Ce Jiao Shu-De Formulas

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Lecture 4
Wind-Dispelling Formulas, Cold-Dispelling Formulas,
and Dampness-Dispelling Formulas
"",
,;
;
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"
":
Wind is the chief of the hundred diseases. Since wind evil easily damages
the body, we often prescribe wind-dispelling formulas in clinic. However,
external wind, internal wind, and vacuity wind cause different wind diseases.
Also, when wind binds together with the individual viscera and bowels it
causes a variety of pathological changes, such as liver wind, kidney wind,
heart wind, and intestinal wind. Moreover, when wind unites with the other
six excesses there are significant differences between wind-phlegm, winddamp, wind-cold, wind-cold-damp, wind-fire, summerheat-wind, and winddryness.
A further characteristic of wind evil is that it is swift and changeable.
Whenever you see frequent transmutations, rapid onset, and symptoms that
come and go, wind is usually involved. In recent years we have reached the
conclusion that allergies, as diagnosed in Western medicine, are frequently
ascribable to the Chinese medicine category of wind evil. Finally, if a
disease is the result of wind evil, its determining characteristics can include:
itching, convulsion, shaking, and dizziness; whenever these symptoms are
present, wind is likely involved. In summary, when you use a wind-dispelling
formula, you have to clearly distinguish the various wind patterns. This
allows you to use wind-dispelling formulas in combination with other
formulas that apply other treatment principles.
Lecture 4
""
Cold evil, as a cause of disease, is also as common in the clinic as wind.

Moreover, the developments and transformations of cold are very complex.
In the Shang1 Han2 Lun4 (On Cold Damage), Zhang1 Zhong4-Jing3 (
) discussed the transformation of disease due to cold damage and handed
down to later generations an established method of treatment that has stood
the test of time. Beyond cold damage diseases, many miscellaneous diseases1
are cold diseases. The characteristic symptoms of cold are: pain; congelations;
fear of cold; clear watery fluids; accumulations; spasms; contractions; and the
sensation of cold. Furthermore, cold evil can also deeply invade the kidneys
and cause reverse-flow of the limbs. This is why our predecessors had colddispelling formulas.
Cold evil manifests in the exterior or interior, in the qi4 and blood, in the
channels and network vessels, and in the skin, muscles, and bones. Since cold
evil differs in each area of the body, one must pay attention to pattern
identification when using cold-dispelling formulas. Even more importantly,
one should pay attention to the transformation of the disease itself and its
subsequent symptoms for these will differ as well. Remember to use formulas
flexibly.
""
Dampness is sticky and slimy as well as heavy and turbid. Damp that
collects causes phlegm or water, and often phlegm leads to disease in
combination with wind, heat, cold, or summerheat evil. While external
dampness is often interrelated with wind, cold, or summerheat, internal
dampness usually relates to insufficient right qi4 of the viscera and bowels, or
1
As explained in an earlier footnote, miscellaneous diseases specifically means diseases

that are not cold damage diseases. (Ed.)
Lecture 4
it is due to erroneously treated external dampness that has subsequently

entered the interior. Another characteristic of damp evil is that it lingers and
is very difficult to treat.
"
"
In summary, when you use formulas that dispel wind, cold, or damp, you
cannot just pay attention to the characteristics of individual evils. You must
also analyze how evils are interacting with each other, assay the strength or
weakness of the right qi4, and grasp the transformations of the disease itself.
For example, cold depression may transform into heat, wind evil may
transform into dryness, and damp evil may transform into heat; an exterior
evil may enter the interior, and an interior evil may pass to the exterior.
Always remember to identify the pattern to determine the treatment.
1. ()
4.1
Feng1 Yin3 Tang1 ( Wind-Drawing Decoction)

from Jin1 Gui4 Yao4 Lue94 ( Essential Prescriptions of the
Golden Coffer)
60 45 30
90 46
34
1
da4 huang2 ( rhubarb, Rhei Radix et Rhizoma) 60 g

gan1 jiang1 ( dried ginger, Zingiberis Rhizoma) 60 g
long2 gu3 ( dragon bone, Mastodi Ossis Fossilia) 60 g
gui4 zhi1 ( cinnamon twig, Cinnamomi Ramulus) 45 g
gan1 cao3 ( licorice, Glycyrrhizae Radix) 30 g
mu3 li4 ( oyster shell, Ostreae Concha) 30 g
han2 shui3 shi2 ( glauberite, Gypsum seu Calcitum) 90 g
hua2 shi2 ( talcum, Talcum) 90 g
chi4 shi2 zhi1 ( halloysite, Halloysitum Rubrum) 90 g
Lecture 4
bai2 shi2 zhi1 ( kaolin, Kaolin) 90 g

zi3 shi2 ying1 ( fluorite, Fluoritum) 90 g
shi2 gao1 ( gypsum, Gypsum Fibrosum) 90 g
Grind the above medicinals into a coarse powder, and use 46 g per dose.
Bring to a boil in 2 small cups of water, but only allow it to boil a few
seconds. Remove the dregs, divide into two doses, and drink warm. For dry
stools, slightly increase the dosage; for loose stools, slightly decrease the
dosage or take one dose each day. Remain flexible when prescribing this
formula.
()
60
()""( 2 3
)
Our predecessors used feng1 yin3 tang1 to treat wind-induced paralysis

(wind epilepsy) in adults, 2 fright epilepsy in children, and tugging and
slacking in which the patient may suffer dozens of attacks per day. But since
the 1960s I have used this formula to treat hypertension in overweight
patients with intense constipation, dizziness, and tendency to wind strike; for
such patients this formula can prevent wind strike. Furthermore, I use feng1
yin3 tang1 to treat hemiplegic sequelae to cerebrovascular disease (wind
strike). This formula is ideal for preventing recurrent strike (i.e., second
and third wind strikes).
;;
In most cases the paralysis is the sequela of wind strike. (Ed.)

Lecture 4
FORMULA ANALYSIS
Feng1 yin3 tang1 is a settling, downbearing, and heat-clearing formula.
Although there are a variety of causes for wind strike disease, mostly it is due
to internally arising wind-fire with exuberant phlegm-heat that counterflows
and blocks the spirit orifices; this is why the patient faints and loses
consciousness. Phlegm obstructing the channels and network vessels causes
the paralysis. Within this formula, long2 gu3 subdues, settles, and quiets the
spirit, mu3 li4 subdues the mind and constrains the spirit, gui4 zhi1 frees
yang2 qi4, and gan1 cao3 moderates urgency. These four medicinals are the
chiefs of this formula, and together they quiet the heart and kidney.
Stirring internal wind harasses liver wood, which in turn insults spleen
earth. When spleen qi4 does not transport, dampness stagnates and humors
gather. If the patient further has wind and fire fanning each other, then dampheat engenders phlegm, and wind-phlegm will invade the upper body. This is
why da4 huang2 serves as the support medicinal in this formula. It flushes
away damp-heat and wind-fire evils to quicken the blood and dispel stasis
and thereby push out the old and lead in the new. Thus, da4 huang2 stops the
source of phlegm-fire obstructions.
The assistants in this formula are: gan1 jiang1, which warms the spleen
and dries dampness to prevent the cold medicinals from damaging the center;
chi4 shi2 zhi1 and bai2 shi2 zhi1, which dry dampness and fortify the spleen;
hua2 shi2, which disinhibits dampness and fortifies the spleen; and shi2 gao1,
which clears the lung to restrain the liver. Finally the couriers are han2 shui3
shi2 and zi3 shi2 ying1. The former is a cold-natured medicinal that
strengthens the yin1 qi4 of kidney water to restrain fire, and the latter is a
sweet-warm medicinal that settles the spirit and supplements the heart
vacuity. Together the ingredients in this formula quiets the five viscera and
govern all of the above-mentioned symptoms.
""
45
There are many causes of wind strike, but we can summarize the causes as
wind, fire, qi4, blood, and phlegm evils, along with various combinations of
these five evils. Feng1 yin3 tang1 has medicinals that treat wind, fire, phlegm,
Lecture 4
and blood diseases, and it also regulates and balances the five viscera. It only
lacks medicinals that treat qi4. While shi2 gao1 clears metal and restrains
wood, and mu3 li4 subdues liver yang2, the formula is missing medicinals
that course and outthrust liver qi4. So, whenever I prescribe this formula, I
usually add 45 g of xiang1 fu4 zi3 (cyperus) to course the liver and rectify qi4.
This medicinal not only soothes the liver and extinguishes fire, it also moves
qi4 in the twelve channels and thereby assists with the unobstructed
movement of qi4 and blood.
:""(
)
The formula I have explained above comes from the Jin1 Gui4 Yao4 Lue94.
Yet, the Qian1 Jin1 Yao4 Fang13 includes a formula named zi3 shi2 zhu3
san3 (Flourite Decocting Powder) while the Wai4 Tai2 Mi4 Yao44 includes
the formula zi3 shi2 tang1 (Flourite Decoction), and both of these formulas
are identical to feng1 yin3 tang1. Some scholars in later generations
attributed feng1 yin3 tang1 to an author of the Song4 dynasty, and others
attributed it to Zhang1 Zhong4-Jing3. Some say do not use this formula
lightly, while others praise it highly. These all have some degree of truth, but
there is still no final conclusion. Within those discussions of the origin of this
formula, no one mentions whether or not the formula is effective. As the
Qing1 dynasty physician Wang1 Ang2 () said in the Jin1 Gui4 Yao4
Lue94 Ji2 Yi4 (Comprehensive Elucidation of Essential Prescriptions in the
Golden Coffer), Do not worry about the opinions of others, try to figure it
out yourself!
Qian1 Jin1 Yao4 Fang1 ( A Thousand Gold Pieces Prescriptions); this was by
Sun1 Si1-Miao3 () and was published in the 7th Century. (Ed.)
4
Wai4 Tai2 Mi4 Yao4 ( Essential Secrets from Outside the Metropolis); this was
by Wang2 Tao2 () and was published in the 8th Century. (Ed.)
Lecture 4
The greatest feature of Chinese medicine is its intimate connection to

clinical practice. Clinical efficacy is the criterion for testing theory on the one
hand and medicinals and formulas on the other. I know from several years of
clinical experience with feng1 yin3 tang1 that it effectively treats wind strike
disease and produces very good results. I hope readers will use this formula
with the proper pattern identification to determine treatment and accurate
selection of medicinals. In this way we can broaden the applications of this
ancient formula in alleviating suffering in the modern world.
CONTRAINDICATIONS
Do not use feng1 yin3 tang1 for vacuity-cold patterns.
2. ()
4.2
Tian1 Ma2 Wan2 ( Gastrodia Pill)

by Zhang1 Jie2-Gu3 ()
180 180 () 180
180 210 () 300 300
150 30 500 ()
5070
100 l
tian1 ma2 ( gastrodia, Gastrodiae Rhizoma) 180 g

niu2 xi1 ( achyranthes, Achyranthis Bidentatae Radix) 180 g
bi4 xie4 ( fish poison yam, Dioscoreae Hypoglaucae seu
Semptemlobae Rhizoma) 180 g
xuan2 shen1 ( scrophularia, Scrophulariae Radix) 180 g
du4 zhong4 ( eucommia, Eucommiae Cortex) 210 g (wine-fried)5
quan2 dang1 gui1 ( whole tangkuei, Angelicae Sinensis Radix
Integra) 300 g
qiang1 huo2 ( notopterygium, Notopterygii Rhizoma et Radix) 300 g
du2 huo2 ( pubescent angelica, Angelicae Pubescentis Radix)6 150 g
pao4 fu4 zi3 ( blast-fried aconite, Aconiti Radix Lateralis
Tosta) 30 g
sheng1 di4 huang2 ( dried/fresh rehmannia, Rehmanniae Radix
5
Fry this ingredient in wine to eliminate the natural elasticity of du4 zhong4 and make it
easier to break. (Au.)
6
One version of this formula omits this ingredient. (Au.)
Lecture 4
Exsiccata seu Recens) 500 g

Soak the tian1 ma2 and niu2 xi1 together in wine for three days, and dry
them over a fire. Grind all the medicinals into a fine powder, and mix with
lian4 mi4 (processed honey) to form pills the size of wu2 tong2 zi3 (firmiana
seed). Take 5070 pills at a time. If the illness is serious, the patient may take
up to 100 pills. Take the pills with warm water once a day early in the
morning on an empty stomach.
FORMULA ANALYSIS
Tian1 ma2 wan2 nourishes blood, dispels wind, supplements the kidney,
and strengthens the muscles and bones. It treats kidney channel vacuity fire
that engenders wind.7 The associated symptoms are: sinew pulling; pain in
the entire body; numbness in the hands and feet; deviated eyes and mouth;
and hemiplegia.
"
This formula emphasizes di4 huang2 and dang1 gui1, the chief medicinals,
which supplement the kidney and nourish blood. Even so, its magical effect
comes entirely from using tian1 ma2 and niu2 xi1 that have been winesoaked and dried together. These two support medicinals make wind-phlegm
and turbidity-dampness downbear and not ascend counterflow. The four
assistant medicinals are bi4 xie4, du4 zhong4, xuan2 shen1, and fu4 zi3. Bi4
xie4 and du4 zhong4 boost the kidney, dispel wind-dampness, and strengthen
the sinews and bones; xuan2 shen1 nourishes kidney yin1 and invigorates
water to restrain fire; fu4 zi3 supplements kidney yang2 and warms the
channels to free the network vessels. Moreover, the combination of di4
huang2 and xuan2 shen1 allow yin1 to obtain the help of yang2 to provide a
7
This refers to wind engendered from liver-kidney yin1 vacuity (Ed.)

Lecture 4
never-ending source. The couriers, du2 huo2 and qiang1 huo2

(notopterygium), dispel wind from the greater yang2 (tai4 yang2) and track
down latent wind in the lesser yin1 (shao4 yin1) to eliminate wind evil.
The medicinals in tian1 ma2 wan2 together support right qi4 and dispel
evil to treat both the branch and the root. This formula nourishes blood,
dispels wind, strengthens tendons and bones, supplements kidney, and
secures the root.
(
)
In recent years we have used this formula with modifications to treat

kidney vacuity stirring wind that manifests in dizziness, flowery vision,
heaviness of the head, unstable legs, numbness or pain in the limbs, and
hypertension. (You can also us it when hypertension is not present.) For this
purpose, consider adding medicinals such as:
sheng1 zhe3 shi2 ( crude hematite, Haematitum Crudum)
sheng1 shi2 jue2 ming2 ( raw abalone shell, Haliotidis Concha
Cruda)
gou1 teng2 ( uncaria, Uncariae Ramulus cum Uncis)
ze2 xie4 ( alisma, Alismatis Rhizoma)
sang1 ji4 sheng1 ( mistletoe, Taxilli Herba)
ju2 hua1 ( chrysanthemum, Chrysanthemi Flos)
:"":"
"
30 ()
; 1012 1520
1525 (); 10
1520
20
Lecture 4
FORMULA VARIATIONS
The Ling2 Shu1 (The Magic Pivot) states:
The brain is the sea of marrow. When the sea of marrow is
insufficient, [the patient experiences symptoms such as] spinning
brain and ringing ears, aching in the lower legs, vertigo, diminished
vision, sluggishness, and somnolence.
This is why tian1 ma2 wan2 contains very large amounts of kidneysupplementing medicinals. I use it to treat dizziness, tinnitus, and
neurasthenia that according to pattern identification are attributable to a
kidney vacuity pattern. The accompanying symptoms include: head dizziness,
tinnitus, diminished vision, forgetfulness, soreness and weakness in the
lumbus and legs, and entire body fatigue. When I treat such patterns the
prescriptions are usually decoctions, and the dosages for the main ingredients
are about 1/20th of the original dosage for the pills. To such a decoction I add
30 g of pre-decocted sheng1 shi2 jue2 ming2 (raw abalone shell), which
nourishes liver yin1 to subdue liver yang2 while also brightening the eyes.
To promote heart-kidney interaction and to quiet the spirit, add 1012 g of
yuan3 zhi4 (polygala) and 1520 g of ye4 jiao1 teng2 (flowery knotweed
stem). To promote kidney qi4 absorption and to treat tinnitus, add 1525 g of
pre-decocted ling2 ci2 shi2 (magnetic loadstone). To dispel wind and
brighten the eyes, add 10 g of ju2 hua1 (chrysanthemum) and 1520 g of
gou1 teng2 (uncaria); these two medicinals combine with tian1 ma2 to
eliminate head dizziness. These modifications always achieve very good
results, so please consider using this formula.
() 250
180 180 180 45
(
)
For patients who are more than 45 years of age and who have symptoms
such as dizzy head and flowery vision, headache with distending pain,
tinnitus and forgetfulness, sore lumbus and weakness in the knees, and
Lecture 4
10
unstable legs, combine tian1 ma2 wan2 with feng1 yin3 tang1 (WindDrawing Decoction)8 and add the following medicinals:
Cruda) 250 g
hua4 ju2 hong2 ( Huazhou pomelo rind, Citri Grandis
Exocarpium Rubrum) 180 g
ze2 xie4 ( alisma, Alismatis Rhizoma) 180 g
gou1 teng2 ( uncaria, Uncariae Ramulus cum Uncis) 180 g
Make into pills. The patients may also have: stubborn hypertension or
intermittent numbness in the limbs, fingers, and toes. Such patients have a
tendency to wind strike, and frequently taking this pill can prevent wind
strike. Use this formula even if blood pressure is not high when the patient
has the above-mentioned symptoms.
(:
34 )
:
() ""
FORMULA COMPARISONS
Tian1 Ma2 San3 ( Gastrodia Powder)
from Wei4 Sheng1 Bao3 Jian4 ( Precious Mirror of Health)
tian1 ma2 ( gastrodia, Gastrodiae Rhizoma)
ban4 xia4 ( pinellia, Pinelliae Rhizoma)
fu2 ling2 ( poria, Poria)
bai2 zhu2 ( white atractylodes, Atractylodis Macrocephalae
Rhizoma)
Grind the medicinals into a fine powder. Take 34 g per dose taken with
decocted sheng1 jiang1 (fresh ginger).
8
Double the dosages of the medicinals in feng1 yin3 tang1. (Au.)

Lecture 4
11
Both tian1 ma2 wan2 and tian1 ma2 san3 treat wind strike, hemiplegia,
deviated eyes and mouth, and difficult speech. Yet you should use tian1 ma2
wan2 to treat internal stirring of vacuity wind that results from kidney vacuity
or blood vacuity. In contrast, use tian1 ma2 san3 to treat internally exuberant
phlegm turbidity and wind-phlegm harassing the upper body. Although we
use the term wind strike in both cases, the patterns that each formula treats
are different. This is why clinicians must correctly perform the pattern
identification to avoid mistakes.
Finally, note that within the ancient books there are versions of this
formula that only use qiang1 huo2 and omit du2 huo2. But, such books
specify that the qiang1 huo2 should have a single stem, which was actually
du2 huo2.9 Thus, they did not separately specify du2 huo2. I mention this for
your reference.
3.(
4.3 Zhen4 Gan1 Xi1 Feng1 Tang1 ( Liver-Settling WindExtinguishing Decoction)

from Yi1 Xue2 Zhong1 Zhong1 Can1 Xi1 Lu4 ( Records of
Chinese Medicine with Reference to Western Medicine)10
30 30 () 15 () 15
() 15 () 15 15 15
6 () 6 6 4.5

sheng1 zhe3 shi2 ( crude hematite, Haematitum Crudum) 30 g
(finely ground)
sheng1 long2 gu3 ( crude dragon bone, Mastodi Ossis Fossilia
Cruda) 15 g (crushed)
sheng1 mu3 li4 ( raw oyster shell, Ostreae Concha Cruda) 15 g
(crushed)
sheng1 gui1 ban3 ( raw tortoise plastron, Testudinis Plastrum
9
This is confusing because the names of these ingredients have changed over time. In effect,
the ancients called both qiang1 huo2 and du2 huo2 by the same name, qiang1 huo2.
However, certain formulas specified that the qiang1 huo2 should have but one stem, which
is what we now call du2 huo2. (Ed.)
10
This book, by Zhang1 Xi1-Chun2 (), was published in seven volumes between
1918 and 1934. It is notable for presenting some of the first comparisons between Western
medicine and Chinese medicine, and it also recorded many very effective formulas. (Ed.)
Lecture 4
12
Crudum) 15 g (crushed)
sheng1 bai2 shao2 ( raw white peony, Paeoniae Radix Alba Cruda)
15 g
tian1 men2 dong1 ( asparagus, Asparagi Radix) 15 g
chuan1 lian4 zi3 ( toosendan, Toosendan Fructus) 6 g (crushed)
sheng1 mai4 ya2 ( raw barley sprout, Hordei Fructus Germinatus
Crudus) 6 g
yin1 chen2 hao1 ( virgate wormwood, Artemisiae Scopariae
Herba) 6 g
gan1 cao3 ( licorice, Glycyrrhizae Radix) 4.5 g
Decoct in water. In recent years we generally pre-decoct the many stone,
shell, and bone medicinals in this formula.
"" 30
6 24
15 30
For extreme heat in the heart, add 30 g of sheng1 shi2 gao1 (raw gypsum).
For profuse phlegm, add 6 g of dan3 xing1 (bile arisaema). For a cubit pulse
that is forceless when heavy pressure is applied, add 24 g of shu2 di4 huang2
(cooked rehmannia) and 15 g of shan1 zhu1 yu2 (cornus). For soft stools,
remove gui1 ban3 and zhe3 shi2, and add 30 g of chi4 shi2 zhi1 (halloysite).
Zhen4 gan1 xi1 feng1 tang1 treats wind strike disease caused by internal
wind. This condition manifests symptoms such as a stringlike long forceful
pulse, especially in the inch position, and excessively high blood pressure.11
The patient could also have: upper body exuberance and lower body vacuity
with frequent dizziness; frequent pain in the brain with heat effusion; eye
11
Normally Dr. Jiao1 does not mention a modern medicine symptom as a primary indication
for formulas. Perhaps the mention of high blood pressure here reflects modern medical
explanations in the source text. (Ed.)
Lecture 4
13
distention and tinnitus; vexation heat in the heart; frequent belching; a feeling
of gradual inhibition of the limbs; gradual deviation of the eyes and mouth; or
a complexion like that of a drunkard. In extreme cases there is dizziness and
fainting, loss of consciousness, and after some time the patient will regain
consciousness. Thereafter they are unable to recover and have spirit-mind
deficit, possibly with wilting of the limbs or with hemilateral wilting.
"
"
;
:
FORMULA ANALYSIS
The Su4 Wen4 (Elementary Questions) states: All wind associated with
shaking and dizzy vision is ascribed to the liver. The name of zhen4 gan1
xi1 feng1 tang1 (i.e., Liver-Settling Wind-Extinguishing Decoction)
references this principle, and the formula was created to treat this problem.
The liver governs wind. When there is kidney vacuity and water failing to
moisten wood, hyperactive liver yang2 ascends and wind arises internally.
With exuberance above and vacuity below, the lung qi4 does not downbear
and kidney qi4 does not contain, so that the wind dynamic makes the
thoroughfare qi4 and stomach qi4 ascend counterflow. This dynamic makes
the qi4 of all the viscera and bowels ascend. Qi4 and blood combine, travel
upward, and produce acute conditions, such as major reversal and sudden
reversal.
In acute conditions, one should treat the branch. Thus, this formula
emphasizes the use of niu2 xi1, which conducts qi4 and blood downward.
Lecture 4
14
Although niu2 xi1 treats the branch, it is the chief medicinal of this formula.
Long2 gu3, mu3 li4, gui1 ban3, and bai2 shao2 yao4 are support medicinals
that treat the root. They enrich liver and kidney yin1 and thereby emolliate
the liver, settle the liver, and subdue yang2 to extinguish liver wind. The
assistant medicinals are zhe3 shi2, xuan2 shen1, tian1 men2 dong1, mai4 ya2,
and gan1 cao3. Zhe3 shi2 downbears stomach qi4 and thoroughfare qi4, and
xuan2 shen1 and tian1 men2 dong1, which clear lung qi4 and depurate and
downbear the lung qi4. This action in turn settles and restrains liver wood.
Mai4 ya2 has a germinating and effusing nature; it normalizes the orderly
reaching of liver qi4 yet does not result in excessive depression. Moreover, it
harmonizes the stomach and assists digestion. Gan1 cao3 harmonizes the
center, regulates the hundred medicinals, and moderates the urgent action of
the formula. Yin1 chen2 hao1 enters the lesser yang2 (shao4 yang2) and has
an upbearing and effusing nature, like the qi4 of the early spring. These
actions are similar to those of the liver itself, so yin1 chen2 hao1 both drains
liver heat and soothes liver depression. Chuan1 lian4 zi3 conducts the liver
qi4 downward. Of these two courier medicinals, yin1 chen2 hao1 upbears
while chuan1 lian4 zi3 downbears. Used together, the medicinals in this
formula settle the liver and extinguish wind.
The source text explicitly states that in patients with vacuous and weak
cubit pulses on both hands, then because of true yin1 vacuity-detriment of the
kidney, kidney yin1 does not hold true yang2 together. When true yang2 then
deserts and rushes upward, it carries qi4 and blood in surging upward to the
head and brain. In such situations, add shu2 di4 huang2 (cooked rehmannia)
and shan1 zhu1 yu2 (cornus) to the formula as these medicinals enrich and
supplement kidney yin1 to astringe kidney qi4.
In recent years we have mostly used zhen4 gan1 xi1 feng1 tang1 to treat
hypertension with accompanying symptoms such as head and eye dizziness,
drunkard-like complexion, unstable legs, and tendency to wind strike. My
own conclusion is that even if the patient does not have high blood pressure,
this formula is still applicable as long as there are symptoms of liver and
kidney insufficiency and internal stirring of liver wind (as explained above).
In short, use this formula to treat dizziness and headache whenever the
Lecture 4
15
patterns of insufficient liver yin1 and internal stirring of liver wind are
present.
25
FORMULA MODIFICATIONS
I have also realized that wind strike disease patients often have windphlegm harassing the upper body. Therefore, in those cases of phlegm
exuberance, add one or two of the following medicinals:
hua4 ju2 hong2 ( Huazhou pomelo rind, Citri Grandis
Exocarpium Rubrum)
quan2 gua1 lou2 ( whole trichosanthes, Trichosanthis Fructus
Integer)
dan3 xing1 ( bile arisaema, Arisaema cum Bile)
tian1 zhu2 huang2 ( bamboo sugar, Bambusae Concretio Silicea)
For pronounced headache, consider adding xia4 ku1 cao3 (prunella) and
ju2 hua1 (chrysanthemum). For liver depression engendering heat, add
xiang1 fu4 zi3 (cyperus) and huang2 qin2 (scutellaria). If constipation
continues after taking the medicinals, add 25 g of jiu3 da4 huang2 (wineprocessed rhubarb) to disinhibit and precipitate the bowels.
(
)
Lecture 4
16
FORMULA COMPARISONS
Tian1 Ma2 Gou1 Teng2 Yin3 ( Gastrodia and Uncaria
Beverage)
tian1 ma2 ( gastrodia, Gastrodiae Rhizoma)
Cruda)
shan1 zhi1 zi3 ( gardenia, Gardeniae Fructus)
huang2 qin2 ( scutellaria, Scutellariae Radix)
chuan1 niu2 xi1 ( cyathula, Cyathulae Radix)
du4 zhong4 ( eucommia, Eucommiae Cortex)
yi4 mu3 cao3 ( leonurus, Leonuri Herba)
sang1 ji4 sheng1 ( mistletoe, Taxilli Herba)
ye4 jiao1 teng2 ( flowery knotweed stem, Polygoni Multiflori
Caulis)
fu2 shen2 ( root poria, Poria cum Pini Radice)
Zhen4 gan1 xi1 feng1 tang1 and tian1 ma2 gou1 teng2 yin3 both treat liver
wind stirring internally. The accompanying symptoms for this pattern are:
dizziness; headache; tinnitus; flowery vision; and trembling and numbness. In
extreme cases there is also hemiplegia. The former formula is quite strong in
settling the liver and extinguishing wind and also in enriching and nourishing
the liver and kidneys. In contrast, the latter is more effective for clearing liver
heat, quieting the heart spirit, calming the liver, and extinguishing wind.
Furthermore, zhen4 gan1 xi1 feng1 tang1 extinguishes wind by emphasizing
settling, enriching, and emolliating, while tian1 ma2 gou1 teng2 yin3
extinguishes wind by emphasizing clearing, cooling, and quieting the spirit as
well as boosting the kidney and quieting the liver.
Some of the medicinals in tian1 ma2 gou1 teng2 yin3, such as sang1 ji4
sheng1, du4 zhong4, and huang2 qin2, also quiet the fetus. Thus, to treat
epilepsy of pregnancy12 and gestational hypertension with symptoms such as
dizziness and headache, fainting, bruxism, and twitching of the limbs,
remove niu2 xi1 and yi4 mu3 cao3 from tian1 ma2 gou1 teng2 yin3 and add
the following medicinals:
12
This is similar to eclampsia. (Ed.)

Lecture 4
17
bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus)

fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix)
ling2 yang2 jiao3 ( antelope horn, Saigae Tataricae Cornu)
(
)
;
30
30 30 20
; 2030
10 9 9
Ling2 Yang2 Gou1 Teng2 Tang1 ( Antelope Horn and

Uncaria Decoction)
ling2 yang2 jiao3 ( antelope horn, Saigae Tataricae Cornu)
sang1 ye4 ( mulberry leaf, Mori Folium)
chuan1 bei4 mu3 ( Sichuan fritillaria, Fritillariae Cirrhosae Bulbus)
zhu2 ru2 ( bamboo shavings, Bumbusae Caulis in Taenia)
Exsiccata seu Recens)
bai2 shao2 yao4 ( white peony, Paeoniae Radix Alba)
fu2 shen2 mu4 ( pine root in poria, Poriae Pini Radix)
gan1 cao3 ( licorice, Glycyrrhizae Radix)
Both zhen4 gan1 xi1 feng1 tang1 and ling2 yang2 gou1 teng2 tang1
extinguish wind. The former formula, however, treats paralysis of the limbs
caused by liver yin1 vacuity and liver wind internally stirring. Settling the
liver and extinguishing wind are the special functions of this formula. The
latter treats clouded spirit, tetanic reversal, and twitching of the limbs caused
by liver heat engendering wind. Its specialty is clearing liver heat and
extinguishing liver wind while simultaneously transforming phlegm and
quieting the spirit.
Lecture 4
18
You can use ling2 yang2 gou1 teng2 tang1 to treat hypertension caused by
liver heat transforming into wind with symptoms such as dizziness, headache,
insomnia, and flowery vision by adding the following medicinals:
Cruda) 30 g
sang1 ji4 sheng1 ( mistletoe, Taxilli Herba) 30 g
While zhen4 gan1 xi1 feng1 tang1 is not appropriate for treating pregnancy
epilepsy, you can treat it with ling2 yang2 gou1 teng2 tang1 by adding the
following medicinals:
huang2 qin2 ( scutellaria, Scutellariae Radix) 10 g
bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 9 g
bai2 ji2 li2 ( tribulus, Tribuli Fructus) 9 g
CONTRAINDICATIONS
Zhen4 gan1 xi1 feng1 tang1 is inappropriate for treating patients with
severe phlegm-damp.
4.(
4.4 Di4 Huang2 Yin3 Zi3 ( Rehmannia Drink)

from Xuan1 Ming2 Lun4 Fang1 ( An Elucidation of Formulas)
90
30 15 10
3 1

ba1 ji3 tian1 ( morinda, Morindae Officinalis Radix) 30 g
shan1 zhu1 yu2 ( cornus, Corni Fructus) 30 g
shi2 hu2 ( dendrobium, Dendrobii Herba) 30 g
rou4 cong1 rong2 ( cistanche, Cistanches Herba) 30 g
Lecture 4
19
pao4 fu4 zi3 ( blast-fried aconite, Aconiti Radix Lateralis

Tosta) 30 g
rou4 gui4 ( cinnamon bark, Cinnamomi Cortex) 30 g
fu2 ling2 ( poria, Poria) 30 g
mai4 men2 dong1 ( ophiopogon, Ophiopogonis Radix) 30 g
shi2 chang1 pu2 ( acorus, Acori Tatarinowii Rhizoma) 30 g
yuan3 zhi4 ( polygala, Polygalae Radix) 30 g
wu3 wei4 zi3 ( schisandra, Schisandrae Fructus) 15 g
Grind these medicinals into a fine powder. For each dose boil 10 g of powder
in 1.5 cups of water with 3 slices of sheng1 jiang1 (fresh ginger), 1 da4 zao3
(jujube), and a little bo4 he2 (mint). Boil the water down to eight-tenths of a
cup and drink warm. In modern times we adjust the dosages and prepare this
formula as a decoction with modifications according to the pattern.
This formula treats wind strike, lesser yin1 (shao4 yin1) qi4 reversal, and
non-interaction of the heart and kidney that manifest as wind disablement.13
The accompanying symptoms include muteness and drooping legs with
inability to walk. Defecation and urination may be obstructed, incontinent, or
normal. The patient may also have a red complexion and vexation thirst.
FORMULA ANALYSIS
Di4 huang2 yin3 zi3 uses a large amount of di4 huang2, which enriches the
true yin1 of the kidney. Ba1 ji3 tian1, rou4 cong1 rong2, rou4 gui4, and fu4
13
Wind disablement ( feng1 fei4): Wilting and loss of the limbs without pain and
sometimes with loss of mental faculties. Usually a sequela of wind stroke. (Ed.)
Lecture 4
20
zi3 restore the fire of the true origin. Shi2 hu2 nourishes the stomach, quiets
the spleen, and secures the qi4. The sour and astringing medicinal shan1 zhu1
yu2 warms the liver and secures the essence. Shi2 chang1 pu2, yuan3 zhi4,
and fu2 ling2 supplement the heart and open the orifices to communicate with
the kidney viscus. Mai4 men2 dong1 and wu3 wei4 zi3 protect the lung and
nourish yin1 to enrich the water source. Thus, the formula makes the heart
and kidney interact so that essence qi4 becomes exuberant and wind and fire
are naturally extinguished. Note that fu4 zi3, rou4 gui4, ba1 ji3 tian1, rou4
cong1 rong2 were originally included in the formula to expel turbid yin1, and
you should not remove them from the formula lightly.
The main function of this formula is to warm and supplement the lower
origin and to promote absorption of floating yang2.14 It simultaneously opens
the heart orifice, expels phlegm turbidity, and promotes interaction of the
heart and kidneys. Appropriate use of this formula brings very good results.
I often use di4 huang2 yin3 zi3 to treat the following Western medical
diagnoses when they manifest with signs of wind strike or wind disablement:
myelanalosis, myelitis, lateral sclerosis, multiple sclerosis, and chronic
progressive bulbar paralysis. Accompanying symptoms could include: stiff
tongue with sluggish speech and choking when swallowing; paralysis in the
legs; muscle atrophy in the four limbs; unsteady and unbalanced gait, as if
stepping on a spongy surface or on a ball; or loss of control of the bowels and
bladder.
14
In this instance, floating yang2 ( fu2 yang2) refers to yang2 that floats astray due to
vacuity cold in the lower origin (i.e., kidney yang2 vacuity). (Ed.)
Lecture 4
21
For patients who have difficulty walking and cold legs with a pronounced
preference for warmth, use larger dosages of rou4 gui4 and fu4 zi3 and add
the following medicinals:
yin2 yang2 huo4 ( epimedium, Epimedii Herba)
bu3 gu3 zhi1 ( psoralea, Psoraleae Fructus)
xu4 duan4 ( dipsacus, Dipsaci Radix)
niu2 xi1 ( achyranthes, Achyranthis Bidentatae Radix)
For inhibited urination, add che1 qian2 zi3 (plantago seed) and mu4 tong1
(trifoliate akebia). For urinary incontinence, add fu4 pen2 zi3 (rubus), sang1
piao1 xiao1 (mantis egg-case), and wu1 yao4 (lindera). For hypertonic
muscles in the limbs, add:
shen1 jin1 cao3 ( ground pine, Lycopodii Herba)
sheng1 yi3 mi3 ( raw coix seed, Coicis Semen Crudum)
sheng1 bai2 shao2 ( raw white peony, Paeoniae Radix Alba Cruda)
bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus)
When enduring, recalcitrant cases, add:
hong2 hua1 ( carthamus, Carthami Flos)
tao2 ren2 ( peach kernel, Persicae Semen)
di4 long2 ( earthworm, Pheretima)
zhi4 shan1 jia3 ( mix-fried pangolin scales, Manis Squama cum
Liquido Fricta)
19591960
()
CASE HISTORIES
From 1959 to 1960 I worked in coordination with the Chinese Academy of
Medical Sciences and its associated hospital and Institute of Dermatology
and Venereology as well as the Department of Dermatology and Venereology
at the hospital associated with the Tian1Jin1 College of Traditional Chinese
Medicine. We did a clinical study on the use of di4 huang2 yin3 zi3 with
modifications for the treatment of tabes dorsalis and myelitis. In the study,
Lecture 4
22
we used no drugs from modern medicine, but did use vitamin supplements.
The research had quite satisfying results. Here I summarize two of the cases
for your reference.
:49 1959 4 13 . 11
4
:
;
B1
B12B6C B.A.L
Case 1: Mr. Liu2, 49 years old, admitted to the hospital on April 13, 1959.
Eleven days before entering the hospital the patient had shivering, heat
effusion, and aching soreness and weakness in both legs. By April 4 he had
anuria and could not walk. He had tried many Western drugs, but the
treatments were ineffective. A neurological examination revealed complete
flaccid paralysis in both legs, loss of pain sensation, tactile hypoesthesia,
absence of superficial and deep reflexes, absence of plantar reflex, and
urinary and fecal retention. A lumbar puncture and blood tests were also
performed, and the diagnosis was myelitis. While in the hospital he took
vitamins B1, B12, B6, and C as well as penicillin, and a catheter was inserted
to open and drain the bladder. However, his condition did not improve.
4 22
(),4 25
4 27
4 28
5 23 6 23
6 30 ""
On April 22 the patient started to use Chinese medicinals. The diagnosis

was wind disablement, and the treatment was primarily di4 huang2 yin3 zi3,
with modifications according to the pattern. He continued taking the same
vitamins. By April 25 he had regained a portion of his sense of pain in the
lower legs, muscle tone had increased, and the tendon reflexes appeared. By
April 27 he could slightly move his right leg. By April 28 the patient could
slightly move both legs; he had recovered feeling in his legs and had
Babinskis sign in both legs. By May 23 he could get out of bed and get
around with a walker. By June 23 he could walk by himself; the catheter had
Lecture 4
23
been removed and he could urinate without assistance. On June 30 he was

basically cured and the hospital discharged him.
:22 1958 9 24
1956 2 7 0.1
9 3 1958 5 7
: 0.1 0.5
1 2
B1B12
B.AL
Case 2: Ms. Wang2, 22 years old, admitted to the hospital on September 24,
1958. In February 1956 the patient experienced diminished vision in her left
eye, and after July of that year lost her sight. After treatment she regained her
eyesight only to 0.1.15 In September 1956 she experienced numbness below
her waist. She recovered after three months with no treatment. In May 1958
she had diminished eyesight in both eyes, and 7 days later she could only
perceive light. Her limbs were numb and weak, especially on the right side.
When she entered the hospital she had difficulty urinating, and she could not
walk.
Her eyesight was 0.1 and 0.5 in the left and right eyes, respectively; she
had primary atrophy of the optic disk in both eyes. Below the first cervical
vertebra she had a slightly diminished superficial sensibility; below the T-2
thoracic vertebra deep sensibility had disappeared. The limbs on the right
side were weak, and on the left the limbs were completely paralyzed. There
were hypertonic tendon reflexes in the upper limbs, tendon reflexes in the
lower limbs could be elicited, but superficial reflexes were absent as were
pathological reflexes. The hospital performed lumbar puncture, blood tests,
and other examinations, and the diagnosis was ophthalmoneuromyelitis. The
patient received vitamin therapy with B1 and B12, methenamine, penicillin,
streptomycin, cortisone, and physiotherapy. Her condition would sometimes
fluctuate, but overall there was no improvement.
15
The relevant scale for vision tests goes to 2.0, which is the best vision. In China, a score
below 1.0 can disqualify people for certain careers, so obviously this patient has quite poor
vision. (Ed.)
Lecture 4
24
1959 4 18
4 24 5 9
5 15
(+)5 18 5 27
6 3
8 16 ""
On April 18, 1959, she turned to Chinese medicine, and continued ordinary
vitamin therapy but gave up other modern medicine drugs. According to the
four examinations of Chinese medicine the patient had kidney vacuity that
manifested as wind disablement. The primary treatment for her was di4
huang2 yin3 zi3, prepared as a decoction and modified according to the
pattern. By April 24 her lower legs could sense pain. By May 9 she had
recovered some sense of pain in half of her body, and her left knee joint
could resist heavy force. By May 15 she had completely recovered sensibility,
both legs could resist heavy force, and the ankle reflex was (+). By May 18
bilateral pathological reflexes had disappeared. By May 27 she was urinating
easily. By June 3 her arms had recovered their strength. At that point we
changed to a different formula and adjusted it according to pattern
identification. By August 16 she was basically cured and released from the
hospital.
: 15 12 10 15
912 69 912
912 10 1015 912
912 915 12 9
69 10 ;
915 15 ; 0.61
10 ; 10 6
Here is the basic formula that we used in the study as well as the standard
modifications:
shu2 di4 huang2 ( cooked rehmannia, Rehmanniae Radix
Praeparata) 12 g
shan1 zhu1 yu2 ( cornus, Corni Fructus) 10 g
rou4 cong1 rong2 ( cistanche, Cistanches Herba) 15 g
Lecture 4
25
fu4 zi3 ( aconite, Aconiti Radix Lateralis Praeparata) 912 g

ba1 ji3 tian1 ( morinda, Morindae Officinalis Radix) 912 g
yin2 yang2 huo4 ( epimedium, Epimedii Herba) 912 g
lu4 jiao3 jiao1 ( deerhorn glue, Cervi Cornus Gelatinum) 10 g
yuan3 zhi4 ( polygala, Polygalae Radix) 912 g
xu4 duan4 ( dipsacus, Dipsaci Radix) 915 g
shi2 hu2 ( dendrobium, Dendrobii Herba) 12 g
tian1 men2 dong1 ( asparagus, Asparagi Radix) 9 g
mai4 men2 dong1 ( ophiopogon, Ophiopogonis Radix) 9 g
For patient with pronounced pain, add:
chuan1 wu1 tou2 ( aconite main tuber, Aconiti Radix) 69 g
cao3 wu1 tou2 ( wild aconite, Aconiti Kusnezoffii Radix) 69 g
an1 lu92 zi3 ( Keiske artemisia fruit, Artemisiae Keiskeanae
Fructus) 10 g
For inhibited urination, add 915 g of hai3 jin1 sha1 (lygodium spore) and
15 g of che1 qian2 zi3 (plantago seed).
For vacuity cold in the lower origin, add 0.61 g of powdered liu2 huang2
(sulfur) (taken drenched) and 10 g of zhong1 ru3 shi2 (stalactite).
For patients with thick slimy tongue fur and a poor appetite, add 10 g of
huo4 xiang1 (agastache) and 6 g of sha1 ren2 (amomum).
30
I have used this formula with modifications for more than 30 years to treat
spinal cord pathologies such as tabes dorsalis, myelitis, lateral sclerosis,
combined sclerosis, and myelosringosis. It has always achieved quite good
Lecture 4
26
results. I hope that everyone will try this formula and advance the research
even further.
FORMULA COMPARISONS
Di4 huang2 yin3 zi3 and zhen4 gan1 xi1 feng1 tang1 (Liver-Settling WindExtinguishing Decoction) both treat wind strike, but the former strongly
supplements the kidney, nourishes the liver, and opens the orifices, whereas
the latter strongly settles the liver, downbears counterflow, and extinguishes
wind.
5. ()
4.5
Xiao1 Feng1 San3 ( Wind-Dispersing Powder)

from Cheng2 Fang1 Qie4 Yong4 ( Effective Use of Formulas)
15 () 15 15 15 60
60 60 60 60 () 60
60 50 3 3
5
hou4 po4 ( officinal magnolia bark, Magnoliae Officinalis

Cortex) 15 g (roasted in ginger juice)
chen2 pi2 ( tangerine peel, Citri Reticulatae Pericarpium) 15 g
zhi4 gan1 cao3 ( mix-fried licorice, Glycyrrhizae Radix cum
Liquido Fricta) 15 g
jing1 jie4 sui4 ( schizonepeta spike, Schizonepetae Flos) 15 g
fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 60 g
chan2 tui4 ( cicada molting, Cicadae Periostracum) 60 g
huo4 xiang1 ( agastache, Agastaches Herba) 60 g
bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 60 g (roasted)
chuan1 xiong1 ( chuanxiong, Chuanxiong Rhizoma) 60 g
ren2 shen1 ( ginseng, Ginseng Radix) 50 g
Grind the medicinals into a fine powder. Take 3 g three times a day. For
serious cases, increase the dosage to 5 g per dose. Swallow the powder with
tea. Patients who have sores or lichen should take the powder with huang2
jiu3 (yellow wine).
Lecture 4
27
( 9 )
: 3 3 3 3
9 10 10 10 10
10 10 10
Since the dosages in the original formula were too large (9 g per day), later
practitioners made this formula as a decoction. In general the dosages are:
Cortex) 3 g (roasted in ginger juice)
Liquido Fricta) 3 g
bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 10 g (roasted)
Decoct in water. If the patient has no vacuity pattern or has a wind-heat
pattern, omit ren2 shen1.
Xiao1 feng1 san3 treats wind evil attacking the upper body, which causes:
headache with dizzy vision; hypertonicity of the nape and neck; congested
nose with a heavy voice; sneezing with nasal mucus and tearing; and itchy
Lecture 4
28
wind papules or dry lichen 16 that appear on the skin and are difficult to
eliminate. In some cases the wind evil assails a woman during menstruation,
such that the thoroughfare and controlling vessels contract wind that then
enters into the blood aspect. This causes retention of wind evil in the blood,
which gives rise to papules in the skin that are small, red, itchy, and difficult
to endure. When the patient scratches these papules, they often rupture the
skin in some areas such that sores form.
FORMULA ANALYSIS
In this formula the acrid, dissipating, light, and floating medicinals qiang1
huo2, fang2 feng1, jing1 jie4, and chuan1 xiong1 eliminate wind from the
head, eyes, neck, and back. Bai2 jiang1 can2 and chan2 tui4 are light and
clearing medicinals; as they are skins themselves, they tend to penetrate the
human skin and thus eliminate wind from the skin. Huo4 xiang1 and hou4
po4 are aromatic and foulness repelling medicinals that regulate qi4, and
disperse distention to eliminate evils and dissipate fullness. Ren2 shen1, fu2
ling2, chen2 pi2, and gan1 cao3 boost qi4 and transform dampness; they
regulate the center, support the right qi4, and prevent wind evil from abiding
and stagnating. Together these medicinals comprise a commonly used
formula that treats wind evil.
9
15 5 13
,
FORMULA VARIATION
Except for slight differences in dosages, this formula is similar to a formula
of the same name from Tai4 Ping2 Hui4 Min2 He2 Ji4 Ju2 Fang1 (Tai416
Dry lichen ( gan1 xian3): Lichen is a skin diseases characterized by elevation of the
skin, serous discharge, scaling, and itching; dry lichen is a variety of lichen that is
characterized by dryness and scaling. (Ed.)
Lecture 4
29
Ping2 Imperial Grace Pharmacy Formulas). The Yi1 Zong1 Jin1 Jian4 (The
Golden Mirror of Medicine) also provides a formula with the name xiao1
feng1 san3 (Wind-Dispersing Powder), and it consists of the following
medicinals:
dang1 gui1 ( Chinese angelica, Angelicae Sinensis Radix) 9 g
zhi1 mu3 ( anemarrhena, Anemarrhenae Rhizoma) 9 g
ku3 shen1 ( flavescent sophora, Sophorae Flavescentis Radix) 9 g
hei1 zhi1 ma2 ( black sesame, Sesami Semen Nigrum) 9 g
jing1 jie4 ( schizonepeta, Schizonepetae Herba) 9 g
cang1 zhu2 ( atractylodes, Atractylodis Rhizoma) 9 g
niu2 bang4 zi3 ( arctium, Arctii Fructus) 9 g
shi2 gao1 ( gypsum, Gypsum Fibrosum) 15 g
mu4 tong1 ( trifoliate akebia, Akebiae Trifoliatae Caulis) 5 g
This version of xiao1 feng1 san3 treats wind-heat assailing the exterior. The
accompanying symptoms are itching skin and red papules that come and go.
In extreme cases, the patient will simultaneously have headache and heat
effusion.
Both formulas treat itching skin, dormant papules, wind papules, and lichen
sores, and the chief action of both formulas is to course wind and stop itching.
The Cheng2 Fang1 Qie4 Yong4 version of xiao1 feng1 san3 is stronger for
externally dissipating wind-cold, but it is weaker for eliminating dampness
and stopping itch. It furthermore supports right qi4. The Yi1 Zong1 Jin1
Jian4 version is stronger for eliminating dampness and stopping itching and
for dissipating wind and clearing heat, but it cannot dissipate wind-cold and it
does not support right qi4.
Lecture 4
30

()
: 9 12
10 912 610 1218
10 915 1030 1030
10 69 618 9
I often mix these two formulas together and modify the resulting formula
according to the pattern, which principally treats stubborn cases of diseases
such as wind papules (urticaria or hives), itching eruptions due to blood-heat
or wind-heat, and psoriasis. I often obtain extraordinary results with this
approach. Here is a formula I frequently use:
chi4 shao2 yao4 ( red peony, Paeoniae Radix Rubra) 12 g
hong2 hua1 ( carthamus, Carthami Flos) 10 g
lian2 qiao2 ( forsythia, Forsythiae Fructus) 1218 g
ku3 shen1 ( flavescent sophora, Sophorae Flavescentis Radix) 10
30 g
bai2 xian1 pi2 ( dictamnus, Dictamni Cortex) 1030 g
Decoct in water.
69 35
30 30 30
2030 610
10
20 912
30 () 610
35 () 1015
Lecture 4
31
10 9 36
For stubborn wind papules that do not heal, change the dosages of ku3
shen1 and bai2 xian1 pi2 to 30 g, use 2030 g of lian2 qiao2, and add the
zao4 jiao3 ci4 ( gleditsia thorn, Gleditsiae Spina) 69 g
she2 tui4 ( snake slough, Serpentis Periostracum) 35 g
ren3 dong1 teng2 ( lonicera stem, Lonicerae Caulis) 30 g
dan1 shen1 ( salvia, Salviae Miltiorrhizae Radix) 30 g
If the patient also has headache and late or scant menses, add 610 g of
chuan1 xiong1 (chuanxiong).
For itching skin that the patient scratches and causes red skin and a burning
sensation, add 1020 g of sheng1 di4 huang2 (dried/fresh rehmannia) and 9
12 g of chao3 huang2 bai3 (stir-fried phellodendron).
For patients who also have thirst and aversion to heat (possibly during the
summertime or in a hot environment), add:
sheng1 shi2 gao1 ( raw gypsum, Gypsum Crudum) 30 g (predecoct)
huang2 lian2 ( coptis, Coptidis Rhizoma) 610 g
bo4 he2 ( mint, Menthae Herba) 35 g (add at end)
For red papules that are indistinct, itchy, and do not outthrust easily, add:
niu2 bang4 zi3 ( arctium, Arctii Fructus) 10 g
sheng1 ma2 ( cimicifuga, Cimicifugae Rhizoma) 9 g
jie2 geng3 ( platycodon, Platycodonis Radix) 36 g
I have used this method to treat many patients of this kind, and all of them
had very good results, so please consider using it yourself.
Lecture 4
32
()
FORMULA COMPARISON
Many doctors use fang2 feng1 tong1 sheng4 san3 (Saposhnikovia SageInspired Powder) (sometimes in pill form) to treat itching skin and lichen
sores. Fang2 feng1 tong1 sheng4 san3 principally treats patterns of wind-heat
congestion and exterior-interior repletion, while xiao1 feng1 san3 treats
fettered wind evil depressed in the skin and exterior.
6()
4.6
Qian1 Zheng4 San3 ( Pull Aright Powder)

from Cheng2 Fang1 Qie4 Yong4 ( Effective Use of Formulas)
50 50 50 6
bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 50 g

quan2 xie1 ( scorpion, Scorpio) 50 g
Grind the medicinals into a fine powder. Take 6 g per dose, mixed with
huang2 jiu3 (yellow wine).
()
Qian1 zheng4 san3 treats sudden occurrence of wind strike with

accompanying symptoms such as deviated eyes and mouth, facial
hemiparalysis, inability to pucker the mouth, deviation of the nasolabial
groove, drooping at the corner of the mouth, and inability to close one of the
eyes. There is an absence of other symptoms throughout the body. According
to Western medicine, this is facial paralysis.
()
Lecture 4
33
According to Chinese medicine, when you see a patient has deviated eyes
and mouth along with no other systemic symptoms, you can conclude that the
disease is associated with the foot greater yang2 (tai4 yang2) and foot yang2
brightness (yang2 ming2) channels. The foot yang2 brightness channel passes
the mouth and surrounding lips, while the foot greater yang2 channel travels
upward to the medial portion of the eye. The deviated eyes and mouth are the
result of wind-phlegm and brewing heat that pull and tighten in the channels.
The patient has no other systemic symptoms because neither the other
channels nor the viscera and bowels contract evils.
;;
FORMULA ANALYSIS
Although the name of this disease is wind strike, the character for wind
indicates the abrupt and sudden nature of the disease and does not refer to
damage caused by wind. Bai2 fu4 zi3 is an acrid and dissipating medicinal
that expels wandering wind from the face. Bai2 jiang1 can2 is a light
medicinal that travels upward to clear the face; its salty nature softens and
transforms phlegm-turbidity, while its acrid nature expels wind evil. Quan2
xie1 is an important medicinal for treating wind; it is slightly toxic, and it
breaks wind-phlegm binds. Finally, huang2 jiu3 has an acrid-warm nature
that courses and dissipates. It conducts the other medicinals into the channels
and network vessels so that they can set the eyes and mouth aright.
610 ( 56 )
Today many people administer this formula as a decoction and add

ingredients according to the pattern. In general, the dosage of each medicinal
is 610 g. Some people will slightly decrease the dosage of bai2 fu4 zi3 to 5
6 g, and the curative effect is still very good.
: 6
10 9 10 1015 610
Lecture 4
34
10 23 1218 10
3 6 1
I have used this formula with added ingredients to treat many cases of
facial nerve paralysis. The majority of the patients who have this disease can
completely recover and have no sequelae. The following is my empirical
formula:
bai2 zhi3 ( Dahurian angelica, Angelicae Dahuricae Radix) 10 g
ge2 gen1 ( pueraria, Puerariae Radix) 1015 g
wu2 gong1 ( centipede, Scolopendra) 23 pieces
su1 mu4 ( sappan, Sappan Lignum) 1218 g
xi4 xin1 ( asarum, Asari Herba) 3 g
Liquido Fricta) 6 g
Decoct in water and take one packet each day.
( 1 >;
1 1 .
12 1
23
In addition to taking the decoction, the patient should use powdered bai2
jie4 zi3 (white mustard) mixed with hot water to form a thin paste that is
placed on a gauze bandage and applied to the deviated side of the face. Here
are the steps in the procedure. First place the paste inside the oralbuccal
Lecture 4
35
cavity directly on the membrane inside the cheek. Then with the patients
mouth open, use needle-picking therapy to slightly bleed the front, middle,
and back along the upper teeth, the lower teeth, and between the upper and
lower teeth. All nine points should be on the deviated side. After the
acupuncture treatment, apply the gauze bandage with the thin paste made of
powdered bai2 jie4 zi3 to the deviated side. Press the bandage tightly to the
shape of the face and cut it to size. Apply the plaster in the evening. Half way
through the night the medicinal will have lost its efficacy and the patient can
discard the plaster. Perform this supplementary treatment every evening or
every other evening. If the plaster causes blisters or erosion on the skin, then
wait until the skin heals before using the plaster again. In such cases, apply
the bai2 jie4 zi3 paste more thinly to avoid again causing skin erosion.
Generally speaking, the above mentioned formula and the plaster together
will produce the desired result in approximately 12 weeks. The patient will
gradually improve over the course of one month. Please note that the best
results occur when the patient simultaneously takes the decoction internally
and applies the bai2 jie4 zi3 plaster externally. In this way we enhance the
curative effect. If the patient also has an acupuncture treatment 23 times a
week, the patient will recover even more quickly.
1980 :
50 1980 11 29
: 10 10
10 6 6 10
30 () 10 10 20
10 15 20 () 6 3
CASE HISTORIES
In 1980 the mother of one of my students suddenly suffered deviation of
the eyes and mouth. This is her case history:
Case 1: Mrs. Shao4, 50 years old. Date of first visit: November 29, 1980.
One day before the patient suddenly had facial paralysis on the left side.
She had deviation of the mouth toward the right and her left eye would not
close. She also had numbness of the tongue, tinnitus in the left ear, and heart
Lecture 4
36
palpitations. She usually had constipation, and prior to the onset of deviated
eyes and mouth she had a sore throat. The tongue fur was thin and slightly
yellow, and the pulse was stringlike and slippery. By correlating the pulse
and signs, I diagnosed wind strike in the network vessels with depressed heat
in the interior; the combined interior and exterior evils were obstructing the
channels and network vessels, which resulted in the symptom of deviated
eyes and mouth.
Method of treatment: Course wind and clear heat as well as calm the liver
and quicken the network vessels.
I combined ideas from qian1 zheng4 san3 and xiao1 feng1 san3 (WindDispersing Powder)17 and then made modifications. This was the prescription:
jing1 jie4 ( schizonepeta, Schizonepetae Herba) 10 g
ju2 hua1 ( chrysanthemum, Chrysanthemi Flos) 10 g
Cruda) 30 g (pre-decoct)
jin1 yin2 hua1 ( lonicera, Lonicerae Flos) 10 g
ling2 ci2 shi2 ( magnetic loadstone, Magnetitum
Magneticum) 20 g (pre-decoct)
I gave the patient three packets.
(12 2 ):
: 10 10 10
10 6 9 10
17
For the details of xiao1 feng1 san3 ( Wind-Dispersing Powder), see the preceding
formula in this Lecture. (Ed.)
Lecture 4
37
10 30 30 () 30 (
) 12 3 3
Second visit: December 2. The patient still had deviated eyes and mouth,
dizziness, tinnitus in the left ear, numbness on the left side of the tongue, no
sense of taste, a red tongue with thin yellow tongue fur, and a stringlike fine
pulse. I modified the original prescription to emphasize the liver-calming,
fire-clearing medicinals. This was the second prescription:
man4 jing1 zi3 ( vitex, Viticis Fructus) 10 g
(pre-decoct)
chao3 huang2 qin2 ( stir-fried scutellaria, Scutellariae Radix
Fricta) 12 g
I again gave the patient three packets.
(12 5 ):
10 6 10
40 5
Third visit: December 5. The corner of the mouth on the left side could
move on its own accord, and the mouth already had no visible deviation. The
left side of the face and the superciliary ridge were both painful, while the
tongue fur was yellow and the pulse was slippery. Using the second
prescription as the base formula, I further adjusted it by omitting bai2 ji2 li2
and da4 huang2, increasing the dosage of sheng1 zhe3 shi2 (crude hematite)
to 40 g, and adding:
Lecture 4
38

Liquido Fricta) 6 g
I gave the patient five packets.
(12 13 ):
: 10
10 10 9 9
6 30 12 30 10
9 10 30 () 6
5
Fourth visit: December 13. The patient showed no evidence of deviated

eyes and mouth except for slight asymmetry when she made a big smile. The
tinnitus in the left ear continued, and the tongue and pulse were the same as
the previous visit. I further modified the prescription and gave the patient five
packets of the following:
Integer) 30 g
Fricta) 12 g
Liquido Fricta) 6 g
Lecture 4
39
(12 19 ):
: 10 10 15 10
10 12 9 6 10
30 30 () 10 9 5
Fifth visit: December 19. The patient had completely recovered from the
facial paralysis and deviation of the eyes and mouth. Only a few minor issues
remained, such as a slightly noticeable shallowness on the left side of the
nasolabial groove, tinnitus in the left ear, and ungratifying defecation. The
patient had a red tongue with thin yellow fur and a fine stringlike pulse,
particularly in the cubit pulse. From the pulse I knew that the patient had fire
in the kidney,18 so I changed the prescription once again:
chao3 huang2 bai3 ( stir-fried phellodendron, Phellodendri Cortex
Frictus) 10 g
gua1 lou2 ( trichosanthes, Trichosanthis Fructus) 30 g
Liquido Fricta) 9 g
I gave the patient five packets.
18
Here the fire in the kidney refers to a vacuity fire, not the life gate fire that is supposed to
be in the kidney. Later in the case Dr. Jiao1 further mentions liver-kidney fire, another
reference to vacuity fire. (Ed.)
Lecture 4
40
(1981 1 2 ):
: 20 12 10
12 9 10 5
30 () 20 () 10
15 10 30 6
Sixth visit: January 2, 1981. The shape of the face, the feeling on the left
side of the face, and the feeling in the tongue had all made a complete
recovery and returned to normal. During the preceding few days the patient
had dry bound stools, dry mouth, tinnitus in the left ear, and a red tongue
with thin yellow dry fur. So, although she had recovered from the paralysis,
she still had liver-kidney fire. I treated her by emphasizing the kidneyboosting and liver-calming medicinals in the prescription that follows:
di4 gu3 pi2 ( lycium root bark, Lycii Cortex) 12 g
ling2 ci2 shi2 ( magnetic loadstone, Magnetitum
Magneticum) 20 g (pre-decoct)
cao3 jue2 ming2 ( fetid cassia, Cassiae Semen) 10 g
tian1 hua1 fen3 ( trichosanthes root, Trichosanthis Radix) 15 g
Integer) 30 g
I gave the patient six packets. In follow-up inquiries over several years, we
found that after recovering the patient had no relapses.
1960 (18 )
Lecture 4
41
: 10 10
10 10 6 9
9 10 10 10 10
1
Case 2: In 1960 my eldest daughter was eighteen years old and she
suddenly had deviated eyes and mouth. I immediately needled the following
acupuncture points:
Tai4 Yang2 ( Greater Yang2)
TB-21 ( er3 men2, Ear Gate)
GB-3 ( shang4 guan1, Upper Gate)
ST-7 ( xia4 guan1, Below the Joint)
SI-18 ( quan2 liao2, Cheek Bone-Hole)
ST-4 ( di4 cang1, Earth Granary)
LI-4 ( he2 gu3, Union Valley)
I treated her once every other day, alternating between the two sides, and at
the same time gave her the following modified qian1 zheng4 san3
prescription:
Liquido Fricta) 9 g
dang1 gui1 wei3 ( tangkuei tail, Angelicae Sinensis Radicis
Extremitas) 10 g
We decocted these medicinals in water and she took one packet each day.
Also, after brewing the medicinals and straining off all of the liquid, we
Lecture 4
42
wrapped the medicinal dregs in a towel and pressed it on the affected side of
her face. She recovered in ten days.
"":
(
9 ) 1
FORMULA COMPARISON
Bu2 Huan4 Jin1 Dan1 ( Priceless Elixir)19
Among the ancient pill prescriptions there is one known as bu2 huan4 jin1
dan1:
jing1 jie4 sui4 ( schizonepeta spike, Schizonepetae Flos) 1 liang3
gan1 cao3 ( licorice, Glycyrrhizae Radix) 1 liang3
fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 1 liang3
tian1 ma2 ( gastrodia, Gastrodiae Rhizoma) 1 liang3
bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus) 1 liang3
bo4 he2 ye4 ( mint leaf, Menthae Folium) 3 liang3
qiang1 huo2 ( notopterygium, Notopterygii Rhizoma et
Radix) 5 qian2
chuan1 xiong1 ( chuanxiong, Chuanxiong Rhizoma) 5 qian2
bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 5 qian2
wu1 tou2 ( aconite, Aconiti Radix Wutou) 5 qian2
xie1 shao1 ( scorpion tail, Buthi Caudex) 5 qian2
huo4 xiang1 ye4 ( agastache leaf, Agastaches Folium) 5 qian2
Grind the medicinals into a fine powder, mix with lian4 mi4 (processed
honey), and form into pills with each pill weighing 3 qian2 (or roughly 9 g).
Each dose consists of one pill taken with tea or huang2 jiu3 (yellow wine).
19
The name of this formula, bu2 huan4 jin1 dan1 (), literally means do not trade
gold elixir. That is, because this elixir is so efficacious, one would not want to trade it even
for gold. Thus, we render it as Priceless Elixir. (Ed.)
Lecture 4
43
Like qian1 zheng4 san3, this formula also treats mouth deviation due to wind
strike, and furthermore one can also dissolve the pills in huang2 jiu3 and
spread the resulting tincture on the affected area. In comparison, bu2 huan4
jin1 dan1 is a stronger than qian1 zheng4 san3 for abating wind and
dissipating heat as well as expelling phlegm and cold. When you treat
patients with deviation of the eyes and mouth due to wind strike, you can use
bu2 huan4 jin1 dan1 not only for patterns of exuberant wind evil, but also for
patterns with cold accompanying wind, phlegm accompanying wind, or qi4blood congestion. You can also modify bu2 huan4 jin1 dan1 according to the
pattern and prescribe it in decoction form. Because qian1 zheng4 san3 has
only a few medicinals, it is easy to modify for specific patterns and thus it is
used relatively more frequently than bu2 huan4 jin1 dan1.
7. {}
4.7 Gui4 Zhi1 Shao2 Yao4 Zhi1 Mu3 Tang1 (

Cinnamon Twig, Peony, and Anemarrhena Decoction)
Golden Coffer)
12 9 12 15 15 12
6 6 6 3
1

bai2 shao2 yao4 ( white peony, Paeoniae Radix Alba) 9 g
sheng1 jiang1 ( fresh ginger, Zingiberis Rhizoma Recens) 15 g
Rhizoma) 15 g
ma2 huang2 ( ephedra, Ephedrae Herba) 6 g
zhi4 fu4 pian4 ( sliced processed aconite, Aconiti Radix Lateralis
Praeparata Secta) 6 g
Liquido Fricta) 6 g
Decoct the medicinals in water two times and mix together the resulting
medicinal juice. Divide into three doses, and take them during the course of
one day.
Lecture 4
44
"
"
FORMULA ANALYSIS
Gui4 zhi1 shao2 yao4 zhi1 mu3 tang1 treats wind-cold-damp impediment
in the channels and network vessels. It also treats impediment of qi4 and
blood. This formula addresses enduring, difficult to cure disease with
symptoms such as pain in the joints of the entire body, lameness with marked
emaciation, extremely swollen feet, dizzy head and shortness of breath, and
seething with a desire to vomit. In this formula gui4 zhi1, ma2 huang2, and
fang2 feng1 warm and dissipate wind-cold. Bai2 shao2 yao4 and zhi1 mu3
harmonize and protect yin1 from heat and dryness. Sheng1 jiang1 and gan1
cao3 regulate the stomach and harmonize the center. The combination of
bai2 zhu2 and fu4 zi3 warms the channels, dissipates cold, and quickly expels
cold-damp impediment pain. Together, these medicinals effectively expel
wind-cold-damp, warm the channels and vessels, and stop pain. When
Zhang1 Zhong4-Jing3 () wrote lameness with marked emaciation in
the source text, he meant the joints of the body are stiff, bent, and deformed
such that they do not move independently, and the body is so emaciated and
weak that the patients cannot take care of themselves and become disabled. In
effect he was succinctly describing what modern medicine diagnoses as
rheumatoid arthritis with deformed joints of the limbs and damaged osseous
tissue.
50
Since the late 1950s, I have used this formula modified according to the
pattern to treat rheumatoid arthritis with rickets and rigidity of the spine and
have had very good results.
1974
""
Lecture 4
45
1981
".
"32 "1981 12
""
1983 ""
300
;""
Around 1974 I presented a paper entitled Conclusions on Identifying and

Treating Impediment Disorder to a conference of internal medicine
specialists. Among other things, I introduced my empirical formula for
treating rheumatoid arthritis, which was essentially gui4 zhi1 shao2 yao4 zhi1
mu3 tang1 modified according to the pattern. In 1981 a Dr. Li3 Heng2-Min3
sent a letter to me at the hospital stating that he had used my empirical
formula in response to a patient of his with rheumatoid arthritis. Several
months later, The Peoples Daily printed a thank you letter from the patient.
Consequently, the hospital and outpatient center became very busy, and the
director of the institute charged several of us with establishing a research
organization for treating impediment disorders as well as with opening a
specialized outpatient center and hospital ward for treating this disorder.
I then decided to use gui4 zhi1 shao2 yao4 zhi1 mu3 tang1 combined with
the formula for hu3 gu3 san3 (Tiger Bone Powder) from the Tai4 Ping2 Hui4
Min2 He2 Ji4 Ju2 Fang1 (Tai4-Ping2 Imperial Grace Pharmacy Formulas),
and I combined them with modifications according to the pattern. I called this
new formula bu3 shen4 qu1 han2 zhi4 wang1 tang1 (Kidney-Supplementing
Cold-Dispelling Lameness Decoction).
Lecture 4
46
During this same period of time, I adopted the name of lame impediment
for the impediment pattern associated with the symptoms of deformed joints
of the body and damage to the osseous tissue. In a few short months our
organization put together a report on our results in having treated 32 cases of
rheumatoid arthritis. In December of 1981 I presented a paper entitled
Discussion on Lame Impediment to my colleagues in the Chinese medical
community. The presentation was part of the first session of the Society of
Internal Medicine of the All-China Association of Traditional Chinese
Medicine, which convened in the city of Wu3 Han2. In 1983 the impediment
disorders group of that Society adopted the name of lame impediment for
this new disease. They also agreed to support scientific research on bu3 shen4
qu1 han2 zhi4 wang1 tang1, and eventually 300 clinical cases were included
in the study.
Thereafter, we developed a new medicine, wang1 bi4 chong1 ji4 (Lame
Impediment Granules), which the Number Three Pharmaceutical Company
manufactured in Ben3 Xi1, a city in Liao2 Ning2 Province. It has already
won many prizes for quality, including a Silver Medal in national quality
awards. This product sells well at home and abroad; the demand has always
exceeded the supply.
Here I present the ingredients of bu3 shen4 qu1 han2 zhi4 wang1 tang1 so
that others may use it in their own practices.
Bu3 Shen4 Qu1 Han2 Zhi4 Wang1 Tang1 ( KidneySupplementing Cold-Dispelling Lameness Decoction)
: 912 1224 1218
912 612( 15 1020 )
1020 915 912
915 10-12 12 36
610 1215 30 915
69 610 20
15 ()69
bu3 gu3 zhi1 ( psoralea, Psoraleae Fructus) 912 g

Praeparata) 1224 g
yin2 yang2 huo4 ( epimedium, Epimedii Herba) 912 g
Lecture 4
47
Praeparata Secta) 612 g20

gu3 sui4 bu3 ( drynaria, Drynariae Rhizoma) 1020 g
qiang1 huo2 ( notopterygium, Notopterygii Rhizoma et Radix) 10
12 g
du2 huo2 ( pubescent angelica, Angelicae Pubescentis Radix) 10
12 g
wei1 ling2 xian1 ( clematis, Clematidis Radix) 1215 g
shen1 jin1 cao3 ( ground pine, Lycopodii Herba) 30 g
song1 jie2 ( knotty pine wood, Pini Nodi Lignum) 15 g
zhe4 chong2 ( ground beetle, Eupolyphaga seu Steleophaga) 610 g
tou4 gu3 cao3 ( speranskia/balsam, Speranskiae seu Impatientis
Herba) 20 g
xun2 gu3 feng1 ( mollissima, Aristolochiae Mollissimae
Herba) 15 g
zi4 ran2 tong2 ( pyrite, Pyritum) 69 g (soak in vinegar, predecoct)21
:
Bu3 shen4 qu1 han2 zhi4 wang1 tang1 supplements the kidneys and expels
cold, transforms dampness and courses wind, quickens the stasis and frees the
network vessels, and strengthens sinew and bone.
:
20
If it is necessary to use 15 g of this medicinal, then pre-decoct it for 1020 minutes. (Au.)
The original formula included zhi4 hu3 gu3 (mix-fried tiger bone), which is now
prohibited. I use the last three medicinals in this list to replace it. (Au.)
21
Lecture 4
48
This formula treats lame impediment in patients who have kidney-vacuity

exuberant cold. Lame impediment encompasses diseases in modern medicine
such as rheumatoid arthritis, rickets with rigidity of the spine, tuberculous
arthritis, and osteoarthritis. The symptoms include pain in the joints of the
limbs, joint deformity, and damage to the osseous tissue.
:
I created bu3 shen4 qu1 han2 zhi4 wang1 tang1 by combining and
modifying gui4 zhi1 shao2 yao4 zhi1 mu3 tang1, which is from the Jin1 Gui4
Yao4 Lue94, and hu3 gu3 san3 (Tiger Bone Powder), from the Tai4 Ping2
Hui4 Min2 He2 Ji4 Ju2 Fang1. Within the formula, xu4 duan4 and bu3 gu3
zhi1 supplement kidney yang2 and strengthen the bones and sinews. Zhi4 fu4
pian4 strengthens kidney yang2 and dispels cold evil. Sheng1 di4 huang2
supplements the kidney and replenishes the essence and also nourishes the
liver and boosts blood. These four are the chiefs.
Gu3 sui4 bu3 quickens stasis and expels bone wind. Yin2 yang2 huo4
supplements kidney yang2 and expels kidney wind.22 Gui4 zhi1, qiang1 huo2,
du2 huo2, and wei1 ling2 xian1 track and dissipate wind-cold-damp evils in
the lesser yin1 (shao4 yin1) and greater yang2 (tai4 yang2) channels and in
the limbs. Bai2 shao2 yao4 nourishes blood and enhances the sinews and also
relaxes tension and slackens hypertonicity. These are the support medicinals.
Fang2 feng1 dissipates wind, and ma2 huang2 dissipates cold. Together
with shu2 di4 huang2, they warm the interstices of the flesh. Cang1 zhu2
transforms dampness. Chi4 shao2 yao4 quickens stasis and clears heat; zhi1
mu3 enriches the kidney and clears heat; chuan1 shan1 jia3 frees the
22
According to Su4 Wen4 (Elementary Questions), kidney wind ( shen4 feng1) is

characterized by symptoms such as copious sweating and aversion to wind, puffy swelling of
the face, pain and inability to straighten the spine, black-colored flesh, large tight pulse, and
inability to eat. (Ed.)
Lecture 4
49
channels and dissipates accumulation; zhe4 chong2 quickens stasis and

strengthens the sinews and bones; shen1 jin1 cao3 relaxes the tendons and
quickens the network vessels; and song1 jie2 frees and disinhibits the joints.
These are all assistant medicinals. Of these, chi4 shao2 yao4, zhi1 mu3, and
zhe4 chong2 act as paradoxical assistants, because they prevent the
transformation to heat that often results from using dampness-eliminating
medicinals. Niu2 xi1, the courier, boosts the kidneys and guides the other
medicinals to the kidneys.
: 10 1O
6 6
30 12
()12
3040 912
15 912
40 9 (
) 12 12
9 ( 1 )
5 10
10
For patients with severe symptoms in the upper limbs, add 10 g of pian4
jiang1 huang2 (sliced turmeric).
For pronounced blood stasis, add:
ru3 xiang1 ( frankincense, Olibanum) 6 g
mo4 yao4 ( myrrh, Myrrha) 6 g
For pronounced pain in the lumbus and legs, remove song1 jie2 and cang1
zhu2 from the base formula, increase the dosages of xu4 duan4 and bu3 gu3
zhi1, and add 30 g of sang1 ji4 sheng1 (mistletoe) and 12 g of du4 zhong4
(eucommia). When taking the medicinals, the patient should also chew 12
pieces of mix-fried hu2 tao2 ren2 (walnut).
For stiff limbs, remove cang1 zhu2, fang2 feng1, and song1 jie2 and add
the following:
Lecture 4
50
sheng1 yi3 mi3 ( raw coix seed, Coicis Semen Crudum) 3040 g
mu4 gua1 ( chaenomeles, Chaenomelis Fructus) 912 g
For rigidity, crookedness, or deformity of the spinal column, remove cang1
zhu2 and niu2 xi1, change the dosage of qiang1 huo2 to 12 g, and add:
gou3 ji3 ( cibotium, Cibotii Rhizoma) 40 g
lu4 jiao3 jiao1 ( deerhorn glue, Cervi Cornus Gelatinum) 9 g23
For severe pain in the joints, increase the dosage of fu4 pian4 and add 9 g
of cao3 wu1 tou2 (wild aconite). Furthermore, take qi1 li2 san3 (Seven
Pinches Powder) with the decoction, 1 g per dose.
If the tongue fur is white, thick, and slimy, remove shu2 di4 huang2 and
add 5 g of sha1 ren2 (amomum) and 10 g of huo4 xiang1 (agastache).
For stomach duct distention with torpid intake due to center failing to move
and transform, add 10 g each of chen2 pi2 (tangerine peel), jiao1 mai4 ya2
(scorch-fried barley sprout), and jiao1 shen2 qu1 (scorch-fried medicated
leaven).
:(1) 46
(2) 3 3 ()
Pay attention to two points when using this formula. First, since this
formula treats the root of the disease, patients invariably have to take the
formula for 46 weeks before the curative effects begin to show. Second,
after you see improvement in the patient, powder three packets of the formula
and give it to the patient to take in 3 g doses with warm water or huang2 jiu3
(yellow wine). This facilitates long-term use.
""
3
23
Alternatively, use either lu4 jiao3 pian4 (sliced deerhorn) or lu4 jiao3 shuang1
(degelatinated deer antler). (Au.)
Lecture 4
51
I use this formula with modifications according to the pattern to treat lame
impediment and always have satisfactory results. I have recruited three
groups of graduate students to research lame impediment, and they also all
had fine results.
:
XX48 ,1971 10 28
: 1
CASE HISTORY
Here I would like to present a successful case study for your reference.
Case 1: Mr. Ren4, 48 years old, worker. Date of first visit: October 28,
1971.
Major complaint: For more than one year the patient had experienced joint
pain, swelling and deformation of the joints, and increasing rigidity such that
he was unable to independently move his limbs.
:1970 9
40 degrees C
( 55 /)
80 (118 /)
Disease History: During September of 1970 the patient was digging as part
of a tunnel building project, and sometimes between or after shifts he would
go on breaks and rest or even go to sleep underground. One day he suddenly
had a high fever of more than 40C (104.0F). Later he developed redness,
swelling, and pain of the left knee and ankle, and walking became
challenging. Although he received about six months of treatment, his
condition was gradually getting worse. Both wrists and both index fingers
developed redness, swelling, and pain, and these joints also became deformed
and rigid such that motion was severely limited; when the patient got up in
Lecture 4
52
the morning he could not extend them. The patient had swollen and deformed
knees and was unable to move them by himself; the left leg was particularly
bad. Both ankles had extreme swelling.
A hospital tested him and diagnosed rheumatoid arthritis. At that time his
erythrocyte sedimentation rate (ESR) was 55 mm per hour. He then turned to
the Chinese medicine department of the hospital. The patient took 80 packets
of medicinals, but there was no improvement in his condition, and in fact the
ESR had increased to 118 mm per hour. That was when they sought my help
with the treatment.
:
(
120 )
Presenting symptoms: In addition to the swelling, deformation, pain, and

inflexibility of both knees, both ankles, both wrists, and the fingers, as
explained above, the patient also had developed rigidity of the hip joints,
such that his thighs and trunk were inflexibly locked at a 120 angle. The
patients shoulder and elbow joints had also become rigid and immobile, so
when the patient came in for treatment, someone had to carry him in.
The patient had a fever, but not continuously. He had fear of cold with
vexation heat in the heart, poor appetite, and occasional nausea. He had
bowel movements once or twice each day, yellow or reddish urine, slimy
white tongue fur, and a stringlike rapid pulse. X-rays taken at our hospital
showed that the patient still had rheumatoid arthritis.
:
Pattern identification: The conditions in underground work environments

are cold and damp, and being in those conditions for a long time resulted in
the patient contracting wind-cold-damp evils that assailed his channels and
resulted in impediment. Cold-damp easily damages the kidney, and because
the vacuous kidney could not defend against the evil, cold-damp exploited
Lecture 4
53
vacuity to make a deep invasion. Kidney governs the bones, and when cold
evil entered the bones and abided for a long time, it deprived the bones of
nourishment; this is what resulted in bone deformation, hypertonicity of
joints and contraction of sinews, inability to bend the limbs, extremely
swollen feet, and the seething with desire to vomit, all of which formed the
lame impediment pattern. By correlating the pulse and signs, the diagnosis
was lame impediment. Although the patient was showing signs of heat, those
were from the branch and the true problem was cold.
:
:
10 12 10 10 6
10 12 12 10 10
10 6 6
Method of treatment: supplement the kidney and dispel cold; dissipate

wind and quicken the network vessels.
I prescribed bu3 shen4 qu1 han2 zhi4 wang1 tang1 with modifications as
follows:
zhi4 hu3 gu3 ( mix-fried tiger bone, Tigris Os cum Liquido
Frictum) 6.25 g
Rhizoma) 10 g
Lecture 4
54

I gave the patient six packets and instructed him to decoct them in water.
30
1972 3 10
30 3 17
After the patient took this medicine all of his symptoms were relieved. I
continued giving the above prescription, but added 30 g of shen1 jin1 cao3
(ground pine) and changed the dosage of hu3 gu3 to 12 g. I also advised the
patient to drink the medicine frequently.
When the patient came for an examination on March 10, 1972, he was able
to walk into the clinic by himself without the use of a walking cane. Although
there was still some deformation of both wrists and the finger joints, the
patient was able to move them when he exerted himself, and when one
pressed those joints they were not painful. There was still swelling in the
knee joints. I once again gave the above prescription, this time with the
addition of 30 g of huang2 qi2 (astragalus).
By March 17th the patient could ride his bicycle on the streets, and I
continued to prescribe more of the same.
1972 5 3
22 11O
: 45 54 60
36 60 36 45
30 120 36 12
45 120 36 45 21
30 3 2
At a consultation on May 3, 1972, the patient had a very good appetite, but
sometimes there was still swelling in his wrist, back, and ankle regions, and
occasionally he had light pain. Although the joints of his wrists, fingers,
knees, and ankles appeared to be deformed, the deformities did not affect his
movements. Altogether the patient had 22 visits and he took more than 110
packets of his prescription. His condition had stabilized, so we started using a
Lecture 4
55
powder preparation that he was to take regularly. This is the prescription I

gave him:
zhi4 hu3 gu3 ( mix-fried tiger bone, Tigris Os cum Liquido
Frictum)
Rhizoma) 30 g
di4 long2 ( earthworm, Pheretima) 45 g
We ground these medicinals into a fine powder, and the patient took 3 g per
dose, two doses per day, with warm huang2 jiu3 (yellow wine).
1973 1 27
36 30 30 36
90 1973 5 29
1
Lecture 4
56
By January 27, 1973, the patient had less knee swelling and his joints were
noticeably smaller. I gave him more of the same prescription, but changed the
dosage of xu4 duan4 to 90 g and added the following medicinals:
Extremitas) 36 g
jiao1 shen2 qu1 ( scorch-fried medicated leaven, Massa Medicata
Fermentata Usta) 30 g
pian4 jiang1 huang2 ( sliced turmeric, Curcumae Longae
Rhizoma Sectum) 30 g
At a consultation on May 29, 1973, the patient had pronounced
improvement in limb function. He could freely squat down, stand up, stand
for more than an hour without becoming tired, and even ride his bicycle on
the streets for more than 10 kilometers. The pulse was more harmonious,
moderate, and forceful than before, while the tongue fur was normal. At that
time his only symptoms were light pain in the left wrist and ankle joints. I
continued to give the same prescription to solidify the results.
1975
1979 13 /
A follow-up interview in the summer of 1975 revealed the patient had been
working full-time for more than one year. Although the joints in his fingers,
wrists, and left knee had not fully recovered their normal shape, they all
functioned well and the patient could work without pain.
In the summer of 1979 we re-examined the patient. His ESR was 13 mm
per hour and his testing confirmed he still had rheumatoid arthritis. Yet he
had been continuously working full time, and he even performed very
arduous work.
1986
""
" III "
Lecture 4
57
In 1986 our research topic, Experimental Research on the Clinical

Mechanism of Lame Impediment, became one of the key topics for research
in our countrys seventh 5-year plan. We further had the honor of winning
third prize in the National Traditional Chinese Medicine and Medicinals
Advancement of Science and Technology Awards. Meanwhile we developed
the next generation of new medicinals for treating rheumatoid arthritis, which
we called Lame Impediment Health-Restoring Formulas I and II, and a
pharmaceutical company in Liao2 Ning2 Province has undertaken the
manufacture of these formulas. As of this writing, we are close to getting
regulatory approval for the medicine, and soon it will become available to
everyone.
Bu3 shen4 qu1 han2 zhi4 wang1 tang1 is effective not only in the
treatment of rheumatoid arthritis, but also in the treatment of rigidity in
rickets. It is also effective in the treatment of tubercular arthritis. I am
currently preparing for further clinical and experimental research into the use
of this formula for treating osteoarthritis and fluorosis of the bone.
8. ()
4.8 Du2 Huo2 Ji4 Sheng1 Tang1 ( Pubescent Angelica and

Mistletoe Decoction)
from Qian1 Jin1 Yao4 Fang1 ( A Thousand Gold Pieces
Prescriptions)
9 1520 10 10 36
69 9 69 1215 912
9 56 10 5 35
1218 2
du2 huo2 ( pubescent angelica, Angelicae Pubescentis Radix) 9 g

qin2 jiao1 ( large gentian, Gentianae Macrophyllae Radix) 10 g
Lecture 4
58

du4 zhong4 ( eucommia, Eucommiae Cortex) 912 g
gui4 xin1 ( shaved cinnamon bark, Cinnamomi Cortex Rasus) 35 g
When physicians of antiquity prescribed this formula, some used 3 liang3 of
du2 huo2 along with 2 liang of each of the remaining ingredients. They
would grind the medicinals into a coarse powder, and the patients would boil
1218 g per dose and take it twice each day. In modern times physicians
modify this formula according to the pattern and prescribe it as a decoction,
commonly using the dosages mentioned above.
Du2 huo2 ji4 sheng1 tang1 is a commonly used formula for impediment
pattern. It treats patients with dual vacuity of liver and kidney when wind,
cold, and damp evils concur and combine to impede and obstruct the
channels and network vessels. The resulting symptoms include: pain,
soreness, and weakness in the lumbus and knees; inhibited bending and
stretching; and desire for warmth with fear of cold.
;
;;
;
Lecture 4
59
FORMULA ANALYSIS
Within the formula, du2 huo2 and xi4 xin1 enter the foot lesser yin1 (shao4
yin1) kidney channel, track down wind-cold, and free the blood vessels. Qin2
jiao1 and fang2 feng1 course the channels and upbear yang2 to expel wind
and transform dampness. Sang1 ji4 sheng1 supplements the liver and kidneys,
boosts qi4 and blood, and expels wind-cold. Du4 zhong4 and niu2 xi1
strengthen the kidneys and fortify bones, strengthen the sinews, and secure
the lower origin. Dang1 gui1, bai2 shao2 yao4, chuan1 xiong1, and sheng1
di4 huang2 quicken the blood and supplement yin1, while ren2 shen1, gui4
zhi1, fu2 ling2, and gan1 cao3 boost qi4 and supplement yang2. As a whole,
the formula has acrid-warm medicinals that dissipate and sweet-warm
medicinals that supplement. It thus strengthens the liver and kidneys, makes
qi4 and blood sufficient, eliminates wind-damp, and strengthens the sinews
and bones. As a result, it naturally cures impediment pattern in the lumbus
and knees.
I often use this formula, modified according to the pattern, to treat

impediment pattern, and many times I have used it to cure a deeply rooted
disease. I believe I have the opportunity to apply this formula almost every
day. Du2 huo2 ji4 sheng1 tang1 is a comprehensive formula that treats the
root. Thus, one should not usually expect it to make any noticeable effect in a
short time, as it often requires long-term treatment to be effective. I usually
modify the formula according to the symptoms, as this makes it more quickly
effective. It is especially important to prescribe according to the cause of
disease and the disease mechanism, for these may differ. By using strong
treatments that specifically expel the relevant evils, one treats the branch and
root simultaneously and hastens effectiveness. Here I present a summarized
version of my empirical formulas for treating impediment, along with their
primary indications and their modifications.
Lecture 4
60
(1)
: 2030 912 35
1215 1215 10 12
12 1215 10 1012
59 9 1215 30
: 30
10 1530 ; 2030
69 610 ;
1530 10
20 1215 ; X
1218 10 5
1520 ()
FORMULA ONE
This formula treats painful impediment in the hips and legs. The patient
will desire warmth and fear cold, the pain will be worse on exposure to cold,
and the knees and legs will have inhibited bending and stretching. This
corresponds to Western medical diagnoses such as sciatica, arthritis, bone
spurs, and rheumatoid arthritis. The medicinals are:
Praeparata) 12 g
Lecture 4
61

cao3 wu1 tou2 ( wild aconite, Aconiti Kusnezoffii Radix) 59 g
Liquido Fricta) 9 g
Decoct in water.
For pronounced joint swelling, remove sheng1 di4 huang2 and shu2 di4
huang2 and add 30 g of sheng1 yi3 mi3 (raw coix seed), 10 g of fen3 fang2
ji3 (mealy fangji), and 1530 g of fu2 ling2 (poria).
For pronounced pain in the spinal column, add 2030 g of gou3 ji3
(cibotium), 69 g of zhe4 chong2 (ground beetle), and 610 g of qiang1 huo2
(notopterygium).
If the chief complaint is pain from the lateral portion of the thigh to the
lateral portion of the calf, increase the amount of niu2 xi1 (achyranthes) to
1530 g, and add 10 g of di4 long2 (earthworm), 20 g of qing1 feng1 teng2
(Orient vine), and 1215 g of bing1 lang2 (areca).
If X-rays reveal a bone spur in the lumbus or knees, omit shen1 jin1 cao3
and du4 zhong4 and add:
ru3 xiang1 ( frankincense, Olibanum) 5 g
mo4 yao4 ( myrrh, Myrrha) 5 g
sheng1 long2 gu3 ( crude dragon bone, Mastodi Ossis Fossilia
(2)
: 30 10 10 12
1215 10 12 1215
10 6 10 10 20
25 20 15
Lecture 4
62
FORMULA TWO
This formula treats women who usually have pain in the lumbus and hips
when they furthermore develop severe lumbus and hip pain after several
months of pregnancy. The medicinals are:
chao3 bai2 zhu2 ( stir-fried white atractylodes, Atractylodis
Macrocephalae Rhizoma Frictum) 12 g
Fricta) 6 g
zi3 su1 geng3 ( perilla stem, Perillae Caulis) 10 g
Frictus) 10 g
luo4 shi2 teng2 ( star jasmine stem, Trachelospermi Caulis) 20 g
qian1 nian2 jian4 ( homalomena, Homalomenae Rhizoma) 15 g
(3)
"O"
: 30 12 1215 18
35 10 15 12 5
18 12 10 10
15 12 18
FORMULA THREE
This formula treats knee and ankle joint pain in patients who desire warmth,
fear cold, and sometimes also have heel pain. Such patients will also have a
Lecture 4
63
rapid ESR (erythrocyte sedimentation rate) and a high anti-streptolysin O

(ASO) test. The formula comprises:
Praeparata) 12 g
ze2 lan2 ( lycopus, Lycopi Herba) 18 g
bing1 lang2 ( areca, Arecae Semen) 10 g
di4 long2 ( earthworm, Pheretima) 10 g
(
)
FORMULA COMPARISON
Juan1 Bi4 Tang1 ( Impediment-Alleviating Decoction)
from Yi1 Xue2 Xin1 Wu4 ( Medical Insights)
qiang1 huo2 ( notopterygium, Notopterygii Rhizoma et Radix)
du2 huo2 ( pubescent angelica, Angelicae Pubescentis Radix)
qin2 jiao1 ( large gentian, Gentianae Macrophyllae Radix)
gui4 xin1 ( shaved cinnamon bark, Cinnamomi Cortex Rasus)
Liquido Fricta)
Lecture 4
64
dang1 gui1 ( Chinese angelica, Angelicae Sinensis Radix)

sang1 zhi1 ( mulberry twig, Mori Ramulus)
chuan1 xiong1 ( chuanxiong, Chuanxiong Rhizoma)
ru3 xiang1 ( frankincense, Olibanum)
mu4 xiang1 ( costusroot, Aucklandiae Radix)
hai3 feng1 teng2 ( kadsura pepper stem, Piperis Kadsurae Caulis)
Du2 huo2 ji4 sheng1 tang1 and juan1 bi4 tang1 are both commonly used
formulas that treat impediment. Juan1 bi4 tang1, however, is more
appropriate for treating impediment pattern in the upper region of the body
when there is absence of liver and kidney insufficiency. Du2 huo2 ji4 sheng1
tang1 is better suited for treatment of impediment pattern in the lower region
of the body when the disease is severe and there is insufficiency of the liver
and kidneys.
9.()
4.9
San1 Bi4 Tang1 ( Three Impediment Decoction)

Cheng2 Fang1 Qie4 Yong1 ( Effective Use of Formulas)
()
6 3 4

huang2 qi2 ( astragalus, Astragali Radix) 6 g
du4 zhong4 ( eucommia, Eucommiae Cortex) (stir-fried with
ginger) 6 g
gui4 xin1 ( shaved cinnamon bark, Cinnamomi Cortex Rasus) 6 g
qin2 jiao1 ( large gentian, Gentianae Macrophyllae Radix) 6 g
Lecture 4
65

Decoct in water with 3 slices of sheng1 jiang1 (fresh ginger) and 4 da4 zao3
(jujube).
:"
"
FORMULA ANALYSIS
San1 bi4 tang1 is another commonly used formula for impediment pattern.
It is used when wind, cold, and damp evils concur and combine to impede
and obstruct the channels and network vessels, which results in qi4 and blood
stagnation, hypertonicity24 of the arms and legs, as well as all three forms of
impediment pattern: moving impediment, painful impediment, and fixed
impediment.
The Ming2 dynasty physician Yu4 Jia1-Yan2 () once praised this
formula as follows:
San1 bi4 tang1 uses ren2 shen1, huang2 qi2, and si4 wu4 tang1
(Four Agents Decoction), and within these supplementing
medicinals it uses: fang2 feng1 and qin2 jiao1 to overcome winddampness, gui4 xin1 to overcome cold, and xi4 xin1 and du2 huo2
to free the kidney qi4. It is appropriate to use this formula for
patients in whom the three evil qi4 have exploited vacuity and given
rise to impediment.
24
Hypertonicity ( ju1 luan2): Stiffness and tension in the limbs that inhibits normal
bending and stretching. (Ed.)
Lecture 4
66
FORMULA COMPARISONS
San1 bi4 tang1 treats impediment pattern caused by qi4-blood
insufficiency and attacks of wind-cold-damp evils; it furthermore
supplements qi4-blood. Juan1 bi4 tang1 (Impediment-Alleviating Decoction),
in contrast, treats impediment pattern in the upper half of the body but does
not supplement vacuity.
Du2 huo2 ji4 sheng1 tang1 (Pubescent Angelica and Mistletoe Decoction)
treats impediment obstruction in the lower half of the body that results from
liver-kidney insufficiency and the invasion of wind-cold-damp evils. In
contrast, san1 bi4 tang1 is more suitable for the treatment of impediment
pattern that occurs simultaneously with qi4 and blood vacuity.
10 1015
10 18 2
() 3
15 30
2030
In modern times physicians prescribe san1 bi4 tang1 as a decoction
modified according to the pattern, and rarely use the same dosage for all of
the medicinals in the formula.25 When qi4 vacuity signs are not pronounced,
substitute dang3 shen1 (codonopsis) for ren2 shen1.
For pronounced pain in the upper limbs (the shoulders, elbows, and wrists),
add 10 g of pian4 jiang1 huang2 (sliced turmeric) and 1015 g of gui4 zhi1
(cinnamon twig).
For pronounced lower back pain, add 10 g of bu3 gu3 zhi1 (psoralea) and
18 g of xu4 duan4 (dipsacus). Chew and swallow one hu2 tao2 ren2 (walnut)
with each dose.
25
The original formula called for 6 g of every medicinal in the formula. In clinical practice
this usually changes. (Ed.)
Lecture 4
67
For pronounced swelling and pain in the ankles and pain in the heel,
increase the dosage of niu2 xi1 by 3 g and add 15 g of ze2 lan2 (lycopus) and
30 g of sheng1 yi3 mi3 (raw coix seed).
If the menses is early or the amount excessive, omit chuan1 xiong1
(chuanxiong) and add 2030 g of xu4 duan4 tan4 (charred dipsacus).
10.()
4.10 Qing1 Zhen4 Tang1 ( Clearing Invigoration Decoction)

by Liu2 Wan2-Su4 ( )
30 30 1 <(1520 ) 15

gan1 he2 ye4 ( dried lotus leaf, Nelumbinis Folium
Exsiccatum) 1520 g (one leaf)
Grind the medicinals into a powder and boil 15 g each time in water.
(
)
()
Qing1 zhen4 tang1 is an effective cure for thunder head wind,26 which is
marked by headache and by lumps and swellings of the head and face, and
possibly by the sound of thunder in the head. There is also abhorrence of cold
with vigorous heat that is similar to cold damage.
26
Thunder head wind ( lei2 tou2 feng1): Thunder head wind usually results from
either wind evil assailing from the exterior or phlegm-heat engendering wind. (Ed.)
Lecture 4
68
FORMULA ANALYSIS
Sheng1 ma2 is a sweet-flavored medicinal with a yang2 nature. Its qi4
upbears, and it is able to resolve the hundred toxins. Cang1 zhu2 is a harshly
acrid medicinal that dries dampness and strengthens the spleen. It repels
miasma and severe epidemic qi4. He2 ye4 is an aromatic green medicinal that
upbears and assists the upward movement of clear yang2 qi4 in the stomach.
By using sweet, warm, acrid, and dissipating medicinals, this formula
upbears, effuses, and dissipates evils. In particular, it makes evils stray
upward and dissipate. Furthermore, it secures the stomach qi4 and prevents
evils from passing to the interior.
""
CASE HISTORIES
I often use qing1 zhen4 tang1 to treat stubborn headaches. For example, a
patient named Mr. Zhang1 had suffered headaches for several years that were
sometimes mild and sometimes severe. He underwent treatments for a long
time, but without results. When the outbreaks were severe, his entire head
was painful, and there was a roaring in his brain like wind or thunder. Every
time the weather changed or a strong wind blew he would experience severe
pain. The tongue fur was slightly white, and the pulse was stringlike and
slippery. Another hospital had modified a variety of decoctions and pills for
him, such as qing1 kong1 gao1 (Blue Sky Paste), yu4 feng1 dan1 (WindHealing Elixir), chuan1 xiong1 cha2 tiao2 san3 (Tea-Blended Chuan1xiong1
Powder), niu2 huang2 shang4 qing1 wan2 (Bovine Bezoar Upper-BodyClearing Pill), and qiang1 huo2 sheng4 shi1 tang1 (Notopterygium
Dampness-Overcoming Decoction). Yet none of these were effective. After
correlating the pulse and the signs, my diagnosis was thunder head wind,
and I prescribed qing1 zhen4 tang1 with modifications according to the
pattern.
: 10 10 6 10
18 30 () 10 10
12 6
Lecture 4
69
I gave him this prescription:

gao3 ben3 ( Chinese lovage, Ligustici Rhizoma) 6 g
xia4 ku1 cao3 ( prunella, Prunellae Spica) 18 g
he2 ye4 ( lotus leaf, Nelumbinis Folium) 12 g
wu2 zhu1 yu2 ( evodia, Evodiae Fructus) 6 g
Decoct in water.
The patient took this formula for three weeks, and his headache was
completely cured.
;;
;
;;
Within this prescription, the qing1 zhen4 tang1 is the chief, as it is a light,
effusing formula that dissipates wind and transforms dampness. The two
supports are: qiang1 huo2, which is a wind-expelling and dampnessovercoming medicinal that enters the greater yang2 (tai4 yang2) channel and
treats greater yang2 (tai4 yang2) headache; and gao3 ben3, which enters the
governing vessel, dissipates wind-cold, and treats pain at the crown of the
head.
There are also several assistant medicinals. Wu2 zhu1 yu2 is an acrid-warm
medicinal that enters the liver channel and treats headache. Xia4 ku1 cao3
enters the liver channel and calms liver yang2 to treat liver depression
headache. Sheng1 shi2 jue2 ming2 nourishes liver yin1 and subdues liver
yang2. Man4 jing1 zi3 enters the lesser yang2 (shao4 yang2) channel and
Lecture 4
70
dissipates wind-heat in the head to treat pain on both sides of the head.
Finally, bai2 ji2 li2, the courier, enters the liver and lung channels and breaks
stagnation. Thus, it is useful for treating pain from enduring disease that has
entered the network vessels, because it opens and dissipates depression and
accumulation in the liver and lung channels.
""
:
30 20 15 45
9
?
"
"
Qing1 Kong1 Gao1 ( Blue Sky Paste)

by Li3 Dong1-Yuan2 ()
Fricta) 30 g
chao3 huang2 lian2 ( stir-fried coptis, Coptidis Rhizoma Frictum)
30 g
chai2 hu2 ( bupleurum, Bupleuri Radix) 20 g
Lecture 4
71
Grind the medicinals into a fine powder. Each time take 9 g, mix with tea to
make a paste, and swallow with warm water. Li3 Dong1-Yuan2 suggests
qing1 kong1 gao1 for enduring unilateral headaches that are difficult to cure.
His formula treats wind-damp-heat congesting in the upper body, head, and
eyes accompanied by ceaseless pain in the brain.
So why was this paste not effective for the patient mentioned above? The
reason is that this formula uses large amounts of medicinals that primarily
enter the greater yang2 (tai4 yang2) channel, secondarily enter the lesser
yang2 (shao4 yang2) channel, and less significantly enter the reverting yin1
(jue2 yin1) and greater yin1 (tai4 yin1) channels. Furthermore, this formula
uses wine-fried huang2 qin2 and huang2 lian2, which ascend and clear heat.
Therefore, qing1 kong1 gao1 treats wind-damp-heat congesting the upper
body. The patient described above had thunder head wind, which is much
more serious than a headache. Moreover, when the weather changed or a
strong wind blew, the condition of the patient worsened. The pain of the
headache involved the entire head, and there were sounds like wind or
thunder inside the head. Thus, the case above was not headache due to winddamp-heat congesting the upper body. Rather it was due to wind evil that
penetrated so deeply it blocked the clear orifices and was not susceptible to
effusing, dispersing, and coursing treatments. Because the patient had
channel and network vessel blockage with binding and depression of winddamp-cold, it was appropriate to use qing1 zhen4 tang1 modified according
to the pattern.
While qing1 zhen4 tang1 primarily dissipates wind, it also dispels cold and
transforms dampness. Because the pulse was stringlike, I added medicinals to
nourish liver yin1, subdue liver yang2, calm the liver and prevent heat, warm
the reverting yin1 (jue2 yin1), and break binding qi4 in the liver and lung. By
making the qi4 and blood move and by freeing the obstructed channels and
network vessels, the formula allowed the acrid, warm, yang2-natured
medicinals to upbear and dissipate wind-cold-damp evils. This is why the
formula was effective so quickly.
Considering the diagnosis and treatment in this example, we can strongly
conclude that Chinese medicine does not just treat symptoms, but instead
aims at understanding the disease causes, the disease mechanisms, and their
changes and transformations. To treat patients effectively we must grasp the
very root of a how a disease forms within the body, establish the suitable
treatment method, select an appropriate formula, and modify the ingredients
accordingly. Thus, our predecessors have continually admonished that to
treat disease, one must seek the root.
Lecture 4
72
4.11 Li3 Zhong1 Tang1 ( Center-Rectifying Decoction)

by Zhang1 Zhong4-Jing3 ()
9 9 9 9

Rhizoma) 9 g
Liquido Fricta) 9 g
Decoct in water and take.
""
""
""
Li3 zhong1 tang1 is from the Shang1 Han2 Lun4, where it appears in the
form of li3 zhong1 wan2 (Center-Rectifying Pill). One makes li3 zhong1
wan2 by grinding the four medicinals into powder, mixing with lian4 mi4
(processed honey), and forming the mix into pills the size of egg yolks. Later,
boil one pill in water, grind into pieces, and take warm. In this fashion, take
34 times per day. If there is no feeling of heat in the abdomen after taking 1
pill per dose, increase the dosage up to 34 pills. However, taking pills is not
as effective as taking the formula as a decoction. While people make this
formula both as a pill and as a decoction, in current practice we tend to make
it as a decoction. Nevertheless, amongst Chinese patent medicines li3 zhong1
wan2 and fu4 zi3 li3 zhong1 wan2 (Aconite Center-Rectifying Pill) are both
available for clinical practice.
()
Li3 zhong1 tang1 treats patients who have center burner vacuity cold that
prevents the smooth flow of qi4, which has symptoms such as: abdominal
pain, spontaneous diarrhea, sloppy formless stool, absence of thirst, many
cold signs with retching, and a sunken and forceless pulse. There may also be
counterflow cold of the extremities (reverse flow).
Lecture 4
73
FORMULA ANALYSIS
(
)""
The chief medicinal in this formula, ren2 shen1, supplements qi4 and
boosts the spleen. Bai2 zhu2, the support, fortifies the spleen and dries
dampness. Gan1 cao3, the assistant, harmonizes the center and supplements
earth. The courier, gan1 jiang1, warms the stomach and dissipates cold. The
spleen and stomach are both located in the center burner,27 hence the formula
name is li3 zhong1 (Center-Rectifying).
FORMULA VARIATIONS
69 ()
Fu4 Zi3 Li3 Zhong1 Tang1 ( Aconite Center-Rectifying

Decoction)28
Use li3 zhong1 tang1 as the base formula.
Add:
This formula treats exuberant cold in the center burner, abdominal pain,
generalized pain, reverse-flow of the limbs, and hypertonicity.
69 912
(
)(
) 10
; 2030 ()
Zhi3 Shi2 Li3 Zhong1 Wan2 ( Unripe Bitter Orange CenterRectifying Pill)
27
Another name for the center burner is center palace ( zhong1 gong1). (Au.)
When we make this formula in pill form, we call it fu4 zi3 li3 zhong1 wan2 (
Aconite Center-Rectifying Pill). (Au.)
28
Lecture 4
74
Add:
zhi3 shi2 ( unripe bitter orange, Aurantii Fructus Immaturus) 69 g
Powder, mix with lian4 mi4, and form into pills. This formula treats patients
who have cold repletion chest bind with such severe pain that they might pass
out, raised chest and diaphragm, and incapacity to bear the slight touch of a
hand; use it when da4 xian4 xiong1 tang1 (Major Chest Bind Decoction)29
has been ineffective. That is, the patient has a vacuity counterflow pattern
after greatly precipitating treatments with non-rectified qi4 that attacks
upwards and binds in the chest. For such patients, first use this pill to rectify
qi4, then address the other symptoms. This approach works like magic. For
patients with thirst, further add 10 g of tian1 hua1 fen3 (trichosanthes root)
and increase the dosages of ren2 shen1 (ginseng) and bai2 zhu2 (white
atractylodes). For copious spontaneous sweating, add 2030 g of predecocted sheng1 mu3 li4 (raw oyster shell).
15 69 69
Li3 Zhong1 An1 Hui2 Wan2 ( Center-Rectifying WormQuieting Pill)

Remove: gan1 cao3
Add:
hua1 jiao1 ( zanthoxylum, Zanthoxyli Pericarpium) 69 g
wu1 mei2 ( mume, Mume Fructus) 69 g
Mix the ingredients with honey and form into pills. This formula treats
stomach cold pain and vomiting of roundworms.
9 12 9 9 6
6
29
The ingredients of da4 xian4 xiong1 tang1 ( Major Chest Bind Decoction) are:
da4 huang2 (rhubarb), mang2 xiao1 (mirabilite), and gan1 sui4 (kansui). (Au.)
Lecture 4
75
Wen1 Wei4 Tang1 ( Stomach-Warming Decoction)

Add:
Rhizoma) 12 g
Cortex) 9 g
hua1 jiao1 ( zanthoxylum, Zanthoxyli Pericarpium) 6 g
This formula treats depression bind from anxiety and thinking, spleen-lung
qi4 stagnation, distention and fullness with upward surges, and inability to
get food down.
6 9
Zhi4 Zhong1 Tang1 ( Center-Ordering Decoction)

Add:
qing1 pi2 ( unripe tangerine peel, Citri Reticulatae Pericarpium
Viride) 6 g
This formula treats patients who have a li3 zhong1 tang1 pattern as well as
fullness in the abdomen, glomus oppression, and food accumulation.
9 15
69 ; 6
Bu3 Zhong1 Tang1 ( Center-Supplementing Decoction)

Add:
Lecture 4
76

This formula treats diarrhea. For incessant diarrhea, further add 69 g of fu4
zi3 (aconite). For little thought of eating or non-transformation of food, add
6 g of sha1 ren2 (amomum).
69 925
Lian2 Li3 Tang1 ( Coptis Rectifying Decoction)

Add:
This formula treats summerheat damage diarrhea with thirst. Our
predecessors believed lian2 li3 tang1 was irreplaceable for treating external
contraction of harsh summerheat with internal damage induced by cold and
raw foods.
12
12 10 6 6 6
6
FORMULA COMPARISON
Hou4 Po4 Wen1 Zhong1 Tang1 ( Officinal Magnolia Bark
Center-Warming Decoction)
from Nei4 Wai4 Shang1 Bian4 Huo4 Lun4 ( Clarification of
Perplexities about Internal and External Damage)
Cortex) 12 g
cao3 dou4 kou4 ( Katsumadas galangal seed, Alpiniae
Katsumadai Semen) 6 g
Lecture 4
77
mu4 xiang1 ( costusroot, Aucklandiae Radix) 6 g

Liquido Fricta) 6 g
Hou4 po4 wen1 zhong1 tang1 and li3 zhong1 tang1 both fortify the spleen
and dry dampness. They both treat symptoms such as exuberant cold in the
center burner, vomiting and no appetite, cold pain in the stomach duct and
abdomen, a liking for warmth and for pressure, clear urine and sloppy stool,
pale tongue with white fur, and slippery pulse.
:
;
However, there are differences between the two formulas. Li3 zhong1
tang1 contains ren2 shen1 and bai2 zhu2, and thus we tend to use it for
patients with lassitude of spirit, shortage of qi4, and a sunken fine forceless
pulse or a slow moderate pulse. Hou4 po4 wen1 zhong1 tang1, contains hou4
po4, mu4 xiang1, chen2 pi2, and fu2 ling2, and thus we tend to use it for
patients with severe fullness and distention in the stomach duct and abdomen,
upwelling and vomiting of clear water, and a sunken tight pulse or a sunken
stringlike pulse. The former warms the center burner and dispels cold and
also supplements and boosts the spleen and stomach; the latter warms the
center burner and rectifies qi4 and also dries dampness and eliminates
fullness.
In clinical practice I often modify li3 zhong1 tang1 according to the

individual pattern of the patient and use it in the treatment of center burner
vacuity-cold abdominal pain and diarrhea. This includes diseases in Western
medicine such as acute and chronic enteritis, chronic dysentery, and
ulcerative colitis.
Lecture 4
78
:
: 10 6 () 6
25 10 10 10
15 6 9 5 6
12 () 6
When the symptoms include acute diarrhea, gastrointestinal discomfort, or

in extreme cases retching counterflow with distention and fullness, I often
modify a combination of li3 zhong1 tang1 and huo4 xiang1 zheng4 qi4 san3
(Agastache Qi4-Righting Powder)30 according to the individual pattern of the
patient. Here is my empirical formula:
zi3 su1 ye4 ( perilla leaf, Perillae Folium) 6 g (add at end)
tu3 chao3 bai2 zhu2 ( earth-fried white atractylodes,
Atractylodis Macrocephalae Rhizoma cum Terra Frictum) 10 g
ban4 xia4 qu1 ( pinellia leaven, Pinelliae Massa Fermentata) 10 g
qian4 shi2 ( euryale, Euryales Semen) 15 g
dang3 shen1 ( codonopsis, Codonopsis Radix) 9 g
Liquido Fricta) 5 g
che1 qian2 zi3 ( plantago seed, Plantaginis Semen) 12 g (wrap in
gauze)
he1 zi3 ( chebule, Chebulae Fructus) 6 g
(
)
: 10 69
9 10 10 912 (
36 ) 2030 6 69
10 12 () 12 12
5 60 C )
30
See the 10th formula in Lecture 3 for more details on huo4 xiang1 zheng4 qi4 san3. (Ed.)
Lecture 4
79
I often vary the combination of li3 zhong1 tang1 and si4 shen2 wan2 (Four
Spirits Pill),31 according to the individual pattern, to treat chronic diarrhea,
dull pain in the abdomen before defecation, defecation about three times per
day, and sloppy thin unformed stool that is possibly mixed with small
amounts of blood or possibly accompanied by tenesmus. According to
modern medicine such patients could have chronic enteritis, ulcerative colitis,
chronic dysentery, or tubercular colitis. My empirical formula for this pattern
is below.
rou4 dou4 kou4 ( nutmeg, Myristicae Semen) 10 g
(or ren2 shen1 ( ginseng, Ginseng Radix) 36 g)
che1 qian2 zi3 ( plantago seed, Plantaginis Semen) 12 g (wrap in
gauze)
yu3 yu2 liang2 ( limonite, Limonitum) 12 g
Liquido Fricta) 5 g
fu2 long2 gan1 ( oven earth, Terra Flava Usta) 60 g
Decoct this last ingredient and use as the decoction medium for the other
ingredients. If the patient has copious blood in the stool, add 2030 g of di4
yu2 tan4 (charred sanguisorba) and 6 g of fang2 feng1 (saposhnikovia).
2030 6
31
See the 17th formula in this Lecture for more details on si4 shen2 wan2. (Ed.)
Lecture 4
80
I have found the two empirical formulas given above very effective in
clinical practice, and I hope you will try them.
32 1975 12 16
1975 9 20 X
60
:
10
Case study: Mr. Yang2, male, 32 years old, first consultation date: 16
December 1975.
On the 20 September 1975, a big Bei3jing1 hospital used X-rays to
diagnose the patient with chronic ulcerative colitis. They treated him with
more than 60 medicinal enemas, antibiotics, and berberine, but the treatment
was ineffective.
When I diagnosed him the patient was passing stool two to three times
daily. The stool was alternately dry or watery and sometimes contained pus
and blood. The patient passed stool frequently, and sometimes had a sagging
feeling or dull pain in the left side of the lower abdomen. Microscopy of the
stool revealed high counts for both erythrocytes and leucocytes. The patient
had fear of cold in the abdominal area, thin white tongue fur, and sunken
slippery pulse.
:
:
Identified pattern: Spleen-kidney vacuity diarrhea.

Treatment principle: Warm and supplement spleen and kidney; secure the
origin and check diarrhea.
: 10 9 12 9
12 6 12 6 3
12 15 () 60 (
)
Lecture 4
81
Prescription:
chao3 bai2 zhu2 ( stir-fried white atractylodes, Atractylodis
Macrocephalae Rhizoma Frictum) 9 g
pao4 jiang1 ( blast-fried ginger, Zingiberis Rhizoma
Praeparatum) 3 g
chi4 shi2 zhi1 ( halloysite, Halloysitum Rubrum) 15 g (break into
pieces)
fu2 long2 gan1 ( oven earth, Terra Flava Usta) 60 g
The patient pre-decocted the fu2 long2 gan1 and used the resulting soup as
the medium for boiling the other ingredients in the decoction
1975 2 23 : 20
9 12 9
610
Follow-up consultation on 23 February 1976: After taking 20 packets of

the above prescription, the patients abdominal pain ceased and he was
defecating once daily. Microscopy of the stool was negative. On the whole
the patient had basically recovered from his illness. There was a slight
tendency for tongue fur to be thin and yellow, with a stringlike slippery pulse.
I adjusted the above prescription by adding 9 g of chao3 mai4 ya2 (stir-fried
barley sprout) and by changing the dosage of chi4 shi2 zhi1 to 12 g and of
dang3 shen1 to 9 g. After taking another 610 packets the patient
successfully recovered.
( 36 69 69
3 36 ):
()
Lecture 4
82
FORMULA COMPARISON
Li3 zhong1 tang1 and yang3 zhong1 jian1 (see formula below) both treat
retching and diarrhea caused by vacuity cold of the center burner.
Yang3 Zhong1 Jian1 ( Center-Nourishing Brew)
chao3 shan1 yao4 ( stir-fried dioscorea, Dioscoreae Rhizoma
Frictum) 69 g
chao3 bian3 dou4 ( stir-fried lablab, Lablab Semen Album
Frictum) 69 g
Liquido Fricta) 3 g
chao3 gan1 jiang1 ( stir-fried dried ginger, Zingiberis Rhizoma
Frictum) 36 g
However, li3 zhong1 tang1 includes bai2 zhu2 (but does not have shan1 yao4
or bian3 dou4), thus it is stronger than yang3 zhong1 jian1 in its ability to
boost qi4 and fortify the spleen; moreover, it brings quicker results in acute
cases of abdominal pain or diarrhea caused by center burner vacuity cold.
Yang3 zhong1 jian1, on the other hand, includes chao3 shan1 yao4 (stir-fried
dioscorea) and chao3 bian3 dou4 (stir-fried lablab) (but does not have bai2
zhu2). Shan1 yao4 not only fortifies the spleen, it also boosts the lung and
supplements the kidney. Bian3 dou4 not only fortifies the spleen, it also
dispels summerheat-damp. Thus yang3 zhong1 jian1 is a more effective
spleen-fortifying, kidney-boosting, dampness-transforming, and summerheatdispelling formula than li3 zhong1 tang1. The name Center [burner]Nourishing ( yang3 zhong1) is due to its balanced, harmonious, and
moderate effect.
12()
Lecture 4
83
4.12 Da4 Jian4 Zhong1 Tang1 ( Major Center-Fortifying

Decoction)
Golden Coffer)
69 912 4.56 3
chao3 hua1 jiao1 ( stir-fried zanthoxylum, Zanthoxyli

Pericarpium Frictum) 69 g
ren2 shen1 ( ginseng, Ginseng Radix) 4.56 g
yi2 tang2 ( malt sugar, Maltosum) 3 spoonfuls32
500 250
16O 25
Boil the first three ingredients in 500 ml of water until 250 ml remain, then
remove the dregs, add yi2 tang2 (malt sugar), and boil the decoction over a
small flame until 160 ml remain. Divide into two doses and take warm.
Twenty-five minutes after taking each dose, drink half a bowl of thin gruel to
help the strength of the medicines. Take two doses daily and rest in bed with
covers on after taking the medicine. The patient should only eat soft foods.
:"
()"()
Here is the original text by Zhang1 Zhong4-Jing3 that describes the

indications for this formula:
[When there is] great cold pain in the heart and chest with
retching and inability to eat or drink, [if] cold in the abdomen surges
upward and lifts the skin, [causing a lump like a] head or foot to
appear and pain above and below that cannot be touched, da4 jian4
zhong1 tang1 governs.
"
"
"
32
Roughly 40 g. (Ed.)
Lecture 4
84
()
(
)
;;
"
"""""
;
Da4 jian4 zhong1 tang1 comes from the Abdominal Fullness, Cold
Mounting, Lodged Food Disease; Pulses & Signs section of Jin1 Gui4 Yao4
Lue94 by Zhang1 Zhong4-Jing3. It treats patients with yang2 vacuity in
whom the center burner has received cold evil such that yin1-cold qi4
counterflows, surging up to the heart and chest, which results in great cold
pain in the heart and chest. The cold crosses over into the center burner and
surges up, which results in what appears like head and feet moving up and
down in the abdominal region (intestinal peristalsis) and causing pain. Pain,
retching, and inability to eat are due to spleen cold and non-movement and to
non-dispersion of food. Because the pattern is one of cold evil exuberant
repletion, there is severe pain in the abdomen; moreover, the patient does not
let others draw near and has aversion to the abdomen being touched or
pressed. This pattern requires urgent treatment that warms the center and
supplements vacuity and that dissipates cold and stops pain.
FORMULA ANALYSIS
Within the formula, the chief medicinal is chao3 hua1 jiao1; it is an acridhot medicinal 33 that enters the spleen and warms the stomach, enters the
kidney and supplements water, and furthermore enters the lung and dissipates
cold. Acrid-hot gan1 jiang1, the support medicinal, frees the heart and assists
yang2 and also expels cold and dissipates counterflow. Ren2 shen1, which is
sweet and warm, greatly supplements original qi4 and serves as the assistant.
Yi2 tang2, the courier, is a sweet-warm medicinal that supplements the spleen
and also relaxes tension and harmonizes the center.
In the human body, center burner qi4 is of primary importance. Da4 jian4
zhong1 tang1 (i.e., Major Center-Fortifying Decoction) uses hot-spicy, acrid,
33
Stir frying hua1 jiao1 makes it sweat (i.e., eliminates certain volatile oils). (Au.) Note that
this reduces its acridity and toxicity as well as its dissipating and moving nature. (Ed.)
Lecture 4
85
sweet, and hot ingredients that provide major fortification of center burner
yang2; this allows it to dispel upward counterflowing turbid yin1. Fortifying
( jian4) center ( zhong1) yang2, dispels yin1-cold so that all of the
symptoms naturally disperse, the spleen moves, and original qi4 recovers.
This is why the name of the formula includes center-fortifying ( jian4
zhong1). Also, relative to Zhang1 Zhong4-Jing3s minor center-fortifying
formula, this formula is the major center-fortifying decoction.
69 1015 69
10
I often use this formula to treat gripping pain in the abdomen in diseases
such as enterospasms and enterocele pain. If the pain radiates to the lesser
abdomen or smaller abdomen (or even if there is a cold pain that radiates to
the testicles in a man or to the genitals in a woman), add the ingredients
below to warm the liver-kidney and to dissipate cold and regulate qi4.
wu1 yao4 ( lindera, Linderae Radix) 1015 g
chao3 xiao3 hui2 xiang1 ( stir-fried fennel, Foeniculi Fructus
Frictus) 69 g
chao3 li4 zhi1 he2 ( stir-fried litchee pit, Litchi Semen Frictum)
10 g
FORMULA COMPARISONS
Da4 jian4 zhong1 tang1 and xiao3 jian4 zhong1 tang1 (Minor CenterFortifying Decoction) (see next formula) both treat abdominal pain from
vacuity cold of the center burner. The former, however, treats vacuity and
weakness of center burner yang2 with cold qi4 counterflowing up and leading
to pain of the stomach duct and abdomen as well as of the heart and chest.
The latter, in contrast, treats vacuity and weakness of the center burner,
Lecture 4
86
disharmony of construction and defense, disharmony of the liver-spleen, and

dull pain in the abdomen. While the strength of the former is its acridity and
heat, the strength of the latter is its sweetness and warmth. Da4 jian4 zhong1
tang1 is a drastic formula; in accordance with the principle in acute
conditions, treat the branch, we mostly use it to treat acute diseases. In
contrast, xiao3 jian4 zhong1 tang1 is a moderate formula; in accordance with
the principle in chronic conditions, treat the root, we mostly use it for
chronic diseases, and the patient will take it for a long time.
:
Da4 jian4 zhong1 tang1 and li3 zhong1 tang1 (see preceding formula) both
treat center burner yang2 vacuity with exuberant cold. The former is suited
for center burner yang2 vacuity with cold evil counterflow ascent that causes
attacks of pain in the heart, chest, stomach duct, and abdomen. The latter is
suited for yang2 vacuity of the stomach-spleen and for internal exuberance of
cold-damp that causes abdominal pain, retching and diarrhea, and no thirst, or
in extreme cases reversal cold of the limbs or even cold contraction sudden
turmoil (which is marked by alternating vomiting and diarrhea, flailing
agitation of the hands and feet, and gripping pain of the abdomen).
13()
4.13 Xiao3 Jian4 Zhong1 Tang1 ( Minor Center-Fortifying

Decoction)
by Zhang1 Zhong4-Jing3 ()
9 9 4 () 18 9 40
( 3 )

Liquido Fricta) 9 g
da4 zao3 ( jujube, Jujubae Fructus) 4 pieces (split)
Lecture 4
87

yi2 tang2 ( malt sugar, Maltosum) 40 g (approximately 3 soup
spoons)
Add 7 teacups of cold water to the first five of the above ingredients, boil
until 3 teacups remain, and remove the dregs. Then add the yi2 tang2 (malt
sugar), and return to a boil very briefly, two or three times. Take one teacup
of the decoction each time, and take three times per day.
"
""
()()
Xiao3 jian4 zhong1 tang1 is essentially gui4 zhi1 tang1 (Cinnamon Twig
Decoction) with a doubled dosage of bai2 shao2 yao4 (white peony) and the
addition of yi2 tang2 (malt sugar). It has a very broad range of use that
encompasses both externally contracted cold damage diseases and internal
damage from miscellaneous diseases. The following quotations from the
Shang1 Han2 Lun4 explain the indications of this formula for treating cold
damage diseases.
When in cold damage, the yang2 pulse is rough and the yin1
pulse is stringlike, as a rule, there should be acute pain in the
abdomen, so one should first give xiao3 jian4 zhong1 tang1 and if
[there is] no improvement, giving xiao3 chai2 hu2 tang1 (Minor
Bupleurum Decoction) governs.34
34
Zhang1, p. 419.
Lecture 4
88
When in cold damage [that has lasted for] two or three days,
[there are] palpitations and vexation in the heart, Minor CenterFortifying Decoction (xiao3 jian4 zhong1 tang1) governs.35
In looking at these writings we can see that xiao3 jian4 zhong1 tang1 is a
center-warming vacuity-supplementing formula. In cold damage greater
yang2 (tai4 yang2) disease, if the patient manifests insufficiency of center
burner construction-blood (the yang2 pulse is rough), vacuity cold of the
spleen-stomach with wood exploiting earth (the yin1 pulse is stringlike),
and acute pain in the abdomen, use xiao3 jian4 zhong1 tang1 to warm and
fortify the center burner and construction-qi4 so that the abdominal pain will
spontaneously resolve.
If the patient takes this decoction and the center burner and constructionqi4 are fortified, yet the abdominal pain is not fully resolved, then use xiao3
chai2 hu2 tang1 (Minor Bupleurum Decoction) in subsequent treatments to
shift the pivot, 36 which will outthrust the evil qi4 and the disease will
naturally be resolved. In some cases the patient gets to the second or third day
of cold damage, and due to excessive consumption of exterior-effusing
formulas the symptoms of aversion to wind and cold have gone away, yet
two or three days of sweating has been excessive and has caused the
formation of a vacuity pattern. Because the construction-blood is already
vacuous, blood no longer nourishes the heart, and the result is heart
palpitations. Because of blood vacuity, the heart-spirit has nothing on which
to rely, and the result is vacuity vexation. At that point, the disease has
already entered the pericardium network, and shifting the pivot is no longer
the appropriate treatment method. As a result, you should use xiao3 jian4
zhong1 tang1, because its warming and supplementing actions on the spleenstomach will engender construction-blood and spontaneously cure the
palpitations and vexation.
"()
"
;;
35
Zhang1, p. 178.
Shift the pivot ( zhuan4 shu1): The lesser yang2 (shao4 yang2) is also known as the
pivot between the interior and the exterior. Shifting the pivot means to enhance the pivot
function such that the evil does not lodge in the lesser yang2. (Ed.)
36
Lecture 4
89
:""
The following quote from the Jin1 Gui4 Yao4 Lue94 explains the internal
damage from miscellaneous diseases that xiao3 jian4 zhong1 tang1 treats:
Vacuity taxation with abdominal urgency, palpitations, spontaneous
external bleeding, pain in the abdomen, seminal loss while dreaming,
aching pain in the limbs, vexation heat in the extremities, dry throat
and dry mouth.
From this quotation we can see that xiao3 jian4 zhong1 tang1 is a spleenfortifying and vacuity-supplementing formula. It supplements the center with
sweet-warm, harmonizes and fosters construction and defense, and frees and
moves fluids. The patient has enduring vacuity taxation because the
construction-blood is already consumed; the abdominal urgency and pain
results from vacuity weakness of center burner yang2 and improper
nourishment of the spleen-stomach. The heart palpitations result from blood
failing to nourish the heart. Spontaneous external bleeding, vexation heat of
the extremities, and dry throat and mouth result from vacuity of essenceblood with internally engendered vacuity heat. Seminal loss while dreaming
results from frenetic movement of the ministerial fire. Because center-earth is
vacuous, the other four viscera are all vacuous. This is why using xiao3 jian4
zhong1 tang1 to warm and fortify the center viscus fosters construction,
blood, essence, and fluids, distributes them throughout the body, and relieves
all the symptoms.
Yu4 Jia1-Yan2 ( ) explained that after a patient with vacuity
taxation already has blood collapse, seminal loss, vexation heat in the five
hearts, and dry mouth and throat, they already have desiccated essence-blood
and are excessively vacuous and weak. One should therefore urgently fortify
the center viscus because this increases intake of food and drink and makes
yin1-blood effulgent; choose sweet medicinals to engender essence-blood.
Other than this, there is no other good treatment. This decoction by Zhang1
Zhong4-Jing3 truly actualizes the spirit of the following saying from the Nei4
Jing1:
Lecture 4
90
[When] supplementing yang2 leads to yin1 exhaustion, and

supplementing yin1 leads to yang2 desertion, use sweet medicinals.
""
()
According to the theories of Chinese medicine, the spleen and stomach

reside in the center burner and are in the center of the other four viscera.
They engender construction and defense, circulate body fluids, and are the
root of later heaven. When there is disharmony of the center viscus, you must
use this formula to warm and fortify (jian4) the center (zhong1) viscus; thus,
the name of this formula includes the term jian4 zhong1 (center-fortifying).
FORMULA ANALYSIS
Because the spleen likes moderation and urgently eating sweet moderates
the spleen, we use sweet for supplementation. Thus, sweet-warming yi2
tang2 nourishes the spleen and serves as the chief medicinal. Gan1 cao3 and
da4 zao3, the supports, enter the spleen and harmonize the center; using
sweet to assist sweet strengthens the moderate-supplementation action. The
two assistants are gui4 zhi1 and bai2 shao2 yao4. The former is an acriddissipating and warm-moistening medicinal that dissipates by moistening the
insufficient construction-defense. The latter is a sour-cold and yin1constraining medicinal that emolliates the liver to safeguard the spleen (it
drains wood within earth); it also moves and contracts fluids that are not
circulating. Sheng1 jiang1, the courier, is an acrid-dissipating and stomachwarming medicinal that boosts defense-yang2. Construction emerges from
the center burner, while defense emerges from the upper burner. Defense is
yang2, and to boost defense one must use acrid medicinals; construction is
yin1, and to supplement it one must use sweet medicinals. Within this
formula, acridity and sweetness unite to transform and engender yang2, while
sourness and sweetness unite to engender and transform yin1. This fortifies
the stomach-spleen, frees construction-defense, moves fluids, and engenders
essence-blood. Supplementing center-earth irrigates all sides and invigorates
Lecture 4
91
and fortifies the entire body; this naturally cures all of the symptoms of
vacuity taxation.
Recently laboratory tests on animals have demonstrated that xiao3 jian4

zhong1 tang1 increases immune capacity. There have been many cases of
vacuity debilitation or taxation damage patterns where the patient had
reached a very critical state, yet by taking this formula they gradually
improved. By very slowly moistening and supplementing the center burner,
you can bring about a cure.
3040
612
9 69 30
12 37.638%
912 912
FORMULA VARIATION
Huang2 Qi2 Jian4 Zhong1 Tang1 ( Astragalus CenterFortifying Decoction)
Use xiao3 jian4 zhong1 tang1 as the base formula.
Add:
huang2 qi2 ( astragalus, Astragali Radix) 3040 g
This formula treats vacuity pain in the abdomen. In modern times there
have been reports of people successfully treating ulcerating sores with
huang2 qi2 jian4 zhong1 tang1, and laboratory testing has demonstrated it
helps the sores heal and close.
For heart pain37 and pain of the stomach duct, add 612 g of yan2 hu2 suo3
(corydalis).
37
Note that heart pain ( xin1 tong4) has a broad meaning of pain in the pit of the
stomach or the heart region. (Ed.)
Lecture 4
92
For blood vacuity, add 9 g of dang1 gui1 (Chinese angelica) and 69 g of

chuan1 xiong1 (chuanxiong).
For copious night sweating, add 30 g of fu2 xiao3 mai4 (light wheat) and
12 g of fu2 shen2 (root poria). If the patient also has vacuity heat, with a body
temperature of around 37.638C (99.7100.4F), add 912 g of bei3 chai2
hu2 (northern bupleurum) and 912 g of di4 gu3 pi2 (lycium root bark).
Patients who vomit frequently should not take either da4 jian4 zhong1
tang1 (Major Center-Fortifying Decoction) or xiao3 jian4 zhong1 tang1
because they are too sweet. There is an old saying that sweetness is
contraindicated for patients who vomit.
;
CASE HISTORIES
In the past I have varied xiao3 jian4 zhong1 tang1 in accordance with the
symptoms to treat many cases of problematic illnesses. Such diseases
included allergic enteritis, gastro-intestinal neurosis, intestinal dysfunction,
intractable ulcer, and abdominal pain that endured for years without being
cured. Here I am providing a couple of such examples for your consideration.
1 45 1975 10 16
1969 1
1 1972
( 3839'C)
56
??
: 9 18 6
3 4 30 () 4.5 9
9 6 9 9 9
1020
Lecture 4
93
CASE 1
Mr. Li3, age 45. On 16 October 1975, the patient had a consultation at a
major hospital. Since 1969 he had paroxysmal pain to the right of the
umbilicus and in the upper abdomen that would occur in attacks that lasted
for one hour and occurred approximately once each month. Because he also
had pain in the right side of the lower abdomen, he underwent an
appendectomy in 1972. After the operation, there was still no resolution to
the attacks of pain in the right upper abdomen. From the beginning of the
current year, the attacks of pain occurred with fever (body temperature of
approximately 3839C (100.4102.2F)) and increased leukocyte count.
Antibiotic treatments reduced the body temperature and leukocyte count, but
there was no change in the abdominal pain. During May and June of this year,
the patient underwent further hospital testing. The hospital discharged him
with the diagnosis of pain in the right side of the upper abdomen that required
further investigation. Was it gallstones? Was it a biliary tract infection? The
pain had a fixed location, the tongue fur was normal, and the pulse was
slightly stringlike and slippery. The diagnosis was qi4 stagnation and blood
stasis of the spleen and stomach channels; the treatment was to warm the
channels, move qi4, and quicken stasis. The prescription I gave, which
follows, was xiao3 jian4 zhong1 tang1 with additions.
Liquido Fricta) 6 g
sheng1 jiang1 ( fresh ginger, Zingiberis Rhizoma Recens) 3 slices
da4 zao3 ( jujube, Jujubae Fructus) 4 pieces
yi2 tang2 ( malt sugar, Maltosum) 30 g (divide and take drenched)
wu2 zhu1 yu2 ( evodia, Evodiae Fructus) 4.5 g
tao2 ren2 ( peach kernel, Persicae Semen) 6 g
wu3 ling2 zhi1 ( squirrels droppings, Trogopteri Faeces) 9 g
xiang1 fu4 zi3 ( cyperus, Cyperi Rhizoma) 9 g
I prescribed 1020 batches.
Lecture 4
94
1975 12 4 :
12 9
4.5 1020
90
9
1 3
4 December 1975: The patient had reduced abdominal pain; he was no

longer taking antibiotics and was only taking Chinese decoctions. His tongue
and pulse were the same as before. Because he had attacks at regular intervals,
I added the following ingredients to the above prescription:
cao3 guo3 ( tsaoko, Tsaoko Fructus) 9 g
chang2 shan1 ( dichroa, Dichroae Radix) 4.5 g
The patient took another 1020 packets. From this time on the attacks
steadily became lighter and lighter until when attacks occurred the patient no
longer needed to rest. After a total of 90 packets, the patient completely
recovered. To consolidate the therapeutic results, I modified his prescription
by removing chang2 shan1 and adding the following ingredients:
dang3 shen1 ( codonopsis, Codonopsis Radix)
Viride)
bing1 lang2 ( areca, Arecae Semen)
We used equal parts of lian4 mi4 (processed honey) and yi2 tang2 (malt
sugar) to form the ingredients into pills. The pills were 9 g each, and the
patient took 1 pill per dose and three doses per day. From then on, he had no
relapses.
2
CASE 2
45 1965 9 25
: 5
Lecture 4
95
15 10 30 4.5
10 6 60 ()4
Mr. Zheng4, Age 45. Date of initial consultation: 25 September 1965. The
patient had constipation for many years. His stool was like sheep feces, and
his bowels moved only once every several days. He had a constant, dull pain
around his umbilicus as well as scant food intake and insomnia. The Western
medical diagnosis was intestinal dysfunction. The patient liked warmth
applied to the abdomen and had a red tongue tip and a fine pulse. The pattern
identified was center yang2 failing to move and intestinal blood vacuity; the
treatment was to warm the center and nourish blood. I prescribed a modified
version of xiao3 jian4 zhong1 tang1, as follows:
sheng1 bai2 shao2 ( raw white peony, Paeoniae Radix Alba
Cruda) 15 g
Integra) 10 g
gua1 lou2 ( trichosanthes, Trichosanthis Fructus) 30 g
Liquido Fricta) 4.5 g
tao2 ren2 ni2 ( crushed peach kernel, Persicae Semen
Tusum) 10 g
huo3 ma2 ren2 ( cannabis fruit, Cannabis Fructus) 6 g
yi2 tang2 ( malt sugar, Maltosum) 60 g
Divide the yi2 tang2 into equal halves and add separately to the first and
second decoctions. I prescribed 4 packets.
(1965 9 30 ): l
6 ,
2
Second Consultation (30 September 1965): After taking this medicine the
patient started having one bowel movement each day and his stool was no
longer dry. But, he still had a dull pain around the umbilicus. The tongue had
a thin white fur and the pulse was much more lively than before. I gave the
above prescription again with 2 g of yan2 hu2 suo3 (corydalis), which the
patient divided in half and took drenched with the decoction.
Lecture 4
96
(1965 10 9 ): l
: 6 20 10 30
4.5 10 75 60
()6
Third Consultation (9 October 1965): The patient continued to have daily

bowel movements and they were not excessively dry. There was still dull
pain around the umbilicus and the patients appetite was as before. His sleep
had improved while his tongue had become normal and his pulse was
moderate. The prescription below shows further variations:
sheng1 bai2 shao2 ( raw white peony, Paeoniae Radix Alba
Cruda) 20 g
Integra) 10 g
Integer) 30 g
tao2 ren2 ni2 ( crushed peach kernel, Persicae Semen
Tusum) 10 g
huo3 ma2 ren2 ( cannabis fruit, Cannabis Fructus) 7.5 g
yi2 tang2 ( malt sugar, Maltosum) 60 g
Divide the yi2 tang2 into two equal parts and take drenched. I prescribed 6
more packets for the patient.
(1965 10 16 ): 1
;
()6
Fourth Consultation (16 October 1965): The patients bowels were moving
once daily and sometimes twice in a day. He had mostly well formed stool
that was not dry, and his umbilical and abdominal pain did not recur. He had
increased appetite, improved sleep, a normal tongue fur, and a slightly fine
pulse. He took 6 more packets of the above prescription (with the tao2 ren2
ni2 removed), and he fully recovered.
14()
Lecture 4
97
4.14 Si4 Ni4 Tang1 ( Counterflow Cold Decoction)

from Shang1 Han2 Lun4 ( On Cold Damage)
915 9 12 (
)
zhi4 fu4 zi3 ( processed aconite, Aconiti Radix Lateralis

Praeparata) 915 g
Decoct in water and take.38
Si4 ni4 tang1 is an important yang2-returning counterflow-stemming

formula. It treats debilitation of yang2 qi4, exuberant internal yin1-cold,
reverse-flow cold of the four limbs, fear of cold with curled-up lying posture,
clear-food diarrhea, abdominal pain, and no thirst. The patient may
simultaneously have dry retching, sore throat, or great sweating with yang2
collapse. The pulse is sunken, slightly fine, and verging on expiry. In modern
times people have used this formula to save patients in shock who had
symptoms such as cold sweat over the whole body, lowered body
temperature, blood pressure that cannot be assayed because it is too low, and
a pulse that cannot be felt or that switches from being present to being absent.
::
38
The dosages in the above formula derive from Fang1 Ji4 Xue2 ( Formulas),
which is part of the national textbook series for all Chinese medicine colleges in China. (Au.)
Lecture 4
98
FORMULA ANALYSIS
The classics state: [For] internal cold excess, treat with sweet-warm
[medicinals]. Also, [For] prevalence of cold excess, calm [it] with acridwarm [medicinals]. Fu4 zi3 has great acridity and great heat; it is the chief
medicinal because it warms the channels and saves yang2 to rescue yang2
when it is verging on expiry. Gan1 jiang1, an acrid-warm medicinal that
warms the center and dissipates cold, supports fu4 zi3 in vitalizing yang2 qi4;
gan1 jiang1 and fu4 zi3 bring out the best in each other. The assistant is gan1
cao3, a sweet and warm medicinal that supplements center yang2, stimulates
stomach qi4, and furthermore moderates and regulates the harsh natures of
gan1 jiang1 and fu4 zi3. These medicinals comprise a formula that returns
yang2 with sweet-warmth and stems counterflow with acridity and warmth. It
cures disease by using the heat of fu4 zi3, the acridity of gan1 jiang1, and the
sweetness of gan1 cao3.
10
4
( 1218 )
9 i 18 10
I 3 ()
FORMULA VARIATIONS
Si4 Ni4 Jia1 Ren2 Shen1 Tang1 ( Counterflow Cold
Decoction Plus Ginseng)
Use si4 ni4 tang1 as the base formula.
Add:
Si4 ni4 jia1 ren2 shen1 tang1 treats patients who have had great vomiting
and great diarrhea then later develop generalized aversion to cold and a faint
pulse that verges on expiry. When diarrhea recurs, urgently apply this
formula to warm the channels and return yang2 and to boost qi4 and
engender liquids.
Bai2 Tong1 Tang1 ( Scallion Yang2-Freeing Decoction)
Lecture 4
99

Remove: gan1 cao3
Add:
cong1 bai2 ( scallion white, Allii Fistulosi Bulbus) 4 bulbs
Bai2 tong1 tang1 treats diarrhea from yang2 vacuity and exuberant cold.
The patient will have a faint pulse and the pattern of yang2 qi4 not
outthrusting.
Tong1 Mai4 Si4 Ni4 Tang1 ( Vessel-Freeing Counterflow
Cold Decoction)
Increase the dosage of gan1 jiang1 to 1218 g.
Tong1 mai4 si4 ni4 tang1 treats yang2 vacuity with exuberant cold in
patients with symptoms such as: clear-food diarrhea; reverse flow of the
limbs; cold interior and hot exterior; and red facial complexion. Contrary to
expectation, the patient does not have generalized aversion to cold. Other
possible symptoms include: abdominal pain; dry retching; throat pain;
dysentery; and absence of pulse.
For patients with red face, further add 9 bulbs of cong1 bai2. For
abdominal pain, add 18 g of bai2 shao2 yao4 (white peony). For vomiting
add 10 g of sheng1 jiang1. For throat pain add 3 g of jie2 geng3 (platycodon).
Add ren2 shen1 for patients in whom dysentery stops and the pulse is absent,
as it boosts qi4 and moves blood.
""
In the last 30 years several large hospitals have used ren2 shen1, fu4 zi3,
and gan1 jiang1 to make an injection fluid called shen1 fu4 jiang1 injection
fluid. 39 It achieves a fine result, and we use it in emergency rescue for
patients with shock or heart failure.
39
In the name shen1 fu4 jiang1 injection fluid, the shen1 stands for ren2 shen1 and the fu4
and jiang1 stand for fu4 zi3 and gan1 jiang1, respectively. (Ed.)
Lecture 4
100

;;
FORMULA COMPARISON
Si4 ni4 tang1, li3 zhong1 tang1 (Center-Rectifying Decoction), and wu2
zhu1 yu2 tang1 (Evodia Decoction) all treat yang2 vacuity patterns with
vomiting and diarrhea. However, si4 ni4 tang1 primarily treats reverse flow,
li3 zhong1 tang1 primarily treats diarrhea, and wu2 zhu1 yu2 tang1 primarily
treats vomiting. Within their similarities these three formulas also have their
differences, so you cannot overlook doing a proper identification.
( 9 6 3 6
9 10 6 4.5 ):
;
Si4 ni4 tang1 is also comparable to the formula below.

Hui2 Yang2 Jiu4 Ji2 Tang1 ( Yang2-Returning Emergency
Decoction)
Rhizoma) 9 g
Si4 ni4 tang1 treats reverse flow of the four limbs with vacuous yang2 and
effulgent cold. In contrast, hui2 yang2 jiu4 ji2 tang1 returns yang2 and stems
counterflow with much greater force. It treats cold evil that directly strikes
the three yin1. The patient may have vomiting and diarrhea with yang2
collapse, wherein yin1-cold is severe and vomiting is comparatively light.
There can also be right qi4 verging on expiry.
Lecture 4
101
Si4 ni4 tang1 and si4 ni4 san3 (Counterflow Cold Powder) 40 both treat
counterflow reversal of the limbs. However, the former primarily treats
counterflow reversal in which vacuous yang2 does not warm the extremities,
while the latter treats counterflow reversal from liver depression and qi4
stagnation, lack of harmony between exterior and interior, and internal heatevil depression in which the qi4 mechanism cannot freely communicate with
the four limbs. Thus, we use si4 ni4 san3 to harmonize and resolve the
exterior and interior and to course the liver and rectify the spleen. These two
formulas are entirely different and you should not confuse them.
CAUTION
Si4 ni4 tang1 is contraindicated for patients with true heat and false cold.
15.(
4.15 Dang1 Gui1 Si4 Ni4 Tang1 ( Chinese Angelica

Counterflow Cold Decoction)
9 9 9 6 6 <
)6 8 ()

Liquido Fricta) 6 g
tong1 cao3 ( rice-paper plant pith, Tetrapanacis Medulla)41 6 g
40
See the 17th formula in Lecture 3 for more on si4 ni4 san3 (Counterflow Cold Powder).
(Ed.)
41
Historically we called this medicinal mu4 tong1 (), but you should not use mu4 tong1
(trifoliate akebia) in this formula. (Au.)
Lecture 4
102
da4 zao3 ( jujube, Jujubae Fructus) 8 pieces

Decoct in water and take. In the original formula, the dosage of xi4 xin1 was
the same as that of gui4 zhi1.
;
;
FORMULA ANALYSIS
This formula treats reverting yin1 (jue2 yin1) cold damage and wind-cold
striking the blood vessels, with symptoms like reversal cold of the limbs and
a fine pulse verging on expiry. The symptoms show that vacuous yin1-blood
in the interior is not luxuriating the vessels, while vacuous yang2 of the
exterior is not warming the limbs. The result is reversal cold and a fine pulse
that is verging on expiry.
Acrid-warm dang1 gui1, the chief medicinal, nurtures blood and frees the
vessels. Gui4 zhi1 and bai2 shao2 yao4 are supports; the former frees the
channels and network vessels and dispels wind-cold, while the latter nurtures
yin1-blood and harmonizes construction and defense. Xi4 xin1 and tong1
cao3 are the assistants; the former dissipates blood-aspect cold while the
latter disinhibits the nine orifices and frees the blood vessels. Da4 zao3 and
gan1 cao3 are sweet, spleen-boosting medicinals that supplement vacuity and
engender blood; they serve as the couriers.
In modern times we use this formula to treat invasions of cold evil that
obstruct the channels and network vessels and lead to pain in the flesh and
joints or even to arteritis and absence of a pulse. Many reports have claimed
it works quite well.
;
Lecture 4
103
FORMULA COMPARISON
Si4 ni4 tang1 (Counterflow Cold Decoction) treats reverse flow with
vacuous yang2 that is unable to warm the four limbs; this requires a treatment
that returns yang2 and stems counterflow. In contrast, dang1 gui1 si4 ni4
tang1 treats reverse flow with vacuous blood that is unable to warm the four
limbs; this requires a treatment that nurtures blood and frees the vessels.
From this comparison we can comprehend that all of the formulas by
Zhang1 Zhong4-Jing3 in the si4 ni4 tang1 family have fu4 zi3 (aconite) and
gan1 jiang1 (dried ginger), with the sole exception of dang1 gui1 si4 ni4
tang1, which does not include those two medicinals. This is because all of the
si4 ni4 tang1 formulas treat vacuous yang2 and effulgent yin1, and for that
purpose the gan1 jiang1 and fu4 zi3 are required. Dang1 gui1 si4 ni4 tang1
primarily treats extreme vacuity of yin1-blood wherein the pattern evolves
from yin1 to yang2, and for that purpose gan1 jiang1 and fu4 zi3 are not
required.
In the past I have had unusually good results by using a variation of dang1
gui1 si4 ni4 tang1 to treat Raynauds disease. Below is an example of one of
my empirical formulas for your consideration.
1220 12 10 35
69 10 912 6
10 69 20 6 (
) 10

Extremitas) 10 g
Lecture 4
104

Rhizoma Sectum) 912 g
tong1 cao3 ( rice-paper plant pith, Tetrapanacis Medulla) 6 g
lu4 lu4 tong1 ( liquidambar fruit, Liquidambaris Fructus) 10 g
bai2 jie4 zi3 ( white mustard, Sinapis Albae Semen) 69 g
Praeparata) 20 g
tao2 ren2 ( peach kernel, Persicae Semen) 10 g
Pound the shu2 di4 huang2 and the ma2 huang2 together. Then, boil the
ingredients in water and take.
l
13
Mix together the medicinal juice from the first and second boilings, then
divide the juice into two equal doses that the patient takes separately. Next,
place the dregs in a small pan with plenty of water and boil them again. Wait
until the liquid has cooled enough to allow the patient to soak both hands,
then soak the hands in the medicinal liquid until it is no longer hot.
Afterwards, discard the cooled liquid and the dregs. Perform this procedure
once each day, and continue the treatment for 13 months.
16.(
4.16 Zhen1 Wu3 Tang1 ( True Warrior Decoction)

9 15 9 6--9 9
(
9 5 5 )( 3
12 )( 6 )

Lecture 4
105

Rhizoma) 69 g
We primarily use this formula for the following circumstances:42
When lesser yin1 (shao4 yin1) disease has not ceased [after] two or
three days, and at four or five days [there is] abdominal pain,
inhibited urination, heaviness in the limbs, and spontaneous
diarrhea.43
Zhen1 wu3 tang1 is for yang2 vacuity lesser yin1 (shao4 yin1) disease that
results from the interior having water qi4. When the patient also has cough,
add the following ingredients:
For concurrent retching, remove the fu4 zi3 and add a total of 12 g of sheng1
jiang1 (i.e., 3 g more than indicated above). For concurrent diarrhea, remove
the bai2 shao2 yao4 and add 6 g of gan1 jiang1 (dried ginger). If the patient
does not have water qi4 and therefore does not have inhibited urination,
remove the fu2 ling2.
()
We also use zhen1 wu3 tang1 for the following condition:44

When in greater yang2 (tai4 yang2) disease, sweating has been
promoted and sweat issues [but the disease] does not resolve, the
person still has heat effusion, and [there are] palpitations below the
42
Zhang1, p 484.
Spontaneous diarrhea is diarrhea that is part of the natural course of the disease, in contrast
to diarrhea that results from a mistaken medical treatment. (Ed.)
44
Zhang1, p 185.
43
Lecture 4
106
heart, dizzy head, generalized twitching, 45 and [the person is]

quivering and about to fall
These symptoms result from internal vacuity of true qi4 as well as yang2
collapse due to sweating; by urgently applying this decoction, one assists true
qi4 and warms the channels, thereby restoring yang2.
(
)
;
;
FORMULA ANALYSIS
We call this formula zhen1 wu3 tang1 (True Warrior Decoction) because in
ancient times the name true warrior (zhen1 wu3) referred to a deity of the
north, and the north is ascribed to water. The kidney governs water, and this
decoction specifically enters the kidney to treat water. Zhen1 wu3 tang1
governs this disease because there is internal vacuity of kidney qi4 that is
failing to dam water.
Within the formula, fu2 ling2 is the chief medicinal and bai2 zhu2 is the
support; these two medicinals enter the spleen and penetrate the kidney,
supplement earth and disinhibit water, and quell kidney evils to treat heart
palpitations. Sour-neutral bai2 shao2 yao4, the assistant, constrains yin1 and
harmonizes yang2 to boost the spleen. Acrid-hot fu4 zi3 and sheng1 jiang1
are couriers that warm the channels and dissipate cold; together they
supplement true fire to expel vacuity cold.
FORMULA COMPARISON
According to the Shang1 Han2 Lun4, xiao3 qing1 long2 tang1 (Minor
Green-Blue Dragon Decoction) and zhen1 wu3 tang1 are both appropriate
when the patient has water qi4 concurrently with greater yang2 (tai4 yang2)
45
Generalized twitching ( shen1 shun4 (run2) dong4): Jerking and jumping of the
bodys sinews. (Ed.)
Lecture 4
107
disease. However, the former is appropriate for water qi4 when the exterior
has not been resolved and when both interior and exterior are in repletion
patterns, while the latter is appropriate for cases when the exterior pattern has
already been resolved and when both the interior and exterior are in vacuity
patterns.
+++++
50
: 30 10 12
(>10 610
30 () 20 25 15
40 610 1 2
20 15 15
(910 )
30 12
2030 10 10
912 12 (
)
In modern times we often vary this formula according to the pattern and
use it to treat patients with recalcitrant nephritic edema and urinary protein of
++ or +++. I once treated a middle-aged woman suffering from chronic
nephritic uremia by varying a combination of yue4 bi4 tang1 (SpleenEffusing Decoction) and zhen1 wu3 tang1. The treatment not only eliminated
her symptoms and the protein in her urine, it also changed her urea nitrogen
count from approximately 50 to the normal range. Moreover her spirit
improved, and her strength and body weight increased. The result was
extraordinarily satisfying. The following is my empirical formula for such
circumstances.
chao3 bai2 shao2 yao4 ( stir-fried white peony, Paeoniae Radix
Alba Fricta) 10 g46
sheng1 ma2 huang2 ( raw ephedra, Ephedrae Herba Cruda) 6
46
When the patient does not have abdominal pain and is not irascible, you can leave out this
ingredient. (Au.)
Lecture 4
108
10 g
zhu1 ling2 ( polyporus, Polyporus) 20 g
che1 qian2 zi3 ( plantago seed, Plantaginis Semen) 15 g
dong1 gua1 pi2 ( wax gourd rind, Benincasae Exocarpium) 40 g
Decoct in water and take. Cook up one batch per day, and divide it into two
doses.
For lumbar pain, add the following medicinals:
ze2 lan2 ( lycopus, Lycopi Herba) 15 g
For generalized fear of cold, increase the dosage of zhi4 fu4 pian4 to 9
10 g. Or, if there is no fear of cold and there are no signs of kidney yang2
vacuity pattern, remove this medicinal from the formula. For patients who
have a microscopic examination of the urine that shows an overabundance of
erythrocytes, add the following medicinals:
sheng1 mao2 gen1 ( raw imperata, Imperatae Rhizoma
Crudum) 30 g
huang2 bai3 tan4 ( charred phellodendron, Phellodendri Cortex
Carbonisatus) 12 g
xiao3 ji4 ( field thistle, Cirsii Herba) 2030 g
If the patient has a thick white slimy tongue fur, add 10 g of each of huo4
xiang1 (agastache) and pei4 lan2 (eupatorium). For vomiting remove zhi4 fu4
pian4 and add 912 g of ban4 xia4 (pinellia). Also use 12 g of yu4 shu1
dan1 ( Jade Pivot Elixir); divide it into two parts and take it drenched.
17.(
4.17 Si4 Shen2 Wan2 ( Four Spirits Pill)

from Jiao4 Zhu4 Fu4 Ren2 Liang2 Fang1 ( Revised Good
Lecture 4
109
Remedies for Women)

120 60 ()60 120
120 49 :< 30
100 ()
50 : 69
1 2

rou4 dou4 kou4 ( nutmeg, Myristicae Semen) 60 g (bake in flour
to remove the oil)47
da4 zao3 ( jujube, Jujubae Fructus) 49 pieces48
Grind all of the ingredients (except for the sheng1 jiang1 and da4 zao3)
together into a fine powder. Boil the sheng1 jiang1 and da4 zao3 in a bowl of
water; when the da4 zao3 is cooked, remove the sheng1 jiang1 and continue
boiling until the water has all dried up. Use the flesh of the da4 zao3 to mix
with the medicinal powder and form pills the size of wu2 tong2 zi3 (firmiana
seed). Take 50 pills per dose, before meals. In modern times patients swallow
69 g of these pills with warm water, twice per day.
(
)
47
Here are the particulars of that procedure. Mix flour with water to form a dough, roll the
dough thin, and wrap the rou4 dou4 kou4 in small sections of the rolled dough. Bake or dryfry in sand until the outer surface is yellow. This process removes the oils from the medicinal,
which prevents the oils from moistening or scorching the intestines and also increases the
astringing and securing actions. (Ed.)
48
The version of this formula that appears in Zheng4 Zhi4 Zhun3 Sheng2 (The Level-Line
of Pattern Identification and Treatment) calls for 30 g of wu2 zhu1 yu2 and 100 pieces of
da4 zao3. (Au.)
Lecture 4
110
The medicinals in this formula are concise and make for a precise
treatment. We commonly use si4 shen2 wan2 for fifth-watch diarrhea49 (also
known as cocks crow diarrhea) that results from dual vacuity of kidney and
spleen as well as for enduring diarrhea from kidney vacuity. It also treats
spleen-kidney vacuity cold, which has symptoms such as slow dispersion of
food after eating, coldness and distention in the abdomen, and limp aching
lumbus and legs. But, si4 shen2 wan2 mainly treats spleen-kidney vacuity
diarrhea. Pharmacies have this medicine in packaged form and available for
sale, and physicians commonly vary it according to the symptoms and
prepare it as a decoction.
FORMULA ANALYSIS
Within the formula, bu3 gu3 zhi1 is the chief medicinal; an acrid, bitter,
and greatly warm medicinal, it supplements the kidney and invigorates yang2,
warms the cinnabar field, and secures the lower origin. Wu3 wei4 zi3 is the
support medicinal. It is a sour and warm medicinal that supplements the
kidney and also constrains essence and strengthens yin1. Although this
medicinal has all five flavors, it is mostly sour; sourness constrains, and
extreme constraint possesses a contracting and storing nature, which in this
formula contracts dissipated qi4 in the kidney. Thus, in si4 shen2 wan2 wu3
wei4 zi3 assists spleen yang2. The assistant, rou4 dou4 kou4 (nutmeg),
regulates the center with acridity and warmth; it secures the spleen and
astringes the intestines while simultaneously moving qi4. Wu2 zhu1 yu2 is an
acrid-hot medicinal that warms the center to stop abdominal pain; it rectifies
qi4 and courses depression while also regulating the liver. It is the courier
because it both ascends, where it encourages stomach qi4 to soar upward, and
descends to the lower burner, where it warms the liver and kidney to check
abdominal pain. Sheng1 jiang1 and da4 zao3 further act as conductors that
unite and transform with acridity and sweetness to boost the spleen and
regulate the center.
49
Fifth-watch diarrhea ( wu3 geng1 xie4): Diarrhea before daybreak. The name arises
from an ancient system of time that marked the different sections of the night. (Ed.)
Lecture 4
111
Because the medicinals in this formula are so concise, they make a truly
great result in treating vacuity diarrhea. The ancients had a saying that
fortifying the spleen to treat diarrhea was not as good as supplementing the
kidney. Si4 shen2 wan2 not only supplements the kidney, it furthermore
fortifies the spleen; the chief, support, assistant, and couriers interact with
such precision that the effectiveness of this formula is truly outstanding.
FORMULA VARIATIONS
I often use the combination of si4 shen2 wan2 with fu4 zi3 li3 zhong1 wan2
(Aconite Center-Rectifying Pill); I modify this combination according to the
symptoms and apply it in the treatment of what modern medicine recognizes
as chronic dysentery, chronic colitis, ulcerative colitis, and other such
diseases when they manifest with the symptoms of vacuity diarrhea. Below I
introduce my empirical formula and its variations.
915 69 912 6
10 1220 610
6 10 610 69
10 1

chao3 zhi3 qiao4 ( stir-fried bitter orange, Aurantii Fructus
Frictus) 610 g
Lecture 4
112
Decoct in water and take; use one packet per day.

12 1530
10 56
For patients with bloody stools, remove gan1 jiang1 and zhi4 fu4 pian4
and add the following medicinals:
Carbonisatus) 12 g
di4 yu2 tan4 ( charred sanguisorba, Sanguisorbae Radix
Carbonisata) 1530 g
huai2 hua1 tan4 ( charred sophora flower, Sophorae Flos
Carbonisatus) 10 g
1220 ;
10 10 15
For stool with pus-like sticky fluid, remove gan1 jiang1 and zhi3 qiao4
(ke2) and add the following:
chao3 bai2 shao2 yao4 ( stir-fried white peony, Paeoniae Radix
Alba Fricta) 1220 g
Frictus) 10 g
shu2 yi3 mi3 ( cooked coix, Coicis Semen Conquitum) 15 g
610 1520 30 30
6 1218 1530
For stool with scant pus and blood in patients who have repeated relapses,
remove gan1 jiang1, dang3 shen1, zhi4 fu4 pian4, and zhi3 qiao4 (ke2) and
add the following medicinals:
Lecture 4
113
di4 yu2 tan4 ( charred sanguisorba, Sanguisorbae Radix

Carbonisata) 30 g
xu4 duan4 tan4 ( charred dipsacus, Dipsaci Radix
Carbonisata) 1530 g
10
12 12 10 10
For abdominal distention, dull pain in the abdomen, and poor appetite,
remove dang3 shen1, huang2 lian2, and zhi3 qiao4 (ke2) and add the
jiao1 bing1 lang2 ( scorch-fried areca, Arecae Semen Ustum) 10 g
sheng1 mai4 ya2 ( raw barley sprout, Hordei Fructus Germinatus
Crudus) 12 g
yan2 hu2 suo3 ( corydalis, Corydalis Rhizoma) 10 g
9 18 30 () 20 20
For constant, dull pain surrounding the umbilicus and rumbling intestines
with sounds like gurgling water, remove zhi3 qiao4 (ke2), dang3 shen1, and
huang2 lian2 and add the following medicinals:
yi2 tang2 ( malt sugar, Maltosum) 30 g50
50
Take this drenched with the decoction. (Au.) That is, each packet yields two doses of the
decoction, and the patient should drench 15 g of yi2 tang2 with each dose. (Ed.)
Lecture 4
114
1520
12
For limp and aching lumbus and legs as well as general fatigue, remove
zhi3 qiao4 (ke2) and add the following medicinals:
chao3 du4 zhong4 ( stir-fried eucommia, Eucommiae Cortex
Frictus) 12 g
CASE HISTORIES
I provide the following case history for your reference.
33 1958 3 13 4
45
45
: 12 9
12 6 10 6
6 5 6 3 9
5 9 3
10
Mr. Zhang1, age 33. Initial consultation on 13 March 1958. More than four
months prior to the initial consultation the patient had felt great thirst and
responded by voraciously drinking water and eating fruit, which resulted in
diarrhea. The patient had bowel movements 45 times each day and had
occasional abdominal pain and abdominal distention. He took Western
medicines for this problem, and they were able to reduce the frequency of the
diarrhea, but after discontinuing medication it always returned. In this way
the disease had continued for months.
Lecture 4
115
When I saw the patient he had intestinal rumbling and diarrhea at about 4
5 A.M. every day. He also had poor appetite, flusteredness and fatigue, and a
liking for hot compresses on his abdomen. His urine was scant, yet it was not
yellow. The patient further had a lusterless facial complexion, slight white
tongue fur, a sunken slippery pulse on the left hand, and a sunken fine pulse
on the right side; both cubit pulses were weak, particularly the right cubit
pulse. According to the pulse and symptoms, the pattern was dual vacuity of
spleen and kidney that resulted in fifth-watch diarrhea. My treatment for him
was to fortify the spleen and transform dampness, warm and invigorate
kidney yang2, and supplement fire to engender earth. I gave him three
packets of the following prescription:
Rhizoma) 9 g
Liquido Fricta) 6 g
chao3 shan1 yao4 ( stir-fried dioscorea, Dioscoreae Rhizoma
Frictum) 9 g
chao3 yi3 mi3 ( stir-fried coix, Coicis Semen Frictum) 9 g
After he took this prescription, his symptoms were less severe and his spirits
greatly improved. He no longer had diarrhea at dawn. After taking 10 packets,
he not only no longer had diarrhea, but he had increased strength, a roaring
appetite, and better productivity at work. I gave him three more packets of the
prescription to eliminate the root of the disease. This cured the disease and
immensely pleased the patient.
Lecture 4
116
CAUTION
Si4 shen2 wan2 primarily treats diarrhea from spleen-kidney vacuity cold.
It is contraindicated for internal brewing and binding of damp-heat.
18(
4.18 Ban4 Liu2 Wan2 ( Pinellia and Sulfur Pill)

from Tai4 Ping2 Hui4 Min2 He2 Ji4 Ju2 Fang1 ( Tai4Ping2 Imperial Grace Pharmacy Formulas)
120 ()()120 ()
ban4 xia4 ( pinellia, Pinelliae Rhizoma) 120 g (finely powdered)

liu2 huang2 ( sulfur, Sulphur) 120 g51
sheng1 jiang1 ( fresh ginger, Zingiberis Rhizoma Recens) (as
needed)
:
1520
Ancient Pill Manufacturing Method: Boil all of the above ingredients

with natural juice from ginger. Thoroughly mix the juice with powder from
steamed buns that have been dried by pounding several hundred times with
mortar and pestle. Form into pills the size of wu2 tong2 zi3 (firmiana seed).
Take 1520 of such pills for each dose; take them before meals (on an empty
stomach), and swallow them with warm wine (or women should swallow the
pills with hot, diluted vinegar).
: 12O
36
Modern Pill Manufacturing Method: Grind the first two medicinals

listed above into a fine powder, and pound 120 g of sheng1 jiang1 (fresh
ginger) to get the juice. Mix the powder and juice with cold water and make
into water pills that are the size of lu94 dou4 (mung bean). Take 36 g of the
pills per dose, and swallow them with warm water.
51
The best quality liu2 huang2 is bright, clean, and free of impurities. (Au.)
Lecture 4
117
Ban4 liu2 wan2 primarily treats bound stool in elderly patients with kidney
yang2 vacuity, which Chinese medicine refers to as cold constipation.52
Yang2 vacuity cold constipation gradually forms when an elderly patient
with kidney yang2 insufficiency has vacuity cold of the lower origin and fire
not engendering earth; thereafter, congealing yin1 does not transform, and the
large intestine lacks force in its conveyance, thus stool is not expelled
smoothly. Although ancient physicians said that this formula also treats
yang2 vacuity diarrhea in elderly patients, in clinical practice we primarily
use it for cold constipation in elderly patients with yang2 vacuity.
""()
FORMULA ANALYSIS
Ban4 liu2 wan2 uses liu2 huang2 to supplement the true fire of the life gate
and to warm and invigorate kidney yang2. Our predecessors referred to liu2
huang2 as the essence of fire, and they referred to the duo of liu2 huang2 and
da4 huang2 (rhubarb) as the military general. This is because da4 huang2
is a powerful bitter-draining medicinal and liu2 huang2 is a great warmsupplementing medicinal. When an elderly patient has debilitated and
exhausted true yang2, the lower origin fire is slight, kidney yang2 is vacuous
and weak, fire does not engender earth, and there is forceless movement in
the center burner. The result is a loss of conveyance by the large intestine,
waste stagnates and does not descend, and the patient has vacuity
constipation with stools that are not free.
52
Cold constipation ( leng3 bi4): Constipation that arises when spleen-kidney yang2
vacuity causes yin1-cold to congeal and bind, which reduces warmth and movement of food.
(Ed.)
Lecture 4
118
Within the formula, liu2 huang2 not only warms and supplements the life
fire, it furthermore warms without drying. Liu2 huang2 combined with ban4
xia4 harmonizes and downbears qi4 of the center burner and also makes grain
qi4 descend. As the treatment warms and invigorates kidney qi4 and as true
yang2 becomes full, the governance of the lower origin and the control of
urine and stool gain in strength, and the body expels waste through the turbid
path. Thus, the formula treats vacuity constipation and cold constipation that
result from vacuous, debilitated true yang2 and from vacuity cold of the
lower origin.
: 1.53
612 1 ()
As far as the dosage of liu2 huang2, we normally use 1.53 g of this

medicinal in making pills. At present people mostly make a decoction with
612 g of ban4 xia4 (pinellia) and take 1 g of powdered liu2 huang2
drenched. No matter how it is prepared, the dosage of liu2 huang2 cannot be
excessive.
: 30
56
56 .
CAUTION
To prepare the liu2 huang2, one should wash clean a section of pig
intestine, stuff it with 30 g of liu2 huang2, stitch the intestine tightly closed,
place it in a wok, and boil for 56 hours. Then remove the intestine, dry the
liu2 huang2 in the sun, and make it into a powder. Alternatively, coarsely
powder the liu2 huang2, place it in the center of a piece of dou4 fu3
(beancurd), fix it in place with a strip of cloth, then boil for 56 hours. Later,
sun dry it and grind to a fine powder.
When taking liu2 huang2, patients should avoid consuming the blood of
any kind of animal, such as pig blood, cow blood, chicken blood, and sheep
blood.
19()
Lecture 4
119
4.19 Nuan3 Gan1 Jian1 ( Liver-Warming Brew)

from Jing3 Yue4 Quan2 Shu1 ( Jing3-Yue4s Complete
Compendium)
69 9 6 6 9 3
6 3 3 6 6
69

gou3 qi3 zi3 ( lycium, Lycii Fructus) 9 g
xiao3 hui2 xiang1 ( fennel, Foeniculi Fructus) 6 g
chen2 xiang1 ( aquilaria, Aquilariae Lignum Resinatum) 3 g
sheng1 jiang1 ( fresh ginger, Zingiberis Rhizoma Recens) 3 slices
Decoct in water and take. If the patient has severe cold, add:
Should they be even more cold, add:
This formula treats liver-kidney genital cold,53 pain of the smaller abdomen,
mounting qi4 with unilateral sagging of the testicles, and testicular pain. Note
that while this formula treats patients with liver-kidney vacuity cold pattern,
it is contraindicated for redness, swelling, and pain of the testicles due to
damp-heat flooding downward.
;
;
53
Liver-kidney genital cold ( gan1 shen4 yin1 han2): The characters in this term
literally translate as liver-kidney yin1 cold, but the yin1 refers to the testicles here. (Ed.)
Lecture 4
120
;
;
FORMULA ANALYSIS
Within this formula, the chief medicinals are dang1 gui1, which nurtures
blood and supplements the liver, and gou3 qi3 zi3, which warms yang2 and
supplements the kidney. The supports are rou4 gui4 and xiao3 hui2 xiang1;
the former assists kidney yang2 and the latter warms the liver, regulates qi4,
and treats mounting. The assistants are wu1 yao4, which normalizes
counterflow qi4 to treat mounting, fu2 ling2, which eliminates damp, and
sheng1 jiang1, which dissipates cold. Chen2 xiang1, the courier, conducts qi4
back to the kidney to effectively warm the kidney and liver as well as move
qi4 and dispel cold.
According to the theories of Chinese medicine, the liver governs the seven
mounting diseases; whatever kind of mounting qi4 a patient may have, the
treatment must begin work through the liver then proceed to address the
relevant variety of mounting disease, such as cold mounting, heat mounting,
water mounting, bulging mounting, and foxy mounting.
Nuan3 gan1 jian1 specifically treats liver-kidney genital cold that leads to
cold mounting with unilateral testicle sagging, distending pain of the testicles
that reaches into the lower abdomen, and pain that is relieved by warmth. The
patient may have a sunken stringlike slow cubit pulse. It is a warming
formula (it warms the kidney and dispels cold while also nurturing the liver
and regulating qi4) that treats the liver (the liver governs mounting diseases),
so the name of the formula is nuan3 gan1 jian1 (Liver-Warming Brew).
9 912 9
69 6 69
915
""
I often get fine results by using a variation of this formula to treat chronic
orchitis in which the pattern identified is vacuity cold of the liver and kidney
Lecture 4
121
with qi4 stagnation of the lower burner. I vary the formula by removing
chen2 xiang1 and adding the following ingredients:
chao3 ju2 he2 ( stir-fried tangerine pip, Citri Reticulatae Semen
Frictum) 9 g
chao3 chuan1 lian4 zi3 ( stir-fried toosendan, Toosendan
Fructus Frictus) 912 g
chao3 li4 zhi1 he2 ( stir-fried litchee pit, Litchi Semen Frictum)
9g
Viride) 69 g
For patients with pronounced abdominal pain, add:
You only have to be sure that the pattern identification is accurate to use this
approach; do not be afraid to warm the kidney and liver or to apply
ingredients that move qi4 and treat mounting just because the disease name in
modern medicine may reference inflammation.54
When a woman has attacking and surging pain in the smaller or lesser
abdomen during menstruation, further add xiang1 fu4 zi3 (cyperus) and yan2
hu2 suo3 (corydalis). This is very effective.
20.()
4.20 Wu3 Ling2 San3 ( Poria Five Powder)

24 24 24 48 15
35 3 1520
54
In modern medical Chinese, the character yan2 is used for the suffix -itis, such as in
the terms laryngitis, bronchitis, and orchitis. As comprises the doubled character for fire
(one above and one below), to Chinese readers it immediately gives rise to the notion of
inflammation. Dr. Jiao1s point here is that the disease name in modern medicine may seem
to reference heat in the symptoms, but practitioners of Chinese medicine should look purely
at the questions posed in pattern identification to decide whether or not warming the liver
and kidney is appropriate. (Ed.)
Lecture 4
122

Rhizoma) 24 g
Grind all of the above medicinals into a fine powder, and take 35 g per dose.
Swallow the powder with warm water, three times each day. Alternatively,
boil 1520 g of the powder, remove the dregs, and take. After taking the
medicine drink hot water and cover with warm blankets to effuse a light
sweat. In modern times we make this formula into a decoction by boiling the
ingredients in water.
This formula transforms qi4 and disinhibits water and also fortifies the
spleen and dispels dampness. It mainly treats cold damage greater yang2
(tai4 yang2) pattern with water-damp collecting internally when a sweateffusing formula does not resolve the exterior pattern such that headache and
heat effusion persist. Damp-heat evils then enter the interior and amass
internally in the bowel associated with the greater yang2 (tai4 yang2)the
bladder. This leads to inhibited urination and thirst with a desire to drink.
Also, drinking water causes immediate vomiting, the patient has a floating
pulse, and the internal amassment of water-damp gives rise to water swelling
and to short voidings of scant urine or to water-damp diarrhea and scant urine.
In modern times we use this formula to treat nephritic edema, gastroenteritis
with vomiting and diarrhea, and infectious hepatitis when the patient has
inhibited urination. Wu3 ling2 san3 is a water-disinhibiting formula that
modern laboratory experiments on animals have demonstrated has a diuretic
action.
Lecture 4
123

;
;
;
35
FORMULA ANALYSIS
Within the formula, ze2 xie4 is salty and cold; it enters the water viscus,
overcomes bound heat, and serves as the chief medicinal. The supports, zhu1
ling2 and fu2 ling2, drain water-heat by disinhibiting damp with bland
percolation, freeing and regulating the water pathways, and transporting
water evils down and out through the bladder. Bai2 zhu2, the assistant,
fortifies the spleen and dries dampness and also assists earth in damming
water. Gui4 zhi1, the courier, perfuses yang2 qi4 with acridity and warmth,
assists qi4 transformation throughout the body, and steams and transforms the
triple burner to disinhibit water. These five medicinals together not only treat
internal patterns such as water collecting in the bladder and disinhibited
urination, they also resolve the exterior pattern of water collecting and heat
effusion. For patients who have no symptoms of an exterior pattern, change
the gui4 zhi1 to 35 g of rou4 gui4 (cinnamon bark).
(())
FORMULA COMPARISON
Wu3 ling2 san3 and zhu1 ling2 tang1 (Polyporus Decoctionsee formula
below) are both water disinhibiting formulas.
Zhu1 Ling2 Tang1 ( Polyporus Decoction)
zhu1 ling2 ( polyporus, Polyporus)
e1 jiao1 ( ass hide glue, Asini Corii Colla) (dissolve)
Lecture 4
124
hua2 shi2 ( talcum, Talcum)

ze2 xie4 ( alisma, Alismatis Rhizoma)
There is a difference between these two formulas, however, in that zhu1
ling2 tang1 primarily treats binding of water and heat in which internal heat
damages yin1 and leads to: heat effusion; thirst with desire to drink; inhibited
urination; lesser yin1 (shao4 yin1) pattern dysentery where after 6 or 7 days
the patient has coughing as well as retching and thirst, heart vexation and
inability to sleep; or there may be blood strangury or bloody urine. Such
patients have yin1 vacuity with heat, and the emphasis should be on treating
yang2 brightness (yang2 ming2) and lesser yin1 (shao4 yin1) channels
because water-heat has already damaged yin1. In contrast, we tend to use
wu3 ling2 san3 when the treatment should address water-heat of the greater
yang2 (tai4 yang2) channel in which the patient has both exterior and interior
signs and yin1 is not yet damaged.
For patients who have yang2 brightness (yang2 ming2) disease with
copious sweating and thirst with taking of fluids, neither wu3 ling2 san3 nor
zhu1 ling2 tang1 is appropriate. You must avoid disinhibiting water in this
situation, as it can make fluids severely collapse.
9 9 9 915
6
10
30 30
15 12
I often treat damp-heat in the lower burner with wu3 ling2 san3 plus the
following additions:
huang2 bai3 ( phellodendron, Phellodendri Cortex) 9 g
Lecture 4
125
This pattern results in symptoms such as frequent and inhibited urination with
no pain of the urethra, thirst yet no desire to drink, and a yellow slimy tongue
fur. Standard urinalysis usually uncovers no diseases in patients with this
pattern.
For patients with urinary infections that are attributable to the pattern of
damp-heat in the lower burner, I further modify the above variation by
removing gui4 zhi1 and adding 10 g of chai2 hu2 (bupleurum).
For pain on urination with blood in the urine, change the huang2 bai3 to
12 g of huang2 bai3 tan4 (charred phellodendron), and add the medicinals
listed below.
xiao3 ji4 tan4 ( charred cephalanoplos, Cephalanoploris Herba seu
Radix Carbonisata) 30 g
mao2 gen1 tan4 ( charred imperata, Imperatae Rhizoma) 30 g
qu2 mai4 ( dianthus, Dianthi Herba) 15 g
(4050 )
13 3040 15 15
I also modify the combination of wu3 ling2 san3 and liu4 wei4 di4 huang2
tang1 (Six-Ingredient Rehmannia Decoction) to treat dispersion-thirst with
intake of fluids in diabetic patients. The modifications include increasing the
dosage of sheng1 di4 huang2 to 4050 g, changing gui4 zhi1 to 13 g of rou4
gui4 (cinnamon bark), and adding the following medicinals:
sheng1 shi2 gao1 ( raw gypsum, Gypsum Crudum) 3040 g
ge2 gen1 ( pueraria, Puerariae Radix) 15 g
tian1 hua1 fen3 ( trichosanthes root, Trichosanthis Radix) 15 g
These modifications not only stop thirst, they furthermore lower levels of
glucose in the blood and in the urine.
()
"
"(
Lecture 4
126
FORMULA VARIATIONS
Si4 Ling2 San3 ( Poria Four Powder)
Use wu3 ling2 san3 as the base formula.
Remove: gui4 zhi1
Si4 ling2 san3 treats thirst and inhibited urination in patients who do not
have heat effusion or aversion to cold.
Zhu1 Ling2 San3 ( Polyporus Powder)
Golden Coffer)
Remove: gui4 zhi1 and ze2 xie4
Zhu1 ling2 san3 treats vomiting when the disease is above the diaphragm
and desire to drink.
Yin1 Chen2 Wu3 Ling2 San3 ( Virgate Wormwood and Poria
Five Powder)
Add:
Herba)
Yin1 chen2 wu3 ling2 san3 treats damp-heat yellowing with repletion in
neither the interior nor the exterior and inhibited urination.
Chun1 Ze2 Tang1 ( Spring Pond Decoction)
Lecture 4
127
Add:
ren2 shen1 ( ginseng, Ginseng Radix)
Chun1 ze2 tang1 engenders fluids by assisting qi4 transformation (which
gives rise to the name Spring Pond); we use it to treat vacuous patients
with no major disease who have thirst or to treat patients with thirst when
they are recovering from a major disease. Note that some people also add
gan1 cao3 (licorice) to this formula.
Gui4 Ling2 Gan1 Lu4 Yin3 ( Cinnamon and Poria Sweet Dew
Beverage)
Change gui4 zhi4 to rou4 gui4 (cinnamon bark)
Add:
sheng1 shi2 gao1 ( raw gypsum, Gypsum Crudum)
hua2 shi2 ( talcum, Talcum)
han2 shui3 shi2 ( glauberite, Gypsum seu Calcitum)
Powder the medicinals for the patient to take. Gui4 ling2 gan1 lu4 yin3
clears summerheat of the six bowels, transforms qi4 and disinhibits damp,
and treats contraction of damp in summerheat strike with headache and heat
effusion, vexation thirst with fluid intake, and inhibited urination.
Wei4 Ling2 Tang1 ( Stomach-Calming Poria Five Decoction)
Combine with:
ping2 wei4 san3 ( Stomach-Calming Powder)
Wei4 ling2 tang1 treats symptoms such as damp damage with collecting
rheum, food stagnation and abdominal pain, summerheat-strike diarrhea,
thirst, and inhibited urination.
In summary, wu3 ling2 san3 is a water-disinhibiting, dampness-dispelling
formula that physicians have been modifying and transforming from ancient
times to the present. Here we cannot review all of the variations one by one,
so please remember that in clinical practice everything depends on clearly
understanding the circumstances and masterfully implementing appropriate
changes.
Lecture 4
128
21.()
4.21 Wu3 Pi2 Yin3 ( Five-Peel Beverage)

from Dan4 Liao2 Fang1 ( Tranquil Hut Formulary)
()
chen2 pi2 ( tangerine peel, Citri Reticulatae Pericarpium)

fu2 ling2 pi2 ( poria skin, Poriae Cutis)
sang1 bai2 pi2 ( mulberry root bark, Mori Cortex)
da4 fu4 pi2 ( areca husk, Arecae Pericarpium)
jiang1 pi2 ( ginger skin, Zingiberis Rhizomatis Cortex)
Use equal amounts of all of these medicinals (collectively a suitable amount),
boil as a decoction, and take.
()
This formula treats skin water55 and is a clever medicine for disinhibiting
water and dispersing swelling. It treats symptoms such as: water swelling of
the head, face, and four limbs; inhibited urination; distention and fullness in
the heart [region] and abdomen; qi4 ascent hasty panting; and even water
swelling during pregnancy.
;;
FORMULA ANALYSIS
According to the Nei4 Jing1, All dampness with swelling and fullness is
ascribed to the spleen. Within the formula, chen2 pi2 is the chief medicinal
because it transforms dampness with aroma, rectifies qi4 and harmonizes the
55
Skin water is a form of water swelling under the body surface that is not very deep. (Au.)
Lecture 4
129
center, and arouses the spleen. Fu2 ling2 pi2, the support, disinhibits
dampness with bland percolation and also fortifies the spleen and regulates
the center. Sang1 bai2 pi2 and da4 fu4 pi2 are the assistants. The former
drains the lung and moves water to treat the upper source of water; it also
opens and regulates the water pathways to transport water evils downward to
the bladder. The latter moves qi4 and disperses distention, for when qi4
moves, water moves. The courier, jiang1 pi2, is an acrid-dissipating
medicinal that opens the entire body to dissipate water-qi4. Disinhibiting
water-damp makes water swelling naturally disperse. Because the formula
primarily treats skin water, all of the agents used in the formula are the skin56
(i.e., the peel, bark, or husk) of various plants; this embodies the idea of using
skin ingredients to treat skin diseases.
The dosage of this medicine should be relatively light, for the water pattern
to be treated is also relatively light; in clinical practice, use discretion in
modifying this formula.
There are also recipes for wu3 pi2 yin3 in Tai4 Ping2 Hui4 Min2 He2 Ji4
Ju2 Fang1 (Tai4-Ping2 Imperial Grace Pharmacy Formulas) and in Ma2
Ke1 Huo2 Ren2 Quan2 Shu1 (Life-Saving Collected Works on the
Treatment of Measles). The former is like the wu3 pi2 yin3 presented above,
except that wu3 jia1 pi2 (acanthopanax) and di4 gu3 pi2 (lycium root bark)
replace chen2 pi2 and sang1 bai2 pi2. Likewise, the latter variation is like the
formula above, but wu3 jia1 pi2 (acanthopanax) replaces sang1 bai2 pi2.
There is no big difference between these two formulas,57 so keep them in
mind in your clinical practice and select the one that is most suitable.
30 15
612 2535 () 69 (
) 3040
56
In Chinese, the character for peel ( pi2) also means skin (on the body), bark (on
plants), husks (on nuts), and so forth. (Ed.)
57
Note that all three of these formulas have five-peel in the name, and it is only the kinds
of peels that change. (Ed.)
Lecture 4
130
I often treat nephritic edema by modifying wu3 pi2 yin3. In particular, I
increase the dosages of fu2 ling2 pi2 and da4 fu4 pi2 to 30 g and 15 g,
respectively, and add the following ingredients:
sheng1 ma2 huang2 ( raw ephedra, Ephedrae Herba Cruda) 6
12 g
cang1 zhu2 ( atractylodes, Atractylodis Rhizoma) 69 g58
dong1 gua1 pi2 ( wax gourd rind, Benincasae Exocarpium) 30
40 g
As this always gets a fine result, I hope you will try it.
3045 15
9 9 9 ()912
912 (
)
40 3040 6
10
FORMULA VARIATIONS
Wu3 Zi3 Wu3 Pi2 Yin3 ( Five-Seed and Five-Peel Beverage)
Use wu3 pi2 yin3 as the base formula.
Increase the dosage of fu2 ling2 pi2 to 3045 g and of da4 fu4 pi2 to 15 g
Add:
chao3 su1 zi3 ( stir-fried perilla fruit, Perillae Fructus Frictus) 9 g
chao3 lai2 fu2 zi3 ( stir-fried radish seed, Raphani Semen
Frictum) 9 g
ting2 li4 zi3 ( lepidium/descurainiae, Lepidii/Descurainiae
Semen) 9 g
bing1 lang2 ( areca, Arecae Semen)59 912 g
58
With these additions, the formula captures the essence of yue4 bi4 jia1 zhu2 tang1 (
Spleen-Effusing Decoction Plus White Atractylodes). (Au.)
Lecture 4
131
shui3 hong2 hua1 zi3 ( princes-feather, Polygoni Orientalis

Fructus)
Wu3 zi3 wu3 pi2 yin3 treats water drum distention (which can encompass
ascites in early stage hepatocirrhosis and cardiac ascites), and it is quite good
at eliminating ascites. To further increase the capacity to move qi4 and
disperse distention, I add the following medicinals.
dong1 gua1 pi2 ( wax gourd rind, Benincasae Exocarpium) 40 g
hu2 lu2 ( bottle gourd, Lagenariae Depressae Fructus) 3040 g
xiang1 fu4 zi3 ( cyperus, Cyperi Rhizoma) 10 g
22(<)
4.22 Ba1 Zheng4 San3 ( Eight Corrections Powder)

from Tai4 Ping2 Hui4 Min2 He2 Ji4 Ju2 Fang1 ( Tai4Ping2 Imperial Grace Pharmacy Formulas)
100
15 1 3

bian3 xu4 ( knotgrass, Polygoni Avicularis Herba) 100 g
shan1 zhi1 zi3 ( gardenia, Gardeniae Fructus) 100 g
Grind all of these medicinals into a coarse powder. For each dose, take 15 g
of the powder, decoct in water with 1 g of deng1 xin1 cao3 (juncus) and 3 g
of dan4 zhu2 ye4 (lophatherum), and take.
59
Another Chinese name for this medicinal is da4 fu4 zi3 (). (Au.) With this
alternative name, the ingredients more obviously include five peels and five seeds, thus the
name for this formula. (Ed.)
Lecture 4
132

: 912 1015 912 (
) 9 69 35 6
35 l
While the explanation above covers the original formula and administration
procedures, in modern times we commonly make this formula into a
decoction with the following dosages:
bian3 xu4 ( knotgrass, Polygoni Avicularis Herba) 1015 g
che1 qian2 zi3 ( plantago seed, Plantaginis Semen) 912 g (gauzewrapped)
shan1 zhi1 zi3 ( gardenia, Gardeniae Fructus) 69 g
gan1 cao3 shao1 ( fine licorice root, Glycyrrhizae Radix
Tenuis) 35 g
jiu3 da4 huang2 ( wine-processed rhubarb, Rhei Radix et
Rhizoma cum Vino Preparati) 35 g
deng1 xin1 cao3 ( juncus, Junci Medulla) 1 g
Ba1 zheng4 san3 clears heat and drains fire and also disinhibits water and
frees strangury. We primarily use it to drain and disinhibit damp-heat in the
lower burner. It treats damp-heat pouring downward that amasses in and
obstructs the bladder, inhibited voidings of reddish urine, urinary frequency,
pain on urinating, dribbling of urine, distention and fullness of the smaller
abdomen, dry mouth and throat, strangury pain with bloody urine, and dry
stool. In extreme circumstances there is dribbling urinary block with pain.
In modern times we have used this formula to treat diseases such as acute
urinary infections, cystitis, acute nephritis, urethritis, pyelitis, and urinary
calculi.
Lecture 4
133
;
;
;
;
;
FORMULA ANALYSIS
Within this formula, qu2 mai4 and bian3 xu4 are the chiefs. The former
clears heart heat and disinhibits damp-heat of the small intestine and bladder,
while the latter clears and disinhibits damp-heat of the lower burner and
further downbears fire and frees strangury. As one support, mu4 tong1
conducts heart channel damp-heat out via the urine; as the other support, che1
qian2 zi3 disinhibits water and frees strangury while also boosting the kidney,
which disinhibits water while not damaging kidney yin1. Shan1 zhi1 zi3
simultaneously clears fire from all three burners and passes it out of the body
through the bladder; it makes the entire formula govern treatment of the
lower burner, but the formula does not just treat the lower burner. It also
clears heat evils from the upper and center burners and also frees and
disinhibits the triple burner, such that the triple burner can manage governing
the sluices. Hua2 shi2 disinhibits damp-heat while simultaneously lubricating
the orifices and freeing strangury. Together, shan1 zhi1 zi3 and hua2 shi2 are
the assistants. The couriers are gan1 cao3 shao1 and da4 huang. The former
goes directly to the urethra in the anterior yin1, where it relaxes tension and
stops pain. The latter is a bitter-cold medicinal that descends and drains fireheat out of the body through the rectum60 in the posterior yin1.
3040 912 (
) 912 912 612
I often achieve good results treating and expelling urinary calculi with this
formula. For that purpose I usually add the following medicinals:
jin1 qian2 cao3 ( moneywort, Lysimachiae Herba) 3040 g
60
The Chinese term used here for rectum ( gu3 dao4) literally means grain pathway
while the term for urethra ( niao4 dao4) used above literally means urine pathway. In
the Chinese, the former relates to the posterior yin1 and the latter relates to the anterior yin1
such that the Chinese reader sees the front and the backall possible sidesare treated. (Ed.)
Lecture 4
134
hai3 jin1 sha1 ( lygodium spore, Lygodii Spora) 912 g (gauzewrapped)

chao3 ji1 nei4 jin1 ( stir-fried gizzard lining, Galli Gigeriae
Endothelium Corneum Frictum) 912 g
dong1 kui2 zi3 ( mallow seed, Malvae Semen) 912 g
912 9
6
10 12 12
For acute urinary tract infections, I often add the following ingredients to
strengthen the heat-clearing and toxin-resolving effects.
Frictus) 912 g
Fricta) 9 g
For high temperature with alternating sensations of hot and cold, add the
following ingredients to harmonize and resolve the exterior and interior.
jin1 yin2 hua1 ( lonicera, Lonicerae Flos) 12 g
lian2 qiao2 ( forsythia, Forsythiae Fructus) 12 g
Modern laboratory experiments have demonstrated that ba1 zheng4 san3
prevents infections by numerous bacteria, including Bacillus coli and
Staphylococcus aureus.
Lecture 4
135
According to Chinese medicine, damp-heat strangury refers to damp-heat

pouring downwards that manifests as frequent urination, painful urination,
urinary urgency, rough stagnant urination, and sagging pain of the smaller
abdomen. Urine tests of patients with these symptoms can show acute urinary
infection or acute cystitis, or in some cases there is nothing abnormal in the
patients urine. No matter whether the lab tests show that the patient has or
does not have an inflammatory disease, as long as you accurately identify the
patient has damp-heat strangury, you can use some variation of ba1 zheng4
san3. When the diagnosis indicates inflammation, increase the strength of the
formula by further adding huang2 qin2 and huang2 lian2, as these increase
the capacity to clear heat and resolve toxin.
915 2030
30 35 1520
()3 () 9
5
We also use ba1 zheng4 san3 for bladder cancer patients who manifest
signs of damp-heat strangury, which is often concurrent with bloody urine.
Modify the formula for such patients by adding medicinals like the following:
Carbonisatus) 915 g
xu4 duan4 tan4 ( charred dipsacus, Dipsaci Radix
Carbonisata) 2030 g
xiao3 ji4 tan4 ( charred cephalanoplos, Cephalanoploris Herba seu
Radix Carbonisata) 30 g
e2 zhu2 ( curcuma rhizome, Curcumae Rhizoma) 35 g
bai2 hua1 she2 she2 cao3 ( oldenlandia, Oldenlandiae
Diffusae Herba) 1520 g
hu3 po4 fen3 ( amber powder, Succini Pulvis) 3 g (divide and take
drenched) 3 g61
For patients who have severe pain, add:
yan2 hu2 suo3 ( corydalis, Corydalis Rhizoma) 9 g
61
Instead of hu3 po4 fen3, consider using san1 qi1 fen3 ( powdered notoginseng,
Notoginseng Radix Pulverata). As with hu3 po4 fen3, use 3 g, and divide it up to take
drenched with each dose. (Au.)
Lecture 4
136
zhi4 ru3 xiang1 ( processed frankincense, Olibanum

Praeparatum) 5 g
zhi4 mo4 yao4 ( processed myrrh, Myrrha Praeparata) 5 g
()
FORMULA COMPARISON
Ba1 zheng4 san3 and wu3 lin2 san3 (Five Stranguries Powder) both treat
strangury.
Wu3 Lin2 San3 ( Five Stranguries Powder)
dang1 gui1 ( Chinese angelica, Angelicae Sinensis Radix)
gan1 cao3 shao1 ( fine licorice root, Glycyrrhizae Radix Tenuis)
chi4 shao2 yao4 ( red peony, Paeoniae Radix Rubra)
shan1 zhi1 zi3 ( gardenia, Gardeniae Fructus)
However, we tend to use wu3 lin2 san3 for patients who have: painful,
dribbling strangury that comes and goes; damp-heat congesting the bladder
that results in rough, inhibited urination; normal stools; and relatively light
symptoms. In contrast, we tend to use ba1 zheng4 san3 for damp-heat
transforming to fire; the patient not only has painful urination, severe
abdominal pain, and inhibited urination, but also constipation with dry, bound
stools.
23.()
4.23 Yin1 Chen2 Hao1 Tang1 ( Virgate Wormwood Decoction)

20--50 () 6 () 6 3

Herba) 2050 g (pre-decoct)
shan1 zhi1 zi3 ( gardenia, Gardeniae Fructus) 6 pieces (split)
Lecture 4
137
Decoct in water, divide into three doses, and take.

()
()
"M"
"""
This formula primarily treats damp-heat jaundice, which we also call yang2
jaundice. The symptoms are: yellowing over the whole body that is the color
of tangerines; yellowing of the eyes in which the color is bright; generalized
heat effusion (or there may be no heat effusion); thirst; slight fullness in the
abdomen; inhibited urination with scant, reddish voidings; yellow slimy
tongue fur; and rapid pulse.
We also use it to prevent yellowing, as is explained in the Shang1 Han2
Lun4:
When in yang2 brightness disease, [there is] heat
effusionSweating only from the head, not from the body, [and]
stopping at the neck, [as well as] inhibited urination and thirst with
intake of fluids, indicates stasis heat in the interior; [hence] there
will be generalized yellowing and [therefore,] yin1 chen2 hao1
tang1 governs.62
Because Zhang1 Zhong4-Jing3 said there will be generalized yellowing,

we can see he meant that yellowing had still not occurred. When we use yin1
chen2 hao1 tang1 to eliminate yang2 brightness (yang2 ming2) stasis heat via
the urine, it either prevents yellowing or reduces yellowing.
;
;
FORMULA ANALYSIS
Within this formula, yin1 chen2 hao1 is the chief, because it is a bitter-cold
medicinal that clears heat and disinhibits dampness while abating jaundice.
Shan1 zhi1 zi3, the support, is a bitter-cold medicinal that clears heat of the
62
Zhang1, p 369.
Lecture 4
138
triple burner and furthermore passes the heat out through the urine such that it
abates stasis heat and jaundice. Da4 huang2 acts as assistant-courier by
discharging stasis heat downward and thereby eliminating jaundice. Together
these three medicinals successfully clear heat, disinhibit dampness, and abate
jaundice.
Modern laboratory testing has demonstrated that this formula has a

cholagogic action and encourages growth of liver cells. The medicinal yin1
chen2 hao1 has diuretic, hypotensive, and antiasthmatic actions.
Researchers abroad have performed laboratory tests on animals that

demonstrated the three ingredients of yin1 chen2 hao1 tang1 have no clear
cholagogic actions when tested individually, yet in combination as per the
original formula, they have a great capacity to expel bile. Furthermore, not
only the quantity of bile expelled increases, but the quality of the expelled
bile improves also.
69 9 9 912
912 915 9
I often use this formula to treat infectious icterohepatitis that manifests in

yang2 jaundice pattern. This condition commonly occurs in tandem with
distention and pain (or dull pain) in the right rib-side, nausea and bitter taste
in the mouth, and no desire to eat or drink. Thus, I often add the medicinals
below, and the result is extremely good.
ban4 xia4 ( pinellia, Pinelliae Rhizoma) 9 g
chao3 chuan1 lian4 zi3 ( stir-fried toosendan, Toosendan
Fructus Frictus) 912 g
Lecture 4
139
huang2 bai3 ( phellodendron, Phellodendri Cortex) 912 g

jiao1 san1 xian1 ( scorch-fried three immortals, Tres Immortales
Usti) 9 g (of each of these medicinals)
()
Yin1 chen2 hao1 tang1 is also effective for treating jaundice that occurs in
the early stages of liver cirrhosis or cancer. For those diseases I usually add,
as needed, medicinals like the following:
chai2 hu2 ( bupleurum, Bupleuri Radix)
xiang1 fu4 zi3 ( cyperus, Cyperi Rhizoma)
ban4 xia4 ( pinellia, Pinelliae Rhizoma)
Rhizoma Sectum)
yu4 jin1 ( curcuma, Curcumae Radix)
hou4 po4 ( officinal magnolia bark, Magnoliae Officinalis Cortex)
yan2 hu2 suo3 ( corydalis, Corydalis Rhizoma)
When the jaundice is severe, further add fu2 ling2 (poria), che1 qian2 zi3
(plantago seed), and bai2 xian1 pi2 (dictamnus). For liver cancer add e2 zhu2
(curcuma rhizome), sheng1 mu3 li4 (raw oyster shell), and chao3 zhi3 shi2
(stir-fried unripe bitter orange); also, take either xiao3 jin1 dan1 (Minor
Golden Elixir) or xi1 huang2 wan2 (Rhinoceros Bezoar Pill), but swallow
these pills separately.
()
You can combine yin1 chen2 hao1 tang1 with wu3 ling2 san3 (Poria Five
Powder) to treat yin1 jaundice, which usually occurs in the later stages of
liver cirrhosis or the later stages of some other disease affecting the liver and
gallbladder. Depending on the presenting symptoms, add medicinals such as
the following:
Lecture 4
140
mu4 xiang1 ( costusroot, Aucklandiae Radix)

Praeparata Secta)
wu2 zhu1 yu2 ( evodia, Evodiae Fructus)
gan1 jiang1 ( dried ginger, Zingiberis Rhizoma)
dang3 shen1 ( codonopsis, Codonopsis Radix)
huang2 qi2 pi2 ( astragalus root bark, Astragali Radicis Cortex)
che1 qian2 zi3 ( plantago seed, Plantaginis Semen)
da4 fu4 pi2 ( areca husk, Arecae Pericarpium)
Lecture 4
141

Ce Jiao Shu-De Formulas

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TTeenn LLeeccttuurreess iinn tthhee U

Cold evil, as a cause of disease, is also as common in the clinic as wind.

As explained in an earlier footnote, miscellaneous diseases specifically means diseases

it is due to erroneously treated external dampness that has subsequently

Feng1 Yin3 Tang1 ( Wind-Drawing Decoction)

da4 huang2 ( rhubarb, Rhei Radix et Rhizoma) 60 g

bai2 shi2 zhi1 ( kaolin, Kaolin) 90 g

Our predecessors used feng1 yin3 tang1 to treat wind-induced paralysis

In most cases the paralysis is the sequela of wind strike. (Ed.)

The greatest feature of Chinese medicine is its intimate connection to

Tian1 Ma2 Wan2 ( Gastrodia Pill)

tian1 ma2 ( gastrodia, Gastrodiae Rhizoma) 180 g

Exsiccata seu Recens) 500 g

This refers to wind engendered from liver-kidney yin1 vacuity (Ed.)

never-ending source. The couriers, du2 huo2 and qiang1 huo2

In recent years we have used this formula with modifications to treat

Double the dosages of the medicinals in feng1 yin3 tang1. (Au.)

4.3 Zhen4 Gan1 Xi1 Feng1 Tang1 ( Liver-Settling WindExtinguishing Decoction)

niu2 xi1 ( achyranthes, Achyranthis Bidentatae Radix) 30 g

This is similar to eclampsia. (Ed.)

bai2 jiang1 can2 ( silkworm, Bombyx Batryticatus)

Ling2 Yang2 Gou1 Teng2 Tang1 ( Antelope Horn and

4.4 Di4 Huang2 Yin3 Zi3 ( Rehmannia Drink)

sheng1 di4 huang2 ( dried/fresh rehmannia, Rehmanniae Radix

pao4 fu4 zi3 ( blast-fried aconite, Aconiti Radix Lateralis

On April 22 the patient started to use Chinese medicinals. The diagnosis

been removed and he could urinate without assistance. On June 30 he was

fu4 zi3 ( aconite, Aconiti Radix Lateralis Praeparata) 912 g

Xiao1 Feng1 San3 ( Wind-Dispersing Powder)

hou4 po4 ( officinal magnolia bark, Magnoliae Officinalis

Qian1 Zheng4 San3 ( Pull Aright Powder)

bai2 fu4 zi3 ( typhonium, Typhonii Rhizoma) 50 g

Qian1 zheng4 san3 treats sudden occurrence of wind strike with

Today many people administer this formula as a decoction and add

bai2 zhi3 ( Dahurian angelica, Angelicae Dahuricae Radix) 10 g

Fourth visit: December 13. The patient showed no evidence of deviated

4.7 Gui4 Zhi1 Shao2 Yao4 Zhi1 Mu3 Tang1 (

gui4 zhi1 ( cinnamon twig, Cinnamomi Ramulus) 12 g

Around 1974 I presented a paper entitled Conclusions on Identifying and

bu3 gu3 zhi1 ( psoralea, Psoraleae Fructus) 912 g

Praeparata Secta) 612 g20

This formula treats lame impediment in patients who have kidney-vacuity

According to Su4 Wen4 (Elementary Questions), kidney wind ( shen4 feng1) is

channels and dissipates accumulation; zhe4 chong2 quickens stasis and

Presenting symptoms: In addition to the swelling, deformation, pain, and

Pattern identification: The conditions in underground work environments

Method of treatment: supplement the kidney and dispel cold; dissipate

gan1 cao3 ( licorice, Glycyrrhizae Radix) 6 g

powder preparation that he was to take regularly. This is the prescription I

In 1986 our research topic, Experimental Research on the Clinical

4.8 Du2 Huo2 Ji4 Sheng1 Tang1 ( Pubescent Angelica and

du2 huo2 ( pubescent angelica, Angelicae Pubescentis Radix) 9 g

dang1 gui1 ( Chinese angelica, Angelicae Sinensis Radix) 69 g

I often use this formula, modified according to the pattern, to treat

Praeparata Secta) 1012 g

rapid ESR (erythrocyte sedimentation rate) and a high anti-streptolysin O

dang1 gui1 ( Chinese angelica, Angelicae Sinensis Radix)

San1 Bi4 Tang1 ( Three Impediment Decoction)

ren2 shen1 ( ginseng, Ginseng Radix) 6 g

fang2 feng1 ( saposhnikovia, Saposhnikoviae Radix) 6 g

4.10 Qing1 Zhen4 Tang1 ( Clearing Invigoration Decoction)

sheng1 ma2 ( cimicifuga, Cimicifugae Rhizoma) 30 g

I gave him this prescription: