In cases of kidney yang deficiency, there are several common base formulas to choose from. While hundreds of formulas for supplementing yang exist, the three most common recipes are Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet), You Gui Wan (Right-Restoring [Life Gate] Pill), and You Gui Yin (Right-Restoring [Life Gate] Beverage). Each of these three formulas has its strengths and weaknesses, and they are suitable for different nuances of presentation.
Shen Qi Wan, also called Jin Gui Shen Qi Wan (Golden Coffer Kidney Qi Pill), is a formula that was originally recorded in the text Jin Gui Yao Lue (“Essential Prescriptions of the Golden Coffer”). The Jin Gui was written during the latter part of the Han dynasty, and it preceded the You Gui Wan/You Gui Yin formulas by just over 1400 years. You Gui Wan and You Gui Yin were first recorded in 1624 CE, in the Ming dynasty text Jing-Yue Quan Shu by Zhang Jing-Yue. The differences between the Shen Qi Wan family of formulas and the You Gui family of formulas are subtle but significant. According to my teacher Feng Ye, these differences in formula construction are related to differences in the respective patient populations that were served by Zhang Zhong-Jing vs. Zhang Jing-Yue.
In essence, Feng Ye always emphasized the attention that Shen Qi Wan places on regulating water in comparison to You Gui Wan’s attention to pure kidney supplementation. At the time of the Shang Han Lun, the actions of the herbs were not stated as we know them today, but the basic principle of engendering yang by combining yin-supplementing agents like rehmannia with yang-warming agents like Fu Zi was already evident. Both the Shen Qi and You Gui formulas use yin-supplementing medicinals along with warming medicinals, so they fundamentally draw from the same basic principles. However, the kidney governs water and Shen Qi Wan targets the kidney’s function of governing water more directly by combining Ze Xie with Fu Ling, Gui Zhi, and Fu Zi. For yang vacuity patients that experience problems such as water swelling, Shen Qi Wan is thus an ideal choice. In comparison, You Gui Wan is more purely supplementing in nature and it has less focus on regulating water by disinhibiting urination.
According to Feng Ye, many of Zhang Zhong-Jing’s patients were ordinary people during a time of upheaval, whereas Zhang Jing-Yue had more patients that were wealthy aristocrats looking for tonics to keep up with their many mistresses. These latter patients were looking for pure supplementation and would reject formulas that included “draining” medicinals like Ze Xie. This caused Zhang Jing-Yue to develop more purely supplementing formulas such as You Gui Wan, Zuo Gui Wan, You Gui Yin, and Zuo Gui Yin. Both Shen Qi Wan and its related yin-supplementing formula Liu Wei Di Huang Wan feature Liu Wei’s famous combination of “three supplementing, three draining” medicinals, whereas Zhang Jing-Yue’s formulas lack the “draining” component.
As mentioned above, Shen Qi Wan is the mother formula of Liu Wei Di Huang Wan. Liu Wei was originally a pediatric formula but it is now used as a major base formula for yin vacuity in general. Beyond Liu Wei, Shen Qi Wan is also the parent formula of Ji Sheng Shen Qi Wan, which is actually more commonly available than Shen Qi Wan itself in markets such as Taiwan. The original Jin Gui Shen Qi Wan formula used Sheng Di Huang and Gui Zhi, while Ji Sheng Shen Qi Wan uses Shu Di Huang and Rou Gui, with the addition of Che Qian Zi and Niu Xi. The addition of Che Qian Zi and Niu Xi gives the formula an even better ability to regulate water to treat water swelling, and the substitution of Sheng Di and Gui Zhi for Shu Di and Rou Gui strengthens the kidney-supplementing effect (these same substitutes without Che Qian Zi and Niu Xi create the formula Gui Fu Di Huang Wan [Cinnamon and Aconite Rehmannia Pill]). This emphasis on helping the kidney in its function of governing water makes formulas such as Jin Gui Shen Qi Wan and Ji Sheng Shen Qi Wan ideal for patients with kidney yang vacuity and water swelling. One can also add the additional ingredients and principles of formulas such as Zhen Wu Tang (True Warrior Decoction) or Wu Ling San (Poria Five Powder) to further strengthen this direction.
In comparison with Shen Qi Wan, You Gui Wan and You Gui Yin are more purely supplementing in nature. You Gui Wan and You Gui Yin have a very similar construction. You Gui Yin is basically the same formula as Shen Qi Wan, but the water-disinhibiting medicinals Fu Ling and Ze Xie are removed and Du Zhong and Gou Qi Zi are found in their place. This helps to supplement the liver and kidney and strengthen sinew and bone, without the need for medicinals to downbear turbid yin (water) as we see with Shen Qi Wan. Zhi Gan Cao is also added in You Gui Yin to help Shan Yao to supplement the spleen.
So what is the difference between You Gui Wan and You Gui Yin? The two are interchangeable in terms of their indications, but they differ in that You Gui Wan has the addition of Lu Jiao Jiao, Dang Gui, and Tu Si Zi. The addition of Dang Gui gives the formula a stronger ability to nourish blood, and Tu Si Zi adds to the kidney-supplementing effect. Tu Si Zi is a balanced medicinal that tends to supplement yin, yang, and essence, but it is generally classified as a yang tonic. Lu Jiao Jiao is also a yang-supplementing agent that nourishes blood, yin, and essence, and as a “flesh and blood” medicinal it is thought to have a strong supplementing effect. Thus, You Gui Wan is a stronger, more richly supplementing formula that is stronger for enriching blood and essence in addition to supplementing yang.