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Home , Nosebleed, Tian, Xian (Taoism), Yao (surname)

San Formula San Qi Pian Origins: Modern formula

San Qi Formula (San Qi Pian) is a modern formulation designed to replicate the actions of the famous Chinese formula, Yunnan Baiyao. The ingredients of the original formula are a well-guarded secret, with only the chief ingredient, san qi, disclosed. The formulation under discussion here is designed to be fully transparent in order to aid the practitioner in prescription. General Signs/Symptoms San Qi Formula (San Qi Pian) can be used to treat of nearly any etiologyi (external trauma or internal disharmony, such as reckless , heat, toxic heat, qi deficiency, or blood stasis). This formula also effectively treats pain and swelling from trauma or arthritis. Applications 1. Stanches bleeding 2. Dispels blood 3. Disperses swelling 4. Purges toxicity stasis and relieves pain

Ingredients Latin English Percent of Formula (Sheng) San Qi, Qi (chief) Notoginseng (radix) Tienqi ginseng, Pseudoginseng Root 45% (deputy) Agrimoniae (herba) Agrimony 20% Guan Hua (deputy) Celosiae Cristatae (flos) Cockscomb Flower 15% Gen (deputy) Imperatae (rhizoma) Imperata Rhizome 10% (Sheng) Ce Bai (deputy) Platycladi (cacumen) Oriental Arborvitae Leaf and Stem (raw) 10%

General Indications / Modern Applications • Arthritis • Crohn’s disease, acute with • Phlebitis • Bi syndrome (wind-damp with bleeding • Postpartum bleeding blood stasis) • Epistaxis () • PTSD • Bleeding (internal or external) • Gums, bleeding • Rectal bleeding from trauma • Hematemesis ( of • Swelling (from toxin or trauma) • Bleeding from blood) • Trauma, emotional • Blood in stool or urine • (coughing blood) • Trauma, physical, pain, swelling • Blood in the urine (hematuria) • Hemorrhage or bleeding from • Bruising (contusion) • Hemorrhoids • Ulcers, bleeding • Coughing blood (hemoptysis) • Menstrual bleeding, excessive • Uterine bleeding (excessive) Formula Discussion Most of the time, when a practitioner finds a patient’s indication listed with a particular formula, s/he must take care to determine that the disease pattern and the formula pattern are also a match. This is a basic doctrine of Chinese medicine. When treating bleeding disorders with San Qi Formula (San Qi Pian), pattern identification is not usu- ally a crucial determinant. A perusal of Table 3 below will demonstrate the variety of patterns this formula addresses. Tables 1 and 4 show the variety of bleeding disorders treated and channels entered by each of the ingredients of San Qi Formula (San Qi Pian). The chief exceptions for usingSan Qi Formula (San Qi Pian) to treat bleeding disorders are (1) when the origin of the bleeding is purely hormonal; and (2) when the bleeding is due to severe deficiency. In the case of hormonal bleeding, San Qi Formula (San Qi Pian) can still be used, but it is usually wise to use in con- junction with the correct prescription hormone. When severe qi deficiency causes blood to leak out of the vessel,San Qi Formula (San Qi Pian) should be combined with Ginseng and Astragalus Formula (Bu Qi Tang). Aside from most types of bleeding disorders, a curious application of San Qi Formula (San Qi Pian)—and Yunnan Baiyao­—is the treatment of emotional trauma and Post-Traumatic Stress Disorder (PTSD). The theory here is that all trauma, be it physical or emotional, involves blood stasis. The heart stores theshen in the blood by imprinting experience into blood. When we experience emotional trauma, it is as much a physiological event as it is emotional.

San Qi Formula Monograph © May 2013, Herbal Medicine Press San Qi Formula 2 dosage, see “Formula Discussion.” severity. For emotional trauma 2-4 times daily, depending on The standardtablets, dosageis 2-4 D Do not during use pregnancy. C weak hidden wiry Hollow P or pale and qideficient. swollen if Often purple; can red be from heat T • Purges toxicity • Disperses swelling and relieves • Dispels stasis • Stanches bleeding F g on ormula ul ontraindication osage pain s e (xianmai) ue (ruomai) (fumai)

(koumai)

A ction , and others. choppy , rapid s , hurried s /C (shuomai) aution (semai) (cumai) s , , , therapy. Wait 3-10 days between courses, multiple if courses are needed. 3-4 nights in a row. This strategy shouldbe concurrentwith proper psycho tion) and taken with a small red glass of wine (or ginger tea) before bed for or complex. The dosageis usually large (4-8tablets, depending on constitu ingredients the in following tables. bleeding disorders,of helpful it is to compare the the constituent actions of To appreciate how zones and tissues. (See Table 1.) constituents of cooling blood and arresting the chaotic movement blood. of All the other remove strong. is stasis Imperata rhizome ( stasis, the formula, but 45%of it is the so action to invigorate blood and togineng to not damage the stomach qiand to actually have anourishing effect. No cold.is Yet the only cold substance, imperata rhizome ( mula warm, is neutral, 20%is cool, 15%is slight 10%is cold, and only 10% overall temperature this formula of very close to neutral. the for 45%of The temperatures the constituentof substances enoughvary to make the Synergy of Ingredients According to traditional explanations, the qifrom food not does become printation’ continuously as the moments our of lives accumulate. according to classical theory. The heart performs this action of ‘im food, observations, or experience, is imprinted into the blood by the heart, Anything we take in from the world and make a part ourselves, of be it an especially effective strategy to rectify the disturbed combination these of three. i.e., the heart therefore must also affect some or multiple partsthe emperor-complex,of affects the this hesitation creates a stasis. The shock emotional of trauma invariably tion is interrupted, shaken; it stutters or hesitates at the moment shock; of scenarios involve stasis because the heart’s continuous imprintation func concurrent with physical trauma, or it can be experienced on its own; both link between blood stasis and emotional trauma. Emotional trauma can be to describe a shocking event. But within this cliché is a truth revealing a judgments and attitudes. The term,“heart-stopping” is oftenused as a cliché entries in a ledger, but the feeling-impressions from memory, experience, in the blood. The record imprinted into our in turn are influenced by the our psychic of constitutions, our combining food and air. The But blood and yuan withintheis heart chamber that the emperor combines red substance and (essence) and tion place in is to remind that us blood not is blood until it contains our usuallyit is referred to not as but as “blood” “red substance”.distinc This (oxygen) it travels to the heart. But before into it passes the heart lungs; once earth the ( qiof food into rises the chest where it first combineswith gathered qi by the blood simply by being absorbed from the intestines. Rather, the . The heart-kidney axis qi, and all the previously-imprinted qi, finallyinfusing that combinationwith (san qi) shen zang yuan (by definition itsbeing of emotionally traumatic), and shen San Formula Qi is the is only substance the in formula that invigorates blood itself, its vessels, the blood that carries the qiwith the red substance inside the heart chamber. It San Formula Qi are not synonymous. The San Qi Formula (shaoyin) shen qi/qifrom food) combines with the qiof

comes from the heart’s impressions, which (San Qi Pian)(San Qi

allows for the easycombination of (San Qi Pian)(San Qi shen bai mao gen) shen

that circulates memoryas (San Pian) Qi shen astringe bleeding various in shen , is not like the record of does not come from can treat many so types to make blood. shen bai mao gen) stops bleeding by with the emper can be part of shen gu , or any qifrom is said is - - - - jing , - - - - San Qi Formula 3 X Gums Bleeding Bleeding heat Ce Bai Ye Bai Ce X X X Uterine Uterine Bleeding Bleeding from deficiency deficiency from Bleeding Bleeding from excess heat excess from Bleeding

X X X X X Hemorrhoids X X X heat X X X Bai Mao Gen Ce Bai Ye Bai Ce Reduces Toxicity / Toxicity Reduces Anti-inflammatory X X X X X urine) Bleeding from deficiency deficiency from Bleeding Bleeding from excess heat excess from Bleeding Bleeding from infection from Bleeding (blood in Hematuria Hematuria X X X X X X Anti-fungal X X X X Bai Mao Gen blood) (vomiting (vomiting heat Hematemesis Hematemesis Ji Guan Hua

Bleeding from stasis from Bleeding X X Bleeding from deficiency deficiency from Bleeding Bleeding from cold stasis cold from Bleeding Bleeding from excess heat excess from Bleeding Bleeding from infection from Bleeding X X Anti-viral X X X X Ji Guan Hua Hemoptysis (coughing blood) (coughing X X cold heat X X X X X X X Xian Cao He Xian Cao He Anti-parasitic Epistaxis Epistaxis (nosebleed) Bleeding from deficiency deficiency from Bleeding deficiency from Bleeding Bleeding from cold stasis cold from Bleeding Bleeding from excess heat excess from Bleeding Bleeding from infection from Bleeding qi deficiency from Bleeding X X X San Qi X X X X X X X Bleeding Bleeding Anti-bacterial from trauma from San Qi Bleeding from stasis from Bleeding Bleeding from cold stasis cold from Bleeding Bleeding from excess heat excess from Bleeding Ce Bai Ye Bai Ce Bleeding from infection from Bleeding Ji Guan Hua Bai Mao Gen San Qi Xian Cao He Small Intestine Small Bladder Urinary Stomach Spleen Liver Lung Intestine Large Ce Bai Ye Bai Ce Ji Guan Hua Bai Mao Gen San Qi Xian Cao He Table 3: OM Patterns of Bleeding Disorders Addressed by Constituent Substances Constituent by Addressed Disorders of Bleeding Patterns OM 3: Table Table 1: Common Bleeding Disorders and the Applications of Constituent Substances of Constituent Applications the and Disorders Bleeding Common 1: Table Table 2: Anti-Toxin Actions of Constituent Substances of Constituent Actions Anti-Toxin 2: Table Table 4: Channels Entered by Constituent Substances Constituent by Entered Channels 4: Table San Qi Formula 4 Table 5: Unique Actions Constituent of Substances (other than hemostatic) given adecoction of time greatly was reduced mice in five days after they were cools blood, and stops bleeding. One study shows bleeding Ji Guan Hua swelling and edema. significant anti-inflammatoryaction, effectively reducing analgesic effect,increasing the pain threshold, and done on mice concluded that at relieving pain and reducing edema. A recent study Modern research shown has this herb to very be effective arachidonate-induced thromboembolic death. indomethacin had no effect) and collagen and sodium acute pulmonary thromboembolic death ( and that thromboembolism. A study done was on mice showing antiplatelet action effective is in treating acute pulmonary dependent and most is effective at lower doses. Its to invigorate blood. The anti-hemostatic effect is dose time. bleeding. It promotes platelet production and accelerates Xian He Cao— Notoginseng San Qi— on the individual ingredients this formula. of informative here and useful to mention some studies done bleeding each be in will or trauma. However, it may be ingredients this formula, of but the common denominator amoebic dysentery, that are known to helped be with the designations,disease such PTSD, as Crohn’s Disease, or issues are bleeding issues. There aresome modern Pian) The “modern applications” for Modern Applications Increases sperm motility Anti-atherosclerotic xian cao he Hepatoprotective Reduces swelling Cardioprotective do not vary from classical indications. Bleeding CNS protectiveCNS Antiarrhythmic PNS protective Renoprotective Antioxidant and edema Analgesic See See San Qi San ­— Published Studies onSan Qi/ was effective was at preventing ADP-induced Agrimony has to used been stanch Celosiae or cockscomb flower clears heat, , on page 6. 1

Xian cao he

iii ji guan hua ji guan

to heat, cold, excess, or Used for bleeding due Prevents qi leakage of Alleviates diarrhea Reduces swelling xian cao he also has the has also function San Formula Qi and dysentery versus the control group. and edema Xian He Cao Xian and blood deficiency Analgesic has apowerful has

ii (San Qi (San Qi Stops discharge vaginal Preserves fluids body Consolidates Ji GuanHua measures overall fibrinolysis) compared to the control significantlywell as shortenedeuglobulin lysis time (which prothrombin time, and plasma recovery shortened, was as daysSeven after taking In the same study rabbits were given the same decoction. and, asingle-herb as tablet, ideal is for combining with their astringency.by virtue of gen, invigorates blood to stanch bleeding. stanch bleeding function. san qi notoginseng root. ( blood to stasis treat trauma and bleeeding. PianQi San Qi Tablets Formula Comparisons micein and rats. plasma recalcification(partial time thromboplastin time) ye to the control group. mice showed bleeding time reduced was by 62%compared bleeding including of type deficiency. One study done on bleeding due to heat the in blood. It for can used be any Ce Bai Ye renal function. and IgA nephropathy rats, in showing well as as improved mao gen nephropathy rats in done. was The results showed that study to investigate the effectiveness of for treating epistaxis, hematuria, and nephropathy. A Bai Mao Gen­ group. San Qi WanSan Qi (charred) can significantly shorten bleeding time and jing and ) is used more used ) is often for cardiovascular problems , plus four other herbs that assistand broaden the iv ) have similaractions to stanch bleeding and dispel can significantly reduce hematuria, proteinuria, ce bai ye —Oriental Arborvitae is ) has only) has one ingredient: — Effectively vents rashes v Promotes urination,

Decreases vascular ( vii Imperata rhizome is Protects the yin Clears excess or all cool all the blood and stanch bleeding Treats jaundice reduces edema San Qi WanSan Qi permeability San Formula Qi Bai Mao Gen Bai Mao latent heat vi Another study showed that ji guan hua ji guan Xian cao he ) and San Qi Tablets

coagulation time, known for stopping San Formula Qi ( Stops bleeding from qiand San Qi PianSan Qi Disperses dampness from both astringes and Ji bai hua, mao guan most often used bi Boosts and protects yin Stops discharge vaginal Promotes hairgrowth Topically to used heal syndrome and trauma san qi bai mao gen Regenerates flesh blood deficiency Expectorant San Qi Tablets burnt flesh Ce Bai Ye /panax ( San Qi San Qi ) is 45% ) is ce bai for ( San bai

San Qi Formula 5 - , Vol Vol , ujian ujian for for qi for for lung lung for Tu Ling Fu Tu ( for damp-for for blood blood for for yin defi yin for , Vol 6, 2006. 6, Vol , Vol 2, 1983. 2, Vol The American Journal of Journal American The Journal of Nanjing University of University of Nanjing Journal Vol 6, 1986. 6, Vol , 1996. , Hua Formula Hua Formula Wu ) or another appropriate formula to to formula appropriate another ) or Rehmannia Cool Blood Rehmannia Cool Chong Release Formula Chong , Vol 15, 1987. 15, Vol , Journal of Pharmaceutical Practice of Pharmaceutical Journal Chinese Medicine Bulletin, Bulletin, Medicine Chinese Mulberry and Lycium Formula Mulberry and Lycium Lily Preserve Metal Formula Lily Preserve Rehmannia Cool Blood Formula Rehmannia Cool Formula Ginseng and Astragalus Formula and Dianthus Polyporus Formula Ginseng and Astragalus Formula and Dianthus Polyporus Formula Ginseng and Astragalus for blood heat blood for Rehmannia and Scrophularia Rehmannia and Scrophularia Rehmannia Cool Blood Formula Blood Cool Rehmannia Zhen Medicine and Materia Medica Research Medica Materia and Shi ZhenLi Medicine Chao, et al., “Pharmacodynamic Study of Oriental Study “Pharmacodynamic et al., Chen Chao, , Chungui, et al., “Experimental ofAnti- Studies et al., Chungui, Gong, Zhenwen, et al., “Oriental Arborvitae Hemostatic Hemostatic Arborvitae “Oriental et al., Zhenwen, Xu Liwei, et al., “Hemostatic Effect of Flos Celosiae of Celosiae Effect “Hemostatic Flos et al., Liwei, Guo Hsu M F, et al., “Effect of Hsien-ho-t’sao (Agrimonia Pilosa) Pilosa) (Agrimonia “Effectof Hsien-ho-t’sao et al., M F, Hsu Yin Yousheng, et al., “Effects of Rhizoma Imperatae and its “Effects and of Imperatae Rhizoma et al., Yousheng, Yin Wei Xianhui, “The Clinical Application of Agrimony”, F Agrimony”, of Application “The Clinical Xianhui, Wei Use with Use or ciency, heat Use with Use with Use with Use Formula with Use with Use or spleen deficiency, heat with Use with Use or deficiency, or stagnation, Formula Ingredients,” Ingredients,” vii Medicine Chinese Traditional Effect” Hemostatic Arborvitae 2008. Symposium, Association of Chinese Medical the Branch stop the bleeding, after the initial bleeding has subsided has subsided bleeding initial the after bleeding, the stop to switch Wan Sheng of cause bleeding. the underlying the on focus more Endnotes i Medicine, Chinese Traditional ii Mice”, in Experimental on Medicine Chinese iii Herba from Effects of Extract Analgesic and inflammatory Agrimoniae”, iv Mechanism”, its and Cristatae Medicine Chinese Traditional v in Nephropathy of IgA Model the on Decoction Rats”, 2011. 11, vi

) to ) to San QiSan ( ce bai ye bai ce ) works ) works ) is a Useful Combinations Useful and San QiSan Pian ( Tu Fu Ling Sheng Di Ling Fu Tu San QiSan Pian San QiSan Pian ( ( ( San Qi Formula San San Qi Formula San ji guan hua, bai mao gen, guanji hua, mao bai San Qi Formula San San Qi Formula Qi Formula San ) also treats these conditions when blood-heat blood-heat when conditions these ) also treats ) focuses on effectively stopping the bleeding. It alsoIt bleeding. the stopping ) focuses effectively on For with blood cough For For excessive menstrual bleeding excessive For For bleeding from fibroids bleeding from For For blood in the urine blood in the For stool blood in the For For bleeding due to spleen deficiency bleeding due to For yin deficiency bleeding due to deficiency with For fire For bleeding due to heat in the blood heat bleeding due to For stanch bleeding. Use Use bleeding. stanch treats the underlying cause, heat in the blood with several several with blood in the heat cause, underlying the treats of herbs, deputy the focus is its to though bleeding, stanch and blood cool to it will in turn stop the bleeding. bleeding. the willit stop in turn Pian Rehmannia Cool Blood Formula Blood Cool Rehmannia Wan Huang blood cooling and heat clearing By cause. underlying isthe ecchymosis. The bleeding is often accompanied with with accompanied often is bleeding The ecchymosis. blood The will of feeling heat. a general and thirst, fever, be profuse. can amount the and red bright or red be dark on various manifestations of excess bleeding such as such bleeding of excess manifestations various on in the blood bleeds, nose blood, vomiting or coughing and bleeding, intestinal bleeding, uterine excessive urine, bleeding occurs it is due to heat pushing out the blood blood the out pushing heat to is it due occurs bleeding vessels. the from internal bleeding: excess and deficient. Excess type Excess deficient. and excess bleeding: internal While blood. in the heat to due often is most bleeding time the by involvement, organ internal is often there caused by heat. heat. by caused non-traumatic for classifications main two are There other formulas. formulas. other its with but type of any bleeding, for formula general is if bleeding the choice is a better function heat-clearing San Qi Formula 6 Suppl Kwan, C. Y. (1995) “Vascularselected antihypertensive effects of drugs derivedfrom traditional medicinal herbs.” (DIC).” Kubo, M., Matsuda, Matsuda, R., H., Arichi, S. (1984) of Panax “Effect notoginseng on experimentaldisseminated intravascular coagulation 1150–1152. Konoshima, T., Takasaki, M., Tokuda, H. (1999) “Anti-carcinogenic the Panax roots activity of of notoginseng.” II. notoginseng and immediate total eschar excision one in operation.” Huang, Y. S., , Z. C., , B. G., , X. C., Li, A. N., Crowther, S. R. 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