Ling gui zhu gan tang

fu ling 12 gui zhi 9 bai zhu 6 zhi gan cao 6

Warms the tai yang channel and organ, promote qi and water transformation, tonifies the spleen and drain dampness. It restores earth’s control over water. It warms a cold center with fluid accumulation, fullness in the chest, dizziness, and palpitations, cough and loose stools.

Jin gui yao lue formula

Line 16 For phlegm-rheum below the heart manifesting with propping fullness in the chest and rib-sides and dizzy vision, ling gui zhu gan tang is indicated.

Line 17 With shortness of breath and mild rheum, rheum should be eliminated by urination, ling gui zhu gan tang is indicated. Shen qi wan is also indicated.

If we combine these two lines we see that ling gui zhu gan tang is used for rheum and dampness causing chest and rib-side fullness, shortness of breath and dizzy vision, and should be eliminated by promoting urination.

What is the difference between dampness and phlegm rheum?

Rheum is an old-fashioned word for the watery discharge that drips from your nose and eyes when you have a cold or allergies.

Phlegm is the thick mucus secreted in the respiratory passages and discharged through the mouth, especially that occurring in the lungs and throat passages, as during a cold.

Phlegm rheum is a slightly thicker fluid than dampness that is accumulating.  

Wiseman and Wilms, Medical literature from the Song period onward uses tan, phlegm to denote a thick turbid substance, and yin, rheum to denote a thinner, clearer form of pathological fluid.

For phlegm-rheum below the heart, refers to the stomach and epigastric region.

Dizzy vision is being caused by the internal wind created by the failure of the yang qi to descend. And by the failure of clear qi to reach the eyes. The phlegm is obstructing the yang qi from ascending.

Fu ling, Poria

Fu ling restores normal qi transformation of the kidneys by disinhibiting urination and opening the waterways.

Bai zhu and fu ling are the core herbs for clearing dampness from earth and draining it out by promoting urination. Bai zhu builds a dyke and fu ling opens the waterways.

Gui zhi, Cinnamomi cassiae ramulus

Gui zhi warms all three burners through the ministerial fire and so tonifies function of the yang and yin organs.

Gui zhi is the main herb to restore the water metabolism of the tai yang bladder. It warms the yang on the bladder channel and promotes the transformation of kidney qi as vapor from the stored fluids of the bladder.

Bai zhu, Atractylodis macrocephalae rhizome

It tonifies tai yin qi of the spleen and lung and strengthens the spleen by drying and draining dampness to allow normal function to return.

Zhi gan cao, Glycyrrhizae radix prep

Zhi gan cao directly enters the heart. It strongly tonifies heart qi and regulates heart rhythm. It also builds spleen qi to strengthen lung and heart qi to revive the pulse beat.

Ling gui zhug an tang contains two pairs of herbs. The first pair of gui zhi and zhi gan cao tonify yang qi. This strengthens the heart yang and fire element. Yang qi when weak fails to transform fluids.

Gui zhi tonifies yang qi and zhi gan cao ensures a smooth transition of the yang qi into the yin divisions.

Gui zhi corresponds with the southern direction and summer season. Zhi gan cao corresponds with the center and the last period of each season.

The second pair of bai zhu and fu ling promote the transformation of fluids, especially in the middle and lower burners. Bai zhu tonifies the fire element in earth. Fu ling promotes the movement of fluids in the middle and lower burners.

Bai zhu corresponds with the southern direction and the summer season. It also corresponds with the center and the last period of each season.

Fu ling corresponds with the center and the last period of each season.

fu zi 9 bai zhu 6 fu ling 9 bai shao 9 sheng jiang 9

The most complex and variable syndromes are those that pertain either to diseases of the pivot, and diseases in which water plays a key role.

There are three pivots and two sources.
Pivot one is the shao yang, pivot two is the shao yin, and pivot three is the earth. The two sources are the earth as post-heaven and shao yin kidneys as pre-heaven.

In this post I will discuss line 316 from the Shan Han Lun.

Line 316 When shao yin disease has not ceased after two or three days, and at four and five days there is abdominal pain, inhibited urination, heaviness and pain in the limbs, and spontaneous diarrhea, it means there is water qi and the person may cough, or have uninhibited urination, or diarrhea, or retching, therefore zhen wu tang governs.

Tai yang rules water, it is the extreme yang within yang. Shao yin is the storage of water and fire. Water and fire together are referred to as shao yin.

Water and fire must remain co-joined and interdependent in the body. They should never separate from each other. Water and fire together are the yin and yang.

Zhen wu tang is the representative formula of the northern direction. It restores the yang qi so it can once again descend into water, so it can once again rise to the heavens.

When shao yin disease has not ceased after two or three days, and at four and five days there is abdominal pain, inhibited urination, heaviness and pain in the limbs, and spontaneous diarrhea, it means there is water qi and the person may cough,

Cold and fluids have accumulated which gives rise to abdominal pain. The cold has closed off the bladder. Yang qi fails to reach and warm the extremities which belong to earth. Yang fails to warm the interior and fluids drop out the bottom as diarrhea. Fluids can accumulate in the lungs giving rise to cough. This is water qi.
Line 316 modifications, If there is a cough add wu wei zi, xi xin and gan jiang. Wu wei zi, xi xin, and gan jiang are the core trio to treat fluid accumulation is the lungs due to cold.

or have uninhibited urination,

Obviously the bladder is not always closed in this pattern. Line 316 modifications, If the urine is uninhibited remove fu ling.

or diarrhea,

Line 316 modifications, If there is diarrhea remove bai shao and add gan jiang.

Removing the bai shao makes the formula more pungent and dispersing. Its sour collecting nature calms internal movement as wind. Bai shao also nourishes fluids and blood which will make the diarrhea worse. Gan jiang introduces dryness into the yang ming domain.

or retching

Line 316 modifications, If there is retching remove fu zi and add sheng jiang.

This modification is interesting because it illustrates that the yang levels, tai yang, yang ming, and shao yang, need to be functioning first before progressing to the yin levels. Retching indicates the accumulation of cold and fluids in the yang ming stomach organ. This prevents yang ming from descending into tai yin to warm the interior. The cold and fluids prevent the exchange of qi between the upper and lower burners. Sheng jiang restore the pivot of earth.

Comparison
Zhen wu tang, fu zi 9 bai zhu 6 fu ling 9 bai shao 9 sheng jiang 9
Fu zi tang, fu zi 9 bai zhu 12 fu ling 12 bai shao 9 ren shen 6
Si ni tang, fu zi 6 gan jiang 4.5 zhi gan cao 6

These formulas open the southern direction. It is fu zi that brings fire to water.

Si ni tang is treating mostly cold.

Zhen wu tang and fu zi tang are both treating cold and fluid accumulation with the addition of bai zhu and fu ling.

Zhen wu tang is more dispersing with the addition of sheng jiang. Fu zi tang it tonifying and nourishing with the addition of bai shao and ren shen.

Gan jiang huang qin huang lian ren shen tang

gan jiang 9 huang qin 9 huang lian 9 ren shen 9

Line 359 In cold damage originally there was spontaneous cold diarrhea, yet the physician used vomiting and precipitation so there is repelling cold. After further adverse treatment through vomiting and precipitation, if there is immediate vomiting after food enters the mouth, gan jiang huang qin huang lian ren shen tang governs.

In cold damage originally there was spontaneous cold diarrhea,

This must be a tai yang wind cold pattern. Tai yang opens and then yang ming closes. The rising and growing of the yang qi is needed internally to warm the organs such as the spleen.

In a tai yang wind cold pattern the yang fails to descend then cold diarrhea occurs.

In tai yang and yang ming combined disease, there will be spontaneous diarrhea, and therefore ge gen tang governs.

If the wind cold tai yang pattern is unresolved, the pattern can change to yang ming and gives rise to diarrhea, dual tai yang and yang ming.

yet the physician used vomiting and precipitation so there is repelling cold.

Vomiting causes a loss of fluids and this weakens the shao yin heart yang and the jue yin blood level. The shao yin then fails to pivot and the exchange between fire and water fails. Yin and yang separate. With yang in the upper and yin below. Yang will continue to rise and yin will continue to sink.

Precipitation, a downward purging of the yang ming bowel causes the fluids on the surface to be pulled inwards. These fluids can be warm because in a tai yang cold strike pattern there can be a high fever. These warm fluids accumulate in the stomach.

After further adverse treatment through vomiting and precipitation, if there is immediate vomiting after food enters the mouth, gan jiang huang qin huang lian ren shen tang governs.

Vomiting after eating indicates heat in the stomach.

Gan jiang warms the cold and dries damp in the yang ming intestines. Gan jiang brings yang to the earth to warm the fluids. It also prevents excessive cooling from huang qin aand huang lian.

Huang qin is a shao yang herb. It clears liver and gall bladder damp and heat that flares up to the upper burner. It also clears san jiao damp heat through its bitter drying taste and cold cooling nature. It also cools the jue yin blood level.

Huang lian is bitter and cold to clear yang ming heat, it clears excessive damp heat in the intestines, resolves toxins, and dries damp.

Ren shen tonifies but also moistens. The tonifying restores normal function while the moistening prevents excessive drying from huang qin and huang lian.

The yin fluids from ren shen moderate excessive movement by anchoring yang within yin. It raises the original qi and gathering qi. It strengthens righteous qi, righteous qi is also called true qi and is a combination of original qi and gathering qi. All are dependent on the qi of shao yin and tai yin. Which in turn are dependent on the jue yin and shao yang for the ministerial fire in all three burners.

Line 176 When in cold damage the pulse is floating and slippery, this means there is heat in the exterior and cold in the interior, bai hu tang governs.

Editors of the Song version believe this to be an error. According to Wiseman and the editors of the Song version it should read. There is heat in the exterior, and heat in the interior.

This makes no sense according to the theory of opening, closing and pivoting.

Tai yang opens, yang ming closes, and shao yang pivots.

The slippery pulse indicates heat. The yang qi has been damaged and the yang is on the exterior. The pulse follows the yang. But now the yang is becoming excessive. The tai yang pattern is turning into a yang ming channel pattern.

The tai yang opens. But now it is opening excessively. If left unchecked it continues and fails to make its descent into the yang ming. Yang ming closes and this ensures that the yang qi descends into the interior. When yang fails to descend the interior will not be warmed. This gives rise to coldness and dampness.

Tai yang is summer and yang ming is fall. The yang ming qi is one of coolness and collecting. The yang ming ensures that the yang qi goes into storage for the winter.

The formula Bai hu tang is ensuring that the yang qi is collected and cooled. Bai hu tang brings the autumn to the excessive summer. It represents the west and the qi of the west is descending.

Liu Lihong, After tai yang begins the process of opening the yang door, the yang qi gradually begins to rise as it is released and emerges from storage. The aspect that carries out the closing of the yang qi is the yang ming. The transition between opening and closing depends on the pivoting function of shao yang.

Once tai yin initiates the process of opening the door of gathering and storage, the yang qi enters into the state of gathering and storage in earnest. The door that opened by tai yin is closed by jue yin. Shao yin acts as the pivot between opening and closing.

The white tiger, bai hu, is used to clear yang ming channel heat. This is the spirit of the western direction, and it dominates the changes and transformations associated with that particular cardinal direction. These changes are the collecting and descending, and using bai hu tang is saying that there is a problem in the collecting and descending of the yang qi.

Jiao ai tang also known as Xiong gui jiao ai tang also known as Jiao ai si wu tang

sheng di huang 18 dang gui 9 bai shao 12 chuan xiong 6 zhi gan cao 6 ejiao 9 ai ye 9

Women can have blood leakage, or continuous and incessant blood loss after premature birth, or blood loss during pregnancy, for if accompanied by abdominal pain during pregnancy, jiao ai tang governs.

This formula treats the Water and Wood elements. It nourishes the shao yin heart and kidney while nourishing and moving the shao yang and jue yin.

The formula gui zhi gan cao tang is the representative formula for treating shao yin heart yang deficiency. In jiao ai tang the dang gui is replacing the gui zhi because more nourishing is needed.

The trio of dang gui, bai shao and chuan xiong is used in many different blood nourishing formulas.

Dang gui san

dang gui 12 bai shao 12 chuan xiong 12 huang qin 12 bai zhu 6

In this formula the trio is combined with damp heat clearing herbs huang qin and bai zhu. The bai zhu is helping the blood moving by moving fluids. Bai zhu restores the metabolism of fluids which is needed to nourish the blood. Huang qin is freeing the movement of the ministerial fire.

Dang gui shao yao san

dang gui 9 bai shao 48 chuan xiong 24 bai zhu 12 fu ling 12 ze xie 24

In this formula the trio is combined bai zhu, fu ling and ze xie which restore the metabolism of fluids which is needed to nourish blood.

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

In this formula the trio is being used in much the same way as in the formula dang gui san.

Shu yu wan

shan yao 30 gui zhi 9 sheng di huang 9 bai shao 6 dang gui 9 chuan xiong 6 mai meng dong 6

ejiao 6 ren shen 6 bai zhu 6 fu ling 6 gan jiang 3 dou huang juan 9 shen qu 9 zhi gan cao 9

da zao 9 jie geng 6 chai hu 6 fang feng 6 xing ren 6 bai lian 1

In this formula the trio is being used but with the addition of the sheng di huang and ejiao which is being used in the formula jiao ai tang.

Dang gui, bai shao and chuan xiong treat the Wood element and the shao yang and jue yin.

The sheng di huang and ejiao treat the Water and the shao yin kidney. Sheng di huang and ejiao nourish the true Water so it can once again give birth to Wood and Fire.

The use of ai ye and ejiao stops the menstrual bleeding.

Jiao ai tang treats blood leakage, or continuous and incessant blood loss after premature birth, or blood loss during pregnancy, for if accompanied by abdominal pain during pregnancy.

Ben tun tang

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

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

This formula treats a jue yin liver blood deficiency and upward rushing due to heat. It also treats the shao yang flaring of the ministerial fire. It also clears heat, dampness and counter flow qi in the stomach and lungs.

It contains the formula xiao ban xia tang for the counter flow qi and dampness of the middle.

Ben tun tang is based on the trio of herbs that is used in the famous formulas dang gui san, dang gui shao yang san and jiao ai tang. Together they nourish, warm and move the jue yin liver blood storage and shao yang ministerial fire.

Dang gui, Angelicae sinensis radix is sweet tonifying and nourishing of liver blood and the ministerial fire. It is pungent dispersing of the liver blood and ministerial fire.

Dang gui is the core jue yin liver blood storage herb. Dang gui tonifies blood and nourishes the liver while moving blood and transforming stasis and so protects the jue yin liver blood from heat.

Bai shao, Paeoniae radix lactiflora is sour, bitter and cool. It is sour collecting of yin fluids and blood. It is bitter descending of heat. It nourishes dryness in yang ming and the jue yin. It descends Earth and Metal and calms Wood wind.

Bai shao softens the liver body and extinguishes internal wind to stop cramping pains. It replenishes nutritive fluids and pacifies the blood layer that is about to be moved. It is the core pain herb.

Chuan xiong, Ligustici radix is pungent dispersing of the liver and pericardium blood and the ministerial fire in the san jiao.

Chuan xiong is used to move the liver qi to move the liver blood. It moves blood by moving the propelling qi contained within blood but does not strongly eliminate stasis.

Huang qin and ban xia, this pair is seen in shao yang formulas. Huang qin frees the movement in the ministerial fire and ban xia descends the stomach domain.

This formula nourishes blood and sets it in motion while ensuring it stays moving. It is not a shao yang formula like xiao chai hu tang and it is more nourishing of jue yin blood than xiao yao san.

The addition of ge gen and sang bai pi make this formula even more nourishing of yin and fluids.

Ge gen is sweet tonifying and nourishing of the spleen and lungs. It is pungent dispersing and sweet nourishing of the tai yang and yang ming channels. In this formula it is used for the abdominal pain and it raises the clear grain qi and it opens the chest and stops the upward rushing.

Both ge gen and bai shao are treating the abdominal pain.

Sang bai pi is sweet tonifying, nourishing and cooling of the lungs.

At first glance the formula ge gen tang seems strange. Why would anyone add ge gen and ma huang to gui zhi tang?

Ge gen tang

ge gen 12 ma huang 9 gui zhi 6 bai shao 6 sheng jiang 9 da zao 9 zhi gan cao 6

If the wind cold tai yang pattern is unresolved, the pattern can change to yang ming and gives rise to diarrhea, dual tai yang and yang ming.

In tai yang disease with a stretched stiff nape and back, absence of sweating, and aversion to cold, ge gen tang governs.

In tai yang and yang ming combined disease, there will be spontaneous diarrhea, and therefore gegen tang governs.

In tai yang disease, there is no sweating and urination is adversely little, there is qi surging upward to the chest, with clenching of the mouth and inability to speak, there is a desire to develop hard convulsion, and ge gen tang governs.

Ge gen tang is based on a concept found in two formulas that combine ma huang tang and gui zhi tang.

Ma huang tang is used to clear excess cold on the surface in a tai yang cold strike pattern. In this pattern the surface is closed and there is no sweating. The treatment goal is to clear excess cold and this is achieved with warm pungent gui zhi and ma huang. Xing ren assists ma huang in descending the tai yin lung. Zhi gan cao nourishes yin fluids and tonifies tai yin spleen to moisten the lung and anchor pungent gui zhi and ma huang.

In a gui zhi tang pattern there is excess cold but also sweating. In this pattern the surface is open and there is sweating. Warm pungent gui zhi and sheng jiang warm and disperse the cold on the surface. Gui zhi and zhi gan cao tonify heart yang. Gui zhi, bai shao and da zao nourish the jue yin liver blood and the shao yang ministerial fire. Sheng jiang warms the tai yin and raises the nutritive provided by da zao to the surface.  

The combination of ma huang tang and gui zhi tang means that the surface is half open and half closed so there we will be tight cold muscles but also sweating.

These two formulas, gui zhi er ma huang yi tang and gui zhi ma huang ge ban tang do just that.

Gui zhi er ma huang yi tang

gui zhi 18 bai shao 18 sheng jiang 18 da zao 18 zhi gan cao 12 ma huang 9 xing ren 12

Nourishes the nutritive better than gui zhi ma huang ge ban tang.

Gui zhi ma huang ge ban tang

gui zhi 9  bai shao 9 sheng jiang 9 da zao 9 zhi gan cao 6 ma huang 9 xing ren 12

Better at clearing excess cold than gui zhi ma huang yi tang.

Back to ge gen tang. It also treats a half open and a half closed surface.

Ge gen, Puerariae radix is sweet tonifying and nourishing of the spleen and lungs. It is is pungent dispersing and sweet nourishing of the tai yang and yang ming channels. Ge gen connects the tai yin to the tai yang and yang ming channels.

Neutral, sweet and pungent it clears yang ming channel congestion and ascends the clear fluids of the sea of water and grain to moisten the hand yang ming channel. It clears the channel stagnation located on the upper back and neck. Combined with bai shao it benefits yin and relieves the convulsions and spasms by relaxing the tendons.

The ma huang is helping with clearing the cold on the surface and in tonifying the heart yang while supporting the tai yin lung in dispersing and descending fluids.

The formula ge gen tang is more nourishing than gui zhi tang and better at clearing cold and stopping diarrhea.

If you want to make gui zhi er ma huang yi tang even more nourishing for the nutritive on the surface and stop diarrhea add ge gen.

If you need to descend and disperse the lungs more add xing ren to ge gen tang.

I have wrestled with understanding shao yin. My struggle with understanding shao yin and in simple terms just become clear. Let me share.

All things can be defined by the theoretical knife of yin and yang. Shao yin contains two parts, a yang and a yin part.

Shao yin contains two of the five elements which are opposite of each other and namely Fire and Water.

Shao yin is connected to the tai yang which also contains the same two elements.

Tai yang and shao yin both represent the Fire and Water element and they balance each other. Fire must make its descent into Water to create qi as vapor and Water must rise to cool Fire.

In tai yang cold rules and in shao yin heat rules.

If tai yang is a yang energy how can cold rule? And if shao yin is a yin energy how can heat rule?

Tai yang needs to contain more yang energy so normal function on the outermost parts of the kingdom can function. This yang energy comes from the shao yin and tai yin. Tai yang is considered yang because its organs transport turbid qi. The small intestine and bladder also provide heat needed for proper transport and transformation of food qi.

Shao yin is a yin energy because it stores jing. Heat rules in shao yin because it contains the imperial true fire necessary to warm and move the true Water. The heat in shao yin is comparable to the brilliance of the sun. Yet it is dependent on the yin blood to be strong.

The heart is the ruler of the twelve channels. Its position is south, its season is summer, and its nature is fire. The heart represents the body’s imperial fire.

The heart is the root of life. It is the seat of the spirit, the master of blood and vessels. It is the most important organ because of the spirit which resides in the qi which is anchored in jing. Jing is also known as blood.

The heart is connected to the kidney. The heart resides in the vessels. It rules the kidneys because it is the master of all organs. The kidney true water must be abundant or the heart fire will flare out of control.

The yang qi of the body is like the sun. If the sun loses its brilliance or illuminating effect, all things on earth become inactive. The sun is the ultimate yang. This heavenly energy of the sun, yang qi, surrounds the earth. Correspondingly, in the body this means that the yang qi circulates around the center or core and has the functions of protecting the body.

Yin is the essence of the organs and the fountain of the qi. Yang protects the exterior of the body against pathogens and makes the muscles function. When the yin fails to contain the yang, the flow in the channels will become rapid, causing the yang qi to become excessive and reckless. If the yang qi is deficient and unable to counterbalance the yin, communication between the internal organs will be disrupted, and the nine orifices will cease to function. When the yin and yang are balanced the true zhen qi becomes unshakable, and pathogens cannot invade.

Li zhong wan

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

When there is spontaneous diarrhea and thirst is absent, this belongs to tai yin disease, because there is cold in the store house, one should use a warming treatment. A counter flow cold decoction is appropriate.

The formula Li zhong wan is balanced in such a way as to clear the accumulation of dampness and cold in the store house while preventing excessive dryness. Ensuring that yang ming becomes dry while tai yin remains damp.

Over tai yang coldness qi rules. Over yang ming dryness qi rules. Over shao yang ministerial fire qi rules.

Over tai yin dampness qi rules. Over shao yin heat qi rules. Over jue yin, wind rules.

Li zhong wan restores the balance between yang ming dryness and tai yin dampness. Yang ming and Tai yin work together to take the food qi and transform it into clear qi and turbid qi. The clear qi goes up to the chest which becomes true qi that then circulates in the 100 vessels, while the turbid qi goes down and out.

Yang ming conformation of the dry Metal of the west

Tai yin conformation of the damp Earth of the Center

The yang ming and tai yin represent more than just the balance between dryness and dampness. Together they form the Earth and Metal elements. These two elemental movements of qi represent the uptake and transformation of food qi into true qi. Earth and Metal give birth to the element Water and control Water and Wood.

To properly function Earth and Metal need the warm imperial and ministerial blood in the jue yin and shao yin. If shao yin and jue yin are weak then the yang ming and tai yin will suffer leading to less transformation of true qi which in turn leads to less support for shao yin and jue yin.

Li zhong wan warms and dries excessive dampness while moistening and tonifying.

This is achieved with just four herbs. This is possible because each herb works with another and has multiple qualities.

It uses two pairs of herbs to achieve this harmonizing treatment. Ren shen and zhi gan cao moisten Earth while gan jiang and bai zhu dry and warm Earth.

Both ren shen and zhi gan cao treat shao yin. Zhi gan cao directly nourishes the heart and ren shen tonifies the kidney original qi.

Ren shen and bai zhu are restoring the transforming and transport function of tai yin. Ren shen brings healthy fluids to the spleen and bai zhu clears the pathological fluids out. The ren shen raises the clear qi and the bai zhu transports the pathological fluids downward while warming.

It is not a nourishing formula but a tonifying formula. There are no herbs that nourish blood like dang gui. It tonifies and raises the tai yin and shao yin qi while drying and warming.

The gan jiang tonifies and warms the center while astringing or collecting. This restores the excessive downward movement seen as diarrhea. The astringing or collecting nature of gan jiang is used in the formula si ni tang. The gan jiang keeps the fu zi from being excessively dispersing. It is this action that can stop bleeding due to cold.

You could consider using pao jiang which is more astringing than gan jiang and is considered better at stopping bleeding due to cold.

Adding fu ling would support bai zhu in clearing the dampness out through the urine.  

This formula is for treating dampness and not phlegm. Phlegm being thicker needs herbs that transform like ban xia.

Li zhong wan uses the sweet taste and astringing nature to raise the qi back upwards while tonifying. The sweet taste is one that is both tonifiying and moderating. Moderating in the way that it calms movement such as physiological wind. Moderating is also a collecting nature that pulls inward.

Sweet governs moderation and its movement can ascend therefore it can tonify the middle burner.

Ren shen, and zhi gan cao are both considered sweet. The astringing nature is used to collect movement towards the middle. Consider that in the formula xiao chai hu tang contains ren shen and zhi gan cao but in da chai hu tang they are not. In da chai hu tang the yang ming stomach domain is dry and fails to descend so using ren shen and zhi gan cao would hold this descension back.

Bai zhu and gan jiang are both dried which produces an astringing nature. Both the sweet and astriging nature are being used together to stop diarrhea and transform the dampness.

Tai yang

Bai zhu dries dampness on the surface

Yang ming

Bai zhu dries dampness and tonifies the stomach, gan jiang tonifies and warms while drying dampness in the stomach and intestines, zhi gan cao tonifies stomach while moistening

Tai yin

Ren shen tonifies spleen while moistening, bai zhu warms and tonifies spleen while drying dampness, gan jiang tonifies and warms while drying dampness in lung and spleen, zhi gan cao tonifies spleen while moistening

Shao yin

Ren shen tonifies original qi, zhi gan cao nourishes heart blood

Understanding Li zhong wan is understanding the balance between the dryness and dampness and there are an infinite number of modifications.

For example the formula si jun zi tang is based on li zhong wan and more can be read here. http://www.itmonline.org/articles/si_junzi_tang/si_junzi_tang.htm

Gui zhi gan cao tang

gui zhi 12 zhi gan cao 6

We can learn much about the balance between the yang and yin aspects in a formula, but also in treating pathology by understanding gui zhi gan cao tang.

When too much (another version uses copious) sweating has been promoted, and the person crosses both hands to cover one’s heart, with palpitations under the heart, and a desire to apply pressure, gui zhi gan cao tang governs.

Sweat is the fluid of the heart and it is produced from the steaming of body fluids by yang qi. Excessive promotion of sweat can cause the yang qi to leak out with the sweat, depleting the heart yang, and resulting in palpitations and restlessness, which can be eased by the pressure of the hands on the chest.

This illustrates the mutual dependence of warm dynamic protecting functional yang qi and nourishing fluid structural yin qi. Any loss of fluids can lead to a loss of yang and in this case it is sweat. Recently a client of mine had just given blood and ended up with palpitations. Another client of mine ended up with palpitations after vomiting.

To tonify yang qi of the heart we use the taste combination of pungent and sweet.

The taste of warm pungent herbs adds movement and warmth and any excessive movement is controlled or calmed by the moderating sweet taste.

Zhi gan cao, Glycyrrhizae radix praep mix fried with honey

Zhi gan cao contains both a yang and yin aspect that is mostly yin and slightly yang.

It is yang because it tonifies. It is yin because it moistens, nourishes, calms and moderates.

Zhi gan cao is an Earth herb because it nourishes and directly tonifies Earth. Zhi gan cao warms cold and generates dampness in the form of fluids. It tonifies and nourishes yang ming stomach and tai yin spleen.

It directly tonifies and nourishes shao yin heart blood.

Gui zhi, Cinnamomi cassiae ramulus

Gui zhi contains both a yang and yin aspect that is mostly yang and slightly yin.

It is yang because it warms, moves blood, tonifies function, and transforms water. It is yin because it nourishes blood. It is much more yang than yin.

Gui zhi is a Fire and Wood herb because it warms Wood which is the mother of Fire to support the imperial and ministerial Fire.

Gui zhi warms cold and creates wind as movement in the jue yin liver blood. It nourishes and tonifies shao yin heart blood. It puts the emperor back on the throne. It transforms Water by warming the tai yang bladder organ.

Gui zhi is one of the most important herbs in that it warms the heart yang which warms imperial fire. When the emperor is strong there is peace in the kingdom.

Gui zhi opens the vessels and promotes flow of blood, it is one of the most important herbs for moving blood. It warms the vessels and heart and moves stagnant and congealed blood.

Gui zhi frees the flow of yang of the channels and organs of tai yang to help expel evils.

Gui zhi opens channels and promotes blood and fluids movement.

The yang and yin aspects of each herb complement each other. Together they create more heart yang while anchoring it in yin.

Let’s look at some formulas that use this pair to tonify shao yin heart blood.

Gui zhi jia gui tang

gui zhi 15 bai shao 9 sheng jiang 9 da zao 9 zhi gan cao 6

When was promoted with a burning needle, and the needle location was invaded by cold, there will be a papule that will turn red, for then imperatively running piglet will arise, and qi will surge upward from the lower abdomen striking the heart, for then one should burn one moxa cone on each papule, and gui zhi jia gui tang can be given, which is an extra two lian of gui zhi.

In this formula the dose of the gui zhi has been increased to create more Wood wind to anchor the yang qi back downwards in the abdomen for treating running piglet qi.

Gui zhi qu shao yao tang

gui zhi 9 sheng jiang 9 da zao 6 zhi gan cao 6

In tai yang disease, when after precipitation the pulse is skipping and there is fullness in the chest, gui zhi qu shao yao tang governs.

Obviously bai shao has been removed from gui zhi tang. Taking out the sour collecting nature of bai shao will increase the Wood wind to tonify Fire and the shao yin heart blood.

This is a tai yang exterior pattern where inappropriate purging has adversely affected the chest yang. The qi dynamic is affected, resulting in fullness in the chest and a hasty pulse. A hasty pulse or cu mai also known as a skipping pulse refers to a rapid and irregular pulse which can indicate extreme heat agitating qi, heart fire, heart qi deficiency or the obstruction of the flow of qi and blood.

Gui zhi qu shao yao jia shu qi long gu mu li jiu ni tang

gui zhi 9 sheng jiang 9 da zao 6 zhi gan cao 6 fu zi 9  long gu 9  mu li 9

For fire evils (burns) gui zhi qu shao yao jia shu qi long gu muli jiu ni tang governs.

In cold damage with a floating pulse, after the doctor has forced and hijacked with fire, there is death of yang, which imperatively causes fright and mania, and disquietude in both, lying and standing, gui zhi qu shao yao jia shu qi long gu muli jiu ni tang governs.

It treats a weak yang that is floating up and outwards either causing sweating or palpitations and fear and fright. Fear and fright is what we call panic attacks. There will be mental unrest and vexation due to the floating yang.

This formula is also based on gui zhi tang and also the bai shao has been removed but now fu zi has been added to increase the Wood wind to tonify Fire. The long gu will anchor the yang downward and keep the formula from getting excessively warm.

This taxation formula augments the heart yang, eliminates turbid phlegm and sedates and calms the heart shen, use for fear and fright and exhaustion. It treats weak heart yang while supporting tai yin.

Originally shu qi, Dichroae folium was used but we now use fu zi. Shu qi is toxic, warm, bitter, and pungent. Bitter drains and we want to nourish yin and blood while tonifying yang so it makes sense to use fu zi. Draining is normally drying of fluids.

Zhi gan cao tang

sheng di huang 48 mai men dong 12 ejiao 6 ren shen 6 hou ma ren 12 gui zhi 9 sheng jiang 9 da zao 18 zhi gan cao 12

For cold damage with a pulse that is bound and intermittent and stirring heart palpitations, zhi gan cao tang governs.

Zhi gan cao tang treats deficiency taxation with insufficiency, there is sweating and oppression, a knotted pulse and palpitations, and although activities and movement is regular, it will not last more than one hundred days, and in dangerous cases, one day after eleven days.

Zhi gan cao tang also contains gui zhi tang but with bai shao removed and for the same reason of treating the heart yang deficiency. Since the nature of this formula is mostly yin you may want to consider increasing the dose of gui zhi or even adding fu zi and long gu.

The yang and yin aspects of a formula have a great impact on what and how the treatment will work. Gui zhi gan cao tang and its use in other formulas illustrates this nicely.