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Dang Gui Shao Yao San Reintegrating Blood and Water Suzanne Connole L Ac

Dang Gui Shao Yao San Formula actions tonifies and invigorates the blood dispels damp and strengthens the spleen It treats a complicated pattern of blood and water resulting in conflicting wet and dry symptoms Dang Gui Shao Yao San Makes the Blood absorb the fluids It puts the fluids back in to the blood

What is the source of Blood TCM class notes Blood is yin Qi is Yang Spleen Stomach is the source of qi and blood Marrow is the source of blood Fluids are the liquid for the blood The heart engenders the blood The essence of fluid and grain cannot become blood until after it has been subject to the gas exchange of respiration Essence and blood originate from the same source

What is the source of Blood What is the blood really Is it Yin Is it Yang Blood is yin infused with yang Yang within yin All Blood is the liver blood Is Jue Yin the blood Jue yin upward movement from deep below spreading and sprouting upwards like the early spring It is a restart a coming back to life Jue yin is the movement that carries the warm blood upwards into the body and to the surface What is blood stasis

Imperial fire comes in via Yang ming and descends Shaoyang pivots allowing fire to root and become ministerial fire Tai yin Lungs descend to kidney yin See Jue Yin liver as the mediator between heart and kidney Taiyin absorbs and transforms Jue yin gathers from deep to spread and rise up and outwards to the heart and the surface Kidney yin and yang interact to become the Jueyin blood

What is Quality Blood What does blood do Carries moisture warmth and nutrients Softens and creates flexibility Key blood is absorptive it absorbs and contains fluids and warmth When it is deficient and stagnant it cannot absorb Fluids leak out warmth yang leaves What does good blood need Quality fresh and free flowing not thick Quantity Filling the vessels Smooth movement and warmth within Blood deficiency is a problem of both fluids and nutrition

Crappy Blood What is it Crappy blood is blood that is both deficient and stagnant it is thick lacking fluids lacking smooth movement Two types of crappy blood Blood is deficient and dry and therefore cannot flow smoothly and becomes stagnant Water and blood separate water leaks out of the vessels leaving the blood thick and creating dryness The water may leak out of the body in some way or accumulate as dampness Crappy blood affects muscles uterus heart vessels lungs everything Sharon Weizenbaum Pathological substances cannot perform physiological functions

Dang Gui Command Return Dang Gui in Shen Nong Ben Cao Jing Sabine Wilms translation Sweet warm Treats counterflow cough with ascent of qi warm malaria cold and heat with shivering inside skin vaginal leaking and interrupted childbearing in women all sorts of malign sores and festering ulcers and incised wounds Decoct it and drink it Grows in river valleys Dang Gui in Formulas and Strategies Sweet Acrid Slightly warm Tonifies blood invigorates blood regulates menstruation alleviates pain moistens bowels reduces swelling and generates flesh Dang Gui pharmacological effects Has both a stimulating and inhibitory on uterus Reduces plasma cholesterol levels anti platelet immunostimulant calms bronchospasms hepatoprotective analgesic and anti inflammatory Chen and Chen lists 23 different conditions that have been studied with positive results

Notes on Dang Gui Dang gui is indicated for all types of Female abdominal pain It can Tonify spleen blood and have a moistening effect on the tissues and muscles It can generate new transform the old treat numbness and pain in the body It can be used in all cases where there is blood deficiency or blood dryness or depletion of the Ying layer Dang gui does not treat the surface but by filling vessels and setting it in motion wind is dispelled Dang gui is essential to harmonizing the blood This means warming the ministerial fire within the fluid and enriching the fluid that contains the fire Jue Yin Dang gui has both inhibitory and excitatory effects on the uterus It can increase uterine contraction It can inhibit the smooth muscles and allow for relaxation of contractions

Dang Gui Formulas Si Wu Tang Ba Zhen Tang and all variations Dang Bui Bu Xue Tang Dang Gui San Dang Gui Shao Yao San Dang Gui Jian Zhong Tang Dang Gui Si Ni Tang Xiong Gui Jiao Ai Tang Chi Xiao Dou Dang Gui Tang Xiao Yao San and variations Bu Zhong Yi Qi Tang Dang Gui Yin Zi Wen Jing Tang Gui Pi Tang Dang Gui Liu Huang Tang Xue Fu Zhu Yu Tang and variations

Dang Gui Shao Yao San The Blood and Water Harmonizing Formula Dang Gui Bai shao 9g 12 v Modern dosages in parentheses 48g 12 24 Dang gui Tonify and invigorate the blood harmonizes blood Bai shao nourishes softens moderates pain Chuan xiong 24 6 9 Bai zhu 12 Bai zhu support spleen and water metabolism Banks up the earth Fu ling 12 Ze xie promotes water metabolism at kidney level Ze xie 24 12 Chuan xiong invigorate the blood Fu ling transforms water

Formula Actions Jin Gui Yao Lue Line 20 5 Wiseman Wilms For women s tense pain in the abdomen during pregnancy Dang Gui Shao Yao San governs Commentary After conception blood gathers to nourish the fetus hence yin blood becomes relatively vacuous The liver is the unyielding viscus and if it is not emolliated and moistened it Is not harmonious Thus the liver blood becomes vacuous and orderly reaching is impaired Therefore the blood becomes stagnant and causes tension Formulas and Strategies Actions Nourishes liver blood spreads the liver qi strengthen spleen resolves dampness Indications continuous cramping pain of the abdomen that is not severe urinary difficulty slight edema pregnancy or other gyn disorders Disharmony of liver and spleen Modern Research Shown to activate and regulate the uterine ovarian pituitary axis and the circulatory system Also shown to be anti inflammatory analgesic

Symptom Analysis Body type Blood deficiency type or damp watery type Type of pain We have the possibility of multiple types of pain with this formula Sharp stabbing blood stasis pain Heavy distended water damp pain But the pain that is described in the text is blood deficiency pain causing tightness spasming and a cramping type of pain We see the original dose of Bai shao is very high indicating that the formula is meant to treat pain due to crappy blood not just blood stasis The treatment principle is not a method of pushing the blood through the pain rather it is about improving the quality of the blood so that it flows smoothly Edema This is usually in the lower limbs but it is not kidney yang defiance the root is the spleen so we see it in the flesh

Symptom Analysis and Expansion Symptoms expanded Where can we see the blood and water pathology Blood deficiency menses light or not flowing at all pale dry lustreless complexion poor night vision and floaters pale tongue or peachy tongue especially sides Also see tightness spasming pain and dry skin and hair Blood stasis pain darkish or purple skin signs dusky tongue body color is common in this pattern sublingual veins vascular abnormalities Water buildup discharges vaginal nasal sweat urination etc swellings and cysts edema and puffiness dizziness nausea heavy headedness Urinary difficulty watery menses Tongue It can show up in different ways depending on which aspect of the conditions is prominent See combinations of puffy tongue pale or dusky body sublingual veins purple or swollen dryness or wetness or combined Abdomen Can be flaccid or tight Both are signs of deficiency Often will see both squishy but with tightness of the rectus abdominus reflecting the combination of dryness and dampness Often the okestsu sign will be present Pulse can also be varied thin and deficient or spread out large and deficient Can also see unevenness choppy quality or a tight quality showing more stagnation

Dang Gui Shao Yao San Unpacked Blood herbs Dang gui see notes above Bai shao sweet and sour it softens relaxes stops pain constrains the liver tonifies the blood With Dang gui it is the yin aspect Bai shao regulates the liver by nourishing and containing With Dang gui this pair is best for stopping pain in deficiency conditions Chuan xiong warm and acrid and moving moves qi and blood to stop pain Combined with Dang Gui and bai shao it can generate new blood Water herbs Do these herbs really drain excess water Bai zhu Slightly bitter and drying it parches downward Improves the ability of earth spleen to regulate water Improves absorptive capacity of the spleen It banks up the earth Fu ling With Ze xie below drains and improves function at Spleen level We can say that these two percolate dampness one at the spleen level and one at the kidney level Ze xie Downbears water strengthens kidney functions of regulating water in the lower jiao

Formulas that are found within Dang Gui Shao Yao San Shao Yao Gan Cao Tang increase Bai shao and add Gan cao for this action of stopping pain and softening spasms Si Wu tang Wu ling San Add Gui zhi for more activating on cold water Ze Xie Tang increase Ze xie for this action Ze Xie Tang treats dizziness and vertigo due to water rising out of right relationship Ze xie homes to the kidneys and descends water and qi to the lower jiao Xiao Yao San This formula is similar in its liver spleen harmonizing action but different

Commonly Used Formula Modifications Severe pain Mu xiang yan hu suo Dizziness anxiety insomnia Gou teng lian zi xin Epigastric distention poor appetitie Chen pi fo shou Low back pain Du Zhong xu duan More lower jiao water accumulation Che qian zi Cold Xiao hui xiang wu zhu yu wu yao gui zhi rou gui Rib side pain Chai Hu or Si Ni San Damp heat in lower jiao Huang bai yi yi ren

Dang Gui Shao Yao San Conditions Other conditions that may present with a Dang Gui Shao Yao San pattern Dysmenorrhea PMS menopausal symptoms edema cough wheeze sinusitis dizziness Meniere s disease vaginal discharge malposition of fetus hypertension coronary heart disease kidney disease Men s disease impotence nocturnal emissions prostatitis hydrocele

Dang Gui Shao Yao San and Pregnancy To protect and grow the fetus blood must be both plentiful and free flowing If water and blood are not harmonized we will get edema puffiness and fullness in the tissues with poor blood flow to the uterus This can result in many pregnancy complications Early pregnancy is governed by Jue yin and then Shaoyang following it The blood is key to protecting the growth of the fetus habitual miscarriage is almost always a blood problem not a spleen problem Harmonizing the blood improving he blood improves circulation of blood and warmth to uterus Calms spasms pain and promotes growth Blood brings warmth openness and light The Jue yin movement of spreading up and out helps to create the capillary system that becomes the placenta Allows for growth and life to take hold Later pregnancy is marked by dramatic growth Blood volume needs to be full fluids need to fill the amniotic sac nutrition needs to flood into the uterus to promote growth Thickness of the blood hampers circulation Water metabolism impaired can affect amniotic fluid levels Both situations can lead to complications Labor and delivery Regulates uterine contractions calms and smooths muscles Poor blood flow affects pain levels and the ability to relax The formula can assist in repositioning a breech or a posterior position as well as improving blood flow to promote a smooth passage

Dang Gui Shao Yao San and Pregnancy Pregnancy conditions that can be related to crappy blood and water Miscarriage failure to develop premature labor pre eclampsia eclampsia post partum difficulties difficult labor malposition of fetus High blood pressure Holistic Midwifery The mothers body tried to compensate for a contracted blood volume by attempting to supply the placenta although it doesn t have a large enough blood volume to do so properly In response to a low or falling blood volume the kidneys produce renin which contracts the blood vessels This is the same mechanism which raises blood pressure in order to preserve vital organs after blood loss From our perspective we can identify the patterns of blood deficiency blood stasis and water imbalance before this cycle starts and hopefully treat preventatively Hypertension and edema are late signs We can work to prevent these scenarios Dr Xia Gui Cheng Modification Add Su geng to regulate liver qi and calm fetus and Sang ji sheng to support kidneys and blood

Case Study Ovarian Cysts 39 yo F CC Ovarian cyst Patient feels pain with ovulation Ultrasound reveled an ovarian cyct on the L side Not severe pain more pressure with sharp localized pain Also feels pelvis imbalance and psoas problem Yoga helps History of left side herniated disc and left side ACL tear Has been fatigued very a few months Legs feel heavy and tired Sleeping well through night but not rested experiencing brain fog Cycle is regular Feels like she has to pee a lot during the period with pressure feeling Period pain is moderate level PMS significant water retention about 5 lbs Feels tight and full Experienced fertile cervical mucous but also gets watery discharge with PMS Has gained weight recently and is not sure why Diet and exercise levels consistent Temperature tends to feel cold cold hands and feet Sweat feels normal Stress is high feels like lt is hard to move forward Mood is pretty balanced Moderate anxiety nervousness Feels vulnerable Abdomen hypochondriac sign R okestu L lower jiao empty T pale puffy scalloped wet SLV Pulse L thin and deep R chi position full and wiry not flowing to upper

Case Study Ovarian Cysts continued Diagnosis Water damp accumulation Blood stasis Spleen deficiency Formula Dang Gui Shao Yan San Gui zhi Activate blood and water circulation warm and acrid and moving Bai jie zi warms and activates movement dissipates nodules Kun bu salty breaks down cysts Li zhi he regulate qi and stops pain in liver channel especially good for ovaries Bu gu zhi strengthens spleen and kidney yang Initial results Much less abdominal swelling flow of period smoother less heaviness in lower body less swelling less pressure Feels warmer overall no pain with the next ovulation

Dang Gui Shao Yao San for Ovarian Cysts Textbook patterns spleen qi deficiency phlegm damp accumulation of phlegm and blood stasis damp heat and blood stasis Most of the formulas are designed to crack stasis regulate qi and transform phlegm Gui Zhi Fu Ling Wan Shao Fu Zhi Yu Tang What is not understood is that cysts are different than other abdominal masses They are primarily patterns of blood and water mixed together Dang Gui Shao Yao San is more appropriate Poor blood circulation leads to water build up Or Water buildup leads to poor blood quantity and quality The solution is to harmonize blood and water Jin Gui Yao Lue These herbal methods compliment each other They are effective for reversing a pathological condition in which poor blood has caused there to be water and inhibited water has caused the blood to be unharmonious Common Modifications for cysts Move blood and water Yi mu cao Improve water metabolism at kidney Che qian zi Warm and stop pain Gui zhi Wu yao Wu zhu yu Guide to ovaries Lu lu tong Li zhi he Damp heat Huang bai Yi yi ren Bai jiang cao More sharp pain Yan hu suo Chuan lian zi Watery vaginal discharge Shan yao Bai bian dou Yi yi ren

Dr Huang Huang Case Study Dysmenorrhea On August 26 2008 Dr Huang treated Mrs Wang 30 She had a strong physique with a dark yellow lusterless complexion irregular periods an unsettled spirit premenstrual and increasingly worsening abdominal pain during menstruation with dark menstrual blood More severely she also had cold limbs and could lose consciousness with the pain She had dry skin on the lower limbs and spasms in the feet and also reported having headaches dizziness and loose stools sleep disorders timidity palpitations and nervousness Her tongue was large and she had a slippery pulse She mentioned that in the past she had been afraid of heights and small animals Based on her overall condition the patient took Dang Gui Shao Yao San during her period and Wen Dan Tang during the rest of the month Second visit The patients complexion was normal and all symptoms were alleviated This month her period came on time the abdominal pain was relieved and the stools gradually became formed She took the original prescription again Third visit Over the past year she had taken the original prescription from time to time both abdominal pain during the menstruation and the sleep disorders appeared only rarely She felt she still lacked energy during her last period and her pulse was still slippery Dr Huang modified the original prescription She took half a dose daily

Dr Huang Huang Case study continued Fourth visit She felt she had returned to normal reporting that dizziness and headaches were relived However the frequent dreaming remained She continued the previous prescription Commentary Dang Gui Shao Yao San for women who have edema in the lower aspect of the body loose unformed stools or vertigo Dang Gui Shao Yan san is also a beautifying formula when the complexion has become yellow lacks lustre and appears anemic and swollen Wen Dan Tang principally treats one who is easily frightened when touched The most common symptoms of this presentation are nightmares fright fear timidity agitation with lack of peace and changing emotions Useful for phobias and carsickness as well Ban xia constitutional type slightly overweight complaints of nausea vomiting insomnia dreamful sleep palpitations stuffiness in chest dizziness sweating

Case Study Chronic Sinusitis 45 year old F patient CC Chronic Sinusitis Patient complains of chronic sinus congestion for many years Thick white clear mucous is often present but alternates with dryness and crusty in the nasal passages It is clearly worse with consumption of dairy sugar and wine Decongestant herbs work but can be drying and lead to dry throat and sinuses Seasonal allergies cause itching and sneezing with clear runny nose but do not seem to increase the congestion itself In addition she often feels water or phlegm in the back of the throat that leads to throat clearing or coughing Digestion tends to bloating easily Bowels tend to be slow will often skip a day alternates between loose sometimes and formed Urination seems normal Tends to feel cold Has aversion to wind Sweats easily and excessively Easily gets body odor Energy is low Body feels heavy Tends to feel swollen in hands and legs easily Menses very light flow mostly brown spotting 1 day red flow with clotting then more brown spotting Heaviness not cramping pain Observation Puffy swollen ankles and spider veins on lower legs Pulse deep weak L side thin Tongue puffy tooth marked pale with dusky hue red tip watery white coat Palpation abdomen is soft and flaccid okestsu sign is present as well as water sounds Flesh is soft Skin is dry and rough

Case Study Chronic Sinusitis continued Diagnosis Spleen deficiency tongue signs abdomen Damp accumulation in the flesh swelling in hands and legs congestion and water in nose and throat Worse with humidity and damp producing foods Blood deficiency very light menses dry skin Blood stasis dusky tongue body oketsu sign on abdomen spider veins dark clotted menses rough skin Secondary patterns poor processing on surface Tai yang Formula Dang Gui Shao Yao San Xin Yi San Ban Xia Hou Po Tang xin yi hua di long huang qin ban xia zi su ye hou po This formula addresses both the root of blood and water disharmony and the branch symptoms of congestion and water in the upper jiao