Yang He Tang - 陽和湯 - Temperate Yang Decoction

Source: Complete Collection of Pattern and Treatments in External Medicine (1740)

Category: Formulas that Treat Abscesses and Sores

Pattern: Yin-type flat abscesses when Cold or Phlegm congeal in discrete areas and the Yang Qi is too weak to disperse them.

Key Symptoms: Localised painful swellings without a head that blend into the surrounding tissue and do not affect the texture or colour of the skin and are not hot to touch.
Secondary Symptoms: No thirst.

Tongue: Very pale
Pulse: Submerged, thin and forceless

Ingredients

Shu Di Huang

30g

Lu Jiao Jiao

Rou Gui

Pinyin: Rou Gui Chinese: 肉桂 Pharmaceutical: Cortex Cinnamomi Taxonomy: Cinnamomum cassia English: Cinnamon Bark
Tastes: Pungent, sweet, hot Meridians Entered: Kidney, Spleen, Heart and Liver
Actions & Indications: Warms the Kidneys, Spleen and Heart and strengthens Yang and Ming Men Fire Kidney Yang Deficiency and Deficiency of Ming-Men Fire with aversion to Cold, cold limbs, weak back, impotence and urinary frequency Spleen and Kidney Yang Deficiency with abdominal pain and Cold, reduced appetite and diarrhoea Kidney Unable to Grasp Qi Heart Yang Deficiency, particularly with chest Bi Disperses deep Cold, warms the channels, unblocks the channels and vessels and alleviates pain Deep Cold causing Qi Stagnation or Blood Stasis with Cold in the Blood causing amenorrhea or dysmenorrhea, Cold-Damp Bi, Yin-type boils (chronic sores that are usually concave and ooze a clear fluid) and sores or abscesses that do not heal It enters the Blood aspect and, in small amounts, enhances the Blood moving action of other substances Leads the Fire back to its source Upward Floating of Deficient Yang (False Heat, True Cold or Heat Above and Cold Below) with flushed face, wheezing, severe sweating (the sweat pours out like oil), weak and cold lower extremities and a deficient and rootless pulse Any condition with Heat in the Upper body (dry mouth, sore throat, or teeth which is worse at night) and Cold in the Lower body (Lower back pain, cold lower extremities, diarrhoea and weakness in the proximal portion of the pulse) Assists in the generation of Qi and Blood Chronic Qi and Blood Deficiency (auxiliary) Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, enable one to communicate with spirits, make the body light, and prevent forgetfulness. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
Standard Dosage: 1-5g in decoction. It should be decocted later. Cautions: It is contraindicated for syndrome of yin deficiency with fire effulgent, haemorrhage due to blood heat and pregnant women. It is incompatible with Chi Shi Zhi (nineteen incompatibilities).

Pao Jiang

1.5g

Bai Jie Zi

Ma Huang

1.5g

Pinyin: Ma Huang Chinese: 麻黄 Pharmaceutical: Herba Ephedrae Taxonomy: Ephedra sinica seu intermedia seu equisetina English: Ephedra Stem / Joint Pine / Joint Fir / Mormon Tea / Brigham Tea
Tastes: Pungent, slightly bitter, warm Meridians Entered: Lung and Bladder
Actions & Indications: Induces sweating and releases the Exterior Taiyang Stage Wind-Cold Invasion of the Lung, with anhidrosis, chills, fever, headache and a tight, floating pulse Disseminates and facilitates Lung Qi, calms wheezing and stops coughing Wind-Cold Obstructs Lung Qi Promotes urination and reduces oedema Externally generated oedema Warms and disperses Cold pathogens Wind-Cold Bi Cold extremities (Reynaud's disease) *Breaks up concretions, firmness, accumulations and gatherings (Shen Nong Ben Cao Jing)* Yin sores that are firm, deeply rooted and without a head
Standard Dosage: 1.5-9g in decoction to release the exterior, and 10-15g for the treatment of oedema. Maximum dose is 20g. Toxic dose is considered to be 30-45g but side effects and risks are possible at any dosage. Cautions: It is prohibited to be used for patients with deficient dyspnea without blockage of the lung qi and should be used with caution for patients with hypertension and insomnia because ephedrine can stimulate central nervous system and raise blood pressure. The Shang Han Lun recommends removing the nodes and decocting Ma Huang first, scooping the foam from the top of the decoction. It has been argued this is to reduce the "vexing" effects although the efficacy of this is debated and rarely done today. It should not be used in conjunction with MAOIs, central nervous system stimulants, alkaloids ergotamines and xanthines enhancing their effects by acting as a receptor level agonist. In the UK the maximum daily dose permitted without prescription is 1.8g daily in three 0.6g doses. This makes it difficult to achieve a pharmacologically active effect and must be complemented with other herbs that release the exterior and expel Wind-Cold such as Gui Zhi, Jing Jie, Fang Feng and Zi Su Ye. Huang Hua Zi (Sida cordifolia), more common in Ayurveda where it is known as Bala बला, also contains ephedrine at lower concentrations and has no legal restrictions placed on it by the UK MHRA. It is considered more cooling, Heat clearing and Damp draining without Exterior Releasing properties in Chinese medicine so best used as a substitute in Warm Diseases, especially Damp-Warm Disease, or supplemented with increased warm Exterior Releasing herbs like those described above.

Gan Cao

Pinyin: Gan Cao Chinese: 甘草 Pharmaceutical: Radix Glycyrrhizae Taxonomy: Glycyrrhiza uralensis seu glabra seu inflata English: Liquorice Root
Tastes: Sweet, slightly cold Meridians Entered: Heart, Lung and Spleen (and all 12 meridians)
Actions & Indications: Tonifies the Spleen and augments Qi Spleen Qi Deficiency with shortness of breath, lassitude and loose stools Qi and Blood Deficiency with an irregular pulse and/or palpitations Heart Qi Deficiency or Heart Yang Deficiency Moistens the Lungs, resolves Phlegm and stops coughing Lung Heat or Cold Productive or non-productive coughing Moderates spasms and alleviates pain Painful muscle spasms of the abdomen and legs Clears Heat and relieves Fire Toxicity Raw for Toxic Heat with sore throat or carbuncles and sores (Chuang Yung) Antidote for many toxic substances (internal and topical) Poisoning Bites (after washing the wound, chew Gan Cao and apply a thick layer on the bite wound, changing whenever it dries out; Bao Xiang-Ao, 1846, New Compilation of Proven Formulas) Moderates and harmonizes the harsh properties of other herbs and guides the herbs to all twelve channels Often added in small doses to harmonise formulas Tonifies the Qi while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015) Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
Standard Dosage: Typically 1.5-9g in decoction. Large doses can be up 30g. Cautions: It is contraindicated for combining with Hai Zao, Da Ji, Gan Sui and Yuan Hua because of "eighteen antagonisms". It is also contraindicated in cases of dampness obstruction in middle energizer and edema because it can help dampness obstruct qi, and it is prohibited from long-term usage in large dosage (more than 20g/day) and should be avoided or used with extreme caution in patients with high blood pressure because it may raise aldosterone levels in the blood causing retention of sodium. The NHS recommends avoiding during pregnancy.

Subsitutions:
Lu Jiao Jiao is often substituted for Lu Jiao Shuang. In the UK either one has to be substituted as both are animal products. The standard substitutions would be Xu Duan and either Rou Cong Rong or Suo Yang.

Rou Gui may also be substituted with Gui Zhi.

Preparation: Decoction.

Actions: Warms the Yang, tonifies the Blood, disperses Cold and unblocks areas of stagnation.

Contraindications: Yang type swellings, Yin deficiency or swelling that have ulcerated for a long time. If modified the ration of Shu Di Huang to Ma Huang must be followed to avoid worsening the deficiency and aggravating the condition.

Research Links:

American Dragon

TCMWiki

Journal of Chinese Medicine

National Resource Centre for Chinese Materia Medica, China

TCM-ID Integrated Database, East China Normal University

TCM-ID Information Database, National University of Singapore

Pubmed

Science Direct

Google Scholar

Bai Du (Chinese)

A+ Medical Encyclopedia (Chinese)

Reference Notes: (click to display)

These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.

Herb Formulas Notebook

陽 和 湯  Yang He Tang

Temperate Yang Decoction