New Applications for Wen Dan Tang (Warm the Gallbladder Decoction): Four Clinical Cases

by Wu Heng-sheng & Wang Cheng-xiang, Shan Xi Zhong Yi (Shanxi Journal of Chinese Medicine), #5, 1997, pp. 49-50.
Translated by
Lynn M. Kuchinski, L.Ac., Dipl. Ac. & CH

Keywords: Wen Dan Tang; wind stroke; headache; chest impediment; impotence

COMP designation: Denotative translation using a standard translation terminology, i.e., Nigel Wiseman’s English-Chinese Chinese-English Dictionary of Chinese Medicine, Hunan Science and Technology Press, Changsha, 1995

Abstract: Wen Dan Tang is a formula for disharmony between the gallbladder and stomach with phlegm heat. It is commonly prescribed for gastritis, hepatitis, peptic ulcer, and chronic bronchitis. In this article, the author demonstrates the versatility of this formula for four other disease disorders without losing sight of the particular pattern associated with phlegm heat.

Wen Dan Tang was first noted during the Tang [dynasty] in Sun Si-miao’s Bei Ji Qian Jin Yao Fang (Essential Formulas for Emergencies [Worth] a Thousand [Pieces of] Gold) as a primary treatment "after major illness [when there is] vacuity vexation and insomnia." The author has used Wen Dan Tang as a basic formula with added medicinals to treat phlegm heat in many various types of internal damage illnesses, all with good results, as seen from the four cases presented below.

Wind stroke. Male, 69 years old, initial examination in July 1991. The patient had an addiction to alcoholic drinks. Two weeks prior to the clinic visit, the patient had been drinking, and one night [after he] regained consciousness, he discovered that he could not move his upper and lower limbs on the right side. His family members immediately carried him to a [local] hospital, and the diagnosis [there] was cerebral thrombosis. He underwent treatment [at the hospital], but without marked improvement. He then voluntarily left the hospital and requested yet another diagnosis and treatment. His symptoms were a dull spirit mind, difficult and slow speech, the right side of his body was affected, the mouth and eye were deviated, drooling from the corners of the mouth, acid upflow, and torpid intake. The tongue fur was slimy and slightly yellow. The pulse was bowstring and slippery.

Wen Dan Tang Jia Wei (Warm the Gallbladder Decoction with Added Flavors) was used as follows: Rhizoma Pinelliae Ternatae (Ban Xia), 10g, Sclerotium Poriae Cocos (Fu Ling), 24g, Radix Glycyrrhizae (Gan Cao), 6g, Fructus Immaturus Citri Aurantii (Zhi Shi), 10g, Caulis Bambusae in Taeniis (Zhu Ru), 10g, Radix Puerariae (Ge Gen), 30g, Radix Salviae Miltiorrhizae (Dan Shen), 30g, Rhizoma Acori Graminei (Shi Chang Pu), 15g, Lumbricus (Di Long), 15g, Caulis Millettiae Seu Spatholobi (Ji Xue Teng), 30g.

After six ji, the [patient’s] spirit mind had much improved, the acid upflow and drooling had lessened, and intake of food improved. Therefore, an additional 10 ji were prescribed. [After that,] the deviation of the mouth and eyes showed obvious improvement, and the upper and lower limbs were able to move freely. After following up with 30 additional ji, all symptoms disappeared, and the limbs and body were able to move and health was restored.

Basically, for this patient who liked drinking excessively, the alcohol had caused accumulation of dampness engendering phlegm. The phlegm depression transformed into heat, and phlegm heat caused the obstruction. Therefore, acid upflow and torpid intake were also seen [as symptoms]. Phlegm heat clouding the heart orifice resulted in the dullness of the spirit mind, and phlegm heat harassing the channels and network vessels affected the right side of the body and caused the mouth and eyes to deviate. In this case, for phlegm heat, the treatment should clear [heat] and transform [phlegm]. Therefore, Wen Dan Tang was the primary formula used. In addition, [this formula] opens the orifices, quickens the blood, and frees the flow of the network vessels, which enables the transformation of phlegm and the clearing of heat. [When] the orifices were opened and the spirit regained consciousness, the channels and vessels were disinhibited, the qi was moved, and the blood was nourished. Hence the patient recovered.

Headache. Female, 49 years old, initial examination in September 1994. The patient suffered from right side headache pain which had repeatedly flared up for nine years. Every time she slept badly or her emotions were depressed, her headache would start. During the time of the headache, she had no desire to live or to do everyday tasks. After the headache stopped, she again acted normally. At the hospital, the diagnosis was neurovascular headache. She had frequently used the [previous] formulas prescribed, but the results were only minimal. This time, upon examination, the headache had recurred and the right temporal area presented with a drilling, stabbing, and fixed, severe pain. She had a bitter taste in her mouth, a dry throat, but no desire for liquids. The tongue body was dark purple, while the tongue fur was slimy and slightly yellow. The pulse was slippery and forceful.

Xue Fu Zhu Yu Tang (Blood Mansion Dispel Stasis Decoction) with the addition of Radix Scutellariae Baicalensis (Huang Qin), Lumbricus (Di Long), Buthus Martensis (Quan Xie) was prescribed (3 ji), but [there was] no improvement. After some consideration of the symptoms of dry mouth with no desire to drink, the tongue fur being slimy, and the pulse being slippery, etc., [it was determined that] phlegm heat brewing internally was the pattern, and Wen Dan Tang together with blood-quickening and stasis-dispelling [medicinals] was used: Rhizoma Pinelliae Ternatae (Ban Xia), 10g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Sclerotium Poriae Cocos (Fu Ling), 20g, stir-fried Fructus Immaturus Citri Aurantii (Zhi Shi), 6g, Caulis Bambusae in Taeniis (Zhu Ru), 20g, Radix Scutellariae Baicalensis (Huang Qin), 12g, Radix Ligustici Wallichii (Chuan Xiong), 15g, Semen Pruni Persicae (Tao Ren), 10g, Flos Carthami Tinctorii (Hong Hua), 10g, Radix Salviae Miltiorrhizae (Dan Shen), 30g, Lumbricus (Di Long), 15g. After three ji, the headache markedly improved. Therefore, the original formula was continued for five additional ji, and then the headache disappeared.

This is a case of phlegm fire upwardly harassing and static blood obstructing the network vessels resulting in headache. The treatment principles are to clear heat and transform phlegm, dispel stasis and free the flow of the network vessels. In the initial diagnosis, only the stasis was given attention and not the phlegm heat. Therefore, the first prescription was without effect. On the subsequent visit, when the prescription was changed and phlegm and stasis were treated simultaneously, the results were more noteworthy.

Chest impediment. Male, 51 years old, initial examination in October 1996. The patient had an aching pain in the area in front of the heart. The pain had occasionally bothered him for five years, but during the last month, the frequency had greatly increased and was quite severe. At times, he had gone to the hospital where the diagnosis of coronary heart disease and myocardial ischemia had been given to him, and he had tried Western drug treatment but with no marked improvement. [This time,] the Chinese medical examination showed oppressive pain in the chest radiating to the left scapula, vexation, nausea and vomiting, dry mouth with no desire for liquids, and dark, purple lips. The tongue body had static macules on the sides and tip, while the tongue fur was yellow and slimy. The pulse was bowstring and slippery.

Wen Dan Tang Jia Wei was prescribed: Rhizoma Pinelliae Ternatae (Ban Xia), 15g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Sclerotium Poriae Cocos (Fu Ling), 30g, stir-fried Fructus Immaturus Citri Aurantii (Zhi Shi), 12g, Caulis Bambusae in Taeniis (Zhu Ru), 15g, Radix Glycyrrhizae (Gan Cao), 10g, Fructus Trichosanthis Kirlowii (Gua Lou), 30g, Bulbus Allii (Xie Bai), 30g, Radix Salviae Miltiorrhizae (Dan Shen), 30g, Fructus Crataegi (Shan Zha), 30g, Tuber Curcumae (Yu Jin), 15g. Three ji were prescribed, and, after one ji, the chest pain was greatly reduced. After three [more] ji, the chest pain had disappeared and only the feeling of weakness remained. Therefore, Radix Astragali Membranacei (Huang Qi), 30g and Radix Codonopsitis Pilosulae (Dang Shen), 15g, were added, and three additional ji were prescribed. The patient’s symptoms were eliminated and did not return.

This is a case of phlegm turbidity accumulation and stagnation with depressive and transformative fire accumulating in the heart and chest and obstructing the qi and blood. The heart and vessels were without nourishment, leading to this illness. Therefore, Wen Dan Tang Jia Wei was used to clear and transform the phlegm heat. Trichosanthes and Allium were added to move the qi and transform phlegm, Curcuma to move the qi and quicken the blood, Salvia to dispel stasis and engender the new [blood], and Crataegus was added to transform stasis and disperse accumulation. All together, these medicinals clear heat and transform stasis, move the qi and quicken the blood, free the flow of the impediment and stop pain. Because the medicinals match the pattern, the results were quite outstanding.

Impotence. Male, 28 years old, initial examination in August 1995. The patient had suffered from impotence for more than a year. He had repeatedly taken prescriptions to supplement the kidneys and invigorate yang but with no results. He had a bitter, sticky taste in the mouth, chest oppression with desire to vomit, profuse phlegm, no appetite, and restlessness at night. The tongue body was slightly red, and the tongue fur was yellow and slimy. The pulse was slippery and rapid.

Therefore, Wen Dan Tang together with Kang Wei Ling (Effective Medicine to Prevent Wilting)⁴ [were prescribed]. The ingredients were: Rhizoma Pinelliae Ternatae (Ban Xia), 10g, Pericarpium Citri Reticulatae (Chen Pi), 10g, Sclerotium Poriae Cocos (Fu Ling), 20g, Fructus Citri Aurantii (Zhi Ke), 10g, Caulis Bambusae In Taeniis (Zhu Ru), 15g, Radix Glycyrrhizae (Gan Cao), 6g, Radix Angelicae Sinensis (Dang Gui), 15g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 15g, Scolopendra Subspinipes (Wu Gong), 2 pieces. Five ji were prescribed. After taking the prescription, the chest oppression lessened, the appetite improved, the mouth bitterness disappeared, and the penis became vigorous. The patient was capable of an erection but not for a prolonged period of time. After an additional eight ji, sexual intercourse became more frequent, and the following year, [he and his wife] had a baby boy.

Impotence is an illness which is usually associated with kidney vacuity. As Zhang Jing-yue said: "Fire debilitation occurs in seven or eight out of 10 cases; fire flourishes in [the other] cases." Although this patient had repeatedly supplemented the kidney and invigorated yang, there were no good results. [Therefore, the cause] was not fire debilitation. This patient’s symptoms were chest oppression with desire to vomit, a bitter and sticky taste in the mouth, no pleasure in eating, slimy tongue fur, and a slippery pulse, a group of symptoms typical of phlegm heat. The cause of the impotence itself was internal depression of phlegm heat encumbering the spirit mind and depriving the penis of its [ability] to erect and extend. Therefore, using Wen Dan Tang to clear and transform phlegm heat, together with Kang Wei Ling, the two formulas drain and free the flow of qi and blood, enabling the turbid phlegm to be dispelled and the heat to be cleared. As a result, the spirit mind was no longer encumbered, the flow of qi and blood was promoted, and the patient regained his ability to achieve an erection. Hence the illness was cured.