All combinations of herbs used to nourish and replenish blood for treating 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 slippery tongue coating with little moisture.
These formulas often include main ingredients such as Shu Di Huang (熟地黄, Rehmannia Root), Dang Gui (当归, Angelica Sinensis), Bai Shao (白芍, White Peony), and Ejiao (阿胶, Donkey-hide Gelatin), with representative formulas like 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, Dang Gui Blood Nourishing Decoction).
1. Si Wu Tang (Four Substance Decoction) from Taiping Huimin Heji Ju Fang
Ingredients: Dang Gui (10g, prepared and wine-soaked), Chuan Xiong (8g), Bai Shao (12g), Shu Di Huang (12g, prepared, or 12g of raw dried Rehmannia).
Dosage: Grind into 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 10 leaves of Ai Ye (艾叶, Mugwort) and 1 slice of Ejiao, 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, hard blood masses causing pain, instability in pregnancy with continuous bleeding, postpartum lochia not expelling, hard masses in the lower abdomen, intermittent cold and heat.
Formula Explanation: This formula is the primary prescription for nourishing blood and regulating menstruation, derived from Jinkui Yaolue – 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.
The Chong channel is the sea of blood, and the Ren channel governs the uterus. If the Chong channel 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 channels are unstable, symptoms like excessive bleeding may follow.
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 the qi in the blood; and Bai Shao nourishes blood and astringes yin. Thus, the entire formula belongs to blood-nourishing herbs. However, the combination is appropriate, nourishing blood without stagnation, invigorating blood without breaking it, balancing nourishment and dispersal, forming a key formula for treating blood.
Modifications:
1. If there is cold in the blood with abdominal pain during menstruation, 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, invigorate blood, and relieve pain.
2. If there is bleeding during pregnancy, add Ejiao, wine-soaked Ai Ye, and roasted Gan Cao to create Xiong 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 circulation and eliminate stasis.
4. If there is blood deficiency with heat, add Huang Qin (黄芩, Scutellaria) and Dan Pi (丹皮, Moutan Root).
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 syndromes.
2. Sheng Yu Tang (Holy Recovery Decoction) from Yizong Jinjian
Ingredients: Shu Di Huang (20g), Bai Shao (15g, wine-mixed), Chuan Xiong (8g), Ren Shen (人参, Ginseng, generally use Lu Dang Shen 20g), Dang Gui (15g, wine-washed), Huang Qi (18g).
Water decoct.
Function: Tonifies qi, nourishes blood, and holds blood.
Indications: Early menstruation with heavy light-colored flow, fatigue in limbs, and general weakness. This syndrome is due to qi and blood deficiency, 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 Yizong Jinjian
Ingredients: Shu Di Huang (15g or use dried Sheng Di Huang 15g), Chuan Xiong (8g), Bai Shao (10g, fried), Dang Gui (12g), Tao Ren (6g), Hong Hua (4g).
Water decoct, take three times a day, finishing in one day.
Function: Nourishes blood, invigorates blood, and eliminates stasis.
Indications: Women with early menstruation, heavy purple flow, thick and sticky, or with clots, abdominal pain, and distension.
This formula nourishes and invigorates blood with Si Wu Tang and adds Tao Ren and Hong Hua to eliminate stasis. When blood flows smoothly, abdominal pain and distension will subside. However, this formula is strong in its action to break 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 (Dang Gui Blood Nourishing Decoction) from Nei Wai Shang Bian Huo Lun
Ingredients: Huang Qi (30g), Dang Gui (6g, wine-washed).
Dosage: Grind into a single dose, decoct until one cup, strain and take warm on an empty stomach before meals (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. Symptoms include heat in the muscles, red face, thirst, large and weak pulse, and in women, blood deficiency during menstruation or postpartum.
Formula Explanation: This formula addresses internal injury from overwork, insufficient original qi affecting yin blood, leading to symptoms of heat in the muscles, red face, thirst, and large weak pulse. Therefore, it uses a tonic to generate qi and blood.
Since tangible blood is generated from intangible qi, this formula emphasizes 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 nourish blood.
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.
For women with blood deficiency and heat during menstruation or postpartum, this formula is used to tonify qi and nourish blood to reduce heat. For chronic non-healing sores, this formula can be used to tonify qi and nourish blood, which is beneficial for tissue regeneration and healing.
The symptoms presented by this formula are quite similar to those of Bai Hu Tang (白虎汤, White Tiger Decoction), which includes a large pulse, thirst for cold drinks, high fever, and red face, but upon careful examination, there are strict distinctions between the two.
In Bai Hu syndrome, the pulse is large and full, with great thirst and a preference for cold drinks, high fever, and profuse sweating, which are the characteristics of the “Four Greats” of Bai Hu syndrome. In contrast, in Dang Gui Bu Xue syndrome, the pulse is large but weak, with thirst for warm drinks, and while the body is hot, it is not excessively high, and there is no profuse sweating.
Therefore, when using this formula, it is essential to distinguish between the two aspects of Yangming heat and qi weakness with blood deficiency. If the diagnosis is unclear, using this formula may not only be ineffective but may also lead to adverse effects.
5. Gui Pi Tang (Restore the Spleen Decoction) from Ji Sheng Fang
Ingredients: Bai Zhu (30g), Fu Shen (茯神, Poria without wood) (30g), Huang Qi (30g), Long Yan Rou (龙眼肉, Longan) (30g), Suan Zao Ren (酸枣仁, Sour Jujube Seed) (30g, fried), Ren Shen (15g), Mu Xiang (木香, Saussurea) (15g, not exposed to fire), Gan Cao (炙, 8g), Dang Gui (3g), Yuan Zhi (远志, Polygala) (3g, honey-fried).
Dosage: Grind and mix, take 15g with 1.5 cups of water, add 5 slices of ginger and 1 jujube, decoct until reduced to 70%, strain and take warm, no time restriction.
Modern Usage: Add 6g of fresh ginger and 3-5 jujubes, decoct and take. Alternatively, adjust the dosage ratio to make honey pills, each weighing about 15g, taken on an empty stomach, three times a day.
Function: Tonifies qi, nourishes blood, strengthens the spleen, and nourishes 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 not governing blood. Symptoms include blood in stools, excessive menstrual flow, light-colored flow, or continuous dripping, or leukorrhea.
Formula Explanation: This formula primarily treats the 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 qi deficiency, fatigue, poor appetite, and heat; heart blood is consumed, and the heart loses nourishment, resulting in 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 nourishing 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 both heart nourishment and spleen strengthening, 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 results in instability of the blood sea, causing excessive menstrual flow or light-colored flow; if the spleen is deficient and cannot transport dampness, it leads to leukorrhea.
This formula can benefit 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 of 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, used to treat excessive thinking and overwork injuring the heart and spleen, leading to 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 not governing blood, leading to vomiting blood and blood in stools.
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 applicability in Yi Fang Ji Jie, using it for palpitations, night sweats, poor appetite, women’s leukorrhea, and intestinal wind bleeding. These adaptations were gradually perfected by later physicians through clinical practice.
This formula shares the function of tonifying qi with Bushi Zhongyi 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 tonifying qi and spleen with nourishing the heart and calming the spirit, aiming to strengthen the spleen and nourish the heart, restoring its function of governing blood and generating blood; while Bushi Zhongyi Qi Tang combines tonifying qi and spleen with lifting sinking yang, aiming to tonify qi and lift the clear, restoring its function of raising and descending.
2. Different indications: This formula primarily treats deficiency of both heart and spleen and spleen not governing blood, with symptoms of palpitations, forgetfulness, poor appetite, and blood in stools; while Bushi Zhongyi Qi Tang primarily treats qi deficiency of the spleen and stomach with symptoms of fever, fatigue, shortness of breath, and sinking.
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, without 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, dissolve Ejiao, and take warm, three times a day.
Modern Usage: Retain Ejiao, mix the other herbs, decoct, and add 10ml of clear wine. Dissolve Ejiao in a little boiling water, mix into the decoction, and take in three doses, 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 lung qi. Symptoms include dry cough without phlegm, or phlegm with blood streaks, thin body, shortness of breath, insomnia, spontaneous sweating or night sweats, dry throat, constipation, or heat during illness, with a weak pulse.
Formula Explanation: This formula is used in Shang Han Lun for treating “irregular pulse and palpitations.” The clinical manifestation of irregular pulse is described in Bin Hu Mai Xue: “Irregular pulse is slow and sometimes stops, then comes back;” “Palpitating pulse moves and stops, unable to return, then moves again.”
This syndrome is caused by yang deficiency unable to circulate pulse qi, and yin deficiency unable to nourish heart blood. Symptoms of insomnia and palpitations, 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 the heart, 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 and yin tonics, they can warm without drying, and also 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 conditions of qi and yin deficiency, such as dry cough, the use of this formula is beneficial for nourishing qi and yin to support the lungs. However, for significant yin deficiency with lung dryness, the warming herbs should be used cautiously or omitted, as warming herbs can deplete yin fluids.
7. Jia Jian Fu Mai Tang (Modified Restore Pulse Decoction) from Wen Bing Tiao Bian
Ingredients: Zhi Gan Cao (5g), Gan Di Huang (20g), Bai Shao (18g), Mai Men Dong (15g, without heart), Ejiao (10g), Ma Ren (10g).
Use 8 cups of water, decoct until reduced to 8 parts, take in three doses.
If severe, increase Gan Cao to 30g, Gan Di Huang and Bai Shao to 30g each, and Mai Men Dong to 20g, taking three times a day, once 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, Ginger, Da Zao, and Wine, 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, this formula takes the meaning of Zhi Gan Cao Tang but removes the warming and pungent ingredients, 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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