[Source]

Shang Han Lun

 [Composition]

Cinnamon Twig, (baked) Licorice Root, Atractylodes Macrocephala Rhizome, Ginseng, Dried Ginger
(5)

 [Classification]

<Tonify Spleen and Middle Jiao>: Atractylodes Macrocephala Rhizome, Licorice Root

<Tonify Qi>: Ginseng

<Dispel Exterior with Acrid Warmth>: Cinnamon Twig

<Warm the Interior>: Dried Ginger

[Analysis]

Ke Qin stated: Unresolved external heat indicates the exterior is not resolved, and persistent diarrhea indicates the interior is not resolved. The cause is the same. One case shows epigastric distension and hardness with a weak pulse, indicating deficiency of pulse but excess of symptoms; another case shows a rapid pulse with panting and spontaneous sweating, indicating excess of pulse but deficiency of symptoms. The exterior, interior, deficiency, and excess should be differentiated based on the pulse. A weak pulse seen after frequent purging indicates deficiency and hardness. Therefore, this formula uses the acrid, sweet, and warm properties of Lizhong Tang to stop diarrhea and resolve epigastric distension and hardness, and also adds Cinnamon Twig to dispel the exterior. First decoct the four ingredients and then add Cinnamon Twig; the ability to harmonize the center is abundant, and the Qi to release the muscles is sharp. This is a balanced approach that combines both actions. The pulse for Cinnamon Twig syndrome is normally slow, but after mistaken purgation, it becomes rapid, indicating excess Yang and that the pathogen is constrained by the exterior while Yang is agitated internally. Therefore, panting and sweating with persistent diarrhea indicates sudden downward rushing and oppression, which belongs to heat. Thus, Kudzu Root, which has clear Qi and light texture, is used as the chief herb to release the muscles and stop diarrhea; Scutellaria and Coptis, which are bitter, cold, and clear the heat, are used as assistants to stop sweating and relieve panting; Licorice Root is added to harmonize the center. First decoct Kudzu Root and then add the other herbs; the ability to release the muscles is moderate, and the Qi to clear the center is sharp. This is a different method from that of tonifying the center and expelling pathogens. He also said: The pulse and symptoms in the upper section indicate Yang deficiency, where although there is external heat, the interior is cold and deficient; the pulse and symptoms in the lower section indicate Yang excess, where despite persistent diarrhea, both the exterior and interior are replete. For the same condition of external heat and diarrhea, the methods of attack and tonification differ due to the different exterior and interior, cold and heat, deficiency and excess. The former formula, Lizhong Tang plus Cinnamon Twig, is headed by Cinnamon Twig over Ginseng; the latter formula, Xie Xin Tang plus Kudzu Root, is headed by Kudzu Root over Scutellaria and Coptis. It is not called Lizhong or Xie Xin Tang because the exterior has not been resolved. Tonifying the center can also dispel the exterior, cooling the center can also scatter the exterior, tonifying the center can also resolve distension, and cooling the center can also stop diarrhea. The divine transformation of Zhang Zhongjing’s dual-action formulas is evident.

 [Functions]

Warms the center and expels cold, and also dispels external pathogens.

 [Indications]

Headache, fever, aversion to cold, diarrhea, epigastric distension, continuous abdominal pain, thin white tongue coating, floating and slow pulse.

 [Mnemonic]

Lizhong Tang + Cinnamon Twig.