Zhang Jingyue's 'Guishen Pill'
Guishen Pill ("Return-to-Kidney Pill") is a kidney-yin-nourishing formula from Jingyue Quanshu (Complete Works of Zhang Jingyue) by the Ming-dynasty physician Zhang Jingyue. It is composed of Shudihuang (processed Rehmannia) 8 liang (240 g), Huaishanyao (Chinese yam), Shanzhurou (cornus fruit), Fuling (Poria), Gouqizi (lycium fruit), Chao Duzhong (dry-fried eucommia), and Tusizi (Cuscuta seed), 4 liang (120 g) each, and Danggui (Angelica sinensis) 3 liang (90 g). The herbs are ground into fine powder, refined honey is added as a binder, and pills are formed. The dosage is 3 qian (9 g) each time, twice daily, washed down with light salt water. This formula may also be decocted; if decocted, the daily adult dosage may be prepared at one-tenth of the original formula.
According to traditional TCM theory, this formula has the action of nourishing yin and tonifying the kidney, and mainly treats the pattern of insufficiency of kidney water. The symptoms include decline of essence and blood, aching and weak lower back and legs, a haggard appearance, seminal emission and impotence, vacuity vexation and unrest, dry mouth and throat, dry bound stool, a red tongue, and a fine rapid or fine wiry pulse. Clinically, aching and weak lower back and knees, dizziness and blurred vision, vacuity vexation and unrest, a red tongue, and a fine rapid pulse are the basis for using the formula.
Nowadays this formula is often used for infertility, dysfunctional uterine bleeding, menopausal syndrome, chronic glomerulonephritis, Sjogren's syndrome, and other conditions presenting with the pattern of kidney-water insufficiency.
This formula is derived from Liuwei Dihuang Pill. It omits Zexie (Alisma) and Mudanpi (Moutan), which drain kidney turbidity, and instead adds Duzhong, Gouqi, and Tusizi to increase the force of warmly tonifying kidney yin, plus Danggui to invigorate and generate blood. After such adjustments to Liuwei Dihuang Pill, Guishen Pill becomes a purely tonifying formula rather than one that tonifies while draining.
Duzhong, Gouqizi, and Tusizi all tonify the kidney and strengthen the lower back, and can relieve aching and weak lower back and knees, lower-back pain, and dizziness. Shudihuang and Danggui improve the blood picture and belong to the blood-tonifying herbs in TCM. Therefore this formula is more suitable for patients who are relatively weak. But such patients may also exhibit the phenomenon of "deficiency unable to receive tonification," so using a decoction is not appropriate; one should consider using pills for gradual treatment and slow regulation. Once effects appear, hold to the formula unchanged and persist in treatment.
If the patient also has insomnia and dream-disturbed sleep, one may follow the model of Guipi Pill and add Yuanzhi (Polygala) and Suanzaoren (sour jujube seed) to this formula; for abdominal distention, one may likewise follow Guipi Pill and add Muxiang (Aucklandia). For yin deficiency with effulgent fire, one may add Guiban (turtle shell), Ejiao (ass-hide gelatin), Nüzhenzi (ligustrum), and Mohanlian (eclipta), plus a small amount of Huanglian (Coptis) to nourish yin and downbearing fire. For severe dry mouth and thirst, this formula may be used together with Yangyin Qingfei Pill.