Xiaoyao Wan: A Marvelous Formula for Depression, Liver Disease, and Menstrual Irregularity
Xiaoyao Wan is a famous TCM formula. Because its greatest effect is treating the various diseases caused by depression—patients who are gloomy and morose become cheerful after taking it—it is named Xiaoyao Wan (“Free-and-Unrestrained Pill”). In modern times it is mostly used for depression or neurasthenia. Xiaoyao Wan is also a famous gynecological formula; in treating women's menstrual irregularities it has outstanding efficacy. At the same time, Xiaoyao Wan is an effective adjunct in treating various tumor diseases, especially for cancer patients who also suffer from emotional depression or whose cancer arose from depression; for such patients Xiaoyao Wan is particularly effective. It has frequent application in lymphoma, breast cancer, liver cancer, pancreatic cancer, and other cancers.
Xiaoyao Wan was originally named Xiaoyao San; it comes from the Taiping Huimin Heji Jufang (Prescriptions from the Taiping Imperial Pharmacy). It consists of seven herbs: Chaihu (Bupleuri Radix), Danggui (Angelicae Sinensis Radix), Shaoyao (Paeoniae Radix), Bohe (Menthae Herba), Fuling (Poria), Shengjiang (Zingiberis Rhizoma Recens), and Dazao (Jujubae Fructus). It nourishes blood, fortifies the spleen, soothes the liver, and clears heat. The Heji Jufang states that Xiaoyao Wan is good for blood deficiency with fatigue, five-palm heat, limb pain, heaviness and dizziness of head and eyes, palpitations with flushed cheeks, dry mouth and throat, fever and night sweats, reduced appetite and excessive sleepiness, as well as the binding of heat in the blood causing menstrual irregularity, abdominal and umbilical distending pain, and chills and fever alternating like malaria; it also treats unmarried women with blood weakness and yin deficiency, disharmony of ying and wei, phlegm cough with steaming fever, and an emaciated body gradually progressing to bone-steaming. In modern practice Xiaoyao Wan is used for chronic hepatitis, cirrhosis, gallstones, chronic gastritis, gastrointestinal dysfunction, premenstrual tension syndrome, lobular hyperplasia of the breast, menopausal syndrome, and depression; it may also be used for chronic pelvic inflammatory disease, uterine fibroids, and optic atrophy presenting the pattern of liver-qi depression with blood deficiency and spleen weakness.
When Dihuang (Rehmanniae Radix) is added to Xiaoyao Wan, it becomes Hei Xiaoyao Wan, another famous TCM formula, with even stronger blood-nourishing and menstruation-regulating effects. When Mudanpi (Moutan Cortex) and Zhizi (Gardeniae Fructus) are added, it is called Jiawei Xiaoyao Wan or Danzhi Xiaoyao Wan. Its main action is to treat liver-qi depression with blood deficiency and internal constrained heat: tidal fever and night sweats, irritability and propensity to anger, or spontaneous and night sweating, or headache with dry eyes, or flushing of the cheeks with dry mouth, or menstrual irregularity with distending pain in the lower abdomen, or painful urination, a red tongue with thin yellow coating, and a wiry, deficient, and weak pulse.
The ancestral formula of Xiaoyao Wan is Zhang Zhongjing's Sini San, a famous harmonizing formula that regulates and harmonizes liver and spleen and outthrusts evil to resolve constraint. It governs the pattern of yang depression with reversal: cold hands and feet, or abdominal pain, or diarrhea with tenesmus, and a wiry pulse; and the pattern of liver-spleen qi stagnation: fullness and oppression in the costal and hypochondriac regions, epigastric and abdominal pain, and a wiry pulse. Clinically it is often used for chronic hepatitis, cholecystitis, gallstones, biliary ascariasis, intercostal neuralgia, gastric ulcer, and gastritis presenting liver-gallbladder qi stagnation or liver-stomach disharmony.
This group of formulas are famous harmonizing prescriptions in TCM; they protect the liver and gallbladder, harmonize the stomach, and resolve constraint. Their main indication is a patient with emotional depression and liver-spleen disharmony causing various abdominal and bilateral hypochondriac discomforts. As long as the patient has a wiry pulse, fullness and distension in the chest and hypochondria, and nervous tension, the formula may be prescribed. The indications for Xiaoyao Wan are extremely broad, fully embodying the TCM advantage of “treating different diseases with the same method.”
In treating various external diseases such as luoli (scrofula/tuberculous lymphadenitis), shirong (lymphoma), and ruyan (breast cancer), the ancients also often used Xiaoyao Wan as an adjunct, because such patients are mostly emotionally depressed.