Introduction: Learn the application of Danggui Shaoyao San.

Luo Anbang's Experience

One: Dysmenorrhea

According to Elder Luo:

Women often experience depletion of essence and blood due to menstruation, pregnancy, childbirth, and child-rearing, leading to deficiency of Qi and blood in the Chong and Ren meridians. During menstruation, the sea of blood shifts from storage to discharge, transitioning from fullness to deficiency and dispersion. In an already deficient constitution, Yin and blood become even more insufficient. Therefore, menstrual pain is often attributed to deficiency. For those experiencing dull, lingering pain in the lower abdomen during or before menstruation, which is relieved by pressure or warmth, accompanied by soreness in the lower back and weakness in the knees, scanty menstrual flow with pale color and thin consistency, a deep, thin, and weak pulse, and a pale tongue with thin white coating, this is due to deficiency of the liver and kidneys and insufficiency of Qi and blood. The cause is often Qi stagnation and blood stasis, sometimes accompanied by dampness. In such cases, this formula should be supplemented with Eucommia bark, Mulberry mistletoe, Himalayan teasel root, prepared rehmannia root, and Astragalus root for treatment.

If symptoms include distending pain and cramping in the lower abdomen before or after menstruation, with pain radiating to the lumbosacral region, aggravated by pressure, dark purple menstrual flow or the presence of blood clots, a dark purple tongue or the presence of ecchymosis or petechiae, and a deep, thin, and choppy pulse, this indicates menstrual pain due to Qi stagnation and blood stasis. In such cases, this formula should be combined with Cinnamon Twig and Poria Pill as the primary treatment.

If menstruation occurs irregularly, with cold pain or colicky pain in the lower abdomen during or after menstruation, scanty menstrual flow of dull color, pale face and lips, a pale tongue with white and moist coating, and a deep and tight pulse, this belongs to cold congealing in the meridians. In such cases, this formula should be modified by removing Alisma and Poria, and adding Evodia fruit, Aconite, Cinnamon twig, and Fennel to warm the meridians, dispel cold, warm the uterus, and relieve pain.

Patient Jiang, female, 26 years old. She has a history of dysmenorrhea for over 2 years. Each time before and during menstruation, she experiences distension and pain in the lower abdomen, sometimes severe enough to be unbearable, along with soreness in the lower back and spine. Her menstrual flow is scanty, with dark-colored blood and occasional passage of blood clots. She also experiences cold limbs, slight swelling of the eyelids and face, a pale complexion, pale lips, a pale tongue with a white and moist coating, and a deep, thready pulse. Dr. Luo believes this is due to qi and blood deficiency, emptiness of the sea of blood, and invasion of cold-dampness, leading to the accumulation of cold-dampness in the lower jiao and obstruction of menstrual blood flow, resulting in dysmenorrhea. The treatment principle is to tonify qi and blood, warm the meridians, and dispel cold and dampness.

Medicinal formula: Angelica sinensis (Danggui) 15g, Paeonia lactiflora (Baishao) 15g, Ligusticum chuanxiong (Chuanxiong) 20g, Poria cocos (Fuling) 10g, Atractylodes macrocephala (Baizhu) 10g, Alisma orientale (Zexie) 15g, Astragalus membranaceus (Huangqi) 30g, Aconitum carmichaelii (Fuzi) 10g, Cinnamomum cassia (Guizhi) 10g, Evodia rutaecarpa (Wuzhuyu) 15g, Foeniculum vulgare (Xiaohuixiang) 10g.

The patient was instructed to take the medication starting one week before menstruation and continue until one week after menstruation. After the second cycle of treatment, her menstruation became regular, the pain ceased, and all symptoms resolved.

Case Two: Edema During Pregnancy

During pregnancy, women often experience facial puffiness and limb swelling, soreness and weakness in the lower back, pale complexion, palpitations and shortness of breath, poor appetite, a pale and swollen tongue with a white coating, and a deep, slow, and weak pulse.

Lao Luo believes that this is due to inherent deficiency of visceral qi and insufficiency of spleen yang, which is further weakened by pregnancy. The burden on the spleen and stomach for transformation and nourishment becomes excessive, leading to dysfunction in qi transformation and impaired ability to transport and transform dampness. This results in the overflow of water and dampness, which infiltrates the muscles and limbs, causing edema.

The treatment should focus on activating blood circulation and promoting qi flow to ensure smooth qi movement. Strengthening the spleen and replenishing qi can consolidate the function of transporting and transforming dampness, thereby controlling water overflow. This formula can be modified by adding cinnamon twigs to promote yang and transform qi, and combining it with polyporus to incorporate the dampness-draining and diuretic effects of the Five-Ingredient Powder with Poria.

Li, female, 23 years old, from Hui'an. The patient has a constitutionally weak physique. At the time of diagnosis, she was four months pregnant and presented with the following symptoms: facial puffiness and limb swelling, particularly below the knees, accompanied by palpitations and shortness of breath, coldness in the lower limbs, lower back pain and fatigue, reduced appetite, and scanty urine. Her tongue was pale with a white coating, and her pulse was deep, slow, and slippery.

Prescription: Angelica sinensis 10g, Ligusticum chuanxiong 10g, Atractylodes macrocephala 15g, Poria cocos 15g, Alisma orientale 15g, Polyporus umbellatus 15g, Cinnamomum cassia 15g, Astragalus membranaceus 30g, ginger and jujube 3g each. Take 4 doses.

Second consultation: After taking the medication, the edema in the lower limbs and face has subsided by half, but the lower back remains sore and painful. Following the previous prescription, add Eucommia ulmoides 15g and Dipsacus asperoides 15g to strengthen the lower back and relieve pain. After taking 4 doses, all symptoms disappeared, and the condition was cured.

III. Threatened Abortion

Lao Luo believes that this condition is mostly due to deficiency of both the spleen and kidneys, deficiency of the liver and kidneys, and insufficiency of qi and blood. The treatment method should focus on tonifying the kidneys and strengthening the spleen, replenishing qi and nourishing blood, nourishing the kidneys and softening the liver, and consolidating the Chong and Ren meridians. The Danggui Shaoyao San (Angelica and Peony Powder) is often used as the base formula, with modifications according to the syndrome. For example, Eucommia ulmoides, Taxillus chinensis, Cuscuta chinensis, and Dipsacus asperoides are commonly used to strengthen the lower back and kidneys, and replenish qi and blood to support the fetus. Additionally, donkey-hide gelatin is used to nourish blood and stop bleeding, combined with Astragalus membranaceus and Codonopsis pilosula to replenish qi. Since qi supports the fetus and blood nourishes the fetus, when qi and blood are sufficient, the Chong and Ren meridians are harmonious, and the fetus is properly settled and securely anchored.

He often advises patients to take it regularly after conception, as a preventive measure, which often yields twice the result with half the effort. Elder Luo believes that regular consumption of this formula during pregnancy can not only secure the fetal foundation, harmonize the Chong and Ren meridians, nourish blood and support the fetus, but also prevent miscarriage, threatened miscarriage, and fetal restlessness, offering benefits for health maintenance, disease prevention, and treatment.

Zhuang, female, 28 years old, has experienced four miscarriages in the three years since her marriage, each triggered by overexertion or physical trauma.

At the time of consultation, she had missed her period for 40 days, presenting with symptoms such as nausea, vomiting, and reduced appetite. The urine latex test was positive. One week prior, due to fatigue from cycling, she experienced slight vaginal bleeding accompanied by a sensation of lower abdominal heaviness, soreness in the lower back and spine, dizziness, and blurred vision. Her tongue was pale with a thin white coating, and her pulse was fine and slightly rapid.

Prescription: Angelica sinensis 9g, Paeonia lactiflora 15g, Atractylodes macrocephala 10g, Poria cocos 10g, Alisma orientale 9g, Astragalus membranaceus 30g, Codonopsis pilosula 15g, Taxillus chinensis 15g, Eucommia ulmoides 15g, Donkey-hide gelatin 15g, honey-fried Glycyrrhiza uralensis 6g. After taking five doses, the soreness in the lower back and the sensation of lower abdominal heaviness were alleviated, and vaginal bleeding became minimal.

The medication has hit the mark, and the formula remains unchanged for its efficacy. She was instructed to continue taking it, completing a total of 15 doses. All ailments were resolved, and follow-up revealed that the woman later gave birth naturally to a healthy baby boy.

IV. Abdominal Pain During Pregnancy

According to Elder Luo, although the causes of abdominal pain during pregnancy may vary, including blood deficiency, cold deficiency with qi stagnation and binding, or trauma from falls and injuries, most cases are predominantly due to blood deficiency and qi stagnation.

Additionally, during pregnancy, yin-blood gathers to nourish the fetus, leading to further depletion of yin-blood in the body. Liver deficiency and blood stagnation disrupt the flow of qi, resulting in malnourishment of the uterine vessels and the onset of abdominal pain.

In summary, the main pathogenesis is the poor circulation of qi and blood, leading to pain due to obstruction. Therefore, the treatment should focus on nourishing blood, soothing the liver, calming the fetus, and relieving pain. It is advisable to remove Alisma from this formula and add Astragalus to replenish qi and generate blood, combined with Polygonatum, Evodia, Mugwort, and Loranthus to strengthen the waist and kidneys and warm the uterus.

If there is qi stagnation, regulating the qi mechanism is essential. It is advisable to add Bupleurum, Green Tangerine Peel, and Lindera to this formula. In cases of accidental falls or injuries, it is recommended to add Loranthus, Eucommia, Dipsacus, and Cibotium to tonify the kidneys, strengthen the waist, relax tendons, activate collaterals, and relieve pain.

Xie, female, 30 years old, began experiencing lower abdominal distension and pain, increased leukorrhea, and occasional bloody vaginal discharge after 2 months of pregnancy. Despite seeking medical treatment from various doctors and taking dozens of doses of Wenjing Tang and Jiao Ai Tang, there was no improvement.

At the time of consultation, the symptoms observed were: lower abdominal distension and pain extending to the lower back, irritability and restlessness, loss of appetite, nausea with a tendency to vomit, edema in both lower limbs, a pale tongue with thin yellow coating and tooth marks along the edges, and a wiry, thin, and weak pulse.

Therefore, Danggui Shaoyao San (Angelica and Peony Powder) was prescribed to promote the smooth flow of qi and blood, soothe the liver and regulate the spleen, calm the fetus, and relieve pain. The formula consisted of: Angelica sinensis (Danggui) 10g, Ligusticum chuanxiong (Chuanxiong) 15g, Atractylodes macrocephala (Baizhu) 15g, Poria cocos (Fuling) 15g, Alisma orientale (Zexie) 10g, Paeonia lactiflora (Baishao) 30g, Bupleurum chinense (Chaihu) 10g, Cyperus rotundus (Xiangfu) 15g, Citrus reticulata (Qingpi) 10g, and Glycyrrhiza uralensis (Gancao) 5g. After more than 10 doses of this formula with modifications, the condition resolved completely in response to the treatment.

[Luo Weibin, Zhou Laixing, Chen Xi. Luo Anbang's Experience in Using Danggui Shaoyao San to Treat Gynecological Diseases. Fujian Journal of Traditional Chinese Medicine, 1994, 25 (4): 16]

Chen Qiaolin's Experience

Stasis-swelling syndrome refers to a condition characterized by periodic swelling, soreness, numbness, and heaviness in the feet and ankles. It is often accompanied by clinical manifestations such as low energy and fatigue, emotional distress, vague abdominal pain, irregular menstruation, difficulty urinating, a dull and pale tongue with a white greasy coating, and a deep, thready pulse.

It is more commonly seen in middle-aged and elderly women. This syndrome may be related to pituitary-gonadal endocrine dysfunction and is a disorder of water and salt metabolism, similar to idiopathic edema.

The pathogenesis of stasis-swelling syndrome involves constitutional spleen deficiency, compounded by emotional disturbances leading to liver qi stagnation, impaired dispersion, transverse invasion of the spleen, impaired spleen function in transportation, and internal retention of dampness.

Dampness descends with liver qi, causing swelling in the feet and knees; spleen deficiency with dampness encumbrance leads to low energy and fatigue; disharmony between the liver and spleen disrupts qi and blood, resulting in vague abdominal pain and menstrual irregularities; obstruction of water and qi prevents normal urination, leading to difficulty urinating; spleen deficiency with dampness stagnation manifests as a pale tongue with a white coating and a deep, thready pulse.

Qi deficiency leads to insufficient blood circulation, while qi stagnation results in poor blood flow, leading to the formation of blood stasis. Blood stasis obstructs the meridians, further affecting water metabolism, exacerbating edema. The combination of water retention and blood stasis results in the syndrome of stasis-induced distension.

In light of the pathological characteristics of stasis-induced distension syndrome, treatment should focus on fortifying the spleen and regulating the liver, harmonizing and promoting qi and blood, resolving dampness, and promoting diuresis. The prescription Danggui Shaoyao San (Angelica and Peony Powder) is recommended.

If accompanied by shortness of breath, spontaneous sweating, soreness and weakness of the waist and knees, delayed menstruation with scanty, pale-colored flow, and loose stools, this indicates spleen and kidney qi deficiency. In such cases, add Dangshen (Codonopsis), Huangqi (Astragalus), Buguzhi (Psoralea), and Duzhong (Eucommia) as appropriate.

If the condition arises from internal injury due to the seven emotions or liver qi stagnation, accompanied by emotional depression and distending pain in the hypochondriac region, add Xiangfu (Cyperus), Yujin (Curcuma), Zisugeng (Perilla Stem), and Danshen (Salvia) to soothe the liver and relieve depression.

If there is swelling and cyanosis of the limbs, stabbing pain in the lower abdomen, and dark menstrual blood with clots, consider adding Leonurus japonicus, Lycopus lucidus, peach kernel, and safflower to enhance the effect of promoting blood circulation and removing blood stasis.

If accompanied by cold limbs and sweating, abdominal fullness and distending pain, this indicates internal cold causing distension and fullness, and yang deficiency leading to impaired movement. Consider combining with Guifu Lizhong Decoction or Sini formulas to supplement fire and dispel cold.

If there is heaviness of the body and fatigue of the limbs, poor appetite, and reduced food intake, this indicates dampness stagnation in the middle jiao and disharmony of the spleen and stomach. Consider adding spleen-strengthening and stomach-harmonizing formulas, such as Xiangsha Liujunzi Decoction.

If swelling persists for a long time and urination is difficult, this indicates water and blood stasis congealing in the lower jiao, with impaired bladder qi transformation. Consider adding cinnamon twig, peach kernel, fried fenugreek, and Stephania tetrandra to promote diuresis and reduce swelling.

The mentor emphasized that the application of modifications should focus on the syndrome of blood stasis and distension, and should only be used when it is a secondary syndrome. If other syndromes have already become the primary syndrome, this does not apply. For example, in the case of edema due to yang deficiency treated with Zhenwu Decoction, it is clearly no longer a syndrome of blood stasis and distension.