Post Shang Han Run Formulas ② Renshen-Yǎngyíng-Tang (人蔘養營湯) Héjì-Jjúfāng(和劑局方)

By Jubong Kang, K.M.D.

▲ Action and Diagnosis

To understand Renshen-Yǎngyíng-Tang’s action, we need to look this formula over in two components; Huangqi-Jiànzhōng-Tang and Bāzhēn-Tang. The former strengthens the spleen and stomach to promote digestion and to benefit nourishment. The latter supplements and circulates both qi and blood. In other words, the former builds up digestion and absorption to resolve a lack of nutrients; the last reinforces the blood and qi-vitality. The latter formula subdivides again into two prescriptions, which are Sijunji-Tang and Siwu-Tang. Therefore, in Renshen-Yǎngyíng-Tang, three componential recipes are working; Sijunji-Tang helps the functions both of Siwu-Tang and Huangqi-Jianzhong-Tang in digestion and absorption to enhance qi-benefit.

For the abdominal diagnosis, the hypertonicity of Shaoyao is comparatively evident in many cases. Weakness and subsidence of Shudihuang in the lower abdomen and epigastric pressure-pain due to indigestion come out slightly. Besides, extremities’ lethargy, weak pulse, dry skin, hair loss, night sweat, anemia, palpitation, nocturnal emission, and neurotic symptoms such as insomnia, forgetfulness, and dyspnea may appear also.

Shaoyao roles as a monarch drug in Renshen-Yǎngyíng-Tang as well as in Huangqi-Jianzhong-Tang does. This drug dilates the blood vessels to relieve contracted muscles’ pain. The expansion of the intestines’ capillaries can also increase the flowing blood in the digestive organs to promote digestive abilities.

It’s required for perspiration symptom, to increase the amount of Huangqi or Shudihuang according to the syndrome, whether yin-deficiency or qi-deficiency. If the tongue is comparatively dry and red or dark-red due to yin-deficiency, add Shudihuang or Shengdihuang. When the tongue’s state is rather damp and pale, cun-mai is weak or sunken qi-deficiency then increase Huangqi. In the prescription, Wuweizi and Renshen have a meaning of Shengmai-San to alleviate palpitation and sweat, Yuanzhi assists memory to restore forgetfulness.

The source text says that this formula treats feverishness, aversion to cold, extremities’ lethargy, growing thinner, short-breath, loss of appetite, fright, frequent sweat, which are due to lack of qi and blood, caused by the feebleness of the spleen and stomach. In clinics, Renshen-Yǎngyíng-Tang applies to the recovery period of febrile diseases or delivery, in sicknesses of chronic pleurisy, peritonitis, tuberculosis, etc.

▲ Practical Discrimination]

Shuanghe-Tang(雙和湯): The efficacies of Shuanghe-Tang and Renshen-Yangying-Tang are similar. If a person of the former formula’s symptoms has weak digestion, then the latter one is better; inversely, a person who has the former’s symptoms has good digestion, then the latter one is fit. The former Shuanghe-Tang added Sijunji-Tang becomes the latter Renshen-Yanying-Tang; Sijunji-Tang invigorates the spleen and stomach to promote digestion and absorption in Renshen-Yangying-Tang.

Bāzhēn-Tang(八珍湯): In Bāzhēn-Tang, the lower abdomen swells a little due to the blood-stagnation, while, in Renshen-Yǎngyíng-Tang, the lesser abdomen’s swelling is not so noticeable. Bazhen-Tang contains Chuanxiong to resolve the blood-stagnation, marked by swelling or small masses of stagnated blood. If the syndrome of blood-stagnation appears in Renshen-Yangying-Tang, Chuanxiong needs to add to it.

Shíquán-Dàbŭ-Tang(十全大補湯): Bazhen-Tang added to Huangqi and Rougui is Shiquan-Dabu-Tang. In (Renshen-)Yangying-Tang, if Shaoyao decreases to the half amount, and substituted Rougui for Guizhi, then becomes (Shiquan-)Dabu-Tang, so that ingredients and structure of Yangying-Tang and Dabu-Tang are almost equal, and efficacies are similar too. The distinction is whether the shape or meaning of Huangqi-Jianzhong-Tang is in it or not; in Yangying-Tang, Huangqi-Jianzhong-Tang is present; in Dabu-Tang, it’s a modified form as Rouqui instead of Guizhi and half the amount of Shaoyao. It suggests that Yangying-Tang emphasizes the digestion and nourishment of the middle energizer through Huangqi-Jianzhong-Tang included.

For differences between Guizhi in Yangying-Tang and Rougui in Dabu-Tang, the former has a function of warming the channels and promoting blood circulation. The latter can warm and recuperate the gate of life.

Gui-Shao-Zhimu-Tang(桂芍知母湯): For rheumatic arthritis, in the early state, Duhuo-Jisheng-Tang presents a little efficacy, but in a worsening process, no more effect comes out by Duhuo-Jisheng-Tang. If Knee joint pain and swelling with more or less deformation manifest, then Gui-Shao-Zhimu-Tang is applicable.

Danggui-jiànzhōng-Tang(當歸建中湯): When a patient is suffering from lower back pain and leg pain, sign-symptom hypertonicity appears plainly at the abdomen, then instead of Duhuo-Jisheng-Tang, necessary to think about Danggui-Jianzhong-Tang. In this case, the disorder has arisen, not from the feeble kidney-qi. Still, disharmony between nourishing-qi and protecting-qi, and the patient’s constitutional type is commonly taiyang or shaoyin-type. When taiyang or a shaoyin-type person of delicate physical features has a back pain and leg pain, it usually shows hypertonicity, and Danggui-Jianzhong-Tang is suitable.

Guizhijia-Fuzi-Tang(桂枝附子湯): A patient of lumbago with a sign-symptom hypertonicity has cold extremities or feet coldness, aversion to cold, frequent perspiration with cold sensitivity; Guizhijia-Fuzi-Tang is applicable. If the hypertonicity is not so clear, then Guizhiqu-Shao-Jia-Fuzi-Tang is better.

Wǔjiāpí-Zhuàngjǐ-Tang(五加皮壯脊湯): A patient of back pain and knee pain could not get efficacy by almost all lumbago formulas for a long time, if taiyang-type in the constitution, then Wǔjiāpí-Zhuàngjǐ-Tang is applicable to get the effect.

▲ Action and Diagnosis

Duhuo-Jisheng-Tang is a representative formula capable of treating hip and lumbar pain with pricking or numb legs due to spinal disc disorders. That is useful for kidney-deficiency syndrome with wind-dampness and coldness marked by pain over the back and hip, and numbness or lethargy of the lower extremities. In the source text, it says that a person whose kidney-qi is weak lay down on a dampish place, so to get an ache of the back and loins and joint, or exposed himself to the wind and cold so that wind-cold evil invaded into the channels of foot and knee to be painful or swelling of the muscles.

This prescription builds on Siwu-tang; Siwu-Tang combines with added drugs to strengthen yang and to dispel wind-dampness. Siwu-Tang supplements blood and yin to promote blood circulation and consolidate the liver and kidney to enhance the body’s muscles and bones. One of the ingredients Shudihuang subtracts, then the effect of reinforcing hip and legs reduces. Invigorating-yang drugs Sangjisheng and Duzhong arouse muscular movement of the waist, coxa, and legs; Duhuo and Fangfeng of acrid and warm in property can dispel wind-dampness through the pores to relieve back pain, joint and muscle pain, and foot numbness.

For abdominal diagnosis of Duhuo-Jisheng-Tang, subsidence or weakness appears below the umbilicus due to kidney-qi feebleness with yin and blood deficiency; the fur is whitish or a little thick and yellowish, the pulse is generally weak.