Liang Di Tang (两地汤) — Two Rehmannia Decoction

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Cautions

Overview

Liang Di Tang — the “Two Rehmannia Decoction” (referring to Sheng Di and Di Gu Pi) — is from Fu Qing-zhu’s Fu Qing Zhu Nu Ke (Fu Qing-zhu’s Gynaecology). It treats menstrual bleeding from Yin deficiency with empty Heat, where lack of cooling fluids allows Heat to harass the Blood and push periods early and heavy. Unlike Heat-pattern formulas that use draining cold herbs, this formula nourishes Yin to anchor the empty Heat at the source.

I prescribe Liang Di Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Liang Di Tang is prescribed for Yin deficiency with empty Heat causing menstrual irregularity:

• Periods come early (cycle shorter than 24 days)
• Heavy or moderate flow, bright or slightly dark red
• Possibly with small clots
• Five-palm Heat, low-grade afternoon flushes
• Dry mouth and throat
• Insomnia^[8], mild night sweats
• Dry skin, scant cervical mucus
• Tongue — red, scant coat or peeled
• Pulse — thin, rapid

Key herbs

1. Sheng Di Huang (Rx. Rehmanniae, 30g) — cools Blood; nourishes Yin
2. Di Gu Pi (lycium bark, 9g) — clears Heat from the Yin (empty-Heat); cools Blood
3. Xuan Shen (Rx. Scrophulariae, 15g) — nourishes Yin; cools Blood; clears upward-floating Yin-deficient Heat
4. Mai Men Dong (Rx. Ophiopogonis, 9g) — nourishes Lung and Stomach Yin
5. Bai Shao (Rx. Paeoniae Alba, 15g) — nourishes Liver Blood and Yin
6. Shu Di Huang (Rx. Rehmanniae Praeparata) and Dang Gui (Rx. Angelicae Sinensis) — nourish Blood

Formula actions

1. Nourishes Yin
2. Cools Blood and stops empty-Heat bleeding
3. Regulates the menstrual cycle

Conditions treated

1. Early-cycle heavy menstrual bleeding with Yin deficiency — see heavy periods
2. Short menstrual cycle with Yin-deficient pattern
3. Perimenopausal heavy bleeding with empty Heat
4. Climacteric heavy periods with hot flushes^[3]
5. Functional uterine bleeding with Yin-deficient pattern
6. Menstrual disorders in PCOS with Yin-deficient pattern (rare)

Cautions

Heavy menstrual bleeding always warrants medical investigation to exclude fibroids^[20], polyps, hyperplasia, malignancy or coagulation disorders.

Not appropriate for Spleen-Qi-deficient bleeding (pale dilute blood, fatigue^[9], pale tongue) or cold-pattern bleeding — the cold nourishing herbs damage Spleen Yang.

Always consult a qualified Chinese herbalist registered with the RCHM.

Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide.

References

[3] Li M, Hung A, Lenon GB, Yang AWH. Chinese herbal formulae for the treatment of menopausal hot flushes: A systematic review and meta-analysis. PLoS One. 2019 Sep 19;14(9):e0222383. https://doi.org/10.1371/journal.pone.0222383. PMID: 31536531.

[8] Hu J, Teng J, Wang W, Yang N, Tian H, Zhang W, Peng X, Zhang J. Clinical efficacy and safety of traditional Chinese medicine Xiao Yao San in insomnia combined with anxiety. Medicine (Baltimore). 2021 Oct 29;100(43):e27608. https://doi.org/10.1097/MD.0000000000027608. PMID: 34713840.

[9] Wang YY, Li XX, Liu JP, Luo H, Ma LX, Alraek T. Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials. Complement Ther Med. 2014 Aug;22(4):826-33. https://doi.org/10.1016/j.ctim.2014.06.004. PMID: 25146086.

[20] Chen NN, Han M, Yang H, Yang GY, Wang YY, Wu XK, Liu JP. Chinese herbal medicine Guizhi Fuling Formula for treatment of uterine fibroids: a systematic review of randomised clinical trials. BMC Complement Altern Med. 2014 Jan 2;14:2. https://doi.org/10.1186/1472-6882-14-2. PMID: 24383676.