Yin deficiency. Yuxing Liu. Academy of Oriental Medicine at Austin

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1 Yin deficiency Yuxing Liu Academy of Oriental Medicine at Austin

2 General introduction Concept Key symptoms Etiology Most Related Organs

3 Herbs that nourish Yin Herbs for Nourishing yin herbs HT Lu ST LIV KI SP LI sha shen x x bai he x x mai dong x x x tian dong x x shi hu x x yu zhu x x huang jing x x x gou qi zi x x han lian cao x x nu zhen zi x x sang shen zi x x hei zhi ma x x x (Chinese book) gui ban x x x bie jia x x (Chinese book) x (bensky) the following herbs are in different category in Chinese books xi yang shen x x x sang ji sheng x x luo han guo x x bai mu er x x

4 Yin liquid deficiency Yin deficiency Yin essence deficiency hyperactivity of yang

5 Yin liquid deficiency

6 Zeng Ye Tang 增液汤 increase the fluids decoction - Wen Bing Tiao Bian Sheng Di 24g Mai dong 24g Xuan Shen 30g Functions: nourishes Yin, clears heat; increases fluids, moisten dryness; promote bowel movement Indications: constipation (due to injury of fluids usually from a warm febrile disease, or a patient with chronic Yin deficient constitution), thirst, dry mouth or throat, T- dry red tongue with scanty yellow coat P- slightly rapid or weak forceless. If more purgative is required Zeng Ye Cheng Qi Tang should be used. Modern applications: habitual constipation, hemorrhoids, irritable bowel syndrome, hyperthyroidism

7 Yin essence deficiency

8 Liu Wei Di Huang Wan 六味地黄丸 Six ingredients rehmania pill Shu di 24g Shan zhu yu 12g Shan yao 12g Fu ling 9g Ze xie 9g Mu dan pi 9g Tonifying herbs KI LIV SP Sedating (drain) herbs SP KI LIV Functions: nourish and enriches Liver and Kidney Yin (essence) Indications: Liver and Kidney Yin deficiency (essence deficiency) Lower back and knees soreness and weakness, dizziness or vertigo, tinnitus or deafness, night sweats, nocturnal emissions, thirst, feeling heat in the palms and soles, toothache, chronic sore throat, scanty, difficult or painful urination, tidal fever T: red with scanty coating P: thin, somewhat rapid Contraindicated for diarrhea from SP Qi deficiency; phlegm-damp retention with greasy white tongue coating

9 The reasons for using draining herbs in Liu Wei Di Huang Wan: 1. To protect water transformation: KI dominates water metabolism, lifts the clears ad descends the turbid fluids. Fu ling, Ze xie helps raise clear and descends turbid fluids. 2. clear empty heat from KI: KI is the source of water and fire in the body. If KI yin is deficiency, empty fire may injure the fluids. 3. for symptoms: Mu Dan Pi for clears and empty and full heat from LIV & KI, Ze xie promote urination and drain turbidity from KI, Fu Ling drains dampness from the SP. 4. for side effects: Ze xie promote urination to control the greasy stickiness of Shu Di, Fu ling transform dampness to help Shan yao to tonify SP, Mu Dan pi purges heat from LIV to control the warmth of Shan Zhu Yu. 5. for internal pathogen: before tonification begin, the pathogenic factor must be expelled from interior, otherwise attempts to tonify will be futile. Analytic collection of medical formulas (Wang Ang 1682) : Tonifying herbs must be accompanied by herbs to expel the existing evils. Once the evil has been removed, tonification can begin.

10 Modifications of Liu Wei Di Huang Wan Qi Wei Du Qi Wan Liu Wei Di Huang Wan + Wu Wei Zi 6g Mai Wei Di Huang Wan Liu wei di huang wan + mai dong 9g, wu wei zi 6g Qi Ju Di Huang Wan Liu wei di huang wan + gou qi zi 9g, ju hua 9g Zhi Bai Di Huang Wan Liu Wei Di Huang Wan + Zhi Mu (salt fried) 6g, Huang Bai (salt fried) 6g

11 Qi Wei Du Qi Wan Shu di 24g Shan zhu yu 12g Shan yao 12g Wu weizi6g Fu ling 9g Ze xie 9g Mu dan pi 9g Functions: Nourish the KI yin and LU yin, astringents the Qi, stops coughing and wheezing. Indications: KI yin and LU yin deficiency Cough, wheezing, difficult breathing, worse in the afternoon, weak voice, shortness of breath, soreness and weakness of lower back, tidal fever, night sweats, or nocturnal emission T: red with scanty coat P: thin, rapid Cautions for patients with indigestion and diarrhea due to deficiency of the SP and ST Modern applications: chronic cough, asthma, hemoptysis, pulmonary emphysema, pulmonary tuberculosis, diabetes

12 Mai Wei Di Huang Wan (Ba Xian Chang Shou Wan) 麦味地黄丸 ophiopogen, schizandra, and rehmannia pill Mai dong 9g Wu wei zi 6g Shu di 24g Shan zhu yu 12g Shan yao 12g Ginger juice swallow together Fu ling 9g Ze xie 9g Mu dan pi 9g Functions:. Nourish the KI yin and LU yin, astringents the Qi, stops coughing and wheezing. Indications: KI yin and LU yin deficiency Cough, wheezing, difficult breathing, worse in the afternoon, weak voice, shortness of breath, soreness and weakness of lower back, tidal fever, night sweats, or nocturnal emission T: red with scanty coat P: thin, rapid Cautions for patients with indigestion and diarrhea due to deficiency of the SP and ST Modern applications: chronic cough, asthma, hemoptysis, pulmonary emphysema, pulmonary tuberculosis, diabetes

13 Qi Ju Di Huang Wan 杞菊地黄丸 Lycium, chrysanthumum, and rehmannia pill Gou qi zi 9g Shu di 24g Fu ling 9g Ju hua 9g Shan zhu yu 12g Ze xie 9g Shan yao 12g Mu dan pi 9g Functions: nourishes the Liver and Kidney Yin; brighten the eyes; calms the Liver Yang Indications: Yin deficiency of the liver and kidney with eye disturbances Blurred and diminished vision, dry or painful eyes, tearing when exposed to wind, dizziness, vertigo, soreness and weakness of lower back, tinnitus, tidal fever, T: red tongue with scanty coat P: thin, rapid pulse Cautions for patients with indigestion and diarrhea due to deficiency of the SP and ST Modern applications: diabetes, hypertension, arteriosclerosis, optic neuritis or atrophy, glaucoma, ophthalmalgia, retinitis, cataract

14 Zhi bai di huang wan 知柏地黄丸 Anemarrhea, phellodendron, and rehmannia pill (salt chao) Zhi mu 6g Shu di 24g Fu ling 9g (salt chao) Huang bai 6g Shan zhu yu 12g Ze xie 9g Shan yao 12g Mu dan pi 9g Functions: nourishes the Liver and Kidney Yin; reduces the deficient fire; clears damp-heat in the lower Jiao Indications: Yin deficiency of the liver and kidney with deficient fire Lower grade of fever or steaming bone fever, irritability, night sweats, a feverish sensation in the palms and soles, soreness and weakness of lower back, nocturnal emission, toothache or loose teeth, scanty and difficulty urination T: red tongue with scanty coat or thin yellow coat P: thin, rapid and empty pulse Cautions for patients with indigestion and diarrhea due to deficiency of the SP and ST Modern applications: diabetes, hypertension, arteriosclerosis, hyperthyroidism, chronic UTI, pulmonary tuberculosis, optic neuritis or atrophy, infantile dysplasia amenorrhea, menopausal syndrome, chronic toothache

15 KI yin deficiency Liu wei di huang wan

16 Zuo Gui Wan 左归丸 left restoring pill Shu di 240g Shan yao (chao)120g Shan zhu yu 120g Gou qi zi 120g Chuan niu xi (zhi) 90g Gui ban jiao (chao zhu) 120g Tu si zi (zhi) 120g Lu jiao jiao (chao zhu) 120g Functions: nourishes Kidney Yin and essence Indications: KI Yin and essence deficiency Blurred vision, soreness and weakness of lower back, nocturnal emission, spermatorrhea, night sweats, dry mouth and throat, thirst with a desire to drink water, lose of hair or tooth, infertility or amenorrhea T: red tongue with scanty coat P: thin, rapid pulse Cautions for patients with indigestion and diarrhea due to deficiency of the SP and ST Modern applications: diabetes, lumbago, chronic consumptive diseases, tuberculosis, infertility or amenorrhea, spermatorrhea

17 Da bu yin wan 大补阴丸 (great tonify the yin pill) Shu di 18g (zhi) Gui ban 18g (chao) Zhi mu 12g (chao) Huang bai 12g Zhu ji sui 猪脊髓 Feng mi Functions: nourish the Yin, tonifies the liver and kidney and replenishes the essence; clears empty heat Indications: severe liver and kidney yin and essence deficiency with empty heat Afternoon tidal fever, a feeling of bone-steaming, night sweats, coughing with scanty sticky blood-streaked sputum, irritability, constant hunger, weakness, pain in the knees and legs; purpura T: red with scanty or no coating P: rapid, full, empty Cautions for poor appetite or loose stool from SP/ST qi deficiency

18 Da bu yin wan Zhi bai di huang wan Ingredients Common Shu di, zhi mu, huang bai Different Gui ban, zhu ji shui, feng mi Shan zhu yu, shan yao, fu ling, ze xie, mu dan pi Functions Common Nourish yin, clear empty heat Different Stronger on clear empty heat Stronger on nourish Yin

19 LIV yin deficiency LIV yin deficiency Eyes Tendons Menstruation

20 Qi Ju Di Huang Wan 杞菊地黄丸 Lycium, chrysanthumum, and rehmannia pill Gou qi zi 9g Shu di 24g Fu ling 9g Ju hua 9g Shan zhu yu 12g Ze xie 9g Shan yao 12g Mu dan pi 9g Functions: nourishes the Liver and Kidney Yin; brighten the eyes; calms the Liver Yang Indications: Yin deficiency of the liver and kidney with eye disturbances Blurred and diminished vision, dry or painful eyes, tearing when exposed to wind, dizziness, vertigo, soreness and weakness of lower back, tinnitus, tidal fever, T: red tongue with scanty coat P: thin, rapid pulse Cautions for patients with indigestion and diarrhea due to deficiency of the SP and ST Modern applications: diabetes, hypertension, arteriosclerosis, optic neuritis or atrophy, glaucoma, ophthalmalgia, retinitis, cataract

21 Yi Guan Jian 一贯煎 one link decoction Shashen10g Mai dong 10g Dang gui shen 10g Sheng di 15-30g Gou qi zi 12g Chuan lian zi 5g Functions: nourishes the yin and tonifies the liver and kidney; spreads liver qi and releases constraint Indications: liver and kidney yin deficiency with liver qi stagnation Hypochondriac and chest pain, epigastric and abdominal distension or pain, acid regurgitation, sour taste in the mouth, dry mouth and throat, emotional upset; hiatus hernia T: red, dry with dry coating P: weak and thin, or weak, thin and wiry Cautions and contraindications: contraindicated for full heat; caution for phlegm, water retention or diarrhea

22 LU yin deficiency

23 Yang Yin Qing Fei Tang 养阴清肺汤 nourish Yin and clear lung decoction / Chong Lou Yu Yao Sheng di 12g Mai dong 9g Gan cao 3g Mu dan pi 5g Bo he 3g Chao bai shao 5g Xuan shen 9g Bei mu 5g (chuan?) Moisten Lung and stop cough Functions: nourishes Yin, clears Lungs, benefit throat Indications: diphtheria with Yin deficiency white covering or membrane in the throat that is difficult to scrape off (this covering effects breathing), sore swollen throat, hoarse voice, dry nose and lips, fever, breathing similar to wheezing, dry hacking cough, T- red dry, P- thin, weak, rapid. Modern applications: If is diphtheria, western medicine should be use. Acute tonsillitis, acute pharyngitis

24 Bai he gu jin tang 百合固金汤 / Lily Bulb Decoction to consolidate the metal Yi Fang Ji Jie Bai he 12g Sheng di 9g Dang gui shen 9g Jie geng 6g Xuan shen 3g Bai shao 6g Chuan Bei mu 6g Mai dong 9g Shu di 9g Gan cao 3g Functions: nourishes Yin, moistens Lungs; transforms Phlegm, stops coughing; clear heat, cool blood Indications: LU and KI yin deficiency with deficient dry sore throat, cough and wheezing, may see blood streaked sputum, a feverish feeling on palms and soles, night sweats, anxiety, irritable, thirst, fidgety, afternoon cheek flushing, light sleeps, sore low back T- red with scanty coat, P- rapid thin. Contraindicated in cases of diarrhea, abdominal distention and pain, poor appetite due to SP deficiency. Modern applications: pulmonary tuberculosis, bronchitis, chronic laryngopharyngitis

25 HT yin deficiency

26 Zhi Gan Cao Tang 炙甘草汤 glycyrrhiza decoction Zhi gan cao 12g Sheng jiang 9g Gui zhi 9g Renshen6g Sheng di 50g E jiao 6g (dissolve in the decoction) Mai dong 10g Huoma ren10g Da zao 10pc Rice wine Cooking methods: Wine (Qing jiu) 7 liter, water 8 liter, cook 8 herbs until 3 liter, get decoction add E Jiao dissolve, 1 liter x 3/day. Functions: tonifies the Qi and nourishes the blood; nourishes the Yin and fluids, generates and regulates the pulse Indications: Qi, blood and fluids deficiency causing an irregular pulse Palpitations with anxiety or irritability, insomnia, emaciation, shortness of breath, pale face, possible low-grade fever, cough without sputum or with scanty bloodstreaked sputum, night sweats or spontaneous sweating, dry mouth, constipation; arrhythmia, coronary disease T: pale with scanty coating P: weak, irregular, thin, minute or weak and rapid Contraindicated for ST/SP deficiency with diarrhea; empty heat from Yin deficiency (this formula is somewhat warm)

27 Tian Wang Bu Xin Dan 天王补心丹 (chief herb) heavenly emperor s Heart-tonic pill Suan zao ren 9g Baiziren9g Dang gui shen 9g Tian men dong 9g Mai men dong 9g Sheng di 12g Renshen5g Dan shen 5g (sl. Chao) Xuan shen 5g (sl. Chao) Fu ling 5g Wu wei zi 5g Yuan zi 5g (chao) Jie geng 5g Zhu sha (coating the pills) Functions: nourishes Yin & blood; tonifies and nourish Heart & Kidney; clears empty heat and calms spirit Indications: Heart and Kidney Yin deficiency with empty heat irritable, palpitations with anxiety, fatigue, insomnia, restless sleep, easily awakened during the night, inability to concentrate even for small periods of time, nocturnal emissions, forgetfulness, dry mouth, dry stools, cankers, night sweats T: red tongue scanty coat P: thin rapid pulse Contraindicated in: SP/ST Qi deficiency; phlegm-damp accumulation

28 Formula functions symptoms common Tian wang bu xin dan Suan zao ren tang Calms the mind, Nourish the Blood Different Nourish Yin Clears empty heat common insomnia Different Insomnia, palpitations, anxiety, poor memory Frequent waking up during the night Mental fatigue, poor mental focus, nocturnal emissions Restless sleep, irritable Dizziness, vertigo Gui pi tang Tonifies Qi Difficult falling asleep, poor, shallow sleep Fatigue, worry, poor appetite, sallow complexion Tongue red, dry Red, dry Pale, swollen Pulse thin rapid Wiry, rapid Thin, weak indications HT & KI yin deficiency, with empty heat LIV & HT blood deficiency with empty heat flaring organs KI, HT LIV, HT SP, HT SP qi and HT blood deficiency

29 ST yin deficiency

30 Mai Men Dong Tang 麦门冬汤 Jin Gui Yao Lue Mai dong 70g Ban xia 10g Renshen6g Gan cao 6g Jing (geng) mi 5g Da zao 12pc Functions: nourishes Lung Stomach Yin, generates fluids, directs rebel Qi downwards; tonifies Qi, harmonize middle Jiao Indications: LU and ST Yin deficiency with rebellious and deficient Qi cough with sputum which is difficult to expectorate, or spitting of whitish frothy saliva, shortness of breath, nausea, vomiting, dry mouth, dry throat, lips, cankers, bad breath, thirst, a feverish sensation in the palms and soles T- red with scanty coat P- thin, weak, rapid. Contraindicated in the case of deficient cold. Modern applications: chronic bronchitis, pulmonary tuberculosis, chronic pharyngitis, chronic gastritis, atrophic gastritis

31 Hyperactivity of Yang

32 Tian Ma Gou Teng Yin 天麻钩藤饮 Gastrodia and uncaria decoction Za bing zheng zhi xin yi Tian ma 9g Gou teng 12g (end) Shi jue ming 18g (cook 1 st ) Zhizi9g Huang qin 9g Chuan niu xi 12g Du zhong 9g Yi mu cao 9g (Move blood, reduce edema) Sang ji sheng 9g Ye jiao teng 9g Fu shen 9g Functions: clear Heat, eliminate Phlegm, soothe Liver, stop Wind, anchors Yang Indications: Liver yang rising with internal wind headache, dizziness, vertigo, tinnitus, blurred vision, heat rising to the head, tremors, twitching or spasms in the hands and feet, numbness of extremities, insomnia with many dreams; (hypertension), hemiplegia, facial deviation T: red tongue, P: wiry rapid pulse Contraindicated for internal wind due to deficiency

33 Yin deficiency yin fluid deficiency yin essence deficiency KI yin deficiency KI Yin deficiency (KI essence deficiency) KI Yin deficiency with breathing problems KI Yin deficiency with empty heat KI Yin deficiency (no damp) KI Yin deficiency with empty heat KI Yin deficiency with eyes problems KI and LIV Yin deficiency LIV yin deficiency LIV yin deficiency LU yin LU yin deficiency deficiency LU and KI yin deificiency HT yin HT yin deficiency deficiency HT and KI yin deficiency ST yin deficiency (LU yin deficiency) hyperactivity of LIV Yang

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