Harmonizing

In herbal medicine we often talk about herbs that harmonize. Harmonize what? The key herb that harmonizes is zhi gan cao. You know, stir fried with honey Glycyrrhizae radix.

Zhi gan cao is often paired with other herbs like, da huang, gan jiang, gui zhi, or bai shao. Why is that?

Zhi gan cao is a sweet, mildly warm herb that nourishes and tonifies. It is an earth herb that nourishes fluids and tonifies function of the stomach and spleen. It tonifies the center.

Plain Questions, The Center generates Dampness, Dampness generates Earth, Earth generates Sweet, Sweet generates the spleen, the spleen generates the flesh.

It transforms, Earth corresponds with transformation and the sweet taste.

The last eighteen days of each season belongs to earth. This implies that without the earth to give birth to the myriad of things there would be death. This also implies that without earth the seasons could not transform from one to the next.  

Plain Questions, The spleen, does not have a season that it governs.

Plain Questions, The spleen is earth, it rules the central region, it holds fast to the four seasons, and extends to the four viscera. Eighteen days from each season are entrusted to it, but it does not have a season all its own.

Dong Zhongshu called the spleen, The lord of the five elements. It is the ruler because all the other elements cannot come into being without earth.

The spleen and earth makes the transition of yang and yin qi possible from season to season.

Because it is the ruler it corresponds to the element earth, and it is used for the same reason in herbal medicine.  

Sweet warm zhi gan cao is the herb that is the most representative for tonifying the earth. The sweet taste tonifies but also nourishes, it allows for the smooth transformation of qi.

Did you ever wonder why there is no zhi gan cao in the formula da chai hu tang?

Da chai hu tang

chai hu 24 huang qin 9 ban xia 12 sheng jiang 15 da zao 9 bai shao 9 zhi shi 6 da huang 6

It would hold back the needed descending action of the yang ming stomach family. After the stool has started to move and there is no more heat and vexation, naturally put it back in and remove the zhi zhi, and or the da huang.

Da huang, Rhei rhizoma

Cold bitter da huang belongs to the west, autumn, and dryness.

It strongly cools and descends the yang qi in the stomach domain. Which is why it is used in the Cheng qi family of formulas.

It is used when internal yang ming heat is so great that the normal cooling, drying, and descending function fails.

But there is another use of da huang that is not so well known. And that is in clearing evil qi from the channels.

By descending, cooling, and drying the stomach domain the channels are affected. Which is why da huang can cause problems if used improperly.

Plain Questions Chapter 5

The six channels are streams, the intestines and the stomach are the sea. The nine orifices are where the qi flows like water.

Zhang Jiebing suggests that the last sentence should be; The nine orifices are where water and qi flow.

All rivers flow into the seas.

By descending the yang ming the sea is drained and the channels which are rivers follow.

The most representative formula of this action is tao he cheng qi tang.

Tao he cheng qi tang

tao ren 9 da huang 12 gui zhi 6 mang xiao 6 zhi gan cao 6

When a tai yang disease is unresolved and heat binds in the bladder, the person is as if manic, and spontaneous blood descent will bring recovery. If the exterior has not been resolved, one should not yet attack, but should first resolve the exterior. When the exterior has been resolved and there is only tense bound lesser abdomen, one can attack and therefore tao he cheng qi tang is appropriate.

It treats blood build up in the lower abdomen which is caused by heat. There will be acute lower abdominal pain, incontinence of urine, night fevers, mental vexation, and thirst. The heat can arise from an external tai yang pattern that progresses to the interior and turns into heat. The heat can be in the lower abdomen, body, or bladder.

The internal heat build up in the lower abdomen is cleared by moving the blood with tao ren and gui zhi, and by draining the seas with da huang and mang xiao.

This is also being done in Feng yin tang.

Feng yin tang

da huang 9 gan jiang 9 long gu 9 gui zhi 6 zhi gan cao 3 mu li 3 han shui shi 12 hua shi 12 chi shi zhi 12 bai shi zhi 12 zi shi ying 12 shi gao 12

Chapter 5 Feng yin tang: for heat paralysis and epilepsy.

Feng yin tang eliminates heat that causes paralysis and seizures. It treats seizures due to major wind in adults, and in children treats convulsions or seizures due to fright, occurring multiple times a day, and medicine has not been able to treat, for it is a heat eliminating formula.

It clears excess heat and internal wind in acute patterns.

Da huang belongs to the west, autumn, and dryness. It also drains the seas to drain the rivers.

Huang qi, Astragali radix

Huang qi, Astragali radix

Huang qi is a yang herb that tonifies the yang of the surface and interior.

Huang qi is a yin herb that nourishes earth and yin fluids.

Its core use is in raising the clear qi up to the lungs and heart so it can become blood and be transported out to the circulating yang.

It is the core taxation herb. It counters the collapse of yang and blood.

Huang qi tonifies the yang of the surface which is need to control the opening and closing of the pores.

Huang qi replaces the lost fluids due to excessive sweating of taxation.

Huang qi tonifies tai yin spleen and lung. It raises clear qi to the gathering qi of the chest while nourishing the clear qi.

Huang qi is being used to treat the surface in the formula huang qi gui zhi wu wu tang.

Huang qi gui zhi wu wu tang

huang qi 30 gui zhi 9 bai shao 9 sheng jiang 18 da zao 6

For blood impediment with dual debilitation of yin and yang, faint pulses at the inch opening and bar position, small and tight pulses at the cubit position, and the external sign of generalized numbness resembling that of wind impediment, huang qi gui zhi wu wu tang is indicated.

Huang qi is being used to treat taxation in the formula huang qi jian zhong tang, which is causing internal urgency or cramping.

Huang qi jian zhong tang

gui zhi 9 bai shao 18 sheng jiang 9 da zao 9 zhi gan cao 6 yi tang 30 huang qi 30

For deficiency taxation with internal urgency, and all kinds of insufficiency, huang qi jian zhong tang governs.

Huang qi is warm and sweet.

Chao huang qi, Dry fried huang qi is warmer than non-dry fried and therefore tonifies better.

Zhi huang qi, Honey dry fried huang qi is also warmer than non-dry fried and also much sweeter. Therefore it tonifies better and nourishes better.

Can you use the xiao chai hu tang modifications for ban xia xie xin tang?

Xiao chai hu tang

chai hu 24 huang qin 9 ban xia 12 sheng jiang 9 ren shen 9 da zao 9 zhi gan cao 9

Ban xia xie xin tang

ban xia 24 huang qin 9 huang lian 3 ren shen 9 gan jiang 9 da zao 9 zhi gan cao 9

They share ban xia, huang qin, ren shen, da zao, zhi gan cao.

Xiao chai hu tang uses chai hu, and sheng jiang.

Ban xia xie xin tang uses huang lian and gan jiang.

Lets ignore gan jiang and sheng jiang for a moment because they both treat the yang ming stomach excess dampness and cold.

The difference then is the huang lian and chai hu.

Chai hu is a shao yang herb and huang lian is a yang ming herb.

There really is not much difference between the formulas. They both treat shao yang and yang ming, but xiao chai hu tang treats shao yang more with chai hu, and ban xia xie xin tang treats yang ming more with huang lian.

So, yes it is reasonable to use the modifications in line 96 for ban xia xie xin tang.

Line 96 Modifications of xiao chai hu tang.

If there is vexation in the chest without retching, remove ban xia and ren shen and add gua lou shi.

If there is thirst remove ban xia and add more ren shen and add gua lou gen.

If there is pain in the abdomen remove huang qin and add bai shao.

If there is a hard glomus under the ribs remove da zao and add muli.

If there are palpitations below the heart with inhibited urination remove huang qin and add fu ling.

If there is no thirst and mild generalized heat remove ren shen and add gui zhi, and take the decoction till a slight sweat occurs.

If there is cough remove ren shen, da zao  and sheng jiang and add wu wei zi and gan jiang.

Understanding Mingmen

In seeking to understand Chinese Medicine I am always on the lookout for material that clarifies my thoughts. The concept of mingmen has remained unclear for me, until now.

This text is from the website of http://www.itmonline.org. Hat tip to Subhuti  Dharmananda for his sources of information.

From Chen Shiduo, A Secret Manual from the Stone Chamber (Shishi Milu), ca. 1690:

As has already laid out in detail in the Nanjing, mingmen is the master of the twelve channel networks. But even though many texts have since been written about this subject, the quintessence (most typical example) of mingmen still remains in the dark. Therefore I chose to bring up this topic one more time.

It is always said that mingmen is the master of the twelve channel networks. Now, what kind of master is it exactly and what does it master?

Let me put it this way: if there is no fire inside us, we cannot exist. This fire must be there first so that the twelve channel networks can be imbued with the igniting spark of transformation. mingmen, therefore, is a type of prenatal fire.

So mingmen is a type prenatal, or pre-heaven fire.

Chinese Medicine and the I Ching share the same root.

The eight trigrams can be arranged in two ways: pre-heaven and post-heaven.

Six trigrams are born from the Qian heaven and Kun earth trigrams.    

Qian heaven consists of three solid yang lines. Yang is the principle of light and the heavenly, so it has to be represented in abundance in the trigram of Heaven.

It’s the ultimate yang.

Kun earth consists of three broken yin lines. Yin stands for earth, dark, and cold. The trigram represents the receptive, since that is traditionally seen as the role of earth in relation to heaven. It also represents the field on which is grown what we need to survive. 

It’s the ultimate yin.

The Classic of Changes, Qian heaven trigram and the Kun earth trigram gave birth to six offspring.

The three male offspring, Zhen thunder, Kan water, Gen mountain.

The three female offspring, Sun wind, Li flame, Dui lake.

True Transmission of Medical Principals, Of Qian and Kun’s six children, the youngest and the oldest are all imbued with biases of Qian and Kun. Only the middle male and female have received their natural disposition from Qian and Kun. People receive the cardinal qi of their original nature from heaven and earth and thereby come to life. Kan and Li therefore act as the root of establishing life.

Kan water and Li flame are able to act as the root of establishing life.

Chen Shiduo calls mingmen a type of prenatal fire. He is referring to the Qian heaven and Li flame types of yang qi.

This fire is immaterial and dwells in water.

The yang line in the trigram Kan water is yang. Yang dwells in water.

On earth, material fire is being quenched by water. Immaterial water, on the contrary, has the ability to generate fire. Therefore, when we say that “fire is being quenched by water” we refer to material water; when we say that “fire is being fueled by water” we refer to immaterial water. And it so happens that immaterial fire can generate immaterial water, meaning that fire is not contained within fire, but within water.

Tai yang is all the yang in the body. Wang Bing, All yang, where magnificent, is tai yang.

Shao yin represents the fire and water of the body and it contains the organs heart and kidneys.

Plain Questions, Heart is the root of life and the seat of shen. It manifests its prosperity on the face, because of its function of keeping blood vessels full. It is located above the diaphragm and is considered yang. Its element is fire. Therefore it is called the tai yang of the yang. In the universal pattern of flow it corresponds to summer.

The kidneys are the storage place of the true yang and the root of all storage in the body. They store jing essence qi of the five zang and six fu organs. They manifest their abundance and health in the head hair. Its effect is to fill the bones and marrow. Being a water element in the lower trunk, the kidneys are considered yin. They are called the shao yin and correspond to the winter energy.

The heart is the element fire and it corresponds to summer.

The kidneys are the element water and it corresponds to winter.

Mingmen fire, is yang fire-a yang that is embedded within two yin. In the microcosmic context of the human body, mingmen is generated first, and only then the heart. Does this fact not illuminate the importance of mingmen? When the heart procures the power of mingmen, consciousness is in command, and we can relate to the outside world. When the liver procures the power of mingmen, it can plan. When the gallbladder procures the power of mingmen, it can make decisions. When the stomach procures the power of mingmen, it can absorb food. When the spleen procures the power of mingmen, it can transport. When the lung procures the power of mingmen, it can fulfill its administrating and regulating functions. When the large intestine procures the power of mingmen, it can pass on the waste. When the small intestine procures the power of mingmen, it can disseminate. When the kidney procures the power of mingmen, it can bring about physical vigor. When the triple burner procures the power of mingmen, it can keep the body’s water pathways unobstructed. When the bladder procures the power of mingmen, it can store. In other words, there is not a single one among the organ networks that does not rely on the mingmen fire for warmth and nourishment.

Mingmen is synonymous with the mandate of each organ. This is illustrated in Chapter 8 of the Yellow Emperor’s Classic.

The heart holds the office of the sovereign and ruler.

The lungs hold the office of chancellor and mentor.

The liver holds the office of general.

The gall bladder holds the office of centered righteousness.

The pericardium holds the office of minister and envoy.

The spleen and stomach holds the office of the granaries.

The large intestine holds the office of transmitting along the way.

The small intestine holds the office of receiving sacrifices.

The kidneys holds the office of making strong.

The san jiao holds the office of clearing the canals.

The urinary bladder holds the office of regional rectifier. 

This type of fire should be tonified rather than purged. This is done by tonifying fire within water, and especially by tonifying water within fire. In this fashion, fire can be fueled by water and at the same time be stored within water. If we just use cold or cool herbs to attack the mingmen fire, it will become weak, and how could it then nourish the twelve channel networks? This is what is really meant by the Neijing statement ‘when the master is dim, the twelve officials are all in a state of crisis.’ Doesn’t that strongly emphasize the importance of mingmen?

Chapter 8 Yellow Emperor’s Classic

However, the decision making is the kings job. If the spirit is clear, all functions of the other organs will be normal. It is in this way that one’s life is preserved and perpetuated, just as a country becomes prosperous when all its people are fulfilling their duties.

If the spirit is disturbed and unclear, the other organs will not function properly. This creates damage. The pathways and roads along which the qi flows will become blocked and health will suffer. The citizens of the kingdom will also suffer.

Mingmen is the prenatal yang of heaven, the postnatal fire, the yang spirit brightness, the spirit of each individual organ. Mingmen is all the yang qi in the body. It is the heart fire and kidney water interacting that produce the rising and falling, entering and exiting of the body’s transformation of qi.

Disease Progression

Does disease progress according to a set structure?

In other words, does disease progress from tai yang, to yang ming, to shao yang, to tai yin, to shao yin, and finally jue yin?

The quick and simple answer is no. The reason why this is taught is complicated and interesting.

In my basic TCM acupuncture class I was also taught this progression so I understand the confusion.

The chapters of the Shang Han Lun are structured according to the three yang and three yin levels. This structure seems logical. But remember that Wang Shu He found copies of the text and had to decide on the structure. He, and no one else, knows what the original order is of the text. He choose the format that is still used today, first the three yang and then the three yin levels.

But just because the classic text uses this format does not mean that all disease progress from tai yang to jue yin in any structured way.

I believe that the structure that Wang Shu He choose is the best format. It represents the true nature of yang. The progression of yang qi in year and a day are the same. This progression is based on the seasons.

Yang qi rises, grows, collects and is stored.

Spring corresponds with shao yang, summer corresponds with tai yang, autumn corresponds with yang ming, and winter corresponds with all three yin levels.

Morning corresponds with shao yang, afternoon corresponds with tai yang, evening corresponds with yang ming  and night corresponds with all three yin level.

Why is there no standard progression of disease? There are any number of unique ways that disease can manifest. Every person has a precondition that affects this progression.

The yang and yin levels used in the Classic on Cold Damage is where the disease is located.

So why is this standard progression theory taught in basic TCM classes? TCM was born in 1940 right after the cultural revolution in China. This rebirth had to reflect modern medicine to be accepted. In doing so it severed ties with its rich past. This new Chinese Medicine is based mainly on the five element structure, where each element is named after the associated yin organ. This is the birth of TCM and the zang fu school.

But what about the Huang Di Nejing Suwen and the Shang Han Lun?  They use the three yang and three yin whendescribing disease. In order to integrate the classics two different diagnostic systems are used. One is based on the five elements zang fu school and the other is the three yang and three yin model found in the Classic’s.

My belief is that only one diagnostic system is needed to understand all diseases and treatments. All of Chinese Medicine can be explained by the yin yang theory. Yin and yang can and should be used to explain every aspect of Chinese Medicine, from herbs, to formulas, to treatment strategies.

How does disease then progress?

The name of the Shang Han Lun implies that all damage to yang qi gives rise to a weakening of yang. Yang when weak, fails to go into storage to recover, which weakens it even further. The Shang Han Lun deals with all possible diseases and gives treatment strategies on how to restore yang function.

The genius of Zhang Ji is reflected in his ability to describe the different patterns of disease, including the different paths of progression. No, disease does not progress in any formal structure.

Patterns of passage

Tai yang to shao yang line 266

Line 266 When originally there was tai yang disease that was unresolved and thereby shifted into the shao yang, there is hardness and fullness under the rib side, dry retching and inability to eat, and alternating aversion to cold and heat effusion. When neither vomiting treatment nor precipitation has yet been used and the pulse is sunken and tight, one should give xiao chai hu tang.

Shao yang fails to pivot and yang fails to makes its descent and warm the interior.

Tai yang to yang ming line 181

Line 181 Question: Why does one get yang ming disease? Answer: In tai yang disease, if sweating is promoted, if precipitation is used, or if urination is disinhibited, this causes liquid and humor collapse and dryness in the stomach; hence there is a shift to the yang ming. No changes of clothes, internal repletion, and difficult defecation; these are signs of yang ming.

Yang ming closes excessively and then excess arises.

Tai yang to tai yin line 279

Line 279 When originally there was tai yang disease, but the physician used precipitation, and consequently there is abdominal fullness with periodic pain, this belongs to tai yin disease. Gui zhi jia shao yao tang governs. If there is great repletion pain gu zhi jia da huang tang governs.

Excessive dryness is causing yang ming to closing excessively. This causes pain and fullness. It is called tai yin because the normal opening function of tai yin is failing and yang is entering the interior to fast.

Tai yang to shao yin line 82

Line 82 When in tai yang disease, sweating has been promoted and sweat issues but the disease does not resolve, the person still has heat effusion, and there are palpitations below the heart, dizzy head, generalized twitching and the person is quivering and about to fall, zhen wu tang governs.

Yang qi has failed to warm the interior and cold water is accumulating. The yang qi is still on the surface and there is cold in the interior.

Tai yang to jue yin line 351

Line 351 When there is reversal cold of the limbs and the pulse is fine and verging on expiry, dang gui si ni tang governs.

Tai yang fails to open and this creates cold in the interior which prevents jue yin form fully giving birth to yang. Jue yin closes the yin levels and gives birth to the rise of yang through shao yang.

Yang ming line 184

Line 184 Question: Why does aversion to cold cease spontaneously? Answer: Yang ming resides in the center and governs earth. All things converge here and nothing passes further. Although at the beginning there is aversion to cold in two days it will spontaneously cease, indicating yang ming disease.

Shao yang to yang ming line 179, 265

Line 179 Question: Yang ming disease includes tai yang yang ming, right yang yang ming, and shao yang yang ming. What does this mean? Answer: In tai yang yang ming, the spleen is straightened. In right yang yang ming, the stomach domain is replete. In shao yang yang ming, when sweating is promoted and urine is disinhibited, there is dry vexing repletion in the stomach and difficult defecation.

Line 265 When in cold damage the pulse is string like and fine and there is headache and heat effusion, this belongs to shao yang. In shao yang one cannot promote sweating, as sweating will lead to delirious speech, which belongs to the stomach. If the stomach is harmonized there will be recovery and if the stomach is not harmonized, there will be vexation and palpitations.

Tai yin to shao yin line 273, 277

Line 273 In tai yin disease, there is abdominal fullness and vomiting, inability to get food down, severe spontaneous diarrhea, and periodic spontaneous abdominal pain, and if precipitation is used, there will be a hard bind below the chest.

Tai yang fails to open and this leads to internal cold which affects tai yin and shao yin.

Line 277 When there is spontaneous diarrhea and thirst is absent, this belongs to tai yin because there is cold in the storehouse, one should use a warming treatment. A counter flow cold decoction type of formula should be used.

The formula si ni tang can be used to clear cold in the storehouse, and this formula warms both tai yin and shao yin.

Shao yin to tai yang line 293

Line 293 When in shao yin disease that has lasted eight or nine days, the body and extremities are completely hot, it is because the heat is in the bladder, and there will be bloody excretions.

The bladder belongs to tai yang and now heat is causing the blood to heat up and yang qi becomes abundant and reckless which leads to bleeding.

Shao yin to jue yin 338

Line 338 When in cold damage, there is a faint pulse and reversal, and at seven or eight days, the skin is cold, and the person does not even have periods of peace, this indicates visceral reversal, not roundworm reversal. In roundworm reversal, the person should vomit roundworms. Now the person is still, and then has periodic vexation, which indicates reversal cold. Roundworms ascend and enter one’s diaphragm, so there is vexation, but wait a moment and it will stop. After receiving food, there is retching and again vexation, because the roundworms smell malodor of food, and the person often spontaneously vomits roundworms. For roundworms reversal, wu mei wan governs. It also governs longstanding diarrhea.

The internal cold is preventing the jue yin from closing, this prevents yang from rising. Heat can accumulate in the upper and cold in the lower burner whch gives rise to internal wind.

Jue yin to shao yang line 379

Line 379 When there is retching and heat effusion, xiao chai hu tang governs.

When jue yin closes excessively then heat can influence the shao yang, giving rise to heat in the stomach and heat effusion.

Dang gui si ni tang and Dang gui si ni jia wu zhu yu sheng jiang tang

Dang gui si ni tang

dang gui 9 gui zhi 9 bai shao 9 da zao 15 zhi gan cao 6 xi xin 9 tong cao 6

Line 351 When there is reversal cold of the limbs and the pulse is fine and verging on expiry, dang gui si ni tang governs.

This formula is based on gui zhi tang. The sheng jiang has been removed and xi xin has been added. The reason is due to the lack of internal yang qi.

The fine and verging on expiry pulse indicates a shao yin and jue yin level pattern. Fire fails to warm the interior and transform qi, but there is also a lack of yin to transform.

Dang gui, gui zhi, xi xin, warm and move the yang qi.

Bai shao, da zao, and zhi gan cao nourish yin and blood.

Tong cao is a jue yin herb that moves blood and drains heat that can build up in the pericardium nutritive level. It tonifies wood by tonifying the fresh kidney water. Tong cao is bitter and bitter tonifies the kidneys in the five element correspondences.

All other sources use mu tong. Mu tong is cold, bitter and clears heat from the heart and small intestine. It clears from the heat upper and promotes urination to lead it out the lower.

Zhi gan cao replenishes the nutritive ying layer and clears deficient heat while moistening tendons and connective tissue, and so often combined with bai shao. Strengthens qi and moderates other pungent herbs from being too dispersing. It also moistens to prevent excessive drying from pungent herbs.

Why remove sheng jiang and add xi xin? Xi xin is better at adding yang warmth and function to the body then sheng jiang. Sheng jiang adds warmth and function but mostly to the tai yin spleen and lungs. Xi xin is better than sheng jiang at warming and moving the jue yin liver blood. And reversal cold is exactly that, a deficiency of warm circulating yang qi.

Dang gui si ni jia wu zhu yu sheng jiang tang

dang gui 9 gui zhi 9 bai shao 9 sheng jiang 24 da zao 15 zhi gan cao 6 xi xin 9 tong cao 6 wu zhu yu 48 (18)

Line 352 If the person has enduring internal cold, dang gui si ni jia wu zhu yu sheng jiang tang governs.

This formula treats the same pattern as dang gui si ni tang but is stronger at warming the jue yin blood with wu zhu yu and stronger at dispersing outward with sheng jiang.

A note on the dose of the wu zhu yu. Most sources recommend the lower dose of 18 grams instead of the original 48 grams. Therapists choice.

Xiao ban xia tang

Xiao ban xia tang

ban xia 24 sheng jiang 24

This formula restores the pivot of earth. Earth must pivot for normal function. The separation of pure and impure depends on it. The organs associated with earth are the stomach and spleen. The stomach belongs to yang ming and it functions with the large and small intestine and is called the stomach domain. The mandate associated with yang ming is collecting and descending. The spleen belongs to tai yin and it raises clear qi up to the lungs and the 100 vessels.

Chapter 12 Line 28 Persons who suffer with vomiting are supposed to be thirsty; such thirst indicates that the condition is on the verge of resolution. An absence of thirst is caused by propping rheum below the heart. Xiao ban xia tang is indicated.

Vomiting with thirst indicates that the phlegm is being eliminated through vomiting. If there is no thirst then the condition is continuing.

Chapter 15 Line 20 For jaundice disease with unchanged urine color, a tendency to spontaneous diarrhea, and abdominal fullness with panting, heat-eliminating treatments are prohibited; this will result in retching. For retching, xiao ban xia tang is indicated.

If jaundice manifests with cold, there will be signs such as, unchanged urine color, a tendency to spontaneous diarrhea, and abdominal fullness with panting. The panting is due to 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.

This is due to failure of the pivoting of the middle.

General

The pivoting action of the middle consists of the yang ming descending and the tai yin ascending. Yang ming closes and this collecting action brings the yang qi to the interior. Tai yin opens to receive the yang qi. When warm the normal ascending of clear qi and descending of turbid qi occurs.

In other formulas sheng jiang supports the movement of yang on the surface. It does so by supporting the normal function of tai yin in sending clear qi up to the heart and 100 vessels.

This pivoting is important and many complex formulas use ban xia and sheng jiang.

Xiao chai hu tang

chai hu 24 huang qin 9 ban xia 12 sheng jiang 9 ren shen 9 da zao 9 zhi gan cao 9

Line 96 When in cold damage that has lasted for five or six days or wind strike, there is alternating aversion to cold and heat effusion, the person suffers from fullness in the chest and rib side, taciturnity with no desire for food and drink, heart vexation and frequent retching, or possibly there is vexation in the chest and no retching, or thirst or pain in the abdomen, or a hard glomus under the rib side, or palpitations below the heart with inhibited urination, or absence of thirst with mild generalized heat, or cough, then xiao chai hu tang governs.

Ban xia and sheng jiang restoring the pivoting of the middle. Ban xia is working with huang qin in descending. Sheng jiang is working with ren shen in ascending.

Ban xia hou po tang

ban xia 24 hou po 9 sheng jiang 15 fu ling 9 zi su ye 6

Chapter 22 Line 5 For women as if with a piece of fried meat stuck in the throat, ban xia hou po tang governs.

Zi su ye is used in modern formulas to warm the surface. By increasing the dose of zi su ye it could be effectively used for a tai yang pattern with tai yin congestion.

Da chai hu tang

chai hu 24 huang qin 9 ban xia 12 sheng jiang 15 da zao 9 bai shao 9 zhi shi 6 da huang 6

Line 165 When in cold damage there is heat effusion and sweating that brings no resolution, hard glomus below the heart, retching, vomiting, and diarrhea, then da chai hu tang governs.

In this formula the pivot of earth is really stuck, due to dryness. Bai shao descends, cools, and moistens yang ming. Da huang opens yang ming, and zhi shi pushes yang ming downward.

Chai hu jia mang xiao tang

chai hu 24 huang qin 9 ban xia 9 ren shen 9 sheng jiang 9 da zao 9 zhi gan cao 9 mang xiao 18

Line 104 Here in cold damage the disease has not resolved in thirteen days, and there is fullness in the chest and rib side, retching, late afternoon tidal heat effusion, and shortly afterward mild diarrhea. This was originally a chai hu tang pattern in which precipitation should not cause diarrhea, yet now there is diarrhea, so one knows that a pill medicine was used to precipitate, and this is not the appropriate treatment. Tidal heat effusion means repletion. It is appropriate to first take xiao chai hu tang in order to resolve the external aspect. Afterwards chai hu jia mang xiao tang governs.

late afternoon tidal heat effusion, tidal heat effusion means repletion. This indicates a yang ming bowel pattern, mang xiao cools and drains the excess heat.

It is appropriate to first take xiao chai hu tang in order to resolve the external aspect. Free the circulation of the ministerial fire so tai yang can open, then clear heat so yang ming can descend.

Chai hu jia long gu mu li tang

chai hu 24 huang qin 9 ban xia 12 ren shen 9 sheng jiang 9 gui zhi 9 fu ling 9 long gu 9 mu li 9

da huang 12 da zao 6 dai zhe shi 9

Line 107 When in cold damage that has lasted for eight or nine days, precipitation is used, and there is fullness in the chest, vexation and fright, inhibited urination, delirious speech, heaviness of the entire body, and inability to turn sides, chai hu jia long gu muli tang governs.

vexation and fright, indicates that heat is harassing the heart, gui zhi, long gu, mu li, and dai zhe shi are tonifying, cooling, and descending yang qi, while the da huang descends yang ming.

Ben tun tang

ge gen 15 sang bai pi 24 huang qin 6 ban xia 12 bai shao 6 chuan xiong 6 dang gui 6 sheng jiang 12 zhi gan cao 6

Chapter 8 Line 2 In running piglet qi surges upwards to strike the chest, with abdominal pain, and alternating hot and cold, ben tun tang governs.

Chai hu gui zhi tang

chai hu 24 huang qin 9 ban xia 12 ren shen 9 gui zhi 9 bai shao 9 sheng jiang 9 da zao 9

zhi gan cao 9

Line 146 When in cold damage that has lasted for six or seven days, there is heat effusion, mild aversion to cold, vexing pain of the limb joints, mild retching, popping bind below the heart, and the exterior pattern is still present chai hu gui zhi tang governs.

Ban xia and sheng jiang are restoring the pivot. Sheng jiang is supporting gui zhi in warming the surface.

Ban xia xie xin tang

ban xia 24 huang qin 9 huang lian 3 ren shen 9 gan jiang 9 da zao 9 zhi gan cao 9

Line 149 If there is fullness, hardness, and pain below the heart, this indicates chest bind, therefore da xian xiong tang governs. If there is fullness only, without pain, this indicates a glomus, and one should not give chai hu tang but ban xia xie xin tang is appropriate.

Gan cao xie xin tang

zhi gan cao 12 huang qin 9 huang lian 3 ban xia 12 ren shen 9 gan jiang 9 da zao 9

Line 158 When in cold damage or wind strike, the physician has used precipitation, the person will have diarrhea about ten times a day containing food that has not been transformed, with thunderous rumbling in the abdomen, fullness and a hard glomus below the heart, dry retching and a vexation that cannot be quieted.

When the physician sees a glomus below the heart, suggesting the illness has not finished, and again uses precipitation, as a result the glomus increases in severity, it is because heat bind is absent, only stomach vacuity is present with counter flow ascent of visiting qi, causing hardness therefore gan cao xie xin tang governs.

Sheng jiang xie xin tang also known as sheng jiang ban xia tang 

sheng jiang 12 ban xia 12  huang qin 9 huang lian 3 ren shen 9 gan jiang 3 da zao 9

zhi gan cao 9

Line 157 When in cold damage after sweating has issued and brought resolution of the exterior, the stomach is in disharmony, there is a hard glomus below the heart, dry belching with no desire of food, water qi under the rib side, thunderous rumbling in the abdomen, and diarrhea, sheng jiang xie xin tang governs.

Yue bi jia ban xia tang

ma huang 18 shi gao 24 sheng jiang 9 da zao 9 zhi gan cao 6 ban xia 9

Chapter 7 Line 13 Coughing with qi ascent indicates lung distention. The patient presents with panting, eyes bursting from their sockets, and floating large pulses yue bi jia ban xia tang is indicated.

Yue bi tang is being modified with ban xia to treat the pivot of earth.

Vomiting patients should normally be thirsty, for thirst is a sign that it is about to resolve, but now there adversely is no thirst, because there is poking rheum under the heart, and xiao ban xia tang governs.

Xuan fu dai zhe tang

xuan fu hua 9 dai zhe shi 3 ban xia 12 ren shen 6 sheng jiang 15 da zao 6 zhi gan cao 9

Line 161 If in cold damage sweating is promoted, if then vomiting is promoted, or if purged, after resolution, there will be hard glomus under the heart, and incessant hiccups, then xuan fu dai zhe tang governs.

She gan ma huang tang

she gan 9 ma huang 12 sheng jiang 12 wu wei zi 12 ban xia 12 xi xin 9 kuan dong hua 9 zi wan 9

da zao 3 (use jie geng for kuan dong hua)

Chapter 7 Line 6 Cough and adverse flow of qi, with the sound of a water bird in the throat, she gan ma huang tang governs.

Huang qin jia ban xia sheng jiang tang

huang qin 9 ban xia 12 bai shao 6  sheng jiang 3 da zao 9 zhi gan cao  6

Line 172 When in tai yang and shao yang combination disease there is spontaneous diarrhea, give huang qin tang, if there is retching, huang qin jia ban xia sheng jiang tang governs.

Hou po sheng jiang ban xia gan cao ren shen tang

hou po 24 sheng jiang 24 ban xia 24 zhi gan cao 6 ren shen 3

Line 66 When, after the promotion of sweating, there is abdominal distension and fullness, hou po sheng jiang ban xia gan cao ren shen tang governs.

Huang Lian Tang

Huang lian tang

huang lian 9 ban xia 12 gui zhi 9 ren shen 6 gan jiang 9 da zao 9 zhi gan cao 9

Line 173 When in cold damage, there is heat in the chest, evil qi in the stomach, pain in the abdomen, and a desire to vomit, huang lian tang governs.

Huang lian tang connects the upper and lower. It restores the fire and water relationship needed for life. Fire must make its descent into water. Fire is bringing water it to life so it can move, moisten and nourish all living things.

This formula is based on ban xia xie xin tang. Huang qin has been removed and gui zhi added.

Gui zhi is being used to clear the tai yang wind strike pattern. The use of huang qin would cool the ministerial fire which is needed to open the yang qi.

It clears heat and cold at the same time. The heat is in the chest and the cold is in the stomach domain.

This is a complicated pattern. There is heat and dampness in the upper burner and cold and dampness in the middle. Heat is yang and like fire it tends to rise. Cold is yin and like water tends to sink. If this yang rising and yin sinking continues the transformation of qi will fail and lead to death. The treatment strategy is to reconnect the fire and water of the upper and lower.

The use of huang lian to cool the heat indicates the presence of dampness. Huang lian is cold, bitter, and intensely drying. Gan jiang is used to warm and dry the earth and stomach domain.

It is not mentioned in Line 173, but there will be vexation and agitation from the heat, and cramping pain in the abdomen due to cold. There should be a soft, or watery stool.

The desire to vomit can be caused from either cold or heat.

Da huang gan cao tang

da huang 12 gan cao 3

For vomiting immediately after eating, da huang gan cao tang is indicated.

Xiao ban xia tang

ban xia 24 sheng jiang 24

Vomiting patients should normally be thirsty, for thirst is a sign that it is about to resolve, but now there adversely is no thirst, because there is poking rheum under the heart, and xiao ban xia tang governs.

The combination of ban xia and gan jiang is used in the formulas ban xia xie xin tang, gan cao xie xin tang, and sheng jiang xie xin tang.

Ban xia gan jiang san

ban xia 9 gan jiang 9

Chapter 17, Line 20 For dry retching, vomiting with counterflow, and drool foaming at the mouth, ban xia gan jiang san, is indicated. Grind the ingredients and drink with sour rice milk. Dry retching, vomiting with counterflow, and drool foaming at the mouth, indicate the accumulation of cold in the middle burner. The pivot of the earth is impaired.

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.