Tian Ma Gou Teng Yin or Gastrodia and Uncaria Decoction is a formula for symptoms of high blood pressure, such as hypertensive headaches, dizziness and insomnia due to liver yang rising, leading to internal stirring of wind. So Tian Ma Gou Teng Yin is kind of interesting because this is actually a more modern formula that combines traditional theories of Chinese medicine with modern research on the pharmacological effects of herbs. It was developed by physician Hu Guang-Ci and first published in 1958, specifically to treat the biomedical disease hypertensive headaches. He referred to these as liver inversion headaches. So from a TCM perspective, this formula treats a pattern of liver yang rising or hyperactive ascent of liver yang, which can lead to internal stirring of liver wind. So we use herbs that calm the liver, anchor liver yang rising, and extinguish wind. From a biomedical perspective, many of the herbs in this formula have been shown by modern research to lower high blood pressure. So Tian Ma Gou Teng Yin was formulated with both perspectives in mind. So if we want to look at this from a TCM point of view, the pattern we're treating with Tian Ma Gou Teng Yin is something that Bensky calls “hyperactive liver yang”; Nigel Wiseman calls it “ascendant hyperactivity of liver yang”; and Maciocia just calls it “liver yang rising.” These all mean the same thing. And this is actually a mixed pattern of excess and deficiency. Remember, the nature of the liver is to move and ascend, or we could say that the liver governs upbearing and effusion. So just like a tree grows upward and spreads its branches outward, that's the direction of liver -- it moves things up and it spreads qi outward into the limbs. And that's why we say that the liver corresponds to the wood element. Counterbalancing that yang nature, the liver stores blood, which nourishes the liver and keeps it soft and flexible. So the statement “the liver is yin in substance and yang in function” is referring to this balanced nature of the liver. But what's happening with this “liver yang rising pattern” is there's an imbalance between the yin and yang of the liver. The yin is no longer able to anchor and restrain the yang, so the liver yang rises excessively. And that's why we see these symptoms in the upper body like headache, dizziness, tinnitus, a red face or a sensation of heat in the face, and blurred vision. And this upward movement of liver yang can also affect the heart spirit, giving us things like insomnia or dream disturbed sleep. So that's why we call this a mixed pattern. There's excess symptoms in the upper body due to excess liver yang rising, but there's usually some underlying liver yin deficiency that fails to restrain and control the yang. Now, to what extent is it predominantly liver excess versus predominantly liver yin deficiency? In practice, that's going to vary patient to patient. The point is there's an imbalance between the two. And then, as a consequence of all of this, that hyperactive movement of liver yang can also stir up internal wind. The way I think about this is like a chimney. When you light a fire in the fireplace, the heat rises up the chimney, and that creates a draft. The rising heat actually creates a movement of air that draws the smoke upwards, and that's why your living room doesn't fill up with smoke. Similarly, that excessive upward movement of liver yang can stir up internal wind, which could eventually lead to a stroke. But that's why we say in severe cases of liver yang rising, we may see things like numbness, twitching and spasm or hemiplegia. So how does this pattern come about? Well, there's usually an emotional component. You can maybe remember that anger causes the qi to rise; or you can think about things like anger, frustration, depression, anxiety or just stress can impair the liver's function of free coursing. When the liver is no longer free-coursing, that qi gets constrained, and that constrained qi can easily turn into heat, which then damages the yin-blood. And now the yin is no longer able to restrain the yang, and the liver yang rises upwards excessively. Getting back to our formula, we see that Tian Ma Gou Teng Yin treats this pattern of “hyperactive liver yang leading to internal stirring of liver wind.” Headache, dizziness, vertigo, and tinnitus are all those upper body symptoms that we talked about before. We may even see a sensation of heat rushing to the head. Like you can literally feel the yang rising up into the head. Insomnia with dream-disturbed sleep is a sign that this liver yang rising is affecting the heart. And then we say in severe cases there may also be numbness, twitching and spasms in the extremities, or hemiplegia, and these are signs of the internal wind that was brought about by this hyperactive ascent of liver yang. The tongue is red because this is a heat condition (again, there's relatively more yang than yin, so we see heat signs). The pulse is rapid because of the heat, and it's wiry because this is a condition of the liver. Now, according to Maciocia, “Headache is one of the most common and distinctive signs of liver yang rising,” which makes sense because, remember, this formula was originally created specifically to treat hypertensive headaches. He goes on to say that Liver Yang Rising is the most common cause of chronic headache, and this headache tends to be one-sided, on the temple or lateral aspect of the head, and throbbing in nature. He also makes this interesting note that excess conditions tend to manifest on the right side of the body, whereas deficiency symptoms tend to manifest on the left. So since we're dealing with excess liver yang rising, the headache typically appears on the right side of the head. But in practice, I don't know how often that's true or not. When we look at the ingredients of Tian Ma Gou Teng Yin the first two are of course Tian Ma and Gou Teng. Both of these come from the category “Substances that Extinguish Wind and Stop Tremors.,” so they both calm the liver and extinguish wind. These two herbs are very commonly used together as paired herbs, but if we wanted to compare them: Tian Ma is neutral in temperature, so it can be used for internal wind due to heat or cold; whereas Gou Teng is slightly cold in temperature, so it's better for wind conditions due to liver heat. Also, Tian Ma can be used to treat Bi syndrome, and Gou Teng has an additional action of releasing the exterior. This isn't really relevant to this formula, but if you're studying for a big herbology test, it might be good to know. The next one, Shi Jue Ming is also from the “Extinguish Wind” category. This is abalone shell. So because of its heavy weight, it's able to anchor down liver yang rising. The rest are assistants. Zhi Zi and Huang Qin clear heat. Yi Mu Cao and Chuan Niu Xi invigorate blood to prevent it from rising to the head. Remember, Niu Xi means “ox knees,” and it has a strong downward nature, which is helpful when we're dealing with liver yang rising. So you can remember that your knees are in your lower body so Niu Xi moves downward. Du Zhong and Sang Ji Sheng tonify by the liver and kidney, treating the root cause or the underlying deficiency that allowed the liver yang to ascend. And Ye Jiao Teng and Fu Shen calm the spirit, treating those symptoms of insomnia and dream-disturbed sleep that can occur when liver yang rising affects the heart. So that's an explanation of this formula composition in terms of traditional Chinese medicine concepts. But like we said, this formula also makes use of modern research. It was specifically designed to treat the biomedical condition hypertensive headaches. So many of these herbs have been experimentally shown to have an action of lowering high blood pressure. So that's another explanation as to why these herbs were included in this formula. For example, I always thought it was kind of strange that Du Zhong was included in this formula. I mean, Du Zhong is from the category “Herbs that Tonify Yang,” and it kind of generally tonifies the liver and kidney, specifically strengthening tendon and bone. But why would he use a yang tonic in a formula for Liver Yang Rising? Well, it turns out that Du Zhong does have this action of lowering high blood pressure. So that could be one of the reasons it's included in this formula. It's also interesting to note that many of these herbs have an action of promoting urination as well. Well, in biomedicine, diuretics are sometimes used to treat high blood pressure. So that's another reason these herbs were included in this formula. And while we're talking about ingredients, we should probably mention that some of these herbs have special cooking instructions as well. Like we said, Shi Jue Ming is a shell, so it needs to be pre-decocted. That is, you boil it for 10 to 20 minutes before adding the rest of the ingredients. Gou Teng, on the other hand, should be added near the end, ideally cooking it for no more than 10 minutes. In fact, there's a note in Chen and Chen saying, “The antihypertensive effect of Gou Teng is greatly reduced if cooked for more than 20 minutes.” Looking at the herb sample, Gou Teng means “hook vine” in Chinese because it looks like a hook. And according to Bensky, the good quality go tong has double hooks, so it looks kind of like an anchor. Again, I'm not sure that this is really relevant to understanding this formula, but if you're taking a big herbology test, that might be good to know. Next, we can look at some of the common modifications of this formula. And hopefully these will be pretty obvious. Usually, if you know the category of an herb or just its major functions, then the modifications become pretty self-evident. So for more severe symptoms add Ling Yang Jiao. Ling Yang Jiao is antelope horn, and it's also in the “Extinguish Wind / Stop Tremor” category. It's especially useful for wind due to extreme liver heat, but it also anchors liver yang rising and lowers high blood pressure. So it makes sense to add it here. For severe dizziness, add Dai Zhe Shi, Mu Li, Long Gu or Ci Shi. These are all shells or minerals, so their heavy nature weighs down and anchors liver yang, so it makes sense that they could pull things out of the head and treat dizziness. For liver fire, add Long Dance Cao, Xia Ku Cao, and Mu Dan Pi. Long Dan Cao is in the “Damp-Heat” category; tt drains both liver- gallbladder damp-heat and liver fire. Xia Ku Cao is in the “Drain Fire” category; tt's especially useful for clearing liver heat and brightening the eyes, and it also lowers high blood pressure. Mu Dan Pi is in the “Cool the Blood” category, but it also clears liver heat. So even though these herbs are from different categories, they all have an action of clearing liver heat and liver fire. For constipation, add Da Huang and Mang Xiao, which makes sense because both of these are from the “Purgative” category. And for liver and kidney deficiency, add Nu Zhen Zi, Gou Qi Zi, Bai Shao, Sheng Di Huang, or He Shou Wu. And again, this should make sense because all of these herbs can tonify yin, tonify blood, or both. And finally, it might be helpful to compare this formula to other similar formulas. In the category “Formulas that Pacify and Extinguish Internal Wind,” we learn Ling Jiao Gou Teng Tang, Zhen Gan Xi Feng Tang, and Tian Ma Gou Teng Yin. So first, Ling Jiao Gou Teng Tang has Ling Yang Jiao or antelope horn as one of its chief ingredients. Like we said in the modification section, Ling Yang Jiao is especially useful for wind due to extreme liver heat. So here we see symptoms of extreme heat like persistent high fever, irritability, a deep red tongue with prickles, and even loss of consciousness. So this is not a mixed pattern of excess and deficiency. This is pure liver excess with a lot of heat sign. Zhen Gan Xi Feng Tang is actually more for wind-stroke or even cerebral hemorrhage. Not only is the liver yang moving upwards, the qi is rebelling upwards, and blood is getting congested in the brain. That's why the chief ingredient is Niu Xi: it conducts the blood downward and out of it out of the head. Maybe a key sign to point out here is the wiry, long and forceful pulse, indicating a vigorous ascent of qi and yang. And based on the ingredients, we could say that this formula does have a stronger action of tonifying liver and kidney yin. Tian Ma Gou Teng Yin is the mildest of the three. It calms the liver and extinguishes wind, specifically for hypertensive headache, accompanied by dizziness and insomnia. Now, at this point, if you're a little bit confused about the differences between these last two formulas, that's okay. So am I. A lot of the signs and symptoms between these two are very similar, and I feel like none of our textbooks do a really good job of clearly differentiating them. Really, I think that these are two modern formulas that were trying to combine traditional Chinese principles with modern Western biomedical principles, but with one they were trying to treat stroke and cerebral hemorrhage, and with the other they were trying to treat headache due to high blood pressure. So I think that's really the main difference. But to summarize, Ling Jiao Gou Teng Tang is for wind due to excess heat, so look for extreme heat signs like a deep red or burnt tongue with prickles. Zhen Gan Xi Feng Tang is for wind-stroke or cerebral hemorrhage due to ascendant liver yang with an upward gushing of qi and blood. A key sign to look for here is a rapid, long and forceful pulse. And Tian Ma Gou Teng Yin is for wind due to liver yang rising, specifically for hypertensive headache accompanied by dizziness and insomnia. So that is a deep-dive look into our formula Tian Ma Gou Teng Yin. Again, this is a formula that was created to treat symptoms of high blood pressure, specifically hypertensive headaches, and the way it did that was by combining TCM treatment principles with biomedical treatment principles. From the TCM side, Tian Ma Gou Teng Yin treats the pattern of liver yang rising leading to internal stirring of liver wind. From the biomedical side, Tian Ma Gou Teng Yin is a combination of herbs that lower high blood pressure and act as diuretics. And just to be clear, this video is meant as an educational resource for students of traditional Chinese medicine who are studying at an accredited school and preparing for finals or exams. If you are a person who wants to take Chinese herbs for yourself, please do not self-prescribe herbs based on a video that you saw on the internet. This can be dangerous, especially if you are on medications or you have other risk factors. These herbs are very potent and should be prescribed by a licensed practitioner. So if you are interested in taking this formula or any other Chinese herbs, I recommend booking an online consultation with one of the licensed practitioners at My Herbal Pharmacy. Ram and Kim are two practitioners that I went to school with and they are very good with Chinese herbs. When you schedule an online consultation, they'll set up a video meeting where they go over your history and symptoms, look at your tongue, and create a custom herbal formula. What's good about this is they can customize the formula to specifically fit your situation, and they can also manage any potential drug herb interactions if you are taking any medications. And after they create your formula, they can direct you to a location where you can pick it up locally or they can have it shipped to you. So if you want to take Chinese herbs for yourself or leave a link in the description below where you can set up an appointment with Ram or Kim. And if you are a student who is studying for a big Herbology test, I do have a review course that goes over all of the formulas on the NCCAOM list. And just note, this isn't a subscription; you buy the course once and then you own it forever. So I've had many students who purchase the course while they're in school to help with their coursework. Then they use it again as they’re studying for boards. So I'll leave a link to that below as well. But that's all for this one. If you want to review more Chinese herbs, check out this video over here.