Disorders of the Spleen and Stomach

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By Prof. Dian Bang-Shi From a lecture given by Dr Jin Zhang Translated and edited by Eunkyung Kim and Attilio D'Alberto

ncient Chinese medical textbooks and digesting’ and ‘transformation’ is different Athat discuss Spleen and Stomach disorders and according to this it is necessary to differenti- include the typical symptom manifestations of ate between the Stomach and Spleen”. For exam- abdominal distention, abdominal pain, nausea, ple, the text Zheng Zhi Ji Yao (A Collection of Pat- acid regurgitation, gastric discomfort and irregu- terns and Treatments) states that “if digested food lar bowel movements. Today, Chinese medicine’s is unable to transform, there is a Spleen disorder categorisation includes modern allopathic medi- and treatment should tonify the Spleen. However, cal diseases such as chronic gastritis, peptic ulcer if a patient is reluctant to eat but feels comfort- and several liver and gallbladder disorders. With able after eating, it is a Stomach disorder”. any Spleen and Stomach disorder, the pattern The Stomach is a fu organ and receives food differentiation and treatment strategy should be and water. There are numerous factors that can based upon the variations of yin and yang, qi and affect the Stomach: exogenous pathogens, emo- blood, excessive and deficiency as well as hot and tions and Stomach qi weakness. For example, if cold patterns and zangfu theory. In this article, the Stomach is invaded by exogenous pathogens Prof. Shi outlines each pattern differentiation as- such as summer-heat, damp or phlegm-damp, sociated with the Spleen and Stomach. For each they cause internal blockages. If the Stomach qi is categorisation, a pattern analysis, treatment strat- deficient the Stomach will not be able to receive egy, herbal formulae and individual herbal com- food. Stomach fluid is Stomach yin and Stomach binations are provided. This information is based qi is Stomach yang. Clinically, a Stomach fluid upon a wide and deep knowledge of the classics, (yin) and Stomach qi (yang) deficiency can cause quotes from which are presented, along with his a poor appetite with no desire to eat. vast clinical experience. In certain instances, his The transformation of food into food essence classical and clinical knowledge is utilised to depends upon the function of the Spleen. Once provide insights into treating the complex nature transformed, food essence is then transported of Spleen and Stomach disorders. and dispersed to the zangfu, four extremities, n Dian Bang-Shi opened his bones and other parts of the body. If the Spleen’s own clinic in 1942 and gradu- Transformation and transportation transportation function is deficient, the food ated from Beijing University of remains in the Stomach and cannot be digested TCM in 1957 and is the retired The physician Wang Jie Zhai during the Ming causing abdominal distention and indigestion. director of China Academy of dynasty stated that “the Stomach receives and If the Spleen is deficient and unable to transport TCM. He specialises in Spleen digests food whilst the Spleen governs transpor- and disperse food essence, yuan qi will be insuf- and Stomach disorders and still tation and transformation, transforming the food ficient and the whole body will be lethargic. practises at the age of 83 in Xi into jing qi”. Many physicians during the Qing Treatment strategy: If the patient has a poor ap- Yuan hospital, Beijing, China. dynasty stated that “the function of ‘receiving petite and indigestion but no abdominal disten-

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tion after eating, it indicates that the transporta- of the rectum, uterus and lower abdomen with tion and transformation function is normal, but haemorrhoids. If the Spleen qi descends, use Bu that the receiving of food is abnormal. Harmo- Zhong Yi Qi Tang (Tonify the Middle and Aug- nise the Stomach with the formula Er Chen Tang ment the Qi Decoction) or Sheng Yang Yi Wei Tang (Two-Cured Decoction). Modify according to the (Raise the Yang and Benefit the Stomach Decoc- pattern: hot, cold, deficiency, excess, yin and yang, tion) to raise the clear qi and stop diarrhoea. i.e. add Bai Dou Kou (Amomi rotundus Fructus), The Stomach’s function is to descend. Factors Mai Ya (Hordei Fructus germinantus), Dao Ya that inhibit this include exogenous pathogenic (Oryzae Fructus germinantus), Sha Ren (Amomi factors, diet, emotions, the Liver overwhelming, Fructus), Shen Qu (Massa medicata fermentata) phlegm, qi and blood disharmonies, etc. If Stom- and Bian Dou (Lablab Semen album). ach qi fails to descend, this can result in the fol- If the main complaint is food retention with in- lowing three disorders: digestion, abdominal distention and an aversion Stomach qi fails to descend: If Stomach fluid to excessive eating, but there is a good appetite is damaged it cannot moisten the Stomach. This with no nausea after eating, then the Stomach causes a failure of the descending function mani- function is normal and the Spleen is abnormal. festing as a poor appetite, deficient glomus with Strengthen the Spleen and assist the transforma- inability to eat, constipation or dry stools and dif- tion and transportation function by using the for- ficulty in defecating. Use sweet, cool and moist mula Liu Jun Zi Tang (Six Gentleman Decoction). herbs to tonify the Stomach yin and induce the Additional herbs that can be added include Sha Stomach qi to descend. For example Mai Men Ren (Amomi Fructus), Gan Jiang (Zingiberis Rhi- Dong (Ophiopogonis Radix), Gua Lou Ren (Tri- zoma), Zhi Ke (Aurantii Fructus) and Yi Zhi Ren chosanthis Semen), Sha Shen (Glehniae Radix), (Alpiniae oxyphyllae Fructus) etc. They are pun- Yu Zhu (Polygonati odorati Rhizoma), Shi Hu gent, sweet and warm in nature and strengthen (Dendrobii Herba), Huo Ma Ren (Cannabis Se- the Spleen qi. men) and Tian Hua Fen (Trichosanthis Radix). If both the Spleen and Stomach function is ab- Stomach qi fails to descend with turbidity: normal, the practitioner must treat both but ana- If the Stomach qi fails to descend and turbid qi lyse which organ is weaker and which stronger. cannot descend, the patient may complain of Some herbs can treat both the Spleen and Stom- chest and Stomach distention, inability to eat and ach at the same time. For example the classical nausea. If the Stomach fluid is not damaged, har- text Bi Hua Yi Jing states that “Bai Zhu (Atracty- monise the Stomach and promote the yang qi by lodis macrocephalae Rhizoma), Bian Dou (Semen using the formula Er Chen Tang (Two Cured De- Dolichoris Lablab), Shan Yao (Dioscoreae Rhizo- coction), plus herbs such as Hou Po (Magnoliae ma), Zhi Ke (Aurantii Fructus), Zhi Shi (Aurantii officinalis Cortex), Zhi Shi (Aurantii Fructus Im- Fructus Immaturus), Shen Qu (Massa medicata maturus), Gan Jiang (Zingiberis Rhizoma), Huo n Jin Zhang graduated from fermentata), Sha Ren (Amomi Fructus), Gan Jiang Xiang (Pogostemonis/ Agastaches Herba), Bai Beijing University of TCM in (Zingiberis Rhizoma) and Gan Cao (Glycyrrhizae Dou Kou (Amomi Fructus rotundus), Su Geng 1993. She is now a medical doc- Radix) can treat both the Spleen and Stomach.” (Perillae Caulis) etc. Or use the formula Ban Xia tor practising in the Foreign Xie Xin Tang (Pinellia Decoction to Drain the Ep- Department at Xi Yuan Hospital, Ascending and descending functions igastrium) which is pungent and bitter in nature Beijing, China. and helps the qi to disperse and descend. The Spleen is a yin zang that governs ascending. Stomach qi cannot descend with rebellious n Eunkyung Kim graduated with The Stomach is a yang fu that governs descend- qi: The symptoms in this category include vomit- a B.Sc. (Hons) in TCM (Middlesex ing. ing, belching, hiccups, nausea, etc. The treatment University) and a Bachelor of The Spleen carries the clear essence of food strategy is to harmonise the Stomach and descend Medicine (Beijing University up. If this function is impaired and qi stagnates the rebellious qi. Formulas that can be prescribed of TCM). She practises at The in the middle jiao, a person may experience in- include Wen Dang Tang (Warm the Gallbladder Earth Health Clinic in London. digestion, abdominal distention and chronic di- Decoction) or Ju Pi Zhu Ru Tang (Tangerine Peel Correspondence via: arrhoea. In acute cases use Xiang Sha Liu Jun Zi and Bamboo Shaving Decoction from Formulas www.aprilkim.net/contact.htm Tang (Six-Gentleman Decoction with Aucklandia to Aid the Living) or Xuan Fu Dai Zhe Tang (Inula and Amomum) and Liu Jun Zi Tang (Six-Gentle- and Haematite Decoction). Modify according to n Attilio D’Alberto gradu- man Decoction) with Bai Dou Kou (Amomi Fruc- hot or cold patterns with the main strategy being ated from a jointly run pro- tus rotundus), Gan Jiang (Zingiberis Rhizoma), to descend the Stomach qi. gram at Middlesex and Beijing Huang Qi (Astragali Radix), Hou Po (Magnoliae Universities in with a BSc (Hons) officinalis Cortex), Zhi Shi (Aurantii Fructus Im- Dry and damp patterns in Traditional Chinese Medicine maturus) and Zhi Ke (Aurantii Fructus), etc., all (Middlesex University) and a MD of which are pungent, sweet and warm in nature According to wu xing theory, the Spleen is damp (Beijing University). He practises and help the Spleen’s ascending function. earth and dislikes dampness, while the Stomach is in various busy clinics in London. If Spleen qi fails to ascend upwards, the qi will dry earth and dislikes dryness. During the Ming Correspondence: www.attilio- descend causing chronic diarrhoea with prolapse dynasty the physician Fang Guang stated that dalberto.com/contact.htm

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“the Spleen dislikes dampness and prefers dry- ma), Xia Ku Cao (Prunellae Spica) and Huang Qin ness”. Therefore many formulas use drying herbs (Scutellariae Radix), etc. If there is cold damp add to eliminate dampness in the Spleen. However, Wu Zhu Yu (Evodiae Fructus), Gan Jiang (Zin- when Stomach fire flares upwards with symptoms giberis Rhizoma), Cao Dou Kou (Alpiniae katsu- During the Ming dynasty it of a dry mouth and throat, inability to eat and madai Semen), Yi Zhi Ren (Alpiniae oxyphyllae hiccups, use herbs to moisten the Stomach. Fructus), etc. was stated in the text Yi Fang Stomach dryness patterns Kao that “[in diarrhoea] the Stomach dryness can be caused by several factors: Spleen, Stomach and Liver pain is caused by the Liver n Febrile disease can damage the Stomach fluid. while the diarrhoea is caused n Chronic disease can cause a yin deficiency. Liver qi exploits the stomach n The use of strong diuretic herbs can injure the Stomach is earth and the Liver is wood. When the by the Spleen”. ‘ yin. Liver exploits the Stomach it is like wood growing n The wrong use of herbs, i.e. hot or dry herbs up into and through the earth, a form of coun- can also injure the yin. ter-action. There are three types of disharmony If the Stomach fluid is damaged and cannot within this category. moisten, it is categorised as Stomach dryness, Liver fire exploits the Stomach with symptoms of a dry red tongue, thin pulse, Here the main symptoms include acid regurgi- dry mouth, dry or hard stools, thirst, fullness, tation, nausea and epigastric pain. In such in- poor appetite, no desire for food when hungry, stances use a formula to disperse the Liver and and Stomach ache/pain. In these cases pungent, harmonise the Stomach such as Er Chen Tang warm, dry, aromatic, qi regulating herbs will have (Two-Cured Decoction) plus Jin Ling Zi Tang no effect and may worsen the pain. The correct (Melia Toosendan Decoction) and Zuo Jin Tang treatment strategy is to use sweet, cooling, mois- (Left Metal Deoction) or use Er Chen Tang (Two- ’ turising herbs. Use the formula Yu Zhu Mai Men Cured Decoction) with Wu Mei (Mume Fructus), Dong Tang1, first recorded in the classical textWen Huang Lian (Coptidis Rhizoma) and Chuan Jiao Bing Tiao Bian (Systematic Identification of Warm (Zanthoxyli Pericarpium), etc, which makes up Diseases). In cases of Stomach dryness with pain the formula Wu Mei An Wei Wan2 (Harmonise the and dry stools use Yi Guan Jian (Linking De- Stomach Pill with Mume). During the Qing dy- coction). If the bowel movements become drier, nasty, the physician Wang Xu Gao was recorded harder and difficult to pass then promote the as stating that “the use of bitter, pungent and sour fluids and moisten the bowels by adding Sheng herbs can disperse Liver fire and inhibit its inva- Di Huang (Rehmanniae Radix), Mai Men Dong sion into the Stomach”. (Ophiopogonis Radix), Xuan Shen (Scrophular- Liver qi stagnates then exploits the Stomach iae Radix), Huo Ma Ren (Cannabis Semen), Gua The main symptoms of this pattern include epi- Lou Ren (Trichosanthis Semen), Xing Ren (Arme- gastric and hypochondriac pain and distention niacae Semen), Bai Zi Ren (Platycladi Semen), etc. and belching. These symptoms are related to If these are administered and the stools are still emotional upsets. The treatment strategy should difficult to pass add Sheng Shou Wu (Raw Poly- soothe the Liver and harmonise the Stomach. Use goni multiflori Radix). the formula Si Ni Tang (Frigid Extremities Decoc- Spleen dampness patterns tion). Additional herbs that can be added include The main symptoms of Spleen dampness include Gui Zhi (Cinnamomi Ramulus), Qing Pi (Citri re- diarrhoea, abdominal distention and fullness ticulatae viride Pericarpium), Chen Pi (Citri retic- with a thick, or watery, greasy tongue coating. In ulatae Pericarpium), Xiang Fu (Cyperi Rhizoma), these patterns, use bitter, warm or pungent herbs Ban Xia (Pinelliae Rhizoma preparatum) and Bai to dry dampness and strengthen the Spleen, for Dou Kou (Amomi Fructus rotundus). example Ping Wei San (Calm the Stomach Pow- Stomach yin depletion allows Liver qi to exploit der). To promote diuresis and resolve damp- In this category the main symptoms include pro- ness use mainly sweet and bland herbs such as longed epigastric pain, dry stools, dry mouth Fu Ling (Poria), Hua Shi (Talcum), Che Qian Zi and a deep red tongue. The use of warm, pun- (Plantaginis Semen), Yi Yi Ren (Coicis Semen), gent herbs to regulate qi will make the symptoms and Tong Cao (Tetrapanacis Medulla). To trans- worse because the Liver is a hard organ and needs form dampness, use aromatic herbs such as Huo herbs to soften and harmonise it. Xiang (Pogostemonis/Agastaches Herba) and Pei The treatment strategy should be directed to- Lan (Eupatorii Herba). Wind expelling herbs can wards softening the Liver and nourishing the also be used to dry dampness such as Fang Feng Stomach yin. Use Yi Guan Jian (Linking De- (Saposhnikoviae Radix), Qiang Huo (Notoptery- coction) or Di Ding Tang3, which nourishes the gii Rhizoma seu Radix) and Du Huo (Angelicae Stomach yin and Stomach qi, controls the Liver, pubescentis Radix), etc. If there is damp heat, add stops pain and vomiting and regulates qi. These bitter and cold herbs that can dry dampness and formulas are not too dry and nourish the yin clear heat, such as Huang Lian (Coptidis Rhizo- without being too greasy. If there is constipation

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remove Wu Wei Zi (Schisandrae Fructus) and Wu is not successful use Xiao Chai Hu Tang (Minor Mei (Mume Fructus) as they astringe. Bupleurum Decoction) and Xiao Jian Zhong Tang The Liver qi exploits the Spleen’s deficiency (Minor Construct the Middle Decoction) plus In this category the Spleen is primarily deficient and minus various herbs. Clinically, Prof. Shi likes and allows itself to be exploited by the Liver qi. to use Xiao Jian Zhong Tang (Minor Construct The main manifestations include diarrhoea, ab- the Middle Decoction) plus Xiao Chai Hu Tang dominal distention and pain: (Minor Bupleurum Decoction), modified, for Diarrhoea: When a deficient Spleen allows itself hunger pains relieved by eating, epigastric dis- to be invaded by the Liver with symptoms of diar- comfort with excessive eating and an aversion to rhoea, it is by definition a chronic condition. Other cold food. Riddle me this! symptoms will include abdominal pain, the need to defecate accompanied by pain which is relieved Spleen, Stomach and Kidney after defecating. During the Ming dynasty it was stated in the text Yi Fang Kao (Medical Remedies According to wu xing theory, the Spleen and Answer? The Lantern Researched) that “the pain is caused by the Liver Stomach are earth. The Kidney has two character- riddle and win a while the diarrhoea is caused by the Spleen”. The istics, fire (Kidney yang, the gate of vitality, which Liver disease is primarily characterised by excess warms) and water (Kidney yin). In Spleen and year’s subscription! and therefore exploits the deficient Spleen. In such Stomach disorders, some common patterns of the cases use Tong Xie Yao Fang (Important Formula Spleen, Stomach and Kidney’s pathomechanisms A mystery to science, ram- for Painful Diarrhoea) to control wood and assist are related. pant, widespread; earth. Prof. Shi likes to use the physician Li Dong Spleen, Stomach and Kidney yang deficiency And contagious, though not Yuan’s formula Sheng Yang Yi Wei Tang (Raise the Fire generates earth because Kidney yang can fatal or all would be dead. Yang to Benefit the Stomach Decoction) and add warm the Spleen earth. When the Stomach and or remove herbs to tonify qi, ascend yang qi and Spleen yang qi are deficient, the practitioner Even silent still hidden, most strengthen the Spleen to remove dampness. If the should tonify not only the Spleen and Stomach often thought crude abdominal pain is severe add Rou Gui (Cinnam- but also warm and nourish the Kidney yang. This There is no quicker damper to omi Cortex) and Wu Zhu Yu (Evodiae Fructus). method is known as tonifying fire to generate a passionate mood. For diarrhoea, it is also possible to use Pao Jiang earth. (Zingiberis Rhizoma preparata) instead of Sheng Chronic diarrhoea: When the Spleen, Stomach Dogs, cats and budgerigars, Jiang (Zingiberis Rhizoma recens). and Kidney are deficient there will be symptoms even babes in the womb, Abdominal distention and pain: Many patho- of chronic diarrhoea and distention. The chronic Theatres, churches, sparing genic factors can cause abdominal distention and diarrhoea presents as loose stools as well as un- only the tomb. pain, the most common of which is Liver qi invad- digested food. Symptoms will include four limbs ing the Spleen. In the Qing dynasty, Hua Xiu-Yun that are cold and tire easy, pale tongue and face, a Be first to answer it correctly stated that “the Liver exploits the Spleen causing lack of shen, an aversion to cold and wind and a and you will win a year’s free abdominal distention”. Sometimes the patient will thin, small, deep pulse. During the consultation subscription to The Lantern. have alternating constipation or loose stools. Ab- the physician should ask the patient if there is any dominal distention is caused by a failure of the undigested food present in the stools. This may Spleen’s role in transformation and transporta- indicate that the patient has a deficiency of Kid- tion. Deficient cold and qi dissipating also caus- ney fire. The treatment strategy should warm and es distention. The main treatment strategy is to tonify Kidney yang. Use Fu Zi Li Zhong Wan (Pre- strengthen the Spleen to assist its transportation pared Aconite Pill to Regulate the Middle) plus Si function. If this is not successful, add sour herbs Shen Wan (Four-Miracle Pill). If the tongue is ten- to soothe the Liver thus inhibiting its invasion der (fresh), use Pi Shen Shuang Bu Wan4 to tonify into the Spleen. Use the formulas Li Zhong Tang the Spleen and Kidney. The practitioner can also (Regulate the Middle Decoction) and Liu Jun Zi use Wei Guan Jian5. Additionally add Rou Dou Tang (Six Gentlemen Decoction). It is also pos- Kou (Myristicae Semen) and Bu Gu Zhi (Psor- sible to add Bai Shao (Paeoniae Radix Alba), Rou aleae Fructus) to tonify the Kidney. Gui (Cinnamomi Cortex), Mu Gua (Chaenom- Abdominal distension: When the Spleen and elis Fructus), Wu Mei (Mume Fructus) etc. For Stomach yang are deficient, the main symptoms abdominal pain due to Spleen and Stomach de- will include a poor appetite, epigastric distension ficient cold, warm the middle jiao and regulate which is worse after eating, an aversion to cold qi. If this is not effective use Liu Jun Zi Tang (Six- food, an aversion to cold, a white tongue coat- Gentlemen Decoction) and Wu Zhu Yu (Evodiae ing and a deep, thin pulse. Use the formula Li Yin Fructus), Rou Gui (Cinnamomi Cortex), Bai Shao Jian6 plus Bai Zhu (Atractylodis macrocephalae (Paeoniae Radix Alba), Mu Xiang (Aucklandiae Rhizoma), Dang Shen (Codonopsitis Radix), Sha Radix) and Chuan Jiao (Zanthoxyli Pericarpium). Ren (Amomi Fructus), Cao Dou Kou (Alpiniae If this is still not effective, then change the main katsumadai Semen) and Mu Xiang (Aucklandiae formula to Huang Qi Jian Zhong Tang (Astragalus Radix) to warm and tonify the Spleen and Kid- www.thelantern.com.au Decoction to Construct the Middle). If this again ney.

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The physician Yu Ting-Hong stated in the text and tonify the Heart and Spleen. If there is poor Zhen Yu Ji (Medical Case Records of Yu Ting appetite, epigastric distention after eating and di- Hong), that “in deficient distention cases use arrhoea caused by Spleen or Stomach deficiency, herbs to warm and tonify the Spleen and Kidney”, Prof. Shi believes that tonifying the Kidney fire is If there is a case where a for example Huang Qi (Astragali Radix), Bai Zhu a better method. If there is Heart blood deficiency, (Atractylodis macrocephalae Rhizoma), Ren Shen one can also warm and tonify Heart fire. If there patient has Kidney yin deficien- (Ginseng Radix), Fu Zi (Aconiti Radix lateralis is excessive Heart fire it can lead to a Spleen and cy which causes a deficiency of preparata), Rou Gui (Cinnamomi Cortex), Ba Ji Stomach disorder with symptoms such as irrita- Stomach yin and the treatment Tian (Morindae officinalis Radix), Tu Si Zi (Cus- bility, palpitations, insomnia, mouth ulcers and a strategy used does not nourish cutae Semen), Gou Qi Zi (Lycii Fructus), Shu Di thin, rapid pulse. In such cases use Tian Wang Bu the Kidney yin, the treatment (Rehmanniae Radix preparata), Du Zhong (Eu- Xin Tang (Emperor of Heaven’s Special Decoction ‘ commiae Cortex), Yi Zhi Ren (Alpiniae oxyphyl- to Tonify the Heart) to nourish Heart yin. will not be successful. lae Fructus) and Bu Gu Zhi (Psoraleae Fructus). Clinically, therefore, for deficiency distension a Differentiating yin and yang patterns practitioner should use tonifying herbs accompanied by symptoms of obstruction, a therapeutic In yin and yang theory, zang is yin and fu is yang; method contrary to the usual strategy. Another Spleen is yin earth and Stomach is yang earth, al- physician Yan Yong-He stated in the text Ji Sheng though the Spleen and Stomach both have yang Fang that “tonifying the Spleen method is inferior and yin. This is useful in clinical pattern differen- to tonifying the Kidney”. tiation and when devising a treatment strategy. Spleen, Stomach and Kidney yin deficiency: Stomach yang deficiency Spleen and Stomach disorders have four differ- A deficiency of Stomach yang can be due to irreg- ent patterns: yin, yang, heat and cold. If there is ular eating – either too much or too little – inter- a Spleen and Stomach yin deficiency, invigorate nal injuries due to the consumption of cold food, and nourish Kidney yin. The physician Gao Gu- emotional upsets, or overwork, all of which result ’ Feng stated that “if the Kidney is vigorous then in the impairment of Stomach yang, causing de- the Stomach yin will be abundant”. Another phy- ficiency cold in the Stomach. Symptoms will in- sician Jiang Wen Zhai stated that “tonifying the clude an aversion to cold food, a poor appetite, Kidney can help the appetite and the Stomach Stomach distention or pain, rebellious Stomach qi function”. If there is Stomach pain due to Stomach such as nausea, vomiting, dyspepsia, pale tongue yin deficiency, nourish the Liver and Kidney yin. with a white coating and a deep, thin, small pulse. For example, in cases of dysphagia with a Kidney In such cases use Li Zhong Tang (Restore the Mid- yin deficiency leading to the Spleen and Stomach’s dle Decoction) and Liu Jun Zi Tang (Six-Gentle- fluid to dry out, it will be unable to moisten with men Decoction), plus Ding Xiang (Flos Caryo- food being difficult to pass down. The patient will phylli), Bai Dou Kou (Fructus Amomi Kravanh) usually be thin and the stools like pellets. Use the and Sha Ren (Fructus Amomi). If there is severe formula Liu Wei Di Huang Wan (Six-Ingredient cold add Bi Ba (Fructus Piperis Longi), Bi Cheng Pill with Rehmannia). However, if there is a case Qie (Fructus Cubebae), Gao Liang Jiang (Rhi- where a patient has Kidney yin deficiency which zoma Alpiniae Officinari) and Rou Gui (Cortex causes a deficiency of Stomach yin and the treat- Cassiae Cinnamomi). ment strategy used does not nourish the Kidney Stomach yin deficiency yin, the treatment will not be successful. Use the A deficiency of Stomach yin is associated with a formula Yi Guan Jian (Linking Decoction) or Shu deficiency of fluids. Symptoms will include a poor Gan Yi Shen Tang [Liu Wei Di Huang Tang plus appetite, no feeling of hunger or feels hunger but Chai Hu (Bupleuri Radix) and Bai Shao (Paeo- eats a little, burning Stomach pain, a dry mouth, niae Radix alba)]. thirst, irritability, dry stools, dark red tongue and a thready, rapid pulse. In these cases, use sweet, Spleen, Stomach and Heart cool herbs to generate fluids, while sweet and sour herbs can generate yin. Use Yu Zhu Mai Men Tang Ante Babic’s The Heart is fire and in general fire generates plus Sheng Di (Radix Rehmanniae Glutinosae), Tips for running earth. However, clinically if the Spleen and Stom- Shi Hu (Herba Dendrobii), Mai Men Dong (Tuber a successful clinic ... ach yang is deficient it is necessary to tonify fire Ophiopogonis Japonici), Bai Shao (Radix Paeo- to generate earth as mentioned in the discussion niae Lactiflorae), Wu Mei (Fructus Pruni Mume) a) I knew I was clinically on Spleen, Stomach and Kidney yang deficiency. and Bai Bian Dou (Semen Dolichoris Lablab). If depressed when I kept hear- To generate Spleen earth, one should tonify Kid- there is Stomach pain, use a modified version of ing the answering machine ney fire. To generate Stomach earth, one should Yi Guan Jian (Linking Decoction). say “I am just calling to tonify Heart fire. If there is a Stomach deficiency Spleen yang deficiency confirm disappointment with with prolonged epigastric pain, use Gui Pi Tang The Stomach depends upon the Spleen yang’s Ante Babic.” (Restore the Spleen Decoction) or Miao Xiang warmness to function correctly; the Stomach is San (Marvellously Fragrant Powder) to warm then able to perform its function of rotting and

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ripening water and grain. and young with a little or dry coating. The pulse The main Spleen yang deficient symptoms can will be soft and thin or thin and rapid. Prof. Shi be seen in the dysfunction of the transformation often uses Zi Yin Jian Pi Wan7 and sometimes and transportation actions; severe abdominal adds Shen Ling Bai Zhu San (Ginseng, Poria and distention after eating, qi stagnation in the mid- Atracylodes Macrocephala Powder) to tonify the dle Jiao, epigastric pain or distension, all indicate Spleen yin. To treat Spleen yin deficient symp- After the physician Li Dong that the Spleen is not able to ascend the clear qi. toms such as diarrhoea, it is also possible to use Yuan’s teachings, physicians Instead it descends, with diarrhoea and smaller Ba Zhen Tang (Eight-Treasure Decoction). were aware that they should abdomen or rectal prolapse. The Spleen controls tonify Spleen yang in severe the four extremities, if the Spleen yang is defi- Differentiating hot and cold patterns cient the symptoms will manifest as four cold ex- Stomach and Spleen disorders tremities, a pale complexion, tiredness, moderate, There are three types of hot and cold patterns. but were unaware they had to week or thin and deep pulse and a slightly white Spleen and Stomach deficient cold ‘ tonify Spleen yin as well. tongue coating. Sweet and warm herbs can tonify Most symptoms in this category are associated qi, whilst pungent and sweet herbs can regulate with a Spleen and Stomach yang deficiency lead- yang. Use the formula Bu Zhong Yi Qi Tang (Ton- ing to internal cold. The symptoms include a re- ify the Middle and Augment the Qi Decoction), duced food intake, Stomach and abdominal cold Li Zhong Tang (Restore the Middle Decoction), pain, a comfortable feeling after consuming a lit- Xiang Sha Liu Jun Zi Tang (Six-Gentlemen Decoc- tle amount of food and distention after consum- tion with Aucklandia and Amomum), Huang Qi ing too much food, indigestion, diarrhoea, pale Jian Zhong Tang (Astragalus Decoction to Con- complexion, tiredness, an aversion to cold, pale struct the Middle), Sheng Yang Yi Wei Tang (Raise tongue with a white coating and a soft, thin pulse. the Yang and Benefit the Stomach Decoction), etc. If the Spleen and Stomach deficient cold is mild For regulating qi add Mu Xiang (Radix Auck- use pungent, warm herbs to expel the cold and landiae Lappae), Hou Po (Cortex Magnoliae Of- pungent, sweet herbs to rectify yang. The main ficinalis), Qing Pi (Pericarpium Citri Reticulatae formula for this pattern is Liu Jun Zi Tang (Six- ’ Viride), Chen Pi (Pericarpium Citri Reticulatae), Gentleman Decoction). Additionally add Gan Zhi Ke (Fructus Citri Aurantii), Zhi Shi (Fructus Jiang (Rhizoma Zingiberis Officinalis), Cao Dou Immaturus Citri Aurantii), etc. For warming the Kou (Semen Alpiniae Katsumadai) and Yi Zhi Spleen add Fu Zi (Radix Lateralis Aconiti Car- Ren (Fructus Alpiniae Oxyphyllae) to warm the michaeli Praeparata), Yi Zhi Ren (Fructus Alpini- Spleen and Stomach. If this treatment strategy is ae Oxyphyllae), Cang Zhu (Rhizoma Atractylo- not effective and the distension and pain become dis), Pao Jiang (Quick-fried Rhizoma Zingiberis worse, the Nei Jing (Plain Questions) states, “when Officinalis), etc. cold pathogen attacks internally use pungent and In the late Qing dynasty the physician Tang warm herbs and bitter and sweet herbs to assist”. Rong-Chuan stated in the text Xue Zheng Lun Prof. Shi uses the formula Fu Yang Zhu Wei Tang8 – Nan Yu Yi Tong Lun that “to harmonise and in Spleen and Stomach deficient cold patterns treat the Spleen and Stomach, the practitioner with abdominal distending pain and loose stools. should differentiate between yin and yang”. After However, if one has internal heat this formula the physician Li Dong-Yuan’s teachings, physi- can induce Stomach fire rising upwards causing a cians were aware that they should tonify Spleen dry mouth and throat, mouth and tongue ulcers yang in severe Stomach and Spleen disorders but and tooth ache. In such cases, replace the formula were unaware they had to tonify Spleen yin as with Li Yin Jian6, which warms and moistens plus well. When Spleen yang is deficient, grain and additional herbs to warm the Spleen yang. If the water can absolutely not be transformed. When main symptom is Stomach pain due to Spleen the Spleen yin is deficient, grain and water can and Stomach deficient cold and the pain is ag- also not be transformed. For Spleen deficient pat- gravated by hunger but is relieved by eating with terns use warm herbs to promote the appetite and an aversion to cold food, along with distension cold herbs to subdue the appetite. Tonifying yang after excessive eating, use the formula Xiao Jian herbs include Gan Jiang (Rhizoma Zingiberis Zhong Tang (Minor Construct the Middle Decoc- Officinalis), Fu Zi (Radix Lateralis Aconiti Car- tion) plus Xiao Chai Hu Tang (Minor Bupleurum michaeli Praeparata), etc, which promote the ap- Decoction). If it is serious use Liang Fu Wan (Ga- petite. Tonifying Spleen yin herbs include Zhi Mu langal and Cyperus Pill). (Rhizoma Anemarrhenae Asphodeloidis) and Shi Spleen and Stomach damp heat Gao (Gypsum), etc, which act to generate fluids. This can be caused by a deficiency of Spleen and Generally, Spleen yin deficient symptoms will Stomach qi as well as internal injury caused by manifest as dysphasia, constipation, abdominal food intake causing damp heat. Other causes in- distention, dry mouth, hot feeling in the hands clude external pathogenic factors such as damp and feet, irritability, dry skin, yellow complexion heat. The patient will have an aversion to food, and a thin body. The tongue will be red or pale stuffiness of the epigastrium and abdominal re-

The Lantern 33 feature

gions, epigastric pain, a dry, bitter, sticky use Huo Xiang Zheng Qi Tang (Agastache will experience Stomach and abdominal mouth, loose stools and ungratifying def- Decoction to Rectify the Qi), plus Huang distention with reduced food intake or will ecation. The tongue will have a thick, greasy, Lian (Rhizoma Coptidis) and Huang Qin complain of loose stools and tired extremi- yellow coating. If damp heat injures yin the (Radix Scutellariae Baicalensis) to clear heat ties. Use a formula such as Zhi Shi Li Zhong tongue will be red. In these cases use herbs to and resolve dampness. Tang (Immature Bitter Orange Decoction resolve dampness, clear heat and rectify the Exterior pathogenic cold to Regulate the Middle) or Jia Wei Zhi Zhu Spleen and Stomach dampness or regulate An invasion by exterior pathogenic cold Tang (Modified Immature Bitter Orange qi to remove stagnation and clear heat. Use will include symptoms such as vomiting and Atractylodes Macrocephala Decoction). the formula Yue Ju Tang (Escape Restraint clear fluids, epigastric pain, abdominal dis- If there is excessive distention due to dam- Decoction), plus Huang Lian (Rhizoma tension and diarrhoea. Use Li Zhong Tang age caused by food, add Lai Fu Zi (Semen Coptidis), Huang Qin (Radix Scutellariae (Regulate the Middle Pill). For severe cold Raphani Sativi) and Ji Nei Jin (Endothelium Baicalensis), Qing Pi (Pericarpium Citri Re- pain add Fu Zi (Radix Lateralis Aconiti Car- Corneum Gigeriae Galli). If the cold is se- ticulatae Viride) and Chen Pi (Pericarpium michaeli Praeparata). If there is diarrhoea vere add Fu Zi (Radix Lateralis Aconiti Car- Citri Reticulatae). If there is severe heat add use Wei Ling Tang (Calm the Stomach and michaeli Praeparata) and Gan Jiang (Rhi- Sheng Shi Gao (Gypsum), Zhi Mu (Rhizoma Poria Decoction). zoma Zingiberis Officinalis). For heat add Anemarrhenae Asphodeloidis) and Zhu Ru Retention of food Huang Lian (Rhizoma Coptidis) and Huang (Caulis Bambusae in Taeniis), etc. The retention of food can be caused by an Qin (Radix Scutellariae Baicalensis). Spleen-Stomach hot and cold combination improper diet or the existence of a previous It is necessary to differentiate between ex- This pattern, commonly seen in clinical Spleen and Stomach disorder. It can be as- cess and deficient patterns in cases of epigas- practice, is caused by the Spleen and Stom- sociated with either an excess or deficiency, tric distension. In protracted diseases due to ach originally having a deficient cold pat- but this is mainly a branch, excess pattern. a Spleen and Stomach deficiency, if the treat- tern and if this stagnates for a long period Symptoms will include distension, pain ment strategy of regulating qi to dissipate qi of time it causes heat, therefore this disor- in the epigastrium, nausea, vomiting, foul or dispersing formula still allows the disorder has hot and cold pattern combinations. breath, sour regurgitation or diarrhoea and der to be present, then consider that the dis- Symptoms include epigastric distension, indigestion. The retention of food can be tention is caused by a deficiency pattern. a reduced food intake, an aversion to cold broken down into a further three patterns: Excess distention is caused by qi stagna- food, with the distention and pain becom- Deficient cold: With Spleen and Stomach tion; in such cases use pungent and dissi- ing worse after consuming cold food, with deficient cold and the impairment of the pating herbs. Deficiency distention is caused heartburn and a dry mouth with a bitter transformation and transportation func- by qi dissipating. The treatment strategy taste. Use pungent, warm and bitter cold for- tion due to food intake, use Bao He Wan should be to use sour herbs to astringe. If mulas such as Ban Xia Xie Xin Tang (Pinellia (Preserve Harmony Pill from the Precious formulas which are sweet and warm are Decoction to Drain the Epigastrium). For se- Mirror). Do not use Lian Qiao (Fructus used to invigorate qi and tonify the Spleen vere Stomach distension add Zhi Ke (Fructus Forsythiae Suspensae) because it is pungent causing the distention to become severe, it Citri Aurantii) and Cao Dou Kou (Semen Al- and cool, instead add Bai Zhu (Rhizoma At- should be considered that the distention is piniae Katsumadai). If there is Stomach pain ractylodis Macrocephalae), Zhi Ke (Fructus an excessive type. After treatment it is usu- use Ban Xia Xie Xin Tang (Pinellia Decoc- Citri Aurantii) and Gan Jiang (Rhizoma Zin- ally possible to differentiate if the pattern is tion to Drain the Epigastrium) and Yue Tao giberis Officinalis), etc. Or use Dou Kou Ju either excessive or deficient after a reaction San9, plus Jin Ling Zi San (Melia Toosendan Hong San10 and modify it. to the previously prescribed formula. Powder). If there is acid regurgitation use Internal heat: With internal heat caused For deficiency distention pattern, if Xiang Zuo Jin Wan (Left Metal Pill) plus Duan Wa by an improper diet, use Da An Tang (Great Sha Liu Jun Zi Tang (Six Gentleman Decoc- Leng Zi (Fried Concha Arcae) and Qing Pi Tranquility Decoction), plus Huang Lian tion with Aucklandia and Amomum) or Bu (Pericarpium Citri Reticulatae Viride). The (Rhizoma Coptidis) with Huang Qin (Radix Zhong Yi Qi Tang (Tonify the Middle and physician Zhu Dan Xi stated that “to treat Scutellariae Baicalensis). Augment the Qi Decoction) are not effective Stomach pain use pungent and warm herbs Phlegm damp: When phlegm damp stag- then not only can a practitioner use sour to rectify the Stomach and Spleen”. Add Shan nates in the Spleen and Stomach it causes herbs to astringe, but also herbs to warm Zhi Zi (Fructus Gardeniae Jasminoidis) and chest and Stomach excess and stuffiness, and nourish the Kidney fire or warm and Huang Lian (Rhizoma Coptidis), etc, which nausea and the vomiting of phlegm and tonify the Spleen and Kidney. Therefore, it are bitter and cold and clear heat. sometimes Stomach pain. Use Er Chen Tang can be said, that tonifying the Spleen is infe- (Two-Cured Decoction) or Fu Ling Yin11, or rior to tonifying the Kidney. Differentiating excess and deficiency use Xiao Ban Xia Jia Fu Ling Tang or He Wei Er Chen Jian (Er Chen Tang plus Gan Jiang Differentiating qi and blood patterns Deficient patterns have already been dis- (Rhizoma Zingiberis Officinalis) and Sha cussed. Excess patterns can include a Ren (Fructus Amomi) to resolve phlegm and Spleen and Stomach qi deficiency number of factors such as summer heat harmonise the Stomach. When the Spleen and Stomach yang qi is damp invading the body or an invasion by deficient, the transformation and transpor- pathogenic cold. Symptoms will include a Root deficiency and branch excess tation will be dysfunctional with symp- torpid intake, nausea, vomiting, or epigas- toms of abdominal distension, epigastric tric pain and loose stools. In these cases assist the digestion to reduce pain, reduced food intake, diarrhoea, loose Summer heat damp the branch (xiao bu fa). The root pattern is a stools, weak four extremities, pale complex- When summer heat damp invades the body Spleen and Stomach deficiency. The patient ion and a thin, soft pulse. Use Shen Ling

34 Vol 2–3 feature

Bai Zhu San (Ginseng, Poria and Atractylodes Ba Zhen Tang (Eight-Herb Powder for Rectifica- Macrocephala Powder from the Analytic Collec- tion) or Shi Quan Da Bu Tang (All Inclusive Great tion). If the Spleen and Stomach is deficient with Tonifying Decoction). a deficiency of yuan qi and lassitude, use Si Jun Zi Tang (Four Gentleman Decoction), plus Huang Blood stasis causing epigastric pain Qi (Radix Astragali Membranacei) and Shan Yao (Radix Dioscoreae Oppositae). If there is pain add In the classics it states that “pain at the begin- Rou Gui (Cortex Cinnamomi Cassiae), Bai Shao ning is in the meridians, the meridians govern qi, (Radix Paeoniae Lactiflorae), Xiang Fu (Rhizoma chronic pain moves into the collaterals and the Cyperi Rotundi), Gao Liang Jiang (Rhizoma Al- collaterals control blood”. When protracted epi- piniae Officinari) and Wu Yao (Radix Linderae gastric pain does not improve, it moves into the Strychnifoliae), etc. If tonifying the Spleen and blood level within the collaterals. The treatment Stomach formula is not effective use a tonifying strategy should use pungent and moist herbs Kidney formula. Use herbs such as Tu Si Zi (Se- to unblock the collaterals. Clinically, Prof. Shi’s men Cuscutae Chinensis), Shu Di Huang (Radix experience is that when the use of qi regulating Rehmanniae Glutinosae Conquitae) and Bu Gu herbs does not improve the condition, use herbs Zhi (Fructus Psoraleae Corylifoliae) to warm the to quicken the blood and unblock the collater- lower jiao. als and stop the pain. The symptoms of chronic epigastric pain, hypochondriac and back pain Spleen and Stomach qi stagnation tells the practitioner that the disease is in the collaterals. Use herbs such as Dang Gui (Radix An- The pathogenic factors that cause Spleen and gelicae Sinensis), Tao Ren (Semen Persicae), Bai Zi Stomach qi stagnation include summer heat Ren (Semen Biotae Orientalis), Dan Shen (Radix damp, wind-cold or internal injury due to the Salviae Miltiorrhizae), Yu Jin (Tuber Curcumae), consumption of cold, greasy food along with Yan Hu Suo (Rhizoma Corydalis Yanhusuo), Wu emotional upset or anger. Ling Zhi (Excrementum Trogopteri seu Pteromi), All these factors will damage the transportation Hong Hua (Flos Carthami Tinctorri) and Ze Lan and transformation function of the Spleen and (Herba Lycopi Lucidi), etc. If it is a cold pattern Stomach, manifesting as abdominal distention, add Gui Zhi (Ramulus Cinnamomi Cassiae) and indigestion, foul breath, belching, sour regurgita- Liang Jiang (Rhizoma Alpiniae Officinari). For tion or abdominal pain with no desire for food. heat patterns add Mu Dan Pi (Cortex Moutan The bowel movements will be difficult to pass Radicis) and Shan Zhi Zi (Fructus Gardeniae Jas- and the tongue will have a thick, greasy coating. minoidis). Rectify qi and disperse stagnation. Use formulas For blood stasis patterns as well as using blood such as Ping Wei San (Calm the Stomach Powder) quickening herbs, also use qi regulating herbs as and Shen Xiang San12. qi commands the blood. Include herbs such as If the stagnation transforms into heat with Xiang Fu (Rhizoma Cyperi Rotundi), Jiang Xiang symptoms of a dry mouth, yellow tongue coating (Lignum Dalbergiae Odoriferae), Chen Pi (Peri- and hard stools use Huang Lian (Rhizoma Cop- carpium Citri Reticulatae) and Qing Pi (Pericar- tidis), Huang Qin (Radix Scutellariae Baicalensis) pium Citri Reticulatae Viride), etc. Examples of and Tian Hua Fen (Radix Trichosanthis Kirilowii). blood quickening formulas include Xue Fu Zhu Yu If severe add Da Huang (Radix et Rhizoma Rhei). Tang (Drive Out Stasis in the Mansions of Blood Decoction) and Ge Xia Zhu Yu Tang (Drive Out Spleen and Heart blood deficiency Blood Stasis Below the Diaphragm Decoction). When the stools are black in blood stasis patterns Spleen and Heart blood deficiency is a combi- use Da Huang (Radix et Rhizoma Rhei) to remove nation of both a deficiency of qi and blood. The the blood stasis and produce new blood. When commonly seen symptoms include epigastric the stools colour turns from black to yellow the pain, distention, reduced food intake, tiredness, treatment has been successful. Clinically, Prof. Shi insomnia, palpitations and a delayed menstrua- sometimes sees patients with chronic epigastric tion. When regulating and harmonising the Spleen pain with unsuccessful treatment and uses Dan If tonifying the Spleen and and Stomach in blood deficiency patterns do not Shen Yin (Salvia Decoction) and Dan Shen (Radix use pungent and warm herbs as they damage yin Salviae Miltiorrhizae) at 30g each, which he finds Stomach formula is not and blood causing exuberant Stomach fire with very effective. effective use a tonifying depleted Spleen yin. The Stomach and Intestines Kidney formula... will become dry with dry and hard stools. The Conclusion treatment strategy is to nourish and harmonise the Heart and Spleen. Formulas that can be pre- Clinically, zangfu theory, yin and yang, qi and ‘ scribed include Gui Pi Tang (Restore the Spleen blood, hot and cold, deficiency and excess have a Decoction) or Gui Shao Liu Jun Zi Tang13, or use very close relationship. It is not easy to differenti- The’ Lantern 35 feature

ate and distinguish their mechanisms. A practi- rocarpae), Shan Zhu Yu (Fructus Corni Officinalis), Ba tioner should understand pattern differentiation Ji Tian (Radix Morindae Officinalis), Tu Si Zi (Semen Cuscutae Chinensis), Wu Wei Zi (Fructus Schisandrae from a holistic perspective. Prof. Shi’s understand- Chinensis), Bu Gu Zhi (Fructus Psoraleae Corylifoliae), ing is that treatment should have different strate- Rou Dou Kou (Semen Myristicae Fragrantis) and Che When the stools are black in gies, for example when treating the Stomach and Qian Zi (Semen Plantaginis). blood stasis patterns use Da the treatment strategy is not effective, a practitioner should consider that the Liver is exploiting 5. Wei Guan Jian: Shu Di (Radix Rehmanniae Gluti- Huang to remove the blood the Stomach and so treat the Liver. nosae Conquitae), Shan Yao (Radix Dioscoreae Opposi- tae), Bai Bian Dou (Semen Dolichoris Lablab), Bai Zhu stasis and produce new blood. With disorders of the Spleen, if the treatment (Rhizoma Atractylodis Macrocephalae), Zhi Gan Cao When the stools colour turns strategy of treating the Spleen is not responding (Processed Radix Glycyrrhizae Uralensis), Wu Zhu Yu from black to yellow the then treat the Kidney. For example, if Spleen yang (Fructus Evodiae Rutaecarpae) and Pao Jiang (Quick- ‘ is deficient and warming the Spleen yang is not fried Rhizoma Zingiberis Officinalis). treatment has been successful. effective then warm the Kidney. If the treatment 6. Li Yin Jian: Shu Di (Radix Rehmanniae Glutinosae strategy directed at the qi level is not effective Conquitae), Dang Gui (Radix Angelicae Sinensis), Gan then redirect the strategy to the blood level. For Jiang (Rhizoma Zingiberis Officinalis) and Zhi Gan blood stasis patterns differentiate between defi- Cao (Processed Radix Glycyrrhizae Uralensis). ciency and excess. For excessive type blood stasis patterns, quicken the blood and dispel blood 7. Zi Yin Jian Pi Wan: Dang Shen (Radix Codonopsitis), stasis. For deficient blood stasis patterns, regulate Bai Zhu (Rhizoma Atractylodis Macrocephalae), Fu Ling (Sclerotium Poriae Cocos), Gan Cao (Radix Glycyr- and nourish qi and blood to dispel blood stasis. rhizae Uralensis), Mai Men Dong (Tuber Ophiopogonis If when treating an excessive pattern it is not ef- Japonici), Wu Wei Zi (Fructus Schisandrae Chinensis), fective consider that the pattern may be one of Shan Yao (Radix Dioscoreae Oppositae), Shi Hu (Herba deficiency. Dendrobii), Chen Pi (Pericarpium Citri Reticulatae) In conclusion, bian zheng lun zhi should be used and Shan Zha (Fructus Crataegi). with basic Chinese medical theory to differenti- 8. Fu Yang Zhu Wei Tang: Ren Shen (Radix Ginseng), Bai ’ ate the pathogenic factors, characteristics, mecha- Zhu (Rhizoma Atractylodis Macrocephalae), Gan Jiang nisms and disease, disorder location. When using (Rhizoma Zingiberis Officinalis), Zhi Gan Cao (Proc- formulas a practitioner should have a set of strat- essed Radix Glycyrrhizae Uralensis), Shu Fu Zi (Radix egies that are well thought out. With extensive Lateralis Aconiti Carmichaeli Praeparata), Rou Gui clinical experience and Chinese medicine theory (Cortex Cinnamomi Cassiae), Bai Shao (Radix Paeoni- a practitioner can have good clinical results. ae Lactiflorae),Chen Pi (Pericarpium Citri Reticulatae), Yi Zhi Ren (Fructus Alpiniae Oxyphyllae), Wu Zhu Yu Endnotes (Fructus Evodiae Rutaecarpae) and Cao Dou Kou (Se- men Alpiniae Katsumadai). 1. Yu Zhu Mai Men Dong Tang: Yu Zhu (Rhizoma Atrac- tylodis Macrocephalae), Mai Men Dong (Tuber Ophi- 9. Yue Tao San: Shan Zhi Zi (Fructus Gardeniae Jasmi- opogonis Japonici), Sha Shen (Radix Ginseng) and Gan noidis), (cold) and Gao Liang Jiang (Rhizoma Alphiniae Cao (Radix Glycyrrhizae Uralensis). Officinari) (hot), 2. Wu Mei An Wei Wan: Wu Mei (Fructus Mume), 10. Dou Kou Ju Hong San: Ding Xiang (Flos Caryo- Chuan Jiao (Pericarpium Zanthoxyli Bungeani), Fu phylli), Mu Xiang (Radix Aucklandiae Lappae), Bai Zi (Radix Aconiti Lateralis Praeparata), Gui Zhi (Ra- Dou Kou (Fructus Amomi Kravanh), Ren Shen (Radix mulus Cinnamomi), Gan Jiang (Rhizoma Zingiberis), Ginseng), Hou Po (Cortex Magnoliae Officinalis), Shen Huang Bai (Cortex Phellodendri), Huang Lian (Rhizo- Shu, Gan Jiang (Rhizoma Zingiberis Officinalis), Ban ma Coptidis), Chen Pi (Pericarpium Citri Reticulatae), Xia (Rhizoma Pinelliae Ternatae), Ju Hong (Pars Rubra Qing Pi (Pericarpium Citri Reticulatae Viride), Bai Shao Epicarpii Citri Erythrocarpae), Gan Cao (Radix Gly- (Radix Paeoniae Lactiflorae), Ren Shen (Radix Gin- cyrrhizae Uralensis), Huo Xiang (Herba Agastaches seu seng), Chuan Lian Zi (Fructus Meliae Toosendan). Pogostemi) and Bai Zhu (Rhizoma Atractylodis Mac- rocephalae). 3. Di Ding Tang: Sheng Di (Radix Rehmanniae Gluti- nosae), Ding Xiang (Flos Caryophylli), Bai Zhu (Rhizo- 11. Fu Ling Yin: Ren Shen (Radix Ginseng), Fu Ling (Scle- ma Atractylodis Macrocephalae), Chen Pi (Pericarpium rotium Poriae Cocos), Bai Zhu (Rhizoma Atractylodis Citri Reticulatae), Hou Po Hua (Flos Magnoliae Offici- Macrocephalae), Zhi Shi (Fructus Immaturus Citri Au- nalis), (milder than Hou Po (Cortex Magnoliae Officina- rantii), Ju Pi (Pericarpium Citri Reticulatae) and Sheng lis), not too dry), Dang Shen (Radix Codonopsitis Pilo- Jiang (Rhizoma Zingiberis Officinalis Recens). sulae), Mai Men Dong (Tuber Ophiopogonis Japonici), 12. Shen Xiang San: Ding Xiang (Flos Caryophylli), Sha Wu Wei Zi (Fructus Schisandrae Chinensis), Wu Mei Ren (Fructus Amomi) and Cao Dou Kou (Semen Al- (Fructus Pruni Mume), Gan Cao (Radix Glycyrrhizae piniae Katsumadai). Uralensis) and Huang Lian (Rhizoma Coptidis). 13. Gui Shao Liu Jun Zi Tang: Liu Jun Zi Tang (Six-Gen- 4. Pi Shen Shuang Bu Wan: Ren Shen (Radix Ginseng tleman Decoction), plus Dang Gui (Radix Angelicae or Dang Shen), Shan Yao (Radix Dioscoreae Oppositae), Sinensis) and Shan Yao (Radix Dioscoreae Oppositae) Lian Rou (Semen Nelumbinis Nuciferae), Sha Ren (Fruc- tus Amomi), Ju Hong (Pars Rubra Epicarpii Citri Eryth-

36 Vol 2–3