More on Shao Yao Gan Cao Tang

To continue…..

Hopefully you’ve had a chance to read the previous posts about Gui Zhi Tang and about Shao Yao Gan Cao Tang.  Below I have included more discussion on Shao Yao Gan Cao Tang.  The work of Liu Han-Tang I translated from his text A Record of Clinical Experience using Classical Formulas.  After that I included some quotes from a newly translated text called A Walk Along the River: Transmitting a Medical Lineage through Case Records and Discussions by Yu Guo-Jun, translated by Andrew Ellis, Craig Mitchell and Michael FitzGerald and published through Eastland Press.  I cannot recommend this text more enthusiastically.  It will not only teach you with many subtle and awesomely cool insights, it will also inspire you and help you feel connected to this medicine we love to study.  I think it’s on sale through the end of May too.  20% off!  I think the passages I’ve quoted below will give you a taste of his work.

So, here is a bow to Liu Han-Tang, a bow to Yu Guo-Jun and a bow to Shao Yao Gan Cao Tang.

From Liu Han-Tang’s A Record of Clinical Experience using Classical Formulas.

For Nerve Disorders

Shao Yao Gan Cao Tang can be used for a variety of nerve disorders. In modern times it is used for hysterical fainting, Parkinson’s syndrome, shriveling tightness of the whole body, lack of strength in the muscles of the body, Charlie horse, spasming of the 4 limbs, fingers and toes, eye muscle spasm, long term muscle spasm, muscle rigidity, spasming type numbness, facial muscle spasm, stubborn diaphragm muscle spasm, restless leg syndrome, headaches due to blood vessels constriction or dilation, intercostal neuralgia, trigeminal neuralgia, sciatica pain, post-surgical anal stimulation and torticollis. Modern research considers Shao Yao Gan Cao Tang as a formula that treats the muscles (the straie muscles and the smooth muscles of the internal organs) when they are in spasm. This combination of herbs controls the excitement of the central and nerve endings. It can treat muscles spasms that give rise to pain. It treats the muscles and brain tissue when there is a lack of nourishment due to Yin deficiency. The symptoms are pain from spasming of the vessels. There is inhibition of bending and stretching with pain and disordered spirit. There is a red tongue with scanty moss and a wiry thin pulse.

For Digestive Disorders

Shao Yao Gan Cao Tang can be applied to digestive system illnesses. Modern doctors primarily use it for allergic and hypersensitivity type gastro-intestinal inflammation, gastrointestinal spasming (acute stomach and abdominal pain) chronic gastritis, gastric polyps, stomach and duodenal ulcers (stomach heat type), acute cholestasis, round worms in the bile duct, Cholelithiasis, acute gallbladder pain, chronic gallbladder inflammation, chronic colitis, acute bleeding and necrosis type colitis, viral hepatitis (A or B), acute edematous pancreatitis, acute appendicitis, pylorus blockage, acute intestinal adhesions, post-surgical intestinal adhesions, geriatric intestinal blockage, and all chronic constipation. The important points for differentiation are disharmony between the liver and stomach, Yin deficiency with heat and lack of nourishment of tendons and muscles with the symptoms of stomach duct pain, poor appetite, mouth thirst, red tongue with scanty moss and wiry thin pulse.

For the Vascular System:

Allergic purpura, simple purpura, joint type purpura and gastro-intestinal purpura, when there is a differentiation of the pattern as Yin deficiency with heat, heat entering the blood level or heat struggling with blood or blood congealed in the muscles and skin. These can be treated when there is a liver and stomach disharmony, Yin deficiency with heat, and spasming of the undernourished tendons and vessels.

For the Endocrine System Disorders:

Hyper-prolactinemia type impotence in men, bleeding disorders, infertility, high testosterone type bleeding patterns and polycystic ovarian syndrome. These can be treated when there is a liver and stomach disharmony, Yin deficiency with heat, and spasming of the undernourished tendons and vessels.

For Urinary and Reproductive Disorders:

Acute renal pelvic nephritis, urinary stones, kidney stones combined with renal pelvic water accumulation, uremia nerve damage (causing numbness and pain), bladder spasms, impotence, priapism, incontinence, frequent urination and hematuria. These can be treated when there is a liver and stomach disharmony, Yin deficiency with heat, and spasming of the undernourished tendons and vessels.

For Gynecological Disorders

Dysmenorrhea, abdominal pain in pregnancy, post partum abdominal pain, post partum fever, infertility, headache, inappropriate lactation, twitching and numbness of the four limbs. These can be treated when there is a liver and stomach disharmony, Yin deficiency with heat, and spasming of the undernourished tendons and vessels.

Other disorders:

Damp heat leg Qi, weakness of the legs with no strength, angina pectoris, pediatric night crying, pediatric abdominal pain, cervical vertebrae illness, diabetes, heel pain, osteo-proliferation on the heel, geriatric hip and leg contraction, cease-hormone use syndrome, lumbar sprain, piriformis syndrome, tooth grinding, hersutism, ulcers on the shank, wind damp rheumatism, pain at night with many types of cancers, thrombic phlebitis due to external damage, soft tissue damage, osteo-proliferation, sprains, pyogenic arthritis, Yin and blood deficiency with fever, local skin diseases etc.

In general, the differentiating points for the use of Shao Yao Gan Cao Tang are as follows: The disease mechanism is one of Qi constraint and damage to the liver, lack of flow and discharge of liver wood, lack of harmony between the liver and stomach or liver and spleen, Yin deficiency with heat, insufficient Yin fluids with undernourished tendons and vessels (manifesting primarily as skeletal muscle or smooth muscle twitching or spasming), pain syndromes, convulsions, dry mouth, mouth thirst, red tongue with scanty moisture, thin or wiry-thin, or thin and rapid pulse.

The dosages of the original formula are 4:4. Clinically there are time when one can use a 4:1 or 3:1 dosage of Bai Shao with Zhi Gan Cao.

From Walking Along the River: By Yu Guo-Jun[1]

Spastic Cough

Paeoniae Radix alba (bái sháo) paired with Glycyrrhizae Radix (gān cǎo) comprises Peony and Licorice Decoction (sháo yào gān cǎo tāng). Together, sour and sweet transform the yin, and thus the two herbs enrich the Lung’s yang fluids and soothe and moderate the Lung qi. Modern pharmacological research has shown that this formula is able to relax spams in the smooth muscle of the bronchioles. Although the dosage of the other herbs in this formula can be changed or even eliminated, Inulae Flos (xuán fù huā), Paeoniae Radix alba (bái sháo), and Glycyrrhizae Radix (gān cǎo) are key herbs and thus should not be deleted when the formula is modified.

Constipation

The Spleen is the ultimate yin (至陰 zhì yīn) of yin. ‘Ultimate’ means ‘large’ and we can say that its fluid permeates the entire body. However, the character 至 zhì also means far-reaching, and so we can also say that the Spleen distributes essence through- out the body. When Spleen yin is insufficient, the fluids of the whole body become depleted and the Stomach and Intestines are the first to be affected by this. Why? Because, as it says in Chapter 45 of Basic Questions (Sū wèn), “the Spleen manages the proper movement of fluids on behalf of the Stomach.”

Patients with constipation from insufficiency of Spleen yin are commonly seen with symptoms such as hunger without a desire to eat, thirst without a desire to drink, dry lips, emaciation, fatigue, lack of strength, a pale tongue that lacks moisture, and a thin, dry tongue coating. The patient above fits this pattern.

In terms of well-known classical formulas that are used to enrich Spleen yin, one of the first to know is Peony and Licorice Decoction (sháo yào gān cǎo tāng). The early modern physician Zhang Xi-Chun praised this formula for its ability to transform yin with sour and sweet flavors, and he would add Ginseng Radix (rén shēn) for its strong ability to nourish Spleen yin. When I treat habitual constipation caused by insufficiency of Spleen yin and Intestinal dryness, I generally use Peony and Licorice Decoction (sháo yào gān cǎo tāng) as follows:

Bai Shao 30-50 gm
Gan Cao 5-10 gm
Zhi Gan Cao 5-10 gm

These herbs greatly enrich Spleen yin.

If you consider the formula that I generally use, there is a large dose of gentle, yin-natured herbs such as Paeoniae Radix alba (bái sháo), Glycyrrhizae Radix (gān cǎo), and Cassiae Semen (jué míng zǐ). These substances must be accompanied by something like Cistanches Herba (ròu cōng róng), which has the ability to generate yang qi. Only then will the formula be able to stimulate peristalsis and to achieve the effect of moistening the Intestines and unblocking the bowels. In fact, Cistanches Herba (ròu cōng róng) is the only herb in the formula for which there is no substitute.

The diagnosis in this case was insufficiency of Spleen yin with Intestinal dryness. I used Peony and Licorice Decoction (sháo yào gān cǎo tāng) with a large dosage of Paeoniae Radix alba (bái sháo) and additional herbs.

Kidney Stone Pain

When there is pain on the lower abdomen, I often combine Roasted Kidney Pill (wēi shèn wǎn) with Peony and Licorice Decoction (sháo yào gān cǎo tāng). If, during the period when the patient is taking herbs, the abdominal and lower back pain increases and they have pain radiating from these areas down to the lower abdomen, this indicates that the stone is moving downward and a large dose of Peony and Licorice Decoction (sháo yào gān cǎo tāng) can be used to relax tension and alleviate pain. At the same time one can help the body to guide the urinary stone downward and expel it by combining Peony and Licorice Decoction (sháo yào gān cǎo tāng) with Rhei Radix et Rhizoma (dà huáng) to guide downward and expel the urinary stones.

Post Herpatic Neuralgia

I usually use either Peony and Licorice Decoction (sháo yào gān cǎo tāng) with 30-60g of Paeoniae Radix alba (bái sháo) and 15-30g of Glycyrrhizae Radix (gān cǎo) or a version of that formula with normal dosages of those two ingredients in combination with Dredge the Liver Decoction (shū gān tāng). The treatment is different because the pathodynamic is different. Post-herpetic neuralgia is attributable to a lack of nourishment, as the fire toxin has caused the yin and blood to be insufficient, and the result is a lack of flow through the collateral vessels. The pain comes from this, so 
the combination of sour and sweet flavors that is Peony and Licorice Decoction (sháo yào gān cǎo tāng) can transform the yin and stop the pain.

[1] A Walk Along the River, Transmitting a Medical Lineage through Case Records, by Yu Guo-Jun, Translated by Andrew Ellis, Michael Fitzgerald and Craig Mitchell, Eastland Press, 2017

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