Agar 35 is a classical Tibetan herbal formula for the treatment of wind disorders accompanied by heat. It calms the mind, balances the central channel, supports sleep, and restores positivity in the mind. It is a more appropriate alternative to the equally popular formula, Bimala, especially when heat needs to be cleared.

Agar 35 is one of my favorite formulas for vata-pitta constitutions, especially in the Spring season. From the perspective of five phase theory, I see this as an excellent formula for supporting the Wood phase element. Wood corresponds to the season of Spring, the Liver and Gallbladder, the eyes, the power of birth, and windy climates. The Chinese concept of “Wood” encapsulates the humoral qualities of vata (wind, upward-moving, creative) and pitta (vision, Liver / Gallbladder).

Bob Flaws gave a valuable commentary on Agar 35 from a Chinese medical perspective. I have excerpted the bulk of his commentary below. Note that his reference to “lung” is not the organ “lung” but a romanization scheme for a Tibetan word, usually transliterated as “rlung” (pronounced “looong”). Rlung is identical to the Chinese concept of qi and the Ayurvedic concept of vata as well as prana.

Agar-35 is a very commonly prescribed Tibetan ready-made medicine which includes a number of ingredients or close relatives of ingredients which are common to Chinese medicine as well. Agar-35 is used to treat what Tibetan medicine refers to a lung disease complicated by heat and blood (stasis). The Tibetan medical concept of lung corresponds closely to the Chinese medical concept of qi. In particular, these pills are famous for treating anxiety and nervousness. Since this is both a very effective and a safe, gentle formula, I think it might be useful to look at this medicine from the point of view of Chinese medicine.

In Chinese medicine, anxiety disorders are mostly seen as a combination of liver-spleen disharmony resulting in malnourishment of the heart spirit. Thus the heart spirit is bu an or not quiet. This basic disease mechanism is then often complicated by phlegm and heat harassing the heart spirit above. Further, if there is enduring or severe qi stagnation, this may easily lead to blood stasis. This mutual engenderment of blood stasis is all the more likely if the flow of qi and blood is also blocked and obstructed by phlegm dampness. In this case, the phlegm is to any or all of four factors. 1) Due to spleen vacuity failing to move and transform water fluids, these may collect and transform into damp evils. If these damp evils linger and endure, then they congeal into phlegm. 2) liver depression qi stagnation may lead to the collection of water fluids and, therefore, to the congelation of phlegm, remembering that the qi moves water fluids. So, if the qi stops, water fluids stop. 3) Since water fluids and the blood move together, stoppage of one may lead to stoppage and blockage of the other. Hence, blood stasis may lead to phlegm engenderment. And 4) depressive heat due to liver depression qi stagnation may stew the body's juices and cook them into phlegm. In terms of the heat mentioned above, this is where it comes from, liver depression transforming heat. This heat accumulates in the liver and gallbladder, but it is also commonly shifted to the stomach, heart, and/or lungs.

In terms of Chinese medical pattern discrimination, what we then have is a so-called heart-gallbladder qi timidity pattern complicated by heat and possible blood stasis. This is a not uncommonly seen pattern in clinical practice, and it is the main pattern in the contemporary Chinese medical literature associated with general anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). The treatment principles for this multi-element patterns are to course the liver and rectify the qi, fortify the spleen and supplement the qi, nourish the heart and quiet the spirit, transform phlegm, clear heat, and quicken the blood. Because it is common to see not only a liver-spleen disharmony but a liver-stomach disharmony as well, we can also add the treatment principles of downbearing counterflow and harmonizing the stomach.

This formula is called Agar-35 because its main ingredient is Agaru (Sanskrit), A-gar (Tibetan), or Chen Xiang (Lignum Aquilariae) and it contains 35 ingredients altogether. This is a common naming convention for formulas in Tibetan medicine. Because Tibetans lived very spread out in a vast and sparsely populated territory, Tibetan medicine makes heavy use of ready-made pills. This is because Tibetans may only see their doctor once or twice a year. Therefore, Tibetan formulas tend to contain relatively low doses of each ingredient but many ingredients. By administering small doses of many different medicinals which all accomplish a similar group of functions, A) there is less likelihood for side effects from any one ingredient, and B) should the patient's symptoms change over time, one or more ingredients should cover any new symptoms. Further, because of the low doses involved, Tibetan doctors can use some very powerful but otherwise toxic ingredients, such as Ma Qian Zi (Semen Strychnotis). Therefore, such a large formula achieves very comprehensive, rounded effects. In fact, this formula not only treats the liver, spleen, stomach, and heart, but also takes into account secondary relationships between these four main organs and the lungs, large intestine, and kidneys. For instance, the lungs and liver together control the movement of the qi throughout the body, the lungs providing the motivating power and the liver allowing the qi to flow. Similarly, the liver can only do its function of governing coursing and discharge if it is warmed and steamed by kidney yang/life-gate fire. So all in all, this is a very complex and subtle formula when looked at from a Chinese medical point of view which goes beyond standard Chinese formulas for a heart-gallbladder qi timidity pattern, such as Shi Yi Wei Wen Dan Tang (11 Flavors Warm the Gallbladder Decoction).

It is my experience that sometimes Tibetan formulas are able to treat conditions more effectively than Chinese formulas, although they tend to work more slowly over an extended period of time. For instance, the typical course of treatment with Agar-35 is 1-2 months. In any case, I think it is useful to look at Tibetan medical formulas from a Chinese medical point of view in order to gain new insights into the possible practice of Chinese medicine.