『Most Popular TCM Public Account』
The Most Popular TCM Public Account』
Dedicated to the growth and inheritance of Traditional Chinese Medicine, especially folk TCM
Accompanying TCM practitioners in their growth every day
Issue 703
Author: Tong Xiaolin
Guang’anmen Hospital, China Academy of Chinese Medical Sciences
Editor / Zhao Xin ⊙ Proofreader / Duan Rui
Long TCM Novel“The Unmatched Ice of TCM” Part One: “The Ancient Tomb of Taibai” (Click to read automatically) can be viewed in historical articles.Follow Qihuang Folk Inheritance (Public Account: qhmjcc) for healthy and happy reading.
●Rehmannia glutinosa (Shu Di Huang) primarily nourishes Yin and replenishes blood, effectively supplementing true Yin, and can treat various deficiencies and conditions of Yin and Yang deficiency. According to Zhang Jingyue, it can be applied to external pathogenic conditions, vomiting, diarrhea, dysentery, water retention, phlegm, swelling, and nausea.
●Modern practitioners are hesitant to use large doses of Rehmannia glutinosa, fearing its cloying nature may obstruct the stomach. However, it is crucial for critical conditions to use large doses to ensure sufficient Yin blood, allowing Yang Qi to stabilize and prevent collapse. As long as it is appropriate for the condition, it can be used boldly, starting with small doses and gradually increasing, typically ranging from 30 grams to as much as 90 or 120 grams.
Application Summary
Rehmannia glutinosa is most suitable for greatly nourishing true Yin. Zhang Jingyue effectively used Rehmannia glutinosa to treat various diseases, whether due to external pathogens, internal injuries, cold-heat, or deficiency-excess conditions, significantly expanding its application range. For instance, the formulas Zuo Gui Wan (Left Return Pill) and You Gui Wan (Right Return Pill) treat insufficiencies of true Yin and true Yang of the kidneys; Jin Shui Liu Jun Decoction nourishes the kidneys and strengthens the spleen to resolve phlegm for lung and kidney insufficiency; San Qi Decoction treats rheumatic arthralgia; Ji Chuan Decoction addresses elderly constipation due to deficiency; Gu Yin Decoction treats Yin deficiency with diarrhea; Wei Guan Decoction addresses long-term diarrhea due to spleen and kidney deficiency; Hua Yin Decoction treats urinary retention and turbid urination; Wu Wu Decoction or Jue Jin Decoction treats women’s blood disorders; Tai Yuan Decoction addresses fetal restlessness in women; Zan Yu Dan treats male impotence and infertility; Liu Wu Decoction treats children’s chickenpox; Li Yin Decoction and Da Wen Zhong Decoction treat true Yin deficiency with external wind-cold; Liu Wei Hui Yang Decoction addresses impending collapse of Yuan Yang; and Dang Gui Ji Li Decoction treats surgical sores and toxic conditions.
However, regarding the application of Rehmannia glutinosa, especially in treating phlegm and cold diarrhea, many practitioners have raised objections, pointing out that its cloying nature may obstruct the spleen, making it unsuitable for those with phlegm-damp conditions. As stated in “Ben Cao Meng Quan”: “In blood tonics, none surpass Rehmannia and Angelica. If taken excessively, its nature becomes obstructive, and it may deplete stomach Qi.” “Ben Cao Shu Gou Yuan” quotes Miao Zhongchun, stating: “For those with excessive phlegm in the chest and obstructed Qi pathways, Rehmannia should be avoided in decoctions.” Clinically, many practitioners are influenced by this and are cautious in using Rehmannia.
Regarding the “cloying” and “obstructing Qi leading to phlegm” nature of Rehmannia glutinosa, Zhang Jingyue believes, “The spleen governs dampness; when dampness moves, phlegm is produced. The transformation of phlegm is dependent on the spleen, while the root of phlegm lies in the kidneys. Therefore, to treat phlegm, one must address its root, and phlegm can be cleared.” Thus, Zhang Jingyue’s Jin Shui Liu Jun Decoction primarily uses Rehmannia glutinosa to nourish kidney Yin, addressing the root of phlegm, combined with Er Chen Decoction to strengthen the spleen and resolve phlegm.
Qing Dynasty physician Chen Shiduo also corrected this viewpoint, providing relevant discussions: “Some say Rehmannia is a medicine of extreme Yin, but its nature is very obstructive. Excessive use may lead to phlegm and wheezing, which can be dangerous. This reflects a misunderstanding of the power of Rehmannia… Phlegm varies by organ. Phlegm from the spleen and lungs may be exacerbated by Rehmannia, making it seem unsuitable. However, if phlegm arises from the heart, liver, or kidneys, how can one exclude Rehmannia to resolve it?” Renowned Qing physician Wang Xugao explicitly stated that Rehmannia can eliminate deficiency phlegm: “Deficiency refers to the inherent weakness of the lungs and kidneys, where the ability to descend and absorb is compromised, and the spleen and stomach Qi is weak, unable to transform the essence of food, leading to phlegm and fluid accumulation… Rehmannia is most effective in eliminating deficiency phlegm, as it can replenish kidney Qi and transform formless phlegm.” For chronic phlegm and wheezing with kidney deficiency, regardless of whether phlegm-damp is present, even with “yellow and turbid tongue coating that does not transform,” Rehmannia is not to be avoided, and large doses are recommended, as it is believed that “the deficiency of liver and kidneys is significant, and the focus should be on absorption,” advising future practitioners not to fear its cloying nature.
Thus, Rehmannia glutinosa not only nourishes Yin and replenishes blood but also stabilizes Qi and eliminates deficiency phlegm. Zhang Jingyue’s Zhen Yuan Decoction uses Rehmannia as the main herb to greatly replenish kidney Yuan Qi, treating symptoms of “shortness of breath resembling wheezing, rapid breathing, inability to rise, inability to swallow, obstructed Qi pathways, and imminent danger,” while Jin Shui Liu Jun Decoction pioneered the approach of nourishing the kidneys, transforming phlegm, and treating conditions of excess above and deficiency below.
Is Rehmannia glutinosa really cloying? It has a thick taste and sticky texture, which can obstruct the stomach and promote dampness, but this should not be generalized. Even ancient texts refer to this in specific situations such as stomach deficiency or excessive phlegm. Mr. Zhang Chengming from Nanjing University of Chinese Medicine believes that for those with excessive dampness in the spleen and stomach, Rehmannia glutinosa can indeed stagnate Qi and hinder movement, exacerbating abdominal distension and loss of appetite. However, for those with phlegm turbidity in the lungs and normal spleen and stomach function, this issue does not arise. Regarding “deficiency phlegm,” it is only Rehmannia that can eliminate it. Furthermore, in clinical practice for patients with mixed deficiency and excess phlegm and wheezing, it is common to simultaneously nourish the kidneys and transform phlegm, and thus the adverse effects of Rehmannia obstructing the stomach and promoting dampness are not observed.
The author believes that Rehmannia glutinosa primarily nourishes Yin and replenishes blood, effectively supplementing true Yin in the body, and can treat various deficiencies and conditions of both Yin and Yang deficiency. According to Zhang Jingyue, it can be used for external pathogenic conditions, vomiting, diarrhea, dysentery, water retention, phlegm, swelling, and nausea. Conditions such as Qi stagnation, phlegm-damp water overflow, spleen deficiency leading to diarrhea, and external pathogens binding the surface are not contraindicated; as long as appropriate combinations are made, the disadvantages can be transformed into benefits.
Theoretical Basis for Heavy Use
Zhang Jingyue is regarded as the foremost expert in the use of Rehmannia glutinosa. He advocated for its use based on the principle of maintaining the body’s true Yin and true Yang, emphasizing that “Yang is not in excess, but Yin is fundamentally insufficient,” and stressed that “Yang deficiency leads to cold; it should be supplemented and warmed; Yin deficiency has heat; it should be supplemented and cleared.” Zhang Jingyue also famously stated, “Those who are good at supplementing Yang must seek Yang within Yin, so that Yang receives assistance from Yin, leading to boundless transformation.” Rehmannia glutinosa, with its “thick flavor and thin Qi,” and “Yin containing Yang,” can replenish the true Yin of the five organs and replenish the Yuan Qi in the kidneys. Due to its Yin nature, he advocated that “without sufficient quantity, it is difficult to achieve efficacy.” Zhang Jingyue frequently used Rehmannia glutinosa in both warming Yang and benefiting Yin, whether using it to replenish deficiency to treat form or seeking Yang within Yin.
In modern times, practitioners like Qiu Peiran have effectively used Rehmannia glutinosa to treat various difficult and complicated diseases. Qiu Peiran believes that the pathogenesis of difficult diseases is often complex, and in many cases, there is a weakness of righteous Qi or a mixture of deficiency and excess. Therefore, strengthening righteous Qi is an important treatment principle. Rehmannia glutinosa can rescue Yin and replenish essence and blood, making it a key herb for treating all conditions of essence and blood deficiency. Thus, in treating difficult diseases, Mr. Qiu does not forget to support the root and often adds Rehmannia glutinosa to formulas to strengthen the root while expelling evil, achieving good results in difficult diseases.
Dosage and Precautions
Those who are skilled in using Rehmannia glutinosa and understand its application often advocate for heavy use. Zhang Jingyue commonly used Rehmannia glutinosa in doses of one to two taels or even two to three taels, such as in Zuo Gui Wan for nourishing Yin and replenishing the kidneys, where the dosage of Rehmannia glutinosa is 1-2 taels; in You Gui Wan for warming and supplementing kidney Yang, the dosage is also 1-2 taels; and in the formula Liang Yi Gao for greatly replenishing Qi and blood, the dosage can reach one pound.
Qing Dynasty physician Chen Shiduo discussed in “Ben Cao Xin Bian” that Rehmannia glutinosa should be used in large doses: “Some ask whether Rehmannia should be used in large doses for efficacy or in small doses for effect? Rehmannia should be used more rather than less. However, it must be used appropriately; even if used in large doses, it may not be excessive; if used improperly, even a small amount may not be effective. When used for severe kidney water depletion, large doses may still feel insufficient; when used for significant spleen earth collapse, small doses may feel excessive; when used for kidney fire boiling diseases, using more may still feel inadequate; when used for stomach earth distension, using less may feel excessive. It all depends on appropriate use; the quantity does not need to be counted.” “Rehmannia is a monarch herb, and can be used from one tael to eight taels… For Yang-replenishing herbs, small doses may be effective, while for Yin-replenishing herbs, large doses are necessary for efficacy. Since Yang governs rising and Yin governs descending, when Yang rises, using less Yang herbs allows Qi to easily ascend; when Yin descends, using less Yin herbs makes it difficult for flavors to descend. Rehmannia, being a Yin herb, is particularly different from other Yin herbs; without using it in large quantities, how can one achieve victory?”
Regarding the dosage of Rehmannia glutinosa, the author believes that as long as it is appropriate for the condition, it can be used boldly, starting with small doses and gradually increasing, typically ranging from 30 grams to as much as 90 or 120 grams. For critical conditions, only large doses can ensure sufficient Yin blood, allowing Yang Qi to stabilize and prevent collapse.
However, Rehmannia glutinosa is static and has a thick taste; it should not be taken indiscriminately or for prolonged periods. Prolonged use may obstruct the rising of Yang Qi. After taking Yin-nourishing herbs, if symptoms of thirst and dry throat have disappeared, and the tongue coating has developed, one should stop nourishing Yin; if appetite has returned to normal but then begins to decline again, one should stop nourishing Yin; if stool has changed from dry to moist but then becomes loose and sticky, one should stop nourishing Yin; if sleep has improved but then becomes excessive, with a heavy body and weak legs, one should stop nourishing Yin.
Further Reading
Excerpts from Ancient and Modern Medical Cases
Vomiting and Diarrhea Deficiency and Collapse Syndrome – Nourishing Yin and Reviving Yang (Zhang Xichun’s Medical Case)
A boy named Hou, 5 years old, suffered from excessive use of cold diarrhea medicine, leading to chronic fright, cold stomach, and vomiting and diarrhea, often experiencing convulsions, lethargy, and a dangerous state. The prescription included Rehmannia glutinosa 2 taels, raw yam 1 tael, dried ginger, Aconite, and cinnamon each 2 qian, clean wolfberry fruit and wild ginseng each 3 qian, decocted into one and a half cups, and slowly warmed to drink. Vomiting, diarrhea, and convulsions all ceased, and his spirit improved. However, he seemed restless, so dried ginger was removed and 4 qian of raw Hang Shao was added, and after taking another dose, he was cured.
For Yin is the guardian of Yang, and blood is paired with Qi. Rehmannia glutinosa greatly nourishes Yin and replenishes blood. Taking it in large doses ensures sufficient Yin blood, preventing the loss of Yuan Yang Qi. As Zhang Jingyue stated in “Liu Jing Fu Yi”: “Not knowing this Yin character is the root of Yang Qi… Yang cannot exist without Yin; without form, there is no Qi to carry it. Therefore, the birth of things relies on Yang, and the formation of things relies on Yin; this is called Yuan Yin and Yuan Yang, also true essence and true Qi.” The Yang Qi of the human body is rooted in true Yin essence and blood; when Yang Qi is deficient, it is “Yang losing Yin and separating,” and “how can one restore the scattered and lost Yang Qi without nourishing Yin?”
Heavy Use of Rehmannia Glutinosa in Treating Restless Leg Syndrome (Case Summary)
Ren, male, 78 years old, consulted for “diabetic peripheral neuropathy and restless legs.” The patient has had diabetes for over 10 years, and one month ago, he began experiencing burning and discomfort in the calves to the soles of his feet, especially at night, with relief after patting or walking, accompanied by dizziness, palpitations, and a weight loss of 4 kilograms in one month. Current symptoms include fatigue, lower back pain, leg cramps with burning and discomfort, numbness from the left arm to the fingertips, hand tremors, heat in the palms and soles, cough with phlegm, white phlegm in large amounts, tinnitus, dry throat, poor sleep with many dreams, frequent urination, slightly dry stool, red tongue with little coating, and thin rapid pulse.
Western diagnosis: diabetic peripheral neuropathy and restless legs. TCM diagnosis: diabetes and blood obstruction.
TCM differentiation: liver and kidney deficiency, with obstructed collaterals. Treatment principle: nourish liver and kidneys, invigorate blood.
Prescription: Liu Wei Di Huang Wan with modifications. The medicinal ingredients include Rehmannia glutinosa 120 grams, Shan Yao 30 grams, Dan Shen 30 grams, Ji Xue Teng 30 grams, whole scorpion 9 grams, Ge Gen 30 grams, Da Huang 6 grams, Hai Fu Shi 30 grams.
After taking the above formula for 14 doses, during the second consultation, the patient reported significant reduction in burning sensation in the lower limbs, reduced cramps, less lower back pain, no cough or phlegm, reduced tinnitus, normal appetite, and improved sleep. After taking another 14 doses, during the third consultation, the patient reported that the burning sensation in the lower limbs had basically disappeared, and the numbness in both hands had significantly improved. After further adjustment of the herbal formula, he switched to water pills to control blood sugar and will return for regular follow-ups.
This case is a manifestation of blood obstruction due to liver and kidney deficiency. The patient is elderly, with kidney depletion and insufficient Yin essence, leading to stagnation of Yin blood in the lower limbs, compounded by insufficient liver blood, resulting in the disease. This formula heavily uses Rehmannia glutinosa as the monarch herb to nourish Yin and replenish the kidneys, filling essence and marrow, combined with Shan Yao to nourish the liver and astringe essence, assisting Rehmannia in replenishing kidney Yin. Additionally, blood-invigorating and collateral-unblocking herbs are included to smooth the blood vessels and enhance the function of nourishing Yin blood. In this formula, Rehmannia glutinosa is used in a heavy dose of 120 grams, chosen for its sweet and warm nature to enter the kidneys, greatly replenishing the liver and kidneys. With sufficient kidney water and nourishing liver wood, the muscles and tendons can function, Qi flows, and blood is sufficient, thus resolving the “restless” condition.
|
I This article is excerpted from “China Traditional Chinese Medicine News” Issue 3426, 2010.。I Copyright belongs to the relevant rights holder. If there is any improper use, please contact us for immediate deletion.I Submission email: [email protected]I Consultation and cooperation:WeChat ID: lianshangpuying. I Warning: This content is for the popularization of TCM knowledge only and is not intended as a prescription. Please use under the guidance of a physician.。 |
