SANGPIAOXIAO SAN

Example of a "Mind-Body" Formula

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Sangpiaoxiao San (or Sang Piao Xiao San) is a formula based on a very unusual ingredient in the Chinese Materia Medica: the mantis egg case (sangpiaoxiao); the formula is often known in English as "Mantis Formula." Mantis, as used here, refers to the Mantidae family of large carnivorous insects, of which the "praying mantis" is best known. The Chinese insects involved are mainly Tenodera sinensis (aka Paratenodera sinensis), Statilia maculata, and Hierodula patellifera (1; see egg case photos below). They deposit an egg casing (ootheca) containing several eggs on twigs (such as mulberry branches, the "sang" in sangpiaoxiao) in autumn. The case is secreted as a foamy material that becomes very hard; it protects the eggs from winter weather and most parasitic insects. Depending on the species and conditions, a female lays from 10-400 eggs per egg case, and usually lays about 6 egg cases (up to 20) in a short period.

The casings are collected for use as an herbal medicine in late autumn through early spring (the eggs hatch May to June as the weather turns warm); they are steamed (which kills eggs that may be present) and then dried (under the sun or in an oven). Although they have not been analyzed to determine their active constituents, a large portion of the egg case is comprised of protein, which would explain the frothy material that turns hard (think of egg whites made into meringue). It also contains a variety of unique constituents produced by the metabolism of the insect, such as aromatic compounds that deter ants, birds, and mice. Other insect secretions used in Chinese medicine include royal jelly from bees and droppings from silkworms.

Mantis egg case is an ancient remedy, described in the Shennong Bencao Jing (ca. 100 A.D.), and one may wonder how it came to be used. The answer is simple: the mulberry plant (Morus alba) was revered in ancient China, mainly for its support of the silkworm and the valuable byproduct silk. This plant became a source of numerous herbal medicines, including its root bark (sangbaipi), branches (sangzhi), leaves (sangye), and fruits (sangshen)-each considered to have their own unique properties-as well as the silkworms (bradycated, meaning infected by fungus, jiangcan) and their droppings (cansha). So, it would not be surprising that these egg cases, which appeared on some of the plants, were also collected and considered a valuable medicine.

Tenodera sinensis egg case (tuanpiaoxiao)

Statilia maculata egg case (changpiaoxiao)

Hierodula patellifera egg case (heipiaoxiao)

The Shennong Bencao Jing description is (2):

Sangpiaoxiao is salty and balanced. It mainly treats damaged center, mounting conglomeration, and impotence. It boosts the essence, makes pregnancy possible, cures blood blockage and lumbago in women, alleviates the five urinary bleeding disorders ['wu lin'], and regulates urination and the water passageways.

Over time, the description of this substance has focused on the treatment of urinary disorders and impotence; it is now classified as a tonifying astringent, particularly for urinary frequency. The doctors in China have concluded that this material affects the urinary system, despite some variation in its applications (e.g., cloudy urine, frequent urination). Its tonic effects, attributable to the kidney system, explain its use in treating impotence, infertility, and lumbago, as well as "boosting the essence." In modern texts, mantis egg case is depicted as being sweet as well as salty; sweet is associated with tonification, and salty with the kidney system. According to Jiao Shude (3), mantis egg case functions to restrain excessive urination by "securing the kidney," which refers to strengthening the kidney's function of "grasping" that is important for restraining fluids and maintaining the integrity of the body. The Advanced Textbook of Traditional Chinese Medicine and Pharmacology (4) lists indications for mantis egg case: "To nourish the kidney, promote yang, arrest seminal emission, and reduce urination." Among the herbs in the Materia Medica astringent category, this one is considered the primary ingredient to use in cases of kidney yang deficiency.

The formula named for this unique ingredient is from the text Bencao Yanyi (Development of Herbal Medicine) by Kou Zongshi, written in 1116 and published by his son in 1119, during the Song Dynasty. His philosophy is worth relaying here (5):

Heaven and earth have creation and perfection as their virtues. Their most important creation is the human body. The body has peace and joy as its foundation. Peace and joy may be obtained if one takes protection and maintenance of life as its foundation. All men must base their actions on this foundation, and, as a result, the foundation of their body will be firm. If the foundation of the body is firm, how can illness arise? How could early death or unexpected suffering occur? This is the principle of the preservation of life; nothing can equal it.

…When one is able to leave behind superficial matters and be completely absorbed in the truth, and when one is able to avoid internal and external distraction, the spirit cannot cause destruction from within, and the environment will not be able to cause destruction from outside. One achieves true unity without confusion, and the spirit can obtain peace from within itself. This is the nourishment of the spirit.

…The exemplary men of times past regretted that continuous suffering and sudden illness followed each other and that the natural harmony of the body was often lost. For this reason, they acquainted the rest of mankind with the techniques to protect and preserve life. In addition, they made known the medications that eliminate illnesses, so that experts and laymen could achieve together the goal of longevity.

It is evident that Kou considered the state of mind (spirit) to be of great importance, and thought that one must support the root (foundation) of the body through spiritual harmony (peace and joy). By calming the mind and strengthening the foundation, one could attain longevity, as well as freedom from suffering. Thus, herbs and formulas that could help accomplish these goals were of special importance to him, and sangpiaoxiao is a good example.

Sangpiaoxiao San is comprised of equal parts of its ingredients, as follows (6):

An essential aspect of this formula's function is to harmonize the fire and water of the heart and kidney and maintain coordination between the yin and yang. As described in the Advanced Textbook of Traditional Chinese Medicine and Pharmacology (with further explanation added in brackets):

The heart produces fire; the heart fire descends to warm up the kidney water in order to keep the kidney water warm [when the water is cold, it drains out in frequent urination; when the water is overheated, it steams upward, the kidney yin becomes damaged, and the urine becomes concentrated and produces a burning sensation], while the kidney produces water; the kidney water ascends to cool the heart fire in order to keep the heart fire from becoming overactive [overactive heart fire disturbs the mind; insufficient heart fire leads to mental dullness]. If the water and fire are harmonized, the yin and yang of the heart and kidney can be coordinated: this is called harmony between the heart and kidney.

Polygala and acorus are frequently used as a pair, well known today for treatment of mental disorders via their action of opening the orifices, resolving phlegm mist, and brightening the mind. According to Jiao Shude, polygala is especially important for promoting heart-kidney interaction, supplementing the heart and boosting the kidney qi, being used for fright, forgetfulness, insomnia, and spiritlessness, though both herbs are considered to have this effect. Ginseng and fu-shen are commonly used as a pair for calming the spirit. Dragon bone and tortoise shell represent two mineralized materials for promoting longevity, astringing discharge, nourishing the kidney, and calming the mind. According to Chinese English Manual of Commonly Used Prescriptions in Chinese Medicine (7), these herbs act in concert with mantis egg case to "keep the heart-fire and kidney fluid in balance and restore their functions." Mantis serves to tonify the yang (and this effect is enhanced by ginseng), tortoise shell to nourish the yin and settle agitated yang, and dragon bone to astringe the essence and tranquilize the mind. Tang-kuei, provided with fu-shen, nourishes the heart blood and produces a tranquilizing effect. This formula accomplishes the goal that Kou Zongshi established by calming and focusing the mind while strengthening the root (the kidney). In Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine (8), the tonic nature of the formula is noted as a key element: it is said to be used for deficiency of both heart and kidney, manifesting as frequent urination, absent mindedness, poor memory, loss of appetite, enuresis, and seminal emission.

The traditional preparation is made by grinding the herbs to powder, and taking 6 grams at bedtime; it may be swallowed down with a decoction of ginseng. In modern times, this formula is often produced by making a decoction of all the ingredients, which is dried and then consumed as a powder or granule.

Sangpiaoxiao San was simplified by later herbalists to take advantage of its effects on the spirit. Removing the kidney tonifying mantis egg case and tortoise shell leaves a prescription that is suited primarily for treating the problem of mental agitation. Thus, Yuanzhi Wan was recorded in one of the Jisheng Fang volumes (ca. 1300 A.D., by Chong Dingyan): it is an emotion-stabilizing pill used for treating fright, agitated dreams, restlessness, and emotional distress, made with equal parts polygala, acorus, dragon teeth, ginseng, fu-shen, and hoelen. The same formula was presented again in the text Yixue Xinwu (1732, by Cheng Goupeng), with a different name, indicating it to be a "mind-calming, emotion normalizing pill": Anshen Yuanzhi Wan, which has become a popular patent remedy used in modern times. A slight modification was offered as the "emotion calming pill," Dingzhi Wan, described in the Zabing Yuanliu Xizhu (1773, by Shen Jinao), with dragon's teeth replaced by cinnabar. Modern prescriptions like these are used in treatment of attention deficit disorder, mental illness, insomnia, fright disorders, and senile dementia. Adding urinary astringent herbs, such as mantis egg case or cuscuta, restores the treatment to one addressing the symptoms of urinary frequency or incontinence.

Because mantis egg case is classified in the astringent section of the Materia Medica, the formula that takes the name of this ingredient, Sangpiaoxiao San, is often thought of primarily as a therapy for urination disorders. Clearly, this can lead to misunderstanding of its broader effects and its best application. Urinary disorders, particularly frequent urination, are one sign that this prescription should be considered, but its mechanism of astringing urination through kidney-heart coordination is just as important to take into account.

Mantis Formula has been used in treatments for diabetes, prostate disorders, hyper-parathyroidism, primary aldosteronism, and urinary incontinence. For patients who have little problem with mental functions and emotional distress, alternative formulations aimed at addressing urinary disorders might be more suitable, or this formula may be adjusted by adding ingredients such as cuscuta (tusizi), cornus (shanzhuyu), euryale (qianshi), lotus seed (lianzi), dioscorea (shanyao), rubus (fupenzi), or schizandra (wuweizi). These herbs could benefit patients who do not have the "kidney-heart" syndrome as their primary cause of urinary dysfunction. In Clinic of Traditional Chinese Medicine (9), a mantis formulation for treating frequent and profuse urination, particularly in a case of diabetes, is described: the decoction is comprised of 20 grams mantis, 15 grams cornus, 12 grams cuscuta, and 10 grams of schizandra, along with kidney nourishing herbs that have a reputation of lowering blood sugar (rehmannia, ophiopogon, lycium, and dioscorea).

According to the Five Element system that was very much a focus of Chinese herbal medicine during the time the Mantis Formula was designed, the kidney system is associated with the water element and the emotion of fear. That is, excessive fear will weaken that system and one result can be urinary disorders, such as frequent urination. It is also understood that fright disturbs the spirit (shen) that rests in the heart (associated with the fire element); frightening experiences can weaken the heart system and result in mental distress, agitated dreams, and insomnia. Thus, persons who are adversely affected by fright and fear may suffer from conditions of disturbed shen and weakened kidney function. Mantis Formula is a potentially useful therapy in such cases. These situations may be described as anxiety disorder, panic attacks, post-traumatic stress syndrome, etc. Dr. Jiang Yongping (10) mentions that: "Fear or fright comes from the heart, liver and gall bladder, and damages the heart and kidney. These emotions tend to cause deficiency patterns, so the treatment principle is to tonify the heart, liver and kidney. Typical formulas include Dingzhi Wan and Suanzaoren Tang. If the fear has caused incontinence or enuresis, you can use Sangpiaoxiao San."

REFERENCES

1. Pharmacopoeia Commission of the Ministry of Public Health, A Color Atlas of the Chinese Materia Medica, 1995 Guangdong Science and Technology Press, Guangzhou.
2. Yang Shouzhong (translator), The Divine Farmer's Materia Medica, 1997 Blue Poppy Press, Boulder, CO.
3. Mitchell C, et al. (translators), Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shude, 2003 Paradigm Publications, Brookline, MA.
4. State Administration of Traditional Chinese Medicine, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, 1995-1996 New World Press, Beijing.
5. Unschuld PU, Medicine in China: History of Pharmaceutics, 1986 University of California Press, Berkeley, CA.
6. Bensky D and Barolet R, Chinese Herbal Medicine: Formulas and Strategies, 1990, Eastland Press, Seattle, WA.
7. Ou Ming, Chinese-English Manual of Common-Used Prescriptions in Traditional Chinese Medicine, 1989 Joint Publishing Co., Hong Kong.
8. Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine, 1993 Heilongjiang Education Press, Harbin.
9. Zhang Enquin, Clinic of Traditional Chinese Medicine, 1990 Publishing House of Shanghai College of Traditional Chinese Medicine, Shanghai.
10. Jiang Yongping, The Effect of Sadness and Other Emotions on the Body, Acupuncture Today 2003; 4(1).

December 2004