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ZHEN REN YANG ZANG TANG
(TRUE MAN’S DECOCTION FOR NOURISHING THE ORGANS)

By John Chen, L.Ac., O.M.D., Pharm.D., Ph.D.

Pinyin Name: Zhen Ren Yang Zang Tang
Literal Name: True Man’s Decoction for Nourishing the Organs
Original Source: Tai Ping Hui Min He Ji Ju Fang (Imperial Grace Formulary of the Tai Ping Era) by the Imperial Medical Department in 1078-85

COMPOSITION

DOSAGE / PREPARATION / ADMINISTRATION

The source text states to grind the ingredients into coarse powder. Cook 6g of the powder in 1.5 bowls of water until it is reduced down to 80%. Take the warm, strained decoction before meal. Today, this formula may be prepared as a decoction with the doses suggested in brackets.

CHINESE THERAPEUTIC ACTIONS

1. Binds the intestines and stops diarrhea and dysentery
2. Warms and tonifies the Spleen and Kidney

CLINICAL MANIFESTATIONS

Chronic diarrhea or dysentery due to deficiency and cold of the Spleen and Kidney: uncontrollable bowel movement throughout the day and night, rectal tenesmus and prolapse, abdominal pain that is relieved by pressure and warmth, red or white dysentery, stools with pus or blood, lethargy, and loss of appetite.

CLINICAL APPLICATIONS

Chronic enteritis, chronic colitis, chronic diarrhea, chronic dysentery, and rectal prolapse.

EXPLANATION

Zhen Ren Yang Zang Tang (True Man’s Decoction for Nourishing the Organs) is designed to treat chronic diarrhea or dysentery due to deficiency and cold of the Spleen and Kidney. Deficiency and cold of the Spleen and Kidney may cause the normally ascending qi of these two organs to descend, leading to diarrhea or dysentery. In severe cases, rectal prolapse may occur. Abdominal pain that is relieved by pressure and warmth indicates general deficiency and cold conditions. Presence of red [blood] or white [pus or mucus] stools and rectal tenesmus indicates disharmony of qi and blood. A chronic condition of diarrhea or dysentery may lead to generalized deficiency with lethargy and loss of appetite.

In general, diarrhea or dysentery due to deficiency and cold of the Spleen and Kidney should be treated with warm herbs that tonify these organs. However, in the case of severe diarrhea and dysentery with uncontrollable bowel movement and rectal prolapse, use of astringent herbs is necessary to quickly treat the symptoms.

This formula contains Ying Su Ke (Pericarpium Papaveris) to bind the intestines to quickly relieve diarrhea or dysentery. Rou Dou Kou (Semen Myristicae) binds the intestines and warms the Spleen and Kidney. He Zi (Fructus Chebulae) helps to bind the intestines and stop diarrhea. Rou Gui (Cortex Cinnamomi) warms the Spleen and Kidney to raise the yang. Ren Shen (Radix et Rhizoma Ginseng) and Bai Zhu (Rhizoma Atractylodis Macrocephalae) are used to warm the Spleen and tonify qi. Since chronic dysentery may damage the yin and blood, Dang Gui (Radix Angelicae Sinensis) and Bai Shao (Radix Paeoniae Alba) are used to nourish the yin and blood. Mu Xiang (Radix Aucklandiae) is employed in this formula for two reasons: to offset the rich tonics from causing stagnation and to regulate qi and relieve pain. Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) harmonizes the herbs in this formula. Also, the combination of Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) and Bai Shao (Radix Paeoniae Alba) has a good pain-relieving effect.

MODIFICATIONS

• For rectal prolapse, add Sheng Ma (Rhizoma Cimicifugae) and Huang Qi (Radix Astragali), or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).


• With cold extremities and diarrhea with undigested food due to Spleen and Kidney yang deficiencies, add Fu Zi (Radix Aconiti Lateralis Praeparata) and Gan Jiang (Rhizoma Zingiberis), or combine with Fu Zi Li Zhong Wan (Prepared Aconite Pill to Regulate the Middle).

CAUTIONS / CONTRAINDICATIONS

• Zhen Ren Yang Zang Tang contains astringent herbs, and is contraindicated for dysentery in which heat and toxins still remain in the body.


• This formula is designed for chronic diarrhea or dysentery with underlying deficiency and cold. It is inappropriate for acute cases of dysentery or diarrhea, which are often characterized by an excess condition.


• Avoid consumption of alcohol, fish, and foods that are raw, cold, oily, or greasy while taking this formula.


• Overdose or long-term usage of Ying Su Ke (Pericarpium Papaveris) may result in numerous side effects and adverse reactions, as this herb is potentially toxic and addictive.

CLINICAL STUDIES AND RESEARCH

1. Chronic colitis: According to one study, the use of modified Zhen Ren Yang Zang Tang was associated with 95.92% effectiveness in treating chronic colitis in 49 patients (37 males and 12 females, between 17-58 years of age, with 1-28 years history of illness). The herbal treatment contained the following ingredients: Huang Qi (Radix Astragali) 12-15g, Dang Shen (Radix Codonopsis) 12-30g, dry-fried Bai Zhu (Rhizoma Atractylodis Macrocephalae) 12-15g, Dang Gui (Radix Angelicae Sinensis) 9-12g, roasted Rou Dou Kou (Semen Myristicae) 9-15g, roasted He Zi (Fructus Chebulae) 9-15g, Bai Shao (Radix Paeoniae Alba) 9-15g, Mu Xiang (Radix Aucklandiae) 6-12g, Rou Gui (Cortex Cinnamomi) 3g [given in powder form], Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) 6-9g, Chi Shi Zhi (Halloysitum Rubrum) 15-30g, Yan Hu Suo (Rhizoma Corydalis) 9-15g, and Wu Mei (Fructus Mume) 9-15g as the base formula. Modifications included the addition of Gan Jiang (Rhizoma Zingiberis) for cold in the Stomach with cold extremities; Sha Ren (Fructus Amomi) and Hou Po (Cortex Magnoliae Officinalis) for poor appetite with abdominal distention; charred Di Yu (Radix Sanguisorbae) for yang deficiency with hematochezia; Yin Yang Huo (Herba Epimedii), Du Zhong (Cortex Eucommiae) and Bu Gu Zhi (Fructus Psoraleae) for Spleen and Kidney yang deficiencies; and Er Cha (Catechu) for ulceration of the intestinal mucous membrane. The treatment protocol was to administer the herbs in decoction one time per day, for 30 days per course of treatment. Patients were instructed to avoid all other medications (herbs and drugs) and refrain from eating greasy or oily foods. Of 49 patients, the study reported complete recovery in 29 cases, significant improvement in 10 cases, improvement in 8 cases, and no effect in 2 cases. (i)


2. Chronic dysentery and rectal prolapse: One study reported good results using modified Zhen Ren Yang Zang Tang to treat chronic dysentery and/or prolapsed rectum in 162 patients (108 with chronic dysentery and 54 with prolapse rectum). The herbal treatment contained Ren Shen (Radix et Rhizoma Ginseng) 5-20g, Bai Zhu (Rhizoma Atractylodis Macrocephalae) 5-20g, Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) 3-15g, Rou Dou Kou (Semen Myristicae) 5-30g, Rou Gui (Cortex Cinnamomi) 3-15g, Fu Zi (Radix Aconiti Lateralis Praeparata) 5-30g, He Zi (Fructus Chebulae) 5-30g, Ying Su Ke (Pericarpium Papaveris) 5-25g, Bai Shao (Radix Paeoniae Alba) 5-20g, Dang Gui (Radix Angelicae Sinensis) 5-10g, and Mu Xiang (Radix Aucklandiae) 3-10g. Furthermore, Chi Shi Zhi (Halloysitum Rubrum) 10-30g was added for those with chronic dysentery, and processed Huang Qi (Radix Astragali) was added for rectal prolapse. In addition, those with rectal prolapse were also treated with topical soaking of an herbal solution made from Shi Liu Pi (Pericarpium Granati), Bai Fan (Alumen) and Wu Bei Zi (Galla Chinensis). The treatment protocol was to cook the herbs and administer the decoction in three equally-divided doses daily, for 20 days per course of treatment, for up to 3 courses total. The study reported 91.7% effectiveness for treatment of chronic dysentery, and 87% for rectal prolapse. (ii)


3. Diarrhea: Administration of modified Zhen Ren Yang Zang Tang was associated with good results in treating 78 patients with recurrent diarrhea and diabetes mellitus. The herbal treatment contained herbs such as Ren Shen (Radix et Rhizoma Ginseng) 5g [or Dang Shen (Radix Codonopsis) 30g], dry-fried Bai Zhu (Rhizoma Atractylodis Macrocephalae) 12g, Rou Gui (Cortex Cinnamomi) 12g, Bai Shao (Radix Paeoniae Alba) 12g, Rou Dou Kou (Semen Myristicae) 15g, He Zi (Fructus Chebulae) 15g, Ying Su Ke (Pericarpium Papaveris) 6g, Mu Xiang (Radix Aucklandiae) 6g, Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) 5g, and others as needed. For severe cold, Fu Zi (Radix Aconiti Lateralis Praeparata) 12g and Gan Jiang (Rhizoma Zingiberis) 10g were added. For diarrhea with clear watery stools, 5 a.m. diarrhea, or abdominal pain with preference of pressure, Ba Ji Tian (Radix Morindae Officinalis) 15g and Bu Gu Zhi (Fructus Psoraleae) 15g were added. For chronic diarrhea with stabbing pain in the abdomen with dark colored tongue with spots, Wu Ling Zhi (Faeces Trogopteri) 12g, Pu Huang (Pollen Typhae) 12g, and Xi Xin (Radix et Rhizoma Asari) 6g were added. The herbs were cooked in 800 mL of water, and the decoction was given for 5 days per course of treatment. Of 78 patients, the study reported complete control of bowel movement in 61 cases, improvement in 14 cases, and no effect in 3 cases. The overall rate of effectiveness was 96.2%. (iii)

AUTHORS’ COMMENTS

Zhen Ren Yang Zang Tang, Ge Gen Huang Qin Huang Lian Tang (Kudzu, Coptis, and Scutellaria Decoction), Shao Yao Tang (Peony Decoction) and Bai Tou Weng Tang (Pulsatilla Decoction) all treat diarrhea, but have different functions and indications.

• Zhen Ren Yang Zang Tang warms and tonifies the Spleen and Kidney to bind the Intestines to stop diarrhea. From a biomedical perspective, this formula is most effective for diarrhea due to inflammatory bowel condition, such as chronic colitis and enteritis.


• Ge Gen Huang Qin Huang Lian Tang treats damp-heat accumulation in the intestines, which manifests in burning diarrhea, rectal tenesmus, and heat sensation. From a biomedical perspective, this formula is most effective for diarrhea due to various gastrointestinal infections.


• Shao Yao Tang regulates qi and blood, clears heat, and eliminates toxins to treat damp-heat accumulation and qi stagnation in the Intestines, causing abdominal pain, bloody stools with mucus, and rectal tenesmus. From a biomedical perspective, this formula is most effective for diarrhea due to various gastrointestinal infections.


• Bai Tou Weng Tang clears heat and eliminates toxins to treat toxic heat invading the xue (blood) level leading to bloody diarrhea. From a biomedical perspective, this formula is most effective for diarrhea due to amoebic infection. (iv)

REFERENCES
(i) Cheng Du Zhong Yi Xue Yuan Xue Bao (Journal of Chengdu University of Traditional Chinese Medicine) 1989;4:27.
(ii) Gan Su Zhong Yi Xue Yuan Xue Bao (Journal of Gansu University of Chinese Medicine) 1987;4:24.
(iii) Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine) 1993;9:395.
(iv) Wang MZ, et al. Zhong Yi Xue Wen Da Ti Ku (Questions and Answers on Traditional Chinese Medicine: Herbal Formulas).

ABOUT THE AUTHOR

John K. Chen, L.Ac., Pharm.D., O.M.D., Ph.D.

Dr. John Chen is a recognized authority in both western pharmacology and Chinese Herbal Medicine.  He teaches at the USC School of Pharmacy, Emperor’s College, Yo San University of TCM, OCOM, Five Branches, AOMA and ACTCM. Dr. Chen’s most recent published work is Chinese Medical Herbology and Pharmacology (2003, AOM Press) and Chinese Herbal Formulas and Applications (2008, AOM Press) for which he was lead author.

This article was taken out of Dr. Chen’s upcoming book Chinese Herbal Formulas and Applications.
To pre-order a copy, click here.

To learn more about herbs, John Chen is speaking on the following topic for Lotus Institute. This class is approved for 8 CEUs/PDAs by the California Acupuncture Board and NCCAOM.

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