Aquada (Er Miao San)-A Simple Botanical Combination With Miraculous Applications
Join us on a journey spanning 1800 years from the Su Wen, to Dr. Li Dong Yuan, to yours truly and in the process come to understand how the qi theory of the an ancient Chinese medical text holds up next to modern evidence. We explore the herbs er miao san (Aquada) in depth to better understand why this simple, yet powerful formula works from both traditional and biomedical lenses.
I have seen extraordinary clinical results with this simple, yet elegant formula. I’m going to take you through the history and pharmacology of the individual herbs in this formula, and then we will go through the formula as a whole. The formula’s name is Double Awesome Powder, Er Miao San. It uses two seemingly opposite herbs, which complement each other perfectly.
The first is an herb with a cold nature. Huang bai: Cortex Phellodendri. It's very bitter, which causes qi to rise in order to sink. Because of the degree of bitterness it has a cold nature. It goes to the kidney and bladder meridians. This is used for damp heat in the lower areas of the body. Basically if you have swamp body and are getting fungal infections in the lower half of the body, this herb will drain the swamp and Kill the fungus by way or urination.
To start off understanding this let's step back in time.
Around 9 centuries ago there was a wealthy entrepreneur called Wang Shan Fu. Part of his lifestyle involved entertaining influential people with lavish banquets and drinking rituals.
These marathons of drinking, feasting, and meetings are as part of East Asian life today as they were 9 centuries ago years ago.
It is a lifestyle I am intimately familiar with so there are details of Wang Shan Fu’s life which I can understand in a way that may be lost on those who don’t have as visceral of an understanding when it comes to this way of life.
These drinking rituals in East Asian society may look from the outside to be Dionysian affairs which lack temperance. In actuality, they are more often acts of self sacrifice on behalf of the larger group. I believe this context is important because it can lend valuable context into the challenges inherent in this lifestyle.
Imagine if you local court worked a bit like an auction house. Imagine having to bribe the judges and police so that they would actually enforce the law keeping your extended family safe. In addition picture having private security while traveling and guarding your fed ex packages from raiders. Good mercenaries don’t come cheaply and those who can hire better mercenaries may very well use them to rob you and prey upon your family. As a result of this social condition it becomes a necessity to attain power and wealth not for personal comfort, but for the support and safety of one’s clan. In fact, in rural China to this day much of this is the same or at least very similar although much improved with the recent reforms by President Xi. I have seen trucks laden with coal have to stop because brigands dug trenches across roads commandeering the 30k dollars worth of cargo once it stopped. Which police can you go to in these cases when 10k of that theft supports the local police?
In this world, which is much of the world today, and much of life throughout world history, this political leveraging requires armies of loyal friends and armies are expensive to maintain. In order to compete to ones safety there is an art to growing successful which requires teamwork and networking on a scale that is difficult for most western Europeans to comprehend. To get close with so many people, social lubricant is required in liberal doses.
The night begins with three drinks, one for heaven, earth, and humanity although what is verbalized may be regarding meeting new friends or being brothers for life or something of that sort.. 5-10 people may toast you. However much they drink, you should drink if you want to show that you have a gengzhi intent. Gengzhi is showing that you are with them through thick and thin. If you fail to drink as they do, then it may be a sign that you don’t respect them. In addition it is wise to return the toast them. As it progresses this can means anywhere from 13-20 shots in a night.
This is then followed by more drinking and singing. The Geisha types on zithers have been replaced with karaoke houses where maidens are employed strategically the entice the officials into drinking even more so they will be more likely to sign contracts the following day.
Once a banquet is over, the music is done, and everyone retires for the night, they are typically carried home from your carriage usually by a bodyguard as they tend to be strong, you do your best to drink tea to sober up so you can rehydrate, but many times people just pass out. I have been both the bodyguard carrying people, the live in doctor using formulas to help wealthy men, and the one being carried and redressed by servants so I know this drill from all angles.
The following day doesn’t bring the luxury of sleeping in. This isn’t a college homecoming drinking ritual where you can wake up at noon and then tube down a river in the afternoon. A successful night out means tea in the morning. Business details are carried out over tea and a failure to show up for tea the next morning around 9:00 displays a lack of discipline and internal fortitude
Now imagine this lifestyle with sleep deprivation over the course of months and years and it creates unique patterns of illness.
I have seen men with the same condition I will soon describe with Mr. Wang.
Wang discovered that after retiring for the evening he couldn’t pee. Instead his abdomen was hard and distended so that he could not sleep.
His distended abdomen became painful. The story describes his Yellow fluid weeping from his legs which were swollen with edema. His eyes started to bulge out as well.
He sent for a famous physician, Li Dong Yuan, one of the more prominent of the Jin-Yuan dynasty
Li thought of a statement from the Su Wen, written nearly a millennia earlier.
“Yin cannot generate without yang. Yang can not activate without yin. The urinary bladder is like the official in charge of rivers, it's where the fluids are stored.
Only when the urinary bladder attains gas transformation will the normal physiology return.”
This is an interesting concept. It's only when a certain gas arrives that can fluid exit (lets shelve this idea for now, because 2,000 years ago a scientific breakthrough seems to support it.) In the mean time Li Dong Yuan is using this idea 900 years after it was recorded in the medical treatise the Su Wen. Li dong yuan told the patient, you feasted too well. the inflammation accumulated from the food damaging the waters of your kidney, leading to dryness in the urinary bladder. Without urination the inflammatory fire rose leading to nausea,
He used a formula consisting mainly of Huang bai Cortex Phellodendri, zhimu Anemarrhena Rhizome, rougui cortex cinnamoni, and qian4 shi2 Euryale Seeds . After a while, the Wang Zong felt the burning pain in the pelvic floor, then urine rushed out like a busting dam. His edema went away soon after.
900 years later I would use this method myself on a Mr. Lin who lived the exact same lifestyle and as a result found himself in a very similar condition.
4 years ago I was once the live in doctor and bodyguard for Mr. Lin in Long Quan, Sichuan. A kung fu master and businessman. In the late summer the windows were all open. We had returned from a banquet, followed by karaoke, which was then followed with bbq and beer. We returned home at around 2am. I had taken my recovery herbs, drank as much water as I could hold and I laid my head down onto a spinning pillow. As i was going to sleep I could hear muffled groaning.
Because our apartments were positioned around a central courtyard I went to his room. You may be thinking that his wife would be there, but she had her own quarters with her extended family.
I went to his room and he was bleary. He showed me his distended belly.
I offered to help, but his pride was in the way. To go and get herbs for him would be to show weakness to the gossipy servants so we had to wait for the following day for the right tools and discretion. He was also black out drunk and not making good decisions. He spat blood onto the toilet. The blood was coming from his throat and his voice was hoarse.
I wrote the Rx and a loyal servant went to see it filled. Using Dr. Li Dong Yuan’s formula from 900 years earlier he was able to pee.
However the next day was another banquet at lunch with some government and military officials. As usual the morning teahouse meetings were followed by lunch and dinner banquets with heavy libations. In spite of the physical torture this created he persisted stoically.
Gout soon followed and his walking became painful. In private he would limp, but with others around he would walk as though he wasn’t in pain. He continued like this for the next few weeks until the national holiday when he could take a few days of rest and herbs to recover.
The principle herb in Dr. Li Dong Yuan’s formula is called Huang Bai
Let's unpack this herb a bit to unlock its secrets and see what other treasures are hidden inside.
Enhances GH mRNA expression
This may help break down fats, increase muscle, and have effects on the immune system.
Suppresses neural inflammation.
This is very important as neural inflammation is the key factor for just about every chronic illness of the central nervous system.
Inhibits acytlecholineesterase which increases the available acytlcholine, an important neurotransmitter.
In cases of neural damage mast cells flood in contributing to brain fog
This also influence the microglia. This is thought to influence two aspects of pain in fibromyalgia.
Hyperalgesia is the amplification of pain by the central nervous system, essentially "turning up the volume." It's why an injury hurts especially bad, and back pain you've had since before you were chronically ill became worse when fibromyalgia or chronic fatigue syndrome hit.
Allodynia is pain from something that normally doesn't cause pain. Mechanical allodynia is pain caused specifically by movement. That means gentle massage or something as little as the brush of clothing against your skin can cause intense pain.
Reduces nitric oxide
The effect of nitric oxide on the resting tone and the contractile behaviour of the external urethral sphincter: a functional urodynamic study in healthy humans.
This study shows a functionally relevant effect of nitric oxide on the resting tone and the contractile behaviour of the human external urethral sphincter in vivo while the fatigue properties did not changed significantly. Nitric oxide donors could offer a new pharmacological approach to treat urinary retention due to overactive or non-relaxing external urethral sphincter.
This echos the concept in the Su Wen of a gas being required to arrive at the bladder recorded 18 centuries before.
Too much or too little will block the effect. It required a sweet spot to allow the smooth muscle to relax and release the urine.
A nun of Mao Shan Daoism treated people. Mao Shan is known to be a deep school of Taoism, but also regarded with a little fear by outsiders. The words of Mao Shan conjure images of Chinese witches and curses. Because of the cultural connotations I’ll call this nun Revered Mother Witchy. She only treated those with lots of cash. Yolanda drove a BMW, had a different LV bag for every day of the week. The combination of her botox injections and tattooed eyebrows made her look perpetually grouchy.
One day a poor man went in asking for help with his paralyzed father, the old nun told him she would have to schedule him later…never in fact. Their people would contact his people…never.
A younger nun named Betty was a bit dim, but was moved to help them man.
She didn’t know anything about herbs, but felt compelled to do what she could.
In a well meaning effort to help she handed him a bushel of herbs with white flowers.
He took them home with gratitude. Then the young nun felt bad. What if she had given him the wrong medicines.
A few weeks later the poor man returned elated that his father was improving.
Revered Mother Witchy did her best to make a fake smile and later grabbed Dim betty by the arm asking which herb she had used.
It turned out that Betty had simply grabbed some extra herbs on her trip because they had white flowers and she thought they were pretty and couldn’t find them again.
Revered Mother Witchy beat Betty with a stick for her insubordination.
Betty cried in bed, got pissed, packed her bag and left the nunnery. She grabbed a bunch of cang zhu and left.
She went to a new city to specialize in paralysis. She soon found that cang zhu was hit or miss when used alone for paralysis, but for diarrhea and nausea it was an easy win. She focussed on this instead and grew successful enough that the herb she discovered is one of the most utilized in East Asia. Good work Betty. You may have been a useless employee, but you turned out to be of tremendous service to civilization.
Cang zhu’s NO signals
“When fungus attacks this plant, it signals volatile oils to kill the fungus. When you take this herb, you ingest these same fungicidal components”
Er miao is a rename by zhu dan xi, which was cang zhu san, he called it a double awesome powder. This name caught on because it's just superior branding. Following Zhu Dan Xi’s example of updating the name, we call it “Aquada” to help english speakers get a sense for its actions.
The warmth of cang zhu is kept in check by the cold nature of Huang bai. Huang bai goes to the kidney and bladder meridians which cover the upper and lower part of the body. Cangzhu goes to the spleen and st channels, is spicy, bitter, dramatic and warm. This makes a solid herbal pair. The theory behind it is that the warm cang zhu which lifts upward can give Huang bai’s cold and descending nature a back stage pass to the upper body. Huang bai returns the favor, offering cang zhu a ticket to the lower body. Like yin and yang they support each other and keep each other from going too far. This means that the power of this formula can be high, along with its safety. Without this underlying yin/yang balance one can expect many side effects. This brilliant blending based on an underlying theory and tested with real world application is one of the reasons this formula can be used so broadly.
Curiously, I use this formula quite a bit for chronic pain, particularly when exacerbated by gut dysbiosis. I will often see people who have had an injury which won’t heal. When this comes along with obesity, then I will use aquada and it's very successful.
I have also used this formula to help patients get off of metformin. This formula helps with islet beta cell repair and blood sugar regulation.
I also use it for those with gout.
Apparently it works on uric acid in mice as well. Er Miao:
A Chinese herbal medicine Ermiao wan reduces serum uric acid level and inhibits liver xanthine dehydrogenase and xanthine oxidase in mice.
Intestinal Immune System Modulating Polysaccharides from Rhizomes of Atractylodes lancea
Effect of the rhizomes of Atractylodes lancea and its constituents on the delay of gastric emptying
Intestinal motility enhancing effect of Atractylodes lancea rhizome.
Hinesol, a compound isolated from the essential oils of Atractylodes lancea rhizome, inhibits cell growth and induces apoptosis in human leukemia HL-60 cells
Structure of oligosaccharide side chains of an intestinal immune system modulating arabinogalactan isolated from rhizomes of Atractylodes lancea DC
Comparison of the anti-ulcer activity between the crude and bran-processed Atractylodes lancea in the rat model of gastric ulcer induced by acetic acid