Li zhong wan modifications

Li zhong wan

ren shen 9 bai zhu 9 gan jiang 9 zhi gan cao 9

386 When in sudden turmoil, there is headache, heat effusion, and generalized pain, if there is more heat and the patient desires to drink water, wu ling san governs; but if there is more cold and the patient does not drink water, li zhong wan governs.

This line discusses two different patterns. A wu ling san pattern and a li zhong wan pattern. Zhang ji wanted to make clear the difference between the two.

In a wu ling san pattern there will be more thirst with a desire to drink water. Wu ling san treats the failure of transformation of fluids due to cold of the tai yang bladder.

Li zhong wan treats the failure of transformation of fluids due to cold in the middle. The middle is earth and this is the area of the stomach and spleen. In this pattern fluids are still being transformed by the tai yang bladder so there is no thirst, or very little.

Li zhong wan brings yang qi to the interior with gan jiang and bai zhu.

Wang Bing, All yang, where magnificent, is tai yang.

Tai yang opens and yang ming closes. This illustrates the normal function of yang qi and how it reaches the interior. If the yang qi fails to open and descend there will be internal cold. It is the yang qi that warms the tai yin so it to can open. Yang must makes its descent into yin for the transformation of yin and yang.

If there is pounding above the umbilicus, the kidney qi has been stirred and one should remove bai zhu and add gui zhi.

The shao yin kidney has been stirred and there is pounding, indicating that yang qi has been weakened.

The combination of gui zhi and zhi gan cao makes the formula gui zhi gan cao tang. This formula tonifies the shao yin heart. Gui zhi warms and mildly nourishes the heart. When the yang qi has been tonified it will once again descend into the interior. Zhi gan cao makes the transition of the yang qi into the yin levels happen, just like it does in the seasons. Zhi gan cao represents earth and earth relates to the last period of each season.

For excessive vomiting remove bai zhu and add sheng jiang.

Sheng jiang disperses excess fluids and will work better than bai zhu. Bai zhu dries and warms fluids but does not disperses.

Consider using ban xia and sheng jiang for vomiting. Together they form the formula xiao ban xia tang. They treat a failure of the pivoting of the middle.

Chapter 17 Line 12 For all vomiting with an inability to keep food down, xiao ban xia tang is indicated.

For excessive diarrhea still use bai zhu.

For palpitations add fu ling.

Fu ling frees the middle from excessive dampness by draining it out through the tai yang bladder.

Fu ling restores a normal qi transformation of the shao yin kidneys by promoting urination and opening the waterways, and this stops palpitations by creating yang qi.

Fu ling restores the balance between water and fire.

For thirst with a desire to drink water add extra bai zhu.

Bai zhu restores the control over water and reabsorbs the fluids in the turbid yin of the large intestine to replenish fluids.

For pain in the abdomen add extra ren shen.

Ren shen tonifies the true qi which will strengthen the shao yin heart and kidneys, while it nourishes and blood to stop pain in the abdomen.

For cold add extra gan jiang.

Raising the dose of the gan jiang can help, and consider adding fu zi to warm the true water to create yang qi. This is being done in si ni tang.

For abdominal fullness remove bai zhu and add fu zi.

Fu zi warms the original qi of the kidneys and the gathering qi of the lungs and heart. Fu zi infuses the body with fire and promotes water metabolism through the descent of fire into the water reservoirs of the body to create qi.

Published by Paul Freedman

Herbal Nerd

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