Blood Nourishing Agents
Indications: Blood deficiency syndrome.
Main Symptoms: Pale complexion, dizziness, pale lips and nails, palpitations, insomnia, pale tongue with thin pulse, or irregular menstruation in women, light flow with pale color, amenorrhea, etc.
Commonly Used Herbs: Shu Di Huang (Rehmannia glutinosa), Dang Gui (Angelica sinensis), Bai Shao (Paeonia lactiflora), Ejiao (Donkey-hide gelatin), Long Yan Rou (Longan fruit), etc.
Representative Formulas: Si Wu Tang (Four Substance Decoction), Dang Gui Bu Xue Tang (Angelica Blood Nourishing Decoction), Gui Pi Tang (Restore the Spleen Decoction), etc.
1. Si Wu Tang (Four Substance Decoction)
In Si Wu Tang, Dang Gui, Chuan Xiong, Bai Shao, and Shu Di Huang are combined to nourish the blood and harmonize the channels, addressing various blood-related ailments.
Formula Composition: Dang Gui 9g, Chuan Xiong 6g, Bai Shao 9g, Shu Di Huang 15g.
Functions and Indications: Nourishes and invigorates the blood. Used for symptoms of blood deficiency with dizziness, palpitations, insomnia, irregular menstruation, or amenorrhea, abdominal pain, pale complexion, pale tongue, thin and wiry or thin and rough pulse.
Simple Formula Verse: Blood nourishing Si Wu Tang, Dang Gui, Chuan Xiong, and Bai Shao.
Formula Explanation: In this formula, Shu Di Huang is the monarch herb, sweet and warm, nourishing the blood; Dang Gui is the minister herb, spicy and warm, invigorating blood and promoting qi; Bai Shao and Chuan Xiong are the assistant herbs, nourishing blood and calming the yin, dispelling stasis and alleviating pain. The four herbs work together to nourish the blood without causing stagnation, promote blood flow without harming the blood, achieving the function of nourishing and regulating the blood.
This formula is a fundamental prescription for nourishing and regulating the blood, originally designed for external injuries, later used for various women’s ailments, and has become a universal formula for treating related diseases across different specialties, demonstrating its influence and intricacies.
This formula is commonly used in modern treatments for blood system-related diseases, coronary heart disease, women’s irregular menstruation, and conditions related to pregnancy and postpartum.
Clinical Insights: The driving force of a person is qi and blood; diseases arise from qi and blood. In discussing blood-related diseases, there are few actual blood diseases, with most being deficiency syndromes. To treat diseases, one must treat the blood, which is the hallmark of skilled practitioners. Si Wu Tang is the fundamental formula for nourishing and regulating the blood; no practitioner can do without this formula, as stated in the “Song of Decoction Head” that “this formula is the key to all blood diseases.” Shu Di Huang has both raw and cooked forms; use the cooked form for its nourishing properties; if the blood condition is heat-related, one may switch to raw Shu Di Huang. Bai Shao has red and white varieties; use the white for its gentleness; if the blood condition is stasis-related, one may switch to red Bai Shao. The renowned physician Pu Fuzhou stated: “This formula is universally applicable to all blood diseases. For stasis, replace white Bai Shao with red Bai Shao; for blood heat, replace cooked Shu Di Huang with raw Shu Di Huang. The dosage of Chuan Xiong should be small, about half that of Dang Gui, while Shu Di Huang should be double that of Dang Gui.” (“Pu Fuzhou’s Medical Experience”) The essence of Pu’s clinical experience should not be overlooked.
2. Dang Gui Bu Xue Tang (Angelica Blood Nourishing Decoction)
Dang Gui Bu Xue Tang combines Dang Gui and Huang Qi to effectively nourish blood and support the body, especially for women with blood deficiency.
Formula Composition: Huang Qi 30g, Dang Gui 6g.
Functions and Indications: Nourishes qi and generates blood. Used for symptoms of blood deficiency with fever, flushed face, thirst, large and weak pulse, and in cases of women experiencing blood deficiency with fever during menstruation or postpartum, headaches, or non-healing sores.
Formula Explanation: In this formula, Huang Qi is heavily used as the monarch herb, tonifying lung and spleen qi, securing the exterior, and providing the source for qi and blood generation; Dang Gui serves as the minister herb, nourishing blood and harmonizing the channels. The two herbs, one as monarch and the other as minister, represent yin and yang, qi and blood, working in harmony to ensure mutual generation of qi and blood, ultimately achieving the goal of securing the exterior and eliminating heat.
This formula is a representative prescription for treating blood deficiency with fever, based on the principle that “the tangible blood cannot be quickly generated, while the intangible qi must be urgently secured,” emphasizing the use of Huang Qi to tonify the righteous qi and stabilize the floating yang; supplemented with blood nourishing to secure the foundation and enter the yin blood.
This formula is commonly used in modern treatments for allergic purpura, autoimmune pancytopenia, diabetes with ulcers, and functional uterine bleeding.
Clinical Insights: Although this formula is named “Dang Gui Bu Xue Tang,” it uses Huang Qi, which nourishes qi, as the monarch herb; is this not strange? In fact, it is not strange, as blood relies on qi, and qi supports blood. The treatment of this formula addresses blood deficiency as the root of the disease; while the floating yang deficiency is the urgent symptom. “At this time, the yang qi has left the interior and floated to the exterior, fearing that the interior cannot be secured in time, thus it is necessary to secure the exterior to retain it.” (Qing Dynasty, Zhang Bingcheng, “Cheng Fang Bian Du”) The physician emphasizes the use of Huang Qi, achieving a balance of internal and external treatment, addressing both the root and the symptom: treating the symptom to immediately restore the floating yang, reducing fever symptoms; and treating the root to ensure blood has a foundation, restoring the deficiency. Qi generates blood, and with the effective function of Dang Gui in nourishing blood and harmonizing the channels, the two functions work together to achieve blood nourishment. Nourishing qi and generating blood is a major principle in TCM treatment, and Li Gao’s perfect interpretation with these two herbs is truly impressive.
3. Gui Pi Tang (Restore the Spleen Decoction)
Gui Pi Tang contains four monarch herbs: Huang Qi, Dang Gui, Long Yan Rou, and Suan Zao Ren, which tonify qi, strengthen the spleen, and nourish the heart.
Formula Composition: Bai Zhu 18g, Fu Shen 18g, Huang Qi 18g, Long Yan Rou 18g, Suan Zao Ren 18g, Ren Shen 9g, Mu Xiang 9g, Zhi Gan Cao 6g, Dang Gui 3g, Yuan Zhi 3g, Sheng Jiang 5 slices, Da Zao 1 piece.
Functions and Indications: Tonifies qi and nourishes blood, strengthens the spleen, and nourishes the heart. Used for symptoms of both heart and spleen qi and blood deficiency, such as palpitations, forgetfulness, insomnia, shortness of breath, fatigue, poor appetite, pale and sallow complexion, pale tongue with thin white coating, and weak pulse; also for women with uterine bleeding, early menstruation, excessive light flow, or continuous spotting, blood in stool, and purpura.
Formula Explanation: In this formula, Huang Qi and Long Yan Rou serve as the monarch herbs, tonifying spleen qi and nourishing heart blood; Ren Shen, Bai Zhu, Dang Gui, and Suan Zao Ren serve as the minister herbs, enhancing spleen and stomach function, calming the mind and stabilizing the spirit; Fu Shen, Yuan Zhi, Mu Xiang, and Zhi Gan Cao serve as the assistant herbs, nourishing the heart, calming the mind, and harmonizing the formula; Sheng Jiang and Da Zao serve as the guide, regulating the spleen and stomach, and aiding digestion. The herbs work together to treat both heart and spleen, primarily tonifying the spleen; both qi and blood are tonified, with a focus on qi to promote blood generation.
This formula is a commonly used prescription for tonifying the heart and spleen, having been relied upon by many physicians since its inception in the Song Dynasty, with its functions continuously supplemented, improved, and innovated, and modern research has yielded many results.
This formula is commonly used in modern treatments for neurasthenia, heart disease, gastrointestinal bleeding, gum bleeding, uterine developmental disorders, functional uterine bleeding, uterine fibroids, thrombocytopenic purpura, leukopenia, aplastic anemia, menopausal syndrome, arthralgia, and elderly skin itching.
Clinical Insights: The term “Gui Pi” refers to returning to the spleen, clarifying the main function of tonifying the spleen, which is the original intention of the formula’s creator, the Song Dynasty physician Yan Yonghe, who developed it based on the Si Jun Zi Tang (Four Gentlemen Decoction); the Yuan Dynasty physician Wei Yilin discovered its application in treating spleen qi deficiency leading to bleeding, thus enhancing its function towards blood-related conditions closely linked to the heart; the Ming Dynasty physician Xue Ji added Dang Gui and Yuan Zhi to the original formula, significantly increasing the heart-nourishing elements; and the Qing Dynasty physician Wu Qian further summarized and improved the experiences of predecessors in the “Yi Zong Jin Jian,” making it a representative prescription for simultaneous treatment of the heart and spleen.
The unchanging principle is that this formula is based on postnatal treatment, embodying the principle of tonifying the spleen to nourish the heart and benefiting qi to generate blood. The evolution of this formula’s composition and function illustrates that the success of a prescription or treatment method is the result of long-term experimentation and application by countless physicians. The transmission of knowledge through practice and the creation of new methods within that tradition is a vital pathway for the continuous advancement and development of Traditional Chinese Medicine.
