2. Shenling Baizhu San "Heji Jufang"

2. Shenling Baizhu San ("Heji Jufang")

[Composition]
Dangshen: 1000 grams
Baizhu: 1000 grams
Fuling: 1000 grams
Gancao (stir-fried): 1000 grams
Shanyao: 1000 grams
Baidou: 500 grams (soaked in ginger juice, peeled, and lightly stir-fried)
Lianzi rou: 500 grams
Jiegeng (stir-fried): 500 grams
Gancao (stir-fried): 500 grams
Yiyiren: 500 grams
Suosha ren: 500 grams

[Administration]
Grind all ingredients into a fine powder, take 6 grams each time, and mix with jujube soup. Modern usage: prepare as a decoction and drink the broth.

Take as a decoction; some also prepare it as pills.

[Indications]
Spleen and stomach qi deficiency with dampness in the middle jiao.

[Symptoms]
Pale complexion, poor appetite, fatigue, shortness of breath, abdominal distension and fullness, intestinal rumbling and diarrhea.

[Functions]
Strengthen the spleen and replenish qi, harmonize the stomach and drain dampness.

[Formula Analysis]
When spleen and stomach qi are deficient, the complexion becomes pale, appetite declines, one feels fatigued, and one speaks less; when there is dampness in the middle jiao, one experiences abdominal distension and fullness, along with intestinal rumbling and diarrhea. Spleen and stomach qi deficiency impairs the ability to transform and transport food, leading to dampness in the middle jiao. In this formula, Si Jun Zi Tang strengthens the spleen and replenishes qi, primarily addressing the root cause. Yiyiren harmonizes the stomach and drains dampness, serving as a supplementary action. When qi is deficient for a long time, yin fluids cannot circulate widely; baidou, shanyao, and lianzi rou invigorate the stomach and nourish yin, serving as complementary treatments. Dampness in the middle jiao blocks the flow of qi, so suosha ren promotes qi flow and warms the stomach, also serving as a complementary treatment. Jiegeng carries the medicine upward to reach the site of the disease, acting as a guiding force.

[Clinical Modifications]
① Add chenpi to make Shenling Baizhu San ("Yifang Jijie"), suitable for those with spleen and stomach qi deficiency, dampness in the middle jiao, and accompanying phlegm cough. ② Remove the jujubes and add huoxiang, juhong, huanglian, zexie, qianshi, shanzha, maiya, and baiduokou to make Zisheng Wan ("Xianxing Zhai Medical Broad Notes"), used to treat pregnant women in their third month whose yangming pulse is weak and who are prone to miscarriage.

[References]
① To treat the spleen and stomach, one needs to replenish its deficiency, eliminate its dampness, clear its stagnation, and regulate its qi. Renshen, baizhu, fuling, gancao, shanyao, yiyiren, baidou, and lianzi rou are all medicines that strengthen the spleen. However, fuling, shanyao, and yiyiren not only strengthen the spleen but also drain dampness, while suosha ren and chenpi regulate qi and clear stagnation. Yet when combined with renshen, baizhu, fuling, and gancao, they warm the stomach while still strengthening the middle jiao; jiegeng, with its bitter-sweet taste, enters the lungs, carrying the medicine upward and facilitating the flow of qi through the airways, allowing qi to rise and fall smoothly, thus harmonizing the qi and preventing the lungs from drying out. (From "Yifang Jijie") ② Ms. Zhou ××, 48 years old. She has a history of diarrhea and frequent abdominal pain and intestinal rumbling. In recent months, she has had loose stools two or three times a day, poor appetite, bland food, thin physique, tired spirit, a pale tongue coating, and a weak pulse. This is spleen deficiency with dampness, so treatment should focus on strengthening the spleen and draining dampness. Prescription: three qian of xidangshen, three qian of jiaobaizhu, three qian of baifuling, four qian of huashanyao, three qian of stir-fried baidou, four qian of yiyiren, one qian of bitter jiegeng, eight fen of suosha ren, three qian of stir-fried lianzi rou, and one qian of stir-fried gancao. After taking the above prescription for three doses, the diarrhea stopped; after seven more doses, her appetite increased, and her bowel movements returned to normal. (From "Fujian Journal of Traditional Chinese Medicine," May 1965)

[Commentary] This formula can be used for chronic enteritis, chronic pancreatic diarrhea, and simple digestive disorders in children. In recent years, this formula has been modified and used to treat chronic gastritis, chronic nephritis, infiltrative pulmonary tuberculosis, and chronic bronchitis.

137

3. Buzhong Yiqi Tang ("Piwei Lun")

[Composition]
Huangqi: 15 grams (one qian)
Dangshen: 12 grams (three fen)
Baizhu: 12 grams (three fen)
Gancao (stir-fried): 6 grams (five fen)
Danggui: 9 grams (two fen)
Chenpi: 3 grams (three fen)
Shengma: 3 grams (three fen)
Chaihu: 3 grams (three fen)

[Administration]
Chew the herbs, decoct in water, remove the residue, and take the decoction while slightly warm after meals. Modern usage: decoct in water, or prepare as pills and swallow them.

[Indications]
Middle jiao qi deficiency.

[Symptoms]
Pale complexion, poor appetite, fatigue, and shortness of breath; or accompanied by sweating, craving hot drinks, headache and sensitivity to cold, and a weak pulse; or accompanied by rectal prolapse, uterine prolapse; or accompanied by hematemesis, epistaxis, hematochezia, or hematuria.

[Functions]
Replenish middle jiao qi.

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[Explanation] This formula is a representative prescription of Li Dongyuan, with the basic syndrome being deficiency of middle qi. Li believed that "the human body takes stomach qi as its foundation; once the spleen and stomach are injured, the five organs will be in disorder." "When the qi of the spleen and stomach is damaged, the original qi cannot be replenished either, which leads to various diseases." Based on this view, Li's Buzhong Yiqi Tang primarily aims to tonify the middle jiao and replenish qi, achieving multiple therapeutic effects in clinical practice. Pale complexion, poor appetite, fatigue, shortness of breath, and reluctance to speak are the basic symptoms of middle qi deficiency; accompanied by fever with sweating, thirst for hot drinks, headache, and aversion to cold, it indicates qi deficiency with fever; if accompanied by uterine prolapse or gastric ptosis, it signifies sinking of middle qi; while bleeding from the mouth, nose, or rectum suggests qi failing to control blood. All these conditions stem from deficiency of middle qi, hence this formula serves as the principal prescription. ① Why does qi deficiency cause fever? Li believed that fire is the enemy of original qi; fire and original qi cannot coexist—when one prevails, the other declines. Excessive fire damages original qi; when original qi is replenished, fire can subside. Buzhong Yiqi Tang uses this principle to reduce fever, a method known as "sweet-warm removal of great heat." ② Middle qi is the foundation of postnatal life; when qi is abundant, the five organs function harmoniously. However, if middle qi sinks, the viscera may slip and prolapse. Buzhong Yiqi Tang can elevate the yang qi of the spleen and stomach, thereby stabilizing the slipping viscera. ③ Qi governs blood; when qi is deficient, blood loses its ability to be controlled and will inevitably flow erratically. Buzhong Yiqi Tang greatly tonifies middle qi and strengthens blood control, thus curbing erratic bleeding.

In this formula, Astragalus is the superior herb for tonifying middle qi and can serve as the principal ingredient. Codonopsis and Atractylodes both have sweet-warm properties that benefit qi, and when used together with Astragalus, their qi-tonifying and middle-qi-replenishing effects are further enhanced, making them auxiliary herbs. When the qi of the spleen and stomach is deficient, digestion and transformation are impaired, and qi circulation becomes obstructed. Tangerine peel regulates qi and strengthens the spleen to aid digestion; prolonged qi deficiency will inevitably lead to blood deficiency, 138

Angelica nourishes and replenishes blood; when middle qi is insufficient, spleen qi may sink, prompting Chaihu to lift yang qi and guide it along the meridians of the chest and flanks; Shengma lifts yang qi up to the apex of the Yangming meridian. All these herbs serve as adjunct treatments. Licorice harmonizes all the herbs and acts as a guiding agent.

[Clinical Modifications] ① Remove Angelica, add Agarwood, replace Atractylodes with Cangzhu, and name it "Tiaozhong Yiqi Tang" (from "On the Spleen and Stomach"). It treats qi deficiency, dampness stagnation in the spleen and stomach, and qi obstruction causing chest fullness and fatigue. ② Add Ophiopogon, Cangzhu, Phellodendron, and fried malt, naming it "Astragalus and Ginseng Decoction" (from "On the Spleen and Stomach"). It treats excessive summer heat, which damages original qi, leading to weakness, drowsiness, fever, loss of appetite, and profuse sweating. ③ Remove Shengma, add Banxia, Qianghuo, Duhuo, Baishao, Fangfeng, Fuling, Zexie, Huanglian, ginger, and jujubes, naming it "Yang-Lifting and Stomach-Nourishing Decoction" (from "Secrets of the Orchid Chamber"). It treats spleen and stomach qi deficiency, abdominal discomfort, and limb pain. ④ Modification rules for this formula (from "On the Spleen and Stomach"): For abdominal pain, add Baishao and Zhigancao; for cold-induced pain, remove the bark of cinnamon (cinnamon heart); for heat-induced pain, add Baishao, Zhigancao, and Huangqin; for cold-related abdominal pain, remove Baishao and add Yizhiren, or add Banxia and ginger; for pain below the navel, add Shudidi, and if the pain persists, add Rougui; for qi stagnation in the chest, add Qingpi, but remove it if there is shortness of breath; for flank pain, add Chaihu; for epigastric fullness, add Huanglian, and if unable to eat, add Jiaosanxian.

[References] ① Treats middle qi deficiency, weakened defensive qi, susceptibility to wind-cold headaches, fever, and internal injuries from overwork, as well as descending clear yang. Although the true yang qi of the human body resides in the kidneys, since birth, it has always relied on the spleen and stomach for nourishment and growth. Therefore, Dongyuan wrote extensively on the spleen and stomach. If the spleen and stomach become weak, the source of yang qi production diminishes, and the mechanisms responsible for distributing and circulating yang qi also lose their effectiveness,

resulting in sinking of yang qi and weakening of defensive qi, making the body more susceptible to external pathogens. However, such cold and heat symptoms are mostly due to excess pathogenic factors and deficiency of vital energy, so we should strengthen the body to resist pathogens. If we only use exterior-releasing medicines for exterior syndromes, we will miss the point... This is Dongyuan’s method for treating internal injuries caused by overwork, adapted for treating external infections. ("Convenient Readings on Formulas") ② The classics state: "Those who are exhausted should be warmed," and "Those who are damaged should be strengthened." Based on these principles, Li Dongyuan formulated the famous Buzhong Yiqi Tang, primarily using sweet-warm ingredients. The original formula includes one qian of Astragalus, five fen of Zhigancao, three fen each of Ginseng and Atractylodes, two fen of Angelica, and two to three fen each of Tangerine Peel, Shengma, and Chaihu, decocted once and taken slightly warm.

It treats qi deficiency, fever, and sweating caused by dietary and work-related exhaustion, along with thirst for hot drinks, headache, aversion to cold, irritability, lack of appetite, a large pulse that feels weak upon palpation, limb fatigue, intolerance to labor, or even shortness of breath after movement, chronic malaria and dysentery, as well as vomiting blood, hematochezia, anal prolapse, uterine prolapse, and other downward-sinking conditions caused by middle qi deficiency. (Mao Yu’s experience: "Selected Academic Experiences in Traditional Chinese Medicine of Guizhou Province," 1978.7 edition) ③ One case of qi-deficiency-induced fever cured by Buzhong Yiqi Tang. Long-term fever, slightly subsiding in the afternoon and at night

139 +------+ | > Various | > Discussions

Poor sleep, headache, fatigue, limb weakness, slight facial swelling, chest and abdominal distension, thirst without desire to drink, pale tongue, thin white and slippery coating, and a deep, fine pulse. After taking three doses of Buzhong Yiqi Tang, the fever subsided after seven doses, and the patient fully recovered after ten doses. ("Fujian Journal of Traditional Chinese Medicine," March 1964) ④ Modified Buzhong Yiqi Tang treated 103 cases of gastric prolapse. All cases were confirmed by X-ray barium meal examination to show that the lower edge of the stomach was 5–17 centimeters below the iliac crest. The treatment involved adding Zhike, Jineijin, Yujin, Yam, and Hawthorn to Buzhong Yiqi Tang. For severe stomach pain, add Yuanhu; for liver and spleen prolapse, add Biejia; for concurrent ulcers, add Baiji and Cuttlefish Bone. Take one dose daily, divided into two servings, strongly decocted, and taken warm. Treatment results: 54 cases cured, 25 markedly improved, 22 effective, and 2 ineffective. The longest course was 60 days, the shortest 15 days, with an average of 35 days. ("New Medical Journal," November 1971) ⑤ Buzhong Yiqi Tang treated a case of long-term hematuria due to spleen qi deficiency. Ms. Hu, 28 years old. Since age 22, she has experienced intermittent hematuria, with a sallow complexion and pale tongue with white coating. The treatment involved adding Zhimu and Huangbo to Buzhong Yiqi Tang. After a total of four and a half months of treatment, including 10 doses of the above formula and 20 bags of Buzhong Yiqi Pills, the hematuria disappeared, though occasional dribbling remained. Later, she took more than ten doses of Danggui Shaoyao San to improve her condition. ("Collection of Yue Mei’s TCM Cases") ⑥ Buzhong Yiqi Tang treated a case of postpartum urinary retention. The patient had a mid-force delivery with forceps, after which she developed urinary retention. Various diuretics proved ineffective. TCM consultation revealed a pale complexion, shallow breathing, palpitations, dizziness, vertigo, extreme fatigue, poor appetite, pale tongue, and a weak pulse. The treatment involved adding Cheqianzi, Mutong, Jiegeng, and Shepherd’s Purse to Buzhong Yiqi Tang. Two doses brought improvement, and four doses led to complete recovery. ("Zhejiang Journal of Traditional Chinese Medicine," October 1964)

[Notes] This decoction can be used to treat unexplained fever, hypotension, neurasthenia, uterine prolapse, gastric prolapse, various bleeding disorders, and menstrual irregularities in women.

4. Shengmai San ("Discussions on Internal and External Injuries")

[Composition] Ginseng 4.5 grams, Ophiopogon 4.5 grams, Schisandra berries 7 pieces

[Administration] Decocted in water and taken orally.

[Indications] Summer heat damaging the lungs, with deficiency of both qi and yin.

[Suitable Conditions] Spontaneous sweating, fatigue, shortness of breath, thirst, weak pulse, dry mouth and throat, coughing with little phlegm, and in severe cases, shortness of breath and a nearly imperceptible pulse.

[Functions] Tonifies qi and nourishes yin, protects the lungs and generates pulse.

[Explanation] According to "The Great Discussion on the Six Elements of the Yellow Emperor’s Classic of Internal Medicine," "When intense heat prevails, people suffer from qi deficiency." And according to "The Great Discussion on the Changes in Qi," "When the year’s fire is too strong, summer heat spreads, and the metal lung is invaded." Furthermore, "The Five Movements Theory" states, "In heaven, it is heat; on earth, it is fire; its nature is summer heat." Thus, summer heat, like summer itself, shares the characteristics of damaging the lungs, depleting qi, and injuring yin. In this formula, spontaneous sweating and fatigue indicate qi depletion; dry mouth and throat, along with coughing with little phlegm, signify yin injury; since the lungs govern all the meridians, when qi and yin are severely depleted, the pulse becomes weak and nearly imperceptible. Among the three herbs, ginseng has sweet-warm properties, tonifying qi and nourishing yin while also protecting the lungs, making it the principal ingredient. Ophiopogon has cool, sweet properties, greatly nourishing lung yin and serving as an auxiliary herb. Schisandra berries have sour-warm properties, helping to consolidate lung qi and also acting as an auxiliary herb. Together, these three herbs achieve the functions of tonifying qi, nourishing yin, and protecting the lungs; with lung qi protected, all the meridians naturally recover, hence the name "Shengmai San."

[Clinical Modifications] For those with prominent cough, add Lily and Winter Jasmine; for those with palpitations and insomnia, add Sour Jujube Seed, Night-Blooming Jasmine, and Albizia Bark; for those with excessive sweating, add Floating Wheat and Ephedra Root; for those feeling restless and agitated, add Dragon and Oyster Shell; for those with arrhythmia, add Cinnamon Twig, Donkey Hide Glue, Zhigancao, and Tea Tree Root.

[References] ① Treats conditions such as heat damage to original qi, shortness of breath and fatigue, excessive sweating and thirst, and lung deficiency with cough. The lungs are the master of all qi in the body and the center of all meridians; when lung qi is strong, the qi of all organs is also strong, vitality is generated, the body is robust, and the pulse never ceases. Once exposed to summer heat, the metal lung is harmed by fire, and lung qi is scorched, leading to all the aforementioned symptoms. However, summer heat is the primary evil of summer, and those whose original qi is strong may not get sick. Therefore,

when evil forces gather, the qi must be weak. In this formula, ginseng protects lung qi, Ophiopogon protects lung yin, and Schisandra consolidates what has been lost. Rather than treating summer heat directly, we focus on strengthening the body to resist it, viewing summer heat as an invisible evil. If there is no humidity during summer heat, there will be no lingering problems. Moreover, since this summer heat is not extremely intense, there is nothing to cleanse, so protecting the lungs is the best way to counteract it. ("Convenient Readings on Formulas") ② Mr. Li, 46 years old. Western medicine diagnosed him with rheumatic heart disease, mitral stenosis, left ventricular enlargement, and pulmonary congestion. Symptoms included palpitations, shortness of breath, insomnia, frequent dreams, lower limb edema, pale complexion, flushed cheeks, purple lips, pale tongue, and a tense, intermittent pulse. The treatment involved adding Dragon and Oyster Shell, Angelica, Baishao, Gou Teng, Goji Berry, and Zhigancao to Shengmai San. Over four consultations, the same formula was adjusted and administered, totaling 30 doses. The pulse became slower and smoother, the lips turned rosy, the heartbeat stabilized, sleep improved, physical strength partially recovered, and the murmur at the apex of the heart disappeared upon auscultation. He then switched to Ginseng Gui Pi Wan, and after four weeks, he returned to work. ("Selected Cases of Zheng Qiao’s TCM Practice," People’s Health Publishing House, June 1978 edition) ③ Animal experiments have proven that Shengmai San injection has the following effects: ① significantly raises blood pressure in dogs experiencing acute hemorrhagic shock, with no noticeable effect on normal blood pressure; ② enhances the contractile force of the heart in anesthetized rabbits; ③ when animals are given Shengmai San injection during shock, they tend to calm down. Clinical observations show that administering Shengmai San injection to rescue patients in shock can raise their blood pressure. ("Tianjin Medical News," November 1972)

[Notes] This formula, with modifications, can be used for summer heat, chronic bronchitis, tuberculosis, neuralgia,

| > Weakness, rheumatic heart disease, arrhythmia, hypotension; in the rescue of end-stage myocardial infarction with circulatory failure, intravenous infusion of Shengmai San injection can achieve certain therapeutic effects. | > | > 5. Yupingfeng San | > | > "Effective Prescriptions of World-Class Physicians" | > | > [Composition] Astragalus 180 grams, Atractylodes 60 grams, Saposhnikovia 60 grams | > | > [Administration] Made into fine powder, 10 grams per dose; or prepared as a decoction, with dosage adjusted accordingly. | > | > [Indications] Qi deficiency and weak defensive qi. | > | > [Suitable Conditions] Pale face, spontaneous sweating and aversion to wind, susceptibility to wind-cold, pale tongue, and floating, slow pulse. | > | > [Functions] Tonifies qi and fortifies the exterior. | > | > [Explanation] When qi is deficient, the face appears pale and the tongue is light; when qi cannot protect the exterior, the skin pores become loose, leading to spontaneous sweating, aversion to wind, susceptibility to wind-cold, and a floating, slow pulse. In this formula, Astragalus greatly tonifies lung qi, strengthening the skin and making the pores dense, making it the principal ingredient. Atractylodes nourishes middle qi, generating gold from earth, and works in tandem with Astragalus, further enhancing its qi-tonifying and exterior-fortifying effects, making it an auxiliary herb. Saposhnikovia clears the exterior to dispel wind pathogens, serving as an adjunct treatment. The purpose of this formula is to tonify qi and fortify the exterior, building a strong defense against invaders—this is a typical formula embodying the principle of "where evil gathers, qi must be weak," applied concretely in formula design. | > | > [Clinical Modifications] ① For those with colds, add Buzhong Yiqi Tang; for persistent spontaneous sweating, add Floating Wheat, Dragon and Oyster Shell, and Schisandra berries; for those with low blood pressure, add Shengmai San. ② Boil the three herbs in equal amounts to make "Astragalus Decoction" (according to Zhang Jiegǔ), used to treat exterior deficiency due to wind-cold. | > | > [References] ① Generally, for those with exterior deficiency who cannot protect the exterior, one should first establish middle qi. Therefore, Atractylodes’ role in tonifying the spleen and establishing middle qi is paramount; when the spleen is strong, the qi of all four organs benefits, the exterior is naturally fortified, and evil forces cannot penetrate. Then, Astragalus fortifies the exterior and strengthens defensive qi, while Saposhnikovia excels at clearing wind and moving smoothly, working in synergy and complementarity, further enhancing the effect. ("Convenient Readings on Formulas") ② "Old Physician Pu Fuzhou treated this condition (exterior deficiency with spontaneous sweating) using powdered medicine, taking 9 grams daily for a month. Not only did the sweating stop, but the effect was consolidated and did not recur. I suddenly realized that exterior deficiency with spontaneous sweating is a relatively chronic physiological weakening of the skin. To change and restore physiology through medication, one must allow it to evolve from quantitative change to qualitative change. Can three to five doses of decoction really bring about a sudden physiological recovery? Even if it does, it’s still a manifestation of medicinal power, not physiological healing. Therefore, whenever I encounter exterior deficiency with spontaneous sweating, I now choose powdered medicine for long-term treatment, and the results are satisfactory." ("Collection of Yue Mei’s TCM Cases") | > | > 142

[Notes] This formula, with added ingredients, is often used for habitual colds, autonomic nervous system dysfunction, hyperthyroidism, and spontaneous sweating due to rheumatism.

6. Baoyuan Tang

"Heartfelt Appreciation"

[Composition] Astragalus 9 grams, Ginseng 9 grams, Zhigancao 3 grams, Rougui 2 grams

[Administration] Add a slice of ginger, decoct in water, and take warm.

[Indications] Deficiency of vital energy.

[Suitable Conditions] Pale face, fatigue, loss of appetite, spontaneous sweating and weakness, lower back pain and leg fatigue, pale tongue and thin pulse.

[Functions] Replenishes vital energy.

[Explanation] Vital energy consists of innate kidney qi and acquired spleen qi. Acquired spleen qi combines with respiratory qi governed by the lungs to form zong qi, which drives respiration and circulation throughout the body. Therefore, the spleen, kidneys, and lungs are most closely related to vital energy. In this formula, the pale face and spontaneous sweating indicate lung deficiency; fatigue and loss of appetite suggest spleen deficiency; lower back pain and leg fatigue point to kidney deficiency. The formula uses ginseng to strengthen the spleen and replenish qi, with the spleen as the central organ for governing all things. When the spleen qi is replenished, lung qi is generated, and kidney qi is strengthened, making ginseng the principal ingredient. The lungs are the canopy of the five viscera and six bowels, with all meridians converging on them; when lung qi is replenished, zong qi flows, allowing qi and blood to circulate throughout the body. Astragalus has sweet-warm properties, tonifying the lungs as an auxiliary herb; rougui warms kidney yang, strengthening kidney qi as another auxiliary herb. Zhigancao harmonizes all the herbs as a guiding agent; the slice of ginger is intended to disperse the herbs, preventing ginseng and astragalus from becoming stagnant and less active, also serving as a guiding agent. This formula replenishes the spleen, lungs, and kidneys, restoring vital energy—making it a fundamental formula for strengthening the body and nurturing the root.

[Clinical Modifications] ① Remove rougui and ginger, naming it "Astragalus Decoction" (Li Dongyuan). It treats spleen and lung qi deficiency, fatigue, and poor appetite. ② Remove rougui and ginger, add Manjingzi, Gegen, Phellodendron, Baishao, Shengma, naming it "Qi-Strengthening and Intelligence-Boosting Decoction" (Li Dongyuan). It treats general weakness, colds, headaches, and tinnitus. ③ Remove rougui and ginger, add Qianghuo, Duhuo, Banxia, Chenpi, Fuling, Chaihu, Fangfeng, Zexie, Huanglian, naming it "Yang-Lifting and Stomach-Nourishing Decoction" (Li Dongyuan). It treats spleen and stomach weakness, and rheumatic conflicts.

[References] For smallpox cases with yang deficiency and sunken lesions, and for blood deficiency with clear serum, this formula is also used, based on the principle of "yang generating yin"... Wei observed in practice that although adding astragalus and purple grass to Si Jun Zi Tang can indeed help smallpox erupt and resolve, if the outbreak is severe, the serum may not form, leading to drying up and withering, even death. Upon deeper analysis, he found that Atractylodes dries out dampness, while Fuling is bland and lacks vigor, which is unfavorable for bodies with qi and blood deficiency. Removing Fuling and Atractylodes would make the formula more effective; however, the drugs themselves act slowly, so adding official cinnamon helps boost the potency. (Jiangsu New Medical College: "Traditional Chinese Medicine Formulas")

[Notes] Originally, this formula was used to treat smallpox with yang deficiency, sunken lesions, and thin, clear serum, making it difficult to induce eruption and form scabs, and hard to consolidate crusts. In modern times, this formula has become a foundational remedy for strengthening the body and nurturing the root, widely applied to various conditions involving deficiency and exhaustion.

II. Blood Tonification

The method of treating blood deficiency is called blood tonification. According to "The Generation Chapter of the Five Viscera" in the "Yellow Emperor’s Classic of Internal Medicine," "All blood belongs to the heart." Therefore, symptoms of blood deficiency first appear in the heart, such as palpitations, shortness of breath, insomnia, frequent dreams, and a dull complexion (the heart governs blood vessels, and its radiance shows on the face). Secondly, due to the relationship between "the liver stores blood" and "the liver and kidneys share the same origin," blood deficiency symptoms also manifest in the liver and kidneys, such as dizziness, blurred vision, and lower back pain. Accordingly, in blood-tonifying formulas, Fu Shen, Yuanzhi, and Zao Ren are often used to calm the heart and soothe the spirit, while Danggui, Shengdi, and Baishao are used to nourish the liver and kidneys. Additionally, based on the principle that "qi governs blood, and blood governs qi," ingredients that tonify qi, such as Codonopsis, Atractylodes, Astragalus, and Zhigancao, are commonly used.

1. Siwu Tang

"Harmonious Formulas Bureau"

[Composition] Danggui (stir-fried with wine), Baishao, Chuanxiong, Shudidi (steamed with wine), each in equal parts

[Administration] Made into coarse powder, 9 grams per dose, decocted in water, strained, taken on an empty stomach while warm; in modern times, prepared as a decoction, with dosage adjusted accordingly.

[Indications] Deficiency of nutritive blood, disharmony between the Chong and Ren channels.

[Suitable Conditions] Women with irregular menstruation, abdominal pain around the navel, heavy bleeding, blood clots, dull complexion, pale tongue with thin coating, and a deep, thin pulse.

[Functions] Tonifies blood and nourishes the Chong and Ren channels.

[Explanation] When nutritive blood is deficient, the complexion becomes dull, the tongue pale with thin coating, and the pulse deep and thin; when the Chong and Ren channels are disharmonious, menstruation becomes irregular, there is abdominal pain around the navel, heavy bleeding, and blood clots accumulate. The deficiency of nutritive blood is attributed to the heart (all blood belongs to the heart), while the disharmony of the Chong and Ren channels is attributed to the liver (the liver governs the Chong and Ren channels). Ke Qin said, "This formula is specifically for regulating blood in the liver channel, not for generating blood in the heart channel." Therefore, regulating the Chong and Ren channels is the main function of this formula. Among the ingredients, Danggui has sweet-warm properties, benefiting the liver by nourishing, activating, and regulating blood, without causing stagnation—its dynamic action makes it the principal ingredient for regulating the Chong and Ren channels. The liver and kidneys share the same origin; the liver’s blood is nourished by kidney yin, so Shudidi has cool, sweet properties, nourishing yin and blood, serving as an auxiliary herb. Baishao has sour properties, calming the liver and regulating blood, while Chuanxiong has spicy-warm properties, entering the liver to promote qi and activate blood—both serve as adjunct treatments.

[Clinical Modifications] Add Ajiao, Aiye, and Zhigancao, naming it "Ajiao-Aiye Decoction," for treating postpartum bleeding and miscarriage; add Taoren, Honghua, and Baishao, renaming it "Taohong Siwu Tang," for treating blood deficiency and blood stasis; add Zhimu and Huangbo, renaming it "Zhibo Siwu Tang," for treating blood deficiency combined with yin deficiency and fiery agitation; this formula’s pill version is called "Kanli Pill," with the same function as the decoction; add Aiye and Xiangfu, making pills with vinegar paste, naming it "Ai-Fu Warming Uterus Pill," for treating blood deficiency combined with uterine cold and infertility; add Dahuang, Mangxiao, and Zhigancao, naming it "Yucun Powder," for treating amenorrhea, abdominal pain, and resistance to palpation, with a strong pulse; remove Shudidi and Baishao, renaming it "Foshou Powder," for treating women with blood deficiency, colds, fetal movement with bleeding, and fetal death in the womb. Adding Si Jun Zi Tang, renaming it "Bazhen Tang," for treating dual deficiency of qi and blood; adding Si Jun Zi Tang, Rougui, and Astragalus, renaming it "Shiquan Da Bu Tang," for treating dual deficiency of qi and blood, as well as dual deficiency of Ying and Wei.

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[Reference Materials] ① Angelica sinensis is pungent, bitter, and warm in nature; it enters the Heart and Spleen to generate blood and thus serves as the chief herb. Rehmannia glutinosa is sweet and cold; it enters the Heart and Kidney to nourish blood and therefore acts as the minister herb. Paeonia lactiflora is sour and cold; it enters the Liver and Spleen to astringe yin and thus functions as the assistant herb. Ligusticum chuanxiong is pungent and warm; it unblocks the upper and lower parts of the body and circulates qi within the blood, serving as the messenger herb. (From "Yifang Jiejie") ② The modified Jiao Ai Siwu Decoction cured 15 cases of threatened abortion and 4 cases of habitual abortion. All cases of threatened abortion presented with intermittent lower abdominal pain, a feeling of heaviness and distension, and vaginal bleeding; habitual abortion shared the same symptoms but was always accompanied by a history of previous miscarriages. The prescription added Dangshen, Shengma, Baizhu, Huangqin, and Sangjisheng to the original formula. In cases of severe hemorrhage, 25 grams of Korean ginseng were first decocted and taken warm, followed by the above-mentioned formula. For patients with marked qi deficiency, add Huangqi; for those with excessive bleeding that is difficult to stop, add Diyu charcoal; for those with low back pain, add Duzhong; and for those with strong, wiry pulses, add Chrysanthemum. (From "Chinese Medicine Journal" 65.3) ③ The modified Siwu Decoction cured four cases of tonsillar hypertrophy. All four patients were children under the age of twelve, presenting with pharyngeal stenosis, enlarged tonsils that pressed against each other on both sides, thereby affecting breathing; in mild cases, swallowing was difficult, while in severe cases, there were difficulties in breathing and speech. The prescription included 1.5 grams of Chuanxiong, 3 grams of Rehmannia glutinosa, and 2 grams each of Angelica sinensis, Paeonia lactiflora, processed Rhinoceros horn, Platycodon grandiflorus, and Belamcanda chinensis. After taking the medicine for 6–9 doses, all four patients recovered, and the enlarged tonsils returned to normal. (From "Zhejiang Journal of Traditional Chinese Medicine" 1965.7)

[Commentary] This formula has a wide range of applications when modified; it can be used for gynecological menstrual disorders, uterine fibroids, ovarian cysts, and old ectopic pregnancies. In addition, it is also widely applicable to surgical injuries, postoperative conditions in orthopedics, as well as coronary heart disease, liver diseases, skin diseases, and more.

2. Gui Pi Tang

"Jisheng Fang"

[Composition] 30 grams each of Atractylodes macrocephala, Poria cocos, Astragalus membranaceus, Longan aril, and Ziziphus jujuba; 15 grams each of Ginseng and Agastache rugosa; 7.5 grams of Glycyrrhiza uralensis; 3 grams each of Angelica sinensis and Polygala tenuifolia.

[Administration] Chew the herbs, take 12 grams per dose, add five slices of fresh ginger and one jujube, decoct in water, remove the residue, and take warm.

[Indications] Deficiency of both Heart and Spleen.

[Symptoms] Palpitations, forgetfulness, insomnia with frequent dreams, sallow complexion, poor appetite, fatigue and weakness; shortness of breath, reluctance to speak, pale tongue with thin coating, and fine, rapid pulse.

[Functions] Tonifies the Spleen and replenishes qi, nourishes the Heart and calms the spirit.

[Formula Analysis] This formula addresses a combined syndrome of Spleen qi deficiency and Heart blood deficiency. Spleen qi deficiency manifests as sallow complexion, poor appetite, fatigue, weakness, and reluctance to speak; Heart blood deficiency presents as palpitations, forgetfulness, and insomnia with frequent dreams. The Spleen, as the central organ, governs all transformations, and its deficiency leads to Heart blood deficiency. The formula uses Ginseng, Atractylodes, and Astragalus—sweet and warm herbs that tonify the Earth element—to strengthen the Spleen and replenish qi, treating the root cause as the primary action; Poria, Polygala, Ziziphus, and Longan aril—sweet, warm, and slightly bitter herbs that nourish the Heart and calm the spirit—as secondary actions to address the symptoms; Agastache rugosa moves qi, and Angelica sinensis promotes blood circulation, ensuring that the herbs work smoothly without stagnation; ginger and jujubes harmonize the Ying and Wei energies—all these serve as complementary actions; and Glycyrrhiza balances the herbs and acts as a guiding agent.

[Clinical Modifications] ① Add musk, cinnabar, Chinese yam, and Platycodon grandiflorus to create Miaoxiang San (from "Heji Ju Fang"). This formula treats insufficient Heart qi, indecisiveness, palpitations, fear, and mood swings. ② Add Ophiopogon japonicus and Schisandra chinensis to treat lung and kidney damage, cough, and night sweats; add Bupleurum, Moutan cortex, and Gardenia jasminoides to treat liver channel stagnation, flank pain, and bitter taste in the mouth; add Rehmannia glutinosa, Schisandra chinensis, Paeonia lactiflora, and oyster shell to treat Heart-Kidney disharmony and spontaneous leakage of essence; add Coptis, Rehmannia glutinosa, and Fritillaria cirrhosa to treat excessive Heart fire and restlessness; add Phellodendron amurense, Anemarrhena asphodeloides, and Ophiopogon japonicus to treat excessive Xiang fire and bone-steaming with nocturnal emission.

[Reference Materials] ① When blood does not return to the Spleen, it flows erratically; the sweet and warm properties of Ginseng, Atractylodes, Astragalus, and Glycyrrhiza are meant to tonify the Spleen; the sweet, warm, sour, and bitter qualities of Poria, Polygala, Ziziphus, and Longan aril are intended to nourish the Heart. The Heart is the mother of the Spleen, and Angelica sinensis nourishes yin and blood, while Agastache rugosa moves qi and soothes the Spleen, both helping to clear stagnation in the blood and supporting the Qi and Spleen tonification by Ginseng and Astragalus. When qi is strong, it can control the blood, allowing the blood to return to its proper channels, thereby eliminating all symptoms. (From "Yifang Jiejie") ② The modified Gui Pi Tang was used to treat two cases of gastric ulcer. Both cases were confirmed by barium meal X-ray, with main symptoms including a pale complexion, severe stomach pain, dizziness, reluctance to speak, palpitations, insomnia, and a weak, deep pulse or a large, rapid pulse. After using Gui Pi Tang with appropriate modifications based on the individual case, all symptoms improved. (From "Zhejiang Journal of Traditional Chinese Medicine" 64.6) ③ Zhao ××, female, 50 years old. She presented with frequent nosebleeds, gum bleeding, and widespread purpura, later hospitalized due to massive vaginal bleeding, where she was diagnosed with thrombocytopenic purpura. Symptoms included fatigue, poor appetite, palpitations, and disturbed sleep, with a weak, deep pulse. The prescription included: 5 grams of Ginseng, 3 grams of Atractylodes, 3 grams of Poria, 5 grams of Ziziphus, 2 grams of Agastache rugosa, 3 grams of Angelica sinensis, 3 grams of Astragalus, 3 grams of Longan aril, 3 grams of Rehmannia glutinosa, 3 grams of Ophiopogon japonicus, 3 grams of Moutan cortex, 3 grams of Epimedium, 3 grams of Dipsacus, 3 grams of Psoralea corylifolia, and 3 grams of Morinda citrifolia. After taking the medicine for 23 doses, her platelet count increased from 56,000 to 146,000, and the skin purpura, nosebleeds, gum bleeding, and vaginal bleeding all disappeared. (From "Shanghai Journal of Traditional Chinese Medicine" 1964.10)

[Commentary] This formula, when modified, can be used for neurasthenia, anemia, aplastic anemia, thrombocytopenic purpura, chronic gastritis, gastric and duodenal ulcers, women's menstrual irregularities and functional uterine bleeding, early-stage rheumatic heart disease, hypotension, and other conditions.

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