2. Danggui Liuhuang Tang ("Secrets of the Orchid Chamber")

[Composition] Danggui, Rehmannia glutinosa, Shu Di, Coptis chinensis, Scutellaria baicalensis, Phellodendron amurense, each in equal parts; Astragalus membranaceus doubled.

[Administration] Coarsely ground into powder, 15 g each time, decocted in water and taken orally.

[Indications] Pathogenic heat mixed with deficient heat.

[Symptoms] Red face and dry lips, difficulty in defecation and urination, bone steaming with profuse sweating, red tongue and rapid pulse.

[Functions] Draining fire and nourishing yin, consolidating the exterior and stopping sweat.

[Formula Analysis] In the late stage of febrile diseases, pathogenic heat remains; yin fluids are severely depleted, and deficient heat is active internally. The former is real fire, the latter is deficient heat, and their combination creates this condition. With remaining pathogenic heat, the face becomes red and the lips dry, and defecation and urination become difficult; with deficient heat active internally, bone steaming and nocturnal sweating occur. In this formula, the three Huang herbs are bitter and cold, draining the remaining pathogenic heat; the two Di herbs nourish yin and calm the internal deficient heat, together achieving the effect of draining fire and nourishing yin as the principal herbs. When yin is deficient internally, sweat occurs; when pathogenic heat remains, excessive sweating occurs, so sweating is an important manifestation of this condition. This formula emphasizes Astragalus membranaceus to consolidate the exterior and stop sweat, which can be considered an auxiliary herb. Danggui nourishes blood and promotes circulation, serving as an adjunct treatment.

[Clinical Modifications] Add Cortex Lycii, White Peony, Oyster Shell, Ephedra root, Floating Wheat, and Glutinous Rice Root to enhance the sweat-stopping effect; in severe cases, add Anemarrhena asphodeloides, Tortoise Shell, and Turtle Shell.

[Reference Materials] ① The heart stores blood internally, while sweat emerges externally; sweat is the liquid of the heart. Sweating upon waking is spontaneous sweat, caused by weak defensive qi that fails to consolidate; sweating during sleep is nocturnal sweat, caused by deficiency of yin essence and disturbance of fire. But why does sweat occur during sleep when yin is deficient, while there is no sweat upon waking? Because during sleep, defensive qi flows in the yin aspect, and since defensive qi is weak, sweat occurs; upon waking, defensive qi returns to the yang aspect, and defensive qi is restored. The two Di herbs nourish yin and replenish blood, while Danggui draws them into the heart; the three Huang herbs are bitter, draining the hidden fire in the yin aspect, calming the fire, keeping the blood quiet and preventing sweat from emerging, thus consolidating the exterior—therefore, Astragalus membranaceus is added to consolidate it. ("Convenient Reading of Formulas") ② Cai Xiaohong, female, 8 years old. Ten days ago, she had persistent fever that never subsided, reaching 39°C–40°C every night, nearly dawn, with profuse nocturnal sweating, then dropping to around 38.5°C, dry mouth, tongue sores, and restlessness. Examination revealed a slippery, rapid pulse, a red tongue with thin, dry, and parched coating, and a bright red tip. The prescription was Danggui Liuhuang Tang with Lotus Seed Heart, Ophiopogon japonicus, and Ephedra root, five doses were administered, nocturnal sweating completely stopped, nighttime fever subsided, then switched to Zhi Bai Di Huang Tang for complete recovery.

[Commentary] This formula is used for fever and nocturnal sweating in tuberculosis, rheumatism, and hematological diseases.

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Chapter Six: Heat-Clearing Agents

Heat is one of the six exogenous pathogenic factors and a major cause of exogenous diseases. The "Plain Questions: Discussion on the Five Movements" states: "In heaven, it is heat; on earth, it is fire... Its qi is heat." It is evident that heat and febrile diseases are similar in nature, so heat-clearing methods can also be used to treat heat-related conditions. Previous scholars said that "heat is essentially a summer disease," with spring preceding summer, where wind predominates, making heat prone to combine with wind; after summer comes long summer, where dampness dominates, making heat prone to combine with dampness; heat is a febrile disease, so it easily damages yin; heat qi communicates with the heart, and sweat is the liquid of the heart, so heat-related conditions often involve excessive sweating, which depletes qi. For pure heat conditions, heat-clearing is appropriate; for heat combined with wind, heat-dispelling and exterior-releasing methods are suitable; for heat combined with dampness, heat-clearing and dampness-draining methods are appropriate; for heat that depletes qi, heat-clearing and qi-tonifying methods are appropriate.

1. Xiangru Powder ("Harmonized Formulas Bureau")

[Composition] Xiangru 500 g, Magnolia bark (prepared with ginger) 250 g, White Broad Bean 250 g

[Administration] Coarsely ground into powder, 9 g each time, decocted in water and taken orally. In modern times, it is made into a decoction and taken by boiling in water, named Xiangru Drink.

[Indications] Heat combined with exterior dampness.

[Symptoms] Headache and heaviness in the head, fever and chills, chest tightness without sweating, abdominal pain and diarrhea, white and greasy tongue coating, floating and rapid pulse.

[Functions] Clearing heat, releasing the exterior, and draining dampness.

[Formula Analysis] This condition arises from cooling off and drinking cold beverages in summer, with external cold invasion combined with interior dampness. Headache, fever and chills, lack of sweating, and floating pulse are all evidence of exterior involvement; heaviness in the head, chest tightness, abdominal pain and diarrhea, and greasy tongue coating are all evidence of interior dampness. In this formula, Xiangru is aromatic and pungent-warm, likened to "long summer ephedra," dispersing exterior cold and transforming interior dampness, making it a key ingredient for summer exterior-releasing and dampness-draining, suitable as the principal herb. Magnolia bark transforms dampness and harmonizes the stomach, while White Broad Bean clears heat and strengthens the spleen; together, these two herbs achieve the effect of transforming dampness and harmonizing the middle, serving as auxiliary herbs.

[Clinical Modifications]

① For those without exterior symptoms, omit Xiangru; for those without abdominal pain or diarrhea, omit Magnolia bark and White Broad Bean; for those with severe thirst, add Coptis chinensis, named Four-Ingredient Xiangru Drink; for those without White Broad Bean, named Coptis Xiangru Drink, used for excessive interior dampness; for those with abdominal bloating and diarrhea, omit Coptis chinensis, add Poria cocos and licorice, named Five-Ingredient Xiangru Drink; for those with excessive sweating due to deficiency, add Ginseng, Astragalus membranaceus, Atractylodes macrocephala, Citrus peel, and Papaya, named Ten-Ingredient Xiangru Drink.

② This formula omits White Broad Bean, adds Two Flowers, Forsythia suspensa, and Fresh Broad Bean Flowers, named New Xiangru Drink ("Warm Disease Differentiation"). Treats Taiyin summer heat, resembling typhoid fever, with a large right pulse and a small left pulse, red face and thirst, but no sweating.

[Reference Materials]

① Li Shizhen said: "Some people suffer from heatstroke even in high-end buildings because they seek too much coolness and drink too many cold beverages, causing their yang qi to be suppressed by yin pathogens and flowing inward instead, resulting in headache and chills. Using Xiangru to release yang qi and disperse water and strengthen the spleen can cure this condition." Wang Lu said: "This is not heatstroke, but rather a type of typhoid fever." Note: Xiangru is a summer sweat-inducing herb, with a warm and pungent nature, suitable only for those who are sensitive to cold. If people with heat-fire syndrome take it, it can actually do more harm. Those with weak original qi who use it may even attract heat, and nowadays people think it can relieve heat, casually using it as tea substitute, which is like opening the door to thieves. ("Practical Application of Formulas") ② Xiangru is pungent and warm, suitable for yin heat but not for yang heat. Since yin heat does not involve sweating, using Xiangru to release it is appropriate; but for yang heat, which involves excessive sweating, can using it really be harmless? Li Shizhen said: Xiangru is a summer exterior-releasing herb, just like ephedra in winter. From this perspective, its effectiveness in releasing the exterior is evident. Nowadays, people do not distinguish between yin and yang, using it indiscriminately, which is a serious mistake. ("Discussion on Seasonal Diseases")

[Commentary] This formula can be used for summer gastrointestinal colds and acute gastroenteritis.

2. Liu Yi Powder ("Shanghan Biaoben")

[Composition] Talc 180 g, Licorice 30 g

[Administration] Ground into powder, 9 g each time, with a little honey, dissolved in warm water, three times a day. In modern times, it is made into a decoction.

[Indications] Heat combined with dampness.

[Symptoms] Body heat, irritability, thirst, difficulty in urination, urinary retention and pain, or vomiting and diarrhea, or bloody diarrhea.

[Functions] Clearing heat and draining dampness.

[Formula Analysis] For heat-related conditions, there is body heat, irritability, and thirst; for dampness-related conditions, there is difficulty in urination, urinary retention and pain, or vomiting and diarrhea, or bloody diarrhea. In this formula, Talc is slightly cold, cold clears heat and dispels heat, while lightness drains dampness—just this one herb can clear heat and drain dampness to treat heat combined with dampness, so it serves as the principal herb. Licorice is added as an auxiliary herb to harmonize the qi and moderate Talc's overly strong coldness. The two herbs are in a ratio of six to one, hence the name Liu Yi Powder.

[Clinical Modifications] This formula is also known as Tian Shui Powder, with Cinnabar added to form Yi Yuan Powder ("Six Books of Hejian"), which has the effects of clearing heat and draining dampness, as well as calming the mind and stabilizing the spirit; with Peppermint added to form Ji Su Powder ("Six Books of Hejian"), which has the effects of clearing heat and draining dampness, as well as dispersing wind-heat; with Blue Pigment added to form Bi Yu Powder ("Six Books of Hejian"), which can also clear liver fire. For example, when treating sandstone urinary stones, Sea Sand Gold and Herba Lysimachiae can be added; when treating blood in urine, raw Cypress leaves, raw Plantago seeds, and raw Lotus root can be added, named Three Raw Yi Yuan Powder. Adding Red Yeast to form Qing Liu Wan can treat red dysentery; adding dried ginger to form Wen Liu Wan can treat white dysentery.

[Reference Materials] For treating heatstroke and colds, with both exterior and interior heat, irritability, thirst, difficulty in urination, and all kinds of diarrhea, urinary turbidity, etc., this is a formula that releases muscle tension and promotes water flow to dispel heat. Talc's lightness can release muscle tension, its weight can clear heat, its coldness can overcome heat, its smoothness can open up blockages, and its lightness can drain water. Adding Licorice balances the formula, moderating Talc's coldness, so Talc's effects can reach both exterior and interior, eliminating pathogenic factors without harming the righteous, thus effectively treating the above-mentioned conditions. ("Convenient Reading of Formulas")

[Commentary] This formula is often modified and used for various urinary tract diseases, such as infections, stones, tuberculosis, etc.; it is also often used for various oral diseases and summer gastrointestinal diseases, etc.

3. Qing Shu Yi Qi Tang ("Warm and Hot Compass")

[Composition] Light Bamboo Leaves 6 g, Lotus Stem 15 g, Ophiopogon japonicus 9 g, Coptis chinensis 3 g, Watermelon Rind 30 g, American Ginseng 4.5 g, Dendrobium 9 g, Anemarrhena asphodeloides 6 g, Japonica Rice 15 g, Licorice 6 g

[Administration] Decocted in water and taken orally.

[Indications] Heat and qi depletion due to summer heat.

[Symptoms] Excessive sweating and thirst, large but weak pulse.

[Functions] Clearing heat and tonifying qi.

[Formula Analysis] Zhang Jiegou said: "The lungs govern qi; when summer heat and fire burn metal, the lungs are injured and qi becomes deficient." It is evident that summer heat is the most likely to deplete qi. When real heat accumulates in the qi aspect, it manifests as the White Tiger Soup syndrome; when summer heat depletes qi, it manifests as excessive sweating and thirst, with a large but weak pulse. This is similar to the White Tiger Syndrome, except that the White Tiger Syndrome involves pathogenic heat accumulating in the qi aspect, while this syndrome involves summer heat accumulating in the qi aspect. Summer heat communicates with the heart, so Coptis chinensis is used to clear heat from the heart meridian as the principal herb. Watermelon rind and Lotus Stem clear heat and dispel heat as auxiliaries. Summer heat easily depletes qi and harms yin, so American Ginseng, Japonica Rice, and Licorice tonify qi; Ophiopogon japonicus, Dendrobium, and Anemarrhena asphodeloides nourish yin as adjunct treatments. Bamboo Leaves clear heat and drain water, allowing summer heat to be eliminated through urination, serving as a conduit.

[Clinical Modifications]

① Omit Coptis chinensis and Anemarrhena asphodeloides, add White Veil and Cicada Slough to treat summer heat in children.

② For excessive sweating, add Floating Wheat; for severe fatigue, add Sheng Mai San; for thirst, add Gypsum fibrosum.

[Reference Materials]

① White Tiger Plus Ginseng Soup and Wang's Qing Shu Yi Qi Tang are both heat-clearing and qi-tonifying formulas, treating the same condition of dual qi deficiency, but their pathogenesis differs. If the heat is in the Yangming Stomach Meridian, with pathogenic factors moving outward, manifesting as high fever, excessive sweating, thirst, and a large, wiry pulse, then White Tiger Plus Ginseng Soup is used; if the heat is trapped inside, manifesting as body heat, irritability, yellow urine, and dry, thirsty mouth, then Wang's Qing Shu Yi Qi Tang is used. The former contains Gypsum, which helps heat escape outward, while the latter contains Coptis chinensis, which clears heat and relieves irritation. Although both aim to clear heat and tonify qi, one focuses on expelling heat outward, while the other focuses on clearing heat from within. ("New Jiangsu Medical College: Interpretation of Warm Disease Theory")

② There is also Li Dongyuan's "Qing Shu Yi Qi Tang," with the following composition: Astragalus membranaceus, Atractylodes macrocephala, Cimicifuga heracleifolia, Ginseng, Atractylodes macrocephala, Citrus peel, Six Quarters, Alisma plantago-aquatica, Ophiopogon japonicus, Danggui, Honey-processed Licorice, Phellodendron amurense, Kudzu, Green Peel, and Five Flavor Berry. Indicated for people with weak qi who are exposed to summer heat and dampness, with spleen dampness not being transformed, manifesting as body heat, headache, thirst and sweating, limb fatigue, loss of appetite, chest fullness and heaviness, loose stools, short and reddish urine, and greasy tongue coating with weak pulse. Both formulas are called Qing Shu Yi Qi Tang, but Li Dongyuan's version is used for those with inherently weak qi who are also harmed by summer heat and dampness; Wang Mengying's version, on the other hand, is used for those whose qi and yin are depleted by summer heat, without accompanying dampness.

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[Preface] This formula is suitable for prodromal heatstroke and mild heatstroke. As for severe heatstroke accompanied by shock, coma, or heat cramps, it is not appropriate for this formula.

Chapter 7: Opening the Orifices and Unblocking the Channels

Opening the orifices is a method for treating unconsciousness. When a patient loses consciousness and becomes unresponsive, it is because pathogenic factors have invaded the pericardium, causing blockage of the heart orifices. In such cases, only by opening the heart orifices can unconsciousness be treated. However, there are two types of unconsciousness: ① unconsciousness accompanied by locked jaw and stiff neck and limbs, known as the "closed syndrome." ② unconsciousness accompanied by open mouth and closed eyes, with involuntary urination and defecation, known as the "open syndrome." This group of formulas is only suitable for the closed syndrome and not for the open syndrome. The "guan" refers to the jaw; patients with the closed syndrome have two main symptoms: unconsciousness and locked jaw. Therefore, while opening the orifices, it is also necessary to unblock the channels to achieve complementary effects. The closed syndrome can be further divided into cold and heat types, so the formulas for opening the orifices and unblocking the channels are also classified as cooling or warming formulas.

I. Cooling Formulas

This formula is suitable for the heat type of the closed syndrome (heat closure), characterized by unconsciousness, delirium, locked jaw, stiff neck, limb twitching, high fever with flushed face, rapid and large pulse, and thick yellow tongue coating. It is usually caused by internal invasion of heat pathogens that block the pericardium, or by sudden intrusion of filthy and foul qi into the pericardium.

1. Niuhuang Qingxin Wan ("Wanmizhai Formula")

[Composition] 0.8 grams of bezoar, 15 grams of coptis, 9 grams of scutellaria, 9 grams of gardenia, 6 grams of curcuma, and 4.5 grams of cinnabar.

[Administration] Grind all ingredients into fine powder, mix with melted snow to form pills the size of millet grains, take eight pills each time with lampwick decoction. Modern usage: make pills with refined honey, seal each pill in a wax shell weighing about 3 grams according to local weight, take one pill each time, crush it and dissolve in hot water before taking; reduce the dosage for children.

[Indications] Heat invading the pericardium (heat closure).

[Indications] Unconsciousness, delirium, locked jaw, stiff neck, limb twitching, high fever with flushed face, thick yellow tongue coating, rapid and large pulse.

[Functions] Clearing heat and detoxifying, opening the orifices and calming the spirit.

[Formula Analysis] When heat invades the pericardium, the heart orifices become blocked, manifesting as unconsciousness, delirium, locked jaw, stiff neck, limb twitching, high fever with flushed face, thick yellow tongue coating, and rapid and large pulse. In this formula, bezoar clears the pathogenic heat from the pericardium and removes the heat toxin from the orifices, thus opening the orifices and clearing the heat as the primary action. Curcuma promotes qi circulation and relieves depression to facilitate opening the orifices, while also activating blood circulation and cooling the blood to help clear heat, thereby assisting the bezoar in opening the orifices and clearing heat. Coptis clears heart fire, scutellaria clears lung fire, and gardenia clears fire from the triple burner; these three herbs together drain the body's excess heat, serving as a supplementary treatment. Cinnabar calms the spirit and stabilizes the mind; its cool nature enters the heart, drawing other herbs into the heart and acting as a guiding agent.

[Clinical Adjustments] ① Add rhinoceros horn, pearl, gold leaf, musk, borneol, realgar to create Angong Niuhuang Wan ("Warm Disease Differentiation"), which is more potent than the original formula and suitable for severe cases with intense heat-induced unconsciousness. ② If constipation and thick yellow tongue coating occur, add rhubarb and mirabilite.

[References] ① Once external heat invades, the internal channels immediately close, and cannot be opened by herbs like sweet flag or curcuma; only formulas like Bezoar Pill or Zhibao Dan can break the blockage. ("Warm and Hot Compendium") ② When heat invades the pericardium, causing unconsciousness and delirium with locked jaw, in addition to this formula, Angong Niuhuang Wan, Zixue Dan, and Zhibao Dan can also be used. All three have the effects of clearing heat, relieving spasms, and opening the orifices. Among them, Angong Niuhuang Wan has stronger heat-clearing power, Zixue Dan has stronger antispasmodic power, and Zhibao Dan has stronger orifice-opening power, while Bezoar Qingxin Wan combines heat-clearing, antispasmodic, and orifice-opening effects.

[Preface] This formula is used to treat meningitis, encephalitis, toxic dysentery, sepsis, uremia, measles with internal collapse, and toxic pneumonia, among others.

2. Zixue Dan ("Harmonized Formulary")

[Composition] 500 grams of halite, 500 grams of gypsum, 1,000 grams of magnetite, 500 grams of talc, 1,000 grams of nitre, 150 grams of agarwood, 150 grams of sandalwood, 150 grams of musk, 30 grams of cloves, 150 grams of rhinoceros horn, 150 grams of antelope horn, 500 grams of cimicifuga, 250 grams of licorice, 1,000 grams of mirabilite, 500 grams of black ginseng, and 90 grams of cinnabar (the original formula included gold, but modern practitioners often omit it).

[Administration] Grind all ingredients into powder, take 3–6 grams each time, 1–2 times daily, mixed with cold boiled water.

[Indications] Heat invading the pericardium, extreme heat causing wind-like agitation.

[Indications] High fever with unconsciousness, convulsions and spasms, thirst and dry lips, locked jaw, stiff neck, thick yellow tongue coating, and rapid and large pulse.

[Functions] Clearing heat and detoxifying, calming the liver and suppressing wind.

[Formula Analysis] When heat invades the pericardium, the heart orifices become blocked, leading to unconsciousness and delirium. The pericardium and liver both belong to the Jueyin meridian and are connected through the meridians; when heat invades the pericardium, it also stirs up liver wind, resulting in stiff neck, locked jaw, and convulsions and spasms. The liver and kidneys share the same origin, so when heat stirs up liver wind, kidney yin is depleted, causing thirst and dry lips. In this formula, antelope horn has a cool nature and enters both the heart and liver meridians, clearing the heat toxin from the pericardium to open the orifices while also calming the internal wind in the liver meridian to suppress spasms—addressing both root and branch as the primary action. Rhinoceros horn enters the heart to assist antelope horn in clearing the heat toxin from the pericardium, facilitating the opening of the orifices as a supplementary action. Since this condition involves signs of excessive heat damaging yin, such as thirst and dry lips, instead of using bitter-cold, drying herbs like coptis and scutellaria to purge fire, the formula uses gypsum, halite, and talc—sweet and cooling herbs that generate fluids—as a supplementary treatment. Musk detoxifies and opens the orifices, black ginseng drains fire and nourishes yin, cinnabar and magnetite strongly calm the spirit, agarwood, cloves, and sandalwood promote qi circulation and unblock the channels, mirabilite and nitre drain fire and disperse clumps, and cimicifuga detoxifies and dissipates heat—all of which can be considered supplementary treatments. Licorice harmonizes all the herbs and acts as a guiding agent.

[Clinical Adjustments] ① Remove talc, and the formula becomes Zixue (from "Qianjin Yifang"), indicated for "severe heat caused by metal and stone toxins." ② Remove rhinoceros horn and sandalwood, and the formula is still called Zixue Dan (from "Benshi Fang"), with slightly different indications.

[References] ① This formula is very potent; those who are not physically strong or whose conditions are not truly due to excess heat should not use it indiscriminately. I have seen some modern doctors who, upon encountering unconsciousness and delirium, assume that pathogenic factors have invaded the pericardium without distinguishing between deficiency and excess, and prescribe this formula without any caution. If the patient’s muttering is due to insufficient heart and spirit, reckless use of this formula will surely lead to disaster. In clinical practice, one must distinguish between deficiency and excess before prescribing, so as to avoid mistakes. ("Treatise on Seasonal Diseases") ② Mr. Wang from Qilin came to the capital to take an exam and suddenly contracted a heat-related illness. His teacher thought it was rheumatism and prescribed herbs like qianghuo, fangfeng, hawthorn, and qu, but his thirst worsened and he became delirious. He invited me to treat him; his pulse was rapid and forceful, and his tongue coating was dark, dry, and thick—this was clearly due to heat turning into dryness and consuming body fluids. Simply using salty and bitter purgatives would not address the heat while preserving yin; if one hesitates and does not use them, the body fluids will soon be depleted. So I added five parts of Zixue to the moistening and purging regimen, then prepared and administered the decoction. About half a day later, he wanted to change clothes and passed several hard stools, and his delirium seemed to ease. After another decoction, he passed even more hard stools, and his spirits grew tired, so the room fell silent. He slept peacefully for about five or six hours before waking up, with clear consciousness, a slight sweat, a dark yet moist tongue, and a steady pulse without agitation. Feng said, “The pathogenic factors have been eliminated,” and prescribed Western ginseng, ophiopogon, rehmannia, polygonatum, sesame seeds, dried tangerine peel, rice bran, and roasted licorice for three doses to stabilize his condition. (Lei Feng: "Clinical Case Records")

[Preface] This formula is used to treat encephalitis, meningitis, hepatic coma, typhoid fever, typhus, toxic dysentery, high-fever convulsions in children, blood disorders, cerebrovascular accidents, and epilepsy with high fever and unconsciousness.

3. Zhibao Dan ("Harmonized Formulary")

[Composition] 30 grams each of rhinoceros horn, tortoiseshell, amber, cinnabar, and realgar; 0.3 grams each of borneol and musk; 15 grams of bezoar; 45 grams of benzoin (the original formula included fifty pieces of gold and silver foil, but these are no longer used).

[Administration] Grind all ingredients into powder, mix with refined honey to form pills the size of Chinese parasol seeds, and take three to five pills with ginseng decoction. In modern times, each pill weighs about 3 grams, take one pill each time, crush it and dissolve in hot water before taking.

[Indications] Heat invading the pericardium, phlegm obstructing the heart orifices.

[Indications] Unconsciousness and muteness, excessive phlegm and coarse breathing, high body temperature with red tongue, thick yellow and greasy tongue coating, and slippery, rapid pulse.

[Functions] Clearing heat and detoxifying, resolving phlegm and opening the orifices.

[Formula Analysis] When heat pathogens invade internally, body fluids are boiled away by the fiery heat, blocking the pericardium and leading to this condition. The root cause is the internal invasion of heat, while the obstruction of the pericardium is the manifestation. The manifestation is urgent, while the root cause is slow; therefore, we first treat the manifestation, making it the primary focus. In this formula, musk, borneol, borneol, and benzoin work together to dispel filth and turbidity, resolve phlegm, and open the orifices, serving as the main drugs. Rhinoceros horn, bezoar, and tortoiseshell enter the pericardium to clear heat and detoxify, acting as supplementary drugs. Although realgar has the effect of resolving phlegm and detoxifying, its meridian affiliation is not the heart but the liver and stomach, so it only serves as a supplementary treatment; cinnabar and amber calm the heart and stabilize the spirit, also serving as supplementary treatments. Ginseng decoction is used to support the body's vital energy and harmonize the flavors of all the herbs, acting as a guiding agent.

[Clinical Adjustments] ① Ancient practitioners used ginseng decoction to administer this formula, aiming to restore spiritual clarity and strengthen the body's vital energy while eliminating pathogenic factors. ② The "Formulary" recommends administering this formula with children's urine and natural ginger juice, intending to enhance its ability to clear fire and open the orifices.

[References] This formula is effective for treating all kinds of strokes, miasmas, and plagues, whether due to internal phlegm-heat blockage, poison or water toxicity, or acute spasms in children where the jaw needs to be urgently opened before medication can be administered. Although internal blockages can vary in terms of wind, phlegm, cold, or heat—for example, Suhe Wan leans toward warmth, Yushu Dan leans toward purging, while Bezoar and Zixue lean toward cooling—each has its own characteristics, but the overarching principle is to use aromatic herbs to open the channels and eliminate toxins. Practitioners can choose based on the specific condition; this formula seems to lean slightly toward cooling, but not as much as Bezoar or Zixue, which are too cold. ("Compendium of Practical Knowledge")

[Preface] This formula is used for meningitis, encephalitis, toxic dysentery, epilepsy, and high-fever convulsions.

II. Warming Formulas

This formula is suitable for the cold type of the closed syndrome (cold closure). Symptoms include unconsciousness, drowsiness, locked jaw, crooked mouth and eyes, and limb twitching. However, the tongue is pale and the pulse is slow, with no signs of heat; this condition is often caused by cold pathogens invading internally due to wind, qi, phlegm, or blood stagnation, or by phlegm-dampness lingering in the pericardium.

1. Suhe Xiang Wan ("Harmonized Formulary")

[Composition] 30 grams of agarwood, 30 grams of cloves, 30 grams of benzoin, 30 grams of sandalwood, 30 grams of musk, 30 grams of white sandalwood, 30 grams of cyperus, 30 grams of suhe xiang oil, 30 grams of long pepper, 15 grams of borneol, 30 grams of rhinoceros horn, 30 grams of white atractylodes, 30 grams of chebulic myrobalan, 30 grams of cinnabar, and 15 grams of frankincense.

[Administration] Take clean powder and mix well, then add borneol and musk, grind thoroughly, and finally mix suhe xiang oil with a little warm white honey to blend evenly with the medicinal powder, forming pills (each pill weighs 3 grams). Take one pill each time with warm boiled water; reduce the dosage for children.

[Indications] Cold pathogens invading internally, blocking the pericardium.

[Indications] Unconsciousness, drowsiness, locked jaw, phlegm sounds, and floating tongue with no signs of heat.

[Functions] Warming and dispersing cold turbidity, opening the orifices with fragrance.

[Formula Analysis] Wind, qi, and evil (phlegm-turbidity and filth) cause cold pathogens to invade internally, blocking the pericardium and leading to this condition. Although the main cause is the invasion of cold pathogens, the blockage of the pericardium results in major symptoms such as unconsciousness and drowsiness, locked jaw, and so on. In this formula, suhe xiang oil, benzoin, musk, and borneol work together to transform turbidity into fragrance and penetrate the orifices, serving as the main drugs. Sandalwood, agarwood, cyperus, frankincense, cloves, white sandalwood, long pepper, and other aromatic herbs act as auxiliary drugs, promoting qi circulation, harmonizing blood, and relieving depression to assist the main drugs in penetrating the orifices. Chebulic myrobalan has a warming and astringent effect to prevent the fragrant herbs from dissipating vital energy, serving as a supplementary treatment; rhinoceros horn clears heat and detoxifies, while cinnabar cools the blood and calms the spirit, both of which counteract the tendency of warming herbs to stir up fire; white atractylodes strengthens the spleen and dries dampness, aiming to support the body's vital energy, all of which serve as supplementary treatments. White honey harmonizes all the herbs and acts as a guiding agent.

[Clinical Adjustments] ① Remove rhinoceros horn, chebulic myrobalan, long pepper, sandalwood, cyperus, frankincense, cloves, white atractylodes, benzoin, and musk to create Guanxin Suhe Wan ("Chinese Medicine Knowledge Handbook"), used to treat angina pectoris caused by coronary artery disease. ② Remove white atractylodes, frankincense, and benzoin to treat qi-stagnant, spasm-prone, and epileptic seizures caused by wind and phlegm, with efficacy comparable to the above three herbs.

[References] ① Used to treat stroke with cold closure and loss of consciousness; exposure to filthy and foul air causes phlegm to block qi, leading to chest and abdominal fullness and coldness; during epidemics like cholera, the abdomen and chest feel full and tight, with nausea and diarrhea that cannot be relieved, sometimes even leading to coma. Also used to treat coronary artery sclerosis with angina pectoris caused by qi stagnation, blood stasis, and cold congealing. This formula was mentioned early on in "Waitai Mi Yao" (quoted from "Guangji" formula), named Chiliga (i.e., white atractylodes) pill. ("Concise Dictionary of Traditional Chinese Medicine") ② Used to treat various sudden deaths, comas, phlegm-blocked qi, loss of consciousness, as well as evil spirits and epidemic miasmas. The diseases covered by "zhong" are diverse—stroke, cold, heat, dampness, phlegm, qi, and evil—and their symptoms are mostly similar. Regardless of which pathogenic factor is involved, the first step is to determine whether the condition is closed or open. For closed syndromes, although limbs may be stiff and pulses weak, both hands are usually clenched, bowel movements are blocked, the mouth is tightly shut, and the eyes stare straight ahead—this indicates a sudden surge of pathogenic factors that suppress the body's vital energy, requiring the use of aromatic herbs to open the orifices and treat the manifestation, or formulas like Suhe, Bezoar, Zhibao, or Zixue, depending on whether the condition is cold or hot, and choosing the appropriate remedy accordingly, so that the meridians can be cleared and vital energy restored, after which the underlying cause of the disease can be treated. ("Compendium of Practical Knowledge")

[Preface] This formula is often used for hysteria, gas poisoning, cerebrovascular accidents, epileptic seizures, angina pectoris caused by coronary artery disease, and food poisoning leading to coma.

2. Tongguan San ("Danxi Xinfa Fuyu")

[Composition] Equal parts of pig bile soap and asarum.

[Administration] Grind into extremely fine powder, mix well, and blow a small amount into the nose to induce sneezing.

[Indications] Closed syndrome with locked jaw.

[Indications] Sudden fall, unconsciousness, locked jaw, phlegm buildup, and a large, powerful pulse.

[Functions] Unblocking the orifices and opening the channels.

[Formula Analysis] Wind, qi, and evil cause pathogenic factors to invade the pericardium, leading to locked jaw and thus this condition. The function of this formula is to unblock the channels, and it is often used in conjunction with the aforementioned orifice-opening formulas to achieve complementary effects. In this formula, soap and asarum have a warming nature and are responsible for unblocking the channels, while also having the effect of opening the orifices and expelling phlegm, making them the main drugs. Asarum has a warming and dispersing effect on cold, helping soap unblock the channels and open the orifices as a supplementary drug; the two complement each other and form an excellent formula for opening the orifices and unblocking the channels. The lungs open their orifices through the nose, and the lungs govern the body's qi; by inducing sneezing through the nose, the lung orifices are opened, the lung qi is circulated, the zongqi flows smoothly, the jaw is unlocked, and the person regains consciousness.

[Clinical Adjustments] Adding musk and peppermint to this formula creates Tongguan San ("Easy Compilation of Medical Prescriptions"), with the same functions as the original formula.

[References] After using this formula, those who sneeze can be cured; those who do not sneeze have already lost lung qi and cannot be cured. (Jiangsu New Medical College: "Traditional Chinese Medicine Formulary")

[Preface] This formula can be used for patients in a coma with locked jaw as an emergency measure to stimulate awakening; after awakening, treatment can be tailored according to the specific condition. Clinically, it is often used for hysterical pseudo-death and comas caused by gas poisoning, among others.

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Chapter 8: Warming the Interior and Restoring Yang

Warming the interior and restoring yang are collectively referred to as the warming method, one of the Eight Methods. Formulas that have the effects of warming the interior and restoring yang are called warming-the-interior-and-restoring-yang formulas. Warming the interior aims to dispel cold in the spleen and stomach; restoring yang aims to revitalize declining kidney yang. Cold in the spleen and stomach and declining kidney yang are collectively referred to as internal cold, and the causes include direct invasion of cold pathogens and self-generated cold within the body. To treat cold in the spleen and stomach, the method is to warm and disperse cold, abbreviated as warming <span style="text-decoration: underline;">interior</span>; to revitalize declining kidney yang, the method is to urgently restore yang, abbreviated as restoring yang. The former focuses on postnatal factors, while the latter focuses on prenatal factors. The "Plain Questions" says: "Yang qi is like heaven and the sun—if it loses its place, life will be shortened and vitality will be diminished." This shows the importance of yang qi for the human body. Cold is a yin pathogen that easily harms yang; if internal cold is not treated, it will inevitably lead to yang deficiency. Therefore, the two methods of warming the interior and restoring yang are usually complementary.

I. Warming and Dispersing Cold

Warming and dispersing cold is a method for treating spleen and stomach deficiency-cold. The spleen and stomach are located in the center of the body and are responsible for digestion and transformation; when deficient and cold, symptoms include bloating and pain in the epigastrium, intestinal rumbling and diarrhea, nausea and vomiting. Cold easily harms yang; when deficiency-cold is severe, the body feels cold and weak. If cold becomes severe and accumulates, it can cause severe abdominal pain, with upward surges that make the skin stand on end, and pain throughout the body that makes it impossible to approach.

1. Lizhong Wan (Ginseng Decoction) ("Shanghan Lun")

[Composition] 9 grams each of ginseng, dried ginger, licorice, and white atractylodes (three liang).

[Administration] Grind all ingredients into powder, sieve, and make pills with refined honey, about the size of chicken eggs; in modern times, it is often made into a decoction.

[Indications] Spleen and stomach deficiency-cold.

[Indications] Abdominal distension and vomiting, inability to eat, abdominal pain that worsens over time, increased salivation, prolonged indigestion, feeling cold and weak, spontaneous sweating.

[Functions] Warming and dispersing cold, strengthening the spleen and benefiting qi.

[Formula Analysis] "Qi deficiency means cold," so when the spleen and stomach qi is deficient, there is inevitably a condition of spleen and stomach cold; deficiency and cold are causally related. The spleen and stomach are located in the center of the body and are responsible for digestion and transformation; when they are deficient and cold, their ability to digest and transform is impaired. The pure cannot rise, leading to worsening indigestion; the impure cannot descend, leading to vomiting and increased salivation; cold qi accumulates in the middle jiao, hindering the flow of qi, leading to abdominal distension, abdominal pain, and prolonged indigestion; when deficiency-cold exists internally, yang qi cannot reach the exterior, leading to feeling cold and weak, spontaneous sweating. The root cause of all these symptoms is deficiency-cold; within deficiency-cold, cold is urgent and deficiency is slow, so in this formula, dried ginger warms and disperses cold, serving as the main drug. Codonopsis strengthens the spleen and benefits qi as a supplementary drug. When the spleen and stomach are deficient and cold, dampness tends to accumulate in the middle jiao, so white atractylodes strengthens the spleen and dries dampness as a supplementary treatment. Licorice harmonizes all the herbs and acts as a guiding agent.

[Clinical Adjustments] ① Add guizhi to create Guizhi Ginseng Decoction. Treats cases where solar exterior syndrome has not been resolved and repeated doses have led to heat-related diarrhea, with persistent diarrhea, palpitations, and unresolved exterior and interior conditions. ("Shanghan Lun") ② Add coptis to create Lianli Decoction ("Zhengyin Maitreatment"). Treats cases of acidic vomiting and slow, tense pulse. ③ Add fuzi to create Fuzi Lizhong Wan ("Yan's Pediatric Formulary") to treat spleen and stomach deficiency-cold, heart pain, and cholera with vomiting and diarrhea. ④ Add zhishi and fuling to make Zhishi Lizhong Wan (from "Harmonized Formulary"). Clears the middle jiao, eliminates fullness and distension, expels phlegm and fluid, and stops abdominal pain. ⑤ Add banxia (processed with ginger) and fuling to create Lizhong Phlegm-Resolving Pill ("Miscellaneous Writings of Famous Doctors"). Treats spleen and stomach yang deficiency, internal accumulation of cold fluid, poor appetite and loose stools, and vomiting of clear water.

[References] ① The solar disease is characterized by vomiting, diarrhea, and abdominal pain, which affect the entire body! However, although vomiting is a symptom of the upper part, and diarrhea is a symptom of the lower part, both are caused by the middle jiao not being treated. There are three reasons: one is external wind-cold entering due to exterior deficiency; another is internal cold and dampness rising from below; the third is cold pathogens generated internally due to cold food and drink. Ultimately, all these are caused by deficiency-cold, so the solution is to warm and tonify to support the yang of the epigastrium. With just one Lizhong formula, all symptoms—fullness, pain, vomiting, and diarrhea—are alleviated! ("Collection of Shanghan Studies in Suzhou") ② Lizhong Decoction is highly effective in treating epigastric pain, vomiting, nausea, phlegm, excessive sleepiness, yang deficiency with blood loss, and morning sickness. According to recent experimental studies, this formula has a certain regulatory effect on the functions of the autonomic nervous system, hematopoiesis, immunity, neuromuscular system, and endocrine system. ("Hunan Medical Journal," May 1980, p. 38) ③ Observation of Lianli Decoction's treatment of 14 cases of chronic colitis: the duration of illness was more than three months, with recurring abdominal pain and diarrhea, frequent bowel movements (as few as three times, as many as eight times), most with mucus and pus, including five cases originating from acute bacillary dysentery, two from amoebic dysentery, and the rest with unknown causes. Other symptoms included fatigue, coldness in the abdomen, and chills; most patients had tenderness around the navel or lower abdomen, but no masses were palpable. The diagnosis was spleen and stomach deficiency-cold, with residual heat remaining. Treatment mainly relied on Lianli Decoction (codonopsis, white atractylodes, dried ginger, licorice, coptis, and fuling). For severe abdominal distension and pain, add wood fragrance, wu zhu yu, and green peel. For urgency and heaviness in the bowels, add zhishi, shenqu, and radish seed. For pus and blood in the stool, add huangqin and qinpi. Once the urgency and heaviness in the bowels, along with mucus and pus, disappear, and the stool hardness and frequency remain abnormal for a long time, add wuweizi, kezi rou, calcined dragon, and oyster. After basically curing all symptoms, most people use Shenling Baizhu Wan or Lizhong Wan to consolidate the effect. The course of treatment ranges from 8 days to 62 days, with most lasting 16–22 days. Among the 14 cases, 11 were clinically cured, 2 showed significant improvement, and 1 was ineffective. ("Journal of Traditional Chinese Medicine," February 1963)

[Preface] This formula can be used for gastric and duodenal ulcers, chronic gastritis, chronic colitis, localized ileitis, bacterial dysentery; it can also be used for gastrointestinal bleeding and gastroenteric neurosis.

2. Xiaojianzhong Tang ("Shanghan Lun")

[Composition] 6 grams of guizhi (three liang, peeled), 12 grams of baishao (six liang, stir-fried with wine), 3 grams of zhigancao (two liang), 9 grams of shengjiang (three liang, sliced), 24 grams of yitang (one liter), and 5 jujubes (twelve pieces).

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[Dosage and Administration] Decoct the five ingredients in water, remove the residue, add malt syrup, then simmer over low heat until dissolved, and take warm.

[Main Indications] Deficiency-cold of the middle jiao.

[Indications] Intermittent abdominal pain, preference for warmth and pressure, with relief upon pressing; palpitations and restlessness; fever due to deficiency.

[Functions] Warm the middle jiao to tonify deficiency, harmonize the interior and relieve urgency.

[Formula Analysis] Cold causes contraction and obstruction; obstruction leads to pain. When cold stagnates in the middle jiao, intermittent abdominal pain occurs. With deficiency in the middle jiao, pain is relieved by warmth and pressure, and pressing alleviates the pain. The spleen and stomach reside in the center and belong to earth, which is generated by heart fire. When the child suffers, it steals the mother's qi, resulting in palpitations, restlessness, and insomnia. The spleen and stomach are the source of nourishing and defensive qi; when they are deficient and cold, the balance between ying and wei is disrupted, with cold prevailing internally and deficient yang floating outward, leading to fever due to deficiency. All these symptoms stem from deficiency-cold of the middle jiao, so the primary treatment should be warming the middle jiao to disperse the cold and tonifying deficiency to address the root cause. Among the symptoms caused by deficiency-cold, abdominal pain is the most urgent and distressing, so combining this with methods to harmonize the interior and relieve urgency can address both the symptoms and the root cause, achieving comprehensive efficacy. In this formula, malt syrup is sweet and warm, tonifying deficiency; cinnamon twig warms the middle jiao and disperses cold. Together, these two herbs fulfill the important task of warming the middle jiao and tonifying deficiency, making them the principal herbs. White peony is sour and bitter, while licorice is sweet and neutral. These two herbs complement each other, embodying the principle of sour-sweet transformation into yin, working together to relieve urgency and stop pain as auxiliary herbs. Ginger and jujubes have one pungent and one sweet flavor, one exterior and one interior, harmonizing ying and wei, thus serving as guiding herbs.

[Clinical Modifications]

① Add astragalus, named Astragalus Jianzhong Decoction (from "Jingui Yaolue"). Treats deficiency-cold in the interior and various deficiencies.

② Add angelica, named Angelica Jianzhong Decoction (from "Qianjin Yifang"). Treats postpartum deficiency and weakness, persistent abdominal pain, shortness of breath, or lower abdominal cramping radiating to the back, accompanied by inability to eat.

③ Add angelica and astragalus, named Guiqi Jianzhong Decoction, treating patients with both small Jianzhong syndrome and dual deficiency of qi and blood.

[References]

① This formula is essentially Guizhi Tang with double the amount of white peony and added malt syrup, called "Small Jianzhong," meaning a small establishment of middle jiao qi. Since the middle jiao is already deficient but the exterior has not yet been harmonized, we dare not use large doses of tonifying herbs. Therefore, we use cinnamon twig to harmonize ying and wei, double the white peony and add malt syrup to regulate the middle jiao, without drinking thin porridge and taking it warm to induce sweating. The emphasis is on the deficiency of the middle jiao rather than the exterior condition of wind-cold. Once the middle jiao is established, ying and wei will naturally harmonize, body fluids will be produced, sweating will resolve, and palpitations and restlessness will disappear. ("Yizong Jinjian")

② Using Small Jianzhong Decoction to treat cases of blood deficiency, abdominal pain, fever, and yellowish complexion all achieved significant therapeutic effects. ("Shaanxi Journal of Traditional Chinese Medicine," May 1980, p.30)

③ Using Astragalus Jianzhong Decoction as the main treatment, three cases of sick sinus syndrome, paroxysmal supraventricular tachycardia, and ventricular premature beats due to cardiomyopathy were treated, all with satisfactory results. ("Jiangsu Journal of Traditional Chinese Medicine," June 1980, p.15)

[Commentary] This formula, with modifications, can be used to treat gastric and duodenal ulcers, neurasthenia, aplastic anemia, and immune thrombocytopenic purpura; it can also treat paroxysmal hypoglycemia and unexplained fevers.

3. Wu Zhu Yu Tang from "Shanghan Lun"

[Composition] 3 grams of Wu Zhu Yu (washed in one liter of water), 9 grams of ginseng (three taels), 4 jujubes (split into twelve pieces), 15 grams of ginger (cut into six taels).

[Dosage and Administration] Decoct in water and take.

[Main Indications] Cold congealing in the stomach, headache due to Jueyin, vomiting and diarrhea due to Shaoyin.

[Indications] Pain in the epigastric region, nausea after eating, acid regurgitation and discomfort; severe headache at the crown of the head, dry vomiting with foamy saliva; vomiting and diarrhea, cold extremities, and extreme restlessness.

[Functions] Disperse cold and reverse upward flow.

[Formula Analysis] When cold congeals in the stomach, there is pain in the epigastric region, nausea after eating, and acid regurgitation and discomfort. The Foot Jueyin Liver Meridian intersects with the Governing Vessel at the crown of the head, and the cold qi from the stomach rises upward, carrying the liver qi directly to the crown, resulting in dry vomiting, foamy saliva, and headache. The spleen and stomach reside in the center, with the heart above and the kidneys below; when cold qi prevails in the middle jiao, the "Yellow Lady" does not mediate, causing the heart and kidneys to fall ill, manifested as cold extremities and extreme restlessness. Although this formula addresses three conditions, the root cause lies in the cold qi in the stomach. Wu Zhu Yu warms the stomach and dispels cold, while also reversing the upward flow of the three yin meridians, serving as the principal herb. Ginger warms the stomach, dispels cold, and reverses upward flow, working in tandem with the principal herb to double the effect of dispersing cold and reversing upward flow, making it an auxiliary herb. Ginseng and jujubes tonify qi and strengthen the spleen, serving as complementary treatments. The entire formula focuses on warming the middle jiao and reversing upward flow, strengthening the spleen-earth and stabilizing the heart-kidney.

[Clinical Modifications] For severe stomach pain, add salvia miltiorrhiza, costus root, and amomum villosum; for severe vomiting, add pinellia ternata and raw ochre; for severe headache, add chuanxiong, baizhi, artemisia, and asarum; for severe cold extremities and restlessness, add Si Ni Tang.

[References]

① Dry vomiting with foamy saliva and headache indicate that cold qi from the Jueyin meridian is attacking upward; vomiting and diarrhea with cold extremities indicate that cold qi is prevalent internally; restlessness and near-death state indicate that yang qi is struggling internally; nausea after eating indicates that the stomach is too cold to accept food. For these three conditions, this formula uses Wu Zhu Yu to reverse the upward flow of the three yin meridians as the principal herb, ginger to disperse cold as the assistant herb, and ginseng and jujubes to gently harmonize all qi, serving as supporting herbs to stabilize the situation. ("Neitai Fangyi")

② Fu × Chun, male, 26 years old. Presented with headache, fine pulse, pale white tongue, cold extremities, clear stools, sometimes dry vomiting with foamy saliva. This is due to the upward flow of Jueyin liver qi, as its meridian intersects with the Governing Vessel at the crown of the head, causing headache—commonly known as phlegm-induced headache. Used four qian of Wu Zhu Yu, six qian of ginger, three qian of codonopsis pilosula, and four jujubes, one dose cured him. ("Fujian Journal of Traditional Chinese Medicine," May 1964)

③ Lin × Sao, female, in her forties. Suffered from cold stomach, yesterday vomited foamy saliva, felt cold in the mouth, even water made her vomit, fine and tense pulse, white tongue without coating, cold extremities, no thirst. This is due to turbid yin evil stirring up liver qi, cured with one dose of Wu Zhu Yu Tang. ("Fujian Journal of Traditional Chinese Medicine," May 1964)

[Commentary] This formula, with modifications, can be used to treat chronic gastritis, ulcers, neural headaches, acute gastroenteritis, pregnancy-related vomiting, gastrointestinal neurosis, Meniere's disease, and drug-allergy-induced vomiting.

4. Da Jianzhong Tang from "Jingui Yaolue"

[Composition] 3 grams of sichuan pepper (stir-fried twice and removed), 4.5 grams of dried ginger (four taels), 9 grams of ginseng (two taels), 30 grams of malt syrup (one liter).

[Dosage and Administration] Decoct three ingredients in water, remove the residue, add malt syrup, simmer briefly over low heat, take warm, preferably after drinking a bowl of porridge before taking it.

[Main Indications] Congealing of yin cold, severe abdominal pain.

[Indications] Severe cold pain in the chest and abdomen, unable to eat or drink due to vomiting, upward surge of qi causing skin rashes, visible from head to feet, unbearable pain throughout the body.

[Functions] Warm the middle jiao to disperse cold, relieve pain, and reverse upward flow.

[Formula Analysis] According to "Suwen·Bilun," "Pain is mostly caused by cold qi; pain arises because of cold." Thus, cold is the primary cause of pain. When yin cold stagnates internally, there is severe cold pain in the chest and abdomen, with unbearable pain throughout the body; when cold qi rises upward, there is an upward surge of qi causing skin rashes and visible from head to feet; when cold qi stagnates in the middle jiao, there is vomiting and inability to eat. All these symptoms stem from internal cold. In this formula, sichuan pepper warms the middle jiao, disperses cold, relieves pain, and reverses upward flow, serving as the principal herb; dried ginger warms the middle jiao, disperses cold, and also has the function of reversing upward flow, serving as an auxiliary herb; codonopsis pilosula strengthens qi and the spleen, serving as a complementary treatment; malt syrup strengthens qi and replenishes the middle jiao, serving as a complementary treatment, harmonizing all herbs and acting as a guiding herb.

[Clinical Modifications] For epigastric pain, add salvia miltiorrhiza, costus root, and cardamom; for flank pain, add bupleurum, citrus aurantium, white peony, and licorice; for diarrhea and intestinal rumbling, add dried ginger and processed aconite; for yellow tongue and constipation, add rhubarb and coptis; for poor digestion, add atractylodes and poria.

[References]

① Sichuan pepper is pungent and hot, dispersing cold in the lungs, warming the spleen, and invigorating the kidneys; dried ginger is pungent and hot, promoting yang in the heart and dispelling cold; ginseng is self-warming, greatly tonifying the qi of the spleen and lungs; malt syrup is sweet and can replenish earth, easing the middle jiao, because people prioritize middle jiao qi. Using spicy and sweet-hot medicines to greatly invigorate the internal organs' yang, thereby eliminating the turbid yin that rises upward. ("Chengfangbian Du")

② Adding flavors to Da Jianzhong Decoction to treat 45 cases of biliary ascariasis. Formula composition: three qian each of dried ginger, sichuan pepper, black plum, neem bark, betel nut, and codonopsis pilosula, two taels of malt syrup, one and a half qian each of coptis and fried licorice, halved for children. All 45 cases were confirmed by Western medicine, among which 39 were cured (complete disappearance of symptoms, normal blood counts), 4 improved (clinical symptoms alleviated, normal blood counts), and 2 progressed slowly (symptoms disappeared but blood tests remained normal). ("Zhejiang Journal of Traditional Chinese Medicine," February 1964)

[Commentary] This formula, with modifications, can be used to treat chronic gastritis, ulcers, chronic pancreatitis, chronic cholecystitis, biliary ascariasis, and intestinal tuberculosis.

II. Reviving Yang and Reversing Collapse

Reviving Yang and reversing collapse is a method to save dying yang. According to "Suwen·Shengqi Tongtian Lun," "When yin is balanced and yang is concealed, spirit is healthy; when yin and yang separate, spirit is lost." Patients with declining yang qi and excessive yin cold present with cold extremities, weak and nearly absent pulse, and clear watery diarrhea. Other conditions such as yang deficiency preventing water metabolism, floating yang rising upward, or yang being blocked externally can also be treated with this method.

1. Si Ni Tang from "Shanghan Lun"

[Composition] 9 grams of processed aconite (one piece, raw, split into eight slices) 9 grams of dried ginger (one and a half taels) 4.5 grams of licorice (fried for two taels)

[Dosage and Administration] Decoct in water, remove the residue, and take warm.

[Main Indications] Declining kidney yang, weak spleen yang.

[Indications] Cold extremities, weak and nearly absent pulse, profuse sweating, cold abdominal pain, clear watery diarrhea, feeling cold and timid.

[Functions] Revive yang and reverse collapse.

[Formula Analysis] When kidney yang declines, there are cold extremities, weak and nearly absent pulse, profuse sweating, and feeling cold and timid; when spleen yang is weak, there is cold abdominal pain and clear watery diarrhea. Spleen yang relies on kidney yang's warmth to develop, so in this formula, processed aconite warms the kidneys and strengthens yang, serving as the principal herb for reviving yang and reversing collapse; dried ginger warms the middle jiao, disperses cold, and serves as an auxiliary herb for reviving yang and reversing collapse; licorice harmonizes all herbs, serving as a guiding herb. The strong heat of ginger and aconite works to eliminate deep-seated cold, rescuing the escaping yang, paired with licorice's sweetness to harmonize, together forming a sweet-hot combination, exactly in line with the "Inner Canon's" principle of "treating internal cold with sweet-hot."

[Clinical Modifications] ① Double the amount of dried ginger, named Tongmai Si Ni Tang (from "Shanghan Lun"). Treats Si Ni, weak and nearly absent pulse, using more dried ginger to warm the middle jiao and enhance the effect of reviving yang. ② Add ginseng, named Si Ni Jia Ren Tang (from "Shanghan Lun"). Treats Si Ni with severe cold, weak pulse, and continued diarrhea, with bleeding after stopping diarrhea. ③ Add poria and ginseng, named Poria Si Ni Tang (from "Shanghan Lun"). Treats cases where fever from Shanghan is brought down but the illness remains unresolved, with restlessness. ④ Add white onion, named Bai Tong Tang (from "Shanghan Lun"). Mainly treats Shaoyin diseases with diarrhea and weak pulse. ⑤ Add white onion and pig bile, named Bai Tong Jia Zhu Dan Zhi Tang. Mainly treats cases where Bai Tong Tang is taken but diarrhea persists, with cold extremities and no pulse, accompanied by dry vomiting and restlessness. ⑥ Add pinellia ternata, galangal, and ground cinnamon, named Jiangshui San (from "Baoming Ji"). Take 10 grams per dose, decoct in water, remove the residue, and take warm. Treats sudden diarrhea like water, with sweat all over the body, complete coldness, and weak pulse.

[References] ① The pathogenesis of yin excess and yang deficiency varies in severity and urgency, so when using Si Ni Tang, adjustments should be made according to the specific condition. For example, in Si Ni Jia Ren Tang, diarrhea stops suddenly, but the severe cold and weak pulse remain, indicating that it's not a case of yang recovery, but rather depletion of yin fluids and cessation of diarrhea. Therefore, "Shanghan Lun" says, "Diarrhea stops, but blood is lost." If only reviving yang is attempted at this point, it won't work and may even accelerate death. Therefore, ginseng should be added to Si Ni Tang to restore yang and replenish yin. If after sweating and diarrhea both yin and yang are damaged and the patient is restless, more poria can be added to Si Ni Jia Ren Tang, forming Poria Si Ni Tang, to calm the yang and reverse the collapse. If it's a Shaoyin cold condition with diarrhea and cold extremities, red face, restlessness, and weak pulse, it's due to yin cold below and yang deficiency above, so in Si Ni Tang, remove licorice and add white onion, forming Bai Tong Tang. The pungent and slippery nature of white onion helps circulate yang qi and dispel cold evil. If yin dominates and blocks yang externally, with red face, dry vomiting, and restlessness, human urine and pig bile can be added to Bai Tong Tang, forming Bai Tong Jia Zhu Dan Zhi Tang. At this point, yin and yang are locked, so in the yang-warming medicine, add salty and bitter cooling agents to prevent rejection of the hot medicine, in accordance with the "Suwen·Zhizhen Yao Dailun" principle of "using heat to counter cold" and "following the extreme." ("Jiangsu New Medical College: 'Traditional Chinese Medicine Formulary Science'")

② Using Si Ni Tang with coptis to treat 70 cases of infantile diarrhea. All patients were infants aged 45 days to one and a half years, with the shortest illness lasting 8 days and the longest 64 days. Among them, 53 had previously tried both traditional and Western medicines without success, while 17 had never taken any medication. All these cases were treated with Si Ni Tang plus coptis (first decoct five parts of processed aconite, three qian each of dried ginger and licorice, add 300 ml of water, simmer over low heat until 150 ml remains, then add three qian of coptis, continue simmering over low heat until 80 ml remains, filter, add appropriate sugar, bring to boil, and set aside). Infants under five months took 3–5 ml per dose, those between six and ten months took 5–8 ml, and those between one and one and a half years took 8–10 ml, every four hours. Treatment results: 58 cured, 8 nearly cured, and 4 ineffective. The longest treatment duration for cured cases was seven days, the shortest one day, with an average of four days. ("Zhejiang Journal of Traditional Chinese Medicine," August 1964, p.14)

③ Si Ni Tang injection can enhance the contractility of isolated rabbit hearts during anesthesia; clinical observations show that using Si Ni Tang injection to rescue shock can raise blood pressure. ("Tianjin Medical Communications," November 1972)

[Commentary] This formula can be used for infantile diarrhea and chronic colitis; it can also be used when pulmonary heart disease, pneumonia, or dehydration lead to collapse and drop in blood pressure.

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2. Huiyang Jiuji Tang from "Shanghan Liu Shu"

[Composition] 9 grams of processed aconite 4.5 grams of dried ginger 3 grams of cinnamon 6 grams of ginseng 9 grams of atractylodes 9 grams of poria 6 grams of tangerine peel 4.5 grams of licorice 3 grams of schisandra 9 grams of processed pinellia ternata

[Dosage and Administration] Add three slices of ginger and boil in water, then add 0.1 gram of musk just before taking. After taking the medicine, hands and feet become warm, so no further doses are needed.

[Main Indications] Cold invading the three yin meridians, yin predominance and yang deficiency.

[Indications] Cold extremities, weak and nearly absent pulse, feeling cold and timid, cold abdominal pain, clear watery diarrhea, cyanosis of the fingernails.

[Functions] Revive yang and rescue emergency.

[Formula Analysis] Cold evil directly attacks the three yin meridians, resulting in yin predominance and yang deficiency, hence these symptoms. The three yin meridians are the Foot Taiyin Spleen, Foot Shaoyin Kidney, and Foot Jueyin Liver, with the kidney being the origin of both yin and yang. When cold evil enters the kidney, the kidney yang gradually declines, manifesting as cold extremities, weak and nearly absent pulse, and feeling cold and timid; when cold evil enters the spleen, the spleen yang becomes weak, manifesting as cold abdominal pain and clear watery diarrhea; when cold evil enters the liver, the liver meridian becomes cold, manifesting as cyanosis of the fingernails. In this formula, processed aconite and cinnamon enter the kidney to dispel cold, rescuing the escaping yang, serving as the principal herb. Dried ginger enters the spleen to disperse cold and revive the weakened spleen yang as an auxiliary herb. The liver and kidney share the same origin, so when kidney yang recovers, the cold in the liver meridian also dissipates. The Six Gentlemen Decoction strengthens the spleen and benefits qi, serving as a complementary treatment; schisandra benefits lung qi and restrains kidney yin, embodying the principle of metal-water mutual generation, also serving as a complementary treatment. Musk is aromatic and penetrates deeply, breaking barriers and guiding all herbs directly into the three yin meridians as a guiding herb; ginger is pungent and disperses yang qi, also serving as a guiding herb. With three yin meridians involved, the urgent need for all yang to be restored is resolved. He Xiushan said, "This is the first excellent prescription for reviving yang and consolidating collapse, while benefiting qi and generating pulse."

[Clinical Modifications] ① For vomiting with foamy saliva or lower abdominal pain, add salt-fried wu zhu yu; for those with no pulse, add a spoonful of pig bile; for persistent diarrhea, add cimicifuga and astragalus; for persistent vomiting, add ginger juice. ② Remove the Six Gentlemen Decoction, schisandra, and cinnamon, add soapberry, named Zhengyang San (from "Taiping Shenghui Fang"). Mainly treats cases of yin-toxin-induced shanghan, with blue face, open mouth breathing, hard heart, cold extremities, and sweat on the forehead.

[References] ① This is also a formula for the three yin meridians. When cold attacks the three yin, yin predominates and yang is weak, so use spicy and hot medicines like processed aconite, dried ginger, and cinnamon to dispel cold, while use the Six Gentlemen Decoction to tonify yang, schisandra combined with ginseng can generate pulse, and adding musk opens the orifices. ("Yifang Jijie")

② Emergency revival formula for Yang from "Medical Zhongchong Canxi Lu": 24 grams of codonopsis pilosula, 30 grams of raw yam, 15 grams of raw white peony, 24 grams of mountain cornelian cherry, 9 grams of fried licorice, 12 grams of ochre, 1.5 grams of cinnabar, half a cup of children's urine heated, followed by cinnabar, then continue taking herbal medicine. Mainly treats cholera with extreme vomiting and diarrhea, mental confusion, fainting breath, and critical condition.

[Commentary] This formula can be used for chronic colitis, chronic diarrhea, salmonella infections, toxic dysentery, and other conditions that lead to peripheral circulatory failure.

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3. Shenfu Tang from "Shiyi De Xio Fang"

[Composition] 10 grams of ginseng 6 grams of processed aconite

[Dosage and Administration] Decoct in water and take.

[Main Indications] Sudden loss of yang qi.

[Indications] Diminished consciousness, cold extremities, cold sweat on the forehead, weak or nearly absent pulse.

[Functions] Revive yang and rescue collapse.

[Formula Analysis] According to "Suwen·Shengqi Tongtian Lun," "Yang qi is like heaven and sun; if it loses its place, life expectancy decreases and vitality diminishes." Thus, yang qi is crucial for life. Sudden loss of yang qi is what we call "dying yang," indicating that yin and yang are about to separate, manifested as diminished consciousness, cold extremities, cold sweat on the forehead, and weak or nearly absent pulse. In such emergencies, only powerful warming and tonifying medicines can revive yang and rescue collapse. In this formula, ginseng greatly tonifies original qi, and when qi is sufficient, yang naturally recovers, making it the principal herb for reviving yang and rescuing collapse, aiming to treat the root cause; processed aconite is extremely pungent and hot, warming yang and opening yang channels, allowing yang qi to reach the four extremities, serving as an auxiliary herb. The two herbs complement each other, treating the root cause and achieving comprehensive efficacy.

[Clinical Modifications] ① For those with flushed faces, add children's urine, even pig bile in severe cases; for those whose yang is about to dissipate, add raw dragon and oyster; for those whose pulse is about to disappear, add dried ginger; for those whose yang is difficult to recover, add schisandra, rehmannia, and other yin-conserving, yin-nourishing herbs to the yang-tonifying medicine. ② Remove ginseng, add astragalus, named Qi Fu Tang (from "Wei Shi Jia Cang Fang"), treating night sweats. ③ Remove ginseng, add atractylodes, named Shu Fu Tang (from "Yizong Jinjian"). Treating cases of cold and dampness clashing, causing body pain.

[References] ① There's no better way to supplement postnatal qi than ginseng, and no better way to supplement prenatal qi than processed aconite, which is why this Shenfu Tang is so important. ... When the two herbs are used appropriately, they can instantly transform qi from nothing into existence, and quickly generate yang within the vital gate, making this formula the most rapid and effective. ("Shanbu Mingyi Fanglun")

② For patients with heart failure who experience side effects after using digitalis or whose long-term use of digitalis has become ineffective, treating them with Shenfu Tang with added flavors is also effective. Regarding the dosage ratio of ginseng and processed aconite, we believe that since the focus is on using ginseng and processed aconite to revive yang and rescue collapse, the two can be used in equal amounts. ("Shanghai Journal of Traditional Chinese Medicine," November 1965)

[Commentary] This formula can be used for various types of shock caused by different reasons, such as hemorrhagic shock and toxic shock; it can also be used for congestive heart failure and gastrointestinal autonomic dysfunction.

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4. Zhenwu Tang from "Shanghan Lun"

[Composition] 9 grams of white peony (three taels) 6 grams of atractylodes (two taels) 9 grams of poria (three taels) 6 grams of processed aconite (one piece, peeled) 9 grams of ginger (three taels)

[Dosage and Administration] Decoct in water and take warm.

[Main Indications] Yang deficiency with water overflow.

[Indications] Feeling cold and timid, spontaneous sweating, difficulty urinating, severe pain in the limbs, edema, abdominal pain and diarrhea, palpitations, dizziness, body trembling, feeling like collapsing, swollen tongue with white coating, and deep pulse.

[Functions] Warm yang and promote water metabolism.

[Formula Analysis] The kidneys control water, and when kidney yang is insufficient, qi cannot transform water, which is what we call "when yang fails to transform qi, body fluids are not distributed." When yang is deficient, there is feeling cold and timid, spontaneous sweating; when water overflows externally, there is severe pain in the limbs and edema; when water overflows internally, there is abdominal pain and diarrhea, difficulty urinating, and deep pulse; when water qi overwhelms the heart, there is dizziness and palpitations; "the kidneys are the organ of strength, where skills emerge," so when kidney yang is insufficient, skills do not emerge, manifested as body trembling and feeling like collapsing. All these symptoms stem from kidney yang deficiency, so in this formula, the extremely pungent and hot processed aconite warms the kidneys and restores yang, addressing the root cause as the principal herb. Poria and atractylodes strengthen the spleen and promote water metabolism, serving as auxiliary herbs. Ginger is pungent and warm, penetrating the surface, while white peony is bitter and cold, entering the interior, one outside and one inside, dispersing surface water qi and restraining internal water moisture, serving as complementary treatments.

[Clinical Modifications] ① For those who cough, add schisandra, asarum, and dried ginger; for those who urinate easily, remove poria; for those who have diarrhea, remove white peony and add ginger; for those who vomit, remove processed aconite and increase the amount of ginger.

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② Remove the ginger and add Codonopsis, resulting in Fu Zi Tang (from "Shang Han Lun"). It is indicated for yang deficiency with internal invasion of cold-dampness, causing pain in the bones and joints. ③ Adding Hou Pu, Cao Dou Kou, and Ze Xie to this formula treats abdominal distension alone.

[References] ① Xiao Qing Long Tang treats conditions where the exterior pattern is unresolved and there is water qi, with both exterior and interior being real cold patterns; Zhen Wu Tang treats conditions where the exterior pattern has been resolved and there is water qi, with both exterior and interior being deficient cold patterns. Zhen Wu refers to the northern deity in charge of water. The name of the soup is derived from its function of controlling water. In the human body, the spleen controls water, while the kidneys govern water. The kidneys act as the gatekeeper of the stomach, gathering water and storing it in its form. If there is no yang in the kidneys, although the spleen's mechanism operates, the kidney's gate remains closed, so water wants to flow but lacks a governing force, leading to overflow and erratic movement, which results in these symptoms. Using the pungent and warm properties of Fuzi to transform the original yang of the kidneys gives water a governing force; Bai Zhu's bitter and drying nature establishes the middle earth, thus controlling water; ginger's pungent and dispersing nature assists Fuzi in tonifying yang, embodying the idea of dispersing water within the process of generating water; Fu Ling's bland and seeping nature supports Bai Zhu in strengthening the middle earth, embodying the principle of promoting water drainage within the process of controlling water; most remarkably, Peony's sour and astringent nature—this is a subtle point in Zhang Zhongjing's intention! After all, in the human body, yang roots in yin. If one only uses pungent and warm substances to tonify yang without accompanying astringent agents, there is a risk that the true yang will dissipate. By using Peony, we urgently draw yang back to its roots in yin. (From "Yi Zong Jin Jian")

② This formula, with double the amount of Fuzi and roasted licorice, doubles its ability to restore yang and control water. For conditions such as edema, asthma, and hernia, as long as the pulse is deep and weak, almost disappearing, with a floating pulse that lacks grounding, and the tongue coating is white and moist or black and slippery,

New Compilation of Traditional Chinese Medicine Formulas

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Qi in the upper part causes anger and bloating. "In this formula, Hou Pu warms the middle and dispels cold to treat the root cause, while drying dampness and relieving fullness address the symptoms; treating both root and symptoms makes it suitable as the main medicine. Cao Dou Kou and two kinds of ginger warm the middle and dispel cold as auxiliary medicines; Fu Ling strengthens the spleen and drains dampness, Chen Pi strengthens the spleen and promotes qi circulation, and Mu Xiang promotes qi circulation and relieves pain—all serving as complementary treatments."

【Clinical Adjustments】 ① Add Sang Bai Pi, named Dui Jin Yin Zi (from "Cheng Fang Qie Yong"). It treats cases where the spleen and stomach are affected by dampness, resulting in abdominal distension, heaviness, poor appetite, limb soreness, and skin swelling. ② Remove Cao Dou Kou, ginger, and Fu Ling, named He Wei Yin (from "Cheng Fang Qie Yong"). It treats conditions where cold-dampness injures the spleen, causing cholera-like vomiting and diarrhea, phlegm, water, and qi-related issues, as well as gastric fullness and distension. ③ If stomach pain is severe, add Dan Shen; if flank pain is accompanied by acid reflux, add Zuo Jin Wan; if food stagnation cannot be digested, add Jiao San Xian.

【References】 ① Adjusting Hou Pu Wen Zhong Tang to treat two cases of peptic ulcer. Both cases were confirmed by barium meal X-ray: one was a gastric ulcer, the other a duodenal bulb ulcer. For gastric ulcers: Hou Pu, Gan Jiang, Yu Jin, Bai Shao, Cao Dou Kou, Ru Xiang, Mo Yao, Mu Xiang, Roasted Licorice, and Zi He Che Powder (taken by brewing). Decoction is taken once daily on an empty stomach; after three doses, symptoms improve significantly, and after more than thirty doses, symptoms completely disappear. At fifty-two doses, the barium meal X-ray shows no abnormalities. For duodenal bulb ulcers: Hou Pu, Sha Ren, Mu Xiang, Gan Jiang, Bai Shao, Yu Jin, Wuer Gu, Ru Xiang, Cao Dou Kou, Fu Ling, Bai Zhu, and Gan Cao. Decoction is taken once daily; after four doses, pain greatly decreases, and after thirty doses, symptoms completely disappear, with the barium meal X-ray showing complete normalcy. (From "Zhejiang Journal of Traditional Chinese Medicine," May 1964, p. 37) ② The formula appears in "Internal and External Injury Differentiation" (mistakenly recorded in the "Chinese Medical Dictionary" as a formula from "Shen Shi Zun Sheng Shu"). Clinical application focuses on treating primarily cold in the middle. For those with mild stomach cold, fresh ginger can replace dried ginger. (From "A Preliminary Discussion on Li Gao's Contributions to Pharmacology," Medical History and Literature Research Office of the Chinese Academy of Traditional Chinese Medicine, April 1979)

【Notes】This formula is used for chronic gastritis, gastric and duodenal bulb ulcers, gastrointestinal neurosis, chronic pancreatitis, and other conditions.

2. Dang Gui Si Ni Tang from "Shang Han Lun"

【Composition】 Dang Gui 9 grams (three liang) Gui Zhi 6 grams (three liang, peeled) Bai Shao 9 grams (three liang) Xi Xin 3 grams (three liang) Mu Tong 3 grams (two liang) Roasted Licorice 3 grams (two liang) Jujubes 8 pieces (twenty-five pieces split open)

【Dosage】Decoction is taken warm.

【Indications】Cold congealing in the meridians and blood stasis.

【Symptoms】Pain in the limbs, cold extremities, and a weak, nearly absent pulse.

【Functions】Warming the meridians, dispelling cold, unblocking yang, and restoring the pulse.

【Explanation】When cold congeals in the meridians, it causes pain in the limbs; when blood stasis occurs, it leads to cold extremities and a weak pulse. Cold is the root cause, while stasis is the symptom. In this formula, Gui Zhi and Xi Xin warm the meridians and dispel cold, unblocking yang and restoring the pulse—treating both root and symptom, with the former being the primary focus. "Where evil gathers, qi must be deficient." Meridians are where nutritive blood circulates; when cold qi condenses in the meridians, it often occurs in patients with inherent blood deficiency. In this formula, Dang Gui and Bai Shao nourish the blood and reinforce the body, making the blood strong and healthy, thus preventing cold qi from entering—making them auxiliary medicines. Jujubes benefit qi and strengthen the spleen, while Mu Tong clears the meridians and removes dampness—all serving as complementary treatments. Licorice harmonizes all the herbs and acts as a guide. The name "Dang Gui Si Ni Tang" emphasizes the importance of Dang Gui in nourishing the blood and reinforcing the body, ranking second only to Gui Zhi and Xi Xin in terms of their role in dispelling cold and restoring the pulse, making them the primary auxiliary medicines.

【Clinical Adjustments】 ① Add Wu Zhu Yu and ginger, decocted half in water and half in wine, named Dang Gui Si Ni Jia Wu Zhu Yu Ginger Tang (from "Shang Han Lun"). It treats cold extremities, a weak pulse, and individuals with long-term internal cold. ② Add Wu Yao, Xiao Hui Xiang, Liang Jiang, and Mu Xiang to treat lower abdominal pain and testicular heaviness.

【References】 ① Si Ni Tang is entirely about restoring yang, Si Ni San is entirely about harmonizing the exterior and interior, while Dang Gui Si Ni Tang is entirely about nourishing the blood and unblocking the pulse. (Qing Dynasty, Zhou Yang Jun) ② Yang ××, male, 2 years old. After a fever, he lost the ability to move his limbs. Western medicine diagnosed him with epidemic anterior horn gray matter myelitis—paralysis stage. Prescription: Dang Gui, Gui Zhi, Chi Shao, and Mu Tong, each one qian; Xi Xin and Gan Cao, each seven fen; one jujube. After taking a total of 17 doses, the child was able to walk with support, his limb muscles were fuller and stronger than before, and his complexion and pulse returned to normal. Follow-up 11 months later showed sustained improvement. (From "Journal of Traditional Chinese Medicine," September 1965, p. 21)

【Notes】This formula is effective for peripheral nerve disorders and peripheral vascular diseases, such as multiple neuritis, sequelae of polio, peripheral phlebitis, obliterative vasculitis, and varicose veins of the lower limbs; additionally, it can also be used for frostbite, hernias, testicular diseases, and chronic ulcers of the lower limbs.

3. Si Shen Wan from "Internal Medicine Abstracts"

【Composition】 Bu Gu Zhi 120 grams Wu Wei Zi 60 grams Rou Dou Kou 60 grams (oil removed) Wu Zhu Yu 30 grams Ginger 120 grams Jujubes 50 pieces

【Dosage】Boil ginger and jujubes together, remove the ginger, then mix the jujube pulp with the finely powdered herbs (sieved) to form pills about the size of a tung tree seed. Take five to seventy pills per dose, on an empty stomach or before meals. In modern times, take six to nine grams per dose, washed down with plain water.

【Indications】Deficiency of Ming Men fire.

【Symptoms】Lower back pain and cold limbs, diarrhea at dawn, lack of appetite, indigestion, fatigue, and a deep, slow, weak pulse.

【Functions】Warming and tonifying Ming Men, warming the spleen and stopping diarrhea.

【Explanation】The kidneys govern all yang in the body, and the spleen relies on the warmth of kidney yang to carry out digestion. In this case, due to the decline of kidney yang (deficiency of Ming Men fire), the spleen's yang is weakened. When kidney yang declines, it leads to lower back pain and cold limbs, as well as diarrhea at dawn; when spleen yang is weak, it results in loss of appetite, indigestion, and fatigue. In this formula, Bu Gu Zhi warms the kidneys and restores yang, strongly replenishing the fire of Ming Men as the primary action. Rou Dou Kou warms the middle and dispels cold, helping to revitalize spleen yang as an auxiliary measure. Wu Zhu Yu enters the liver to dispel cold; since the liver and kidneys share the same origin, dispelling cold from the liver also helps strengthen the fire of Ming Men, making it a complementary treatment. Wu Wei Zi is sour and astringent, stopping diarrhea and entering the lungs to gather qi; the lungs connect to all the meridians, so when lung qi is gathered, all yang returns and does not disperse again, making it another complementary treatment. Ginger and jujubes harmonize ying and wei, serving as guides. The purpose of this formula is to warm and tonify Ming Men. According to "Medical Formula Compendium," "Long-term diarrhea is always caused by deficiency of Ming Men fire, so it cannot be solely attributed to the spleen and stomach. Therefore, we must strongly replenish the lower jiao's original yang, making the fire strong and the earth robust, so that it can control water and prevent it from flowing erratically."

【Clinical Adjustments】 ① Remove Wu Wei Zi and Wu Zhu Yu, add Xiao Hui Xiang and Mu Xiang, named Dan Liao Si Shen Wan (from "Zheng Zhi Jun Sheng"), with slightly similar indications. ② Remove Wu Wei Zi and Wu Zhu Yu, named Er Shen Wan (from "Ben Shi Fang"). Treats spleen and kidney weakness, with no appetite. ③ Remove Po Gu Paper and Rou Dou Kou, named Wu Wei Zi San (from "Ben Shi Fang"). Treats kidney deficiency-related diarrhea. ④ For those with external prolapse, combine with Bu Zhong Yi Qi Tang; for those with excessive diarrhea, add Fuzi and Rou Gui.

【References】 ① In "Shen Shi Zun Sheng Shu," Si Shen Wan consists of Wu Zhu Yu, Bi Cheng Jia, Qing Mu Xiang, and Xiang Fu, mainly treating cold-stagnant liver meridian-related hernias. ② Without fire in Ming Men, the central palace cannot properly digest food and water, and kidney qi is unstable. Who else can take over the role of storing and containing? Thus, wood qi emerges, neither dispersing nor leaking. Although wood qi interferes with earth qi, it is actually the kidneys' insult to the spleen. At this point, we need to strengthen both the spleen and kidneys, stabilize the liver, and therefore use Bu Gu Zhi to warm the kidneys, Rou Guo to strengthen the spleen, Wu Wei Zi to astringe, and Wu Zhu Yu to drain the liver. With warm kidneys and rising qi, the liver calms down and the spleen thrives, closing the gates and allowing food and water to be properly digested. (From "Yi Zong Jin Jian") ③ Mr. Xiong, male, 41 years old. Has had diarrhea for nine years, with 3–5 bowel movements per day, no pus or blood in the stool, and no tenesmus. Barium meal X-ray shows that the colon is relatively narrow, with shallow haustra, especially in the sigmoid, descending, and transverse colon. Diagnosis: allergic colitis. Tongue is pale white, pulse is deep and thin. First tried Shen Ling Bai Zhu San with little effect, then switched to Si Shen Wan, three times a day, two qian each time, for a total of 30 days, and recovered. Follow-up one month later showed no recurrence. (From "Shanghai Journal of Traditional Chinese Medicine," October 1965, p. 3)

【Notes】This formula can be used for allergic colitis, chronic colitis, intestinal tuberculosis, autonomic dysfunction of the intestines, malabsorption syndrome, and other conditions.

Chapter Nine: Digestive and Accumulation-Resolving Agents

Digestive means eliminating food stagnation, while accumulation-resolving means breaking down accumulated masses. Food stagnation arises from undigested food, and accumulation results from persistent stagnation. Stagnation is invisible, so digestive methods can eliminate it; accumulation, however, is visible, requiring methods to break it down and grind it into smaller pieces. Whether it's food stagnation or accumulated mass, both can obstruct the smooth flow of qi and affect the smooth circulation of nutritive blood, leading to symptoms like distension, accumulation, and masses. The treatment methods for these conditions are collectively called "digestive methods," which are one of the "Eight Methods" in traditional Chinese medicine. According to "Medical Insight," "There is nothing inherently between organs, meridians, and muscles; they must be dispersed to achieve balance." Thus, digestive and accumulation-resolving agents, like purgatives, both have the effect of eliminating tangible pathogenic factors. However, in clinical practice, the two differ. Purgatives are suitable for sudden, tangible pathogenic factors, while digestive and accumulation-resolving agents are better suited for gradual distension and accumulation. Although digestive and accumulation-resolving agents are milder than purgatives, they are still powerful eliminators and should be avoided in patients who are purely deficient and have no tangible pathogenic factors.

I. Digestive and Stagnation-Resolving

The target of digestive and stagnation-resolving methods is patients whose diet is undigested and stagnant in the spleen and stomach. Undigested food leads to belching and acid regurgitation; stagnation in the spleen and stomach causes abdominal distension; if the spleen and stomach lose their ability to rise and fall, symptoms like vomiting, diarrhea, and intestinal rumbling may appear.

1. Bao He Wan from "Dan Xi Xin Fa"

【Composition】 Shan Zha 180 grams Shen Qu 60 grams Ban Xia 90 grams Fu Ling 90 grams Chen Pi 30 grams Lian Qiao 30 grams Lai Fu Zi 30 grams

【Dosage】Grind everything into powder, make pill-shaped cakes about the size of a tung tree seed, take seventy to eighty pills per dose, washed down with plain water after meals. Modern usage: take pills of 9–12 grams, washed down with hot water; or make a decoction and drink it.

【Indications】Undigested food with dampness and heat.

【Symptoms】Chest and epigastric fullness, abdominal distension with pain, belching and aversion to food, food-related diarrhea, yellow and greasy tongue coating, and a slippery, rapid pulse.

【Functions】Digesting food and harmonizing the middle, clearing heat and draining dampness.

【Explanation】Undigested food leads to chest and epigastric fullness and abdominal distension with pain; stagnation generates dampness, and dampness generates heat, so when dampness and heat combine, symptoms like belching, aversion to food, food-related diarrhea, yellow and greasy tongue coating, and a slippery, rapid pulse appear. In this formula, Shan Zha eliminates meat-based food, Shen Qu eliminates grain-based food, together achieving the function of digesting food and harmonizing the middle as the primary goal; Lian Qiao clears heat, and Er Chen removes dampness, jointly fulfilling the task of clearing heat and removing dampness as auxiliary measures; Lai Fu Zi expands the intestines and regulates qi, also serving as a complementary treatment.

【Clinical Adjustments】 ① Add Bai Zhu, named Da An Wan (from "Dan Xi Xin Fa"). Treats food stagnation combined with spleen deficiency, as well as childhood food accumulation. ② Remove Ban Xia, Lai Fu Zi, and Lian Qiao, add Bai Zhu and Bai Shao, named Xiao Bao He Wan (from "Medical Formula Compendium"), which helps the spleen to eat. ③ Add Mai Ya, still named Bao He Wan (from "Medical Grade"); add Bai Zhu, Hou Pu, Xiang Fu, Zhi Shi, Huang Lian, and Huang Qin, also named Bao He Wan (from "Ancient and Modern Medical Compendium"). The effects are largely the same as this formula.

【References】Food poisoning is caused by overeating, indulging in greasy alcohol and meat, which aligns with the principle stated in "Plain Questions·Discussion on Arthritis": "When diet doubles, the stomach and intestines are injured." Overeating overwhelms the spleen's ability to transport food, inevitably leading to food stagnation. Treatment methods: if food stops in the upper abdomen, there is a tendency for it to reverse upward, so use emesis to expel it; if food stops in the lower abdomen, it forms a hard mass, so use purgatives to attack it; if food stops in the middle abdomen, the accumulation is not severe, but you see fullness in the middle, belching and refusal to eat, and abdominal distension—neither reversal nor hard mass occurs, so neither emesis nor purgatives are appropriate. Only gentle methods can dissolve and transform it. That's why this formula is called "Bao He." (Jiangsu New Medical College: "Traditional Chinese Medicine Formulas")

【Notes】This formula can be used for acute gastroenteritis and acute exacerbations of chronic gastritis.

2. Zhi Shi Dao Zhi Wan from "Internal and External Injury Differentiation"

【Composition】 Da Huang 30 grams Huang Qin 9 grams Huang Lian 9 grams Fu Ling 9 grams Bai Zhu 9 grams Ze Xie 6 grams Zhi Shi 15 grams (stir-fried with bran) Shen Qu 15 grams (stir-fried)

【Dosage】Grind everything into powder, steam into cake-shaped pills about the size of a walnut, take five to seventy pills per dose, washed down with warm water. Modern usage: take water pills of 6–12 grams, washed down with hot water, or make a decoction and drink it.

【Indications】Food stagnation in the middle jiao, with dampness and heat combining.

【Symptoms】Chest and epigastric fullness, diarrhea and abdominal pain, tenesmus, or severe constipation, red and yellow urine, yellow and greasy tongue coating, and a slippery, rapid pulse.

【Functions】Digesting food and stagnation, clearing heat and draining dampness.

【Explanation】Food stagnation in the middle jiao leads to chest and epigastric fullness; stagnation generates dampness, and dampness generates heat, so when dampness and heat combine, symptoms like diarrhea and abdominal pain, tenesmus, or severe constipation, red and yellow urine, yellow and greasy tongue coating, and a slippery, rapid pulse appear. In this formula, Zhi Shi primarily addresses the root cause of food stagnation. Da Huang, Huang Qin, and Huang Lian clear heat and dry dampness as auxiliaries. Bai Zhu and Fu Ling strengthen the spleen and dry dampness, while Ze Xie drains water and removes dampness—these three drugs work from different angles to achieve the goal of treating dampness, all serving as complementary treatments. This formula is used for food stagnation, with Shen Qu digesting food accumulation, acting as a guide.

【Clinical Adjustments】 ① Add Mu Xiang and Bing Lang, steam into cake-shaped pills, named Mu Xiang Dao Zhi Wan (from "Song Ya Yi Jing"). Treats cases of food poisoning, where people feel bloated, restless, and uneasy. ② Add Mu Xiang and Bing Lang to treat red and white diarrhea.

【References】The main indication for Zhi Shi Dao Zhi Wan is damp-heat stagnation, a condition where the intestines and stomach are stuck together, manifested as abdominal distension, abdominal pain, diarrhea that doesn't feel good, or constipation, with hard, full, and resistant-to-pressure sensations upon touching the abdomen. The tongue coating is very important; if it's mostly yellow and greasy or slippery, it's significant, regardless of whether the tongue is red or not. Pulse changes are far less important than tongue coating changes. Therefore, this formula has been adapted to treat cirrhosis with ascites, urinary tract infections, and incomplete intestinal obstruction, all of which achieved the expected results. Three patients, during the use of this formula, added drugs to resolve blood stasis, clear heat and dry dampness, expand the intestines, and promote qi circulation according to their specific conditions. (From "Hubei Journal of Traditional Chinese Medicine," April 1980, p. 23)

【Notes】This formula is used for autonomic dysfunction of the gastrointestinal tract and chronic dysentery, among other conditions.

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3. Zhi Shi Xiao Pi Wan from "Lan Shi Mi Cang"

【Composition】 Ren Shen 9 grams Bai Zhu (soil-fried) 6 grams Mai Ya Qu 6 grams Fu Ling 6 grams Gan Cao 6 grams Ban Xia Qu 9 grams Zhi Shi 15 grams Hou Pu 12 grams Gan Jiang 3 grams Huang Lian (ginger-fried) 15 grams

【Dosage】Grind everything into fine powder, steam into small pills, take 9–12 grams per dose, washed down with warm water.

【Indications】Spleen deficiency and inability to transport, with cold and heat intermingling.

【Symptoms】Pale face, loss of appetite, fatigue, epigastric fullness, full abdominal pain, and difficulty with bowel movements.

【Functions】Strengthening the spleen and benefiting qi, eliminating fullness and distension.

【Explanation】The spleen is inherently weak and unable to transport, leading to cold and heat intermingling in the epigastric region. Spleen deficiency manifests as: pale face, loss of appetite, and fatigue; cold and heat intermingling in the epigastric region leads to: epigastric fullness; because of this intermingling, qi circulation is blocked, resulting in full abdominal pain and difficulty with bowel movements. In this formula, Zhi Shi primarily breaks up the blockage and eliminates fullness. Fullness arises from the intermingling of cold and heat, so Huang Lian clears heat to disperse the heat in the blockage; Ban Xia and Gan Jiang warm and disperse to remove the cold in the blockage, together clearing heat and dispersing cold to assist the main drug in breaking up the blockage and eliminating fullness as auxiliaries. Hou Pu promotes qi circulation and expands the middle, Mai Ya digests food and harmonizes the middle, and the Four Gentlemen benefit qi and supplement the middle—all serving as complementary treatments. Gan Cao harmonizes all the herbs and acts as a guide.

【Clinical Adjustments】 ① Remove Huang Lian, add Chen Pi and Sha Ren to strengthen the stomach and dispel phlegm, treating phlegm in the chest. ② Add Shi Jun Zi, Fei Zi, and Bing Lang to expel parasites and eliminate accumulations.

【References】Treating epigastric emptiness, loss of appetite, and laziness, with a tense right pulse. Spleen deficiency leads to fullness and loss of appetite; the spleen governs the limbs, so deficiency leads to laziness; the right pulse belongs to the spleen, and a tense pulse indicates spleen deficiency and wood interfering with it. As the saying goes: "When Taiyin reaches, it becomes accumulated fluid and fullness, all due to yin overpowering yang. The organs affected are the heart and spleen, so when cold and moisture accumulate, it becomes fullness, fire and moisture." After all, the heart's yang fire governs blood, while the spleen's yin earth governs warmth. When yang is damaged, fire becomes stifled and blood coagulates; when yin is damaged, earth becomes congested and moisture accumulates. The division between yin and yang determines the treatment method, which cannot be the same. (From "Cheng Fang Qie Yong")

【Notes】This formula can be used for chronic gastritis, chronic bronchitis, chronic dysentery, and gastrointestinal neurosis.

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4. Mu Xiang Bing Lang Wan from "Ru Men Shi Qin"

【Composition】 Mu Xiang 30 grams Bing Lang 30 grams Qing Pi 30 grams Chen Pi 30 grams E Zhu 30 grams Huang Lian 30 grams Huang Bo 30 grams Da Huang 30 grams Xiang Fu 120 grams (stir-fried) Qian Niu Zi 120 grams

【Dosage】Grind everything into fine powder, make water pills about the size of a small bean, take thirty pills per dose, washed down with ginger tea after meals. Modern usage: take pills of 6–9 grams, twice a day, washed down with warm water; or make a decoction and drink it warm.

【Indications】Damp-heat combination, stagnation in the middle jiao.

【Symptoms】Abdominal fullness and pain, severe constipation, or red and white diarrhea, tenesmus, yellow and greasy tongue coating, and a slippery, rapid pulse.

【Functions】Promoting qi circulation and stagnation, clearing heat and draining dampness.

【Explanation】Damp-heat combination in the middle jiao blocks qi circulation, manifesting as abdominal fullness and pain, tenesmus; when heat prevails over dampness, it leads to severe constipation, while when dampness prevails over heat, it leads to red and white diarrhea; yellow and greasy tongue coating and a slippery, rapid pulse are all signs of damp-heat combination. Damp-heat is the root cause of this condition, but it's slow; qi blockage is the symptom, but it's urgent. When urgent, treat the symptom, and the symptom is the primary focus. In this formula, Mu Xiang, Bing Lang, Xiang Fu, and Qing Pi promote qi circulation and relieve pain as the primary action. Huang Lian and Huang Bo clear heat and dry dampness as auxiliaries. Chen Pi strengthens the spleen, E Zhu resolves symptoms, and Qian Niu Zi drains water—all serving as complementary treatments. Da Huang cleanses the intestines and drains fire, allowing damp-heat to descend, embodying the principle of "using the cause to treat the effect," which can serve as a guide; ginger tea washes down, embodying the idea of warming and dispersing, also serving as a guide.

【Clinical Adjustments】 ① Add Zhi Shi, also named Mu Xiang Bing Lang Wan (from "Dan Xi Xin Fa"), with the same indications as this formula. ② Add Zhi Shi, San Leng, Mang Xiao, and Dang Gui, also named Mu Xiang Bing Lang Wan (from "Medical Formula Compendium"). Same indications as this formula, but with stronger stagnation-resolving power.

【References】

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The damp-heat resides in the qi level of the three burners; medicinal herbs such as agarwood and costus root, which move qi, can unblock the three burners and resolve the six types of stagnation. Citrus peel regulates the qi of the upper burner, green tangerine peel balances the qi of the lower burner, bitter orange peel expands the intestines and promotes qi flow, while black castor bean and areca nut are the fastest at descending qi. When qi flows smoothly, there is no longer the problem of fullness, distension, or heaviness in the lower abdomen. Malaria and dysentery arise from the accumulation of damp-heat and disharmony between qi and blood. Huangbai and huanglian, which dry dampness and clear heat, along with sanleng, which breaks up blood stasis, and ezhushi, which breaks up qi stasis, together with dahuang and mangxiao, which act on the blood level to eliminate hidden heat in the blood and facilitate the movement of accumulated stagnation, form a potent combination for breaking down hard masses and resolving fullness. Once the accumulation of damp-heat and stagnation is removed, bowel movements become regular, and the three burners function smoothly. After all, if old accumulations are not cleared, the pure yang energy will never be able to rise; therefore, it is necessary to use agents that push and disperse them—this is also the principle of "using the same method to treat the underlying cause." However, one should not administer such powerful formulas lightly unless there is actual accumulation. (From "Yifang Jijie")

[Commentary] This formula, with appropriate modifications, can be used to treat acute and chronic dysentery, acute and chronic infectious hepatitis, and acute and chronic cholecystitis.

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5. Zhizhu Wan (Quoted from Zhang Jieggu's formula in "Piwei Lun")

[Composition] Zhishi (stir-fried with bran until golden yellow, pith removed): 30 grams
Baizhu: 60 grams

[Administration] Grind all ingredients into an extremely fine powder, wrap the powder in lotus leaves and cook it with rice to form pills about the size of tung tree seeds. Take 50 pills each time with plain boiled water. Modern usage: swallow 6–9 grams each time with hot water.

[Indications] Deficiency of middle jiao qi with fullness and distension.

[Symptoms] Fatigue, poor appetite, abdominal distension and fullness.

[Functions] Strengthen the spleen and dispel fullness.

[Formula Analysis] When the spleen qi is deficient, its ability to transform and transport food is impaired: the clear portion cannot ascend, and the turbid portion cannot descend, leading to a mixture of clear and turbid qi in the epigastric region, resulting in fullness and distension. Spleen qi deficiency manifests as fatigue and poor appetite, while the mixing of clear and turbid qi causes abdominal distension and fullness. In this formula, baizhu is used in double the amount of zhishi, primarily to strengthen the spleen and replenish qi, thus supporting the body’s righteous qi to expel pathogenic factors; zhishi, being bitter and cold, disperses qi and relieves fullness, serving as a secondary action. The combination of these two herbs embodies the principle of eliminating pathology while reinforcing the body’s vital energy—strengthening without harming the body, and expelling pathogenic factors without obstructing the body’s natural functions. As stated in "Yifang Lun": "One strengthens the spleen, the other eliminates pathogenic factors; this simple yet effective approach should not be overlooked just because it seems mild." The light fragrance of lotus leaves helps elevate the clear qi, acting as a guiding force.

[Clinical Modifications] ① Increase the amount of zhishi to twice that of baizhu and prepare it as a decoction, known as Zhizhu Tang in "Jin Gui Yao Lue." It is used to treat a hard mass in the epigastric region, as large as a plate and with edges like a spinning disk, caused by fluid retention. ② Add shenqu and maiya to make Qu Mai Zhizhu Wan ("Yixue Zhengchuan"), used to treat overeating and discomfort due to abdominal distension and fullness. ③ Add banxia and chenpi to make Ju Ban Zhizhu Wan ("Yixue Rumen"), used to treat spleen deficiency with phlegm accumulation, indigestion, and qi stagnation causing fullness and discomfort. ④ Add muxiang and sha ren to make Xiang Sha Zhizhu Wan ("She Sheng Mi Pao"), which can break up qi stagnation, digest leftover food, and stimulate appetite.

[References] Modern pharmacological studies have shown that zhishi enhances gastrointestinal peristalsis, making it a key drug for treating gallstones, gastric ptosis, uterine prolapse, and gastrointestinal dysfunction. Recent clinical reports indicate that using Zhizhu Tang to treat gastric ptosis yields better results than using Zhizhu Wan. Therefore, it can be concluded that when treating gastric ptosis, zhishi should be used in larger doses. (Shanghai University of Traditional Chinese Medicine: "Clinical Handbook of TCM Formulas")

[Commentary] This formula, with added ingredients, is used for chronic gastritis, gastric and duodenal ulcers, gastric ptosis.

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6. Jianpi Wan ("Zhengzhi Zhunsheng")

[Composition] Renshen: 45 grams
Baizhu (stir-fried): 75 grams
Fuling (peeled): 60 grams
Gancao: 22 grams
Chenpi: 30 grams
Muxiang: 22 grams
Sha Ren: 30 grams
Shanzha: 30 grams
Maiya: 30 grams
Shenqu: 30 grams
Shanyao: 30 grams
Roudoukou: 30 grams
Huanglian: 22 grams

[Administration] Grind all ingredients into a fine powder, steam the powder with cake flour to form pills about the size of mung beans. Take 50 pills each time on an empty stomach, twice a day, with aged rice soup. Modern usage: take 9–12 grams of pills with hot water, or prepare as a decoction and drink the broth.

[Indications] Spleen deficiency with impaired transportation.

[Symptoms] Fatigue, poor appetite, indigestion, abdominal distension and fullness, loose stools, greasy tongue coating, and a weak pulse.

[Functions] Strengthen the spleen and replenish qi, regulate qi and relieve stagnation.

[Formula Analysis] When the spleen and stomach are deficient, one experiences fatigue and poor appetite, with a weak pulse; when their ability to transform and transport food is impaired, one suffers from indigestion, abdominal distension and fullness, loose stools, and a greasy tongue coating. Spleen and stomach deficiency is the root cause, while impaired transportation is the manifestation. The formula uses dangshen, baizhu, fuling, gancao, and chenpi to primarily strengthen the spleen and replenish qi. Muxiang, doukou, and sha ren are used to regulate qi and relieve stagnation as supplementary actions. Shan zha, maiya, and shenqu help digest food and remove stagnation; prolonged stagnation leads to dampness, and prolonged dampness leads to heat, which in turn damages yin. Thus, huanglian clears heat and dries dampness, while shanyao nourishes the spleen’s yin—all of these serve as complementary treatments. Gancao harmonizes all the herbs, acting as a guiding force.

[Clinical Modifications] For those with cold rather than heat, omit huanglian and add fried ginger; for those with severe constipation, add dahuang; for those with epigastric pain, add danshen; for those with nausea and vomiting, add sheng zhe shi, shengjiang, and banxia.

[References] The stomach is the granary of the body; when the stomach is deficient, it cannot hold food, so one loses appetite. When the spleen is deficient, it cannot transform and transport food, leading to stagnation. This happens because of qi deficiency. Dangshen and baizhu replenish qi, while chenpi promotes qi flow; when qi flows, the spleen becomes stronger and the stomach more robust. Shan zha digests meat, maiya digests grains, and since the earth element is lacking, these two herbs help transform food. Zhishi is powerful and can dissolve accumulations and fullness; combined with dangshen and baizhu, its effect is even greater without damaging qi. When the spleen and stomach are injured, they must be strengthened; when food is difficult to digest, it should be aided by digestion-promoting agents. Combining these two approaches is how one strengthens the spleen. (From "Yifang Jijie")

[Commentary] This formula can be used for chronic gastritis, gastric and duodenal ulcers, chronic bacillary dysentery, ulcerative colitis, and autonomic dysfunction of the gastrointestinal tract.

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II. Dissolving Accumulations and Breaking Down Stagnation

The target of the method of dissolving accumulations and breaking down stagnation is conditions characterized by accumulation and mass formation. These conditions are typically marked by severe deficiency mixed with excess; attempting to attack them directly would overwhelm the body’s righteous qi, while simply tonifying them would fail to eliminate the accumulation. Clinically, the gradual, slow-dissolving approach is most appropriate, allowing the internal accumulation to disappear imperceptibly.

1. Chan Sha San ("Jiangnang Sheyao")

[Composition] One large toad
An unspecified amount of sha ren

[Administration] Grind the sha ren into powder, fill the toad’s abdominal cavity with it, sew up the opening, coat the entire toad in mud, then bake it in charcoal fire until red-hot. After cooling, remove the mud, and take the toad and sha ren powder in three doses, washed down with chenpi decoction.

[Indications] Pediatric malnutrition (accumulation in the middle jiao, with spleen and stomach deficiency)

[Symptoms] Yellowed, emaciated face, thin limbs, a swollen belly with visible veins, and palpable masses.

[Functions] Eliminate accumulation and strengthen the spleen.

[Formula Analysis] "Malnutrition" refers to a yellowed, emaciated face and thin limbs; "accumulation" refers to the buildup of masses.

2. Biejia Jian Wan ("Jin Gui Yao Lue")

[Indications] Long-standing malaria that does not heal, with palpable masses in the flank area.

[Functions] Resolve blood stasis and break down masses, dispel pathogenic heat.

[Formula Analysis] Long-standing malaria indicates that pathogenic factors remain trapped in the membrane layer and have not been eliminated; treatment should focus on dispelling pathogenic heat. When pathogenic factors combine with qi and blood, they coalesce into masses, resulting in palpable lumps in the flank area; treatment should aim to resolve blood stasis and break down these masses. Malaria pathogens are the root cause, while the masses are the manifestation. The formula uses biejia to soften and disperse the masses, while also entering the liver to search for and eliminate pathogenic factors, thereby addressing both the root and the manifestation. This dual-action approach makes it suitable as a primary remedy. If pathogenic heat persists for a long time, it will inevitably spread to the three yang meridians; chaihu, huangqin, dangshen, and banxia embody the spirit of Xiao Chaihu Tang to dispel the pathogenic heat in the shaoyang meridian; guizhi and baishao represent the spirit of Guizhi Tang to eliminate the pathogenic heat in the taiyang meridian; dahuang and chixiao embody the spirit of Chengqi Tang to eliminate the pathogenic heat in the yangming meridian. All these herbs work together to address the pathogenic heat in the three yang meridians, serving as auxiliary agents. Caozao ash, peony bark, ao chong, peach kernels, rat fleas, and purple wisteria break up blood stasis and resolve blood-related blockages; houpu, banxia, wushan, bee nests, and dung beetles help disperse qi and resolve qi-related blockages. Together, these herbs contribute to the overall goal of breaking down masses, serving as auxiliary agents. Shiwei, qumai, and tingli promote diuresis and help eliminate pathogenic factors; ganjiang warms yang, and ajiao nourishes yin—all of these serve as complementary treatments. Qingjiu, with its pungent and warming properties, circulates blood and guides all the herbs into the blood system, acting as a guiding force. This is a formula that combines cold and heat, attacks and tonifies, treats qi and blood simultaneously, and integrates multiple therapeutic approaches. All the herbs work synergistically to achieve the ultimate goal of eliminating masses and dispelling pathogenic toxins.

[Clinical Modifications] The composition of this formula is quite complex, and it is only available in pill form, not as a decoction, so there is limited flexibility in clinical practice.

[References] ① For those who use Biejia Jian Wan, biejia enters the liver to eliminate pathogenic factors and nourish righteous qi, while the ash from the kiln and the liquor used in the preparation further enhance its effectiveness in eliminating masses. Therefore, biejia is considered the principal herb. Xiao Chaihu Tang, Guizhi Tang, and Da Chengqi Tang serve as the main herbs for the three yang meridians, but gancao is too gentle and weakens the potency of the formula, while zhishi is too aggressive and directly targets qi, so they are omitted. Instead, ganjiang and ajiao are added to support the warming and nourishing effects of dangshen. Since masses always depend on blood and phlegm, four insects and peach kernels are combined with banxia to eliminate blood stasis and phlegm. Any accumulation is ultimately caused by qi stagnation; when qi flows smoothly, the accumulation disappears. Therefore, wushan and tingli are used to promote lung qi, while shiwei and qumai clear pathogenic heat and disperse qi, helping to resolve the accumulation. Blood tends to accumulate heat, so peony and purple wisteria are used to eliminate hidden heat in the blood and clear the heat in the heart. (Xu Zhongke: "Commentary on Jin Gui Yao Lue")

② The true brilliance of this formula lies in the way biejia is prepared: the ash from the kiln is mixed with liquor and cooked until it becomes as sticky as glue. Not only does biejia eliminate masses, but the liquor-soaked ash also effectively dissolves them, making it hundreds of times more effective than using vinegar to prepare malaria pills. (From "Zhangshi Yitong")

[Commentary] This formula is used for chronic hepatitis, early-stage cirrhosis, malaria, and black fever.

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Chapter 10: Tonifying Formulas

Any formula that can nourish the body’s qi, blood, yin, and yang is collectively referred to as a tonifying formula. The application of tonifying formulas falls under the category of tonification within the Eight Methods. The principle stated in "Suwen·Sanbu Jiuhou Lun"—"when there is deficiency, tonify"—serves as the theoretical basis for this method. Tonification is generally divided into five aspects: tonifying qi, tonifying blood, tonifying yin, tonifying yang, and tonifying both qi and blood. Although each aspect has its own focus, they are closely interconnected. Take tonifying qi and tonifying blood, for example: Li Dongyuan believed that "blood cannot be produced on its own; it requires medicines that generate yang qi, only then can blood flourish." He also said, "When blood is deficient, use ginseng to tonify it; when yang qi is strong, it can generate yin blood." Clearly, to achieve the goal of tonifying blood, one must add tonifying qi medicines to the blood-tonifying formula to make it more effective. When there is excessive blood loss, it often leads to yang depletion; only by tonifying qi to consolidate the yang can one reverse the crisis of blood loss, which further illustrates this point. Patients with qi deficiency generally do not receive blood-tonifying medicines, because blood-tonifying medicines tend to be sticky and yin-oriented, easily causing qi stagnation.

Tonifying yin and tonifying yang are also interrelated. Zhang Jingyue said, "Those who are good at tonifying yang must seek yang within yin; those who are good at tonifying yin must seek yin within yang." "Zhongcang Jing" states, "Fire enters the kan door, water reaches the li lock." Both emphasize that when tonifying yin and yang, one should not focus solely on one side while neglecting the other; instead, one should balance the two while emphasizing one side. Furthermore, the methods of tonifying qi, blood, yin, and yang are interconnected. One must understand their characteristics, prioritize certain aspects, and consider others as well, in order to prescribe the right medicine for the right condition.

In addition, when applying tonifying methods, one must also take into account the characteristics of the organs. According to the principles of tonification outlined in "Nanjing," "If the lungs are damaged, tonify the qi; if the heart is damaged, regulate the ying and wei; if the spleen is damaged, adjust the diet and maintain appropriate temperature; if the liver is damaged, soothe the middle jiao; if the kidneys are damaged, nourish the essence." Treatment should be tailored to the specific organ involved. Among the five viscera, the spleen is the foundation of postnatal life, while the kidneys are the foundation of innate life—these two organs are crucial to the human body. The spleen governs the middle jiao qi, while the kidneys govern the original qi, forming the very foundation of the body’s vital energy. Given the importance of these two organs, the method of tonifying them is called "supporting the foundation and consolidating the vital energy." When implementing tonifying methods, one must also pay attention to the relationship between the local and the whole. As the ancients said, "Great excess may appear as weakness, while extreme deficiency may manifest as abundance." This requires careful assessment of the patient’s condition: for local "excess," one should attack; for the overall "weakness," one should tonify; for local "extreme deficiency," one should tonify; for the overall "abundance," one should attack. As for the ratio of attack to tonification, it should be determined based on clinical circumstances. Sometimes one may need to rely solely on attack—eliminating the "excess" will restore the "weakness"; sometimes one may need to rely solely on tonification—tonifying the "extreme deficiency" will naturally dissipate the "abundance."

Tonifying formulas can also be divided into "strong tonification" and "gentle tonification." For urgent conditions, such as cases of sudden qi and blood loss, strong tonification is appropriate to quickly avert danger; for milder conditions, such as qi and blood deficiency or imbalance of yin and yang, long-term planning is needed, and gentle tonification is more suitable. Strong tonifying formulas usually contain larger doses of medicine and fewer flavors, aiming for concentrated and powerful effects; gentle tonifying formulas usually contain smaller doses of medicine and more flavors, aiming for sustained and long-term benefits.

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I. Tonifying Qi

Tonifying qi means strengthening the body’s vital energy. Vital energy, also known as true qi, consists of two components: innate and acquired. The innate component is called yuan qi, originating from the kidneys, also known as kidney qi; the acquired component originates from the spleen and stomach, also known as middle jiao qi. Part of the middle jiao qi combines with respiratory qi and accumulates in the sea of qi in the chest, known as zong qi, which provides the driving force for blood circulation and respiration; part of the middle jiao qi comes from the middle jiao, travels through the vessels, and is soft and smooth, known as ying qi, which nourishes the body; part of the middle jiao qi comes from the upper jiao, travels outside the vessels, and is gentle and slippery, known as wei qi, which protects against external pathogens. The body’s vital energy is distributed throughout all the organs and systems to maintain their normal functions; the portion of vital energy that each organ relies on to function properly is referred to as liver qi, kidney qi, heart qi, lung qi, and so on. In short, tonifying qi is a method of strengthening vital energy, suitable for patients with deficiency of vital energy. Common symptoms of middle jiao qi deficiency include: pale complexion, poor appetite, fatigue, and shortness of breath; common symptoms of yuan qi deficiency include: dizziness, tinnitus, lower back pain, and leg fatigue.