Xiao Yao San, famous or misunderstood?

Source is He ji ju fang
dang gui 9 chai hu 9 bai shao 9 bai zhu 9 fu ling 9 pao jiang 6 bo he 6 zhi gan cao 6

This formula just may be the most famous in the west. It does seem like all our patients are in some form of chronic shao yang pattern. Also, it just may be the most misunderstood formula.

Structure
It is built around the herbs dang gui, chai hu, and bai shao.
Dang gui is the foremost herb for nourishing jue yin liver blood storage. It is pungent, sweet and warm. It increases Wood wind while nourishing Wood. Meaning it is a mild blood moving tonic. It fills the blood vessels and frees blood circulation by nourishing blood. Chai hu allows dang gui to move freely and bai shao controls any excessive movement.

Dang gui and bai shao work together to nourish blood and yin. Bai shao nourishes yin, collects the nutritive qi, while moving the nutritive in blood and opening stagnation. Bai shao buffers convulsions and pain and calms Wood wind. It is the foremost herb for pain due to yin and blood deficiency.

We see the pair dang gui and bai shao in dang gui san and dang gui shao yao san.

In dang gui san chaun xiong is added to create more movement in the jue yin blood layer. Still this movement is considered safe even for pregnant women if used at a low dose.

In dang gui shao yao san the dose of the bai shao is much higher than 10 grams. Chuan xiong is also used at a much higher dose to create more movement in the jue yin blood layer. It is used for all types of abdominal pain, even for pregnant women.

Xiao yao san has a reputation of being the best formula for liver qi stagnation. The use of dang gui and bai shao nourish Wood wind but it only mildly moves the liver blood.

Chai hu is the core shao yang herb. It frees the movement in Wood. Chai hu moves the gall bladder qi while clearing congestion in the form of dampness. It frees the movement of the liver blood which restores the balance of yin and yang in the middle burner. The transformation of Earth relies on the free movement of the element Wood.

Chai hu is not combined with ban xia and huang qin as in xiao chai hu tang.  The ban xia transforms phlegm in the stomach and moves the qi downwards. Huang qin dries dampness and cools heat in the stomach and san jiao. Meaning xiao yao san is not as effective as xiao chai hu tang in clearing congestion and heat in the middle burner.

Bai zhu and fu ling drain dampness in Earth to restore control over the Water element. Moving water also moves blood.

Bo he is pungent cool dispersing of heat congestion in the jue yin liver blood. It supports chai hu in clearing congestion heat that can arise from stagnant dampness. It moves Wood and disperses stagnation.

In the source text this formula recommended for blood vacuity taxation fatigue. Dang gui and bai shao nourish blood and yin while chai hu and bo he keep the heat from building up.

Some versions of this formula suggest dried or roasted version of jiang. It seems logical to me to use sheng jiang. This supports tai yin in sending clear qi to to the chest to be dispersed by the lungs and heart to the 100 vessels.

Xiao yao san is limited in clearing the shao yang compared to xiao chai hu tang. It is less nourishing for blood deficiency than dang gui jian zhong tang. Its strength is in transitioning out of a shao yang and into tonifying and nourishing of the tai yin and jue yin levels.

I suggest something like this for getting out of shao yang.
dang gui 9 bai shao 9 chai hu 24 bo he 9 fu ling 9 bai zhu 9 sheng jiang 9 da zao 9 zhi gan cao 6

Modifications
If blood and yin deficiency are causing cramping of the muscles and abdomen use bai shao at 18.

If the blood deficiency is causing stagnant heat to arise add chuan xiong at 9 for move movement. If the heat from the blood deficiency is pronounced add tao ren and mu dan pi to move and cool.

This is a yang formula in that it warms, moves and tonifies the tai yin and jue yin. It is a yin formula in that it nourishes yin and blood and cools heat due to congestion.  

We can compare this formula with si ni san which contains chai hu, bai shao, zhi shi and gan cao. In xiao yao san the bai zhu and fu ling replace the zhi shi. Si ni san nourishes blood and yin and drains and dries dampness. It decongests the middle and frees yang to move yin.  It is not a real strong shao yang formula and it is limited in supporting tai yin.

It is said of chai hu that it raises yang so we should be careful. Chai hu restores the function of Wood to support Earth. Chai hu only frees the movement of clear food qi so it can rise to the 100 vessels. It does not functionally raise qi but facilitates normal movement.

In the source text this formula is for blood vacuity taxation fatigue. It treats a jue yin blood layer pattern with mild damp accumulation. This treats patterns on a shao yang and jue yin level.

The strength of xiao yao san is as a transitioning formula. It can be used for a mild shao yang pattern and then at a low dose for a long time.

What? We all know gui zhi tang as the go to formula for an external attack on tai yang. We also learned in school that it induces sweating which clears the surface of wind. So how can it be a yin tonic Mr Freedman?

Tai yang shang han is tai yang cold damage

Tai yang zhong feng is tai yang wind strike

In a tai yang wind cold attack there are two possibilities, a wind strike or wind cold. Both are an attack of cold but a wind strike is less cold than a wind cold attack.

In a wind strike pattern the circulation of yang wei qi is disrupted by the cold. In a wind cold pattern the cold has closed the surface.

In treating a tai yang wind strike pattern we want to restore the circulation of yang wei qi but also nourish yin to anchor yang. Yin is the mother of yang.

Gui zhi and sheng jiang are both warm and pungent. Gui zhi warms Wood and sheng jiang warms Earth. Together they are 18 grams of yang herbs.

Bai shao is cool sour nourishing of yin and blood. It controls Wood by nourishing Metal. Da zao and zhi gan cao are neutral and sweet. Da zao directly nourishes heart blood and tonifies the Earth. Zhi gan cao nourishes fluids and tonifies function in Earth. Together they are 24 grams of yin herbs.

Since da zao and zhi gan cao both tonify we can consider them yang herbs. Tonifying is restoring funtion and function is yang compared to yin nourishing.

Gui zhi also nourishes yin with its sweet taste so it is partly a yin herb. Bai shao also moves blood so it is partly a yang herb.

Gui zhi tang is a yin tonic that also tonifies yang. Gui zhi tang nourishes deficiency of both yin and yang in a wind strike pattern. Wind is a yang climatic qi that dries yin fluids on the surface of the body. The fluids need to be replaced and gui zhi tang fits that need.

When I was learning about herbs it was said the formula structure of the Shang Han Lun was influenced by the Decoction Classic.

I figured understanding the text from the Decoction Classic would teach me about structure and taste.

Text from the Decoction Classic

All pungent belongs to wood, for it is governed by

gui zhi is wood, shu jiao is fire, jiang is earth, xi xin is metal, fu zi is water

All salty belongs to fire, for it is governed by

xuan fu hua is fire, ze xie is earth, hou po is metal, da huang is wood, xiao shi is water

All sweet belongs to earth, for it is governed by

ren shen is earth, mai men dong is metal, fu ling is water, gan cao is wood, da zao is fire

All sour belongs to metal, for it is governed by

Metal is wu wei zi, shu yu is water, zhi shi is wood, dou chi is fire, shao yao is earth

All bitter belongs to water, for it is governed by

Water is di huang, huang qin is wood, huang lian is fire, bai zhu is earth, zhu ye is metal

When I first tried to understand this text I immediately thought it’s all about the taste. Pungent belongs to Wood. Easy enough, I thought. All the herbs in the text are pungent, so that’s it.  

That works for Wood and pungent. And that works for Earth and sweet. And that works for Water and bitter. The problem was with Fire and Metal. With Fire not all the herbs are salty and with Metal not all the herbs are sour.

Frustration!

How can that be? Did someone make a mistake? I studied the herbs that did not match taste with the element. Eventually I realized that it did make sense if I considered movement of the element. I even doubted myself because I still thought it’s all about the taste.

It is defining the way the elements nourish and control each other and how different herbs achieve this.

For example Zhi shi is not sour but it is in the Metal class. It makes Metal descend. So keep in mind how the element is being affected.

Taste and movement

Pungent governs dispersion, and its movement can traverse, and thus it can release the surface.

Salty governs softening, its nature sinks, and therefore it can lead out stagnation.

Sweet governs moderation and its movement can ascend therefore it can tonify the middle burner.

Sour governs collecting, its nature cans astringe, and therefore it treats drainage.

Bitter governs purging, its movement can descend, and therefore it can expel excess.

Bland governs percolation, its nature disinhibits, and therefore it can clear by separation.

Understanding the placement of each herb.

Gui zhi, Cinnamomi cassiae ramulus

Gui zhi belongs to Wood because the taste associated with Wood is pungent. Gui zhi brings the Wood class to the element Wood because it warms and disperses yang qi. Wind belongs to jue yin because in jue yin wind rules.  Jue yin has an internal external relation with shao yang.

Jue yin transforms from its middle and that is the ministerial fire. Shao yang transforms from its climatic qi and that is ministerial fire.

Shu Jiao, Pericarpum zanthoxyli bungeani

Shu jiao belongs to Wood because the taste associated with Wood is pungent. Shu jiao brings the Wood class to the element Fire by warming Fire directly. By warming the Fire element it warms the imperial fire of shao yin heart and kidneys and the ministerial fire of the pericardium and san jiao.

Shu jiao is not used often and because of the tradition of tonifying the mother to tonify the child. It is used to clear cold that has caused internal cramping.

Sheng jiang, Zingiberis rhizoma recens

Sheng jiang belongs to Wood because the taste associated with Wood is pungent. Sheng jiang brings the Wood class to the element Earth by warming the stomach and spleen and moving the qi in Earth while dispersing dampness and cold. This restores the strength of Earth which prevents Wood from over controlling Earth.

Sheng jiang also warms and disperses the qi of tai yin. This supports tai yin in transforming and transporting food qi into clear qi and turbid qi. Sheng jiang supports the Earth as the source of post heaven yang qi and blood.

Sheng jiang promotes yang ming dryness which restores the balance with tai yin dampness.

Xi xin, Asari herba

Xi xin belongs to Wood because the taste associated with Wood is pungent. Xi xin brings the Wood class to the element Metal by warming and dispersing fluids that prevent Metal from controlling Wood. The mandate of Metal is to disperses and descend qi and the dispersing nature of Wood needs to guided downward.

Xi xin warms and disperses the tai yin lung and spleen which clears cold and excessive dampness. Xi xin promotes yang ming dryness to balance tai yin dampness.

Xi xin also warms the tai yang channels by warming the tai yin and shao yin. The Metal lungs control the channels, blood vessels, skin and hair.

Fu zi, Aconiti radix lateralis praeparata

Fu zi belongs to Wood because the taste associated with Wood is pungent. Fu zi brings the Wood class to the element Water by warming Water to give birth to Wood. Fu zi warms the Fire element directly and by bringing Fire to Water it can once again move and control Fire and give birth to Wood.

Fu zi warms and disperses the shao yin Water and this clears excessive cold and fluids. When yang is weak yin takes its place. Fu zi puts the emperor back on his throne.

Xuan fu hua, Inulae flos

Xuan fu hua belongs to Fire because the taste associated with Fire is salty. Xuan fu hua brings the Fire class to the element Fire by clearing excess in the chest which houses the heart that belongs to Fire. By softening hardness in the chest the Fire can be controlled. Stagnation can block the flow of qi which leads to a buildup of heat which will consume fluids and further weaken yang qi.

Ze xie, Alismatis rhizome

Ze xie brings the Fire class to the Earth element by restoring the control over Water which controls Fire. The Shen Nong Ben Cao Jing suggests that ze xie is cold and sweet. Sweet tonifies and ze xie tonifies Earth which controls Water.

Hou po, Magnoliae cortex

Hou po is warm, bitter and pungent. Hou po brings the Fire class to the element Metal by clearing phlegm accumulations in yang ming so Metal can descend which controls Wood which gives birth to Fire.

By clearing the excess it prevents excessive drying of fluids which can weaken yang qi as imperial Fire.

Da huang, Rhei rhizoma

Da huang is cold and bitter. Da huang brings the Fire class to the element Wood by descending Metal to control Wood which gives birth to Fire. Excessive heat in Metal and Wood will cause heat in Fire. If left unchecked the excessive heat will further weaken yang qi till a separation of yin and yang causes death.

Mang xiao, Natrii sulfas replaces xiao shi

Mang xiao belongs to Fire because the taste associated with Fire is salty. Mang xiao brings the Fire class to the element Water by clearing excessive heat in Metal. When Metal fails to nourish and give birth to Water Fire will weaken.

Mang xiao is cold, bitter and salty. It drains excess in yang ming to preserve fluids and eventually yang qi.

Ren shen, Ginseng radix

Ren shen belongs to Earth because the taste associated with Earth is sweet. Ren shen brings the Earth class to the element Earth by nourishing fluids in Earth and by tonifying the Qi in the yang ming stomach and tai yin spleen and lung.

Ren shen also tonifies the original qi from shao yin kidney and together with food qi and gathering qi nourishes and produces true qi. True qi is then dispersed by the shao yin heart and tai yin lung over the kingdom.

Mai men dong, Ophiopogonis radix

Mai men dong belongs to Earth because the taste associated with Earth is sweet. Mai men dong brings the Earth class to the element Metal by nourishing yin of the yang ming stomach and tai yin lung. Mai men dong brings the Earth class to Metal by adding yin to Earth which gives birth to Metal and then Water.

Fu ling, Poria

Fu ling is not sweet but bland and bland can belong to Earth. Fu ling brings the Earth class to the element Water by promoting urination. Fu ling restores control over Water by Earth. Fu ling directly drains excess water and this restores control.

Fu ling is often combined with bai zhu to restore control over Water. Bai zhu by Earth and fu ling by Water.

Zhi gan cao, Glycyrrhizae radix prep

Zhi gan cao belongs to Earth because the taste associated with Earth is sweet. Zhi gan cao brings the Earth class to the element Wood by nourishing Wood and tonifying Earth. Zhi gan cao nourishes fluids to calm Wood excess yang. If Wood is excessively warm it can over control Earth causing dryness in the yang ming stomach.

Da zao, Jujubae fructus

Da zao belongs to Earth because the taste associated with Earth is sweet. Da zao brings the Earth class to the element Fire by nourishing blood directly and by tonifying tai yin. By nourishing heart blood yang qi becomes stronger. Tai yin is the source of post heaven qi, yin and blood.

Wu wei zi, Schisandrae fructus

Wu wei zi belongs to Metal because the taste associated with Metal is sour. Wu wei zi brings the Metal class to the element Metal by tonifying the tai yin lung which belongs to Metal.

Shan yao, Dioscoreae rhizome aka shu yu

Shan yao brings the Metal class to the element Water by tonifying the lung and spleen. Shan yao is sweet and it strongly tonfies Metal to give birth to Water. Metal lung disperses fluids over the body and Earth spleen transforms fluids to be sent to the lungs from Earth.

Zhi shi, Aurantii fructus immaturus

Zhi shi brings the Metal class to the element Wood by clearing accumulations in yang ming stomach so Metal can once again descend. Metal can then once again control Wood.

Zhi shi is a shao yang and yang ming herb. It is bitter and cold and it clears the damp phlegm congestion that causes the Wood wind to stagnant and heat up.

Dan dou chi, Sojae semen praeparatum aka dou chi

Dan dou chi brings the Metal class to the element Fire by mildly warming the Lung. It warms the surface and the lung and stomach. Dan dou chi warms the Fire element which controls Metal. 

Bai shao, Paeoniae radix lactiflora aka shao yao

Bai shao belongs to Metal because the taste associated with Metal is sour. Bai shao brings the Metal class to the element Earth by nourishing yin and blood to moisten yang ming dryness. Bai shao creates dampness and calms Wood wind by nourishing yin.

Sheng di huang, Rehmanniae radix recens aka di huang or sheng di

Sheng di belongs to Water because the taste associated with Water is bitter. Sheng di brings the Water class to the element Water by nourishing the fluid essences. It is bitter, sweet and cold. It is heat clearing and yin nourishing. The cold bitter drains heat from deficiency and the sweet nourishes yin and blood. It clears deficient heat in the kidney heart connection.

Huang qin, Scutellariae radix

Huang qin belongs to Water because the taste associated with Water is bitter. Huang qin brings the Water class to the element Wood by clearing excess heat that damages fluids that weaken imperial Fire yang qi. Cold and bitter heat clearing that cools blood which when hot gives way to excessive bleeding or flaring of ministerial fire.

Huang lian, Coptidis rhizome

Huang lian belongs to Water because the taste associated with Water is bitter. Huang lian brings the Water class to the element Fire by clearing heat in yang ming dryness that damages fluids that weaken imperial Fire yang qi.

Bai zhu, Atractylodis macrocephalae rhizome

Bai zhu belongs to Water because the taste associated with Water is bitter. Bai zhu brings the Water class to the element Earth by drying excessive dampness which restores control over Water. Bai zhu warms the Earth and dries the tai yin dampness which restores the control over Water.

Zhu ye, Lophatheri herba aka dan zhu ye

Zhu ye belongs to Water because the taste associated with Water is bitter. Zhu ye brings the Water class to the element Metal by clearing heat and draining it out through urination. It clears Earth stomach and Metal large intestine dry heat without damaging depleted fluids.

I must say that this took me a long time to figure out and there is still a feeling that I am missing something. I may never know why each herb justifies its place. Still it taught me about movement!