Always a Divine Response
Notes on Guī Pí Tāng
Guī Pí Tāng (Spleen-Returning Decoction or Restore the Spleen Decoction) was the first Chinese herb formula I ever took. Back in 1993, I complained of insomnia to my first Chinese medicine teacher, Dr. Wu, in his shop on Clark Street in Chicago. He handed me a bottle of teapills, labeled GUI PI WAN. They worked. I have had a fondness for the prescription ever since.
Guī Pí Tāng is one of those war horse formulas, one that gets used so much it gets taken for granted. I once heard an herbalist I respect sort of dismiss Guī Pí as being a bit one-dimensional. But I think there is more potential to the formula than insomnia, worries, and midcycle spotting.
The story of Guī Pí is that it comes from the Sòng period, generally attributed to Yán Yònghé (嚴用和, 1206-1268). Xuē Jǐ (薛己, 1487-1559) added Yuǎn Zhì and Dāng Guī to the original formula to get the combination we have today.
Contemporary view
The most common composition of the formula is such:
Chief herbs:
· Rén Shēn (Rx Ginseng)
· Bái Zhú (Rz Atractylodis macrocephalae)
· Zhì Gān Cǎo (Rx Glycyrrhizae prep)
· Huáng Qí (Rx Astragali)
Deputy herbs:
· Dāng Guī (Rx Angelicae sinensis)
· Fú Shén (Poriae Pararadicis)
· Suān Zǎo Rén (Sm Ziziphi spinosae)
· Lóng Yǎn Ròu (Arillus Longan)
· Yuǎn Zhì (Rx Polygalae)
Assistant herb:
· Mù Xiāng (Rx Aucklandiae)
Envoy herbs:
· Shēng Jiāng (Rz Zingiberis recens)
· Dà Zǎo (Fr Jujubae)
The modern analysis of the formula, exemplified by Scheid et al. (2009) is that it can be seen as a combination of Sì Jūn Zǐ Tāng (Four Gentlemen Decoction) and Dāng Guī Bǔ Xuè Tāng (Chinese Angelica Blood-Supplementing Decoction), which utilizes the principle of strongly boosting qì to build blood. Scheid et al. gives the spleen tonics the role of collective chief in the formula. The blood tonics and spirit calming ingredients get the deputy position. Mù Xiāng, the sole qì-regulating ingredient, is given the assistant position and Shēng Jiāng and Dà Zǎo (as ever) are the envoys.
The indications are generally spirit disorders like sleeplessness, frequent dreaming, anxiety, forgetfulness, and fearfulness; spleen issues like lack of appetite and fatigue; and vacuity-type bleeding syndromes.
Harmonizing Potential
One of the aspects of Guī Pí that I think has been underutilized is its potential as a harmonizing prescription. It is easy to overlook this, being loaded up with tonics. But there is a sort of liver-wood link in the formula, as Gāo Gǔfēng (高鼓峰, 1623-1670) mentions in his Sì Míng Xīn Fǎ (Siming Heart Method):
通於各症。無不神應。曰歸脾者。從肝補心。從心補脾。
Unblocks in every illness. Always a divine response. It is said that it returns the spleen. Through the liver, it supplements the heart. Through the heart, it supplements the spleen.
The liver-wood constituents of the formula are, of course, Dāng Guī and Suān Zǎo Rén. But Gāo suggests some additions to the formula that turn it further in that direction. Being an exponent of the Warm Supplementation (Wēn Bǔ) school of thought, Gāo was well acquainted with the doctrine of preserving the true yīn of the body; thus he seemed to have an issue particularly with Mù Xiāng, which he deemed too aromatic and drying, that it “stirs rebellious liver fire and dries the jīn-yè [反動肝火而干津液]”. He would often replace it with Sháo Yào (Rx Paeoniae), one of the most important liver herbs. Bái Zhú, too, was singled out as intensely drying and possibly aggravating to the lungs, which are prone to heat; the recommendation there as well was to add Sháo Yào to offset its parching quality. In cases of liver depression, Gāo proposed not only adding Sháo Yào but Chái Hú (Rx Bupleuri), Shān Zhī Zǐ (Fr Gardeniae) and Mǔ Dān Pí (Cx Moutan). This makes a formula very similar to Dān Zhī Xiāo Yáo Sǎn (a.k.a. Jiā Wèi Xiāo Yáo Sǎn, a.k.a. Free and Easy Wanderer Plus), but with a significant spirit-calming component.
Mù Xiāng – Problem herb or not?
Despite Gāo’s concerns, I have not had any problems with the standard formula; rather than caution over excessive drying, I have more often been concerned that the prescription would be too stagnating. But I have given Guī Pí even as a followup to phlegm formulas (once the tongue coating has largely cleared up) and the patients have done well with it. Scheid et al. mention the function of Mù Xiāng in awakening the spleen (which Gāo cited as the only reason to leave it in the formula, in cases of spleen vacuity cold), but also in regulating the qì dynamic, both functions being enhanced by the presence of Bái Zhú.
Wáng Xùgāo (1798-1862), held that Mù Xiāng was indispensible to the formula:
方內木香不可缺，香先入脾，總欲引血歸脾耳。凡思慮過度，勞傷心脾之病，此方允稱良劑。
In the formula, there should be no lack of Mù Xiāng. The fragrance first enters the spleen, always intending to lead the blood to return to the spleen. For all who suffer from excessive thought and preoccupation, and taxation damage illnesses of the heart and spleen, this formula is a well-suited and excellent medicine.
Mù Xiāng holds another interesting possibility: it is one of what I refer to as the ghost herbs mentioned in the Shén Nóng Bӗn Cӑo Jīng (Divine Farmer’s Materia Medica Classic), and appears in the formula alongside another ghost herb, namely Yuǎn Zhì. I speculated briefly on the pairing in an earlier post.
Gāo’s modifications
Some of Gāo’s modifications to Guī Pí Tāng, from Sì Míng Xīn Fǎ:
· If lung and kidney are injured then add Mài Dōng (Rx Ophiopogonis), and Wǔ Wèi Zǐ (Fr Schisandrae).
· If liver and kidney are injured add Sháo Yào. If secondarily anger and depression arise, to this add Chái Hú, Shān Zhī Zǐ, and Mǔ Dān Pí.
· If there is fearful throbbing and concurrent fire and phlegm in the pericardium, add Huáng Lián (Rz Coptidis), Shēng Dì (Rx Rehmanniae), Bèi Mǔ (Blb Fritillariae), and the like to clear.
· If there are nocturnal emissions, add things like Wǔ Wèi Zǐ, Shú Dì (Rx Rehmanniae preparatae), Bái Sháo (Rx Paeoniae Alba), Mǔ Lì (Concha Ostreae), etc. If the nocturnal emissions are complicated by ministerial fire add Huáng Bǎi (Cx Phellodendri), Zhī Mǔ (Rx Anemarrhenae), and Mài Dōng to clear.
Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Gāo, G. (n.d.). Sì míng xīn fǎ. https://jicheng.tw/tcm/book/%E9%86%AB%E5%AE%97%E5%B7%B1%E4%BB%BB%E7%B7%A8/index.html
Scheid, V., Bensky, D., Ellis, A., & Barolet, R. (2009). Chinese herbal medicine: Formulas & strategies (2nd ed.). Eastland Press.
Wáng, X. (1897). Yī fāng zhèng zhì huì biān gē jué. https://jicheng.tw/tcm/book/%E9%86%AB%E6%96%B9%E8%AD%89%E6%B2%BB%E5%BD%99%E7%B7%A8%E6%AD%8C%E8%A8%A3/index.html .