Teeny Tiny Formula: Shao Yao Gan Cao Tang

The last post was introducing the two teeny tiny formulas within Gui Zhi TangShao Yao Gan Cao Tang and Gui Zhi Gan Cao Tang as sort of a Yin Yang pair.  Now it’s time to go into these two formulas more deeply.  In this post I am sharing some brief discussion and 9 case studies by various doctors about Shao Yao Gan Cao Tang.  There is quite a range of illnesses that can treated with this formula.  It is an incredibly useful formula that I, again, use every clinic day.   Once you really understand this formula, you will also use it all the time with great success.  In my own experience I’ve used it for spastic cough, constipation, intersticial cystitis, TMJ, restless leg syndrome and abdominal pain, among many other applications.  It is teeny tiny so you can see these components in many other formulas such as Xiao Jian Zhong Tang, Si Ni San or Wen Jing Tang.  Oh so many formulas!  I love that the Tang Ye Jing‘s version of Xiao Chai Hu Tang, which is called Yang Dan Tang, is Xiao Chai Hu Tang plus Shao Yao, making this a formula that includes Shao Yao Gan Cao Tang.  Since the Tang Ye Jing is the pre-cursor of the Shang Han Lun, I see this as hearty encouragement to consider integrating Xiao Chai Hu Tang with Shao Yao Gan Cao Tang by adding Shao Yao to it.

I hope you enjoy these cases as much as I have.

Shao Yao Gan Cao Tang

Directions: Boil the ingredients in 3 sheng of water, reducing to 1 sheng 5 ge (1 1/2 sheng), strain. Divide into two doses to be taken warm twice in one day.

Original Clause

Clause 29: In Shang Han, the pulse is floating, there is spontaneous sweating, frequent urination, there will be heart vexation, a slight aversion to cold and cramps in the feet. Gui Zhi Tang is given to attack the exterior but this is a mistake. Having given it, there is Jue fainting, dry throat, vexation and agitation with vomiting due to reversal. Give Gan Cao Gan Jiang Tang to restore the Yang. If the Jue recovers, and the feet become warm then, after giving Shao Yao Gan Cao Tang and the feet will stretch. Where there is lack of harmony of the stomach Qi, with delirious speech, give a little Tiao Wei Cheng Qi Tang. Where heavy sweating was promoted and repeated hot needling, Si Ni Tang is indicated.

Bai Shao Yao
4 liang
12 gm
Zhi Gan Cao
4 liang
12 gm

Formula Explanation

The liver stores the blood and governs the tendons. When the liver blood is insufficient, the tendons and vessels are not moistened and they often become painful in a tight and spastic way. This formula has only two flavors. Yet it has the subtle ability to use sweet with sour to transform Yin. This formula emolliates the liver and harmonizes the spleen, enriches Yin, nourishes blood, relaxes spasming and stops pain. It stops spastic pain by disinhibiting the blood vessels. It can allow spastic painful feet or calf muscles due to Yin and blood deficiency to smoothly stretch. It is especially effective when the tongue is red and the pulses are wiry. When both the Yin and Yang are deficient, with aversion to cold, spastic feet and a slightly thin pulse, Shao Yao Gan Cao Fu Zi Tang can be used to restore the Yang and boost the Yin.

Cases

Case 1. Restless Legs

Dr. Wang Ming-Ru ⺩王明如Ms. Zhu, age 45, came for her consultation on November 30, 1986. For the past 4 months she had an indescribable feeling in her legs. They felt sore, numb, distended with a pain that was not quite pain. Sometimes her legs would twitch or she may feel an electric shock feeling. When she rested it got worse. She often patted or slapped her legs and squeezing them would slightly alleviate the symptom. She went to the hospital’s psychiatric department and was diagnosed with restless legs. However western and Chinese treatments were ineffective. The she came to consult with Dr. Wang. The movement of her legs was normal. Wei Zhong and Cheng Shan acupuncture points had a sore distended feeling when pressed. She also felt dizzy and weak. Her sleep was poor and she had a poor appetite. She was restless when sitting. Her tongue was pale red and split in the middle. The moss was thin white. Her pulse was thin and wiry. This was liver blood deficiency in which the tendons and vessels lost their nourishment. The treatment was directed to emolliate the liver, nourish the blood, relax spasms and sooth the tendons.

Sheng Bai Shao
60 gm
Gan Cao
5 gm

I gave her 5 packages of this formula and afterwards the pattern had clearly changed for the better. She was already sleeping at night and her appetite had improved. She continued with the same herbs, 30 more packs, and there was a cure.

浙江中医杂志1988; 6: 273

Discussion: The liver stores the blood and governs the tendons. When the liver blood is deficient the tendons and vessels loose their nourishment. This can cause soreness and discomfort of the 4 limbs, pain, numbness or distention. This requires a formula to relax spasming. The amount of Shao Yao is quite big and it is generally without side effects.

Case 2: Hiccup

Dr. Feng Han-Long 浙江中医杂志
1988: A venerable sage named Wang had repeated hiccups. Day and night he hiccupped ceaselessly. The result was that he ate and drank very little. At night he was unable to sleep. Day and night, he was suffering deeply. He had gone to a doctor and taken Ding Xiang Shi Di Tang and Xuan Fu Dai Zhi Tang and these were without effect. He inhaled tobacco and the hiccups would stop for a short while and then start again. He used it again but it didn’t help. The sides of his tongue were without moss and his mouth was dry with scanty fluids. His pulse was wiry, thin and slightly rapid. This appeared like Yin deficiency. The Yin of the spleen earth had received damage. This caused the liver wood to harass upward. It rose and was not controlled. The result was hiccups. The 医学启源 say, “Shao Yao discharges the liver and supplements the spleen and stomach.” And “Gan Cao generates the Jin fluid of the Yang Ming while Shao Yao harmonizes the Ye of Tai Yin.” This is a Yin harmonizing Yang method.

Sheng Bai Shao
30 gm
Gan Cao
15 gm

Boil as a soup and drink frequently.When the package was finished, the hiccups had ceased. Because the tongue was still without fluids I gave the first formula with the addition of 15 gm of Xian Shi Hu added (cooked ahead). After 1 package, the hiccups did not return.

Discussion: When the liver Yin is insufficient, the wood Qi rises up and coerces the earth Qi to rise up in reversal. The treatment uses sour to discharge the wood and sweet to supplement. It fells the liver and boosts the stomach. This treats Yin deficiency hiccups. This is from Dong Yuan and Dan Xi’s books.

Case 3: Priapism

Chao Bao-Gou 乔保钩

Mr. Wang, age 36 came for a consultation on April 15, 1964. 3 months earlier he had a disagreement with a neighbor and his emotions were poor. He had chest oppression and no joy. This continued though he was able to obtain and maintain an erection. In the last month he his erection would not go down. After sexual relations it would stay strong and not wane. He had distention and pain that was hard to bear. He went to the Chinese medical hospital but the treatment was without effect. He had a robust constitution and the sides of his tongue were completely red with yellow moss. His pulse was wiry and it had strength. This was liver constraint transforming into fire. There was also Yin Qi consumed. The more deficient the Yin, the more effulgent the Yang. The ministerial fire was steaming while the Qi and blood were insufficient. I gave a heavy dose of Shao Yao Gan Cao Tang:

Sheng Bai Shao
90 gm
Gan Cao
150 gm

 I had him boil the herbs and drink cold. After 5 packages, the distention and pain of the penis was clearly diminished. There was a definite trend for it to be softer. Following that I used the same formula with lower doses. I gave 3 more packages and he recovers.
河南中医1989; 3: 31

Discussion: This case is one in which there was gradually increasing liverconstraint and this damaged the Yin. This caused the ministerial fire to flare and harass, causing priapism. The treatment should obey the Nei Jing when it says, “When the liver suffers spasming, eat Gan Cao to moderate,” and “sour discharges.” This points to using Shao Yao Gan Cao Tang in which sour and sweet transform the Yin, nourish and down bear the ministerial fire. This way, priapism is cured. Increasing the dosage makes the effect even better.

Case 4: Anal Fissure

Yan Qi-Da 严其达
Ms. Li was 32. She had suffered from dry bowel for half a month. 5 days previously it had gotten very serious. After she moved her bowels she had anal pain with a small amount of fresh blood. After this, every time she moved her bowels she felt a cutting pain with a small amount of fresh blood. This pain lasted 3 hours and then resolved. The anal check showed that there was a fissure right at the center of her anus. This was both deep and at the skin level and all around it was bright red. When the opening was pulled, a small amount of blood would seep out and there was pain. This was spastic type anal fissure. I gave Shao Yao Gan Cao Tang.

Sheng Bai Shao
50 gm
Gan Cao
12 gm

The next day she had a soft bowel movement and the anal pain decreased. I gave one more package and the stool was soft and there was no pain. 5 days later the anal fissure was checked and it was gone.
四 川中医1987: 8: 34

 

Discussion: Anal fissure is usually related to habitual pain with bowel movements. With spastic type anal fissures, the treatment is to first both moisten the stool and stop pain in order to relax and resolve spasms. Shao Yao Gan Cao Tang has these two functions. When used in the clinic, the results are really good. There are
reports that generally after using the herbs the stool becomes soft and the pain stops. This way the anal fissure also resolves. Often the dosages are Bai Shao 40-60 gm and Gan Cao 12 gm. 24 gm of Huo Ma Ren can also be added to increase the moistening function.

Case 5: Constipation

Geng Shou-Xu 耿守绪
Mr. Li, age 62 came for a consultation on April 2, 1988. For the last 3 years his stool had become dry like goat turds. He moved his bowels several times a day. He had to try so hard that he sweat, he became flustered and had shortness of breath. The western doctor often used Phenolphthalein to resolve the immediate suffering. His tongue was pale and dark with thin white moss. His pulse was wiry and thin as well as chopping. This was geriatric constipation. The treatment was to boost the Qi and nourish the blood, moisten the intestine and open the bowel.

Bai Shao
30 gm
Gan Cao
10 gm

1 package for 1 day decocted in water.After 3 days the bowel opened. After 10 packages the bowel consistency moderated. He moved his bowel once each day. Aone year follow up showed no relapse.
四 川中医1991: 3: 34

Discussion: The 本经疏 证 says, “Shao Yao enters the spleen and opens knotting.” Shao Yao with Gan Cao breaks the knotting in the stomach and intestines. The use of this formula depends on the clinical observations. This formula is definitely effective for opening through the bowel and opening knots especially in the elderly and those with weak bodies.

Case 6: Tooth grinding

Dr. Shi Yi-Ming 石石宜明A
5 year-old boy named Zhang came for a consultation on September 4, 1984.He was grinding his teeth in his sleep. He did treatments to expel worms, clear the stomach and discharge heat but there was no effect. The pattern was one of wind tightening the tendons and vessels. The treatment principle was to emolliate the liver, relax spasming, resolve spasm and dispel wind.

Vinegar Prepared Bai Shao
30 gm
Zhi Gan Cao
10 gm
Chan Tui
10 gm

After 3 packages the tooth grinding decreased and after 3 more packages there was a cure. After that there was an occasional recurrence and he was given herbs and they worked.

四川中医1987: 3:18

Discussion: According to Yuan. In the past a large dose of Shao Yao Gan Cao Tang was used to treat pediatric convulsions. To his surprise, the tooth grinding suddenly resolved as well. This means that pediatric tooth grinding is due to spasms of the tendons and vessels and it can be treated with a large dose of Shao Yao Gan Cao Tang with Chan Tui. Each of many cases has obtained results. This still needs more clinical observation.

Case 7: Stomach pain

Dr. Liu Han-Tang
Ms Zuo was age 38. She was an accountant for a bank. On May 4, 2003 she came in for a consultation. Ordinarily she had mouth thirst with a desire for cold. Half a month ago, she had a disruption with her mother-in-law and then she gradually developed stomach pain and distention. This arose paroxysmally. Each time it lasted 6-10 minutes. It came on 3-5 times each day. She went to the local doctor and was given anti-spasmodic and analgesics but these were not effective. Her complexion was greenish-red, she had thirst, burping and a slightly dry stool. Her appetite was poor. He pulse was thin and wiry and her tongue was red with scanty moss. This was stomach pain due to liver wood harassing the stomach. The Qi mechanism was not running smoothly and the stomach Yin was insufficient. The treatment principle was to con
strain the liver and harmonize the stomach while regulating Qi, resolving constraint, enriching Yin and stopping pain. Modified Shao Yao Gan Cao Tang was used with Jin Ling Zi San.

Sheng Bai Shao
24 gm
Zhi Gan Cao
6 gm
Chuan Lian Zi
10 gm
Yan Hu Suo
10 gm
Fou Shou
10 gm

Decocted in water. 5 packages.
The stomach pain and other symptoms all disappeared.
Discussion: This patient usually had a dry mouth with a desire to drink cold liquids. This indicates that her constitution was one of Yin deficiency with fire excess. It was only in the past month that the wood arrogantly rebelled horizontally to attack the stomach. This manifested as stomach pain. There was also a greenish-red complexion, mouth thirst, dry stool, red tongue with scant moss and a thin wiry pulse. This was how the Yin deficiency manifested to be seen. There was stomach distention and pain with burping and poor appetite. This was the manifestation of the liver harassing the stomach with the blocked stomach hindering the appetite. She was given Shao Yao Gan Cao Tang and Jin Ling Zi San. Shao Yao Gan Cao Tang constrains the liver, harmonizes the stomach, enriches Yin and stops pain. Jin Ling Zi San sooths the liver and resolves constraint. Together these formulas treat heat pain. Fou Shou was added to assisting in moving the Qi, resolving constraint and waking up the stomach.
From Liu Han-Tang’s A Record of Clinical Experience using Classical Formulas. 2007

Case 8: Lower calf pain (Charlie horse)

Dr. Liu Han Tang
Mr. Xu was a 46 year-old peasant. He came for a consultation on October 4, 2000.

In recent years he has suffered from occasional right side calf pain in which his calf muscles spasm. This happens at night while he sleeps. It happened every 4-6 days. The pain was quite severe. He had to stand immediately to reduce the pain. He went to a local hospital for treatment so that these outbreaks would be controlled. His face was red colored, he had dry mouth, and stool. His appetite and urination were normal. His tongue was red with scanty moss and his pulse was thin. This was differentiated as insufficiency of the Yin fluids so that the tendons and vessels lost their nourishment. For treatment it was appropriate to use sweet and sour to transform Yin, while enriching and nourishing the tendons and vessels. He was given Shao Yao Gan Cao Tang.

Chao Bai Shao
30 gm
Zhi Gan Cao
10 gm

Decocted in water.
After 10 packages there was a cure.
After a year, there was no recurrence.
Discussion: In this case there was calf muscle pain. The disease mechanism was Yin deficiency with lack of nourishment of the tendons and muscles so that they spasmed. The symptoms of red complexion, mouth thirst, dry stool, red tongue with scanty moss, and thin pulse were all indications of Yin deficiency. This was what caused the calf muscle spasming pain. Shao Yao Gan Cao Tang was given to use sour and sweet to transform Yin. This enriched the tendons and vessels so that they were emolliated and harmonious. Then the spasming pain spontaneously dispersed.
From Liu Han-Tang’s A Record of Clinical Experience using Classical Formulas. 2007


Case 9: Yin contraction syndrome.

Dr. Zhou treated a 48 year-old man. The day before he had traveled from home to visit relatives. He got very tired and then had sexual relations. He then had acute pain, appearing to be suffering a lot. He was having paroxysmal pain in his lower abdomen that desired heat and touch. His penis and scrotum were contracted. His feet had reversal cold. His tongue body was pale with white moss. His pulse was deep and tight. This was cold stasis in the liver vessels with serious Yin contraction. I immediately got some Xie Bai and Sheng Jiang, which he pounded into a plaster and placed on his lower abdomen. He also did moxa on Bai Hui to return the Yang and rescue reversal. He was also given modified Shao Yao Gan Cao Tang:

Bai Shao
60 gm
Gan Cao
20 gm
Xiao Hui Xiang
30 gm

After taking the first package the illness improved by 60-70%. After two more packages, the symptoms suddenly were gone. (周均清.苟药甘草汤临床运用三则.长沙湖南中医杂志,1987, (3): 44)

In the next post, I will share more discussions on the clinical experience and range of use of Shao Yao Gan Cao Tang.

First 6 Cases From Collected Classic Formula Case Studies from Renowned Physicians, complied by Chen Ming and Zhang Yin-Sheng, 1998, Xue Yuan Publishers, Bei Jing

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