by Bob Flaws

Wu Ling San (Five [Ingredient] Poria Powder) comes from Zhang Zhong-jing's late Han dynasty Shan Han Lun (Treatise on Damage [Due to] Cold) where it is recommended for those with an exterior pattern complicated by an interior accumulation of water. However, today, like so many of Zhang's formulas, Wu Ling San has a broader scope of application. In particular, this formula is excellent for treating damp accumulation resulting in water swelling and bodily heaviness due to spleen vacuity. The ingredients in Wu Ling San are:

Fu Ling
Zhu Ling
Ze Xie
Bai Zhu
Gui Zhi

...

Within this formula, the two main ingredients are Fu Ling and Zhu Ling, the so-called two Lings. Both are species of fungus which grow underground (similar to truffles). In terms of these two medicinals' Chinese medical descriptions, they are mirror images of each other. In other words, Fu Ling primarily fortifies the spleen and seeps dampness, while Zhu Ling primarily seeps dampness and, therefore, secondarily benefits the spleen. In addition, of the three viscera which control water fluids in the body (the lungs, spleen, and kidneys), Fu Ling mainly enters the spleen, while Zhu Ling mainly enters the kidneys and bladder. Hence these two Ling, complement each other and reinforce each other's functions very nicely. Of the two main ways of eliminating dampness from the body in Chinese medicine -- aromatically transforming (a.k.a. drying) and seeping -- both these medicinals seep dampness and disinhibit urination.

Fu Ling and Zhu Ling used together form a well-known empirically effective combination in Chinese medicine. This function of seeping is then further augmented by the addition of Ze Xie. However, because this formula contains Bai Zhu, it also does eliminate at least some dampness by aromatically transforming or drying it. In the same way that Fu Ling and Zhu Ling are a well-known, empirically effective combination, Fu Ling and Bai Zhu are also a well-known and frequently used combination. Because both Fu Ling and Bai Zhu fortify the spleen, this formula is often used, at least as a module, for the treatment of water dampness due to spleen vacuity failing to transform water fluids.

Gui Zhi resolves the exterior. That is probably why this formula's original author chose it for this formula, remembering that this formula is indicated for the treatment of an exterior pattern in the Shang Han Lun. However, Gui Zhi also mildly warms the center. Thus it can help Fu Ling and Bai Zhu fortify the spleen and supplement the center. Because qi and water fluids move together in the body and Gui Zhi warms the channels and can help move the qi, Gui Zhi also helps move water. In addition, Gui Zhi downbears turbid yin, guiding damp evils from the middle to the lower burners for excretion via urination. Although Gui Zhi is warm in nature, because its warmth is much less than Rou Gui's, Gui Zhi can typically be used safely even when there are no cold signs and symptoms. It can even be used without undue concern in the presence of heat evils as long as those heat evils are addressed by other medicinals. Thus one should not think that there have to be cold signs and symptoms before one can use this formula just because it contains Gui Zhi.

This formula can be used alone, especially in children where one generally prefers small formulas with mild ingredients. However, I find it most useful when thought of as a module. In that case, I often add this formula to other formulas when I want to increase the seepage and transformation of damp evils. For instance, this formula can be added to any of the spleen-supplementing formulas when there is more dampness than those formulas routinely treat. Wu Ling San can also be added to several different families of harmonizing formulas, such as the Xiao Yao San family, the Xiao Chai Hu Tang family, and the Ban Xia Xie Xin Tang family of harmonizing formulas, again when one want to seep and eliminate more significant dampness. Yet another possibility is to add this formula to any of the Di Huang Wan family of formulas. One of the indications of this formula is for the treatment of phlegm rheum in the lower burner. Because this formula seeps dampness via disinhibiting urination, it can be combined with any of the Di Huang Wan formulas when there is water swelling and bodily heaviness due to primarily kidney vacuity.

In particular, I'd like to share with my readers a specific situation where Wu Ling San is absolutely essential. Sometimes you will come across a patient who has obvious signs of spleen vacuity dampness, such as chronically loose stools and an enlarged tongue, at the same time as they are markedly thirsty. However, if they drink water, it doesn't feel good and can actually make them nauseous. In this case, it may be that water is accumulating in the middle burner. Because it is not being transported upward, the mouth feels dry and thirsty. However, this condition is not one of true fluid dryness but actual damp accumulation. To help confirm this, you may ask the patient if he or she sometimes hears water sloshing about in their belly, for instance when turning over in bed. (some people call this "water brash.") If the patient answers yes to this, lie the patient down on his or her back and gently jiggle the belly repeatedly with the fingertips of a single hand, moving your hand rapidly but not too heavily up and down. If this elicits the sound of water sloshing around in the stomach, then definitely prescribe Wu Ling San no matter what other Chinese medicinals you also prescribe. In such cases, even only a few doses or days of Wu Ling San can get a remarkable effect, sometimes eliminating long-standing complaints quickly and easily.

So whether you use Wu Ling San alone or in combination with one or more other formulas, don't forget this important formula whenever there is marked water dampness. Blue Poppy carries this formula in our Blue Poppy Classic line as a 10:1 capsule and in our Great Nature line as a 7:1 tablet. Shawn and Malia, our Blue Poppy practitioner customer service representatives, can help you decide which of these is right for your clinic depending on whether strength or cost are most important to your and your patients.

Copyright Blue Poppy Press, 2010. All rights reserved.