Class 7: Yin and Yang Tonics

1. Class 7: Yin and Yang Tonics Fayi Wu

2. Herbs Fructus Corni (Shanzhuyu) MM: pp 855-858 Radix Dioscoreae (Shanyao) MM: pp 723-726 Cortex Moutan radicis (Mudanpi) MM: pp 126-128 Fructus Lycii (Gouqizi) MM: pp 759-761 Flos Chrysanthemi (Juhua) MM: pp 58-61 Rhizoma Anemarrhena (Zhimu) MM: pp 92-95 Cortex Phellodendri (Huangbai) MM: pp 138-141 Tuber Ophiopogonis (Mai men dong) MM: pp 822-825 Fructus Schizandrae (Wu wei zi) MM: pp 858-862

3. Shan zhu yu (Fructus Corni) Categories: Herbs that stabilize and bind Taste and Property: sour, slightly warm Meridian tropism: Liver and kidney Actions: augments the liver and kidneys, secures the primal qi, prevents abandonment Applications: For leakage of fluids due to weak essence with such symptoms as urinary frequency, incontinence, spermatorrhea, and excessive sweating. For excessive sweating, especially in cases of devastated yang and collapsed qi, as in shock. Also used when sweating was mistakenly induced as a treatment. For liver and kidney deficiency For deficiency patterns of excessive uterine bleeding and prolonged menstruation Dosage: 6~12g Attention: contraindicated in cases with urinary pain and difficulty, or where there is damp-heat

4. Shan Yao (Rhizoma Dioscoreae) Categories: Herbs that tonify qi Taste and Property: Sweet and neutral Meridian tropism: Spleen, lung and kidney Actions: supplement qi, nourish yin, tonify the spleen, the lung and the kidney Applications: Deficiency of the spleen qi marked by poor appetite and diarrhea Cough or asthma due to lung deficiency Kidney deficiency marked by emission, frequent urination and leukorrhea: This herb can both tonify the kidney and astringe Emission due to kidney deficiency: Frequent urination due to kidney deficiency: Leukorrhea: Diabetes: Used at a large dosage (250g/day), to be taken as tea Dosage: 10-30g, or up to 60-250g Attention: This herb can not be used for patients with abdominal fullness due to dampness or retention of food

5. Mu dan pi (Cortex Moutan radicis) Categories: Herbs that cool the blood Taste and Property: acrid, bitter and slightly cold Meridian tropism: Heart, liver and kidney Actions: clears heat, cools the blood, invigorates blood and removes blood stasis Applications: For heat entering the blood level during a warm-heat pathogen disease with nosebleed, blood in sputum or vomit or subcutaneous bleeding, For yin deficiency patterns such as steaming bone disorder For liver blood stasis patterns with amenorrhea, abdominal masses, lumps, or bruises due to traumatic injury For liver fire, used with zhi zi, i.e. jia wei xiao yao san Used topically for firm, non draining sores or internally for intestinal abscess Dosage: 6~12g Attention: inappropriate for cold in the blood, or women who are pregnant or have excessive menstrual bleeding

6. Ju hua (Flos Chrysanthemi) Categories: Herbs that release the exterior Taste and Property: Sweat, slightly bitter, slightly cold Meridian Tropism: Lung and liver Actions: disperses wind heat, resolves toxin, brightens eyes Applications: Wind heat exterior pattern, used together with Bo He, Sang Ye, Jie Geng for wind heat exterior pattern marked by cough, i.e. Sang Ju Yin Red, swollen and painful eyes due to wind heat in the eyes or upward attack of liver fire, often used together with Sang Ye,Xia Ku Cao, Chan Tui. Vertigo of eyes due to deficiency of both the liver yin and the kidney yin, often used together with Gou Qi Zi, Shu DI Huang, etc., i.e. Qi Ju Di Huang Wan Calm hyperactivity of the liver yang, often used together with Shi Jue Ming, Bai Shao Yao and Gou Teng, i.e. Dosage: 6-12g

7. Zhi Mu (Radix Anemarrhenae) Categories: Herbs that clear heat Taste and Property: Bitter, sweet and cold Meridian Tropism: Lung, stomach and kidney Actions: Clear heat and purge fire, nourish yin and moisten dryness Applications Excessive heat of the lung and stomach in epidemic febrile diseases, Cough due to lung heat or yin deficiency marked by thick phlegm Exuberance of fire due to yin deficiency marked by bone heat, tidal fever, night sweating and restlessness Diabetes due to yin deficiency, often used together with Tian Hua Fen and Wu Wei Zi Dosage: 6-12g. Contraindication: Being cold and moist, this herb is not suggested for loose stool due to spleen deficiency.

8. Gou Qi Zi (Fructus Lycii) Categories:Herbs that tonify Yin Taste and Property:Sweet and neutral Meridian Tropism:Liver, Kidney and Lung Actions:Nourish liver and kidney, improve vision, and moisten the lung Applications: Deficiency of the liver blood and the kidney yin. This herb is a very good herb for this condition Cough due to yin deficiency, used with Zhi Mu, Mai Dong and Bei Mu Dosage:5-15g Attention:Not suggested for patient with accumulation of dampness in the middle jiao or with phlegm, retained water or fire.

9. Huang bai (Cortex Phellodendri ) Categories: Herbs that clear heat and dry dampness Taste and Property: bitter and cold Meridian tropism: kidney, bladder and large intestine Actions: clear heat, dry dampness, directs fire down, resolves toxin, clear deficiency heat Applications: For damp-heat in the lower jiao: thick, yellow vaginal discharge, foul smelling diarrhea, or dysenteric disorder, also for damp-heat pouring downward: red swollen, and painful knees, leg or feet. For empty fire: steaming bone disorder, night sweats, afternoon fevers and sweating, nocturnal emissions and spermatorrhea For fire toxin-generated sores and damp lesions of the skin Dosage: 3~12g Attention: inappropriate for cold from deficiency in the spleen and stomach

10. Mai Men Dong (Ophiopogonis, Radix ) Categories:Herbs that tonify yin Taste and Property:Sweet, slightly bitter and cold Meridian Tropism:Heart, lung, and stomach Actions: Moistens lungs and nourishs Yin, augments the stomach Yin and generates fluids, clears the heart and eliminates irritability Applications: dry cough or epistaxis due to lung yin deficiency, Er Dong Gao Heat impairing yin or diabetes, Sha Shen, Sheng Di huang, Yu Zhu Insomnia or irritability due to yin deficiency, Tian wang bu xin dan Dosage:6-15g. Attention:Deficiency cold of the spleen and stomach

11. Wu wei zi (Fructus Schizandrae) Categories: Herbs that stabilize and bind Taste and Property: sour, sweet and warm Meridian tropism: heart, kidney and lung Actions: contains leakage of lung qi, enriches the kidneys, constrains essences, stop diarrhea, generates fluids and inhibits sweating, quiets the spirit Applications: For chronic cough and wheezing due to lung deficiency or lung and kidney deficiency, Gan Jiang, Xi Xin For nocturnal emissions, spermatorrhea, vaginal discharge, and urinary frequency due to kidney deficiency, Wu Wei Zi Gao For excessive sweating, Sheng Mai San For irritability, palpitations, dream-disturbed sleep and insomnia due to injury to yin and blood Dosage: 3~6g Attention: contraindicated where an exterior disorder has not been cleared, or there is heat from excess in the interior, or in the early stages of a cough or rash

12. Formulas Liu Wei Di Huang Wan, Qi Ju Di Huang Wan, Zhi Bai Di Huang Wan, Ba Xian Chang Shou Wan, Ming Mu Di Huang Wan FS: pp 263-265 Zuo Gui Yin FS: pp 266-267

13. Liu wei di huang wan (Six ingredient pill with rehmannia) Categories: Formulas that tonify yin Ingredients: Shu di huang, Shan zhu yu, Shan yao, Fu ling, Mu dan pi, Ze xie

14. Actions and indications of the formula Actions Enrich the yin and nourish the kidneys. Indications Kidney yin deficiency in children characterized by an open anterior fontanel, lack of spirit. Soreness and weakness in the lower back, vertigo, tinnitus, diminished hearing, night sweats, spontaneous and nocturnal emissions. hot palms and soles, a chronic dry and sore throat, toothache, or wasting and thirsting disorder. A red tongue with little coating, a rapid and thin pulse.

15. Analysis of Formula Monarch: Shu di huang enrich the kidney yin and essence. Deputy: Shan zhu yu, shan yao Shan zhu yu: nourish the liver and restrain the leakage of essence. Shan yao: stabilize the essence by tonifying the spleen Assistant: ze xie, mu dan pi, fu ling Ze xie: clear and drain the overabundance of kidney fire, prevent the rich, cloying properties of the chief herb from congesting the mechanisms of the kidneys. Dan pi: clear and drain liver fire and is used here to counterbalance the warm properties of Shan zhu yu. Fu ling: a bland herb that leaches out dampness from the spleen. Paired with Shan yao to strengthen the transportive functions of the spleen. Prevent the formula from clogging up the digestive process.

16. Modern application and modifications Modern application: Neurasthenia, pulmonary tuberculosis, diabetes mellitus, hyperthyroidism, chronic nephritis, urinary tract infection, hypertension, functional uterine bleeding, optic neuritis, optic nerve atrophy, and central retinitis Modifications: Qi Ju Di Huang Wan: Add Gou qi zi and Ju hua. for dry or painful eyes, diminished visual acuity, night blindness, photophobia Zhi Bai Di Huang Wan: Add Zhi mu and Huang bai. for yin deficiency with vigorous fire, consumptive heat, or steaming bone disorders. Also for urinary difficulty and lower back pain from damp-heat in the lower burner in patients with underlying kidney yin deficiency. Ba Xian Chang Shou Wan (Eight immortal pill for longevity): Add Mai men dong, Wu wei zi. For lung and kidney yin deficiency with cough with blood, tidal fever, and night sweat. Ming mu di huang wan: add sheng di, chai hu, dang gui, wu wei zi. For diminished vision due to liver and kidney deficiency. Shen qi wan: add fu zi, rou gui

17. Zuo Gui Yin (Restore the left decoction) Categories: Formulas that tonify yin Ingredients: Shu di huang, Shan zhu yu, Shan yao, Fu ling, Gou qi zi, Zhi gan cao

18. Actions and indications of the formula Actions Enrich the yin and nourish the kidneys. Indications Soreness and weakness in the lower back, night sweats, spontaneous and nocturnal emissions. Dry mouth and throat. A peeled, shiny tongue, a rapid and thin pulse

19. Analysis of Formula Monarch: Shu di huang enrich the kidney yin and essence. Depute: Shan zhu yu, shan yao, gou qi zi Shan zhu yu: nourish the liver and restrain the leakage of essence. Shan yao: stabilize the essence by tonifying the spleen Gou qi zi: nourish liver blood Assistant: fu ling, zhi gan cao Fu ling: a bland herb that leaches out dampness from the spleen. Paired with Shan yao to strengthen the transportive functions of the spleen. Prevent the formula from clogging up the digestive process. Zhi gan cao: augment qi and strengthen spleen.

20. Formula Comparisons

21. Herbs Ramulus Cinnamomi (Gui zhi) MM: pp 8-11 Aconite (Fu zi) MM: pp 673-677

22. Gui Zhi (Ramulus Cinnamomi ) Categories: herbs that release exterior Taste and Nature: Pungent, sweet and warm Channel tropism: Heart, lung and bladder Actions: induces sweating, releases exterior, warm the channel, and unblock yang qi Application: Treat exterior syndrome of deficiency type with symptoms of wind-cold type Relieve pain by dispersing wind cold from the channels and collaterals, applicable to pain or soreness in the shoulder and lumbar region Assist yang to promote flow of yang qi and remove obstruction from the collaterals, applicable to phlegm syndrome, abdominal pain due to yang deficiency and dysmenorrhea due to accumulation of cold in the collaterals Dosage: 3-9g for oral use Contraindications: Pregnancy ,Menorrhagia, Deficiency heat syndrome.

23. Fu Zi (Prepared Aconite) Categories: herbs that warm interior Taste and Property: Pungent and hot Meridian Tropism: Heart, kidney and spleen Actions: Rescue yang from collapse, Tonify fire and assist yang, Disperse cold and relieve pain Applications Collapse of yang: Marked by cold sweating, cold limbs, feeble and indistinct pulseFu Zi can assists the heart yang to promote flow of qi and blood in the vessels and tonify the kidney yang to supplement fire to rescue the depleting yang. Often used together with Gan Jiang and Gan Cao, i.e. Si Ni Tang Yang deficiency patterns: Yang deficiency of the kidney, the spleen and the heart can all be treated with this herb. Kidney Yang deficiency: Marked by aversion to cold, cold limbs, soreness and weakness of the loins and knees, impotence and frequent urination. Spleen yang deficiency with excess of cold marked by cold pain in the abdomen, and loose stool Heart yang deficiency: Palpitation, shortness of breath, cardialgia due to CHD Arthralgia: More suitable for exuberance of cold dampness marked by pain of the joints of all over the body, often used together with Gui Zhi and Bai Zhu, i.e. Fu Zi Gan Cao Tang Dosage: 3-15g. It should be decocted first for 30-60m to reduce its toxicity

24. Formulas Jin Gui Shen Qi Wan FS: pp 275-278

25. Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) Categories: formulas that tonify yang Ingredients: Shu di huang, Shan zhu yu, Shan yao, Fu ling, Mu dan pi, Ze xie, Fu zi, Gui zhi

26. Actions and indications of the formula Actions Warm and tonify Kidney Yang . Indications Lower back pain, weakness of the lower extremities, a cold sensation in the lower half of the body, dyspnea, A pale swollen tongue with a thin white and moist coating, empty pulse, Difficult urination with edema or excessive urination with incontinence.

27. Analysis of Formula Liu wei di huang wan: tonify kidney yin Fu zi: tonify the source of fire, dispel cold, eliminate dampness Gui zhi: benefit the joints, warm the channels, and unblock the vessels. Warm the bladder and promote urination by assisting in the transformation the organ’s qi. Together they assist yang and enhance the metabolism of water.

28. Modern application and modifications Modifications Replace Gui zhi with Rou gui in order to accentuate the warming and tonification of the lower burner, which leads the fire back to its source in kidneys. treating wheezing, severe sweating, weakness and cold of the lower extremities, and a deficient, rootless pulse. Modern application: Nephritis, chronic urethritis, diabetes mellitus, hypothyroidism, neurasthenia, arthritis, chronic bronchial asthma.