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.

Xiao chai hu tang

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

zhi gan cao 6

This has got to be the most popular formula in the modern clinic, it certainly is in mine.

But why is it the representative formula for a shao yang pattern.

Understanding xiao chai hu tang is understanding the balance between the yang and yin levels and the imperial and ministerial fire.

Shao yang patterns are the most common because all weakness of the imperial fire weakens the ministerial fire. The imperial fire is the true fire and water of the body. When this becomes weak there arises unrest in the kingdom.

The unrest that arises in the kingdom causes accumulations such as dampness and phlegm and a flaring of the ministerial fire due to stagnation. Look for cold hands and feet, hot flashes, a stool that is alternating hard and soft, a sore throat, dizziness, and mental vexation.

There are different causes of this weakness of the imperial fire. It is often caused by a tai yang wind strike pattern that has progressed internally. It can also be caused by taxation where yin fails to contain yang which then becomes overabundant and reckless. It is certainly the most common pattern seen in modern clinics.

Let’s take a look at the difference between the imperial fire and the ministerial fire. The imperial and ministerial are one Fire with different qualities. The imperial Fire is more static and stable. The ministerial Fire is more circulatory and supportive.

We can compare the imperial fire to the sun.

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. Ch 3 Neijjing suwen.

It is the same for the emperor of a land. As a secondary climatic qi it is called heat because it can never be excessively warm.

The job of the minister is to bring the message from the emperor to the people. As a secondary climatic qi it is called fire because it can change in intensity. If too hot it burns tissues. If too cool it fails to support the bodily functions in all three burners.

The ministerial fire is only hot when it stagnates.

Xiao chai hu tang is considered a harmonizing formula because it clears the accumulation of excess as in damp and phlegm but also the heat that arises due to stagnation while supporting the weakness that gives rise to the accumulation in the first place. It clears problems in the shao yang level while tonifying and moistening the tai yin, shao yin and jue yin levels.

It allows the ministerial fire to once again freely circulate in all three burners supplying the warmth and nutritive to the organs and surface.

By freeing the ministerial fire it allows the clear qi formed from food qi to rise up through the tai yin to the 100 vessels as true qi which can then protect, warm and nourish the surface and body.

Chai hu frees jue yin liver blood needed to support the Earth and Metal.

Huang qin clears the congestion in the jue yin liver and shao yang gall bladder and the yang ming stomach domain.

Chai hu relieves the surface of wind heat evils and frees the body from evils that have entered the shao yang realm and have transformed into heat.

Huang qin is a qi layer heat clearing herb, it also clears internal heat in the shao yang and yang ming channels. It clears internal gall bladder heat that flares up to the upper burner. It also clears san jiao damp heat through its bitter drying taste and cold cooling nature.

Together they clear the congestion on the surface and interior of the shao yang realm.

Chai hu, huang qin are shao yang herbs. Ban xia, ren shen, sheng jiang, da zao and zhi gan cao are the magik five.

Ban xia forms part of the magik five. The magik five tonifies tai yin and clears phlegm accumulation in the stomach, yang ming domain, lung and chest.

Ban xia dries Earth dampness, it transforms damp phlegm and disperses qi stagnation. It moves qi in yang ming and transforms phlegm and dampness in tai yin spleen and lung.

This formula works on all levels at once.

Tai yang

chai hu clears heat congestion on the surface, sheng jiang warms  the surface

Yang ming

huang qin clears damp and heat in the stomach domain, ban xia dries dampness and moves qi in the stomach, sheng jiang tonifies and disperses excess fluids in the stomach, zhi gan cao tonifies stomach while moistening

Shao yang

chai hu clears damp and heat in the san jiao, huang qin clears damp and heat from the san jiao, gall bladder

Tai yin

ban xia tonifies, warms and dries spleen and lung, ren shen tonifies spleen and lung while moistening, sheng jiang tonifies and warms spleen and lung and sends clear qi upwards, da zao tonifies spleen while moistening, zhi gan cao tonifies spleen while moistening

Shao yin

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

Jue yin

huang qin clear damp and heat from the liver, da zao nourishes blood

Modifications from line 96 of the Shang han lun

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.

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

Ban xia treats retching and if this is absent it is ok to remove and replace with herbs that will treat the vexation which is due to excessive heat rising to the chest. Ren shen replaces lost fluids to help contain reckless yang qi and gua lou shi cools heat, opens the chest and flushes out accumulations.

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

Ban xia is drying and this will cause more thirst. Ren shen moistens taiyin fluids and gua lou gen or tian hua fen clears heat while moistening.

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

Huang qin is very cold and very bitter so the pain must be caused by dryness in Earth. Bai shao moistens yin and blood so the Metal element can once again descend. We see the combination of chai hu and bai shao in the small formula si ni san. The chai hu treats the yang level of shao yang and the bai shao treats the yin level of jue yin.

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

Da zao moistens and this creates more dampness which can make the glomus worse. It is the muli which makes it clear that the glomus is from dampness because muli is salty and the taste of salt softens hardness.

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

Huang qin is drying and this can cause the shao yin heart to become even more weak. When the imperial fire is weak water can surge upwards causing palpitations. Fu ling promotes urination to clear excessive water.

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.

Adding gui zhi will treat the surface and mild generalized heat if due to tai yang wind strike. Gui zhi is creating more Wood wind to clear the surface of cold and ren shen would hold this dispersing back with its yin fluid generating nature.

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

If the cough is due to excessive fluids in the lung then the ren shen and da zao which create fluids will make it worse. The sheng jiang is not drying enough and is replaced with gan jiang which is much more drying. Wu wei zi will correct the counter flow qi of the lung with its sour collecting nature.

Once the balance between the yang and yin levels has been cleared then you can proceed to tonifying and nourishing the yin levels.

Xiao chai hu tang puts the emperor back on his throne.

Really? Have we lost our past?

Like most practitioners of TCM I looked forward to seeing how the symptoms of the latest influenza would translate into a known pattern. Naturally so I would know how to treat if it came my way. What I see is that it fits with my training and experience. Simple. It progresses in a Shang han lun and Wen bing structure. Easy, right?

What worries me is the circulation of a formula used for prevention of Pneumonia. It was used in China in a major hospital. So it must be good, right? Lets take a look.

huang qi 15 bai zhu 10 fang feng 10 mian ma guan zhong 10 jin yin hua 10 chen pi 6 pei lan 10

Suitable for: Prevention of pneumonia due to viral infections, and the flu

In what way does this increase wei qi?

Mian ma guan zhong is bitter and cold. It kills parasites, clears heat and drains fire toxicity, cools blood and stops bleeding.

Mian ma guan zhong cools the jue yin blood layer while draining Fire causing toxicity. By cooling the blood it stops bleeding due to heat naturally. Meaning it cools the ministerial fire and imperial fire needed to support yang qi or wei qi. Using this herb as a prevention is contradictory to supporting normal health.

Jin yin hua is sweet and cold. It clears heat from the nutritive and blood layer outwards. Meaning it cools the ministerial fire and imperial fire needed to support yang qi or wei qi. Using this herb is contradictory to supporting normal health.

Pei lan is pungent, aromatic and neutral. It clears dampness causing heat without drying and is often used for summer heat. It clears heat without causing excessive dryness. It is used to support the separation of food qi into pure and impure.

It works together with chen pi and bai zhu in this regard.

Lets look at what this formula does not do. Why? Because our strength of treatment comes from identifying patterns of disharmony. Using this formula for prevention of a tai yang wind strike or wind cold or wind heat pattern may work for some clients but it will fail for others.

The jue yin level is connected to the shao yang level. It contains the circulating warm blood that is the ministerial fire. The jue yin is the blood storage and the shao yang is the circulating blood that causes movement or internal wind. Yang qi or wei qi is dependent on abundant warm blood to protect the body.

Qi is the commander of blood. Blood is the mother of qi.

Qi generates blood. Qi moves blood. Qi holds the blood.

Blood nourishes qi.

In this formula there is only huang qi that nourishes warm yang filled blood. There are no other herbs that support the post heaven qi or the pre heaven qi. If you give this formula to a client that has blood deficiency and cold it will make it worse.

The tai yin level is connected to the yang ming level and together they are the post heaven source of qi, blood and fluids. The tai yin represents the bodies dampness and yang ming the dryness. This needs to be balanced. Chen pi, bai zhu and pei lan will move the qi in Earth and help with transforming dampness. If there is too much dryness as in chronic constipation they could make it worse.

The shao yin level is connected to the tai yang level and together they represent the true fire and true water of the body. They are dependent on nourishment from tai yin and yang ming. Huang qi and fang feng do increase yang qi at the surface and both are moistening and warm pungent. They are considered tai yang herbs. If there is a shao yang pattern with flaring of ministerial fire due to stagnation from dampness they will make it worse.

All three yin levels work together to rule the kingdom and keep us healthy.

This is dependent on abundant warm freely circulating blood.

It is almost impossible to used a one size fits all approach in herbal therapy. This formula will help some but for others it will cause weakness due to cooling of the imperial and ministerial fire.

But, what would I do if not allowed to treat the pattern I see or take the pulse? If I was pressured into developing a formula that could be used for preventing any kind of infectious disease I would try to choose a formula that represents the pattern of weakness that I see in my clients every day.

By far the most common patterns I see are a shao yin pattern of weakness due to a deficiency of yang and yin with a shao yang pattern of dampness causing stagnation with a flaring of ministerial fire. For me this makes sense. There is a tendency to over stimulate the imperial heart yang which causes a failure of yin to supply the nourishment needed to contain the yang qi which then becomes reckless and over abundant. This leads to a weakness of the ministerial fire which is naturally dependent on the imperial fire. Weakness in the ministerial fire causes problems in all three burners such as the formation of dampness. This dampness in turn causes problems with the circulation and heat develops and flares outwards.

Therefore the treatment will reflect tonifying and nourishing the shao yin while ensuring that the jue yin and shao yang can circulate freely.

I choose ….wait for it

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 gan cao 9 da zao 9 jie geng 6 chai hu 6

fang feng 6 xing ren 6 bai lian 1

In deficiency taxation and insufficiency, for the hundred diseases due to wind qi, shu yu wan governs.

This formula can be used for weak patients in a tai yang wind strike pattern or for tonifying and nourishing to increase the wei qi function of yang qi.

Often underrated in effect but probably due to expense; seeing as the number of herbs is 21.

Primary, tai yang

Secondary, yang ming, shao yang, tai yin, shao yin, jue yin

Tai yang, gui zhi warms the surface, chuan xiong clears stagnation on the surface, bai zhu drains dampness on the surface, chai hu clears heat congestion on the surface, fang feng clears cold on the surface while moistening, bai lian clears heat accumulations that prevent proper function

Yang ming, mai men dong moistens stomach, bai zhu dries dampness in stomach, gan jiang dries dampness in stomach, shen qu moves the stomach qi downwards, zhi gan cao tonifies stomach qi while moistening

Shao yang, chai hu clears damp and heat in the san jiao

Tai yin, shan yao tonifies spleen and lung, mai men dong moistens lung, ren shen tonifies lung and spleen while moistening, bai zhu warms and tonifies spleen while drying dampness, gan jiang warms and dries damness in lung and spleen, dou huang juan drains dampness, zhi gan cao tonifies spleen while moistening, da zao tonifies spleen, jie geng disperses qi in lung to clear heat that forms pus and abscess, fang feng raises clear qi and stops diarrhea, xing ren disperses and descends lung qi

Shao yin, shan yao tonifies kidney qi, gui zhi warms imperial fire to warm the ministerial fire, ren shen tonifies original qi, fu ling moves water, zhi gan cao nourishes heart blood

Jue yin, sheng di huang nourishes blood while cooling heat, bai shao nourishes and moves blood, dang gui warms and nourishes blood and cools deficiency heat, chuan xiong moves qi in liver blood, mai men dong nourishes the upper source of water, ejiao nourishes yin and blood, da zao nourishes blood

Thank you Zhang Ji.

True qi and Yu ping feng san

Yu ping feng san has a reputation of increasing protection from sickness that we call tai yang wind strike and tai yang wind cold.

In what way does it work and is this the best solution? We may lose sight of what makes us unique as therapists in treating sicknesses when it is suggested that just Yu ping feng san can offer some sort of protection.

True qi

Gathering qi is transformed into true qi by the catalytic action of original qi. Original qi and gathering qi form true qi. True qi is the qi that circulates in the channels or vessels and this supports the body in all its needs and processes. True qi and gathering qi originate from the lungs.

The lungs are the meeting place of the 100 vessels. Neijing suwen

There are two forms of true qi, the Nutritive and Defensive qi. Nutritive qi is called Ying qi in Chinese. Defensive qi is called Wei qi in Chinese.

Nutritive qi

It is a nourishing qi and supports the organs, tissues and whole body. It is closely related to blood and flows in the blood vessels.

I consider the nutritive a part of blood and it is the part that we consider the nutrients, fats, sugars, and other nourishing particles. It is yin compared to the defensive wei qi.

Defensive qi

It is yang compared to the nutritive qi. It is the warm active part of blood that also radiates outside of the blood vessels as waves of energy. It is the yang radiance of the yin. It protects the body, warms, moves, moisturizes, and controls the pores of the skin which controls sweating and temperature.

Blood

Blood is a form of qi. It is a dense and material form of qi. Blood is inseparable from qi. Qi infuses life into blood.

Blood comes from food. It is transformed by the catalytic action of Earth and the clear part is raised to the lungs and then to the heart. The kidney essence and original qi play a role in transforming food qi into blood.

The main function of blood is to nourish and moisten the body and contain yang qi. Since they are inseparable we can say that yang qi and blood nourish, warm, and moisten the body.

Qi is the commander of blood. Blood is the mother of qi.

Qi generates blood. Qi moves blood. Qi holds the blood.

Blood nourishes qi.

When explaining the different types of qi and blood there arises a feeling that it is all nicely separated. This is not the case. My problem is the inseparable part of the production of qi and blood.

The production of qi and blood starts in the kidneys and spleen. Kidney essence combined with original qi meets food qi which goes to the lung and becomes gathering qi. When food qi and gathering qi meet in the heart it becomes blood. True qi arises from the gathering qi after being changed from the interaction of original qi.

If we go backwards it makes better sense. Defensive qi and nutritive qi are both inseparable from blood. Blood and qi are inseparable from each other so the production of both should be seen as one whole process ending with both qi and blood which contains two different aspects of one whole. Defensive qi is yang compared to nutritive qi.

All three yin levels work together to produce qi and blood and fluids.

Tai yang is on the surface, and its nature is open and expansive, it is the outside. The yang ming is internal and its action is storing, thus it is the house. The shao yang, which is between the internal and external, acts as a bridge and is considered the hinge between the internal and external. The three yang, however, do not act separately, but rather in unison. So, collectively we call them one yang.

Tai yin is the most superficial of the three yin channels, and its nature is expansive. The jue yin is the deepest of the yin. Its nature is that of storing and thus it is considered the house. The shao yin is in between, and acts to connect and is considered the hinge or door. The three yin must work in unison. Collectively they are considered one yin. Ch 6 Neijing

Tai yin is the source of fluids and food qi. It becomes blood and qi in the chest where the lungs and heart spread it over the body. Tai yin is the post heaven source of qi and blood and fluids and accounts for the biggest part of production.

Shao yin plays a role in qi and blood and fluid production. It is considered the true qi and true water. It plays a role in the production by delivering the original qi and kidney essence. The kidneys are responsible for blood production through the marrow. Marrow produces blood in the same way as in western medicine. Shao yin is the source of pre heaven qi and blood but also a small source of post heaven qi and blood and fluids.

Jue yin plays a part in the production of qi, blood and fluids by the action from the ministerial fire. Ministerial fire is the imperial heat that circulates in all three burners and supports all systems and organs that produce and nourish and move the qi and blood and fluids.

Yu ping feng san

Source is Yifang leiju

huang qi 18 bai zhu 18 fang feng 9 da zao 9

Arnaud Versluys and Hans Fruehauf write…

Though the foremost formula in TCM to be mentioned as a surface firming prescription, the formula focus is primarily based on the tonification of surface qi and secondarily on the stirring of tai yang protective yang.

It is important to stay aware of the fact that the first formulas to be considered in sweat astringing situations, should be the nutritive and protective harmonizing formulas of the gui zhi tang family as dictated by the classics which give regard to the functional treatment of imbalances rather than the material tonification of deficiency.

Huang qi is a rather balanced herb. It is yang functional tonifying and yin material nourishing. It raises yang and yin to the surface while also tonifying the tai yin spleen and lung. In this way it supports the true qi and gathering qi of the post heaven source of qi.

It does not support the kidney essence, and original qi of the pre heaven source.

Fang feng is also a balanced herb. It is yang functional tonifying and yin material nourishing. Warm, pungent, and sweet and is called the moisturizer of the wind herbs.

Fang feng treats wind cold and dampness while dispersing cold and arrests pain with pungent strengthening of yang qi but it also contains the yin needed to anchor the yang.

Is a tai yang and tai yin herb. It raises clear yang of Earth and can stop diarrhea while clearing the surface.

It does not support the kidney essence, and original qi of the pre heaven source.

In conclusion.

What makes Chinese Medicine unique is that we see patterns of disharmony. We take into account the pre-condition of each case when treating a new pattern of disharmony.

Giving just Yu ping fang san as protection does not take into account the precondition.

Giving Yu ping fang san as a treatment for a tai yang wind strike or tai yang wind cold is not good enough.

Adding huang qi and fang feng to other formulas will increase the true qi on the surface.

But the formula must also take into account the precondition. Other formulas just may be a better choice.

For example it would not be logical to add them to a shao yang or yang ming pattern.

Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon has this to say about Yu ping feng san.

Jade Screen Formula was developed originally as a treatment for spontaneous sweating that was due to deficiency syndrome or was the result of a pathological influence still lodged in the surface. More recently, it has become a therapy for prevention of cold, flu, and allergic rhinitis, and a treatment for viral infections, nephritis, and other disorders. These newer uses are derived both from an analysis of the formula by traditional principles and from successful applications of this tonic formula to patients who show signs of deficiency syndrome.

For more, http://www.itmonline.org/arts/jadescreen.htm

Si ni san

chai hu 12 zhi shi 12 gan cao 12 bai shao 12

This is the representative formula for deficient pivoting of shao yang due to dryness in jue yin and yang ming.

When in shao yin disease there is counter flow cold of the limbs, the person may cough, or have palpitations, or inhibited urination, or pain in the abdomen, or diarrhea with rectal heaviness, si ni san governs.

Si ni san is not a shao yin formula but it does treat counter flow qi of the limbs by freeing the yang in shao yin and the ministerial fire.

It is a yang and yin formula. It is yang because it moves, drains, and tonifies. It is yin because it cools and nourishes.

It frees the Wood element to give birth to Fire. It clears accumulation in Earth and Metal to give birth to Water. By freeing Wood and Earth the post heaven source of qi, blood and fluids is restored.

Primarily this is a shao yang formula. It also treats yang ming stomach, tai yin spleen, and jue yin liver.

Chai hu and zhi shi treat the yang levels and gan cao and bai shao treat the yin levels.

It clears damp and heat accumulating in the san jiao. It clears damp and heat in the liver and gall bladder organs. It also moves the qi in the liver and gall bladder and yang ming stomach.

It tonifies the yang ming stomach and tai yin spleen while moistening the yang ming domain.

It nourishes the jue yin liver blood.

Chai hu, Bupleuri radix

Chai hu is a yang and yin herb. It is yang because drains dampness, it is yang because it frees movement. It is yin because it drains heat. It is more yang than yin.

Chai hu is a Wood herb and a Fire herb. It clears damp and heat from Wood organs to free the flow of qi which needs to circulate in the san jiao as ministerial Fire.

Zhi shi, Aurantii fructus immaturus

Zhi shi is a yang and yin herb. It is yang because it moves, it is yang because it tonifies function, it is yang because it transforms phlegm accumulation. It is yin because it is cool. It is more yang than yin.

Zhi shi is a Metal and Earth herb because it clears accumulations in Earth and it descends the Metal.

Gan cao, Glycyrrhizae radix

Gan cao is a yang and yin herb. It is yang because it tonifies. It is yin because it moistens, it is yin because it nourishes, it is yin because it adds material, it is yin because it clears heat, it is yin because it calms and moderates. It is more yin than yang.

Gan cao is an Earth herb because it nourishes and directly tonifies Earth.

Bai shao, Paeoniae radix lactiflora

Bai shao is mostly a yin and a slight yang herb. It is yin because it moistens, it is yin because it nourishes blood, it is yin because it calms Wood wind. It is yang because it mildly moves blood.

Bai shao is a Metal and Water herb. It nourishes Metal and Water to give birth to Wood.

Si ni san may not get used much in clinic due to the complexity of everyday problems but in theory it represents many basic principles.  It is built on the formula shao yang gan cao tang.

Shao yao gan cao tang

bai shao 12 gan cao 12

If there is still slight hyper tonicity of the lower legs, give a large dose of shao yao gan cao tang, so that the lower legs will be able to extend.

It follows the Neijing rule of when the liver suffers urgency, use sweet to moderate, and when wind evils are interior, use sour to purge. Sour bai shao and sweet gan cao generate yin and blood.

When Metal is healthy it controls Wood. Zhi shi and bai shao keep the Metal healthy by moistening and moving Earth and Metal. When Wood is free to warm and move it supports the function in the whole body as circulating ministerial fire.

In lily bulb disease, without undergoing vomiting, purging or sweating, the disease manifestation is as in the beginning, bai he di huang tang governs.

Water failing to cool Fire resulting in dryness of nutritive and blood. This is a yin formula in that it nourishes and cools. It clears jue yin deficiency dryness and heat causing mental unrest.

Bai he nourishes lung and heart yin while mildly clearing deficiency heat. Sheng di huang enters heart and kidney channel and nourishes nutritive of blood while clearing heat from the yin layers. Used fresh it is cooling and nourishes yin.

A bai he pattern is one of dryness. The dryness affects the upper source of Water. The nutritive in jue yin fails to cool and nourish the heart. Heat can arise which causes mental unrest. We often see this occurring in a shao yang pattern when the ministerial fire flares and consumes fluids. We also see this occurring in a yin layer pattern. When yang and yin are both weak dryness can occur.

Think of bai he di huang as a module to add to other formulas. You can add it to xiao chai hu tang to treat dryness and heat causing failure to sleep through the night. You can add it to center tonifying formulas like xiao jian zhong tang to create more nourishment of the nutritive and cool deficient heat.

Also known as shen qi wan, cui shi ba wei wan, jin gui shen qi wan, gui fu di huang wan

Source Shang Han Za Bing Lun

sheng di huang 24 shan yao 12 shan zhu yu  12 fu ling 9 ze xie 9 mu dan pi 9 fu zi 3 gui zhi 3

It is important to understand shen qi wan because many modern formulas are based on the trio of sheng di huang, shan yao, and shan zhu yu.

Such as liu wei di huang wan, you gui wan, zou gui wan, zhi bai di huang wan, zan yu dan, da bu yuan jian. This formula first appeared in the Shang Han Za Bing Lun. We find it in the taxation chapter. Taxation refers to the loss of yang function and yin material and nutritive. If we look at the associated text we see what Zhang ji thought was important to know about the use of this formula

For deficiency taxation with lower back pain, urgent tightness in the lower abdomen, and difficult urination, ba wei shen qi wan governs.

Lower back pain is due to a deficiency of blood, nutritive, and material loss in the bones and muscles. Urgent tightness in the lower abdomen is due to a drying of blood. Difficult urination is due to a dryness of fluids.

We see that the Earth element is dry and not giving birth to Metal and Water. The body is so weakened and dry that it is becoming stiff and painful.

For consumptive thirst in men, but adversely with increased urination, for when one drinks one liter one urinates one liter, shen qi wan governs.

This line mentions increased urination. The body and especially the kidneys are so dry that it fails to hold water. Kind of like my plants after a vacation, dry and cracked earth prevents the water from being absorbed.

Shen qi wan treats a taxation pattern where due to excessive loss of yang function and yin nutritive water either drops out the bottom or is inhibited. It tonifies taxation, creates kidney qi, and restores water metabolism.

Arnaud Versluys writes, this formula not only addresses both excess and deficiency of the body’s innermost organs, but also functionally tonifies both the original yin and original yang of the physical body. Shen qi wan is the representative remedy to restore kidney qi which is produced by the constant interaction of the body’s true water and true fire.

Herbs in Shen qi wan

Sheng di nourishes the yin in blood and cools heat due to deficiency. It nourishes the body’s yin supply to nourish the jue yin liver blood storage. This restores the connection between the heart and kidneys through the jue yin. Imperial fire can then descend to the lower burner where it will warm the cold kidney water and promote the creation of physiological kidney qi for healthy water metabolism.

Shan yao is always used classically in taxation cases with weakened water controlling abilities of the spleen and kidneys.  It restores normal opening and closing functions of the kidneys.

Shan zhu yu astringes kidney essence into the jue yin channels with its sour collecting nature.

Fu ling and ze xie combined promote urination and lead stagnant fluids into the tai yang bladder system to be expelled through urination. They also move water which promotes the movement of blood which has become stagnant and dry.

Mu dan pi is a blood moving herb that clears stagnation heat from the blood layer. The stagnation heat is caused by increased friction due to blood stasis. It is pungent moving, bitter draining and heat cooling herb.

Fu zi and gui zhi put the emperor back on his throne by warming the shao yin. They both warm the water to promote qi production. Some text books suggest the use of rou gui. Gui zhi is more of a tai yang herb and is a better choice for this shen qi wan pattern.

By removing the fu zi and gui zhi it becomes the modern formula liu wei di huang wan.

In TCM text books we see the following kidney pattern: Kidney yin vacuity with deficiency fire. Often the formula liu wei di huang is recommended to treat this pattern.

By calling this pattern by its yin organ it misleading. Using the climatic qi fire is also wrong. If we are talking about the kidneys we are talking about the shao yin and in shao yin the secondary climatic qi heat rules. Fire rules in shao yang. Yin is failing to hold the yang which becomes reckless and excessive. It is caused by a failure of yin to hold and contain the yang.

The kidneys belong to the shao yin level along with the heart and is coupled to the tai yang. If the yin kidneys are deficient then the yang organs of the bladder and small intestine are also deficient.

Chapter 3 Neijing suwen reads,

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.

Using liu wei di huang tang may cool the heat but it will also put out the imperial heat that the emperor needs to rule the kingdom. By removing the fu zi and gui zhi there will be no yang movement and warmth.

In the formula bai zhi di huang tang zhi mu and huang bai are added to cool the deficiency heat even more. Adding zhi mu will weaken the emperor even more. Zhi mu freezes yin fluids and that is why it is used in bai hu tang. Adding huang bai will also cool heat but it also drains dampness causing even more dryness.

Chapter 6 Neijing suwen reads,

Tai yin is the most superficial of the three yin channels, and its nature is expansive. The jue yin is the deepest of the yin. Its nature is that of storing and thus it is considered the house. The shao yin is in between, and acts to connect and is considered the hinge or door. The three yin must work in unison. Collectively they are considered one yin.

To nourish all three yin levels so they can work in unison we need to treat the tai yin, shao yin, and jue yin at the same time. Liu wei di huang just works on the shao yin and jue yin levels. There is no support for the tai yin. There is no tonification of yang qi so there is no movement of yin.

Removing fu zi and gu zhi is creating a very yin formula that will weaken the patient even further.

Xiao Yao San, famous or misunderstood?

Source is He ji ju fang
dang gui 9 chai hu 9 bai shao 9 bai zhu 9 fu ling 9 pao jiang 6 bo he 6 zhi gan cao 6

This formula just may be the most famous in the west. It does seem like all our patients are in some form of chronic shao yang pattern. Also, it just may be the most misunderstood formula.

Structure
It is built around the herbs dang gui, chai hu, and bai shao.
Dang gui is the foremost herb for nourishing jue yin liver blood storage. It is pungent, sweet and warm. It increases Wood wind while nourishing Wood. Meaning it is a mild blood moving tonic. It fills the blood vessels and frees blood circulation by nourishing blood. Chai hu allows dang gui to move freely and bai shao controls any excessive movement.

Dang gui and bai shao work together to nourish blood and yin. Bai shao nourishes yin, collects the nutritive qi, while moving the nutritive in blood and opening stagnation. Bai shao buffers convulsions and pain and calms Wood wind. It is the foremost herb for pain due to yin and blood deficiency.

We see the pair dang gui and bai shao in dang gui san and dang gui shao yao san.

In dang gui san chaun xiong is added to create more movement in the jue yin blood layer. Still this movement is considered safe even for pregnant women if used at a low dose.

In dang gui shao yao san the dose of the bai shao is much higher than 10 grams. Chuan xiong is also used at a much higher dose to create more movement in the jue yin blood layer. It is used for all types of abdominal pain, even for pregnant women.

Xiao yao san has a reputation of being the best formula for liver qi stagnation. The use of dang gui and bai shao nourish Wood wind but it only mildly moves the liver blood.

Chai hu is the core shao yang herb. It frees the movement in Wood. Chai hu moves the gall bladder qi while clearing congestion in the form of dampness. It frees the movement of the liver blood which restores the balance of yin and yang in the middle burner. The transformation of Earth relies on the free movement of the element Wood.

Chai hu is not combined with ban xia and huang qin as in xiao chai hu tang.  The ban xia transforms phlegm in the stomach and moves the qi downwards. Huang qin dries dampness and cools heat in the stomach and san jiao. Meaning xiao yao san is not as effective as xiao chai hu tang in clearing congestion and heat in the middle burner.

Bai zhu and fu ling drain dampness in Earth to restore control over the Water element. Moving water also moves blood.

Bo he is pungent cool dispersing of heat congestion in the jue yin liver blood. It supports chai hu in clearing congestion heat that can arise from stagnant dampness. It moves Wood and disperses stagnation.

In the source text this formula recommended for blood vacuity taxation fatigue. Dang gui and bai shao nourish blood and yin while chai hu and bo he keep the heat from building up.

Some versions of this formula suggest dried or roasted version of jiang. It seems logical to me to use sheng jiang. This supports tai yin in sending clear qi to to the chest to be dispersed by the lungs and heart to the 100 vessels.

Xiao yao san is limited in clearing the shao yang compared to xiao chai hu tang. It is less nourishing for blood deficiency than dang gui jian zhong tang. Its strength is in transitioning out of a shao yang and into tonifying and nourishing of the tai yin and jue yin levels.

I suggest something like this for getting out of shao yang.
dang gui 9 bai shao 9 chai hu 24 bo he 9 fu ling 9 bai zhu 9 sheng jiang 9 da zao 9 zhi gan cao 6

Modifications
If blood and yin deficiency are causing cramping of the muscles and abdomen use bai shao at 18.

If the blood deficiency is causing stagnant heat to arise add chuan xiong at 9 for move movement. If the heat from the blood deficiency is pronounced add tao ren and mu dan pi to move and cool.

This is a yang formula in that it warms, moves and tonifies the tai yin and jue yin. It is a yin formula in that it nourishes yin and blood and cools heat due to congestion.  

We can compare this formula with si ni san which contains chai hu, bai shao, zhi shi and gan cao. In xiao yao san the bai zhu and fu ling replace the zhi shi. Si ni san nourishes blood and yin and drains and dries dampness. It decongests the middle and frees yang to move yin.  It is not a real strong shao yang formula and it is limited in supporting tai yin.

It is said of chai hu that it raises yang so we should be careful. Chai hu restores the function of Wood to support Earth. Chai hu only frees the movement of clear food qi so it can rise to the 100 vessels. It does not functionally raise qi but facilitates normal movement.

In the source text this formula is for blood vacuity taxation fatigue. It treats a jue yin blood layer pattern with mild damp accumulation. This treats patterns on a shao yang and jue yin level.

The strength of xiao yao san is as a transitioning formula. It can be used for a mild shao yang pattern and then at a low dose for a long time.

What? We all know gui zhi tang as the go to formula for an external attack on tai yang. We also learned in school that it induces sweating which clears the surface of wind. So how can it be a yin tonic Mr Freedman?

Tai yang shang han is tai yang cold damage

Tai yang zhong feng is tai yang wind strike

In a tai yang wind cold attack there are two possibilities, a wind strike or wind cold. Both are an attack of cold but a wind strike is less cold than a wind cold attack.

In a wind strike pattern the circulation of yang wei qi is disrupted by the cold. In a wind cold pattern the cold has closed the surface.

In treating a tai yang wind strike pattern we want to restore the circulation of yang wei qi but also nourish yin to anchor yang. Yin is the mother of yang.

Gui zhi and sheng jiang are both warm and pungent. Gui zhi warms Wood and sheng jiang warms Earth. Together they are 18 grams of yang herbs.

Bai shao is cool sour nourishing of yin and blood. It controls Wood by nourishing Metal. Da zao and zhi gan cao are neutral and sweet. Da zao directly nourishes heart blood and tonifies the Earth. Zhi gan cao nourishes fluids and tonifies function in Earth. Together they are 24 grams of yin herbs.

Since da zao and zhi gan cao both tonify we can consider them yang herbs. Tonifying is restoring funtion and function is yang compared to yin nourishing.

Gui zhi also nourishes yin with its sweet taste so it is partly a yin herb. Bai shao also moves blood so it is partly a yang herb.

Gui zhi tang is a yin tonic that also tonifies yang. Gui zhi tang nourishes deficiency of both yin and yang in a wind strike pattern. Wind is a yang climatic qi that dries yin fluids on the surface of the body. The fluids need to be replaced and gui zhi tang fits that need.