head (which can manifest as dizziness, dry mouth and throat, and ear issues). The herbalist must help dredge the Qi pathways and re-introduce proper circulation. While we can consider a number of Chaihu formulas in the context of panic attacks—including Xiao Chaihu Tang; Chaihu Guizhi Tang; Chaihu Guizhi Ganjiang Tang; and Sini San—the main approach is Chaihu jia Longgu Muli Tang.

柴胡加龍骨牡蠣湯
Chaihu jia Longgu Muli Tang
Bupleurum Root Decoction, with Fossilized Mammal Bone and Oyster Shell Added

柴胡 Chaihu (bupleurum root) 4 liang
龍骨 Longgu (fossilized mammal bone) 1½ liang
黃苓 Huangqin (scutellaria root) 1½ liang
生薑 Sheng Jiang (fresh ginger rhizome) 1½ liang
鈆丹 Qiandan (minium) 1½ liang
人參 Renshen (ginseng root) 1½ liang
桂枝 Guizhi (cinnamon twig) 1½ liang
茯苓 Fuling (poria) 1½ liang
半夏 Banxia (pinellia rhizome) 2½ ge
大黃 Dahuang (rhubarb root & rhizome) 2 liang
牡蠣 Muli (oyster shell) 1½ liang
大棗 Dazao (jujube fruit) 6 pieces

SHL 107
傷寒八九日，下之，胸滿煩驚，小便不利，讝語， 一身盡重，不可轉側者，柴胡加龍骨牡蠣湯主之。
By the eighth or ninth day of a case of Cold Damage, purgation has been used. If there is fullness in the chest; vexation and fright; unsmooth urination; delirious speech; and heaviness of the entire body that makes it difficult to turn to the sides: Chaihu jia Longgu Muli Tang governs.

Notes:
In this formula, we find Xiao Chaihu Tang (minus Gancao) with the addition of Longgu and Muli (our pairing for settling fright); Guizhi and Fuling (our pairing for upward surging and impaired water metabolism due to Heart Yang deficiency); Dahuang (for accumulation); and Qiandan (to calm the Mind).

We can look for the typical Chaihu presentation (rib-side distress, irritability, nausea, etc.) as well as anxiety and depression, pulsations/palpitations, and constipation. This formula is very popular in Japan for all manner of psycho-emotional issues. Modern practitioners typically omit Qiandan for its toxicity.

If the patient presents with a Chaihu pattern but a Guizhi constitution (cold, weak), consider Chaihu Guizhi Tang. If there’s even more cold, with loose stool and thirst, consider Chaihu Guizhi Ganjiang Tang. For a Chaihu pattern with a SIBO-like presentation, requiring Baishao and Zhishi to free abdominal tension, consider Sini San and its variations.

Jueyin Disease also features a combination of deficiency and stagnation, but they are occurring at a deeper level than Shaoyang pathologies. There is more severe weakness, requiring stronger tonifying herbs, like Fuzi and Danggui.

In Jueyin Disease, Yin and Yang are not properly intercoursing, resulting in the condition of heat above and cold below. There is thirst, abdominal pain, temperature dysregulation, loss of appetite, diarrhea, and, of course, “Qi upwardly striking the Heart” (to quote SHL 326). This environment is ripe for Wood-type panic, where fear and fright derive from Liver weakness and congestion. Wumei Wan and Bentun Tang represent two herbal approaches to such patterns.

烏梅丸
Wumei Wan
Mume Fruit Pill

烏梅 Wumei (mume fruit) 300 pieces
細辛 Xixin (asarum) 6 liang
乾薑 Gan Jiang (dried ginger rhizome) 10 liang
黃蓮 Huanglian (coptis rhizome) 16 liang
當歸 Danggui (angelica sinensis root) 4 liang
附子 Fuzi (aconite accessory root) 6 liang
蜀椒 Shujiao (Sichuan pepper) 4 liang
桂枝 Guizhi (cinnamon twig) 6 liang
人參 Renshen (ginseng root) 6 liang
黃蘗 Huangbai (phellodendron root bark) 6 liang

*The preparation instructions direct the reader to mix the ingredients with 蜜 Mi (honey) to form pills.

SHL 338
今病者靜，而復時煩者，此為藏寒。蚘上入其膈，故煩，須臾復止，得食而嘔，又煩者，蚘聞食臭出，其人常自吐蚘。蚘厥者，烏梅丸主之。又主久利。
…When the disease features periods of peace punctuated by bouts of vexation: it signals that cold in the zang-organs [is causing] roundworms to ascend into the region of diaphragm, which results in vexation. Wait a while and it will cease. If, upon eating, there is nausea and increased vexation: [it means] the roundworms are smelling the malodor of food and ascending; the patient will experience frequent, unprompted vomiting of roundworms. For roundworm-reversal: Wumei Wan governs. It also treats chronic diarrhea.

*This formula is also found in JGYL 19.8.

Notes:
Wumei Wan treats “roundworm-reversal,” a form of Liver-Stomach disharmony marked by paroxysmal vexation and digestive upset. Beyond the context of parasitism, we might apply this pattern to the presentation of Liver-type panic in which the Wood is poking at the Earth realm.

We should look for heat in the upper body and cold below; nausea and diarrhea; dizziness; and Qi periodically surging to the chest. Huanglian and Huangbai strongly clear heat and descend, while six warm-to-hot and pungent herbs expel cold and bring warmth to the organs and the Blood; Renshen, meanwhile, secures the center. The eponymous herb homes to the Liver via its sourness and “stuns” parasites (and by extension “wind,” in the form of nervous system agitation).

奔豚湯
Bentun Tang
Running Piglet Decoction

甘草 Gancao (licorice root) 2 liang
芎藭 Xiongqiong (Sichuan lovage root) 2 liang
當歸 Danggui (angelica sinensis root) 2 liang
半夏 Banxia (pinellia rhizome) 4 liang
黃苓 Huangqin (scutellaria root) 2 liang
生葛 Sheng Ge (raw kudzu root) 5 liang
芍藥 Shaoyao (peony root) 2 liang
生薑 Sheng Jiang (fresh ginger rhizome) 4 liang
甘李根白皮 Ganligenbaipi (white bark of the plum root) 1 sheng

JGYL 8.2
奔豚氣上衝胸，腹痛，往來寒熱，奔豚湯主之。
When a case of running piglet features Qi surging upward to the chest, abdominal pain, and alternating episodes of cold and heat: Bentun Tang governs.

Notes:
Here we find the Blood-tonifying and Blood-moving triad of Danggui, Chuangxiong (referred to here by its ancient name of Xiongqiong), and Shaoyao—this brings to mind the role of Liver Blood deficiency in the formation of fearfulness. Lingshu 8 says: “The Liver stores the Blood, and the Blood houses the Hun. When Liver Qi is deficient, there will be fear.” Suwen 22 says: “In cases of [Liver] deficiency, the eyes cannot see clearly and the ears cannot hear. There is a tendency toward fear, as if one were about to be apprehended.”

In addition to the Blood herbs, the formula features a collection of herbs to address both heat and cold-rheum disturbing the Heart: the Shaoyang herb Huangqin cools and clears; Gegen cools and raises the fluids (alleviating thirst and diarrhea); and Banxia and Sheng Jiang transform cold-rheum. Lastly, there is a large helping of bitter, cold Ligenpi (plum root bark), which is typically substituted with Sangbaipi (mulberry root bark) in the modern clinic. Wiseman contends that Ligenpi was originally included “to downbear Running Piglet Qi and is the chief medicinal of the formula.” (Wiseman & Wilms, 181)

Supplementing Yingqi and Blood

Depletion of the Middle Jiao—the source of postnatal Qi and Blood—leaves the core of the body vulnerable to anxiety and panic. The Qi- and Blood-deficient patient is prone to startling, fatigue, and palpitations. The formulas below nourish the center—the Spleen, Stomach, and Liver, in particular—thus fortifying the body against eruptions of Running Piglet.

小建中湯
Xiao Jianzhong Tang
Minor Decoction to Establish the Center

桂枝 Guizhi (cinnamon twig) 3 liang
甘草 Gancao (licorice root) 2 liang
大棗 Dazao (jujube fruit) 12 pieces
芍藥 Shaoyao (peony root) 6 liang
生薑 Sheng Jiang (fresh ginger rhizome) 3 liang
膠飴 Jiaoyi (maltose) 1 sheng

SHL 102
傷寒二三日，心中悸而煩者，小建中湯主之。
If, by the second or third day of a case of Cold Damage, there are palpitations and vexation in the Heart: Xiao Jianzhong Tang governs.

*This formula is also found in SHL 100, and JGYL 6.13, 15.22, and 22.18.

Notes:
Another Guizhi Tang modification, Xiao Jianzhong Tang brings the focus to a deficient Middle Jiao by doubling the amount of Shaoyao and adding a helping of sweet, warm maltose. Xiao Jianzhong Tang simultaneously combines pungent and sweet flavors to benefit Yang—stoking the physiological fire of the center—and sour and sweet flavors to benefit Yin—in this case, strengthening the nutritive.

The formula pattern features anxiety and palpitations; abdominal hypertonicity and pain; muscle spasms; weakness; loss of appetite; thirst for warm fluids; pallor of the face, lips, tongue, and nails; epistaxis; and a thin, slack, wiry pulse. The formula can easily be modified to focus on Qi by adding Huangqi or on Blood by introducing Danggui.

甘麥大棗湯
Gan Mai Dazao Tang
Licorice Root, Wheat Berry, and Jujube Fruit Decoction

甘草 Gancao (licorice root) 3 liang
小麥 Xiaomai (wheat berry) 1 sheng
大棗 Dazao (jujube fruit) 10 pieces

JGYL 22.6
婦人藏躁，喜悲傷，欲哭象如神靈所作，數欠伸，甘麥大棗湯主之。
When a case of women’s zang-organ restlessness features a tendency toward grief and a desire to weep, as if spiritually possessed, with frequent yawning and stretching: Gan Mai Dazao Tang governs.

Notes:
The above line calls to mind JGYL 11.12: “When [abrupt episodes of] pathological crying disturb the Hun and Po, [it means] the Blood and Qi are scant.” Gan Mai Dazao Tang addresses such emotional upheaval by tonifying the Ying-nutritive of the Spleen and containing floating Yang. The formula bolsters the Spleen with licorice and jujube so the organ can properly produce Blood, which serves as home to the spirit.

As for wheat, the Suwen links it to the Liver in chapter 4 and to the Heart in chapter 70. The grain’s role in this formula is to astringe: “It is utilized here to control the dispersal of the ethereal and corporal souls.” (Bensky, et.al., Chinese Herbal Medicine: Formulas & Strategies, 471)

The patient might exhibit anxiety, palpitations, insomnia, and night-sweating.

酸棗仁湯
Suanzaoren Tang
Sour Jujube Seed Decoction

酸棗仁 Suanzaoren (sour jujube seed) 2 sheng
甘草 Gancao (licorice root) 1 liang
知母 Zhimu (anemarrhena rhizome) 2 liang
茯苓 Fuling (poria) 2 liang
芎藭 Xiongqiong (Sichuan lovage root) 2 liang

JGYL 6.17
虛勞虛煩不得眠，酸棗仁湯主之。
For deficiency-taxation and deficiency-vexation with insomnia: Suanzaoren Tang governs.

Notes:
Suanzaoren Tang is renowned for treating neurotic insomnia stemming from Liver dysfunction. Gathering and tonifying, sour jujube seed nourishes Liver Blood and reins in the wandering Hun. Meanwhile, Zhimu clears heat and generates fluids; Chuanxiong brings warmth and movement to the Blood; Fuling rectifies water metabolism and calms the Heart; and Gancao harmonizes these actions.

The formula thus moistens the Liver and tonifies Blood, courses Qi and Blood, and clears constrained heat. The patient might exhibit exhaustion, irritability, night-sweating, palpitations, and dryness.

Nourishing Yin: Rehmannia and Lily Bulb

When the Yin of the Heart, Liver, and/or Kidney is depleted, Yang will tend to become untethered and float upward, bringing chaos to the mind/spirit. In such a case, panic tends to manifest with heat and dryness. It should be noted that Zhang Zhongjing did not write much about Yin; his text mainly focuses on the state of Yang. Nevertheless, we can deduce from the nature of the herbs and the context of their formula lines that Dihuang and Baihe were his primary herbs for Yin deficiency leading to panic.

炙甘草湯
Zhi Gancao Tang
Honey-Fried Licorice Root Decoction

甘草 Gancao (licorice root) 4 liang
生薑 Sheng Jiang (fresh ginger rhizome) 3 liang
人參 Renshen (ginseng root) 2 liang
生地黃 Sheng Dihuang (fresh rehmannia root) 1 jin
桂枝 Guizhi (cinnamon twig) 3 liang
阿膠 Ejiao (donkey-hide gelatin) 2 liang
麥門冬 Maimendong (ophiopogon tuber) ½ sheng
麻仁 Maren (hemp seed) ½ sheng
大棗 Dazao (jujube fruit) 30 pieces

SHL 177
傷寒，脈結代，心動悸，炙甘草湯主之。
When, in a case of Cold Damage, the pulse is knotted and skipping, and there are heart-stirring palpitations: Zhi Gancao Tang governs.

*This formula is also found in chapters 6 and 7 of the Jingui yaolue.

Notes:
In a sense, this formula, like Guizhi qu Shaoyao jia Shuqi Longgu Muli Tang, is building upon a base of Guizhi qu Shaoyao Tang. It adds a quartet of nourishing herbs— ginseng, rehmannia, donkey gelatin, and ophiopogon—as well as the vessel-moistening hemp seed (although some claim “Maren” actually refers to Heizhima—black sesame seed—which is more substantiating).

An herbal Yin transfusion, Zhi Gancao Tang serves as the prototype for palpitations due to Yin deficiency. The practitioner must ensure that the patient possesses enough Yang to digest this thick formula.

百合地黃湯
Baihe Dihuang Tang
Lily Bulb and Fresh Rehmannia Root Juice Decoction

百合 Baihe (lily bulb) 7 pieces
生地黃汁 Sheng Dihuang Zhi (juice of the fresh rehmannia root) 1 sheng

JGYL 3.5
百合病不經吐下發汗，病形如初者，百合地黃湯主之。
If, in a Hundred-Union Disease, neither emesis, nor purgation, nor diaphoresis has regulated the condition, and the expression of the disease is as it was in the beginning: Baihe Dihuang Tang governs.

Notes:
Baihe Dihuang Tang serves as the representative formula in a series of lily bulb-based decoctions found in Jingui 3. These formulas treat Baihe Disease, a mental-emotional imbalance resulting from the demise of the Yin of the chest.

Lily bulb moistens and cools the Heart and Lung, calming the Shen. In the above formula, it is paired with Dihuang to cool the heat in the Blood and further enrich the Yin fluids. Variations of this formula pair Baihe with Zhimu (anemarrhena rhizome), Jizihuang (egg yolk), Huashi (talcum), and Daizheshi (hematite).

Draining Heat and Cooling: Gardenia and Coptis

Cold and bitter, Zhizi and Huanglian are core herbs to relieve the Heart of distressing heat. The two formulas below are representative methods of employing these two herbs.

梔子豉湯
Zhizi Chi Tang
Gardenia Fruit and Fermented Soybean Decoction

梔子 Zhizi (gardenia fruit) 14 pieces
香豉 Xiangchi (fermented soybean) 4 ge

SHL 76
發汗吐下後，虛煩不得眠，若劇者，必反覆顛倒，心中懊憹，梔子豉湯主之。若少氣者，梔子甘草豉湯主之。若嘔者，梔子生薑豉湯主之。
…After the promotion of diaphoresis, and vomiting and diarrhea, there will be formless vexation with insomnia. If the condition is severe: there will be tossing and turning, and anguish within the heart; Zhizi Chi Tang governs. If there is weak breathing: Zhizi Gancao Chi Tang governs. If there is nausea: Zhizi Sheng Jiang Chi Tang governs.

*This formula is also found in lines SHL 77, 78, 221, 228, 375, and JGYL 17.44.

Notes:
Zhizi Chi Tang eliminates constrained heat in the chest which afflicts the Heart with severe vexation, restlessness, and insomnia. The chest obstruction should be “formless”—that is, entirely subjective, without palpable signs of accumulation. The formula directs heat downward with bitter, cold Zhizi, and outward with cooling, venting Dandouchi.

Given its proficiency in treating damp-heat in the Liver rising to harass the Heart, Zhizi Chi Tang and its derivative formulas might prove effective for those panic sufferers with a history of alcoholism. We can also look for an aversion to heat; sweating from the head; hunger with difficulty actually eating; and a red-tipped tongue with yellow coating.

黃連阿膠湯
Huanglian Ejiao Tang
Coptis Rhizome and Donkey-Hide Gelatin Decoction

黃蓮 Huanglian (coptis rhizome) 4 liang
黃苓 Huangqin (scutellaria root) 2 liang
芍藥 Shaoyao (peony root) 2 liang
鷄子黃 Jizihuang (egg yolk) 2 pieces
阿膠 Ejiao (donkey-hide gelatin) 3 liang

SHL 303
少陰病，得之二三日以上，心中煩，不得臥， 黃連阿膠湯主之。
When, in a Shaoyin Disease acquired two or three days ago or more, there is vexation in the Heart with insomnia: Huanglian Ejiao governs.

Notes:
This formula treats cases of heat disturbing the Heart-Kidney relationship by reducing fire and nourishing Yin. Huanglian and Huangqin strongly cool and descend; Jizihuang and Ejiao augment the Blood and Yin; and Shaoyao—bitter, sour, and cool— performs both functions, cooling and nourishing.

Huanglian Ejiao Tang helps Heart fire to properly descend into a stable Kidney Yin. We can look for anxiety and palpitations; disturbed sleep; epigastric pi-glomus; oral canker sores; a thin, rapid pulse; and a red tongue with minimal coating.

Warming and Dispersing Interior Cold: Aconite and Evodia

Abundant cold both derives from and paves the way for the freezing response of trauma. Yang withdraws and the body becomes a tundra of dissociation. The use of hot herbs like Fuzi and Gan Jiang (for Kidney cold) and Wuzhuyu (for Liver and Stomach cold) can help thaw this icy inner landscape, so that its frozen fragments might be re-integrated into a coherent, secure—a warmed—sense of self.

乾薑附子湯
Gan Jiang Fuzi Tang
Dried Ginger Rhizome and Aconite Accessory Root Decoction

乾薑 Gan Jiang (dried ginger rhizome) 1 liang
附子 Fuzi (aconite accessory root) 1 piece

SHL 61
下之後，復發汗，晝日煩躁不得眠，夜而安靜，不嘔不渴，無表證，脈沉微，身無大熱者，乾薑附子湯主之。
After purgation has been promoted, diaphoresis is then induced. In the daytime, [the patient] experiences vexation and restlessness, with inability to sleep, but by night there is quiescence. There is neither nausea, nor thirst, nor any exterior signs. If the pulse is submerged and faint, and the body has no great heat: Gan Jiang Fuzi Tang governs.

Notes:
When Kidney Yang deficiency is at the root of anxiety and panic, the primary therapeutic direction is to tonify the Kidney with aconite formulas like Gan Jiang Fuzi Tang. In this particular formula pattern, the body’s debilitated Yang gets some assistance from the Yang inherent in daytime, but rather than bringing harmony, it causes irritation; by night, Yin consumes the person (so, there is “quiescence”).

We should look for loose stool, subjective cold, and fatigue. If Yang begins to stray upward, flushing the face, we can consider adding Congbai (scallion white), creating Bai Tong Tang (“Scallion White Decoction for Connecting [Yin and Yang]”).

吳茱萸湯
Wuzhuyu Tang
Evodia Fruit Decoction

吳茱萸 Wuzhuyu (evodia fruit) 1 sheng
人參 Renshen (ginseng root) 3 liang
生薑 Sheng Jiang (fresh ginger rhizome) 6 liang
大棗 Dazao (jujube fruit) 12 pieces

SHL 309
少陰病，吐利，手足厥冷，煩躁欲死者，吳茱萸湯主之。
When a Shaoyin Disease features vomiting and diarrhea; reversal-cold of the hands and feet; and vexation and restlessness [that is so severe that the patient feels as if] she is about to die: Wuzhuyu Tang governs.

*Note that this formula is also found in lines SHL 243 and 378, as well as JGYL 17.8 and 17.9

Notes:
Wuzhuyu Tang addresses counterflow due to cold in the Liver and Stomach resulting in migraine, nausea, and mental-emotional distress. Wuzhuyu warms the Jueyin Liver channel (which reaches the vertex) and downbears counterflow; Renshen and Dazao tonify the Earth realm to which the Wood is transferring pathology; and a large dosage of Sheng Jiang disperses cold fluid from the Stomach.

Warming and Transforming Phlegm-Rheum: Pinellia and Ginger

Zhang Zhongjing recognized phlegm-rheum—cold, devitalized fluid—as a substance that can manifest as both the cause and the result of mental-emotional instability. On the one hand, phlegm-rheum develops from inadequate Earth, which is not properly transforming and transporting. Viscous liquid tends to make its way from the digestive center to the chest; once there, it can muddy the clear radiance of the Heart. On the other hand, emotional chaos can impede the proper flow of Qi and Blood, which will eventually vitiate the fluids.

Chapter 12 of the Jingui, which focuses on phlegm-rheum, emphasizes the use of warm and pungent herbs to transform pernicious water. The main classical combination for such cases was Banxia (pinellia rhizome) and Jiang (ginger rhizome, whether dried or fresh).

(Note that Ling Gui Zhu Gan Tang and Ling Gui Wuwei Gancao Tang, which reside in the cinnamon section above, are both found in Jingui 12, and could easily be placed in this section.)

半夏厚朴湯
Banxia Houpo Tang
Pinellia Rhizome and Magnolia Bark Decoction

半夏 Banxia (pinellia rhizome) 1 sheng
厚朴 Houpo (magnolia bark) 3 liang
茯苓 Fuling (poria) 4 liang
生薑 Sheng Jiang (fresh ginger rhizome) 5 liang
乾蘇葉 Gan Suye (dried perilla leaf) 2 liang

JGYL 22.5
婦人咽中如有炙臠，半夏厚朴湯主之。
When a woman feels as if there were a piece of broiled meat [lodged] in her throat: Banxia Houpo Tang governs.

Notes:
Recommended in the “Women’s Miscellaneous Diseases” chapter of the Jingui for the phenomenon that would later become known as 梅核氣 meihe qi “Plumpit Qi”— globus hystericus in Western psychological terms—this formula treats cases of phlegm-rheum with emotional disturbance. On Plumpit Qi, Wu Jian writes: “This disorder derives from the knotting of Qi and the condensing of the liquids by the seven emotions.” (Rossi, Shen, 155)

Banxia Houpo Tang relaxes esophageal constriction by rectifying water metabolism. It reaches up to throat to relieve Qi constraint (via Suye); warms and transforms phlegm-rheum and cold water (Banxia, Houpo, and Sheng Jiang); descends through the Yangming (Houpo and Banxia); and percolates downward and outward (Fuling).

甘草瀉心湯
Gancao Xiexin Tang
Licorice Root Decoction to Drain [the Region Below] the Heart

甘草 Gancao (licorice root) 4 liang
黃苓 Huangqin (scutellaria root) 3 liang
人參 Renshen (ginseng root) 3 liang
乾薑 Gan Jiang (dried ginger rhizome) 3 liang
黃蓮 Huanglian (coptis rhizome) 1 liang
大棗 Dazao (jujube fruit) 12 pieces
半夏 Banxia (pinellia rhizome) ½ sheng

SHL 158
其人下利日數十行，穀不化，腹中雷鳴，心下痞硬而滿，乾嘔，心煩不得安。
…The patient has diarrhea more than ten times a day. Food is not transformed, [leading to] thunderous rumbling in the abdomen; a hard pi-glomus and fullness below the heart; dry heaves; and Heart-vexation that cannot be pacified.

*This formula is also found in JGYL 3.10. Note that the Shanghan lun passage does not include Renshen in its list of ingredients, while the Jingui line does include the herb.

Notes:
This formula is a slight variation of Banxia Xiexin Tang, with an emphasis on mental-emotional urgency—thus the need for additional Heart- and Spleen-soothing licorice. The Banxia Xiexin Tang presentation features a mixture of excess and deficiency, heat and cold.

Banxia and Gan Jiang transform the cold phlegm-rheum creating the obstruction at the center of the system (the region xinxia “below the Heart”). Huangqin and Huanglian cool and drain heat accumulating in the upper digestive tract, while the remaining three herbs treat the root of Spleen deficiency.

In Closing, A Note on Minerals

Above, we have seen the medicinals Longgu (fossilized mammal bone), Muli (oyster shell), Qiandan (lead), Huashi (talcum), and Daizheshe (hematite) used as components of panic-relieving formulas. Minerals possess an extraordinary ability to descend—a capacity which we can recruit in cases of upward-surging panic. These heavy substances help to return the spirit, to anchor and calm. They also typically clear heat. The representative classical mineral formula might be Fengyin Tang, which consists of eight stone medicinals, for cases of epilepsy due to heat (see JGYL 5.3).

Daoist priest and Chinese medicine teacher Jeffrey Yuen sees stones as treating the Jing- or Yuan-level of the person, helping them to make contact with their “curriculum”—her purpose in this lifetime. Stones are living events, evolving beings. Possessing a lifetime far longer than that of the human being, they assist us in tapping into our deeper, more enduring patterns.

Over the centuries, minerals have largely been phased out of our Chinese herbal formulas, often with good reason—many, like lead and cinnabar, are toxic. It might behoove us, however, to explore creative ways of incorporating such medicinals. Leslie Franks’s text Stone Medicine, which catalogues the internal and external applications of minerals, is an important step in this direction.

Even if we exclude certain toxic minerals from our formula prescriptions, we can still apply those very substances via non-ingestive methods—for example, by taping them to channels; having patients wear them as pendants; or scraping them on the skin, a la guasha. Alternatively, we can share their charge with quartz crystals (which are known as “enhancers”), and then use those quartz crystals in elixirs or on the body. The quartz serves as a mediator, so that the patient is receiving the therapeutic effect of the medicinal stone without engaging it directly. In this way, we can “complete” our formulas—like, say, Chaihu jia Longgu Muli, which originally included lead—while ensuring the safety of the patient.