Received March 17, 2011; accepted June 13, 2011; published online August 15, 2011.
Full-text LinkOut at PubMed. Journal title in PubMed: Zhong Xi Yi Jie He Xue Bao.

Correspondence: Hai-xia Li, PhD; Tel: 010-88001018; E-mail: haixiali2008@yahoo.com.cn

     Yi Guan Jian decoction, which is composed of Dihuang (Radix Rehmanniae), Shashen (Radix Adenophorea Strictae), Gouqizi (Fructus Lycii), Maidong (Radix Ophiopogonis Japonici), Danggui (Radix Angelicae Sinensis) and Chuanlianzi (Fructus Toosendan), is originated from Wei Yu-huang’s Xu Ming Yi Lei An (Supplement to the Classified Medical Records of Famous Physicians). Its suggested use is in treating liver yin deficiency and disorder of the liver qi syndrome by replenishing yin and soothing the liver. Wei Yu-huang asserted that the decoction can be applied to treat hypochondriac pain, pantothenic acid, hernia, abdominal lumps and other hepatopathies. We have successfully treated acne vulgaris, chloasma faciei, chronic pelvic inflammation, dysmenorrhea, delayed menstrual cycle, scanty menstruation and ovulation bleeding using this decoction. As fixed symptoms and signs regularly appear in certain constitutions^［1］, the identical characteristics of constitution are also found among the patients treated by the decoction, which can be called the “Yi Guan Jian constitution”. It indicated that treatment of diseases can be based on a patient’s constitution. Two cases which are treated with Yi Guan Jian decoction are given below to illustrate the experience of application.

1  Severe acne vulgaris
     Generally speaking, the pathogenesis of acne vulgaris belongs to blood heat, dampness-heat, heat toxin, and blood stasis according to syndrome differentiation and treatment in traditional Chinese medicine (TCM). It includes lung heat syndrome, blood heat syndrome, stomach-intestine excessive heat syndrome, heat toxin syndrome, dampness-heat syndrome and blood stasis syndrome. Therefore, Xiebai San decoction, Piba Qingfei Yin decoction, Tao Hong Siwu Tang decoction, Qingwei San decoction, Wuwei Xiaodu Yin decoction, Chushi Jiedu Tang decoction and so on are widely used. However, in the clinical practice, this is not the case. As we know, syndrome differentiation is necessary in treating acute diseases, but constitutional differentiation should be paid more attention when treating chronic diseases, that is, improving constitution is more important to treat chronic diseases. Famous complex prescriptions such as Yi Guan Jian decoction, Gegen Tang decoction, Guizhi Fuling Wan pills, Jingjie Lianqiao Tang decoction, Huanglian Jiedu Tang decoction and Fangfeng Tong Sheng San decoction are widely used in improving constitutions.
     Typical case: A female patient, aged 33, presented on November 27, 2009 with the chief complaint of serious facial acne vulgaris for 10 years. One hospital diagnosed her with severe acne vulgaris. In spite of orally taking heat-clearing and detoxifying herbs and the application of external ointment for more than half a year, alleviation was not obvious and it recurred after drug withdrawal accompanied with symptoms of abdominal pain and diarrhea. Cosmesis and skin nursing in a beauty parlor also showed ineffective results. The patient complained that she was easily excited with increased blood pressure and heart rate, impatient and irritable, cackle, and with less sweating and scanty menstruation. Examination showed psychological repression, a sallow complexion, many dark red comedoes, papules, pustules and nodules on the cheeks and pores and chin with tenderness. The tongue was thin and dark red with a reduced coating and the pulse was thready-weakened and rapid. Her symptoms of being easily excited with raised blood pressure and heart rate, impatience, irritability and cackle belonged to liver fire flaming upwards, which is a typical manifestation of Zhizi (Fructus Cardeniae) syndrome. Furthermore, liver fire flaming upwards easily injures liver yin, leading to deficiency of body fluids with reduced sweating. Scanty menstruation, the thin and dark red tongue with a reduced coating and the thready-weakened-rapid pulse belonged to liver yin deficiency, which is the indication of Yi Guan Jian decoction. Dermatosis of upper and superficial parts shows pathogenic wind, which is an indication of Juhua (Flos Chrysanthemi) syndrome. Therefore, her syndrome belonged to liver fire flaming upwards and liver yin deficiency, which should be treated by modified Yi Guan Jian decoction for clearing liver fire and replenishing liver yin. The herbs prescribed were Dihuang 45 g, Beishashen (Radix Glehniae) 20 g, Gouqizi 15 g, Maidong 20 g, Danggui 15 g, Chuanlianzi 3 g, Zhizi 10 g and Juhua 30 g. After taking 1 dose of the above prescription, the patient suffered from diarrhea 4 times per day. However, she did not feel abdominal pain and hypodynamia. The stools became normal 3 d later. After taking 10 doses, the sallow complexion and dark red acne vulgaris were alleviated and the comedoes, papules, pustules and nodules fade away. So, Zhizi was subtracted from the prescription. After taking the decoction for another 2 months, her symptoms basically disappeared, the complexion became smooth and bright, and the impatience and irritability relieved obviously while the tongue coating became thick and the pulse turned large. No recurrence was happened until present.

2  Chronic pelvic inflammation
     Famous TCM Prof. Yue Mei-zhong asserted that excess syndromes should be treated by eliminating pathogenic factors first and then strengthening the body’s resistance. While treating deficiency syndromes is exactly the opposite, that is to say, strengthening the body’s resistance is of first importance in deficiency syndromes. These constitute important clinical rules contained in Shang Han Lun (Treatise on Febrile Diseases)^［2］. For example, when treating patients suffering from chronic pelvic inflammation and fallopian tube obstruction, emphasis should be paid not only to removing inflammation, adhesion and blood stasis syndrome, but also to constitution.
     Typical case: On her first visit on June 21, 2009, a female patient, aged 33, complained of dull pain in the lower abdomen for 10 years. She first suffered the symptom of a dull beating pain in the lower abdomen after an induced abortion 10 years ago. She was then hospitalized to receive related examinations and diagnosed with chronic pelvic inflammation. In spite of orally taking Chinese herbs and Western medicine, the effects were not obvious. She underwent an induced abortion again 5 years ago. The patient was hospitalized for emergency treatment of vaginal bleeding accompanied with severe abdominal pain with menolipsis for 45 d one year ago. Type B ultrasonic examination showed an extrauterine pregnancy and the endometrial thickness was of 7 mm. Tubal patent test showed the right tube was impassable and the left tube was partially passable. Ectopic pregnancy was diagnosed and laparoscopic surgery was performed. She was then treated with blood stasis-removing drugs such as Chaihu (Radix Bupleuri Chinensis), Danggui, Chishao (Radix Paeoniae Rubra), Yanhusuo (Rhizoma Corydalis Yanhusuo) and Chuanxiong (Rhizoma Chuanxiong), but she still suffered from repeated attacks of the problem. In the past one year, she experienced more frequent dull beating pain in the lower abdomen, accompanied with a sour taste, habitual constipation, scanty menstruation, thinness, a dim complexion, a thin red tongue with less coating and thready-weakened pulse, which were signs indicating liver yin deficiency. The patient suffered from long-term irritability, which is the typical manifestation of Zhizi syndrome. The herbs prescribed were Dihuang 30 g, Beishashen 15 g, Gouqizi 15 g, Maidong 15 g, Danggui 30 g, Chuanlianzi 6 g and Zhizi 10 g. Five doses of the above prescription were taken in succession. The patient’s symptoms of dull beating pain in the lower abdomen and dysphoria were alleviated. Then, Zhizi was subtracted from the prescription. After she took the decoction for another 5 months, pain in the lower abdomen disappeared, menstrual amount increased and the tongue coating became thick. Type B ultrasonic examination showed no specific abnormalities of the uterus and bilateral accessaries, uterus (5.3×4.7×4.1) cm3, left ovarian (3.1×1.5) cm2, right ovarian (2.8×1.4) cm2 and endometrial thickness 13 mm on January 13, 2010.

3  Summary
     Yi Guan Jian decoction can treat liver yin deficiency and disorders of liver qi syndromes, and Xiaoyao San decoction can treat liver depression, blood deficiency and spleen deficiency syndromes. Although the pathogenesis differences between them are obvious, the clinical symptoms shared high similarity such as hypochondriac pain, headache, vertigo, dry mouth, stomachache, tiredness, poor appetite, irascibility, insomnia, being apt to breathe, mammary swelling pain, menoxenia and a wiry pulse, which can be confused easily. Distinction between Yi Guan Jian decoction syndrome and Xiaoyao San decoction syndrome should be made clearly according to the principle of associated prescriptions^［3-5］. The former mainly includes Dihuang syndrome as Dihuang is the monarch drug in the prescription, which can treat blood syndromes and watery disease according to Yoshimasu Todo^［6］. Prof. Huang Huang held that Dihuang could be used in treating blood syndrome, especially uterine bleeding, accompanied with massive hemorrhage, difficulty in hemostasis, bright red menstrual blood, emaciation, haggardness and a red tongue^［7］. The latter mainly includes Chaihu syndrome as Chaihu is the monarch drug in the prescription, which can treat the symptoms of a bitter taste in the mouth, pharynx dryness, vertigo, poor appetite, emotional fluctuation, cool extremities and breast distension according to the principle of herb prescriptions^［5］. It is noteworthy that the symptoms of emaciation, scanty menstruation, thin dark red tongue with a reduced coating and thready-weakened-rapid pulse are typical indications of Yi Guan Jian decoction syndrome, which do not exist in Xiaoyao San decoction syndrome.

4  Competing interests
     The authors declare that they have no competing interests.