【Source】
Shang Han Lun (Treatise on Cold Damage)
【Ingredients】
Ze Xie (Alisma Rhizome), Zhu Ling (Polyporus), Bai Zhu (Atractylodes Macrocephala Rhizome), Fu Ling (Poria), Gui Zhi (Cinnamon Twig)
(5)
【Category】
<Tonifying the Spleen and Middle Jiao>：Bai Zhu (Atractylodes Macrocephala Rhizome)
<Releasing the Exterior with Acrid and Warm Herbs>：Gui Zhi (Cinnamon Twig)
<Tonifying the Spleen and Promoting Diuresis>：Fu Ling (Poria)
<Promoting Diuresis and Draining Dampness>：Ze Xie (Alisma Rhizome), Zhu Ling (Polyporus)
【Formula Analysis】
Yi Fang (Medical Formulas): It is a Foot Taiyang medicine. (1) The heat of Taiyang enters the Bladder, causing thirst and inhibited urination. (2) The classic says: Bland flavor seeps and drains, representing Yang. Fu Ling and Zhu Ling, sweet and bland, enter the Lung and unblock the Bladder, serving as the chief herbs. Blandness promotes diuresis. Fu Ling (Poria) enters the Qi aspect, and Zhu Ling (Polyporus) enters the Blood aspect. They must ascend to the Lung before descending to the Bladder. (3) Salty flavor flows downward, representing Yin. Ze Xie (Alisma Rhizome), sweet and salty, enters the Kidney and Bladder, jointly promoting water passage as assistant herbs. (4) Strengthening the Earth controls Water, so Bai Zhu (Atractylodes Macrocephala Rhizome), bitter and warm, strengthens the Spleen and removes dampness as an adjuvant herb. (5) The Bladder stores body fluids. Qi transformation enables their excretion. Therefore, Rou Gui (Cinnamon Bark), acrid and hot, serves as the guiding herb, using heat to treat heat, guiding the formula into the Bladder to transform its Qi, allowing damp-heat pathogens to be excreted through urination. Shan Bu (Supplemented and Revised): Ze Xie (Alisma Rhizome), salty and cold, enters the water organs, with cold overcoming heat pathogens. The bland and seeping nature of Fu Ling and Zhu Ling unblocks the water passages, draining downwards to the Bladder, purging water and heat together. Bai Zhu (Atractylodes Macrocephala Rhizome), drying and dampening, strengthens the Spleen, supporting the Earth element, acting as a barrier to control water. Gui (Cinnamon) is acrid and warm, promoting the Yang Qi, steaming and transforming the San Jiao to move water. Ze Xie (Alisma Rhizome), with the downward action of Fu Ling and Zhu Ling, doubles the efficacy of promoting diuresis, alleviating water retention. Bai Zhu (Atractylodes Macrocephala Rhizome), with the ascending action of Gui (Cinnamon), swiftly opens the Yang, transforming fluids through Qi, thus quenching thirst. If fever persists without resolving the exterior, replace Rou Gui (Cinnamon Bark) with Gui Zhi (Cinnamon Twig), and drink warm water after administration to induce sweating and promote recovery. This formula not only treats internal water retention with difficult urination but also resolves external fever due to water retention. Han Dian (Chinese Medicine Dictionary): The so-called water counterflow vomiting refers to thirst with reduced urination, where drinking water leads to immediate vomiting, repeatedly. In cases with heat, the pulse becomes floating and rapid without sweating. Administering Wu Ling San (Five-Ingredient Powder with Poria) promotes increased urination and sweating, reducing fever. Water counterflow vomiting is relieved, and urination is restored. The ingredients of this formula, including Ze Xie (Alisma Rhizome), Zhu Ling (Polyporus), Fu Ling (Poria), and Bai Zhu (Atractylodes Macrocephala Rhizome), are all fluid regulating agents, removing retained water in the gastrointestinal tract, increasing urination, reducing edema. Ze Xie (Alisma Rhizome) and Zhu Ling (Polyporus) treat thirst, while Fu Ling (Poria) provides a sedative effect. Gui Zhi (Cinnamon Twig) removes superficial heat, treats Qi rising upwards, and enhances the diuretic effects of other herbs.
【Functions】
Warms Yang and transforms Qi, dispels dampness and scatters pathogens, seeps dampness, and promotes water circulation.
【Indications】
This formula is effective for various disorders with external evil heat and internal water retention, targeting thirst and reduced urination. Water counterflow vomiting is also a target of this formula. Suitable for urinary difficulty, edema, abdominal distension, vomiting, diarrhea, and thirst without desire to drink caused by impaired Bladder Qi transformation and internal accumulation of dampness. Also for external symptoms such as headache, fever, thirst, vomiting immediately after drinking water, floating pulse, or diarrhea, summer dampness vomiting and diarrhea. Yi Fang (Medical Formulas): (1) Treats Taiyang disease after sweating, profuse sweating, dryness in the stomach, restlessness, insomnia, and desire to drink water, give small amounts to harmonize the Stomach Qi and promote recovery. If the pulse is floating, urination is difficult, mild fever, and wasting and thirsting, this decoction is indicated (Shang Han Lun, Taiyang chapter). (2) Also, for stroke with fever, unresolved for six or seven days with restlessness, internal and external symptoms, thirst, vomiting immediately after drinking water, called water counterflow (Shang Han Lun, Taiyang chapter). (3) Also, for fullness and distention due to cold damage, unresolved by draining the Heart decoction, thirst with dryness, and difficult urination (Shang Han Lun, Taiyang middle chapter). (4) Universally treats abdominal fullness due to dampness, water drinking, edema, vomiting and diarrhea, water cold attacking the Lungs, asthma or cough, thirst, body heat, headache, Bladder heat accumulation, constipation with thirst, cholera vomiting and diarrhea, phlegm retention dampness malaria, body aches and heaviness (all manifestations of dampness damage). Shan Bu (Supplemented and Revised): For floating pulse with difficult urination, mild fever, and wasting and thirsting. Sweating already, floating and rapid pulse with thirst. Stroke with fever, unresolved for six or seven days, restlessness, internal and external symptoms, thirst, vomiting immediately after drinking water.
【Suitable for】
Acute nephritis, early-stage renal failure, urinary retention, edema and fluid accumulation in tissues and organs, urinary system stones and infections, gastroenteritis, diarrhea and vomiting, colds and other febrile diseases with thirst and reduced urination.
【Cautions】
If, after sweating or purgation, internal body fluids are deficient and urination is difficult, do not use Wu Ling San (Five-Ingredient Powder with Poria), as it may further deplete body fluids and damage Yin. For all cases of Yang deficiency failing to transform Qi, or Yin deficiency with depleted fluids, leading to difficult urination, using Wu Ling San (Five-Ingredient Powder with Poria) to further deplete Yin and Yang may lead to adverse effects. Caution is advised.
【Mnemonic】
Wu Ling = Two Dao commands select the honored master (Er Ling Ze Gui Zhu – Two Porias, Alisma, Cinnamon, Atractylodes).
【Modifications】
Yi Fang (Medical Formulas): (1) For water hernia: add Chuan Lian Zi (Melia Toosendan Fruit). (2) For summer heat damage: add Zhu Sha (Cinnabar) and Deng Xin Cao (Rush Pith). (3) For water binding in the chest: add Mu Tong (Akebia Stem). (4) For dampness striking and causing jaundice, add Yin Chen Hao (Artemisia Capillaris). (1) If edema is severe, add Sang Bai Pi (Morus Alba Root Bark), Chen Pi (Citrus Reticulata Peel), Da Fu Pi (Areca Peel), Che Qian Zi (Plantago Seed) to transform Qi, promote diuresis, and enhance urination and reduce swelling. (2) If edema is combined with external symptoms, combine with Yue Bi Tang (Ephedra and Gypsum Decoction) to strengthen the effect of releasing the exterior. (3) If damp-heat diarrhea is present, remove Bai Zhu (Atractylodes Macrocephala Rhizome) and Gui Zhi (Cinnamon Twig), and add Yin Chen Hao (Artemisia Capillaris) to clear heat and remove dampness. (4) If dampness is combined with food stagnation, add Ping Wei San (Calm the Stomach Powder) to promote movement and remove dampness. (5) If combined with deficiency of Middle Jiao Qi, add Dang Shen (Codonopsis) to strengthen the Spleen and tonify Qi. (6) For glaucoma, add Che Qian Zi (Plantago Seed) to clear heat and promote diuresis, Sang Bai Pi (Morus Alba Root Bark) and Da Fu Pi (Areca Peel) to promote water circulation and reduce swelling, and Long Dan (Gentiana) to clear heat, dry dampness, and benefit the Liver and Gallbladder. (7) For acute urinary system infections, add Shi Wei (Pyrrosia Leaf), Hai Jin Sha (Lygodium Spores), Hua Shi (Talcum) to clear heat, remove dampness, and unblock lin (strangury). (8) Removing Gui Zhi (Cinnamon Twig) from this formula results in Si Ling San (Four-Ingredient Powder with Poria) Ming Yi Zhi Zhang (Master Physician’s Manual), which functions to seep dampness and promote diuresis, and is primarily used for internal damage due to diet with dampness, scanty dark urine, and loose stools. (9) Adding Yin Chen Hao (Artemisia Capillaris) to this formula results in Yin Chen Wu Ling San (Five-Ingredient Powder with Poria) Jin Gui Yao Lue (Essentials from the Golden Cabinet), which functions to promote dampness, reduce jaundice, and is primarily used for damp-heat jaundice, with more dampness and less heat, and difficult urination. (10) Adding Ping Wei San (Calm the Stomach Powder) to this formula results in Wei Ling Tang (Stomach-Calming and Poria Decoction) Dan Xi Xin Fa (Danxi’s Experiential Therapy), which functions to dispel dampness, harmonize the Stomach, move Qi, and promote water circulation, and is primarily used during summer and autumn for Spleen and Stomach damage due to cold, failure of water and grain separation, and unremitting diarrhea. (11) For severe accumulation and stagnation, add Ba Dou (Croton Seed). If the heat is severe, add Xiao Chai Hu Tang (Minor Bupleurum Decoction), removing Guan Gui (Cinnamon Bark). Or add Su Zi (Perilla Fruit) 8 fen; if ineffective, add Gan Sui (Kansui Root) 5 fen.
【Pharmacology】
Has Wu Ling San (Five-Ingredient Powder with Poria) Zheng (pattern) effects and diuretic effects, and influences water and electrolyte metabolism, alcohol metabolism, and alcoholic fatty liver and liver damage.