Zhang Jingyue's Famous Kidney-Tonifying Formulas: Zuogui Wan and Yougui Wan
Zhang Jingyue, the great Ming-dynasty TCM physician, created many formulas of excellent clinical efficacy; Zuogui Wan (Left-Restoring Pill) and Yougui Wan (Right-Restoring Pill) are two of them. Zuogui Wan supplements kidney yin; Yougui Wan supplements kidney yang.
The best known of Zhang Jingyue's medical ideas is his doctrine of the mingmen (life gate), which he regarded as the very source of life. The mingmen is the organ of true yin; the essential jing stored in the mingmen is "water within yin," and the primordial qi transformed from that jing is "fire within yin." The mingmen stores jing and transforms qi, embodying both water and fire. The water and fire of the mingmen are the source from which the viscera transform, and deficiency of the primordial yin and yang of the mingmen is the root of yin-yang disorders of the viscera.
Thus Zhang Jingyue was skilled at regulating yin and yang. His famous maxim—"He who is good at supplementing yang must seek yang within yin, so that yang is aided by yin and generates endlessly; he who is good at supplementing yin must seek yin within yang, so that yin is lifted by yang and its spring never runs dry"—was widely accepted by later physicians. This idea is fully embodied in the two formulas he created, Zuogui Wan and Yougui Wan.
Zhang Jingyue's Yougui Wan is composed of Shudi (Rehmanniae Radix Praeparata), Danggui, Shanzhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Gouqi (Lycii Fructus), Lujiaojiao (Cervi Cornus Colla), Tusizi (Cuscutae Semen), Duzhong (Eucommiae Cortex), Rougui (Cinnamomi Cortex), and processed Fuzi (Aconiti Radix Praeparata); Yougui Yin is composed of Shudi, Shanyao, Gouqi, Duzhong, Shanzhuyu, Rougui, processed Gancao, and processed Fuzi. Both formulas warmly supplement the fire of the mingmen and support yang, yet they also include the yin-nourishing Shudi and Shanzhuyu. In supporting yang, Zhang Jingyue did not forget to nourish yin, embodying his principle that "yang is aided by yin and generates endlessly."
Zuogui Wan is composed of Shudi, Shanyao, Gouqi, Shanzhuyu, Tusizi, Lujiaojiao, Guijiajiao (Testudinis Plastri Colla), and Chuanniuxi (Cyathulae Radix); Zuogui Yin is composed of Shudi, Shanyao, Gouqi, Shanzhuyu, Lujiaojiao, Fuling, and processed Gancao. Among a large group of yin-nourishing kidney-supplementing herbs, it adds the yang-warming Lujiaojiao and Tusizi, achieving the effect of "yin lifted by yang so that its spring never runs dry."
Both Yougui Wan and Zuogui Wan are now classic famous formulas, and many pharmaceutical factories produce patent versions that patients can buy in pharmacies or online.
Yougui Wan warms and supplements kidney yang, fills essence, and nourishes blood; it is used for kidney-yang deficiency. Signs are cold hands and feet, abdominal pain and lower-back soreness, timid qi and fatigue, as well as impotence and seminal emission, loose stools, frequent urination, a pale tongue with thin coating, and a vacuous, fine pulse. It is also used for yin exuberance controlling yang, or the pattern of true cold with false heat. Today it is often used for impotence, premature ejaculation, infertility, aspermia, aplastic anemia, and nephrotic syndrome in patterns of decline of mingmen fire; it can also be used for chronic bronchitis, sciatica, and osteoporosis in patterns of kidney-yang insufficiency.
Modern pharmacology suggests Yougui Wan can improve and regulate B-lymphocyte function, promote humoral immunity, and strengthen the body's immunity. It also regulates sex-hormone levels, raising serum testosterone in men and lowering elevated serum estradiol to normal, while raising serum estradiol in women. It adjusts liver and spleen function, increasing the weight of major organs in yang-deficient mice. Yougui Wan has an anti-aging effect and slows aging of heart and kidney tissue.
Many common ailments of the elderly can be treated with Yougui Wan—nocturia, hypertrophic spondylitis, chyluria, leukopenia, and chronic obstructive pulmonary disease. As long as the pattern is kidney-yang deficiency, regardless of the Western diagnosis, Yougui Wan can serve as the base formula.
Zuogui Wan enriches yin and supplements the kidney, adding essence and filling marrow. It is used for insufficiency of true yin. Signs are soreness and weakness of the lower back and legs, dizziness and vertigo, tinnitus and deafness, seminal emission and slipping emission, spontaneous and night sweating, dry throat and mouth, a bare tongue with little coating, and a fine pulse. Today it is often used for impotence, premature ejaculation, dysfunctional uterine bleeding, amenorrhea, and aplastic anemia in patterns of true-yin insufficiency with deficiency of essence and marrow. It can also be used for chronic bronchitis, chronic nephritis, polyneuritis, lumbar muscle strain, and atrophic vulvitis in patterns of true-yin insufficiency.
Modern pharmacology suggests Zuogui Wan regulates endocrine function; it significantly raises serum testosterone in male mice, increases the weight of the testes and seminal vesicles, and increases uterine weight in female mice. It also promotes immunity, improving the abnormal thymus and lymphocyte proliferative response in MSG rats, enhancing nonspecific immunity, and increasing splenic mass and macrophage phagocytosis in mice.
From the standpoint of modern pharmacology, Zuogui Wan and Yougui Wan are remarkably similar in effect: both anti-aging, immunity-enhancing, and improving the blood picture and sex-hormone levels. The TCM mingmen is called the root of life, though from the viewpoint of modern medicine it is hard to assign it to any specific human tissue. Because the TCM mingmen relates to so many bodily functions, many Western diseases—as long as they present the kidney-yin or kidney-yang symptoms described above—can be treated with Zuogui Wan or Yougui Wan.
These kidney-tonifying drugs are best suited to frail and elderly patients. Tumor patients who, after repeated courses of damaging treatment, develop kidney-yin or kidney-yang symptoms can be treated with Zuogui Wan or Yougui Wan. But patients with breast, ovarian, or prostate cancer should use them cautiously. The hallmark of TCM is pattern differentiation and treatment; the key is that the pattern matches. So long as the drug matches the pattern, there will be some effect.