Chinese Herbal Medicine (TCM)

Formulas that warm the interior

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Formulas that warm interior

Warm interior & expel cold

Li Zhong Wan – warms mid Jiao, strengthens Spleen & Stomach

Li Zhong Wan – regulate the middle pill

Shang Han Lun

Gan Jiang (rhizome Zingiberis officinalis)…9g

Ren Shen (radix ginseng)…9g

Bai Zhu (rhizome atractrylodis macrocephalae)…9g

Zhi Gan Cao (honey fried radix glycyrrhizae uralensis)…9g

Indications: deficient cold mid Jiao (Spleen Yang deficiency), diarrhea (watery stool), turbid Stomach Yin rebelling (nausea, vomiting), poor appetite, cold abdominal pain, no thirst, T- pale with white coat, P- deep thin. This can quite often manifest with cold hands and feet, cold Chest Bi with fullness.

This formula is also sometimes called Ren Shen Tang, Zhi Zhong Tang, & Ren Shen Li Zhong Tang.

It can be compared to Hou Po Wen Zhong Tang which dries damp, moves Qi, but does not tonify. It is used more for an invasion of Damp/Cold. Li Zhong Wan is more indicated for Cold from deficiency without Damp (or not significant Dampness).

It is used for Western diseases such as, gastritis, ulcers, gastroptosis, irritable bowel syndrome, colitis, and some bleeding disorders.

Do not use is any signs of Heat are present.

Xiao Jian Zhong Tang – warm & tonifies mid Jiao, moderate spasmodic abdominal pain

Xiao Jian Zhong Tang – minor construct the middle soup

Shang Han Lun

Yi Tang (maltose)…18-30g

Gui Zhi (Ramulus cinnamomi cassiae)…9g

Bai Shao Yao (radix paeoniae)…18g

Zhi Gan Cao (honey fried radix glycyrrhizae uralensis)…6g

Sheng Jiang (rhizome zingiberis officinalis recins)…9g

Da Zao (fructus zizyphi jujubae)…12 pieces

Indications: intermittent spasmodic abdominal pain from mid Jiao deficient Cold, likes warmth and massage. dull complexion, no appetite, T- pale with white coat, P- wiry moderate. When there is deficiency of the Spleen Qi there can be a result of lack of Qi and Blood, this can lead to disharmony between the Wei and Ying levels causing poor regulation between Yin and Yang resulting in a low grade fever, cold sore limbs, dry throat, thirst for warm drinks.

The ingredients of this formula are simply Gui Zhi Tang + Yi Tang (with modifications to the dosages).

When there is intermittent abdominal pain that is due to deficient Cold of the Mid Jiao, and the patient likes warmth and massage, think Xiao Jian Zhong Tang.

Do not use for Yin deficient patients.

Also see Da Jian Zhong Tang (below).

Wu Zhu Yu Tang – warms & tonifies Liver & Stomach, redirects rebel Qi, stops vomiting

Wu Zhu Yu Tang – Shang Han Lun

Wu Zhu Yu (fructus evodiae rutaecarpae)…9-12g

Sheng Jiang (rhizome zingiveris officinalis recens)…18g

Ren Shen (radix ginseng)…9g

Da Zao (fructus zizyphi jujubae)…12 pieces

Indications: cold from Stomach deficiency causes stagnation of Qi which causes vomiting, pain, inability to keep food down, and sometimes hunger. Cold from Liver and Stomach deficiency causes vertex headache (follows Jueyin meridian), dry heaves, spitting of clear fluids. Mid Jiao attacked by Cold causes diarrhea, cold hands and feet, headache and vomiting, which may all combine and be so bad that the patient wants to die!

T- white slippery coat, P- slow and thin, or wiry and thin.

*Occasionally the patient will experience chest discomfort, dizziness, & headache after taking Wu Zhu Yu Tang, although these side effects should subside after about 30 minutes when the formula has taken effect.

Da Jian Zhong Tang – warms & tonifies mid Jiao deficiency, redirects rebel Qi, relieves pain

Da Jian Zhong Tang – major construct the middle soup

Jin gui yao lue- classic dosages

Chuan Jiao (pericarpium zanthoxyli bungeani)…3-9g

Gan Jiang (rhizome zingiberis officinalis)…12g

Ren Shen (radix ginseng)…6g

Yi Tang (maltose)…18-30g (add to the strained decoction)

Indications: very severe abdominal pain, does not tolerate touch, epigastrium also feels cold, may be severe vomiting (can’t keep food down), borborygmus, T- white slippery coat, P- thin tight, or slow wiry. This is deficient Cold and interior Yin Cold pathogen. It is said to eat congee after taking this formula to nourish the Spleen.

For many, a lower dosage of Chuan Jiao would be appropriate, this is up to the discretion of the practitioner.

Collapsed Yang

Si Ni Tang – rescues devastated Heart Kidney Yang (shock), warms mid Jiao, stop diarrhea, warm cold hands & feet

Si Ni Tang – improper flow of Qi to the four limbs (frigid extremities) soup

Shang Han Lun

Fu Zi (radix lateralis aconite carmichaeli praeparata)…6-9g [cook for 30-60 minutes before adding other herbs]

Gan Jiang (rhizome zingiberis officinalis)…4.5g

Zhi Gan Cao (honey freid radix glycyrrhizae uralensis)…6g

Indications: very cold extremities, aversion to cold, sleeping in fetal position to keep warm, always tired, vomiting, diarrhea with undigested food in stool, abdominal pain, no thirst, T- pale with white slippery coat, P- deep weak thin. This is Kidney Yang deficiency with internal Yin Cold pathogen accumulation. This in turn creates a Spleen Yang deficiency causing digestive problems (above). The deficiency of Yang can also easily be observed in the spirit (dull, tired, no will or motivation, no fire). Si Ni Tang is said to be one of the only formulas that can tonify the Fire of both the Water and the Earth without injuring the Yin.

These symptoms are quite closely related to shock, therefore the patient may also show signs of sweating, paleness, & void spirit (collapse of Yang). Some say to use this formula before Yang gets too deficient.

This formula may be indicated in acute myocardial infarction or cardiac failure, gastroenteritis, hypothyroidism, adrenal deficiency, certain arthritis.

Hui Yang Jiu Ji Tang – restores severe depletion of Yang, tonifies & regulates Qi, revives pulse

Hui Yang Jiu Ji Tang – restore and revive the Yang soup - Shang han lun

Fu Zi (radix lateralis aconiti carmichaeli praeparata)…9g

Gan Jiang (thizoma zingiberis officinalis)…6g

Rou Gui (cortec cinnamomi cassiae)…3g

Ren Shen (radix ginseng)…6g

Chao Bai Zhu (dry fried rhizoma atractylodis macrocephalae)…9g

Fu Ling (sclerotium poriae cocos)…9g

Chen Pi (pericarpium citri reticulatae)…6g

Zhi Gan Cao (honey fried radix glycyrrhizae uralensis)…6g

Wu Wei Zi (fructus schisandrae chinensis)…3g

Ban Xia (rhizoma pinelliae ternatae)…9g

*Take 0.1g of She Xiang just before taking the decoction.

Indications: chills, like to curl up, cold extremities, vomiting, diarrhea, abdominal pain, lethargy, constant desire to sleep, pale tongue with white coat, deep faint or imperceptible pulse, may also be cyanosis of lips and fingernails. This is pathogenic Yin Cold attacking all three Yin stages in a weak patient with exhausted source Yang.

This condition is one of great severity.

Warm meridians, disperse cold

Dang Gui Si Ni Tang – warms meridians, expel Cold, nourish blood, moves Blood Stasis (unblocks blood vessels)

Dang Gui Si Ni Tang- Dang Gui for improper flow of Qi to the four limbs (frigid extremities) soup

Shang Han Lun

Dang Gui (radix angelicae sinensis)…9g

Bai Shao Yao (Radix paeoniae)…9g

Gui Zhi (ramulus cinnamomi cassiae)…9g

Xi Xin (herba cum radice asari)…6g

Zhi Gan Cao (honey fried radix glycyrrhizae uralensis)…6g

Da Zao (fructus zizyphi jujubae)…5 pieces

Mu Tong (caulis mutong)…6g

Indications: chronic cold hands and feet (to the touch and patient) due to a lack of Yang warming action. It is said that this is Cold in the meridians in people who are Blood deficient. T- pale with white coat, P- deep weak thin.

Gui Zhi is special as it guides herbs to the upper limbs and opens the blood vessels. With Bai Shao, Gui Zhi warms the meridians and expels Cold, and harmonizes the Ying and Wei levels thus regulating Yin and Yang.

Mu Tong strengthens the effects by encouraging the flow in the meridians and blood vessels.

This formula can also be used in cases of joint pain, irregular menses, abdominal cold pain, and lower back cold pain.

*Note: the way this formula differs from Si Ni Tang is that there is Cold in the meridians with an underlying Blood deficiency, this results in Cold hands and feet only, not the whole limb. Si Ni Tang is used when there is pathogenic Yin Cold generated from Yang deficiency causing cold limbs, tiredness, & watery diarrhea.

It should also be compared to Si Ni San which is used in a Hot type collapse disorder where the fingers and toes are cold, there is aversion to heat, irritability, insomnia, constipation, dark urine, and other internal heat signs.

Huang Qi Gui Zhi Wu Wu Tang – warms & harmonizes Jing Luo, expels Cold, nourishes Qi & blood, Xue Bi Zheng, unblocks painful obstruction, tonifies & harmonizes Qi

Huang Qi Gui Zhi Wu Wu Tang – astragalus cinnamon twig five substance soup

Huang Qi (radix astragali membranacei)…12g

Bai Shao Yao (radix paeoniae)…9g

Gui Zhi (ramulus cinnamomi cassiae)…9g

Sheng Jiang (rhizome zingiberis officinalis recens)…12g

Da Zao (fructus jujubae)…12 pieces

Indications: painful obstruction of blood due to a mild attack of external Wind (which occurs during heavy exertion or sweating) characterized by relatively superficial numbness without pain, paresthesias of the muscles (pins and needles), P- faint, choppy tight.

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Reference:

Benskey & Gamble 1993, Chinese Herbal Medicine formulas and strategies, Seattle Washington, Eastland Press Inc.