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Clear & Calm

This formula is a combination of Li Dong-yuan’s Sheng Yang San Huo Tang (Upbear Yang & Scatter Fire Decoction) and the Yi Zong Jian Jian (Golden Mirror of Ancestral Medicine)’s Xie Xin Dao Chi San (Drain the Heart & Abduct the Red Powder) with additions and subtractions. This formula treats irritability, vexation and agitation, insomnia, sores on the tip of the tongue, and urinary urgency, frequency, and burning hot pain due to heart fire effulgence in turn due to a liver-spleen-stomach disharmony. Our version is a 12:1 extract.

Rx:

uncooked Radix Rehmanniae (Sheng Di)	Rehmannia glutinosa root
Tuber Ophiopogonis Japonici (Mai Men Dong)	Ophiopogon japonicum tuber
Sclerotium Poriae Cocos (Fu Ling)	Poria cocos
Radix Codonopsitis Pilosulae (Dang Shen)	Codonopsis pilosula root
Rhizoma Atractylodis Macrocephalae (Bai Zhu)	Atractylodes ovata rhizome
Herba Lophatheri Gracilis (Dan Zhu Ye)	Lophatherum gracilis herb
Radix Rubrus Paeoniae Lactiflorae (Chi Shao)	red Paeonia lactiflora root
Radix Albus Paeoniae Lactiflorae (Bai Shao)	white Paeonia laciflora root
Radix Et Rhizoma Notopterygii (Qiang Huo)	Notopterygium incisum root & rhizome
Radix Ledeboriellae Divaricatae (Fang Feng)	Ledebouriella divaricata root
Semen Plantaginis (Che Qian Zi)	Plantago asiatica seed
Rhizoma Cimicifugae (Sheng Ma)	Cimicifuga racemosa rhizome
Medulla Junci Effusi (Deng Xin Cao)	Juncus effusus pith
Rhizoma Coptidis Chinensis (Huang Lian)	Coptis chinensis rhizome
Succinum (Hu Po)	Amber
Extremitas Radicis Glycyrrhizae (Gan Cao Shao)	Glycyrrhiza uralensis root tips

Indications:

This formula treats irritability, vexation and agitation, insomnia, sores on the tip of the tongue, and urinary urgency, frequency, and burning hot pain due to heart fire effulgence in turn due to a liver-spleen-stomach disharmony.

Signs and symptoms of heart fire effulgence include:

vexation & agitation
restlessness
insomnia
possible heart palpitations
a red tongue with especially red tip
sores on the tip of the tongue
a surging, rapid pulse in the inch position

Signs and symptoms of heat being transmitted from heart to small intestine-bladder include:

urinary frequency & urgency
difficult urination
dark colored urine
burning urinary pain
possible hematuria

Signs and symptoms of liver (stomach) depression transforming heat include:

irritability & easy anger
a bitter taste in the mouth
possible chest, breast, rib-side &/or abdominal pain
possible yellow fur
a bowstring, rapid pulse

Signs and symptoms of spleen vacuity include:

fatigue, especially after eating
lack of strength in the four extremities
a tendency to loose stools
dizziness when standing up
easy bruising
a swollen tongue with teeth-marks on its edges

Disease mechanisms:

Because the lifegate or ministerial fire is the root of all yang qi in the body, liver-stomach depression transforming heat may cause mutually engendering upward stirring of ministerial fire. Li Dong-yuan called upwardly stirring ministerial fire “yin fire.” He also said that yin fire damages the spleen, while spleen vacuity allows such upward stirring by yin fire. Therefore, this upward stirring causes or aggravates spleen vacuity, and spleen vacuity makes upward stirring of ministerial fire all the more likely. Since heat and fire are yang in nature, they inherently ascend. Thus even though yin fire begins in the lower burner, heat evils ascend to the heart where they harass the spirit, resulting in its disquietude. This then causes restlessness, vexation and agitation, and insomnia or profuse dreams. When such depressive heat causes an especially red tongue tip and/or sores on the tip of the tongue, possible accompanied by heart palpitations, and a surging pulse in the inch position, this is called heart fire effulgence. Heart fire effulgence is most commonly an episodic exacerbation of depressive heat due to a combination of stress, faulty diet, and fatigue. If the heart shifts some of these heat evils to the small intestine and thence to the bladder, there is frequent, urgent, dark, difficult, and/or burning urination. When this heart fire abates, the patient typically returns to their chronic, underlying liver-spleen disharmony. Most out-patients only manifest a heart fire effulgence pattern for a few days at a time when under special stress or due to dietary indiscretions (e.g., overeating greasy, oily, fried, spicy, hot, acrid foods and drinking alcohol).

Formula explanation:

Most Western patients with heart fire effulgence manifest this pattern episodically as an aggravation of liver-stomach depressive heat with concomitant spleen vacuity. Dao Chi San does not address this underlying liver-spleen disharmony. Sheng Yang San Huo Tang treats a yin fire scenario resulting in evil heat at the same time as fatigue. However, it treats depressive heat solely by acridly out-thrusting, does not specifically clear or drain the heart, and also does not address any urinary symptoms. When these two formulas are combined with suitable additions and subtractions, it is Bob Flaws’s experience that they fit a larger percentage of Western patients with fewer side effects and quicker, more complete therapeutic effects.

Within this formula, Codonopsis, Atractylodes, and Poria fortify the spleen and supplement the qi, while uncooked Rehmannia and Ophiopogon enrich yin and engender luids, thus protecting yin from damage caused by flaming fire. When the spleen qi is exuberant, ministerial fire is automatically downborne. Similarly, when kidney water is exuberant, heart fire is automatically downborne. Poria, Plantago, Succinum, Juncus, and Lophatherum all clear heat from the heart by seeping water and disinhibiting urination. In particular, Poria and Plantago are used to take over the roles of Caulis Akebiae (Mu Tong), which is avoided in Blue Poppy Herbs’ formulas due to issues about contamination with aristoclochic acid. Coptis and Ophiopogon bitterly and coldy clear heat from the heart. Uncooked Rehmannia and Red Peony clear heat and cool the blood, thus helping to clear heat from both the liver and heart. According to Bensky and Gamble, the combination of Red and White Peony is especially good for relieving irritability due to liver depression.1 White Peony and uncooked Rehmannia also nourish the blood and moisten the liver, therefore helping it to soften and relax. Further, White Peony’s sour astringence protects yin fluids from damage by the windy natured yang-upbearing, exterior-resolving medicinals in this formula. Ledebouriella, Notopterygium, and Cimicifuga are those yang-upbearing, windy natured medicinals. They out-thrust depressive heat. In addition, Ledebouriella harmonizes the liver and spleen, while Cimicifuga clears heat from the stomach and hence is empirically specific for treating sores in the mouth and on the tongue. Ledebouriella & Notopterygium both enter the bladder channel. Succinum also enters the bladder channel as well as the heart and liver. It quiets the spirit at the same time as it frees the flow of urination. Licorice rootlets harmonize all the other medicinals in this formula in addition to “relaxing the tension of wood,”2 which is one of the main mechanisms of heart fire effulgence.

Dosage:

Three capsules two times per day equal not less than 36g of raw medicinals. However, because our extraction process is so much more efficient than stovetop decoction, we believe that this amount of our extract is actually more like the equivalent of 48-72g of bulk-dispensed herbs.

May patient does have the signs and symptoms of:

Heart fire effulgence Yes No
Liver depression-depressive heat Yes No
Spleen qi vacuity Yes No

1 Bensky, Dan & Gamble, Andrew, Chinese Herbal Medicine: Materia Medica, Eastland Press, Seattle, 1993, p. 278
2 Gu Qin Ming Yi Fang Lun (A Treatise on Famous Ancient & Modern Doctor’s Formulas)