Dang Gui & Blood Deficiency in the Shang Han Lun

Dang Gui is sweet, acrid and warm. It is an important and commonly used herb to enhance the qualities and functions of blood, including movement, warming, nourishing, and promoting healing of damaged tissue.

In the ancient text Jin Gui Yao Lue, which composed the Shang Han Za Bing Lun, together with the Shang Han Lun, there are some important formulas that include dang gui. Many of these formulas are related to gynecological problems with involvement of blood deficiency.

Considering the evident significance of this herbs’ use in the various pathologies of blood deficiency, it is curious to notice that in the Shang Han Lun, dang gui appears only in relation to the Jue Yin conformation, and only in 4 formulas out of the 112 formulas detailed in the text.

Blood deficiency is not specific only to the Jue Yin conformation. This clear identification of Dang Gui as a herb specific only to Jue Yin pathologies, enables us to have a more accurate understanding of the function and correct use of this herb.

Blood deficiency in the Shang Han Lun

Blood deficiency is not often mentioned specifically by name in the Shang Han Lun. However, it can be identified in various pathologies through the clinical presentation described in the text, often manifesting as muscle contraction and spasm, tendency towards cold and a pulse which can be either slow or rough.

Blood deficiency is present in the various conformations, and the treatment of this deficiency, changes according to the conformation involved. While Dang Gui is only mentioned in relation to Jue Yin syndromes, Shao Yao is the herb used to tonify blood in Shao Yang and Tai Yin pathologies.

Treating blood deficiency with Shao Yao

Shao Yang

Blood deficiency is mentioned as a basis for pathology in the Shao Yang conformation:

Line 97:

“When the blood is weak and the Qi is exhausted, the interstices are open, and because evil Qi enters (the body) and contends with right Qi, (there is) binding under the rib side…”

This line discusses the development of Shao Yang disease as a situation where blood and Qi are deficient, and enable the penetration of damaging Qi into the Shao Yang conformation. The source of the deficiency is not mentioned in the text, and is not related to any of the other conformations. We can assume that it is a deficiency related to lifestyle: poor nutrition or over exertion.

The formula recommended for treatment is Xiao Chai Hu Tang. This formula is not usually considered to be a blood strengthening formula. However, based on the statement that there is an underlying blood deficiency involved in this pathology, it leads to the conclusion that blood deficiency must be addressed in the formula.

The ingredients of the formula listed in line 96, include only one blood tonic, Da Zao, which is a relatively mild tonic. However, in the instructions of how to brew the formula, a number of adjustments are mentioned, one of which is the addition of Shao Yao:

“If there is pain in the abdomen, remove Huang Qin and add three liang of Shao Yao.”

While blood deficiency is not specifically mentioned in this adjustment, the symptom mentioned is a clear indication of this pathology. Pain in the abdomen, which is not related to digestive problems, is a symptom of muscle spasm in the abdomen, a symptom often caused by blood deficiency. In the Shao Yang conformation, this can be attributed to a situation of Wood over-controlling Earth.

This combination of herbs: Shao Yao and Da Zao, together with Zhi Gan Cao, which enhances their effect, is also present in Gui Zhi Tang, a formula which I consider to also be of blood tonifying ability.

Tai Yin

Blood deficiency is also evident as a basis for pathology in the Tai Yin conformation, leading to increased muscle tension and spasm. This can include both skeletal muscles, manifesting in orthopedic problems, as well as a wide range of internal problems due to the smooth muscles that facilitate the function of the blood vessels and internal organs.

There are 3 formulas that are mentioned in relation to Tai Yin pathologies with a clinical presentation of blood deficiency:

  • Gui Zhi Jia Shao Yao Tang
  • Xiao Jian Zhong Tang
  • Xin Jia Tang

These formulas are all indicated for muscular spasm and tension leading to pain. All 3 of these formulas have a relatively high dose of Shao Yao compared to the other herbs in the formula. Again, Da Zao together with Zhi Gan Cao are combined with Shao Yao for enhancing the blood strengthening effect.

Treating blood deficiency with Dang Gui

As mentioned above, Dang Gui appears in the Shang Han Lun only in the Jue Yin conformation.

Blood deficiency is not mentioned in the Jue Yin chapter, but can be identified as part of a Jue Yin pathology, simply based on the use of dang gui.

The clinical presentation in this conformation is characterized by its name: The term jue 厥, means “extremes” and relates to a pathological relationship between the Yin and Yang forces of the body. In a healthy state, these two forces have a mutual relationship of nourishment, regulation and balance. In a Jue Yin pathology, there is a constant struggle between the two extremes. This leads to a dysfunction in the healthy cyclic movement in the body. It can be manifested in the cyclic movement of blood throughout the body, leading to the characteristic clinical manifestation of the term Jue – cold in the extremes. Clinical manifestations can also include hormonal imbalances relating to disruption of cyclic movement in the daily cycle, as well as the monthly cycle.

Blood is combined of both Yin and Yang qualities. Yin qualities include: nourishing, moistening, softening and substance. Yang qualities include: warming, invigorating, vitality and color. The harmonic relationship between the Yin and Yang forces of the body are essential to the proper function of blood. The use of Dang Gui only in Jue Yin related pathology, demonstrates that this herb restores the ability of Yang to grow and sprout from within the Yin, restoring cyclic processes of regeneration, renewal and growth.

It is now clear why there is such a close connection between Dang Gui and treatment of gynecological disorders. However, this is an important herb for treating a wide variety of disorders, when the underlying mechanism is related to restoring the various cycles that maintain our physical and emotional well-being.


* English translations taken from: Shang Han Lun: On Cold Damage, Translation & Commentaries . Feng Ye , Nigel Wiseman , Craig Mitchell

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