1. New Interpretation of the Formula
The Dang Gui Shao Yao San (当归芍药散, Dang Gui and Peony Powder) consists of Dang Gui (当归, Angelica Sinensis), Shao Yao (芍药, Peony), Fu Ling (茯苓, Poria), Zei Xia (泽泻, Alisma), Chuan Xiong (川芎, Ligusticum), and Bai Zhu (白术, Atractylodes). This formula can be divided into two groups: the first group includes Dang Gui, Shao Yao, and Chuan Xiong, which are blood-regulating herbs that harmonize the blood and soothe the liver; the second group includes Fu Ling, Bai Zhu, and Zei Xia, which are qi-regulating herbs that strengthen the spleen and promote fluid metabolism.
The entire formula works to nourish and invigorate the blood, strengthen the spleen, and promote fluid metabolism. It is widely used in clinical practice and is considered an excellent formula in gynecology. The “Wan Dai Tang” (完带汤, Perfectly Stabilizing Decoction) developed by the gynecology master Fu Qingzhu is said to be derived from this formula, specializing in strengthening the spleen and draining dampness, and is also an effective remedy for leucorrhea.
This formula originates from the “Essentials of the Golden Coffer” in the section on “Women’s Pregnancy Diseases and Pulse Patterns,” which states: “For women who are pregnant and experience abdominal pain, Dang Gui Shao Yao San is the main treatment. For various abdominal diseases in women, Dang Gui Shao Yao San is the main treatment.” The former refers to abdominal pain during pregnancy, while the latter refers to various abdominal diseases in women, both treated with Dang Gui Shao Yao San.
According to Lu Yuanlei in the “Modern Interpretation of the Essentials of the Golden Coffer,” many references indicate that this formula treats abdominal cramping during pregnancy, urgent fullness in the chest, postpartum blood loss, internal deficiency with qi deficiency, prolonged bleeding, and regular use promotes smooth blood circulation, prevents abscesses, resolves phlegm, nourishes the stomach, and benefits fluids.
The “Qingzhou Medical Talks” states that it is also good for maintaining pregnancy during pregnancy.
The “Classified Formulas” states that it treats abdominal pain and urinary difficulties postpartum. This formula can be used to confirm pregnancy, as well as for fetal growth issues and abdominal tension. It is also said to treat red and painful eyes, with patients experiencing fluid retention in the chest, and can treat anal prolapse and swelling with persistent discharge. The “Tang Ben Qiu Zhen” believes that this formula is effective for spasms of the stomach and uterus in women. Lu cites detailed references, which will not be elaborated here.
The author has also frequently used this formula to treat gynecological diseases. Based on the insights from the “Essentials of the Golden Coffer” regarding abdominal pain in women, any abdominal pain in women such as tubal swelling, pelvic inflammation, cystitis, cervicitis, and uterine fibroids can be treated with Dang Gui Shao Yao San.
For leucorrhea, many people use Wan Dai Tang, which is indeed effective. However, upon closer analysis, Wan Dai Tang primarily strengthens the spleen and drains dampness, making its action more singular compared to this formula.
Using Dang Gui Shao Yao San to treat leucorrhea, along with Bi Xie (萆薢, Dioscorea), Qian Shi (芡实, Euryale), not only harmonizes the blood and softens the liver but also strengthens the spleen and promotes fluid metabolism, making it more effective than Wan Dai Tang. Additionally, one can appropriately add herbs such as Bai Tou Weng (白头翁, Pulsatilla), Ye Ju Hua (野菊花, Wild Chrysanthemum), Pu Gong Ying (蒲公英, Dandelion), and Huang Bai (黄柏, Phellodendron) to clear heat, detoxify, and promote urination, enhancing the efficacy.
Because Dang Gui Shao Yao San has the effects of nourishing and invigorating the blood, strengthening the spleen, and promoting fluid metabolism, later generations believe that this formula is indeed the prototype of Xiao Yao San (逍遥散, Free and Easy Wanderer Powder), which is quite reasonable.
2. Examples of Application
1. Treating Endometritis
Endometritis is a common gynecological disease. Its prominent symptoms include excessive leucorrhea, lower back pain, and abdominal pain. Clinical differentiation of cold and heat, as well as deficiency and excess, is necessary for effective treatment; one cannot simply use anti-inflammatory treatments. Using Dang Gui Shao Yao San with heat-clearing and detoxifying herbs, along with external washing herbs, can achieve the desired therapeutic effect.
Patient Li, female, 42 years old, engineer, visited on November 10, 1982.
Diagnosis: Endometritis. Symptoms: Excessive and thick leucorrhea with foul odor, lower back pain, pain on both sides of the lower abdomen, bleeding during intercourse, pulse wiry and full, tongue pale with white and moist coating.
Prescription: Dang Gui 10g, Chi Shao 10g, Bai Zhu 20g, Fu Ling 12g, Zei Xia 10g, Chuan Xiong 6g, Zi Hua Di Ding 10g, Yin Hua 15g, Bi Xie 10g, Huang Bai 10g, Xiang Fu 10g. Take 15 doses. One dose per day, decocted and taken in two portions.
Second visit (December 12, 1982): After taking the previous formula, leucorrhea decreased, lower back pain reduced, and bleeding during intercourse was minimal; pulse and tongue were normal. Continued with Sheng Qi Bai Yuan Tang (参芪保元汤, Ginseng and Astragalus Decoction) with modifications for internal use, and supplemented with Yin Hua, Zi Hua Di Ding, Pu Gong Ying, Shi Da Gong Lao, and Ye Ju Hua in equal parts for external washing, once daily. After 10 days of treatment, the patient was clinically cured. Six months later, the patient returned for urticaria and reported that the previous symptoms had never recurred, and everything was normal.
Note: Endometrial hyperplasia and chronic cervicitis, which manifest as excessive leucorrhea and lower back pain, are all symptoms of damp-heat accumulation, leading to qi stagnation and blood stasis. Therefore, using Dang Gui Shao Yao San to invigorate blood and promote fluid metabolism, and drain damp-heat is appropriate. The use of Fu Ling in combination with Yin Hua, Zi Hua Di Ding, and Huang Bai specifically targets heat-clearing and detoxifying, which is essentially anti-inflammatory. Especially when combined with external washing, direct local application can be effective for excessive leucorrhea, vaginal moisture, and itching.
2. Treating Pelvic Inflammation
Pelvic inflammation has a high incidence among married women. The pathogenesis is often due to stagnation of qi, blood, and water, leading to qi stagnation, blood stasis, and damp accumulation. Using methods to harmonize qi and blood, promote fluid metabolism, and eliminate stasis is effective.
Patient Chen, female, 45 years old, cadre, visited on October 2, 1978. The patient had an inflammatory mass in the left abdominal cavity, which disappeared after treatment. Current symptoms include pain in the left pelvic area, severe pain during bowel movements, lower back pain, excessive leucorrhea with occasional blood-stained discharge, pulse wiry and full, tongue slightly red with little coating, normal appetite. Uterine scraping ruled out malignancy.
Plan: Use methods to harmonize blood, promote qi, and strengthen the spleen and promote fluid metabolism. The modified Dang Gui Shao Yao San:
Dang Gui 10g, Bai Shao 10g, Fu Ling 15g, Bai Zhu 10g, Zei Xia 10g, Chuan Xiong 5g, Yi Mu Cao 30g, Xu Duan 10g, Xiang Fu 10g, Sheng Yi Mi 15g, Bi Xie 10g, Huang Bai 10g. Instruct to take 7 doses, one dose per day, decocted and taken in two portions.
Second visit (October 10): After taking the previous formula, leucorrhea significantly decreased, blood-stained discharge disappeared, but lower back pain and pain near the uterus persisted, with no other abnormalities. Pulse and tongue were normal. Plan to continue with the previous formula with modifications:
Dang Gui 10g, Chi Shao 10g, Fu Ling 15g, Bai Zhu 10g, Zei Xia 10g, Chuan Xiong 5g, Yan Hu Suo 10g, Niuxi 10g, Xiang Fu 10g, Qin Jiao 10g, Du Huo 10g, Ji Sheng 20g, Xu Duan 10g, Dao Dou Ke 30g. Instruct to take 10 doses, one dose per day, decocted and taken in two portions.
After taking the medicine, leucorrhea decreased, and symptoms such as lower back pain disappeared, with follow-up showing no recurrence.
Note: The “Essentials of the Golden Coffer” states: “For various abdominal diseases in women, Dang Gui Shao Yao San is the main treatment.” Using this as a guide for treating pelvic inflammation aligns with its fundamental principles. The term “various diseases and pains” actually includes pelvic inflammation, especially in married women, as qi and blood stagnation often leads to abdominal pain due to pelvic inflammation, which is frequently seen in clinical practice. Using Dang Gui Shao Yao San as a basic formula, along with qi-invigorating and blood-invigorating herbs, damp-draining and fluid-promoting herbs, and nourishing liver and kidney herbs, can yield satisfactory results.
However, it must be noted that due to the ease of treatment and effectiveness, this condition can easily recur. Therefore, during the treatment process, after achieving clinical cure, necessary consolidation treatment is required, and it is essential to continue taking the medicine for a period of time.
3. Treating Uterine Fibroids
The formation of uterine fibroids, according to TCM theory, is primarily due to qi stagnation and blood stasis. Due to qi stagnation and blood stasis, it accumulates into a disease, resulting in the formation of tangible masses and irregular menstrual bleeding. The use of Gui Zhi Fu Ling Wan (桂枝茯苓丸, Cinnamon and Poria Pill) is a common method, but using Dang Gui Shao Yao San is also an important approach.
Patient Liu, female, 34 years old, worker, visited on December 10, 1994. The patient reported irregular menstruation for six months, with prolonged and heavy bleeding each time. She was fatigued and sought gynecological treatment. B-ultrasound confirmed uterine subserosal fibroids, with a fibroid the size of a quail egg at the lower part of the uterus. Routine gynecological examination showed no abnormalities.
The patient felt lower abdominal pain and distension, with menstruation coming earlier and lasting longer, sometimes up to half a month, with the first menstruation extending only a week before the second. The menstrual blood was light, with excessive leucorrhea, lower back pain, moderate appetite, and normal bowel movements. Pulse was wiry and weak, tongue pale and moist with thin white coating. Plan to use modified Dang Gui Shao Yao San:
Dang Gui 10g, Bai Shao 15g, Fu Ling 15g, Bai Zhu 10g, Zei Xia 10g, Chuan Xiong 6g, Sheng Huang Qi 20g, Yi Mu Cao 20g, Sheng Mu Li 15g, Sheng Chao Pu Huang 6g, Xiang Fu 10g. One dose per day, decocted and taken in two portions.
After taking the above formula for 5 doses, the duration of menstruation shortened, blood volume concentrated, and lower abdominal pain significantly reduced, with improved energy and a pulse that was slow and strong, tongue pale red.
After taking the above formula for over 30 doses, B-ultrasound re-examination showed that the fibroid had significantly shrunk, with a small mass the size of a little finger at the fundus of the uterus. Menstruation became basically normal, with concentrated blood volume for three to four days, and reduced volume. After improvement in energy and appetite, the patient continued with Sheng Qi Si Wu Tang (参芪四物, Ginseng and Astragalus Four Substance Decoction) with additions of Sheng Mu Li, Xiang Fu, Zhe Bei, Zei Xia, and Yi Mu Cao to consolidate the effect.
Six months later, follow-up showed stable condition, normal menstruation, and the medication was stopped for observation.
Note: Using Dang Gui Shao Yao San to treat uterine fibroids also aligns with the principle of invigorating blood and resolving stasis. Adding appropriate softening and resolving masses herbs can achieve certain therapeutic effects. As for softening and resolving masses herbs, options include San Leng (三棱, Sparganium), E Zhu (莪术, Curcuma), Mu Li (牡蛎, Oyster), and Bei Mu (贝母, Fritillaria). Clinically, it is still based on practical considerations; if there is prolonged blood loss, “gentle attack” is preferable to “strong attack,” and the selection of herbs should be moderate and harmonious, aligning with the overall condition.
4. Treating Tubal Swelling
Tubal swelling is often due to qi stagnation and blood stasis, which can lead to obstruction. Bilateral or unilateral tubal swelling and pain can be palpated in the lower abdomen, with tenderness upon palpation, and may be accompanied by lower back pain or increased leucorrhea. Treatment with Dang Gui Shao Yao San can promote qi, invigorate blood, and resolve stasis, achieving ideal therapeutic effects.
Patient Zhang, female, 38 years old, worker, visited on April 10, 1988. The patient reported lower abdominal pain and distension, with significant pain in the left tubal area, where a cord-like mass could be felt, and pressing it increased the pain, which could radiate to the lower abdomen and vagina, with slightly increased leucorrhea and lower back distension. Sexual intercourse exacerbated the lower abdominal pain. The patient appeared somewhat fatigued, with normal bowel and urinary habits, and normal appetite. Tongue was pale and moist, pulse was slow and strong.
Prescription: Modified Dang Gui Shao Yao San: Dang Gui 10g, Chi Shao 10g, Fu Ling 15g, Bai Zhu 10g, Zei Xia 10g, Chuan Xiong 5g, Xiang Fu 10g, Tai Wu 10g, Yu Jin 10g, Sheng Xiao Hui 6g, Yi Mu Cao 15g. One dose per day, decocted and taken in two portions, instructed to take 10 doses.
One month later, the patient reported that after taking the previous formula, her symptoms had improved, with pain basically disappearing, and the cord-like mass in the lower abdomen had also dissipated, feeling soft and painless upon palpation.
Note: Using Dang Gui Shao Yao San to treat tubal swelling works by invigorating blood, promoting fluid metabolism, and resolving stasis. The herbs used are also generally mild. This method has been used in many cases, achieving good clinical results.
The author believes that the use of Dang Gui Shao Yao San to treat various abdominal pains in women is undoubtedly effective, and large sample clinical observations should be conducted to develop effective methods for treating various gynecological diseases, which are worth summarizing and promoting.
This article is excerpted from “Jiangxi Traditional Chinese Medicine”, Volume 29, Issue 4, 1998, Author: Chen Ruichun