The Formula Jia Wei Shao Yao Wan (“Free and Easy Wanderer”) In The Treatment Of The Athlete

In my specialty of acupuncture sports medicine, it did not take long to recognize that supplementing the Kidney with the athlete patient was not always clinically efficacious. First, and most obvious, the traditional formulas such as Liu Wei Di Huang Wan did not bring about an acceptable and immediate change. The more warming the Kidney tonic, the more the patient would experience aggravations. Second, there was always something else that needed treating with these patients, usually an injury or pain syndrome. Third, while you would expect Kidney deficiency symptoms due to their lifestyle of intense training and competition, most of these athletes often did not even have signs and symptoms to confirm.

I found myself looking elsewhere for the causes of imbalance, and the case for treating the Liver became obvious early in my career. Both the Liver and the muscles store glycogen, which are long chains of glucose. During activity – training and competing – the process termed glycogenolysis occurs. This is the breakdown of the glycogen stores to the simple sugar glucose, which is immediately used for energy metabolism of the body. After training, with proper hydration, meals, and rest, the opposite process occurs. Called glycogenesis, blood glucose is stored back in the liver and the muscles as glycogen, awaiting the next athletic endeavor.

Thus glycogen is stored energy, and as a “substance”, can be considered the yin of the Liver. The continuous and on-going consumption of the yin (glycogen) may result in both Liver yin deficiency (yin xu) and Liver blood deficiency (xue xu) syndromes. And it is quite obvious that deficient Liver yin may produce “false fire” symptoms as well as Liver qi stagnation (qi zhi)

Yin                                                   Yang

Glycogen                                                          Glucose

Stored in the liver, muscle tissue                      Circulating, for energy metabolism

Substance                                                        Function

Liver Yin                                                          Liver Yang

During Rest                                                      During Activity

Glycogenesis                                                   Glycogenolysis

Glucose stored as Glycogen                           Glycogen broken down to glucose

The case for the Liver continues. We know the classics state this organ controls the contraction of the muscle-tendon unit. This is Liver qi, and is essentially all physical movement. Furthermore, consider that this organ is the official “in charge of making plans and strategies”. These very important mental and emotional qualities are used in preparation during training, the actual performance, and during the recovery phase after the athletic event.

In the Five Element inter-relationships, the sheng (production) cycle states that Water (the Kidney) is the mother of Wood (the Liver). The proponents of treating the Kidney would suggest that supplementing Water naturally benefits Wood. However, clinically, I point out that any excess, heat, or stagnation in the Liver (the child) will draw and deplete energy of the Kidney (the mother). Thus, it may be useless to tonify the mother until the child is completely passified. And let’s face it, that may never happen with some of the athletes that we treat!

In summary, this is the principle that I emphasize when I teach acupuncture sports medicine: Treat the Liver with acupuncture and herbal medicine. It is ever so clear in my clinical observations that Kidney tonics are ill advised, and generally speaking, not particularly effective. We will briefly suggest other ways to address the needs of the Kidney below.

This brings us to the most important herbal prescription that I use in my clinical practice: Jia Wei Shao Yao Wan. I have been using variations of this formula for nearly 40 years with my athletic and active patients. This is usually where I start in my prescribing. Just this last week, I had a marathon runner call me from out of town, feeling run down from six months of preparing for this 26.2 mile race. While waiting for his appointment time, the patient started Free and Easy Wanderer Plus. When in my office several days later, he said, “Is there any way that this formula could have helped in just the first day? I felt so much better!” The use of a Kidney tonic for the “depletion” that the patient reported would NEVER have produced such immediate results.

The language around Jia Wei Shao Yao Wan itself is interesting—“free and easy wanderer”. Actions such as “encouraging the free-flowing of Liver qi”, clearing heat, cooling blood, and harmonizing the Liver and the Spleen all have a place in the treatment of the athlete, both for training and performance. The tongue usually confirms with a red body and red sides, although sometimes a slightly anemic distance runner may present with a more pale body. The pulse is frequently wiry and thin, all pointing to Liver yin deficiency (yin xu). Due to the cardiac efficiency created from distance running, many athletes will have a slow pulse, so don’t expect to have a rapid pulse confirm the heat symptoms.

Jia Wei Shao Yao Wan is so predictably effective, that I frequently use the formula one or two weeks a month for all my athletic and active patients. Confirming signs and symptoms are helpful, but my clinical experience suggests this is not essential. Most patients will have other root or branch imbalances, so it may never be a “pure” case for Jia Wei.

I use Jia Wei Shao Yao as a base formula, often for a month or so before adaptations. I will then consider adding some tonics for the athlete. The three most common additions are He Shou Wu (Polygonum multiflorum), Xi Yang Shen (Panax quinquefolius, American ginseng), and Ci Wu Jia (Eleuthrococcus senticosus, Siberian Ginseng). While these herbs are well tolerated even when there are heat symptoms, one needs to make these adaptations with skill and clinical consideration. And it is essential to restrain yourself from using most of the other Kidney tonic herbs, even if they appear to be indicated!

The rigors of training and competing do suggest that we need to comment on treatment of the Kidney. However, let’s first make the assumption that the Kidney is depleted from “Other causes of disease”, including excessive lifestyle and over-exertion. Therefore, let’s treat it accordingly – modify the training schedule would be the logical place to begin. Of course, this is where it gets a bit tricky, as I learned early on never to tell a runner not to run. So the practitioner must get creative and skilled regarding this matter. For the runner, consider cross training, including the use of swimming, cycling, and stationary bikes, to help reduce the Kidney-depleting impact of long distance and its resultant high workload.

However, the key lies in the heart rate. Most runners know to monitor their pulse, and if they have a rapid resting heart rate, along with insomnia and increased body temperature, this signals them that they are overtraining. Yes, they too use the pulse to diagnose a “water-fire” imbalance rooted in the Kidney!

Using a heart rate monitor, the astute endurance athlete will monitor their heart rate, keeping it below lactate threshold (at or below 80% of maximum heart rate) for most of their training. Essentially, workouts become more yin with increases in time spent with low heart rate activities. This, along with other similar styles of monitoring training programs, becomes one of the most effective ways to treat Kidney deficiency.

This leads to the obvious – the clinician needs to have a good working relationship with their patient’s coach and trainer. The practitioner may not have detailed knowledge of athletic training, this takes time and additional experience. But one should be able to collaborate in the process and be a “voice of yin” for the patient.

And finally, I have several comments on the formula Jia Wei Shao Yao Wan. I frequently use the formula Free and Easy Wanderer Plus from Golden Flower Chinese Herbs. In the tablet form, I find these products to be very effective, and compare favorably to herbal decoctions. And patient compliance is very reasonable. However, you can adapt the formula for your patient using either powders or raw herbs, as this may be your preferred way to prescribe these medicines. The benefit of this method is that you can add the tonic herbs discussed above to the base formula, and make other adaptations depending on the patient and how they present.

Let’s summarize what I find important in this article:

• Target the Liver for treatment of the athletic patient

• Consider Jia Wei Shao Yao Wan as your base formula

• Be cautious about treating the Kidney with the commonly used formulas

• Address the Kidney by modifying training and competing schedules

• Become more fluent in the language of athletic training

Have fun and enjoy supporting the athletic patient. It can bring joy and certainly add some variety to your day in the office! And don’t overlook the obvious – you need to get out to their place of training and competing to experience first-hand the influences that so effect their health and well-being.

The Formula: Chai Hu, Dang Gui, Bai Shao, Bai Zhu, Fu Ling, Zhi Gan Cao, Chi Shao, Mu Dan Pi, Zhi Zi, Yu Jin, Yi Mu Cao