3. Zhigancao Tang Fumai Tang "Shanghan Lun"

3. Zhigancao Tang (Fumai Tang) "Shanghan Lun"

[Composition] 9 grams of Zhigancao (four liang), six jujubes (thirty pieces), 9 grams of Ejiao (two liang), 9 grams of fresh ginger (three liang), 6 grams of Ginseng (two liang), 30 grams of Rehmannia glutinosa (one jin), 6 grams of Guizhi (two liang), 9 grams of Ophiopogon japonicus, and 9 grams of Ma Ren (half a sheng).

[Administration] Decoct in seven parts wine and eight parts water, remove the residue, then dissolve the Ejiao in the liquid, and take warm.

[Indications] Deficiency of both Heart and Lung, with a weak and irregular pulse.

[Symptoms] Palpitations, shortness of breath, spontaneous sweating, irregular pulse, dry throat and tongue, dry cough due to deficiency heat, sticky and difficult-to-expectorate phlegm, blood-tinged phlegm, restlessness and insomnia, night sweats, and a smooth, thinly coated tongue.

[Functions] Nourishes the Heart and Lung, unblocks yang, and restores the pulse.

[Formula Analysis] "The Heart governs the blood vessels," and "the Lung directs all the meridians." When both Heart and Lung are deficient, the pulse becomes weak and irregular. According to "Shanghan Lun," "When the pulse is irregular and the heart beats erratically, Zhigancao Tang is the principal remedy." This shows that the focus of this formula is on "restoring the pulse." The core symptoms of the formula include palpitations, shortness of breath, spontaneous sweating, and an irregular pulse, which indicate Heart qi deficiency; dry throat and tongue, dry cough due to deficiency heat, sticky and difficult-to-expectorate phlegm, blood-tinged phlegm, restlessness and insomnia, night sweats, and a smooth, thinly coated tongue, which point to Lung yin deficiency. The formula uses Zhigancao, which is sweet and warm, to tonify Heart qi and moisten Lung yin; strengthening both Heart and Lung simultaneously helps to replenish qi and generate blood, making it the main component of the formula. Guizhi warms and unblocks Heart yang to restore the pulse, serving as a supplementary ingredient. Ginseng and jujubes tonify qi and strengthen the Spleen, consolidating the foundation of all qi; Rehmannia, Ejiao, Ophiopogon japonicus, and Ma Ren nourish the Lung and Kidney, replenishing the true yin, all acting as complementary actions. Baijiu is added during decoction to provide warmth and promote dispersion, serving as a guiding agent.

[Clinical Modifications] ① Remove ginger, Guizhi, Ginseng, and jujubes, and add Paeonia lactiflora to create Ji Jian Fumai Tang (from "Wenbing Tiaobian"). This formula treats prolonged invasion of warm pathogenic factors into the Yangming channel, resulting in high body temperature, red face, dry mouth and tongue, a large and weak pulse, and hot palms and soles. ② If palpitations are severe, add raw dragon teeth and cinnabar; if the pulse is markedly irregular, add tea tree root, Salvia miltiorrhiza, sandalwood, and Corydalis yanhusuo; if the pulse is very weak, add Schisandra chinensis; if there is edema, add Poria and Plantago; if there is yang deficiency with spontaneous sweating and aversion to cold, add Aconitum; if stools are loose, remove Ma Ren.

[Reference Materials] ① The Heart is the sovereign, and by its nature should not be invaded by evil forces; in terms of imagery, it represents the sun in the middle of yang. However, within the sun there is yin, and one yin resides amidst two yangs. Although the Heart is a male organ, everything related to blood and pulse ultimately belongs to the Heart. If the Heart lacks yin blood and is damaged by cold pathogens, the above symptoms will appear. In the formula, Rehmannia, Ejiao, and Ophiopogon japonicus replenish the Heart's yin, while Ginseng and Zhigancao strengthen the Heart's yang; Guizhi, fresh ginger, and liquor help disperse external cold pathogens, and Ma Ren and jujubes moisturize the internal organs that have become dry. The treatment of pulmonary atrophy is also closely related to the Heart's warm and fluid nature; readers can refer to "Jingui Yaolu" for more details. (From "Cheng Fangbian Du") ② This formula is a major tonic for blood replenishment. Senior scholar Yang Xishan once said that this formula should never be modified, but unfortunately he did not explain why. In my view, this formula reflects the transformation of qi in the middle jiao into juice, which then turns red—this is the essence of blood. Ginger, jujubes, Ginseng, and Zhigancao all extract juice from the middle jiao; Guizhi transforms qi in the Heart into red, but because Guizhi is pungent and harsh, it can harm the blood. Therefore, Rehmannia, Ophiopogon japonicus, and sesame seeds are added to cool down Guizhi's intense energy, softening its potency so that it can nourish the blood without harming it; moreover, Ejiao lies dormant in the blood vessels, transporting blood to the sea of blood and storing it in the liver. Looking at the source of blood production and the flow of blood in this formula, it truly is the first choice for blood replenishment. (From "Xuezheng Lun") ③ Wang ××, male, suffered from palpitations, with a weak and feeble pulse, and soreness in both legs. He was given Zhigancao Tang (12 grams of Zhigancao, 9 grams of Guizhi, 9 grams of fresh ginger, 18 grams of Ophiopogon japonicus, 1 gram of Ziziphus, 6 grams of Ginseng, 6 grams of Ejiao, 48 grams of Rehmannia glutinosa, and 10 jujubes). Using 4 cups of water and 3 cups of liquor, he boiled the first 8 ingredients, took out 2 cups, removed the residue, dissolved the Ejiao, and took it in two doses, warm. After 4 doses, his legs felt stronger, and after another 4 doses, the palpitations basically disappeared. (From "Yue Mei Traditional Chinese Medicine Case Collection")

[Commentary] This formula, when modified, can be used for various types of arrhythmias seen in heart disease; it can also be used for palpitations and shortness of breath seen in neurasthenia; furthermore, it can be appropriately applied in cases of various types of anemia and hemorrhagic disorders.

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