Sheng Yang Yi Wei Tang (Upbear Yang & Boost the Stomach Decoction) is one of Li Dong-yuan's famous formulas from the Pi Wei Lun (Treatise on the Spleen & Stomach).^[1] It is found in Chapter 4, "Treatise on the Lungs in Relationship to Spleen-stomach Vacuity," of Book 1 of that famous Jin-Yuan dynasty work. As such, it is a yin fire formula. Li indicates it for fatigue, generalized heaviness, painful joints, a bitter taste in the mouth, melancholy and despondency, poor appetite, abnormal defecation, frequent urination, and a dry tongue due to a combination of spleen-stomach vacuity complicated by lung qi (and possibly fluid) vacuity.^[2] In this case, downward fall of the central qi results in confinement and depression of yang in the lower burner which gives rise to upward stirring of ministerial or yin fire. The causes of this condition which Li gives are summerheat dampness and heat damaging the spleen and possible damage by autumnal dryness. However, this formula can be used at other times than late summer and autumn. For instance, Bensky and Barolet say that this formula is also used today for problems with the upper burner lungs which then lead to problems of the lower burner, such as abnormal vaginal discharge. Similarly, Zhang Qi and Long Jia-jun, in an article published in the January 2001 issue of Xin Zhong Yi (New Chinese Medicine), describe several other "new" uses of this formula.^[3]

The patient was a 37 year old female who was first examined on Apr. 2, 1998. For the past two years, this woman had had frequent, urgent urination and low back soreness. Fatigue or irregular diet easily led to the occurrence of these symptoms. She had been examined and treated at a number of different hospitals and clinics, and urine examinations for bacteria had all been negative, and gynecological examinations had revealed no abnormalities. Based on urological examination, the patient was diagnosed as suffering from urethral syndrome. Previous use of a number of different types of antibiotics and Chinese kidney-supplementing and strangury flow-freeing Chinese medicinals had all been ineffective. Therefore, she had come to see Drs. Zhang and Long.

At the time of this examination, there was frequent, urgent urination, insidious lower abdominal pain, low back soreness, lack of strength, no thought for food or drink, epigastric distention, a pale, fat tongue with teeth-marks on its edges and thin, yellow, slimy fur, and a fine, slippery pulse. These symptoms were categorized as central vacuity qi fall with damp heat pouring downward. Therefore, the treatment principles were to supplement the center and upbear yang, transform dampness, clear and disinhibit. Hence the formula chosen was Sheng Yang Yi Wei Tang Jia Jian (Upbear Yang & Boost the Stomach Decoction with Additions & Subtractions): Radix Codonopsitis Pilosulae (Dang Shen), stir-fried Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Ledebouriellae Divaricatae (Fang Feng), Radix Et Rhizoma Notopterygii (Qiang Huo), and Radix Angelicae Pubescentis (Du Huo), 10g each, Sclerotium Poriae Cocos (Fu Ling), 12g, Rhizoma Pinelliae Ternatae (Ban Xia), 6g, vinegar stir-fried Radix Bupleuri (Chai Hu), Pericarpium Citri Reticulatae (Chen Pi), and mix-fried Radix Glycyrrhizae (Gan Cao), 5g each, mix-fried Radix Astragali Membranacei (Huang Qi), Radix Albus Paeoniae Lactiflorae (Bai Shao), and Rhizoma Alismatis (Ze Xie), 15f each, and Rhizoma Coptidis Chinensis (Huang Lian), 3g. One ji of these medicinals was decocted in water and administered per day.

After taking seven ji of the above formula, the symptoms of urinary frequency and astringency had decreased. Therefore, the same medicinals were prescribed for another half month, at which time all the woman's symptoms were eliminated. Modifications of the above formula were made and the formula was again prescribed for a half month in order to secure and consolidate the treatment effect. On follow-up after two years, there had been no recurrence.

According to the Chinese authors, this was a case of central qi falling downward resulting in water dampness becoming obstructed internally. These had become depressed and had transformed heat. This heat had then poured downward and resulted in strangury condition. However, the root of this disease was a spleen-stomach vacuity. Within this formula, Dang Shen, Bai Zhu, and Huang Qi supplement and boost the spleen and stomach. Fang Feng, Chai Hu, and Qiang Huo upbear and raise spleen yang. The ingredients of Er Chen Tang (Two Aged [Ingredients] Decoction) fortify the spleen and dry dampness, while the ingredients of Shao Yao Gan Cao Tang (Peony & Licorice Decoction) relax the center and stop pain. These are combined with Huang Lian which clears heat and with Ze Xie and Du Huo which abduct dampness, hence promoting the discharge of evils via urination. When all these medicinals are combined together, they regulate and harmonize the spleen and stomach, downbear the turbid and upbear the clear.

The patient was a 43 year old female who was first examine don Oct. 9, 1997. This woman had suffered from atrophic gastritis for nine years and from chronic cholecystitis for one year. Ultrasonography showed that her gallbladder was obstructed. Previously, the woman had been treated with Western medicinal choleagogues as well as with Chinese ready-made gallbladder-soothing medicines and liver-coursing, gallbladder-disinhibiting decoctions. However, the treatment effects were not marked, and the woman had come to the Chinese authors for examination.

At the time of this examination, there was upper right abdominal discomfort and insidious pain. Sometimes, this pain referred to her right shoulder, and it was made worse by eating oily, slimy foods. Her appetite was not good and her body and limbs were fatigued. The patient's stools were loose and without form, her tongue was pale red with teeth-marks on its edges and thin, yellow, slimy fur, and her pulse was fine and bowstring. Therefore, the pattern was categorized as enduring disease of the spleen and stomach with damp heat obstructing internally and liver-gallbladder depression and stagnation. The treatment principles were to supplement the spleen and strengthen movement, transform dampness and clear heat, and to course the liver and disinhibit the gallbladder. The formula used was Sheng Yang Yi Wei Tang Jian Jian: Radix Codonopsitis Pilosulae (Dang Shen) and stir-fried Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g each, Radix Et Rhizoma Notopterygii (Qiang Huo), Radix Angelicae Pubescentis (Du Huo), Radix Ledebouriellae Divaricatae (Fang Feng), and Rhizoma Pinelliae Ternatae (Ban Xia), 6g each, Pericarpium Citri Reticulatae (Chen Pi), 5g, Sclerotium Poriae Cocos (Fu Ling), 12g, Rhizoma Coptidis Chinensis (Huang Lian), 3g, uncooked Radix Astragali Membranacei (Huang Qi), and Rhizoma Alismatis (Ze Xie), 15g each, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, vinegar stir-fried Radix Bupleuri (Chai Hu), and mix-fried Radix Glycyrrhizae (Gan Cao), 2g. One ji was decocted per day in water and administered.

After taking 14 ji, the right-sided upper abdominal pain had markedly decreased and the patient's appetite had improved. In addition, her stools had formed, and she had one bowel movement per day. Therefore, the same formula with various additions and subtractions was continued to secure and consolidate the treatment effect. Two months later, repeat ultrasound showed that the signs of chronic cholecystitis had all disappeared.

According to Zhang and Long, this woman's movement and transformation had lost their duty. Therefore, the qi had become stagnant and dampness was obstructing, earth was congested and wood was depressed. The liver had lost its coursing and discharging, the bile was congested and stagnant, and the qi mechanism was not smoothly or easily flowing. Thus non-free flow had led to pain. Because the disease had arisen in the woman's spleen and stomach, simply using liver-coursing, gallbladder-disinhibiting ingredients had not been effective. In the treatment of disease, one should search for the root, which, in this case, was the spleen and stomach, not the liver-gallbladder. Within this formula, Dang Shen, Bai Zhu, Huang Qi, Fu Ling, and Chen Pi boost the qi and fortify the spleen, harmonize the stomach and strengthen movement. Chai Hu and Bai Shao regulate the liver and disinhibit the gallbladder. Fang Feng, Qiang Huo, and Du Huo upbeart the clear and downbear the turbid, while Ban Xia and Ze Xie dry and disinhibit dampness, and Huang Lian clears heat. Hence, taken as a whole, this formula invigorates and fortifies the spleen and stomach, soothes and frees the flow of the gallbladder qi, eliminates dampness and clears heat, and thereby eliminates rib-side pain.

The patient was a 42 year old male who was first examined on Oct. 15, 1998. Beginning in 1994, the man had noted disturbance in his erectile function. Initially, he would become erect and hard but this hardness would not endure. Thus he was unable to maintain an erection. This was accompanied by stomach duct distention and pain referring to the rib-side. Previous Western and Chinese medical treatments had not been effective. Therefore, he came to the authors for examination.

At the time of examination, there was impotence and inability to achieve an erection, poor appetite, lassitude of the spirit, lack of strength, a pale, fat tongue with teeth-marks on its edges and thin, white, slimy fur, and a fine, bowstring, slippery pulse. The man also let it be known that he had had chronic gastritis for 16 years. Based on the above, the patient's pattern was categorized as spleen vacuity loss of movement with liver depression not extending. Hence the ancestral sinews were slack and loose. The treatment principles in this case were to fortify the spleen and strengthen movement, course the liver and free the flow of the network vessels. The formula used was Sheng Yang Yi Wei Tang Jia Jian: Radix Codonopsitis Pilosulae (Dang Shen) and Sclerotium Poriae Cocos (Fu Ling), 12g each, stir-fried Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, Rhizoma Alismatis (Ze Xie) and uncooked Radix Astragali Membranacei (Huang Qi), 15g each, Pericarpium Citri Reticulatae (Chen Pi) and Radix Bupleuri (Chai Hu), 5g each, Radix Albus Paeoniae Lactiflorae (Bai Shao), 20g, Radix Ledebouriellae Divaricatae (Fang Feng), Rhizoma Pinelliae Ternatae (Ban Xia), and Radix Et Rhizoma Notopterygii (Qiang Huo), 6g each, Rhizoma Coptidis Chinensis (Huang Lian), 2g, Scolopendra Subspinipes (Wu Gong), 1 strip, and mix-fried Radix Glycyrrhizae (Gan Cao), 3g. One ji was boiled in water per day and administered.

After taking these medicinals for half a month, the patient's condition had markedly improved. He was able to achieve an erection, although he was still not able to maintain it for very long. In addition, his sexual desire had increased. The above formula was continued for another month, after which, the patient's sex life returned to normal and all his other symptoms disappeared. On follow-up after one year, there had been no recurrence.

As Zhang and Long note, this patient had had spleen-stomach disease for some time. His qi was vacuous and movement and transformation no longer reached (his genitalia). This had engendered dampness which had brewed heat. Earth congestion had reached wood, and liver qi had become depressed and bound and was unable to move and extend. Hence the man's channels and network vessels were not smoothly flowing. Therefore, his ancestral sinews were slack and loose and did not lift up, resulting in impotence. Within this formula, Dang Shen, Bai Zhu, and Huang Qi fortify the spleen and boost the qi. Fang Feng and Qiang Huo upbear yang and strengthen movement. Chai Hu and Bai Shao regulate and smooth the flow of the liver qi. Er Chen Tang combined with Ze Xie rectifies the qi and eliminates dampness. Huang Lian eliminates dampness and clears heat. These are then combined with Wu Gong which courses and frees the flow of the blood vessels, thus increasing blood flow to the penis and treating root and branch simultaneously.

^[1] It is composed of: Radix Astragali Membranacei (Huang Qi), Rhizoma Pinelliae Ternatae (Ban Xia), Radix Panacis Ginseng (Ren Shen), mix-fried Radix Glycyrrhizae (Gan Cao), Radix Albus Paeoniae Lactiflorae (Bai Shao), Radix Ledebouriellae Divaricatae (Fang Feng), Radix Et Rhizoma Notopterygii (Qiang Huo), Radix Angelicae Pubescentis (Du Huo), Pericarpium Citri Reticulatae (Chen Pi), Rhizoma Alismatis (Ze Xie), Radix Bupleuri (Chai Hu), Rhizoma Atractylodis Macrocephalae (Bai Zhu), and Rhizoma Coptidis Chinensis (Huang Lian).

^[2] Li Dong-yuan, The Treatise on the Spleen & Stomach, trans. by Yang Shou-zhong & Li Jian-yong, Blue Poppy Press, Boulder, CO, 1993, p. 37-38

^[3] Zhang Qi & Long Jia-jun, "New Uses of Sheng Yang Yi Wei Tang," Xin Zhong Yi (New Chinese Medicine), #1, 2001, p. 71