Wow, it’s Autumn here in New England and it’s been a year since I last posted on this blog! I now have a blog challenge going with Eran Even so I’m motivated!
I’m continuing by revisiting the long lost series on tiny formulas from the Shang Han Lun and Jin Gui Yao Lue. I believe that it is extremely important to know and understand the tiny formulas because they are the building blocks of bigger formulas. I’ve explained how understanding small formulas helps us understand the power of larger formulas, using Wen Jing Tang as the example in this lecture. (You have to have a free account and login to medigogy to view this).
The next tiny formula, made up of just two herbs taken with barley gruel, is:
Zhi Shi Shao Yao San
Equal proportions of Zhi Shi (slightly blackened) and Shao Yao powdered.
Take 1 square spoon, 3 X/day with barley gruel.
Modern use is to make into a powder and take 6 gm each time with barley gruel.
This formula is from the Jin Gui Yao Lue chapter on Postpartum Diseases. The original text says “For postpartum abdominal pain with vexation, fullness and an inability to lie down.”
Though the patient is deficient of Qi and blood, the Zhi Shi Shao Yao San pattern is considered an internal excess pattern. We could say it is like a Cheng Qi Tang pattern except that there is Qi and blood deficiency and, as the commentary says below, unlike the Cheng Qi Tang pattern, this formula goes to the blood level and postpartum illness tends to be related to the blood level. How does this formula work? Bai Shao nourishes blood and relaxes spasming. It stops pain through this mechanism. It allows flow by relaxing tension rather than being moving itself. When Zhi Shi is blackened, it also enters the blood level. Though our Materia Medica lists Zhi Shi as bitter and acrid, the Míng Yī Bié Lù lists sour as its main flavor and lists “wind pains” as an indication. This is quite similar to Bai Shao. Zhi Shi in addition treats phlegm in the chest and epigastric area, excess knots, distention and fullness. It treats both constipation and loose stool as it benefits the normal contractions of peristalsis as opposed to spasticity that can cause loose stool or constipation.
In the Zhi Shi Shao Yao San pattern, a Cheng Qi Tang formula cannot be given because there is not enough blood fluid in the system. Blood and Ying must be nourished. In addition, it is the tight contracture that comes with blood deficiency that is causing the pain. The wood is dry and this contracts the spleen, leading to abdominal pain. If the constraint is stronger, one can use another formula that includes this, Ma Zi Ren Wan.
Other classic formulas that contain this formula:
Si Ni San
Da Chai Hu Tang
There are broad indications for this formula beyond postpartum abdominal pain. In addition, in formulas that use Bai Shao, one can add Zhi Shi if the blood level symptom is full abdominal pain. For example adding Zhi Shi to Dang Gui Jian Zhong Tang, Xiao Jian Zhong Tang, Dang Gui Shao Yao San or Gui Zhi Tang can direct those formulas to treat the symptom of full abdominal pain.
Below are some cases and discussions:
When there is postpartum abdominal pain, one must differentiate deficiency from excess. If there is no fullness or vexation, this is internal deficiency. If the woman is unable to lay down and has vexation, this is internal excess. However, the Zhi Shi Shao Yao San pattern is not the same as the Cheng Qi Tang internal excess pattern in that the former pattern is due to postpartum Qi and blood constraint and stasis. After all, postpartum illness tends to primarily be related to the blood level. Zhi Shi Shao Yao San uses Bai Shao which harmonizes the blood. When Zhi Shi is charred to blackness it also enters the blood level, moving the Qi within the blood. In addition, the barley gruel harmonizes the stomach Qi. This formula helps the unimpeded flow of the Qi and blood so that the abdominal pain, vexation and fullness pattern is dispelled.
Case 1: Postpartum abdominal pain
From Dr. Yin Guanghou 尹光候
Ms Yang was age 21 when she came for a consultation on April 15, 1985. She was 6 days post partum. Her lochia had already stopped. She experienced lower abdominal spasming pain. She had been treated by a doctor to no avail. Her lower abdominal pain was intense. Her facial color was sallow and dark. The pain and suffering could be seen on her face. She felt agitated and full, unable to lay down and resisting touch. Her tongue was pale purple and the moss was thin white. Her pulse was deep and wiry. This was knotted obstructed Qi and blood. For treatment it was necessary to crack the Qi and scatter knotting, harmonize the blood and stop pain. I gave Zhi Shi Shao Yao San:
| Bai Shao | 12 |
| Zhi Shi roasted to black | 12 |
I had her decoct this in water and drink. She took it that evening and was at peace. One dose and she was cured.
From (四川中医1986:38)
Discussion: For postpartum abdominal pain with agitation and fullness, the pattern matches the Zhi Shi Shao Yao San pattern. The effect is immediate. The powder was changed to decoction so that the effect would be faster.
Case 2: Post Partum Superficial Swelling
Ms. Wu was age 24. She had post partum pain. She took herbs to dispel stasis and generate the new and was cured. Then, deep in the night she got cold, as so she developed superficial swelling on the skin and was gasping for breath. I thought that, although the abdominal pain was gone, the blood stasis was not completely cleared and this was the cause of the skin swelling and distention. The flourishing blood was static on the interior. When she received the external cold, it made the Wei Qi congeal. Since the abdominal pain was a chronic condition, the source Qi was already made deficient. The treatment should move the blood without damaging the correct. It should supplement deficiency without aiding the evil. So I used Zhi Shi Shao Yao San from the Jin Gui Yao Lue. Zhi Shi moves the Qi stasis. Bai Shao moves the blood stasis. Barley Gruel supplements and nourishes the correct Qi. It considers all aspects of the diagnosis. After taking these herbs the swelling and gasping stopped. A long- standing illness was cured.
Discussion: When there is post partum abdominal pain that causes fullness and vexation that makes it difficult to lie down, the cause is Qi and blood constraint and stasis. Zhi Shi Shao Yao San is used. Zhi Shi cracks Qi and scatters knotting while Shao Yao harmonizes the blood and stops pain. These herbs are assisted with barley gruel, which harmonizes the stomach Qi. The cause of this presentation is lack of source Qi in the post partum time. This is also used for abscess with pus, which is also due to congealed Qi and blood. Over time the Qi and blood become corroded. This formula moves the Qi and harmonizes the blood. It makes the Qi and blood flow unimpeded.
In this case the post partum woman had congealed blood and static Qi, which caused superficial swelling with gasping. This formula was given to down bear the Qi and regulate the flourishing while simultaneously benefitting the correct Qi. In the end the swelling dispersed and the gasping stopped. It is definitely true that the effect of this formula is great.
From 沈舒文 Shen Shu-wen
Zhi Shi Shao Yao San combined with San Leng and E Zhu cracks Qi and regulates blood. Shen Shu-wen uses this combination to treat abdominal pain with irregular intestinal function, partial intestinal obstruction, spastic colon and colitis when abdominal pain is the principle symptom.
Zhi Shi Shao Yao San if a formula from the last part of the Jin Gui Yao Lue. Bai Shao enters the blood level. It is able to soften the liver and moderate spasming and in this way, it stops pain. Zhi Shi enters the Qi level. It promotes circulation by cracking Qi and guiding out stasis. When these herbs combine, there is one to scatter and one to restrain. This regulates and corrects the Qi and blood. Shen Shu-wen advocates using a suitable amount of the herbs. He uses 30 gm each of Zhi Shi and Bai Shao. San Leng and E Zhu crack the Qi and move the Qi. They open through the organs to stop pain. When these 4 herbs are combined, they are very effective in treating the above-mentioned conditions when they are due to Qi and blood congealed stasis manifesting with abdominal pain, distention and moving pain.
- • If there is cold congealed Qi stasis, add Wu Yao and Xiao Hui Xiang.
- • If there are heat sensations with the pain, add Chuan Lian Zi and Lian Qiao.
- • For colitis with discharge of viscous liquid, add Huang Lian, Pao Jiang and Bing Lang.
Case: Abdominal Pain
Ms. Yang, age 40. She was a middle school teacher in Shanxi province. She came for a consultation on September 4, 2009. She wanted to see the doctor because of recurrent episodes of abdominal distention and pain. She presented with abdominal distention and pain that was worse after eating. Her bowel was dry and evacuation was not easy. She had flatulence and poor appetite. Her tongue was dark and red and her tongue moss was white. Her pulse was wiry and thin. She had a colonoscopy and was diagnosed with irritable bowel syndrome. Her Chinese differentiated pattern was Qi and blood congealed stasis in the intestine. The treatment principle was to regulate and correct the Qi and blood, open through the organ and stop pain. She was given 14 packs of the following formula:
| Bai Shao | 30 |
| Zhi Shi | 30 |
| Wu Yao | 10 |
| Pao Jiang | 12 |
| Ma Zi ren | 10 |
| Chuan Lian Zi | 10 |
| Dan Shen | 15 |
| Bing Lang | 10 |
| San Qi | 4 (draft) |
| Zhi Gan Cao | 4 |
She decocted this in water. 1 package for 1 day divided into 2 doses and taken warm.
On September 18th she came for her second visit. The abdominal pain symptoms had clearly decreased. Her stool was still dry and did not evacuate easily. In addition, her appetite was still poor and her mouth was dry with the desire for fluids. Her tongue was pale red with scanty moss. Her pulse was deep and thin. The was Qi and Yin insufficiency with constraint and stagnation of the Qi mechanism. Now the treatment principle was to enrich Yin and boost the blood while moving Qi and vitalizing blood. I gave her 10 packages of the following formula:
| Bai Shao | 30 |
| Zhi Shi | 30 |
| Tai Zi Shen | 20 |
| Mai Men Dong | 10 |
| Ma Zi ren | 10 |
| Chuan Lian Zi | 9 |
| Sheng Di Huang | 15 |
| Bing Lang | 10 |
| Tao Ren | 10 |
| Mu Xiang | 10 |
| Hou Po | 10 |
She decocted this in water. 1 package for 1 day divided into 2 doses and taken warm.
She came for her third visit on September 29, 2009. She had no abdominal pain, a good appetite and her evacuation was normal.
Hi Sharon,
Thank you for enlightening post as always. I have missed immensely your input to better understand Classical prescriptions. Good you are back and I hope you will continue to benefit our insight