Ovarian Cyst - Master He Ren’s Basic Formula with Pattern-Based Modifications
20. Ovarian Cyst - Master He Ren’s Basic Formula with Pattern-Based Modifications
Master He Ren, a National Master of Traditional Chinese Medicine. He specializes in internal medicine, gynecology, and oncology, and advocates a twelve-character principle for treating tumors: “continuously support the righteous Qi, expel pathogens in a timely manner, and treat according to the pattern.”
Pathogenesis
Ovarian cysts fall within the category of “Zheng Jia” (abdominal masses and tumors), with the root lying in Qi stagnation, Blood stasis, Cold coagulation, and Dampness obstruction. When the Liver is stagnated and Qi stagnates, Blood circulation becomes sluggish and over time forms stasis; when Cold evil lodges in the Chong and Ren vessels, Blood encounters Cold and coagulates, and stasis accumulates into a form. Qi stagnation, Blood stasis, and Cold coagulation mutually entwine and gather in the lower abdomen to form the cyst. This formula centers on the Cinnamon Twig and Poria Pill (Gui Zhi Fu Ling Wan) method of warming, opening, and resolving stasis, combined with herbs that disperse the Liver, regulate Qi, clear Heat, and disperse nodules, using both cold and warm methods to simultaneously treat Qi and Blood.
Formula Composition
He Ren’s Ovarian Cyst Basic Formula
Processed Cypress Fruit 9g Mandarin Orange Seed 9g Aurantia Seed 9g Cinnamon Twig 9g
Salvia 15g Actinidia Root 15g Soft-shelled Turtle Plastron 15g Prunella 12g
Peach Pit 12g
| Herb Group | Herb Dosage | Function |
|---|---|---|
| Sovereign | Cinnamon Twig 9g, Peach Pit 12g | Taking the core pairing of Cinnamon Twig and Poria Pill (Gui Zhi Fu Ling Wan), Cinnamon Twig warms and opens the Blood vessels and disperses Cold coagulation from the Uterus; Peach Pit breaks up Blood and resolves stasis, directly entering the Blood level of the lower abdomen. The two herbs combined give effect to both warming-opening and resolving stasis |
| Minister | Processed Cypress Fruit 9g, Mandarin Orange Seed 9g, Aurantia Seed 9g | Disperse the Liver and regulate Qi, disperse nodules and relieve pain. “When Qi moves, Blood moves”; Processed Cypress Fruit is the essential Qi-regulating herb for women’s medicine, Mandarin Orange Seed moves Qi and relieves pain, Aurantia Seed disperses the Liver, resolves nodules, and opens collaterals |
| Minister | Salvia 15g, Soft-shelled Turtle Plastron 15g | Invigorate Blood and resolve stasis, soften hardness and disperse nodules. Salvia nourishes Blood and invigorates it, Soft-shelled Turtle Plastron is salty, cold, and softens hardness, especially good at eliminating abdominal zheng masses |
| Assistant | Prunella 12g, Actinidia Root 15g | Clear Heat, disperse nodules, resolve toxins, and reduce accumulation. Prunella clears the Liver and disperses nodules; Actinidia Root is the root of kiwifruit, an empirical herb for He Ren’s tumor treatment, good at dissolving gynecological zheng masses |
Pattern-Based Modifications
| Coexisting Pattern | Modified Herbs |
|---|---|
| Qi deficiency with fatigue, poor appetite | Add Astragalus 15g, Codonopsis 15g to boost Qi, support the righteous, and assist in resolving zheng |
| Blood deficiency with sallow complexion, scanty pale menstruation | Add Donkey Hide Gelatin Pearls 9g, Dry Rehmannia 18g to nourish Blood and fill Jing |
| Heavy menstruation, prolonged spotting | Add Charred Pollinia 9g to resolve stasis and stop bleeding |
| Obvious abdominal pain | Add Corydalis 9g to enhance Qi regulation and pain relief |
| Obvious Cold coagulation, cold pain in the lower abdomen | Add Evodia Fruit 6g, Fennel 6g to warm the menses and disperse Cold |
| Large stasis mass, thick and tough cyst wall | Add Sparganium 9g, Curcuma Zedoary 9g to enhance breaking up Blood and eliminating zheng |
Summary
The entire formula uses Cinnamon Twig combined with Peach Pit for warming-opening and resolving stasis as sovereign, with Processed Cypress Fruit, Mandarin Orange Seed, and Aurantia Seed to disperse the Liver and regulate Qi as ministers, Salvia and Soft-shelled Turtle Plastron to invigorate Blood and soften hardness, and Prunella and Actinidia Root to clear Heat and disperse nodules as assistants. The nine herbs balance cold and warmth, and simultaneously regulate Qi and Blood. It is suitable for ovarian cysts of the Qi stagnation, Blood stasis, and Cold coagulation mutual entwinement type - dull pain or distending pain in the lower abdomen, obstructed menstruation, dark tongue with thin coating. Not suitable for women with heavy menstruation or during pregnancy.
References
[1] He Ren. National Master He Ren’s Clinical Experience Collection [M]. Beijing: China Traditional Chinese Medicine Press, 2011.
[2] He Ren. He Ren’s Medical Experience Collection [M]. Hangzhou: Zhejiang Science and Technology Press, 2005.
[3] He Ren. Cinnamon Twig, Winter Green, and Resolving Zheng Decoction and Pill Formula [J]. Guangming TCM, 2012, 27(4):
20. 卵巢囊腫—國醫大師何任基本方加減應用
何任國醫大師，擅內科、婦科、腫瘤，治腫瘤主張”不斷扶正，適時祛邪，隨證治之”十二字法則。
病機
卵巢囊腫屬”癥瘕”範疇，其本在氣滯血瘀、寒凝溼阻。肝鬱氣滯，血行不暢，日久成瘀；寒邪客於胞脈，血遇寒則凝，瘀積成形。氣滯、血瘀、寒凝三者互結，聚於少腹而為囊腫。本方以桂枝茯苓丸法溫通化瘀為核心，合疏肝理氣、清熱散結之品，寒溫並用，氣血同治。
方藥組成
何任卵巢囊腫基本方
制香附 9g 川楝子 9g 八月札 9g 桂枝 9g
丹參 15g 藤梨根 15g 鱉甲 15g 夏枯草 12g
桃仁 12g
| 藥組 | 藥物 | 功用 |
|---|---|---|
| 君 | 桂枝 9g、桃仁 12g | 取桂枝茯苓丸核心配伍，桂枝溫通血脈、散胞宮寒凝；桃仁破血逐瘀，直入少腹血分。二藥相合，溫通與化瘀並舉 |
| 臣 | 制香附 9g、川楝子 9g、八月札 9g | 疏肝理氣，散結止痛。”氣行則血行”，香附為女科理氣要藥，川楝子行氣兼止痛，八月札疏肝散結通絡 |
| 臣 | 丹參 15g、鱉甲 15g | 活血祛瘀，軟堅散結。丹參養血活血，鱉甲鹹寒軟堅，尤善消腹部癥塊 |
| 佐 | 夏枯草 12g、藤梨根 15g | 清熱散結、解毒消積。夏枯草清肝散結，藤梨根即獼猴桃根，為何任治腫瘤經驗用藥，善消婦科癥積 |
加減法
| 兼證 | 加減藥物 |
|---|---|
| 氣虛乏力、神倦納差 | 加黃芪 15g、黨參 15g，益氣扶正助消癥 |
| 血虛面黃、經少色淡 | 加阿膠珠 9g、乾地黃 18g，養血填精 |
| 月經量多、淋漓不止 | 加蒲黃炭 9g，化瘀止血 |
| 腹痛明顯 | 加延胡索 9g，增強理氣止痛之力 |
| 寒凝明顯，小腹冷痛 | 加吳茱萸 6g、小茴香 6g，溫經散寒 |
| 瘀塊較大、囊壁厚韌 | 加三稜 9g、莪術 9g，增強破血消癥之力 |
小結
全方以桂枝配桃仁溫通化瘀為君，臣以香附、川楝子、八月札疏肝理氣，丹參、鱉甲活血軟堅，佐夏枯草、藤梨根清熱散結。九味藥寒溫相濟、氣血並調，適用於卵巢囊腫屬氣滯血瘀、寒凝互結者——少腹隱痛或脹痛、經行不暢、舌暗苔薄——月經量多或妊娠期不宜。
參考文獻
[1] 何任. 國醫大師何任臨床經驗集[M]. 北京：中國中醫藥出版社，2011.
[2] 何任. 何任醫學經驗集[M]. 杭州：浙江科學技術出版社，2005.
[3] 何任. 附桂消瘕湯丸[J]. 光明中醫，2012，27(4)：724.