Chai Ge Jie Ji Tang (Bupleurum & Pueraria Resolve the Muscles Decoction) Radix Bupleuri (Chai Hu) Radix

Puerariae (Ge Gen) Radix Glycyrrhizae (Gan Cao) Radix Scutellariae Baicalensis (Huang Qin) Radix Et Rhizoma Notopterygii (Qiang Huo) Radix Angelicae Dahuricae (Bai Zhi) Radix Albus Paeoniae Lactiflorae (Bai Shao) Radix Platycodi Grandiflori (Jie Geng) Functions: Resolves the muscles and clears heat Indications: Common cold wind cold, depression transforming heat Main signs & symptoms: Aversion to cold which gradually lessens, bodily heat which steadily increases, no sweating, headache, eye aching, dry nose, heart vexation and insomnia, a floating, slightly surging pulse Dosage: 5 pills three times per day Formula explanation: Within this formula, Bupleurum and Pueraria are the sovereign medicinals which resolve the muscles and clear heat. Notopterygium and Angelica Dahurica assist Bupleurum and Pueraria to resolve the muscular exterior, thus altogether eliminating pain. Scutellaria clears evils which have become depressed and transformed into heat. Platycodon diffuses the lung qi in order to assist the coursing and discharging of evils externally. Peony and Licorice together harmonize the constructive and discharge heat. These are all assistant medicinals. Comments: This formula is especially good for treating muscular stiffness and pain in the back of the neck and occipital region with headache and eye pain due to cold evils lodged in the exterior which are in the process of undergoing transformation into heat. Therefore, aversion to cold is getting less and less, and fever is getting more and more. This formula might also be used for liver depression headache when combined with another appropriate formula, such as Xiao Chai Hu Tang Wan (Minor Bupleurum Decoction Pills) or Xiao Yao Wan (Rambling Pills). However, it should not be used for ascendant hyperactivity of liver yang headache nor for liver blood vacuity headache.

Gui Zhi Tang (Cinnamon Twig Decoction) Composition: 1. Ramulus Cinnamomi (Gui Zhi) 9g 2. Radix Paeoniae Lactiflorae (Shao Yao) 9g 3. Radix Glycyrrhizae (Gan Cao) mix-fried 6g 4. raw Rhizoma Zingiberis (Sheng Jiang) 9g 5. Fructus Zizyphi Jujubae (Da Zao) 12 pieces Method of administration: Traditionally it is advised that one eat rice soup after taking this decoction in order to promote perspiration Functions: Relieves the muscles and emits the exterior, regulates and harmonizes the constructive and defensive Indications: 1. External invasion, wind cold in cases of exterior vacuity of the tai yang; 2. Internal diseases with loss of harmony between the constructive and defensive, such as after prolonged disease or postpartum. 3. Common cold 4. Neuralgia 5. Headache 6. Abdominal pain due to chills 7. Bodily weakness and vacuity 8. eclampsia and 9. Neurasthenia Main signs & symptoms: 1) Exterior vacuity: sweating but yet continuing aversion to wind and fever, stiff neck, stuffy nose, no thirst, no sore throat, a thin, white, moist tongue coating, and a floating, relaxed/retarded or floating, weak pulse. 2) Internal disease with loss of harmony between the constructive and defensive: intermittent aversion to heat and cold, aversion to wind, plus sweating. Contraindications: 1. Exterior repletion patterns of the tai yang 2. Hemorrhagic conditions 3. A red tongue with a yellow or peeled coating Formula explanation: In this case, there is wind cold in the exterior. However, there is also exterior vacuity, the striae (cou li) are not secure, and the defensive is strong and the constructive is weak. Therefore, Cinnamon is used as the sovereign in order to resolve the muscles, emit the exterior, and scatter externally invading wind cold. Peony as the minister medicinal boosts yin and restrains the constructive. When Cinnamon and Peony are combined together, one treats a strong defensive and the other a weak constructive, thus regulating and harmonizing constructive and defensive. Fresh Ginger is acrid and warm. It helps Cinnamon relieve the muscles and is also able to warm the stomach and stop vomiting. Red Dates are sweet and neutral and help boost the qi and supplement the center. They are also able to enrich the spleen and engender fluids. Red Dates and Ginger combined together make room in the spleen and stomach for the generation and emission of qi and regulate and harmonize the constructive and defensive. Likewise, Red Dates assist Peony in harmonizing the constructive and defensive. Mix-fried Licorice is used for two reasons. First, it boosts the qi and harmonizes the center. Together with Cinnamon, it resolves the muscles, and together with Peony, it boosts yin. Secondly, it regulates and harmonizes all the other medicinals.

Ren Shen Bai Du Wan (Ginseng Vanquish Toxins Pills) Radix Et Rhizoma Notopterygii (Qiang Huo) Radix Angelicae Pubescentis (Du Huo) Radix Ligustici Wallichii (Chuan Xiong) Radix Bupleuri (Chai Hu) Radix Peucedani (Qian Hu) Sclerotium Poriae Cocos (Fu Ling) Fructus Citri Aurantii (Zhi Ke) Radix Platycodi Grandiflori (Jie Geng) Herba Menthae Haplocalycis (Bo He) Radix Panacis Ginseng (Ren Shen) Radix Glycyrrhizae (Gan Cao) uncooked Rhizoma Zingiberis (Sheng Jiang) Functions: Resolves the exterior, dispels wind and eliminates dampness, and supplements the qi Indications: Externally contracted wind cold dampness with simultaneous righteous qi vacuity which is unable to expel the disease evils. Upper respiratory tract infections, influenza, initial stage dysentery, initial stage measles, and post-surgical infections Main signs & symptoms: High fever, severe chills, shivering, no sweating, pain and stiffness of the head and neck, pain and soreness of the four limbs, chest and venter fullness and glomus, nasal congestion, cough with profuse phlegm, slimy, white tongue fur, and a soggy pulse Contraindications: This formula is contraindicated if there is any heat. Dosage: 8 pills three times per day Formula explanation: Notopterygium and Angelica Pubescens dispel wind cold from the exterior, dispel dampness and stop pain. Ligusticum upbears and out-thrusts yang qi and moves the blood, thus assisting the previous two medicinals in out-thrusting evils at the same time as guiding the other medicinals upwards to the head and face region and moving the blood to stop pain. Bupleurum and Mentha likewise resolve the exterior and out-thrust evils. In particular, this combination is especially effective for resolving evils from the muscles. Platycodon upbears while Aurantium downbears, thus regulating and rectifying the qi in the chest and epigastrium. In addition, the combination of Platycodon and Peucedanum transforms phlegm, diffuses the lungs, and stops coughing. Poria and uncooked Ginger transform and eliminate dampness, thus eliminating the root of phlegm engenderment. Further, Ginseng, Poria, and Licorice fortify the spleen and supplement the qi. Thus the righteous qi is supplemented and restored so that it can expel evils from the exterior. Comments: This formula was originally designed to expel wind cold damp evils from children who are, by nature, inherently spleen qi vacuous and weak. Now, however, it can be used to treat wind cold damp external invasions in anyone with a vacuous and weak bodily condition.

Yin Qiao San (Lonicera & Forsythia Powder) Composition: 1. Fructus Forsythiae Suspensae (Lian Qiao) 9g 2. Flos Lonicerae Japonicae (Yin Hua) 9g 3. Radix Platycodi Grandiflori (Ku Jie Geng) 6g 4. Herba Menthae (Bo He) 6g 5. Folium Bambusae (Zhu Ye) 4g 6. raw Radix Glycyrrhizae (Sheng Gan Cao) 5g 7. Herba Seu Flos Schizonepetae Tenuifoliae (Jing Jie Sui) 5g 8. Semen Praeparatus Sojae (Dan Dou Chi) 5g 9. Fructus Arctii Lappae (Niu Bang Zi) 9g 10. Rhizoma Phragmitis Communis (Lu Gen) 9g Functions: Acridly and cooly penetrates the exterior, clears heat and resolves toxins Indications: Warm disease, initial stage. Common cold, flus, acute tonsillitis, mumps, measles, scarlatina, epidemic meningitis, encephalitis B, acute suppurative infections, and early stage sores. Main signs & symptoms: Fever, no sweating or possible perspiration which does not flow easily, slight aversion to wind cold, headache, thirst, cough, sore throat, a red tongue tip and a thin, white or thin, yellow coating, and a floating, rapid pulse Formula explanation: The medicinals in this formula can be divided into three groups. First, Schizonepeta, Soja, and Mint emit perspiration, relieve the exterior, and resolve the muscles. Secondly, Lonicera, Forsythia, Folium Bambusae, and Phragmites clear heat and resolve toxins. Thirdly, Arctium, Platycodon, and Licorice stop cough, expel phlegm, and secure yin. In this formula, Lonicera and Forsythia are the sovereigns, which, being acrid and cool, penetrate evils, clear heat, and resolve toxins. Schizonepeta and Soja are the ministers. Although they are acrid and warm, they assist the sovereign medicinals in opening the skin and hair and dispelling evils. Platycodon and Arctium diffuse the lungs and disinhibit the throat. Licorice clears heat and resolves toxins. Folium Bambusae clears heat from the upper burner. Phragmites clears heat and engenders fluids. These are the assistant medicinals. Additions & subtractions: Anemarrhenae (Zhi Mu). Baphicacanthi (Ban Lan Gen) and Folium Isatidis (Da Qing Ye). Qing Ye), and Herba Violae (Zi Hua Di Ding). accompanied by nausea and vomiting, add Herba Agastachis Seu Pogostemi (Huo Xiang) and Herba Eupatorii (Pei Lan). sphaerae Seu Calvatiae (Ma Bo) and Radix Scrophulariae Ningpoensis (Xuan Shen). (Tu Niu Xi), Radix Isatidis Seu Baphicacanthi (Ban Lan Gen), and Fructificatio Lasiosphaerae Seu Calvatiae (Ma Bo). Radix Scrophulariae

Ningpoensis (Xuan Shen). en) to disinhibit the lung qi. One can also add Folium Mori Albi (Sang Ye) along with the Armeniaca. Fructus Trichosanthis Kirlowii (Gua Lou). e has been harassing the lungs for 2-3 days and heat is now entering the interior, add raw Radix Rehmanniae (Sheng Di), and Tuber Ophiopogonis Japonicae (Mai Dong) to protect fluids and humors. dd Radix Scutellariae Baicalensis (Huang Qin), Rhizoma Anemarrhenae (Zhi Mu), and Fructus Gardeniae Jasminoidis (Shan Zhi Zi) plus the above two additions. Gen), carbonized Cacumen Biotae (Ce Bai Tan), and carbonized Fructus Gardeniae Jasminoidis (Zhi Zi Tan) to clear heat and cool the blood so as to stop bleeding. Agastachis Seu Pogostemi (Huo Xiang) and Tuber Curcumae (Yu Jin). Lemnae Seu Spirodelae (Fu Ping) or subtract Soja and add Radix Lithospermi Seu Arnebiae (Zi Cao) and Cicada Slough. Lobatae (Ge Gen). Isatidis (Da Qing Ye). Tang (Pueraria, Scutellaria, and Coptis Decoction), i.e., Radix Puerariae Lobatae (Ge Gen), Radix Scutellariae Baicalensis (Huang Qin), and Rhizoma Coptidis Chinensis (Huang Lian).

llodendron (Huang Bai).

Comment: This formula is similar in many ways to the preceding one. The key to distinguishing these is that Yin Qiao San is for exterior wind heat with fever and sore throat, while Sang Ju Yin is for exterior wind heat with less fever and toxins but more serious cough.

Sang Ju Yin Wan (Morus & Chrysanthemum Drink Pills) Folium Mori Albi (Sang Ye) Flos Chrysanthemi Morifolii (Ju Hua) Semen Pruni Armeniacae (Xing Ren) Fructus Forsythiae Suspensae (Lian Qiao) Herba Menthae Haplocalycis (Bo He) Radix Platycodi Grandiflori (Jie Geng) Radix Glycyrrhizae (Gan Cao) 1Previously, Wiseman had translated shen as seep. Now he suggests percolate. Rhizoma Phragmitis Communis (Lu Gen) Functions: To course wind and clear heat, diffuse the lungs and stop cough Indications: Wind heat, initial stage. Common cold, flus, acute bronchitis, acute tonsillitis, epidemic conjunctivitis, headache, vertigo, acute tracheitis. Main signs & symptoms: Cough, fever, a red, sore throat, slight fever, a thin, white or slightly yellow tongue coating with a red tongue proper, and a floating, rapid pulse Dosage: 8 pills three times per day Formula explanation: In this formula, Folium Mori and Chrysanthemum are the sovereign medicinals. Morus penetrates and clears heat from the network vessels of the lungs. Chrysanthemum clears and scatters wind heat in the upper burner. Mint, acrid and cool, is the minister medicinal. It assists Morus and Chrysanthemum scatter upper burner wind heat. Among Platycodon and Armeniaca, one upbears and one downbears, thus resolving the muscles, depurating the lungs, and, therefore, stopping cough. Forsythia clears heat above the diaphragm. Phragmites clears heat, engenders fluids, and stops thirst. These two are the assistant medicinals. Licorice regulates and harmonizes these medicinals and is the messenger medicinal. The combination of Licorice and Platycodon is called Gan Cao Jie Geng Tang (Licorice & Platycodon Decoction). This is especially for patients with cough and phlegm which is difficult to expectorate accompanied by a slight tickling sensation in the throat. Combined, these medicinals have the function of coursing wind and clearing heat, diffusing the lungs and stopping cough. Comments: If fever is high and cough is severe, as in pneumonia, this formula may not be strong enough. In that case, one should definitely see a professional practitioner of Chinese herbal medicine to receive an individually written prescription for bulk-dispensed, decocted Chinese medicinals. The key to distinguishing these is that Yin Qiao San is for exterior wind heat with fever and sore throat, while Sang Ju Yin is for exterior wind heat with less fever and toxins but more serious cough.

Qing Xu Re Ji (Formulas for clearing vacuity heat).. Representative formula: Qing Hao Bie Jia Tang (Artemisia Apiacea & Carapax Amydae Decoction) Composition: 1. Herba Artemisiae Apiaceae (Qing Hao) 6g 2. Carapax Amydae (Bie Jia) 15g 3. Raw Radix Rehmanniae (Xi Sheng Di) 12g 4. Rhizoma Anemarrhenae (Zhi Mu) 6g 5. Cortex Radicis Moutan (Dan Pi) 9g Functions: Nourishes yin, penetrates heat Indications: 1. Latter stages of warm diseases 2. Yin fluids consumed and damaged 3. Evils hidden in the yin division. 4. Advanced stages of various infectious diseases 5. Pulmonary tuberculosis 6. Chronic nephritis 7. Kidney tuberculosis 8. Fevers of unknown etiology 9. Typhoid fever convalescence 10. Post-surgical fevers Main signs & symptoms: 1. Evening heat 2. Morning coolness 3. Absence of sweating as fever recedes 4. Emaciation with no loss of appetite 5. A red tongue with scant coating 6. Rapid pulse Contraindications: 1. Do not use during the early stage of a warm disease. 2. 2. Do not use with spasms and convulsions. 3. Formula explanation: In this formula, Carapax Amydae enriches yin and recedes fever. It enters the network vessels and tracks down evils. Artemisia Apiacea, sweet-smelling and fragrant, clears heat and penetrates (i.e., vents) the network vessels. It leads evils to be discharged to the outside. Raw Rehmannia is sweet and cool and enriches yin. Anemarrhena is bitter and cold and enriches and moistens. When combined with Carapax Amydae, these three have the function of nourishing yin and penetrating heat. Moutan combined with Artemisia Apiacea clears heat hidden within the blood on the inside and penetrates hidden yin evils on the outside.

Qing Wei San Wan (Clear the Stomach Powder Pills) Rhizoma Cimicifugae (Sheng Ma) Rhizoma Coptidis Chinensis (Huang Lian) Cortex Radicis Moutan (Dan Pi) uncooked Radix Rehmanniae (Sheng Di) Radix Angelicae Sinensis (Dang Gui) Functions: Clears the stomach and drains fire, cools the blood and enriches yin Indications: Stomach heat damaging yin fluids stomatitis, trigeminal neuralgia, gingivitis, periodontal disease, glossitis, and halitosis Main signs & symptoms: Toothache, swelling of the face, emission of heat, bad breath, a dry mouth, a red tongue with scanty fur, and a slippery, large, rapid pulse Dosage: 8 pills three times per day Formula explanation: The bitter and cold of Coptis clear heat from the stomach and drain fire. This is assisted by Cimicifuga which clears heat both due to its cold nature and also by upbearing and out-thrusting depressive heat. Moutan and uncooked Rehmannia clear heat and cool the blood, while Dang Gui disperses swelling and stops pain by harmonizing the blood. Comments: This formula can be combined with others when stomach heat is more pronounced. For instance, it can be combined with Xiao Chai Hu Tang Wan, Jia Wei Xiao Yao Wan, or Bu Zhong Yi Qi Wan in order to clear stomach heat or fire.

Huang Lian Jie Du Wan (Coptis Resolve Toxins Pills) Rhizoma Coptidis (Huang Lian) Radix Scutellariae Baicalensis (Huang Qin) Cortex Phellodendri (Huang Bai) Fructus Gardeniae Jasminoidis (Zhi Zi) Functions: Drains fire and resolves toxins Indications: Replete heat and fire toxins, exuberant heat in the three burners patterns. Septicemia, dysentery,pneumonia, acute urinary tract infections, ulcers, carbuncles, furuncles, boils, acute enteritis, acute icteric hepatitis, acute cholecystitis, encephalitis, acute conjunctivitis, acute pelvic inflammation, erysipelas, cellulitis, hemoptysis, epistaxis, urticaria, pruritus, cerebral hemorrhage, hypertension, anxiety, palpitations, insomnia, neurasthenia, and hysteria Main signs & symptoms: Great heat, vexation and agitation, a dry mouth and throat, delirious speech, insomnia, possible hot diseases with hemoptysis and/or epistaxis, possible high fever with macular eruptions, generalized heat with dysentery, damp heat jaundice, a red tongue with yellow fur, and a rapid, forceful pulse Contraindications: 1. Do not use this medicine in patients with bodily vacuity or weakness of the spleen and stomach. 2. Do not administer for prolonged periods of time. 3. Do not use for heat in the constructive or blood divisions. Dosage: 3 pills three times per day Formula explanation: In this formula, Coptis is the sovereign. It drains heart fire as well as draining fire from the middle burner. Scutellaria clears lung heat and drains upper burner fire. It acts as the minister. Phellodendron and Gardenia are the assistants. Phellodendron drains fire from the lower burner and Gardenia opens and drains fire from all three burners. It leads heat downward and moves it. Therefore, as a whole, this formula has the functions of draining fire, clearing heat, and resolving toxins. Comments: This formula is composed of Chinese medicines most often used anti-mycotic, antibacterial ingredients. For serious conditions, one needs to either combine with other ready-made medicines or increase its dosages. This formula can be used simultaneously with antibiotics administered either orally or intravenously. For use against sores and boils, such sores should be treated locally with external applications as well as internally (i.e., systemically).

Drain the Epigastrium Decoction Xie Xin Tang 'opening of the Heart' da huang Radix et rhizoma Rhei .6g Huang Lian Rhizoma Coptidis 3g Huang qin Radix Scutellarie .3g Actions: Drains fire, relieves toxicity and dries dampness. INDICATIONS: Fever, irritability and restlessness, flushed face, red eyes, dark urine, constipation, a greasy, yellow tongue coating, and in severe cases, delirious speech. Also for epigastric focal distention, jaundice, diarrhea, and dysenteric disorders; or vomiting of blood or nosebleed; or red and swollen eyes and ears; or ulcerations of the tongue and mouth; or abscesses. This is damp-heat excess with interior clumping. Fever, irritability and restlessness, flushed face, red eyes, dark urine, constipation, a greasy, yellow tongue coating, epigastric focal distention, jaundice, diarrhea, and dysenteric disorders are manifestations of dampheat excess and interior clumping. Vomiting of blood and nosebleed are caused by the reckless movement of hot blood. Red and swollen eyes and ears, ulcerations of the mouth and tongue, and abscesses are associated with fire toxin. ANALYSIS OF FORMULA: Radix et Rhizoma Rhei (da hang), the chief herb in this formula, is used more for its action in draining fire than for purging. However, this presentation does include signs of clumping; if accompanied by diarrhea or dysenteric disorders, purging will drain the heat and break up the clumping. In addition, this herb enters the blood level and is useful in the treatment of bleeding, especially in the upper part of the body. The deputies, Radix Scutellariae (huang qin) and Rhizoma Coptidis (huang lian), drain heat from the upper and middle burners. Together the herbs in this formula drain heat from the three burners, primarily through the stool. COMMENTARY: This formula should be distinguished from Coptis Decoction to Relieve Toxicity (huang lianjie du tang). The focus of that formula, which contains Fructus Gardeniae Jasminoidis (zhi zi), is also on draining heat from the three burners. However this formula, which contains Radix et Rhizoma Rhei (da huang), has purgative and heat-clearing functions and can be used in treating any condition of heat excess with high fever, irritability bordering on delirium, and constipation. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as acute gastroenteritis, hepatitis, cholecystitis, dysentery, conjunctivitis, stomatitis, vascular headache, trigeminal neuralgia, and hematemesis associated with pulmonary tuberculosis. MODIFICATIONS: 6 chan tui).*For both yang brightness and terminal yin headache, take with Frigid Extremities Powder (si ni san).

Long Dan Xie Gan Wan (Gentiana Scabra Drain the Liver Pills) Radix Gentianae Scabrae (Long Dan Cao) Radix Scutellariae Baicalensis (Huang Qin) Fructus Gardeniae Jasminoidis (Shan Zhi Zi) Rhizoma Alismatis (Ze Xie) Caulis Akebiae Mutong (Mu Tong) Semen Plantaginis (Che Qian Zi) Radix Angelicae Sinensis (Dang Gui) uncooked Radix Rehmanniae (Sheng Di) Radix Bupleuri (Chai Hu) Radix Glycyrrhizae (Gan Cao) Functions: Drains liver-gallbladder replete heat, clears lower burner damp heat Indications: 1) Liver-gallbladder replete heat harassing above or 2) damp heat pouring below. Acute conjunctivitis, uveitis, corneal ulcers, acute glaucoma, central retinitis, acute otitis media, boils and carbuncles in the vestibular and external auditory canal, nasal furuncles, hypertension, acute icteric hepatitis, acute cholecystitis, herpes zoster, herpes genitalia, cold sores, acute pyelonephritis, acute cystitis, urethritis, acute pelvic inflammation, acute prostatitis, orchitis, epididymitis, vaginitis, abnormal vaginal discharge, vaginal itching, lymphadenitis of the groin, hyperthyroidism, migraine headache, eczema in general and scrotal eczema in particular, and intercostal neuralgia Main signs & symptoms: 1) Headache, red eyes, rib-side pain, a bitter taste in the mouth, loss of hearing, swelling of the ears; 2) genital swelling, genital itching, impotence, genital sweating, urinary strangury, turbid urine, damp heat abnormal vaginal discharge in women, a red tongue with yellow fur, and a rapid, forceful pulse Contraindications: 1. Do not use this medicine in large doses or for prolonged periods of time in patients with spleen-stomach vacuity. 2. Do not use in large doses or for prolonged periods of time in patients with damaged body fluids. 3. Do not use in cases with a red tongue but scanty fur. Dosage: 8 pills three times per day Formula explanation: Within this formula, Gentiana Scabra, greatly bitter and greatly cold, is the sovereign for both draining fire and eliminating dampness. It drains replete liver-gallbladder fire from the upper body. It also precipitates and clears damp heat from the lower body. Scutellaria and Gardenia are the ministers. They also have the functions of draining fire with bitterness and cold and are combined with Gentian Scabra for that purpose. Alisma, Akebia, and Plantago clear heat and disinhibit dampness. They, therefore, assist in eliminating damp heat via the urinary tract. Because the liver stores the blood and heat within the liver channel can easily damage yin and blood, at the same time as using bitter cold ingredients to dry dampness, uncooked Rehmannia and DangGui are used as assistants to enrich yin and nourish the blood. Licorice regulates and harmonizes all the other medicinals. Therefore, within this formula there is supplementation within drainage and enrichment within disinhibition. This assists the downbearing of fire and the clearing of heat and the separation of clear from damp turbidity. Comments: This formula can also be used effectively in combination with Western antibiotics. However, it is one of the most widely misapplied formulas in Chinese medicine in the West. This formula should really not be used unless there is simple replete damp heat or liver fire. Most Western patients have an element of vacuity, especially spleen vacuity, in their pattern discrimination. Although many practitioners assume that it is alright to use this formula for a short period of time to clear heat and eliminate dampness in those with a mixed repletion-vacuity pattern, when damp heat is due to spleen vacuity as it so commonly is, this formula is not a good choice. In that case, one should use Bi Xie Shen Shi Wan (Dioscorea Hypoglauca Overcome Dampness Pills).

Dao Chi Wan (Abduct the Red Pills) uncooked Radix Rehmanniae (Sheng Di) Caulis Akebiae (Mu Tong) Herba Lophatheri Gracilis (Dan Zhu Ye) Extremitas Radicis Glycyrrhizae (Gan Cao Shao) Functions: Clears the heart and disinhibits urination Indications: Heat in the heart being transferred to the bladder via the small intestine. Stomatitis, night-crying in children, urethritis, cystitis, and glomerulonephritis Main signs & symptoms: Irritability, vexatious heat in the chest, oral thirst with a desire for chilled drinks, a red facial complexion, possible tongue and mouth sores, possible dark, scanty, painful, astringent urination, in severe cases, hematuria, and a slippery, rapid pulse Contraindications: Do not use alone in case of concomitant spleen vacuity. Dosage: 8 pills three times per day Formula explanation: Uncooked Rehmannia is the sovereign medicinal in this formula. It cools the blood, and it is the heart which controls the blood. Thus uncooked Rehmannia clears heat from the heart. It is also explained that, since uncooked Rehmannia enriches kidney water, kidney water can control blazing of heart fire. Akebia clears heat from the heart by leading yang downward. It does this by disinhibiting urination. Lophatherum clears heat from the heart and resolves vexation, while Licorice Tips clear heat and resolve toxins as well as harmonize all the other medicinals in this prescription. Comments: Pronounced redness and sores on the tip of the tongue are one of the main diagnostic characteristics of this pattern. In addition, there may or may not be urinary disturbances. This pattern occurs with spleen qi vacuity, in which case, this medicine can be combined with other Chinese ready-made medicines in order to fortify the spleen and supplement the qi. Patients with this pattern are strongly advised to stick to a clear bland, hypoallergenic, yeast-free diet as much as possible.

Bai Tou Weng Tang (Pulsatilla Decoction) Composition: 1. Radix Pulsatillae Chinensis (Bai Tou Weng) 15g 2. Cortex Phellodendri (Huang Bai) 12g 3. Rhizoma Coptidis Chinensis (Huang Lian) 6g 4. Cortex Fraxini (Qin Pi) 12g Functions: Clears heat and resolves toxins cools the blood and stops dysentery Indications: 1. Hot dysentery. 2. Acute enteritis 3. Postpartum enteritis 4. Acute bacillary dysentery 5. Amebic dysentery 6. Ulcerative colitis 7. Abnormal vaginal discharge 8. Urinary tract infection 9. Acute conjunctivitis Main signs & symptoms: 1. Diarrhea with abdominal pain 2. Tenesmus 3. Burning heat around the anus 4. Diarrhea containing pus and blood with more red colored material and less white colored material 5. Thirst with a desire to drink chilled water 6. A red tongue with yellow coating 7. A wiry rapid pulse Contraindications: 1. Do not use in patients with spleen vacuity. 2. Do not use long-term. Formula explanation: Pulsatilla is the main medicinal in this formula for clearing heat toxins from the blood division. Coptis, bitter and cold, clears damp heat and especially from the intestines and stomach. Phellodendron drains damp heat from the lower burner. Together these two are the assistant medicinals for clearing and resolving and cooling the blood. Fraxinus' nature is cold and its flavor is bitter and astringent. It has the functions of restraining, astringing, and stopping dysentery. When combined together with the above medicinals, the entire formula thus clears heat and resolves toxins, cools the blood and stops dysentery.

Medicines for clearing heat from the qi division Bai Hu Tang (White Tiger Decoction). Gypsum Fibrosum (Shi Gao) Radix Dioscoreae Oppositae (Shan Yao) Rhizoma Anemarrhenae Aspheloidis (Zhi Mu) mix-fried Radix Glycyrrhizae (Gan Cao) Functions: Clears heat from the qi division and drains stomach fire, engenders fluids and stops thirst Indications: Blazing heat in the yang ming damage due to cold disease, or heat in the qi division four divisions warm heat disease. Encephalitis, meningitis, lobar pneumonia, heat stroke, diabetes mellitus, periodontitis Main signs & symptoms: High fever with profuse sweating, aversion to heat, a red facial complexion, severe oral thirst, irritability, possible headache, toothache, and/or bleeding gums, and a surging, forceful or slippery, rapid pulse Contraindications: This formula is contraindicated for fever due to spleen vacuity and cases of false heat and true cold. Its use should be suspended immediately if signs of headache, stiff neck, counterflow chilling of the extremities, or clouding or dimming of the spirit occur. Dosage: 8 pills three times per day Formula explanation: Gypsum is the sovereign medicinal in this formula which greatly clears heat and drains fire. Its minister is Anemarrhena which clears heat and drains fire but also enriches yin and engenders fluids.Mix-fried Licorice and Dioscorea harmonize the stomach and protect the spleen from damage by such greatly cold medicinals. Both of these assistants fortify the spleen and boost the stomach at the same time as engendering fluids. Therefore, they help Anemarrhena repair any damage to yin fluids which may have been consumed by great heat. Comments: For great heat in the yang ming or qi division, I think one should preferably use a freshly brewed decoction made from bulk-dispensed medicinals. Such conditions are deemed emergency conditions which typically require large doses. However, if such bulk-dispensed medicinals were unavailable, for instance when traveling, these pills might be a good stop-gap measure. They can also be combined with other formulas when there is a combination of vigorous replete heat in the stomach and spleen and/or fluid vacuities. This formula differs from the standard prescription of the same name in that Dioscorea has been substituted for Semen Oryzae Sativae (Geng Mi). This latter ingredient does not lend itself for inclusion in pill formulas.

Moistening & precipitating medicines Ma Zi Ren Wan (Cannabis Seed Pills) Semen Cannabis Sativae (Huo Ma Ren) Radix Albus Paeoniae Lactiflorae (Shao Yao) Fructus Immaturus Citri Aurantii (Zhi Shi) Radix Et Rhizoma Rhei (Da Huang) Cortex Magnoliae Officinalis (Hou Po) Semen Pruni Armeniacae (Xing Ren) Mel (Feng Mi) Functions: Moistens the intestines and discharges heat, moves the qi and frees the flow of the stools Indications: Stomach and intestinal dry heat, fluid and humor insufficiency. Constipation in those who are either aged or bodily weak and vacuous, postpartum or post-surgical constipation, habitual constipation, chronic colitis, or hemorrhoids. Main signs & symptoms: Dry, bound stools, short, frequent urination, dry, yellow tongue fur, and a floating, rapid pulse Contraindications: 1. Do not use during pregnancy unless warranted by the pattern discrimination. Dosage: 8 pills three times per day Formula explanation: Cannabis Seeds are the sovereign medicinal in this formula. They moisten the intestines and open the bowels. Rhubarb opens the bowels and discharges heat. Armeniaca downbears the qi and moistens the intestines. White Peony nourishes yin and harmonizes the interior. These are the minister medicinals. Aurantium Immaturus and Magnolia precipitate the qi and break binding. Additionally, they have a strong power to downbear, discharge, and free the flow of the stools. Honey is able to moisten dryness and lubricate the intestines. These are the assistant medicinals. Comments: Once constipation has been relieved, the use of these pills should be stopped since it is not good to take Rhubarb habitually.

Da Cheng Qi Tang (Great Order the Qi Decoction) Composition: 8. Radix Et Rhizoma Rhei (Da Huang) 12g 9. Cortex Magnoliae Officinalis (Hou Po) 15g remove skin mix-fried 10. Fructus Immaturus Citri Seu Ponciri (Zhi Shi) 12g 11. Mirabilitum (Mang Xiao) 9g Method of preparation: Decoct the Magnolia and Immature Citrus first. Only add the Rhubarb during the last several minutes of cooking. Prolonged cooking reduces Rhubarb's effectiveness as a purgative. Then Mirabilitum is stirred in and dissolved after the decoction has been strained. Functions: Sternly (or harshly) precipitates heat binding Indications: 1) Yang ming bowel repletion patterns 2) Heat binding circumfluence, and 3) Interior heat repletion patterns of heat inversion. Acute pneumonia, typhoid, flus, measles, meningitis, hypertension, tetanus, beriberi, habitual constipation, appendicitis, intestinal obstruction, acute abdominal pain, neurosis, food poisoning, obesity, dysentery, hemorrhoids Main signs & symptoms: 1) Constipation, high fever, epigastric glomus and fullness, pain in the abdomen which dislikes pressure, if severe, tidal fever, delirious speech, and profuse sweating from the hands and feet, a dry, yellow, prickly tongue coating which may even be charred black and dry, and a deep, replete pulse; 2) precipitation of clear, green colored water, abdominal pain, a hard, lumpy feeling on pressure, a dry mouth and tongue, and a slippery, replete pulse; and 3) Epileptic or convulsive diseases or mania. Contraindications: 1. If inappropriately prescribed, this formula may cause vomiting and severe diarrhea. 2. It is generally prohibited during pregnancy. Additions & subtractions: Mirabilitum. This results in Xiao Cheng Qi Tang (Minor Order the Qi Decoction). Minor Order the Qi Decoction Xiao Cheng Qi Tang Source: Discussion of Cold-induced Disorders (Shang han lun) Radix et Rhizoma Rhei (da huang) 12g Cortex Magnoliae Officinalis (hou po) .6g Fructus Immaturus Citri Aurantii (zhi shi).3 pieces (6-9g) Cook in four cups of water until slightly over two cups remain, and take in two divided doses. Moderately purges clumped heat. For relatively mild yang brightness organ-stage disorders characterized by tidal fever, constipation, focal distention, abdominal fullness, abdominal pain that does not increase upon pressure, an 'old-looking' (dirty and dry) yellow tongue coating, and a slippery, rapid pulse. Also for early-stage dysenteric disorders. If there is no glomus or abdominal fullness but mild constipation with irritability and a slippery, rapid pulse, subtract Citrus Immaturus and Magnolia and add mix-fried Radix Glycyrrhizae (Zhi Gan Cao). This results in Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction).

Regulate the Stomach and Order the Qi Decoction Tiao Wei Cheng Qi Tang Source: Discussion of Cold-induced Disorders (Shang han lun) Radix et Rhizoma Rhei (da huang) 12g Radix Glycyrrhizae Uralensis (gun cao) 6g Mirabilitum (mang xiao)9-12g Cook Radix et Rhizoma Rhei (da huang) with Radix Glycyrrhizae Uralensis (gun cao), and dissolve Mirabilitum (mang xiao) in the strained decoction. Mildly purges clumped heat. For mild constipation due to yang brightness- stage heat characterized by the absence of focal distention and abdominal fullness, but with irritability and a slippery, rapid pulse. Also for nosebleed, swollen gums and throat, and petechiae (subcutaneous bleeding) due to heat in the Stomach and Intestines.

Moisten the Intestines Pill from Master Shen's Book (run chang wan) Desiccated Intestines Lusterless skin and nails, parched mouth with an unquenchable thirst, dry tongue, thin pulse May require extended use. Radix et Rhizoma Rhei (da huang) 15g Rootlets of Radix Angelicae Sinensis (dung gui wei) 15g Radix et Rhizoma Notopterygii (qiang huo) 15g Semen Persicae (tao ren) Semen Cannabis Sativae (huo ma ren) 37.5g Grind the ingredients into powder and form into pills with honey. Moistens dryness, harmonizes the blood, and disperses wind. For constipation (usually severe) from injury to the Spleen and Stomach due to windheat entering the Intestines, or from improper diet or overwork. This type of constipation includes aspects of blood deficiency, blood stasis, and wind (due to blood deficiency). The generation of wind further desiccates the Intestines, thereby aggravating the constipation. This formula is stronger than the principal formula, and is indicated for more severe conditions.

Regulating & harmonizing the liver & spleen medicines Si Ni San Wan (Four Counterflows Powder Pills aka Frigid Extremities Powder) Radix Albus Paeoniae Lactiflorae (Bai Shao) Radix Bupleuri (Chai Hu) Fructus Immaturus Citri Aurantii (Zhi Shi) mix-fried Radix Glycyrrhizae (Gan Cao) Functions: Out-thrusts evils and resolves depression, courses the liver and rectifies the spleen Indications: Liver-spleen disharmony with internal heat but cold extremities; gastritis, peptic ulcers, cholecystitis, cholelithiasis, hepatitis, intestinal obstruction, mastitis, fibrocystic breasts Main signs & symptoms: Irritability, vexatious heat, chest and venter oppression and fullness, a red tongue with yellow fur, and a bowstring pulse Dosage: 8 pills three times per day Formula explanation: Bupleurum courses the liver and rectifies the qi at the same time as it resolves the exterior and out-thrusts internal heat. Immature Aurantium rectifies the stomach and intestinal qi, dispersing accumulations in the middle burner, and thereby promoting the spleens movement and transformation. Peony emolliates and harmonizes the liver which thereby promotes the livers function of coursing and discharge. Mix fried Licorice harmonizes the middle and relaxes tension. When Peony and Licorice are combined together, they are especially effective for relaxing cramps and spasms resulting in pain. Comments: The cold extremities in this case primarily refer to cold hands. These become chilled in response to stress. When the patient relaxes, the hands warm back up. In this case, the cold hands are a type of false cold. In actuality, there is heat depressed internally. That is why there is a red tongue and often a rapid pulse. Practitioners must, therefore, be sure to clarify whether a patient always has cold hands or only has cold hands under stress. They should also be careful to reevaluate their diagnosis of spleen and/or kidney vacuity cold if there is a dark red tongue with bowstring pulse. This formula can be combined with others, such as Xiao Chai Hu Tang Wan (Minor Bupleurum Decoction Pills) and Xiao Yao Wan (Rambling Pills), when there is more pronounced qi stagnation leading to abdominal cramping. Xiao Chai Hu Tang treats the combination of liver depression qi stagnation, spleen qi vacuity, stomach disharmony, depressive heat in the liver, gallbladder, stomach, or lungs, dampness, and phlegm. Amongst these liver depression and spleen qi vacuity are primary, while patients typically have a selection of several but not necessarily all of the others.

FORMULAS THAT HARMONIZE LESSER YANG-STAGE DISORDERS COMMON INDICATIONS: intermittent chills and fever, stifling or full sensation in the chest and hypochondria, bitter taste in the mouth, nausea and vomiting, wiry pulse Ban Xia Xie Xin Tangtreats spleen vacuity and damp heat. In this case, the damp heat is in the stomach and intestines. In most Westerners, when the spleen gets vacuous and weak, the stomach actually gets hot and even dry. The pattern of spleen-stomach vacuity weakness is a relatively rare occurrence in adult Western patients in my experience. Regulating & harmonizing the stomach & intestines medicines Ban Xia Xie Xin Tang Wan (Pinellia Drain the Heart/Epigastrium Decoction Pills) Rhizoma Pinelliae Ternatae (Ban Xia) Radix Scutellariae Baicalensis (Huang Qin) dry Rhizoma Zingiberis (Gan Jiang) Radix Panacis Ginseng (Ren Shen) Radix Glycyrrhizae (Gan Cao) Rhizoma Coptidis Chinensis (Huang Lian) Fructus Zizyphi Jujubae (Da Zao) Functions: Harmonizes the stomach and downbears counterflow, opens binding and eliminates glomus Indications: Lack of harmony of the stomach. Acute and chronic gastritis, enteritis, indigestion, pediatric vomiting and diarrhea, chronic hepatitis, early-stage cirrhosis, and gastric ulcers due to hyperacidity Main signs & symptoms: Glomus and fullness below the heart but no pain, vomiting or dry heaves, borborygmus, diarrhea, a thin, yellow or slimy tongue coating, and a wiry, rapid pulse Dosage: 5 tablets three times per day Formula explanation: This formula is a modification of Xiao Chai Hu Tang. It is used when there is diarrhea and detriment damage of the central yang with possible external evils inhibiting qi dynamic. In this case, cold and heat are mutually binding, producing glomus underneath the heart since the qi is not upbearing and downbearing, is full and not freely flowing. Coptis and Scutellaria are bitter and cold, downbearing and discharging. Thus they eliminate heat. Dry Ginger and Pinellia are acrid, warm, and open nodulation, thus scattering cold. Ginseng, Licorice, and Red Dates are sweet and warm and boost the qi, thus supplementing vacuity. When these seven flavors (i.e., ingredients) are combined, cold and hot medicinals are used together as are bitter, downbearing and acrid, opening ingredients. In addition, the qi is supplemented and the center is harmonized. Therefore, evils are removed at the same time as the righteous is augmented. Comments: This formula is a very useful one in clinical practice, since few Westerners exhibit pure patterns of spleen-stomach vacuity weakness. Although many, if not most, Western patients suffer from spleen vacuity, typically, our stomachs and/or intestines are hot or hot and damp. This formula treats this real-life, complex pattern. In this case, heat can be replete heat, damp heat, or depressive heat, and cold may simply be due to exuberant yin and insufficient yang. Like the other two harmonizing formulas discussed above, this Chinese ready-made medicine can be combined with other ready-made medicines in order to treat even more complex patterns.

Xiao yao san Radix Bupleuri ( c h i hu) ,309- (9g) Radix Angelicae Sinensis (dang gui) 30g (9g) Radix Paeoniae Lactiflorae (bai shao)309- (9g) Rhizoma Atractylodis Macrocephalae (bai zhu) 3og (9g) Sclerotium Poriae Cocos (fu ling) 30g (9g) Honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao) 15g (6g) . Radix Paeoniae Lactiflorae (bai shao) 309- (9g) Spleen becomes excessive, resulting in Spleen deficiency Preparation: Grind the ingredients into powder and take as a draft in 6-9g doses with 6g of roasted Rhizoma Zingiberis Officinalis Recens (wei jiang) and 3g of Herba Menthae Haplocalycis (bo he). May also be prepared as a decoction with the dosage indicated in parentheses. Available in prepared form. Actions: Spreads the Liver qi, strengthens the Spleen, and nourishes the blood. INDICATIONS : Hypochondriac pain, headache, vertigo, a bitter taste in the mouth, dry mouth and throat, fatigue, reduced appetite, pale-red tongue, and a wiry, deficient pulse. There may also be alternating fever and chills, and irregular menstruation or distended breasts. This is Liver constraint with blood deficiency. The relationship between the Liver and Spleen is very close. When the Liver qi is constrained its control over the The chief herb effectively relieves Liver constraint. The deputies work together to nourish the blood and soften the edginess that results from Liver constraint. Slightly aromatic affects. This is known as transverse rebellion of Liver qi violating the Spleen. Deficiency of the Spleen, whose function is to transform nutrients into blood and qi, often results in blood deficiency. Conversely, blood deficiency (regardless of origin) can lead to Liver constraint. The Liver, a yin organ which stores blood, depends upon the yang to carry out its spreading function. But if the supply of Liver blood is insufficient, a surplus of qi may ensue, which is known as constrained Liver qi. Liver qi constraint is indicated by pain along the Liver channel, especially in the hypochondria. In women this can manifest as distended breasts. In some patients, constraint of the Liver may affect its related channel, the Gallbladder, and lead to lesser yang-stage signs and symptoms such as alternating fever and chills and a bitter taste in the mouth. Liver constraint and blood deficiency causes headache, vertigo, and a dry mouth and throat. Fatigue and reduced appetite are symptoms of Spleen deficiency. The tongue and pulse signs reflect the constrained Liver qi and blood deficiency. ANALYSIS OF FORMULA: Although the focus of this formula is on spreading the Liver qi to relieve Liver constraint, nourishing herbs must also be included.

Xiao Yao San (Rambling Powder) Composition: 1. Radix Bupleuri (Chai Hu) 9g 2. Radix Angelicae Sinensis (Dang Gui) 9g slightly stir-fried 3. Radix Albus Paeoniae Lactiflorae (Bai Shao) 12g 4. Rhizoma Atractylodis Macrocephalae (Bai Zhu) 9g 5. Sclerotium Poriae Cocos (Fu Ling) 15g 6. Radix Glycyrrhizae (Gan Cao) 6g mix-fried 7. Herba Menthae (Bo He) 3g 8. raw Rhizoma Zingiberis (Sheng Jiang) 3g Functions: Courses the liver and resolves depression, fortifies the spleen and harmonizes the constructive Indications: 1. Liver depression 2. Blood vacuity. 3. Irregular menstruation 4. Uterine bleeding 5. Abnormal vaginal discharge 6. Breast distention 7. Premenstrual tension 8. Climacteric disorders 9. Chronic hepatitis 10. Pleurisy 11. Chronic gastritis 12. Peptic ulcer 13. Neurosis 14. Anemia 15. Insomnia 16. Optic nerve atrophy 17. Central retinitis 18. Neurasthenia. Main signs & symptoms: 1. Lateral coastal pain 2. Alternating hot and cold 3. Headache 4. Vertigo 5. A dry mouth and throat 6. Fatigued spirit 7. Reduced appetite 8. Menstrual irregularity 9. Breast distention 10. Pale red tongue 11. And a wiry 12. Vacuous pulse. Formula explanation: In this formula, Bupleurum courses the liver and resolves depression. The combination of Dang Gui and Peony nourishes the blood and softens the liver. Because Dang Gui is somewhat aromatic, it moves the qi, but because it is sweet, it also relaxes tension. Therefore, it is an essential medicinal for treating liver depression with blood vacuity. Atractylodis and Poria fortify the spleen and remove dampness, thus promoting transportation and transformation and, ultimately, the origin of qi and blood. Mix-fried Licorice boosts the qi and supplements the center as well as relaxes the liver's tension. It is the assistant

medicinal in this formula. The two messengers in this formula are Ginger and Mint. Ginger warms and harmonizes the center. Mint, when used in small amounts, assists Bupleurum's scattering of liver depression. Thus this formula as a whole regulates and harmonizes the liver and spleen.

Huo Xiang Zheng Qi Wan (Agastaches Correct the Qi Pills) Pericarpium Arecae Catechu (Da Fu Pi) Radix Angelicae Dahuricae (Bai Zhi) Folium Perillae Frutescentis (Zi Su Ye) Sclerotium Poriae Cocos (Fu Ling) Rhizoma Pinelliae Ternatae (Ban Xia) Rhizoma Atractylodis Macrocephalae (Bai Zhu) Pericarpium Citri Reticulatae (Chen Pi) Cortex Magnoliae Officinalis (Hou Po) Radix Platycodi Grandiflori (Jie Geng) Herba Agastachis Seu Pogostemi (Huo Xiang) Radix Glycyrrhizae (Gan Cao) Functions: Resolves the exterior and transforms dampness, rectifies the qi and harmonizes the center Indications: External contraction of wind cold, internal damage by damp stagnation, sudden turmoil, vomiting, diarrhea. Influenza, intestinal flu, nonspecific acute colitis, acute gastroenteritis Main signs & symptoms: Vomiting, diarrhea, effusion of heat, aversion to cold, headache, chest and diaphragmatic fullness and oppression, stomach duct and abdominal aching and pain, slimy, white tongue fur, and a moderate, i.e., slightly slow, soggy or soft pulse Contraindications: Do not use in case of wind heat or fire due to vacuity. Dosage: 8 pills three times per day Formula explanation: Within this formula, Agastaches is the main medicinal used in relatively large proportions. It acridly scatters cold wind at the same time that it is able to aromatically penetrate and transform turbidity. Hence it upbears the clear and downbears the turbid. It is combined with Folium Perillae and Angelica Dahurica which are acrid, aromatic, emitting, and scattering. These assist Agastaches to externally resolve wind cold at the same time as penetrating and transforming dampness and turbidity. Pinellia and Orange Peel dry dampness and harmonize the stomach, downbear counterflow and stop vomiting. Atractylodes and Poria fortify the spleen and move dampness, harmonize the center and stop diarrhea. Magnolia and Pericarpium Arecae move the qi and transform dampness, ease the flow of the center and eliminate fullness. Platycodon diffuses the lungs and disinhibits the diaphragm. Thus it benefits the resolution of the exterior as well as boosts the transformation of dampness. Ginger, Red Dates, and Licorice regulate and harmonize the spleen and stomach as well as harmonize the natures of all the medicinals in this formula. When used together, these medicinals scatter wind cold externally, transform damp turbidity internally, upbear the clear and downbear the turbid, and free and smooth the flow of the qi mechanism. Therefore, all the symptoms are automatically cured. Comments: Typically, this medicine is used by itself. Some Chinese sources categorize it as an exteriorresolving formula, resolving wind dampness. Other Chinese sources suggest it for pediatric damp heat vomiting and diarrhea.

Ping Wei San (Leveling the Stomach Powder)1 Rhizoma Atractylodis (Cang Zhu) Cortex Magnoliae Officinalis (Hou Po) Pericarpium Citri Reticulatae (Chen Pi) Radix Glycyrrhizae (Gan Cao) dry Rhizoma Zingiberis (Gan Jiang) Fructus Zizyphi Jujubae (Da Zao) Functions: Dries dampness and transports the spleen, moves the qi and harmonizes the stomach Indications: Damp stagnation of the spleen and stomach. Acute and chronic gastritis, gastrectasis, gastric ulcer, peptic ulcer, indigestion, especially pediatric indigestion, gastric neurosis, obesity, chronic pancreatitis, and parasitic diseases 1The Chinese word ping means level and calm or peaceful. However, when used medically, the word always implies a spatial connotation which the word calm does not capture. Leveling medicinals and formulas level and downbear upward counterflow. They do not just calm agitation. Main signs & symptoms: Epigastric and abdominal distention and fullness, no thought for food or drink, a bland taste in the mouth or lack of taste, vomiting, nausea, acid eructation, a heavy, sagging feeling in the extremities, easy fatigue and a desire to lie down, white, slimy, or thick tongue fur, and a moderate, i.e., slightly slow, or possibly bowstring pulse Contraindications: 1. Use with caution during pregnancy. 2. Use with caution and/or modification in cases with yin and blood vacuity. Dosage: 8 pills three times per day Formula explanation: In this formula, a relatively large dose of Atractylodes is the sovereign. It is bitter, warm, and drying in nature. It is used to eliminate dampness and transport the spleen. Magnolia is the minister. It moves the qi and transforms dampness, disperses distention and eliminates fullness. Orange Peel is the assistant. It rectifies the qi and transforms stagnation. Licorice is the messenger. It is sweet and relaxing and harmonizes the stomach. It also regulates and harmonizes all the other medicinals. Fresh Ginger and Red Dates also regulate and harmonize the spleen and stomach. Therefore, the medicinals in this formula work together to transform damp turbidity, to regulate and smooth the qi dynamic, to augment and fortify the spleen and stomach, and to harmonize and downbear the stomach qi. Thus all the disease conditions associated with this formula are automatically eliminated.

Heat-clearing, dampness-eliminating medicines Ba Zheng San (Eight Correcting [Ingredients] Powder) Semen Plantaginis (Che Qian Zi) Herba Dianthi (Qu Mai) Herba Polygoni Avicularis (Bian Xu) Talcum (Hua Shi) Fructus Gardeniae Jasminoidis (Shan Zhi Zi) Radix Glycyrrhizae (Gan Cao) Caulis Akebiae (Mu Tong) Radix Et Rhizoma Rhei (Da Huang) Medulla Junci Effusi (Deng Xin Cao) Functions: Clears heat and drains fire, disinhibits water and frees the flow of strangury Indications: Damp heat pouring downward. Acute urinary tract infection, urinary calculi, cystitis, urethritis, acute prostatitis, acute nephritis, acute pyelonephritis, glomerulonephritis, and acute gonorrhea Main signs & symptoms: Hot strangury, bloody strangury, urination cloudy and red, astringent and painful, dribbling and dripping, uneasy flow, if severe, complete urinary blockage, lower abdominal tension and fullness, a dry mouth and tongue, a slimy, yellow tongue coating, and a slippery, rapid pulse Contraindications: 1. Do not use long-term since it may cause light-headedness, palpitations, and diminished appetite. 2. Use only with care during pregnancy. 3. Do not use for vacuity cold. 4. Do not use in persons with bodily vacuity. Dosage: 8 pills three times per day Formula explanation: In this formula, Akebia, Talcum, Plantaginis, Dianthus, and Polygonum Avicularis all disinhibit water and open strangury. They also clear heat and disinhibit dampness. Gardenia clears and drains damp heat from the three burners. Rhubarb discharges heat and downbears fire. Juncus conducts heat and moves it downward. Licorice harmonizes these medicinals and relaxes urgency or cramping.

Water-disinhibiting, dampness-percolating medicines Wu Ling San (Five [Ingredients] Poria Powder) Sclerotium Polypori Umbellati (Zhu Ling) Rhizoma Alismatis (Ze Xie) Rhizoma Atractylodis Macrocephalae (Bai Zhu) Sclerotium Poriae Cocos (Fu Ling) Ramulus Cinnamomi Cassiae (Gui Zhi) Functions: Disinhibits water and percolates dampness, warms yang and transforms qi Indications: 1) Exterior pattern with interior collection of water dampness, 2) water dampness collected internally, and 3) phlegm rheum. Chronic nephritic edema, acute and chronic nephritis, chronic renal failure, acute gastritis, cardiac edema from congestive heart failure, gastroptosis, gastrectasis, ascites due to liver cirrhosis, infectious hepatitis, urinary retention, scrotal hydrocele, acute gastroenteritis with diarrhea, Meniere's disease, genitourinary tract infections, and neurogenic bladder syndrome Main signs & symptoms: 1) Headache, fever, vexatious thirst, a desire to drink but vomiting upon entering of water into the stomach, inhibited urination, white tongue fur with a floating pulse; 2) puffy swelling, diarrhea, inhibited urination, cholera-like vomiting and diarrhea patterns; and 3) throbbing palpitations below the umbilicus, vomiting frothy saliva, and vertigo or shortness of breath and coughing Contraindications: 1. Do not use or overuse in patients with spleen and kidney vacuity or combine with medicines which supplement and nourish the spleen and stomach and supplement and enrich the kidneys. 2. Do not use for the treatment of yin vacuity dysuria. 3. Do not use for prolonged periods of time. Dosage: 5 pills three times per day Formula explanation: Within this formula, relatively heavy doses of Alisma are used as the sovereign medicinal. Alisma is sweet, bland, and percolating, while its nature is cold. It out-thrusts the bladder, disinhibits water, and percolates dampness. The minister medicinals are Poria and Polyporus which also blandly percolate. They help strengthen the disinhibition of water. Added to these is Atractylodes which fortifies spleen qi and transports and transforms water dampness. The assistant medicinal is Cinnamon Twigs which is a single medicinal with two uses. First, it resolves the tai yang on the exterior. Secondly, it aids the bladder qi internally. When these five medicinals are combined together, water is moved and qi is transformed, the exterior is resolved and the spleen is fortified.

Wu Pi Yin Wan / Wu Pi San (Five Skins Drink Pills)4. Cortex Radicis Mori Albi (Sang Bai Pi) Cortex Rhizomatis Zingiberis (Sheng Jiang Pi) Cortex Sclerotii Poriae Cocos (Fu Ling Pi) Pericarpium Citri Reticulatae (Chen Pi) Pericarpium Arecae Catechu (Da Fu Pi) Functions: Disinhibits dampness and disperses swelling, rectifies the qi and fortifies the spleen Indications: Spleen vacuity damp exuberance, skin edema. Edema during pregnancy, protein-deficiency edema, ascites from cirrhosis, congestive heart failure, urticaria, menopausal edema Main signs & symptoms: Generalized edema, heavy, encumbered limbs, heart and abdominal distention and fullness, ascending qi panting and hasty breathing, inhibited urination, edema during pregnancy, slimy, white tongue fur, and a deep, moderate, i.e., slightly slow, pulse Dosage: 8 pills three times per day Formula explanation: Within this formula, Poria Skin disinhibits water and percolates dampness while simultaneously supplementing the spleen and assisting movement and transformation. Ginger Peel acridly scatters water rheum. Morus Bark depurates and downbears the lung qi in order to free the flow of and regulate the water passageways. Pericarpium Arecae moves water qi and disperses distention and fullness. Orange Peel harmonizes the stomach qi and transforms damp turbidity. When these five ingredients are used together, their effect of regulating the qi and fortifying the spleen, disinhibiting dampness and dispersing swelling is very good. 4 Although the Mayway catalog calls this medicine Wu Pi Yin Wan, its ingredients are that of Wu Pi San (Five Skins Powder). Comments: Because edema is so often due to spleen vacuity failing to control movement and transformation, this medicine is most often combined with spleen-supplementing formulas, such as Bu Zhong Yi Qi Wan (Supplement the Center & Boost the Qi Pills) and Si Jun Zi Wan (Four Gentlemen Pills). Although the Mayway catalog calls this medicine Wu Pi Yin Wan, its ingredients are that of Wu Pi San (Five Skins Powder).

FORMULAS THAT PROMOTE URINATION AND LEACH OUT DAMPNESS 1 COMMON INDICATIONS: urinary difficulty, fluid metabolism dysfunction Polyporus Decoction (zhu ling tang) Clumping of water and heat Fever and thirst with a desire to drink Also for diarrhea in infants from damp-heat and injury to the yin. Polyporus Decoction Zhu ling tang Sclerotium Polypori Umbellati (zhu ling). . . . . . . .3g Sclerotium Poriae Cocos (fu ling). . . . . . . . . . . . . .3g Rhizoma Alismatis Orientalis (ze xie) . . . . . . . . . .3g Talcum (hua shi) . . . . . . . . . . . . . . . . . . . . . . . . . . . .3g Gelatinum Corii Asini (e jiao) . . . . . . . . . . . . . . . .3g Preparation: Prepare the first four ingredients as a decoction and dissolve one-half of the Gelatinum Corii Asini (e jiao) into the strained liquid. Today I 2-3 times the original dosage is generally used. Available in prepared form. Actions: Promotes urination, clears heat, and nourishes the yin. INDICATIONS: Urinary difficulty accompanied by fever and thirst with a desire to drink. There may also be diarrhea, cough, nausea, irritability, or insomnia. According to the source text, this is injury from cold entering the yang brightness or lesser yin stage where it transforms into heat. The heat battles with the water (controlled by the Kidneys, the organ corresponding to the leg lesser yin channel), which leads to clumping of water and heat. Heat also injures the yin (fluids) and disturbs the water pathways, resulting in urinary difficulty. It is also common for this pattern to develop in patients with constitutional yin deficiency and invasion of heat into the lower burner. Heat gives rise to fever. Injury to the fluids and obstruction of the water pathways causes thirst with a desire to drink (in contrast to thirst without a desire to drink, which is characteristic of damp-heat). When fluids cannot be eliminated through the urine they are eliminated through the stool, resulting in diarrhea. If the disturbance of the water pathways affects the flow of qi in the Lungs, there will be coughing. If the disturbance affects the middle burner, there will be nausea. Vigorous heat due to yin deficiency agitates the Heart and leads to irritability and insomnia. ANALYSIS OF FORMULA: Treatment should focus on the acute problem of urinary difficulty, while also clearing the heat and nourishing the yin. Sclerotium Polypori Umbellati (zhu ling), one of the chief ingredients, strongly reinforces the proper functioning of the water pathways and thereby promotes urination. The other chief ingredient, Sclerotium Poriae Cocos (fu ling), promotes urination, benefits the Spleen, and harmonizes the Stomach. The chief ingredients work together synergistically. The deputy, Rhizoma Alismatis Orientalis (ze xie), promotes water metabolism, unblocks the deep parts of the water pathways that involve the Kidneys, and aids the chief ingredients in promoting urination. The assistant, talcum-(hua shi), clears heat and unblocks painful urinary dysfunction. The combination of these four ingredients clears heat and promotes flow in the water pathways, and is therefore very effective in resolving the clumping of water and heat. Gelatinum Corii Asini (e jiao) is a moist substance that enriches the yin (without causing retention of the pathogenic influences) and prevents excessive urination, which would further injure the yin.

Remove Painful Obstruction Decoction from Medical Revelations Juan Bi Tang Source: Medical Revelationr (Yi xue xin wu) Radix et Rhizoma Notopterygii (qiang huo) . . . . .3g Radix Angelicae Pubescentis (du huo) . . . . . . . . . .3g Radix Gentianae Qinjiao (qin jiao) . . . . . . . . . . . -3g Ramulus Mori Albae (sang zhi) . . . . . . . . . . . . . . .9g Caulis Piperis Futokadsurae (haifeng tend . . . . . .9g Radix Angelicae Sinensis (dang gui). . . . . . . . . . . .9g Radix Ligustici Chuanxiong (chuan xiong) . . . . .2.lg Gummi Olibanum (TU xiang) . . . . . . . . . . . . . . . .2.4g I Radix Aucklandiae Lappae (mu xiang) . . . . . . . .2.4g Cortex Cinnamomi Cassiae (TOUgu i) . . . . . . . . .1.5g Honey-fried Radix Glycyrrhizae Uralensis (zhi gun cao) . . . . . . . . . . . . . . . . . . . . . . . . . . . . l .5 g Preparation: Decoction. Today the dosage is increased 2-3 times, and Rarnulus Cinnamomi Cassiae (gui zhi) is substituted for Cortex Cinnarnomi Cassiae (mu gui). Actions: Removes wind-dampness and alleviates painful obstruction. INDICATIONS: Joint pain that increases with cold and diminishes with warmth, possibly accompanied by a sensation of heaviness and numbness in the limbs, a thick, white tongue coating, and a slow, possibly slippery pulse. This is joint pain due to local obstruction of qi from the effects of wind, dampness, and cold. This is painful obstruction (bi). The presence of wind is manifested in the changing position of the pain. The presence of cold is evidenced by the response to temperature change, the white tongue coating, and the slippery pulse. The numbness is caused by a combination of wind and dampness. ANALYSIS OF FORMULA: The chief herbs, Radix et Rhizoma Notopterygii (qiang huo) and Radix Angelicae Pubescentis (du huo), together relieve painful obstruction in both the upper and lower parts of the body. The deputies, Radix Gentianae Qinjiao (qin jiao), Rarnulus Mori Albae (sang zhi), and Caulis Piperis Futokadsurae (hi feng teng), effectively expel winddampness. Two of the assistants, Radix Angelicae Sinensis (dang gui) and Radix Ligustici Chuanxiong (chuan xiong), invigorate the blood, which helps expel wind-dampness and stop the pain. Another assistant, Gummi Olibanum (ru xiang), breaks up blood stasis and helps treat localized pain. Yet another assistant, Radix Aucklandiae Lappae (mu xiang), revives the Spleen and is therefore helpful in treating dampness, as this improves fluid metabolism. The assistant and envoy herb, Ramulus Cinnamomi Cassiae. (gui zhi), improves the circulation of the yang qi and helps direct the actions of the other herbs toward the extremities, especially the shoulders. The other envoy, honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao), prevents injury to the normal qi and harmonizes the actions of the other herbs. COMMENTARY: This is an important formula for treating relatively early-stage painful obstruction. It may be modified to focus the actions on whichever pathogenic influence is predominant. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as osteoarthritis, rheumatoid arthritis, gouty arthritis, and bursitis.

Warming & transforming water dampness medicines Zhen Wu Tang Wan (True Warrior Decoction Pills) Sclerotium Poriae Cocos (Fu Ling) Rhizoma Atractylodis Macrocephalae (Bai Zhu) Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi) Radix Albus Paeoniae Lactiflorae (Bai Shao) dry Rhizoma Zingiberis (Gan Jiang) Functions: Warms yang and disinhibits water Indications: 1) Spleen-kidney yang vacuity, water qi collecting internally; 2) tai yang disease. Chronic nephritis, rheumatic valvular heart disease, congestive heart failure, cirrhosis of the liver, chronic hepatic disease, other causes of edema and ascites, chronic enteritis, intestinal tuberculosis, other causes of chronic diarrhea, Menieres disease, primary hypertension, primary hyperaldosteronism, hypothyroidism, rheumatoid arthritis, chronic bronchitis Main signs & symptoms: 1) Inhibited urination, heaviness, sagging, aching and pain of the four limbs, abdominal pain, downward precipitation (i.e., diarrhea), puffy swelling of the limbs and body, white tongue fur, no thirst, and a deep pulse. 2) Sweating, no resolution after sweating, continuing effusion of heat, palpitations below the heart, dizziness, shivering, slimy, white tongue fur, and a deep, fine, forceless pulse Dosage: 8 pills three times per day Formula explanation: Within this formula, prepared Aconite is the sovereign. It is greatly acrid and greatly hot. It warms the kidneys and warms earth, thus invigorating yang qi. The minister medicinal is Poria. It is sweet and bland and percolates and disinhibits. It fortifies the spleen and percolates dampness, thus disinhibiting water evils. Ginger is also a minister medicinal in this formula. It is acrid and warm and it assists Aconites warming of yang and dispelling of cold. When combined with Poria, it also warms and scatters water qi. Atractylodes is the assistant which fortifies the spleen and dries dampness, thus supporting the spleens movement and transformation. And Peony relaxes urgency and stops abdominal pain. When all these medicinals are used together, there is scattering within warming and transforming within disinhibiting. Both the spleen and kidneys are supplemented, while yin water is controlled. Comments: This medicine treats some very serious conditions and diseases. Therefore, one should exercise great care when treating patients with the corresponding pattern. Treating Dryness Formulas This category of formulas is composed of formulas which treat externally contracted dryness and those which treat internal dryness due to yin vacuity. The former subcategory of formulas uses medicinals which gently diffuse dry evils, while the latter are composed of medicinals which enrich yin and moisten dryness. External dryness is primarily due to external invasion by dry evils. These evils may combine with wind or cold and may easily transform into heat or fire. Internal dryness is due to essence deficiency and fluid consumption of the viscera and bowels. In turn, this may be due to excessive loss of body fluids through vomiting, sweating, or diarrhea, excessive urination, sexual taxation, or overindulgence in spicy foods. The lungs, spleen, kidneys, and large intestine are the viscera and bowels most commonly affected by fluid dryness. Cautions & Contraindications: 1. Do not use moistening, enriching formulas with patients who have a damp body constitution. 2. Use with care in cases of diarrhea due to spleen vacuity. 3. Use with care in cases of qi stagnation since greasy, enriching, and supplementing ingredients can further obstruct the free flow of qi.

13.1 Ruan Xuan Ru Zao Ji (Mildly diffusing & moistening dryness formulas). Representative formula: Xing Su San (Armeniaca & Perilla Powder) Composition: 1. Folium Perillae Frutescentis (Su Ye) 6g 2. Rhizoma Pinelliae Ternatae (Ban Xia) 6g 3. Sclerotium Poriae Cocos (Fu Ling) 6g 4. Radix Peucedani (Qian Hu) 6g 5. Radix Platycodi Grandiflori (Ku Jie Geng) 6g 6. Fructus Citri Seu Ponciri (Zhi Ke) 6g 7. Radix Glycyrrhizae (Gan Cao) 6g 8. Raw Rhizoma Zingiberis (Sheng Jiang) 6g 9. Pericarpium Citri Reticulatae (Ju Pi) 6g 10. Semen Pruni Armeniacae (Xing Ren) 6g 11. Fructus Zizyphi Jujubae (Da Zao) 2 pieces Functions: Gently diffuses and cools dryness diffuses the lungs and transforms phlegm Indications: 1. External invasion 2. Cool dryness. 3. Common cold 4. Chronic tracheitis 5. Acute and chronic bronchitis 6. Bronchiectasis 7. Pulmonary emphysema Main signs & symptoms: 1. Slight headache 2. Aversion to cold 3. No sweating 4. Cough with sticky phlegm 5. Stuffed nose 6. Dry throat 7. A white tongue coating 8. Wiry pulse Formula explanation: Within this formula Folium Perillae and Peucedanum relieve the exterior and scatter evils as well as cause slight sweating. Armeniaca and Platycodon diffuse the lungs and out-thrust evils, disinhibit the qi and stop coughing. Pinellia and Poria dispel dampness and transform phlegm. Citrus and Orange Peel rectify the qi and loosen the chest. Fresh Ginger, Red Dates, and Licorice regulate the constructive and defensive and harmonize all the other medicinals. Taken as a whole, this formula emits the exterior, diffuses the lungs, and cools and resolves dryness. It also disinhibits the qi, transforms phlegm, and stops cough. Internal dryness of the Lungs (Lung and Kidney yin deficiency) Blood-streaked sputum, wheezing, dry and hot palms and Lily Bulb Decoction to Preserve the soles, night sweats, a red tongue with little coating, and a Metal (bai he gu jin tang), 161 thin, rapid pulse

Lily Bulb Decoction to Preserve the Metal Bai He Gu Jin tang This formula acts to preserve and stabilize the function of the ~ u n&,w hich are associated with the metal phase, and one of its chief herbs is lily bulb (bai he), hence the name. Source: Analytic Collection of Medical Formulas (Yi fang ji jie) Bulbus Lilii (bai he) . . . . . . . . . . . . . . . . . . . . . . . . .3g Radix Rehmanniae Glutinosae (sheng di huang). . .6g Radix Rehmanniae Glutinosae Conquitae (shu di huang) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9g Tuber Ophiopogonis Japonici ( m i men dong). . .4.5g Radix Scrophulariae Ningpoensis (xuan shen) . .2.4g Bulbus Fritillariae (bei mu) . . . . . . . . . . . . . . . . . . .3g Radix Platycodi Grandiflori (jie geng) . . . . . . . .2.4g Radix Angelicae Sinensis (dang gui). . . . . . . . . . . . 3g Radix Paeoniae Lactiflorae (bai shao) . . . . . . . . . .3g Radix Glycyrrhizae Uralensis (gan cao) . . . . . . . . . 3g Preparation: Decoction. Today most practitioners use 2-3 times the specified dosage, and some texts advise to increase the dosage of Bulbus Lilii (bai he) to 24 grams. Bulbus Fritillariae Cirrhosae (chuan bei mu) is generally the species of Fritillariae used. Available in prepared form. Actions: Nourishes the yin, moistens the Lungs, transforms phlegm, and stops coughing. INDICATIONS: Coughing with blood-streaked sputum, wheezing, a dry and sore throat, hot palms and soles, night sweats, a red tongue with little coating, and a thin, rapid pulse. This is internal dryness of the Lungs due to Lung and Kidney yin deficiency. Yin deficiency generates internal heat which rises to cause a dry and sore throat. Yin deficiency may be caused either by a chronic disorder of the Lungs which injures the yin and fluids, or by any condition which injures the Kidney yin. Heat from deficiency 'steams' the delicate, uppermost organ (the Lungs), and interferes with the regulation of Lung qi, producing coughing and wheezing. Heat from deficiency also 'scorches' the collaterals of the Lungs, leading to blood-streaked sputum. The other signs and symptoms are classic indications of heat from deficiency. ANALYSIS OF FORMULA: Bulbus Lilii (bai he), one of the chief herbs in the formula, moistens and nourishes dryness in the Lungs, and clears heat. Another of the chief herbs, Radix Rehmanniae Glutinosae (sheng di huang), strongly enriches the yin and tonifies the Kidneys. It also performs the important function of cooling the blood to stop the bleeding. Radix Rehmanniae Glutinosae Conquitae (shu di huang), the third chief herb, is a very powerful tonic for the Liver and Kidney yin. In concert with Radix Rehmanniae Glutinosae (shng di huang), it is also especially helpful in treating fire due to yin deficiency. One of the deputies, Tuber Ophiopogonis Japonici (mai men dong), is an important herb for tonifying the yin, especially that of the upper burner. It also potentiates the actions of Bulbus Lilii (bai he) on the Lungs, and the yin-tonifying actions of the other chief herbs. The other deputy, Radix Scrophulariae Ningpoensis (xuan shen), helps the Kidney water to ascend to the Lungs, and is very useful in clearing fire from deficiency and treating steaming bone condition. Bulbus Fritillariae Cirrhosae (chuan bei mu), one of the assistants, moistens the Lungs, transforms phlegm, and stops coughing. Another assistant, Radix Platycodi Grandiflori (jie geng), facilitates the movement of Lung qi and stops coughing, especially when combined with Bulbus Fritillariae Cirrhosae (chuan bei mu). The other assistant herbs, Radix Angelicae Sinensis (dang gui) and Radix Paeoniae Lactiflorae (bai shao), nourish the blood to support the yin. In ancient material medica, Radix Angelicae Sinensis (dang gui) was considered to be useful in stopping coughing. Another way of viewing the actions of Radix Paeoniae Lactiflorae (bai shao) and Radix Angelicae Sinensis (dang gui) is that by calming the Liver they protect the Lungs from violation. The envoy, Radix Glycyrrhizae Uralensis (gan cm), harmonizes the actions of the other herbs and, in combination with Radix Platycodi Grandiflori (jie geng), improves the condition of

the throat. COMMENTARY: This formula and Tonify the Lungs Decoction with Ass-hide Gelatin (bufei e jiao tang) have similar functions. Lily Bulb Decoction to Preserve the Metal (bai he gu jin tang) possesses stronger yinnourishing actions; Tonify the Lungs Decoction with Ass-hide Gelatin (bufei e jiao tang) focuses on clearing heat and stopping the bleeding. This formula and Eliminate Dryness and Rescue the Lungs Decoction (qing zao jiufei tang) are also similar in that they both moisten and nourish the Lung yin. However, this formula only nourishes the Lung and Kidney yin and treats fire from deficiency. Eliminate Dryness and Rescue the Lungs Decoction, (qing m j i u j i tang), which augments the qi and has a slight exterior-releasing function, addresses injury to the qi and yin. Both this formula and Fritillaria and Trichosanthes Fruit Powder (bei mu gua lou san) treat Lung dryness with phlegm. However, Fritillaria and Trichosanthes Fruit Powder (bei mu gua lou san) primarily transforms phlegm and is used when the phlegm is severe, the dryness is not intense, and the yin is not yet deficient. This formula focuses on moistening the Lungs and is used when the dryness is more severe than the phlegm, and the yin is already deficient. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as chronic bronchitis, bronchiectasis, pharyngitis, spontaneous pneumothorax, cor pulmonale, silicosis, and pulmonary tuberculosis. CAUTIONS & CONTRAINDICATIONS: Most of the herbs in this formula are of a sweet, cold, and cloying nature. For this reason, it should be used with caution or modified (using herbs that strengthen the Spleen and regulate the qi) in cases with Spleen deficiency or food stagnation. Failure to do so may result in indigestion or diarrhea. It should not be used for patients with exterior conditions.

Ophiopogonis Decoction Source: Essentialsfrom the Golden Cabinet Uin gui yao he) Tuber Ophiopogonis Japonici (mai men dong). . . . . . . . . . . . . . . . . . . . . . . . .15-18g Radix Ginseng (ren shen) . . . . . . . . . . . . . . . . . . . . .6g Nonglutinous rice (geng mi) . . . . . . . . . . . . . . . .9-15g Fructus Zizyphi Jujubae (da zao). . . . . . . . .12 pieces Radix Glycyrrhizae Uralensis (gan cao) . . . . . . . . .6g Rhizoma Pinelliae Ternatae (ban xia) . . . . . . .4.5-9g Preparation: Decoction. Today 3-4 pieces of Fructus Zizyphi Jujubae (da zao) are used. Available in prepared form. Actions: Benefits the Stomach, generates fluids, and directs rebellious qi downward. INDICATIONS: Coughing and spitting of saliva, wheezing, shortness of breath, a dry and uncomfortable sensation in the throat, a dry mouth, a dry, red tongue with little coating, and a deficient, rapid pulse. This is a form of Lung atrophy (fei wii). Although the symptoms are primarily related to the Lungs, the condition is actualiy caused by heat from deficiency in the Stomach, which rises in rebellion and scorches the Lung yin. It may also be understood by reference to the theory of the five phases, wherein the 'mother' (Stomach) transmits the problem to the 'child' (Lungs). The Lungs are the most delicate of the yin organs and serve as a canopy for the trunk. They depend on the earth (SpleenIStomach) for nourishment and for some of its fluids. If, over an extended period of time, the Lungs do not receive proper nourishment or moisture, they shrivel up or 'atrophy.' The rebellious qi from the Stomach prevents the Lung qi from descending properly, and results in coughing and wheezing. The scorching of the Lung yin causes shortness of breath and depletes the fluids. The depletion of the fluids leaves only saliva or a thick, viscous sputum that becomes lodged in the throat and causes a dry, uncomfortable sensation. The dry mouth, and the tongue and pulse signs, are classic indications of heat from deficiency leading to internal dryness. ANALYSIS OF FORMULA: Following the classical precepts of moistening dryness and tonifying the 'mother' for deficiency, the focus of this formula is primarily to moisten and nourish the Stomach yin, and only secondarily to direct the rebellious qi downward. The chief herb, Tuber Ophiopogonis Japonici ( m i men dong), clears heat from deficiency from the Stomach, and generates fluids in the Stomach and Lungs. It is therefore very useful in the treatment of Lung atrophy. Some sources recommend a dosage of as much as 45g of this herb. The deputy, Radix Ginseng (ren shen), augments the qi, generates fluids, and revives the qi and yin. Tuber Ophiopogonis Japonici ( m i men dong) and Radix Ginseng (ren shen) form a particularly powerful combination for reviving the qi and yin of the Lungs and Stomach. The remaining ingredients are regarded as assistants. Nonglutinous rice, Fructus Zizyphi Jujubae (da zao), and Radix Glycyrrhizae Uralensis (gan cao) work synergistically with the chief and deputy herbs to assist the Stomach qi and generate fluids. While - honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao) has a relatively stronger action in tonifying the Stomach, its unprepared form is used here because it also improves the condition of the throat. Rhizoma Pinelliae Ternatae (ban xia) facilitates the flow of Stomach qi and directs the qi downward. The warm, acrid, drying nature of this herb is moderated by the moistening herbs in the formula, and by its relatively low dosage. In fact, adding a small amount of this acrid, dispersing herb to the formula will assist in the distribution of nourishment from the middle burner to the upper burner, and redirect the qi, thereby facilitating the replenishment of fluids in the Lungs.

Evodia Decoction Wu zhu Yu Tang Source: Discussion of Cold-induced Disorders (Shang han lun) Fructus Evodiae Rutaecarpae (wu zhu yu) 9-12g Rhizoma Zingiberis Officinalis Recens (shng jiang) 18g Radix Ginseng (ren shen).9g Fructus Zizyphi Jujubae (da zao) I2 pieces Ginseng (ren shen) with 2-3 times the dosage. Most practitioners use a slightly lower dosage than specified Jujubae (da zao). The dosage is reduced to prevent distention in the middle burner. Available in and tonifies the Liver and Stomach, INDICATIONS: This formula is used for three different presentations: 1) vomiting immediately after eating, indeterminate gnawing hunger, and acid regurgitation with or without epigastric pain; 2) dry heaves or spitting of clear fluids with headache at the vertex; 3) vomiting and diarrhea with cold hands and feet, and agitation so severe that the patient wants to die. In all cases the tongue is not red, but has a white, slippery coating, and the pulse is thin and slow or thin and wiry. The first presentation is due to cold from deficiency of the Stomach. The cold causes the Stomach qi to stagnate, which forces the Stomach qi to rebel upward causing vomiting. The stagnation can also lead to pain. When the Stomach is deficient, it is unable to accept food, which causes vomiting immediately after eating. Indeterminate gnawing hunger may also arise from cold from deficiency of the Stomach. The second presentation is thought to be due to cold from deficiency of the Stomach and Liver. As the cold (yin) rebels upward, it follows the course of the Liver channel which results in headache at the vertex. The Stomach qi loses its proper downward flow and the turbid yin flows upward. This combination of turbidity and deficiency leads to dry heaves or spitting of clear fluids. The third presentation is due to cold attacking the middle burner. In this pattern, not only does the Stomach qi lose its correct directional tendency, but the clear yang (which is rooted in the Kidneys) cannot rise, which leads to diarrhea. The deficiency of yang qi renders it incapable of spreading to the limbs, which manifests as cold hands and feet. The combination of headache, vomiting, diarrhea, and cold hands and feet is so unbearable that the patient feels as if he wants to die. To summarize, although there are different manifestations of this disorder, they all share a common, primary symptom (vomiting) and mechanism (cold from deficiency of the middle burner). There is no heat present because the tongue is not red, nor is the pulse rapid. The white, slippery tongue coating and the thin and slow or thin and wiry pulse reflect the cold from deficiency and the disruption of the ascending and descending functions of the middle burner. Depending on the other aspects of the presentation, the problem is said to be either a yang brightness (first), terminal yin (second), or lesser yin (third) disorder. ANALYSIS OF FORMULA: The chief ingredient, acrid, hot Fructus Evodiae Rutaecarpae (wu zhu yu), warms the Stomach, warms and soothes the Liver, and directs rebellious qi downward. It thereby addresses all the major pathological processes involved here. The primary function of the formula is to stop vomiting, and the rather large dosage of the deputy herb, Rhizoma Zingiberis Officinalis Recens (sheng jiang), helps the chief herb accomplish this task by warming the Stomach and directing its qi downward. In order to treat the cold from deficiency, it is necessary not only to warm, but also to tonify. The assistant ingredient, Radix Ginseng (ren shen), serves this function by strengthening the Spleen. It also promotes the generation of fluids and calms the spirit (severe vomiting injures the Spleen and fluids and disturbs the spirit). The envoy, sweet Fructus Zizyphi Jujubae (da zao), moderates the acrid, drying properties of the chief and deputy ingredients, and supports the qi-tonifying action of the assistant ingredient. CAUTIONS & CONTRAINDICATIONS: For particularly severe vomiting, the decoction will be easier to keep down if taken cool. Rarely patients may experience a transitory sensation of discomfort in the

chest, dizziness, and a worsening of the headache after taking the decoction. These symptoms will disappear once the formula begins to take effect (within 30 minutes). The patient should rest after taking the decoction to minimize these side effects. This formula is contraindicated in cases with vomiting or acid regurgitation due to heat.

Frigid Extremities Decoction This formula treats disorders in which the extremities become frigid due to deuastated yang. Its name literally means the ffOur rebellions' (si ni), which refers to thejact that the extremities cur1 UP from the cold rather than properly extending. Source: Discussion of Cold-induced Disorders (Shang han lun) Radix Lateralis Aconiti Carmichaeli (sheng fu zi).I piece (6-9g) Rhizoma Zingiberis Officinalis (gan jiang) 4.5g Honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao) 6g Preparation: Prepare as a decoction and take warm. Today the less toxic Radix Lateralis Aconiti Carmichaeli Praeparata (fu, zi) is almost always substituted for Radix Lateralis Aconiti Carmichaeli (sheng fu zi). Cook Radix Lateralis Aconiti Carmichaeli Praeparata (fu zi) for thirty minutes to one hour before adding the other ingredients. (The larger the dosage, the longer it should be cooked.) Available in prepared form. Actions: Rescues devastated yang, warms the middle burner, and stops diarrhea. INDICATIONS : Extremely cold extremities, aversion to cold, sleeping with the knees drawn up, a lethargic state with a constant desire to sleep, vomiting, diarrhea with undigested food particles, abdominal pain and cold, lack of thirst, a pale tongue with a white, slippery coating, and a submerged, thin or submerged, faint pulse. This is Kidney yang deficiency accompanied by an increase of internal cold. Cold is a yin pathogenic influence that readily injures the yang qi. The Kidney yang, which is the foundation of the body's yang qi, is responsible for transmitting warmth to all the organs. When cold invades the interior and injures the Kidney yang, its warming function is inhibited, which is manifested in various signs of deficiency and cold such as extreme cold in the extremities, aversion to cold, sleeping with the knees drawn up, and a lethargic state with a constant desire to sleep. The Spleen, which transforms food and fluids into refined essence, is dependent upon the warmth from the Kidney yang to carry out this function. When the Kidney yang is deficient, it cannot provide adequate Frigid Extremities Decoction warmth to the Spleen yang, which reduces the Spleen to a "cauldron without a fire under it." When the Spleen yang is deficient, it cannot digest, assimilate, transform, and transport the essence of food and fluids. As a result, the clear yang cannot ascend, nor can the turbid yin properly descend. Vomiting, diarrhea with undigested food particles, and an absence of thirst ensues. Because cold contracts, congeals, and stagnates, congealed cold and qi stagnation causes pain and cold in the abdomen. The yang qi also nourishes the spirit. When the yang qi is sufficient the spirit will be vigorous, but when the spirit is deprived of nourishment it will weaken, which is manifested in a lethargic state and a desire to sleep. A pale tongue with a white, slippery coating and a submerged, thin or submerged, faint pulse is also indicative of yang deficiency. ANALYSIS OF FORMULA: A crucial aspect of treating yang deficiency with cold extremities is to stimulate the exhausted yang. Radix Lateralis Aconiti Carmichaeli Praeparata (fu zi) serves this purpose and is therefore designated as the chief herb in the formula. Because of its very hot and acrid properties, it is especially effective in warming and stimulating the Kidney yang so that it disseminates throughout the body and reaches the extremities. If the condition is considered critical, the unprepared form of Radix Lateralis Aconiti Carmichaeli (shng fu zi) is used because it is stronger. The deputy, Rhizoma Zingiberis Officinalis (gun jiang), warms the middle burner and eliminates cold, which strengthens the Spleen's functions of transforming and transporting food and fluids. The chief and deputy ingredients work synergistically: the deputy assists the chief in strengthening the Kidney yang, while the chief assists the deputy in strengthening the Spleen yang. These herbs should be used together in order to realize the full benefit of each. In fact, it is traditionally said that Radix Lateralis Aconiti Carmichaeli Praeparata (fu zi) is not hot if it is used apart from Rhizoma Zingiberis Officinalis (ganjiang). The field of action of these two herbs is also complementary. The chief ingredient warms the entire body by traveling through all of the twelve channels, while the focus of the deputy ingredient is primarily onthespleen, Stomach, andLungs. The assistant herb, honey-fried Radix Glycyrrhizae Uralensis (zhi gun

cao), augments the qi, strengthens the Spleen, reduces the toxicity of the chief ingredient, and moderates the drying properties of the chief and deputy ingredients.

Major Construct the Middle Da jian Zhong Tang This formula constructs or builds middle qi. 'Major' indicates that the formula is relatively strong. Source: Essentialsfrom the Golden Cabinet Uin gui yao he) Pericarpium Zanthoxyli Bungeani (chuan jiao) . .3-9g Rhizoma Zingiberis Officinalis (gun jiang) 12g Radix Ginseng (ren shen).6g Maltose (yi tang) 18-30g Preparation: Add maltose (yi tang) to the strained decoction. Do not use cane sugar as a substitute. Its sweet and cold nature will cause further injury to the Spleen. Today 2-3 times the dosage of Radix Codonopsis Pilosulae (dang shen) is usually substituted for Radix Ginseng (ren shen), the lower dosage of Pericarpium Zanthoxyli Bungeani (chuan jiao) is used, and the dosage of the other two ingredients is reduced by one-half. Available in prepared form. Actions: Warms and tonifies middle burner deficiency, directs rebellious qi downward, and alleviates pain. INDICATIONS: Excruciating epigastric and abdominal pain to the point that the patient cannot tolerate being touched, a strong sensation of cold in the epigastrium, vomiting to the point of being unable to eat, a white, slippery tongue coating, and a thin and tight or slow and wiry (or in especially severe cases, hidden) pulse. There may also be borborygmus. This is weakness and deficiency of the middle burner yang (the root), and yin or cold which is ascendant in the interior (the manifestation). This combination of deficiency and excess is reflected in the distinctive characteristics of the pain and cold in the abdomen. Vigorous cold in the interior leads to an upsurge of cold qi, which produces a strong sensation of cold in the epigastrium. The Stomach qi follows the upsurge of cold qi, causing vomiting and an inability to keep food down. The tongue coating indicates vigorous cold in the interior. A thin pulse reflects yang deficiency, and a tight pulse reflects cold in the interior. If the cold is more severe, the pulse will be slow (indicating cold) and wiry (indicating pain). In especially severe cases when the pain is intolerable, the pulse will be hidden. If the cold causes the fluids to congest, borborygmus will ensue. ANALYSIS OF FORMULA: Because of their severity, it is important that treatment focus on the manifestations or symptoms. The chief ingredient, very hot and acrid Pericarpium Zanthoxyli Bungeani (chuanjiao),stimulates the yang of the middle burner and dispels cold, thereby alleviating the pain. The deputy, Rhizoma Zingiberis Officinalis (gan jiang), reinforces the chief ingredient and also quiets the upsurge of cold qi. Without the upsurge of cold qi, the Stomach qi will not rebel upward and the vomiting will thereupon cease. The assistant ingredients, Radix Ginseng (ren shen) and maltose (yi tang), tonify and strengthen the middle qi, which ameliorates the painful abdominal spasms.

Minor Construct the Middle Decoction Xiao Jian Zhong Tang This formula constructs or builds middle qi. 'Minor' indicates that the formula is relatiuely mild. Source: Discussion of Cold-induced Disorders (Shang han lun) Maltose (yi tang) 18-30g Ramulus Cinnamomi Cassiae (gui zhi) 9g Radix Paeoniae (shao yao) 18g Honey-fried Radix Glycyrrhizae Uralensis (zhi gun cao).6g Rhizoma Zingiberis Officinalis Recens (sheng jiang) 9g Fructus Zizyphi Jujubae (da zao) 12 pieces Preparation: Add maltose (yi tang) to the strained decoction. Do not use cane sugar as a substitute. Its sweet and cold nature will cause further injury to the Spleen. Today Radix Paeoniae Lactiflorae (bai shao) is the form of Radix Paeoniae (shao yao) used, and only 3-5 pieces of Fructus Zizyphi Jujubae (da zao) are prescribed. Available in prepared form. Actions: Warms and tonifies the middle burner and moderates spasmodic abdominal pain. INDICATIONS: Intermittent, spasmodic abdominal pain that responds favorably to local application of warmth and pressure, a lusterless complexion, reduced appetite, a pale tongue with a white coating, and a thin, wiry, and moderate pulse. There may also be low-grade fever, palpitations, irritability, cold and sore extremities with nonspecific discomfort, and a dry mouth and throat. This is spasmodic abdominal pain due to consumptive deficiency (xii lho). Internal injury due to consumption (brought on by overwork, improper eating habits, poor diet, etc.) leads to cold from deficiency of the middle qi. When the abdomen loses the warmth of the yang qi, the result is intermittent, spasmodic abdominal pain that responds favorably to local application of warmth and pressure. A lusterless complexion, reduced appetite, and pale tongue with a white coating indicate cold from deficiency of the middle burner. The pulse is of particular interest. The combination of cold from deficiency and the body's reaction to the pain caused by it results in a thin, wiry, and moderate pulse. The Spleen is the source of the transformation and transportation of nutrients in the body, and governs the flesh and the limbs. When the Spleen qi is cold and deficient, the source of transformation is weakened. This can lead to dissipation of both qi and blood and give rise to problems at the level between the protective and nutritive qi. The disharmony between these two levels and the resulting lack of proper regulation between the yin and yang can lead to a low-grade fever. The same process can manifest as cold, soreness, and general discomfort in the extremities. The lack of proper transportation combined with cold from deficiency leads to the seemingly paradoxical signs of a pale tongue with a dry throat. Note that if the patient is thirsty there will be a desire for hot beverages. When the Spleen qi is deficient it drains an inordinate amount from its mother organ, the Heart, which not only causes palpitations and irritability, but also contributes to the lusterless complexion. ANALYSIS OF FORMULA: Proper treatment of this condition requires strengthening the middle qi and regulating the yin and yang. One of the chief ingredients, maltose (yi tang), tonifies and moderates spasmodic abdominal pain. The other chief ingredient, Ramulus Cinnamomi Cassiae (gui zhi), warms the middle burner and disperses cold. Together they are a powerful combination for warming and tonifying the middle burner. The deputy, Radix Paeoniae Lactiflorae (bai shao), harmonizes the relationship between the protective and nutritive qi. This effect is present only when it is combined with Ramulus Cinnamomi Cassiae (gui zhi). The assistant, honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao), works with the deputy to stop spasmodic abdominal pain. It also harmonizes the functions of the middle burner. The envoy ingredients, Rhizoma Zingiberis Officinalis Recens (shng jiang) and Fructus Zizyphi Jujubae (dazao), harmonize the protective and nutritive qi. This formula balances the actions of warm and sweet ingredients, which restore the yang function to the middle burner, with the actions of sour Radix Paeoniae Lactiflorae (bai shao), which protects the yin.

Regulate the Middle Pill Li Zhong Wan This formula regulates the yang qi of the Spleen and Stomach, which occupy the middle burmer, hence the name. Source: Discussion of Cold-induced Disorders (Shang han lun) Rhizoma Zingiberis Officinalis (ganjianl) .9g Radix Ginseng (ren shen).9g Rhizoma Atractylodis Macrocephalae (bai zhu) .9g Honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao) 9g Preparation: Grind the ingredients into powder and form into pills with honey. The source text advises to take three times a day and twice at night with warm water. Todav it is taken 2-3 times a day in 9g doses. It may also be prepared as a decoction. The pill form is often taken with warm rice porridge. Except in acute cases, today Radix Codonopsis Pilosulae (dang shen) is substituted for Radix Ginseng (ren shen) with 2-3 times the dosage. Available in prepared form. Actions: Warms the middle burner and strengthens the Spleen and Stomach. INDICATIONS: Diarrhea with watery stool, nausea and vomiting, no particular thirst, loss of appetite, abdominal pain, a pale tongue with a white coating, and a submerged, thin pulse. This is middle burner cold from deficiency, which is also known as middle burner yang deficiency. When the Spleen yang is deficient, the clear yang cannot ascend, which causes diarrhea with watery stool. When the Stomach loses its ability to make the turbid yin descend, nausea and vomiting ensue. The loss of appetite is indicative of Spleen deficiency. When cold invades the abdomen, it causes contraction, and thus pain. This process is reflected in the saying, "When the yang is deficient, the yin ascends." The absence of thirst is indicative of cold. Cold from deficiency is also reflected in the pale tongue with a white coating, and the submerged, thin pulse. ANALYSIS OF FORMULA: The chief herb, Rhizoma Zingiberis Officinalis (ganjiang), warms the Spleen and Stomach yang and eliminates interior cold, which is the primary function of this formula. The yang and the qi are intimately related. The deputy herb, Radix Ginseng (ren shen), strongly tonifies the source qi; this reinforces the yang and rectifies the ascending and descending functions of the middle burner. When the Spleen is deficient, it loses its ability to transform and transport, which leads to internal stagnation of water and dampness. The assistant herb, Rhizoma Atractylodis Macrocephalae (bai zhu), not only aids the deputy herb in tonifying the Spleen and Stomach, but also strengthens the Spleen and dries dampness. This combination of herbs (one warming, one tonifymg, and one drying) is quite effective in warming and improving the functions of the middle burner. The envoy, honey-fried Radix Glycyrrhizae Uralensis (zhi gun cao), augments the qi of the middle burner and harmonizes the actions of the other herbs in the formula.

All inclusive great tonifying decoction Shi Quan Da Bu Tang Source: Imperial Grace Formulary of the Tai Ping Era (Tai ping hui min he ji ju fang) Radix Ginseng (ren shen) Rhizoma Atractylodis Macrocephalae (bai zhu) Sclerotium Poriae Cocos ( f u ling). 1 2-15g) Honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao).( 3-6g) Radix Rehmanniae Glutinosae Conquitae (shu di huang) .(1 5-18g) Radix Paeoniae Lactiflorae (bai shao) (12-15g) Radix Angelicae Sinensis (dang gui). ( 12-15g) Radix Ligustici Chuanxiong (chuan xiong) (6-9g) Cortex Cinnamomi Cassiae (rou gui).( 6-9g) Radix Astragali Membranacei (huang qi) (15-18g) The source text advises to coarsely grind equal amounts of the ingredients and take 6g as a draft with three pieces of Rhizoma Zingiberis Officinalis Recens (sheng jiang) and two pieces of Fructus Zizyphi Jujubae (da zao). Today it is usually prepared as a decoction with the dosage specified in parentheses. Warms and tonifies the qi and blood. For qi and blood deficiency in consumptive disorders with coughing, reduced appetite, spermatorrhea, and weakness of the lower extremities. May also include sores that refuse to heal, or continuous spotting from uterine bleeding. This is a very commonly used formula for qi and blood deficiency with a predominance of deficient qi tending toward cold. Today two-to-three times the dosage of Radix Codonopsis Pilosulae (dang shen) is usually substituted for Radix Ginseng (ren shen). Available in prepared form.

Eight-Treasure Decoction Ba zhen tang This formula is composed of eight ingredients which are highly valued for their ability to tonify the qi and blood, hence the name. Source: Catalogued Essentials for Correcting the Body (Zhng ti lei yao) Radix Ginseng (ren shen).3g (6-9g) Rhizoma Atractylodis Macrocephalae (bai zhu).3g (9-12g) Sclerotium Poriae Cocos (fu ling) 3g (12-15g) Honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao).1.5g (3-6g) Radix Rehmanniae Glutinosae Conquitae (shu di huang).3g (15-18g) Radix Paeoniae Lactiflorae (bai shao) 3g (12-15g) Radix Angelicae Sinensis (dang gui). 3g (12-15g) Radix Ligustici Chuanxiong (chuan xiong) .3g (6-9g) Preparation: Cook with three slices of Rhizoma Zingiberis Officinalis Recens (sheng jiang) and two pieces of Fructus Zizyphi Jujubae (da zao). The larger dosage used today is specified in parentheses. Two-to-three times the dosage of Radix Codonopsis Pilosulae (dang shen) is usually substituted for Radix Ginseng (ren shen). Available in prepared form. Actions: Tonifies and augments the qi and blood. INDICATIONS: Pallid or sallow complexion, palpitations with anxiety that may be continuous, reduced appetite, shortness of breath, laconic speech, easilyfatigued extremities, light-headedness andlor vertigo, a pale tongue with a white coating, and a pulse which is either thin and frail or large, deficient, and without strength. This is concurrent deficiency of the qi and blood which is most often due to imbalances caused by chronic disease or excessive loss of blood. The Lungs control the body's qi; when the qi is deficient, the Lung qi will also be deficient. This manifests as shortness of breath and laconic speech. A poor appetite is an almost pathognomonic sign of Spleen qi deficiency. In this case, the Spleen qi is too weak to transform and transport nutrients to the extremities. When this is combined with blood deficiency, the extremities become easily fatigued. The concurrent deficiency of the qi and blood also prevents nourishment (the clear yang and the blood) from reaching the head and Heart. This leads to palpitations (which may be continuous), light-headedness andlor vertigo, and a pallid or sallow complexion. The complexion will be more pallid if the condition is primarily one of qi deficiency, and more sallow if blood deficiency is predominant. The pale tongue with a white coating is a combination of signs of blood and qi deficiency. If blood deficiency is predominant, the pulse will be thin and frail, and if qi deficiency is predominant, the pulse will be large, deficient, and without strength. ANALYSIS OF FORMULA: The chief herbs are warm in nature. Radix Ginseng (ren s h n ) augments the qi, and Radix Rehmanniae Glutinosae Conquitae ( s h di h a n g ) nourishes the blood. Two of the deputies, Rhizoma Atractylodis Macrocephalae (bai zhu) and Sclerotium Poriae Cocos ( f u ling), strengthen the Spleen and dry or leach-out dampness, thereby assisting Radix Ginseng (ren s h n ) in strengthening the qi of the Spleen and Lungs. The other deputies, Radix Paeoniae Lactiflorae (bai shao) and Radix Angelicae Sinensis (dang gui), nourish the blood and thereby reinforce the action of Radix Rehmanniae Glutinosae Conquitae ( s h di hang). One of the assistant ingredients, Radix Ligustici Chuanxiong (chuan xiong), invigorates the blood and promotes the movement of qi. The other, honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao), augments the qi and harmonizes the middle burner. The envoys are Rhizoma Zingiberis Officinalis Recens (shng jiang) and Fructus Zizyphi Jujubae (da zao), which regulate the absorptive function of the Stomach and Spleen. This is especially important because it allows the other herbs in the formula to be absorbed. The envoys also regulate the relationship between the protective and nutritive qi, which allows the patient suffering from deficiency to recover without developing other problems.

Four-Gentleman Decoction Four-Gentleman Decoction Si Jun zi tang after the Confucian term for a person who exhibits ideal behauior. The four herbs in this formula are mild in nature and blend well together in tonifying the qi. They are therefore called the your gentlemen' of herbal medicine. Source: Imperial Grace Formulary of the Tai Ping Era (Tai ping hui min he ji ju fang) Radix Ginseng (ren shen) 3-9g) Rhizoma Atractylodis Macrocephalae (bai zhu). (6-9g) Sclerotium Poriae Cocos ( f u ling). (6-959 Honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao) (3-6g) Preparation: The source text advises to grind equal amounts of the ingredients into a fine powder and take 6g as a draft, either with plain or lightly salted water. It need not be taken at any particular time. Today it is usually prepared as a decoction with the dosage specified in parentheses, but with 2-3 times the dosage of Radix Codonopsis Pilosulae (dangshen) substituted for Radix Ginseng (ren shen). Available in prepared form. Actions: Tonifies the qi and strengthens the Spleen. INDICATIONS: Pallid complexion, low and soft voice, reduced appetite, loose stools, and weakness in the limbs. The body of the tongue is pale, and the pulse is thin andlor frail. This is the classic presentation of deficient Spleen qi, usually caused by improper eating habits, excessive deliberation, or overworking. When the Spleen qi is deficient, the transformation of food into blood and qi is impaired. This manifests as a pallid complexion and a low, soft voice. Spleen deficiency also leads to a decline in that organ's transportive functions and thus a lack of transport through the Stomach. This manifests as reduced appetite and unformed stools. Because the Spleen governs the limbs, the patient will first experience weakness in those parts of the body. The pale tongue and the thin andlor frail pulse are typical reflections of deficient Spleen qi. ANALYSIS OF FORMULA: The chief herb in this formula is sweet, warm Radix Ginseng (ren shen), a powerful tonic for the Spleen qi. In most modern formulations, however, Radix Codonopsis Pilosulae (dang shen) is substituted both because it is well-suited for this pattern and is much less expensive. The deputy, bitter and warm Rhizoma Atractylodis Macrocephalae (bai zhu), strengthens the Spleen and dries dampness. These two herbs work synergistically to improve the transportive and transformative functions of the Spleen, i.e., the Spleen qi. The assistant herb is Sclerotium Poriae Cocos (fu ling), a sweet, bland substance that leaches out dampness. It also assists the chief and deputy herbs in strengthening the Spleen. The envoy, honey-fried Radix Glycyrrhizae Uralensis (zhi gun cao), warms and regulates the middle burner. The combination of these two herbs is instructive. Sclerotium Poriae Cocos (fu ling) moderates the cloying nature of honey-fried Radix Glycyrrhizae Uralensis (zhi gun cao) to prevent abdominal distention, while the tonifying properties of Radix Glycyrrhizae Uralensis (zhi gun cao) moderate the draining properties of the former ingredient. These herbs work harmoniously together as a simple but effective formula. COMMENTARY: This is the basic formula for tonifying the qi. It is distinguished by its relatively harmonious and moderate nature, unlike many of the other qi-tonifying formulas that are quite warm and drying. It may be used in treating any disorder for which deficient Spleen qi is considered to be the root. Successive generations of physicians have modified the formula to expand its use. Some examples are included among the variations and associated formulas listed below, as well as Tonify the Middle and Augment the Qi Decoction (bu zhong yi qi tang) discussed later in this section, and Restore the Spleen Decoction (gui pi tang) discussed in another section of this chapter. Today it is usually modified and augmented with other herbs before being used in the clinic. Many modern practitioners base their treatment of childhood nutritional impairment on this formula. In some ways this formula can be viewed as a modification of Regulate the Middle Pill (li zhong wan), with Sclerotium Poriae Cocos (fu ling) substituted for Rhizoma Zingiberis Officinalis (ganjiang). This is an example of how the substitution of a single herb can change the basic nature of a formula, in this case from one that dispels cold from the

middle burner to one that tonifies the Spleen. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as neurasthenia, chronic gastritis, peptic ulcer, irritable bowel syndrome, diabetes mellitus, periodic paralysis, uterine fibroids, and to reduce the recovery time after gastric surgery. CAUTIONS & CONTRAINDICATIONS: The overuse of this formula may result in a dry mouth, thirst, and irritability. It should not be used without modification in cases with high fever, heat from deficiency, or a combination of irritability, thirst, and constipation.

Four-Substance Decoction si wu tang Source: Imperial Grace Formulary of the Tai Ping Era (Tai ping hui min he ji ju fang) Radix Rehmanniae Glutinosae Conquitae (shu di huang) (9-21g) Radix Paeoniae Lactiflorae (bai shao) (9-15g) Radix Angelicae Sinensis (dang gui) (9-12g) Radix Ligustici Chuanxiong (chuan xiong) (3-6g) Preparation: The source text advises to coarsely grind equal amounts of the ingredients and take in 9g doses as a draft before meals. Today it is usually prepared as a decoction with the dosage specified in parentheses. Available in prepared form. Actions: Tonifies the blood and regulates the Liver. INDICATIONS: Dizziness, blurred vision, lusterless complexion and nails, generalized muscle tension, irregular menstruation with little flow or amenorrhea, periumbilical and lower abdominal pain, a pale tongue, and a thin and wiry or thin and choppy pulse. Also used for menorrhagia, hard abdominal masses with recurrent pain, restless fetus disorder, or lochioschesis with a firm and painful abdomen and sporadic fever and chills. This is blood deficiency, primarily of the Liver. When the Liver blood is deficient it is unable to rise and supply nourishment to the head. This manifests as dizziness and a lusterless complexion. The Liver's ability to supply its associated sensory organ (eyes) and tissue (sinews) is also impaired, which leads to blurred vision or chronic eye strain and generalized muscle tension. The health of the Liver is reflected in the nails; when the Liver blood is deficient, the nails become soft, dry, and lusterless (described as being 'wretched'). A normal menstrual cycle depends on the Liver to provide and shut off the flow of blood at the appropriate times. When the Liver blood is deficient, the menses are typically irregular with a scanty flow. There may even be amenorrhea. However, when the blood becomes disordered, menorrhagia may occur. When the blood is deficient it does not move well, and there is a tendency for blood stasis to develop. This commonly manifests as periumbilical and lower abdominal pain, often occurring at the onset of menstruation, which is due to stasis and insufficiency of blood in the womb. This same process can also lead to hard abdominal masses with recurrent pain, restless fetus, or lochioschesis. The Heart is also dependent on the Liver blood; when it is deficient, one may experience palpitations. The pale tongue reflects blood deficiency, as does the thin pulse. The wiry or choppy quality of the pulse, which almost always accompanies this condition, signals the stasis of blood and demonstrates the link between blood deficiency and stasis. ANALYSIS OF FORMULA: This formula consists of two groups of herbs. The 'blood of the blood7 herbs directly tonify the blood. The first of these, Radix Rehmanniae Glutinosae Conquitae (shu di huang), has a very strong tonifymg effect on the Liver and Kidneys and is said to nourish the yin of the blood. It is therefore particularly effective in treating problems with menstruation, conception, and birth. Radix Paeoniae Lactiflorae (bai shao) tonifies the blood and preserves the yin. In concert with Radix Rehmanniae Glutinosae Conquitae (shu di huang), it provides a strong tonic for the Liver blood. However, because these two herbs are rich and cloying in nature, there is a risk that their use will aggravate the stasis of blood. This risk is prevented by the second group of herbs, which treat problems with the 'qi of the blood.' Radix Angelicae Sinensis (dang gui) tonifies and invigorates the blood and is therefore said to nourish the yang of the blood. It also moistens the Intestines and regulates the relationship between the Liver and Kidneys. Radix Ligustici Chuanxiong (chuan xiong) Four-Substance Decoction primarily acts to invigorate the blood and promote the movement of qi. It thereby releases areas of constraint (particularly the Liver) and alleviates pain. The combination of these herbs with the first group facilitates the production of blood. At the same time, the ability of Radix Paeoniae Lactiflorae (bai shao) to preserve the yin prevents the aromatic nature of these two herbs from injuring the yin. If the blood-deficiency aspect of the presentation is predominant, the dosage of the first group of herbs should be increased. Conversely, if blood stasis is predominant, the dosage of the second

group should be increased. For this reason, the hierarchy of ingredients will change depending on the condition. COMMENTARY: This is the basic formula for tonifying the blood and regulating menstruation, for which it is very effective. It can be used (with appropriate modification) in treating a wide variety of problems associated with menstruation or birth in which the nails are lusterless, the tongue is pale, and the pulse is thin. It has many derivatives, some of which are listed under the variations and associated formulas below, as well as Eight-Treasure Decoction (ba zhen tang), which is discussed in the following section. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as primary dysmenorrhea, irregular menstruation, anemia of various etiologies, threatened miscarriage, post partum weakness, insufficient lactation, urticaria, and neurogenic headache. CAUTIONS & CONTRAINDICATIONS: This formula is appropriate for chronic conditions which are not too severe. It should not be used in treating acute, severe blood loss or other problems of blood deficiency which include severe weakness and labored breathing. In such cases one should heed the adage, "For exhaustion of blood, tonify the qi;" a formula such as Tangkuei Decoction to Tonify the blood (dang gui bu xue tang) should be used instead. Furthermore, if this formula is used in treating patients who have a constitutional deficiency of Spleen yang with a poor appetite and loose stools, it should be modified to include herbs which strengthen the middle burner.

Generate the Pulse Powder Sheng Mai san A pulse without enoughforce (qi) or volume (fluids) is very weak. The name of this formula is derived from its effect in tongying the qi and generating f luids. Source: Clargying Doubts about Injury from Internal and External Causes (Nei wai shang bian huo lun) Radix Ginseng (ren shen) 1.5g (9-15g) Tuber Ophiopogonis Japonici (mi men dong) 1.5g (9-12g) Fructus Schisandrae Chinensis (wu wei zi) 7 seeds (3-6g) Preparation: Decoction. Generally taken three times a day. The source text recommends using running water in preparing the decoction, and notes that it does not matter when the formula is administered. Today the dosage (in parentheses) is larger than that specified in the source text. If the condition is not critical, 2-3 times the dosage of Radix Codonopsis Pilosulae (dang shen) or Radix Panacis Quinquefolii (xi yang Shen) may be substituted for Radix Ginseng (ren shen). Actions: Augments the qi, generates fluids, preserves the yin, and stops excessive sweating. INDICATIONS: Chronic cough with sparse sputum that is difficult to expectorate, shortness of breath, spontaneous sweating, a dry mouth and tongue, a pale, red tongue with a dry, thin coating, and a deficient, rapid or deficient, thin pulse. This is concurrent deficiency of qi and yin, primarily of the Lungs. Chronic cough not only injures the Lung qi, but is also a manifestation of injured Lung qi together with shortness of breath and spontaneous sweating. Prolonged, profuse sweating injures the fluids and yin, which is manifested here in the sparse sputum that is difficult to expectorate, and the dry mouth and tongue. The pulse is deficient, which reflects deficient qi, and rapid or thin, which reflects deficient yin. The same condition can develop over a relatively short period of time if the sweating is profuse, as in summerheat-stroke or heat-stroke. The mechanism in such cases is that excessive sweating injures both the Lung qi and the fluids or yin. When qi deficiency develops quickly, it almost always produces a tendency to curl up. ANALYSIS OF FORMULA: The chief herb, Radix Ginseng (ren shen), strongly tonifies the source qi, and strengthens the qi that generates fluids and calms the spirit. When the source qi is strong, the Lung qi is replete and properly regulates the interstices and pores so that the fluids are no longer lost through the superficial levels of the body. The deputy herb is Tuber Ophiopogonis Japonici ( m i men dong), which nourishes the yin and moistens the Lungs. It also benefits the Stomach and generates fluids, and clears heat from the Heart to eliminate the irritability that may occur with this condition. The chief herb acts on the qi of the fluids, while the deputy herb acts directly on the fluids, a combination which gives the formula a very strong, fluid-generating effect. The assistant, Fructus Schismdrae Chinensis (wu wei zi), restrains the leakage of Lung qi (and sweat) and generates fluids. In concert with the deputy, it forms a powerful combination for generating fluids. Together with the chief herb, this enables the formula to rescue the injured qi and yin. This formula is simple yet well-balanced: the chief herb tonifies, the deputy clears, and the assistant restrains leakage. COMMENTARY: The author of this formula, Li Ao, designed it for heat injuring the basal or source qi. Later generations of physicians expanded its scope to include the patterns described above. Recently this formula has been widely used in treating various types of heart disease, including palpitations and coronary artery disease. It is particularly useful in treating palpitations with a stifling sensation in the chest, shortness of breath, sweating, a dry mouth and thirst, poor sleep, a pale, red, and dry tongue, and a slow-irregular or consistently-irregular pulse. When this formula is used in treating a critical condition, no substitution should be made for Radix Ginseng (ren shen). It is interesting to note that under the entry for this herb in the Divine Husbandman's Classicof the Materia Medica, it is said to "tonify the five yin organs, calm the essential spirit, steady the souls, and relieve palpitations with anxiety." All of these functions are drawn upon in this formula. However, for debility following a febrile disease, Radix Panacis Quinquefolii (xi yang Shen), which tonifies both the qi and the yin, is preferred. This is one of the few

formulas that are used in treating acute collapse. Two others are Ginseng and Prepared Aconite Decoction (shenfu tang), which is used for sudden exhaustion of the yang qi, and Frigid Extremities Decoction (si ni fang), which is used for extremely weak yang qi with internal ascent of yin cold. (Both of these formulas are discussed in chapter 7.) It is of the utmost importance that the diagnosis be very clear before any of these formulas are prescribed. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as chronic bronchitis, pulmonary tuberculosis, supraventricular arrhythmias, rheumatic heart disease, coronary artery disease, and post-bypass debility. In modern China preparations of this formula are often administered via intravenous drip as part of the treatment for hemorrhagic or cardiogenic shock CAUTIONS & CONTRAINDICATIONS: This formula should be used only with extreme caution in cases with high fever, or in which the pathogenic influence has not been resolved, or has yet to injure the fluids. If it is used in cases where the external pathogenic influence remains in the system, it will prolong the disease.

Ginseng, Poria, and White Atractylodes Powder Source: Imperial Grace Wrmulary of the Tai Ping Era (Shen ling bai zhu san) Radix Ginseng (ren shen) 1000g Rhizoma Atractylodis Macrocephalae (bai zhu) 1000g Sclerotium Poriae Cocos (fu ling). 1000g Honey-fried Radix Glycyrrhizae Uralensis (zhi gun cao) 1000g Radix Dioscoreae Oppositae (shan yao) 1000g Semen Dolichoris Lablab (bai bian dou) 750g Semen Nelumbinis Nuciferae (lian zi).500g Semen Coicis Lachryma-jobi (yi yi ren).500g Fructus Amomi (sha ren), 500g Radix Platycodi Grandiflori (jie gmS) . 500g Preparation: The source text advises to grind the ingredients into powder and take in 65 doses with warm water. Today 2-2.5 times the dosage of Radix Codonopsis Pilosulae (dang shen) or Radix Pseudostellariae Heterophyllae ( h i er shen) is usually substituted for Radix Ginseng (ren shen). Often prepared as a decoction with approximately one-hundredth the dosage specified above. Available in prepared form. Actions: Augments the qi, strengthens the Spleen, leaches out dampness, and stops diarrhea. INDICATIONS: Loose stools or diarrhea, reduced appetite, weakness of the extremities, weight loss, distention and a stifling sensation in the chest and epigastrium, pallid and wan complexion, a pale tongue with a white coating, and a thin, moderate or deficient, moderate pulse. There may also be vomiting. This is Spleen qi deficiency leading to internallygenerated dampness. The Spleen is responsible for transforming and transporting food and nutrients which it sends upward and to the extremities. When the Spleen qi is weakened, usually from improper eating habits or overworking, the fluids accumulate and transform into dampness. The primary signs of this process are loose stools or diarrhea, and a white coating on the tongue. When the Spleen and Stomach qi are weakened, one cannot take in food, which manifests as reduced appetite. The loss of the Spleen's ability to transform and transport nutrients leads to weig- ht loss, weakness of the extremities, and a pallid and wan complexion. The internally-generated darnpness obstructs the qi mechanism in the middle burner, which manifests as distention and a stifling sensation in the chest and epigastrium. In some patients this can lead to rebellious Stomach qi, which manifests as vomiting. The pale tongue body and the thin or deficient pulse reflect deficient Spleen and Stomach qi, while the tongue coating and moderate pulse reflect dampness. ANALYSIS OF FORMULA: The primary focus of this formula is to tonify and strengthen the Spleen qi. The chief herbs are Radix Ginseng (ren shen), Rhizoma Atractylodis Macrocephalae (bai zhu), Sclerotium Poriae Cocos (fu ling), and honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao), which together comprise Four-Gentleman Decoction (si jun zi tang), discussed above. The reader is referred to that formula for a discussion of how these herbs interact in tonifying the Spleen qi. The deputy herbs include Radix Dioscoreae Oppositae (shun yao), which tonifies the Spleen and supports the chief herbs; Semen Coicis Lachryma-jobi (yi yi ren), which strengthens the Spleen and leaches out dampness; and Semen Dolichoris Lablab (bai bian dou) and Semen Nelumbinis Nuciferae (lian zi), which strengthen the Spleen and stop diarrhea. In relation to the chief herbs, the deputies support the functions of Rhizoma Atractylodis Macrocephalae (bai zhu) and Sclerotium Poriae Cocos (fu ling) in strengthening the Spleen and eliminating dampness, which are the most important factors in this condition. Fructus Amomi (sha ren) serves as the assistant herb. It transforms dampness and promotes the movement of qi. The latter action enables the formula to tonify without causing stagnation. The envoy, Radix Platycodi Grandiflori (jk geng), unblocks the flow of Lung qi. Its functions are threefold: by disseminating the Lung qi, it helps spread nourishment throughout the body; its ascending nature helps treat the diarrhea; and it guides the actions of the other herbs into the Lungs. This last function prevents the development of Lung deficiency, which is a common sequela of Spleen deficiency. COMMENTARY: This is a well-balanced formula which is warm without being drying. It is also a good

example of how to regulate both the ascending and descending functions. As such, its use leads naturally to the cessation of vomiting and diarrhea, and to the - regaining of strength after a period of debilitation. It can also be used as a foundation for treating problems of chronic cough with copious sputum due to Lung deficiency. This is known as "cultivating the earth [Spleen] to generate metal [Lungs]." Two common applications of this formula in treating women are diarrhea with the onset of menstrual flow, and leucorrhea in relatively obese women with edema and other signs of Spleen deficiency with dampness. Both this formula and Four-Gentleman Decoction (si jun zi tang) tonify the qi and strengthen the Spleen. The difference is that the latter formula focuses solely on those functions, while this formula also harmonizes the Stomach, leaches out dampness, and protects the Lungs. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as chronic gastritis, chronic hepatitis, chronic bronchitis, chronic nephritis, diabetes mellitus, malabsorption syndromes, and malnutrition (especially in children). CAUTIONS & CONTRAINDICATIONS: Use with caution and only after significant modification in cases with concurrent heat from yin deficiency.

Kidney Qi Pill from the Golden Cabinet Jin gui shen qi wan In chapter 5 of Basic Questions it is noted that "the lesser [Kidneyl f ire generates qi." This formula combines herbs that nourish the yin with those that tonify the yang, not so much to tonify the Kidney fire itself, but as a means of generating Kidney qi. It is therefore named 'Kidney Qi Pill' rather than 'Kidney Warming Pill.' 1 Source: Essentials from the Golden Cabinet gin gui yao he) Radix Rehmanniae Glutinosae (sheng di huang).24g Fructus Corni Officinalis (shan zhu yu) .12g Radix Dioscoreae Oppositae (shan yao) 12g Radix Lateralis Aconiti Carmichaeli Praeparata ( f u z i ). .3g Ramulus Cinnamomi Cassiae (gui zhi) 3g Rhizoma Alismatis Orientalis (ze xie).9.S Sclerotium Poriae Cocos (fu ling).9g Cortex Moutan Radicis (mu dan pi).9g Preparation: Grind the ingredients into powder and form into small pills with honey. Take 6-9g of the pills once or twice daily with warm water. Radix Rehmanniae Glutinosae Conquitae (shu di huang) is almost always substituted for Radix Rehmanniae Glutinosae (sheng di huang). Today, when prepared as pills, the dosage of the ingredients is increased by a factor of ten. May also be prepared as a decoction. Available in prepared form. Actions: Warms and tonifies the Kidney yang. INDICATIONS: Lower back pain, weakness of the lower extremities, a cold sensation in the lower half of the body, tenseness in the lower abdomen, a pale, swollen tongue with a thin, white, and moist coating, and an empty or frail pulse which is submerged and faint at the proximal position. The patient may also be irritable to the point of having difficulty lying down, and will breathe most comfortably while leaning against something. There is either urinary difficulty with edema, or excessive urination, sometimes to the point of incontinence. This is the classic presentation of Kidney yang deficiency with insufficient fire at the gate of vitality. The Kidneys are the foundation of the prenatal essence and store the essence. Essence transforms into qi, and the qi which arises from the transformation of Kidney essence is what is meant by the term 'Kidney qi.' Kidney qi is also known as 'Kidney yang' or 'source yang,' as it is the basis for the yang of the entire body and the source of motivating power underlying the body's functions of movement. The Kidneys govern the bones and reside in the lower back, and the Kidney channel ascends from the foot and enters the spine to pass upward through the lower back. Kidney deficiency is therefore accompanied by lower back pain and weakness of the lower extremities. From the spine, a branch of the channel diverges and enters the abdomen. When the Kidney yang is deficient, it is unable to warm the lower burner, which causes a cold sensation in the lower half of the body and tenseness in the lower abdomen. Stagnation of water and fluids produces a pale, swollen tongue with a thin, white, and moist coating. Kidney yang deficiency generally manifests as an empty or frail pulse which is submerged and faint at the proximal (Kidney) position. The yang qi of the Kidneys drives the functional transformation and movement of water in the body, directing the pure upward and the turbid downward. When the Kidney yang is insufficient, its ability to regulate the ascent and descent of water and fluids is impaired. Various symptoms of urinary difficulty may result. If the Kidneys are unable to transform qi and move water, there will be urinary difficulty and edema. The water and qi may also rebel upward causing panting and irritability to the point that the patient will have difficulty lying down, and will lean against things for support. In those instances where the debilitated Kidney qi is unable to provide stability in the governance of water, the Bladder may lose its ability to restrain the water, manifested by frequent and copious urination, or in severe cases, incontinence. ANALYSIS OF FORMULA: The chief herb, Radix Rehmanniae Glutinosae Conquitae (shu di huang), nourishes the yin and tonifies the Kidneys, with a particular emphasis on tonifying the blood. When the blood is tonified, the yin qi will be harmonious, which prevents withering and drying. The formula originally contained Radix Rehmanniae Glutinosae (sheng di huang) rather than Radix Rehmanniae

Glutinosae Conquitae (shu di huang), which was substituted in the Tang dynasty. This substitution strengthened the effect of those herbs which warm and tonify the Kidneys and enter the Kidney channel. The large dosage of this herb relative to the other ingredients reflects the importance of tonifying the Kidneys and replenishing the essence, which is the underlying purpose of this formula. Two of the deputies, Fructus Corni Officinalis (shan zhuyu) and Radix Dioscoreae Oppositae (shan yao), tonify the Liver and benefit the Spleen in order to tonify and reinforce the essence and blood. Sour and slightly warm Fructus Corni Officinalis (shun zhu yu) tonifies the Liver and Kidneys, thereby helping to preserve the essential qi while nourishing the yin and reinforcing the blood. Strengthening the Kidney qi is beneficial to its role as the repository of the body's yin and yang. It also ensures that nourishment will be supplied to the Liver, which derives its essence from the Kidneys. The supply of yin and essence to the Liver serves to facilitate the free and smooth operation of its spreading function. Sweet and bland Radix Dioscoreae Oppositae (shan yao) strengthens the Spleen, stabilizes the Kidneys, and nourishes the essence. It is effective in treating deficiency and various consumptive patterns. The other deputies are Radix Lateralis Aconiti Carmichaeli Praeparata (fu zi), which tonifies the source fire, dispels cold, and eliminates dampness, and Ramulus Cinnamomi Cassiae (gui zhi), which benefits the joints, warms the channels, and unblocks the vessels. It also warms and tonifies the Kidney yang. Together they assist the yang and enhance the metabolism of water. Radix Lateralis Aconiti Carmichaeli Praeparata (fu zi) strongly promotes movement and reaches down to the source to warm chronic cold conditions. The relatively small dosage of these ingredients suggests that they are intended only to slightly generate the Kidney yang in order to strengthen the Kidney qi. The three assistants are Rhizoma Alismatis Orientalis (ze xie), Sclerotium Poriae Cocos (fu ling), and Cortex Moutan Radicis (mu dun Pi). Their purpose is to regulate the three yin organs: the Kidneys, Liver, and Spleen. Rhizoma Alismatis Orientalis (ze xie) unblocks and regulates the water pathways, Sclerotium Poriae Cocos (fu ling) strengthens the Spleen and drains dampness, and Cortex Moutan Radicis (mu dan pi) clears heat and quells Liver fire. These herbs work synergistically with Radix Rehmanniae Glutinosae Conquitae (shu di huang), Fructus Corni Officinalis (shan zhu yu), and Radix Dioscoreae Oppositae (shanyao) to provide a draining action as an accompaniment to the primary strategy of tonification. Thus, Rhizoma Alismatis Orientalis (ze xie) and Sclerotium Poriae Cocos (fu ling) unblock and regulate the water pathways, strengthen the Spleen, and drain dampness to enable Ramulus Cinnamomi Cassiae (gui zhi) to warm the Bladder and promote urination by assisting in the transformation of that organ's qi. Cortex Moutan Radicis (mu clan Pi) cools the blood, dispels blood stasis, and, in concert with Ramulus Cinnamomi Cassiae (gui zhi), helps move blood stasis. Together these two herbs invigorate the blood and thereby facilitate its unimpeded flow to the Kidneys. This accelerates the recovery of that organ. In summary, this elegantly-balanced formula nourishes without being cloying, warms without producing dryness, tonifies the deficiency of yin to promote the generation of qi, assists the frail yang in its transformation of water, and stimulates the yang to overcome this disorder by restoring the functional capacity of the Kidneys. COMMENTARY: This formula consists of those herbs which comprise Six-Ingredient Pill with Rehmannia (liu wei di huang wan), plus others that warm the yang. These additions help regulate the relationship between the yin and yang, thereby strengthening the Kidney qi. The formula is typically used in treating patterns of deficiency of both the Kidney yin and yang. Six-Ingredient Pill with Rehmannia (liu wei di huang wan) is actually a variation of this formula which was devised approximately nine-hundred years later. The well-balanced design of this formula, which drains in the course of tonifying, has been the subject of much comment by later generations of physicians. The renowned Ming-dynasty physician, Li Shi-Zhen, offered this insight: "Sclerotium Poriae Cocos (fu ling) and Rhizoma Alismatis Orientalis (ze xie) are both aimed at draining the pathogenic qi from the Bladder. [When] the ancient physicians used tonifying herbs they necessarily combined them with [herbs that] drain the pathogenic influences. When the pathogenic influences are removed, the tonics gain in strength." The Qing-dynasty author, Wang Ang, noted in his Analytic Collection of Medical Formulas: "This formula uses Rhizoma Alismatis Orientalis (ze xie) like an enemy whose purpose is to connect with and guide Radix Lateralis Aconiti Carmichaeli Praeparata (fu zi) and Ramulus Cinnamomi Cassiae (gui zhi) into the Kidneys." Most of the formulas in this section contain both draining and tonifying

ingredients, the use of which can be traced back to this formula. Another important aspect of the formula is its ability to lead the fire back to its source in the Kidneys. This aspect was highlighted by a modification made during the Tang dynasty which replaced Ramulus Cinnamomi Cassiae (gui zhi) with Cortex Cinnamomi Cassiae (rou gui) in order to accentuate the warming and tonification of the lower burner, which leads the fire back to its source in the Kidneys. The use of this modification is appropriate in treating waning fire at the gate of vitality with deficient yang floating upward characterized by a flushed face, wheezing, severe sweating, weakness and cold of the lower extremities, and a deficient, rootless pulse. This condition should be distinguished from the flushed face and Kidney symptoms associated with Kidney yin insufficiency with ascending fire from deficiency, for which this formula is generally contraindicated. This formula is also useful in treating leg qi disorder in which water and dampness pour into the legs and cause edema of such severity that it interferes with the ability to walk. (In fact, the source text recommends it be used for leg qi that ascends and enters the lower abdomen where it causes numbness. Retention of water and dampness in the lower abdomen may lead to numbness.) It is also indicated for lower burner-type wasting and thirsting disorder with Kidney yang deficiency characterized by thirst and frequent, copious urination. When the Kidney yang is deficient, it is unable to 'steam' the fluids to the upper part of the body, which causes thirst. The frequent, copious urination is caused by the inability of the deficient Kidneys to stabilize the water and fluids, as well as restrain the Bladder. Many other conditions due to Kidney yang deficiency with disruption of water and fluid metabolism may be treated with this formula. However, it is important to remember in these cases that Kidney deficiency is the root, and that the associated problems with the fluids are only the manifestations of this disorder. The wide clinical application of this formula has spawned numerous commentaries and interpretations. Several distinctly different analyses of the formula exist in the classical and contemporary medical literature. Some scholars maintain that it primarily tonifies the yin, others that it nourishes the Liver, and still others that it provides balanced, moderate tonification of the yin and yang. It is perceived as being both very warming and only slightly stimulating of the Kidney fire. Despite this divergence of opinion, however, it is the general consensus that the formula warms and tonifies the Kidney yang, and that it supports its function of transforming water in particular. This aspect of the formula is emphasized in a Song-dynasty variation by Yan Yong-He in his book, Formulas to Aid the Living. (See associated formulas below.) Like this formula, True Warrior Decoction (zhen wu tang) is also used in treating problems of fluid metabolism due to Kidney yang deficiency. However, that formula focuses on deficiency of the Kidney yang or Formulas that Warm and Tonify the Yang deficiency of both the Spleen and Kidney yang together with the retention of pathogenic fluids. There are manifestations of excess including abdominal pain that is aggravated by cold, deep aching and heaviness in the extremities, and a pale or dark, swollen tongue. This formula, on the other hand, is for problems of fluid metabolism due to Kidney yang deficiency without any accumulation. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as chronic glomerular, interstitial or diffuse nephritis, chronic urethritis, diabetes mellitus, primary hyperaldosteronism, hypothyroidism, neurasthenia, arthritis, beriberi, and chronic bronchial asthma. CAUTIONS & CONTRAINDICATIONS: Contraindicated in cases of yin deficiency with a dry mouth and throat and a red tongue with little coating

Restore the Left [Kidney] Pill Zuo Gui wan Source: Collected Zeatises of [ZhangJ Jing-Yue Uing yue quan shu) Radix Rehmanniae Glutinosae Conquitae (shu di huang) 240g Radix Dioscoreae Oppositae (shan yao) 120g Fructus Lycii (gou qi zi) 120g Fructus Corni Officinalis (shan zhu yu) 120g Radix Cyathulae Officinalis (chuan niu xi) .90g Semen Cuscutae Chinensis (tu si zi) 120g Colla Cornu Cervi (lu jiao jiao) 120g Colla Plastrum Testudinis (gui jiao) 120g Grind the ingredients into powder and form into piIIs with honey. Take in 15g doses twice a day with salted water. Nourishes the yin, tonifies the Kidneys, supplements the essence, and benefits the marrow. For deficiency of the Kidneys (especially the marrow and essence) with light-headedness, vertigo, tinnitus, soreness and weakness in the lower back and legs, spontaneous and nocturnal emissions, spontaneous and night sweats, dry mouth and throat, thirst, a red, shiny tongue, and a thin, rapid pulse. This is a stronger version of the principal formula which is used in more severe cases. It is prepared in pill form because this type of disorder usually requires longterm treatment. Available in prepared form.

Restore the Right [Kidney] Pill You gui wan The right Kidney is the seat of the gate of vitality, i.e., the Kidney yang. This formula focuses on warming and tonifying the Kidney yang, thereby restoring function and potency to the right Kidney. Source: Collected Treatises of [Zhang] Jing-Yue (Jing yue quan shu) Restore the Right [Kidney] Pill 279 Radix Lateralis Aconiti Carmichaeli Praeparata (fu zi).60-180g Cortex Cinnamomi Cassiae (TOUgu i).60-120g Colla Cornu Cervi (lu jiao jiao). 120g Radix Rehmanniae Glutinosae Conquitae (shu di huang) 240g Fmctus Corni Officinalis (shan zhu yu).90g Radix Dioscoreae Oppositae (shan yao) 120g Fmctus Lycii (gou qi zi) 120g Semen Cuscutae Chinensis (tu si zi).120g Cortex Eucommiae Ulmoidis (du zhong).120g Radix Angelicae Sinensis (dung gui)90g Preparation: Grind the ingredients into a fine powder and form into pills with honey. Take 9-15g, 2-3 times daily with warm water. May also be prepared as a decoction with an appropriate reduction in the dosage of the ingredients. Actions: Warms and tonifies the Kidney yang, replenishes the essence, and tonifies the blood. INDICATIONS: Exhaustion from long-term illness, - aversion to cold, coolness of the extremities, impotence, spermatorrhea, and aching and weakness of the lower back and knees. There may also be infertility, loose stools (sometimes with undigested food particles), incontinence, and edema of the lower extremities. This is Kidney yang deficiency with waning of the fire at the gate of vitality. The source text describes the condition as "basal (source) yang deficiency and decline of the prenatal endowment such that the fire at the gate of vitality wanes. Because it is unable to generate earth, the Spleen and Stomach are cold and deficient ... Cold is in the lower burner and pathogenic water arises, leading to floating edema." The root aspect of this condition, Kidney yang deficiency, causes such symptoms as aversion to cold, coolness of the extremities, impotence, spermatorrhea, aching and weakness of the lower back and knees, infertility, incontinence, and edema of the lower extremities. The secondary aspect, cold and deficiency of the middle burner, causes loose stools to the point of containing undigested food particles. ANALYSIS OF FORMULA: The chief ingredients, Radix Lateralis Aconiti Carmichaeli Praeparata (fu zi), Cortex Cinnamomi Cassiae (rou gui), and Colla Cornu Cervi (lu jiaojiao), warm and tonify the Kidney yang. Colla Cornu Cervi (lu jiao jiao) also has a certain 'flesh-and-blood' quality that replenishes the essence and tonifies the marrow. The deputies, Radix Rehmanniae Glutinosae Conquitae (shu di huang), Fructus Corni Officinalis (shan zhu yu), Radix Dioscoreae Oppositae (shan yao), Fructus Lycii (gou qi zi), Semen Cuscutae Chinensis (tu si zi), and Cortex Eucommiae Ulmoidis (du zhong), nourish the yin to benefit the Kidneys, nourish the Liver, and tonify the Spleen. Specifically, sweet and warm Radix Rehmanniae Glutinosae Conquitae (shu di hang) nourishes the yin and tonifies the Kidneys, especially the blood. Fructus Corni Officinalis ( s h zhu yu) and Radix Dioscoreae Oppositae (shanyao) tonify the Liver and benefit the Spleen in order to indirectly tonify and supplement the essence and blood. Fructus Lycii (gou qi zi), Semen Cuscutae Chinensis (tu si zi), and Cortex Eucommiae Ulmoidis (du zhong) nourish and tonify the Liver and Kidneys. They are particularly helpful in treating lower back pain and weakness. Radix Angelicae Sinensis (dang gui) is added to tonify the blood and nourish the Liver. COMMENTARY: This formula may be viewed as a variation of Kidney Qi Pill from the Golden Cabinet (shen qi wan). The primary modifications are the increase in the dosage of the yang-tonifying herbs, omission of the three herbs which are predominantly draining in nature (Sclerotium Poriae Cocos Ifu

ling], Rhizoma Alismatis [ze xie], and Cortex Moutan Radicis [mu dan pi]), and the addition of ingredients which strengthen the tonifying action of the formula and increase both the yin and yang of the Kidneys (Colla Cornu Cervi [lu jiao jiao], Semen Cuscutae Chinensis [tu si zi], Cortex Eucommiae Ulmoidis [du zhong], and Fructus Lycii [gou qi zil). Some physicians prefer to use Cornu Cervi Parvum (lu rong) in place of Colla Cornu Cervi (lu jiao jiao) because of its superior ability to replenish essence. This is one of the best formulas for treating Kidney yang deficiency with insufficiency of essence and blood. It is commonly used for waning of the fire at the gate of vitality, most often seen in the elderly and those suffering from chronic diseases. Although this disorder gives rise to symptoms in both the middle (Spleen) and lower burners (Kidneys), according to the source text its etiology is invariably the insufficiency of source yang. This formula is designed to "increase the source of fire by firming up the source yang of the right [Kidney]." That is to say, it tonifies the 'yang within the yin' since the Kidneys themselves are associated with yin. For this reason, one should combine ingredients which nourish the yin and replenish the essence with ingredients that firm up and tonify the Kidney yang. This is the most commonlyused approach for firming up and tonifying the source Yaw

Restore the Spleen Decoction Gui Pi Tang formula benefit the Spleen qi and thereby aver the blood, hence the name. Source: Formulas to Aid the Living ('Ji sheng fang) Radix Ginseng (ren shen) 15g (3-6g) Radix Astragali Membranacei (huang qi) .30g (9-12g) Rhizoma Atractylodis Macrocephalae (bai zhu) 30g (9-12g) Sclerotium Poriae Cocos ( f u ling) 30g (9-12g) Semen Zizyphi Spinosae (suan zao ren) .30g (9-12g) Arillus Euphoriae Longanae (long yan rou) .30g (6-9g) Radix Aucklandiae Lappae (mu xiang) 15g (3-6g) Honey-fried Radix Glycyrrhizae Uralensis (zhi gan caa).7.5g (3-6g) Radix Angelicae Sinensis (dang gui) 30g (6-9g) Honey-fried Radix Polygalae Tenuifoliae (zhi yuan zhi) 30g (3-6g) Preparation: The source text advises to coarsely grind the ingredients and take in 12g doses as a draft with five pieces of Rhizoma Zingiberis Officinalis Recens (sheng jiang) and one piece of Fructus Zizyphi Jujubae (da zao). Today it is usually prepared as a decoction with the dosage specified in parentheses. Two-to-three times the dosage of Radix Codonopsis Pilosulae (dang shen) is generally substituted for Radix Ginseng (ren shn), and Sclerotium Poriae Cocos Pararadicis (fu shen) is !j substituted for Sclerotium Poriae Cocos (fu ling). Actions: Augments the qi, tonifies the blood,' strengthens the Spleen, and nourishes the Heart. INDICATIONS: Forgetfulness, palpitations (with or without anxiety), insomnia, dream-disturbed sleep, anxiety and phobia, feverishness, withdrawal, reduced appetite, a pallid and wan complexion, a pale tongue with a thin, white coating, and a thin, frail pulse. Chronic bleeding syndromes may also be part of the presentation. Women may experience early periods with copious, pale blood or prolonged, almost continuous periods with little flow. Excessive deliberation for a long period of time or obsessive behavior injures both the Spleen and Heart and leads to this condition. The primary injury is to the Spleen, which is the organ that generates blood. When it is weak, the blood becomes deficient and is unable to nourish the Heart. The Heart stores the spirit and the Spleen stores the intelligence (yi). When they are insufficient, the patient loses his ability to concentrate and becomes forgetful. Spleen qi deficiency manifests as a reduction in appetite and withdrawal. When the Heart is deprived of nourishment, the patient may have palpitations, with or without anxiety. When this affects the spirit, the patient will present with anxiety and phobia, insomn.ia, and dreamdisturbed sleep. Blood deficiency may give rise to the feverishness associated with heat from deficiency. The pallid and wan complexion, pale tongue with a thin, white coating, and the thin, frail pulse are all signs of qi and blood deficiency. Another way of analyzing the etiology of this disorder is with the generative cycle of the five phases. In this cycle, the relationship between fire (Heart) and earth (Spleen) is one of mother and child. When the child is deficient, the mother will in turn become drained and deficient. Here the Spleen deficieilcy brought on by excessive deliberation (or other causes) will lead to deficiency of the Heart. Because the relationship between these two organs is expressed primarily through the blood, it is the blood aspects of the organs that are primarily affected. ANALYSIS OF FORMULA: The chief herbs in this formula focus on the Spleen. Radix Ginseng (ren shen) and Radix Astragali Membranacei (huang qi) are very powerful substances for tonifying the Spleen qi. Rhizoma Atractylodis Macrocephalae (bai zhu) strengthens the Spleen and dries dampness, while honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao) tonifies the Spleen and augments the qi. Together these four herbs have a strong, tonifying effect on the Spleen which enables it to generate blood. The deputies 'root' the spirit by tonifying the blood and calming the spirit. Arillus Euphoriae Longanae (long yan rou) performs both of these functions, while Radix Angelicae Sinensis (dang gui) tonifies the blood and regulates the menses. The combination of Radix Angelicae Sinensis (dang gui) and Radix Astragali

Membranacei (huang qi) is very effective in generating and tonifying the blood. Semen Zizyphi Spinosae (suan zao ren) and Sclerotium Poriae Cocos Pararadicis (fu shen) both serve to calm the spirit, while the latter ingredient also reinforces the Spleen-tonifying action of the chief herbs. The final deputy, honey-fried Radix Polygalae Tenuifoliae (zhi yuan zhi), calms the spirit by facilitating the flow of qi in the Heart. It is especially effective when it is balanced by the astringent properties of Semen Zizyphi Spinosae (suan zao ren). The assistant herb, Radix Aucklandiae Lappae (mu xiang), regulates the qi and revives the Spleen. It is especially effective when combined with Rhizoma Atractylodis Macrocephalae (bai zhu). Its use also prevents indigestion due to the rich, cloying nature of the other herbs. The envoys, Rhizoma Zingiberis Officinalis Recens (sheng jiang) and Fructus Zizyphi Jujubae (da zao, improve the appetite and regulate the nutritive and protective qi, thereby facilitating the actions of the other ingredients. They also assist the chief herbs in strengthening the Spleen. COMMENTARY: This formula is basically a modified combination of Four-Gentleman Decoction (si jun zi tang) and Tangkuei Decoction to Tonify the blood (dang gui bu xue tang). Its historical development is of interest. In the source text written in the Song dynasty, it was recommended for palpitations with anxiety and forgetfulness from long-term pensiveness injuring the Spleen and Heart. In the Yuan-dynasty text, Effective Formula from Generations of Physicians, its use was expanded to include bleeding disorders caused by Spleen qi deficiency. The Ming-dynasty text, Revised Fine Formulas for Women, added two herbs, Radix Angelicae Sinensis (dang gui) and Radix Polygalae Tenuifoliae (yuan zhi), which gave the formula its present form and defined its therapeutic parameters. This formula is appropriate for treating many common clinical disorders. As outlined above, it is used for three types of manifestations: 1) restless Heart spirit; 2) qi and blood deficiency; and 3) the inability of the Spleen to control the blood. In fact, however, all three patterns arise from the deficiency of qi and blood. Although the formula is used in treating deficiency of both the Heart and Spleen, it focuses primarily on the Spleen. Both this formula and Tonify the Middle and Augment the Qi Decoction (bu zhong yi qi tang) strengthen the Spleen, but they have different applications. Restore the Spleen Decoction (gui pi tang) is used Honey-Fried Licorice Decoction for Spleen and Heart deficiency with palpitations, withdrawal, reduced appetite, and sometimes chronic bleeding. Tonify the Middle and Augment the Qi Decoction (bu zhong yi qi tang) is used for Spleen and Stomach qi deficiency with shortness of breath, weight loss, withdrawal, and sometimes signs of ptosis or sinking. While it is true that with modifications they can be made to look quite similar, it is better to use the one which was designed for the primary mechanism -of the disorder. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as neurasthenia or personality disorders, postconcussion syndrome, myasthenia gravis, congestive heart disease, supraventricular tachycardia, anemia (especially from chronic disease), thrombocytopenic or allergic purpura, cervicitis, and functional uterine bleeding.

Six-Ingredient Pill with Rehmannia liu wei di huang wan Source: Craft of Medicinal Treatment for Childhood Disease Patterns (Xiao er yao zheng zhi jue) Radix Rehmanniae Glutinosae Conquitae (shu di huang).240g Fructus Corni Officinalis (shan zhu yu) 120g Radix Dioscoreae Oppositae (shan yao) 120g Sclerotium Poriae Cocos (fu ling) .90g Cortex Moutan Radicis (mu clan pi) .9Og Rhizoma Alismatis Orientalis (ze xie)90g Preparation: Grind the ingredients into powder and form into small pills with honey. Take in 9g doses three times a day. May also be prepared as a decoction with one-tenth the specified dosage. Available in prepared form. Actions: Enriches the yin and nourishes the Kidneys. INDICATIONS: Soreness and weakness in the lower back, light-headedness, vertigo, tinnitus, diminished hearing, night sweats, spontaneous and nocturnal emissions, a red tongue with little coating, and a rapid, thin pulse. The patient may also present with a variety of other symptoms including hot palms and soles, a chronic dry and sore throat, toothache, or wasting and thirsting disorder. - This is the classic presentation of Kidney and Liver yin deficiency. The Kidneys are involved in a few different ways. The lower back is the abode of the Kidneys, which are also associated with the bones and are responsible for generating marrow (which gives the bones their resiliency and strength). When the Kidneys are weak, the marrow will become depleted and there will be a general weakness of the skeletal structure which is focused in the area of the body most closely associated with the Kidneys, the lower back and legs. Kidney and Liver yin deficiency also means that the essence (Kidneys) and blood (Liver) are not flourishing and are therefore unable to nourish the upper parts of the body, primarily the sensory orifices. The eyes are nourished by the Liver; lack of nourishment manifests as light-headedness and vertigo. The ears are nourished by the Kidneys; lack of nourishment manifests as tinnitus and diminished hearing-. When the yin is deficient, it is unable to retain substances during the night, which is the time associated with yin. This causes night sweats and nocturnal emissions. The deficient yin is also unable to preserve the essence, which is manifested in men as spontaneous emissions. Yin deficiency and internally-generated heat is reflected in the red color of the tongue and the less-thannormal moisture (little or no coating), and also in the pulse, which holds little volume (thin) and is rapid. Depending on the individual and the particular etiology of Kidney and Liver yin deficiency, other problems may also occur. If the heat from deficiency is more severe, the patient will present with hot palms and soles, a flushed face, or a dry and sore throat. If the heat transforms into fire and ascends to the teeth (which are connected with the Kidneys), there will be toothache. And if the Kidney qi is also unstable, there will be wasting and thirsting disorder with copious urination. ANALYSIS OF FORMULA: This formula focuses on tonifying the yin and thereby allowing it to flourish. When this occurs, the signs and symptoms will disappear. The formula is an eleg- ant combination of two groups of ingredients, each of which consists of three herbs. The first group is comprised of tonifying herbs. The chief herb, Radix Rehmanniae Glutinosae Conquitae (shu di huang), strongly enriches the Kidney yin and essence. One of the deputies, Fructus Corni Officinalis (shan zhu yu), nourishes the Liver and restrains the leakage of essence. It performs the latter function by inhibiting the improper dispersion and rainage through the Liver, thereby enabling the essence to build up in the Kidneys. For this to occur, a substance with the strong, essence-building properties of the chief herb must be used at the same time. The other deputy, Radix Dioscoreae Oppositae (shan yao), stabilizes the essence by tonifying the Spleen. To reinforce the essence and improve its function, it is necessary to ensure that the Spleen (the source of postnatal essence) is functioning properly. The second group of ingredients has a predominantly draining effect in the context of this formula. They are viewed as assistants. Rhizoma Alismatis Orientalis (ze xie) clears and drains the overabundance of Kidney fire. It is used here to prevent the rich, cloying properties of the chief herb from congesting the mechanisms of the

Kidneys, which will induce even more fire from deficiency. Cortex Moutan Radicis (mu dan pi) clears and drains Liver fire and is used here to counterbalance the warm properties of Fructus Corni Officinalis (shan zhu y ~ ) S. clerotium Poriae Cocos (fu ling) is a bland herb that leaches out dampness from the Spleen. It is paired with Radix Dioscoreae Oppositae (shan yao) to strengthen the transportive functions of the Spleen. This prevents the formula from clogging up the digestive process, and reinforces the Spleen's function of nourishing the body. This herb and Rhizoma Alismatis Orientalis (ze xie) work together to improve the metabolism of fluids and promote urination, thereby preventing a buildup of stagnant fluids. Formulas that Nourish and Tonify the Yin COMMENTARY: This formula is a variation of Kidney Qi Pill (shen qi wan) from Essentialsfrum the Golden Cabinet, which is discussed in the final section of this chapter. The author of this script, Qian Yi, omitted the yang-tonifymg herbs to create a formula for treating Kidney yin deficiency in children characterized by an open anterior fontanel, lack of spirit, and a shiny, pale complexion. Because of its elegant and well-balanced formulation, it is considered to be an exemplary formula. Because the Kidneys house the true yin, problems of the type described above can influence all the other yin organs. For example, the Heart and Kidneys are both lesser yin organs, the former being relatively yang as it is located higher in the body. Kidney yin deficiency often results in a lack of control over the yang (Heart), with fire from deficiency blazing upward through the lesser yin channels. This manifests as a dry throat, pain in the tongue, night sweats, and insomnia. However, despite this interrelationship among the yin organs, not all disorders of yin deficiency can be treated alike, i.e., with this formula. Each must still be carefully diagnosed on its own merits and treated accordingly. The comparison of this formula with Tonify the Middle and Augment the Qi Decoction (bu zhongyi qi tang) will help illuminate the concept of ascending and descending functions in traditional Chinese herbal medicine. This comparison was first made by the eighteenth-century physician, You Yi. When the yang is deficient, the qi collapses. A combination of relatively 'light' herbs is therefore used to strengthen and raise it. This is the thrust of Tonify the Middle and Augment the Qi Decoction (bu zhong yi qi tang). By contrast, when the yin is deficient, the qi rises but does not return downward. Thus cloying, 'heavy' herbs such as the chief herb in this formula are combined with herbs that leach out fluids through the urine to encourage the qi to descend. This is the mechanism underlying Six-Ingredient Pill with Rehmannia (liu wei di hang wan). Similarly, collapse of the qi is usually accompanied by some stagnation. To move the qi, Pericarpium Citri Reticulatae (chen pi) is used in Tonify the Middle and Augment the Qi Decoction (bu zhong yi qi tang). By contrast, when the qi floats there is usually heat. To clear this type of heat from yin deficiency, Cortex Moutan Radicis (mu dan, pi) is used in Six-Ingredient Pill with Rehmannia (liu wei di hang wan). Clinically, this formula is prepared as a decoction for treating relatively intense fire from deficiency, eye disorders, or weakened Spleen and Stomach function. The pill or concentrate forms are used for patients with edema, reduced urination, or for those with restricted fluid intake. For long-term constitutional treatment, pills are the preferred form. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as neurasthenia, pulmonary tuberculosis, diabetes mellitus, hyperthyroidism, chronic nephritis, chronic glomerulonephritis, urinary tract infection, hypertension, failure to thrive, functional uterine bleeding, optic neuritis, optic nerve atrophy, and central retinitis. CAUTIONS & CONTRAINDICATIONS: Despite its elegant design, this formula still has cloying properties and should be used with caution in cases with indigestion, diarrhea due to Spleen deficiency, or a white, greasy tongue coating.

Tangkuei Decoction to Tonify the Blood Dang Gui Bu Xue Tang Source: Clargying Doubts about Injury from Internal and External Causes (Nei wai shang bian huo lun) Radix Astragali Membranacei (huang qi)30g Radix Angelicae Sinensis (dang gui).6g Preparation: Decoction. Available in prepared form. Actions: Tonifies the qi and generates blood. INDICATIONS: Hot sensation in the muscles, a red face, irritability, thirst with a preference for warm beverages, a pale tongue, and a flooding, large, and deficient pulse that is forceless when pressed hard. Also for fever and headache due to loss of blood. This is consumptive fatigue (ldo juhn), a form of blood deficiency caused by injury to the source qi. When the source qi is deficient, the nutritive qi and blood in turn become deficient. The yin is then unable to contain the yang, which floats to the superficial aspects of the body. The classic signs of 'floating yang' include a hot sensation in the muscles, a red face, irritability, and thirst with a preference for warm beverages. The definitive (almost pathognomonic) sign is the flooding, large, and deficient pulse which reflects perfectly the weak yang qi dilating in an attempt to reach the superficial parts of the body. The pale tongue is indicative of blood deficiency. The same pathological mechanism underlies the fever which follows a severe loss of blood. Headache occurs in such cases because the process is relatively acute and therefore has some force behind it: when the yang floats to the head, it causes pain. ANALYSIS OF FORMULA: The qi generates and leads the blood. The qi and nutrients (from air and food) from which blood is formed enter the body through the Lungs and Spleen. The large dosage of Radix Astragali Membranacei (huang qi) in this formula strongly tonifies the Spleen and Lung qi, and thereby reinforces the source of blood. Among the bloodtonifying herbs, Radix Angelicae Sinensis (dang gui) in particular is used here for two reasons. It tonifies but also invigorates the blood, and therefore works better in generating new blood than do other, more cloying substances. In a related manner it also replenishes the 'qi of the blood,' and therefore works particularly well in conjunction with Radix Astragali Membranacei (huang qi), which indirectly tonifies the blood by tonifying the qi, as previously explained. COMMENTARY: A passage in Basic Questions (chapter 39) notes that, "With consumption, the qi is depleted." Restore the Sfileen Decoction Consumptive fatigue is first mentioned in chapter 62: "With what is called consumptive fatigue, the qi of the form is debilitated and meager. The qi from food does not ascend, and there is no movement in the upper burner; nor is the lower epigastrium open. The Stomach qi becomes hot [from constraint] and the heat sears the chest. Therefore, there is internal heat." This suggests that the internal injury from consumptive fatigue depletes the source qi. This formula is also used for bleeding associated with deficient qi being unable to control the blood, which illustrates one aspect of the relationship between blood and qi in traditional Chinese medicine. Another very common use of this formula is in the treatment of sores that refuse to heal for a long period of time after ulcerating, and which continue to exude a thin, pale fluid. These are called yin-type ulcers and are attributed to weakness of the protective qi and blood, which inhibits the normal healing process. In this case, the formula acts to support the protective qi, relieve toxicity, and generate flesh to heal the sores. This combination of herbs (not necessarily in the same proportion) is found in many important formulas including Restore the Spleen Decoction (gui Pi tang), Tonify the Middle and Augment the Qi Decoction (bu zhong yi qi tang), Tangkuei and Sixlyellow Decoction (dang gui liu huang tang), and Tonify the Yang and Restore Five- Tenths Decoction (bu yang hang wu tang).On first glance, the signs and symptoms for which this formula is indicated (fever, irritability, thirst, a red face, and a flooding, large pulse) are similar to those for White Tiger Decoction (bai hu tang). However, the latter formula is used in treating a condition of excess (yang brightness-channel stage), the manifestations of which are typical of excess (high fever with profuse sweating, strong thirst for cold beverages, and an excessive pulse). This formula, on the other hand, is for a condition of deficiency (consumptive fatigue), the manifestations of

which are typical of deficiency (low fever, slight sweating, a thirst for warm beverages, and a deficient pulse). Needless to say, prescribing one of these formulas when the other is indicated will have disastrous consequences. With the appropriate presentation, this formula may be used in treating such iomedically-defined disorders as anemia, allergic purpura, thrombocytopenic purpura, functional uterine bleeding, leukopenia, and neurasthenia. CAUTIONS & CONTRAINDICATIONS: Use with caution in cases with tidal fever from yin deficiency.

Tonify the Middle and Augment the Qi Decoction B. Bu Zhong Yi Qi Tang (Supplement the Center, Boost the Qi Decoction). Composition: 1. Radix Astragali Membranacei (Huang Qi) 15g 2. Radix Glycyrrhizae (Gan Cao) 5g mix-fried 3. Radix Panacis Ginseng (Ren Shen) 10g 4. Radix Angelicae Sinensis (Dang Gui) 10g 5. Pericarpium Citri Reticulatae (Ju Pi) 6g remove the white 6. Rhizoma Cimicifugae (Sheng Ma) 3g 7. Radix Bupleuri (Chai Hu) 3g 8. Rhizoma Atractylodis Macrocephalae (Bai Zhu) 10g Functions: Supplements the center and boosts the qi upbears yang and lifts the fallen Indications: 1. Spleen/stomach qi vacuity 2. Qi vacuity downward falling. 3. Debility after prolonged disease 4. Common cold in a person with bodily vacuity 5. Chronic bronchitis 6. Prolapsed uterus 7. Prolapsed rectum 8. Chronic hemorrhoids 9. Gastroptosis 10. Hernia 11. Chronic gonorrhea 12. Diarrhea 13. Persistent malaria 14. Habitual miscarriage 15. Functional uterine bleeding and other hemorrhagic disorders 16. Abnormal vaginal discharge 17. Various postpartum problems 18. Urinary incontinence 19. Lochioschesis 20. Agalactia 21. Chronic hepatitis 22. Peritonitis 23. Tuberculosis 24. Neurasthenia 25. Impotence 26. Corneal ulcers 27. Cerebral arteriosclerosis 28. Pernicious anemia 29. Leukopenia 30. Chronic nephritis 31. Myasthenia gravis Main signs & symptoms: 1. Fever spontaneous sweating 2. Thirst with a desire for warm drinks 3. Shortness of breath 4. Disinclination to speak

5. Dyspnea on minor movement 6. Bodily fatigue and chilled extremities 7. An ashen white or faded yellow facial color 8. Loose stools 9. A pale tongue with thin white coating 10. A flooding 11. Vacuous or large 12. Vacuous pulse 13. Anal prolapse 14. First and second degree uterine prolapse 15. Prolonged diarrhea 16. Prolonged dysentery 17. Prolonged malaria 18. Other such complaints due to downward falling of clear yang Contraindications: 1. Do not use for fever due to yin vacuity. 2. Only use for prolapse due to central qi vacuity. Formula explanation: Within this formula, Astragalus, which boosts the qi, is the sovereign. Ginseng, Atractylodis, and mix-fried Licorice fortify the spleen and boost the qi. They are the ministers. Together, they are able to supplement the center and boost the qi. Orange Peel is added to rectify the qi. Dang Gui is added to supplement the blood. These two are the assistant medicinals. Bupleurum and Cimicifugae upbear and lift downfallen clear yang. Thus they are the messengers within this qi-supplementing formula. Additions & subtractions:

or uterine prolapse, add Fructus Alpiniae Oxyphyllae (Yi Zhi Ren), Folium Artemisiae Argyii (Ai Ye), and Fructus Schizandrae Chinensis (Wu Wei Zi). -fried Licorice and add Radix Albus Paeoniae Lactiflorae (Bai Shao).

Pinelliae Ternatae (Ban Xia). (Man Jing Zi). If it becomes even more severe, add Rhizoma Ligustici Wallichii (Chuan Xiong). Ben). n). 47

Cinnamon subtracted. rritability, loss of appetite, chest oppression, shortness of the breath, etc., replace Rhizoma Atractylodis Macrocephalae with Rhizoma Atractylodis (Cang Zhu), subtract Dang Gui, and add Radix Albus Paeoniae Lactiflorae (Bai Shao). This results in Tiao Zhong Yi Qi Tang (Regulate the Center, Boost the Qi Decoction).

izoma Atractylodis (Cang Zhu), and Fructus

Alpiniae Oxyphyllae (Yi Zhi Ren). Semen Myristicae Fragrantis (Rou Dou Kou), Fructus Schizandrae Chinensis (Wu Wei Zi), and Fructus Pruni Mume (Wu Mei). Xiang). -fried Rhizoma Zingiberis (Pao Jiang) and Hallyositum Rubrum (Chi Shi Zhi). Ledebouriellae Sesloidis (Fang Feng). is Citri Reticulatae (Qing Pi), Fructus Amomi (Sha Ren), Radix Saussureae Seu Vladimiriae (Mu Xiang), and Fructus Alpiniae Oxyphyllae (Yi Zhi Ren). Yu) and Fructus Alpiniae Oxyphyllae (Yi Zhi Ren). Ligustici Wallichii (Chuan Xiong). Cuscutae (Tu Si Zi). Argyii (Ai Ye). This results in Jia Jian Bu Zhong Yi Qi Tang (Modified Supplement the Center, Boost the Qi Decoction). It can then be made even stronger by adding Radix Dipsaci (Chuan Duan) and Ramus Loranthi Seu Visci (Sang Ji Sheng). (Cang Zhu) and Cortex Phellodendri (Huang Bai). or abdominal distention, add Fructus Immaturus Citri Seu Ponciri (Zhi Shi), Cortex Magnoliae Officinalis (Hou Po), Radix Saussureae Seu Vladimiriae (Mu Xiang), and Fructus Amomi (Sha Ren). oeniculi Vulgaris (Xiao Hui Xiang), and Semen Litchi Chinensis (Li Zhi He).

ary strangury in the elderly due to fallen yang qi, add Rhizoma Alismatis (Ze Xie) and Caulis Akebiae Mutong (Mu Tong). Rehmanniae Pills), i.e., Rhizoma Anemarrhena (Zhi Mu), Cortex Phellodendri (Huang Bai), prepared Radix Rehmanniae (Shu Di), Radix Dioscoreae Oppositae (Shan Yao), Fructus Corni Officinalis (Shan Zhu Yu), Sclerotium Poriae Cocos (Fu Ling), Rhizoma Alismatis (Ze Xie), and Cortex Radicis Moutan (Dan Pi). Also for taxation strangury, add Liu Wei Di Huang Wan (Six Flavors Rehmannia Pills), i.e. prepared

Radix Rehmanniae (Shu Di), Radix Dioscoreae Oppositae (Shan Yao), Fructus Corni Officinalis (Shan Zhu Yu), Sclerotium Poriae Cocos (Fu Ling), Rhizoma Alismatis (Ze Xie), and Cortex Radicis Moutan (Dan Pi), plus Tuber Ophiopogonis Japonicae (Mai Dong) and Fructus Schizandrae Chinensis (Wu Wei Zi). Fructus Schizandrae Chinensis (Wu Wei Zi). Schizandrae Chinensis (Wu Wei Zi). -fried Rhizoma Zingiberis (Pao Jiang) and Rhizoma Coptidis Chinensis (Huang Lian). -wetting, add Ootheca Mantidis (Sang Piao Xiao) and Fructus Alpiniae Oxyphyllae (Yi Zhi Ren). nic rhinitis, add Fructus Xanthii (Cang Er Zi) and Flos Magnoliae (Xin Yi Hua). Ming Zi), and Radix Dioscoreae Oppositae (Shan Yao). yin vacuity, either subtract Bupleurum and Cimicifugae or reduce their dosages and add Rhizoma Anemarrhenae (Zhi Mu) and Cortex Phellodendri (Huang Bai). Zhu Yu), Radix Dioscoreae Oppositae (Shan Yao), and prepared Radix Rehmanniae (Shu Di). ix Scutellariae Baicalensis (Huang Qin) and Radix Puerariae Lobatae (Ge Gen). Shen), Rhizoma Ligustici Wallichii (Chuan Xiong), Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Flos Carthami Tinctorii (Hong Hua), and Lignum Dalbergiae Odoriferae (Jiang Xiang).

-fried Radix Albus Paeoniae Lactiflorae (Jiu Chao Bai Shao). If there is liver heat, add Radix Scutellariae Baicalensis (Huang Qin). heat, Folium Artemisiae Argyii (Ai Ye) and Gelatinum Corii Asini (E Jiao) for qi vacuity, raw Radix Rehmanniae (Sheng Di) for vacuity heat, and Os Sepiae Seu Sepiellae (Hai Piao Xiao) for loss of securing and astringing. blood and accompanied by palpitations, shortness of breath, slow speech, fatigue, and a dragging feeling in the lower abdomen, subtract Dang Gui, Bupleurum, and Orange Peel. This results in Ju Yuan Jian (Lift the Source Decoction). This formula can then be augmented by adding Os Sepiae Seu Sepiellae

(Hai Piao Xiao), Radix Rubiae Cordifoliae (Qian Cao), and Fructus Pruni Mume (Wu Mei). If there is liver heat, add Radix Scutellariae Baicalensis (Huang Qin). Atractylodis, and Orange Peel, and add Radix Albus Paeoniae Lactiflorae (Bai Shao) and Fructus Schizandrae Chinensis (Wu Wei Zi). odily weakness, dry, flaky skin, and itching, add prepared Radix Rehmanniae (Shu Di) and Radix Albus Paeoniae Lactiflorae (Bai Shao). (Ye Jiao Teng).?,'A--:.%, .I 1 . Preparation: The source text advises to coarsely '- '- grind the ingredients and prepare as a decoction a',: by cooking two bowls of liquid down to one (if the ,it patient is weak, use smaller bowls). Take the i:, strained liquid warm between meals. Today it is :,g, usually prepared as a decoction with the larger ! , dosage specified in parentheses. Also, 2-3 times the !2$2 dosage of Radix Codonopsis Pilosulae (dang shen) is &$ 2"; usually substituted for Radix Ginseng (ren shen). , Available in prepared form. is, Actions: Tonifies the qi of the middle burner and raises sunken yang. INDICATIONS: Intermittent fever (that worsens upon exertion), spontaneous sweating, aversion to cold, a thirst for warm beverages, shortness of breath, laconic speech, a tendency to curl up, weak limbs, a shiny, pale complexion, loose and watery stools, a pale tongue with a thin, white coating, and a flooding, deficient pulse in general, or a deficient, rootless pulse at the middle position on the right. Formulas that Tonijy th Qi This is deficiency of the Spleen and Stomach qi leading to sinking of the yang. The Spleen controls the flesh and limbs. When the Spleen qi is deficient, the flesh and limbs are deprived of nourishment and become soft and weak. One also has a tendency to curl up, a passive movement in which the body seems to 'collapse' inward. (This is different from the active curling up that occurs with interior cold.) When the Spleen and Stomach are deficient, the qi from nourishment cannot ascend. Because the clear yang depends on this upward movement to ascend, the yang sinks into the yin and is unable to circulate in the superficial levels of the body. This manifests as fever, spontaneous sweating, and aversion to cold. Because the fluids depend on the yang for distribution (especially to the upper parts of the body), there is also thirst. The fever is intermittent (i.e., it varies during the day) and worsens upon exertion. The thirst is for warm beverages, which distinguishes this condition from that due to heat from deficiency. The aversion to cold, which arises from the inability of the yang qi to circulate between the interstices and pores and support the protective qi, can be alleviated by wearing more clothing. This distinguishes it from the aversion to cold due to externally-contracted conditions, which is not as easily alleviated. The deficiency of qi also results in shortness of breath with little exertion, and laconic speech, as the qi is too weak to support any activity. The tongue, pulse, and complexion also reflect that this is not an externally-contracted disorder. The pale tongue with a thin, white coating is indicative of Spleen deficiency. The deficient, rootless pulse at the middle position on the right reflects a collapse of the Spleen qi. However, the pulse is often flooding and deficient in this condition because the yang qi has lost its ability to restrain the pulse. ANALYSIS OF FORMULA: The chief herb, Radix Astragali Membranacei (huang qi), strongly augments the qi (particularly its superficial aspects) and raises the yang qi of the Spleen and Stomach. The deputy herbs are those which strengthen the Spleen qi, namely, Radix Ginseng (ren shen) (or Radix Codonopsis Pilosulae [dang shen]), Rhizoma Atractylodis Macrocephalae (bai zhu), and Honey-fried Radix Glycyrrhizae Uralensis (zhi gun cao). For a discussion of the interactions of these herbs, the reader is referred to Four-Gentleman Decoction (si jun zi tang) above. There are two assistant herbs. The first is

Radix Angelicae Sinensis (dang gui), which tonifies the qi in the blood. It works synergistically with the qi-tonifying herbs in this formula (especially the chief herb) to augment the qi by invigorating the blood. The second is Pericarpium Citri Reticulatae (chen pi), which regulates the qi. Its use in this formula is twofold: it facilitates the digestion of the tonifying herbs (which are quite rich and cloying) and thereby increases their effectiveness; and its qi-regulating properties contribute slightly to the qi-raising action of the formula. The envoys, Rhizoma Cimicifugae (sheng ma) and Radix Bupleuri (chi hu), help raise the sunken yang qi, especially in conjunction with the chief herb. COMMENTARY: This is the 'flagship' formula of the Discussion of the Spleen and Stomach, and there are whole schools of practice based on this single formula. Many of the signs and symptoms among the indications for this formula have an on-again, off-again nature and are brought on by exertion. This is because the extent of injury to the qi in this condition does not always prevent the clear yang from rising. This formula is commonly used for prolapse of the rectum or uterus, chronic diarrhea, chronic dysenteric disorders, incontinence, and bleeding disorders. The aspect of Spleen and Stomach deficiency that pertains here is the breakdown of the ability of the middle burner qi (or middle qi) to restrain or hold things in place. An early symptom of this problem, which is among the indications discussed above, is diarrhea with loose and watery stools. Weakness of the Spleen can also interfere with the organ's function in governing or controlling the blood. This may result in bleeding, usually of a chronic nature, but occasionally acute. The use of this formula has been expanded to include a host of problems: vertigo, headache, visual or auditory disorders, sensitivity of the back to cold and wind, as well as acute upper respiratory infection (for which the dosage of Radix Bupleuri [chi and Rhizoma Cimicifugae [sheng md is greatly increased). There are many other problems for which this formula can be used, provideithat they fit within the pattern of qi deficiency. This formula is very useful in treating many types of chronic low fever, including some which fall into the modern biomedical category of fevers of unknown origin. There has been discussion over the years about the mechanism underlying this manifestation and how it can best be treated. Two passages from the Vital Axis are often cited in support of this formula. The first (chapter 1) provides: "For insufficiencies of the body [form], warm it by means of the qi." The second (chapter 74) provides: "Consumptive disorders should be warmed." With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as debility in the aftermath of a severe illness, chronic bronchitis, first- or second-degree prolapsed uterus, prolapsed rectum, gastric prolapse, recurrent Tonify the Mi& and Augment the Qi Decoction miscarriage, functional uterine bleeding, leukorrhea, post partum problems (including urinary incontinence, lochioschesis, and insufficient lactation), chronic hepatitis, corneal ulcers, cerebral arteriosclerosis, pernicious anemia, leukopenia, chronic nephritis, and myasthenia gravis. CAUTIONS & CONTRAINDICATIONS: Contraindicated for fever due to heat from yin deficiency. It should also be remembered that this formula is not indicated in all instances of prolapse, but only in those due to qi deficiency.

Heat-clearing, phlegm-transforming medicines Qing Qi Hua Tan Wan (Clear the Qi & Transform Phlegm Pills) Semen Trichosanthis Kirlowii (Gua Lou Ren) Pericarpium Citri Reticulatae (Chen Pi) Radix Scutellariae Baicalensis (Huang Qin) Semen Pruni Armeniacae (Xing Ren) Fructus Immaturus Citri Aurantii (Zhi Shi) Sclerotium Poriae Cocos (Fu Ling) bile-treated Rhizoma Arisaematis (Dan Nan Xing) Rhizoma Pinelliae Ternatae (Ban Xia) Functions: Clears heat and transforms phlegm, rectifies the qi and stops coughing Indications: Phlegm heat internally binding. Chronic tracheitis, acute and chronic bronchitis, bronchiectasis, pneumonia, chronic rhinitis, and nasosinusitis Main signs & symptoms: Cough with yellow phlegm which is thick and difficult to expectorate, chest and diaphragm glomus and fullness, short, red urination, a red tongue with slimy, yellow fur, and a slippery, rapid pulse Dosage: 6 pills three times per day Formula explanation: Bile-treated Arisaema is the sovereign medicinal in this formula. Its flavor is bitter and its nature is cold. It clears heat and transforms phlegm and it treats replete phlegm and replete fire obstruction and blockage. Scutellaria and Semen Trichosanthis are the minister medicinals. They downbear lung fire and transform hot phlegm. They assist the power of Arisaema. Because the treatment of phlegm also requires the rectification of the qi, Immature Aurantium and Orange Peel descend the qi and open glomus, disperse phlegm and scatter nodulation. Poria is one of the assistants. It fortifies the spleen and percolates dampness. Armeniaca is another assistant. It diffuses and disinhibits the lung qi. Pinellia is the third assistant. It dries dampness and transforms phlegm. When all these medicinals are combined together, they clear heat and transform phlegm, rectify the qi and stop coughing. Once heat is cleared and fire downborne, qi normalized and phlegm dispersed, all pathological conditions associated with this pattern are automatically resolved. Comments: This medicine is usually used alone. However, the recommended dose of this medicine commonly needs to be increased in order to effectively treat the conditions for which it is indicated. (Dryness-moistening, phlegm-transforming formulas) Representative formula: Bei Mu Gua Lou San (Fritillaria & Trichosanthis Powder) Composition: 1. Bulbus Fritillariae (Bei Mu) 9g 2. Fructus Trichosanthis Kirlowii (Gua Lou) 12g 3. Radix Trichosanthis Kirlowii (Tian Hua Fen) 12g 4. Sclerotium Poriae Cocos (Fu Ling) 9g 5. Exocarpium Citri Rubri (Ju Hong) 6g 6. Radix Platycodi Grandiflori (Jie Geng) 9g Functions: Moistens the lungs and clears heat rectifies the qi and transforms phlegm Indications: 1. Lung dryness with phlegm 2. Sore throat 3. Bronchitis 4. Tracheitis 5. Laryngitis 6. Pulmonary emphysema 7. Cervical lymphadenitis

8. Thyroiditis 9. Diabetes mellitus with polydipsia and polyuria Main signs & symptoms: 1. Tenacious phlegm which is astringent and difficult to spit up 2. Cough 3. Dry throat 4. A red dry tongue with scant coating 5. A rapid pulse Contraindications: 1. Do not use for cough with lung yin vacuity. Formula explanation: Fritillaria is the sovereign medicinal within this formula. It clears heat and moistens the lungs, transforms phlegm and stops cough. It also opens phlegm qi depression binding. Fructus Trichosanthis is the minister. It clears heat and moistens dryness, rectifies the qi and washes away phlegm. It also opens bi and obstruction in the chest and diaphragm. Radix Trichosanthis clears heat and transforms phlegm, generates fluids and moistens dryness. Poria fortifies the spleen and disinhibits dampness, remembering that the spleen is the origin of phlegm generation. Red Orange Peel rectifies the qi and transforms phlegm, thus assisting in normalizing the qi and dispersing phlegm. Platycodon diffuses and disinhibits the lung qi, thus reestablishing lung metal's authority over diffusing and downbearing. Therefore, by using these medicinals in combination, lung dryness is moistened and phlegm is automatically transformed; clearing and depurating are restored and coughing is automatically stopped. Additions & subtractions: Ningpoensis (Xuan Shen), and Radix Glycyrrhizae (Gan Cao). ae (Mai Dong), Radix Scrophulariae Ningpoensis (Xuan Shen), and Rhizoma Anemarrhenae (Zhi Mu). Lappae (Niu Bang Zi). -streaked phlegm, subtract Red Orange Peel and add Radix Glehniae Littoralis (Sha Shen) and Gelatinum Corii Asini (E Jiao). Cao), and raw Radix Rehmanniae (Sheng Di). Again for bloody phlegm, subtract Red Orange Peel and add Radix Glehniae Littoralis (Sha Shen), Tuber Ophiopogonis Japonicae (Mai Dong), Rhizoma Phragmitis Communis (Lu Gen), and Herba Agrimoniae Pilosae (Xian He Cao). dd Semen Pruni Armeniacae (Xing Ren), Folium Eriobotryae Japonicae (Pi Pa Ye), and Flos Tussilaginis Farfarae (Kuan Dong Hua). (Xing Ren), Radix Peucedani (Qian Hu), and Fructus Arctii Lappae (Niu Bang Zi). Comment: This condition should be treated by a combination of dryness-moistening and phlegm-transforming medicinals and should not be mistaken for lung yin vacuity, in which case, greasy, yin-enriching ingredients may aggravate phlegm by damaging the spleen and inhibiting the qi.

15.5 Zhi Feng Hua Tan Ji (Wind-treating, phlegm-transforming formulas) Representative formula: Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes, & Gastrodia Decoction). Composition: 1. Rhizoma Pinelliae Ternatae (Ban Xia) 9g 2. Rhizoma Gastrodiae Elatae (Tian Ma) 6g 3. Sclerotium Poriae Cocos (Fu Ling) 6g 4. Exocarpium Citri Rubri (Ju Hong) 6g 5. Rhizoma Atractylodis Macrocephalae (Bai Zhu) 15g 6. Radix Glycyrrhizae (Gan Cao) 4g 7. Raw Rhizoma Zingiberis (Sheng Jiang) 1 slice 8. Fructus Zizyphi Jujubae (Da Zao) 2 pieces Functions: Dries dampness and transforms phlegm, levels the liver and extinguishes wind Indications: 1. Wind and phlegm harassing above 2. Recurrent headaches and dizziness 3. Meniere's disease 4. Neurotic vertigo 5. Hypertension 6. Tubercular meningitis 7. Orthostatic hypotension Main signs & symptoms: 1. Dizziness 2. Vertigo 3. Headache 4. Chest oppression 5. Vomiting 6. Nausea 7. A white slimy tongue coating 8. Wiry slippery or soft slippery pulse Contraindications: 1. Do not use for dizziness and vertigo due to ascendant liver yang. 2. Do not use for dizziness and vertigo due to blood vacuity. Formula explanation: Within this formula, Pinellia dries dampness and transforms phlegm, downbears counterflow and stops vomiting. Gastrodia transforms phlegm and extinguishes wind. It also stops vertigo. These two used together are the essential medicinals for the treatment of wind phlegm dizziness, vertigo, and headache and are the two sovereign medicinals in this formula. Atractylodes is the minister. It fortifies the spleen and dries dampness. When combined with Pinellia and Gastrodia, these two's ability to dispel dampness, transform phlegm, and stop vertigo is boosted. Poria is an assistant. It fortifies the spleen and percolates dampness. Combined with Atractylodes, these two are able to treat phlegm at its root, i.e., the spleen. Red Orange Peel, fresh Ginger, and Red Dates are also assistants. Red Orange Peel rectifies the qi and transforms phlegm. Fresh Ginger and Red Dates regulate and harmonize the spleen and stomach. Licorice is the messenger. It harmonizes the center and regulates the other medicinals. Additions & subtractions: -treated) Rhizoma Arisaematis (Dan Nan Xing).

n due to food stagnation, add Fructus Crataegi (Shan Zha). Vladimiriae (Mu Xiang). ms of hot phlegm, add Caulis In Taeniis Bambusae (Zhu Ru). (Huang Qi). Bombyx Batryticatus (Jiang Can). cold feet, sinusitis, and/or compulsive sleeping after meals, add Cortex Phellodendri (Huang Bai), Rhizoma Atractylodis (Cang Zhu), Radix Panacis Ginseng (Ren Shen), Radix Astragali Membranacei (Huang Qi), Rhizoma Alismatis (Ze Xie), Fructus Germinatus Hordei Vulgaris (Mai Ya), and Massa Medica Fermentata (Shen Qu). This results in Li Dong-yuan's Ban Xia Bai Zhu Tian Ma Tang (Pinellia, Atractylodes, & Gastrodia Decoction). follow with this formula. In this case, subtract Licorice and Red Dates and add bile(-treated) Rhizoma Arisaematis (Dan Nan Xing) and Rhizoma Acori Graminei (Shi Chang Pu).

Stop coughing powder Zhi sou san Source: Medical Revelatiom (Yi m e xin wu) Radix Platycodi Grandiflori (jie geng).960g Herba seu Flos Schizonepetae Tenuifoliae (jing jie) 960g Radix Asteris Tatarici (zi wan)960g Radix Stemonae (bai bu) .960g Radix et Rhizoma Cynanchi Baiqian (bai qian).960g Radix Glycyrrhizae Uralensis (gan cao) 3609Pericarpium Citri Reticulatae (chen Pi) 480g Preparation: Grind the ingredients into powder and take 9g after meals and before bedtime with warm water. May also be prepared as a decoction with a proportionate reduction in dosage. Available in prepared form. Actions: Stops coughing, transforms phlegm, disperses the exterior, and disseminates the Lung qi. INDICATIONS: Coughing with or without slight chills and fever, an itchy throat, a thin, white tongue coating, and a moderate, floating pulse. This is wind attacking the Lungs. This presentation usually occurs as the sequela to an externallycontracted disease that has been treated, but in which the cough persists. In such cases, the pathogenic influence is said to be only 80-90% dispelled, which is reflected in the itchy throat and the slight chills and fever. The proper directional tendency of the Lung qi is also disturbed, which is reflected in the coughing. The thin, white tongue coating and the moderate, floating pulse indicate that the pathogenic influence has not penetrated deeply. ANALYSIS OF FORMULA: The chief herbs, Radix Asteris Tatarici (zi wan), Radix et Rhizoma Cynanchi Baiqian (bai qian), and Radix Stemonae (bai bu), are all effective in stopping coughs and transforming phlegm, both in acute and chronic disorders. The deputies, Radix Platycodi Grandiflori (jie geng) and Pericarpium Citri Reticulatae (chen Pi), encourage the proper dissemination and descent of the Lung qi, and thereby help the chief herbs stop the coughing. The assistant, Herba seu Flos Schizonepetae Tenuifoliae (jing jie), gives the formula a slight, exterior-releasing action which helps eliminate the lingering pathogenic influence. The envoy, Radix Glycyrrhizae Uralensis (gan cao), harmonizes the actions of the other herbs, and together with Herba seu Flos Schizonepetae Tenuifoliae (jingjie) and Radix Platycodi Grandiflori (jie geng), is very effective in treating throat disorders due to externally-contracted wind. COMMENTARY: This is an effective, well-balanced formula for treating the very common problem of lingering cough due to an externally-contracted disorder. With modifications, it can be used in treating the sequelae of a wide variety of disorders, as shown below. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as upper respiratory tract infection, acute bronchitis, pertussis, and the early stages of viral and mycoplasmic pneumonia. CAUTIONS & CONTRAINDICATIONS: This formula has a tendency to dry and should therefore not be used in treating coughs associated with yin deficiency. It was designed for treating wind-cold and should not be used without modification in treating coughs due to heat in the Lungs.

Zhu Tan Ji Dispelling Phlegm Formulas Phlegm is a yin evil. It is congealed from body fluids and water dampness. Body fluids are transported and transformed by qi. If qi becomes insufficient or depressed, fluids and humors may not be transported and transformed properly. In that case, they may gather and accumulate, eventually congealing into phlegm. It is also possible for heat and fire to steam the juices and congeal body fluids into phlegm. Once generated, phlegm itself may hinder and obstruct the free flow of qi, blood, and body fluids. Depending upon its cause and the patient's bodily constitution, phlegm may be either hot or cold, damp or dry, and may exist either under the skin, in the channels and network vessels, or in the viscera. There are five subcategories of phlegm-dispelling formulas. These are: 1) Formulas which dry dampness and transform phlegm. These fortify the spleen and transform phlegm and are used to treat cough with phlegm dampness. 2) Formulas which clear heat and transform phlegm. These are used to treat hot phlegm patterns. 3) Formulas which moisten dryness and transform phlegm. These are used to treat dry phlegm patterns. 4) Formulas which warm and transform cold phlegm. These warm the lungs and transform phlegm and are typically used to treat phlegm due to spleen yang vacuity or phlegm rheum obstructing the lungs patterns. 5) Formulas which treat wind and transform phlegm. These are used to treat either external wind invading the lungs resulting in phlegm accumulation or retention of turbid phlegm with internal stirring of liver wind. 15.1 Zao Shi Hua Tan Ji (Drying dampness, transforming phlegm formulas) Representative formula: Er Chen Tang (Two Aged [Ingredients] Decoction) Composition: 2. Rhizoma Pinelliae Ternatae (Ban Xia) 15g 3. Pericarpium Citri Reticulatae (Ju Pi) 15g 4. Sclerotium Poriae Cocos (Bai Fu Ling) 9g 5. Radix Glycyrrhizae (Gan Cao) 5g mix-fried 6. Raw Rhizoma Zingiberis (Sheng Jiang) 7 slices 7. Fructus Pruni Wumei (Wu Mei) 1 whole one Functions: Dries dampness and transforms phlegm rectifies the qi and harmonizes the center Indications: 1. Damp phlegm cough 2. Chronic tracheitis 3. Chronic bronchitis 4. Pulmonary emphysema 5. Goiter 6. Chronic gastritis 7. Peptic ulcer 8. Eclampsia 9. Hangover 10. Gastroptosis 11. Meniere's disease 12. Neurosis Main signs & symptoms: 1. Excessive phlegm which is colored white and easily spit out 2. Chest and diaphragm glomus and oppression 3. Nausea and vomiting 4. Fatigue of the body and limbs 5. Possible vertigo and palpitations 6. A white moist tongue coating 7. A slippery pulse

Contraindications: 1. Do not use unmodified for lung yin vacuity cough. Formula explanation: In this formula, Pinellia is the sovereign. It is acrid and warm and its nature is drying. It is able to dry dampness and transform phlegm as well as to downbear counterflow and harmonize the stomach and thus stop vomiting. Orange Peel is the minister. It rectifies the qi and dries dampness. It aids in normalizing the qi and dispersing phlegm. The assistants are Poria, fresh Ginger, and Mume. Poria fortifies the spleen and percolates dampness. Once dampness is removed, the spleen may become effulgent and phlegm can no longer be engendered. Fresh Ginger downbears counterflow and transforms rheum. It is also able to control the toxins in Pinellia. It also helps Pinellia and Orange Peel move the qi and disperse phlegm. A small amount of Mume is used to restrain the lung qi. Combined with Pinellia, these two scatter and restrain at the same time. Thus phlegm is dispelled without damaging the righteous. Licorice is the messenger. It regulates and harmonizes all these other medicinals. Simultaneously it moistens the lungs and harmonizes center. Additions & subtractions: with irritability, timidity, insomnia, and palpitations, subtract Ginger and Mume and add Caulis In Taeniis Bambusae (Zhu Ru), Fructus Immaturus Citri Seu Ponciri (Zhi Shi), and Fructus Zizyphi Jujubae (Da Zao). This results in Wen Dan Tang (Warm the Gallbladder Decoction). results in Huang Lian Wen Dan Tang (Coptis Warm the Gallbladder Decoction). bile(-treated) Rhizoma Arisaematis (Dan Xing), Radix Panacis Ginseng (Ren Shen), and Rhizoma Acori Graminei (Chang Pu). This results in Di Tan Tang (Flush Phlegm Decoction). For common cold with profuse phlegm in the elderly complicated by lung/kidney vacuity, add Radix Angelicae Sinensis (Dang Gui) and prepared Radix Rehmanniae (Shu Di). This results in Jin Shui Liu Jun Jian (Metal & Water Six Gentleman Decoction). Amomi (Sha Ren). This results in Xiang Sha Er Chen Tang (Saussurea & Amomum Two Aged [Ingredients] Decoction). n Jiang) and Herba Cum Radice Asari (Xi Xin). Lou Ren), and Herba Houttuyniae Cordatae (Yu Xing Cao). wii (Gua Lou) and Concretio Silicea Bambusae (Tian Zhu Huang). -treated) Rhizoma Arisaematis (Dan Xing) and Rhizoma Typhonii Gigantaeae (Bai Fu Zi). i). Geng), Fructus Citri Seu Ponciri (Zhi Ke), and Caulis Agastachis (Huo Geng). u Zi) and Massa Medica Fermentata (Shen Qu). Rhizoma Atractylodis Macrocephalae (Bai Zhu). (Hou Po), Rhizoma Atractylodis (Cang Zhu), and Fructus Zizyphi Jujubae (Da Zao). Panacis Ginseng (Ren Shen), Cortex Cinnamomi (Rou Gui), and Radix Scutellariae Baicalensis (Huang Qin).

nausea, chest and diaphragm glomus and obstruction, vomiting, and reduced appetite complicated by liver wind, subtract Mume and add Rhizoma Arisaematis (Nan Xing) and Fructus Immaturus Citri Seu Ponciri (Zhi Shi). This results in Dao Tan Tang (Lead Out Phlegm Decoction). x Scutellariae Baicalensis (Huang Qin), Fructus Gardeniae Jasminoidis (Shan Zhi), Semen Pruni Armeniacae (Xing Ren), and Radix Platycodi Grandiflori (Jie Geng). Coptidis Chinensis (Huang Lian), Cortex Magnoliae Officinalis (Hou Po), and Semen Coicis Lachryma-jobi (Yi Yi Ren). (Huang Bai), and Talcum (Hua Shi). wind dampness, add Radix Clematidis (Wei Ling Xian), Radix Gentianae Macrophyllae (Qin Jiao), Fructus Xanthii (Cang Er Zi), and Ramulus Cinnamomi (Gui Zhi). Semen Pruni Armeniacae (Xing Ren), and Radix Platycodi Grandiflori (Jie Geng).

Huang) and Semen Pruni Armeniacae (Xing Ren). Rhizoma Atractylodis (Cang Zhu) and Rhizoma Atractylodis Macrocephalae (Bai Zhu). -like diseases) with vomiting and diarrhea, add Radix Panacis Ginseng (Ren Shen), Radix Praeparatus Aconiti Carmichaeli (Fu Zi), Rhizoma Coptidis Chinensis (Huang Lian), and Fructus Zizyphi Jujubae (Da Zao). -standing phlegm in the channels and muscles with rubbery nodulation, add Concha Ostreae (Mu Li), Radix Scrophulariae Ningpoensis (Xuan Shen), Thallus Algae (Kun Bu), and Herba Sargassii (Hai Zao). astringent urination, add Cortex Cinnamomi (Rou Gui) and Radix Praeparatus Aconiti Carmichaeli (Fu Zi). y during the day which becomes worse after meals, add Rhizoma Atractylodis Macrocephalae (Bai Zhu) and Rhizoma Acori Graminei (Chang Pu). Sinensis (Dang Gui). discharge, add Rhizoma Ligustici Wallichii (Chuan Xiong) and Radix Angelicae Sinensis (Dang Gui). add Fructus Trichosanthis Kirlowii (Gua Lou) and Bulbus Fritillariae Cirrhosae (Chuan Bei Mu). Perillae Frutescentis (Su Ye). -poisoning and summerheat patterns, add Rhizoma Atractylodis (Cang Zhu), Cortex Magnoliae Officinalis (Hou Po), Herba Agastachis Seu Pogostemi (Huo Xiang), and Fructus Zizyphi Jujubae (Da Zao).

Wen Dan Tang Wan (Warm the Gallbladder Decoction Pills). Caulis Bambusae In Taeniis (Zhu Ru) Fructus Immaturus Citri Aurantii (Zhi Shi) Rhizoma Pinelliae Ternatae (Ban Xia) Pericarpium Citri Reticulatae (Chen Pi) Sclerotium Poriae Cocos (Fu Ling) Radix Glycyrrhizae (Gan Cao) uncooked Rhizoma Zingiberis (Sheng Jiang) Fructus Zizyphi Jujubae (Da Zao) Functions: Rectifies the qi and transforms phlegm, clears heat and eliminates vexation Indications: Liver depression-depressive heat complicated by phlegm and an element of heart-spleen vacuity. Chronic gastritis, peptic ulcers, chronic hepatitis, neuroses, nightmares, insomnia, palpitations, emotional depression, early stage schizophrenia, Menieres disease, and chronic bronchitis Main signs & symptoms: Dizziness, vertigo, nausea and/or vomiting, insomnia and especially waking from sleep in a terror, heart palpitations, timidity or susceptibility to fright, profuse phlegm, chest oppression and venter glomus, a bitter taste in the mouth, slimy, yellow tongue fur, and a slippery, bowstring, rapid pulse Dosage: 8 pills three times per day Formula explanation: This formula is built on a basis of Er Chen Wan (Two Aged [Ingredients] Pills) discussed above, the basic phlegm-transforming prescription in Chinese medicine. Immature Aurantium rectifies the qi and disperses accumulations, while Bamboo Shavings clear heat and transform phlegm, eliminate vexation and quiet the spirit. Licorice and Red Dates not only act as harmonizing medicinals in this formula, they also supplement both the heart and spleen qi and blood. This helps to quiet the spirit. Only if the spirit obtains sufficient qi and blood can it rest quietly in the mansion of the heart. Comments: The pattern this medicine treats is actually a complex one. It is sometimes called gallbladder qi timidity for short. However, it has mostly to do with the spleen, stomach, liver, and heart, phlegm and heat.Depressive heat mixes with dampness due to spleen vacuity and leads to congelation of phlegmheat. Spleen vacuity leads to qi and blood vacuity and thus malnourishment of the heart spirit at the same time that depressive heat ascends to harass the heart spirit above. Patients with this pattern are usually obese. However, this is typically a tai yang obesity as opposed to a tai yin obesity. Tai yang obesity describes a person who is overweight but with a strong musculature underneath. Tai yin obesity describes a person who is even more grossly overweight with very poor, underdeveloped muscle tone. If one suspects this pattern, one should ask if the patient startles easily and/or if they wake in panic from sleep. If they then have a slippery, bowstring pulse and other symptoms of liver depression and profuse phlegm, then one may use this medicine. In clinical practice, this medicine may be combined with a number of other famous formulas, such as Xiao Chai Hu Tang Wan (Minor Bupleurum Decoction Pills), Xiao Yao Wan (Rambling Pills), Jia Wei Xiao Yao Wan (Added Flavors Rambling Pills), and Ban Xia Xie Xin Tang Wan (Pinellia Drain the Heart Decoction Pills). In some menopausal women, it might even be combined with Er Xian Wan (Two Immortals Pills).

Li Qi Ji (Qi-rectifying Formulas) Qi-rectifying formulas address either of two anomalies of the qi. In the first case, there may be qi stagnation. This means the qi does not move freely as it should. Usually this is due to the liver losing its control over coursing and discharge. However, because the qi transports and transforms the blood, dampness, phlegm, and food, qi stagnation may be complicated by depression of any of these yin substances. In addition, if qi becomes depressed, it may transform into depressive heat or fire. Therefore, the subcategory of qirectifying formulas known as qi-moving formulas commonly include medicinals which treat one or more of these complicating depressions. This subcategory is itself divided into two groups of formulas: 1) those formulas which treat stagnation of the spleen and stomach qi with upper abdominal distention, belching, nausea, and possible vomiting and 2) those formulas which treat liver depression, qi stagnation with distention and pain in the lateral costal region with possible distention and pain more prominent in the lower abdomen. Secondly, if qi accumulates, because it is yang, it will eventually counterflow upward. This may affect the downward flow of the qi of the stomach and lungs. In such cases, the qi of this viscus and bowel may counterflow upward. Therefore, the second subcategory of qi-rectifying formulas is known as qi-downbearing formulas. These formulas downbear upwardly counterflowing qi, thus insuring the regular and harmonious arising of clear yang and the downbearing of turbid yin. Qi-rectifying ingredients have many similarities to exterior-resolving medicinals. Both groups can be referred to as windy medicinals. This is because both groups tend to be acrid, drying, ascending, and out-thrusting. Even within the downbearing group of qi-rectifying formulas, downbearing medicinals are usually used in tandem with dry, acrid medicinals to upbear yang and thrust outward. Due to their dry, windy nature, qi-rectifying ingredients can consume yin and blood if improperly used and damage the righteous qi. Cautions & Contraindications: 1. Use with care in patients with blood vacuity, yin vacuity, or insufficient body fluids. 2. Do not use indefinitely once the condition improves. 10.1 Xing Qi Ji (Moving qi formulas) Representative formulas: A. Yue Ju Wan (Escape Restraint Pills) Composition: 1. Rhizoma Cyperi Rotundi (Xiang Fu) 12g 2. Rhizoma Atractylodis (Cang Zhu) 12g 3. Rhizoma Ligustici Wallichii (Chuan Xiong) 12g 4. Fructus Gardeniae Jasminoidis (Zhi Zi) 12g 5. Massa Medica Fermentata (Shen Qu) 12g Functions: Moves the qi and resolves depression Indications: 1. Qi depression with chest and diaphragm glomus and oppression 2. Gastrointestinal neurosis 3. Gastric or duodenal ulcer 4. Chronic gastritis 5. Infectious hepatitis 6. Chronic cholecystitis 7. Cholelithiasis 8. Intercostal neuralgia 9. Irregular menstruation 10. Dysmenorrhea Main signs & symptoms: 1. Epigastric and abdominal distention and pain 2. Belching

3. Burping 4. Acid eructations 5. Nausea 6. Vomiting 7. Indigestion 8. A thin white or slimy glossy tongue coating 9. And a wiry or wiry slippery pulse Contraindications: 1. Do not use unmodified for stagnation due to vacuity. Formula explanation: Because qi depression may cause depression of blood, phlegm, fire, dampness, and/or food, each ingredient in this formula addresses one of these depressions. Cyperus is the main ingredient in this formula. It moves the qi and resolves depression, thus treating qi depression. Ligusticum quickens the blood and dispels stasis, thus treating blood depression. Gardenia clears heat and drains fire, thus treating fire depression. Atractylodis dries dampness and transports the spleen, thus treating damp depression. Massa Medica Fermentata disperses food and conducts stagnation, thus treating food depression. Qi depression leads to gathering of dampness and the generation of phlegm. If the qi dynamic flows smoothly, these five depressions are resolved and the resolution of phlegm depression follows suit. Therefore, it is generally not necessary to add any medicinals specifically for it. Additions & subtractions: Seu Ponciri (Zhi Ke). Pericarpium Viridis Citri Reticulatae (Qing Pi). Curcumae (Yu Jin). Carthami Tinctorii (Hong Hua). (Hong Hua). Radix Angelicae Sinensis (Dang Gui). Xie). Coicis Lachryma-jobi (Yi Yi Ren). ce due to damp depression, add Sclerotium Poriae Cocos (Fu Ling) and Ramulus Cinnamomi (Gui Zhi) to move the qi and transform dampness. Crataegi (Shan Zha). or loss of appetite, nausea, and vomiting due to food stagnation, add Fructus Germinatus Hordei Vulgaris (Mai Ya) and Caulis Perillae Frutescentis (Su Gen). i Jin) and Semen Arecae Catechu (Bing Lang). Citri Reticulatae (Chen Pi), Fructus Immaturus Citri Seu Ponciri (Zhi Shi), and Semen Arecae Catechu (Bing Lang). Arisaematis (Tian Nan Xing). Citri Reticulatae (Chen Pi) to rectify the qi and transform phlegm.

Pinelliae Ternatae (Ban Xia), either Pericarpium Trichosanthis Kirlowii (Gua Lou Pi), Fructus Trichosanthis Kirlowii (Gua Lou), or Semen Trichosanthis Kirlowii (Gua Lou Ren), and bile-processed Rhizoma Arisaematis (Dan Nan Xing). and Cortex Radicis Moutan (Dan Pi). re serious fire depression, add Rhizoma Coptidis Chinensis (Huang Lian) and Radix Scutellariae Baicalensis (Huang Qin). Lian) and Fructus Evodiae Rutecarpae (Wu Zhu Yu). (Fo Shou). Radix Angelicae Sinensis (Dang Gui), and Radix Albus Paeoniae Lactiflorae (Bai Shao).

pulse, add Rhizoma Corydalis Yanhusuo (Yan Hu). hizoma Alpiniae Officinari (Gao Liang Jiang). Rutecarpae (Wu Zhu Yu) and dry Rhizoma Zingiberis (Gan Jiang) and subtract Gardenia. Comment: Depression in this context does not mean emotional depression as understood in the West. Here it is used as a technical term within TCM.

B. Ban Xia Hou Po Tang (Pinellia & Magnolia Decoction) Composition: 1. Rhizoma Pinelliae Ternatae (Ban Xia) 12g 2. Cortex Magnoliae Officinalis (Hou Po) 9g 3. Sclerotium Poriae Cocos (Fu Ling) 12g 4. Raw Rhizoma Zingiberis (Sheng Jiang) 9g 5. Folium Perillae Frutescentis (Su Ye) 6g Functions: Moves the qi and scatters nodulation, downbears counterflow and transforms phlegm Indications: 1. Plum pit qi 2. Neurotic esophageal stenosis 3. Globus hystericus 4. Gastrointestinal neurosis 5. Chronic laryngitis 6. Tracheitis 7. Neurasthenia 8. Morning sickness 9. Bronchitis 10. Hysteria neurosis 11. Recurrent palpitations 12. Asthma 13. Pertussis 14. Toxemia during pregnancy 15. Edema Main signs & symptoms: 1. The sensation of something stuck in the throat which cannot be spit up or swallowed down 2. Chest and lateral costal fullness and oppression 3. Possible cough with copious phlegm 4. Possible vomiting 5. A white moist or slimy glossy tongue coating 6. A wiry or wiry slippery pulse Contraindications: 1. Do not use in patients with a flushed face, bitter taste in the mouth, and a red tongue with scant coating. This means those with yin vacuity or heat due to liver depression, stagnant qi transforming into internal heat. Formula explanation: This formula uses Pinellia to transform phlegm and scatter nodulation, downbear counterflow and harmonize the stomach. It is the sovereign medicinal in this prescription. Magnolia lowers the qi and eliminates fullness. It assists Pinellia in scattering nodulation and downbearing counterflow. Poria, sweet and bland, percolates dampness. It assists Pinellia in transforming phlegm. Magnolia and Poria are this formula's minister medicinals. Fresh Ginger, acrid and warm, scatters nodulation, harmonizes the stomach, and stops vomiting, while Folium Perillae aromatically moves the qi, rectifies the lungs, and soothes the liver. These are the assistant and messenger medicinals. Additions & subtractions: Ginseng (Ren Shen), Semen Arecae Catechu (Bing Lang), Lignum Aquilariae Agallochae (Chen Xiang), and Radix Linderae Strychnifoliae (Wu Yao).

Rotundi (Xiang Fu), and Pericarpium Viridis Citri Reticulatae (Qing Pi). i.e., Radix Bupleuri (Chai Hu), Radix Angelicae Sinensis (Dang Gui), Radix Albus Paeoniae Lactiflorae (Bai Shao), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Sclerotium Poriae Cocos (Fu Ling), mix-fried Radix Glycyrrhizae (Zhi Gan Cao), and Herba Menthae (Bo He). slimy, white tongue Amomi (Sha Ren). coating, and a wiry, slippery pulse, add Tuber Curcumae (Yu Jin) and Fructus no thirst, subtract Magnolia, Perilla, and Poria. This results in Xiao Ban Xia Tang (Minor Pinellia Decoction). Cardamomi (Bai Dou Kou). with a scant, dry coating, add Radix Glehniae Littoralis (Sha Shen), Tuber Ophiopogonis Japonicae (Mai Dong), and Radix Scrophulariae Ningpoensis (Xuan Shen). ilder condition with less phlegm dampness, one can add Fructus Zizyphi Jujubae (Da Zao) to nourish the stomach. This results in Si Qi Tang (Four [Ingredients for the] Seven [Emotions] Decoction). Jin) and Fructus Citri Seu Ponciri (Zhi Ke).

Geng), Cortex Radicis Mori (Sang Bai Pi), and Semen Pruni Armeniacae (Xing Ren). -fried Radix Glycyrrhizae (Zhi Gan Cao). s (Huang Qin). Xiang). Rhizoma Corydalis Yanhusuo (Yan Hu). pain and swelling of the throat, add Radix Scrophulariae Ningpoensis (Yuan Shen) and Radix Platycodi Grandiflori (Jie Geng)

FORMULAS THAT DIRECT REBELLIOUS QI DOWNWARD The formulas in this section are used in treating rebellious Lung or Stomach qi. The normal flow of qi in these organs is downward. When it rebels upward the flow is reversed, and such symptoms as coughing, wheezing, vomiting, or belching occur. In diagnosing these conditions, the practitioner should ascertain whether the disorder is one of excess or deficiency, heat or cold, or a combination of factors. These formulas are indicated for relatively acute conditions and should not be prescribed long-term. Perilla Fruit Decoction for Directing Qi Downward Su zi jiang qi tang Fructus Perillae Frutescentis (su zi) 75g (9-12g) Rhizoma Pinelliae Ternatae (ban xia) 75g (6-9g) Radix Angelicae Sinensis (dang gui) 45g (6-9g) Honey-fried Radix GIycyrrhizae Uralensis (gun cao) 60g (3-4.5g) Cortex Magnoliae Officinalis (hou Po) 30g (3-6g) Radix Peucedani (qian hu) 30g (6-9g) Cortex Cinnamomi Cassiae (rou gui).45g (1.5-3g) Preparation: The source text advises to grind the ingredients into a fine powder and take 6g as a draft with the addition of two slices of Rhizoma Zingiberis Officinalis Recens (sheng jiang), three pieces of Fructus Zizyphi Jujubae (da zao), and five leaves of Folium Perillae Frutescentis (su ye). Today the formula is usually prepared as a decoction with the dosage indicated in parentheses, and with the addition of the same ingredients mentioned above. In one version of the source text 45g (6-9g) of Pericarpium Citri Reticulatae (chen pi) is added. It is this version that is usually available in prepared form. Actions: Directs rebellious qi downward, arrests wheezing, stops coughing, and warms and transforms phlegm-cold. INDICATIONS: Coughing and wheezing with watery, copious sputum, a stifling sensation in the chest and diaphragm, shortness of breath marked by relatively labored inhalation and smooth exhalation, and a white tongue coating that is either slippery or greasy. There may also be pain and weakness of the lower back and legs, edema of the extremities, andlor fatigue. This condition is known as excess above and deficiency below. 'Excess above' refers to phlegm-cold obstructing the Lungs. This interferes with the normal circulation of qi and results in coughing and wheezing with copious, watery sputum together with a stifling sensation in the chest. 'Deficiency below' refers primarily to the Kidneys being unable to grasp the qi, which manifests as wheezing and shortness of breath characterized by relatively labored inhalation. It may also include Kidney yang deficiency with pain and weakness of the lower back and legs, and a disturbance of water metabolism (water failing to transform into qi), which manifests as edema. This condition occurs in patients with constitutionally deficient Kidney yang (the root) with internal phlegm who contract external wind-cold, which transforms into phlegm-cold (the manifestation) and obstructs the circulation of the Lung qi. ANALYSIS OF FORMULA: This formula takes into account both the pathology above and below. Where the condition is acute, however, one must necessarily focus on the manifestations; thus, the primary strategy here is to direct the rebellious qi downward, stop the coughing and wheezing, and expel the phlegm. Warming the Kidneys and helping them grasp the qi is of secondary importance. Fructus Perillae Frutescentis (su zi) directs rebellious qi downward, expels phlegm, stops the coughing, and arrests the wheezing. Because it addresses all of - the manifestations, it is regarded as the chief herb. Rhizoma Pinelliae Ternatae (ban xia), Cortex Magnoliae Officinalis (hou Po), and Radix Peucedani (qian hu) are a powerful combination for expelling phlegm, stopping the coughing, and arresting wheezing. When Pericarpium Citri Reticulatae (chen Pi) is used, it further strengthens these effects. It is noteworthy that although Radix Peucedani (qian hu) has a cool nature, when it is combined with these warm herbs only its phlegm-transforming and qi-directing properties are evident. In concert with the chief herb, these deputies effectively treat the excess above. In treating the deficiency below, the assistant, Cortex Cinnamomi Cassiae (rou gui), warms the Kidneys and restores their ability to grasp the qi. Its

yang-warming action also helps to dispel cold. The functions of the other assistant, Radix Angelicae Sinensis (hng gui), are complex. First, one of its ancient functions which is rarely utilized today-treating the cough from rebellious qi-is drawn upon in this formula. Second, this condition represents an acute aggravation of a chronic disorder. Chronic disorders often lead to deficiency or 'devitalization' of the blood. this 'herb is therefore used to harmonize the functions of the blood, and is one reason why it is said to treat the 'qi of the blood.' This has the effect of conducting errant aspects of the body back to their respective sources, and here has a positive influence on the qi grasping function of the Kidneys. Finally, this herb is used to prevent injury to the yin and qi from the acrid, dry properties of many of the other ingredients. The remaining herbs serve as envoys. Rhizoma Zingiberis Officinalis Recens (sheng jiang) and Folium Perillae Frutescentis (su ye) disperse cold and improve circulation in the Lungs. Honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao) and Fructus Zizyphi Jujubae (da zao) harmonize the middle burner, which helps resolve the phlegm. They also harmonize the actions of the other ingredients, which is especially important in a formula with so many different types of herbs. COMMENTARY: This formula is somewhat warm and dry in nature and primarily acts to expel phlegm and direct rebellious qi downward. Although this formula and Lead Special Pill (hi xi dun) are both used in treating the condition of excess above and deficiency below, their focus is different. This formula focuses on excess, while Lead Special Pill (hei xi dun) focuses on deficiency. Similarly, although both this formula and Minor Bluegreen Dragon Decoction (xiao qing long tang) are used in treating the coughing and wheezing associated with cold and congested fluids, this formula is indicated specifically for a condition of excess above and Kidney deficiency below, while Minor Bluegreen Dragon Decoction (xiao qing long tang) is indicated for externally-contracted wind-cold in patients with chronic Spleen deficiency and congested fluids. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as chronic bronchitis, emphysema, bronchial asthma, and cardiac asthma. CAUTIONS & CONTRAINDICATIONS: Inappropriate for treating Lung and Kidney deficiency in the absence of an externally-contracted pathogenic influence, and in cases of wheezing and a productive cough due to heat in the Lungs. MODIFICATIONS: For concurrent exterior cold, add Herba Ephedrae (ma hang) and Semen Pruni Armeniacae (xing ren). For less severe cold, substitute Herba Menthae Haplocalycis (bo he) for Folium Perillae Frutescentis (zi su ye). For more sputum and coughing, add Pericarpium Citri Reticulatae (chen pi). For qi deficiency, add Radix Codonopsis Pilosulae (hng shen) and Fructus Schisandrae Chinensis (wuwei zi). For urinary difficulty, add Semen Plantaginis (che qian zi). For greater difficulty in inhalation without lower back pain, omit Cortex Cinnamomi Cassiae (rou gui) and add Lignum Aquilariae (chen xiang).

Jiang Qi Ji (Downbearing qi formulas) Representative formula: Ju Pi Zhu Ru Tang (Orange Peel & Caulis Bambusae Decoction) Composition: 2. Pericarpium Citri Reticulatae (Ju Pi) 12g 3. Caulis In Taeniis Bambusae (Zhu Ru) 12g 4. Fructus Zizyphi Jujubae (Da Zao) 5 pieces 5. Raw Rhizoma Zingiberis (Sheng Jiang) 9g 6. Radix Glycyrrhizae (Gan Cao) 6g 7. Radix Panacis Ginseng (Ren Shen) 3g Functions: Downbears counterflow and stops hiccup boosts the qi and clears heat Indications: 1. Qi vacuity with heat 2. qi counterflow and no downbearing. 3. Hiccup 4. Nausea and vomiting 5. Morning sickness 6. Post-surgical persistent hiccup 7. Chronic gastric diseases 8. Incomplete pyloric obstruction Main signs & symptoms: 1. Hiccup 2. Nausea 3. Dry heaves 4. A tender 5. Red tongue 6. A thready rapid or vacuous rapid pulse Contraindications: 1. Do not use for hiccup or vomiting due to replete heat. 2. Do not use for hiccup or vomiting due to vacuity cold. Formula explanation: Within this formula, Orange Peel and Caulis Bambusae are the sovereign medicinals. Orange Peel moves the qi and harmonizes the stomach, thus stopping hiccup. Caulis Bambusae clears heat and quiets the stomach, thus stopping hiccup. They are both used in relatively large amounts in this formula. Ginseng supplements the qi and supports the righteous. When combined with Orange Peel, these two both move and supplement the center. Fresh Ginger harmonizes the stomach and stops vomiting. Combined with Caulis Bambusae, these two clear but also warm the center. Ginseng and Ginger are the minister medicinals in this formula. Licorice and Red Dates assist Ginseng in boosting the qi and harmonizing the stomach. Being regulating medicinals, they are the assistants and messengers within this prescription. Taken as a whole, this formula supplements stomach vacuity, clears stomach heat, and downbears stomach counterflow. Thus it supplements with causing stagnation and clears with causing cold. It is appropriate to use when there is both stomach vacuity and heat causing hiccup, vomiting, and dry heaves. Additions & subtractions: Xia). ai Dong) and Herba Dendrobii (Shi Hu). Littoralis (Sha Shen), Rhizoma Phragmitis Communis (Lu Gen), and Folium Eriobotryae Japonicae (Pi Pa Ye).

or no concomitant qi vacuity, subtract Ginseng. Ling), Rhizoma Pinelliae Ternatae (Ban Xia), Tuber Ophiopogonis Japonicae (Mai Dong), and Folium Eriobotryae Japonicae (Pi Pa Ye). This results in Ji Sheng Ju Pi Zhu Ru Tang (Aiding Life Orange Peel & Caulis Bambusae Decoction). Diospyros (Shi Di). This results in Xin Zhi Ju Pi Zhu Ru Tang (Newly Processed Orange Peel and Caulis Bambusae Decoction). Comment: For the treatment of morning sickness, this decoction can be given by drops on the tongue throughout the day.

Gui Zhi Fu Ling Wan (Cinnamon Twigs & Poria Pills) Ramulus Cinnamomi Cassiae (Gui Zhi) Sclerotium Poriae Cocos (Fu Ling) Cortex Radicis Moutan (Dan Pi) Radix Rubrus Paeoniae Lactiflorae (Chi Shao) Semen Pruni Persicae (Tao Ren) Mel (Feng Mi) Functions: Quickens the blood and transforms stasis, relaxes and disperses concretions and lumps Indications: Static blood retained and binding in the uterus, menstrual pain, fetal stirring restlessness, leaking precipitation which does not stop. Dysmenorrhea, uterine myomas, cervical erosion, ovarian cysts, chronic salpingitis, chronic pelvic inflammatory disease, endometriosis, lochioschesis Main signs & symptoms: Lower abdominal or menstrual pain which refuses pressure, dark, purplish, black menstrual blood, possible blood clots, palpable lumps within the abdomen, a dark or purplish tongue, possible static spots or macules, and a fine, bowstring, possibly choppy pulse Contraindications: Use with care and only when warranted during pregnancy. Dosage: 8 pills three times per day Formula explanation: Within this formula, Cinnamon Twigs and Poria are the sovereign ingredients. Cinnamon Twigs warm and free the flow of the blood vessels, while Poria percolates, disinhibits, and moves downward at the same time as boosting the qi of the heart and spleen. Hence they assist each other to move static blood and also disinhibit and quiet the fetal source. Because concretion lumps, an enduring depression, are often able to transform heat, Red Peony and Moutan are combined with Persica in order to transform static blood at the same time as clear stasis heat. These are the minister and assistant medicinals in this formula. By making these pills with honey, this also moderates and harmonizes the power of the blood-dispelling medicinals, thus moderating their dispersing effect. Therefore, honey is the messenger medicinal. When all these medicinals are used together, their effect is to quicken the blood and transform stasis and moderately disperse concretions and lumps. Comments: This formula is quite sophisticated even though it is not a large one. It recognizes that there can be lower burner cold at the same time as stasis heat. It also recognizes that blood and fluids travel together, concretions are often associated with phlegm dampness, and the spleen is the root of phlegm engenderment. That being said, this formula should usually be combined with other formulas, and especially if there are actual abdominal masses. For instance, the clinical symptoms of uterine myomas are often only fatigue, lower abdominal heaviness, persistent vaginal discharge, and low back pain. In that case, this medicine would need to be combined with Bu Zhong Yi Qi Wan (Supplement the Center & Boost the Qi Pills) and Ba Ji Yin Yang Wan (Morinda & Epimedium Pills). In China, concretions and conglomerations tend to be treated with very large doses of water-decocted, bulkdispensed Chinese medicinals. However, abdominal masses typically only shrink very slowly. Therefore, the Chinese medical treatment of conditions such as uterine fibroids may take 12-36 months! In such cases, it may make more sense to use ready-made medicines in the form of pills. Since physical results in such cases only come slowly and grudgingly, persistence in treatment may be more important than large doses. Nevertheless, it is probable that the standard dose on the bottle will have to be increased.

Wen Jing Tang Wan (Warm the Menses Decoction Pills) cooked Radix Rehmanniae (Shu Di) Fructus Evodiae Rutecarpae (Wu Zhu Yu) Radix Angelicae Sinensis (Dang Gui) Radix Albus Paeoniae Lactiflorae (Bai Shao) Radix Panacis Ginseng (Ren Shen) Rhizoma Pinelliae Ternatae (Ban Xia) Ramulus Cinnamomi Cassiae (Gui Zhi) Cortex Radicis Moutan (Dan Pi) Radix Glycyrrhizae (Gan Cao) Radix Ligustici Wallichii (Chuan Xiong) Tuber Ophiopogonis Japonici (Mai Dong) uncooked Rhizoma Zingiberis (Sheng Jiang) Gelatinum Corii Asini (E Jiao) Functions: Warms the channels (or menses) and scatters cold, dispels stasis and nourishes the blood Indications: Chong and ren vacuity cold, static blood obstruction and stagnation, menstrual irregularities, leaking precipitating which will not stop. Functional uterine bleeding, primary dysmenorrhea, infertility, polycystic ovarian disease, chronic pelvic inflammatory disease, menopausal syndrome Main signs & symptoms: Early, late, or intermenstrual bleeding, leaking precipitation which will not stop, ceased menstruation which does not arrive, afternoon effusion of heat, vexatious heat in the hands and feet, dry lips and mouth, lower abdominal tenesmus, abdominal fullness Contraindications: This medicine is contraindicated in cases of abdominal masses exhibiting repletion patterns. Dosage: 8 pills three times per day Formula explanation: Within this formula, Evodia and Cinnamon Twigs are the sovereign medicinals. They warm the channels and/or menses and scatter cold, free the flow of and disinhibit the blood vessels. Dang Gui, Ligusticum Wallichium, and Peony quicken the blood and dispel stasis, nourish the blood and regulate menstruation. Moutan dispels stasis and frees the flow of the channels and/or menses at the same time as receding or abating vacuity heat. These are the minister medicinals. Donkey Skin Glue and Ophiopogon nourish yin and moisten dryness at the same time as clearing vacuity heat. Donkey Skin Glue is also able to stop bleeding. Ginseng and Licorice boost the qi and fortify the spleen. They insure that the blood has a source from which it can be engendered and which can contain and restrain the blood within its vessels. The two vessels of the chong and ren connect with the foot yang ming stomach channel. Pinellia is able to free the flow of and downbear the stomach qi as well as scatter nodulation. This assists in the dispelling of stasis and regulation of menstruation. Uncooked Ginger warms the stomach qi in order to assist engenderment and transformation. These are all the assistant medicinals. Licorice is simultaneously a messenger medicinal since it also is able to regulate and harmonize all the other medicinals. When all these medicinals are used together, they warm the channels (or menses) and free the flow of the vessels, nourish the blood and dispel stasis. Hence static blood is removed, new blood is engendered, vacuity heat is dispersed, the menstruation is regulated, and the disease is automatically resolved. Comments: This is another complex and sophisticated formula. It treats blood stasis in the lower burner accompanied by vacuity cold, vacuity heat, spleen and blood vacuity, and phlegm nodulation. Originally it was created to treat menopausal uterine bleeding. It takes into account that womens spleens typically get vacuous and weak from their mid-30s to menopause. After menopause, if the change has gone correctly and is entirely complete, the spleen and kidneys can recuperate themselves. Because menopausal conditions often include signs and symptoms of kidney yang vacuity and not just spleen vacuity, one may choose to combine this medicine with Bai Ji Yin Yang Wan (Morinda & Epimedium Pills). If there are more prominent symptoms of yin vacuity/vacuity heat, then it may be combined with Da Bu Yin Wan (Greatly Supplementing Yin Pills)

Xue Fu Zhu Yu Tang Wan (Blood Mansion Dispel Stasis Decoction Pills). Semen Pruni Persicae (Tao Ren) Flos Carthami Tinctorii (Hong Hua). Radix Angelicae Sinensis (Dang Gui) uncooked Radix Rehmanniae (Sheng Di) Radix Ligustici Wallichii (Chuan Xiong) Radix Rubrus Paeoniae Lactiflorae (Chi Shao) Radix Achyranthis Bidentatae (Niu Xi) Radix Platycodi Grandiflori (Jie Geng) Radix Bupleuri (Chai Hu) Fructus Citri Aurantii (Zhi Ke) Radix Glycyrrhizae (Gan Cao) Functions: Quickens the blood and dispels stasis, moves the qi and stops pain Indications: Blood stasis in the chest, blood not moving smoothly. Coronary heart disease, angina pectoris, rheumatic heart disease, intercostal neuralgia, costochondritis, functional neurosis, post-concussion syndrome, migraine, trigeminal neuralgia, external injury to the chest, irregular menstruation, dysmenorrhea, menopausal syndrome, cerebral hemorrhage, hypertension, cor pulmonale, and urticarial Main signs & symptoms: Chest pain, headache which does not heal for many days, pain like a needle prick, possible hiccup for many days which will not stop, a choking sensation when drinking water, dry heaves, internal heat and oppression, possible heart palpitations, possible inability to sleep at night or ones sleep is not quiet, tension, agitation, easy anger, tidal fever, a dark red tongue, possible static patches or spots on the tongue, dark lips or dark around the eyes, and a choppy3 or bowstring, tight pulse Contraindications: 1. Do not use unwarrantedly during pregnancy. 2. Do not use for uterine bleeding or other hemorrhagic disorders. Dosage: 5 pills three times per day Formula explanation: Within this formula, Tao Hong Si Wu Tang (Persica & Carthamus Four Materials Decoction, i.e., Dang Gui, Ligusticum Wallichium, Peony, Rehmannia, Persica, and Carthamus) quickens the blood, transforms stasis, and also nourishes the blood, while Si Ni San (Four Counterflows Powder, i.e., Bupleurum, Aurantium, Peony, and Licorice) moves the qi, harmonizes the blood, and soothes the liver. Platycodon opens the lung qi and guides the other medicinals upward. Combined with Aurantium, these two upbear and downbear the qi of the upper burner and loosen 3 Wiseman has changed his translation of se mai to rough pulse. We are sticking with choppy in order to remain consistent with our other Blue Poppy books which use this term. the chest. Achyranthes frees the flow of and disinhibits the blood vessels and leads the qi to move downward. Taken as a whole, this formula quickens the blood and moves the qi, transforms phlegm and disperses heat while it also resolves depression of the liver.

C. Sheng Hua Tang (Engendering & Transforming Decoction) Composition: 1. Radix Angelicae Sinensis (Quan Dang Gui) 25g 2. Rhizoma Ligustici Wallichii (Chuan Xiong) 9g 3. Semen Pruni Persicae (Tao Ren) 6g remove the skin and tip 4. Dry Rhizoma Zingiberis (Gan Jiang) 2g blast-fried till blackened 5. Radix Glycyrrhizae (Gan Cao) 2g mix-fried Method of preparation: Decoct with rice wine, rice wine and water, or simply water. Functions: Quickens the blood and transforms stasis, warms the channels and stops pain Indications: 1. Postpartum blood vacuity contracting cold 2. Retention of lochia 3. Retention of placental fragments 4. Numerous other postpartum complaints associated with malign blood retained in the lower abdomen and then possibly thrusting here and there 5. Chronic endometritis 6. Trichomonas vaginitis Main signs & symptoms: 1. Retention of lochia 2. Lower abdominal chilly pain which dislikes pressure 3. Dark purplish lochia containing clots 4. A pale purplish tongue with possible static patches or spots 5. A fine deep choppy pulse Contraindications: 1. Do not use during pregnancy. 2. Do not use for hemorrhagic disorders. 3. Do not use in cases of blood stasis due to heat in the blood. Formula explanation: Within this formula a large dose of Dang Gui is the sovereign medicinal. It supplements and activates the blood, transforms stasis and generates new (i.e., new blood). Ligusticum quickens the blood and moves the qi. Persica quickens the blood and dispels stasis. These are the two minister medicinals. Blast-fried Ginger enters the blood and scatters cold, warms the channels and stops pain. Rice Wine warms and opens the blood vessels, thus assisting the power of the other medicinals. Mix-fried Licorice regulates and harmonizes all these other medicinals and is the messenger medicinal in this prescription. Together, this formula nourishes the blood and transforms stasis, warms the channels and stops pain. It helps the lochia move smoothly and also cures lower abdominal chilly pain. Additions & subtractions:

(Rou Gui). d, add Shi Xiao San (Loss of Smile Powder), see above, and Rhizoma Corydalis Yanhusuo (Yan Hu). Yanhusuo (Yan Hu), and Herba Leonuri Heterophylli (Yi Mu Cao). If the lochia is almost finished or the pain associated with the lochia is mild, subtract Persica.

(Huang Qi). s, subtract blast-fried Ginger and add Radix Rubrus Paeoniae Lactiflorae (Chi Shao) and Cortex Radicis Moutan (Dan Pi). Shen), Cortex Radicis Moutan (Dan Pi), and Radix Rubrus Paeoniae Lactiflorae (Chi Shao) to quicken the blood and recede fever. , pain in the lower abdomen, a purple tongue, and a choppy pulse, subtract Licorice and add Herba Lycopi Lucidi (Ze Lan) to quicken the blood and dispel stasis.

Peach Pit Decoction to Order the Qi Tao he cheng qi tang This is one in the family of formulas that order the qi as a meam of expelling accumulation and s h i s . It is named after one of its chief ingredients, Semen Penicae (tao ren) orpeach pit. Source: Discussion of Cold-induced Disorders (Shang han lun) Semen Persicae (tao ren). 50 pieces (12-15g) Radix et Rhizoma Rhei (da huang) 12 Ramulus Cinnamomi Cassiae (gui zhi) 6g Mirabilitum (mang xiao) [add to strained decoction] 6g Honey-fried Radix Glycyrrhizae Uralensis (zhi gun cao) 6g Preparation: Decoction. The source text advises to bring the strained decoction to a boil after adding the Mirabilitum (mang xiao). This is rarely done today. Wine-treated Radix et Rhizoma Rhei (jiu zhi da huang) is often used to accentuate the blood invigorating action of the formula. Actions: Drains heat and breaks up blood stasis. INDICATIONS: Acute lower abdominal pain, incontinence of urine, night fevers, delirious speech, irritability, restlessness and thirst, and a submerged, full, or choppy pulse. In severe cases there may be manic behavior. Women will usually experience dysmenorrhea or amenorrhea. This is blood buildup (xi xu;) in the lower burner which is caused by the accumulation of blood stasis and heat. The source text attributes this condition to the transmission of an externally-contracted pathogenic influence into the lower burner. The static blood and heat obstruct the lower burner and cause acute lower abdominal pain. The buildup of blood disturbs the lower burner and disrupts the normal function of the Bladder qi such that urine is not properly stored, but becomes incontinent. Because the heat is in the blood level, but not the qi level, the feverishness occurs at night. The Heart rules the blood and is the organ from which the clarity of spirit emanates. Here the retained heat rises and disturbs the spirit, producing abnormal and chaotic manifestations of the spirit such as delirious speech, irritability, restlessness, and thirst, or in more severe cases, manic behavior. Moreover, the accumulation and stasis of blood in the lower abdomen inhibits blood circulation and causes amenorrhea or dysmenorrhea in women. ANALYSIS OF FORMULA: The chief ingredients are Semen Persicae (tao ren), which breaks up and eliminates blood stasis, and Radix et Rhizoma Rhei (da huang), which attacks and purges accumulations and cleanses pathogenic heat. By attacking the blood stasis and guiding it out of the body, the pathogenic heat is left without anything to which it can attach, and is thereby more easily cleansed or washed away. The ability of the deputy ingredient, Ramulus Cinnamomi Cassiae (gui zhi), to warm the sinews, unblock the vessels, and dispel retained blood from the lower burner effectively unblocks the circulation of blood in the vessels, and assists Semen Persicae (tao ren) in breaking up and eliminating blood stasis. One of the assistants, Mirabilitum (mang xiao), softens areas of hardness and dispels accumulation. This helps Radix et Rhizoma Rhei (da huang) in moving the stool, draining heat, and eliminating blood stasis. Serving as both an assistant and envoy, honey-fried Radix Glycyrrhizae Uralensis (zhi gun cao) protects the Stomach and calms the middle burner by moderating the harsh properties of the other ingredients in the formula. COMMENTARY: This is a modification of Regulate the Stomach and Order the Qi Decoction (tiao wei cheng qi tang), which is also listed in the Discussion of Cold-induced Disorders. There the formula is discussed in the context of a failure to release an externally-contracted pathogenic influence from the greater yang stage, resulting in its transmission to the Bladder, which is the organ connected with the greater yang channel in the lower burner. In the course of its transmission to the Bladder, it is transformed into heat, and accumulates with blood stasis. This leads to blood buildup in the lower burner. In this situation, the source text tells us, there are three possibilities: 1) if the blood descends (either of its own accord or following treatment), then the heat will follow the blood and there will be recovery; 2) if the exterior has not been released one should not proceed to purge, but must first release the exterior; 3) if the exterior has been released, but there is still acute clumping (and pain) in the lower abdomen, then one

may purge. It is the third scenario for which this formula is indicated. There has been much debate concerning which form of cinnamon should be used in this formula. The source text prescribes Ramulus Cinnamomi Cassiae (gui zhi), which has also been the choice of such noted physicians as Cheng Wu-Ji in the twelfth century, and Yu Chang in the seventeenth century, because its acrid, dispersing qualities unblock the blood vessels. However, other notables, such as the Ming-dynasty physician Wang Ken-Tang, insisted that Cortex Cinnamomi Cassiae (rou gui) was more appropriate for treating problems of the lower burner. Today the vast majority of practitioners use Ramulus Cinnamomi Cassiae (gui zhi). When diagnosing this condition in the clinic, look for several distinguishing characteristics: the abdominal symptoms are acute and there is fixed pain that increases with pressure (usually in the lower abdomen); if the spirit is disturbed, it will manifest as delirious speech or manic behavior; the urinary symptom will be one of incontinence; if there is bleeding, the blood will be very dark purple with clots; the tongue has dark purple spots; and the pulse is submerged and choppy. More recently this formula has also been used in treating other disorders which involve the accumulation of heat and blood stasis leading to clumping. These include traumatic injury with intractable pain or difficulty in passing urine or stool; pain and distention of the head, red eyes, and toothache which results from blood stagnation due to the presence of vigorous fire; nosebleeds, vomiting, or coughing up blood due to reckless movement of hot blood; gynecological disorders such as amenorrhea, irregular menstruation, dysmenorrhea, and lochioschesis; fixed, lower abdominal pain; and severe wheezing and distention of the chest. With the appropriate presentation, this formula may be used in treating such biomedicdy-defined disorders as acute endometritis, retained placenta, pelvic inflammatory disease, and intestinal obstruction. CAUTIONS & CONTRAINDICATIONS: Contraindicated during pregnancy. If there are still exterior symptoms, the exterior should first be released before using this formula.

Dan Shen Yin Wan (Salvia Drink Pills) Radix Salviae Miltiorrhizae (Dan Shen) Lignum Santali Albi (Tan Xiang) Fructus Amomi (Sha Ren) Functions: Quickens the blood and dispels stasis, moves the qi and stops pain Indications: Chest impediment due to blood stasis and qi stagnation. Angina pectoris, coronary artery disease Main signs & symptoms: Chest pain which is fixed in location and severe or stabbing and, if severe, the pain may radiate down the left arm, a purple tongue or possible static spots or macules on the tongue or distended, tortuous veins under the tongue, and a bowstring, fine, deep, and/or choppy pulse Dosage: 8 pills three times per day Formula explanation: Salvia is the sovereign medicinal in this formula. It quickens the blood and dispels stasis, entering the heart, pericardium, and liver channels. Sandalwood is the minister medicinal. It moves the qi and stops pain, especially chest pain. Amomum also moves the qi. However, it additionally transforms dampness and downbears counterflow. Comments: This medicine can be used for the symptomatic relief of chest pain due to qi stagnation and blood stasis. However, it can also be combined with other Chinese ready-made medicines whenever chest pain is a part of a more complicated scenario. Although Salvia mainly quickens the blood, it does also have some ability to supplement the heart. Likewise, although Amomum mainly moves and rectifies the qi, it does also fortify the spleen.

Jiao Ai Tang (Donkey Skin Glue & Mugwort Decoction) Radix Ligustici Wallichii (Chuan Xiong) Gelatinum Corii Asini (E Jiao) Folium Artemisiae Argyii (Ai Ye) Radix Glycyrrhizae (Gan Cao) Radix Angelicae Sinensis (Dang Gui) Radix Albus Paeoniae Lactiflorae (Bai Shao) dry Radix Rehmanniae (Gan Di Huang) Functions: Supplements the blood and stops bleeding, regulates menstruation and quiets the fetus Indications: Womens chong and ren vacuity detriment, flooding and leaking, excessively profuse menstruation, vaginal bleeding during pregnancy. Functional uterine bleeding, threatened miscarriage, post-partum uterine bleeding, bleeding peptic ulcers, bleeding hemorrhoids Main signs & symptoms: Excessive menstruation, flooding and leaking, dribbling and dripping which will not stop, post-partum precipitation of blood which will not stop, precipitation of blood during pregnancy, aching and pain within the abdomen, pale-colored, thin consistency blood without clots, low back soreness and weakness, a dull, lusterless complexion, a pale tongue with thin, white fur, and a fine, weak pulse Dosage: 4 tablets three times per day Formula explanation: Within this formula, Donkey Skin Glue supplements the blood and stops bleeding, while Mugwort warms the channels and stops bleeding. These two medicinals are also essential medicinals for regulating menstruation and quieting the fetus, treating flooding and stopping leaking. They are the sovereign medicinals in this formula. Cooked Rehmannia, Dang Gui, Peony, and Ligusticum Wallichium (the so-called Four Materials) supplement the blood and regulate menstruation. They are also able to quicken the blood and regulate the blood. They are in order to prevent discharge of the blood enduring for days resulting in retained blood. They are both minister and assistant medicinals. Licorice regulates and harmonizes all the other ingredients in this formula. When combined with Donkey Skin Glue, it also has a tendency to stop bleeding. When combined with Peony, it is able to relax urgency (i.e., cramping) and stop pain. When all these medicinals are used together, they mainly supplement the blood and stop bleeding. However, they simultaneously regulate menstruation and quiet the fetus.

Huai Hua San (Sophora Japonica Flower Powder) Source: Ben Shi Fang Huai Hua (Sophorae flos) 12 g Ce Bai Ye (Platycladi cacumen) 12 g Jing Jie Sui (Schizonepetae flos) 6 g Zhi Ke (Aurantii fructus) 6 g Analysis of the formula This formula can cool the intestines, stop bleeding, disperse wind and regulate Qi. In this way it treats intestinal wind syndrome that is caused by windheat or damp-heat accumulation in the intestines that blocks the Qi and injures the blood vessels. The manifestations are fresh red blood before or after defecation, blood in the stool, bleeding due to hemorrhoids, a red tongue and a wiry and rapid pulse. The sign of wind in the intestines is quick-spreading blood drops before defecation. In this formula: The fragrant Huai Hua is used as chief. It can regulate and ascend the Qi, clear the heat, cool the blood and stop bleeding in the intestines. Ce Bai Ye, as deputy, helps Huai Hua to cool the blood and stop bleeding. It can also promote wound healing and relieve pain. Jing Jie Sui, as assistant, can disperse the restrained Qi and heat in the intestines and stop bleeding. Zhi Ke, which serves as assistant to Jing Jie Sui and Huai Hua, regulates the Qi in the intestines to calm the wind and reduce the tension. Commentary on strategies This formula suggests several strategies. When the bleeding manifests in the lower part of the body, herbs that move upwards should be selected in the formula. Herbs that clear heat and herbs that disperse heat should be used together. When heat disturbs the blood, light and gentle herbs should be selected to ascend the clear Qi and disperse the constrained heat and Qi without the likelihood of the blood being forced to move. When the herbs fulfill these conditions, the wind calms down and the bleeding in the intestines stops. Although there are only four herbs in the formula, each has more than two functions or properties to suit the syndrome. It is a perfect example of herb selection.

Coptis and Ass-Hide Gelatin Decoction Huang lian E jiao Tang Source: Discussion of Cold-induced Disorders (Shang han lun) Rhizoma Coptidis (huang lian) 12 Radix Scutellariae (huang qin).6g Gelatinum Corii Asini (e jiao) [dissolve in strained decoction] 9g Radix Paeoniae (shao yao) 6g Egg yolks (ji zi huang [stir into strained decoction] 2 yolks Preparation: Decoction. Today Radix Paeoniae Lactiflorae (bai shao) is the form of Radix Paeoniae (shao yao) used, and the dosage of Rhizoma Coptidis (huang lian) is usually reduced by one-third to onehalf. Available in prepared form. Actions: Enriches the yin, causes fire to descend, eliminates irritability, and calms the spirit. INDICATIONS: Irritability with a sensation of heat in the chest, insomnia, palpitations with anxiety, a red tongue with a dry, yellow coating, and a thin, rapid pulse. There may also be sores of the tongue or mouth. This is fire from yin deficiency in the aftermath of a febrile disease. The externally-contracted heat has not been fully cleared from the body, and the yin fluids are injured. From the perspective of the six stages of disease, this is a lesser yin-stage disorder. The internal heat scorches the yin and fluids. This not only causes signs of yin deficiency with heat (red tongue with a dry, yellow coating and a thin, rapid pulse), but also prevents the Kidneys (lesser-yin water) from properly controlling the Heart (lesser-yin fire), a form of disharmony between the Heart and Kidneys. This leads to a sensation of heat in the chest and symptoms of a disturbed spirit: palpitations with anxiety, irritability, and insomnia that results from the inability of the patient to calmly lie down. Sores of the mouth and tongue are also a sign of heat in the Heart. ANALYSIS OF FORMULA: The chief ingredients are Rhizoma Coptidis ( h a n g lian) and Radix Scutellariae (huang qin), which directly clear fire from the Heart and thereby calm the spirit, together with Gelatinum Corii Asini (e jiao), which indirectly controls the Heart fire by nourishing the Kidney yin. The deputy ingredient, egg yolk ( j i zi hang), with its combined functions of draining fire and generating blood, aids both the chief ingredients. The assistant, Radix Paeoniae Lactiflorae (bai shao), assists Gelatinum Corii Asini (e jiao) in enriching and retaining the yin to harmonize the functions of the Heart and Kidneys. COMMENTARY: The scope of this formula has been expanded to include heat in the blood level with dysenteric disorders due to heat toxin. Both this formula and Sour Jujube Decoction (suan zao ren tang) are used in treating irritability and insomnia. Comparing the indications of these formulas in their source texts, the differences between them becomes clear. Coptis and Ass-Hide Gelatin Decoction (huan lian e jiao tang) is actually for irritability when the patient is unable to lie down, i.e., when he is so irritable that he cannot even tolerate lying in bed. This is due to the yang not entering the yin, and the treatment strategy focuses on clearing fire from the Heart and enriching the Kidney yin. Sour Jujube Decoction (suan zao ren tang) is for irritability with insomnia in which the patient is able to lie in bed, but cannot sleep. This occurs when deficient Liver blood is unable to nourish the Heart, and the treatment strategy focuses on nourishing the Liver. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as neurasthenia, the recuperative stage of an infectious disease, apthous ulcers, and dysentery.

Licorice, Wheat, and Jujube decoction Gan Mai Da Zao Tan Radix Glycyrrhizae Uralensis (gan cao).9g Semen Tritici Aestivi Levis (fu xiao mai).9-15g Fructus Zizyphi Jujubae (da zao)..l0 pieces Preparation: Decoction. Available in prepared form. Actions: Nourishes the Heart, calms the spirit, and harmonizes the middle burner. INDICATIONS: Disorientation, frequent attacks of melancholy and crying spells, inability to control oneself, restless sleep (sometimes with night sweats), frequent bouts of yawning, a red tongue with a sparse coating, and a thin, rapid pulse. In severe cases, the behavior and speech become abnormal. This is called restless organ disorder (z* zho), an emotional condition that is generally attributed to excessive worry, anxiety, or pensiveness. This injures the Heart yin, disrupts the flow of Liver qi, and also affects the Spleen qi. Such patients have often suffered recent or recurring blood loss, which can further injure the blood and qi, as well as the Liver yin (especially in patients with chronic frustration). When the substantive aspect (yin) of the Heart is injured, the spirit has nowhere to dwell. Not only is the cause of this disorder primarily emotional, its manifestations are also of an emotional nature. In its early stages, the patient is mentally disoriented, anxious, impulsive, and suffers from fitful sleep. During attacks, the patient feels extremely upset or depressed to the point of uncontrollable crying, manic behavior, or severe disorientation. The Heart deficiency combined with Liver constraint produces a 'lost soul' with frequent attacks of unusual behavior, especially those relating to a loss of self-control (crying, yawning, etc.) One explanation for the yawning is that it reflects the frustrated attempt of the yang (which has been almost extruded from the body due to deficiency of the yin) to reintegrate with the body. The insomnia and night sweats, red tongue with a sparse coating, and the thin, rapid pulse reflect the internal dryness and deficient yin that underlie this disorder. ANALYSIS OF FORMULA: The chief herb, Semen Tritici Aestivi Levis (fu xiao mai), regulates and nourishes the qi and yin of the Heart. The Heart is the 'child' of the Liver in the generation cycle of the five phases. Because the child should be able to secure the situation of the mother, the eventeenth-century physician, Miao Xi-Yong, noted in his Commentary of the Divine Husbandman's Classic of the Materia Medica that this herb also nourishes the Liver, which here helps calm the spirit. The deputies are Radix Glycyrrhizae Uralensis (gan cao), which nourishes the Heart and harmonizes the middle burner, and Fructus Zizyphi Jujubae (da zao), which augments the qi and moistens internal dryness. Together these herbs mildly tonify the Heart, Spleen, and Liver, and are very effective in treating this disorder. COMMENTARY: In the source text, this formula is discussed under the heading of women's disorders. There has been some discussion by later commentators about the meaning of 'organ' in the term restless organ disorder. Some, like the eighteenth-century author, You Zai-Jing, believed that it referred to the womb, and specifically to the deficiency of blood in that organ. However, this type of problem is also seen, if less frequently, in men. Others, such as You's contemporary, Wu Qian, believed that it referred to the Heart. Wu argued that when the Heart is tranquil, the spirit is properly stored, but when th'at organ loses its tranquility, the spirit becomes disorderly. This explanation fits more closely with the purpose of the formula, which focuses on the Heart. In fact, all of the yin organs can be involved depending on the specific case. Besides the Heart, the Spleen can be injured by overwork or excessive deliberation; fire from Liver constraint is often implicated in yin deficiency; and yin deficiency affects the Kidneys and Lungs. Note that while the source text mentions attacks of yawning as one of the indications for this formula, many modern practitioners believe that attacks of moaning or deep sighing occur more frequently in this type of case. The first mention of the treatment principle underlying this type of formula is found in Basic Questions (chapter 22): "When the Liver is in a bitter and urgent state, quickly eat sweet things to moderate it." This formula is an example of 'kitchen medicine' and is quite popular. Note that it should be taken longterm for the best effect. A peculiarity of this condition is that there is fire from deficiency (so that bitter herbs which drain fire are inappropriate), but the deficiency is not really

pronounced, and strong tonification is therefore unwarranted. The modern physician, Wu De-Xi, recommends that this formula not be limited to the treatment of restless organ disorder, but that it can be widely used in treating women's disorders as long as the diagnosis is one of yin deficiency of the Heart and Spleen. Among other conditions, he recommends it (with modifications) for menopausal syndrome, premenstrual syndrome, post partum palpitations, and severe sweating post partum. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as hysteria, neurosis, menopausal syndrome, autonomic dystonia, enuresis, and fever of unknown origin.

Zi Yang An Shen Ji (Enriching & nourishing spirit-quieting formulas). Representative formula: Suan Zao Ren Tang (Zizyphus Spinosa Decoction) Composition: 2. Semen Zizyphi Spinosae (Suan Zao Ren) 18g 3. Radix Glycyrrhizae (Gan Cao) 3g 4. Rhizoma Anemarrhenae (Zhi Mu) 9g 5. Sclerotium Poriae Cocos (Fu Ling) 9g 6. Rhizoma Ligustici Wallichii (Chuan Xiong) 3g Functions: Nourishes the blood and quiets the spirit clears heat and eliminates vexation Indications: 1. Vacuity taxation 2. Vacuity vexation 3. Inability to sleep 4. Insomnia 5. Nervous exhaustion 6. Night sweats 7. Poor memory 8. Nightmares 9. Rapid heart palpitations 10. Crying and irritability in teething infants 11. Neurasthenia 12. Schizophrenia Main signs & symptoms: 1. Heart palpitations 2. Night sweats 3. Dizziness and vertigo 4. Dry throat and mouth Formula explanation: Zizyphus Spinosa nourishes liver blood and is the ruling medicinal for quieting the heart spirit. Its assistant is Ligusticum which regulates and nourishes liver blood. Poria tranquilizes the heart and quiets the spirit. Anemarrhena supplements insufficiency of yin at the same time as clearing internal flaring of fire. Thus it has the functions of enriching and clearing simultaneously, and Licorice clears heat and harmonizes the other medicinals. Additions & subtractions: pale tongue and fine, wiry pulse, add Radix Codonopsis Pilosulae (Dang Shen) and Os Draconis (Long Gu). Zi Ren) and Fructus Schizandrae Chinensis (Wu Wei Zi). Ligustri Lucidi (Nu Zhen Zi), and Radix Albus Paeoniae Lactiflorae (Bai Shao). e yin vacuity with internal heat, add Radix Albus Paeoniae Lactiflorae (Bai Shao) and raw Radix Rehmanniae (Sheng Di). ai Dong) and Semen Biotae Orientalis (Bai Zi Ren). (Dan Shen), Cortex Albizziae Julibrissinis (He Huan Pi), and Caulis Polygoni Multiflori (Ye Jiao Teng).

Shen). Comment: Zizyphus Spinosa should be decocted before the other ingredients.

Xiao Feng San (Eliminate Wind Powder) Source: Wai Ke Zhong Zong Dang Gui (Angelicae sinensis radix) 3 g Sheng Di Huang (Rehmanniae radix) 3 g Fang Feng (Saposhnikoviae radix) 3 g Chan Tui (Cicadae periostracum) 3 g Zhi Mu (Anemarrhenae rhizoma) 3 g Ku Shen (Sophorae flavescentis radix) 3 g Hei Zhi Ma (Sesami semen nigricum) 3 g Jing Jie (Schizonepetae herba) 3 g Cang Zhu (Atractylodis rhizoma) 3 g Niu Bang Zi (Arctii fructus) 3 g Shi Gao (Gypsum) 3 g Gan Cao (Glycyrrhizae radix) 1.5 g Mu Tong (Mutong caulis)* 1.5 g Analysis of the formula This formula is able to expel wind, nourish the blood, clear heat and eliminate dampness. It is used for treating skin lesions that are caused by invasion and accumulation of wind, dampness and heat in the skin, subcutaneous region, muscles and blood, which are manifested as itchy and red skin rashes that weep after being scratched, a white or yellow tongue coating and a superficial and rapid pulse. In this formula: The pungent and dispersing Jing Jie, Fang Feng, Niu Bang Zi and Chan Tui are used as chief. They can directly expel wind and relieve itch. Cang Zhu, Ku Shen and Mu Tong are used as deputies. They can eliminate damp-heat from the body and treat itchy and weeping skin disorders. Among them, the bitter and warm Cang Zhu has a strong drying nature, particularly enters the Spleen meridians and can effectively eliminate dampness from the muscles; the bitter and cold Ku Shen enters the blood and can cool and regulate the blood so as to treat red skin lesions; Mu Tong, which is very bitter and cold, can clear heat and increase urination in order to eliminate damp-heat from the body. Shi Gao and Zhi Mu also serve as deputies. They can strongly clear heat, especially from the muscles, and are used when red rashes appear. Wind-heat easily injures the Yin and blood, and dryness of blood can make the itch worse. Dang Gui, Sheng Di Huang and Hei Zhi Ma are used as assistants to tonify the blood, nourish the Yin, cool the blood and moisten dryness so as to treat this condition. In addition, since the chief and deputies are drying in nature and can weaken the Yin and blood, these three herbs can reduce the side effects. Gan Cao is used as assistant and envoy to clear heat, remove toxins and harmonize the herbs in the formula. Commentary on strategies This formula contains the main treatment aspects for skin disorders, e.g. expel wind, eliminate dampness, clear heat, cool the blood and nourish Yin. As such, it is considered a principal formula to treat general conditions of common skin disorders. Since it treats many aspects, it is not very strong in action. It is often used for chronic conditions after varying the formula to generate clearer and stronger actions in one or two specific aspects to treat a specific syndrome.

Tian Ma Gou Teng Yin (Gastrodia and Uncaria Decoction) Source: Za Bing Zheng Zhi Xin Yi Composition Tian Ma (Gastrodiae rhizoma)** 9 g Gou Teng (Uncariae ramulus cum uncis) 12 g Shi Jue Ming (Haliotidis concha) 18 g Chuan Niu Xi (Cyathulae radix) 12 g Zhi Zi (Gardeniae fructus) 9 g Huang Qin (Scutellariae radix) 9 g Yi Mu Cao (Leonuri herba) 9 g Sang Ji Sheng (Taxilli herba) 9 g Du Zhong (Eucomniae cortex) 9 g Fu Shen (Poriae cocos pararadicis) 9 g Ye Jiao Teng (Polygoni multiflori caulis) 9 g Analysis of the formula This formula is able to pacify the Liver-wind, clear heat and invigorate blood. It is used for treating the common syndrome or chronic condition of Liverwind disturbance in a condition of Liver-Yin deficiency with Liver-Yang ascending. The main symptoms are headache, dizziness, irritability and insomnia. In this formula: Tian Ma, Gou Teng and Shi Jue Ming are used as chief. Tian Ma is sweet and neutral, and can effectively extinguish Liver-wind in a condition of deficiency of Liver-Yin and blood. Gou Teng is sweet and cold, and can strongly clear and reduce either excess heat or empty-heat of the Liver, thereby pacifying Liver-wind. These two herbs can accentuate each others therapeutic actions. Shi Jue Ming can clear Liver-heat, descend the Yang and benefit the vision. When these three substances are used together, they can effectively treat dizziness, headache, blurred vision, and tired and dry eyes. Zhi Zi and Huang Qin are used as deputies. They are bitter and cold, and can clear the heat of the Liver and in the Upper-Jiao. Because they have a descending tendency, they enhance the chief substances to descend the Yang of the Liver. They can also treat irritability, a bitter taste in the mouth and scanty urine due to Liver-heat. Yi Mu Cao and Chuan Niu Xi are used as assistants in the formula. They regulate, descend and clear the heat in the blood. Du Zhong and Sang Ji Sheng also serve as assistants. They enter the Liver and Kidney meridians, can tonify the Liver and Kidney, and therefore prevent the ascending of Liver-Yang and generation of Liver-wind. Ye Jiao Teng and Fu Shen are used as assistants too. They calm the mind and improve sleep. Moreover, Sang Ji Sheng and Ye Jiao Teng relax the tendons and nourish blood, and are particularly suitable for treating insomnia with a sensation of discomfort in the body that is caused by high tension of the muscles. Commentary on strategies This formula is used for treating a chronic, mild or common condition of Liver-Yang ascending and disturbance of Liver-wind. It is composed in a balanced way of descending Liver-Yang and extinguishing Liver-wind, together with tonifying the Liver and Kidney. It also considers the coexistence of Liver-heat that often disturbs sleep and brings an irritable mood. If comparing this formula with Zhen Gan Xi Feng Tang, the previous formula, in herb selection and dosage arrangement, an obvious difference can be found between treating a severe and acute condition and a common or chronic condition of Liver-Yang ascending with Liver-wind disturbance.

Minor Invigorate the Collaterals Special Pill Xiao Huo Lou Dan Source: Imperial Grace Formulary of the Tai Ping Era (Tai ping hui min he ji ju fang) Radix Aconiti Kusnezoffii Praeparata (zhi cao wu)180g Radix Aconiti Carmichaeli Praeparata (zhi chuan wu).180g Rhizoma Arisaematis (tian nun xing) . . . . . . . . .180g Myrrha(moyao) 66g Gummi Olibanum (ru xiang) 66g Lumbricus (di long) 1809. Preparation: Grind the ingredients into powder and form into pills with honey. Take twice a day in 3g doses on an empty stomach with wine or warm water. Actions: Invigorates the blood, unblocks the collaterals, dispels dampness, and transforms phlegm. INDICATIONS: Chronic pain, weakness, and numbness (especially in the lower extremities) due to windstroke. Also for fixed or migrating pain in the bones and joints with reduced range of motion due to windcold-damp painful obstruction. In both conditions, the symptoms are aggravated by cold. The tongue coating is white and moist. After the onset of wind-stroke, dampness, phlegm, and lifeless blood obstruct the channels and collaterals. This leads to persistent numbness and weakness in the extremities. In severe cases, the obstruction causes severe pain. Although its pathogenesis is quite different, wind-cold-damp painful obstruction presents with similar symptoms. The white, moist tongue coating reflects the presence of interior cold. ANALYSIS OF FORMULA: The chief ingredients, Radix Aconiti Kusnezoffii Praeparata (zhi cao wu) and Radix Aconiti Carmichaeli Praeparata (zhi chuan wu), are among the strongest herbs in the materia medica for warming the channels and dispersing cold and dampness. They are particularly effective in treating this type of disorder. The deputy, Rhizoma Arisaematis (tian nan xing), strongly expels wind and scours out phlegm. Two of the assistants, Myrrha (mo yao) and Gummi Olibanum (7u xiang), invigorate the blood and increase the flow in the channels. The other assistant, Lumbricus (di long), opens the collaterals and invigorates the blood. Wine serves as the envoy by strengthening the blood-invigorating action of the formula. COMMENTARY: Cold is the predominant pathogenic influence, and therefore pain is the predominant symptom in these patterns. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as hemiplegia after cerebrovascular accident, rheumatoid arthritis, osteoarthritis, and peripheral nervous disorders. CAUTIONS & CONTRAINDICATIONS: Because this formula is quite harsh, it should only be prescribed for individuals with a relatively strong constitution. It is contraindicated for patients with yin deficiency, or during pregnancy.

12.2 Ping Xi Nei Feng Ji (Levelling & extinguishing internal wind formulas) Representative formulas: A. Zhen Gan Xi Feng Tang (Settle the Liver & Extinguish Wind Decoction). Composition: 1. Radix Achyranthis Bidentatae (Huai Niu Xi) 30g 2. Haemititum (Dai Zhe Shi) 30g 3. Raw Os Draconis (Sheng Long Gu) 15g 4. Raw Concha Ostreae (Sheng Mu Li) 15g 5. Raw Plastrum Testudinis (Sheng Gui Ban) 15g 6. Raw Radix Albus Paeoniae Lactiflorae (Sheng Hang Yao) 15g 7. Radix Scrophulariae Ningpoensis (Yuan Shen) 15g 8. Tuber Asparagi Cochinensis (Tian Dong) 15g 9. Fructus Meliae Toosendan (Chuan Lian Zi) 6g 10. Raw Fructus Germinatus Hordei Vulgaris (Sheng Mai Ya) 6g 11. Herba Artemisiae Capillaris (Yin Chen) 6g 12. Radix Glycyrrhizae (Gan Cao) 4.5g Functions: Settles the liver and extinguishes wind, enriches yin and subdues yang Indications: 1. Liver/kidney yin deficiency 2. Liver yang ascendancy 3. Qi and blood counterflow and chaos 4. Wind stroke 5. Convulsions 6. Epilepsy 7. Cerebrovascular accident 8. Aphasia 9. Apraxia 10. Renal hypertension 11. Essential hypertension 12. Hypertensive encephalopathy 13. Arteriosclerosis 14. Arteriosclerotic heart disease 15. Hyperthyroidism 16. Premenstrual tension 17. Postpartum fever with spasms and convulsion 18. Glaucoma Main signs & symptoms: 1. Headache dizziness 2. Vertigo 3. Distention of the eyes 4. Tinnitus 5. Hot pain in the brain region 6. Vexatious heat within the heart 7. A facial color as if drunk (i.e. flushed) 8. Frequent belching 9. Inability to control the limbs of the body 10. Deviation of the eyes and mouth 11. If serious dizziness and vertigo leading to collapse 12. Loss of consciousness of human affairs

13. Essence spirit short and scant 14. Long wiry forceful pulse Contraindications: 1. Use with care and/or modification in patients with spleen vacuity. Formula explanation: Within this formula, Achyranthis restores the liver/kidney channels and conducts the blood to move downward. It also supplements and boosts the liver and kidneys. It is the sovereign medicinal in this prescription. Hematite, Dragon Bone, and Oyster Shell downbear counterflow and subdue yang. They settle and extinguish liver wind and are the minister medicinals. Plastrum Testudinis, Scrophularia, Asparagus, and White Peony enrich and nourish yin fluids. Thus they control yang hyperactivity. Artemisia Capillaris, Melia, and Malted Barley, when combined with the sovereign medicinal, clear and drain surplus of liver yang and out-thrust liver qi depression and stagnation. Thus these ingredients disinhibit liver yang by levelling, resolving, settling, and subduing. Licorice regulates and harmonizes all these other medicinals. Combined with Malted Barley, these two are also able to harmonize the stomach and regulate the center. These are the assistant and messenger medicinals. Additions & subtractions: Flos Chrysanthemi Morifolii (Ju Hua). Haliotidis (Shi Jue Ming). Chrysanthemi Morifolii (Ju Hua). ssive phlegm, subtract Licorice and Scrophularia and add bile-processed Rhizoma Arisaematis (Dan Nan Xing) and Bulbus Fritillariae Cirrhosae (Chuan Bei Mu). Officinalis (Shan Zhu Yu). and supplement the liver and kidneys. and Fructus Gardeniae Jasminoidis (Shan Zhi Zi). Zhi). Chaenomelis Lagenariae (Mu Gua) and Ramulus Uncariae Cum Uncis (Gou Teng). Teng), and Flos Chrysanthemi Morifolii (Ju Hua). Concha Haliotidis (Shi Jue Ming), Rhizoma Atractylodis (Cang Zhu), Pericarpium Citri Reticulatae (Chen Pi), Semen Pruni Persicae (Tao Ren), and Herba Agastachis Seu Pogostemi (Huo Xiang). iflorae (Chi Shao) and Radix Salviae Miltiorrhizae (Dan Shen).

Xiao Shi Dao Zhi Ji Dispersing Food, Conducting Stagnation Formulas Formulas within this category disperse food stagnation. Food stagnation may be due to either lack of discipline and regularity in eating, liver qi stagnation, or spleen/stomach vacuity with loss of promotion of transportation and transformation. Because stagnant food is a yin accumulation which obstructs the free flow of yang qi, this obstruction to the flow of qi may give rise to transformative heat. However, if there is spleen vacuity or over-eating cold, raw foods, food stagnation may also be complicated by cold. Representative formula: Bao He Wan (Protecting Harmony Pills) Composition: 1. Fructus Crataegi (Shan Zha) 12g 2. Massa Medica Fermentata (Shen Qu) 9g 3. Rhizoma Pinelliae Ternatae (Ban Xia) 9g 4. Sclerotium Poriae Cocos (Fu Ling) 9g 5. Pericarpium Citri Reticulatae (Chen Pi) 6g 6. Fructus Forsythiae Suspensae (Lian Qiao) 9g 7. Semen Raphani Sativi (Luo Bo Zi) 12g Functions: Disperses food and harmonizes the stomach Indications: 1. Food accumulation 2. Indigestion 3. Diarrhea 4. Abdominal pain 5. Gastrointestinal flu 6. Belching 7. Acute exacerbation of chronic gastritis 8. Hepatitis 9. Acute pancreatitis 10. Acute or chronic cholecystitis Main signs & symptoms: 1. Epigastric glomus 2. Fullness 3. Distention and pain 4. Acid eructations 5. Nausea on eating 6. Vomiting of undigested food 7. Possible diarrhea 8. A foul mouth odor 9. A thick slimy 10. Possibly yellow tongue coating 11. Slippery pulse Contraindications: 1. Do not use unmodified in case of spleen vacuity. Formula explanation: Within this formula Crataegus is the sovereign. It disperses food and drink accumulations and stagnation. In particular it disperses accumulations of meat and greasy, slimy substances. Massa Medica Fermentata disperses food and fortifies the spleen. It also transforms alcohol and eliminates accumulations of rotten food. Radish Seeds precipitate the qi and disperse food and particularly disperse accumulation of grains. These are the minister medicinals in this prescription. When used together, these three medicinals disperse all types of accumulated and stagnant food stuffs. The assistants, Pinellia and Orange Peel, move

the qi and transform stagnation, harmonize the stomach and stop vomiting. Poria fortifies the spleen and disinhibits dampness, harmonizes the center and stops diarrhea. Since food accumulations easily transform into heat, another assistant is added. Forsythia clears heat and scatters nodulation. When all these medicinals are combined together, food accumulation is transformed and the stomach qi is harmonized. Additions & subtractions: recae Catechu (Bing Lang). Shi), Radix Saussureae Seu Vladimiriae (Mu Xiang), and Cortex Magnoliae Officinalis (Hou Po). llow, the pulse is rapid and there is bad breath, add Radix Scutellariae Baicalensis (Huang Qin) and Rhizoma Coptidis Chinensis (Huang Lian). Lang). ch flu, add Caulis Perillae Frutescentis (Su Gen) and Herba Agastachis Seu Pogostemi (Huo Xiang). results in Da An Wan (Great Quieting Pills). on the head due to transformative heat, add Rhizoma Coptidis Chinensis (Huang Lian) fried in ginger juice. Rhizoma Coptidis Chinensis (Huang Lian), Semen Arecae Catechu (Bing Lang), and Fructus Immaturus Citri Seu Ponciri (Zhi Shi). Radix Scutellariae Baicalensis (Huang Qin), and Radix Puerariae Lobatae (Ge Gen). and easy anger, add Radix Bupleuri (Chai Hu), Tuber Curcumae (Yu Jin), Rhizoma Cyperi Rotundi (Xiang Fu), and Radix Albus Paeoniae Lactiflorae (Bai Shao).

B. Wan Dai Tang (Finish Abnormal Vaginal Discharge Decoction) Composition: 2. Rhizoma Atractylodis Macrocephalae (Bai Zhu) 30g earth stir-fried 3. Radix Dioscoreae Oppositae (Shan Yao) 30g 4. Radix Panacis Ginseng (Ren Shen) 6g 5. Radix Albus Paeoniae Lactiflorae (Bai Shao) 15g wine stir-fried 6. Semen Plantaginis (Che Qian Zi) 9g wine stir-fried 7. Rhizoma Atractylodis (Cang Zhu) 9g processed 8. Radix Glycyrrhizae (Gan Cao) 3g 9. Pericarpium Citri Reticulatae (Chen Pi) 1.5g 10. blackened Herba Seu Flos Schizonepetae Tenuifoliae (Hei Jing Jie) 1.5g 11. Radix Bupleuri (Chai Hu) 1.8g Functions: Supplements the center and fortifies the spleen, transforms dampness and stops vaginal discharge Indications: 1. Spleen vacuity/liver depression 2. Damp turbidity pouring downward 3. Abnormal vaginal discharge 4. Hemophilus vaginitis 5. Vulvitis 6. Cervical inflammation 7. Diarrhea 8. Edema during pregnancy 9. Edema during menstruation 10. Headache Main signs & symptoms: 1. Abnormal vaginal discharge which is colored white or pale yellow and is clear 2. Thin and without odor 3. An ashen 4. White facial color 5. Fatigue 6. Loose stools 7. A pale tongue with white coating 8. A relaxed/retarded or soggy weak pulse Contraindications: 1. Do not uses if the vaginal discharge is thick, dark yellow, contains blood, or is foul smelling and the patient has a yellow tongue coating and a wiry pulse. Formula explanation: In this formula, Ginseng, Atractylodis, and Dioscorea are the sovereign medicinals. They are all qi-supplementing, spleen-fortifying ingredients. Atractylodis is additionally able to dry dampness. Dioscorea simultaneously astringes the essence. Thus this combination helps to fortify the spleen and stop abnormal vaginal discharge. Atractylodis and Orange Peel dry dampness and transport the spleen. They aromatically move the qi. They enable the sovereign ingredients to supplement without causing stagnation. Plantago blandly percolates and disinhibits dampness. It helps remove water dampness via urination. These all are the minister medicinals. This combination of sovereign and minister medicinals stops abnormal vaginal discharge without retaining dampness and disinhibits dampness without damaging the righteous. White Peony soothes the liver and supports the spleen. Bupleurum upbears yang. They assist in assuring that damp qi is not flow downward into the interior. Schizonepeta enters the blood division, expels wind, overwhelms dampness, and thus stops vaginal discharge. These are the assistant medicinals. Licorice regulates these medicinals and harmonizes the center. Therefore, it is the messenger

medicinal in this formula. Additions & subtractions: (Tu Si Zi), and Radix Dipsaci (Xu Duan). Eucommiae Ulmoidis (Du Zhong), and Rhizoma Cibotii Barometsis (Gou Ji). (Ai Ye), Rhizoma Cyperi Rotundi (Xiang Fu), and Radix Linderae Strychnifoliae (Wu Yao). Vulgaris (Xiao Hui Xiang), and blast-fried Rhizoma Zingiberis (Pao Jiang). Rhizoma Cyperi Rotundi (Xiang Fu). Shuang), Cortex Cinnamomi (Rou Gui), Radix Morindae (Ba Ji Tian), and Os Sepiae Seu Sepiellae (Wu Zei Gu). Gu) and calcined Concha Ostreae (Duan Mu Li).

B. Si Shen Wan (Four Spirits Pills). Composition: 1. Semen Myristicae Fragrantis (Rou Dou Kou) 9g 2. Fructus Psoraleae Corylifoliae (Bu Gu Zhi) 12g 3. Fructus Schizandrae Chinensis (Wu Wei Zi) 9g 4. Fructus Evodiae Rutecarpae (Wu Zhu Yu) 6g 5. raw Rhizoma Zingiberis (Sheng Jiang) 3g 6. Fructus Zizyphi Jujubae (Da Zao) 5 pieces Functions: Warms and supplements the kidneys, astringes the intestines and stops diarrhea Indications: 1. Spleen/kidney vacuity cold 2. Chronic colitis 3. Chronic dysentery 4. Autonomic dystonia of the intestinal tract 5. Intestinal tuberculosis 6. Allergic colitis 7. Tabes dorsalis 8. Pancreatic dysfunction Main signs & symptoms: 1. Fifth watch diarrhea (i.e. cockcrow diarrhea) 2. No thought for food or drink 3. Prolonged diarrhea which will not heal 4. Abdominal pain 5. Low back soreness 6. Chilled extremities 7. Exhausted spirit 8. Lack of strength 9. A pale tongue 10. A deep slow forceless pulse Contraindications: 1. Do not use unmodified if there is stagnation or accumulation within the stomach and intestines. Formula explanation: In this formula, Psoralea is acrid and bitter and its nature is hot. It supplements the ming men and therefore is an essential medicinal for strengthening fire and boosting earth. It is the sovereign medicinal within this formula. Nutmeg warms the spleen and kidneys, astringes the intestines, and stops diarrhea. Evodia also warms the spleen and kidneys as well as scatters cold and eliminates dampness. These are the minister medicinals. Schizandra is a warming and astringing ingredient. Fresh Ginger scatters cold and moves water. Red Dates enrich and nourish the spleen and stomach. These are the assistant medicinals. Taken as a whole, this formula warms the spleen and kidneys, astringes the large intestine, and augments transportation and transformation. When these are accomplished, diarrhea automatically stops and the disease is completely cured. Additions & subtractions: Ma). Macrocephalae (Bai Zhu). dix Praeparatus Aconiti Carmichaeli (Fu Zi) and Cortex Cinnamomi (Rou Gui).

(Mu Xiang) and Fructus Foeniculi Vulgaris (Xiao Hui Xiang). with abdominal pain and nausea, add Li Zhong Wan (Rectify the Center Pills), i.e., Radix Panacis Ginseng (Ren Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), mix-fried Radix Glycyrrhizae (Zhi Gan Cao), and dry Rhizoma Zingiberis (Gan Jiang). Comment: The previous formula is for more pronounced spleen vacuity with relatively less kidney yang vacuity. This formula is for more pronounced kidney vacuity and less obvious spleen vacuity.

Exterior-securing, perspiration-stopping medicines Yu Ping Feng San Wan (Jade Windscreen Powder Pills). Radix Astragali Membranacei (Huang Qi) Radix Atractylodis Macrocephalae (Bai Zhu) Radix Ledebouriellae Divaricatae (Fang Feng) Functions: Boosts the qi, secures the exterior, and stops sweating Indications: Exterior vacuity spontaneous perspiration, easy contraction of wind evils. Upper respiratory tract infection, exacerbation of chronic bronchitis, mild bronchitis, especially in children, allergic rhinitis, hyperthyroid condition, autonomic dystonia Main signs & symptoms: Spontaneous sweating on slight or no movement, aversion to wind, recurrent or easy contraction of external wind evils, a pale white complexion, a pale tongue with white fur, and a floating, vacuous or soggy, soft pulse Dosage: 8 pills three times per day Formula explanation: Within this formula, Astragalus is the sovereign medicinal which boosts the qi and secures the exterior. Atractylodes is then the minister medicinal which fortifies the spleen and boosts the qi. It assists Astragalus by increasing its power of boosting the qi and securing the exterior. The combination of these two ingredients makes the qi effulgent and the exterior replete. Thus sweat is not able to be discharged externally and evils also cannot easily invade internally. The assistant medicinal is Ledebouriella. It mildly dispels any wind evils lodged in the exterior. Thus the combination of Astragalus with Ledebouriella insures that the exterior is secured but evils are not retained, the combination of Ledebouriella with Astragalus insures that evils are dispelled without damaging the righteous. Hence there is scattering within supplementation and supplementation within scattering. Comments: In modern clinical practice, this medicine is most commonly used during the remission stages between acute allergic or infectious episodes. In that case, it is usually used in combination with other supplementing medicines and formulas with the intention of preventing further acute attacks. These other medicines are typically either lung and spleen supplements, spleen and kidney supplements, or lung, spleen, and kidney supplements. For instance, this medicine is commonly combined with Bu Zhong Yi Qi Wan (Supplement the Center & Boost the Qi Pills) which supplement the lungs and spleen. This is based on the principle of treating the root during remission. During acute attacks or episodes, other more scattering and diffusing medicines are then used in order to emphasize treatment of the branch.

Essence-astringing, loss-stopping medicines Jin Suo Gu Jing Wan (Golden Lock Secure the Essence Pills) Semen Astragali Complanati (Sha Yuan Ji Li) Semen Euryalis Ferocis (Qian Shi) Stamen Nelumbinis Nuciferae (Lian Zi Xin) Os Draconis (Long Gu) Concha Ostreae (Mu Li) Semen Nelumbinis Nuciferae (Lian Zi) Functions: Supplements the kidneys and secures the essence Indications: Kidney vacuity and essence debility, seminal emission. Neurasthenia, premature ejaculation, myasthenia gravis Main signs & symptoms: Seminal emission, seminal discharge, lassitude of the spirit, loss of strength, aching and weakness of the four limbs, low backache, tinnitus, a pale tongue with white fur, and a fine, weak pulse Contraindications: 1. Do not use for seminal emission or urinary enuresis or incontinence due to damp heat in the lower burner. 2. Do not use alone for seminal emission due to heart and kidneys not interacting. Dosage: 8 pills three times per day Formula explanation: Within this formula, Semen Astragali is the sovereign medicinal. It supplements the kidneys and astringes the essence. Semen Nelumbinis and Euryales are the minister medicinals which assist the sovereign to supplement the kidneys and astringe the essence. This combination of sovereign and minister medicinals is mainly in order to supplement insufficiency. Stamen Nelumbinis, Dragon Bone, and Oyster Shell are all astringent, restraining, and constraining in nature. Their purpose is thus to astringe the essence, and they are the assistant medicinals in this formula. When all these ingredients are used together, they can astringe the external discharge of essence and fluids as well as supplement kidney essence insufficiency. Although it mainly secures and astringes, once seminal emission and seminal discharge are stopped, it goes on to treat the root by supplementing vacuity and securing the kidneys. Comments: This medicine can be used alone for the treatment of pediatric enuresis due to kidney qi immaturity and weakness manifesting as bed-wetting and frequent urination. In that case, there will be no particular signs of spleen qi vacuity nor of damp heat in the lower burner. Children suffering from enuresis are usually old enough to swallow pills. In that case, this is a cheap and easy cure. For the treatment of seminal emission, this medicine is usually combined with other Chinese ready-made medicines. This is because, in adults, kidney qi vacuity will usually also involve either yin vacuity, yang vacuity, or both. In that case, this medicine should be used in combination with yang-supplementing medicines, such as Jin Gui Shen Qi

Stabilize the Menses Pill Gu jin wan Source: Introduction to Medicine (Yi xue ru men) Plastrum Testudinis (gui ban).30g Radix Paeoniae Lactiflorae (bai shao) .30g Radix Scutellariae (huang qin) 30g Cortex Ailanthi (chun gen pi).21g Cortex Phellodendri (huang bai) 9g Rhizoma Cyperi Rotundi (xiang fu) 7.5g Preparation: Grind the ingredients into powder and form into pills with wine. Take 9g twice a day with warm water. May also be prepared as a decoction with a proportionate reduction in the dosage of the ingredients. Actions: Enriches the yin, clears heat, stops bleeding, and stabilizes the menses. INDICATIONS: Continuous menstruation or uterine bleeding that alternates between trickling and gushing of blood. The blood is very red and may contain darkpurple clots. Accompanying signs and symptoms include a sensation of heat and irritability in the chest, abdominal pain, dark urine, a red tongue, and a rapid, wiry pulse. This disorder arises when constraint of the Liver gives rise to heat, which disturbs the penetrating and conception vessels. When this occurs, the blood becomes hot and moves recklessly, which manifests either as continuous menstruation or uterine bleeding that alternates between trickling and gushing of blood. When bleeding is due to the reckless movement of hot blood, its color is very red. Heat from constraint tends to congeal the blood, so there may also be dark-purple clots. Liver heat disturbs the flow in the penetrating and conception vessels, which produces a sensation of heat and irritability in the chest, and abdominal pain. The dark urine, red tongue, and rapid, wiry pulse are characteristic of heat in the Liver. Yin deficiency usually precedes this disorder, and is aggravated by the loss of blood. ANALYSIS OF FORMULA: This type of heat from constraint is considered to be a form of heat from deficiency as it results in a loss of equilibrium between the yin and yang. The chief ingredients in the formula, Plastrum Testudinis (gui ban) and Radix Paeoniae Lactiflorae (bai shao), enrich the yin and nourish the blood. The former is particularly useful in treating heat symptoms associated with yin deficiency. The deputies are Radix Scutellariae (huang qin), which clears heat from the upper burner, and Cortex Phellodendri (hang bai), which clears heat from the lower burner, especially heat from deficiency. Together with the chief ingredients, they control the fire (yang) by fortifying the water (yin). xiang fu), is an acrid substance that regulates the qi and relieves the constraint of the Liver. It adequately addresses the constraint in this disorder, but does not disperse so much that the yin is further injured. The other assistant, Cortex Ailanthi (chun gen Pi), is an astringent substance that binds up the blood and prevents an abandoned disorder from developing, which is otherwise likely with long-term blood loss. It is considered to be of less importance than the other ingredients because if the heat is cleared and the yin is enriched, the blood will resume its normal movement in the channels, and the bleeding will stop of its own accord. The use of an astringent, binding substance only serves to hasten this effect. COMMENTARY: This type of uterine bleeding was first mentioned in Basic Questions (chapter 7 ) where it is attributed to "deficient yin and belligerent yang." The deficient yin aspect of this presentation is not obvious because it underlies the heat. However, as the composition of the formula reflects, addressing the yin deficiency is an essential part of the treatment. With the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as functional uterine bleeding and chronic pelvic inflammatory disease. MODIFICATIONS: For more severe yin deficiency characterized by menstruation that lingers on with scanty, red blood, malar flush, hot palms and soles, dry throat and mouth, a red tongue with little coating, and a thin, fast pulse, omit Radix Scutellariae (huang qin) and Rhizoma Cyperi Rotundi (xiang fu), and add Cortex Lycii Radicis (di gu pi) and Radix Rehmanniae Glutinosae Conquitae (shu di huang). + For severe

bleeding, add Radix Sanguisorbae Officinalis (di yu) and Herba Agrimoniae Pilosae (xian he cao). For yin vacuity night sweats, add Radix Astragali Membranacei (Huang Qi), Rhizoma Coptidis Chinensis (Huang Lian), Radix Scutellariae Baicalensis (Huang Qin), and Cortex Phellodendri (Huang Bai). This results in Dang Gui Liu Huang Tang (Dang Gui Six Yellows Decoction).

Dang Gui Liu Huang Tang (Tangkuei and Six Yellow Decoction) Dang Gui (Angelicae sinensis radix) 12 g Sheng Di Huang (Rehmanniae radix) 12 g Shu Di Huang (Rehmanniae radix praeparata) 12 g Huang Qin (Scutellariae radix) 12 g Huang Lian (Coptidis rhizoma) 12 g Huang Bai (Phellodendri cortex) 12 g Huang Qi (Astragali radix) 24 g Analysis of the formula This formula nourishes the Yin and reduces heat of the Kidney, and is used particularly to stop sweating caused by Yin deficiency with severe empty-heat. The severe empty-heat manifests as night sweats, a red face, dry lips, irritability, constipation, dark and scanty urine, a red tongue with a yellow coating and a rapid pulse. In this formula: Dang Gui, Sheng Di Huang and Shu Di Huang are used as chief herbs to tonify blood and Yin in order to treat the cause of the empty-heat. Huang Bai, Huang Lian and Huang Qin serve as deputies. They are used to clear the heat in the Lower-, Middle- and Upper-Jiao respectively, so as to powerfully control the heat and prevent further Yin consumption. Huang Qi, as assistant, tonifies the Qi, which is injured by the heat. It strengthens the exterior and therefore stops sweating. Commentary on strategies The composition is characterized by using two groups of herbs that nourish the Yin and reduce fire. These groups support each other in stopping the pathological change. Moreover, herbs that usually reduce excess fire, such as Huang Lian and Huang Qin, can be used to reduce the severe empty-heat when the heat is intense. However, they must be used in combination with Yin-tonifying herbs such as Sheng Di Huang and Shu Di Huang. These herbs should not be used long term in the process of reducing the intensive empty-heat. As soon as the heat is less strong, herbs that reduce the empty-heat and nourish the Yin should be used, such as Zhi Mu (Anemarrhenae rhizoma), and Han Lian Cao (Ecliptae herba).