As the first stirrings of spring start to show themselves in delicate new buds, the sorbet yellow of primroses, and the amorous antics of sparrows and robins… it’s a good time to reflect on our relationship to the Wood element and its dynamic of growth, expansion and creativity. Do you embrace this ‘flow’ or do you hold back and try to contain this force for fear of who it might upset, where it might take you, and what transformation it may require?
As acupuncturists one of the commonest syndromes we see in the clinic is Liver Qi stagnation. This may be the root cause of menstrual disturbances, ovarian cysts or endometriosis; or it may present in the form of depression, insomnia, and bi-polar disorder. Many stress related digestive problems such as IBS or ulcerative colitis develop as a result of constrained Liver Qi invading a relatively vulnerable Earth element. Inflammatory conditions, even infections, can develop as constrained Qi accumulates and turns into Heat and Fire. In our culture we have an epidemic of these chronic, stress related problems….something is amiss in our ability to follow the expansive logic of spring and to allow our physical, emotional and creative potential to expand and express itself.
This constraint explains why the most commonly prescribed Chinese herbal patent medicine globally is the nine hundred year old Xiao Yao San – or Free and Easy Wanderer. Even the name feels therapeutic! This is a good time to reflect on this formula, both as a simple remedy to relieve Qi stagnation but also as representation of the genius of Chinese medical thinking about illness which considers how disease occurs and is maintained as a result of a systemic imbalance within the body, and also between the body and the mind.
Xiao Yao San is composed of 8 herbal ingredients:
- Chai Hu – Bupleurum
- Bai Shao – White Paeony
- Dang Gui – Chinese Angelica
- Bai Zhu – White Atractylodes
- Fu Ling – Poria
- Bo He – Mint
- Zhi Gan Cao – Stir fried liquorice
- Wen Jiang – (Baked) Ginger
Chai Hu is considered the Sovereign herb in the formula. Although it may be used to dispel Wind and Heat, in this instance its pungent and bitter taste gives it the ability to spread the Liver Qi and also cool Heat resulting from constraint of Qi. It enters the Liver, Gall Bladder, Triple Heater and Pericardium channels so it takes the formula to the Liver organ but also circulates Qi both physically and emotionally. It is supported by its Minister herbs: cool, bitter and sour Bai Shao which softens and cools the Liver by nourishing its Blood and Yin, and by warm, sweet and pungent Dang Gui which nourishes and gently circulates the Liver Blood. Already we can see complexity at work. This is not a simple case of using Qi moving herbs this is a sophisticated strategy to move Qi, circulate Blood and nourish Blood and Yin in order to soften and relax the Liver to enable it to discharge its duties of circulating the Qi.
The formula then addresses the role of the Spleen as a possible cause of Liver disfunction and as a potential target for an irritable Liver. If the Spleen is deficient and unable to transform food and drink to generate Qi and Blood then the Liver loses its flexibility and softness and becomes stiff and constrained. Also if the Wood element (Liver) is afflicted then it has the tendency to overcontrol and invade the element of Earth (Spleen). This is the cause of many digestive diseases. In Xiao Yao San the warm, sweet and bitter Bai Zhu can strengthen the Spleen and the neutral, sweet and bland Fu Ling can also strengthen the Spleen, gently promote urination and leach out the Damp that results from this insufficiency.
The remaining herbs in the formula act to reinforce these actions. Pungent and warm baked ginger acts to transform Damp and to harmonise and settle the Stomach whilst the light, pungent and cool Bo He cools the Liver and gently disperses constrained qi. Finally Zhi Gan Cao – liquorice – acts to reinforce the Spleen, and to detoxify and harmonise the formula.
Xiao Yao San is used to treat a wide range of biomedical conditions including hepatitis, irritable bowel syndrome, premenstrual syndrome, fibrocystic breast disease, dysmenorrhoea and depression. It can be easily modified to enhance its heat clearing effects, or its pain reducing ability.
Although Xiao Yao San appears simple you can see how it starts to build up a complex, multifaceted and holistic treatment strategy. Organs are not isolated, minds are not separated from bodies, and the causes and effects of illness are linked and addressed. Although we are commonly taught syndromes as static entities in fact they operate as dynamic interrelated and interdependent phenomena. The Liver can invade the Spleen, but the Spleen may also fail to nourish the Liver. If Liver Qi stagnates it can accumulate and generate Heat. If the Spleen is impaired then it cannot transform food properly and Dampness is generated. Heat and Damp may combine to form Damp-Heat…which in turn can progress into Fire toxin… a multitude of diseases can result from these interrelated pathological changes.
Xiao Yao San is one of the (many) treasures of Chinese Herbal Medicine. It has been used for over 900 years as a way of relaxing the Liver and harmonising Wood and Earth. Spring in the UK in 2020 holds different challenges to spring in China in 1109 when details of this formula were first published, but there is no doubt that if we are to succeed individually and as a species we will need to embrace our abilities to move freely, easily and creatively in both body and mind.