Wang Qingren, a physician during the Qing dynasty, is the author of the famous book Yi Lin Gai Cuo (Correcting the Errors in the Forest of Medicine). In this book, he criticized his medical predecessors for their mistakes in anatomical drawings and descriptions of physiological processes. In the introductory chapter, he wrote:

In the chapter in which Wang describes Shao Fu Zhu Yu Tang, he states:

Rx. Shao Fu Zhu Yu Tang

The following analysis of the composition first deals with the individual groups of similar medicinals and then evaluates the interplay of these different groups. Shao Fu Zhu Yu Tang is also particularly broad in its applicability because the formula is composed of so many different groups of remedies.

Xiao hui xiang, gan jiang, and guan gui are all acrid and warm or hot medicinals. Xiao hui xiang and guan gui enter the lower burner. Gan jiang warms yang, especially in the center and upper burner; because of its acrid and hot properties, this substance also disperses cold. Cold congeals and causes qi stagnation and blood stasis. Movement demands acridity and warmth. This first group of medicinals hence not only warms the lower burner. Because of the acrid medicinals, it also moves qi and disperses cold. Thereby, it supports the movement of blood.

The qi-moving and stagnation-resolving function of these substances is further supported by the two acrid ingredients chuan xiong and dang gui. While these primarily move blood, they also support the qi-moving and stagnation-resolving functions of the warming and cold-dispersing ingredients with their warm and acrid properties. This effect assists in the treatment of blood stasis.

The combination of chuan xiong and dang gui is a good fit. Both are seen as “qi within blood” substances. Chuan xiong, however, is an active and slightly aggressive yang substance. By contrast, dang gui is a more nourishing but still also acrid and moving yin substance. The blood-nourishing properties of dang gui protect the blood from the stronger blood-breaking substances in this formula.

The blood-quickening ingredients are mo yao, pu huang, wu ling zhi, chi shao, and yan hu suo. With the exception of chi shao and yan hu suo, these medicinals all belong to the strongest category of stasis-eliminating substances, namely bloodbreaking remedies. The combination of pu huang and wu ling zhi produces the classic basic formula for pronounced blood stasis-related pain in the epigastrium and abdomen: Shi Xiao San (Sudden Smile Powder). Today, this small formula is primarily used in the treatment of dysmenorrhea due to stasis. What is special about this formula is the fact that pu huang not only breaks stasis but primarily stanches bleeding. This function is supported and complemented by wu ling zhi, which primarily breaks blood but also stanches bleeding. In addition, gan jiang also has a blood-stanching function. Hence, we can also use this formula for bleeding that is caused by blood stasis. Nevertheless, pao jiang (blast-fried ginger) has a much stronger blood-stanching effect than gan jiang (dried ginger) and should be substituted in cases of bleeding.

Shi Xiao San as a pain-relieving formula is supported by yan hu suo, also an acrid-warm substance that not only quickens blood but also moves qi. Out of all the blood-quickening and-moving substances, yan hu suo is regarded as the best one for relieving pain.

Altogether we can divide the ingredients into two groups that define the primary effect of the formula:

• warm and acrid, cold-dispersing substances
  
• blood-quickening, pain-relieving substances

Furthermore, the focus of the formula lies, as its name already expresses, in the lower abdomen. In women, this region applies to the uterus. But the formula not only breaks stasis, quickens blood, warms, and resolves stasis, it also stanches bleeding and nourishes blood. This last function is emphasized, for example, by the high dosage of dang gui—primarily a nourishing root with a mild blood-quickening effect.

Together with Xue Fu Zhu Yu Tang (House of Blood Stasis-Expelling Decoction), Ge Xia Zhu Yu Tang (Infradiaphragmatic Stasis-Expelling Decoction), Shen Tong Zhu Yu Tang (Generalized Pain Stasis-Expelling Decoction) and Bu Yang Huan Wu Tang (Yang-Supplementig Five-Returning Decoction), Shao Fu Zhu Yu Tang belongs to Wang Qingren’s most famous formulas today. In the treatment of gynecological complaints, the formula and its modifications belong to the standard repertoire of Chinese medicine. The formula can, however, also have a broader application.

As we look through the modern literature for references to Shao Fu Zhu Yu Tang, we quickly realize that the most common application of this formula is in the treatment of dysmenorrhea due to cold and stasis. When cold and stasis block the uterus, infertility may result. For this reason, Shao Fu Zhu Yu Tang is also one of the most popular formulas in fertility treatment. As the above translation from the Yi Lin Gai Cuo illustrates, Wang Qingren did in fact compose this formula for the specific purpose of stimulating fertility and treating spontaneous abortions.

It is important to realize that appropriate modifications of Shao Fu Zhu Yu Tang can extend its range of application considerably. Furthermore, such modifications are important for improving the treatment success by precisely matching the patient’s disease pattern. It is one of the outstanding properties of this formula that it is very easy to modify and can therefore be used for many different disease patterns.

As the above formula analysis shows, Shao Fu Zhu Yu Tang has three characteristics. The formula:

• quickens blood and transforms stasis
  
• affects especially the lower burner
  
• is warm and disperses cold

The first two of these characteristics make this formula suitable for the many different gynecological and urological conditions for which it is used today. The third characteristic is more flexible. The reason for this is that its warm nature can quite easily be changed into the opposite, so that a cool formula is created. The following research and clinical reports show that Shao Fu Zhu Yu Tang can also treat many hot conditions. Regardless of this transformation from warm to cool, the formula always continues to quicken blood and break stasis. As such, the addition of the proper “cold” modifications makes this formula applicable for stasis with heat. This means that Shao Fu Zhu Yu Tang is able to treat practically all conditions with stasis in the lower burner.

Reversing the formula hierarchy can serve as one example here. If the only cold root in the formula, chi shao, becomes the sovereign and the acrid warm and hot ingredients gan jiang, xiao hui xiang, and guan gui become assistants and couriers, and we add a few bitter and cold substances, this medicinal combination quickly turns into a formula that clears heat and breaks stasis.

Summaries of research and clinical reports follow. The quality of the reports varies greatly. We must ask the reader not to focus primarily on the methods and results of the studies. Instead, direct your attention to the form and composition of the formulas. These describe the modern and successful application in clinic and indicate the manifold possibilities for modifying Shao Fu Zhu Yu Tang.

In this study, 41 women with fertility problems were treated with a modification of Shao Fu Zhu Yu Tang. The husbands’ sperm was checked and found to be normal. Thirty-four women suffered from primary infertility; seven women from secondary infertility. Twenty-eight women were between 25 and 30 years old, 13 women between 31 and 40. Twenty-six women had been trying to become pregnant for 5 years; 15 women for 6–9 years. In 11 women, the menstrual cycle was normal, 12 women had a shortened cycle, and 14 had a delayed cycle. In four cases, the periods were irregular, that is, either too early or too late.

All women were treated only with Chinese medicine. Shao Fu Zhu Yu Tang was the basic formula. In women with symptoms of qi deficiency, bai zhu (atractylodis macrocephalae rhizome) and tai zi shen (pseudostellariae radix) were added. In women with blood deficiency, shu di huang (rehmanniae glutinosae radix praeparata) and dan shen (salviae miltiorrhizae radix) were added. In cases with pronounced symptoms of vacuity cold, fu zi (aconiti radix lateralis praeparata) and xi xin (asari herba) were added as well. For pronounced yin deficiency symptoms, xuan shen (scrophulariae radix) and e jiao (asini corii colla) were added as well.

After treatment with this formula, 30 women became pregnant and gave birth. The longest treatment span was 1 year, the shortest 3 months.

A total of 38 women were treated. The average age was 30.6 years. Twenty-six women suffered from primary infertility, 12 women from secondary infertility.

All women were treated with a modification of Shao Fu Zhu Yu Tang. The formula consisted of the following ingredients:

• xiao hui xiang, 6 g
  
• chi shao, 15 g
  
• chuan xiong, 15 g
  
• guan gui, 6 g
  
• mo yao, 6 g
  
• gan jiang, 6 g
  
• chao pu huang (Typhae pollen frictus) 15 g
  
• wu ling zhi, 15 g
  
• yan hu suo, 15 g
  
• dang gui, 6 g

Additional Modifications

This basic formula was adjusted in accordance with the patients’ disease patterns. For a tendency to cold, the following were added:

• xi xin, 3 g
  
• wu zhu yu (Evodiae fructus), 3 g

For a tendency to heat, gan jiang, guan gui, and xiao hui xiang were removed, and the following were added instead:

• mu dan pi (Moutan cortex), 15 g
  
• bai jiang cao (Patriniae herba), 15 g
  
• zhi zi (Gardeniae fructus) 15 g

For a tendency to vacuity, the following were added:

• huang qi (Astragali radix), 30 g
  
• dang shen (Codonopsis pilosulae radix), 15 g
  
• bai zhu, 9 g

For a tendency to repletion, the following were added:

• san leng (Sparganii rhizoma), 10 g
  
• e zhu (Curcumae rhizoma), 10 g

• chuan lian zi (Toosendan fructus), 15 g
  
• wu yao (Linderae radix), 10 g

For a tendency to cold-related coagulation with blood stasis, the following were added:

• xiang fu (Cyperi rhizoma), 10 g
  
• zi shi ying (Fluoritum), 30 g

For a tendency to qi stagnation with blood stasis, the following were added:

• yu jin (Curcumae radix), 18 g
  
• chuan shan jia (Manis squama), 15 g
  
• lu lu tong (Liquidambaris fructus), 10 g

Chinese medicinal therapy was combined with biomedical treatment for tubal patency. Treatment length varied between 1 and 6 months. The average treatment length was 3.2 months.

After treatment, an effect was seen in 92% of all cases and a cure in 66 patients.

This study demonstrates vividly how Shao Fu Zhu Yu Tang can be modified to match all kinds of disease patterns. In particular, the treatment of heat patterns is noteworthy here. For this purpose, the warm ingredients in this essentially warm formula had to be reduced, and heat-clearing medicinals had to be added. All blood-moving medicinals were left in place! At the same time, we should emphasize that Shao Fu Zhu Yu Tang, a formula for cold and stasis in the lower burner, does not possess markedly hot properties. In cases of pronounced cold, we must therefore add strongly heating substances like wu zhu yu and xi xin. Incidentally, this fact can also be highlighted in the first study. In that study, the hot ingredient fu zi was added, for example. All in all we can thus see that Shao Fu Zhu Yu Tang serves as a moderate treatment for very different disease patterns. By adding the correct medicinals, the formula can be designed to fit almost any presentations.

A total of 40 women suffering from infertility were treated. Their age ranged between 25 and 38. The women had been suffering from infertility for between 2 and 14 years. Twenty-four women were diagnosed with primary infertility; 16 women with secondary infertility. Twenty-one women additionally suffered from mild to medium tubal obstruction. In five women with primary infertility, uterine dysplasia was discovered; 28 women suffered from adnexitis.

The women were treated with the following variation of Shao Fu Zhu Yu Tang:

• xiao hui xiang, 6 g
  
• gan jiang, 9 g
  
• yan hu suo, 9 g
  
• dang gui, 9 g
  
• chuan xiong, 9 g
  
• rou gui, 6 g
  
• chi shao, 12 g
  
• pu huang, 12 g
  
• wu ling zhi, 9 g
  
• mo yao, 9 g
  
• dan shen, 18 g

This prescription was started at the onset of the menstrual period and taken for 7 days. Treatment was continued for a minimum of three menstrual cycles.

Additional Modifications

For cold pain in the lower abdomen and a delayed menstrual period due to yang vacuity or an accumulation of cold-damp:

• the amount of gan jiang, xiao hui xiang, and rou gui was increased, and the following medicinals were added:
  
  
  
  • fu zi, 9 g
    
  • cang zhu (Atractylodis rhizoma), 9 g
    
  • fu ling (Poria), 12 g

For stabbing pain in the lower abdomen during the period with clots or tissue in the menstrual fluid, caused by blood stasis, the following were added:

• tao ren (Persicae semen), 12 g
  
• hong hua (Carthami flos), 9 g
  
• yi mu cao (Leonuri herba), 30 g

• huang qi, 30 g
  
• shu di huang, 24 g
  
• e jiao, 12 g

For heavy menstrual periods with red blood, internal disquietude, dry mouth, and yellow urine, the following were removed:

• xiao hui xiang, gan jiang, and rou gui with the addition of:
  
• sheng di huang (Rehmanniae radix exsiccata seu recens), 24 g
  
• huang bai (Phellodendri cortex), 9 g
  
• mu dan pi, 12 g
  
• di gu pi (Lycii cortex), 12 g

For a feeling of fullness in the lower abdomen during the menstrual period with pain in the chest area and ribs and tension in the breasts, caused by qi stagnation, the following were added:

• xiang fu, 12 g
  
• wu yao, 12 g

For cervicitis or adnexitis, the following were added:

• jin yin hua (Lonicerae flos), 12 g
  
• pu gong ying (Taraxaci herba), 15 g
  
• chuan lian zi, 9 g
  
• che qian zi (Plantaginis semen), 12 g

Additionally, all women received biomedical treatment for tubal patency.

The results were measured by whether the treated patients became pregnant or not after a certain length of treatment. Of the total of 40 patients, eight became pregnant after 1 month of treatment, 10 after 2 months, and nine after 3 months. An additional 10 were pregnant after 4–6 months. Four women failed to become pregnant even after a full year of treatment.

Again we can see from the modifications how broadly we can use Shao Fu Zhu Yu Tang. The formula is used not only in cases with cold stasis, but also for adnexitis and cervicitis, which both tend to be manifestations of heat accumulation. In this study, the formula Shao Fu Zhu Yu Tang was modified so as either to warm or to clear heat. Furthermore, huang qi, shu di huang, and e jiao were added as strengthening substances and thereby gave Shao Fu Zhu Yu Tang a supplementing effect. The addition of tao ren, hong hua, and yi mu cao further increased the stasis-resolving function. By adding two or three ingredients or removing the warming and hot substances like xiao hui xiang, gan jiang, and rou gui, we can thus use this formula to treat vacuity and repletion, heat and cold.

Also interesting is the timing when the formula was dispensed: always during the menstrual period. The reason for this is that the effect of Shao Fu Zhu Yu Tang in fertility treatment is firmly rooted in its function to “cleanly” build up the uterine lining—the endometrium—as a result of which the fertilized egg is able to implant. When the formula is prescribed during the menstrual period, it can assist in the “shedding” of the endometrium and thereby facilitate the unobstructed construction of a new endometrium.

The age of the 12 patients ranged between 25 and 36 years. Two women had been trying to become pregnant for more than 10 years; five women for 6–10 years; two women for 4–6 years; and the remaining three women for 3–4 years.

The women were treated with the following prescription:

• xiao hui xiang, seven seeds
  
• gan jiang, 2 g
  
• yan hu suo, 5 g
  
• mo yao, 5 g
  
• dang gui, 15 g
  
• chuan xiong, 5 g
  
• rou gui, 5 g
  
• chi shao, 10 g
  
• pu huang, 15 g
  
• chao wu ling zhi (Trogopteri feces frictum), 10 g

This prescription was started on the 6th day of the menstrual cycle and taken for 7 days.

This treatment lead to good results. The improvement rate was around 90%. Most patients required two or more treatment cycles.

According to the author of this study, Shao Fu Zhu Yu Tang is effective in liver qi stagnation with internal blockage due to blood stasis. Shao Fu Zhu Yu Tang is indicated especially for infertility due to vacuity cold in the uterus.

A total of 94 women ranging from 24 to 38 years in age were treated for endometriosis with accompanying infertility. All women presented with the following symptoms: no pregnancy for at least 2 years, menstrual pain or a history of menstrual pain, cold in the lower abdomen, and pain relieved by the application of heat.

A gynecological check-up found tender knots on the uterosacral ligaments and in the pouch of Douglas. In the blood, antibodies against the endometrium (EmAb) were found. No anti-sperm antibodies were discovered. The fallopian tubes of the women were all patent. The length of infertility was between 2 and 10 years.

The patients were treated with a prescription consisting of the following ingredients:

• chao xiao hui xiang (Foeniculi frictus fructus), 5 g
  
• pao jiang (Zingiberis rhizoma praeparatum), 5 g
  
• mo yao, 6 g
  
• rou gui, 6 g
  
• chi shao, 10 g
  
• chuan xiong, 10 g
  
• chao wu ling zhi (Trogopteri feces frictum), 10 g
  
• chao pu huang, 12 g
  
• zhi shui zhi (Hirudo praeparata), 12 g
  
• dang gui, 15 g
  
• yan hu suo, 15 g
  
• zhi huang qi, 20 g

Additional Modifications

In blood deficiency, the following were added:

• ji xue teng (Spatholobi caulis), 30 g
  
• he shou wu (Polygoni multiflori radix), 15 g

In qi deficiency, the following was added:

• chao bai zhu (Atractylodis macrocephalae rhizoma frictum), 15 g

This prescription was taken during the menstrual period. After three cycles, the women were checked again for antibodies against the endometrium.

The antibody-test after 3 months showed negative results (i. e., no more antibodies) in 86% of the patients (81 women). The dysmenorrhea and dyspareunia had improved in 72% of all cases (73 women) and the rate of pregnancy within 6–12 months after the conclusion of treatment was around 62% (55 women).

The authors of this study explain the disease mechanism of infertility from the perspective of TCM as follows:

“Static blood blocks the uterus and the chong mai and ren mai; for this reason, infertility results. In blood stasis in the lower abdomen, the bao mai is blocked as well, resulting in pain. In blood stasis in the chong mai and ren mai, these two channels cannot contain any essence. This results in infertility as well. The pattern describes this.”

They comment on the addition of huang qi as follows:

“Huang qi strengthens right qi and eliminates stasis. As a result, circulation in the pelvis is improved and the amount of T-cells increases. This regulates the immune function in the abdomen, and the antibodies against the endometrium are reduced.”

This statement points to the special properties of huang qi: not only does it boost qi, but it also quickens the blood. Huang qi is also the main ingredient for boosting qi, for example when qi vacuity leads to blood stasis.

The men were treated with the following basic prescription:

• xiao hui xiang, 6 g
  
• gan jiang, 3 g
  
• yan hu suo, 6 g
  
• mo yao, 5 g
  
• chuan xiong, 6 g
  
• rou gui, 3 g
  
• chi shao, 10 g
  
• pu huang, 10 g
  
• wu ling zhi, 10 g
  
• dang gui, 12 g
  
• huang jing (Polygonati rhizoma), 30 g

Additional Modifications

For pus corpuscles in the semen, the following were added:

• bi xie (Dioscoreae hypoglaucae seu semptemlobae rhizoma), 15 g
  
• shi chang pu (Acori tatarinowii rhizoma), 10 g
  
• shi wei (Pyrrosiae folium), 20 g
  
• che qian zi, 20 g

In cases where liquefaction had normalized after the treatment but the motility continued to be reduced, the following were added:

• huang qi, 30 g
  
• xian ling pi (Epimedii herba), 30 g

For a reduced sperm count, Wu Zi Yan Zong Wan (Five Seeds Pills for Abundant Descendants) was administered. It consists of the five seeds gou qi zi (Lycii fructus), fu pen zi (Rubi fructus), wu wei zi (Schisandrae fructus), che qian zi and tu si zi (Cuscutae semen). The formula supplements the kidneys and boosts essence.

One batch of the above prescription was decocted in 400 mL and taken twice per day in doses of 200 mL. A course of treatment lasted 20 days.

After one or two courses of treatment, 17 of the total of 20 patients were cured, that is, their lab values had normalized. The remaining three patients experienced an improvement after two courses of treatment. This means that liquefaction had normalized but sperm motility or sperm count continued to be reduced.

There is a saying in Chinese medicine: “Yang transforms qi, yin produces form.” According to the authors of this study, sperm coagulation is one of the functions associated with kidney yin (“produce form”), while liquefaction of semen is one of the functions associated with kidney yang (“transform qi”).

The authors comment:

“A lack of original yang (yuan yang) hence causes vacuity cold in the essence chamber. As a result, qi transformation becomes abnormal. The essence becomes cold and coagulates. By contrast, a lack of original yin causes the kidney fire to flare up. Essence fluids condense.”

Treatment therefore concentrated on boosting original yang (yuan yang) and regulating qi transformation. While Shao Fu Zhu Yu Tang does not have the direct effect of doing so, it still serves as a suitable formula in light of the guideline “cold leads to coagulation and warmth leads to movement.” The authors explain the formula as follows:

__________

Wang Qingren noted in his description of this formula:

The following five representative case studies serve to concretely illustrate the successful application of the formula Shao Fu Zhu Yu Tang in modern clinical practice.

The 25-year-old female patient had been trying for 3 years unsuccessfully to become pregnant. Examinations of her husband revealed no abnormal results. The woman had begun menstruating at age 15. Her periods lasted 5–7 days, the color of the blood was dark red, and the amount of blood was scanty. The blood also contained clots and she was suffering from premenstrual pain in the lower abdomen. Gynecological examinations showed a normal vagina, a soft cervix, and an immature, slightly forward-tilted uterus (anteversion). The adnexas were normal on both sides.

The body of the woman was rather thin, her facial complexion was pale and colorless, and her lips were pale as well. Just recently she had lost her appetite and experienced pressure in the chest, which she attempted to release by sighing. She was also suffering from dizziness, a feeling of weakness, and disturbed sleep. Defecation and urination were both normal. The tongue was pale and enlarged, its body was relatively dark. The margins and tip of the tongue were covered with bluishpurple spots. Her pulse was thin and weak.

The diagnosis was infertility and dysmenorrhea. The identified disease pattern was qi stagnation and blood stasis with concurrent weakness of qi and blood. The treatment principle was to free qi and quicken blood. Additionally, qi and blood should be boosted and nourished.

A variation of Shao Fu Zhu Yu Tang was prescribed:

• xiao hui xiang, 6 g
  
• gan jiang, 6 g
  
• yan hu suo, 10 g
  
• wu ling zhi, 10 g
  
• mo yao, 10 g
  
• chuan xiong, 15 g
  
• pu huang, 9 g, wrapped in cloth for decocting
  
• rou gui, 6 g
  
• chi shao, 10 g
  
• dang gui, 9 g
  
• bai zhu, 15 g
  
• shu di huang, 12 g

This prescription was prepared as a water decoction. Until the onset of her next period, the patient took one package per day. Afterwards, she returned for treatment. The pain in the lower abdomen had disappeared and the clots in her menses were greatly reduced. But she still suffered from weakness, sleep problems, and lack of appetite. Therefore, the above prescription was modified by removing shu di huang and substituting the following instead:

• ze lan (Lycopi herba), 15 g
  
• yi mu cao, 24 g
  
• suan zao ren (Ziziphi spinosi semen), 15 g
  
• shen qu (Massa fermentata medicata), 10 g

By the time of her next appointment 1 month later, her problems had continued to improve. The menses no longer contained any clots, and no other symptoms manifested either. The tongue was pale with few purple spots on the tip and margins. The pulse was fine and weak. She therefore received another prescription:

• xiao hui xiang, 6 g
  
• gan jiang, 6 g
  
• yan hu suo, 9 g
  
• wu ling zhi, 9 g
  
• dang gui, 10 g
  
• pu huang, 9 g
  
• chi shao, 12 g
  
• tai zi shen, 15 g
  
• sheng di huang, 12 g
  
• bai zhu, 15 g
  
• gou qi zi, 10 g
  
• yi mu cao, 24 g

Her menstruation became normal after 5 months. In March of the following year, she gave birth to a daughter.

The patient was a 37-year-old woman who had been trying to become pregnant for 9 years already. She had been treated unsuccessfully with Western medicine. Her menstrual period had started at age 16. Her cycle was always delayed by 10–14 days. During menstruation, she suffered from cold pain in the lower abdomen. Her blood was dark and contained clots. Her tongue was pale with a white fur, and her pulse was stringlike and slow.

The diagnosis was infertility, and the pattern was identified as qi stagnation with blood stasis and concurrent cold stagnation in the liver channel. Treatment therefore aimed at freeing liver qi, transforming stasis, and warming the channels.

The patient received the following prescription:

• Rx. Shao Fu Zhu Yu Tang plus
  
• xi xin
  
• fu zi
  
• wu zhu yu

This prescription was prepared as a water decoction. After the woman had taken five batches, fu zi was deleted from the prescription and Tetrapanacis medulla (tong cao) was added. Five more batches were prescribed. After this, her menstruation had become regular and the cold pain in the lower abdomen was reduced. Nevertheless, the blood continued to be dark and contain clots. The number of clots, though, was reduced. At the onset of the menstrual period, the woman stopped taking this prescription. Afterwards, another modification of the above prescription was given.

After taking these medicinals for 6 months, the woman became pregnant and gave birth to a baby girl.

The 28-year-old patient had been trying to become pregnant for 3 years without success. Examinations of her husband showed no abnormal results. She had begun menstruating at age 18. Her cycle was irregular and varied between 25 and 60 days. The periods were light and lasted between 5 and 7 days. The blood was dark and contained dark clots. Menstruation was accompanied by abdominal pain, aversion to cold, cold extremities, lumbar pain, and hardness in the abdomen. Her discharge was watery and reddish-white in color. Her tongue was pale dark with a thin white fur; the pulse was deep and thin.

The biomedical diagnosis was primary infertility. The Chinese pattern identification was kidney exhaustion with blood deficiency, cold in the uterus, and qi stagnation with blood stasis. The treatment principles were therefore to strengthen the kidneys, nourish the blood, warm the uterus, move cold and qi, and transform stasis.

The patient received the following prescription:

• shu di huang, 20 g
  
• shan zhu yu (Corni fructus), 9 g
  
• shan yao (Dioscoreae rhizoma), 10 g
  
• dang gui, 12 g
  
• chi shao, 12 g
  
• chuan xiong, 6 g
  
• guang mu xiang (Aucklandiae radix), 6 g
  
• chao zhi ke (Aurantii fructus frictus), 9 g
  
• xiao hui xiang, 6 g
  
• xiang fu, 10 g
  
• yi mu cao, 20 g
  
• chai hu (Bupleuri radix), 6 g
  
• fu zi, 9 g
  
• rou gui, 6 g
  
• tao ren, 10 g
  
• hong hua, 10 g
  
• huai niu xi (Achyranthis bidentatae radix), 10 g
  
• gan cao (Glycyrrhizae radix), 6 g

Three to five batches of this prescription were taken during the menstrual periods in three cycles. In between, the woman received Chinese medicinals to nourish the blood and supplement the kidneys, warm the uterus, and disperse cold. This prescription consisted of:

• shan zhu yu, 10 g
  
• bai shao yao (Paeoniae radix alba), 10 g
  
• dang gui, 10 g
  
• chuan xiong, 6 g
  
• shan yao, 10 g
  
• fu zi, 4 g
  
• rou gui, 5 g
  
• ba ji tian (Morindae officinalis radix), 10 g
  
• pu huang, 9 g
  
• gan cao, 3 g
  
• da zao (Jujubae fructus), three pieces

Of this prescription, she took one preparation every other day.

Half a year later, the woman became pregnant and 9 months later gave birth to a baby girl.

The 27-year-old man had already been trying for 3 years without success to have a child with his wife. His wife was examined, and no problems were found. The man therefore underwent a semen analysis. This showed that liquefaction was inadequate after 24 hours. The man felt healthy and showed no other symptoms. His tongue was pale with a thin white fur. His pulse was deep and thin.

The disease pattern was identified as lack of original yang (yuan yang) with insufficient qi transformation. Therefore, qi was boosted, yang supplemented, and stasis transformed.

The following prescription was administered:

• xiao hui xiang, 6 g
  
• gan jiang, 3 g
  
• yan hu suo, 6 g
  
• mo yao, 10 g
  
• pu huang, 10 g
  
• wu ling zhi, 6 g
  
• huang jing, 30 g

The man took one batch of this prescription every day for 20 days. Afterwards, his seminal fluid was examined again.

Liquefaction had normalized and his sperm count was 80 million/mL and motility around 80%. Half a year later, his wife became pregnant.

The pattern was identified as kidney yang deficiency with blood vacuity. Hence treatment aimed at boosting yang and nourshing blood.

The patient received a prescription for You Gui Wan (Right [Kidney]-Restoring Pill) with the addition of fu ling, Citri reticulatae pericarpium (chen pi), and tu si zi. The woman took this prescription for 7 days as granules. After this week, her extremities felt warmer. Hence she received a new prescription that was less supplementing, but more moving instead. This movement was intended to promote her menstrual period. Because the lower burner had to be warmed and the blood had to be quickened, the new prescription was based on the basic working principles of Shao Fu Zhu Yu Tang as a combination of warm, cold-dispersing substances with blood-moving medicinals. The prescription contained:

• shu di huang
  
• dang gui wei (Angelicae sinensis radicis extremitas)
  
• bai shao yao
  
• xu duan (Dipsaci radix)
  
• du zhong (Eucommiae cortex)
  
• nü zhen zi (Ligustri lucidi fructus)
  
• fu zi
  
• wu yao
  
• ze lan
  
• tao ren
  
• hong hua
  
• chuan xiong
  
• fu ling
  
• dang shen

This prescription was given as granules for 1 week. Subsequently, the patient reported that she suffered from abdominal fullness and distention as if she were about to start her period. The prescription was therefore again adjusted to more strongly move qi and blood. It consisted of:

• Rx. Xiao Yao San (Free Wanderer Powder) plus
  
• he huan pi (Albizziae cortex)
  
• ye jiao teng (Polygoni multiflori caulis)
  
• tao ren
  
• hong hua
  
• mu dan pi
  
• dang shen
  
• mu xiang
  
• shan zha (Crataegi fructus)

Two weeks later, her menstrual period started. While it was still weak, the color and duration were normal. From this point on, her menses arrived regularly. Three months later, she became pregnant and gave birth to a baby boy 9 months after that.

This case study illustrates well that we do not always have to use the exact composition of a classic formula. Instead, we can apply its working principle as a guideline.

Shao Fu Zhu Yu Tang warms the uterus and lower burner and quickens the blood. The formula is often administered during the menstrual period in order to promote it. It is only when all the “old” blood has been discharged that a healthy uterine lining (endometrium) can be built with fresh blood. This in turn favors the implantation of a fertilized ovum. In the woman above, the menses failed to flow at all due to yang deficiency and blood vacuity. As such, blood, yin, essence, and yang had to be supplemented first. Her menstruation could only be promoted afterwards by applying the working principle of Shao Fu Zhu Yu Tang to warm the lower burner and quicken the blood. At the same time, the prescription continued to supplement the kidneys. This treatment was enough to trigger premenstrual-like feelings of fullness, a clear symptom of liver qi stagnation. To move liver qi, Xiao Yao San was administered. The warm and hot substances were removed to prevent heat transformation due to qi stagnation. The blood-moving substances were left in the prescription to promote the elimination of blood during menstruation by quickening the blood, in accordance with the working principle of Shao Fu Zhu Yu Tang, thereby boosting the creation of a healthy endometrium.

Shao Fu Zhu Yu Tang is one of Wang Qingren’s four famous Zhu Yu Tang formulas. As such, it belongs to the category of blood-moving and stasis-eliminating formulas. Blood stasis is one of the most common pathogenic factors in modern Chinese medicine. It is part of the disease pattern in most, if not all, chronic illnesses. According to a guiding principle in Chinese medicine, “long-lasting illnesses enter the network vessels.” This means that chronic conditions lead to blood stasis. Treatment therefore also has to aim at least partially at resolving this stasis.

Wang Qingren was the master of stasis-eliminating formulas. Similar to the opinion of many modern physicians and TCM specialists, Wang also believed stasis to be a central aspect of many different illnesses. His formula Shao Fu Zhu Yu Tang was intended for the treatment of all types of stasis in the lower abdomen, including stasis that leads to infertility.

What makes Shao Fu Zhu Yu Tang so remarkable is its broad range of applications. In spite of the fact that the basic formula possesses warm blood-quickening properties, it can easily be converted into a cool blood-quickening formula. While it is a quickening formula, with few modifications it can also be used in vacuity patterns. The common denominator for the application of Shao Fu Zhu Yu Tang is blood stasis. Because a certain amount of stasis is part of most disease patterns in infertility patients and because Shao Fu Zhu Yu Tang is very easy to modify, it is no surprise that this classic formula is one of the most commonly used formulas for infertility. It is hereby completely irrelevant whether the infertility presents with heat or cold, vacuity or repletion.

Shao Fu Zhu Yu Tang is used so frequently and effectively in the treatment of infertility because stasis is a key aspect in the disease mechanism of infertility. The quickening properties not only assist in restoring patency to blocked fallopian tubes, but they are also ideal for optimizing the “internal conditions” of the uterus. Optimizing these “internal conditions” means to prepare the endometrium for implantation. During the menstrual period, Shao Fu Zhu Yu Tang promotes contractions in the uterus and the elimination of “old and static” blood that is blocking the uterus. Afterwards, the formula assists in activating the microcirculation and thereby in the stasis-free construction of the endometrium. As a result, a mucous membrane is built in which the fertilized ovum can implant. One of the key characteristics of Shao Fu Zhu Yu Tang in the treatment of infertility is hence the “repair” of the endometrium, as a result of which the implantation process is supported. To benefit from this function, the formula should be taken during the menstrual period. During this time, it can promote the elimination of blood and the development of a new and stasis-free endometrium. This application follows the recommendations of Wang Qingren, as he already stated in his description of the formula: