Tiny Formulas 3: Xiǎo Bàn Xià Jia Fú Líng Tāng

Our previous tiny formula posts were on formulas that are made up of Bàn Xià and Shēng Jiāng.  We learned that these formulas treat vomiting and cough and treat diseases such as stomach prolapse, vomiting in pregnancy, acute gastrointestinal inflammation and duodenal ulcer.  Shēng Jiāng is increased when there are more fluids.

In this next formula, Xiǎo Bàn Xià Jia Fú Líng Tāng, Fú Líng is added to  Xiǎo Bàn Xià Tāng.  How does the presentation change when Fú Líng is added.  Symptoms that appear in addition to the stomach rebellion symptoms are water rebellion symptoms such as palpitations, dizziness, abdominal pulsations, inhibited urination and thirst without the desire to drink.

小半夏加茯苓汤Xiǎo Bàn Xià Jia Fú Líng Tāng (Minor Pinellia with Poria Decoction)

Case 1: Vomiting

Patient named Zhu Zuo. Arrested fluids with congealed phlegm gathered in the stomach Fu. The stomach Qi rose excessively and descended only slightly. After 5-7 days there was vomiting with sticky phlegm and spittle. The bowels and urination were not open through. The pulse was deep and wiry. This was phlegm and clear fluids. When clear Qi transforms it causes the spittle to follow the Qi and spread upward. When the clear Qi does not transform, the fluids stagnate and gather as phlegm in the middle. This transformation or lack of transformation relates to the rotating movement of the spleen Yang. Therefore the Jin Gui contains formulas for fluids that use warm herbs to harmonize.

Zhang Yu-Qing张聿青: 《张幸青医案》上海科学技术出版社第I版 1963年7月

Case 2: Water Qi with Head Sweating

During the very dry summer months,傅金生 Fu Quan-Sheng had too much water. He developed chest pain with profuse sweating and ceaseless vomiting. Looking at his tongue I could see there was no thirst. Feeling his pulse showed it was not rapid. I gave him a formula to warm the stomach and the chest pain was cured. However, the vomiting did not stop. The spontaneous sweating and dizziness was extreme. I again gave a warming the stomach formula with added Huáng Qí. After taking this, there was no obvious effect. There was still sweating, dizziness upon standing and pulsing below the heart.

A short time after boiling and taking, the sweating was contained and the vomiting stopped. The dizziness and palpitations were immediately dispelled.

Xie Ying-Lu谢映庐:《谢映庐医案》上海科学技术出版社第1版1962年10月

Case 3: Tai Yin Pattern of Phlegm Cough

A 5-year-old named Li was the son of a Beijing Cadre.

Disease history: Soon after birth, this child developed bronchitis. He was hospitalized and treated in Beijing. Because he was not cured, he became weak and often developed colds with fever. His cough became more severe. In July of 1978 he came in for an exam. This was treated as a Tai Yin phlegm fluid cough according to the coordination of the 2 diagnostics.

First visit: This child had a cough for more than a year already. It returned repeatedly. The phlegm was clear saliva. While he slept, the phlegm sounds could be heard. He had a poor appetite and his complexion was dull and yellowish. His body was emaciated. His tongue was pale with watery sticky white moss. The skin and muscles of his arms were slightly cold. This was an illness of both the hand and foot Tai Yin in which water Qi stagnated over time without leaving. This rose up to interfere with the lungs. This is why he coughed for many years without cease. The treatment principle was to warm and transform water fluids while down bearing the lungs and stopping cough. I gave him Xiǎo Bàn Xià Jiå Fú Líng Tāng as the principle formula:

Second visit: He took two packages of the above formula and the coughing decreased and the phlegm sounds were gone. However he was vomiting clear phlegm rheum so I gave him the same formula with some increases and decreases.

I tracked him down on May 24, 1979 and his family reported that he had been cured. He made it through winter into spring with no relapse.

Discussion

Zhong Jing said, “The diaphragm has water.” And “water stoppage below the heart.” This is actually all pointing to water stopping in the stomach. When water stops in the stomach, the stomach looses its harmonious down bearing. The Qi then rebels upward. This is why there is sudden vomiting. When water stops in the stomach Fu, this is also below the heart and this is why there is focal distention and fullness below the heart. The water fluids cover the clear Yang and cause dizziness. It goes upward to the heart and causes palpitations. This is treated with Xiǎo Bàn Xià Jiå Fú Líng Tāng to downbear rebellion and harmonize the stomach while guiding the water to promote downward movement. The formula includes Shēng Bàn Xià to downbear rebellion and stop vomiting. Shēng Jiāng harmonizes the stomach and scatters focal distention. Fú Líng is added to guide the water to move downward. It stops dizziness and palpitations. 谭日强 Tan Ri-Chan teaches us as follows “the Xiǎo Bàn Xià Jiå Fú Líng Tāng presentation includes dizziness and palpitations.”

In case 1 there were phlegm fluids in the stomach and the stomach Qi rebelled upward causing vomiting of phlegm water. Xiǎo Bàn Xià Jiå Fú Líng Tāng was given to downbear rebellion, stop vomiting and dispel phlegm water. Although the phlegm fluids were dispelled, the original Yang was insufficient so Lái Fù Dån was added to warm the Yang and downbear rebellion. The root and branch were treated together.

In case 2 the patient drank too much water in the hot summer and the water stopped below the heart. This caused chest pain, sweating and ceaseless vomiting. There was no thirst and the pulse was not rapid which showed that there was no yang heat presentation. Stomach cold was treated first with warming the stomach herbs. The chest pain was less but the vomiting, sweating, dizziness and heart palpitations rose up. The doctor switched to using Xiǎo Bàn Xià Jiå Fú Líng Tāng to downbear rebellion, stop vomiting and guide to water to move downward. After one package the sweating was contained and the vomiting had stopped. The dizziness also stopped. It can be seen that, 必伏其所主而先其所因(素问·至真要大论)

In case 3, the child had a chronic cough with vomiting of phlegm and clear spittle. The appetite was poor and the face was yellow. The form was emaciated and the limbs were cold.   His tongue body tended to be pale and the moss was slippery and sticky. This was hand and foot Tai Yin two Zang presentation. The spleen is the source of the generation of phlegm while the lung is the vessel that stores phlegm. Using Xiǎo Bàn Xià Jiå Fú Líng Tāng fortified the spleen to transform phlegm, downbear rebellion and stopping cough. Zě Wǎn and Dōng Huā were added to lower the Qi and disperse phlegm. Gān Cǎo moderates spasms and harmonizes the middle. At the return visit the cough had decreased and so the Zě Wǎn and Dōng Huā were removed from the formula. Yet the vomiting of clear phlegm rheum still remained and so Shēng Jiāng was replaced by Gān Jiāng. When this is combined with Gān Cǎo, this is Gān Cǎo Gān Jiāng Tāng. This formula warms the spleen and lung to transform cold fluids. A child’s body is pure Yang and the mechanism of generation is vigorous. As long as the medicine corresponds to the illness, as soon as you apply it there is the result.

Modern doctors often use this formula to treat vomiting in pregnancy, stomach prolapse, acute gastrointestinal inflammation and duodenal ulcer.