A Trek Through Yi Gan San aka Yokukansan

Once upon a time in China, during the Ming dynasty almost 500 years ago, there was a book named “Synopsis for Protecting Infants”. In this book was an herbal formula called Yi Gan San or “Restrain the Liver Powder”. Although written about in 1555, it is agreed that this formula was being used a thousand years before this. So what is it?

Seven herbs make up Yi Gan San:

• Chao Hu
• Bai Zu
• Fu Ling
• Dang Gui
• Chaun Xiong
• Gou Teng
• Gan Cao.

Yi Gan San was used mainly for children

• soothing spasms
• fevers
• tooth grinding
• palpitations with anxiety
• restless sleep
• low appetite
• bloated abdomens. ⁽¹⁾ 

In Traditional Chinese Medicine (TCM) terms, these symptoms are caused by wind and damp in relation to the Liver. TCM diagnoses sound like the weather report and for good reason. Health and imbalances are all part of the natural phenomena of life. It is natural to use the language of nature to describe them.

In TCM theory, there are five elements: Wood, Fire, Earth, Metal, and Water. These organize concepts for diagnosis and treatment. Liver is associated with the element of Wood, specifically bamboo. Wood is disturbed by wind and makes Wind. If Wood gets too dry or is not nourished, wind occurs. In the body, Wind causes spasms and uncontrollable movements. Choosing bamboo to represent Wood tells us about Liver energy. Bamboo is very flexible. It can easily be bent in any direction without breaking. When bamboo is bent and released, the force created is considerable.

In the Martial Arts, the Wing Chun Style is built around bamboo energy: yielding, flexible and explosive. The ability to bend without breaking is bamboo’s gift/curse to the Liver. The Liver is prone to stagnation because it will bend and bend. This is exhibited in upper body tension, temporomandibular (TMJ) disorder, anxiety, and depression. When it does snapback, there are angry outbursts, sudden headaches, and palpitations. When the Liver is stagnant, dampness accumulates.⁽¹⁾ Excess dampness manifests as phlegm. This causes symptoms which include fatigue, digestive weakness, and foggy thinking.

Yi Gan San is called Yokukansan in Japan.

It has had a place in the traditional Kampo system of Japanese herbal remedies since 1555. In the beginning, it helped infants who suffered from night crying, restlessness, and convulsions. Use expanded to patients of any age with nervousness, irritability, sleeplessness, twitching eyelids and shaking limbs. In recent times Yokukansan is used to treat the psychological and physical symptoms of dementia. In particular, to treat aggression associated with Alzheimer’s. ⁽²⁾

Looking at what an herbal formula effectively treats gives a feel to its scope and focus. A collection of symptoms indicate a condition with a name. Science loves to name things. The names of some conditions that are helped by Yi Gan San are Parkinson’s, Alzheimer’s, Schizophrenia, and tardive dyskinesia*. The language of TCM says the shaking of Parkinson’s and uncontrollable movements of tardive dyskinesia is wind. Alzheimer’s and Schizophrenia and is wind and phlegm in the brain. The phlegm or damp impedes rational thought. A common and temporary example of this is the difficulty we have trying to think with a common cold. The wind adds an unpredictable and sometimes violent element in behavior and emotions.

Japanese based studies show Yokukansan having beneficial results with a variety of conditions:

• visual hallucination due to vision loss ⁽³⁾
• restless legs syndrome ⁽⁴⁾
• chronic urticaria (5)
• behavioral and psychological symptoms of Alzheimer’s disease (6)
• behavioral and psychological symptoms of Parkinsonian dementia (7).

Note all are wind and phlegm disturbances.

Mice and rat studies allow for more control over variables and different data. The mice were bred to have brains with the same Beta-amyloid plaque as Alzheimer’s patients. The mice exhibited memory and social problems, which were relieved by Yokukansan. The authors concluded the formula could be useful in the treatment or prevention of Alzheimer’s. ⁽⁸⁾

Zinc deficiency produces a depressed, joyless, and aggressive mouse. For the study, isolated zinc-deficient mice had their space invaded by another rat. Mice taking Yokukansan had none of the glutamate toxicity that their untreated peers presented. Glutamate toxicity is linked to Alzheimer’s. Glutamate sends signals between nerve cells. Under stress, it accumulates. Under normal conditions, it plays an important role in learning and memory. ⁽⁹⁾

Rats were given vascular dementia exhibit sleep disturbance. The rats slept better after two weeks of Yokukansan. The authors concluded Yokukansan might reduce this sleep disturbance by preventing neuroinflammation.⁽¹⁰⁾ An anxious rat will shake like a dog. This action was used to document anxiety while performing tasks and tests. Normal rats, and rats with cerebrovascular dementia exhibited less anxiety when taking Yokukansan.⁽¹³⁾ Five mice given injections of Beta-amyloid protein had learning disturbances and aggressiveness. Yokukansan imbibing mice had learning ability restores and they stopped being aggressive. ⁽¹²⁾

Through the discipline of science, we can examine the cellular response to Yi Gan San. Research reveals some insights into exactly how it works in the brain. Old rats are anxious and spend a long time doing mazes. Anxiety was measured by the number of droppings during the maze. Learning and memory by the amount of time spent in the maze. With Yi Gan San, there were fewer dropping and less time spent in the maze. Additionally, the abnormal excess of neurotransmitters in the brain was normalized. ⁽¹⁵⁾

Glutathione

Glutathione is critical to brain function. Low levels are associated with cancer, cardiovascular disease, and mental illness. In the brain, low levels lead to a miss-firing of neurons, causing several types of mental disorders and neurological disorders.  The brain uses 20% of the body’s oxygen but is 2% of the body’s composition making for a toxic waste dump if not cleared out. The antioxidant Glutathione keeps metabolic waste from building up in the brain cells. This metabolic waste includes the glutamate end neurotransmitters noted in the previous studies. Cells damaged due to chronic excess waste collect Beta-amyloid protein plaque. This plaque correlates with the development of Alzheimer’s.

When the body is healthy and well-nourished Glutathione is naturally produced. (T) Production is easily disrupted. The ability to produce Glutathione decreases with age. Chronic low-level stress is the primary cause of Glutathione depletion. Other causes are poor diet, stress, medications, infections and radiation and other toxins. Oral supplements are ineffective in raising cellular Glutathione levels. The molecule is too big to enter the cell. The bio-chemical reaction that creates Glutathione happens in the cytoplasm of cell wall. Glutathione needs three amino acids amino acids: cysteine, glutamine, and glycine. These are the precursors. They are small enough to enter the cytoplasm of the cell. Using adenosine triphosphate (ATP) as energy for creation they combine to become Glutathione. This synthesis is initiated either by a precursor or genetically. Yi Gan San is not supplementing any precursors. It is regulating glutathione restoration through the genetic gateway. (H) maybe (G).

Yi Gan San, aka Yokukansan, restores Glutathione levels in the brain by catalyzing the inherent glutathione production system. Restoration of Glutathione levels helps with emotional and neurological disorders. Yi Gan San is a Glutathione mine for neurological conditions. Whether the imbalance is based in the mental, emotional or physical realms, Yi Gan San may help restore proper neurological function. A condition could have a long name like “tardive kinesis” or just be childhood night terrors, Yi Gan San doesn’t care so much so you can even call it Yokukansan!

Use herbs wisely

Before taking this formula to consult with a knowledgeable practitioner. Chinese herbalism is based on treating the pattern of symptoms, not a western medical diagnosis. If you have questions or special considerations, please work with your practitioner. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Yi Gan San offered as granules or capsules. Choose the one which is easiest for the patient to take. Serving size is according to instructions on the label or as per your practitioner. A close relative to Yi Gan San is Yi Gan San Jia Chen Pi Ban Xia. This would be a good choice if dampness is the main problem. Symptoms of this are the tongue is coated thick and white, fatigue, confused thinking, drooling, cough with phlegm.

References

1 Chinese Herbal Medicine Formulas & Strategies 2nd Edition, Scheid, Bensky, Ellis, Barolet, Eastland Press
2 Yokukansan: A Traditional Kampo Formula for Dementia
3 Yokukansan (TJ-54) for treatment of very-late-onset schizophrenia-like psychosis: An open-label study,
4  Shinno, Hideto & Yamanaka, Mami & Ishikawa, Ichiro & Danjo, Sonoko & Nakamura, Yu & Inami, Yasushi & Horiguchi, Jun. (2009). Successful treatment of restless legs syndrome with the herbal prescription Yokukansan. Progress in neuro-psychopharmacology & biological psychiatry. 34. 252-3. 10.1016/j.pnpbp.2009.11.007.
5 Wang, Y., Du, L. & Zhu, Y. Chin. J. Integr. Med. (2017) 23: 566.
6 Kazunori Okahara et al, Effects of Yokukansan on behavioral and psychological symptoms of dementia in regular treatment for Alzheimer’s disease, Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 34, Issue 3, 2010, Pages 532-536, ISSN 0278-5846
7 Tsuyoshi Miyaoka, Motohide Furuya, Jun Horiguchi, et al., “Efficacy and Safety of Yokukansan in Treatment-Resistant Schizophrenia: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Trial,” Evidence-Based Complementary and Alternative Medicine, vol. 2015, Article ID 201592, 11 pages, 2015.
8 H.Fujiwara et al., Yokukansan, a traditional Japanese medicine, ameliorates memory disturbance and abnormal social interaction with anti-aggregation effect of cerebral amyloid β proteins in amyloid precursor protein transgenic mice, Neuroscience Volume 180, 28 April 2011, Pages 305-313, doi.org/10.1016/j.neuroscience.2011.01.064
9 Haruna Tamano, Fumika Kan, Naoto Oku, Atsushi Takeda, “Ameliorative effect of Yokukansan on social isolation-induced aggressive behavior of zinc-deficient young mice”, Brain Research Bulletin Volume 83, Issue 6, 20 November 2010, Pages 351-355, doi.org/10.1016/j.brainresbull.2010.08.013
10 Ah-ReumDoo et al., “Neuroprotective effects of an herbal medicine, Yi-Gan San on MPP+/MPTP-induced cytotoxicity in vitro and in vivo”, Journal of Ethnopharmacology, Volume 131, Issue 2, 15 September 2010, Pages 433-442
11 Nogami, A., Sakata, Y., Uchida, N. et al. J Nat Med (2011) 65: 275. doi.org/10.1007/s11418-010-0487-5
12 “Research shows herbal benefit in Parkinson’s Disease”, Healthcare Medical Institute, 24 July 2010,
13 Nogami, A., Sakata, Y., Uchida, N. et al. J Nat Med (2011) 65: 275. doi.org/10.1007/s11418-010-0487-5
14 Yi-Gan San Restores Behavioral Alterations and a Decrease of Brain Glutathione Level in a Mouse Model of Schizophrenia
15 Mizoguchi, K., Tanaka, Y. & Tabira, T. Anxiolytic effect of a herbal medicine, yokukansan, in aged rats: involvement of serotonergic and dopaminergic transmissions in the prefrontal cortex. Journal of ethnopharmacology 127, 70-76 2010.