Er Xian Tang — Two Immortals Decoction

Overview

Er Xian Tang — Two Immortals Decoction — was developed in the 1950s at the Shanghai College of Traditional Chinese Medicine specifically for menopausal syndrome. Its name refers to its two principal herbs, Xian Mao (Curculigo) and Yin Yang Huo (Epimedium), both of which powerfully tonify Kidney Yang. The formula addresses the complex mixed pattern of Kidney Yin and Yang deficiency with rising Empty Fire that is characteristic of the menopausal transition.

TCM pattern

Er Xian Tang is prescribed for Kidney Yin and Yang deficiency with Empty Fire rising, producing an apparently contradictory combination of hot and cold signs: hot flushes alternating with cold sensations in the lower back and limbs, night sweats alongside fatigue, irritability alongside weakness. This mixed pattern is extremely common in perimenopausal and menopausal women.

Key herbs

Xian Mao (Curculigo orchioides rhizome) — powerfully warms Kidney Yang; one of the two “immortals”
Yin Yang Huo (Epimedium grandiflorum herb) — tonifies Kidney Yang and strengthens the sinews; the second “immortal”
Ba Ji Tian (Morinda officinalis root) — tonifies Kidney Yang and strengthens the lower back and knees
Dang Gui (Angelica sinensis root) — nourishes Blood and Liver Yin; balances the warming Yang herbs
Huang Bai (Phellodendron amurense bark) — clears Empty Fire from the Kidney without damaging Yang
Zhi Mu (Anemarrhena asphodeloides rhizome) — nourishes Yin and clears Empty Fire; works synergistically with Huang Bai

Conditions treated

Menopausal and perimenopausal symptoms — particularly effective for the mixed hot-cold pattern of hot flushes with fatigue and cold lower back
Hypertension in menopausal women where Kidney Yin and Yang deficiency underlies the pattern
Premature ovarian insufficiency and elevated FSH levels
Insomnia, night sweats and hot flushes in perimenopausal women