The Formulas of Li Dong-yuan: Complex Formulas for Complex Conditions

Functions: Warms the center and moves the qi, dries dampness and eliminates fullness

Indications: Stomach duct fullness and distention due to dampness, cold, and qi stagnation in the middle burner

Although some people only remember that Li supplemented earth and cleared heat by the method of using sweet, warm medicinals, this is a gross over-simplification of Li’s real methodology and importance to modern practitioners. Of the 330 formulas found in Li’s four books^[8], fully 221 or 58.2% include bitter, cold, fire-draining medicinals. Not only did Li eliminate heat with sweet and warm, he also 1) drained fire and upbore yang, 2) drained fire and resolved toxins, 3) cleared and drained dampness and heat, 4) drained fire and cooled the blood, 5) drained heat and cleared glomus, 6) drained fire and boosted yin, 7) cleared and resolved summerheat heat, 8)drained fire and quieted the spirit, and 9) cleared and abated vacuity heat. Likewise, 80 of Li’s 330 formulas or 24.2% quicken the blood and transform stasis by either 1) nourishing the blood and transforming stasis, 2) boosting the qi, upbearing yang, and transforming stasis, 3) enriching yin and transforming stasis, 4) warming the channels and/or yang and transforming stasis, 5) moving the qi and transforming stasis, 6) dispersing food and transforming stasis, 7) dispersing phlegm and transforming stasis, 8) transforming stasis and dispersing wind, 9) transforming stasis and stopping bleeding, 10) transforming stasis and freeing the flow of the network vessels, 11) cooling the blood and transforming stasis, and 12) breaking the blood and scattering stasis. Therefore, anyone who says Li only supplemented the spleen and used sweet, warm medicinals clearly has not taken a very good look at Li’s actual formulas other than Bu Zhong Yi Qi Tang.

In presenting the above formulas, I am not suggesting that each and every one of them is a masterpiece of composition. Since the Yuan dynasty, only a handful of these formulas have been considered among the most important in Chinese medicine. In addition, a number of effective medicinals have been added to the Chinese materia medica since Li’s day. However, I do believe that they are good models for composing complex formulas for complex, multi-pattern situations. In such cases, one will usually need two or more medicinals for fortifying the spleen, one or more medicinals for rectifying the qi, one or more medicinals for clearing heat, and several other medicinals for dealing with other concomitant patterns and major complaints. In general, chronic diseases with multi-pattern presentations require what are referred to in Chinese medicine as da ji, big prescriptions. For instance, I rarely prescribed formulas with less than 15 ingredients for my patients with chronic, enduring conditions. Practitioners should not be afraid to prescribe such large formulas as long as 1) each ingredient or pair of ingredients is warranted by the treatment principles and 2) the treatment principles are logically derived from the stated patterns.

In closing, let me also remind readers that, in real-life clinical practice, it is rare for a patient’s presentation to match a formula point for point, medicinal for medicinal. This means that any and all these formulas will probably have to be modified with suitable additions and subtractions. As Zhu Dan-xi, the fourth of the four great masters of the Jin-Yuan dynasties, said of his studies with Luo Tai-wu, "During a year and a half, there was not [one] set formula [prescribed]."^[9] In other words, during his apprenticeship, Zhu never saw his master prescribe a standard formula in the standard way. There is nothing magical or sacrosanct about the composition of these formulas. Even though these formulas were created by one of the great geniuses of Chinese medicine, one must not be afraid to tailor them to their individual patient’s needs.

For More Information...

Check out The Treatise on the Spleen & Stomach

^[1] For more information on the causes and disease mechanisms of Li dong-yuan/s concept of yin fire, please see the freely downloadable articles on this subject at www.bluepoppy.com.

^[2] I am indebted to Charles (Chip) Chace for first identifying these five principles.

^[3] Although this formula is Li’s most famous, because it does not include any heat-clearing medicinals, it is not actually representative of the majority of his treatment protocols.

^[4] Originally this formula was designed to treat the spleen vacuity and fluid damage of summerheat dampness. However, summerheat is really only a species of damp heat. Therefore, this formula can be used in a wider range of situations than originally intended.

^[5] This formula differs from Huang Qi Ren Shen Tang above in that it addresses more serious qi stagnation.

^[6] Li created a number of related formulas, each of whose name ended in Zhi Zhu Wan. These include simple Zhi Zhu Wan (Aurantium & Atractylodes Pills), Mu Xiang Zhi Zhu Wan (Auklandia Aurantium & Atractylodes Pills), Ban Xia Zhi Zhu Wan (Pinellia Aurantium & Atractylodes Pills), Qu Mai Zhi Zhu Wan (Massa Medica, Hordei, Aurantium & Atractylodes Pills), San Huang Zhi Zhu Wan (Three Yellows Aurantium & Atractylodes Pills), Mu Xiang Gan Jiang Zhi Zhu Wan (Auklandia, Dry Ginger, Aurantium & Atractylodes Pills), and Mu Xiang Ren Shen Sheng Jiang Zhi Zhu Wan (Auklandia, Ginseng, Uncooked Ginger, Aurantium & Atractylodes Pills). Each of these pills treats a core pattern of spleen vacuity, dampness, and qi stagnation complicated by one or more of the following patterns: more serious spleen vacuity, more serious dampness, more serious qi stagnation, food stagnation, interior cold, and internal heat.

^[7] Because acrid and windy exterior-resolving medicinals upbear and out-thrust the yang qi, they also rectify the qi. Therefore, even though there are no qi-rectifying medicinals in this formula, given its combination of blood-nourishers and exterior-resolvers, it can course the liver and rectify the qi.

^[8] I.e., the Pi Wei Lun, Lan Shi Mi Cang, Nei Wai Shang Bian Hou Lun (Treatise on Discriminating [i.e., Clarifying] Doubts of Internal & External Damages), and Yi Xue Fa Ming (Shining Light on The Study of Medicine)

^[9] Zhu Dan-xi, Extra Treatises Based on Investigation & Inquiry, trans. by Yang Shou-zhong & Duan Wu-jin, Blue Poppy Press, Boulder, CO, 1994, p. 132. Modern students should also note that, when Zhu went to Luo to apply to become his student, Luo roundly rebuked him 5-7 times. Zhu had to linger around Luo’s residence for three months before he proved himself worthy to be accepted as a student.