益腎通经汤 Yi Shen Tong Jing Tang Boost the Kidneys and Open-Through the Menstruation Decoction

In this next entry on Dr. Xia’s opening through methods, we learn some very interesting principles.  His formula, Yi Shen Tong Jing Tang is indicated for Kidney deficiency type amenorrhea or scanty menstruation.  However the mechanism of the formula works with the Heart’s descending action to both supplement the Kidneys and to open through the menstruation.  This formula and this chapter on the formula illustrates a fundamental aspect of women’s physiology that is not often described.  This is the relationship between the Heart Qi and the vessels of the womb.  The Heart Qi must descend to the womb.

It is also interesting to note that Dr. Xia uses this formula for adolescent women who are suffering from amenorrhea, scanty or late menstruation.  He makes clear that there must be some vaginal discharge present to begin this formula.  In other words, if the woman is completely dry, with no vaginal discharge, the first treatment principle must be to increase moisture.  When the moisture just begins to show – that is the time to use this formula.  After using this formula, the vaginal discharge and ovulation mucous will begin to flow even more abundantly.

Yi Shen Tong Jing Tang

Formula Name:

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.

Formula Constituents:

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.

Effect

This formula supplements the Kidneys, calms the Heart, vitalizes the blood and opens through the menstruation.

Suitable usages

Liver and Kidney insufficiency amenorrhea, late or scanty menstruation accompanied by chest oppression, agitation, lack of sleep and difficult bowel movements

Formula explanation:

The primary aim of this formula is on the Heart, Kidney and uterus and so herbs to supplement the Kidney, calm the Heart and regulate the uterus are used.  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 substantial and rich.  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 createYi Shen Tong Jing Tang which treats Kidney deficiency amenorrhea.

Clinical Application

Though this formula treats menstrual irregularity due to Kidney deficiency, its primary indication is scanty menstruation, amenorrhea and late menstruation.  At the same time it can be used to promote ovulation at mid-cycle and to treat adolescent menstrual irregularity.
1. When there is scanty ovulation discharge at mid-cycle ovulation with dizziness, back soreness and weakness, weak spirit and red tongue with scanty moss you can use this formula with Wu Ling Zhi and Tai Zi Shen.

2. 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. 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.

Modifications:

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.

Clinical Experience

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 Xiao Zhu Fu Ren Liang Fang (Corrections and Annotations to Fine 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

“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 insufficiency of the Kidney Yin and menstrual water.  The Ming dynasty master, Zhang Jing-yue demonstrates this clearly with his formula from Fu Ren Da Quan Liang Fang (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 open through the menses and vitalize blood herbs and 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 with in this formula.  Because of this, it is also able to promote ovulation when there is Yin deficiency.

The principle herbs in these formulas are Bai Zi Ren, Chaun Niu Xi and Ze Lan Ye.  I will put forth and analysis of these below:

Detailed analysis of the principle 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 Yao Ping Hua Yi (Transforming the Significance of Medicinal Substances) says “Bai Zi 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”.

Niu Xi

is bitter, sour and the nature is neutral.  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 Orthodox Materia Medica (Vol. 48-49 of The Complete Works of [Zhang] Jing-yue)) 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

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, post partum stasis and abdominal pain, water swelling and ascites and traumatic injury.  The Ben Cao Guan Mu (The Grand Compendium of Materia Medica 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 Ben Jing Feng Yuan (Encountering the Sources of the ‘Classic of Materia Medica) says “Ze Lan treats post partum 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 Ben Jing (Classic of the Materia Medica) 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.

Practical Experience

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 at least some vaginal discharge present {in order to use this formula].  When this formula is taken, the discharge will begin in ernest more strongly and then you will know it is being effective.  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 mono-phasic 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.

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