4. Danggui Buxue Tang "Nei Wai Shang Bian Huo Lun"

[Composition] 30 grams of Astragalus membranaceus and 6 grams of Angelica sinensis (washed with alcohol).

[Administration] Decoct in water and take.

[Indications] Deficiency of yin blood.

[Symptoms] Hot skin and flushed face, thirst and desire to drink, and a large, weak pulse.

[Functions] Tonifies qi and generates blood.

[Formula Analysis] Due to internal injury from overwork or postpartum blood loss, yin blood deficiency occurs, leading to the above symptoms. When yin is deficient, fire becomes rampant, and when blood is deficient, yang floats to the surface, resulting in hot skin and flushed face, thirst and desire to drink, and a large, weak pulse—all signs of excess yang and rising fire. Visible blood is born from invisible qi, just as "Cheng Fangbian Du" says: "Visible blood cannot be produced quickly; invisible qi must be strengthened urgently." Therefore, Astragalus is used to greatly tonify the original qi of the Lung and Spleen, enabling yang to generate yin and qi to solidify blood—this is the main action of the formula; Angelica sinensis supplements blood and nourishes the body as a supplementary action. The combination of these two herbs aims to support yang to preserve yin, keeping yin balanced and yang stable, thereby naturally reducing excess yang and heat.

[Clinical Modifications] This formula is the basic formula for tonifying qi and generating blood. It is included in many commonly used formulas such as Bu Zhong Yi Qi Tang, Gui Pi Tang, Sheng Yu Tang, Dang Gui Liu Huang Tang, and Bu Yang Huan Wu Tang. As long as the key principle of "tonifying qi and generating blood" is understood, this formula can be widely combined with other formulas in clinical practice.

[Reference Materials] ① Blood deficiency causes fever, which resembles the White Tiger syndrome, but the pulse is not long and full—only the pulse can distinguish between the two. Taking White Tiger by mistake will surely lead to death. (From "Piwei Lun") ② When blood is abundant, the body feels cool; when blood is deficient, the body feels hot. This formula is caused by hunger, overwork, and injury to yin blood, resulting in excess yang and floating yang, hence the hot skin and thirst, similar to the White Tiger syndrome. However, the White Tiger syndrome is caused by external pathogens and internal heat, so the pulse is large and long, and feels strong upon palpation; whereas this formula is caused by internal injury and blood deficiency, resulting in a large, weak pulse. According to "Neijing," a weak pulse means blood deficiency, and taking White Tiger by mistake will certainly result in death. (From "Cheng Fang Qie Yong")

[Commentary] This formula is used for anemia, allergic purpura, functional uterine bleeding, leukopenia, and neurasthenia, among others.

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III. Nourishing Yin

According to "Suwen·Tiaojing Lun," "When yin is deficient, internal heat arises." Thus, the clinical manifestations of yin deficiency are all signs of internal heat, such as bone-steaming and tidal heat, and five-heart heat. In addition, since yang qi wanders inward at night and the outer defensive barrier is not strong enough, coupled with the pressure of internal heat on bodily fluids, yin deficiency often results in night sweats. The treatment for this condition is called "nourishing yin," also known as "reducing fire by nourishing yin." According to "Suwen·Zhizhen Yao Dalun," "All cold conditions are treated by reducing fire through nourishing yin." Wang Bing said, "Strengthen the master of water to control the sunlight." Both statements refer to the concept of nourishing yin and reducing fire.

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1. Liu Wei Di Huang Wan

"Xiao’er Yao Zheng Zhi Jue"

[Composition] 24 grams of Shu Di, 12 grams of Shan Yu Rou, 12 grams of Shan Yao, 9 grams of Dan Pi, 9 grams of Fu Ling, and 9 grams of Ze Xie.

[Administration] Grind all ingredients into powder, mix with honey to form pills about the size of a wutong seed, take three pills per dose, washed down with warm water. In modern times, it is also used as a decoction.

[Indications] Deficiency of kidney yin.

[Symptoms] Dizziness, blurred vision, tinnitus, lower back pain, leg fatigue, bone-steaming and tidal heat, five-heart heat, and night sweats.

[Functions] Nourishes yin and tonifies the kidneys.

[Formula Analysis] People with kidney deficiency experience dizziness, blurred vision, tinnitus, lower back pain, and leg fatigue; those with yin deficiency suffer from bone-steaming and tidal heat, five-heart heat, and night sweats. Together, these symptoms indicate kidney yin deficiency. The treatment for this condition focuses on "strengthening the master of water," meaning the formula comprehensively tonifies the three yin—kidney, liver, and spleen—and its effect is primarily on the kidneys, making it an excellent formula for nourishing yin and tonifying the kidneys. In the formula, Shu Di is sweet and cold, entering the kidneys to specifically tonify the kidney and strengthen the water element, thus serving as the main ingredient. Shan Yu Rou is pungent and enters the liver to astringe liver yin; Shan Yao is sweet and neutral, going to the spleen to nourish spleen yin. Since the liver and kidneys share the same origin, nourishing the liver also nourishes the kidneys; earth gives birth to all things, so nourishing the spleen can also benefit the kidneys. These two herbs together assist Shu Di in tonifying kidney yin, serving as auxiliary ingredients. All three of these herbs are greasy and easy to stagnate. Ze Xie clears kidney turbidity to prevent Shu Di from becoming stagnant; Dan Pi clears heat from the liver to relieve Shan Yu Rou's stagnation; Fu Ling lightly drains spleen dampness to avoid Shan Yao's stagnation. The function of these three herbs is to unblock the three yin, making the formula both nourishing and non-stagnant, thus becoming a representative formula for greatly nourishing the original yin. Since the original yin originates in the kidneys, this formula focuses specifically on the kidneys, making it the premier formula for nourishing yin and tonifying the kidneys.

[Clinical Modifications]

① Add Zhimu and Huangbo to create Zhibo Di Huang Wan (from "Yizong Jinjian"). This formula treats yin deficiency with excessive fire and persistent internal heat.

② Add Goji berries and Chrysanthemum to create Qiju Di Huang Wan (from "Yiji"). This formula treats liver-kidney yin deficiency and blurry, painful vision.

③ Add Schisandra to create Du Qi Wan (from "Yizong Ji Ren Bian"). This formula treats kidney's inability to hold qi, resulting in breathing difficulties.

④ Add Ophiopogon japonicus and Schisandra to create Baxian Changshou Wan (from "Yiji"). This formula treats lung-kidney yin deficiency and frequent coughing.

⑤ Remove Dan Pi, add Goji berries and Zhigancao to create Zuogui Yin (from "Jingyue Quanshu"). This formula treats kidney water deficiency, yin liquid loss, lower back pain and urinary incontinence, dry mouth and night sweats, or blackened lips and tongue, along with extreme thirst.

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[Reference Materials]

① This formula greatly nourishes the true yin of the liver, spleen, and kidneys, as well as conditions like blood deficiency and depletion of essence. Ancient practitioners believed that supplementation must be accompanied by drainage of pathogenic factors; only when pathogenic factors are eliminated can supplementation be effective. Therefore, Shu Di is used as the main ingredient to greatly replenish the kidney's essence and blood; Ze Xie is added to guide the removal of impurities from the kidneys and bladder as an auxiliary ingredient. Shan Yu Rou strengthens the liver and preserves essence; Dan Pi clears the fire of the Jueyin and Shaoyang channels. Following that, Shan Yao nourishes spleen yin, and Fu Ling drains spleen dampness, working together harmoniously without being either too dry or too cold—this is the ideal formula. (From "Cheng Fangbian Du")

② This formula is used for differential diagnosis and treatment of the following seven conditions:

1. Bleeding: Liver-kidney yin deficiency, blood running wild with bright red color. In this case, Ze Xie is removed, and Herba Eclipta, Cypress leaves, Motherwort, Lotus seed pod charcoal are added to cool the blood and stop bleeding; additionally, Cistanche deserticola, Turtle shell, and Oyster shell are added to greatly nourish the liver and kidneys and stop bleeding.

2. Hypertensive dizziness: Symptoms include headache, dizziness, blurred vision, and a strong, wiry pulse. In this case, Shi Jue Ming, Turtle shell, Zhimu, Huangbo, Earthworm, and Hook vine are added.

3. Urinary stones: Damp heat accumulates in the lower burner, scorching body fluids and causing impurities in urine to clump into stones, resulting in excruciating lower back pain, painful urination, and hematuria. In this case, Amber, Money grass, Dangshen, and Sandalwood powder (to be taken orally) are added.

4. Chronic otitis media in children: Kidney heat has been steaming for a long time, causing pus to flow from both ears. In this case, Hu Lu tiao, Dandelion, Huangbo, and Zhimu are added.

5. Chronic pharyngitis: Yin deficiency with excessive fire, causing throat pain that is hard to cure over time. In this case, Yuan Shen, Ophiopogon japonicus, Glycyrrhiza, Platycodon grandiflorus, and Tu Yuan are added.

6. Diabetes: Yin deficiency with excessive fire, injuring yin fluids, leading to excessive drinking, eating, and urination. In this case, Yuan Shen, Zhimu, and Huangbo are added.

7. Hair loss: Kidney yin deficiency with blood having accumulated heat. In this case, Fu Ling is removed, and Herba Eclipta, Salvia miltiorrhiza, and Polygonum multiflorum are added. (Guangzhou College of Traditional Chinese Medicine: "Selection of Old Doctors' Medical Cases and Stories")

③ Clinical cases of using Liu Wei Di Huang Wan with modifications:

Case 1: Chronic pyelonephritis—dizziness, tinnitus, lower back pain, frequent dreaming, and edema. Urine test: protein (++), pus cells (+++), red blood cells (+). In this case, Goji berries and Cuscuta are added, and after taking the medicine for 14 doses, all symptoms improve. Later, this formula is alternated with Jin Gui Shen Qi Wan, supplemented with Fu Ling, Lotus seeds, Euryale ferox, Shan Yao, and Coix seed, stewed with pig stomach, for two months. All symptoms disappear, and urine tests return to normal.

Case 2: Chronic hepatitis—pale complexion, bitter taste in the mouth, dull pain in the right flank, liver located 2.5 centimeters below the rib cage with tenderness, yellowish coating on the tongue. Liver function tests: brain絮 (++), musk絮 (+). In this case, Salvia miltiorrhiza, Paeonia lactiflora, and Panax notoginseng are added, and after taking the medicine for one week, liver pain eases, appetite improves, and later, the medicine is taken in pill form, three pills per dose, three times a day; concurrently, Renshen Yangrong Wan is taken, two pills per dose, three times a day. After three months of medication, symptoms basically disappear, and liver function returns to normal.

Case 3: Hypertension—dizziness, blurred vision, tinnitus, palpitations, insomnia, lower back pain, numbness in the limbs, blood pressure between 150–160/96–110 mmHg. In this case, Ziziphus, Shi Jue Ming, Earthworm, and Double hook are added, and after taking the medicine for two weeks, all symptoms alleviate, blood pressure returns to normal, followed by Qiju Di Huang Wan for another two months to consolidate the effects. (From "Fujian Journal of Traditional Chinese Medicine" 64.5)

[Commentary] This formula, when modified, can be used for congenital developmental delays in children, glaucoma, diabetes, hypertension, chronic nephritis, chronic hepatitis, systemic lupus erythematosus, emphysema, pulmonary heart disease, women's menstrual irregularities, and other conditions.

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2. Da Bu Yin Wan

"Danxi Xinfa"

[Composition] 120 grams of Zhimu (stir-fried with wine), 120 grams of Huangbo (stir-fried), 180 grams of Shu Di (steamed with wine), and 180 grams of Turtle shell (crispy roasted).

[Administration] Grind all ingredients into powder, steam with pig spinal cord, mix with honey to form pills about the size of a wutong seed, take seventy pills per dose, taken on an empty stomach with salted white soup. In modern times, it is also made into a decoction, taken by boiling in water.

[Indications] Yin deficiency with excessive fire.

[Symptoms] Bone-steaming and tidal heat, night sweats, five-heart heat, red tongue with little coating, dry throat and tongue, lung heat cough, hemoptysis, vomiting blood, burning pain in the feet and knees, and a strong, rapid pulse.

[Functions] Nourishes yin and reduces fire.

[Formula Analysis] When yin is deficient, bone-steaming and tidal heat, night sweats, five-heart heat, and a red tongue with little coating occur; when fire is excessive, dry throat and tongue, lung heat cough, hemoptysis, vomiting blood, burning pain in the feet and knees, and a strong, rapid pulse appear. This syndrome is caused by yin deficiency leading to excessive fire. Zhu Danxi said, "Yin is often insufficient, while yang is often excessive; therefore, we should constantly nourish yin. When yin and yang are balanced, water can control fire, and there will be no illness." Thus, the focus of this formula is on nourishing yin. In the formula, Shu Di enters the kidneys to replenish water, serving as the top choice for nourishing yin. When yin is insufficient, fire has no restraint, so Zhimu and Huangbo—bitter and cold herbs that enter the kidneys directly to clear the virtual fire in the lower burner—are used as auxiliary ingredients. Turtle shell is good at storing, and turtle shells belong to the category of intermediate creatures; turtle shell also contains the idea of controlling fire, so it can act as a complementary ingredient. Pig spinal cord is used to connect the kidneys and enhance essence, serving as a guiding agent.

[Clinical Modifications]

① Remove Turtle shell and Shu Di, add Cinnamon to create Tongguan Wan (from "Lan Shi Mi Cang"). This formula treats heat in the lower burner's blood section, where people do not feel thirsty but have difficulty urinating.

② Remove Shu Di and Turtle shell, add Slippery elm and Hangzhou peony to create Han Tong Tang. This formula treats bladder stones and prostate enlargement in the elderly, resulting in painful urination.

③ Add Chenpi, Paeonia lactiflora, Suoyang, Tiger bone, and dried ginger, mix them with honey to form pills, named Hu Qian Wan. This formula treats liver-kidney deficiency, muscle and bone weakness, thin legs and feet, weak walking, and lower back pain with depleted essence.

④ If night sweats are obvious, add glutinous rice root, oyster shell, and floating wheat; if there is coughing up blood due to exhaustion, add Fairy grass, Cypress leaves, and Ejiao; if there is restlessness and insomnia, add Chuanxiong, Fu Ling, and Ziziphus.

[Reference Materials] When there is an excess of Xiang fire, it is always due to a lack of kidney water. Therefore, Shu Di is used as the main ingredient to greatly replenish kidney water. However, when fire is excessive, it turns into fierce fire, which erodes qi. If we only use the method of nourishing water to balance yang, how can we possibly suppress such rampant fire? Therefore, we must use the bitter and cold herbs Zhimu and Huangbo to enter the kidneys directly and clear the fire in the lower burner, thereby subduing it. Turtle is the divine water animal of the North, and using its spinal cord is meant to connect the kidneys and enhance their life force, replenishing the essence in a tangible way. Mixing with honey to form pills is intended to allow the medicine to penetrate the lower burner slowly and exert its effect gradually. (From "Cheng Fangbian Du")

[Commentary] This formula can be modified and applied to tuberculosis, blood diseases, diabetes, neurasthenia, and other illnesses.

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3. Tianwang Buxin Dan

"She Sheng Mi Pao"

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[Composition] Ginseng (remove the root) 15 g, Xuan Shen (stir-fried) 15 g, Dan Shen (lightly stir-fried) 15 g, Fu Ling (peeled) 15 g, Yuan Zhi (remove the heart and stir-fry) 15 g, Jie Geng each 15 g, Wu Wei Zi (stir-fried) 30 g, Dang Gui Body (washed with wine) 30 g, Tian Dong (remove the heart) 30 g, Mai Dong (remove the heart) 30 g, Bai Zi Ren (stir-fried) 30 g, Suan Zao Ren (stir-fried) 30 g.

[Administration] Make into honey pills, about the size of a wu zi seed, coat with cinnabar, take 9 g on an empty stomach.

[Indications] Yin deficiency with excessive fire, loss of spiritual stability.

[Symptoms] Mouth and tongue ulcers, dry stools, bone-steaming heat, vexation in the five hearts, red tongue with little coating, fine and rapid pulse; restlessness and insomnia, palpitations and frequent dreams.

[Functions] Nourish yin and clear heat, tonify the heart and calm the spirit.

[Formula Analysis] Yin deficiency with excessive fire leads to mouth and tongue ulcers, dry stools, bone-steaming heat, vexation in the five hearts, red tongue with little coating, and a fine and rapid pulse; loss of spiritual stability results in restlessness and insomnia, palpitations and frequent dreams. Yin deficiency causes excessive fire, and excessive fire disturbs the spirit. The "Plain Questions" states: "When yin is tranquil, the spirit is stored; when it is restless, it dissipates." This shows that the root cause of this formula's syndrome lies in yin deficiency with excessive fire. The formula includes Sheng Di, Yuan Shen, and Mai Dong, known as the "Augmenting Fluid Decoction," which primarily nourishes yin and reduces fire to treat the root cause; Fu Ling, Yuan Zhi, Bai Zi Ren, Suan Zao Ren, and Wu Wei Zi nourish the heart and calm the spirit to treat the symptoms, serving as auxiliary ingredients. Excessive fire consumes qi, so the formula uses Dang Gui and Dan Shen to nourish blood and invigorate qi, working together to address both root and symptoms. Jie Geng acts as a vessel for the herbs, carrying them upward, thus serving as a guiding agent; Cinnabar coats the pills, entering the heart to calm the spirit, also acting as a guiding agent.

[Clinical Modifications] For severe palpitations, add Sheng Long Mu; for excessive dreaming, add Ye Jiao Teng and He Huan Pi; for excessive sweating, add Fu Xiao Mai and Ma Huang Gen; for a weak pulse, add Huang Qi.

[References] ① The heart is the "separating fire," containing true water. When one reads, chants, or overthinks, it damages the yin of the separating fire, necessitating the replenishment of true water. Therefore, Sheng Di and Yuan Shen strengthen kidney water; Er Dong nourishes the upper source of water. Although Dang Gui and Dan Shen enter the heart to nourish blood, they are ultimately moving substances, requiring the powerful support of ginseng to achieve the effect of yang generating yin and yin growing. Fu Ling and Yuan Zhi dispel heart heat and calm the spirit, eliminate phlegm and dampness, cleanse the palace and remove obstructions, allowing the tonic herbs to work effectively. However, overthinking leads to stagnation of heart qi, so Bai Zi Ren, with its aromatic and moisturizing properties, enters the heart to soothe the spirit and open up the chest. Suan Zao Ren and Wu Wei Zi collect the scattered qi, while Jie Geng guides all the herbs upward into the heart; the cinnabar coating serves to stabilize the vacuity and counteract floating yang, and it also aligns with the principle of like attracting like. (From "Convenient Readings on Formulas")

② Guipi Tang and this formula both belong to the category of heart-nourishing and spirit-calming agents, treating forgetfulness, palpitations, and insomnia. However, the former focuses on strengthening the spleen and invigorating qi, making it suitable for qi-deficiency syndromes; the latter emphasizes nourishing yin and clearing heat, making it more appropriate for yin-deficiency and blood-heat conditions. (Jiangsu New Medical College: "Chinese Medicine Formula Science")

③ Adding modifications to Tian Wang Bu Xin Dan cured four cases of chronic urticaria (hives). The whole body developed hives, with intense itching, recurrent attacks, lasting for years without healing, accompanied by palpitations, easy startle, insomnia, a red tip of the tongue, thin white coating, and a fine, rapid pulse. Based on the principle that "all pain and itching originate from the heart," this formula proved highly effective in treating this condition. (Shanghai Journal of Traditional Chinese Medicine, issue 65.8)

[Commentary] This formula is effective for early-stage heart diseases characterized by palpitations and shortness of breath, as well as for various types of anemia marked by pallor and palpitations. It can also be used for neurasthenia, menopausal syndrome in women, chronic urticaria, and other conditions.

4. Gan Mai Da Zao Tang from "Jin Gui Yao Lue"

[Composition] Gan Cao 4.5 g (three liang), Xiao Mai 15 g (one sheng), Da Zao 4 pieces (ten pieces).

[Administration] Decoct in water and take warm.

[Indications] Deficiency of nutritive yin, restlessness of the spirit.

[Symptoms] Frequent crying and sadness, feeling as if possessed by spirits, often stretching.

[Functions] Tonify nutritive yin and calm the spirit.

[Formula Analysis] This formula is specifically designed in "Jin Gui Yao Lue" to treat "Zang Zao." The pathogenesis of Zang Zao is deficiency of nutritive yin and restlessness of the spirit. Symptoms include frequent crying and sadness, feeling as if possessed by spirits, and frequent stretching. When nutritive yin is deficient, yin fails to contain yang, causing yang to overflow and resulting in restlessness of the spirit. In this formula, Xiao Mai has a sweet and slightly cool taste, primarily tonifying nutritive yin and calming the spirit. Nutritive yin originates from food and is generated in the spleen and stomach, so the formula uses Da Zao and Gan Cao to tonify the middle jiao and benefit qi, thereby supporting the original source of nutritive yin.

[Clinical Modifications] ① Add Shao Yao and Zi Shi Ying to create "Modified Gan Mai Da Zao Tang" (from "Shen's Women's Gynecology Collection"), mainly for treating Zang Zao cases with opisthotonus. ② If abdominal examination reveals tightness in the right rectus abdominis muscle, or stiffness around the right flank near the navel with lumps, adding Dang Gui, Bai Shao, Fu Shen, Zao Ren, Long Chi, Mu Li, and Bai Zi Ren will enhance the therapeutic effect. (From "Jiangsu Traditional Chinese Medicine," August 1958)

[References] ① Wheat can harmonize with the guest heat of liver yin and nourish heart fluid, while also relieving irritability, promoting urination, and stopping sweat, making it the principal herb. Gan Cao clears heart fire and harmonizes the stomach to generate fluids, serving as the minister. Da Zao regulates the stomach and promotes fluid circulation, alleviating dryness in the upper part, thus acting as the assistant. Since the disease originates from blood, and the heart is the master of blood while the liver is its child, when heart fire is cleared and earth qi is harmonized, stomach qi descends, the liver is moistened, lung qi is regulated, dryness is eliminated, and the disease naturally resolves. (From "Practical Application of Formulas")

② Compound Gan Mai Da Zao Tang treated 34 cases of neurasthenia. All patients had insomnia and frequent dreams, palpitations and easy startle, memory decline, some even experiencing headaches, nocturnal emission, excessive sweating, low-grade fever, tremors, etc. Prescription: Roasted Gan Cao 5–10 qian, Huai Xiao Mai 2 liang, Hong Zao 8 pieces, Bai He 1 liang, Su Ye 1–1.5 qian, Jiang Ban Xia 3 qian, Fu Ling 4 qian, Ci Shi 4 qian (decocted first), one dose daily, decocted in water and taken warm. Results: 30 cases were effective, accounting for 88.2%; 4 cases were ineffective, accounting for 11.8%. (New Medical Journal, July 1974)

③ Ms. Liu, 38 years old. She has always been quick-tempered and easily agitated. In the past six months, she has felt depressed and hypersensitive, sometimes worrying and getting angry, sometimes becoming silent and withdrawn. A month ago, after an argument with someone, she initially remained silent, then became unusually sad, and recently developed fear, isolating herself at home, disliking human voices, and panicking and avoiding strangers. Prescription: Powdered Gan Cao 3 qian, fried Zhi Shi 1.5 qian, Zhu Fu Shen 2 qian, Chen Xiao Mai 5 qian, Jiao Shan Zhi 2 qian, Hong Zao 8 pieces, fresh Zhu Ru 2 qian, Sheng Di 3 qian. Additionally, take two doses of magnetic cinnabar pills morning and evening, dissolved in hot water. After applying these modifications for more than ten doses, her symptoms completely disappeared, and she was able to return to work. (Shanghai Journal of Traditional Chinese Medicine, September 1962)

[Commentary] This modified formula is used to treat neurasthenia, hysteria, and mild schizophrenia.

5. Suan Zao Ren Tang from "Jin Gui Yao Lue"

[Composition] Suan Zao Ren 15 g (two sheng), Gan Cao 3 g (one liang), Zhi Mu 4 g (two liang), Fu Ling 6 g (two liang), Chuan Xiong 3 g (two liang).

[Administration] Decoct Zao Ren first, then add the other herbs, strain out the residue, and take warm.

[Indications] Liver yin deficiency, rising heart qi.

[Symptoms] Dizziness, bone-steaming night sweats, dry throat and mouth, restlessness and insomnia.

[Functions] Nourish yin and calm the spirit.

[Formula Analysis] Liver yin deficiency causes dizziness and bone-steaming night sweats; rising heart qi leads to dry throat and mouth, restlessness and insomnia. This syndrome arises from exhaustion, as prolonged fatigue inevitably depletes yin, leading to insufficient liver yin, which in turn causes heart qi to rise. In this formula, Suan Zao Ren effectively enters both the heart and liver meridians—entering the liver to nourish yin, entering the heart to regulate qi—thus fully embodying the function of nourishing the heart and calming the spirit as the primary action. Yin deficiency leads to excessive fire, so Zhi Mu, with its bitter and cold nature, enters the kidneys to specifically nourish yin and reduce fire as a supplementary action. The stomach is the sea of food and drink, and the spleen is the origin of nutritive blood, so Fu Ling strengthens the spleen and benefits the stomach as a complementary action; Chuan Xiong enters the liver to promote blood circulation, ensuring that the liver-tonifying effects of Zao Ren are not hindered, also serving as a complementary action. Gan Cao harmonizes all the herbs as a guiding agent.

[Clinical Modifications] For those with pronounced yin deficiency, add Han Lian Cao, Nu Zhen Zi, Bai Shao, and Sheng Di; for severe night sweats, add Wu Wei Zi and Fu Xiao Mai; for frequent palpitations, add Sheng Long Mu; for poor sleep, add Long Chi and Ye Jiao Teng.

[References] ① Restlessness arises from mental disturbance and depression, caused by excessive loss of body fluids, dryness inside the body, or insufficient nourishing blood, with yang overpowering yin. (From "Ye's Comprehensive Principles")

② Restlessness occurs when liver yin is deficient and fire energy takes over, so Zao Ren is primarily used to calm the liver and gallbladder, supplemented by Chuan Xiong to regulate blood and nourish the liver, Fu Ling and Gan Cao to nurture the wood element, and Zhi Mu to reduce fire and relieve restlessness—this is a formula that balances the liver and spleen. (From "Zhang's Medical Compendium")

[Commentary] This formula, with modifications, can be used for palpitations and insomnia in various heart diseases and blood disorders; it can also be applied to neurasthenia and autonomic dysfunction where yin deficiency and insomnia are the main symptoms.

6. Da Zao Wan from "Fushou Jing Fang"

[Composition] One piece of Zi He Che (washed and dried by baking), 60 g of Bai Gui Ban, 45 g of Huang Bo (salt-soaked and stir-fried), 45 g of Du Zhong (crispy-roasted), 36 g of Niu Xi (soaked in wine and sun-dried), 36 g of Mai Dong (heart removed), 36 g of Tian Dong (heart removed), Sheng Di (cooked seven times in wine with 18 g of Sha Ren and 60 g of Fu Ling, then Fu Ling and Sha Ren are discarded), and 30 g of Ginseng.

[Administration] Decoct Sheng Di to make a paste, grind the remaining herbs into powder, mix with wine to form pills about the size of a soybean, take 9–12 g per dose, washed down with hot water in the morning.

[Indications] Lung and kidney yin deficiency.

[Symptoms] Bone-steaming heat, vexation in the five hearts, night sweats; cough and asthma, sticky and difficult-to-expectorate phlegm, phlegm mixed with blood; dizziness and tinnitus, lower back pain and leg weakness.

[Functions] Nourish the kidneys and tonify the lungs.

[Formula Analysis] The lungs belong to metal, the kidneys to water; metal and water generate each other, so if kidney yin is deficient, lung yin will also be deficient. Bone-steaming heat, vexation in the five hearts, and night sweats are common symptoms of yin deficiency; cough and asthma, sticky and difficult-to-expectorate phlegm, indicate lung problems; dizziness and tinnitus, lower back pain and leg weakness point to kidney issues. All these symptoms can be summarized as lung and kidney yin deficiency. In this formula, Zi He Che primarily nourishes the lungs and kidneys, enriching yin and generating essence, serving as the main ingredient. This medicine is made of flesh and blood, with a rich flavor and strong energy, embodying the principle in "The Plain Questions" that "when essence is deficient, supplement it with flavor." Tian Dong and Mai Dong nourish yin and tonify the lungs; Sheng Di and Gui Ban nourish yin and tonify the kidneys, and these four herbs work in harmony with Zi He Che to enhance the functions of nourishing yin, tonifying the lungs, and benefiting the kidneys as supplementary actions. "Lonely yin cannot arise, solitary yang cannot grow," so yin deficiency inevitably leads to qi-yang deficiency, hence the use of Ginseng to invigorate qi; yin deficiency also causes excess fire, so Huang Bo is used to clear excess fire; since the liver and kidneys share the same origin, kidney yin deficiency inevitably leads to liver yin deficiency, so Du Zhong and Niu Xi are used to nourish both the liver and kidneys, all these herbs serving as complementary actions. Sha Ren and Fu Ling, paired with the above tonifying herbs, nourish without being greasy, do not harm stomach qi, and serve as guiding agents.

[Clinical Modifications] ① Remove Ginseng, Sha Ren, and Fu Ling, make pills with refined honey, also called "He Che Da Zao Wan" (from "Jing Yue Complete Works"). Treats liver and kidney deficiency, nocturnal emission and spermatorrhea, bone-steaming heat, lower back pain and leg weakness. ② Remove Ginseng, Sha Ren, Fu Ling, and Gui Ban, add full Dang Gui, Suo Yang, Wu Wei Zi, Dan Cong Rong, Shu Di, and Goji berries, also called "He Che Da Zao Wan" (by Wu Qiu), used to treat chronic cough and stubborn phlegm.

[References] ① Overall, this formula uses flesh-and-blood medicines to repair damage and revitalize vitality, addressing the root cause; it also clears excess fire, eliminates bone-steaming heat, moistens dry lungs, and calms the spirit, addressing the symptoms. The combination is extremely well-suited for conditions such as exhaustion, severe depletion of essence and blood, excessive fire, chronic cough and heat, and emaciation. (Jiangsu New Medical College: "Chinese Medicine Formula Science")

② Mr. Peng ××, 15 years old, female. Seven months after birth, she developed chronic cough and phlegm due to a cold, which would flare up whenever the weather changed, persisting for a long time and hindering her development. After starting school, any physical exertion would trigger another episode. Her father, who knew medicine, often treated her with Xiao Qing Long Tang and Er Chen Tang, but over ten years she kept relapsing and being treated, only to relapse again. In the summer of 1970, her father went out and asked me to take care of her illness at all times. Whenever she caught a cold or got tired and her cough flared up, I temporarily gave her a formula to descend qi and clear the lungs, and after recovery, I urged her to take He Che Da Zao Wan continuously. Half a year later, her physique improved significantly, and by the summer of 1971, her development accelerated, and the chronic phlegm was finally eliminated. Over the next year, she only had a single bout of cough during the flu, without any accompanying asthma. (Traditional Chinese Medicine Research Institute: "Yue Mei Traditional Chinese Medicine Case Collection")

[Commentary] This formula can be used during the recovery phase of various chronic diseases, such as pulmonary tuberculosis, chronic bronchitis, emphysema, neurasthenia, and endocrine disorders in women.

7. Bu Fei A Jiao Tang from "Xiao Er Yao Zheng Zhi Jue"

[Composition] A Jiao (bran-fried) 45 g, Ma Dou Ling (baked) 45 g, Niu Bang Zi (stir-fried), Zhi Gan Cao each 7.5 g, Xing Ren (peeled and stir-fried) seven pieces, Nuo Mi (stir-fried) 30 g.

[Administration] Grind into powder, take 6 g per dose, decoct in water; recently, more often made into soup.

[Indications] Lung yin deficiency, excessive fire and blood overflow.

[Symptoms] Dry throat, cough with choking sensation, sticky and difficult-to-expectorate phlegm, phlegm mixed with blood, bone-steaming heat, vexation in the five hearts, red tongue with little coating, fine and rapid pulse.

[Functions] Nourish yin and tonify the lungs, clear fire and stop bleeding.

[Formula Analysis] Lung yin deficiency leads to dry throat, cough with choking sensation, bone-steaming heat, vexation in the five hearts, red tongue with little coating, and a fine, rapid pulse; excessive fire and blood overflow result in sticky and difficult-to-expectorate phlegm, phlegm mixed with blood. Yin deficiency causes excessive fire, and excessive fire leads to blood overflow. In this formula, A Jiao nourishes yin and tonifies the lungs to treat the root cause, while also having hemostatic effects, making it the main ingredient. Niu Bang Zi and Ma Dou Ling clear heat and reduce fire to treat the symptoms, serving as auxiliary ingredients. "The lungs are for coughing," so any deficiency or excess heat in the lungs leads to coughing and asthma; Xing Ren can stop coughing and alleviate asthma, serving as a complementary action; soil generates metal, so strengthening the spleen can also treat the lungs, and Nuo Mi strengthens the spleen and benefits the lungs, also serving as a complementary action. Gan Cao harmonizes all the herbs as a guiding agent.

[Clinical Modifications] For severe hemoptysis, add Bai Ji; for constipation, add Da Huang; for severe lung heat and thick, greasy tongue coating, add Huang Qin; for excessive sweating, add Fu Xiao Mai and Ma Huang Gen; for palpitations and shortness of breath, add Sheng Long Mu; for poor sleep and frequent dreams, add Ye Jiao Teng, He Huan Pi, and Suan Zao Ren.

[References] Ma Dou Ling clears heat and reduces fire, Niu Bang Zi facilitates phlegm clearance and smooths the airways, Xing Ren moistens and disperses wind, while A Jiao clears the lungs, nourishes the kidneys, and supplements blood and yin; when qi flows smoothly, there is no choking, when fluids are replenished, moisture is generated, and when fire subsides, coughing calms down. Soil is the mother of metal, so adding Gan Cao and Nuo Mi helps strengthen the spleen and stomach. (From "Practical Application of Formulas")

[Commentary] This formula is used for pulmonary tuberculosis and bronchiectasis with hemoptysis.

8. Yue Hua Wan from "Medical Insights"

[Composition] Bai Bu 30 g, Sha Shen 60 g, Chuan Bei 40 g, Tan Gan 65 g, Tian Dong 50 g, Mai Dong 50 g, Sang Ye 30 g, Ju Hua 60 g, Sheng Di 60 g, Shu Di 60 g, Guang San Qi 15 g, A Jiao 40 g, Fu Ling 50 g.

[Administration] Make pills with refined honey, 6 g each, take two pills daily, one in the morning and one in the evening.

[Indications] Exhaustion-induced lung damage, yin deficiency with excessive fire.

[Symptoms] Coughing and phlegm, sticky and difficult-to-expectorate phlegm, phlegm mixed with blood, dry throat and mouth, bone-steaming heat, vexation in the five hearts, night sweats.

[Functions] Kill parasites and replenish deficiency, nourish yin and reduce fire.

[Formula Analysis] This syndrome arises from exhaustion, where five types of labor lead to deficiency, and "zai" refers to parasitic infections. Exhaustion-induced lung damage leads to yin deficiency and excessive fire. Exhaustion-induced lung damage manifests as coughing and phlegm, sticky and difficult-to-expectorate phlegm, and phlegm mixed with blood; yin deficiency with excessive fire manifests as bone-steaming heat, vexation in the five hearts, and night sweats. In this formula, Tan Gan and Bai Bu kill parasites and replenish deficiency, serving as the main ingredients. Sha Shen, Er Dong, and Er Di nourish yin and reduce fire as auxiliary ingredients. Beimu clears heat, stops coughing, and dissolves phlegm, serving as a complementary action; Fu Ling and Shan Yao cultivate the earth to generate metal, also serving as complementary actions; Sang Ye and Ju Hua calm the liver and control fire, also serving as complementary actions; A Jiao nourishes the lungs and stops bleeding, while San Qi dissolves blood stasis and stops bleeding, both serving as complementary actions.

[Clinical Modifications] If Tan Gan is lacking, duck liver can be used instead. If there is no hemoptysis, remove San Qi; for chest tightness and pain, add Gua Lou; for poor appetite, remove Er Di and add Sha Ren, Nei Jin, and Jiao Zha; for yellow tongue and thick phlegm, add Huang Qin; for afternoon fever, add Qing Hao and Di Gu Pi; for severe night sweats, add Fu Xiao Mai.

[References] Tan Gan changes shape monthly, producing one leaf each month, and when the moon is full, the leaves combine into one. Due to its unpredictable changes and ability to kill parasites, it is considered a magical medicine passed down through generations. The formula is named "Moonlight Flower" because of this property, and it is indeed named after this medicine. Parasites arise from stagnant blood, so San Qi is used to dissolve blood stasis and thus eliminate parasites; also, since phlegm is heated by fire, the remaining herbs are used to moisten and clear phlegm and fire. However, if the goal is to kill parasites, Tan Gan alone is sufficient; if the goal is to eliminate blood stasis, San Qi alone is sufficient. But when multiple herbs are combined, they complement each other, treating both root and symptoms, achieving a comprehensive victory. (From "Blood Evidence Theory," Volume 7)

[Commentary] This formula is an effective remedy for pulmonary tuberculosis, especially for those with obvious poisoning symptoms and hemoptysis, as it can alleviate the symptoms.

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9. Yi Guan Jian from "Liu Zhou Medical Talks"

[Composition] Bei Sha Shen, Mai Dong, Dang Gui each 9 g, Sheng Di 30 g, Gan Qi Zi 15 g, Chuan Lian Zi 4 g.

[Administration] Decoct in water, strain out the residue, take warm.

[Indications] Yin deficiency and liver stagnation.

[Symptoms] Dry throat and bitter taste, irritability and anger, chest and flank discomfort, vexation in the five hearts, red tongue with little coating, rapid and tense pulse.

[Functions] Nourish yin and soothe the liver.

[Formula Analysis] Kidney yin deficiency leads to vexation in the five hearts, red tongue with little coating, and a tense, rapid pulse; liver qi stagnation leads to bitter taste, dry throat, irritability and anger, and chest and flank discomfort. The liver and kidneys share the same origin, and the liver relies on kidney water to nourish itself. When kidney water is insufficient, the liver loses its nourishment, and the liver's natural flow is disrupted. In this formula, Sheng Di and Gan Qi Zi replenish kidney water to treat the root cause, serving as the main ingredients; Chuan Lian Zi soothes the liver and regulates qi to treat the symptoms, serving as the auxiliary ingredient; Sha Shen and Mai Dong nourish lung yin, providing the upper source of kidney water, embodying the idea of metal-water generation, and serving as complementary actions; Dang Gui nourishes blood and activates the liver to prevent qi-related illnesses from entering the blood, also serving as a complementary action.

[Clinical Modifications] ① Add Shou Wu, Bie Jia, Mu Li, and Hong Hua to create "Yi Gui Tong Yuan Drink" (by Zhou Ruolan). Mainly treats non-jaundice hepatitis (acute, protracted, chronic), for those with liver pain due to yin deficiency. ② If constipation is severe, add Wei Ren; for excessive heat and sweating, add Di Gu Pi; for excessive phlegm, add Beimu; for a red and dry tongue with no coating, add Shi Hu; for flank pain and hardness upon palpation, add Bie Jia; for heat and thirst, add Zhi Mu and Shi Gao; for abdominal pain, add Shao Yao and Gan Cao; for leg weakness, add Niu Xi and Yi Ren; for insomnia, add Zao Ren. (From "Liu Zhou Medical Talks")

[References] ① Treats liver and kidney yin deficiency, liver stagnation and qi blockage, with symptoms such as chest and flank discomfort or pain, dry mouth, and a red tongue with little coating; also used for chronic hepatitis with liver area pain due to liver and kidney yin deficiency. (From "Concise Dictionary of Traditional Chinese Medicine") ② Recently, it has been widely used for chronic hepatitis with good results. However, it is most suitable for those with a red tongue with little coating and a fine, rapid pulse, indicating yin deficiency with fire. Generally, Dang Gui can be omitted, replaced by Dan Shen, Su Xin Hua, and Bai Shao to soothe the liver and blood, soften the liver and relieve pain; for post-meal bloating, add Sha Ren and Ji Nei Jin to promote qi flow and relieve bloating, aiding digestion; for insomnia, add Bai Zi Ren, Suan Zao Ren, and Wu Wei Zi to nourish the heart and calm the spirit. (Guangdong Medical College: "Formula Science")

[Commentary] This formula can be used to treat chronic gastritis, gastric and duodenal ulcers with yin deficiency symptoms; it can also be applied to protracted hepatitis, chronic hepatitis, and gastrointestinal neurosis, among others.

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10. Yu Ye Tang from "Medical Insights into Both Chinese and Western Medicine"

[Composition] Wu Wei Zi 9 g, Zhi Mu 18 g, Sheng Ji Nei Jin 6 g, Tian Hua Fen 9 g, Sheng Huang Qi 15 g, Shan Yao 30 g, Ge Gen 4.5 g.

[Administration] Decoct in water and take.

[Indications] Diabetes insipidus (failure of vital energy to rise, failure of fluids to ascend).

[Symptoms] Emaciation and fatigue, long and clear urine, excessive thirst and drinking.

[Functions] Elevate vital energy and nourish true yin.

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【Formula Analysis】 If the primordial qi fails to ascend, one will experience emaciation and fatigue, along with clear and copious urination; if the body fluids fail to ascend and nourish the upper burner, one will feel thirsty and drink excessively. Primordial qi refers to the primordial yin and primordial yang, originating from the two kidneys, residing in the dantian, and distributed throughout the body via the triple burner, serving as the source of the body's vital energy. When primordial qi fails to ascend, body fluids cannot be properly distributed, leading to symptoms of fluid deficiency in the upper burner. In this formula, astragalus greatly tonifies primordial qi, while kudzu root ascends and elevates primordial qi; these two herbs—one tonifying and the other ascending—work together to accomplish the great task of raising and replenishing primordial qi, serving as the principal ingredients. Chinese yam tonifies spleen yin, anemarrhena rhizome nourishes kidney yin, and pollen nourishes lung yin. The lungs, spleen, and kidneys are the pathways for the transmission of yin fluids in the body; thus, these three herbs jointly nourish the true yin of the three organs, serving as auxiliary ingredients. Chicken gizzard membrane strengthens the spleen and transforms food into body fluids, while schisandra berries astringe and conserve body fluids, both acting as complementary treatments.

【Clinical Modifications】 For severe qi deficiency and fatigue, add wild ginseng; for dry mouth and throat, and thirst that cannot be relieved by drinking water, add gypsum and anemarrhena rhizome; for deficient fire and weak kidney function, resulting in cold urine and excessive urination, add gui fu ba wei; for damp-heat stagnation in the middle burner, yellow greasy tongue coating, and abdominal distension, add er miao san.

【References】 ① The syndrome of diabetes often arises from the failure of primordial qi to ascend; this formula aims to elevate primordial qi to quench thirst. Astragalus is the main ingredient, and kudzu root helps to raise primordial qi. Additionally, Chinese yam, anemarrhena rhizome, and pollen are added to deeply nourish true yin, allowing yang to rise and yin to respond, achieving the wonderful effect of clouds moving and rain falling. Chicken gizzard membrane is used because the urine in this condition contains sugar, so it helps strengthen the spleen and transform dietary sugar into body fluids. Schisandra berries are used for their astringent properties, which effectively seal the kidney gate and prevent water and drinks from rushing downward. (From "Medical Insights from Both Traditional Chinese and Western Medicine") ② A patient in his twenties, engaged in trade in Tianjin, developed diabetes. He sought treatment from local physicians in Tianjin for three months, consulting more than ten doctors without success. Upon returning home, he consulted me. His pulse was extremely weak and fine. He drank water and urinated frequently, needing to do so several times within a short period. I prescribed this decoction with four qian of wild ginseng; after several doses, his thirst subsided, but urination remained frequent. I then added five qian of cornelian cherry, and after ten consecutive doses, he fully recovered. (From "Medical Insights from Both Traditional Chinese and Western Medicine")

【Commentary】 This formula is specifically designed for treating diabetes; however, it can also be used for diabetes insipidus and for conditions involving excessive thirst and sweating due to autonomic nervous system dysfunction.

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IV. Tonifying Yang

The "Plain Questions: On the Great Principles of the Highest Truth" states: "For all conditions characterized by heat but manifesting cold, treat them by tonifying yang." Wang Bing explains: "Strengthen the source of fire to dispel yin shadows." The underlying principle is to tonify yang. Tonifying yang is a method for treating yang deficiency. Within yang deficiency, there are subtypes such as spleen yang deficiency, kidney yang deficiency, and heart yang deficiency. The spleen and heart yang deficiency have already been discussed in previous chapters. Here, we focus on kidney yang deficiency. The clinical manifestations of this condition include dizziness, tinnitus, lower back pain, leg weakness, feeling cold and easily chilled, spontaneous sweating, a weak pulse at the cun position, or accompanying symptoms such as impotence, nocturnal emission, and premature ejaculation.

1. Shenqi Wan from "Jingui Yaolue"

【Composition】 24 grams of dried rehmannia root (eight liang), 12 grams of Chinese yam (four liang), 12 grams of cornelian cherry (four liang), 9 grams of peony bark (three liang), 9 grams of poria (three liang), 9 grams of alisma (three liang), 3 grams of cinnamon twig (one liang), and 3 grams of processed aconite (one liang).

【Dosage】 Grind all ingredients into powder, form into honey pills, take 9 grams each time, twice daily, washed down with hot water. In modern times, it can also be prepared as a decoction and taken orally.

【Indications】 Kidney yang deficiency.

【Symptoms】 Dizziness, blurred vision, tinnitus, lower back pain, leg weakness, feeling cold and easily chilled, spontaneous sweating, and a weak pulse at the cun position; or accompanied by impotence, nocturnal emission, premature ejaculation, or difficulty urinating and generalized edema.

【Functions】 Warmly tonify kidney yang.

【Formula Analysis】 When kidney qi is insufficient, one experiences dizziness, blurred vision, tinnitus, lower back pain, leg weakness, and a weak pulse at the cun position; when yang qi is deficient, one feels cold and easily chilled, with spontaneous sweating; when yang qi fails to restrain yin, one may experience impotence, nocturnal emission, and premature ejaculation; when yang qi fails to transform into qi, one may develop edema and difficulty urinating. All these symptoms are caused by kidney yang deficiency, so warming and tonifying kidney yang is sufficient. However, "solitary yin cannot generate life, and solitary yang cannot grow." "Yin is rooted in yang, and yang is rooted in yin." To tonify kidney yang, one must first use yin-tonifying herbs to complement the treatment. As 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." This formula embodies that principle: based on the Six Flavor Rehmannia Decoction, which greatly tonifies primordial yin, adding cinnamon and processed aconite to strengthen yang makes this formula an excellent choice for tonifying yang. After all, kidney yang is like the fire in water, the fire of dragons and thunder, and can only be obtained by seeking yin. The "Classic of Difficult Questions" says, "The left side represents the kidney, and the right side represents the Mingmen." The kidney is the organ of water, while the Mingmen governs fire, symbolizing the fire in water. Cinnamon and processed aconite are used in small amounts, following the principle of "small fire generates life." If used in excess, they may lead to the problem of "strong fire consumes qi."

【Clinical Modifications】 ① Add achyranthes and plantago seeds to make Jisheng Shenqi Wan (from "Jisheng Fang"). This treats yang deficiency with water overflow, resulting in edema and reduced urination. ② Add deer antler and schisandra berries to make Shibu Wan (from "Jisheng Fang"). This treats long-term yang deficiency, with dark complexion, cold feet and swelling, weak legs and knees, emaciation, and lower back and knee pain. ③ Remove peony bark and add eucommia, goji berries, and licorice to make Yougui Yin (from "Jingyue Quanshu"). This treats conditions where yin predominates over yang, with genuine cold and false heat.

【References】 ① The gentleman phenomenon occurs in the Kua canal, indicating that the kidneys contain both water and fire. Nowadays, when people engage in sexual activity and their yang rises easily, it is due to yin deficiency and fire agitation; when yang becomes weak first, it indicates that the Mingmen fire is declining. When true water is depleted, even midwinter does not feel cold; when true fire is extinguished, even midsummer does not feel hot. This formula uses rehmannia, Chinese yam, alisma, peony bark, poria, and cornelian cherry—all moisturizing ingredients—to strengthen the water element; cinnamon and processed aconite are pungent and moistening, helping to supplement fire in the water, thereby benefiting the original fire. With both water and fire well-nourished, kidney qi can be restored. (From "Medical Compendium") ② Jisheng Shenqi Wan was used to treat 10 cases of chronic nephritis. Four cases achieved complete remission, three improved, and three were ineffective; it was also believed that this formula is particularly effective for patients with mild symptoms, no obvious damage to kidney function, and only long-term proteinuria. (From "Jiangsu Journal of Traditional Chinese Medicine," November 1965) ③ During the Qing dynasty, Wang Ang pointed out: "There are cases of kidney deficiency where fire does not return to its meridian, causing extreme heat and thirst, red eyes and chapped lips, prickling sensation on the tongue, a throat like being burned by fire, soles of the feet like being scorched, a pulse that is wildly large yet feels weak upon palpation." These are cases of Ten Complete Tonics and Eight Flavor Pills, which represent a true yin pattern of cold inside and false heat outside. True cold is the essence, while false heat is the manifestation; however, Wang Ang only mentioned the symptom of "a wildly large pulse that feels weak upon palpation," which is clearly insufficient. Since pulse conditions are not always fixed, a comprehensive analysis is necessary. In cases of true yin cold and false yang heat, the cold is internal while the yang is outwardly manifested; sometimes the cold is below while the yang is above, resulting in fire without roots. The cases Wang Ang cited might easily be mistaken for yang heat, what he called "extreme emptiness with apparent fullness." (From "Collected Essays on Medical Theory by Yue Meizhong")

【Commentary】 This formula can be used for coronary heart disease, pregnancy-induced hypertension, chronic nephritis, chronic pyelonephritis, primary hypertension, prostatitis, systemic lupus erythematosus, Addison's disease, myxedema, Sheehan's syndrome, chronic bronchitis, functional uterine bleeding in women, neurasthenia, and other conditions.

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2. Shenqi Wan (Empirical Formula)

【Composition】 Astragalus 30 grams, Chinese yam 30 grams, epimedium 60 grams, cinnamon 10 grams, psoralea 15 grams, schisandra berries 15 grams, polygonatum 60 grams, morinda 15 grams, eucommia 15 grams, deer antler 30 grams, goji berries 15 grams, angelica 15 grams, processed aconite 10 grams, magnolia bark 15 grams, rehmannia 15 grams.

【Dosage】 Make pills with refined honey, about the size of a wu seed, take six pills twice daily; or prepare as a decoction.

【Indications】 Kidney yang deficiency and weakened sexual function.

【Symptoms】 Dizziness and tinnitus, lower back pain and cold legs, impotence and nocturnal emission, and a deep, weak pulse at the cun position.

【Functions】 Warmly tonify kidney yang and strengthen sexual function.

【Formula Analysis】 When kidney yang is deficient, one experiences dizziness and tinnitus, lower back pain and cold legs; when sexual function is weakened, one suffers from impotence and nocturnal emission. Kidney yang deficiency is the root cause, while weakened sexual function is the manifestation. Following the principle of treating the root cause first, this formula focuses on warming and tonifying kidney yang, which naturally strengthens sexual function, ultimately eliminating all related symptoms. Deer antler comes from the crown of young male deer, uniquely absorbing the yang energy of heaven and earth, making it a powerful tonic for primordial yang, with the strongest effect, suitable as the main ingredient. Morinda, polygonatum, epimedium, cistanche, cinnamon, processed aconite, psoralea, and eucommia are all herbs that warm and tonify kidney yang, working together to support the deer antler as a supplementary ingredient. Qi is the commander of blood, and blood is the mother of qi; therefore, Chinese yam and astragalus tonify qi, while goji berries, angelica, and rehmannia nourish blood, all serving as complementary treatments. Schisandra berries astringe yin and regulate qi, facilitating the smooth flow of yang energy, thus aiding the restoration of kidney yang.

【Clinical Modifications】 For lower back pain, add achyranthes and parasitic plants; for palpitations, add raw oyster shell and magnetite; for insomnia, add night-blooming jasmine and sophora flowers; for long-term impotence, add Si Jun Zi Tang; for yin deficiency with tidal heat, add anemarrhena rhizome.

【Commentary】 This formula is widely used in urban and rural areas of Gansu Province and has proven effective for treating kidney deficiency and impotence.

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Chapter Eleven: Heavy Sedative Formulas

The "Plain Questions: On the Secret Canon of Spiritual Orchards" states: "The heart is the sovereign organ, from which spirit and clarity emerge." When heart qi is insufficient, spirit cannot remain stable; when heart yin is insufficient,虚火 rises. Symptoms include palpitations, anxiety, chest discomfort and heat, restlessness and insomnia, and even sudden panic and wandering. The "Plain Questions: On the Great Principles of the Highest Truth" says: "Suppress the high." This is the fundamental principle for treating such conditions. Metals, stones, and shells are heavy and sink, "heavy things can calm fear," so using them can suppress虚火 and stabilize spirit. Therefore, later generations collectively refer to formulas whose main components are metals, stones, and shells, used to nourish the heart and calm the spirit, as heavy sedative formulas. The scope of application for these formulas is quite broad. Li Shizhen said: "There are four types of heavy formulas: when there is fright, qi becomes chaotic and the soul flies away, like losing one's spiritual guard; when there is anger, qi reverses and liver fire becomes intense, leading to madness and rage, in which case realgar and iron powder are used to calm the liver; when spirit cannot stay put and there is frequent panic and forgetfulness, confusion and lack of self-control, cinnabar and amethyst are used to calm the heart; when there is fear, qi descends and the spirit loses its focus, like being hunted, magnetite and agarwood are used to calm the kidneys. Generally speaking, heavy formulas compress floating fire and settle phlegm, not just for calming fear. Therefore, for conditions such as vertigo caused by wind, panic attacks, phlegm-related asthma, persistent vomiting, and reverse gastritis, all of which are caused by floating fire and phlegm, heavy formulas are suitable for settling them." (From "Compendium of Materia Medica")

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1. Chaihu Jia Longgu Muli Tang from "Shanghan Lun"

【Composition】 Chaihu 12 grams (four liang), scutellaria, ginseng, ginger, poria, lead dan, cinnamon twig, dragon bone, and oyster shell, each 10 grams (one and a half liang), rhubarb 6 grams (two liang), pinellia 6 grams (one he), and six jujubes.

【Dosage】 First decoct all the herbs, then add rhubarb, bring to a gentle boil, remove the residue, and take the liquid. If lead dan is unavailable, raw iron filings can be used instead.

【Indications】 Triple yang syndrome, with yang overflowing and spirit unsettled.

【Symptoms】 After eight or nine days of typhoid fever, chest fullness and anxiety, difficulty urinating, delirium, whole body feeling heavy and unable to turn over, and a tense pulse.

【Functions】 Unblock the triple yang and calm the spirit.

【Formula Analysis】 After eight or nine days of typhoid fever, the whole body feels heavy and unable to turn over, indicating that the solar channel has not yet been resolved; chest fullness and anxiety, along with a tense pulse, indicate that the lesser yang channel is affected by pathogenic factors; difficulty urinating and delirium suggest that heat has entered the greater yang channel. Since all three yang channels are simultaneously diseased, it is called triple yang syndrome. The most prominent symptoms are anxiety and delirium, reflecting the overflow of yang and unsettled spirit. In this formula, cinnamon twig disperses pathogenic factors in the solar channel, chaihu and scutellaria resolve pathogenic factors in the lesser yang channel, and rhubarb has a purgative effect, clearing heat from the greater yang channel; these four herbs together fulfill the great task of unblocking the triple yang, serving as the main ingredients. Dragon bone, oyster shell, and lead dan are all heavy stone-based sedatives, functioning as auxiliary ingredients to calm the spirit. "Wherever pathogenic factors gather, the qi there will inevitably be deficient." The formula uses ginseng and poria to strengthen the spleen and boost qi, serving as complementary treatments; pinellia lowers reverse flow and eliminates phlegm, also serving as a complementary treatment. Ginger has a pungent flavor, regulating the exterior; jujubes have a sweet taste, harmonizing the interior; these two herbs balance yin and yang, balancing the inside and outside, serving as guiding forces.

【Clinical Modifications】 ① For excessive liver fire, add summer withered grass and gentian to clear heat from the liver meridian; or add white peony and turtle shell to soften the liver and relieve urgency. ② For severe heat in the greater yang channel, or for severe mania, use more rhubarb or omit ginseng; once the situation has stabilized, reduce or eliminate rhubarb. ③ For severe blood stasis, use vinegar-treated rhubarb, or add peach kernels and five spirit oils to clear blood stasis. ④ For stubborn phlegm accumulation, choose to add turmeric, alum, white mustard seeds, or whole scorpions to search for phlegm; or use more raw iron filings to settle phlegm and calm the spirit. ⑤ For restlessness and anxiety, choose to add cinnabar, night-blooming jasmine, or jujube seeds to calm the spirit. ⑥ If there are no signs of chaihu syndrome, omit the chaihu portion. If it is not related to phlegm accumulation, consider other formulas. However, such phlegm accumulation often lacks obvious signs, so try this formula for two or three doses; if there is no effect, switch to other methods. ⑦ Once the palpitations have largely subsided, omit rhubarb; or continue with Ganmai Dazao Tang, adding jujube seeds, yuanzhi, and dragon teeth to gently nourish the liver meridian and stabilize the spirit.

【References】 ① In this case, the hand-shao yin heart is oppressed by pathogenic factors, causing inner chaos and delirium, far more severe than typical delirium caused by stomach issues. If treated with methods aimed at the foot meridian, there would be no hope of recovery. The formula uses nine medicinal ingredients, including five heart medicines, which are not considered redundant; moreover, it uses three heavy astringent medicines, which are not overly aggressive. Given the city-wide turmoil, everyone must work together to provide assistance, and it is impossible to rely solely on luck. As for phlegm accumulating in the diaphragm, it is the most destructive, but only pinellia is used; for external pathogenic factors attacking internally, the initial approach is to use cinnamon and chaihu; for yang pathogens invading yin, the most urgent need is to expel them quickly, but only rhubarb is used, which is secondary to treating typhoid fever, coming after addressing heart-related issues. Such a combination of approaches is difficult for ordinary people to understand. (From "Practical Application of Prescriptions") ② Chen ××, female, 11 years old. She has a slender build, resembling a girl of fourteen or fifteen, and is rather impatient. According to her family, in recent years she often wakes up from nightmares, or when she goes out, even if there are no nightmares, she still screams in the middle of the night, otherwise behaving normally. Prescription: eight points each of chaihu, cinnamon twig, and gentian, one qian each of scutellaria and pinellia, three qian each of poria and dragon bone, five points each of guan dan and rhubarb, four qian of oyster shell, three slices of ginger, and three jujubes. Two doses cured the illness. After ten consecutive doses, there has been no recurrence for several months. (From "Zhejiang Journal of Traditional Chinese Medicine," July 1964, issue 19) ③ Sun ××, male, 32 years old. He is usually quiet and reserved, but recently, due to mental stress, he has been unable to sleep at night, and later even lost awareness of people and places, stumbling into ditches and falling into water, becoming silent and dazed, unaware of hunger, muttering to himself, laughing and crying for no reason. Western medicine diagnosed him as having "schizophrenia." Prescription: four qian of chaihu, four qian of ginseng, three qian of scutellaria, four qian of poria, two qian of rhubarb (added later), three qian of calamus, three qian of turmeric, three qian of bamboo leaves, three qian of raw dragon bone, three qian of raw oyster shell, three qian of ginger, five qian of cinnabar (mixed in), five qian of amber (mixed in), all decocted and taken orally. Acupuncture was also performed at Shaoshang point, along with moxibustion. After adjusting the prescription up and down, a total of 27 doses were administered, and the condition stabilized. After three months of medication-free recovery, he returned to work and has remained symptom-free for half a year. (Hebei University of Traditional Chinese Medicine: "Eighty Cases of Traditional Chinese Medicine," page 169) ④ Any neurological or psychiatric disorder that presents as a heat or solid condition, or leans toward heat or solidity, and proves resistant to other treatments, can be observed and treated with this formula. (From "Zhejiang Journal of Traditional Chinese Medicine," June 1980)

【Commentary】 This formula is indeed effective for hysteria and schizophrenia.

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2. Anshen Wan from "Lan Shi Mi Zang"

【Composition】 Coptis chinensis (washed with wine) 4.5 grams, cinnabar (water-flying) 3 grams, rehmannia and angelica root (processed with wine) each 1.5 grams.

【Dosage】 Grind all ingredients into powder, steam rice cakes with the herbal infusion to form pills about the size of millet grains, take fifteen pills each time. In modern times, some prepare it as a decoction.

【Indications】 Excessive heart fire, consuming yin blood.

【Symptoms】 Chest heat, restlessness and insomnia, palpitations and anxiety, dry throat and mouth, red urine, yellow tongue, and rapid pulse.

【Functions】 Calm the heart and spirit, clear fire and nourish yin.

【Formula Analysis】 When heart fire is excessive, these symptoms appear; when fire consumes yin blood, the excess fire becomes even more pronounced, further highlighting the symptoms. The core issue here is the unrest of the heart and spirit, which, although a manifestation, causes significant distress. Following the principle of "treat the manifestation first," the formula uses cinnabar to calm the heart and spirit, serving as the main ingredient. Coptis clears fire from the heart meridian, while rehmannia nourishes yin in the kidney meridian; together, these two herbs achieve the dual purpose of clearing fire and nourishing yin, serving as auxiliary ingredients. Fire is harmful, and prolonged exposure leads to blood consumption; angelica nourishes and activates blood, serving as a complementary treatment, while licorice harmonizes all the herbs, serving as a guiding force.

【Clinical Modifications】 For chest heat, add loofah; for insomnia, add lotus seed hearts and fresh gardenia; for palpitations and shortness of breath, add raw oyster shell and magnetite; for emotional turmoil, add Ganmai Dazao Tang.

【References】 ① Cinnabar... is heavy enough to calm fear, cold enough to overcome heat, sweet enough to generate fluids, suppresses the floating of yin fire, and nourishes the upper burner's primordial qi, making it the top choice for calming the spirit. The heart suffers from heat, paired with the bitterness of coptis...

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3. Guizhi Qu Shaoyao Jia Shuqi Longgu Muli Jiu Ni Tang from "Shanghan Lun"

【Composition】 Cinnamon twig 9 grams (three liang), licorice 6 grams (two liang), ginger 9 grams (three liang), shuqi 9 grams (two liang), four jujubes (twelve pieces), dragon bone 9 grams (four liang), and oyster shell 9 grams (five liang).

【Dosage】 First decoct shuqi, then add the other ingredients, remove the residue, and take the warm liquid.

【Indications】 Heart yang is about to fail, spirit cannot stay within.

【Symptoms】 Palpitations, chest tightness, a barely perceptible pulse, panic and frenzy, restless sleep.

【Functions】 Warm and unblock heart yang, calm the spirit and prevent panic.

It also serves as a complementary treatment to ensure yang qi flows freely both internally and externally. Licorice harmonizes all the herbs, serving as a guiding force.

【Clinical Modifications】 For severe panic and frenzy, add raw iron filings; for yellow tongue and constipation, add rhubarb and mirabilite; for prolonged illness, add licorice, wheat, and jujubes; for a very weak pulse, add wood thoroughfare, asarum, and angelica; for excessive thirst and sweating, add raw gypsum.

【References】 Typhoid fever sufferers experience cold damaging the heart's yang. Forced sweating depletes yang and also drains yin, resulting in fire reversal. Excessive sweating depletes yin, while claiming to deplete yang—after all, the heart is the sun among yang, so the heart's fluid is yang sweat. Panic and frenzy indicate spiritual disturbance, with yin failing to store essence and releasing it internally; yang failing to hold firm, releasing it externally, causing restlessness during waking and panic during sleeping. Anyone experiencing fever and sweating has heart fluid that cannot be contained, so the formula uses shaoyao to acidically capture it. Because of forced sweating, the fluid is already depleted, leaving no fluid to sweat, so shaoyao is omitted; dragon bone is added to compensate for the saltiness, strengthen the heart, calm fear, and solidify the loss, hence the name "rescue against reversal." (From "Collection of Typhoid Fever Remedies")

【Commentary】 This formula can be used for hysteria and mild schizophrenia.

4. Zhenzhong Wan from "Qianjin Fang"

【Composition】 Tortoise shell 15 grams, dragon bone 15 grams, calamus 6 grams, yuanzhi 6 grams.

【Dosage】 Grind all ingredients into powder, form into honey pills weighing 10 grams each, take two pills daily, morning and evening.

【Indications】 Kidney water deficiency, floating yang rising too high.

【Symptoms】 Dizziness and tinnitus, lower back pain and nocturnal emission, palpitations and forgetfulness, insomnia and vivid dreams, mental confusion, red tongue, and a tense pulse.

【Functions】 Nourish the kidney and calm the liver, stabilize the spirit.

【Formula Analysis】 When kidney water is deficient, the liver wood loses nourishment; when liver wood loses nourishment, floating yang rises too high. Kidney water deficiency leads to dizziness and tinnitus, lower back pain and nocturnal emission, and a red tongue; floating yang rising too high results in mental confusion, insomnia and vivid dreams, and palpitations and forgetfulness. In this formula, tortoise shell supplements kidney water and nourishes the kidney, while dragon bone calms the liver and balances yang, together fulfilling the role of nourishing the kidney and calming the liver, serving as the main ingredients. Calamus opens the orifices and calms the spirit, while yuanzhi stabilizes the spirit and calms the mind, together fulfilling the role of calming the spirit and stabilizing the mind, serving as auxiliary ingredients.

【Clinical Modifications】 For severe headaches, add achyranthes and summer withered grass; for severe insomnia, add jujube seeds and anemarrhena rhizome; for lower back pain, add eucommia, achyranthes, and parasitic plants; for fatigue, add astragalus, white atractylodes, and ginseng; for poor appetite, add fried three treasures.

【References】 Tortoises are the longest-lived creatures among yin animals, truly spiritual beings; dragons are the longest-lived creatures among yang animals, also spiritual beings. Using the yin and yang of these two creatures to supplement the yin and yang of the five bodies; using the spiritual energy of these two creatures to assist the spiritual energy of our hearts. Moreover, human essence and spirit are both stored in the kidneys; when kidney essence is insufficient, spirit declines and cannot communicate with the heart, leading to confusion and forgetfulness. Yuanzhi clears heat and disperses stagnation, opening kidney qi and sending it up to the heart, strengthening spirit and enhancing intelligence; calamus disperses liver fire and fragrances the spleen, opening the heart's orifices and benefiting the nine orifices, removing dampness and phlegm; tortoises nourish the kidneys, dragons calm the liver, dispersing fire and phlegm and calming the heart and liver, thus making the mind clearer and memory stronger. (From "Practical Application of Prescriptions")

【Commentary】 This formula can be used for insomnia and forgetfulness caused by neurasthenia, as well as for dizziness, palpitations, and insomnia experienced by hypertensive patients.

5. Ci Zhu Wan from "Qianjin Fang"

【Composition】 Saccharomyces cerevisiae 120 grams, magnetite 60 grams, cinnabar 30 grams.

【Dosage】 Grind all ingredients into powder, form into honey pills about the size of a wu seed, take three pills three times daily. In modern times, some use a 6-gram powdered version, taking it twice daily, mixed with rice soup.

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[Indications] Heart-kidney disharmony, deafness and blindness.

[Indications] Blurred vision, dim sight, tinnitus and deafness, palpitations and insomnia.

[Functions] Harmonize heart and kidney, improve eyesight and hearing.

[Formula Analysis] The ears are the orifices of the kidneys, while the eyes are the servants of the heart. When kidney yin is deficient, tinnitus and deafness occur; when heart fire flares up, both eyes become blurry, vision dims, and there are palpitations and insomnia. With insufficient kidney yin, it cannot nourish the heart fire, causing the heart fire to flare up unchecked. In this formula, magnetite enters the kidneys to nourish yin and improve hearing as the principal ingredient; cinnabar enters the heart to clear the heart and brighten the eyes as the auxiliary ingredient; and fermented wheat strengthens the spleen and harmonizes the middle jiao as the guiding agent. Since the spleen is above the heart and below the kidneys, and earth is yellow in color, it also resides between the heart and kidneys. Therefore, to harmonize the heart and kidneys, it is essential to strengthen the spleen and harmonize the middle jiao as the guiding force.

[Clinical Modifications] For deafness and tinnitus due to yang deficiency, take this formula together with Bawei Wan; for those due to yin deficiency, take it together with Liubei Wan. For blurred vision due to yin deficiency, take it together with Qiju Dihuang Wan; for those due to liver stagnation, take it together with Xiaoyao Wan.

[References] First, place magnetite in a large fire and calcine it seven times, quenching it after each calcination. Grind it finely with vinegar, then float it in water, let it settle, dry it in the sun, and collect the pure powder. Also grind cinnabar finely, float it in water, dry it in the sun, and collect the pure powder—one liang. Mix three liang of raw fermented wheat powder with the previous two ingredients. Then mix one liang of fermented wheat powder with water to form cakes, boil them until they float, and collect the floating pills to make pills about the size of mung beans. Take 30–40 pills each time, on an empty stomach, washed down with rice porridge. This formula treats conditions such as excessive spiritual fluid, gradual dispersion, lack of radiance, posterior cataract, and persistent opacity that cannot be eliminated, thus calming these symptoms. Cinnabar embodies the southern fire energy of the Li palace, yet harbors yin essence within, so it can pacify evil and dispel impurities. It is attracted by magnetite and naturally descends into the kidneys, thereby clearing the spiritual fluid and dispelling the gloom. Using raw fermented wheat helps release the potency of the medicinal stones and enhances their effectiveness. Taking it with rice porridge draws in the grain qi to harmonize the spleen and stomach, allowing cinnabar to enter the heart and magnetite to enter the kidneys, with the middle earth serving as a bridge to achieve balance. (From "Cheng Fang Bian Du")

[Commentary] This formula can treat cataracts, sensorineural deafness, and epilepsy. It must be taken long-term to gradually achieve results.

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Chapter 12: Astringent Formulas

Any formula that has an astringent and consolidating effect, used to treat the loss and leakage of qi, blood, essence, and body fluids, is called an astringent formula. Clinically, the loss and leakage of qi, blood, essence, and body fluids mainly manifest in six ways: spontaneous sweating and night sweats, prolonged cough and weak breathing, chronic diarrhea, failure of the seminal orifice to retain essence, urinary incontinence, and metrorrhagia or menorrhagia. Although their clinical manifestations differ, they all share one common feature during their development—deficiency of vital qi. Because vital qi is deficient, there is no power to contain qi, blood, essence, and body fluids, leading to uncontrolled leakage. According to the principle of “astringency can consolidate leakage,” using this type of formula often yields good results. However, when using such formulas, there is a prerequisite: “Do not use them if external pathogenic factors have not been eliminated.” Zhang Zihé said in “Rumen Shiqin”: “First, address the root cause and eliminate the pathogenic factors; do not assume that astringency alone can solve everything.” This is exactly what he meant.

1. Oyster Powder from “Heji Jufang”

[Composition] Ephedra root, astragalus, and calcined oyster each 30 grams.

[Administration] Grind all ingredients into powder. Take 9 grams per dose, mixed with decoction of 15 grams of floating wheat, strained, and taken orally. In modern times, it is made into a decoction and taken together with floating wheat.

[Indications] Deficiency of defensive qi and nutritive qi, uncontrollable sweating.

[Indications] Uncontrollable sweating, shortness of breath, fatigue, palpitations, and startle response.

[Functions] Consolidate the exterior and stop sweating.

[Formula Analysis] The main reason for uncontrollable sweating is that defensive qi is weak and cannot protect the exterior, while nutritive qi is weak and cannot maintain the interior. Sweat is the liquid of the heart; profuse sweating harms the heart qi, resulting in palpitations and startle response. Since sweat comes out through the skin, profuse sweating also harms lung qi, leading to shortness of breath and fatigue. Although the root cause of this condition is deficiency of defensive and nutritive qi, it is a chronic problem; uncontrollable sweating is the acute manifestation. According to the principle of “treat the acute symptom first,” magnetite, which can calm yang and constrict sweat, is the principal ingredient. Astragalus tonifies qi and consolidates the exterior, assisting magnetite in stopping sweat; ephedra root strengthens the exterior and reinforces defensive qi, while floating wheat nourishes the interior and strengthens nutritive qi. Together, these two herbs help reinforce nutritive qi and defensive qi, serving as auxiliary ingredients.

[Clinical Modifications] For qi deficiency, add Shengmai San; for yin deficiency with night sweats, add Danggui Liu Huang Tang; for yang deficiency with spontaneous sweating, combine with Buzhong Yiqi Tang; for yang collapse with profuse sweating, pair with Shenfu Tang.

[References]

①In the past, people believed that spontaneous sweating was due to yang deficiency, while night sweats were due to yin deficiency. However, since sweat is the liquid of the heart and the heart governs blood, internally it is blood, and externally it is sweat. Although spontaneous sweating and night sweats can be categorized as yang or yin deficiency, the underlying cause of sweating is always the same—excessive internal heat. Therefore, human sweat can be likened to rain from heaven and earth; just as rain falls only after the air becomes humid and hot, so too does sweat arise from internal heat. But fire can be either yin or yang, and its deficiency or excess varies. Nevertheless, despite the distinction between yin and yang, the root cause of both conditions is the same—weak defensive qi. This formula uses astragalus to strengthen defensive qi and reinforce the exterior, while ephedra root leads the way to strengthen the exterior and stop sweating. Magnetite, being salty and cold, calms excess yang and constricts body fluids, while wheat is the grain of the heart, and its bran can cause agitation, so it is used to enter the heart and reduce internal heat. This treatment addresses the situation where defensive qi is weak and the heart has excess internal heat, resulting in spontaneous sweating. (From “Cheng Fang Bian Du”)

②This formula was used to treat 28 cases of spontaneous sweating and night sweats. The formula included five qian of astragalus, one liang of northern wheat, one liang of magnetite, and three qian of ephedra root. For those prone to wind-cold due to qi deficiency, add fangfeng and baizhu; for those with weak spleen yang, add dangshen, fuling, and huai shan; for those with yin deficiency and yang excess, add shudi and zaoren; for those with blood deficiency and fire disturbance, add danggui, shengdi, and hangshao; for those with internal heat, add luohui and yiren… The treatment results were: 20 cases cured, 5 cases basically cured, 1 case improved, and 2 cases ineffective. (From “Fujian Journal of Traditional Chinese Medicine,” March 1966)

[Commentary] This formula can be used for excessive sweating caused by tuberculosis, rheumatic fever, blood disorders, and autonomic nervous system dysfunction.

2. Jiuxian Drink from “Yixue Zhengchuan”

[Composition] Ginseng, donkey-hide gelatin, fritillaria, and schisandra each 1.5 grams; one plum; six grams of roasted poppy seed pods; winter flower, platycodon, and mulberry bark each 1.5 grams.

[Administration] Grind all ingredients into powder. Add one slice of ginger and one jujube to the decoction, warm it up, and take it once.

[Indications] Chronic cough with qi depletion.

[Indications] Persistent cough, shortness of breath with sweating, pale complexion, and lack of energy and speech.

[Functions] Tonify qi, astringe the lungs, and stop coughing.

[Formula Analysis] Prolonged, unremitting cough depletes lung qi, leading to this condition. Shortness of breath with sweating, pale complexion, and lack of energy and speech are all signs of lung qi deficiency. When the lungs are weak, they cannot hold qi, making coughing and wheezing worse. This formula uses ginseng to tonify the lungs and replenish qi as the principal ingredient. Schisandra, with its sour and astringent properties, astringes the lungs and replenishes qi as an auxiliary ingredient. Fritillaria, mulberry bark, and winter flower stop coughing and dissolve phlegm, while plums and poppy seed pods stop coughing and astringe the lungs. Donkey-hide gelatin nourishes yin and replenishes the lungs, and ginger and jujubes harmonize defensive qi—all serving as complementary treatments. Platycodon carries the medicine upward, guiding all the other herbs into the lungs, acting as a guiding agent.

[Clinical Modifications] For red tongue without coating, add shashen and maidong; for excessive phlegm, remove plums and poppy seed pods, and add gualou and jujube; for those with exterior cold, remove plums and poppy seed pods, and add ma huang and guizhi; for those with exterior heat, remove plums and poppy seed pods, and add sangye and juhua; for those with thirst and irritability, add shigao.

[References] For anyone whose cough persists for a long time, resulting in qi depletion and yin deficiency, along with shortness of breath and sweating, this formula is quite suitable. However, if there is excessive phlegm or external pathogenic factors present, do not use it by mistake, as this may leave pathogenic factors behind and cause problems. (Jiangsu New Medical College: “Traditional Chinese Medicine Formulas”)

[Commentary] This formula is suitable for chronic bronchitis, bronchial asthma, asthmatic bronchitis, emphysema, silicosis, pulmonary tuberculosis, and other chronic respiratory diseases characterized by little phlegm and a red tongue with little coating.

3. Peach Blossom Soup from “Shanghan Lun”

[Composition] 24 grams of red stone powder (one jin), six grams of dried ginger (one liang), and 15 grams of japonica rice (one sheng).

[Administration] Use half of the red stone powder to brew a decoction, and the other half to cook together with the other ingredients.

[Indications] Yang deficiency with diarrhea.

[Indications] Long-term diarrhea with pus and blood (dark and not bright), preference for warmth and pressure on the abdomen, pale tongue, and slow pulse.

[Functions] Warm yang and stop diarrhea.

[Formula Analysis] “Shanghan Lun” states: “For Shaoyin disease with diarrhea and pus and blood, Peach Blossom Soup is the primary treatment.” Shaoyin disease is a condition of overall qi and yang deficiency. When yang is deficient, it cannot control yin, leading to diarrhea; when qi is deficient, it cannot control blood, resulting in pus and blood in the stool; and when yang is deficient, it becomes cold, causing abdominal pain that feels better with warmth and pressure. This condition is fundamentally caused by severe yang deficiency and cold, so dried ginger is used to warm yang and dispel cold, restoring the central yang; red stone powder is used to astringe the intestines and stop diarrhea as an auxiliary ingredient; and japonica rice, being sweet and warm, tonifies the spleen and replenishes qi as a complementary treatment.

[Clinical Modifications]

① Remove japonica rice and add fu zi, creating Red and White Stone Powder Soup (from “Zhouhou Fang”). This is used for patients with pus and blood in the stool accompanied by cold hands and feet and a deep, weak pulse.

② Remove dried ginger and japonica rice, and add yu yuliang, creating Red Stone Powder and Yu Yuliang Soup (from “Shanghan Lun”). This treats long-term diarrhea with uncontrolled leakage.

③ For lower abdominal pain, add danggui and baishao; for chronic diarrhea with leakage, add dangshen and roukou; for intestinal bleeding, remove dried ginger and add paojiang; for undigested food, add jiaosanxian.

[References]

①This is a Shaoyin transmission of heat pathogen. Since the Yin meridians run throughout the body, abdominal pain and diarrhea occur. Why did Zhongjing use stone powder and dried ginger? Because when diarrhea becomes unstoppable, the heat has already greatly subsided, but cold deficiency begins to emerge. (From “Cheng Fang Qie Yong”)

②Peach Blossom Soup combined with Four Gods Soup cured one case of vaginal discharge. The patient had been experiencing bloody, mucous-like discharge from the vagina for over a year. Western medicine diagnosed cervical erosion. Previous treatments such as Bixie Fenqing Yin, Buzhong Yiqi Tang, and Guipi Tang were all ineffective. Based on the patient’s sallow complexion, weak pulse, especially a strong pulse at the cun position, and white, slippery tongue without coating, the doctor diagnosed spleen-kidney deficiency and proposed a treatment plan involving peach blossom soup combined with four gods soup. After taking three doses, the vaginal discharge significantly decreased; after another three doses, the discharge disappeared; finally, after taking additional doses of Fu Gui Lizhong Wan, the patient fully recovered. (From “New Traditional Chinese Medicine,” May 1973)

[Commentary] This formula can be used for patients with chronic diarrhea, including allergic colitis, localized ileitis, ulcerative colitis, and other conditions. It can also be used to treat some cases of chronic dysentery and intestinal tuberculosis.

4. Real Person Nourishing the Intestines Soup from “Heji Jufang”

[Composition] 48 grams of white peony, 18 grams each of danggui, ginseng, and bai zhu, 15 grams of nutmeg, 24 grams each of cinnamon and fried licorice, 42 grams of agarwood, 36 grams of chebulic myrobalan bark, and 108 grams of poppy seed pods.

[Administration] Grind all ingredients into powder. Take 5–10 grams per dose, boiled in water. In modern times, it is made into a decoction, with the dosage adjusted proportionally.

[Indications] Long-term diarrhea with spleen-kidney deficiency.

[Indications] Long-term diarrhea, continuous abdominal pain, preference for warmth and pressure, sallow complexion, poor appetite and fatigue, lower back pain and leg weakness, thin pulse, and even uncontrolled leakage.

[Functions] Strengthen the spleen and kidneys, astringe the intestines and consolidate leakage.

[Formula Analysis] “The spleen governs transformation,” and “the kidneys govern water and fluids.” When diarrhea persists for a long time, impaired transformation harms the spleen, and extreme dehydration of water and fluids harms the kidneys, resulting in spleen-kidney deficiency. Continuous abdominal pain, preference for warmth and pressure, sallow complexion, and poor appetite and fatigue indicate spleen deficiency; lower back pain and leg weakness, along with a thin and slow pulse, indicate kidney deficiency. Spleen-kidney deficiency, in turn, exacerbates diarrhea, leading to uncontrolled leakage. In this formula, dangshen and bai zhu strengthen the spleen and replenish qi as the principal ingredients, while cinnamon and nutmeg replenish kidney qi as auxiliary ingredients. Poppy seed pods and chebulic myrobalan bark astringe the intestines and stop leakage, agarwood “promotes qi flow, thereby eliminating constipation,” danggui and white peony nourish blood and “activate blood circulation, thereby healing pus in the stool,” and together these four herbs serve as complementary treatments. Licorice harmonizes all the herbs as a guiding agent.

[Clinical Modifications] For undigested food and severe diarrhea, add dried ginger and fu zi; for extreme qi deficiency and rectal prolapse, add astragalus, shengma, and zhishi; for urgent lower abdominal pain, add binlang; for yellow tongue and rapid pulse, add huanglian and kushen.

[References] ①Rectal prolapse is caused by cold deficiency, so use dangshen, bai zhu, and licorice to replenish deficiency, cinnamon and nutmeg to dispel cold, agarwood to warm and regulate qi, danggui to moisten and harmonize blood, white peony to astringe, and chebulic myrobalan bark and poppy seed pods to stop leakage. (From “Medical Formula Compendium”) ②For treating dysentery, in the early stages, it is best to “use the cause to treat the effect,” rather than using astringent agents too early. For example, if diarrhea persists for a long time, accumulated stagnation has already cleared, and the abdomen is either not painful or feels warm and comfortable when pressed, then in cases of organ deficiency and uncontrolled leakage, it is necessary to use warming and astringent agents to consolidate leakage in order to achieve effective results. (Jiangsu New Medical College: “Traditional Chinese Medicine Formulas”)

[Commentary] This formula is often used for chronic bacterial dysentery, amoebic dysentery, ulcerative colitis, segmental enteritis, allergic enteritis, and chronic diarrhea with rectal prolapse.

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5. Yi Huang Powder from “Xiao’er Yaozheng Zhijue”

[Composition] 30 grams of tangerine peel, 6 grams of cloves, and 15 grams each of green peel, chebulic myrobalan (pitted), and fried licorice.

[Administration] Grind all ingredients into powder. Boil in water and take 10 grams each time, with dosage adjusted for children; in modern times, it is made into a decoction.

[Indications] Spleen deficiency and qi stagnation in children.

[Indications] Abdominal distension around the navel, emaciation, vomiting, and diarrhea.

[Functions] Strengthen the spleen and regulate qi.

[Formula Analysis] Children’s bodies are not fully developed, and their organs are delicate. Consuming cold foods damages the spleen, and when the spleen is damaged, it cannot transform food properly, leading to qi stagnation. Qi stagnation in the middle jiao causes abdominal distension around the navel, while downward movement of stomach qi leads to nausea and vomiting, and upward movement of spleen qi leads to intestinal rumbling and diarrhea. If the spleen remains deficient for a long time, the body cannot receive adequate nourishment from food, resulting in emaciation. This formula uses tangerine peel to strengthen the spleen and regulate qi as the principal ingredient, while green peel regulates qi and strengthens the spleen as an auxiliary ingredient. Cloves warm the middle jiao and stop vomiting, and chebulic myrobalan bark astringes the intestines and stops diarrhea, serving as complementary treatments. Licorice harmonizes all the herbs as a guiding agent.

[Clinical Modifications] For those with long-term stagnation, add jinneijin and maiya; for severe spleen and stomach deficiency, add dangshen and bai zhu; for those with clear stools and diarrhea, add dried ginger and fu zi; for those with bloated abdomens like drums, add laibuzi; for those with masses under the ribs, add sanleng and ezhushi; for those who vomit immediately after eating, add shengjiang and banxia; for those with yellow tongues and hard stools, add huanglian and dahuang.

[References] To strengthen the spleen, do not rely on supplementing the central region; instead, use tangerine and green peel to dispel stagnant qi, with the subtle intention of addressing the issue. For infants with prolonged diarrhea, food accumulates inside the body, so two types of peel are needed to specifically address the liver and spleen’s hidden influence—chebulic myrobalan to prevent leakage, cloves to regulate the central region, and licorice to harmonize the spleen—effectively dispersing the stagnation in the intestines (from “Zhengzhi Junsheng”). Even for early-stage lung abscesses before pus forms, this method can be used. ⑤ Adding ginseng, zhimu, and huangqin creates another formula called Xie Bai San (from “Shen Shi Zun Sheng Shu”), used to treat lung heat cough combined with qi deficiency.

[References] ①Mulberry bark can replenish qi deficiency and relieve excess lung qi, eliminating phlegm and stopping cough; ground bone bark can cool the latent fire in the lungs, alleviate liver and kidney heat, and cool the blood to dispel heat. Licorice can extinguish fire and strengthen the spleen; japonica rice can cleanse the lungs and nourish the stomach (since earth is the mother of metal, when it is deficient, we should replenish its mother). It can also expel heat through urine, and since the lungs belong to the west, it is called Xie Bai. (From “Medical Formula Compendium”) ②The lungs are delicate organs belonging to metal, governing the skin and hair. Their nature is such that actions below are natural, while actions above are unnatural. Once exposed to fire, the upper symptoms appear. Therefore, when treating such conditions, it is best to clear and lower them, restoring their original purity. Mulberry bark can act on the skin, while white can return to the lungs; its sweet and cold nature allows it to enter the lungs and clear heat, which goes without saying. Roots go deepest into the earth, able to clear and lower, and one can imagine ground bone bark going deep into the underworld, with no bottom. Its sweet and cold nature can indeed extinguish the latent fire in the lungs, but judging from its name, it seems to target the liver and kidneys, cooling the blood and dispelling heat. Thus, both peels are used to lower, and when lung qi lowers, the fire naturally disappears. Licorice extinguishes fire and strengthens the spleen; japonica rice cleanses the lungs and nourishes the stomach, combining cleansing and nourishment, embedding nourishment within cleansing. Even though it cleanses the lungs, it still preserves the roots. (From “Cheng Fang Bian Du”)

[Commentary] This formula is often used for acute and chronic bronchitis, bronchial asthma, emphysema complicated by infection. Combined with Maxing Gan Shi Tang, it effectively treats pneumonia in children.

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5. Qingwei Powder from “Lanshi Mizi”

[Composition] One gram of danggui, one gram of huanglian, one gram of shengdi, one and a half grams of mudanpi, and three grams of shengma.

[Administration] Grind all ingredients into fine powder. Boil in water and take once.

[Indications] Stomach fire rising upward.

[Indications] Burning pain in the epigastric region, dry mouth, bad breath, oral ulcers, toothache, swollen gums, bleeding from the gums, red tongue with yellow coating, and rapid pulse.

[Functions] Clear and drain stomach fire.

[Formula Analysis] The hand yangming meridian runs from the maxilla through the cheek to the lower teeth, while the foot yangming meridian runs from the nose through the upper teeth, indicating that teeth and gums are areas where the yangming meridian flows. The stomach belongs to yangming, so when stomach fire rises upward, symptoms such as toothache, swollen gums, and bleeding from the gums appear. The mouth is the upper opening of the stomach, so when stomach fire rises upward, dry mouth, bad breath, and oral ulcers occur. If the stomach has accumulated heat, there will be burning pain in the epigastric region, a red tongue with yellow coating, and a rapid pulse. In this formula, huanglian, being bitter and cold, directly drains stomach fire as the principal ingredient; shengdi and mudanpi nourish yin and cool the blood as auxiliary ingredients; yangming is full of qi and blood, so adding

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7. Sangpiaoxiao Powder from “Bencao Yanyi”

[Composition] 30 grams each of sangpiaoxiao, yuanzhi, changpu, longgu, dangshen, funingshen, danggui, and turtle shell (vinegar-fried).

[Administration] Grind all ingredients into powder. Before bed, mix six grams of dangshen soup and take it. In modern times, it is made into a decoction, with the dosage reduced according to the original formula.

[Indications] Heart-kidney disharmony, spermatorrhea and enuresis.

[Indications] Mental confusion, forgetfulness, enuresis, and spermatorrhea.

[Functions] Tonify the kidneys and consolidate essence, nourish the heart and calm the spirit.

[Formula Analysis] The heart is above and belongs to fire, while the kidneys are below and belong to water. Humans achieve harmony between heart and kidneys through mutual interaction, with water and fire working together to maintain balance. When the heart is weak, it cannot descend to nourish the kidneys; when the kidneys are weak, they cannot ascend to nourish the heart, resulting in heart-kidney disharmony and imbalance between water and fire. Weak heart leads to mental confusion and forgetfulness; weak kidneys lead to enuresis and spermatorrhea. The latter is more urgent, while the former is slower. Therefore, this formula uses sangpiaoxiao to tonify the kidneys, consolidate essence, and stop enuresis as the principal ingredient. Funingshen, yuanzhi, and changpu nourish the heart and calm the spirit as auxiliary ingredients. Turtle shell nourishes kidney yin, longgu calms excess yang in the heart, dangshen tonifies qi, and danggui nourishes blood. Together, these four herbs work to balance qi, blood, yin, and yang, serving as complementary treatments.

[Clinical Modifications] For severe enuresis, add wuyao and yizhiren; for severe spermatorrhea, add qianshi and jinyingzi; for excessive internal fire and bone-steaming heat, add zhimu and huangbo; for weakened Mingmen fire and feeling cold, add rougui and fupian; for spermatorrhea and thin pulse, add shanyurou and shayuanzi.

[References] ①There are two types of urinary incontinence: one caused by excessive fire below, and the other caused by weakness of the lower part. However, for those caused by fire, the symptoms are usually short and intense, or astringent and painful, with clear pulse evidence; for those caused by weakness, it may be due to disharmony between water and fire, or weakness of the spleen and kidneys, leading to involuntary urination. Elderly people and children often experience this. For example, children who wet the bed during sleep often have kidney deficiency, so sangpiaoxiao can tonify the kidneys and consolidate essence, while yuanzhi enters the kidneys to connect with dangshen, allowing kidney qi to reach the heart; changpu opens the heart’s orifices, enabling the ruler to receive the support of dangshen and danggui; and using funingshen to guide qi downward connects the heart and kidneys, achieving mutual exchange. Longgu and turtle shell are both spiritual creatures—one enters the liver to calm the soul, the other enters the kidneys to stabilize the mind. The liver is responsible for excretion, while the kidneys are responsible for storage, so each organ performs its own function. (From “Cheng Fang Bian Du”)

[Commentary] This formula is effective for treating urinary incontinence and frequent urination caused by autonomic nervous system dysfunction and neurasthenia.

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[References] When a woman’s true yin is sufficient and water and fire are balanced, she will never suffer from excessive fire. However, if the true yin of the lungs and kidneys is insufficient, the stomach cannot be adequately moistened, the gastric juice will dry up, and once exposed to fire pathogen, the situation will quickly escalate, leading to symptoms of yin deficiency. In this formula, shudi and niuxi are used to nourish kidney water; maidong protects lung metal; zhimu benefits lung yin above and kidney water below, effectively controlling the dominance of yangming fire; gypsum, being sweet and cold, enters yangming alone, clearing excess heat in the stomach. Although this is the case, if the stomach fire is particularly intense, it is especially important to carefully consider reducing the amount of shudi used. For cases of virtual fire, it is better to switch to shengdi instead. Those who use the formula should be mindful and adaptable, making appropriate adjustments as needed. (From “Cheng Fang Bian Du”)

[Commentary] This formula is often used for neuralgic toothache, acute stomatitis, bleeding from blood disorders, and the later stages of acute infectious diseases.

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7. Huangqin Soup from “Shanghan Lun”

[Composition] Nine grams of huangqin (three liang), nine grams of shaoyao (two liang), two grams of gancao (two liang, roasted), and four jujubes split open (twelve pieces).

[Administration] Boil in water and take warm, once in the morning and once at night.

[Indications] Shaoyang pathogen pressing inward on yangming.

[Indications] Bitter taste in the mouth, dry throat, dizziness, diarrhea, burning sensation in the anus, or diarrhea, abdominal pain, and tenesmus.

[Functions] Clear heat and dry dampness, astringe the nutritive qi and relieve pain.

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[Indications] Heart-kidney disharmony, deafness and blindness.

[Applications] Blurred vision, dim sight, tinnitus and deafness, palpitations and insomnia.

[Functions] Harmonize heart and kidney, improve eyesight and hearing.

[Formula Analysis] The ears are the orifices of the kidneys, while the eyes are the servants of the heart. When kidney yin is deficient, tinnitus and deafness occur; when heart fire flares up, both eyes become blurry, vision dims, and there are palpitations and insomnia. If kidney yin is insufficient, it cannot nourish heart fire, causing heart fire to flare up unchecked. In this formula, magnetite enters the kidney to nourish yin and enhance hearing as the principal ingredient; cinnabar enters the heart to clear the heart and brighten the eyes as a secondary ingredient; and fermented wheat malt strengthens the spleen and harmonizes the middle jiao as an auxiliary ingredient. Since the spleen is above the heart and below the kidney, and earth is yellow in color, it also resides between the heart and kidney. Therefore, to harmonize the interaction between heart and kidney, it is essential to strengthen the spleen and harmonize the middle jiao.

[Clinical Modifications] For deafness and tinnitus due to yang deficiency, take this formula together with Bawei Wan; for those due to yin deficiency, take it together with Liubei Wan. For blurred vision due to yin deficiency, take it together with Qiju Dihuang Wan; for those due to liver depression, take it together with Xiaoyao Wan.

[References] First, place magnetite in a large fire and calcine it seven times, quenching it after each calcination. Grind it finely with vinegar, then float it in water, let it settle, dry it in the sun, and collect the pure powder. Also grind cinnabar finely, float it in water, dry it in the sun, and collect the pure powder—one liang. Mix three liang of raw fermented wheat malt powder with the previous two ingredients. Then mix one liang of fermented wheat malt powder with water to form cakes, boil them until they float, and collect the floating pills to make pills about the size of mung beans. Take 30–40 pills each time, on an empty stomach, washed down with rice porridge. This formula treats conditions such as excessive spiritual fluid, gradual dispersion, lack of radiance, posterior cataract, and persistent opacity that cannot be eliminated, thus calming these symptoms. Cinnabar embodies the southern fire energy of the Li palace, yet contains yin essence within, which calms evil and dispels impurities. It is attracted by magnetite and naturally descends into the kidney, thereby clearing the spiritual fluid and dispelling the gloom. Using raw fermented wheat malt helps release the properties of the medicinal stones and enhances their effectiveness. Taking it with rice porridge draws in the grain qi to harmonize the spleen and stomach, allowing cinnabar to enter the heart and magnetite to enter the kidney, so that the infant and maiden can use the middle earth to achieve balance. (From "Cheng Fang Bian Du")

[Commentary] This formula can treat cataracts, sensorineural deafness, and epilepsy. It must be taken long-term to gradually achieve results.

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Chapter 12: Astringent Formulas

Formulas that have astringent and consolidating effects, used to treat the loss and leakage of qi, blood, essence, and body fluids, are called astringent formulas. Clinically, the loss and leakage of qi, blood, essence, and body fluids mainly manifest as spontaneous sweating, night sweats, chronic cough with weak breathing, prolonged diarrhea, loose control of the seminal orifice, urinary incontinence, and metrorrhagia or menorrhagia—six major aspects. Although their clinical presentations differ, they all share a common feature during their development: deficiency of vital qi. Because vital qi is deficient, the organs lose their ability to contain qi, blood, essence, and body fluids, leading to uncontrolled leakage. According to the principle of “astringency can consolidate leakage,” using these formulas often yields good results. However, there is a prerequisite for using these formulas: “Do not use them if external pathogenic factors have not been eliminated.” Zhang Zihé said in “Rumen Shiqin”: “First, address the root cause and eliminate the pathogenic factors; do not assume that astringency alone can solve everything.” This is exactly what he meant.

1. Oyster Powder from “Heji Ju Fang”

[Composition] Ephedra root, astragalus, and calcined oyster each 30 grams.

[Administration] Grind all ingredients into powder. Take 9 grams per dose, mixed with decoction of 15 grams of floating wheat, strain out the residue, and drink the liquid. In modern times, it is prepared as a decoction and taken together with floating wheat.

[Indications] Deficiency of defensive qi and nutritive qi, uncontrollable sweating.

[Applications] Uncontrollable sweating, shortness of breath, fatigue, palpitations, and startle response.

[Functions] Consolidate the exterior and stop sweating.

[Formula Analysis] The main reasons for uncontrollable sweating are weak defensive qi that cannot protect the exterior and weak nutritive qi that cannot maintain the interior. Sweat is the liquid of the heart; profuse sweating damages heart qi, leading to palpitations and startle response. Sweat comes out through the skin and hair; profuse sweating damages lung qi, resulting in shortness of breath and fatigue. Although the root cause of this condition is deficiency of defensive and nutritive qi, it is a chronic problem; uncontrollable sweating is the acute manifestation. According to the principle of “treat the acute manifestation first,” magnetite, which has the effect of subduing yang and collecting sweat, is the principal ingredient. Astragalus tonifies qi and consolidates the exterior, assisting magnetite in stopping sweat; ephedra root strengthens the exterior and reinforces defensive qi, while floating wheat nourishes the interior and strengthens nutritive qi. Together, these two ingredients help reinforce nutritive qi and defensive qi, serving as auxiliary ingredients.

[Clinical Modifications] For qi deficiency, add Shengmai San; for yin deficiency with night sweats, add Danggui Liu Huang Tang; for yang deficiency with spontaneous sweating, combine with Buzhong Yiqi Tang; for yang collapse with profuse sweating, pair with Shenfu Tang.

[References]

①In the past, people believed that spontaneous sweating was caused by yang deficiency, while night sweats were caused by yin deficiency. However, since sweat is the liquid of the heart and the heart governs blood, sweat is blood internally and sweat externally. Although spontaneous sweating and night sweats can be categorized as yang deficiency or yin deficiency, the underlying cause of sweating is always the same: excessive internal heat. Therefore, human sweat can be likened to rain in nature—rain occurs only after the earth and sky are heated and humidified. But fire can be either yin or yang, and its deficiency or excess varies. Nevertheless, despite the distinction between yin and yang, the root cause of both conditions is the same: weakness of defensive qi. This formula uses astragalus to strengthen defensive qi and consolidate the exterior, while ephedra root leads the way to strengthen the exterior and stop sweating. Magnetite, being salty and cold, suppresses excess yang and collects body fluids, while wheat is the grain of the heart, and its bran can cause restlessness, so it is used to calm the heart and reduce excess heat. This formula treats cases where defensive yang is weak and there is excess heat in the heart causing spontaneous sweating. (From “Cheng Fang Bian Du”)

②This formula was used to treat 28 cases of spontaneous sweating and night sweats. The formula included five qian of astragalus, one liang of northern wheat, one liang of magnetite, and three qian of ephedra root. For those prone to wind-cold due to qi deficiency, add fangfeng and baizhu; for those with weak spleen yang, add dangshen, fuling, and huai shan; for those with yin deficiency and yang excess, add shudi and zaoren; for those with blood deficiency and fire disturbance, add danggui, shengdi, and hangshao; for those with internal heat, add luohui and yiren… The treatment results were: 20 cases cured, 5 cases basically cured, 1 case improved, and 2 cases ineffective. (From “Fujian Traditional Chinese Medicine” March 1966)

[Commentary] This formula can be used for excessive sweating caused by tuberculosis, rheumatic fever, blood diseases, and autonomic nervous system dysfunction.

2. Jiuxian Drink from “Yixue Zhengchuan”

[Composition] Ginseng, donkey-hide gelatin, fritillaria, and schisandra each 1.5 grams; one plum; six grams of roasted poppy seed pods; winter flower, platycodon, and mulberry bark each 1.5 grams.

[Administration] Grind all ingredients into powder. Add one slice of ginger and one jujube to the decoction, warm it up, and drink it once.

[Indications] Chronic cough with qi depletion.

[Applications] Persistent cough, shortness of breath with spontaneous sweating, pale complexion, and lack of energy and speech.

[Functions] Tonify qi, astringe the lungs, and stop coughing.

[Formula Analysis] Prolonged, unremitting cough depletes lung qi, leading to this condition. Shortness of breath with spontaneous sweating, pale complexion, and lack of energy and speech are all signs of lung qi deficiency. When lung qi is weak, it cannot hold qi, making cough and wheezing worse. This formula uses ginseng to tonify the lungs and replenish qi as the principal ingredient. Schisandra, with its sour and astringent properties, helps astringe the lungs and tonify qi as a secondary ingredient. Fritillaria, mulberry bark, and winter flower stop cough and dissolve phlegm, while plums and poppy seed pods stop cough and astringe the lungs. Donkey-hide gelatin nourishes yin and supplements the lungs, and ginger and jujubes harmonize defensive qi—all serving as complementary treatments. Platycodon carries the medicine upward, guiding all the other ingredients into the lungs, acting as a conduit.

[Clinical Modifications] For red tongue without coating, add shashen and maidong; for excessive phlegm, remove plums and poppy seed pods, and add gualou and jujube; for those with exterior cold, remove plums and poppy seed pods, and add ma huang and guizhi; for those with exterior heat, remove plums and poppy seed pods, and add mulberry leaves and chrysanthemum; for those with thirst and irritability, add shigao.

[References] For anyone whose cough persists for a long time, resulting in qi depletion and yin deficiency, along with shortness of breath and spontaneous sweating, this formula is quite suitable. However, if there is excessive phlegm or external pathogenic factors present, do not use it by mistake, as this may leave pathogenic factors behind and cause problems. (Jiangsu New Medical College: “Traditional Chinese Medicine Formulas”)

[Commentary] This formula is suitable for chronic bronchitis, bronchial asthma, asthmatic bronchitis, emphysema, silicosis, pulmonary tuberculosis, and other chronic respiratory diseases characterized by little phlegm and a red tongue with little coating.

3. Peach Blossom Decoction from “Shanghan Lun”

[Composition] 24 grams of red stone powder (one jin), six grams of dried ginger (one liang), and 15 grams of japonica rice (one sheng).

[Administration] Use half of the red stone powder to brew a decoction, and boil the other half together with the other ingredients.

[Indications] Yang deficiency with diarrhea.

[Applications] Prolonged diarrhea with pus and blood (dark and not bright), preference for warmth and pressure on the abdomen, pale tongue, and slow pulse.

[Functions] Warm yang and stop diarrhea.

[Formula Analysis] “Shanghan Lun” states: “For Shaoyin disease, if diarrhea is accompanied by pus and blood, Peach Blossom Decoction is the primary treatment.” Shaoyin disease is a condition of overall qi and yang deficiency. When yang is deficient, it cannot support yin, leading to diarrhea; when qi is deficient, it cannot control blood, resulting in pus and blood in the stool; and when yang is deficient, it becomes cold, causing abdominal pain that feels better with pressure and warmth. This condition is fundamentally caused by severe yang deficiency and cold, so dried ginger is used to warm yang and disperse cold, restoring the central yang; red stone powder is used to astringe the intestines and stop diarrhea as a supplementary ingredient; and japonica rice, being sweet and warm, tonifies the spleen and replenishes qi as a complementary treatment.

[Clinical Modifications]

① Remove japonica rice and add fu zi, creating Red and White Stone Powder Decoction (from “Zhou Hou Fang”). This formula is primarily used for patients with pus and blood in the stool combined with cold extremities and a deep, weak pulse.

② Remove dried ginger and japonica rice, and add yu yuliang, creating Red Stone Powder and Yu Yuliang Decoction (from “Shanghan Lun”). This formula treats prolonged diarrhea with uncontrollable leakage.

③ For lower abdominal pain, add danggui and bai shao; for long-term diarrhea with leakage, add dangshen and roukou; for intestinal bleeding, remove dried ginger and add pao jiang; for incomplete digestion of food, add jiaosanxian.

[References]

①This Shaoyin transmission involves heat pathogens, which travel along the yin meridians inside and outside the body, causing abdominal pain and diarrhea. Why did Zhongjing use stone powder and dried ginger? Because when diarrhea becomes unstoppable, the heat has already subsided, but cold deficiency begins to emerge. (From “Cheng Fang Qie Yong”)

②Peach Blossom Decoction combined with Sishen Decoction cured one case of vaginal discharge. The patient had been experiencing bloody, mucous-like discharge from the vagina for over a year, and Western medicine diagnosed it as cervical erosion. Previous treatments, including Bixie Fenqing Yin, Buzhong Yiqi Tang, and Guipi Tang, had all failed. Based on the patient’s sallow complexion, weak pulse, especially a strong pulse at the cun position, and white, slippery tongue without coating, the doctor diagnosed spleen and kidney deficiency and prescribed a treatment plan combining Peach Blossom Decoction with Sishen Decoction. After taking three doses, the vaginal discharge significantly decreased; after another three doses, the discharge disappeared entirely; finally, the doctor used Fu Gui Lizhong Wan to further regulate and cure the patient. (From “New Traditional Chinese Medicine” May 1973)

[Commentary] This formula can be used for patients with chronic diarrhea, including allergic colitis, localized ileitis, ulcerative colitis, and other conditions. It can also be used to treat some cases of chronic dysentery and intestinal tuberculosis.

4. Real Person Nourishing the Organs Decoction from “Heji Ju Fang”

[Composition] 48 grams of white peony, 18 grams each of danggui, ginseng, and white atractylodes, 15 grams of nutmeg, 24 grams each of cinnamon and honey-fried licorice, 42 grams of agarwood, 36 grams of chebulic myrobalan peel, and 108 grams of poppy seed pods.

[Administration] Grind all ingredients into powder. Take 5–10 grams per dose, boiled in water. In modern times, it is prepared as a decoction, with the dosage adjusted proportionally.

[Indications] Prolonged diarrhea with spleen and kidney deficiency.

[Applications] Prolonged diarrhea, continuous abdominal pain, preference for warmth and pressure, sallow complexion, poor appetite and fatigue, lower back pain and leg weakness, thin pulse, and even uncontrollable leakage.

[Functions] Strengthen the spleen and kidneys, astringe the intestines and consolidate the organs.

[Formula Analysis] “The spleen governs transformation,” and “the kidneys govern water and fluids.” When diarrhea persists for a long time, impaired transformation harms the spleen, and extreme dehydration of water and fluids harms the kidneys, resulting in spleen and kidney deficiency. Continuous abdominal pain, preference for warmth and pressure, and sallow complexion indicate spleen deficiency; lower back pain and leg weakness, along with a thin pulse, indicate kidney deficiency. Spleen and kidney deficiency, in turn, exacerbate diarrhea, leading to uncontrollable leakage. In this formula, dangshen and white atractylodes strengthen the spleen and replenish qi as the principal ingredients, while cinnamon and nutmeg supplement the kidneys and replenish qi as auxiliary ingredients. Poppy seed pods and chebulic myrobalan peel astringe the intestines and prevent leakage, agarwood “moves qi, thus eliminating constipation,” danggui and white peony nourish the blood and “activate blood circulation, thus healing pus in the stool,” and together these four ingredients serve as complementary treatments. Licorice harmonizes all the ingredients and acts as a conduit.

[Clinical Modifications] For cases of undigested food and severe diarrhea, add dried ginger and fu zi; for severe qi deficiency and rectal prolapse, add astragalus, shengma, and zhishi; for acute lower abdominal pain, add binlang; for yellow tongue and rapid pulse, add huanglian and kushen.

[References] ①Rectal prolapse is caused by cold deficiency, so use dangshen, white atractylodes, and licorice to replenish the deficiency, cinnamon and nutmeg to dispel the cold, agarwood to warm and regulate qi, danggui to moisten and harmonize the blood, white peony to astringe, and chebulic myrobalan and poppy seed pods to prevent leakage. (From “Medical Formula Collection”) ②For treating dysentery, in the early stages, it is best to “use the cause to treat the effect” and avoid using astringent agents too early. For example, if diarrhea persists for a long time, stagnation has already cleared, the abdomen is no longer painful or is painful but feels warm and comfortable, and the organs are weak and prone to leakage, then warming and astringing to consolidate the organs is necessary to achieve effective results. (Jiangsu New Medical College: “Traditional Chinese Medicine Formulas”)

[Commentary] This formula is often used for chronic bacterial dysentery, amoebic dysentery, ulcerative colitis, segmental enteritis, allergic enteritis, and long-term dysentery with rectal prolapse.

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5. Yi Huang Powder from “Xiao’er Yao Zheng Zhi Jue”

[Composition] 30 grams of tangerine peel, six grams of cloves, and 15 grams each of green peel, chebulic myrobalan (pitted), and honey-fried licorice.

[Administration] Grind all ingredients into powder. Boil in water and take 10 grams each time, reducing the dose for children; in modern times, it is prepared as a decoction.

[Indications] Spleen deficiency and qi stagnation in children.

[Applications] Abdominal distension around the navel, emaciation, vomiting, and diarrhea.

[Functions] Strengthen the spleen and regulate qi.

[Formula Analysis] Children’s bodies are not fully developed, and their organs are delicate. Consuming cold foods can harm the spleen, and when the spleen is harmed, it cannot transform food properly, leading to qi stagnation. Qi stagnation in the middle jiao causes abdominal distension around the navel, stomach qi does not descend, resulting in nausea and vomiting, and spleen qi does not rise, causing intestinal rumbling and diarrhea. If the spleen is deficient for a long time, food and water cannot nourish the extremities, leading to emaciation. This formula uses tangerine peel to strengthen the spleen and regulate qi as the principal ingredient, while green peel regulates qi and strengthens the spleen as a secondary ingredient. Cloves warm the middle jiao and stop vomiting, and chebulic myrobalan astringes the intestines and stops diarrhea, serving as complementary treatments. Licorice harmonizes all the ingredients and acts as a conduit.

[Clinical Modifications] For those with long-term stagnation, add jinneijin and maiya; for severe spleen and stomach deficiency, add dangshen and white atractylodes; for those with clear stools after diarrhea, add dried ginger and fu zi; for those with bloated abdomens like drums, add laibuzi; for those with masses under the ribs, add sanleng and ezhushi; for those who vomit immediately after eating, add shengjiang and banxia; for those with yellow tongue and hard stools, add huanglian and dahuang.

[References] To strengthen the spleen, do not rely on replenishing the central region; instead, use tangerine and green peel to dispel stagnant qi, which is the most subtle approach. Infants with prolonged diarrhea and continuous accumulation of food in the stomach need two types of peel to specifically address the liver and spleen’s hidden influence—chebulic myrobalan to prevent downward leakage, cloves to regulate the central region, and licorice to harmonize the spleen—this method effectively disperses stagnation in the intestines (from “Zhengzhi Junsheng”). It can also be used to treat early-stage lung abscesses before they develop into pus. ⑤ Adding ginseng, zhimu, and huangqin creates another formula called Xie Bai San (from “Shen Shi Zun Sheng Shu”), which treats lung heat cough combined with qi deficiency.

[References] ①Mulberry bark is sweet and benefits qi deficiency, while pungent herbs drain excess lung qi and eliminate phlegm and cough; ground bone bark cools the latent fire in the lungs, alleviates liver and kidney heat, and cools the blood to dispel heat. Licorice drains fire and strengthens the spleen; japonica rice clears the lungs and nourishes the stomach (earth is the mother of metal, so when it is deficient, we should replenish its mother). It can also drain heat through urine, and since the lungs belong to the west, it is called Xie Bai. (From “Medical Formula Collection”) ②The lungs are delicate organs belonging to metal, governing the skin and hair. Their nature is to act downward and upward; once exposed to fire, the upper manifestations appear. Those who treat this condition should clear and lower the fire to restore its original purity. Mulberry bark can penetrate the skin and return to the lungs, and its sweet and cool nature can directly enter the lungs to clear heat—this is self-evident. Roots go deepest into the earth, clearing and lowering, and one can imagine ground bone bark going deep into the underworld, with no bottom. Its sweet and cool nature can drain the latent fire in the lungs, but judging from its name, it seems to target the liver and kidneys, cooling the blood and dispelling heat. Thus, both peels are used to lower the fire, and when lung qi drops, the fire disappears on its own. Licorice drains fire and strengthens the spleen; japonica rice clears the lungs and nourishes the stomach, draining heat while simultaneously replenishing, embedding replenishment within the act of clearing—though it clears the lungs, it still preserves the roots. (From “Cheng Fang Bian Du”)

[Commentary] This formula is often used for acute and chronic bronchitis, bronchial asthma, and emphysema complicated by infection. Combined with Maxing Gan Shi Tang, it can effectively treat pneumonia in children.

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5. Qingwei Powder from “Lan Shi Mi Cang”

[Composition] One gram of danggui, one gram of huanglian, one gram of shengdi, one and a half grams of mudanpi, and three grams of shengma.

[Administration] Grind all ingredients into fine powder. Boil in water and take once.

[Indications] Stomach fire rising upward.

[Applications] Burning pain in the epigastric region, dry mouth, bad breath, oral ulcers, toothache, swollen gums, bleeding from the gums, red tongue with yellow coating, and rapid pulse.

[Functions] Clear and drain stomach fire.

[Formula Analysis] The hand yangming meridian runs from the maxilla through the cheek to the lower teeth, while the foot yangming meridian runs from the nose to the upper teeth, indicating that teeth and gums are areas where the yangming meridian flows. The stomach belongs to yangming, so when stomach fire rises upward, toothache, swollen gums, and bleeding from the gums appear. The mouth is the upper opening of the stomach, so when stomach fire rises upward, dry mouth, bad breath, and oral ulcers occur. If the stomach accumulates heat, there will be burning pain in the epigastric region, a red tongue with yellow coating, and a rapid pulse. In this formula, huanglian is bitter and cold, directly draining stomach fire as the principal ingredient; shengdi and mudanpi nourish yin and cool the blood as auxiliary ingredients; yangming is rich in qi and blood, so adding

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7. Sangpiaoxiao Powder from “Bencao Yan Yi”

[Composition] Thirty grams each of sangpiaoxiao, yuanzhi, changpu, longgu, dangshen, funshen, danggui, and turtle shell (vinegar-fried).

[Administration] Grind all ingredients into powder. Before bed, take six grams mixed with dangshen soup. In modern times, it is prepared as a decoction, with the dosage reduced according to the original formula.

[Indications] Heart-kidney disharmony, spermatorrhea, and enuresis.

[Applications] Mental confusion, forgetfulness, enuresis, and spermatorrhea.

[Functions] Tonify the kidneys and consolidate essence, nourish the heart and calm the spirit.

[Formula Analysis] The heart is above and belongs to fire, while the kidneys are below and belong to water. Humans achieve harmony between heart and kidney through mutual interaction, where water and fire complement each other. When the heart is deficient, it cannot nourish the kidneys; when the kidneys are deficient, they cannot nourish the heart, resulting in heart-kidney disharmony and imbalance between water and fire. A deficient heart leads to mental confusion and forgetfulness, while a deficient kidney leads to enuresis and spermatorrhea. The latter is urgent, while the former is more gradual. Therefore, this formula uses sangpiaoxiao to tonify the kidneys, consolidate essence, and stop enuresis as the principal ingredient. Funshen, yuanzhi, and changpu nourish the heart and calm the spirit as auxiliary ingredients. Turtle shell nourishes kidney yin, longgu suppresses excess yang in the heart, dangshen tonifies qi, and danggui nourishes blood. Together, these four ingredients work to replenish qi, blood, yin, and yang, serving as complementary treatments.

[Clinical Modifications] For severe enuresis, add wuyao and yizhiren; for severe spermatorrhea, add qianshi and jinyingzi; for excessive internal fire and bone-steaming heat, add zhimu and huangbo; for weakened Mingmen fire and feeling cold, add rougui and fupian; for spermatorrhea and thin pulse, add shanyurou and shayuanzi.

[References] ①There are two types of urinary incontinence: one caused by excessive fire below, and the other caused by weakness of the lower organs. However, for those caused by fire, the symptoms are usually short and intense, or astringent and painful, with clear pulse evidence; for those caused by weakness, it may be due to disharmony between heart and kidney, or weakness of the spleen and kidneys, leading to involuntary urination. Elderly people and children are particularly prone to this. Even children who wet the bed during sleep are often due to kidney deficiency. Sangpiaoxiao tonifies the kidneys and consolidates essence, while yuanzhi enters the kidneys, allowing kidney qi to flow upward to the heart; changpu opens the heart's orifices, enabling the ruler to receive the nourishment from dangshen and danggui; and using funshen to descend, it lowers the heart's qi and connects it to the kidneys, thus achieving heart-kidney harmony. Longgu and turtle shell are both spiritual creatures—one enters the liver to calm the soul, the other enters the kidneys to pacify the will. The liver is responsible for excretion, while the kidneys are responsible for storage, so each organ performs its own function. (From “Cheng Fang Bian Du”)

[Commentary] This formula is effective for treating urinary incontinence and frequent urination caused by autonomic nervous system dysfunction and neurasthenia.

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[References] When a woman’s true yin is sufficient and water and fire are balanced, she will never suffer from excessive fire. However, if the true yin of the lungs and kidneys is insufficient, the stomach cannot be adequately moistened, gastric juice becomes dry, and once exposed to fire pathogens, the situation quickly escalates into a state of yin deficiency. In this formula, shudi and niuxi are used to nourish kidney water; maidong protects lung metal; zhimu benefits lung yin above and nourishes kidney water below, effectively addressing the situation where yangming dominates the fire; gypsum is heavy and cold, entering yangming alone to clear excess heat in the stomach. Despite this, if the stomach fire is extremely fierce, it is especially important to carefully consider reducing the amount of shudi used—when dealing with virtual fire, it is better to switch to shengdi instead. Those who use the formula should be mindful and adaptable, making adjustments as needed. (From “Cheng Fang Bian Du”)

[Commentary] This formula is often used for neuralgic toothache, acute stomatitis, bleeding from blood diseases, and the late stage of acute infectious diseases.

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7. Huangqin Decoction from “Shanghan Lun”

[Composition] Nine grams of huangqin (three liang), nine grams of shaoyao (two liang), two grams of gancao (two liang, roasted), and four jujubes split open (twelve pieces).

[Administration] Boil in water and drink warm, once during the day and once at night.

[Indications] Pathogenic factors of Shaoyang pressing inward on yangming.

[Applications] Bitter taste in the mouth, dry throat, dizziness, diarrhea, burning sensation in the anus, or diarrhea, abdominal pain, and tenesmus.

[Functions] Clear heat and dry dampness, astringe the nutritive qi and relieve pain.

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[Explanation] Although the pathogenic factor of Shaoyang is internally pressing on Yangming, the pathogenic factor still remains, hence symptoms such as bitter taste in the mouth, dry throat, and dizziness; when the pathogenic factor enters Yangming, it transforms into heat. Since Yangming and Taiyin are exterior-interior counterparts, the heat of Yangming combines with the dampness of Taiyin, resulting in symptoms like diarrhea, anal burning, loose stools, and abdominal pain. This syndrome focuses on the pathogenic factor pressing on Yangming, which is what is known as a case where the symptoms are acute while the root cause is slow. The treatment principle should be to clear heat and dry dampness, thereby draining the damp-heat accumulated in Yangming. In this formula, Huangqin clears heat and dries dampness, making it the principal herb; Shaoyao gathers yin and relieves pain, serving as an auxiliary herb; Dazao strengthens the spleen and benefits qi, acting as a complementary treatment; and Gancao harmonizes all the herbs, functioning as a guiding agent.

[Clinical Modifications] ① Remove Dazao, naming it Huangqin Shaoyao Tang (from "Essentials of Treatment Methods"). It treats heat dysentery, abdominal pain, and tenesmus. ② Add Banxia and Shengjiang, naming it Huangqin Banxia Shengjiang Tang (from "Shanghan Lun"), for treating damp-heat diarrhea accompanied by vomiting. ③ Remove Dazao, add Siling (Zhu Ling, Fu Ling, Ze Xie, Bai Zhu), Houpu, Chenpi, and Muxiang, naming it Siling Qin Shaoyao Tang (from "Warm Disease Differentiation"). It treats cases of food-damp obstruction combined with initial dysentery and short urination.

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9. Guchong Tang from "Medical Insights Integrating Chinese and Western Medicine"

[Composition] Baizhu 30g (stir-fried), Sheng Huangqi 18g, Longgu 24g (calcined finely), Muli 24g (finely), Shanyu Rou 24g (pitted), Sheng Hangshao 12g, Haipiaotuo 12g (finely), Qiancao 12g, Zongbian Tan 6g, Wubeizi 1.5g (finely)

[Administration] Decoct in water and take warm; Wubeizi should be ground into fine powder and taken twice—once with the first decoction and once with the second.

[Indications] Deficiency of middle qi and instability of the Chong pulse.

[Symptoms] Pale complexion, poor appetite, fatigue, shortness of breath and reluctance to speak, metrorrhagia or menorrhagia, cold abdomen and limbs; or sudden heavy bleeding with fainting, swollen and pale tongue, and deep, weak pulse.

[Functions] Tonify qi and consolidate the Chong pulse.

[Explanation] The Chong pulse originates from the uterus and ascends to Yangming. The uterus is the blood chamber, while Yangming is rich in both qi and blood; the Chong pulse runs between them and is often referred to as the "sea of blood." When middle qi is deficient and the Chong pulse is malnourished, qi fails to control the blood, leading to these symptoms. Deficiency of middle qi results in pale complexion, poor appetite, fatigue, shortness of breath, reluctance to speak, cold abdomen and limbs, and even fainting; instability of the Chong pulse leads to metrorrhagia or menorrhagia. In this formula, Baizhu and Huangqi serve as the principal herbs for tonifying middle qi. Shanyu nourishes the kidneys, while Shao Yao restrains the liver; with the lower jiao stabilized, there is no longer any opportunity for bleeding or leakage, making them auxiliary herbs. Longgu, Muli, Zongbian Tan, Wuzi Gu, and Wubeizi are all astringent and hemostatic agents, collectively serving as complementary treatments; Qiancao promotes blood circulation and stops bleeding, ensuring that the herbs tonify without stagnation and restrain without suppression, thus functioning as both complementary treatment and guiding agent.

[Clinical Modifications] ① For patients with a hot pulse, add Sheng Didi 30g; for those with a cool pulse, add Fuzi 9g. (Zhang Xichun) ② For patients with massive bleeding, cold extremities, and a weak pulse, add Renshen and Fuzi; for those with lower abdominal pain, add Xiangfu, Danpi, and Taoren; for those with dark-colored blood and difficulty in passing stool, add Yimu Cao.

[References] ① A woman in her thirties suddenly experienced heavy bleeding that lasted for two days. Upon examination, she was already unconscious and unable to speak, with her whole body feeling cold and her pulse extremely weak and slow. It was evident that both her qi and blood were about to collapse, along with excessive yang energy. Therefore, this formula was urgently administered, with Shao Yao removed and Wild Ginseng added at 8 qian, plus Fuzi at 3 qian. After one dose, the bleeding stopped, her whole body warmed up, and her spirit recovered. Subsequently, Shao Yao was added again, and another dose was given to ensure recovery. (From "Medical Insights Integrating Chinese and Western Medicine") ② Li ××, female, 21 years old. One month after a miscarriage, she developed metrorrhagia, which persisted for over five months despite both Chinese and Western medical treatments. Her complexion was pale, she felt exhausted and weak, had headaches and palpitations, lacked appetite, suffered from abdominal pain and lower back soreness, and her menstrual flow was continuous and dark in color. The prescription included Huangqi at 5 qian, Baizhu at 5 qian, and Shengdi at 5

[References] ① Preliminary observation on the treatment of 40 cases of acute bacterial dysentery with Baitouweng Tang: the cure rate reached 62.5%. The prescription was Baitouweng 1 liang, Huanglian 2 qian, Huangbo 3 qian, Qinpi 3 qian. One dose per day, with an average of 7.2 doses per case. ("New Chinese Medicine" September 1957) ② An example of using Baitouweng Tang with enema to treat amebic dysentery lasting for fifteen years: the formula used Baitouweng 1 liang, Lianqiao 1 liang, Huangbo 2 qian, Zhizi 2 qian, boiled in 500 ml of water until reduced to 300 ml, then strained and cooled for later use. Chen ××, 50 years old. Suffered from chronic amebic dysentery with recurrent attacks for 15 years. Each attack caused abdominal distension, tenesmus, and continuous mucoid bloody stools. In 1958, a stool test showed positive for amoebic cysts. Over the years, the patient had received antibiotics, drugs like A's medicine, and traditional Chinese medicine treatments, temporarily controlling the symptoms but still experiencing several attacks each year. After switching to Baitouweng Tang with enema twice (two doses), the condition was cured, and no recurrence was observed during a one-year follow-up. ("New Traditional Chinese Medicine" April 1974, p. 38) ③ An example of using Baitouweng Tang to treat wind-heat eye disease. Chen, female, 11 years old. Had been ill for more than ten days, with red and swollen eyelids, conjunctival congestion, blurred vision, constipation, and short, reddish urine. Western diagnosis: acute conjunctivitis. The prescription was Baitouweng 1 liang, Huanglian half a qian, Huangbo 2 qian, Qinpi 3 qian. Three doses cured the condition. ("New Traditional Chinese Medicine" April 1973)

[Note] This formula is used for acute bacterial dysentery, amebic dysentery, ulcerative colitis, and also for acute conjunctivitis, among others.

9. Qingyi Tang (Tianjin Nankai Hospital)

[Composition] Chaihu 15g, Huangqin 10g, Dahuang 15g, Mangxiao 10g, Huhuanglian 10g, Muxiang 6g, Yuanhu 10g, Shao Yao 15g

[Administration] Decoct in water and take orally.

[Indications] Acute pancreatitis (combined syndrome of Shaoyang and Yangming).

[Symptoms] Severe epigastric pain radiating to the chest and flanks, generalized abdominal distension involving the lower back, accompanied by bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, irritability and nausea, thick yellow tongue coating, and wiry, rapid pulse.

[Functions] Soothe the liver and regulate qi, purge fire and attack excess.

[Explanation] The clinical features of this disease are indistinguishable from the combined syndrome of Shaoyang and Yangming. The Shaoyang aspect is manifested by bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, irritability and nausea, and pain radiating to the chest and flanks; the Yangming aspect is shown by severe epigastric pain, generalized abdominal distension, thick yellow tongue coating, and wiry, rapid pulse. According to "Shanghan Lun," Dachaihu Tang is the main formula for treating the combined syndrome of Shaoyang and Yangming. Qingyi Tang's treatment of pancreatitis is similar to Dachaihu's treatment of the combined syndrome of Shaoyang and Yangming.

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Chapter 13: Qi-regulating Formulas

As previously mentioned, the concept of qi can be divided into three categories: righteous qi, middle qi, and original qi; locally, it can be further categorized into liver qi, lung qi, heart qi, and so on. The former refers to the body's resistance to disease, while the latter pertains to the physiological functions of individual organs. If the righteous qi is insufficient, the appropriate remedy is to tonify it, which has already been discussed in the tonifying formulas; if the local qi is disordered, the appropriate remedy is to regulate it, which is what we call qi-regulating formulas.

The target of qi-regulating formulas is "qi-related diseases," whose clinical manifestations can be broadly classified into two types: qi stagnation and qi rebellion. For qi stagnation, the treatment is to promote the flow of qi; for qi rebellion, the treatment is to descend the qi. These are the two fundamental principles of qi regulation. Since qi stagnation and qi rebellion often coexist in the same case, the methods of promoting qi flow and descending qi are frequently used together in clinical practice. When using qi-regulating formulas, one must first distinguish between deficiency and excess before prescribing. For deficiency, tonification is preferred over promotion; for excess, promotion is preferred over tonification. If tonification is mistakenly applied to excess conditions, it violates the principle of "excess aggravates excess"; if promotion is mistakenly applied to deficiency conditions, it violates the principle of "deficiency aggravates deficiency." Sometimes, there are cases where deficiency is mixed with excess, in which case both deficiency and excess must be treated simultaneously, possibly by adding tonifying ingredients to the qi-promoting and qi-descending medicines. In addition, most qi-regulating medicines are aromatic, drying, bitter, and warming in nature; therefore, if qi stagnation is accompanied by yin fluid deficiency, caution should be exercised when using them.

I. Promoting Qi Flow

To treat qi stagnation, one must promote the flow of qi. Clinically, this condition usually presents in three forms: ① spleen-stomach qi stagnation, ② liver qi stagnation, and ③ chest oppression and heart pain. The signs of spleen-stomach qi stagnation include abdominal distension, nausea, vomiting, and loose stools; the signs of liver qi stagnation include bitter taste in the mouth, dry throat, irritability, and fullness in the chest and flanks; the signs of chest oppression and heart pain include shortness of breath, coughing, and pain in the chest and back.