Two Immortals- Help with Menopausal Symptoms and Hypertension

Er Xian Tang (Two Immortals Teapills)

TCM action: warm kidney yang, tonify kidney essence, and drain deficient fire

Last year one of my esteemed herbal teachers, Leslie Tierra, talked about the great results that she was getting treating women with Er Xian Tang who had yin deficiency with deficient fire. This peaked my interest and I started to look at the history and herbs that comprised the formula. In a nutshell, deficient fire is often seen in women who are experiencing pre and post menopausal symptoms which might include hot flashes, night sweats, facial and malar flushing, irritability, palpitations, insomnia, decreased sex drive and vaginal dryness to name a few.

The formula Er Xian Tang was developed in the 1960’s at a hospital affiliated with Shanghai College of Traditional Chinese Medicine. Er Xian Tang was designed as a treatment for cases of hypertension (Western terminology) where there was a combination of kidney yang deficiency and deficiency fire of the kidney, two seemingly contradictory conditions. Yang deficiency include signs of internal cold and weakness including coldness, lassitude, edema of the legs, loose stools, sterility or infertility, frequent urination, urinary incontinence, while the signs listed above indicate deficiency of Kidney fire.

A comparison of the role of the heart and kidney in allopathic and TCM can be helpful in understanding the intent of the formula. Er Xian Tang treats renal hypertension.   Renal hypertension from an allopathic perspective results impaired functioning of the kidneys, reduced urinary elimination and excessive renin (a protein and enzyme secreted by the kidneys) production. The heart sends a continuous supply of oxygenated blood around the body. The kidney filters the blood, extracting waste in the form of urine, and also helps regulate the water and salt levels to control blood pressure. When the heart is no longer pumping efficiently it becomes congested with blood, causing pressure to build up in the main vein connected to the kidneys and leading to congestion of blood in the kidneys. The kidneys suffer from the reduced supply of oxygenated blood. When the kidneys become impaired, the hormone system, which regulates blood pressure, goes into overdrive in an attempt to increase blood supply to the kidneys resulting in renal hypertension. This eventually damages the heart, which has to pump against higher pressure, in the arteries.

In TCM Er Xian Tang treats kidney yang deficiency and deficiency fire of the kidney. In TCM, according to the five elements theory, the Heart is categorized as yang and the Kidneys are considered yin. Normally, the Heart yang (fire) descends and joins with the Kidney-yang to warm and propels kidney-yin (water) to ascend to nourish heart yang (fire) to prevent it from hyperactive. Think of it as a continual loop with fire warming the kidneys, while water helps to contain heart fire. Or as Western medicine describes: the heart sends a continuous supply of oxygenated blood to organs including the kidneys that help to regulate water and salt levels to control blood pressure. In both systems the heart and the kidneys are closely related, with a mutually dependent function. If this functional relationship becomes abnormal in TCM it results in a condition termed “non-coordination between the heart and the kidney”.

This gets us back to yin deficiency with deficient fire. In Chinese medicine, the Heart and Kidney energies should work together. The Heart sends Fire down to warm the Kidneys: in return, the Kidneys send pure fluids up to nourish the Heart. In Heart and Kidney Yin deficiency with Deficient Heat the downward action or upward action is severely reduced. This leaves too much Yang (fire), due to lack of cooling Yin (water), hence deficient heat, resulting in night sweats, insomnia, and steaming bone syndrome. Normally you expect to see symptoms of deficiency fire of the kidney associated exclusively with yin deficiency, yet in this case, this type of fire is described as yang excess which arises from an imbalance of yin and yang (the deficient yin can not control the yang). When yin and yang are both deficient, one can experience symptoms of each deficiency, which may either flip back and forth between the two or manifest simultaneously.

Er Xian Tang, Two Immortals

Xian Mao-Curculigo, Golden Eye-Grass Rhizome

Tastes and Energies: spicy-hot,

Category: Tonify the Yang

Actions: Warm Kidney yang and tonify Kidney essence,

Contraindications: Yin Deficiency w/ Heat

Yin Yang Hou-Epimedium Leaf

Tastes and Energies: spicy, sweet, warm,

Category: Tonify the Yang

Actions: Warm Kidney yang and tonify Kidney essence, tonify Yin, harnesses Liver yang,

Contraindications: Yin deficiency w/ Heat

Ban Ji Tian-Morinda Root

Tastes and Energies: spicy, hot, toxic,

Category: Tonify the Yang

Actions: warm Kidney yang and tonify Kidney essence,

Contraindications: Yin deficiency w/ Heat amp heat

Huang Bai-Phellodendrum Bark, Amur Cork-Tree Bark

Tastes and Energies: bitter, cold

Category: Clear Heat Dry Dampness

Actions: nourish Kidney yin and drain fire from deficiency, used for steaming bone disorder, night sweats.

Contraindications: Spleen Qi Deficiency w/ Cold

Zhi Mu-Anemarrhena Rhizome

Tastes and Energies: bitter, sweet, cold

Category: Clear Heat, Drain Fire

Actions: nourish Kidney yin and drain fire from deficiency, nourish yin and moistens dryness, generates fluids and clears heat.

Contraindications: Spleen Qi Deficiency, diarrhea

Dang Gui-Angelica Sinensis Root

Tastes and Energies: sweet, spicy, warm

Category: Tonify the Blood

Actions: Moistens and nourishes the blood and regulates the penetrating and conception vessels. Invigorates blood, moistens the intestines, increases circulation

Contraindications: Spleen Qi Deficiency, dampness

Er Xian San cautions:  during pregnancy, during early states of acute illness, loose stools, diarrhea, poor appetite or chronic digestive weakness.

The intriguing aspect of Er Xian Tang is that it contains herbs that are contraindicated (not used) in cases of yin deficiency with deficient fire. It contains hot natured herbs, Xian Mao, Yin Yang Hou, and Ban Ji Tian, which tonify yang but can also increase fire. The formula also contains Huang Bai and Zhi Mu that are bitter and drying, which may damage yin. Huang Bai and Zhi Mu are considered a traditional Dui Yao, or herbs that are often used together to reinforce and complement each other. Together they clear heat, enrich yin and drain deficient fire. Huang Bai is bitter, cold, consolidates yin, drains deficient fire, while Zhi Mu, is sweet, cold, enriches yin, moistens dryness, and supplements the kidneys. Dang Gui builds blood, increases red cell proliferation, normalizes heart contractions and dilates coronary blood vessels increasing peripheral blood flow. Huang Bai and Zhi Mu are cold energetically and help to balance the spicy and heating energies of Xian Mao, Yin Yang Hou, and Ban Ji Tian.

Er Xian Tang serves as an example of evolving TCM formulation, where a new formulations are being utilized to address modern disharmonies by combining strongly warming yang tonics with cold, fire-purging herbs. In this case and the studies that have been conducted the formula appears to be effective for hypertension and for some other applications, such as menopausal syndrome and male infertility.

Additional notes:

Xian Mao and Yin Yang Huo are used to tonify the kidney and according to the Taoist’s aid in prolonging life. The name “Two Immortals” references the use of the word Xian.   Xian Mao was named in the Bencao Gangmu (by Li Shizhen; 1596) as one of the herbs believed to contribute to immortality. Xian Ling Pi (Epimedium, now know as Yin Yang Huo) alludes to the immortals’ intelligent nature, boosts the qi and strengthens the will. Around 100 B.C., a poem about attaining immortality, the ode Yuan Yu (Journey to Remoteness, or Roaming the Universe) was written. It depicts the transition to immortality:

Having heard the precious teaching, I departed,

And swiftly prepared to start on my journey.

I met the feathered ones at Cinnabar Hill,

I tarried in the ancient Land of Deathlessness.

In the morning, I washed my hair in the Hot Springs of Sunrise,

In the evening, I dried myself where the suns perch.

I sipped the subtle potion of the Flying Springs

And held in my bosom the radiant metallous jade.

My pallid countenance flushed with brilliant color,

Purified, my Jing began to grow stronger,

My corporeal parts dissolved to a soft suppleness,

And my spirit grew lissome and eager for movement.