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SUAN ZAO REN TANG (SOUR JUJUBE DECOCTION)
TRADITIONAL USE, PHARMACOLOGICAL EFFECTS AND CLINICAL RESEARCH

By John Chen, L.Ac., O.M.D., Pharm.D., Ph.D.

Pinyin Name: Suan Zao Ren Tang
Literal Name: Sour Jujube Decoction
Alternate Names: Suan Zao Tang, Zizyphus Combination
Original Source: Jin Gui Yao Lue (Essentials from the Golden Cabinet) by Zhang Zhong-Jing
in the Eastern Han Dynasty

COMPOSITION

DOSAGE / PREPARATION / ADMINISTRATION

The source text states to first dry-fry Suan Zao Ren (Semen Ziziphi Spinosae), crack the seeds open, and then cook them with 8 cups [1,600 mL] of water until only 6 cups [1,200 mL] of the liquid remain. Add the other ingredients and cook until the liquid is further reduced to 3 cups [600 mL]. Take the warm, strained decoction in three equally-divided doses.

CHINESE THERAPEUTIC ACTIONS

• Nourishes the blood and calms the shen (spirit)
• Clears heat and relieves irritability

CLINICAL MANIFESTATIONS

Liver blood deficiency with deficiency heat rising: irritability, insomnia, palpitations, night sweating, dizziness, vertigo, dry mouth and throat, and a fine, wiry pulse.

CLINICAL APPLICATIONS

Insomnia, nocturnal emissions, somnolence, neurasthenia, menopausal syndrome, and excessive worrying.

EXPLANATION

Suan Zao Ren Tang (Sour Jujube Decoction) treats insomnia characterized by Liver blood deficiency with deficiency heat rising, caused by over-exertion or chronic consumption. Palpitations and dry mouth and throat are due to blood deficiency and lack of adequate nourishment to the Heart. Patients with this syndrome may have yin deficiency and deficiency heat, which can cause irritability, insomnia, palpitations, and night sweats. Liver blood deficiency may contribute to hyperactivity of Liver yang, leading to dizziness and vertigo.

Suan Zao Ren (Semen Ziziphi Spinosae), the chief herb of this formula, nourishes Liver blood and calms Heart shen (spirit). Chuan Xiong (Rhizoma Chuanxiong) regulates Liver blood. Fu Ling (Poria) tranquilizes the mind and calms the shen. Zhi Mu (Rhizoma Anemarrhenae) nourishes yin and clears deficiency heat. Gan Cao (Radix et Rhizoma Glycyrrhizae) clears heat and harmonizes the herbs in this formula.

MODIFICATIONS

• If there is qi deficiency, add Ren Shen (Radix et Rhizoma Ginseng) and Huang Qi (Radix Astragali Membranacei).
• With night sweats, add Ma Huang Gen (Radix et Rhizoma Ephedrae) and Wu Wei Zi (Fructus Schisandrae Chinensis).
• With severe night sweats, add Mu Li (Concha Ostreae) and Fu Xiao Mai (Fructus Tritici Levis).
• With irritability, thirst, and insomnia, add Mai Dong (Tuber Ophiopogonis Japonici) and Wu Wei Zi (Fructus Schisandrae Chinensis).
• With irritability, restlessness, and insomnia, add Wen Dan Tang (Warm the Gallbladder Decoction).
• For insomnia due to blood deficiency, add Dang Gui (Radix Angelicae Sinensis), Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae), and He Shou Wu (Radix Polygoni Multiflori).
• For insomnia due to heat, add Mu Dan Pi (Cortex Moutan Radicis), Zhi Zi (Fructus Gardeniae Jasminoidis), and Dan Zhu Ye (Herba Lophatheri).
• With fright and palpitations, add Yuan Zhi (Radix Polygalae Tenuifoliae) and Shi Chang Pu (Rhizoma Acori Graminei).
• With excessive thinking and insomnia, add Yi Gan San (Restrain the Liver Powder).
• With palpitations and excessive dreams, or waking up at night from nightmares due to Heart and Gallbladder deficiencies, add Dang Shen (Radix Codonopsis) and Long Chi (Dens Draconis).
• With deficiency fire flaring, remove Chuan Xiong (Rhizoma Chuanxiong) and add Bai Shao (Radix Paeoniae Alba), Di Huang (Radix Rehmanniae), and Huang Lian (Rhizoma Coptidis).

PHARMACOLOGICAL EFFECTS

• Central nervous system: Administration of Suan Zao Ren Tang was associated with marked sedative and hypnotic effects. According to various experiments in mice, rats, guinea pigs, rabbits, dogs, and humans, administration of the formula decreased spontaneous physical activities, inhibited caffeine-induced stimulation, and potentiated the effects of sedative and hypnotic drugs. (i)

CLINICAL STUDIES AND RESEARCH

1. Insomnia: Use of modified Suan Zao Ren Tang was associated with 91.7% effectiveness in treating insomnia. Modifications were made by adding Long Dan (Radix et Rhizoma Gentianae) and Chai Hu (Radix Bupleuri) for restlessness, irritability, anger, red eyes, a bitter taste in the mouth, red tongue, yellow tongue coating, and a wiry, rapid pulse; Tao Ren (Semen Persicae), Hong Hua (Flos Carthami), and Shou Wu Teng (Caulis Polygoni Multiflori) for blood stagnation; E Jiao (Colla Corii Asini), Huang Bo (Cortex Phellodendri Chinensis), and Bie Jia (Carapax Trionycis) for yin-deficient heat; Dang Shen (Radix Codonopsis), Huang Qi (Radix Astragali), and He Huan Pi (Cortex Albiziae) for qi and blood deficiencies; Huang Qi (Radix Astragali) and Yuan Zhi (Radix Polygalae) for Heart qi deficiency; and Dan Nan Xing (Arisaema cum Bile) and Zhu Li (Succus Bambusae) for profuse sputum. The herbs were given 30 minutes before bedtime. Of 72 patients, the study reported recovery in 47 cases, significant improvement in 12 cases, moderate improvement in 7 cases, and no effect in 6 cases. (ii) In another study, 20 out of 31 patients (64.5%) reported improvement following ingestion of 2.5g of an extract preparation of Suan Zao Ren Tang. Improvement was defined as shorter time needed to fall asleep, better quality of sleep, and better energy during the following day. (iii)


2. Nocturnal emissions: Modified Suan Zao Ren Tang was effective in treating 28 patients with nocturnal emissions. The modifications included the addition of Huang Bo (Cortex Phellodendri Chinensis) and others as deemed necessary. The duration of treatment ranged from 10 to 30 days. The overall effectiveness was 78.6%.(iv)

RELATED FORMULA

Ding Zhi Wan (Settle the Emotions Pill)

Pinyin Name: Ding Zhi Wan
Literal Name: Settle the Emotions Pill
Original Source: Za Bing Yuan Liu Xi Zhu (Wondrous Lantern for Peering into Origin and Development of Miscellaneous Diseases) by Shen Jin-Ao in 1773

Note: Zhu Sha (Cinnabaris) is a potentially toxic heavy metal, and is rarely used as a medicinal substance today.  Its discussion here is included primarily for academic purposes, to reflect the historical use of this substance in its original formulation.  Most herbal products today have removed it completely, or replaced it with substitutes with similar functions. For additional information on the toxicity, please refer to Chinese Medical Herbology and Pharmacology by John Chen and Tina Chen.

The source text states to grind all of the ingredients and only 15g of Zhu Sha (Cinnabaris) into powder and form into pills with honey. Use the other 15g of Zhu Sha (Cinnabaris) to coat the pills. Take 6g of pills with warm, boiled water, before bedtime.

The main actions of Ding Zhi Wan (Settle the Emotions Pill) are to tonify Heart qi, benefit cognitive functions, calm the shen (spirit), and ease fear and fright. It is generally indicated for individuals who have fear and fright, yet become easily angered, and have insomnia.

Suan Zao Ren Tang and Ding Zhi Wan (Settle the Emotions Pill) have functions to nourish and calm the shen (spirit).

Suan Zao Ren Tang treats insomnia caused by blood deficiency and the inability of blood to nourish the Heart. The primary functions of the formula are to nourish the blood, clear heat, and calm the shen.

Ding Zhi Wan treats insomnia with fear and fright caused by Heart qi deficiency. The main actions of the formula are to tonify Heart qi and calm the shen.

AUTHORS’ COMMENTS

• Suan Zao Ren Tang is one of the most commonly used formulas for treating insomnia. It is most effective for insomnia due to deficiency, irritability, and consumption, with such key signs and symptoms as irritability, palpitations, dry mouth and throat, and a fine, wiry pulse.


• Proper processing of Suan Zao Ren (Semen Ziziphi Spinosae) is extremely important, as it will determine the overall effectiveness of this formula. According to the source text, Suan Zao Ren (Semen Ziziphi Spinosae) must be dry-fried first, then the seeds should be crushed open before placing them in water for cooking. Dry-frying the seeds enhances the effects of tonifying Liver blood and treating insomnia; crushing them maximizes extraction of the active ingredients.


• Suan Zao Ren Tang, Tian Wang Bu Xin Dan (Emperor of Heaven's Special Pill to Tonify the Heart), and Gan Mai Da Zao Tang (Licorice, Wheat, and Jujube Decoction) all treat insomnia, palpitations, and anxiety caused by lack of nourishment to the Heart and leading to shen (spirit) disturbance.


• Suan Zao Ren Tang is best for nourishing Liver blood and clearing deficiency heat. Chief manifestations include irritability, restlessness, vertigo, night sweats, and dry mouth and throat.


• Tian Wang Bu Xin Dan is better for nourishing yin and blood caused by Kidney and Heart deficiencies. Chief manifestations include anxiety, decreased sleep, palpitations, and a withered shen.


• Gan Mai Da Zao Tang harmonizes the middle jiao, relieves pain, and treats yin deficiency of the zang organs with Liver qi stagnation and Heart deficiency. Chief manifestations include frequent crying urges, emotional mood swings, and absentmindedness.

REFERENCES
(i) Zhong Yi Fang Ji Xian Dai Yan Jiu (Modern Study of Medical Formulae in Traditional Chinese Medicine) 1997;849-850.
(ii) He Nan Zhong Yi (Henan Chinese Medicine) 1999;6:9.
(iii) Shan Dong Yi Kan (Shandong Medical Journal) 1965;27.
(iv) Shi Yong Zhong Xi Yi Jie He Za Zhi (Practical Journal of Integrated Chinese and Western Medicines) 1991;12:729.

ABOUT THE AUTHOR

John K. Chen, L.Ac., Pharm.D., O.M.D., Ph.D.

Dr. John Chen is a recognized authority in both western pharmacology and Chinese Herbal Medicine.  He teaches at the USC School of Pharmacy, Emperor’s College, Yo San University of TCM, OCOM, Five Branches, AOMA and ACTCM. Dr. Chen’s most recent published work is Chinese Medical Herbology and Pharmacology (2003, AOM Press) and Chinese Herbal Formulas and Applications (2008, AOM Press) for which he was lead author.

This article was taken out of Dr. Chen’s upcoming book Chinese Herbal Formulas and Applications.
To pre-order a copy, click here.

To learn more about herbs, John Chen is speaking on the following topic for Lotus Institute. This class is approved for 8 CEUs/PDAs by the California Acupuncture Board and NCCAOM.

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