In today's fast-paced environment, many people are troubled by "excess liver fire," "poor sleep," and "poor appetite." They become easily irritated, struggle to fall asleep, wake up frequently from dreams, or notice their children crying and grinding their teeth at night. Despite eating very little, they often feel abdominal bloating, lack of appetite, and general fatigue. In Traditional Chinese Medicine (TCM), these symptoms are frequently attributed to a "hyperactive liver and deficient spleen."

Here is a classic formula originating from the Ming Dynasty called Yigan San. It can calm the deficiency-heat of the liver meridian, soothe restless emotions, and simultaneously invigorate the spleen and regulate digestion. It is a gentle formula that addresses both "soothing the liver" and "invigorating the spleen." It can be reasonably applied after proper diagnosis for adult neurasthenia, anxiety, and insomnia, as well as for children's night crying and tics. The following explains the origins, composition, efficacy, usage, and precautions of Yigan San in an easy-to-understand manner, including insights into the in managing neuropsychiatric symptoms.

I. Tracing Yi Gan San: From a Pediatric Classic to a "Liver-Soothing Formula" for All (effects of the traditional chinese herbal medicine)

Yi Gan San was first recorded in the Baoying Cuoyao, a classic text on pediatrics compiled by Ming Dynasty physicians Xue Kai and his son Xue Ji. The formula's initial purpose was to treat "acute infantile convulsions" in children, which includes sudden spasms, fever, teeth grinding, and palpitations.

The reason this pediatric formula is now widely used for adults relates to its formulation logic. Children's internal organs are delicate, often presenting with "excess in the liver and deficiency in the spleen," making them prone to liver fire and spleen weakness. Similarly, adults who consistently stay up late, face high stress, and maintain irregular diets develop stagnant liver Qi and hyperactive liver Yang. This affects spleen and stomach functions, leading to the same "hyperactive liver and deficient spleen." The core principle of Yigan San is "calming without damaging the liver, invigorating without stagnating the spleen." Its gentle nature suits most body types, transitioning it from pediatric care to a common TCM formula for adults with liver-spleen imbalances.

II. Deconstructing Yigan San: The Ingenious Combination of 7 Herbs

The composition of Yigan San is concise, containing only 7 herbs. It follows the TCM formulation principle of "monarch, minister, assistant, and courier," progressively balancing the liver, nourishing blood, and invigorating the spleen.

The original dosage (traditional decoction, adjustable based on constitution) is: Soft Bupleurum (Chai Hu) 1.5g, Licorice (Gan Cao) 1.5g, Chuanxiong 2.4g, Angelica (Dang Gui) 3g, Fried Atractylodes (Bai Zhu) 3g, Poria (Fu Ling) 3g, and Uncaria (Gou Teng) 3g.

1. Monarch Herb: Uncaria (Gou Teng) — The "Core Force" for Calming the Liver and Quelling Wind

Uncaria is the core "monarch herb." It clears heat, calms the liver, and stops spasms. Whether treating children's convulsions or adults' headaches and tremors, Uncaria targets the deficiency-heat of the liver meridian and calms liver wind from the root. Note: The active ingredients of Uncaria are easily destroyed by high heat. It must be added later during the decoction process—boil other herbs for 20-30 minutes first, then add Uncaria for the final 15 minutes to retain its efficacy.

2. Minister Herb: Bupleurum (Chai Hu) — The "Catalyst" for Soothing Liver and Resolving Depression

Bupleurum is a classic herb for soothing the liver and regulating Qi. As the "minister herb," it assists the monarch by resolving liver Qi stagnation and clearing heat. It relieves irritability and chest tightness. Yigan San uses "soft Bupleurum," which is gentler and soothes the liver without depleting Qi, making it suitable for long-term, mild conditioning.

3. Assistant Herbal Medicine: Angelica, Chuanxiong, Atractylodes, Poria — Nourishing Blood and Invigorating Spleen

The assistant herbs support the main herbs and regulate internal organs. They are divided into two groups: Group 1: Angelica + Chuanxiong. Angelica nourishes and activates blood, while Chuanxiong moves Qi and relieves pain. Sufficient liver blood prevents the liver from becoming restless, alleviating anger and headaches. Group 2: Atractylodes + Poria. Atractylodes invigorates the spleen and drains dampness, while Poria calms the mind. Enhancing spleen function prevents the overactive liver from damaging digestion, addressing bloating and poor appetite, while also improving sleep.

4. Courier Herb: Licorice (Gan Cao) — Harmonizing Herbs and Protecting the Stomach

As the "courier herb," Licorice harmonizes the cold and warm properties of the other herbs, making the formula gentler. It also protects the spleen and stomach from potential gastrointestinal irritation.

III. Core Efficacy and Application Scenarios of Yigan San

The core efficacy of Yigan San includes calming the liver, soothing depression, nourishing blood, invigorating the spleen, and calming nerves. It targets individuals exhibiting both liver fire and spleen deficiency. Importantly, modern clinical trials and meta-analyses have explored the neuroprotective effects of Yigan San, supporting its use in managing neuropsychiatric symptoms in patients with dementia and behavioral and psychological symptoms of dementia (BPSD), including anxiety, agitation, and sleep disturbance.

1. Traditional Indications (Mainly for Children)

Initially designed for children's constitutions, it treats: • Infantile convulsions: Sudden spasms, fever, teeth grinding, and crying. • Infantile night crying: Frequent nighttime crying, restless sleep, teeth grinding, and sweating. • Poor digestion in children: Vomiting, bloating, poor appetite, loose stools, and irritability.

2. Modern Applications (Adults + Children)

Yigan San is now commonly used for adult daily conditioning, especially for those with high stress and irregular routines: • Neuropsychiatric: Anxiety, depression, neurasthenia, insomnia, children's tics, and teeth grinding. It has also shown promising benefits for patients with dementia with Lewy bodies, including managing cholinesterase inhibitor-resistant visual hallucinations and psychiatric symptoms such as agitation and visual hallucinations resistant to conventional treatment. • Digestive: Bloating, belching, poor appetite, and irregular stools caused by emotional fluctuations. • Other: Headaches, dizziness, mild tremors, and high blood pressure (deficiency-heat type). Evidence from in vitro and in vivo studies supports the antioxidant and neuroprotective actions against MPP+/MPTP-induced cytotoxicity, suggesting Yigan San's protective role in dopaminergic neurons and potential for neurological conditions like tardive dyskinesia and treatment-resistant schizophrenia.

IV. Correct Usage of Yigan San: Dosage and Decoction Tips

Usage varies based on the individual and symptoms. It should follow the principle of "syndrome differentiation" and be used under a physician's guidance.

1. Traditional Decoction (Most precise)

Suitable for those with obvious symptoms requiring tailored dosages. Usage: 1 dose daily, boiled in water. Soak the 6 herbs (excluding Uncaria) in water for 30 minutes, boil on high, then simmer on low for 20-30 minutes. Add Uncaria and simmer for another 15 minutes. Strain and drink warm in 2 portions after meals. Dosage adjustments: Halve the dose for children. For infants, mothers can take the decoction to pass the benefits through breastmilk.

2. Modern Formulations (Convenient)

Granules and pills are available for daily conditioning. • Granules: Adults take 1 bag (approx. 2.5g) 2-3 times daily; Children take 1/3-1/2 bag twice daily. • Pills: Adults take 6-9g twice daily; Children take 3-6g twice daily with warm water.

3. Duration: Stop when symptoms resolve

Yigan San is a conditioning formula. Stop taking it once symptoms are relieved, typically after 2-4 weeks. If there is no improvement after 1 week, seek medical advice to adjust the prescription.

V. Diagnostic Points: Identify "Hyperactive Liver and Deficient Spleen"

effects of the traditional chinese herbal medicine - psychiatric symptoms, neuropsychiatric symptoms, visual hallucinations

Yigan San is only effective for those with a "hyperactive liver and deficient spleen" constitution.

Targeted Symptoms: • Constitution: Thin, tense muscles, easily fatigued yet irritable. • Emotions: Angry, anxious, depressed, experiencing severe emotional fluctuations. • Sleep: Insomnia, frequent dreaming, night crying, or grinding teeth. • Digestion: Bloating, poor appetite, nausea, irregular stools. • Tongue/Pulse: Pale red tongue with red edges, thin white coating; string-taut or fine pulse.

Contraindications (Avoid use): • Hyperactive liver Yang with excess heat: High fever, red face, severe headache, dry stools. • Spleen/stomach deficiency-cold: Chills, cold abdominal pain, watery diarrhea. • Pregnant/nursing women: Due to the blood-activating properties of Chuanxiong, consult a doctor first. • Allergies: To any ingredient in the formula.

VI. Precautions: Details Determine Effectiveness

While taking Yigan San, pay attention to diet, emotions, and daily routines:

1. Diet: Avoid spicy, greasy, and cold foods, as well as strong tea, coffee, and alcohol. Eat light foods like millet and yam to nourish the stomach.
2. Emotions: Maintain a cheerful mood. Avoid anger and anxiety to allow liver Qi to flow smoothly.
3. Routine: Ensure 7-8 hours of sleep and avoid staying up late, ideally sleeping before 11 PM.
4. Side effects: Dry mouth, dizziness, or mild nausea may occasionally occur. Reduce the dose to alleviate these, or stop and consult a doctor if severe.
5. Interactions: Avoid combining with Veratrum, Kansui, Euphorbia, or Genkwa.

VII. Common Misconceptions: Avoid These Mistakes

• Mistake 1: Using it as a direct sleeping pill or blood pressure medication. It is a conditioning formula and cannot replace prescribed Western medicines. • Mistake 2: Long-term continuous use. The cold-natured herbs can damage the spleen over time. Stop when symptoms improve. • Mistake 3: Using it for all types of "liver fire." It is specifically for deficiency-heat, and using it for excess heat will worsen symptoms.

Yigan San utilizes gentle conditioning to bring the liver and spleen back into balance from the root. It is highly suitable for individuals dealing with long-term stress, emotional fluctuations, and poor digestion. Before starting any traditional formula, you can write down a brief log of your daily symptoms, sleep patterns, and digestive habits to share with a certified TCM practitioner for an accurate diagnosis.

Yi-Gan San (also known as Yokukansan) is a traditional East Asian herbal formula widely used in traditional chinese medicine and traditional chinese herbal medicine. It is particularly valued for its neuroprotective effects in managing neuropsychiatric symptoms and behavioral and psychological symptoms of dementia (BPSD).

Clinical studies and meta-analysis have shown that yi-gan san can effectively alleviate sleep disturbance, memory disturbance, visual hallucinations, and other psychiatric symptoms in patients with dementia, including those with dementia with lewy bodies and vascular dementia. It has also demonstrated benefits in treatment-resistant schizophrenia and tardive dyskinesia, with research exploring its protective effects on dopaminergic neurons through both in vitro and in vivo models, including studies on MPP+/MPTP-induced cytotoxicity.

While generally well-tolerated, adverse effects should be monitored, especially when used alongside conventional treatments such as cholinesterase inhibitors for cholinesterase inhibitor-resistant visual hallucinations. Overall, yi-gan san offers a promising integrative option for improving quality of life in dementia patients and individuals experiencing complex neuropsychiatric symptoms.

FAQs about Yi Gan San

What is yi-gan san used for?

Yi Gan San is traditionally used to soothe the liver and invigorate the spleen, treating symptoms like insomnia, anxiety, digestive issues, and pediatric convulsions. It is also applied for neuropsychiatric symptoms in adults and children, including behavioral symptoms of dementia.

Does yokukansan work for tinnitus?

Yokukansan, a formula related to Yi Gan San, has shown some promise in treating neuropsychiatric symptoms, but evidence for tinnitus relief is limited and not well-established. Consultation with a healthcare provider is recommended.

What is the traditional Chinese medicine for schizophrenia?

Traditional Chinese herbal medicines like Yi Gan San and related formulas have been studied for treatment-resistant schizophrenia symptoms, especially addressing neuropsychiatric manifestations and behavioral symptoms, potentially complementing conventional antipsychotic treatments. However, medical supervision is essential.