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In my experience, the overwhelming majority of Western patients
have liver-spleen, liver-stomach disharmonies no matter what other
patterns they may also exhibit. To say one has a liver-spleen
disharmony in Chinese medicine usually means that the liver is
replete and the spleen is vacuous. Liver repletion is most often
due to liver depression qi stagnation which is, in turn, most
commonly due to emotional stress and frustration. Unfulfilled
desires damage the liver's coursing and discharge. Every desire
is, in part, a movement of the qi either towards or away from
something. When we fulfill our desires, this means that our qi
was allowed to move the way it wanted. Conversely, when our desires
are thwarted, it means the movement of our qi was inhibited, and
the liver likes to spread freely.
Spleen vacuity may be due to liver depression due to liver wood's
controlling spleen earth according to the five phase control cycle.
In other words, if the liver becomes depressed and, therefore,
replete, this may, all by itself, result in a spleen qi vacuity.
Spleen qi vacuity may also be the result of faulty diet, excessive
thinking and worry, over-taxation, insufficient exercise, and
excessive or wrongful use of such spleen-damaging medicines as
antibiotics.
Because the spleen is the latter heaven root of the engenderment
and transformation of qi and blood, spleen qi vacuity may also
cause or aggravate liver depression. The liver and lungs work
together to maintain the free and uninhibited flow of qi. The
lungs diffuse and downbear the qi, providing the motivating force
behind the movement of the qi, while the liver allows the qi to
flow freely and easily. The lung qi comes from the spleen qi.
Therefore, if there is insufficient spleen qi, there will also
be insufficient lung qi, and thus less pushing power behind the
movement of the qi. In addition, the liver can only fulfill its
function of coursing and discharging if it obtains sufficient
blood to nourish it. Thus, if spleen qi vacuity leads to blood
vacuity, then a liver blood vacuity may also cause or contribute
to liver depression.
As for a liver-stomach disharmony, this refers to liver depression
with upward counterflow resulting in upward counterflow of the
stomach. The stomach is only harmonious when its qi is downborne.
Qi is, by nature yang. Therefore, inherently, it has a tendency
to rise or ascend. When qi becomes stagnant and accumulates, it
first usually results in distention and fullness. However, this
accumulated qi has to go somewhere. If liver depression qi stagnation
counterflows onto stomach earth via the control cycle, this results
in the stomach also becoming replete. In that case, liver and
stomach qi join to counterflow upward. Since qi is yang and, therefore,
also inherently warm, qi stagnation affecting the liver and stomach
may also easily transform into depressive heat. Thus liver-stomach
disharmony resulting in upward counterflow is also often complicated
by depressive or transformative heat.
Just as the liver and spleen and liver and stomach may become
disharmonious, the spleen and stomach may also become disharmonious.
This means that the spleen becomes vacuous and weak, possibly
cold and/or damp, while the stomach counterflows upward and/or
becomes hot and possibly even dry. In real-life Western patients,
it is very common, in fact for a wood/earth disharmony to include
both liver/spleen and liver/stomach disharmonies.
Because of the prevalence of stress and frustration in our increasingly
complex and speeded up world combined with too much thought and
worry, faulty diet, too much fatigue, and too little physical
exercise plus iatrogenensis from Western medicinals, liver wood/spleen
earth or liver wood/stomach earth disharmonies are extremely common
in contemporary clinical practice. In my opinion, they are the
rule rather than the exception, and this is especially so in the
case of three groups of people: women, the elderly, and the chronically
ill.
Women are prone to liver depression and spleen vacuity because
of changes in modern society forcing them to shoulder both traditional
female and many traditionally male roles. On the one hand, many
women feel extremely stressed and frustrated, while, on the other,
they are over-worked and exhausted. In addition, women are more
prone to spleen vacuity due to their monthly loss of blood via
menstruation as well as gestation and lactation. As we have seen
above, if there is a spleen qi and liver blood vacuity, then liver
depression qi stagnation is far more likely. According to the
Nei Jing (Inner Classic), most women tend to become spleen
vacuous around 35 years of age with concomitant blood vacuity.
This is the Nei Jing's explanation for developing wrinkles
on the face at around this age. The blood is no longer nourishing
the skin the way it once did and the skin dries out and wrinkles.
Older people, whether male or female, are prone to liver depression
qi stagnation as well as spleen vacuity. The maturation process
according to Chinese medical theory is the process of first the
spleen and stomach becoming mature and later, because of the maturation
of the spleen and stomach, the kidneys becoming exuberant and
mature. When we age, this process is reversed. First, typically
the spleen and stomach become vacuous and weak. Because of this,
they no longer engender and transform the same amounts of qi and
blood. With less qi to promote its flow and less blood to moisten
and nourish the liver, liver depression tends to worsen with age.
In addition, unstoppable changes in appearance and deterioration
in physical and mental abilities mean that most of us fulfill
less of our desires as we get older, at least certain kinds of
desires. It's not for nothing that Buddhism considers aging one
of the four great rivers of human suffering.
If one is chronically ill, this also means that one will not
be able to fulfill all one's desires. Either one will not be able
to do and eat what one wants or look the way one would like to,
or one cannot get away from certain pain and discomfort. There
are two types of desires in this life: 1) the desire to get what
we want and 2) the desire to eliminate or get away from what we
don't want. Chronic disease usually results in some combination
of both of these desires being thwarted. Thus, even if liver depression
did not cause a certain disease, if that disease endures, liver
depression will inevitably complicate any chronic disease process.
In addition, since the body's qi mechanism is a unified, inter-related
whole, disease in one part will inevitably affect all the other
viscera and bowels and their functions, including the spleen's
engenderment and transformation of the qi and blood. Hence most
chronic disease is accompanied by fatigue, a main symptom of spleen
vacuity.
The above theory helps explain why harmonizing formulas are some
of the most commonly used and most important of all Chinese medicinal
formulas. Harmonizing formulas do not just harmonize the constructive
and defensive, even though that is their first listed textbook
indication. They also harmonize the liver and spleen, liver and
stomach, spleen and stomach, and stomach and intestines. This
is why I find myself prescribing harmonizing formulas to more
of my chronically ill patients than any other category of formulas.
For instance, Xiao Chai Hu Tang (Minor Bupleurum Decoction),
Xiao Yao San (Rambling Powder), and Ban Xia Xie Xin
Tang (Pinellia Drain the Heart Decoction) and their cognates
and derivatives are all harmonizing formulas.
Ye Tian-shi was one of the greatest Chinese doctors of the Qing
dynasty. Ye lived and worked in Suzhou in eastern China and is
remembered as one of the leading lights in the wen bing xue
or warm disease school. However, Ye was more than just a warm
disease doctor, treating the full range of human disease. Ye was
one of the leading Chinese doctors of his generation. The Ye
Tian Shi Zhen Zhi Da Quan (A Great Collection of Ye Tian-shi's
Diagnoses & Treatments) by Chen Ke-zheng, published by
Chinese National Chinese Medicine & Medicinals Publishing
Co. in Beijing in 1995, is a collection of Ye's theories, case
histories, and special treatments. In this book, there is a chapter
titled, "Wood/Earth Disharmony Pattern Formulas." This chapter
is comprised of a number of Ye Tian-shi's special liver wood/spleen
and stomach harmonizing formulas. Since I think harmonizing formulas
are especially important in the Western practice of Chinese medicine,
I would like to share these formulas with my Western peers.
A. Liver/stomach disharmony mixed with heat
1. Gou Teng Dan Pi Fang (Uncaria & Moutan Formula)
Ramulus Uncariae Cum Uncis (Gou Teng)
Cortex Radicis Moutan (Dan Pi)
blackened Fructus Gardeniae Jasminoidis (Shan Zhi)
Sichuan Rhizoma Coptidis Chinensis (Chuan Lian)
Pericarpium Citri Reticulatae Viride (Qing Pi)
Cortex Magnoliae Officinalis (Hou Po)
Semen Raphani Sativi (Lai Fu Zi)
Pericarpium Citri Reticulatae (Guang Pi)
Caulis Menthae Haplocalycis (Bo He Gen)
(Herba Menthae [Bo He] can be substituted for Caulis Menthae.)
Functions: Clears the liver and harmonizes the stomach
Indications: Treats liver wood insulting earth with enduring
depression making heat and symptoms of drum distention, decreased
eating, and emission of heat (i.e., what is usually called
fever in the West, although one can have emission of heat and
have a subnormal temperature as measured by a thermometer)
Formula analysis: In this formula, Uncaria, Moutan, Gardenia,
Coptis, and Mentha all clear depressive heat from the liver and
stomach. Orange Peel, Immature Orange Peel, and Magnolia rectify
the qi and downbear counterflow. Radish Seeds disperse (food)
accumulation and abduct stagnation. In addition, the combination
of Moutan and Gardenia resolves depression and eliminates vexation
due to depressive heat.
2. Dan Pi Sang Ye Fang (Moutan & Morus Leaf Formula)
Cortex Radicis Moutan (Dan Pi)
Rhizoma Pinelliae Ternatae (Ban Xia)
Ramulus Uncariae Cum Uncis (Gou Teng)
Folium Mori Albi (Sang Ye)
Sclerotium Poriae Cocos (Fu Ling)
Exocarpium Citri Erythrocarpae (Ju Hong)
Functions: Clears the gallbladder and harmonizes the stomach
Indications: Shao yang gallbladder channel depressive
fire, insomnia, heart vexation, and oral thirst
Formula analysis: Morus Leaves and Uncaria both clear
heat from the liver and especially liver heat which has counterflowed
into the upper part of the body. Moutan clears heat from the blood
division as well as quickens the blood, and the liver stores the
blood. Pinellia and Citrus Erythrocarpus both harmonize the stomach
and downbear counterflow, transform phlegm and eliminate dampness.
Poria fortifies the spleen and percolates dampness.
3. Ren Shen Huang Lian Fang (Ginseng & Coptis Formula)
Radix Panacis Ginseng (Ren Shen)
Rhizoma Coptidis Chinensis (Chuan Lian)
Rhizoma Pinelliae Ternatae (Ban Xia)
Succus Zingiberis (Jiang Zhi)
Fructus Immaturus Citri Aurantii (Zhi Shi)
Sclerotium Poriae Cocos (Fu Ling)
(Uncooked Rhizoma Zingiberis [Sheng Jiang] can be substituted
for the Ginger Juice.)
Functions: Acrid opens and bitter downbears, supports
the stomach and opens glomus
Indications: Liver channel qi fire assailing the stomach,
no thought for eating or drinking, (stomach) duct glomus and vomiting,
diaphragmatic occlusion, and nausea
Formula analysis: Ginseng and Poria both fortify the spleen
and supplement the qi. Pinellia harmonizes the stomach and downbeares
counterflow. It also transforms phlegm and eliminates dampness.
When Pinellia and Poria are combined along with uncooked Ginger
or Ginger Juice, the transformation and elimination of phlegm
dampness is even stronger. In addition, Ginger has the strong
specific empirical effect of stopping nausea and vomiting based
on its also downbearing upward counterflow. Coptis clears heat
from the heart, stomach, and intestines. This can either be depressive
or damp heat. Depressive heat in the liver and stomach often ascends
to accumulate in the heart. Immature Aurantium strongly rectifies
the qi and disinhibits the qi mechanism.
4. Ren Shen Sang Ye Fang (Ginseng & Morus Leaf
Formula)
Radix Panacis Ginseng (Ren Shen)
Radix Angelicae Sinensis (Dang Gui)
Succus Fructi Immaturi Citri Aurantii (Zhi Shi Zhi)
stir-fried Rhizoma Pinelliae Ternatae (Ban Xia)
Folium Mori Albi (Sang Ye)
Cortex Radicis Moutan (Dan Pi)
(Fructus Immaturus Citri Aurantii [Zhi Shi] can be substituted
for Immature Aurantium Juice.)
Functions: Supplements earth and discharges wood, clears
depression and nourishes the blood
Indications: Liver depression assailing the spleen with
middle burner glomus and binding and bleeding after defecation
Formula analysis: Ginseng fortifies the spleen and boosts
the qi. Pinellia harmonizes the stomach, transforms phlegm, and
eliminates dampness. Morus Leaves clear liver heat, while Moutan
clears heat from the blood division. Immature Aurantium strongly
rectifies the qi, and Dang Gui both nourishes and quickens the
blood.
5. Suan Ku Xie Re Fang (Sour & Bitter Discharging
Heat Formula)
Radix Panacis Ginseng (Ren Shen)
Concha Ostreae (Mu Li)
Radix Albus Paeoniae Lactiflorae (Bai Shao)
Fructus Pruni Mume (Wu Mei)
Rhizoma Coptidis Chinensis (Chuan Lian)
Rhizoma Pinelliae Ternatae (Ban Xia)
Fructus Meliae Toosendan (Chuan Lian)
Pericarpium Citri Reticulatae (Guang Pi)
Succus Zingiberis (Jiang Zhi)
(Uncooked Rhizoma Zingiberis [Sheng Jiang] can be substituted
for the Ginger Juice.)
Functions: Sour and bitter discharge heat, discharges
the liver and supplements the stomach
Indications: Qi fire upbearing and soaring, liver wind
inversion stroke with tetany inversion, summerheat dampness internally
binding interior heat with heat within the heart and glomus, oppression,
nausea, and vomiting, lack of eating, and diarrhea
Formula analysis: Ginseng fortifies the spleen and boosts
the qi. Pinellia, Orange Peel, and Ginger Juice or uncooked Ginger
harmonize the center and transform and eliminate phlegm dampness.
Coptis clears both damp and depressive heat. Melia rectifies the
qi. It is an especially good qi-rectifying medicinal when there
is damp heat, yin vacuity, and/or chong worms or parasites.
Oyster Shell heavily subdues yang, quiets the spirit, and astringes
yin. Mume is also an astringent. However, in addition, it nourishes
the stomach and engenders fluids at the same time as it dispels
chong parasites. In Chinese medicine, chong parasites
are believed to flourish in a terrain where there is damp heat
complicated by spleen vacuity. Parasites in Chinese medicine include
tapeworms, roundworms, and pinworms as well as candidiasis, and
may include non-specific forms of what Western medicine refers
to as intestinal dysbiosis.
6. Tai Yin Jue Yin Fang (Tai Yin & Jue Yin
Formula)
Rhizoma Atractylodis Macrocephalae (Bai Zhu)
Cortex Magnoliae Officinalis (Hou Po)
Radix Angelicae Sinensis (Dang Gui)
Cortex Radicis Moutan (Dan Pi)
Radix Scutellariae Baicalensis (Huang Qin)
uncooked Carapax Amydae Sinensis (Bei Jia)
Functions: Supplements earth, discharges wood, and clears
heat
Indications: Yin vacuity blood heat, liver/spleen disharmony
vacuity taxation
Formula analysis: Atractylodes supplements the spleen
and aromatically dries dampness. Magnolia rectifes the qi and
downbears counterflow, transforms phlegm and dampness and frees
the flow of the stools. Scutellaria clears damp and/or depressive
heat from the liver, gallbladder, stomach, and lungs. Dang Gui
nourishes and moves the blood, while Moutan cools and quickens
the blood. Uncooked Carapax Amydae likewise performs more than
a single function in this formula. On the one hand, it nourishes
yin anbd heavily subdues yang, while on the other, it quickens
the blood and scatters nodulation. In addition, Carapax Amydae
is a good choice whenever there is blood stasis and/or yin vacuity/vacuity
heat complicated by damp heat. Often times, damp heat, vacuity
heat, and blood stasis occur simultaneously in a single patient.
7. Bei Tu Xie Mu Fang (Bank Earth & Discharge Wood
Formula)
Radix Panacis Ginseng (Ren Shen)
Rhizoma Atractylodis Macrocephalae (Bai Zhu)
Rhizoma Pinelliae Ternatae (Ban Xia)
Sclerotium Poriae Cocos (Fu Ling)
Radix Glycyrrhizae (Gan Cao)
Pericarpium Citri Reticulatae (Guang Pi)
Cortex Radicis Moutan (Dan Pi)
Folium Mori Albi (Sang Ye)
uncooked Rhizoma Zingiberis (Sheng Jiang)
Fructus Zizyphi Jujubae (Da Zao)
Functions: Banks earth and discharges wood
Indications: Glomus and fullness, inability to digest
food, enduring cough bone-steaming
Formula analysis: Ginseng, Atractylodes, Poria, Licorice,
and Red Dates all fortify the spleen and supplement the qi. Pinellia,
Orange Peel, and uncooked Ginger harmonize the stomach and downbear
counterflow, transform phlegm and eliminate dampness. Morus Leaves
clear liver heat, while Moutan clears heat from the blood division.
8. Xie Mu An Wei Fang (Discharge Wood & Quiet the
Stomach Formula)
Folium Mori Albi (Sang Ye)
Ramulus Uncariae Cum Uncis (Gou Teng)
Radix Polygalae Tenuifoliae (Yuan Zhi)
Rhizoma Acori Graminei (Chang Pu)
Rhizoma Pinelliae Ternatae (Ban Xia)
Pericarpium Citri Reticulatae (Guang Pi)
Herba Dendrobii (Jin Hu)
Sclerotium Poriae Cocos (Fu Ling)
Functions: Discharges wood and quiets the stomach
Indications: Liver yang transforming wind and assailing
the stomach, dizziness, vertigo, heart palpitations, reduced intake
(of food), and desire to vomit
Formula analysis: Morus Leaves and Uncaria clear liver
heat, while Uncaria also levels the liver and extinguishes wind.
Polygala rectifies the heart qi and transforms phlegm. Acorus
transforms phlegm and opens the orifices. Pinellia and Orange
Peel transform phlegm and eliminate dampness. Poria supplements
the spleen and percolates or seeps dampness. And Dendrobium clears
heat from the stomach and lungs at the same time that it nourishes
the stomach and engenders fluids. The stomach is averse to dryness,
while the spleen is averse to damp.
9. He Yang Yi Wei Fang (Harmonize Yang & Boost
the Stomach Formula)
Radix Panacis Ginseng (Ren Shen)
Sclerotium Poriae Cocos (Fu Ling)
Rhizoma Pinelliae Ternatae (Ban Xia)
Radix Albus Paeoniae Lactiflorae (Bai Shao)
Fructus Pruni Mume (Wu Mei)
Rhizoma Coptidis Chinensis (Chuan Lian)
uncooked Rhizoma Zingiberis (Sheng Jiang)
Pericarpium Citri Reticulatae (Guang Pi)
Functions: Emoliates the liver and frees the flow of the
stomach
Indications: Liver yang transforming wind and assailing
the stomach with dry vomiting, reduced intake, a bland (taste
in the) mouth, slight perspiration, and clouding inversion
Formula analysis: Ginseng fortifies the spleen and supplements
the qi. Pinellia, Orange Peel, and uncooked Ginger harmonize the
stomach and downbear counterflow, transform phlegm and eliminate
dampness. Poria helps Ginseng supplement the spleen at the same
time that it aids the three foregoing medicinals to eliminate
dampness by percolating or seeping it. White Peony emolliates
and harmonizes the liver. Coptis clears both damp and depressive
heat from the heart, liver, stomach, and intestines. And Mume
astringes and secures at the same time as it nourishes the stomach
and engenders fluids. In addition, Mume dispels chong or
worms.
10. Shi Jun Zi Hu Lian Fang (Quisqualis & Picrorrhiza
Formula)
Fructus Quisqualis Indicae (Shi Jun Zi)
Pericarpium Citri Reticulatae (Guang Pi)
Rhizoma Picrorrhizae (Hu Lian)
Fructus Crataegi (Shan Zha)
Fructus Amomi (Sha Ren)
Rhizoma Atractylodis Macrocephalae (Bai Zhu)
Sclerotium Poriae Cocos (Fu Ling)
Radix Albus Paeoniae Lactiflorae (Bai Shao)
Cortex Magnoliae Offiicnalis (Hou Po)
Endothelium Corneum Gigeriae Galli (Nei Jin)
Functions: Disperses accumulations and rectifies the qi,
fortifies the spleen and emolliates the liver
Indications: Gan accumulation taxation and bodily emaciation,
vexatious heat and night sweats
Formula analysis: Quisqualis kills worms, but it also
fortifies the spleen and disperses (food) accumulation. Gan accumulation
is mostly a pediatric condition made up of a combination of spleen
vacuity and food stagnation. Crataegus and Chicken Gizzard both
transform food and abduct stagnation. However, they are especially
good for treating meat-type food stagnation which, in Chinese
medicine, includes milk. Atractylodes and Poria supplement the
spleen and eliminate dampness. Magnolia also eliminates phlegm
and dampness at the same time as downbearing counterflow and freeing
the flow of the stools. Orange Peel and Amomum both rectify the
qi and harmonize the stomach while aromatically transforming and
drying dampness. Picrorrhiza clears heat, especially damp heat,
from the heart, liver, and stomach. And White Peony emolliates
and harmonizes the liver while it also relaxes cramping, as in
abdominal cramping.
11. Mu Li Chuan Lian Fang (Oyster Shell & Coptis
Formula)
Concha Ostreae (Mu Li)
Fructus Meliae Toosendan (Chuan Lian)
Rhizoma Corydalis Yanhusuo (Yuan Hu)
Semen Pruni Persicae (Tao Ren)
Rhizoma Pinelliae Ternatae (Ban Xia)
Sclerotium Poriae Cocos (Fu Ling)
Exocarpium Citri Erythrocarpae (Ju Hong)
Semen Sinapis Albae (Bai Jie Zi)
Rhizoma Coptidis Chinensis (Chuan Lian)
Fructus Evodiae Rutacarpae (Wu Zhu)
Rhizoma Cyperi Rotundi (Xiang Fu)
Succus Zingiberis (Jiang Zhi)
(Uncooked Rhizoma Zingiberis [Sheng Jiang] can be substituted
for Ginger Juice.)
Functions: Rectifies the qi, clears heat, and transforms
dampness
Indications: Damp heat obstruction and stagnation, liver/stomach
disharmony, vomiting, and gatherings and conglomerations in women
Formula analysis: Pinellia, Poria, Citru Erythrocarpus,
and uncooked Ginger or Ginger Juice fortify the spleen and eliminate
dampness. Mustard Seeds warm and transform cold phlegm, scatter
nodulation and stop pain. Coptis clears heat from the heart, liver,
stomach, and intestines. Evodia is an extremely warming ingredient,
but, in this formula, is mostly used to downbear counterflow at
the same time as strongly stopping pain. Although classified as
a warming medicinal, Evodia is routinely used for damp heat conditions
causing nausea and vomiting complicated by spleen vacuity, in
which case it is usually combined with Coptis. Corydalis quickens
the qi within the blood and also stops pain. Persica quickens
the blood and dispels stasis. Melia moves and rectifies the qi,
and is especially good when there is damp heat. Cyperus also rectifies
the qi and is an excellent choice when qi stagnation manifests
as distention. Oyster Shell subdues yang, downbears counterflow,
and heavily quiets the spirit. It also is empirically specific
for neutralizing stomach acid
B. Liver/stomach disharmony mixed with cold & rheum
1. Pao Fu Ren Shen Fang (Blast-fried Aconite &
Ginseng Formula)
blast-fried Radix Lateralis Aconiti Carmichaeli (Pao Fu)
Radix Panacis Ginseng (Ren Shen)
Rhizoma Pinelliae Ternatae (Ban Xia)
Fructus Evodiae Rutecarpae (Wu Zhu)
uncooked Rhizoma Zingiberis (Sheng Jiang)
Sclerotium Poriae Cocos (Fu Ling)
Functions: Warms the stomach and sweeps away rheum
Indications: Yang minute and yin congealed, wind wood
attacking earth, vomiting provoked by eating, stomach pain and
distention
Formula analysis: Ginseng and Poria fortify the spleen
and supplement the qi. Aconite warms the interior and scatters
cold. Pinellia and Poria eliminate dampness. Pinellia, Ginger,
and Evodia harmonize the stomach and downbear counterflow. In
addition, Evodia also warms the spleen and scatters cold while
specificially stopping nausea and vomiting.
2. Ren Shen Guang Pi Fang (Ginseng & Orange Peel
Formula)
Radix Panacis Ginseng (Ren Shen)
Pericarpium Citri Reticulatae (Guang Pi)
Sclerotium Poriae Cocos (Fu Ling)
Fructus Alpiniae Oxyphyllae (Yi Zhi)
Fructus Chaenomelis Lagenariae (Mu Gua)
uncooked Rhizoma Zingiberis (Sheng Jiang)
Functions: Banks earth and controls wood
Indications: Spleen-stomach yang qi decline and debility
with liver wood attacking vacuous earth, no eating, no transportation,
flavor changed to sour and bitter
Formula analysis: Ginseng and Poria fortify the spleen
and supplement the qi. Orange Peel and uncooked Ginger harmonize
the stomach and rectify the qi. Poria, Ginger, and Orange Peel
eliminate dampness through a combination of transformation and
percolation. Alpinia both warms the kidneys and secures the essence
and warms the spleen and stops diarrhea. In addition, it specifically
treats drooling and unpleasant tastes in the mouth. And Chaenomeles
or Chinese Quince harmonizes the stomach and transforms dampness
at the same time as it relaxes the sinews and quickens the vessels.
3. Ren Shen Wu Zhu Fang (Ginseng & Evodia Formula)
Radix Panacis Ginseng (Ren Shen)
Fructus Evodia Rutecarpae (Wu Zhu)
Rhizoma Pinelliae Ternatae (Ban Xia)
Succus Zingiberis (Jiang Zhi)
Sclerotium Poriae Cocos (Fu Ling)
Fructus Meliae Toosendan (Chuan Lian)
Concha Ostreae (Mu Li)
(Uncooked Rhizoma Zingiberis [Sheng Jiang] can be substituted
for Ginger Juice.)
Functions: Warms the stomach and courses the liver
Indications: Stomach vacuity with liver bullying, turbidity
stagnating, retained, and squatting, abdominal pain with form,
i.e., accumulations and gatherings
Formula analysis: Ginseng and Poria fortify the spleen
and supplement the qi. Pinellia, Poria, and uncooked Ginger or
Ginger Juice eliminate dampness. Pinellia, Ginger, and Evodia
harmonize the stomach and downbear counterflow. Evodia also warms
the interior and scatters cold. Melia rectifies the qi and Oyster
Shell quiets the spirit, subdues yang, downbears counterflow,
and softens the hard.
4. Ju Ye Xiang Fu Fang (Orange Leaf & Cyperus Formula)
Folium Citri Reticulatae (Ju Ye)
Rhizoma Cyperi Rotundi (Xiang Fu)
Fructus Meliae Toosendan (Chuan Lian)
Rhizoma Pinelliae Ternatae (Ban Xia)
Sclerotium Poriae Cocos (Fu Ling)
uncooked Rhizoma Zingiberis (Sheng Jiang)
Functions: Courses the liver and harmonizes the stomach,
rectifies the qi and transforms phlegm
Indications: Liver qi depression and binding mixed with
phlegm rheum and rib-side distention and pain
Formula analysis: Pinellia, Ginger, and Poria transform
and seep dampness. Ginger and Pinellia also harmonize the stomach
and downbear counterflow. Cyperus and Melia both rectify the qi
and disperse distention. Likewise, Orange Leaves rectify and moves
the qi at the same time as aromatically penetrating and drying
dampness.
5. Jiu Bai Gui Zhi Fang (Allium & Cinnamon Twig
Formula)
Succus Allii (Jiu Bai Zhi)
Ramulus Cinnamomi Cassiae (Gui Zhi)
Semen Trichosanthis Kirlowii (Gua Lou Ren)
Cortex Radicis Meliae Toosendan (Chuan Lian Zi Pi)
Rhizoma Pinelliae Ternatae (Ban Xia)
Sclerotium Poriae Cocos (Fu Ling)
Extremitas Radicis Angelicae Sinensis (Dang Gui Wei)
Semen Pruni Persicae (Tao Ren)
Rhizoma Corydalis Yanhusuo (Yuan Hu)
Succus Zingiberis (Jiang Zhi)
(Uncooked Rhizoma Zingiberis [Sheng Jiang] can be substituted
for Ginger Juice.)
Functions: Quickens the blood and transforms stasis, frees
the flow of yang and rectifies the qi
Indications: Liver/spleen disharmony with qi and blood
not flowing freely, (chest) yang minute with impediment and binding,
swelling and distention
Formula analysis: Onion Juice warms the stomach and stops
vomiting while also freeing the flow of the chest yang. Semen
Trichosanthis frees both chest yang and the stools. Cinnamon Twigs
warm the channels and free the flow of yang. Pinellia and Poria
transform and seep dampness respectively, remembering that blood
and fluids move together. Pinellia and Ginger both harmonize the
stomach and eliminate dampness. Cortex Radicis Meliae kills worms,
remembering worms in Chinese medicine mean more than worms in
Western medicine. Persica and Dang Gui Tails quicken the blood
and dispel stasis, while Corydalis quickens the qi within the
blood and stops pain.
6. Tao Ren Yan Hu Fang (Persica & Corydalis Formula)
Semen Pruni Persicae (Tao Ren)
Rhizoma Corydalis Yanhusuo (Yan Hu)
Extremitas Radicis Angelicae Sinensis (Dang Gui Wei)
Fructus Foieniculi Vulgaris (Xiao Hui)
Rhizoma Cyperi Rotundi (Xiang Fu)
Rhizoma Pinelliae Ternatae (Ban Xia)
Sclerotium Poriae Cocos (Fu Ling)
Exocarpium Citri Erythrocarpae (Ju Hong)
Massa Medica Fermentata (Shen Qu)
Functions: Treats the liver and stomach at the same time,
rectifies the qi and quickens the blood, transforms stasis and
harmonizes the center
Indications: Disregulation of the qi and blood with phlegm
rheum gathering and binding and abdominal distention
Formula analysis: Persica, Corydalis, and Dang Gui Tails
all quicken the blood and dispel stasis. Fennel and Cyperus move
and rectify the qi. Pinellia, Poria, and Citrus Erythrocarpus
transform phlegm and eliminate dampness. And Medicated Leaven
disperses (food) stagnation. Once again it should be remembered
that the qi moves the blood and blood and fluids move together,
while phlegm is nothing other than congealed dampness.
C. Liver/stomach disharmony mixed with yin vacuity
1. Huai Mai Ma Ren Fang (Wheat & Cannabis Formula)
Fructus Tritici Aestivi (Huai Mai)
Semen Cannabis Sativae (Ma Ren)
Gelatinum Corii Asini (E Jiao)
uncooked Radix Rehmanniae (Sheng Di)
Radix Panacis Ginseng (Ren Shen)
Fructus Zizyphi Jujubae (Nan Zao)
Functions: Nourishes yin, extinguishes wind, and harmonizes
the stomach
Indications: Yin vacuity wind stirring with the stomach
mouth turning over emptily and vomiting
Formula analysis: Triticus or Wheat nourishes the heart
and quiets the spirit, as opposed to Blighted Wheat (Fructus Levis
Tritici Aestivi, Fu Xiao Mai) mainly securing the exterior
and stopping sweating. Ginseng and Red Dates fortify the spleen
and supplement the qi, nourish the blood and engender fluids.
Cannabis likewise engenders fluids. In addition, Cannabis frees
the flow of the stools, thus leading yang to move downwards. Donkey
Skin Glue nourishes the blood and moistens dryness, while uncooked
Rehmannia nourishes the blood and clears heat from the blood division
Blood is the mother of qi, and internal wind due to vacuity is
nothing other than frenetically stirring qi.
2. Shi Jue E Jiao Fang (Abalone Shell & Donkey
Skin Glue Formula)
Concha Haliotidis (Shi Jue)
Gelatinum Corii Asini (E Jiao)
uncooked Radix Rehmanniae (Sheng Di)
Fructus Lycii Chinensis (Gou Qi)
Sclerotium Poriae Cocos (Fu Ling)
Ramulus Loranthi Seu Visci (Ji Sheng)
Herba Dendrobii (Chuan Hu)
Functions: Nourishes yin and extinguishes wind, harmonizes
the stomach and levels the liver
Indications: Stomach yin network vessel vacuity and liver
wind whirling and raiding with dizziness, numbness, stomach pain,
and vomiting
Formula analysis: Abalone Shell discharges fire, subdues
yang, and brightens the eyes. Donkey Skin Glue, uncooked Rehmannia,
Lycium, Loranthus, and Dendrobium all nourish the blood and enrich
yin. Dendrobiu also clears heat from the heart and stomach, while
uncooked Rehmannia clears heat specifically from the blood. The
heart rules the blood. Therefore, clearing heat from the blood
also tends to clear heat from the heart. Poria supplements the
spleen and percolates dampness, thus leading yang downward by
the yin tract.
3. Ren Shen Wu Mei Fang (Ginseng & Mume Formula)
Radix Panacis Ginseng (Ren Shen)
Sclerotium Poriae Cocos (Fu Ling)
mix-fried Radix Glycyrrhizae (Zhi Cao)
Pericarpium Citri Reticulatae (Guang Pi)
Fructus Pruni Mume (Wu Mei)
Fructus Chaenomelis Lagenariae (Mu Gua)
Functions: Supports earth and nourishes yin, controls
wood and extinguishes wind
Indications: Stomach vacuity with wind stirring diarrhea
and dysentery
Formula analysis: Ginseng and mix-fried Licorice fortify
the spleen and supplement the qi. They also nourish the blood
and engender fluids. Poria and Orange Peel eliminate dampness,
while Orange Peel also harmonizes the stomach and rectifies the
qi. Mume astringes and secures, in this case the intestines, and
also engenders fluids. In addition, it dispels chong or
worms/parasites. Chaenomeles or Chinese Quince harmonizes the
stomach and transforms dampness at the same time as relaxing the
sinews and quickening the vessels. This formula is mainly for
stirring of wind in cholera-like disease with tetany and convulsions.
4. Suan Gan Ji Yin Fang (Sour & Sweet Saving Yin
Formula)
Fructus Pruni Mume (Wu Mei)
Radix Panacis Ginseng (Ren Shen)
uncooked Radix Rehmanniae (Sheng Di)
Gelatinum Corii Asini (E Jiao)
Tuber Ophiopoigonis Japonici (Mai Dong)
Radix Albus Paeoniae Lactiflorae (Bai Shao)
Functions: Sour and sweet nourish yin
Indications: Liver yin/stomach fluid dryness and withering
with vomiting and nausea, wasting thirst, heart vexation, no eating
and no defecation, dizziness and vertigo, vacuity taxation, dysentery,
malaria-like diseases, summerheat diseases
Formula analysis: Ginseng fortifies the spleen and supplements
the qi. Uncooked Rehmannia enriches yin, engenders fluids, and
cools the blood. Ophiopogon engenders fluids, transforms phlegm,
and clears heat from the heart, lungs, and stomach. Mume engenders
fluids, astringes and secures, and dispels worms or parasites.
White Peony emolliates and harmonizes the liver and relaxes cramping.
Donkey Skin Glue nourishes the blood, engenders fluids, and stops
bleeding.
D. Liver/spleen disharmony mixed with vacuity
1. Huang Qi Sha Yuan Fang (Astragalus & Semen Astragali
Complanati Formula)
Radix Panacis Ginseng (Ren Shen)
Radix Astragali Membranacei (Huang Qi)
mix-fried Radix Glycyrrhizae (Zhi Cao)
Semen Astragali Complanati (Sha Yuan)
Fructus Lycii Chinensis (Gou Qi)
Radix Angelicae Sinensis (Dang Gui)
Functions: Supplements the spleen and boosts the liver
Indications: Liver-spleen dual vacuity with menstrual
leaking
Formula analysis: The combination of Ginseng and Astragalus
strongly fortifies the spleen and boosts the qi. This action of
supplementing the qi is aided by mix-fried Licorice. Dang Gui
and Lycium supplement the liver and nourish the blood. Semen Astragali
supplements liver blood and kidney yang and secures the essence.
In Chinese medicine, the menstrual blood is seen as the outward
manifestation of a woman's essence. Kidney yang includes the kidney
qi, and spleen qi and kidney yang are mutually rooted and promoting.
Likewise, yin and yang are mutually rooted and promoting, and
the liver and kidneys have a common source.
E. Spleen vacuity with wind stirring
1. Ren Shen Wu Gong Fang (Ginseng & Centipede Formula)
Radix Panacis Ginseng (Ren Shen)
uncooked Rhizoma Atractylodis Macrocephalae (Bai Zhu)
Scolopendra Subspinipes (Wu Gong)
Buthus Martensis (Quan Xie)
Rhizoma Arisaematis (Nan Xing)
Radix Aconiti Coreani Seu Typhonii Gigantei (Bai Fu)
Functions: Fortifies the spleen, extinguishes wind, and
transforms phlegm
Indications: Yin wind entering the network vessels with
epilepsy-like conditions and chronic fright wind
Formula analysis: Ginseng and Atractylodes fortify the
spleen and supplement the qi. In addition, Atractylodes aromatically
transforms and dries dampness. Centipede and Scorpion level the
liver and extinguish wind. Arisaema dries dampness and transforms
phlegm and especially disperses wind phlegm from the channels.
Korean Aconite dispels wind, cold, dampness and expels wind phlegm
at the same time as it resolves tetany.
In presenting these formulas to Western readers, I am not suggesting
that they are some newly discovered miraculous formulas to be
prescribed by rote. Rather, I present them for study and the contemplation
of their complexity and sophistication. As Qin Bo-wei, one of
the architects of modern Chinese medicine wrote, "When I say to
prescribe Liu Wei Di Huang Wan (Six Flavors Rehmannia Pills),
I don't mean for you to prescribe the ingredients of Liu Wei
Di Huang Wan but rather the idea of Liu Wei Di Huang
Wan." All these formulas treat more than a single viscus or
bowel. They all tend to supplement and drain, support and attack,
and clear and warm at the same time. I offer them as models for
building the complex kinds of formulas most Western patients need.
In real life practice, it's my experience that even the above
formulas are too simple for most cases of chronic disease. Further
additions and subtractions will most likely be necessary. However,
these formulas do provide some alternative starting points to
Xiao Chai Hu Tang, Xiao Yao San, and Ban Xia Xie Xin
Tang. Even more clarity and insight can be gained if one also
looks at these formulas from the point of view of both Li Dong-yuan's
yin fire theory and gu parasite theory. For more on these two
important theories within Chinese medicine and their relevance
to modern Western patients with complex chronic conditions, please
see my essays on these subjects.
For More Information... Check out these Blue Poppy Products: Seventy
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