【Source】

《Shang Han Lun》 (Treatise on Cold Damage)

 【Composition】

Ren Shen (Ginseng), Gan Cao (Licorice), Bai Zhu (Atractylodes Macrocephala), Gan Jiang (Dried Ginger)
(4)

 【Categories】

<Tonify Spleen and Middle Jiao>: Gan Cao (Licorice)、Bai Zhu (Atractylodes Macrocephala)

<Tonify Qi>: Ren Shen (Ginseng)

<Warm the Interior>: Gan Jiang (Dried Ginger)

【Formula Explanation】

《Yi Fang》: A formula for the Foot Taiyin Spleen Meridian. (1) Ren Shen (Ginseng): Tonifies Qi and benefits the Spleen, thus acting as the chief herb. (2) Bai Zhu (Atractylodes Macrocephala): Strengthens the Spleen and dries dampness, thus acting as the deputy herb. (3) Gan Cao (Licorice): Harmonizes the middle and supplements Earth, thus acting as the assistant herb. (4) Gan Jiang (Dried Ginger): Warms the Stomach and disperses cold, thus acting as the envoy herb. (5) Because the Spleen (Earth element) resides in the middle, it is called ‘Regulate the Middle’.《Shan Bu》: Cheng Yingmao said: The movement of Yang begins with warmth. When warm Qi is obtained, the essence of grain is transported; when grain Qi rises, the Middle Qi is nourished. Hence, it is named ‘Regulate the Middle,’ truly serving to harmonize and provide Yang to the Middle Jiao. If Stomach Yang is deficient, the Middle Qi loses its governing function, the chest (Shanzhong) cannot spread and disseminate, and the six fu organs cannot perform their cleansing actions. It is like the firewood under a cauldron losing its flame, leading to unformed stools below, loss of taste above, disruption of the five zang organs, and various other symptoms. Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala), and Zhi Gan Cao (Prepared Licorice) guard the central region, while Gan Jiang (Dried Ginger) is pungent and warms the middle, necessarily igniting the ‘cauldron’s firewood’ to boost Yang Qi. Thus, grain enters the Yin, cultivates Qi within the Yang, ascends to ‘Hua Gai’ (lungs), descends to ‘Zhou Du’ (bladder), and all five zang and six fu organs receive Qi. This is the essence of Li Zhong. If water and cold prevail simultaneously, both Spleen and Kidney should be warmed. Adding Fu Zi (Prepared Aconite Root) then warms the ‘mother of Earth’ (Spleen) through the ‘gate of life’ (Kidney Mingmen). Bai Zhu (Atractylodes Macrocephala) tonifies the Spleen; if combined with Ren Shen (Ginseng), Qi can become stagnant, causing pulsation below the navel; for those with much vomiting and abdominal fullness, omit Bai Zhu. Add Gui (Cinnamon Twig) to dispel Kidney evil, add Sheng Jiang (Fresh Ginger) to stop vomiting. Add Fu Zi (Prepared Aconite Root) to resolve Yin cold. For excessive diarrhea due to dampness, still use Bai Zhu to dry dampness. For thirst wanting water, add Bai Zhu to transform fluids and generate body fluids. For palpitation below the heart due to retained fluid, add Fu Ling (Poria) to guide water. For abdominal pain (due to deficiency), double Ren Shen (Ginseng). For severe cold, add more Gan Jiang (Dried Ginger).《Han Dian》: This formula is composed of four herbs: Ren Shen (Ginseng), Bai Zhu (Atractylodes Macrocephala), Gan Jiang (Dried Ginger), and Gan Cao (Licorice). These herbs collectively strengthen existing functions, eliminate retained water in the stomach, promote blood circulation, and boost metabolism.

 【Functions】

Warm the Middle Jiao and dispel cold, tonify Qi and strengthen the Spleen.

 【Indications】

Weak gastrointestinal function, deficiency-cold in the Middle Jiao Spleen and Stomach leading to impaired transformation and transportation, epigastric and abdominal pain, vomiting and diarrhea, inability to eat or drink, chest bi (obstruction) and chest fullness, abdominal pain with excessive phlegm, direct attack of cold pathogen to the Taiyin meridian with diarrhea without thirst, cold cholera with vomiting and diarrhea, cold limbs, spontaneous sweating with weak pulse, bloody stools or dysentery, deficiency-cold during pregnancy, and also treats stomach injury causing hematemesis.《Yi Fang》: (1) Treats Taiyin stage cold damage with diarrhea without thirst, much coldness and vomiting, abdominal pain, loose stools, and a deep, weak pulse (Shang Han Lun, Taiyin chapter). (2) Or cold extremities with cramps, or chest binding with vomiting of roundworms, and cholera due to cold (Shang Han Lun, Taiyin chapter).《Shan Bu》: Impaired Middle Qi transportation, abdominal distention or discomfort, loss of taste, prolonged inability to eat due to illness, disharmony of zang-fu organs, and cold damage directly attacking Taiyin with diarrhea without thirst, much coldness and vomiting, etc.

 【Modern Applications】

Chronic gastritis, gastric and duodenal ulcers, gastric neurosis, nervous vomiting, gastric atony, gastroptosis, gastrectasis, hyperemesis gravidarum, pylorospasm, chronic enteritis.

 【Mnemonic】

“Li Zhong Zu Ren Chao Jiang” (to remember Bai Zhu (Atractylodes Macrocephala), Ren Shen (Ginseng), Gan Cao (Licorice), Gan Jiang (Dried Ginger)).

 【Modifications】

《Yi Fang》: (1) For diarrhea with abdominal pain: add Mu Xiang (Costus Root). (2) For painless excessive diarrhea: double Bai Zhu (Atractylodes Macrocephala). (3) For thirst: double Bai Zhu (Atractylodes Macrocephala). (4) For lying curled up, heaviness, and unceasing diarrhea: add Fu Zi (Prepared Aconite Root). (5) For abdominal fullness: remove Gan Cao (Licorice). (6) For vomiting: remove Bai Zhu (Atractylodes Macrocephala), add Ban Xia (Pinellia Tuber) and ginger juice. (7) For pulsation below the navel: remove Bai Zhu, add Gui (Cinnamon Twig). (8) For palpitations: add Fu Ling (Poria). (9) For Yin Jaundice: add Yin Chen (Capillary Wormwood). (10) For cold binding in the chest: add Zhi Shi (Immature Bitter Orange).《Shan Bu》: (1) If there is pulsation above the navel, indicating kidney Qi agitation: remove Bai Zhu, add 4 liang of Gui (Cinnamon Twig). (2) For profuse vomiting: remove Bai Zhu, add 3 liang of Sheng Jiang (Fresh Ginger). (3) For profuse diarrhea: still use Bai Zhu. (4) For palpitations: add 2 liang of Fu Ling (Poria). (5) For thirst wanting water: add Bai Zhu, making the total amount 4.5 liang. (6) For abdominal pain: add Ren Shen (Ginseng), making the total amount 4.5 liang. (7) For coldness: add Gan Jiang (Dried Ginger), making the total amount 4.5 liang. (8) For abdominal fullness: remove Bai Zhu, add 1 piece of Fu Zi (Prepared Aconite Root).《Han Dian》: Add Fu Zi (Prepared Aconite Root) for Ren Shen Tang (Ginseng Decoction) patterns accompanied by cold hands and feet, aversion to cold, and a faint, weak pulse in the interior. Add Gui Zhi (Cinnamon Twig) for cases in 《Shang Han Lun》 where there is diarrhea with associated heat (superficial heat with cold and diarrhea), or for Ren Shen Tang patterns with palpitations, headache, etc. (1) If abdominal pain is severe, add Bai Shao (White Peony Root) to soothe spasms and relieve pain. (2) If diarrhea is severe, heavily use stir-fried Bai Zhu (Atractylodes Macrocephala), add Rou Dou Kou (Nutmeg), Bian Dou (Hyacinth Bean), Shan Yao (Chinese Yam), He Zi (Chebula Fruit) to strengthen the Spleen, dispel dampness, and astringe the intestines to stop diarrhea. (3) If there is edema, add Fu Ling (Poria), Ze Xie (Alisma), Dong Gua Pi (Winter Melon Peel) to promote urination. (4) If accompanied by Qi stagnation and retained fluids, add Zhi Shi (Immature Bitter Orange) and Fu Ling (Poria) to this formula, refine with honey into pills, named Zhi Shi Li Zhong Wan. (5) If there is bleeding, change Gan Jiang (Dried Ginger) to Pao Hei Gan Jiang (Charred Dried Ginger), add E Jiao (Donkey-hide Gelatin), Ai Ye Tan (Charred Mugwort Leaf), San Qi (Notoginseng) to stop bleeding. (6) If accompanied by Qi stagnation and bloating, add Hou Po (Magnolia Bark), Cao Guo (Cochinchina Cardamom) to move Qi and relieve bloating. (7) If accompanied by phlegm-fluid retention and pulsation above the navel, add Gui Zhi (Cinnamon Twig), Fu Ling (Poria) to resolve fluids and calm palpitations. (8) If accompanied by cold-damp leukorrhea, add Tu Si Zi (Dodder Seed), Fu Ling (Poria), Lu Jiao Shuang (Deer Antler Gelatin Powder) to warm the Spleen and Kidney, dispel dampness, and stop discharge. (9) If Spleen Qi deficiency is severe, increase the dosage of Ren Shen (Ginseng) to strengthen Qi tonification. (10) If accompanied by severe vomiting, reduce Bai Zhu (Atractylodes Macrocephala), add Sheng Jiang (Fresh Ginger), Ban Xia (Pinellia Tuber) or Ding Xiang (Clove), Bai Dou Kou (White Cardamom) to harmonize the stomach and stop vomiting. (11) Adding Gui Zhi (Cinnamon Twig) to this formula is named <a href='https://whatsintcm.com/dt_articles/Gui Zhi (Cinnamon Twig)Ren Shen Tang (Ginseng Decoction)/’>Gui Zhi Ren Shen Tang, which treats deficiency-cold of the Spleen and Stomach, with concurrent exterior pathogenic syndrome, unceasing diarrhea, epigastric hardness, fever and aversion to cold, unresolved interior and exterior, and diarrhea with associated heat. (12) Adding Ban Xia (Pinellia Tuber) and Fu Ling (Poria) to this formula is named Li Zhong Hua Tan Wan, which treats deficiency-cold of the Spleen and Stomach, with internal retention of phlegm-fluid, coughing and spitting phlegm, indigestion, vomiting with reduced appetite, or loose stools. (13) Adding Fu Zi (Prepared Aconite Root) to this formula is named Fu Zi Li Zhong Wan, which treats Spleen and Stomach Yang deficiency with severe Yin cold, cholera with vomiting, diarrhea, and cramps, cold pain in the epigastrium and abdomen, faint pulse and cold limbs, pale tongue with white and slippery coating. (14) If there is pulsation above the navel, indicating kidney Qi agitation: remove Bai Zhu, add 4 liang of Gui (Cinnamon Twig); for profuse vomiting: remove Bai Zhu, add 3 liang of Sheng Jiang (Fresh Ginger); for profuse diarrhea: still use Bai Zhu; for palpitations: add 2 liang of Fu Ling (Poria); for thirst wanting water: add Bai Zhu, making the total amount 4.5 liang; for abdominal pain: add Ren Shen (Ginseng), making the total amount 4.5 liang; for coldness: add Gan Jiang (Dried Ginger), making the total amount 4.5 liang; for abdominal fullness: remove Bai Zhu, add 1 piece of Fu Zi (Prepared Aconite Root).