Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)
Keywords: Tibetan medicine, Chinese medicine, Semde
The Tibetan medical formula Sems-kyi bDe-skyid (Sem-kyi De-kyid or Sem-de) is meant for the treatment of anxiety, stress, irritability, lack of concentration, mental dullness, and various other mental disorders and its name simply translates a “mental happiness” or “happiness of the mind.” In Tibetan medicine, this formula is indicated for the treatment of all sorts of lung (rLung) disorders. In terms of Chinese medicine, the Tibetan concept of lung or wind is analogous to qi. It is the motivating force within the body which promotes movement, metabolism, transformation, and change. Similar to Chinese qi diseases, lung diseases are due to counterflow of one or more of the five types of wind. In particular, Sem-de is indicated for the treatment of a condition called srog-lung in Tibetan. The srog-rtsa is the central channel in the body analogous to the Chinese concept of the chong mai or penetrating vessel. Its Tibetan name means the “life channel” or “life vessel,” (srog = life; tsa = channel or vessel). Just as with the Chinese chong mai, this channel is closely connecting with the heart and one’s mental-emotional function as well as one’s most basic vitality. If, due to stress, the wind within this vessel, the srog-lung or life-wind, becomes depressed and accumulates pathologically, it may counterflow upward along the srog-tsa thus harassing the heart above. In Chinese medicine, we would say that this causes the heart spirit to stir restlessly (xin shen dong bu an), and this is experienced subjectively as mental-emotional restlessness, anxiety, easy fright, lack of concentration, insomnia, and heart palpitations. The fact that the Tibetan medical condition of srog-lung is equivalent to a Chinese medical qi disease is attested to by its being caused by stress (i.e., unfulfilled desires), the foremost cause of liver depression qi stagnation, and by its causing irritability. Irritability is a pathognomonic symptom of liver depression qi stagnation. There simply is no irritability without some element of liver depression qi stagnation. In fact, we can say that irritability is the subjective sensation of liver depression.
As we know from Chinese medicine, when the liver becomes depressed and the qi becomes stagnant, the stagnant qi must eventually go somewhere. It cannot simply accumulate in the liver indefinitely. Because it is yang, it tends to counterflow upward. Because the liver and stomach have a specially close relationship, upward counterflow of the liver qi can also cause upward counterflow of the stomach qi. (This may also be described as a liver-stomach disharmony due to horizontally counterflowing liver qi.) When this upwardly counterflowing qi or “wind” gets to the heart, it causes the heart qi or spirit to stir frenetically (dong wang, i.e., move excessively). In Tibetan medicine, this is explained by the saying that the lung or wind is the horse upon which the mind rides. If the wind rushes about frenetically, then the mind will also stir abnormally. In Chinese medicine, we also know that, if the liver and stomach qi counterflow upward, often the spleen qi becomes vacuous and weak. This is due to the liver also assailing the spleen. Because the spleen is the source of the engenderment and transformation of blood, spleen vacuity may also leave the heart blood malnourished and the heart spirit malconstructed. This may lead to insomnia on the one hand and difficulty concentrating and mental dullness on the other. Further, because the spleen and kidneys are mutually rooted, spleen vacuity may lead to a kidney yang vacuity. In this case, the person suffers from cold hands and feet, is easily chilled, and their general condition is aggravated by exposure to cold.
If we analyze the ingredients in Sem-de as if they were Chinese medicinals (which, in fact, a number are), I think we will see that the above scenario is exactly what this formula attempts to treat from a Chinese medicinal point of view.
Aquilaria agollocha (Chen Xiang, Ligunum Aquilariae): Qi-rectifier; acrid, bitter, warm, aromatic; enters the kidneys, spleen, stomach; warms the spleen and kidneys, downbears counterflow, assists the kidneys grasp or absorb the qi.
Mucuna prurita: Qi-rectifier, sweet and warm; enters the spleen and kidneys; warms the middle and harmonizes the stomach, warms the kidneys and invigorates yang. This ingredient is only used locally in some specific areas of China as a substitute for Dao Dou (Semen Canavaliae). In my opinion, this ingredient deserves much greater attention and use in its own right. One of its known constituents is L-dopa – hence its pronounced spirit-quieting, sinew-soothing effects.
Myristica fragrans (Rou Dou Kou, Fructus Myristicae): Astringing & securing med; acrid, warm; enters the large intestine, spleen, and stomach; warms the spleen and stomach, moves the qi, secures the intestines. In Tibetan medicine, this ingredient is specific for treating srog-lung. In other words, it specifically rectifies the qi in the srog-tsa (chong mai).
Saussurea lappa (Mu Xiang, Radix Auklanidae): Qi-rectifier; acrid, bitter, warm; enters the gallbladder, large intestine, spleen, stomach, and triple burner; moves the qi and stops pain, fortifies the spleen and disperses (food) stagnation; therefore, it harmonizes the liver and spleen. Most practitioners overlook the fact that this medicinal does supplement the spleen qi, not just rectify the liver qi.
Melia composite (Chuan Lian Zi, Fructus Toosendam): Qi-rectifier; bitter, cold, slightly toxic; enters the bladder, liver, small intestine, and stomach; clears heat, rectifies the qi, stops pain
Ferula jaeschkeana (A Wei, Asafoetida): Stagnation-disperser (as in food stagnation); bitter, acrid, and warm; enters the liver, spleen, and kidneys; disperses accumulations, kills worms; treats concretions and conglomerations, glomus and lumps, descends malign qi (i.e., nausea)
Eugenia caryophylla (Ding Xiang, Flos Caryophylli): Interior-warmer; acrid, warm; enters the kidneys, spleen, and stomach; warms the center, harmonizes the stomach, stops hiccup, nausea, and vomiting, invigorates kidney yang
Piper nigrum (Hu Jiao, Fructus Piperis Nigri): Interior-warmer; acrid, hot, enters the large intestine and stomach; warms the middle and scatters cold, moves the qi and stops pain
Piper longum (Bi Ba, Fructus Piperis Longi): Interior-warmer; acrid and hot; enters the stomach and large intestine; warms the middle and scatters cold, moves the qi and stops pain
Hedychium spicatum: A type of pepper; acrid and warm; warms and harmonizes the stomach, a qi and phlegm medicinal
Aconitum spicatum (some relative of Chuan Wu, Cao Wu, or Fu Zi, Radix Aconiti): Interior-warmer; acrid, hot, toxic; enters the heart, kidneys and spleen; rescues yang desertion, supplements the life-gate fire, guides the actions of other medicinal into the 12 channels, dispels cold damp painful impediment
Lepus Pectus Pectorus: A blood supplement which nourishes and constructs the heart spirit
Bos Grunniens Lipid: A blood and yin supplement
Molasses: A qi supplement which also relaxes the liver via its sweetness
Black salt: Guides the medicinals to move downard
Thus we can see that this formula mainly consists of qi-rectifying and stomach-harmonizing medicinals to downbear counterflow. These then are combined with medicinals which warm and supplement the spleen and kidneys as well as nourish the blood. Perhaps the unique thing about this formula (which Chinese doctors do not seem to recognize) is that there can be upwardly counteflowing qi harassing the heart with a spleen-kidney yang vacuity below but without any discernable heat also harassing the heart spirit. In any case, I believe that this formula contains enough standard Chinese medical ingredients that some thought should be given to its inclusion within our repertoire. The recommended Tibetan medical dose of this medicine is 2-3 grams per day taken with warm water or hot broth.
Copyright © Blue Poppy Press, 2008. All rights reserved.
1. Tsarong, T.J., Handbook of Traditional Tibetan Drugs, Tibetan Medical Publications, Kalimpong, 1986, p. 72-73
2. From a Chinese medical point of view, all stress is the result of unfulfilled desires Ð either not getting what we want or getting what we do not want. Desire is the subjective sensation of the movement of qi. Our qi moves towards that which we positively desires and away from that which we negatively desire. Since the free movement of the qi is controlled by the coursing and discharge of the liver, anything which inhibits the free flow of qi damages the liver, thus resulting in liver depression and qi stagnation. Interestingly, the Chinese word for free flow, tong, also translates as Òto communicate.Ó If our qi flows freely to that which desire, we communicate with that object of desire.