Last post we looked at the formula Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng). I must say that for me, the names of these formulas are a bit dizzying. It has helped me to see these formulas as a group of 5 and then to see that this first formula is the only one to include Cinnamomi Ramulus (guì zhī). Then the next formulas Cinnamomi Ramulus (guì zhī) is removed and new herbs are added progressively:
- first Asari Radix et Rhizoma (xì xīn) and Zingiberis Rhizoma (gān jiāng)
- next Pinelliae Rhizoma preparatum (zhì bàn xià)
- then Armeniacae Semen (xìng rén)
- finally Rhei Radix et Rhizoma (dà huáng)
So this next post is about the next formula with Cinnamomi Ramulus (guì zhī) removed and Asari Radix et Rhizoma (xì xīn) and Zingiberis Rhizoma (gān jiāng) added. For a short little formula, it is packed with meaning. There is tonification within dispersion and scattering with restraining. The commentary by the editors discusses these herbal combinations.
Poria, Licorice, Schisandra, Ginger, and Asarum Decoction (líng gān wǔ wèi jiāng xīn tāng)
|Poria (fú líng)||4 liang – 12 gm|
|Zingiberis Rhizoma (gān jiāng)||3 liang – 9 gm|
|Glycyrrhizae Radix (gān cǎo)||3 liang – 9 gm|
|Schisandrae Fructus (wǔ wèi zǐ)||1/2 sheng – 6 gm|
|Asari Radix et Rhizoma (xì xīn)||3 liang – 9 gm|
Cooking Method: Cooking: Boil the above 5 ingredients in 8 sheng of water to get three sheng. Remove the dregs. Take half a sheng warm, 3 times each day.
Original text [12.37]: When the surging Qi has been reduced but there is again and coughing and chest fullness, use Cinnamon Twig, Poria, Schisandra, and Licorice Decoction (guì líng wǔ wèi gān cǎo tāng) with Cinnamomi Ramulus (guì zhī) removed and Zingiberis Rhizoma (gān jiāng) and Asari Radix et Rhizoma (xì xīn) added. This will treat the cough with fullness.
Case Study 1, Phlegm Rheum:
Cheng Zu Jie 程祖拮
Mr. Liao, age 55. This patient came in with a fever and cough with abundant phlegm. Generally this patient had chronically had abundant phlegm and an occasional cough. Two days previously he had received a chill and the coughing became worse. There was lots of phlegm that was thin and white. He was not able to lay down due to the phlegm. This was accompanied by fever. The pulse was floating and slippery and slightly rapid. The tongue moss was white and slippery. I gave him one package of the following formula:
|Ephedrae Herba (má huáng) without the nodes||9 gm|
|Zingiberis Rhizoma (gān jiāng)||9 gm|
|Glycyrrhizae Radix preparata (zhì gān cǎo)||6 gm|
|Schisandrae Fructus (wǔ wèi zǐ)||6 gm|
|Asari Radix et Rhizoma (xì xīn)||3 gm|
|Cinnamomi Ramulus (guì zhī)||9 gm|
|Paeoniae Radix alba (bái sháo)||9 gm|
|Pinelliae Rhizoma preparatum (zhì bàn xià)||9 gm|
|Armeniacae Semen (xìng rén)||9 gm|
Return visit: The fever had receded and the cough had gotten slightly better. His spirit was better but he still did not want to eat and had lots of phlegm.
|Poria (fú líng)||12 gm|
|Zingiberis Rhizoma (gān jiāng)||9 gm|
|Glycyrrhizae Radix preparata (zhì gān cǎo)||9 gm|
|Schisandrae Fructus (wǔ wèi zǐ)||12 gm|
|Asari Radix et Rhizoma (xì xīn)||6 gm|
Third visit: After 2 packages of this formula, his appetite was slightly better and the phlegm had also decreased. His cough had leveled. His tongue moss was white and his pulse was moderate. I gave him 6 packages of the following herbs:
|Poria (fú líng)||24 gm|
|Cinnamomi Ramulus (guì zhī) tips||24 gm|
|Glycyrrhizae Radix preparata (zhì gān cǎo)||12 gm|
|Atractylodis macrocephalae Rhizoma (bái zhú)||12 gm|
His condition then completely improved.
From Cheng Zu-Jie’s Personal Case Records.
When there is coughing with chest fullness, this is a condition in which there are cold fluids hidden in the lungs. The treatment should warm the lungs and transform fluids while diminishing cough. This formula uses Poria (fú líng). On the one hand Poria (fú líng) will lead and gather the fluids so they can be removed through the urination and on the other hand it will treat the source of the generation of fluids. This is why Poria (fú líng) is the principle herb. The ministers are Zingiberis Rhizoma (gān jiāng) and Asari Radix et Rhizoma (xì xīn) which warm the lung, scatter cold and transform fluids. In order to prevent the Zingiberis Rhizoma (gān jiāng) and Asari Radix et Rhizoma (xì xīn) from squandering and scattering the lung Qi, Schisandrae Fructus (wǔ wèi zǐ) is added as an assistant. Schisandrae Fructus (wǔ wèi zǐ) will restrain the lung Qi and stop cough. Finally there is Glycyrrhizae Radix (gān cǎo) which synchronizes and harmonizes all of the herbs. Altogether this formula scatters while restraining and opens while closing. This will cause the cold in the lungs to warm up and the phlegm to transform. The cough and fullness will then be cured.
In this case, the patient had a previous condition of fluid stoppage in the interior. Consequently, when he received and external wind cold influence so that there was a combined evil on the interior and exterior. This cause the aversion to cold and fever as well as the cough with abundant phlegm. The color of the phlegm was white and it was thin. He was unable to lay down. He was first given Minor Bluegreen Dragon Decoction (xiǎo qīng lóng tāng) with Armeniacae Semen (xìng rén). After 1 package the exterior had resolved and so the fever receded. The cough also decreased but the phlegm rheum had not transformed. This is when the formula was changed to Poria, Licorice, Schisandra, Ginger, and Asarum Decoction (líng gān wǔ wèi jiāng xīn tāng). This was to warm and transform cold fluids. In the end, the Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction (líng guì zhú gān tāng) fortified the spleen and transform the fluids and so the patient was well after that. It is worth pointing out that this case first shows the use of the dual method of resolving both the exterior and interior. Treating the lungs was secondary and then there was treating the spleen.
From the simple to the profound, this treatment method was orderly and this information is worth pondering deeply.
I am wondering a couple things after reading this interesting post. He uses three formulas – first Xiao Qing Long Tang when the condition is exterior. Then after a couple packages of Ling Gan Wu Wei Jiang Xin Tang, he changes the formula and uses just Fu Ling, Gui Zhi, Zhi Gan Cao, and Bai Zhu. I can see why he removes Xi Xin and includes Bai Zhu, and I don’t find it strange that he removed the Gan Jiang and Wu Wei Zi, but I don’t understand why he adds Gui Zhi at this point. Could I assume that there is surging that is not mentioned?
The other things is that in Bensky it says that this formula is indicated for a condition that “lacks any exterior aspect.” You say that this case shows the “dual method of resolving both exterior and interior.” Is that meaning that you think of this formula as resolving both, or is it by using Xiao Qing Long Tang first and then this second that it accomplishes that.
He says that Ling Gui Zhu Gan Tang was used to fortify the spleen and transform fluids. Gui Zhi does fortify the spleen and with the Fu Ling will transform fluids. I don’t think the use of Gui Zhi means that there is surging necessarily.
It’s interesting to consider whether there is still and exterior pattern or not. For me, these formulas are not so much used when there is fever, achey body or the feeling of coming down with something – i.e. an exterior pattern. On the other hand, they are useful for sensitivity and inability to process to outside influences like cold, damp, pollen, cats etc. This formula does warm the lungs so that the surface is warmer and more able to protect and deal with outside influences. Does that answer your question?