How do we get to know herbs? Zhang Jing-Yue says
“There are many medicinals, each with their own respective natures. Because the countless indications and contraindications are diverse, it is difficult to know them all. If he who uses the medicinals does not grasp the essence, it is inevitable that he will make many mistakes. If he only considers the which governs, or only considers the secondary actions; if he only cares about ‘what benefits this but does not benefit that’, then his ignorance about what is true and the rigidity in his attempts to lasso the wild horse will result in a lack of effectiveness.”
What does it mean to “grasp the essence” of an herb? Zhang goes on to say:
“There is only one truth for the use of herbs, and that is the mastery over their qi and taste, along with the knowledge of their yin and yang. This way, even though there are many of them, one will be able to grasp their essence.”
We often learn herbs simply in relation to their listed functions. “What does this herb DO” is the place we learn to focus our attention. Let’s take Bai Zi Ren as an example. According to the Materia Medica, Bai Zi Ren DOES the following things:
- Nourishes the heart and calms the spirit
- Moistens the Intestines and unblocks the bowels
- Treats night sweats due to Yin deficiency
Yet, master Zhang teaches us that “if he only cares about ‘what benefits this but does not benefit that’, then his ignorance about what is true and the rigidity in his attempts to lasso the wild horse will result in a lack of effectiveness.” Clearly, this is not where we should stop in our explorations of our herbal friends.
What does it mean to have mastery over their Qi and taste and knowledge of their Yin and Yang?
Taste, of course, has to do with the flavor of the herb. But more than that, it has to do with the action the combination of flavors in a particular herb has in our bodies when we take it into the intimate interior of our bodies. Bai Zi Ren is, according to
- Shen Nong Ben Cao Jing: sweet
- Ben Cao Si Bian Lu: Acrid, sweet
- Sun Si Miao: Slightly sweet and sour
- Zhang Xi-Chun: sweet and slightly pungent
The Qi of an herb is often described as the temperature of the herb. However, Qi has a broader meaning. It can be thought of as the character of the herb. In addition to being a neutral temperature, Bai Zi Ren is a seed with oil stored inside of it. It is yellow-brown with a bit of pink and it has a light fragrance. These later characteristics are part of Bai Zi Ren’s Qi and are very important to take into account when we want to grasp its essence.
Seeds are small storage vessels of potential. They come into being in the autumn, fall to the ground, and go deep into hibernation during the winter. These seed characteristics are metal generating water in order that there may be a spring. This is why so many seeds are used to supplement the Zang organ associated with winter storage, the kidneys. (Tu Si Zi, Che Qian Zi, Bu Gu Zhi, Nu Zhen Zi, Wu Wei Zi, She Chuang Zi, etc.) Bai Zi Ren is no different. Its oily nature makes it a moistening herb and so it enriches Kidney Yin.
Oily seeds also help to descend and lubricate the large intestine. (Tao Ren, Ma Zi Ren, Gua Lou Ren, etc.) Bai Zi Ren does this as well. Its yellow-brown color associates it with earth. The Yang Ming is an earth/stomach intermediary between the heart and kidneys. Bai Zi Ren, by opening through this intermediary, helps connect the downward movement of the heart to the kidneys. This is, in part, how it calms the spirit, by opening Yang Ming downward to relieve congested heart heat and another way it benefits the kidneys. As we will see in the writings of Dr. Xia Gui-Cheng, a famous modern gynecologist as well as in the work of Zhang Jing-Yue, Bai Zi Ren not only opens-through the large intestine, it also opens-through the Ren vessel, promoting menstruation when it is blocked. Dr. Zhang has a formula to open-through the menses called Nu Ke Bai Zi Ren Tang. The Yang Ming intermediary and the Ren vessel are very related in this way. Tao Ren has this function as well.
In the Jin Gui Yao Lue, Bai Zi Ren is recommended to be added to Zhu Pi Da Wan for cases of insufficient lactation with vexation. This points to its sweet, enriching quality as well as its ability to open through tubes and thereby calm the spirit.
The pinkish hue of Bai Zi Ren gives it resonance with the heart. Bai Zi Ren calms the spirit both by opening-through the Yang Ming to relieve heart heat and by enriching and nourishing the heart. Its fragrance adds a lightness and pleasing aspect to it that also resonates with the heart.
The Shen Nong Ben Cao Jing also designates Bai Zi Ren as an upper-class herb, meaning that it can be taken over a long period of time to “lighten the body and preserve life.”
Zhang Xi-Chun writes:
“Bai Zi Ren is slightly sweet and slightly pungent. Its Qi is fragrant and its nature is neutral. It is able to supplement and help the heart Qi, treating heart deficiency fright palpitations. It is able to conserve and moisten the liver wood, treating pain due to liver Qi brashly going horizontal. It enriches kidney water, treating floating heat from kidney depletion. Although it contains oil, its character is not damp and sticky. The fragrant sweetness of its substance makes it able to boos the spleen and stomach. The Shen Nong Ben Cao Jing says that it dispels wind damp Bi. This is because, when the stomach Qi is exuberant, it reaches out everywhere from the center so that the Bi naturally opens. The flavor is sweet and this is combined with pungent. It also carries the autumn metal clearing and downbearing Qi so it is able to enter the lungs to relieve cough and stop panting. It induces lung Qi to move downward. In summary, it is pacifying, simple and pure. It can supplement and boost the five Zang. This is why the Shen Nong Ben Cao Jing says that it pacifies the five Zang. One should clean off the outer peel and stir-fry until it is fragrant, though it would not be advised to remove the oil. This text also says that Bai Shi is able to pacify the five Zang but especially the liver Zang. In the past, I treated a young person in a neighboring village. His liver Zang was continually damaged. His left guan pulse was the only one that was weak. One day he suddenly had pain under the rib-side. I gave him one Liang of the single herb, Bai Zi Ren, cooked in a soup and there was a cure. It is evident from this that Bai Zi Ren is good and regulating the liver.”
Below is a section of a gynecology book I translated by Dr. Xia Gui-Cheng. Essential Clinical Experience with Herbs and Formulas for Gynecology in Fifteen Chapters. The section below is from the chapter on opening through the menstruation formulas and this formula is called Supplement the Spirit and Open the Menses Decoction.
Yi Shen Tong Jing Tang
Yi Shen – refers to supplementing and boosting the Kidneys. However, amenorrhea is often due to Liver and Kidney Yin deficiency and therefore supplementing and boosting the Liver and Kidney should also be supplementing and boosting Yin. Tong Jing – refers to opening through the menstruation, like making a tube open from end to end. The meaning behind the name Yi Shen Tong Jing Tang is basically combining the methods of boosting the Kidneys and opening through the menstruation.
|Bai Zi Ren||10 gm|
|Dan Shen||10 gm|
|Shu Di||10 gm|
|Chuan Xu Duan||10 gm|
|Ze Lan Ye||10 gm|
|Chuan Niu Xi||10 gm|
|Chao Dang Gui||10 gm|
|Chi Shao||10 gm|
|Bai Shao||10 gm|
|Chong Wei Zi||15 gm|
|Sheng Qian Cao||15 gm|
|Zhi Bie Jia||9 gm (cook ahead)|
|Shan Zha||10 gm|
Method of Application
This formula should be boiled in water and one package each day given.
This formula supplements the Kidneys, calms the Heart, vitalizes the blood and opens through the menstruation.
Liver and Kidney insufficiency amenorrhea, late or scanty menstruation accompanied by chest oppression, agitation, lack of sleep and difficult bowel movements
The primary focus of this formula is the Heart, Kidney, and uterus. The constituents supplement the Kidney, calm the Heart and regulate the uterus. Bai Zi Ren and Dan Shen settle the Heart and calm the spirit. In addition to this they also down bear the Heart Qi. It is said that When the Heart Qi descends and opens through the Uterine vessels are also open through all the way. The formula also uses Shu Di Huang, Chuan Duan, Niu Xi, and Zhi Bie Jia. These herbs all greatly supplement the Liver and Kidney Yin so that the menstrual fluid is abundant and full. When the Kidney Yin is sufficient and the menstrual fluid is abundant the material substance of the menstruation is thick and heavy. This is treating the root. I have also added Dan Shen, Dang Gui, Chi Shao, Chong Wei Zi and Sheng Qian Cao which vitalize the blood and regulate the menstruation. Vitalizing the blood and regulating menstruation basically means that we are regulating the flow to the uterus. So, there are these 3 aspects to this formula and they are put together to create Yi Shen Tong Jing Tang which treats Kidney deficiency amenorrhea.
Though this formula treats menstrual irregularity due to Kidney deficiency, it primarily treats scanty menstruation, amenorrhea, and late menstruation. At the same time, it can be used to promote ovulation at mid-cycle and for adolescent menstrual irregularity.
1. When there is scanty ovulation discharge at mid-cycle ovulation with dizziness, back soreness and weakness, weak spirit, red tongue with scanty moss you can use this formula with Wu Ling Zhi and Tai Zi Shen.
- When there is adolescent menstrual irregularity with the menstruation coming 3-4 years late, when it comes it is late or early but usually late or there is amenorrhea. Leucorrhea is common. There may also be insomnia, thin wiry pulse and the tongue will tend to be red. In this case, you can use this formula with Zi He Che 6-9 gm and Tu Si Zi 10 gm.
Yi Shen Tong Jing Tang is used for a very particular clinical application though there are still modifications that can be made:
If the stool is tending to be sticky you can take out Bai Zi Ren and Dang Gui and add He Huan Pi 10 gm, Wei Mu Xiang 9 gm and Liu Shen 10 gm. If there is clear back soreness, add Du Zhong 10 gm and Sang Ji Sheng 10 gm. If there is thick moss in the middle of the tongue and scanty urine, take out Sheng Di and add Fu Ling 12, Zhi Cang Zhu 10 gm and Yi Yi Ren 15-30 gm. If there is Heart vexation with loss of sleep and the tongue is tending to red, add Lian Zi Xin 5 gm and Qing Long Chi (pre-cook) 10 gm.
Yi Shen Tong Jing Tang is my special formula for amenorrhea when symptoms of Yin deficiency and Liver effulgence are manifesting. This is because it stresses enriching the Yin, down bearing fire and opening through the menstruation methods. Down-bearing fire is not clearing fire. This is because clearing fire will not be able to reach the goal of opening through the menses. Therefore, I chose Bai Zi Ren Wan and Ze Lan Ye Tang with modifications. Let’s consider Bai Zi Ren Wan and Ze Lan Ye Tang. Both of these formulas come from The Complete Collection of Effective Formulas for Women.
Bai Zi Ren Wan is the principle formula and was originally for “young women with worry in the heart” type amenorrhea. It uses the 4 herbs Bai Zi Ren, Sheng Juan Bai, Ze Lan Ye and Chuan Niu Xi which stress obstruction of Heart Qi. In regard to this obstruction, our predecessors considered this to be “Liver depression”. We cannot ignore this. However the ancients, especially in the Nei Jing, considered depression presentation to be in the Heart. For example, it says “the two Yang illnesses arise in the Heart and Spleen. This cannot be kept a secret. Women will have amenorrhea”. It also says that “When the Heart Qi rises up to the Lungs, it cannot descend and the uterine vessels will become obstructed and the monthly event will not occur”. This points to the fact that the vessels of the uterus and the collaterals of the uterus have a close relationship with the heart. When the Heart Qi is obstructed, the Heart blood will not descend and there will be amenorrhea. This is actually seen in the clinic a lot. Naturally, we cannot ignore the importance of Bai Zi Ren Wan when there is an insufficiency of the Kidney Yin and menstrual water. The Ming dynasty master, Zhang Jing-Yue demonstrates this clearly with his formula from The Complete Collection of Effective Formulas for Women, Bai Zi Ren Wan, when, by adding Chuan Duan and Shu Di, it still treats amenorrhea. We consider this formula very appropriate for this type of illness.
Ze Lan Ye Tang is a frequently used light formula. It includes Ze Lan Ye and Dang Gui as the principle herbs and these are assisted by Gan Cao. This formula stresses treating the Heart and Kidney. It treats the Heart by descending and calming the Heart and it treats the Kidney by supplementing it and enriching the Yin. It opens through and down bears while enriching Yin. It can also remove Heart and Liver fire. This formula has several herbs to open through the menses and vitalize blood. Although it does open through the uterus and promotes the menstrual flow, it also calms and descends the Heart Qi and induces the Heart blood to flow openly downward. This deeper layer of meaning is within this formula. Because of this, it is also able to promote ovulation when there is Yin deficiency.
Detailed analysis of the principal herbs in this formula, Bai Zi Ren, Niu Xi, and Ze Lan
Bai Zi Ren
is sweet with a neutral nature. It enters the Heart, Kidney and Large Intestine. The function is to nourish the Heart and calm the spirit, moisten and descend the Intestine. Generally, it is used when blood does not nourish the Heart which gives rise to palpitations or for deficiency vexation and insomnia. It is also used when Yin is deficient and blood is depleted and the Intestine is dry and constipated and for amenorrhea. The Study of Herbs says “Bai Zie Ren has a fragrant Qi and so it penetrates the Heart. It makes the body moist and enriches the blood. Like Fu Shen, Zao Ren, Sheng Di, and Mai Men Dong, it has turbidity within the clear and treats deficiency of the Heart spirit, palpitations, a sallow complexion, itchy skin and all of these herbs nourish the Heart blood function. This herb is also like Shu Di, Gou Qi, Bie Jia, and Niu Xi in that its Qi and flavor is thick and this muddiness goes to the Kidney, seals and fills the bone marrow, primarily treat Kidney Yin depletion with back and knee soreness and weakness, Yin deficiency with night sweats. These all have the strength to enrich the Kidney dryness. The flavor is sweet and it is also able to soften the liver. It supplements Liver and Gallbladder insufficiency and can even sedate and stabilize. Yet is nature is neutral and its strength is moderate so the range of application is wonderful”.
is bitter, sour and has a neutral Qi. It enters the two channels of the Liver and Kidneys. Its function is to vitalize blood, dispel stasis, supplement the Liver and Kidneys, strengthens the tendons and bones, disinhibits the urine and opens through the filter. It is used for blood stasis amenorrhea and back and knee soreness and weakness. The Ben Cao Zheng (The True Materia Medica) says “the flavor is bitter and sweet and the Qi is slightly cold. Its nature is descending and slippery. It is Yin and is not compatible with beef. Niu Xi moves to the 12 channels and helps the whole body Qi. This herb governs blood heat flaccid Bi of the hands and feet, blood dryness tightness and spasms, urinary blockage, dry knotted stool. This herb supplements the marrow and fills the essence, boosts the Yin and vitalizes the blood”. Clinically Huai Niu Xi tends to supplement and Chuan Niu Xi tends to open through. This is why I use Chuan Niu Xi to vitalize blood and open through the menses.
Ze Lan is also called Hu Lan or Long Zao. Its flavor is bitter and pungent and its nature is slightly warm. It enters the Liver and Spleen channels. It is able to vitalize blood and dispel stasis, disinhibit urine and dispel swelling. It can be used for blood stasis amenorrhea, dysmenorrhea, postpartum stasis and abdominal pain, water swelling and ascites and traumatic injury. The Ben Cao Guan Mu (Materia Medica pharmacological compendium by Li Shizhen (1518-1593)) says that “Lan Cao moves to the Qi level and that Ze Lan moves to the blood level. Although Lan Cao and Ze Lan come from the same plant type, Ze Lan has a particular function. It is like the difference between red and white Fu Ling or red and white Shao Yao. There is supplementing and discharging and they are not the same”. The Basis of the Herbal Classics says “Ze Lan treats postpartum blood loss. It promotes free flow in the back and abdomen, treats tightness and spastic pain, cracks abiding blood, scatters masses, dispels water swelling and edema of the body and four limbs”. The Herbal Classic says that this herb treats wounds from knives. All of this indicates that this herb scatters blood and that it is an important herb for birthing women and can assist Chuan Xiong, Dang Gui or child’s urine. It is better than Yi Mu Cao”. I think that Ze Lan not only dispels stasis and regulates menses, it also disinhibits the menstruation and will promote and discharge the menstrual fluid and so is commonly used.
Yi Shen Tong Jing Tang is one of my commonly used formulas in the clinic and is especially commonly used for adolescent amenorrhea. However, there must also be a vaginal discharge. After taking this formula and discharge begins, there will be an effect. Below is a case in which this formula was taken and ovulation resumed:
Ms. Zhang was 17 and had amenorrhea for 8 months. She had scanty vaginal discharge. She had started her menstruation at age 13. It lasted 3-5 days and came every 30-40-60 days. The amount of blood was scanty and the color was red with small clots. She generally had abundant vaginal discharge. In the last year, she took part in a general exam. She was studying very hard and had a lot of stress. She developed amenorrhea and became quite thin. The bimanual exam revealed that her uterus was slightly small. A blood test showed that her female hormones were low. Her BBT was monophasic and her temperature was on the low side. She experienced some vexatious heat and thirst. Her vaginal discharge was not profuse. She moved her bowels one time every two days and her urination was yellow. Her tongue was red. This was Liver and Kidney Yin deficiency and insufficiency of the heavenly water. I first gave her Gui Shen Wan. After taking this she developed some vaginal discharge and some lower abdominal distention. I changed the formula to Yi Shen Tong Jing Tang and her discharge became profuse. She showed a small amount of ovulation mucous so I continued with 7 packages of this same formula. After 5 packages the discharge increased and the BBT was rising. She took the next two packages and ovulated. The BBT rose and was bi-phasic. 10 days later she menstruated.
Another case was a 28-year-old woman who had not menstruated for 6 months. She had been married for 2 years without becoming pregnant. She had very little vaginal discharge and her body was thin. I gave her 10 packages of Yi Shen Tong Jing Tang and she ovulated, her discharge increased, she showed ovulation mucous and her temperature rose and became bi-phasic. Her temperature stayed high for 20 days and a urine test showed that she was pregnant.