This formula is a combination of Er Xian Tang (Two Immortals Decoction), Er Zhi Wan (Two Ultimates Pills), and Gan Mai Da Zao Tang (Licorice, Wheat & Red Dates Decoction) with modifications based on the teachings of Dr. Yu Jin at the Yue Yang Chinese Medical Hospital in Shanghai and Bob Flaws’s personal clinical experience. Blue Poppy Herbs’ version is a 10:1 extract.

Rx

Fu Xiao Mai (Fructus Levis Tritici)
Mu Li (Concha Ostreae)
Long Gu (Os Draconis)
Ye Jiao Teng (Caulis Polygoni Multiflori)
He Huan Pi (Cortex Albiziae)
Nu Zhen Zi (Fructus Ligustri Lucidi)
Han Lian Cao (Herba Ecliptae)
Da Zao (Fructus Jujubae)
Fu Ling (Poria)
Zhi Mu (Rhizoma Anemarrhenae)
Huang Bai (Cortex Phellodendri)
Xian Mao (Rhizoma Curculiginis)
Xian Ling Pi (Herba Epimedii)
Dang Gui (Radix Angelicae Sinensis)
mix-fried Gan Cao (Radix Glycyrrhizae)
Shan Yao (Radix Dioscoreae)
Chuan Lian Zi (Fructus Toosendan)
Ren Shen (Radix Ginseng)

Indications:

This formula is for the treatment of menopausal syndrome due to liver blood-kidney yin and yang vacuity complicated by spleen qi vacuity and liver depression. The main symptoms it addresses are hot flashes and night sweats, fatigue, insomnia, irritability, and depression.

The signs and symptoms of liver-kidney yin vacuity are:

• Hot flashes

• Vexatious heat in the five heartsNight sweats

• Possible tinnitus and/or dizziness

• Insomnia

• Low back aching and soreness

• A pale tongue with red tip or a red tongue with scanty, possibly yellow and/or dry fur

• A fine, rapid or surging, possibly rapid pulse

The signs and symptoms of kidney yang vacuity are:

• Cold feet

• Nocturia

• Decreased sexual desire

• A deep pulse in the right cubit position

Signs and symptoms of spleen qi vacuity include:

• fatigue, especially after eating

• cold hands and feet

• abdominal bloating after eating

• lack of strength in the four extremities

• tendency to loose stools but possibly constipation

• dizziness when standing up

• a swollen tongue with teeth marks on its edges

• easy bruising

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

The signs and symptoms of liver depression include:

• lower abdominal distention/cramping

• irritability

• rib-side ain

• premenstrual breast distention and pain

• a bowstring pulse

• chest oppression

Formula explanation: Er Xian Tang was originally created at the Shu Guang Hospital in Shanghai for the treatment of menopausal hypertension but to lack of regulation between the chong and ren associated with liver blood-kidney yin and yang vacuity. In our version, Anemarrhena and Phellodendron clear vacuity heat

and enrich the essence by leading upwardly stirring ministerial fire back down to its lower source. Curculigo and Epimedium supplement the liver and kidneys, invigorate yang, and nourish the blood, thus filling the essence. Dang Gui nourishes and quickens the blood, and, "The blood and essence [have] a common source."

The ingredients in Er Zhi Wan consist of Eclipta and Ligustrum. These two medicinals strongly nourish the blood and enrich yin. In addition, Eclipta clears heat and cools the blood. These two medicinals supplement yin but are not either slimy or stagnating as is Radix Rehmanniae (Di Huang). Since spleen vacuity commonly complicates most Western cases of menopausal syndrome, this is an important consideration. Gan Mai Da Zao Tang is the main Chinese formula for the treatment of visceral agitation. Visceral agitation is typically seen in females either at adolescence or menopause and describes a paroxysmal mental state characterized by melancholy, depression, and emotional lability. The ingredients in Gan Mai Da Zao Tang include mix-fried Licorice, blighted Wheat, and Red Dates. Licorice supplements the spleen and heart qi, while Red Dates supplement the spleen and nourish heart blood. Together, these two medicinals nourish, construct, and quiet the heart spirit. Blighted Wheat likewise supplements the heart and quiets the spirit. In addition, it astringes yin and stops abnormal sweating.

To this base are added Oyster Shell and Dragon Bone to astringe yin and stop sweating, settle the spirit and quiet the mind, subdue yang and downbear counterflow. Albizzia and Caulis Polygoni both quiet the spirit by nourishing the heart and resolving depression. In addition, Albizzia quickens the blood. Melia helps course the liver and rectify the qi without plundering yin the way Radix Bupleuri (Chai Hu) might. The liver’s coursing and discharging is also aided by yang’s warming and steaming of the liver and all the blood-supplementing medicinals’ nourishing of the blood. The liver can only function if A) it is warmed and steamed by ministerial fire and B) it obtains sufficient blood to nourish its function. Ginseng and Poria both supplement the spleen, thus supplementing the heart and quieting the spirit. Finally, Dioscorea supplements the spleen and kidney qi without being drying the way Rhizoma Atractylodis Macrocephalae (Bai Zhu) would be. Perimenopausal kidney yang vacuity is an evolution of spleen qi vacuity. This spleen qi vacuity does not suddenly disappear when vacuity detriment "reaches the kidneys." Thus the kidney yang vacuity of menopausal syndrome is really a spleen-kidney yang vacuity.

When these medicinals are used together, they nourish liver blood, invigorate and enrich kidney yin and yang, for-tify the spleen and boost the qi, nourish the heart and quiet the spirit, harmonize and soften the liver and subdue yang.

Cautions & contraindications: Epimedium and Curculigo have a pronounced empirical regulating effect on female hormonal function in general and ovarian function in particular. However, because Curculigo is considered to have some toxins according the Chinese medicine (in the same way that Rhizoma Pinelliae Ternatae, Ban Xia, is also considered to have toxins), it is generally considered inappropriate for long-term use. Menopause consists of the change in direction of flow of the chong mai/bao mai. Instead of yin blood flowing from the heart to uterus for discharge and loss each month, yin and blood flow upward to the heart to nourish and construct the spirit. Women with menopausal syndrome have gotten stuck within the "change of life." Typically, the degree of menopausal symptoms is directly proportional to the degree of liver depression, not the degree of yin or yang vacuity. All changes in the body are mediated by the qi mechanism, and if the liver is depressed or malnourished, the qi mechanism will be inhibited. Hence changes and transformations do not take place easily or smoothly.

The point of this discussion is that the main symptoms of menopausal syndrome – hot flashes, night sweats, insomnia, heart palpitations, etc. – can usually be brought under control within several weeks or a couple of months of remedial treatment. The qi mechanism is disinhibited, the change in direction of flow of the chong mai/bao mai is accomplished, and yin blood is stored and transformed into essence and spirit. Therefore, Curculigo’s harshness and toxicity is not a problem. For long-term prevention of post-menopausal osteoporosis and for generally nourishing life and promoting longevity, post-menopausal patients should be switched to a more balanced and moderate formula, such as Blue Poppy Herbs’ Supplement Yin (Bu Yin Tang), to continue supplementing the qi, blood, yin, and yang without any harsh or toxic medicinals.

Dosage: Three capsules two times per day equal not less than 30g of raw medicinals. However, because our extraction process is far more efficient than stove-top decoction, we believe that this amount of extract is actually more like the equivalent of 40-60g of bulk dispensed herbs.

To get the most out of this treatment, the patient also needs to adhere to a yeast-free, sugar-free, clear bland diet for at least three months, and better for 6-12 months. In particular, the patient should avoid chilled, uncooked foods, greasy, fatty foods, and sweets. In addition they should get regular physical exercise combined with regular deep relaxation and stress reduction.

500 mg per capsule