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All combinations of herbs used to nourish and replenish blood for the treatment of blood deficiency syndromes are collectively referred to as blood tonics (补血剂).
This type of formula is suitable for symptoms such as dizziness, blurred vision, pale complexion, pale lips, brittle nails, palpitations, insomnia, dry stools, irregular menstrual cycles in women, light and pale menstrual flow, thin and rapid pulse, pale red tongue, and a slippery and scanty coating.
These formulas often include ingredients such as Shu Di Huang (熟地黄, Rehmannia Root), Dang Gui (当归, Angelica Sinensis), Bai Shao (白芍, White Peony Root), and Ejiao (阿胶, Donkey-hide Gelatin), with representative formulas including Si Wu Tang (四物汤, Four Substance Decoction), Gui Pi Tang (归脾汤, Restore the Spleen Decoction), and Dang Gui Bu Xue Tang (当归补血汤, Angelica Blood Nourishing Decoction).
1. Si Wu Tang (Four Substance Decoction) from “Tai Ping Hui Min He Ji Ju Fang”
Ingredients: Dang Gui (10g), Chuan Xiong (8g), Bai Shao (12g), Shu Di Huang (12g, prepared and steamed with wine).
Dosage: Grind into a coarse powder, take 30g with 1.5 cups of water, decoct until reduced to 80%, strain and take warm on an empty stomach before meals. If there is instability in pregnancy with bleeding, add Ai Ye (艾叶, Mugwort) and Ejiao (1 slice) and decoct as before.
For blood deficiency with coldness, excessive bleeding, also add Ejiao and Ai Ye for decoction (modern usage: prepare as a soup, decoct three times, take on an empty stomach in the morning, noon, and evening).
Function: Nourishes and regulates blood.
Indications: Deficiency of Chong and Ren channels, irregular menstruation, abdominal pain, excessive bleeding, blood stasis with hard masses, pain that occurs intermittently, instability in pregnancy with continuous bleeding, postpartum lochia that does not discharge, and abdominal pain with cold and heat symptoms.
Formula Explanation: This formula is the primary formula for nourishing blood and regulating menstruation, derived from Qiong Gui Jiao Ai Tang in the “Jin Kui Yao Lue – Women’s Pregnancy Chapter” by removing Ejiao, Ai Ye, and Gan Cao (甘草, Licorice). It serves as a foundation for various blood deficiency syndromes, adjusted according to symptoms.
Chong is the sea of blood, and Ren governs the uterus. If the Chong pulse is deficient, women may experience light menstrual flow, pale color, and delayed periods.
If there is cold stagnation in the lower jiao, abdominal pain may occur. If the spleen is deficient and cannot hold blood, or if the kidney is deficient and the Chong and Ren are unstable, symptoms such as excessive bleeding may also occur.
Additionally, if there is liver cold and blood stagnation, blood flow may be obstructed, leading to hard masses and pain in the lower abdomen and around the navel.
This formula uses Dang Gui to nourish and invigorate blood; Shu Di Huang primarily nourishes blood; Chuan Xiong regulates blood circulation; and Bai Shao nourishes blood and calms the liver. Thus, the entire formula is classified as a blood tonic. However, the combination is appropriate, nourishing blood without causing stagnation, promoting blood flow without damaging it, balancing nourishment and dispersal, forming a key formula for treating blood issues.
Modifications:
1. If there is cold in the blood with menstrual pain, consider adding Pao Jiang (炮姜, Dried Ginger), Gui Zhi (桂枝, Cinnamon Twig), Wu Yu (吴萸, Evodia), Zhi Ke (枳壳, Bitter Orange), Xiang Fu (香附, Cyperus), Sang Ji Sheng (桑寄生, Mulberry Parasitic Plant), and Xu Duan (续断, Dipsacus) to warm cold, regulate qi, promote blood flow, and relieve pain.
2. If there is bleeding during pregnancy, add Ejiao, Ai Ye (stir-fried), and Gan Cao to create Qiong Gui Jiao Ai Tang.
3. If there is blood stasis, add Dan Shen (丹参, Salvia), Tao Ren (桃仁, Peach Kernel), and Hong Hua (红花, Safflower) to promote blood flow and eliminate stasis.
4. If there is blood deficiency with heat, add Huang Qin (黄芩, Scutellaria) and Dan Pi (丹皮, Moutan Cortex).
5. If there is qi deficiency unable to hold blood, add Lu Dang Shen (潞党参, Codonopsis) and Huang Qi (黄芪, Astragalus) and Bai Zhu (白术, Atractylodes).
In summary, this formula can be adjusted according to symptoms to govern various blood conditions.
2. Sheng Yu Tang (Holy Recovery Decoction) from “Yi Zong Jin Jian”
Ingredients: Shu Di Huang (20g), Bai Shao (15g, mixed with wine), Chuan Xiong (8g), Ren Shen (人参, Ginseng, generally use Lu Dang Shen 20g), Dang Gui (15g, washed with wine), Huang Qi (18g, roasted).
Take with water decoction.
Function: Tonifies qi, nourishes blood, and holds blood.
Indications: Early menstruation with heavy flow, pale color, fatigue in limbs, and general weakness. This syndrome is due to weakness of qi and blood, unable to hold blood, hence Si Wu Tang is used to nourish and regulate blood, combined with Ren Shen and Huang Qi to tonify qi and hold blood.
3. Tao Hong Si Wu Tang (Peach and Safflower Four Substance Decoction) from “Yi Zong Jin Jian”
Ingredients: Shu Di Huang (15g or use Gan Di Huang (干地黄, Dried Rehmannia) 15g), Chuan Xiong (8g), Bai Shao (10g, stir-fried), Dang Gui (12g), Tao Ren (6g), Hong Hua (4g).
Decoct and take three times a day, finishing in one day.
Function: Nourishes blood, invigorates blood, and eliminates stasis.
Indications: Women with early menstruation, heavy flow, purple color, thick consistency, or clots, with abdominal pain and distension.
This formula nourishes and invigorates blood with Si Wu Tang and adds Tao Ren and Hong Hua to promote blood flow and eliminate stasis. When blood flows smoothly, abdominal pain and distension will subside. However, this formula is strong in its action to break up blood stasis, so it should not be taken excessively, as it may lead to excessive bleeding or heavy menstrual flow.
4. Dang Gui Bu Xue Tang (Angelica Blood Nourishing Decoction) from “Nei Wai Shang Bian Huo Lun”
Ingredients: Huang Qi (30g), Dang Gui (6g, washed).
Dosage: Grind into a powder, decoct until one cup remains, strain and take warm on an empty stomach (modern usage: decoct three times, take on an empty stomach in the morning, noon, and evening).
Function: Tonifies qi and generates blood.
Indications: Internal injury from overwork, qi weakness, blood deficiency, floating yang, with symptoms of heat in the muscles, red face, thirst, large and weak pulse, and in women, blood deficiency during menstruation or postpartum.
Formula Explanation: This formula is indicated for internal injury from overwork, insufficient original qi, affecting yin and blood, leading to floating yang. Symptoms include heat in the muscles, red face, thirst, and a large but weak pulse. Therefore, it is used to tonify qi and generate blood.
Since tangible blood is generated from intangible qi, this formula emphasizes the use of Huang Qi to greatly tonify the qi of the spleen and lungs, thus enriching the source of blood; Dang Gui is used to nourish blood and harmonize the nutrients, allowing yang to generate yin and qi to promote blood generation.
As Wu He Gao stated, “Tangible blood cannot generate itself; it is generated from intangible qi” (from “Ming Yi Fang Lun”), which serves as the theoretical basis for this formula to treat the root cause.
For women with blood deficiency and heat during menstruation or postpartum, it is used to tonify qi and nourish blood to reduce heat. For chronic non-healing sores, this formula is used to tonify qi and nourish blood, which is beneficial for tissue regeneration and healing.
The symptoms presented in this formula are quite similar to those of Bai Hu Tang (白虎汤, White Tiger Decoction), which has a large pulse, thirst, fever, and red face. However, upon careful examination, there are strict distinctions between the two.
The pulse in Bai Hu syndrome is large and full, with great thirst and a preference for cold drinks, and the body is hot with profuse sweating, which are the characteristics of the “Four Greats” of Bai Hu syndrome. In contrast, the pulse in Dang Gui Bu Xue syndrome is large but weak, with thirst and a preference for warm drinks, and the body is warm but not excessively hot, without profuse sweating.
Therefore, when using this formula, it is essential to distinguish between the two aspects of heat excess in Yangming and qi weakness with blood deficiency, as misdiagnosis may lead to ineffective treatment or adverse effects.
5. Gui Pi Tang (Restore the Spleen Decoction) from “Ji Sheng Fang”
Ingredients: Bai Zhu (30g), Fu Shen (30g, remove wood), Huang Qi (30g, remove the reed), Long Yan Rou (30g), Suan Zao Ren (30g, stir-fried, remove shell), Ren Shen (15g), Mu Xiang (15g, not exposed to fire), Gan Cao (8g, roasted), Dang Gui (3g), Yuan Zhi (3g, honey-roasted).
Dosage: Grind and mix, take 30g with 1.5 cups of water, add 5 slices of ginger and 1 date, decoct until reduced to 70%, strain and take warm, no time restriction.
Modern Usage: Add 6g of fresh ginger and 3-5 dates, decoct and take. Alternatively, adjust the dosage ratio to make honey pills, each pill weighing about 15g, taken on an empty stomach, three times a day.
Function: Tonifies qi, nourishes blood, strengthens the spleen, and calms the heart.
Indications:
1. Deficiency of both heart and spleen. Excessive thinking and overwork injure the heart and spleen, leading to insufficient qi and blood. Symptoms include palpitations, forgetfulness, insomnia, night sweats, weakness, poor appetite, pale yellow complexion, pale tongue, thin white coating, and weak pulse.
2. Spleen unable to hold blood. Symptoms include blood in stools, excessive menstrual flow, light color, or continuous dripping, or leukorrhea.
Formula Explanation: This formula primarily treats deficiency of both heart and spleen.
The heart houses the spirit and governs blood, while the spleen governs thought and controls blood. Excessive thinking and overwork injure the heart and spleen, leading to deficiency of qi and blood, resulting in fatigue, poor appetite, and heat symptoms; heart blood is consumed, leading to palpitations, forgetfulness, insomnia, and night sweats; pale yellow complexion, pale tongue, thin white coating, and weak pulse are all signs of insufficient qi and blood.
The treatment should focus on tonifying qi and nourishing blood, strengthening the spleen, and calming the heart.
The formula includes Ren Shen, Huang Qi, Bai Zhu, Gan Cao, Ginger, and Jujube to warm and tonify the spleen and benefit qi; Dang Gui nourishes the liver and generates heart blood; Fu Shen, Suan Zao Ren, and Long Yan Rou calm the heart and nourish the spirit; Yuan Zhi connects the heart and kidney to calm the mind; Mu Xiang regulates qi and awakens the spleen to prevent the tonifying herbs from causing stagnation, which could hinder the spleen and stomach’s function.
Thus, this formula advances the nourishment of the heart and spleen, integrating qi tonification and blood nourishment.
The spleen governs blood and holds it; if the spleen qi is deficient, it cannot control blood, leading to blood in stools; in women, it may result in instability of the blood sea, causing excessive menstrual flow or light color; if the spleen is deficient and cannot transport dampness, it may lead to leukorrhea.
This formula can tonify spleen qi, support spleen yang, and nourish liver blood, thus treating the aforementioned symptoms of blood in stools, excessive menstrual flow, and leukorrhea.
Modern applications of this formula include treating neurasthenia, heart disease, anemia, functional uterine bleeding, and thrombocytopenic purpura. As long as the diagnosis is deficiency of both heart and spleen, adjustments can be made according to symptoms, and it has shown significant efficacy.
Gui Pi Tang was first recorded in the Song Dynasty by Yan Yonghe in “Ji Sheng Fang” for treating excessive thinking, overwork injuring the heart and spleen, forgetfulness, and palpitations.
In the Yuan Dynasty, Wei Yilin expanded on this formula in “Shi Yi De Xiao Fang”, which not only recorded the original indications but also supplemented treatments for spleen unable to hold blood, leading to vomiting blood and bleeding.
In the Ming Dynasty, Xue Lizhai added Dang Gui and Yuan Zhi to the original formula in “Jiao Zhu Fu Ren Liang Fang”, and it has been used ever since.
In the Qing Dynasty, Wang Ren’an expanded its application range in “Yi Fang Ji Jie”, using it for palpitations, night sweats, poor appetite, excessive menstrual flow, and intestinal wind bleeding. These adaptations were gradually perfected by later physicians through clinical practice.
This formula shares the qi tonifying function with Bup Zhong Yi Qi Tang (补中益气汤, Tonify the Middle and Augment Qi Decoction), but the differences lie in:
1. Different combinations: This formula combines qi tonification, spleen strengthening, and heart calming, aiming to strengthen the spleen and nourish the heart, restoring its function to control blood and generate blood; while Bup Zhong Yi Qi Tang focuses on tonifying qi and spleen and lifting sinking yang, aiming to tonify qi and elevate the clear while descending the turbid.
2. Different indications: This formula primarily treats deficiency of both heart and spleen and the inability of the spleen to control blood, leading to palpitations, forgetfulness, poor appetite, and blood in stools; while Bup Zhong Yi Qi Tang treats qi deficiency of the spleen and stomach, leading to fever, fatigue, shortness of breath, and sinking qi.
6. Zhi Gan Cao Tang (Honey-fried Licorice Decoction) from “Shang Han Lun”
Ingredients: Gan Cao (12g), Sheng Jiang (9g, honey-fried), Ren Shen (6g), Sheng Di Huang (30g), Gui Zhi (9g, peeled), Ejiao (6g), Mai Men Dong (10g, remove heart), Ma Ren (10g), Da Zao (5-10 pieces).
Dosage: Combine the nine ingredients with 7 sheng of clear wine and 8 sheng of water, first boil eight ingredients, take three sheng, strain, and dissolve the Ejiao, take one sheng warm, three times a day.
Modern Usage: Retain Ejiao, mix the other herbs, decoct, and add 10ml of clear wine. Separately, slightly boil Ejiao in water, dissolve, and mix into the decoction. One dose decocted three times, finishing in one day.
Function: Tonifies qi, nourishes yin, replenishes blood, and restores pulse.
Indications:
1. Qi deficiency and blood weakness. Symptoms include pulse irregularities, palpitations, weakness, shortness of breath, pale tongue, and dry mouth.
2. Deficiency of yin leading to lung atrophy. Symptoms include dry cough without phlegm, or phlegm with blood streaks, thin body, shortness of breath, irritability, poor sleep, spontaneous sweating or night sweats, dry throat, and constipation.
Formula Explanation: This formula is used in “Shang Han Lun” for treating symptoms of “irregular pulse and palpitations”. The clinical manifestations of irregular pulse include “slow pulse, sometimes stopping and then returning”; “palpitations, moving but stopping, unable to return, and then moving again”.
This syndrome is caused by yang deficiency failing to circulate the pulse qi, and yin deficiency failing to nourish heart blood. Symptoms of irritability and insomnia, pale tongue, and dry mouth are also due to insufficient yin blood.
Therefore, the formula uses Zhi Gan Cao, Ren Shen, and Da Zao to tonify qi and nourish the heart and spleen; Sheng Di Huang, Mai Men Dong, Ejiao, and Ma Ren to sweetly moisten and nourish yin, nourish heart blood, and generate fluids.
Ginger, cinnamon, and wine are all warm in nature, with the function of warming yang and restoring pulse, and when combined with qi tonifying and yin nourishing herbs, they can warm without drying, and promote the flow of qi and blood, ensuring the pulse is smooth. Together, they achieve the effects of tonifying qi, restoring pulse, nourishing yin, and replenishing blood.
For symptoms of qi and yin deficiency, this formula is used to tonify qi and nourish yin to support the lungs. However, for significant yin deficiency with lung dryness, the ginger, cinnamon, and wine should be reduced or omitted, as warming herbs can deplete yin fluids, so caution is advised.
7. Jia Jian Fu Mai Tang (Modified Recovery Pulse Decoction) from “Wen Bing Tiao Bian”
Ingredients: Zhi Gan Cao (5g), Gan Di Huang (20g), Bai Shao (18g), Mai Men Dong (15g, not removed), Ejiao (10g), Ma Ren (10g).
Use 8 cups of water, decoct until 8 parts remain, take in three doses.
If severe, increase Gan Cao to 30g, Gan Di Huang and Bai Shao to 24g, Mai Men Dong to 21g, take three times a day, one at night.
Modern Usage: Decoct three times a day, taking on an empty stomach in the morning, noon, and evening. The method for Ejiao is the same as in Zhi Gan Cao Tang.
This formula is derived from Zhi Gan Cao Tang by removing Ren Shen, Gui Zhi, Sheng Jiang, Da Zao, and Jiu, and adding Bai Shao.
Function: Nourishes blood, astringes yin, generates fluids, and moistens dryness.
Indications: Yangming organ excess syndrome, after purging, the excess heat has been removed, but yin fluids are still deficient, presenting with “weak pulse, heat in the palms and soles more than on the back of the hands and feet”.
Thus, the formula takes the meaning of Zhi Gan Cao Tang, removing the warming and spicy ingredients, and adding Bai Shao to create a purely yin and moistening formula.
Note: The above is for reference only; please adjust under the guidance of a physician.
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