How Acupuncturists Misuse Jia Wei Xiao Yao San

Free & Easy Wanderer (Xiao Yao San) and Free & Easy Wander Plus (Jia Wei Xiao Yao San) are two of the most widely prescribed formulas in American TCM clinics. I have observed this reality on a small scale as an intern at the Five Branches University clinic, and on a larger scale as an herbal consultant for Kan Herb company. American practitioners love to use these formulas, but I’ve had many interactions with colleagues that suggest there is a need for further clarification on their respective indications. Indeed, more than one practitioner has told me, “I use Free and Easy Wander Plus…it has two additional herbs.” Yes, and Brawndo‘s got electrolytes.

Let’s be honest: we live in a culture of excess. Super-sized burgers, Big Gulps, and 5lb tubs of Costco mayonnaise are the norm—but the “plus” in Free and Easy Wanderer Plus (Jia Wei Xiao Yao San) is not synonymous with better. In this case, “plus” does not mean “added value,” or “more effective,” as we are culturally conditioned to think: it is simply a way of indicating that two additional herbs have been added to the original formula. In fact, jiā (加) wèi (味) simply means “add flavor.” It has nothing to do with the effectiveness of either formula.

Free and Easy Wanderer / Rambling Powder (Xiao Yao San)

Xiao Yao San
(Free and Easy Wanderer)

In most cases that I have observed, treated, or provided consultation for, Xiao Yao San is the appropriate formula choice. It moves Liver qì with Chai Hu (bupleurum root) and Bo He (field mint), and it softens the liver with Bai Shao (white peony root). Bai Shao (white peony root) also nourishes the blood in conjunction with Dang Gui (Angelica sinesis).  Xiao Yao San benefits the Spleen as well, with Bai Zhu (atractylodes root),  Fu Ling (poria) and Gan Cao (licorice root). The combination of these actions makes the formula appropriate for a number of clinical complaints, including: headache, dry mouth, fatigue, reduced appetite and irregular menstruation (Bensky & Barolet, 1990).

Free and Easy Wanderer Plus / Augmented Rambling Powder (Jia Wei Xiao Yao San)

Jia Wei Xiao Yao San
(Free and Easy Wanderer Plus)

Many practitioners use Jia Wei Xiao Yao San in place of the original formula, which I believe is a mistake. This modification of the formula is much colder, due to the addition of two “cool blood” herbs: Mu Dan Pi (Moutan cortex) and Zhi Zi (gardenia fruit). I taught both of these herbs to students at Five Branches University as their Herbs-1 teacher, so I’m very familiar with them. Zhi Zi (gardenia fruit) is a bitter, cold herb for cooling the blood. In the Wen Bing school, it is often used to treat blood-level heat, which is a severe condition. Mu Dan Pi (Moutan root bark) also cools the blood, but it has mild blood invigorating actions as well. The combination of these actions makes Jia Wei Xiao Yao San suitable for symptoms like: irritability, painful urination, red eyes, dry mouth, or increased menstrual flow (Bensky & Barolet, 1990).

Commentary and Alternative Approaches

Bupleurum, Dragon Bone, and Oyster Shell
(Chai Hu Long Gu Mu Li Wan)

In my opinion, many practitioners use Jia Wei Xiao Yao San to treat the American lifestyle, which is fast-paced and stressful. Unfortunately, the use of this formula to treat lifestyle runs contrary to the actual clinical manifestations thereof. A fast-paced, stressful life is depleting, if anything. It may contribute to vacuity heat patterns, but this type of lifestyle typically leads to deficiency, not excess (blood heat). For stressed, Type-A personalities, Chai Hu Long Gu Mu Li Wan is often a more effective choice for improving mood and anchoring the spirit.

Great Corydalis (Yan Hu Suo Zhi Tong Wan)

Augmented Four Substances
(Tao Hong Si Wu Tang)

Four Substances
(Si Wu Tang)

When used to treat menstrual complaints, Jia Wei Xiao Yan San should only be used in cases of excessive menstruation and/or painful urination. If you are using it to treat menstrual cramps based on the blood moving functions of Mu Dan Pi, consider using original Xiao Yao San in conjunction with Four Substances (Si Wu Tang), Augmented Four Substances (Tao Hong Si Wu Tang), or Great Corydalis (Yan Hu Suo Zhi Tang Wan), depending on the presentation. These combinations can often lead to a more desirable clinical outcome than the use of any one of these formulas alone.

Final Thoughts

If you are considering the use of Free and Easy Wanderer Plus (Jia Wei Xiao Yao San) to treat a patient—stop—and ask yourself why. Is it based on the clinical applications of the formula? Or is it based on an assumption that has nothing to do with its herbal composition? I have provided several alternative formulas or formula combinations above: is one of those more specific to the condition your are treating? Whether you stock pills or granules, the appropriate use of formulas—based on an accurate clinical diagnosis—is the single best way to see results with herbs in your clinic.

References

Dan Bensky and Randall Barolet, (1990). Formulas and Strategies.

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© Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog, 2014. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Phil Garrison and Dr. Phil’s Chinese Medicine Blog with appropriate and specific direction to the original content.

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