Cara O. Frank, L.OM.
Several years ago, Jill Blakeway wrote an excellent article discussing how Chinese medicine understands and treats perimenopausal estrogen dominance. In it, she articulated Li Dong-yuanâ€™s yin fire theory, which organizes seemingly opposite symptoms of dampness and yin deficiency, qi stagnation and spleen deficiency into a cohesive, practical method. I was delighted to see that she uses his version of LÇ ShÃ¬ QÄ«ng ShÅ YÃ¬ QÃ¬ TÄng (Summerheat-Clearing Qi-Boosting Decoction) since this has long been a favorite of mine as well.
Many Chinese herbal formulas can be dated back to centuries, if not millennia, ago. They are well documented historically and endure to this day based on their efficacy. They work and surpass the test of time. Despite a wide range of doctors, currents of thought, herbs, formulas, strategies, and diseases, the core architecture of well written Chinese herbal formulas incorporates a kind of synchronous harmony of qi mechanisms: of building and clearing; of holding and moving; of ascending and descending; of expansion and contraction. Herbs are relational: they enhance one another; they control one another, and often they become more than the sum of their parts together.
So why does Jill Blakeway use LÇ ShÃ¬ QÄ«ng ShÅ YÃ¬ QÃ¬ TÄng (Summerheat-Clearing Qi-Boosting Decoction) to treat estrogen dominant premenopausal symptoms when clearly they are not suffering from a summerheat invasion with qi deficiency? She doesnâ€™t. She prescribes it to women because she knows that it supplements the spleen, boosts the qi, regulates the qi, clears heat, dries dampness, and nourishes the yin. In fact, this formula addresses the exact symptoms she encounters in her clinical practice when treating a majority of women. Jillâ€™s clinical and educational experiences in Chinese herbal medicine and womenâ€™s health provides her with the competency to know that formulas can be interchanged to treat patterns, not syndromes. While LÇ ShÃ¬ QÄ«ng ShÅ YÃ¬ QÃ¬ TÄng is discussed in older Chinese medical texts as being used to treat summerheat syndrome, when deconstructed, it can address the patterns of qi dynamics and pathologies that manifest as symptoms of estrogen dominance.
Letâ€™s take a closer look at this formula: Formula: LÇ ShÃ¬ QÄ«ng ShÅ YÃ¬ QÃ¬ TÄng (Summerheat-Clearing Qi-Boosting Decoction) [æŽæ°æ¸…æš‘ç›Šæ°”æ±¤]
|é»„èŠª huÃ¡ng qÃ Radix Astragali 9-12g|
|è¥¿æ´‹å‚ xÄ« yÃ¡ng shÄ“n Radix Panacis Quinquefolii 3-4.5g|
|è‹æœ¯ cÄng zhÃº Rhizoma Atractylodis 4.5-g|
|ç™½æœ¯ bÃ¡i zhÃº Rhizoma Atractylodis Macrocephalae 4.5-6g|
|éº¦é—¨å†¬ mÃ i mÃ©n dÅng Radix Ophiopogonis 9-12g|
|äº”å‘³å wÅ wÃ¨i zÄ Fructus Schisandrae Chinensis 3-6g|
|è‘›æ ¹ gÃ© gÄ“n Radix Puerariae Lobatae 6-9g|
|é™ˆçš® chÃ©n pÃ Pericarpium Citri Reticulatae 3-6g|
|é’çš® qÄ«ng pÃ Pericarpium Citri Reticulatae Viride 3-6g|
|å½“å½’ dÄng guÄ« Radix Angelicae Sinensis 6-9g|
|å‡éº» shÄ“ng mÃ¡ Rhizoma Cimicifugae 3-6g|
|æ³½æ³» zÃ© xiÃ¨ Rhizoma Alismatis 6-9g|
|é»„æŸ huÃ¡ng bÄƒi Cortex Phellodendri Chinensis 6-9g|
|ç¥žæ›² shÃ©n qÅ« Massa Medicata Fermentata 6-9g|
|ç‚™ç”˜è‰ zhÃ¬ gÄn cÄƒo Radix et Rhizoma Glycyrrhizae Praeparata cum Melle 2-3g|
The actions of the formula are: to clear summerheat, supplement the qi, strengthens the spleen, and dry dampness. The symptoms include fever, headaches, thirst, sweating, a sensation of heaviness, and loose stools.
- xÄ« yÃ¡ng shÄ“n, mÃ i mÃ©n dÅng and wÅ wÃ¨i zÄ create the formula shÄ“ng mÃ i sÇŽn Pulse-Engendering Powder which preserves yin, supplements qi, calms the spirit and stops excessive sweating.
- huÃ¡ng qÃ and xÄ« yÃ¡ng shÄ“n boost the qi and reduce fatigue.
- cÄng zhÃº and huÃ¡ng bÄƒi create the mini formula Ã¨r miÃ o sÇŽn Mysterious Two Powder, which clears heat and dries dampness, especially in the lower burner. This herbal pair can be especially helpful for treating bacterial vaginosis, which frequently occurs in menopausal women as a consequence of vaginal dryness.
- HuÃ¡ng bÄƒi and zÃ© xiÃ¨ are featured together in the formula zhÄ« bÇŽi dÃ¬ huÃ¡ng wÃ¡n Anemarrhena, Phellodendron, and Rehmannia Pill. While the first herb is bitter and cold and the latter is sweet and bland, they both settle ministerial fire, thus clearing deficiency heat. For severe sweating, Li also suggests that one add zhÄ« mÇ” Anemarrhenae Rhizoma, (along with wÅ wÃ¨i zÄ)â€ to restrain and gather in.â€
- All citrus parts regulate the qi. Here, chÃ©n pÃ and qÄ«ng pÃ dry dampness and reduce stagnation. QÄ«ng pÃ enters the liver channel, and is notable for scattering and lump reducing qualities, making it helpful for breast lumps and ovarian cysts
- GÃ© gÄ“n along with huÃ¡ng qÃ and shÄ“ng mÃ¡, boost and lift the qi. GÃ© gÄ“n is one of my favorite herbs these days. The range of its applications is broad, so I will limit my comments about how it can be helpful for brain-fog. We know that gÃ© huÄ; the flower of gÃ© gÄ“n is used to treat alcohol toxicity. Therefore, gÃ© gÄ“n can be used for feeling dizzy and confused. Modern studies show that it can increase cerebral blood flow. In my practice, I include it in most of my formulas for patients with dementia and Alzheimerâ€™s. So, within the context of this discussion, gÃ© gÄ“n may help alleviate brain fog. The second point of interest is that gÃ© gÄ“n is filled with isoflavones: mainly puerarin, methylpuerarin, daidzein, daidzin, and daidzein glucopyranoside. These are some of the same isoflavones found in soybeans. They are especially cardioprotective, but the weak effect on hormones may act as an estrogen agonist, thus balancing the estrogen dominance.
This large and complex formula is a variation of Liâ€™s most iconic formula: BÅ ZhÅng YÃ¬ QÃ¬ TÄng (Center-Supplementing and Qi-Boosting Decoction). It includes all the hallmarks of his formula construction: GÃ© gÄ“n, shÄ“ng mÃ¡, and huÃ¡ng qÃ raise the clear yang. HuÃ¡ng qÃ, bÃ¡i zhÃº, and zhÃ¬ gÄn cÄƒo supplement the qi and strengthen the spleen. HuÃ¡ng bÄƒi, cÄng zhÃº, and zÃ© xiÃ¨ clear heat and dry dampness. shÃ©n qÅ«, chÃ©n pÃ and qÄ«ng pÃ regulate the qi; xÄ« yÃ¡ng shÄ“n, mÃ i mÃ©n dÅng and wÅ wÃ¨i zÄ nourish the yin and generate fluids.
To illustrate how wide-ranging this formula is, in my book, Case Studies: Eye, Ear, Nose and Throat Disorders, LÇ ShÃ¬ QÄ«ng ShÅ YÃ¬ QÃ¬ TÄng is used to treat a case of MÃ©niÃ¨reâ€™s Disease. It is interesting to consider other disorders that share similar symptoms and indications for this formula, such as chronic fatigue syndrome, gastroenteritis, environmental allergies, SIBO, and many others.
How can a formula, written initially to treat summerheat pathogen, be helpful to a perimenopausal, estrogen dominant woman? The answer is simple: when the pathomechanisms of a disorder are deconstructed, the formula is spot on. Treat the pattern.
A second perspective:
One of my favorite formulas for the mixed patterns of qi stagnation, heat, and blood deficiency and stagnation is JÄ«ng JiÃ¨ LiÃ¡n QiÃ o TÄng, Schizonepeta and Forsythia Decoction. This formula was first recorded in the Wondrous Lantern for Peering into the Origin and Development of Miscellaneous Diseases (ZÃ¡ BÃ¬ng YuÃ¡n LiÃº XÄ« ZhÃº, æ‚ç—…æºæµçŠ€çƒ›) published in 1773
|è†èŠ¥ jÄ«ng jiÃ¨ Herba Schizonepetae 3g|
|è¿žç¿˜ liÃ¡n qiÃ o Fructus Forsythiae 3g|
|é˜²é£Ž fÃ¡ng fÄ“ng Radix Saposhnikoviae 3g|
|å½“å½’ dÄng guÄ« Radix Angelicae Sinensis 3g|
|å·èŠŽ chuÄn xiÅng Rhizoma Chuanxiong 3g|
|ç™½èŠ bÃ¡i shÃ¡o Radix Paeoniae Alba 3g|
|æŸ´èƒ¡ chÃ¡i hÃº Radix Bupleuri 3g|
|æž³å£³ zhÄ qiÃ o Fructus Aurantii 3g|
|é»„èŠ© huÃ¡ng qÃn Radix Scutellariae 3g|
|æ €å zhÄ« zÄ Fructus Gardeniae 3g|
|ç™½èŠ· bÃ¡i zhÄ Radix Angelicae Dahuricae 3g|
|æ¡”æ¢— jiÃ© gÄ•ng Radix Platycodonis 3g|
|ç”˜è‰ gÄn cÄƒo Radix et Rhizoma Glycyrrhizae 1.5g|
The formula is usually grouped with formulas that dispel wind-heat pathogen. The actions of the formula are to dispel wind, clear heat, clear toxicity, and reduce stagnation.
- JÄ«ng jiÃ¨ and liÃ¡n qiÃ o are the chief medicinals that dispel wind and clear heat. You can find this pair in yin qiao san as well. Both are light and ascending. jÄ«ng jiÃ¨ enters the blood, to vent heat from the blood, while liÃ¡n qiÃ o can clear wei level heat.
- BÃ¡i shÃ¡o, chÃ¡i hÃº, zhÄ qiÃ o, and gÄn cÄƒo create the formula Si Ni San- Four Frigid Extremities powder, which regulates the qi, clears constraint and spreads liver qi.
- HuÃ¡ng qÃn and zhÄ« zÄ clear heat. This pair is featured many formulas that clear fire.
- DÄng guÄ« and chuÄn xiÅng harmonize the blood.
- BÃ¡i zhÄmight be paired with liÃ¡n qiÃ o to clear toxic heat. It might also be paired with jiÃ© gÄ•ng for this same purpose.
- GÄn cÄƒo harmonizes the formulas and, along with jiÃ© gÄ•ng, benefits the throat.
- ChÃ¡i hÃº and jiÃ© gÄ•ng have an ascending directional energy, while zhÄ qiÃ o descends. Together, these three opens the chest and alleviates depression. Another formula that features these medicinals is XuÃ¨ FÇ” ZhÃº YÅ« TÄng House of Blood Stasis-Expelling Decoction.
In relation to our discussion, Jillâ€™s list of common symptoms of perimenopausal, estrogen dominant women can include: Breast swelling and tenderness, anxiety and mood swings, â€œfuzzy thinking,â€ irritability, fatigue, loss of ambition, slow metabolism, water retention, loss of libido, PMS, weight gain, insomnia, thickening of endometrial lining, clotted menses, increased risk of uterine fibroid, increased incidence of ovarian cysts.
Lets review how JÄ«ng JiÃ¨ LiÃ¡n QiÃ o TÄng might address these symptoms:
- PMS, mood swings, breast swelling and tenderness, along with irritability, are easily treated with si ni san.
- Anxiety, irritability, and insomnia can be treated with liÃ¡n qiÃ o and zhÄ« zÄ, both of which clear heat from the heart and alleviate vexation.
- Bleeding irregularities such as cramps or clotty menses can be treated with dÄng guÄ« and chuÄn xiÅng and to a certain extent, jÄ«ng jiÃ¨ and huÃ¡ng qÃn.
- Ovarian cysts and breast lumps can be treated with bÃ¡i zhÄ
- Acne is treated with jÄ«ng jiÃ¨, liÃ¡n qiÃ o, fÃ¡ng fÄ“ng, jiÃ© gÄ•ng, and bÃ¡i zhÄ.
Thus, the formula addresses nearly every symptom that might be experienced in a woman presenting with estrogen dominance. In contrast to QÄ«ng ShÅ YÃ¬ QÃ¬ TÄng, JÄ«ng JiÃ¨ LiÃ¡n QiÃ o TÄng is more effective for regulating the liver, harmonizing the blood and clearing heat, while QÄ«ng ShÅ YÃ¬ QÃ¬ TÄng is more effective for spleen deficiency with retention of dampness. If we were to think about the directional energy of the formulas, QÄ«ng ShÅ YÃ¬ QÃ¬ TÄng is uplifting, while JÄ«ng JiÃ¨ LiÃ¡n QiÃ o TÄng uses both ascending and descending herbs to open and regulate the qi.
What is the takeaway? The takeaway is to honor this statement: TÃ³ng bÃ¬ng yÃ¬ zhÃ¬yÃ¬ bÃ¬ng tÃ³ng zhÃ¬. Same disease, different treatments. Different diseases, same treatment. As long as we treat the pattern, not the western diagnosis, we can nearly guarantee clinical results.
About Cara Frank, L.OM.
Cara Frank, L.OM., was raised by beatniks in a health food store in Brooklyn, NY. When she was 8, she cartwheeled 5 miles from Greenwich Village through Soho and Chinatown and across the Brooklyn Bridge. For nearly 40 years, she’s had the same crazy passion for Chinese medicine. At 17, she had her first acupuncture treatment. At 20, she enrolled in acupuncture school. In 1998 she went to China to study where she fell deeply in love with Chinese herbs. Since then, she has devoted her life to studying and teaching the topic.
Cara is the founder of Six Fishes Healing Arts in Philadelphia, where she maintains a busy acupuncture practice and acts as the head fish of warm and lively office. She is also the president of China Herb Company. You can read her full bio or schedule an appointment.