Spasms, Palpitations, and Gnashing of Teeth
On Yì Gān Sӑn
This week we’re going to spotlight another formula which has proven useful in our clinic over the years, but is overshadowed by other prescriptions in its category. There are some specific situations, signs and symptoms that indicate its use, so let’s have a look.
Yì Gān Sӑn (Restrain the Liver Powder)
Not to be confused with Yī Guàn Jiān (Linking Decoction), Yì Gān Sӑn (Restrain the Liver Powder) is found in the Harmonizing section of Formulas and Strategies (Scheid et al., 2009) as a prescription related to Xiāo Yáo Sàn (Free Wanderer/ Free & Easy/ Rambling Powder). It shares many constituent ingredients with Xiāo Yáo Sàn, and treats a similar pattern with one major difference. We’d previously written a brief article for the FSOMA Journal on alternatives to Xiāo Yáo Sàn, which included Yì Gān Sӑn, but we thought we’d flesh out the presentation a bit here.
Origin
Yì Gān Sӑn was originally published in the pediatric text Bǎo Yīng Cuò Yào (Summary of the Protection of Infants) by Ming era physician Xuē Kǎi. The etiology, pathomechanisms, manifestations, and composition of the formula were described thus:
抑肝散
治肝經虛熱發搐，或痰熱咬牙，或驚悸寒熱，或木乘土而嘔吐痰涎，腹脹少食，睡臥不安。
軟柴胡 甘草（各五分） 川芎（八分） 當歸 白朮（炒） 茯苓 鉤藤鉤（各一錢）
上水煎，子母同服。如蜜丸，名抑青丸。
Yì Gān Sӑn
Treats Liver channel deficiency heat engendering spasms, or phlegm-heat gnashing of teeth, or fearful palpitations with chills and fever, or Wood overwhelming Earth with vomiting of phlegm-drool, abdominal distension, lack of appetite, and restless insomnia.
Soft (a.k.a Southern) Chái Hú (Bupleuri Radix), Gān Cǎo (Glycirrhizae Radix), 5 fēn each;
Chuān Xiōng (Ligustici chuanxiong Rhizoma), 8 fēn;
Dāng Guī (Angelicae sinensis Radix), fried Bái Zhú (Atractylodis macrocephalae Rhizoma), Fú Líng (Poriae Sclerotium), Gōu Téng hooks (Uncariae Uncis), 1 qián each.
Decoct in water, mother and child can take together as honey pills, named Yì Qīng Wán (Restrain the Cyan Pills).
Formula analysis
As noted above, Yì Gān Sӑn is very similar in composition to Xiāo Yáo Sàn, and treats much the same pathology: Liver-Spleen disharmony with Liver Qì depression, Liver Blood deficiency, and Spleen Qì deficiency. Both formulas contain Chái Hú, Dāng Guī, Bái Zhú, and Fú Líng. The main differences are that Bái Sháo (Paeoniae alba Radix), Shēng Jiāng (Zingiberis recens Rhizoma), and Bò Hé (Menthae Herba) have been removed from Xiāo Yáo Sàn, and Gōu Téng and Chuān Xiōng have been added. This gives the formula an added heat-clearing and wind-extinguishing capability (Gōu Téng) and extra blood-invigorating and pain-relieving (Chuān Xiōng) properties.
Applications
The formula is commonly used in Japan (which is how we first became aware of it). Despite originating as a pediatric formula, it is used often in adults. Shibata & Wu (1997) emphasize its psychologic presentation: over-excitable, short-tempered, not sleeping, with signs of spasmodic muscle tension, like shoulder stiffness (katakori), gnashing of teeth, tics, and so forth. Rising Liver Yáng or Liver Wind signs like headache or dizziness combine with Spleen deficiency signs like low appetite and fatigue.
Formulas and Strategies (Scheid et al., 2009) mentions that Japanese physicians frequently augment the formula with Bàn Xià (Pinelliae Rhizoma) and Chén Pí (Citri reticulatae Pericarpium), in cases that involve a more pronounced phlegm component.
The abdominal conformation (fukushō, see image below) is tightness of the left rectus abdominis, usually from the lower ribs to the level of the navel. Also possible is a more general subcostal stagnation (usually indicating Chái Hú formulas), and substernal tightness (which is a sign often indicating the inclusion of Bàn Xià).
Its use in the modern pediatric literature includes treatment of ADHD (Flaws & Lake, 2001).
In our own clinic, the most common application is in patients who suffer from spasmodic headaches, neck and shoulder pain, TMJ, and other stress-related issues presenting with a pattern of Liver Qì stagnation with depressive heat and mild to moderate Spleen Qì deficiency. Important confirming signs include left rectus tension (which can also present as tight ropy muscles on the left mid-back around the area of BL17 to BL19), and spasm of the scalenes and SCM (often on the left but may occur on either or both sides).
Comparisons
Yì Gān Sӑn is not as strongly heat-clearing as Jiā Wèi Xiāo Yáo Sӑn (Augmented Free and Easy Wanderer Powder), but it excels at treating Liver Wind manifestations. It addresses Wind and Yáng rising due to underlying Liver-Spleen disharmony, and is not as strong in its ability to anchor and calm as formulas such as Tiān Má Gǒu Téng Yǐn (Gastrodia and Uncaria Decoction), which is better suited to cases involving Liver-Kidney deficiency. It is also less settling than Chái Hú Jiā Lóng Gǔ Mǔ Lì Tāng (Bupleurum plus Dragon Bone and Oyster Shell Decoction), but includes herbs which treat Blood deficiency and stasis without mineral ingredients that can be hard on the Middle Burner.
Modification Examples
For Phlegm, add Bàn Xià and Chén Pí as above. Zhú Rú (Bambusae in Taeniam Caulis) and Xià Kū Cǎo (Prunellae Spica) are also worth considering.
For Spirit disturbance, add Hé Huān Pí (Albizziae Cortex) and Yè Jiāo Téng (Polygoni multiflori Caulis).
For more severe pain, add Yán Hú Suǒ (Corydalis Rhizoma).
For focus issues, add Shí Chāng Pú (Acori Graminei Rhizoma) and Yuǎn Zhì (Polygalae Radix).
Available formulations
Yì Gān Sӑn is not well-represented in premade pill form. Blue Poppy does offer the original formula in tablets, as well as a heavily modified liquid pediatric formulation named Peaceful Focus. Companies such as KPC, Sun Ten, and Evergreen offer the formula in granules and capsules.
Conclusion
Yì Gān Sӑn is a harmonizing formula worth considering for Xiāo Yáo Sӑn or Jiā Wèi Xiāo Yáo Sӑn types of cases in which the clinical picture includes wind symptoms such as spasms, headaches, dizziness, and excessive muscular tension, especially from the upper abdomen to the neck and head. It may also be helpful in modified form for focus issues in children and adults. Integrating the palpatory signs can make for a more accurate confirmation.
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
Flaws, B., & Lake, J. (2001). Chinese medical psychiatry: A textbook and clinical manual. Blue Poppy Press.
Hayden, R. (2020). Beyond Free Wanderer: Options for liver-spleen disharmony. FSOMA Journal, Fall 2020. https://fsoma.memberclicks.net/assets/docs/FSOMAJournal/2020%20Fall%20FSOMA%20Journal%20%20.pdf
Scheid, V., Bensky, D., Ellis, A., & Barolet, R. (2009). Chinese Herbal Medicine: Formulas & Strategies (2nd ed.). Eastland Press.
Shibata, Y., & Wu, J. (1997). Kampo treatment for climacteric disorders. Paradigm publications.
Xuē, K. (1555). Bǎo yīng cuò yào. Retrieved December 9, 2022 from https://jicheng.tw/tcm/book/%E4%BF%9D%E5%AC%B0%E6%92%AE%E8%A6%81/index.html