New Uses of Dang Gui Liu Huang Tang (Dang Gui Six Yellows Decoction)

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM, FRCHM

Keywords: Chinese medicine, allergic purpura, urinary tract infection, viral myocarditis, hypertension

One of the genres of articles in the contemporary Chinese medical journal literature is the “New Uses of...” article. In these articles, the author or authors describe the use of a standard formula, usually a so-called ancient formula, for one or more “off-label” conditions. Off-label conditions are those conditions which are not considered part of the standard indications for that medication. For example, Dang Gui Liu Huang Tang is categorized as a securing and astringing formula, subcategory: formulas which secure the exterior and secure the lungs. This formula was created by Li Gao, a.k.a., Dong-yuan, one of the four great masters of the Jin-Yuan dynasties. It is first found in Li’s Lan Shi Mi Cang (Orchid Chamber Secret Treasury) which was published in 1336. This formula is composed of: Radix Astragali Membranacei (Huang Qi), 12-24g, uncooked Radix Rehmanniae (Sheng Di) and cooked Radix Rehmanniae (Shu Di), 9-15g each, Radix Scutellariae Baicalensis (Huang Qin) and Cortex Phellodendri (Huang Bai), 6-12g each, Radix Angelicae Sinensis (Dang Gui), 6-9g, and Rhizoma Coptidis Chinensis (Huang Lian), 3-6g. Within this formula, Dang Gui, Sheng Di, and Shu Di nourish the blood and enrich yin. Huang Lian, Huang Qin, and Huang Bai clear internal heat, and Huang Qi strongly supplements the qi and secures the exterior. The main standard indication of this formula is night sweats due to yin vacuity-vacuity heat. However, recently, Ding Yu-wei and Xu Ying published an article titled, “New Uses of  Dang Gui Liu Huang Tang (Dang Gui Six Yellows Decoction),” in issue #2, 2001 of Xin Zhong Yi (New Chinese Medicine) (p. 68-69) in which they discuss their use of this well-known standard formula for allergic purpura, urinary tract infection, the sequelae of viral myocarditis, and hypertension.

Allergic purpura

The patient was a 45 year old female who had static macules on her upper back, shoulders, and upper arms. these were acompanied by a slight degree of abdominal pain and profuse, foamy urination which had recurred for the last half year. She had already been diagnosed at another hospital as suffering from allergic purpura and treated with antihistamines. However, the condition had not healed. At the time this patient was seen by the authors of this Chinese article, she had vexatious heat in the five hearts, ductal and abdominal distention and pain, poor appetite, and various sized static macules on both lower limbs. Her urination was yellowish red, profuse, and foamy, while her tongue was red this thin, yellow fur and her pulse was fine and rapid.

Therefore, the patient’s pattern was discriminated as yin vacuity with fire effulgence burning and damaging the network vessels. Hence the treatment principles were to enrich yin and downbear fire, calm the network vessels, and stop bleeding, and her prescription consisted of: uncooked Radix Rehmanniae (Sheng Di), Radix Scutellariae Biacalensis (Huang Qin), Cortex Phellodendri (Huang Bai), Radix Astragali Membranacei (Huang Qi), and Radix Lithospermi Seu Arnebiae (Zi Cao), 15g each, Radix Angelicae Sinensis (Dang Gui), 12g, Flos Seu Herba Schizonepetae Tenuifoliae (Jing jie Sui) and Radix Ledebouriellae Divaricatae (Fang Feng), 9g each, and Rhizoma Coptidis Chinensis (Huang Lian), 6g. One ji of these medicinals was decocted in water and administered orally per day. After five ji the static macules had mostly disappeared and what was left was only scattered static spots. The foamy urination had been eliminated, but the abdominal pain had not yet stopped. Therefore, six grams of Radix Auklandiae Lappae (Mu Xiang) was added, and, after taking 10 more ji, the patient was judged cured. On follow-up after two years, there had been no recurrence.

Urinary tract infection

The patient was a 41 year old female whose complaints were frequent urination, urinary urgency, low back pain, and lack of strength for more than half a year. Urine examination showed urine WBCs (+), RBCs 5/HP, and albumin negative. E. coli in the urine were less than 100,000/mm³. The woman had already been treated with orally administered and intravenous antibiotics but without marked effect. At the time of examination, there was frequent urination, urinary urgency, low back pain, a lusterless facial complexion, a pale tongue with thin, yellow fur, and a fine, forceless pulse.

Based on the above, the woman’s pattern was categorized as enduring disease qi and blood depletion and vacuity with damp heat pouring downward, inhibiting the bladder qi’s transformation. Therefore, the treatment principles were to boost the qi and nourish the blood, clear heat and disinhibit dampness, and the following prescription was written: Semen Plantaginis (Che Qian Zi), 30g, Radix Astragali Membranacei (Huang Qi), uncooked Radix Rehmanniae (Sheng Di), Radix Scutellariae Baicalensis (Huang Qin), and Cortex Phellodendri (Huang Bai), 15g each, Radix Angelicae Sinensis (Dang Gui), 12g, and Rhizoma Coptidis Chinensis (Huang Lian), 6g. One ji of these medicinals was decocted in water and administered per day, and, after seven ji, the low back pain and lack of strength were markedly improved, while the frequent, urgent urination was decreased. Another 14 ji of this same formula was administered and all the patient’s symptoms were eliminated and her urine examination returned to normal. On follow-up after one year, there had been no recurrence.

Sequelae of viral myocarditis

The patient was a 37 year old male. One year previous, the man had experienced a sore throat and fever and then subsequently developed heart palpitations and lack of strength. At that time, the man’s respiration rate was 120-140 times per minute. The patient was diagnosed as suffering from myocarditis and treated with various Western medicines for a half year without obvious improvement. At the time of his examination by the authors of the Chinese article, there were heart palpitations, dizziness, scanty sleep, a red tongue, and a fine, rapid pulse. Based on these signs and symptoms, the patient’s pattern was categorized as heart yin insufficiency with heart fire harassing internally. The treatment principles were to nourish yin and clear heat, calm the heart and quiet the spirit, for which he was prescribed: uncooked Radix Rehmanniae (Sheng Di), Radix Scutellariae Baicalensis (Huang Qin), and Radix Astragali Membranacei (Huang Qi), 15g each, Radix Angelicae Sinensis (Dang Gui), 12g, Radix Scrophulariae Ningpoensis (Xuan Shen), 9g, and Rhizoma Coptidis Chinensis (Huang Lian), 6g. One ji of these medicinals was decocted in water and administered per day. After 14 ji the patient’s heart palpitations had markedly improved. After 21 more ji, all his symptoms were eliminated and his respiration was 80 times per minute. With slight exertion, his respiration rate climbed to 100 times per minute. On follow-up after three years, the patient’s disease condition had remained stable.

Hypertension

The patient was a 51 year old male who had had hypertension for four years. His blood pressure measured 18.7-21.3/12.7-14.7kPa. This was accompanied by dizziness, restless sleep at night, heart palpitations, a flushed red facial complexion, a red tongue with scanty fur, and a bowstring pulse. Based on these signs and symptoms, the man’s pattern was discriminated as liver qi depression and binding transforming fire which had consumed and exhausted liver yin. Thus water was not able to control fire, and this had led to ascendant liver yang hyperactivity. The treatment principles were to enrich yin and clear heat, nourish the blood and quiet the spirit, Therefore, the man was prescribed: Fructus Tribuli Terrestris (Bai Ji Li) and uncooked Radix Rehmanniae (Sheng Di), 30g each, Radix Astragali Membranacei (Huang Qi) and Radiux Scutellariae Baicalensis (Huang Qin), 15g each, Radix Angelicae Sinensis (Dang Gui), 12g, and Rhizoma Coptidis Chinensis (Huang Lian), 6g. One ji of these medicinals was decocted in water and administered per day. After seven ji, the dizziness was markedly improved. After another 14 ji, the restless sleep at night, flushed red facial complexion, heart palpitations, and dizziness had all basically disappeared. The patient’s blood pressure was now 16.0-20.0/10.0-12.7kPa. On follow-up after one year, the patient’s condition was stable.

Conclusion

The over-riding principle of standard professional Chinese medicine is that treatment is primarily predicated on the patient’s pattern discrimination and only secondarily on their disease diagnosis. Therefore, two patient with different disease diagnoses may receive the same Chinese medical treatment, while another two patients with the same disease diagnosis may received very different Chinese medical treatments. The four case histories presented above are good examples of this methodology. Although Dang Gui Liu Huang Tang is primarily indicated for night sweats due to yin vacuity with internal heat, this formula may be used to treat a large number of Western diseases, with or without night sweats. The key to this formula’s use in real-life clinical practice is that the patient has a combination of qi, blood, and yin vacuity with internal heat. In that case, this formula may be made to fit the patient’s disease diagnosis as well as their pattern with a few additions and subtractions.

Copyright © Blue Poppy Press, 2001. All rights reserved.

For more information on Chinese medicinal formulas, see Bob Flaws’s Seventy Essential Chinese Herbal Formulas of Blue Poppy Seminars’ Distance Learning Certificate Program in Chinese Herbal Medicine.