Tiaogan Tang (Liver-Regulating Decoction) by Fu Qingzhu for Dysmenorrhea

Tiaogan Tang comes from Fu Qingzhu Nuke (Fu Qingzhu's Gynecology), an empirical formula of Fu Qingzhu, a famous gynecologist of the late Ming and early Qing dynasties, for treating women's dysmenorrhea. Its composition is: Chao Shanyao (dry-fried Dioscorea, Rhizoma Dioscoreae) 5 qian (15g), Ejiao (Ass-hide Gelatin, Colla Corii Asini), Danggui (Angelica, Radix Angelicae Sinensis), Chao Baishao (dry-fried White Peony, Radix Paeoniae Alba), and Shanzhuyu (Cornus Fruit, Fructus Corni) each 3 qian (9g), and Bajitian (Morinda, Radix Morindae Officinalis) and Gancao (Licorice, Radix Glycyrrhizae) each 1 qian (3g). Decoct in water, one dose daily, taken in the morning and evening.

This formula's effect is to nourish water to moisten wood (nourish kidney yin to support the liver) and to soothe the liver and resolve depression. The clinical indications for its use are dull abdominal pain that prefers pressure, scanty pale menstrual flow, dizziness and lower back pain, a pale tongue and a fine pulse. It is now often used for dysmenorrhea, infertility, menopause syndrome, migraine, chronic hepatitis, and depression belonging to liver-kidney deficiency.

This formula emphasizes fortifying the spleen and nourishing blood, and nourishing yin and supplementing the kidney. In the formula, Chao Shanyao fortifies the spleen; Ejiao, Danggui, and Baishao nourish blood; Shanzhuyu nourishes yin; Bajidian supports yang; and Gancao harmonizes the other herbs. Bajitian is used in a smaller dose than the other herbs and, together with Gancao, serves as an assistant. This is because TCM holds that "solitary yin does not generate, and lone yang does not grow"; thus adding a small amount of a yang-supporting herb to a yin-nourishing formula enhances the effect. Modern pharmacological research has found that Bajitian improves depressive mood, so its use here also helps regulate the patient's emotions; dysmenorrhea patients are often rather depressed and troubled.

If the patient has not only dysmenorrhea but also scanty menstruation, this indicates blood deficiency; one may add Shudihuang (Rehmannia Preparata), Gouqizi (Lycium Berry), Jixueteng (Spatholobus), and Zhi Shouwu (processed Polygonum Multiflorum) to nourish and generate blood. If the patient is markedly depressed and emotionally labile, one may add Hehuanhua (Albizia Flower), Shouwuteng (Polygonum Multiflorum Caulis), Hupo (Amber), Meiguihua (Rose Flower), Daituohua (Pomelo Flower), Xiangfu (Cyperus), and Yujin (Curcuma) to soothe the liver and resolve depression, or use it together with Xiaoyao Wan (Free-and-Easy Wanderer Pills). For severe pain, Yuanhu Zhitong Pian (Corydalis Pain-Relieving Tablets) may be taken concurrently; however, patients with heavy menstrual flow should not use such blood-activating analgesics.