Yanghe Decoction and Its Derivative Formulas: Clinical Notes

Yanghe Tang (Yang-Warming Decoction) is a prescription I particularly love; I have used it widely to treat cancers of the yin pattern, benign tumors, asthma, rhinitis, body deficiency, purpura, bone hyperplasia, cervical spondylosis, lumbar disc herniation, and many other conditions, and have repeatedly obtained good results.

Yanghe Tang comes from the Qing dynasty physician Wang Hongxu's Waike Zhengzhi Quansheng Ji (The Complete Library of Orthodox External Medicine) and was the Wang family's ancestral secret formula. My usual base dose is: Shudihuang 40 g, Lujiaojiao (deer antler gelatin, melted separately) 12 g, Baijiezi (white mustard seed) 8-12 g, Sheng Gancao 4 g, Rougui (cinnamon, added later) 4 g, Paojiang (blast-fried ginger) 2 g, Mahuang (ephedra) 2 g.

Among the cancer patients I currently treat, the two with the best outcomes were both treated with Yanghe Tang, and both were yin-pattern patients. Their tumors were visible on the body surface and would noticeably enlarge whenever the weather turned cold and overcast. Modifying Yanghe Tang for these two patients left them with good strength, no tumor progression, and well-controlled CA markers. They could live and work normally, with ruddy complexions and robust bodies, no different from healthy people.

In treating a patient with a breast nodule, I also used Yanghe Tang as the base, modifying it according to the patient's condition, with outstanding results. For patients whom combined four examinations judge to have a yin-cold constitution, regardless of the disease, I prescribe Yanghe Tang, adding or subtracting herbs according to specific symptoms. I have grown increasingly adept at its clinical application, and Yanghe Tang's efficacy is very good.

Yanghe Tang tends toward warming and supplementing, but without the later harm of fire blazing and the pan drying caused by large doses of Guizhi, Fuzi, or Rougui. Shudihuang and Lujiaojiao in the formula are both excellent blood tonics; with the two present, the patient's yin blood need not fear exhaustion from the formula's warm dryness. But using Yanghe Tang in spring and summer, or using it in some patients with yin deficiency and effulgent fire, can indeed cause excessive warming with floating yang rising upward. The response then is not to abandon Yanghe Tang but to modify its herbs to avoid its drawbacks.

For patients with exuberant lung fire, I derived Sang-Mai Yanghe Tang to prevent the dry mouth and thirst caused by over-warming: add Sangbaipi (Morus root bark) 6-12 g and Maidong 6-12 g to Yanghe Tang. Sangbaipi clears lung heat and Maidong nourishes lung yin, offsetting the side effect of warm-dryness damaging the lung.

Taking Yanghe Tang in spring and summer may also follow the design idea of Shenqi Wan—supplementing with a draining component—to drain kidney turbidity and subdue liver yang. I derived Ze-Ling Yanghe Tang, adding Zexie 8 g, Fuling 8 g, Zhuling 8 g, Mudanpi 8 g, and Baishao 12 g to the base. Zexie, Fuling, and Zhuling drain kidney turbidity; Mudanpi drains kidney heat; Baishao softens the liver and subdues liver yang—offsetting the side effect of liver-kidney yang hyperactivity and fire from Yanghe Tang's warming supplementation.

For patients with pre-existing phlegm-dampness: if dampness is in the upper body, choose Yanghe Erchen Tang (Yanghe Tang plus Chenpi and Fabanxia); if dampness is in the lower body, add Yiyiren (Coix), Niuxi, and Cheqianzi (Plantago seed) to the base.

For wind-cold lodged in the body for a long time and already transformed into static blood and stubborn phlegm, Yanghe Tang alone is insufficient. I derived Er-Huo Yanghe Tang, adding Qianghuo (Notopterygium) 6 g and Duhuo (Angelica pubescens) 6 g to Yanghe Tang to expel wind and scatter cold, resolve stubborn phlegm, and remove static blood; the effect is quicker than Yanghe Tang alone. If cold pathogen is in the patient's Taiyang channel with back pain, lumbar pain, or neck pain, further add Gegen, Guizhi, and Chishao to strengthen efficacy.

The clinical application of Yanghe Tang must not be rigid—neither bound by Wang Hongxu's statement in his work that not one herb may be added or removed, nor blindly superstitious about Ma Peizhi's attack that Yanghe Tang causes severe adverse outcomes. In clinical use, modify and adjust according to the patient's specific situation. Used properly, Yanghe Tang's efficacy is very reliable.