This formula is originally found in the "Gynecology" section of Li Dong-yuan’s Lan Shi Mi Cang (Orchid Chamber Secret Treasury). Our version is a 15:1 extract.

Rx:

Huang Qi (Radix Astragali)
Shu Di (cooked Radix Rehmanniae)
Rou Gui (Cortex Cinnamomi)
Bai Shao (Radix Paeoniae Albae)
Hong Hua (Flos Carthami)
Dang Shen (Radix Codonopsitis)
Chuan Xiong (Rhizoma Chuanxiong)
Du Huo (Radix Angelicae Pubescentis)
Qiang Huo (Radix Et Rhizoma Notopterygii)
Gao Ben (Rhizoma Ligustici)
Fang Feng (Radix Saposhnikoviae)
Bai Zhu (Rhizoma Atractylodis Macrocephalae)
Dang Gui (Radix Angelicae Sinensis)
Chai Hu (Radix Bupleuri)
Tao Ren (Semen Persicae)
mix-fried Gan Cao (Radix Glycyrrhizae)
Bai Zhi (Radix Angelicae Dahuricae)
Zhi Fu Zi (Radix Lateralis Praeparatus Aconiti Carmichaeli)

Indications: (1) This formula treats menstrual pain, menstrual movement head pain, and menstrual movement body pain due to qi stagnation and blood stasis complicated by spleen qi vacuity, kidney yang vacuity, and blood vacuity; (2) wind cold damp impediment (joint pain) associated with a liver-spleen disharmony.

Signs and symptoms of qi stagnation include:

• lower abdominal distention

• irritability

• lower abdominal cramping premenstrual

• a bowstring pulse

• breast distention and pain

Signs and symptoms of blood stasis include:

• fixed, sharp, and/or severe lower abdominal pain

• a sooty facial complexion

• blood clots in the menstruate

• a purplish tongue or static spots or macules on the tongue

• worsening of symptoms at night

• visible engorged varicosities

• a possibly choppy and/or deep pulse

• small hemagiomas, spider nevi, hemorrhoids

Signs and symptoms of spleen qi vacuity include:

• fatigue, especially after eating

• most commonly a tendency to loose stools

• abdominal bloating after eating

• but possibly constipation

• cold hands and feet

• a swollen tongue with teeth marks on its edges

• lack of strength in the four extremities

• dizziness when standing up

• a fine pulse which is often soggy or soft in the right bar

• easy bruising

• position

Signs and symptoms of kidney yang vacuity include:

• low back pain

• nocturia

• decreased sexual desire

• cold feet

Signs and symptoms of blood vacuity include:

• pale or dry brittle nails

• pale lips

• dry skin

• pale tongue

• decreased visual acuity at night

• a fine pulse

• pale undersides of the eyelids

Disease Mechanisms
The qi moves the blood. If the qi moves, the blood moves. If the qi stops, the blood stops. If there is enduring liver depression, then there is blood stasis. If there is enduring blood stasis, stasis will enter the network vessels. Liver depression is inversely proportional to a sufficiency of blood, spleen qi, and kidney yang. If any of these are vacuous and insufficient, then liver depression will be worse. In addition, blood stasis prevents the creation of new blood and blood is the mother of the qi. Hence blood stasis is often complicated by or accompanies qi and/or blood vacuity.

The Nei Jing (Inner Classic) says that by 35, women become spleen vacuous, while Western women are even more prone to spleen vacuity due to faulty diet, over-taxation, under-exercise, too much thinking, and unfilled desires which damage the liver. The liver becomes depressed and replete and then invades the spleen which becomes vacuous and weak. The spleen and kidneys are mutually rooted. Spleen qi vacuity eventually leads to kidney yang vacuity. Many, if not most, Western women exhibit symptoms of some kidney yang vacuity by the early to mid 40s.

This formula takes into account all the above interrelated theories and disease mechanisms. Because endometriosis worsens during the mid 30s and on into the 40s (probably due to an autoimmune ovaritis), this formula is a good one for treating endometriosis and secondary infertility due to endometriosis in Western women who are 35 years or older and who exhibit a combination of vacuity and repletion patterns.

Combinations
This formula's range of applications can be extended by combining it with other already available ready-made pills. For instance, if there is yin vacuity and not just blood vacuity, it can be combined with Liu Wei Di Huang Wan (Six Flavors Rehmannia Pills). If there is concomitant dampness and phlegm, it can be combined with Er Chen Wan (Two Aged [Ingredients] Pills). For greater pain relief, one may combine this formula with Yan Hu Suo Wan (Corydalis Pills). For even more pronounced blood vacuity and blood stasis, one can combine this formula with Tao Hong Si Wu Tang Wan (Persica & Carthamus Four Materials Decoction Pills), etc.

Formula explanation
Within this formula, Codonopsis, Astragalus, Atractylodes Macrocephala, and mix-fried Licorice all fortify the spleen and supplement or boost the qi. Peony, Dang Gui, and cooked Rehmannia all nourish the blood and enrich essence as well as emolliate and harmonize the liver. Cinnamon and Aconite both invigorate and warm yang. Angelica Dahurica, Angelica Pubescens, Notopterygium, Ledebouriella, and Ligusticum Sinensis dispel and eliminate wind, cold, and dampness, free the flow of impediment, and stop pain. Persica, Carthamus, Dang Gui, and Ligusticum Wallichium quicken the blood and transform stasis. Bupleurum and Cimicifuga upbear yang and disinhibit the qi mechanism. To some extent, all the wind, cold, damp medicinals also help upbear clear yang. Angelica Dahurica and Ligusticum Sinensis are a very strong pain-relieving combination. Licorice also acts to harmonize all the medicinals in this formula.

Dosage
Three capsules two times per day equal not less than 45g of raw medicinals. However, because our extraction process is so much more efficient than stove-top decoction, we believe that this amount of our extract is actually more like the equivalent of 60-90g of bulk-dispensed herbs.