Sang Piao Xiao San

Source: Extension of the Materia Medica (1116)

Category: Formulas that Stabilise and Bind

Pattern: Heart and Kidney Qi deficiency causing the Bladder to lose its restraint.

Key Symptoms: Frequent urination to the point of incontinence, gray and cloudy urine like rice water sometimes accompanied by spermatorrhoea
Secondary Symptoms: Disorientation, forgetfulness

Tongue: Pale with white coating
Pulse: Thin, slow and frail

Ingredients

Sang Piao Xiao

9-12g

Long Gu

12-30g

Pinyin: Long Gu Chinese: 龙骨 Pharmaceutical: Ossa Draconis English: Fossilised Bones
Tastes: Sweet, astringent, neutral Meridians Entered: Liver, Heart and Kidney
Actions & Indications: Settles anxiety and calms the Spirit Agitated Heart and Spirit with emotional distress, restlessness, insomnia, palpitations with anxiety, seizures, or withdrawal mania Calms the Liver and anchors and preserves Floating Yang Irritability, restlessness, dizziness, vertigo, blurred vision and a bad temper due to Liver Yin Deficiency with Liver Yang Rising Prevents leakage of fluids Loss of fluids due to Deficiency with spermatorrhea, night sweats, spontaneous sweating, nocturnal emissions, vaginal discharge and uterine bleeding Topically generates muscles and astringes ulcers Chronic non-healing sores and ulcerations Treats Ghost Possession Said in the Shen Nong Ben Cao Jing to treat Heart and Abdomen Ghost Possession, Spiritual Matters (精物 Jing Wu) and Old Ghosts (老鬼). This refers to difficult to treat disorders thought to be of supernatural origin. Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of animal parts which can, with protracted taking, make the body light, enable one to communicate with the Spirit Light (Shen Ming 神明), and lengthen the lifespan. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
Standard Dosage: 15-30g in decoction. Cautions: The high mineral content of this medication may prevent the oral absorption of the fluoroquinolone class of antibiotics. Animal products are prohibited from use in the UK under the Medicines Act 1968 ch. 67 which restricts herbalists to the use of plant products only. It is generally substituted with Bai Shao and Wu Wei Zi. If viewed from a western perspective as a source of calcium which may cause sleep disturbances, then supplementation or inclusion of high calcium/magnesium content herbs (e.g. Kun Bu) could be considered, especially if other signs such as oesteoporosis or muscle cramps are present and risk of side effects from calcium/magnesium supplements are low (stones, calcified arteries, GI issues). However, this assumes a mechanism which does not match many of the traditional patterns for which it is prescribed.

9-12g

9-12g

3-6g

6-9g

9-15g

6-9g

Pinyin: Dang Gui Chinese: 當歸 Pharmaceutical: Radix Angelicae sinensis Taxonomy: Angelica sinensis English: Chinese Angelica Root / Tang-Kuei / Dong Quai Root
Tastes: Sweet, Pungent, Warm Meridians Entered: Heart and Liver
Actions & Indications: Tonifies the Blood and regulates the menses Blood Deficiency, especially when affecting the Heart and Liver with pale, ashen complexion, lusterless nails, tinnitus, blurred vision and palpitations Blood Deficiency associated irregular menstruation, amenorrhea and dysmenorrhea Invigorates and harmonizes the Blood and disperses Cold (stops pain due to Blood Stasis) Blood Stasis causing abdominal pain and carbuncles and pain due to Blood Stasis from traumatic injury, especially when accompanied by Deficiency Cold Postpartum menstruation Pregnancy (use with caution) Blood Deficiency with chronic Wind-Damp-Bi Moistens the Intestines and unblocks the bowels Dry Intestines due to Blood Deficiency Reduces swelling, expels pus, generates flesh and alleviates pain Sores and abscess (Chuang Yung), internally and topically Stops coughing and treats dyspnea Used adjunctively for coughing Tonifies the Blood while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015)
Standard Dosage: 6-12g in decoction. Cautions: It is contraindicated in cases of Damp-Heat stagnating in the Middle, Lung Heat with Phlegm Fire, and Yin deficiency with effulgent Yang because it is warm and sweet in properties. In addition, it should be used with caution in cases of loose stool because it can moisten intestines to smooth stool. Many sources recommend using caution, avoiding or only taking under guidance of a TCM physician during pregnancy as it can cause uterine contractions. However, there are no studies supporting this and the only scientific literature seems to suggest that Z-Ligustilide has anti-spasmodic activities that alleviate dysmenorrhoea by inhibiting uterine contractions (Du et al., 2006; Dietz et al., 2016). Caution is also advised in breast cancer patients due to its oestrogen stimulating activity. This based upon Lau et al (2005) who found it may stimulate breast cancer growth in vitro, however Yue et al, (2019) demonstrated that it is not that stimulatory in breast cancer both in vitro and in vivo through a series of tests, although they suggested it should still be used with caution in estrogen receptor-positive breast cancer. Conversely, a large population study in Taiwan by Wu et al (2014) found it reduced the subsequent risk of endometrial cancer in breast cancer survivors taking tamoxifen, especially in those of reproductive age.

Subsitutions:
In the UK some ingredients, including the principal one, must be substituted due to laws on animal products. Typical substitutes include:
Sang Piao Xiao == Tu Si Zi + Quan Shi
Long Gu == Bai Shao + Wu Wei Zi
Gui Ban == Han Lian Cao + Nu Zhen Zi
Presumably herbs like Fu Pen Zi, Yi Zhi Ren and Bu Gu Zhi could be appropriate too, especially if there are signs of Yang deficiency and cold.

Preparation: Grind equal amounts of each herb into a powder and take 6g at bedtime. In the source text it is advised to take with a decoction of Ren Shen. At present this is usually substituted with Dang Shen at 2-3x the dosage. May also be prepared as a decoction with dosages given.

Actions: Regulates and tonifies the Heart and Kidneys, stabilises the Jing, stops leakage

Contraindications: Should not be used for incontinence due to Damp-Heat or vigorous Fire in the Lower Jiao which will usually present with burning urination.

Research Links:

American Dragon

TCMWiki

Journal of Chinese Medicine

National Resource Centre for Chinese Materia Medica, China

TCM-ID Integrated Database, East China Normal University

TCM-ID Information Database, National University of Singapore

Pubmed

Science Direct

Google Scholar

Bai Du (Chinese)

A+ Medical Encyclopedia (Chinese)

Reference Notes: (click to display)

These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.

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