By Eric Brand

In yesterday's blog I touched on the subject of classical formulas. When students first learn about classical formulas, we often have to memorize their indications for exams; these indications seem obscure and different than typical patient presentations so we don't typically understand classical formulas when we first approach them. As our understanding deepens, the beauty of classical formulas comes to light as we look beyond their archaic indications and into the eloquent herbal pairings and modifications that classical formulas exemplify.

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Dang Gui Liu Huang Tang is not, strictly speaking, a classical formula because it didn't show up until 1276 CE. It was first created by Li Dong-Yuan, one of the four great masters of the Jin-Yuan dynasty. Li Dong-Yuan is famous for his emphasis on the spleen and stomach and yin fire, and Dang Gui Liu Huang Tang is often overshadowed by Li's more famous formulas such as Bu Zhong Yi Qi Tang.

Dang Gui Liu Huang Tang is a formula that treats sweating and vacuity heat. It is typically classified as an astringent formula along with Mu Li San, Yu Ping Feng San, and Si Shen Wan. Mu Li San is a very versatile formula for the branch pattern of sweating, and can be used for sweating from either yang vacuity or yin vacuity. However, Mu Li San does little to address the root problem. Dang Gui Liu Huang Tang simultaneously addresses the root and branch, and is suitable for patients with strong heat signs due to yin vacuity.

Yin vacuity heat is often treated with formulas such as Da Bu Yin Wan and Zhi Bai Di Huang Wan. In contrast to Zhi Bai Di Huang Wan, Dang Gui Liu Huang Tang is much stronger in terms of checking sweating and clearing heat. Patients that primarily complain of sweating and have pronounced heat signs respond well to Dang Gui Liu Huang Tang. The presence of the "three yellows" within the formula gives it a strong heat-clearing principle and also allows the formula to be used in cases that are complicated by damp-heat (the medicinals that treat yin vacuity tend to be rich and warm so patients with damp-heat signs in conjunction with yin vacuity can be tricky to treat).

I've used Dang Gui Liu Huang Tang many times and I've always been quite happy with the results. I think it is underused because people fear the bitter, cold nature and flavor of the three yellows. However, in this formula we see a very eloquent balance of moist and dry, warm and cold medicinals; taken as a whole the formula is perfect for cases of yin vacuity with pronounced heat and a chief complaint of sweating. A translation of the standard Chinese textbook analysis is below:

Source: Lán Shì Mì Cáng (“Secret Treasure of the Orchid Chamber”).

Ingredients

Dāng guī (当归 Chinese angelica, Angelicae Sinensis Radix)
Shēng dì huáng (生地黄rehmannia, Rehmanniae Radix)
Shú dì huáng (熟地黄 cooked rehmannia, Rehmanniae Radix Praeparata)
Huáng qín (黄芩 scutellaria, Scutellariae Radix)
Huáng lián (黄连 coptis, Coptidis Rhizoma)
Huáng bǎi (黄柏 phellodendron, Phellodendri Cortex)
Huáng qí (黄芪 astragalus, Astragali Radix)

Method: Use equal parts of all the medicinals except for huáng qí (Astragali Radix), which is used at twice the dose of the other medicinals. Traditionally, the medicinals were powdered and taken in doses of 5 qián (15 g), decocted in two cups of water. The decoction was reduced to one cup and was taken before meals, with the dosage reduced in half for children. In the modern day, it is often prepared as a decoction, with modifications in dosage based upon the presenting signs.

Actions: Nourishes yin and drains fire, secures the exterior and checks sweating.

Indications: Yin vacuity with fire, manifesting in heat effusion and night sweats. The face may be reddish, and there may be heart vexation, dry mouth and lips, constipation and yellow urine.

Tongue and Pulse: Red tongue, rapid pulse.

ANALYSIS

Internal heat steaming gives rise to yang exuberance and yin vacuity. The construction-yin is not safeguarded and the defense yang is insecure, causing heat effusion and night sweats. Vacuity fire flames upwards, causing the reddish face and heart vexation. Fire wears on the yin-liquids, causing the dry mouth and lips.

Dāng guī, shēng dì huáng, and shú dì huáng foster yin and nourish blood, and bank up the root to clear the internal heat. They are the sovereigns.

The “three yellows” drain fire and eliminate vexation, they clear heat to consolidate yin. They are supporting medicinals here.

Huáng qí is an assistant here. It is used at twice the dose of the other medicinals, and it boosts qi and secures the exterior to check sweating.

As a whole, the formula simultaneously nourishes blood and fosters yin while draining fire. When yin is secure, water can control fire; when heat is cleared, it no longer wears on yin. By boosting qi and securing the exterior while fostering yin and draining fire, the formula reaches both the interior and the exterior, allowing construction-yin to be safeguarded and the exterior to be secured. This allows for the simultaneous treatment of heat in the inner body and sweating in the outer body. Its combination of methods makes it distinct from other formulas that enrich yin and clear heat, drain fire and clear heat, or boost qi to secure the exterior.