Dui Yao in an Ancient Brain Formula

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There are many ways to increase your knowledge of Chinese herbal medicine, one of which is to learn about paired relationships between single herbs called Duì Yào 對藥 . These pairings can be very helpful for understanding single herbs and learning formulas. Duì 对對 means "two" and Yào 药藥 means "herbs." The concept can be translated as "pair medicine" where two herbs are used together to emphasize and harmonize with one another, improving the medicinal effect.

There are 6 Types of Duì Yào Pairs:

1. Combining Herbs to Enhance Mutual Compatibility. These are either:
1. Two similar herbs from the same herbal category, which support each other.
2. Two herbs from different herbal categories that complement each other.
2. Combining Herbs to Enhance Opposite but Complementary Actions. This includes:
1. Hot/Cold
2. Tonifying/Draining
3. Opening/Gathering
4. Fixed/Activating
5. Upward/Downward
3. Combining to Protect.
4. Combining to Harmonize.
5. Combining to Guide.
6. Combining Flavors and Natures.

Let’s look at the second category called, “Combining Herbs to Enhance Opposite but Complementary Actions” through the lens of the harmonizing formula Chái Hú Jiā Lóng Gŭ Mù Lì Tāng 柴胡加龍骨牡蠣湯. Rén shēn (Panax Ginseng) and Dà huáng Rhubarb (Rheum palmatum) are two famous herbs in the formula and they have a Duì Yào paired relationship based on their temperature and functions.

Rén shēn 人參 (Panax ginseng) + Dà huáng 大黃 (Rheum palmatum)

Temperature

Firstly, this pair has opposite temperatures as one is warm, and one is cold. Rén shēn, is a gloriously warming Qi tonic, while Dà huáng is a powerfully cold and heat clearing medicine. Because of their complementary temperatures, this combination is cooling without injuring, and warming without drying.

Functions

Secondly, the pair displays opposite functions of supplementation and draining actions, which can be crucial when treating excess conditions coexisting with underlying deficiency, where you want to support the Upright Qi and drain the Evil Qi simultaneously. Dà huáng, which is bitter and cold, detoxifies stagnant heat by flushing it through the intestines. Rén shēn, which is sweet and warm, restores the original nature by strengthening weak digestion, which is often causitive in terms of how the pathogenic influences were able to take hold originally.

The complementary nature of these ‘draining’ and ‘tonifying’ actions is the crux of the fascinating formula Chái Hú Jiā Lóng Gŭ Mù Lì Tāng, which is magical in its contradictions and effectiveness.

Chái Hú Jiā Lóng Gŭ Mù Lì Tāng 柴胡加龍骨牡蠣湯 - “Bupleurum Plus Dragon Bone and Oyster Shell Decoction”

This 12-herb ancient formula was developed by master herbalist, Doctor Zhāng Zhòng-Jǐng 張仲景, during the Eastern Han Dynasty, and published around 220 C.E. in the classical book Shāng Hán Lùn (Discussion of Cold Damage 伤寒论傷寒論).

Chái Hú Jiā Lóng Gŭ Mù Lì Tāng is primarily a ‘Harmonizing Formula’ with Chái hú as its lead herb. It is for a complicated pattern of excess and deficiency symptoms in all three burners and the Yang organs. Despite many different interpretations over the years, the important thing is that this formula focuses on eliminating excess stagnation while strengthening the underlying deficient person, just like the complementary action of the paired herbs discussed earlier.

Ingredients

A quick look at the ingredients reveals that this formula contains another extremely important formula called Xiǎo Chái Hú Tāng 小柴胡湯 ‘Minor Bupleurum Decoction’, that includes: Chái hú (Bupleurum chinensis), Bàn xìa (Pinella ternata), Huáng qīn (Scutellaria baicalensis), Rén shēn (Panax ginseng), Dà zao (Ziziphus jujube), and Shēng jiāng (Zinziberis rhizoma).

The formula also contains six other ingredients: Lóng gŭ (Fossilia Ossis Mastodi), Mŭ lì (Ostrea gigas), Dà huáng (Rheum palmatum), Guì zhī (Cinnamomum cassia), Fú líng (Poria cocos) and usually a heavy mineral substance such as Dài zhĕ shí (Haematitum).

Chái Hú Type

The lead herb, as the formula name implies, is Chái hú (Bupleurum chinensis). And with that in mind, this formula is excellent for people who fit the ‘Chái hú Type’ personality, namely they are unpredictable and hard to read, which gives rise to the ‘Chái hú demeanor’ which includes:

Chái Hú Type - Outward Signs + Symptoms

• An expressionless face with emotions held in check (as if they are wearing a mask to conceal their feelings)
• Facial color can have a yellow or greenish hue (stagnation)
• Depressed and unsatisfied with emotional ups and downs

Chái Hú Type - Inward Signs + Symptoms

• Introverted personality type
• Rational, disciplined, methodical type
• Quickly changeable emotions (that easily affect appetite or sexual interest)
• Fluctuating allergic tendencies
• Alternating hot and cold temperatures
• Extra or overly sensitivity to the environment (to the point of developing allergies)
• Hypochondriacal in nature

Treating Vexation Fán 烦 煩

When Yáng Qì 陽氣 is stuck internally, the stagnation becomes heated and goes upward to bother the Heart, and the Shén 精神 becomes uncalm. There is a tendency toward mood issues and mental restlessness. The term is called fán 烦煩, translated as ‘vexation’.

1. It means there is a restless mind with anxiety, panic, unstable emotions, insomnia, rapid speech, an inability to focus and jumpiness. This includes being startled easily such as with sudden fears or even startling awake with nightmares. This can also include rage issues or incoherent speech.
2. Secondly, fán-type vexation can give rise to an uncomfortable feeling in the chest like palpitations, chest fullness, difficult breathing or excess sighing.

In the case of “Bupleurum plus Dragon Bone and Oyster Shell Decoction”, fán- type vexation can also lead to depression, especially with marked fatigue or emotional paralysis. There is a lack of interest in life, a form of PTSD from past trauma and fighting. The depressed state can include a bit of a frozen look, similar to that exhibited in Parkinson’s disease. The whole body can feel heavy or have a hard time turning side to side, a lack of interest in moving about. There could be poor reflexes and extreme chronic fatigue, sort of a “deer in the headlights” catatonic state. The person is actually fatigued from Liver Qi Stagnation.

Brain Issues

The main effect of this formula is on the brain. Because it contains herbs like Bàn xìa, Huáng qīn and Dà huáng, it can loosen stagnation, which enlivens brain function and promotes neuroplasticity. The formula helps the hypothalamic-pituitary axis, which is a complex system of neuroendocrine pathways and feedback loops that maintain physiological homeostasis. With herbs like Chái hú, this formula helps regulate this complex system by keeping the levels of dopamine and serotonin properly elevated in the pre-frontal cortex of the brain, which in turn has mood stabilizing effects.₂ These effects can have a positive effect on a number of brain issues associated with normal aging including reduced memory and cognitive decline.

Since the eyes and ears are made up of brain tissue, a practitioner can include a review of these organs to assess whether or not they are finely tuned or under-reactive. The formula is very good for cases where the eyes have a dull, even frozen state at times. It’s also very good when the ears and hearing are impaired. A diminishment of either sense is sufficient for use of the formula.

Neuropsychiatric & Spirit Issues

This formula brings people back to themselves to reconnect with their inner nature. It settles the Spirit, nourishes and calms the central nervous system, with grounding herbs like Lóng gŭ and Mŭ lì. This grounding effect is settling to the Shén, as the herbal formula gives Spirit a home in the body and an expression through the mind. The formula can be used for over-excited cases and can return the Spirit when it is leaving the body or when the person is disassociating. This formula can help restore psycho-emotional and neurological equilibrium.

Spirit issues that this formula treats include:

• Depression (with fatigue)
• Post traumatic stress (with nightmares, insomnia, palpitations)
• Increased muscle tension, tremors
• Disturbed sleep (take right before bed)
• Stress-induced irregular pulse
• Shao Yang headaches
• Emotional disorders associated with Liver excess including: agitation, fright, and rage
• Incoherent or “pressured” speech

Bladder Control

In most Chái Hú Jiā Lóng Gŭ Mù Lì Tāng cases, the urination may be abnormal. There can be a lack of free flow, or conversely it can be frequent or incontinent, especially when startled. There can be a psychological component with a “nervous pee” where the patient gets tense, stressed, upset or nervous and subsequently feels the need to urgently urinate, even if there is a reduced amount of urine. Edema can also be part of this case, which shows that the water is not flowing freely.

Sexual Function

Chái Hú Jiā Lóng Gŭ Mù Lì Tāng can treat a decline in sexual function by unblocking the brain so that it can feel alive, including sexual excitement. Remember, Chái hú is in this formula and can make people happy. Because the formula treats depression, it can improve sexual function when there are emotional issues at play (not so much with physical issues). If there is erectile dysfunction, this is a localized body heaviness and part of the tendency toward lack of movement as discussed above.

Tongue and Pulse

Tongue: reddish body, thick, yellow coating, possibly greasy or slippery tongue coating or the tongue coating could even be dry and scorched
Pulse: rapid, possibly wiry or slippery

In Summary

Chái Hú Jiā Lóng Gŭ Mù Lì Tāng is a unique prescription as it is both a tonifying and purgative formula. The formula treats the Spirit and protects the brain. It treats the mental and emotional aspects for improved mood and sleep. It can benefit the intellect of geriatric patients. It is excellent for chronic illness, advanced age, and long-term psychological stress that leads to a loss of psycho-emotional and neurological equilibrium. The Bupleurum plus Dragon Bone and Oyster Shell Decoction can be a good choice to use clinically to treat complex neuropsychiatric & Spirit issues, mainly related to chronic emotional imbalance. The formula contains paired herbs that push out the old, to create new reserves by supporting the Zheng Qi, ever reminding us that classic Duì Yào herbal pairings can provide a peek into the inner workings of complex healing formulas.

Sources:

• Ten Key Formula Families in Chinese Medicine, Huang Huang, Eastland Press, Seattle WA 2009
• Immediate and persistent antidepressant-like effects of Chaihu-jia-Longgu-Muli-tang are associated with instantly up-regulated BDNF in the hippocampus of mice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328878/
• Discussion of Cold Damage, Shang Han Lun, Guohui Liu, Singing Dragon, London UK 2016
• Formulas & Strategies, compiled, translated by Dan Bensky & Randall Barolet
• Chinese Herbal Formulas and Applications, Chen, J. and T. Chen, 2009
• Duì Yào: The Art of Combining Chinese Medicinals, by Philippe Sionneau, Blue Poppy Press 1997