Perimenopausal Syndrome Exclusive Formula - Master Xiao Chengcong’s “Geng Xin Tang” (Perimenopause Rejuvenation Decoction)

16. Perimenopausal Syndrome Exclusive Formula - Master Xiao Chengcong’s “Geng Xin Tang” (Perimenopause Rejuvenation Decoction)

Master Xiao Chengcong, a National Master of Traditional Chinese Medicine. Geng Xin Tang is his empirical formula for treating perimenopausal syndrome, embodying the approach of nourishing the Kidney and Heart, and establishing communication between the Heart and Kidney.

Pathogenesis

In perimenopausal women, the Tian Gui (reproductive essence) gradually exhausts, leading to Kidney Essence deficiency and Liver Blood insufficiency. Kidney Yin deficiency means Water cannot control Fire; when Heart Fire rises excessively, the Spirit is not at ease, forming Heart-Kidney disconnection. Simultaneously, Liver Yin deficiency causes Liver Yang to be hyperactive; when the Liver’s function of smooth flow is disrupted, vexation and irritability result. When Yin cannot check Yang, deficient heat floats upward, causing hot flashes and sweating. A prolonged disease course may be accompanied by Qi deficiency and blood stasis.

Formula Composition

Composition: Gardenia Fruit 15g, Eclipta 15g, Raw Rehmannia 15g, Wolfberry 15g, White Peony 15g, Anemarrhena 12g, Lily Bulb 30g, Raw Dragon Bone 30g, Raw Oyster Shell 30g, Lotus Seed Heart 4g, Salvia 15g, Chinese Cassia Seed (Astragalus Comosus) 15g, Dorycteni Seed 15g, Liquidambar Bark 15g, Polygonum Multiflorum Vine 15g

Efficacy: Nourishes the Kidney and Liver, establishes communication between the Heart and Kidney, calms the Heart and quiets the Spirit

Indications: Perimenopausal syndrome (Liver-Kidney Yin deficiency with Heart-Kidney disconnection pattern)

In the formula, Gardenia Fruit and Eclipta together form Er Zhi Wan, tonifying Liver and Kidney, nourishing Yin and clearing heat, serving as the sovereign herbs. Wolfberry assists Er Zhi Wan in tonifying Liver and Kidney; Raw Rehmannia nourishes Yin, cools Blood, and nourishes Kidney Water; White Peony nourishes Blood, softens the Liver, and astringes Yin. These three herbs assist the sovereign herbs in nourishing the Kidney and Liver to consolidate the root. Anemarrhena clears heat, drains Fire, and nourishes Yin; Lily Bulb clears the Heart, removes vexation, and calms the Spirit; Lotus Seed Heart clears Heart Fire and establishes Kidney Water communication. These three herbs clear the Heart and descend Fire to establish Heart-Kidney communication. Raw Dragon Bone and Raw Oyster Shell settle and anchor floating Yang, and calm and quiet the Spirit, giving the floating deficient Yang a place to return. Salvia invigorates blood, clears the Heart, and removes vexation, preventing the Yin-nourishing herbs from leaving stasis behind. Chinese Cassia Seed (Astragalus Comosus) tonifies the Kidney and secures Jing; Dorycteni Seed disperses the Liver and pacifies Liver Yang. The two herbs together address both Liver and Kidney. Liquidambar Bark resolves stagnation and calms the Spirit; Polygonum Multiflorum Vine nourishes the Heart, calms the Spirit, and opens the collaterals. These two herbs assist the calming of the Spirit.

The concurrent use of Chinese Cassia Seed (Astragalus Comosus) and Dorycteni Seed is a distinctive pairing feature of Xiao Chengcong’s formula - Chinese Cassia Seed (Astragalus Comosus) is also known as Chinese Cassia Seed (Astragalus Comosus), tonifies the Kidney and secures Jing, and its nature is more tonifying; Dorycteni Seed disperses the Liver and pacifies Liver Yang, and its nature is more dispersing. The two herbs enter both the Liver and Kidney; one tonifies and one disperses, achieving tonification without stagnation and dispersal without depletion. Lotus Seed Heart is used in only 4g, taking advantage of its light and clear nature to clear Heart Fire; the small dosage does not harm righteous Qi. Lily Bulb is used in a heavy 30g dose to make full use of its power to clear the Heart and calm the Spirit; the dosage is greater than in most formulas, reflecting Xiao Chengcong’s emphasis on regulating the Heart-Spirit.

IV. Pattern-Based Modifications

In his original case records, Xiao Chengcong used “Salt Anemarrhena and Salt Phellodendron, 12g each,” meaning Anemarrhena and Phellodendron stir-fried with salt water, guiding the herbs into the Kidney meridian to clear lower jiao deficient heat and drain ministerial Fire without harming middle jiao Yang. In the basic Geng Xin Tang formula, Anemarrhena 12g clears upper jiao deficient heat; if lower jiao deficient Fire is also severe, add salt-stir-fried Phellodendron to assist in clearing. When deficient heat decreases and the underlying Spleen-Kidney double deficiency is revealed, add Mulberry Parasite and Dipsacus to evenly tonify Kidney Yin and Yang, and Stir-fried White Atractylodes to strengthen the Spleen and tonify Qi, tonifying both the prior and postnatal sources to support righteous Qi and consolidate the root.

Summary

Geng Xin Tang uses Er Zhi Wan to tonify Liver and Kidney as the sovereign component, with Raw Rehmannia, Wolfberry, and White Peony added to assist in nourishing Yin, nourishing Blood, and consolidating the root; Lily Bulb and Lotus Seed Heart clear Heart Fire and establish Kidney Water communication to bridge Heart and Kidney; Dragon Bone and Oyster Shell settle and anchor floating Yang to calm the Spirit; Chinese Cassia Seed (Astragalus Comosus) and Dorycteni Seed are used together to address Liver and Kidney with both tonification and dispersal; Liquidambar Bark and Polygonum Multiflorum Vine resolve stagnation and calm the Spirit. The entire formula applies three methods simultaneously - nourishing the Kidney and Liver, bridging Heart and Kidney, and calming the Heart and quieting the Spirit - covering multiple pathogenetic levels of perimenopausal syndrome including Yin deficiency, Fire excess, Heart-Kidney disconnection, and Liver stagnation with Spirit disturbance. It is particularly suitable for patients with significant insomnia and vexation.

References:

[1] Xiao Chengcong’s Experience in Discerning and Treating Gynecological Diseases Using Five Kidney-Treating Methods, “Journal of Traditional Chinese Medicine,” 2023, Issue 2

[2] Case Report on Treating Perimenopausal Syndrome by Nourishing Kidney and Liver, and Calming the Heart and Quieting the Spirit, People’s Medical Publishing House AI Medical Case Database

[3] Clinical Efficacy Study of Geng Xin Tang in Treating Heart-Kidney Disconnection Type Perimenopausal Insomnia, “Periodical China”

16. 更年期綜合徵專方—國醫大師肖承悰“更欣湯 ”

肖承悰屆國醫大師，更欣湯是其治療圍絕經期綜合徵的經驗方，體現滋腎養心、交通心腎的思路。

病機

圍絕經期女性天癸漸竭，腎精虧虛，肝血不足。腎陰虛則水不制火，心火上亢則神不安舍，形成心腎不交。同時肝陰不足，肝陽偏亢，疏洩失常則煩躁易怒。陰不制陽則虛熱外浮，烘熱汗出。病程日久可兼氣虛、血瘀。

方藥組成

組成：女貞子 15g、墨旱蓮 15g、生地黃 15g、枸杞子 15g、白芍 15g、知母 12g、百合 30g、生龍骨 30g、生牡蠣 30g、蓮子心 4g、丹參 15g、潼蒺藜 15g、白蒺藜 15g、合歡皮 15g、夜交藤 15g

功效：滋腎養肝，交通心腎，寧心安神

主治：更年期綜合徵（肝腎陰虛、心腎不交證）

方中女貞子、墨旱蓮合為二至丸，補益肝腎、滋陰清熱，為君藥。枸杞子助二至丸補肝腎之力，生地黃滋陰涼血養腎水，白芍養血柔肝斂陰，三藥助君藥滋腎養肝培本。知母清熱瀉火滋陰，百合清心除煩寧神，蓮子心清心火交腎水，三藥清心降火以交通心腎。生龍骨、生牡蠣潛陽鎮驚安神，使浮越之虛陽有所歸依。丹參活血清心除煩，防滋陰藥留瘀。潼蒺藜（沙苑子）補腎固精，白蒺藜疏肝平肝，二藥同用肝腎並舉。合歡皮解鬱安神，夜交藤養心安神通絡，兩藥助寧神之力。

方中潼蒺藜與白蒺藜同用是肖承悰的配伍特色——潼蒺藜即沙苑子，補腎固精，性偏補；白蒺藜疏肝平肝，性偏散。二藥同入肝腎，一補一疏，補而不滯、疏而不耗。蓮子心僅用4g，取其輕清之力清心火，小量不傷正。百合重用30g，取其清心寧神之功，用量大於一般方劑，體現肖承悰重視心神調治的思路。

四、隨證加減

肖承悰原案中曾用”鹽知柏各12g”，即知母、黃柏鹽水炒制，引藥入腎經，清下焦虛熱瀉相火而不傷中陽。更欣湯基礎方中知母12g清上焦虛熱，若下焦虛火亦重則加黃柏鹽炒助清。虛熱減輕後暴露脾腎兩虛本質時，加桑寄生、續斷平補腎中陰陽，炒白朮健脾益氣，先後天同補以扶正培本。

小結

更欣湯以二至丸補肝腎為君，加生地、枸杞、白芍助滋陰養血培本；百合、蓮子心清心火交腎水以交通心腎；龍骨牡蠣潛納浮陽安神；潼蒺藜與白蒺藜同用肝腎補疏並舉；合歡皮、夜交藤解鬱安神。全方滋腎養肝、交通心腎、寧心安神三法同施，覆蓋更年期綜合徵陰虛、火旺、心腎不交、肝鬱神擾多個病機層面，適於失眠煩躁明顯者。

參考文獻：

[1] 肖承悰運用治腎五法辨治婦科疾病經驗，《中醫雜誌》2023年第2期

[2] 滋腎養肝、寧心安神治療更年期綜合徵一例，人民衛生出版社AI平臺醫案庫

[3] 更欣湯治療心腎不交型圍絕經期失眠症的臨床療效研究，《期刊看中國》