by Shawn Kirby L.Ac.

A patient comes into your office complaining of mild reflux.  She is thirty eight years old and in relatively good health.  She is a distance runner, very fit, and follows a very clean diet, eating vegetarian 5 days per week.  She reports being “crabby” quite a bit, and wonders if she’s premenopausal.   She also reports fairly intense PMS with her cycle.  Her blood pressure is 140/85.  Without further questioning you diagnose her with a liver spleen/stomach disharmony and prescribe Jia Wei Xiao Yao San (Dan Zhi Xiao Yao San).   She comes back the following week reporting that she feels extremely fatigued, dried out, and her reflux is no better – in fact she thinks it might actually be a little worse.

What happened?

...

There are lots of ways of approaching liver qi stagnation, but in many practitioners’ minds the main thing to do is grab for the old standby, Jiao Wei Xiao Yao San (Dan Zhi Xiao Yao San), particularly after hearing a report of PMS.  Unfortunately, no Chinese formula is ever universally applicable.  There just is no such thing as a panacea, not even Xiao Yao San.

One of the most common patterns that you will see among younger to middle aged women who eat well and are in decent shape is GERD/reflux that is actually a result of liver blood/kidney yin vacuity with liver depression qi stagnation.  The classical formula for this pattern is Yi Guan Jian, or “Linking Decoction.”

Linking Decoction is a very simple, very straightforward formula –

• Sheng Di (uncooked Radix Rehmanniae), Gou Qi Zi (Fructus Lycii), and Dang Gui (Radix Angelicae Sinensis) nourish liver blood and enrich kidney yin.
• Sha Shen (Radix Glehniae) and Mai Men Dong (Radix Ophiopogonis) also enrich yin and engender fluids, (remembering that blood and fluids share a common source and that blood and essence share a common source).
• and Chuan Lian Zi (Fructus Toosendan) courses the liver and rectifies the qi without plundering yin

Here’s the main thing you need to remember about coursing the liver – because qi and blood are essentially head and bird of the same coin, the liver has to have sufficient blood present before you try to shove it, or you won’t have anything to shove and you’ll just wipe your patient out.  The majority of the ingredients in Yi Guan Jian moisten, emolliate, and soften the liver – and then the Chuan Lian Zi does its job of kicking the liver square in the ass.  It's all about tough love.

But where’s the GERD/reflux coming from you ask?  Xiao Yao San treats liver spleen disharmony which is usally caused by emotional upset.  In the case of Yi Guan Jian, liver blood vacuity results in liver depressive heat which attacks the stomach.

One of the most, if not THE most common ways of missing your diagnosis when it comes to Yi Guan Jian revolves around the somatic realities of diagnosis.   Had we asked, we would have heard our patient report mild instances of both chest and ribside/hypochondriac pain.  Why didn’t she think to mention this?  To your western patient, these are just a by-product of stress and/or her exercise regimen and something she simply ignores.  With modern western patients who spend all day in cyberspace, somatic symptoms often have to be asked about due our culturally high level of disembodiment.  Modern western patients don't always volunteer every physical symptom simply because they ignore many of them out of hand.

Yi Guan Jian is a slick little formula and one that, once you become  familiar with it, you are likely to find yourself using again and again, with frequent success.