014 LONG DAN XIE GAN WAN - Elixir of Bitterness

Action According to Traditional Chinese Medicine (TCM):

• Clears heat from the liver and gallbladder

• Removes hot dampness from the three burners, especially the lower burner

Characteristics:

This formula is used when there is a flare-up of liver Yang, which can cause symptoms such as headaches, redness and burning in the eyes, ringing in the ears, dizziness, irritability, mood swings, pain in the hypochondrium, reduced urine output, or constipation. In more severe cases, sleep difficulties or insomnia may occur. Another indication is hot dampness in the liver and gallbladder channel, leading to foul-smelling, yellowish vaginal discharge, vaginal itching, inflammatory swelling of the external genitalia, or painful and burning urination. A shortened menstrual cycle with purplish-red menstrual blood may also occur. This formula is effective in cases of wet eczema and labial herpes. It also addresses liver heat due to Qi stagnation when combined with harmonizing formulas. In all cases, the tongue is red with red spots along the edges, with a yellow coating, sometimes greasy, and the pulse is XIAN and SHUO.

This condition involves an excess of heat in the liver and gallbladder channels. The liver channel runs through the hypochondrium and external genitalia, and its orifice is the eyes. The gallbladder channel begins at the outer corner of the eye and runs through the forehead and occipital area. When excess heat enters these channels, it becomes trapped, leading to a state of congestion and heat rising to the head, causing the symptoms mentioned above.

The stringy, rapid, and strong pulse, along with a red tongue with a yellow coating, indicates the presence of excess heat in the liver channel. The gallbladder and the three burners are part of the SHAO YANG section, and pathology in one of these channels typically affects the other. If the three burners channel is involved, it disturbs the water metabolism and leads to internal dampness. This can result in heat and dampness in the lower burner, causing foul-smelling discharge and other pathological conditions of the external genitalia.

Analysis of the Traditional Formula:

In the current composition of the formula, some ingredients are replaced with similar herbs due to restrictions on their importation into the EU or their inclusion in the CITES list.

The primary function of the formula is to clear excess heat from the liver and gallbladder and to clear hot dampness from the lower burner. The "Emperor" herb is Long Dan Cao, which clears heat from the liver and gallbladder, purges heat, and dries dampness in the lower burner. The two "Ministers" Huang Qin and Zhi Zi assist the Emperor herb in draining heat and eliminating dampness. The remaining minister, Chai Hu, disperses heat trapped in the liver and gallbladder channels by unblocking the liver and relieving congestion. Chai Hu and Huang Qin form a classical combination to clear heat from the Shao Yang section. Additionally, Chai Hu directs the action of the other herbs to the liver channel.

A group of assistants, represented by Mu Tong, Che Qian Zi, and Ze Xie, clears heat from the upper burner and expels hot dampness from the lower burner via urination. Since the liver stores blood, heat in the liver can easily damage the blood and Yin. Therefore, to avoid further harm, Sheng Di Huang, which nourishes Yin, and Dang Gui, which replenishes blood without causing stagnation, are added to the formula. The presence of bitter and drying herbs in this formula may harm the stomach, so the "Messenger" herb, Gan Cao, is included to strengthen the middle burner and harmonize the effects of the other herbs in the formula.

Commentary:

This formula has a wide range of uses, but there are three main diagnostic criteria that should be expressed:

1. The presence of heat in the liver channel.

2. A stringy, rapid pulse, and a red tongue with red spots on the sides.

3. Dark urine with difficulty urinating.

The use of this formula should be distinguished from the Jia Wei Xiao Yao Wan formula, which is used for liver Qi stagnation with heat symptoms. While the symptoms may be similar, they are not as intense as those indicated by Long Dan Xie Gan Wan. The herbs in Long Dan Xie Gan Wan cool heat without causing stagnation and disperse trapped Qi without damaging healthy Qi. It is an excellent prescription for treating symptoms and underlying pathological mechanisms associated with liver and gallbladder diseases.

Contraindications:

This formula may harm the spleen, so it should not be used for extended periods or in large doses. It is also not suitable for those with spleen or stomach Qi deficiency or for conditions of fluid loss, such as heat from Yin or blood deficiency.

Primary Focus:

• A wide range of issues related to irritability

• Headaches, insomnia, nervousness

• Increased intraocular pressure

• Glaucoma

• Recurrent cold sores

• Elevated blood pressure in the early stages

• Urinary tract infections

• Gynecological infections with burning

This herbal formula is used to cool the body on both a mental and physical level. Mentally, it calms stress and promotes regeneration. On the physical level, it addresses a wide range of inflammations, hyperfunctions, and irritations. The common underlying factor in the above conditions is an excess of Yang – an active, hot principle that overheats the body and triggers exaggerated reactions. These typically manifest as inflammation or increased function (e.g., elevated blood pressure, intraocular pressure, etc.). The formula is widely used in Chinese herbal medicine, traditionally prescribed for the accumulation of damp heat in the liver and gallbladder channels. From a modern perspective, it is useful for treating inflammatory conditions affecting the eyes, ears, and genital areas, often accompanied by irritability, restlessness, and insomnia. Symptoms can include gynecological discharge (mainly yellow), various ear inflammations, conjunctivitis, or urinary tract infections associated with burning and pain during urination. Symptoms may worsen with stress.

Note:

Since many of these conditions are preceded by psychological discomfort and stress, this formula is often used in combination with one of the harmonizing formulas (formulas 061–063).

Dosage and Duration of Use:

The typical dosage is 8 pills, three times a day, especially for long-term use. For acute issues, a higher dose may be taken, such as double the normal dose. The effect is different for acute and chronic conditions. For acute issues, improvement is usually seen within a week, while chronic conditions may require long-term use. These are often conditions that the body has "adapted" to and may not easily resolve. A longer duration is also necessary for those who do not wish to or cannot slow down their pace of work. For head inflammations, the formula should be taken for at least two weeks. For gynecological issues or urinary tract infections, it should be taken for at least three to four weeks.

Modern View:

This formula is a combination of nine herbs that provide a broad range of effects. It is one of the most complex formulas acting on various parts of the body. Its anti-inflammatory properties are effective for inflammations of any origin (viral for herpes, bacterial, or fungal for other types of infections). These herbs are complemented by harmonizing herbs that support "calmness" and regeneration rather than suppression.

Combination with Other Products:

For the listed symptoms worsened by nervousness, this formula can be combined with products 062 for women or 063 for men. For insomnia as the main issue, it can be combined with formulas 121 or 127. These formulas can be taken in half or full doses from both. Sometimes, it can be beneficial to take the two products only at night, with a dose of 16 pills. For gynecological herpes, it can be combined with formula 062 for long-term use, adding Long Dan Xie Gan Wan one week before menstruation for one week. This formula is also used in combination with product 057 for gynecological discharge accompanied by itching and burning of mucous membranes. For migraines presenting with burning and severe pain, it can be combined with formula 041. For glaucoma with retinal involvement, it can be combined with formula 182. Long Dan Xie Gan Wan lowers intraocular pressure, while the other formulas protect the retina. During an acute episode, only Long Dan Xie Gan Wan is used, and once stabilized, the formulas are combined at half doses, gradually reducing them based on measured values and symptoms.

Formula Author:

Dr. Wang Ang, first mentioned in the work Yi Fang Ji Jie, 1682.

Packaging:

200 pills / 33g