Keywords: Chinese medicine, Chinese herbal medicine, Li Dong-yuan, Sheng Yang Yi Wei Tang (Upbear Yang & Boost the Stomach Decoction), chronic urticaria, duodenal ulcers, upper respiratory tract infection

In issue #5, 2002 of Xin Zhong Yi (New Chinese Medicine), Yu You-cheng and Deng Tou-dong published an article titled, "New Uses of Sheng Yang Yi Wei Tang (Upbear Yang & Boost the Stomach Decoction)," on page 64 of that journal. Because this is one of Li Dong-yuan's formulas and I especially admire and make use of Li's yin fire theory, a summary of this article appears below. In its standard form, this formula contains: Radix Astragali Membranacei (Huang Qi), Rhizoma Pinelliae Ternatae (Ban Xia), Radix Panacis Ginseng (Ren Shen), Radix Glycyrrhizae Uralensis (Gan Cao), Radix Ledebouriellae Divaricatae (Fang Feng), Radix Albus Paeoniae Lactiflorae (Bai Shao), Radix Et Rhizoma N o t o p t e rygii (Qiang Huo), Radix A n g e l i c a e Pubescentis (Du Huo), Pe r i c a rpium Citri Reticulatae (Chen Pi), Sclerotium Poriae Cocos (Fu Ling), Rhizoma Alismatis (Ze Xie), Radix Bupleuri (Chai Hu), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Rhizoma Coptidis Chinensis (Huang Lian), uncooked Rhizoma Zingiberis Officinalis (Sheng Jiang), and Fructus Zizyphi Jujubae (Da Zao).

The patient was a 59 year-old female who was first examined in March 1998. The patient had had generalized, recurrent bouts of urticaria with itching for two years. The patient had a habitually vacuous body. Two years previous, a half month after she had had surgery for a stomach ulcer, she had developed these skin lesions. The itching was especially bad at night. She had tried antibiotics and antihistaminic drugs and had t a ken Chinese medicinals to clear heat and resolve toxins, dispel wind and stop itching. However, their results had not been marked. The woman continued to have bouts at night which kept her from sleeping and her suffering was unbearable. Accompanying symptoms included fear of cold, torpid intake, abdominal distention, loose stools, a pale red tongue with white, slimy fur, and a deep, fine, bowstring pulse. Therefore, her pattern was categorized as wind cold lodged in the exterior damaging central yang. Thus the treatment principles were to boost the qi and upbear yang, course wind, scatter cold, and eliminate dampness, and the formula consisted of: mix-fried Radix Astragali Membranacei (Huang Q i), 60g, mix-fried Radix Gly cy c rr h i z a e Uralensis (Gan Cao), 15g, Radix Rubrus Panacis Ginseng (Hong Shen), Radix Et Rhizoma N o t o p t e rygii (Qiang Huo), Radix A n g e l i c a e Pubescentis (Du Huo), Rhizoma Pinelliae Te rnatae (Ban Xia), Radix Ledebouriellae Divaricatae (Fang Feng), Radix Albus Paeoniae Lactiflorae (Bai Shao), Pe r i c a rpium Citri Reticulatae (Chen Pi), Sclerotium Poriae Cocos (Fu Ling), Radix Bupleuri (Chai Hu), stir-fried

Rhizoma Atractylodis Macrocephalae (Bai Zhu), and Radix Angelicae Sinensis (Dang Gui), 10g each, uncooked Rhizoma Zingiberis Officinalis (Sheng Jiang), 5 slices, and Fructus Zizyphi Jujubae (Da Zao), 5 pieces. One packet of these medicinals was decocted in water and administered per day. After taking three packets of these medicinals, the occurrence of the rash wa s decreased as were the fear of cold and itching. The abdominal distention had disappeared, the appetite had increased, and the tongue and pulse were the same as before. Therefore, another 16 packets were administered, after which the torpid intake, abdominal distention, and loose stools were all eliminated and the tongue was normal, although the pulse was still slightly weak and forceless. When the rash did occur, the woman no longer had to claw at it to try to stop the itching. Another 30 packets of the same medicinals were prescribed and there was no further recurrence of the rash. The patient then went on to take Bu Zhong Yi Qi Wan (Supplement the Center & Boost the Qi Pills) and Gui Pi Wan (Restore the Spleen Pills) to consolidate the treatment results. On follow-up after one half year, there had been no recurrence.

The patient was a 45 year-old male who was initially examined in August 1998. This man had had upper abdominal pain for six ye a r s . Typically, this pain was worse at night and better with obtaint of warmth and food. There was acid regurgitation, devitalized essence spirit, a lusterless, white facial complexion, and fear of chill. Intake was ok but sleep was not good. The patient had black, loose stools 2-3 times per day, and his urination was clear and long. His tongue was pale red with teeth-marks on the edges and thin, white fur. His pulse was fine and weak. The man was diagnosed with duodenal ulcers and H. pylori tested positive. The man tried several different We s t e rn medications, including antibiotics, and sometimes his pain was better and other times its was worse. The man's Chinese pattern was eventually discriminated as spleen-stomach vacuity cold. Therefore, he was prescribed: mix-fried Radix Astragali Membranacei (Huang Qi), Rhizoma Pinelliae Ternatae (Ban X i a), stir-fried Rhizoma A t r a c t y l o d i s Macrocephalae (Bai Zhu), and Radix Codonopsitis Pilosulae (Dang Shen), 15g each, mix-fried Radix Glycyrrhizae Uralensis (Gan Cao), Pericarpium Citri Reticulatae (Chen Pi), Sclerotium Poriae Cocos (Fu Ling), Rhizoma Alismatis (Ze Xie), Ramulus Cinnamomi Cassiae (Gui Zhi), and Radix Bupleuri (Chai Hu), 10g each, Radix Et Rhizoma Notopterygii (Qiang Huo), Radix Angelicae Pubescentis (Du Huo), and Radix Ledebouriellae Divaricatae (Fa n g Fe n g), 6g each, Radix A l bus Pa e o n i a e Lactiflorae ( Bai Shao), 12g, uncooked Rhizoma Zingiberis Officinalis (Sheng Jiang), 5 slices, and Fructus Zizyphi Jujubae (Da Zao), 5 pieces. One packet of these medicinals was decocted in water and administered per day. After taking four packets, the dread of chill and abdominal pain were eliminated, the appetite had increased, and sleep had improved. Another 10 packets of the same medicinals were prescribed. At the end of this time, there were no longer any symptoms, the tongue was pale red with thin, white fur, and the pulse was even and had strength. Because the man had a bitter taste in his mouth, three grams of Rhizoma Coptidis Chinensis (Huang Lian) were added and another 10 packets of medicinals were given to consolidate the therapeutic effects. A half year after stopping taking these medicinals, there had been no recurrence.

The patient was a 63 ye a r-old female who wa s i n i t i a l ly examined in May 1996. The patient complained that she had had dizziness, fear of cold, nausea, and chest oppression for 12 days. T h i s wo m a n 's body was habitually vacuous and we a k and she had many diseases. Twe l ve days before she had lost regulation of her rising and abiding (i.e., getting up and going to bed) and she had caught cold with a high fever, headache, nasal congestion, ru n ny nose, cough, and sore throat. She was diagnosed with an upper respiratory tract infection and treated for seven days with intravenous Shuang Huang Lian ( D o u ble Coptis) and penicillin. The headache got less and the feve r, nasal congestion, ru n ny nose, sore throat, and cough all diminished. Howeve r, the woman had r e c u rrent bouts of dizziness, heaviness of the h e a d, fear of cold, nausea, and chest oppression. When ex a m i n e d, her affect was dev i t a l i z e d, her sleep was poor, and her stools were loose two times per day. On the other hand, her urine wa s long and clear. Her tongue was pale with teeth-marks on its edges and thin, white, glossy fur, while her pulse was fine and moderate (meaning s l i g h t ly slow). Based on all this, her pattern wa s c a t egorized as qi vacuity common cold and the treatment principles were to boost the qi and r e s o l ve the ex t e r i o r. Therefore, the formula consisted of: mix-fried Radix A s t r a gali Membranacei (Huang Qi), 12g, Radix Codonopsitis Pilosulae (Dang Shen), 15g, Radix Et Rhizoma N o t o p t e rygii (Qiang Huo), Radix A n g e l i c a e Pubescentis (Du Huo), Rhizoma Pinelliae Te rnatae (Ban Xia), mix-fried Radix Gly cy rr h i z a e Uralensis (Gan Cao), Radix Ledebouriellae D ivaricatae (Fang Fe n g), Sclerotium Po r i a e Cocos (Fu Ling), Pe r i c a rpium Citri Reticulatae (Chen Pi), Radix Bupleuri (Chai Hu), stir- f r i e d Rhizoma Atractylodis Macrocephalae (Bai Zhu) , and Rhizoma Alismatis (Ze Xie), 10g each, u n c o o ked Rhizoma Zingiberis Officinalis (S h e n g J i a n g), 5 slices, and Fructus Zizyphi Jujubae (D a Z a o), 5 pieces. One packet of these medicinals was decocted in water and administered per day. After two days of this regime, all her symptoms were resolved. Therefore, Qiang Huo, Du Huo, and Fang Fe n g were reduced to three grams each and the patient was prescribed another two months wo rth, after which she was judged cured. In their commentary on this case, Drs. Yu and Deng say that this woman was mistreated by ex c e s s ive cool and cold medicinals (i . e., the intravenous medications) and that these had damaged her righteous qi.

According to Drs. Yu and Deng, Sheng Yang Yi Wei Tang upbears yang and boosts the stomach, resolves the exterior and scatters cold. It was originally designed for the treatment of lung-spleen-stomach vacuity with a disinclination to speak and/or a faint, weak voice, a heavy body, body pain, a bitter taste in the mouth, a dry tongue, no taste for eating, and irregular defecation. In other words, there is a spleen qi vacuity leading to a defensive qi vacuity which has allowed wind, cold, damp evils to enter and lodge in the exterior. In addition, in its original form, depression has transformed heat internally.

Because exterior-resolving medicinals out-thrust depression, they also rectify the qi. Therefore, I would say this formula is for the treatment of a liver-spleen disharmony complicated by wind, cold, damp evils. When we say a liver-spleen disharmony, we mean that the liver is depressed, the qi is stagnant, and the spleen is vacuous and weak. Because of inhibition of the qi mechanism, the clear is not upborne and the defensive qi is not engendered and issued from the middle burner. This leaves the defensive exterior insecure. External evils may then easily take advantage of this insecurity to attack and enter. Once lodged in the exterior or muscles and flesh, the righteous qi may be too vacuous and weak to combat and expel those evils. This formula is a good example of Li Dong-yuan's use of supplementing and draining, warming and cooling, moistening and drying all at the same time. In my experience, this is the key to really effective treatment of complicated, multi-pattern presentations.