On Angelica, Fritillaria, and Sophora Flavescentis Radix Pill

Yesterday, my colleague Zhao Shitong mentioned that combining Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction) with Danggui Beimu Kushen Wan (Angelica, Fritillaria, and Sophora Flavescentis Radix Pill) was remarkably effective in treating various sterile forms of frequent and urgent urination. Naturally, I looked into it right away.

The Danggui Beimu Kushen Wan originates from Zhang Zhongjing’s Jin Gui Yao Lue (Essentials from the Golden Cabinet). The original text reads:

“For the primary complaint of difficult urination during pregnancy, while eating and drinking remain as usual.”

The composition is remarkably simple: Angelica root (Danggui) 4 taels, Fritillaria bulb (Beimu) 4 taels, and Sophora flavescentis root (Kushen) 4 taels. The three ingredients are ground into a fine powder, mixed with refined honey to form pills the size of adzuki beans. The dosage begins at 3 pills taken with rice water, gradually increasing to 10 pills.

Throughout the centuries, physicians have not paid much attention to this formula, and its clinical use has been limited. Many commentators failed to grasp its underlying rationale, producing annotations that are, frankly, baffling. Some even went so far as to argue that the original text contained an error — that it should read “difficult defecation” rather than “difficult urination.”

I reviewed some modern literature and found that the formula has indeed been used to treat constipation with good results. However, many practitioners have also employed it for various urinary disorders — including urethral syndrome, urinary tract infections, and female urinary retention — as well as for male complaints such as frequent and urgent urination, particularly in cases of chronic prostatitis and benign prostatic hyperplasia.

Synthesizing these diverse experiences, I found it still quite difficult to unravel the compositional logic of this formula. With our current pharmacological understanding, it is hard to fathom why Zhang Zhongjing would have combined these three particular herbs together. It truly defies easy explanation.

That said, this need not stand in the way of clinical application. After studying the matter and considering Brother Shitong’s recent cases, I believe this formula may be indicated when the following conditions are met:

1. No obvious deficiency-cold syndrome, no significant cold presentation

2. Frequent urination, urgency, dysuria, or even hematuria

3. Disease-pattern-based treatment where frequent and urgent urination is the chief complaint, with a Western medical diagnosis of prostatic disease, cardiovascular disease, neoplasm, or similar conditions

4. Chronic constipation

昨日赵世同兄告诉我，用柴胡桂枝干姜汤合当归贝母苦参丸治疗各种无菌性尿频尿急疗效显著，我赶紧查了一下。

当归贝母苦参丸出自《金匮要略》，原文描述是：

主妊娠小便难，饮食如故。

组成为：当归4两，贝母4两，苦参4两。

上三味研为细末，炼蜜为丸，如小豆大。每服3丸，米饮下。渐加至10丸。

历代医家对此方好像不是很重视，使用的也不多，许多注家完全不能理解此方的原理，注的是莫名其妙，更有甚者认为原文是错误的，认为应该是大便难，而不是小便难。

我查阅了一些现代文献，确实有用来治疗便秘的，效果不错，但也有许多医家拿他来治疗各种小便难，例如尿道综合征，尿路感染，女性尿潴留等等，也有拿来治疗男性尿频尿急的，比如前列腺炎，尤其是慢性前列腺炎，前列腺增生等疾病。

综合以上的各家经验，我发现还是很难去探讨这个方子的组成原理的，用现在的知识很难看出来仲景为什么会将这三味药组合到一起，确实难以想象。

但是，这并不妨碍我们的临床运用，我研究了一下，结合世同兄近期的验案，符合下列情况的应该可以使用此方：

1、无明显的虚寒证，无明显的寒象

2、有尿频、尿急、甚至尿痛、尿血

3、辨病治疗，具有尿频尿急，并且西医诊断具有前列腺疾病、心血管病、肿瘤等疾病的情况

4、长期慢性便秘