Blood Deficiency, Feeling Cold, Cold Hands and Feet, and Periods That Never Quite End? Zhang Zhongjing’s Jiao Ai Tang (Ass-Hide Glue and Mugwort Decoction): Nourish Blood and Warm Yang at the Same Time

Opening: Why does one person collapse from a cold wind while another is fine?

In the past few days, Doctor Luo Dalun’s series has been about cold in women. The previous lecture dealt with the “blood stasis” left behind after cold exposure. Today he turns to the deepest internal cause of all — blood deficiency (xue kui).

💬 Note from Doctor Luo: What’s the point we’re making? It’s that cold damage always has an internal cause and an external cause. Any disease is the joint result of internal and external causes working together. Why is it you who becomes yang-deficient? Slowly you will find the root of your own body’s problems.

The external causes are easy to understand — air conditioning, cold drinks, cold-natured medicines, wearing too little in winter. The internal causes? Blood deficiency, holding in anger, rich and fatty food, and the gradual waning of yang qi with age… These factors usually mix together and finally drag the body into a yang-deficient state.

Women are nourished by blood

Why devote a whole topic on cold to women? Because a woman’s body is structured completely differently from a man’s.

💬 Note from Doctor Luo: There’s an old saying: “Women are nourished by blood, men are nourished by qi.” There’s truth in it. Women menstruate, get pregnant, and give birth — along the way they are especially prone to blood deficiency. This is completely different from men. Once a woman’s blood becomes deficient, her physiological functions run into all sorts of problems — I even believe that more than half of all women’s diseases may be related to blood deficiency. These diseases are scattered across every department, but if you can grasp the principle of nourishing blood — getting the blood fully replenished — the illness can clear up very quickly. If you don’t understand blood nourishment, things go badly.

How many “hard-to-treat mysteries” can blood deficiency cause? Doctor Luo listed a string of examples, every one familiar from the clinic:

Constipation. Most women’s constipation is related to blood deficiency — when the body’s fluids are insufficient and the blood is insufficient, the fluids in the intestines are insufficient too. The ancients described it as a river with no water: the boat simply cannot move. Many women find their constipation resolves as soon as they nourish their blood.

Headaches before menstruation. This illness is hard to treat — Doctor Luo says he has seen many cases. Why does the head ache before or during the period? Because at that time the blood loss is greater, and the head — the highest point of the body — is the first to run “out of stock.” Nourish the blood and the headache follows.

Rheumatic joint pain. This is the most stubborn kind — you drive out the wind, you disperse the dampness, so why does it still hurt?

💬 Note from Doctor Luo: Because your blood is insufficient — your channels are empty inside. That wind and dampness outside slipped in while you were vulnerable. You drive the wind out and resolve the dampness, but inside is still empty, and a couple of days later the external pathogens come back. So treating wind and dampness alone never works well; combine it with blood nourishment and the effect appears at once. Some women just nourish blood and nothing else, and their joint pain heals as they go — when the blood inside the channels is sufficient and the qi and blood are sufficient, external pathogens can’t get in, and they leave on their own.

Blood deficiency plus cold: cold that reaches the marrow, a bone-piercing chill

If a blood-deficient person is then exposed to cold, how deep does the cold go? Doctor Luo uses four words: straight to the marrow.

💬 Note from Doctor Luo: Qi and blood generate each other and root each other. When blood is deficient, qi becomes insufficient too, and the body’s upright qi is especially weak. Enter the same cold environment once — someone else is fine, but you, because your blood can no longer warm and nourish the limbs and hundred bones, every part of the body is easily affected by outside temperature changes. As soon as the temperature drops outside, the channels move even more sluggishly and cold qi slips in easily.

Over time, the cold pathogen penetrates deep into the body and the person enters a true yang-deficient state — and this yang deficiency masks the blood deficiency underneath it.

💬 Note from Doctor Luo: Yang deficiency plus blood deficiency — blood deficiency is the base, yang deficiency is the pattern created later. So women must learn to protect themselves. Many women are a compound of two constitutions: blood deficiency plus yang deficiency — most were blood-deficient first, then got cold-exposed, and slowly entered this pattern.

Doctor Luo told of an example he saw with his own eyes: a TV hostess — who hosted a health program, no less, yet practiced no health care herself. She filmed night after night — by late night even the audience was collapsing, and she still had to stay bright and energetic on camera. Years of overwork had drained her qi and blood badly. The studio had air conditioning; to look pretty she dressed very lightly; in deep winter she’d wrap herself in a down jacket to use the restroom — cold outside, and on stage the air conditioning blew on her too…

💬 Note from Doctor Luo: In the same job, the lighting and camera crew — young men — were far less affected, because men’s blood isn’t that deficient. When that hostess stuck out her tongue, I took one look and was shocked. The cold was very severe, the yang deficiency too heavy — and there was a bit of blood stasis on top. When the cold is that heavy, the blood can’t circulate, and later blood stasis develops. I told her: this won’t do, you must make changes. You host a health show — you absolutely must not wreck your own body.

The mistake: why does warming yang alone not work?

Once people realize they have “blood deficiency plus cold,” the first reaction of many is: I’m cold — so warm the yang hard! Moxibustion every day, heavy doses of aconite and dried ginger… and what happens?

💬 Note from Doctor Luo: Many friends say, “I’m just yang-deficient, I do moxibustion every day — why don’t I feel the benefits others feel? Afterwards my hands and feet are still ice-cold, I still fear cold?” Others say, “The doctor said I’m yang-deficient and warmed my yang — the aconite went to over 200 grams, Si Ni Tang went down, so why was there still no effect, and it came right back?” The reason is right here — when your blood is deficient and yang deficiency is added on top, warming yang alone is like boiling a dry kettle.

Doctor Luo gave two analogies that are easy to remember:

The sapling — a sapling draws water up from underground and needs sunshine to grow luxuriant. If you give it no water below (as if there were no blood) and let the sun beat down on it above, can that sapling grow healthy?

The kettle — put water in the kettle and the fire boils it; but if there’s no water in the kettle and you just heat the dry pot, it glows red and finally goes “bang” — it cracks.

💬 Note from Doctor Luo: What runs through the human channels are fluids — essence (jing), blood, and body fluids (jin ye), all liquid substances. The human body is 70% water; essence, blood and fluids share one root and transform into one another, so the liquid environment inside the body is crucial. If the fluids in the channels are depleted by half, can the body recover just because you pile on more fire? So moxibustion feels good at the moment, but next week you fear cold again; herbal decoction seems to work while you drink it, but the moment you stop, the cold returns — the adjustment approach was too one-sided.

The medical sage’s law: Jiao Ai Tang — nourish blood and warm yang together

So how should it actually be adjusted? Doctor Luo says the ancient masters long ago worked out the answer.

💬 Note from Doctor Luo: In the Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet), Zhang Zhongjing has a formula called Jiao Ai Tang — very famous, a celebrated formula for gynecological disorders. What did it treat back then? “Half-term leaking” — pregnant, seeing blood, as if the fetus could not be kept; and women’s flooding and spotting (beng lou), periods that never quite end, always a little blood. Zhang Zhongjing’s formulas establish a “law”; the way he thought about a problem is exceptionally clear.

What is Jiao Ai Tang’s strategy? Look at its composition and you’ll understand:

Si Wu Tang (Four Substances Decoction) as the base — cooked rehmannia (shu di huang), danggui (angelica sinensis), chuanxiong (lovage), white peony (bai shao). Si Wu Tang later became the main formula for nourishing blood — it was derived from Jiao Ai Tang; it is the “ancestral formula of the ancestors.”

💬 Note from Doctor Luo: Cooked rehmannia nourishes the essence of the liver and kidneys; danggui nourishes blood and activates blood; chuanxiong activates the channels and moves qi; white peony restrains the liver and nourishes yin — because the liver stores blood, white peony is there to regulate the liver. Cooked rehmannia, danggui, white peony and chuanxiong together are excellent for nourishing a woman’s blood. I think Si Wu Tang should be made into a health supplement for everyone to use — go to Taiwan and you’ll see Si Wu Tang health products everywhere; over here, for reasons unknown, it seems it was never approved.

Add ejiao (ass-hide glue) — it nourishes yin and blood, and at the same time stops bleeding. When a woman bleeds and cannot hold a fetus, it is because the womb is cold and the blood is deficient — the fetus has no blood to be nourished by. When the period runs on and on, that too is from cold with insufficient yang. Ejiao both nourishes blood and stops bleeding — the effect is excellent.

Add ai ye (mugwort leaf) — the same mugwort used in moxibustion. Note: it must be stir-fried — there is real knowledge in that; sometimes mugwort charcoal (ai ye tan) is used instead, and mugwort charcoal has a blood-stopping effect.

Add licorice (gan cao), and the formula is complete.

💬 Note from Doctor Luo: Look at this line of thinking — Si Wu Tang nourishes blood, ejiao is added to nourish blood, and then the warming mugwort. Zhang Zhongjing does not warm yang by itself; he combines blood nourishment with warm nourishment, puts the two together — and the blood-nourishing ingredients are in larger amounts, with just an appropriate measure of yang-warming herbs. This is the law the medical sage established for us: nourish blood combined with warming yang.

From dried rehmannia to cooked rehmannia: the transmission hidden in one herb

One ingredient in Jiao Ai Tang has an interesting history, and Doctor Luo tells it well.

💬 Note from Doctor Luo: In Zhang Zhongjing’s day the formula used “dried rehmannia” — you can read that as fresh rehmannia (sheng di) or cooked rehmannia (shu di); in those days they used it rather crudely. Zhang Zhongjing was from Henan — and what does Henan produce? Huai rehmannia. Rehmannia is a specialty of Henan, so Zhang Zhongjing certainly knew it well. By the Song dynasty, when the formulary Tai Ping Hui Min He Ji Ju Fang included Jiao Ai Tang, it had already become cooked rehmannia. And in essentially every later medical book, it’s cooked rehmannia.

Once the medical sage established his law, later physicians all understood: to regulate cold in women, this is how you do it. So all sorts of formulas appeared — some added liver-soothing herbs, some added blood-activating and stasis-resolving herbs — and the approach grew clearer and clearer.

💬 Note from Doctor Luo: The Fu Ren Da Quan Liang Fang (Complete Good Formulas for Women) also contains a Jiao Ai Tang, and there are many versions with slight variations. Some even add ephedra (ma huang) — blood-deficient, yang-deficient, and cold-damaged, so a little ephedra helps you disperse it. Once Zhang Zhongjing set up this line of thinking, we later generations developed in that direction.

How to tell whether you are “blood-deficient plus cold” — a five-point self-test

Doctor Luo gave women a very practical self-test:

💬 Note from Doctor Luo: The tongue is especially pale, pale along the edges. Usually when you squat down to look for something and stand up, everything goes “black” before your eyes — that’s clearly blood deficiency. The limbs are always cold, and the colder the winter the colder you get. People like this have poor memory and insomnia — sometimes quite severe insomnia. The period is pale in color and scanty in amount — you know all this yourself. If you’re in this state and then get cold-exposed, that’s blood deficiency plus cold. In that case, warming yang alone is wrong — you should nourish blood and warm yang together.

Everyday care: Yu Ling Gao (Jade Spirit Paste) plus a Si Wu Tang foot bath

What if you can’t write your own prescriptions? Doctor Luo offers two home methods.

First, Yu Ling Gao (Jade Spirit Paste). Doctor Luo has discussed it in detail before:

💬 Note from Doctor Luo: Take ten parts longan meat (long yan rou) to one part American ginseng — 300 grams of longan meat with 30 grams of American ginseng. Steam for at least 4 hours — 40 hours is ideal if you can manage it. After steaming, keep it in the refrigerator and take one spoonful, one tablespoon, a day. This nourishes the blood.

Second, a Si Wu Tang foot bath. No ejiao needed (ejiao stops bleeding; you don’t need that in daily life). Instead use a blood-nourishing, yang-warming foot bath formula:

💬 Note from Doctor Luo: Use a few grams of each Si Wu Tang herb — cooked rehmannia 9 g, danggui 9 g, chuanxiong 6 g, white peony 6 g (or make them all 9 g if you like). Add mugwort leaf 6 g (the pharmacy carries stir-fried mugwort, or mugwort charcoal — either is fine), and add pao jiang (blast-fried ginger) 6 g — for warming a woman’s womb, blast-fried ginger is the usual choice. Simmer for half an hour, then soak your feet after dinner, after a little exercise — soak about half an hour each day. Don’t do it too close to bedtime; leave at least an hour between the soak and sleep. Soak every day like this and the warming effect is far better than warming yang without nourishing blood — nourish blood and warm yang together: this is the approach Zhang Zhongjing left us.

Finally, Doctor Luo said something from the heart:

💬 Note from Doctor Luo: Women are an especially important foundation in a family. If the women of a household are unwell, even filial care diminishes. I’m trained in this, so I spend a little time each day talking with you — it’s free, and you can listen freely and pass it on to your friends. There’s no harm in being exposed to this knowledge. Tomorrow we’ll continue: there are more types of yang deficiency in women — what to do when blood stasis is involved, and how to adjust yang deficiency. We’ll take apart this complicated picture bit by bit.

Compiled from Doctor Luo Dalun’s lecture series; the core formula doctrine comes from Zhang Zhongjing’s Jiao Ai Tang in the Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet).