Zhen Gan Xi Feng Tang: Calming Liver Wind and Restoring Balance

In Chinese medicine, Zhen Gan Xi Feng Tang stands out for its remarkable effectiveness and unique formula, making it a key treatment for stroke-like conditions. It not only calms internal wind but also nourishes the liver and kidneys, balances yin and yang, and offers new hope to stroke patients.

Zhen Gan Xi Feng Tang comes from the late Qing and early Republic era physician Zhang Xichun’s book Yixue Zhong Zhong Can Xi Lu (Records of Integrating Chinese and Western Medicine), one of his signature formulas. This book blends Chinese and Western medical theories, showcasing Zhang’s innovative ideas.

Historically, Zhen Gan Xi Feng Tang was used to treat stroke-like conditions caused by liver and kidney yin deficiency, excessive liver yang, and internal liver wind.

Zhen Gan Xi Feng Tang

Formula Explanation of Zhen Gan Xi Feng Tang

Zhen Gan Xi Feng Tang is carefully crafted, following the Chinese medicine principle of “monarch, minister, assistant, and envoy”:

• Monarch Herbs: Huai Niu Xi, Sheng Zhe Shi, Sheng Long Gu, Sheng Mu Li, Sheng Gui Ban. Huai Niu Xi directs blood downward and promotes circulation; Sheng Zhe Shi calms rebellion and suppresses liver wind; Sheng Long Gu and Sheng Mu Li stabilize the mind and subdue yang; Sheng Gui Ban nourishes yin, subdues yang, and softens hardness.

• Supporting Herbs: Sheng Hang Shao, Xuan Shen, Tian Dong. Sheng Hang Shao nourishes blood, softens the liver, and relieves pain; Xuan Shen nourishes yin, reduces heat, and clears toxins; Tian Dong nourishes yin, moistens dryness, and clears heat.

• Assistant Herbs: Chuan Lian Zi, Sheng Mai Ya, Yin Chen. Chuan Lian Zi soothes the liver, regulates qi, and relieves pain; Sheng Mai Ya soothes the liver, supports digestion, and clears stagnation; Yin Chen clears heat, resolves dampness, and reduces jaundice.

• Envoy Herb: Gan Cao. Gan Cao harmonizes the formula and relieves pain.

Zhen Gan Xi Feng Tang

Pathogenesis Analysis of Zhen Gan Xi Feng Tang

Zhen Gan Xi Feng Tang targets the pathogenesis of liver and kidney yin deficiency leading to excessive liver yang, which triggers internal liver wind, disrupts qi and blood, and affects the head.

Liver and Kidney Yin Deficiency

Chronic fatigue, emotional stress, or prolonged illness can deplete liver and kidney yin. The liver stores blood, and the kidneys store essence, which are interconnected. When yin is deficient, it fails to anchor liver yang, causing an imbalance of yin and yang.

Excessive Liver Yang

The liver relies on yin for its function but expresses yang energy. Normally, liver qi flows smoothly, regulating the body’s energy. However, when liver and kidney yin are deficient, yin cannot control yang, leading to excessive liver yang rising upward. This causes dizziness, flushed face, ringing ears, and irritability.

Internal Liver Wind

Prolonged excessive liver yang can transform into wind, triggering internal liver wind. This leads to trembling limbs, spasms, convulsions, or even sudden fainting. Wind’s nature is to move rapidly and change, easily disrupting qi and blood, making the condition complex and variable.

Main Effects of Zhen Gan Xi Feng Tang

Zhen Gan Xi Feng Tang is primarily used to treat stroke-like conditions, with symptoms including:

• Dizziness and ringing in the ears

• Burning head pain and flushed face

• Irritability and heat in the chest

• Frequent belching

• Gradual limb weakness or facial asymmetry

• Severe dizziness, fainting, or inability to fully recover after waking

• Long, forceful, wiry pulse

The formula offers the following key effects:

• Calming Liver Wind: Suppresses excessive liver yang and clears wind, relieving dizziness and other symptoms.

• Nourishing Yin and Subduing Yang: Replenishes liver and kidney yin to anchor yang, restoring yin-yang balance.

Why include herbs to soothe the liver and regulate qi when treating excessive liver yang and wind? The liver, likened to a general, is strong and thrives on smooth, upward movement but dislikes suppression.

Overusing heavy, suppressing herbs to force liver yang downward can stifle the liver’s natural flow, causing stagnation and worsening rebellion. Herbs that soothe the liver and regulate qi support its natural flow, preventing stagnation and allowing liver yang to settle more easily.

Modern Applications

Modern research shows Zhen Gan Xi Feng Tang is effective for conditions like hypertension, cerebral thrombosis, cerebral hemorrhage, and vascular headaches. It can be used to treat:

• Hypertension

• Cerebral thrombosis

• Cerebral hemorrhage

• Vascular headaches

Precautions

When using Zhen Gan Xi Feng Tang, keep the following in mind:

• Pattern Differentiation: Chinese medicine emphasizes pattern-based treatment. Consult a Chinese medicine practitioner to confirm suitability, focusing on symptoms like dizziness, burning head pain, flushed face, and a wiry, forceful pulse.

• Not Suitable for Certain Strokes: Avoid using for strokes caused by qi deficiency or blood stasis.

• Use with Caution: The formula contains heavy, suppressing herbs, which should not be taken long-term to avoid harming the stomach.

• Dietary Guidelines: Maintain a light diet, avoiding spicy or stimulating foods.

• Lifestyle Adjustments: Stay calm, avoid emotional stress, and balance rest and activity to support treatment.

• Complementary Therapies: Combine with acupuncture or massage to enhance effectiveness.

• Monitor Blood Pressure: Regularly check blood pressure during treatment to track changes.

Conclusion

Zhen Gan Xi Feng Tang, a classic formula from Yixue Zhong Zhong Can Xi Lu, perfectly embodies Chinese medicine’s principle of balancing yin and yang. It calms excessive yang and internal wind while nourishing the liver and kidneys with gentle herbs. This approach not only relieves symptoms but also improves overall health, enhancing the body’s self-regulation for lasting wellness.

With its unique philosophy and proven clinical results, it remains a vital tool in treating stroke-like conditions and other disorders related to excessive liver yang, showcasing the profound wisdom of Chinese medicine.

Chinese Name	鎮肝熄風湯
Phonetic	Zhen Gan Xi Feng Tang
English Name	Liver-Sedating and Wind-Extinguishing Decoction
Classification	Wind-calming formulas
Source	《Records of Chinese Medicine with Reference to Western Medicine》Yi Xue Zhong Zhong Can Xi Lu《醫學衷中參西錄》
Combination	Achyranthis Bidentatae Radix (Huai Niu Xi) 1 liang (30g), Haematitum (Sheng Zhe Shi) 1 liang (30g), Draconis Os (Sheng Long Gu) 0.5 liang (15g), Ostreae Concha (Sheng Mu Li) 0.5 liang (15g), Testudinis Plastrum (Sheng Gui Ban) 0.5 liang (15g), Paeoniae Radix Alba (Sheng Hao Shao) 0.5 liang (15g), Scrophulariae Radix (Xuan Shen) 0.5 liang (15g), Asparagi Radix (Tian Dong) 0.5 liang (15g), Toosendan Fructus (Chuan Lian Zi) 0.2 liang (6g), Hordei Fructus Germinatus (Sheng Mai Ya) 0.2 liang (6g), Artemisiae Scopariae Herba (Yin Chen) 0.2 liang (6g), Glycyrrhizae Radix et Rhizoma (Gan Cao) 1.5 qian (4.5g)
Method	Prepare the ingredients as a decoction.
Action	Tranquilizes the liver and extinguishes wind, enriches yin and subdues yang.
Indication	Zhen Gan Xi Feng Tang is indicated for the pattern of apoplectic stroke. The symptoms are dizziness, vertigo, distension of eyes, tinnitus, headache with a warm sensation in the head, flushed face, and irritability; there may also be frequent belching, progressive difficulty in moving the extremities, and deviation of the mouth and eyes. In severe cases there is dizziness and falling down, unconsciousness, mental confusion with moments of clarity, and an inability to fully recover after loss of consciousness, and a wiry, long, and forceful pulse.
Pathogenesis	This is a pattern of wind-like strike caused by liver and kidney yin deficiency, hyperactivity of liver yang, internal stirring of liver wind, and upward reversal of qi and blood. There is vertigo, swollen eyes, and tinnitus because liver yang transforms into wind, which harasses upward when there is liver and kidney yin deficiency and hyperactivity of liver yang. The blood counterflows upwards with the counterflow qi that is ascending due to the wind, so there is a hot and painful sensation in the brain, a drunk-like flush, and possibly a stroke due to the counterflow of qi and blood. A mild case is caused by wind attacking the channels and collaterals, which results in gradual loss of body mobility and a gradual deviation of the mouth. A severe case is caused by wind attacking the zang-fu organs, which results in sudden vertigo, fainting, and unconsciousness. A wiry, long, and powerful pulse is the sign of excessive liver yang. This syndrome has its root in liver and kidney yin deficiency and its branch in the hyperactivity of liver yang and the ascending counterflow of qi and blood. However, the excessive branch overwhelms the deficient root. It should be treated by tranquilizing the liver, extinguishing wind, and subduing blood as the main method, and assisted by nourishing the liver and kidney.
Clarification	Why are medicinals that soothe the liver and regulate qi included in a formula used to treat hyperactivity of liver yang and upward harassing of wind? The liver is the martial organ with an unyielding, ascending, and free nature, with an aversion to becoming depressed. If medicinals that direct counterflow downward with heavy sedatives are used in a heavy dosage to force down the liver yang, the ascending and free nature of the liver will be suppressed so that liver qi is constrained and the counterflow of liver qi is further worsened. Therefore medicinals that soothe the liver and rectify qi are used to comply with its free and ascending nature, so that the liver qi is not constrained and the liver yang is easier to subdue and descend.
Application	1. Essential pattern differentiation Zhen Gan Xi Feng Tang serves as the common formula used to treat wind-like strike whether it is a pre-strike, strike, or post-strike. This clinical pattern is marked by vertigo, hot and painful sensation in the brain, drunk-like flush, wiry, long, and powerful pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of liver-kidney yin deficiency and ascendant hyperactivity of liver yang: hypertension, cerebral thrombosis, cerebral hemorrhage, and angioneurotic headache. 3. Cautions and contraindications It is not applicable for stroke due to qi deficiency and blood stasis.
Additonal formulae	Jian Ling Tang (Down Sweeping Decoction 建瓴汤) [Source]《Records of Chinese Medicine with Reference to Western Medicine》Yi Xue Zhong Zhong Can Xi Lu《医学衷中参西录》 [Ingredients] Sheng huai shan yao 1 liang (30g), niu xi 1 liang (30g), sheng zhe shi 8 qian (24g), sheng long gu 6 qian (24g), sheng mu li 6 qian (24g), sheng di huang 6 qian (24g), sheng bai shao 4 qian (24g), bai zi ren 4 qian (24g) [Preparation and Administration] Grind the iron rust with water. Decoct the medicinals with the iron water. [Actions] Tranquilizes the liver to extinguish wind, and nourishes yin to calm the mind. [Applicable Patterns] Liver and kidney yin deficiency or liver yang hyperactivity. Symptoms include: vertigo, tinnitus, swollen eyes, amnesia, vexation, insomnia and dreaminess, and a wiry, hard, and long pulse.
Remark	Reeves' Terrapin (Chinemys reevesii / Mauremys reevesii) is listed as "Endangered" in the International Union for the Conservation of Nature and Natural Resources (IUCN) Red List of Threatened Species. Also, it is listed in the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) Appendix III. Its trade is regional control and subject to permits or certificates of origin.