This formula is a combination of Dan Zhi Xiao Yao San (Moutan & Gardenia Rambling Powder), Suan Zao Ren Tang (Zizyphus Spinosa Decoction), and Gan Mai Da Zao Tang (Licorice, Wheat & Red Dates Decoction) with additions and subtractions. Xiao Yao San comes from the Song dynasty Tai Ping Hui Min He Ji Ju Fang (Imperial Grace Formula of the Tai Ping [Era]), while Dan Zhi Xiao Yao San dates from the mid-19th century and is first found in Wen Sheng’s Nei Ke Zhai Yao (Selected Essentials of Internal Medicine). The latter two formulas both date from the late Han dynasty and come from Zhang Zhong-jing’s Jin Gui Yao Lue (Essentials from the Golden Cabinet). This combination is based on research carried out in China by Zhang Guo-bin of the Ping Ding Shan Municipal Chinese Medical Hospital in Henan over a five year period from 1995-2003. Our version is a 9:1 extract, 500mg/capsule.

RX

Fu Shen (Sclerotium Pararadicis Poriae)
stir-fried Suan Zao Ren (Semen Zizyphi Spinosae)
Ye Jiao Teng (Caulis Polygoni Multiflori)
Fu Xiao Mai (Fructus Levis Tritici)
Da Zao (Fructus Jujubae)
Wu Wei Zi (Fructus Schisandrae)
Lu Ti Cao (Herba Pyrolae)
Chai Hu (Radix Bupleuri)
Dang Gui (Radix Angelicae Sinensis)
Chuan Xiong (Rhizoma Chuanxiong)
Bai Shao (Radix Paeoniae Albae)
Bai Zhu (Rhizoma Atractylodis Macrocephalae)
Sheng Di (uncooked Radix Rehmanniae)
Dan Pi (Cortex Moutan)
Zhi Zi (Fructus Gardeniae)
Zhi Mu (Rhizoma Anemarrhenae)
Yu Jin (Tuber Curcumae)
Shan Zhu Yu (Fructus Corni)
mix-fried Gan Cao (Radix Glycyrrhizae)

INDICATIONS

This formula is for the treatment of perimenopausal syndrome presenting a pattern of liver-spleen disharmony, liver blood-kidney yin vacuity, and depressive heat harassing the heart spirit above as well as non-construction and malnourishment of the heart spirit. General signs and symptoms include irritability, depression, hot flashes, night sweats, heart palpitations, and insomnia.

SIGNS & SYMPTOMS OF LIVER DEPRESSION QI STAGNATION INCLUDE

• Irritability

• Premenstrual breast distention and pain

• Depression

• A bow-string pulse

• Premenstrual tension (PMT)

• A possibly darkish tongue

SIGNS & SYMPTOMS OF SPLEEN QI VACUITY INCLUDE

• Fatigue (may be mild)

• Cold hands and nose

• Easy bruising

• A possibly fat tongue with teeth-marks on its edges

• Orthostatic hypotension

• Possible loose stools

• A craving for sweets

SIGNS & SYMPTOMS OF LIVER BLOOD-KIDNEY YIN VACUITY INCLUDE

• Pale lips, face, and nails

• Nocturia

• Low back pain and/or knee pain

• Brittle nails

• Tinnitus and/or dizziness

• Night blindness

• A fine and/or floating pulse

SIGNS & SYMPTOMS OF DEPRESSIVE HEAT INCLUDE

• A redder than normal tongue, perhaps only on the tip and/or edges

• A rapid pulse

• Yellow tongue fur

• Hot flashes

• Possible bitter taste in the mouth and/or bad breath

NOTE

While textbooks make a very clear distinction between depressive and vacuity heat, it is commonly depressive heat consuming and damaging yin fluids which gives rise to vacuity heat as well as to ascendant liver yang hyperactivity. Therefore, in real life, it is sometimes not possible. to clearly and absolutely distinguish between depressive heat and vacuity heat, and this formula addresses the cusp between these two.

SIGNS & SYMPTOMS OF HEAT HARASSING THE HEART SPIRIT

• Heart palpitations

• Insomnia

• Vexation, agitation, and restlessness

• Night sweats

SIGNS & SYMPTOMS OF NON-CONSTRUCTION AND MALNOURISHMENT OF THE HEART SPIRIT

• Heart palpitations

• Easy fear and fright

• Insomnia

• Night sweats

• Impaired memory

COMBINATIONS

If spleen vacuity is more, this formula may be combined with Shen Qi Da Bu Wan (Ginseng & Astragalus Greatly Supplementing Pills), Si Jun Zi Wan (Four Gentlemen Pills), or Bu Zhong Yi Qi Wan (Supplement the Center & Boost the Qi Pills). If there is concomitant phlegm dampness, this formula may be combined with Er Chen Wan (Two Aged [Ingredients] Pills). If kidney yin vacuity is more marked, it may be combined with Liu Wei Di Huang Wan (Six Flavors Rehmannia Pills). If there is concomitant blood stasis, it may be combined with Tao Hong Si Wu Tang Wan (Persica & Carthamus Four Materials Decoction Pills), Bu Yang Huan Wu Wan (Supplement Yang & Restore the Five [Tenths] Pills), Huo Luo Xiao Ling Wan (Quicken the Network Vessels Miraculously Effective Pills), or other appropriate blood-quickening formula. However, if correctly selected, this formula should not need much modification or help. If there is concomitant kidney yang vacuity, consider using Ultimate Immortals instead. Once symptoms have been remedied or primarily for perimenopausal low back pain, use Supplement Yin instead.

DOSAGE

Three capsules two times per day equal not less than 27 grams of bulk medicinals. However, because our extraction process is so much more efficient than stovetop decoction, we believe this amount of our extract is actually more like the equivalent of 40-54 grams of bulk-dispensed herbs.

FORMULA EXPLANATION
Menopause or the climacteric is a change in life based on a physiological transformation within the body. In Chinese medicine, all transformations are mediated by the qi mechanism, and it is the liver’s command over coursing and discharge which keeps the qi mechanism freely flowing. While Chinese texts all blame the phenomenon of menopause on depletion of the kidneys and exhaustion of the tian gui (i.e., yin water), the severity and duration of perimenopausal symptoms tend to be proportional not to the degree of yin vacuity but to the severity of liver depression. If the liver qi is freely flowing, then the qi mechanism functions correctly, the change is made without hang-up or hindrance, and, once the change is made, kidney yin can replenish itself since now it is no longer being lost or consumed by menstruation. Therefore, this formula is meant for perimenopausal complaints in women with relatively marked liver depression accompanied by a moderate degree of spleen vacuity and definite liver blood-kidney yin vacuity. In addition, there is depressive heat ascending to harass the heart spirit above at the same time as spleen vacuity leading to a qi and blood vacuity is failing to construct and nourish the heart spirit. Thus there vexation, agitation, restlessness, and disquietude of the heart spirit, while the depressive heat causes hot flashes, night sweats, and heart palpitations.

Within this formula, the ingredients of Dan Zhi Xiao Yao San course the liver, resolve depression, and clear heat, fortify the spleen and nourish the blood. Then the ingredients of Suan Zao Ren Tang nourish the blood and quiet the spirit, clear heat and eliminate vexation, and the ingredients of Gan Mai Da Zao Tang nourish the heart and quiet the spirit, harmonize the center and relax urgency (or tension). The addition of Sheng Di and Shan Zhu Yu further supplements the kidneys, enriches yin, and nourishes the liver. Yu Jin further moves the qi and resolves depression. Ye Jiao Teng further nourishes the heart and quiets the spirit, and Wu Wei Zi calms the heart, quiets the spirit, and constrains sweating. Lu Ti Cao is a wind-treating medicinal which, like many other wind-treating medicinals, also rectifies the qi. It enters the liver and kidney channels and also supplements the kidneys, strengthens the low back and knees, and treats heart palpitations. Research in China suggests that this medicinal can help speed and complete the female change in life. When combined together, these medicinals have the effect of coursing the liver and resolving depression, fortifying the spleen and supplementing the qi, enriching the kidneys and nourishing the liver, clearing the heart, quieting the spirit, and eliminating vexation.

CLINICAL TRIAL

On page 23 of issue #6, 2004 of Ji Lin Zhong Yi Yao (Jilin Chinese Medicine & Medicinals), Zhang Guobin published an article titled, The Treatment of 61 Cases of Climacteric Syndrome with Dan Zhi Xiao Yao San (Moutan & Gardenia Rambling Powder) plus Suan Zao Ren Tang (Zizyphus Spinosa Decoction) with Additions & Subtractions. The 61 women in this study were 45-55 years of age. Twenty-four were premenopausal and 37 were postmenopausal two years or less. These women were treated for 12-36 days with a decocted form of the above formula minus Lu Ti Cao and plus Bo He (Herba Menthae Haplocalysis). Cure was defined as complete disappearance of symptoms, improvement was defined as decrease in symptoms, and no effect meant no effect. Based on these criteria, 41 out of 61 cases were judged cured and the other 20 were improved. Therefore, the total effectiveness rate was 100%.

MY PATIENT DOES HAVE

Liver depression qi stagnation Q Yes Q No
Spleen qi vacuity Q Yes Q No
Liver blood-kidney yin vacuity Q Yes Q No
Heat harassing the heart spirit Q Yes Q No
Non-construction & malnourishment of the heart spirit Q Yes Q No