by Laura Stropes
TCM Functions: Nourishes Blood, Tonifies Qi, Strengthens the Kidneys, Warms the Uterus, Regulates the Chong and Ren Channels, Calms the Fetus
TCM Diagnosis: Blood deficiency, Spleen and Kidney Qi and Yang deficiency, and cold accumulation in the Uterus.
Presentation: trying to conceive, long menstrual cycles, irregular menstruation, decreased amount of menstrual blood with small clots, premenstrual backache, occasional spotting between menses, lengthy postpartum spotting, decreased libido, occasional fatigue, digestive weakness, abdomen cool to the touch, cold extremities, occasional postural dizziness, poor muscle tone, low back and knee weakness, pale skin, lips, nails, and complexion.
Tongue: pale, possibly dusky
Pulse: thready, choppy
Formula: Dang gui/Angelica sinensis root 11.4%, Shu di huang/Rehmannia glutinosa root-prep 11.4%, Bai zhu/Atractylodes macrocephala rhizome 11.4%, Bai shao/Paeonia lactiflora root 8.5%, Chuan xiong/Ligusticum chuanxiong rhizome 8.5%, Xiang fu/Cyperus rotundus rhizome 8.5%, Yi mu cao/Leonurus japonicus herb 8.5%, Du zhong/Eucommia ulmoides bark 5.7%, Huang qi/Astragalus membranaceus root 5.7%, Ai ye/Artemisia argyi leaf 5.7%, Fu ling/Poria cocos fungus 2.9%, Mai men dong/Ophiopogon japonicus tuber 2.8%, Gan cao/Glycyrrhiza uralensis root 2.8%, Chen pi/Citrus reticulata peel 2.8%, E jiao/Equus asinus gelatin 2.8%, Sha ren/Amomum longiligulare fruit 0.6%.
Dosage & Administration: The standard dosage is 8 pills, 3 x day. In severe cases or in the initial phases of treatment, dosage may be increased to 10-12 pills 3 times per day, then reduced to a maintenance dose as the treatment takes effect. Administer half an hour before or one hour after eating for optimal digestion & absorption. May be used long-term for several weeks to several months. Repeat courses of treatment may be administered over several years.
Cautions & Contraindications: Contraindicated for early stages of acute infection or illness, such as cold or flu. Use with caution in patients with phlegm dampness conditions.
Clinical Comments: Based upon Zhang Zhongjing's classical formula, Jiao Ai San (Shu di huang, Bai shao, Dang gui, Ai ye, Chuan xiong, E jiao, Gan cao) with the additions of Yi mu cao, Xiang fu, Du zhong, Huang qi, Bai zhu, Fu ling, Mai men dong, Chen pi, and Sha ren. Jiao Ai San is indicated for a restless fetus due to instability and deficiency of the Chong and Ren Mai from Blood deficiency and cold in the lower abdomen. The additional herbs in Yang Rong Wan add the ability to invigorate the flow of Qi and Blood, strengthen the Kidneys and the lower back, and greatly increase the ability to calm a restless fetus.
The formula's primary focus is on the acute branch problem of the Blood, but it also treats the root cause of the disorder by stabilizing and nourishing the Chong and Ren Mai. Interestingly, although designed for a restless fetus, it contains invigorate Blood herbs, which are usually avoided during pregnancy. Therefore, it is a useful formula to treat other issues due to mild Qi and Blood stagnation in pregnant women. Often, it is used before pregnancy to treat women with a similar presentation who are prone to a restless fetus. It is also a good general tonic following menstruation, for women who occasionally spot in between periods, and to support post-partum recuperation.
Additionally, Yang Rong Wan is a powerful formula to optimize fertility, particularly useful to warm the Uterus and support Kidney Yang while not being overly hot or drying. As such it can even be used during the follicular phase of the menstrual cycle if there are Yang deficiency symptoms, such as the basal body temperature being very low and consistently under 96.6° F. It may be used during the whole cycle to promote smooth ovulation and warm the Uterus, possibly with the addition of a more warming Yang tonic in the luteal phase. It may also be used to benefit male fertility by supporting sperm volume and motility.
Dang gui is a key herb in gynecology to simultaneously tonify and invigorate the Blood to support women’s normal menstruation and healthy hormone balance. Shu di huang, Bai shao and Chuan xiong work with Dang gui as in Si Wu Tang to strongly nourish and gently invigorate the Blood, to in turn nourish and regulate the Chong and Ren channels. Huang qi works with Bai zhu, Fu ling and Gan cao as a modified Si Jun Zi Tang to tonify and raise the Qi, particularly that of the Uterus. Bai zhu, Du zhong, Ai ye, E jiao and Sha Ren all calm a restless fetus. Bai zhu is particularly effective in cases of restless fetus due to Spleen deficiency, and classically indicated in combination with Shu di huang and Bai shao for restless fetus due to Blood deficiency, with Chen pi for Qi stagnation and with Du zhong for Kidney deficiency, all of which are included in this formula. Du zhong is excellent for stabilizing the fetus and when combined with Qi-raising herbs such as Huang qi as it is here, can address symptoms of Qi sinking such as a dragging or pulling sensation in the pelvis, or exhaustion. Xiang fu and Yi mu cao work together to invigorate the flow of Qi and Blood, gently dispel stasis, and regulate the Chong and Ren channels without damaging Qi or Blood. Ai ye, E jiao and Shu di huang combine to tonify the Blood, warm the Uterus, and calm a restless fetus. Mai men dong supports Shu di huang in nourishing Yin and body fluids. Sha ren calms a restless fetus and works with Chen pi to regulate digestive Qi and prevent herbs such as Shu di huang from being too heavy or cloying to digest.
References:
- The Clinical Manual of Chinese Herbal Patent Medicines, 3rd Edition, by Will Maclean with Kathryn Taylor, Pangolin Press, 2016.
- Chinese Herbal Medicine – Materia Medica, 3nd Edition, by Dan Bensky, Steven Clavey and Erich Stoger, with Gamble, Eastland Press, 2004.
- Chinese Medical Herbology and Pharmacology, by John Chen & Tina Chen, Art of Medicine Press, 2004.
- Essential Chinese Formulas – 225 Classical and Modern Prescriptions, by Jake Fratkin, Shya Publications, 2014.
- 160 Essential Chinese Herbal Patent Medicines, by Bob Flaws, Blue Poppy Press, 1999.
- Chinese Patent Medicines, A Beginner’s Guide, by Mark Taylor, Global Eyes International Press, 1998.
