Chapter 12 of the Jīn Guì Yào Lüè focuses on the diagnosis and treatment of Phlegm-Rheum and Cough disorders. There are 20 formulas discussed in this chapter in 41 clauses.
In preparing for the up-coming next weekend of the Graduate Mentorship Program, I got interested in 5 of these formulas that all have similar names and hence ingredients. The 3 herbs that are common to all of these 5 formulas are
- Poria (fú líng),
- Schisandrae Fructus (wǔ wèi zǐ) and
- Glycyrrhizae Radix (gān cǎo)
- Zingiberis Rhizoma (gān jiāng) and
- Asari Radix et Rhizoma (xì xīn)
These 5 formulas are:
- Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng)
- Poria, Licorice, Schisandra, Ginger, and Asarum Decoction (líng gān wǔ wèi jiāng xīn tāng)
- Cinnamon Twig, Poria, Schisandra, and Licorice Decoction, remove cinnamon, add Ginger, Asari, and Pinellia (guì líng wǔ wèi gān cǎo qu gui jia jiang xin xia tāng)
- Poria, Licorice, Schisandra, Ginger, and Asarum Plus Pinellia and Armeniacae Decoction (líng gān wǔ wèi jiāng xīn ban xia xing ren tāng)
- Poria, Licorice, Schisandra, Ginger, and Asarum Plus Pinellia, Armeniacae and Rhubarb Decoction (líng gān wǔ wèi jiāng xīn ban xia xing ren da huang tāng)
These 5 formulas are incredibly useful in the clinic and once you know them, I am sure you will use them every week, if not every day. They are sometimes considered a modification of Minor Bluegreen Dragon Decoction (xiǎo qīng lóng tāng) though none of them include Ephedrae Herba (má huáng). Compared to Minor Bluegreen Dragon Decoction (xiǎo qīng lóng tāng), these formulas have less of a tendency to damage Yin and Yang. I’ve decided to do a series of blog entries about these formulas, one entry for each formula. This will be followed by a post that is a summary discussion about how to use them in the clinic. The discussions and cases below illustrate the usefulness of these formulas and give us teachings about the nature and use of the individual ingredients.
I have translated the writings below having found them in the text 金贵方百家医案评议, An Appraisal through Cases and Discussion of Jin Gui Formulas from Various Schools of Thought.
This post then will focus on the first formula:
Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng)
There are cases from Ye Tian Shi 叶天士 and Ding Gan-Ren 丁甘仁. There is a wonderful discussion about the relationship of the Chong vessel, 冲脉, and surging Qi, 冲气.
|Poria (fú líng)||4 liang – 12 gm|
|Cinnamomi Ramulus (guì zhī)||4 liang – 12 gm|
|Glycyrrhizae Radix (gān cǎo)||3 liang – 9 gm|
|Schisandrae Fructus (wǔ wèi zǐ)||1/2 sheng – 6 gm|
Decoct the above 4 flavors in 8 sheng of water down to 3 sheng. Remove the dregs and drink warm in 3 doses.
Original text [Chapter 12.36]: If after taking Qing Long Tang, there is abundant spittle with a parched mouth. The cun pulse is deep and the chi pulse is minute, reversal cold of the hands and feet, surging Qi from the lower belly into the chest and throat, painful obstruction in the hands and feet and feather-warm facial flushing as if the person is drunk, and because there is flowing down to the Yin section, the urination is difficult and there is occasional dizziness, Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng) treats this surging Qi.
Case Study 1, Phlegm Rheum:
Ye Tian Shi 叶天士
The patient is named Sun. The winter solstice had not yet arrived and so the one Yang had not begun to return. (referring to the one Yang line in hexagram 24, the return). This old man had deficiency below so consolidating and receiving could not be governed. The fluids overflowed from below. This Qi blocked ascending and descending and hence there was coughing. How could it be appropriate to scatter or cool or use bitter to discharge? Zhong Jing says that cough is due to fluids abiding. One should treat these fluids and not just treat cough. One should carefully follow the sage’s instruction and conclude that cough in the elderly is often treated by warming and nourishing the spleen and kidneys. Use Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng). If there is thin mucous add Zingiberis Rhizoma recens (shēng jiāng) and Jujubae Fructus (dà zǎo) .
From 叶天士:临证指南医案, Ye Tian-Shi’s Clinical Manual through Case Studies.
Case Study 2, Cough with Panting:
Ding Gan-Ren 丁甘仁
There was cough with panting. It was difficult for him to rest his head when he lay down. The Qi ascended and did not descend. It had to surge downward and rise excessively. The pulse was deep and wiry. Due to the fact that he was more than 6o years old, the two Yin and Yang, pre and post heaven, were weak so that phelgm fluids overflowed above. Qi and fluids gushed and so there was cough and wheezing. I reviewed the previous prescriptions he was given. He was repeatedly given herbs to clear the lungs, transform phlegm, nourish Yin and down bear Qi. This was no less than adding an accomplice in evil! Furthermore, his back and feet were cold, and yang qi was in decline. Evidently, the line of defense had been taken down. When the sage Zhong (Zhang Zhong-Jing) treats fluids, he uses warming medicinals to harmonize. I gave him Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng) with Aconiti Radix lateralis preparata (zhì fù zǐ) to warm and transform the phlegm fluids and to absorb and receive the kidney Qi.
|Cinnamomi Ramulus (guì zhī)||2.4 gm|
|Poria (fú líng)||9 gm|
|Glycyrrhizae Radix preparata (zhì gān cǎo)||1.5 gm|
|Schisandrae Fructus (wǔ wèi zǐ)||1.5 gm|
|Pinelliae Rhizoma preparatum (zhì bàn xià)||6 gm|
|Stir-fried Psoraleae Fructus (bǔ gǔ zhī)||15 gm|
|熟附块 Aconiti Radix lateralis preparata (zhì fù zǐ)||15 gm|
|Fresh Atractylodis macrocephalae Rhizoma (sheng bái zhú)||15 gm|
|processed Polygalae Radix (zhì yuǎn zhì)||3 gm|
|Huai Dioscoreae Rhizoma (shān yào)||9 gm|
|Large Rehmanniae Radix preparata (shú dì huáng)||9 gm|
|Walnut (he tao rou)||2 pieces|
From 丁甘仁医案, Ding Gan Ren’s Case Studies
Surging Qi relates to the Chong vessel. The Chong vessel emerges from the lower Jiao. Relying on the kidney vessel it goes up and reaches to chest and throat. When Chong Qi rebells upward, the Qi surges upward from the lower belly to the chest and throat. The face flushes hot as if one is drunk. The reversal Qi rises upward and the Yang Qi is not managed. This causes reversal cold of the hands and feet so that there is painful obstruction. When the Chong Qi rebells upward it causes the Qi of the entire body to rebel upward. Below this causes the urination to be difficult while above this causes dizziness. To address this, one must first restrain the Qi and calm surging. It is appropriate to use Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng). Cinnamomi Ramulus (guì zhī) down bears the surging Qi. Poria (fú líng) disinhibits the water Qi. Schisandrae Fructus (wǔ wèi zǐ) restrains rebellious Qi and Glycyrrhizae Radix (gān cǎo) calms the middle Qi. When Cinnamomi Ramulus (guì zhī) and Glycyrrhizae Radix (gān cǎo) are combined, the pungent and sweet transform the Yang and stimulate the heart Yang above. Then the cold water in the lower Jiao is spontaneously warmed and then it cannot rebel upward. The surging Qi is successfully calmed.
In case 1 there is a relationship between the phelgm fluids and the climate. Dr. Ye said “The winter solstice had not yet arrived and so the one Yang had not begun to return.” This means that it had not come but now it came. The Yang Qi was discharged and so the old man became deficient becoming unable to consolidate and receive. This is why the fluids over flowed above and caused cough. The use of sweating, clearing and bitter purging made the deficiency of the Yang Qi worse. How could one be effective with these methods? Ye Tian-Shi gave her Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng) to receive the Qi and transform fluids. He also added Zingiberis Rhizoma (gān jiāng) to warm the Yang and transform fluids. When this is combined with Schisandrae Fructus (wǔ wèi zǐ) it can stop cough. Jujubae Fructus (dà zǎo) builds up the earth and in this way controls water.
In case 2 there was coughing with panting which was made worse with laying down. The phlegm fluids were overflowing and the kidney Qi could not receive. Dr. Ding used Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng) with Aconiti Radix lateralis preparata (zhì fù zǐ) to warm and transform phelgm fluids and absorb and receive the kidney Qi. This was the method of treating the interior fluids by treating the kidneys.
The formulas used in the above two cases are similar. One can see that Ding Gan-Ren was very familiar with Ye Tian-Shi’s cases and that his mind was throughly steeped in Ye’s work. In the clinic he was able to imitate Ye’s methods and give the herbs just perfectly. This work is like a fountain head of running water.
In modern times, this formula is often used to treat chronic bronchitis, bronchial asthma, lung abscess and chronic gastritis with hiccup.
Re: first formula – gui ling wu wei gan cao tang
under the original text, it lists “because there is flowing down to the Yin section”
what does this mean? i am assuming “yin section” means lower jiao but what is flowing down?
I am not sure but I think the “Yin section” is referring to the lower warmer and what is flowing down is water. Water is flowing down pathologically instead of being steamed up physiologically. The inhibited urination in case 1 and what Ding Gan-ren referred to as “surging downward”. At the same time, this fluid that is accumulating below surges up pathologically.
These are fantastic Sharon – the commentary is wonderful and is so useful. I’m really looking forward to the next weekend, which I will be attending – yay! Thanks! – Jan
Thanks for the interesting article. The first case though says that it is from the 临证指南医案 (lin zheng zhi nan yi an) however I have never seen this and could not find it. Maybe I am missing it, can you provide a reference?
The text I found this case in is listed above: 金贵方百家医案评议, An Appraisal through Cases and Discussion of Jin Gui Formulas from Various Schools of Thought. It gives this text as the source of the case. Their edition is the Shang Hai People’s Publishing House, 上海人民出版社第1版1976年7月.
I assume the commentary and case are from the book (金贵方百家医案评议), is this correct? Sometimes secondary sources get the case wrong, here are some corrections after reading the original case in the Ding Ganren text.
1. There should be Sheng Bai Zhu 5 qian after Wu Wei Zi. There should also be (zhi) Yuan Zhi 1 qian after Ban Xia. The Fu Zi is (shu) Fu Zi.
2. After the pulse phrase – the age is mentioned as being older than 60 years.
3. The next part of “yin and yang not merging” is incorrect. It says the two heaven’s yin and yang (referring to pre and post-heaven (earlier and later heaven) where both exhausted. This refers to both Spleen and Kidney. This then [caused] phlegm and thin mucus (tan yin) to flood upwards.
4. “Qi and fluids gushed and so there was cough” after cough it should also say “wheezing (chuan)”
5. After “accomplice of evil”… it should continue with, “Furthermore, his back and feet were cold, and yang qi was in decline. Then “the line of defense]”…
Hope this helps…
Thanks Sharon for the further information.
I have found that many times Chinese books mix up sources, cases, have incorrect characters etc. I have found it important to always try to find the original source and go from there.
If anyone finds this original case in a Ye Tianshi book, I would really like to know. Just for the record, this is an honest request because I am working on a Ye Tianshi book at the moment and one of the chapters is cough.
I am very excited about the upcoming class and learning about these formulas. I wanted to clarify something in case 1. In the first part it says “If there is thin mucous add Zingiberis Rhizoma recens (shēng jiāng) and Jujubae Fructus (dà zǎo) .” In the discussion you say “He also added Zingiberis Rhizoma (gān jiāng) to warm the Yang and transform fluids. When this is combined with Schisandrae Fructus (wǔ wèi zǐ) it can stop cough.” Will either sheng jiang or gan jiang with wu wei zi be useful to stop cough? Or is one better? thanks
Both Sheng and Gan Jiang can help with cough when combined with Wu Wei Zi. Their actions are a bit different though. Sheng Jiang in a larger dose will induce a sweat. I heard one doctor say that “Sheng Jiang makes you sweat from the stomach.” It is more moving and dispersing than Gan Jiang. In my mind it is more for puddles of water in the lung. Gan Jiang is hotter and less moving. I see it as more for melting frozen water. Often with Gan Jiang there may even be dryness since the water is taken up in the ice. It does this in the lungs when combined with Xi Xin. All of these are pungent hot herbs that can be moderated by Wu Wei Zi. I’d love to hear how others think of these.
I’m wondering what your thoughts are regarding the nephro-toxicity of xi xin and the fact that it is often removed and modified in current practice.
Thanks for your question. The correctly identified material has no known issue with nephrotoxicity. The only risks from AA that arise in xixin are due to misuse of the wrong plant part. Only the root and rhizome can be used, not the aerial part.