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The Five Stagnations:
The Mother of all Diseases

Dr. Michael Tierra O.M.D., L.A.C.
and Lesley Tierra L.A.C.

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The Five Stagnations are Qi, Blood, Fluid, Cold and Food. These are determined according to their location in the Triple Warmer or Three Jiao’s. Even though the triple warmer in TCM has its own meridian and is regarded as an organ function, it refers to the coordination of several organs and physiological functions with each other. The Upper Warmer refers to all the organs and parts from the base of the sternum upwards; the Middle Warmer includes the organs and parts in the middle region from the navel to the base of the sternum; the Lower Warmer refers to all the organs and parts from the navel downwards. Interestingly, even though the physical location of the Liver would be in the Middle Warmer, it is actually considered a Lower Warmer organ.

According to TCM theory, any substance that is in excess or not moving is potentially toxic and injurious. Therefore, what the Five Stagnations are about is clearing toxicity. A basic strategy is to first clear toxicity and then, if necessary, give tonics. From this study, it may appear that toxins are all physical, but in fact, they are also mental or at least can be aggravated by emotional stress.

Abstinence of light fasting from food for many types of Stagnations as well as appropriate exercise, must always be considered an option. On the other hand, abstinence from emotional stress and meditation is, for some, another important stagnation clearing strategy. As for exercise, Qi Gong and yoga exercise combining conscious movement, breath and internal visualization is probably the best physical exercise for relieving stagnation.

Indications for the Upper Warmer Stagnations :

Qi Stagnation	Emotional and mental signs, depression, hysteria, etc., headaches, dizziness, etc.
Blood Stagnation	Discoloration, varicosity’s, blueness, heaviness of the head and arms.
Fluid Stagnation	Edema, Dampness of the head and chest, damp, swollen and scalloped tongue, slippery pulse.
Cold Stagnation	Cold extremities

Indications for the Middle Warmer Stagnations

Qi Stagnation	burping, gas, bloating, tight abdomen
Blood Stagnation	Blood stagnation felt as a lump in the abdomen (“oketsu”),
Fluid Stagnation	Borborygmus or gurgling abdominal sounds (“shin sui on”)
Cold Stagnation	Cold digestion (essentially poor digestion), anorexia, diarrhea
Food Stagnation	Greasy tongue coat, epigastric spasms

Indications for the Lower Warmer Stagnations

Qi Stagnation	Stiffness, heaviness, tightness in the lower abdomen and extremities
Blood Stagnation	Palpable lumps (oketsu) in the lower abdomen, menstrual irregularities, varicosity’s
Fluid Stagnation	Edema, pitting, dampness
Cold Stagnation	Cold abdomen, back, legs and feet
Food Stagnation	Constipation

Pulse Diagnosis

There are six basic pulses:

1. Floating pulse --- External syndrome
2. Deep pulse --- Internal syndrome
3. Full Pulse --- Excess syndrome
4. Empty pulse --- Deficient syndrome
5. Rapid pulse --- Heat syndrome (80 or more beats per minute)
6. Slow pulse --- Cold syndrome (60 or less beats per minute)

Tongue diagnosis

Tongue body:

Pale --- Coldness, Blood and Qi Deficiency

Red --- Heat and inflammation

Swollen and/or scalloped --- Dampness and/or Qi Deficiency

Wet tongue --- Dampness

Greasy yellow tongue --- Dampness and Heat

Greasy and White --- Dampness and Cold

Purple tongue --- Blood stagnation

Bluish tongue --- Cold stagnation

Signs on the front of the tongue refer to the Upper Warmer

Signs on the Middle of the tongue refer to the Middle Warmer

Signs towards the back of the tongue refer to the Lower Warmer

Hara Diagnosis

Hara is traditional Japanese abdominal diagnosis. Fourteen different signs are felt to correspond with the different Stagnations and refer to specific herbal formulas.

1. Kyo-ri-no-do (Heart movement felt under the left breast) Qi, Blood and Fluid stagnation in the Upper Warmer
2. Ki-jo-sho (Flushing up of Qi) Qi stagnation in the Upper Warmer.
3. Kyo-chu-ku-mon (Discomfort in the chest) Qi, Blood and/or Fluid stagnation in the Upper Warmer.
4. Shin-ka-hi (tightness of the muscle under the epigastrium) Stagnation of Qi, Blood, Fluid, Cold, and/or food in the upper Warmer.
5. Kyo-kyo-ku-man (Tightness of the muscle under the rib cage) Stagnation of Qi, Blood and/or Food in the middle Warmer.
6. Fu-ku-hi-do-ki (Tightness of the rectus abdominalis muscle) Stagnation of Qi and Cold in the Middle Warmer.
7. Fuku-bu-do-ki (Movement of the aorta felt by light pressure) Stagnation of Qi and/or Blood in the Middle and/or Lower Warmer.

a. Below the sternum

b. superior to the umbilicus

c. lateral to the umbilicus

d. right on the umbilicus

e. inferior to the umbilicus

8. Shin-sui-on (Sound of Fluid) Stagnation of fluid in the middle Warmer

9. Sho-fuku-kyu-ke-tsu (Tightness of the lower colon) Stagnation of Qi and/or Food in the Lower Warmer.

10. Sho-fuku-ko-man (Sensation of a mass in the lower abdomen) Can be a combination of any of the Stagnations in the Lower Warmer

11. Sjo-fuku-fujin (Weakness of the linea alba in the lower abdomen) Stagnation of Qi and/or Cold in the Lower Warmer

12. Sjo-fuku-ko-kyu (tightness of the lower abdominal muscles) Stagnation of Qi and/or Cold in the Lower Warmer

13. Zen-do-fu-on (Hyper-peristalsis of the intestines) Stagnation of Qi and/or Cold in the Lower Warmer.

14. Shin-ka-hi-ken (Tightness of the upper abdominal muscles) Stagnation of Qi, Food and/or Cold in the middle Warmer.

15. Sei-chu-shin (Tightness of the linea alba) May be a sign of a combination of various Stagnations of the three warmers.

16. Sei-tsu-ten (sore umbilicus by pressure) a sign of toxicity from various Stagnations in the Middle and Lower Warmer

17. Fuku-bu-bo-man (Abdominal Distention) Excessive stagnation of all kinds.

Herbal Treatment of The Five Stagnations

An herbal formula can be prescribed based on the location and type of Stagnation. Because it is quite common to detect more than one indication, up to two formulas can be used. If this is done, it is better to take the more tonifying formula before meals and the more cleansing and eliminating formula after meals.

Use the accompanying information to select the most appropriate formula. For reference, consult Commonly Used Chinese Herb Formulas by Hong-Yen Hsu and Chau-Shin published by Oriental Healing Arts institute for the specific herbal formula. Most of the TCM formulas can be purchased in convenient freeze dried extract form from Tashi Enterprises 1-800-538-1333, 1 (510) 873-8681. These are sold under the Min Tong label and are of very good quality.

Dosage of these powder is with a measured spoon sent with each formula. Approximately one spoon (approximately ½ tsp.) is taken daily per 30 lbs. of body weight. For an individual of say 120 lbs., 2 spoons of extract are taken twice daily to make a total of 4 half spoonfulls. An individual of 180 lbs would take 3 spoons twice daily.

Dosing the dried extracts for acute conditions should be per 20 lbs. of body weight.

Treatment for the first stage is commonly from 1 to 2 months. This is the initial phase of detoxification. The patient can learn abdominal massage to help eliminate Qi stagnation. Exercise such as walking, yoga, Qi Gong or Tai Qi can be used for Blood and Fluid Stagnation. Food stagnation is based on a wholesome diet based on high fiber, cooked vegetables, vegetable protein such as tofu and seitan and some fish.

After this initial phase another evaluation is necessary to determine whether there should be a change of treatment. It rarely but occasionally happens that during cleansing there may be a minor aggravation of symptoms. The herbal formula should be at a lower dose or stopped temporarily until the aggravation subsides.

Following are two formulas that can be used initially to eliminate all Stagnations:

Stagnation Relieving Pills (Yue Qu Wan)

Cyperus (Xiang Fu) 9-12gms Cyperus rotunda

Black Atractylodes (Cang Zhu) 9-12gms Atractylodes lances

Ligusticum (Chuan Xiong) 9-12gms Ligusticum wallichii

Medicated Leaven (Shen Qu) 9-12gms Massa fermentata medicinalis

Gardenia Fruit (Zhi Zi) 9-12gms Gardenia jasminoides

Preparation: Grind into a powder, mix into water into pills the size of an azuki bean or take 6-9gms with warm water.

Properties and Actions:

a) Carminative, regulates and circulates Qi

b) Removes all kinds of stagnation, including stagnation of food, Blood, Phlegm, dampness and Fire.

Indications: Used to treat all 5 kinds of stagnation. Symptoms include a feeling of stagnation in the chest and abdomen, possible hypochondriac pain, bloating, belching, acid belching, nausea, vomiting, mild coughing, indigestion with a lack of appetite. It may be considered for nervous stomach, gastro-intestinal ulcers, pain in the chest, hepatitis, cholecystitis, gallstones.

Tongue: Depending upon the type of stagnation, purplish if there is blood stagnation, scalloped, wet and slippery if there is phlegm stagnation, greasy or coated white or yellow if there is food stagnation.

Pulse: Difficult or choppy (thready, short and slow) or Knotted (slow with irregular pauses).

Contraindications: Not for an individual whose stagnation is caused by deficiency and weakness.

Variation:

1. For Cold with stagnant Qi add Galangal (Gao Liang Jiang).
2. For dysmenorrhea or mental depression add Curcuma root (Yu jin) Curcuma longa
3. For Heat and stagnation in the liver with hypochondriac pain, yellow tongue coat, wiry and rapid pulse, add corydalis tuber (Yan hu suo)

The second formula to remove all Stagnations was given to all patients by a master Chinese herbalist as part of an initial herbal treatment. It was passed to me by Jeffrey Yuen, who said that it was created and used by his Chinese herb teacher. It can be taken twice daily either one day or a week prior to the use of any other formula, regardless of the symptoms. Jeffrey says that it looks like a modified Five Accumulations Formula with Dang gui and Magnolia Combination.

Universal Stagnation Dispersing Formula:

1. Cinnamon twig (Ramulus cinnamomi) (Gui Zhi)6gms

Warming energy Moves the Yang, removes cold stagnation

2. Peppermint (Bo He) (Mentha haplocalyx) 4 gms

Clears stagnant Heat, opens the surface, relieves Liver stagnation (relieves depression)

3. Siler (Ledebouriella seseloides) (Fang Feng) 6-9 gms

Pungent, sweet and warm, opens the surface, removes cold, damp stagnation, antispasmodic

4. White peony (Paeonia alba) (Bai Shao Yao) 6-9

Bitter, sour, cool, enters the Liver and Spleen, It nourishes the Blood which can be depleted and dried from the use of too many strongly moving herbs. It also helps remove blood stagnation.

5. Ligusticum wallichii (Chuan Xiong) 6-9 gms

Pungent, and warm, enters the Liver, Pericardium and Gall bladder meridians, Moves Blood and Qi..

6. Poria cocos (Fu Ling) 6-9 gms

Sweet to bland, neutral energy, Enters the Lung, Spleen, Heart and Urinary Bladder

Removes Damp stagnation, calms the mind

7. Angelica dahurica (Bai Zhi) 6-9 gms

Pungent and warm, enters the Lung and Spleen meridians, Clears stagnant Heat and wind

8. Prepared pinellia ternata (Ban Xia) 6-9 gms

Pungent, warm, enters the Lung, Spleen and Stomach; It removes phlegm and Dampness

9. Citrus aurantium (zhi ke) (Bitter orange without the seeds) 3-6 gms

It is sour, bitter and slightly cold, it enters the Spleen and Stomach meridians. It is carminative and mildly laxative, Clears Qi and Heat stagnation (Promotes bowel movement)

10. Platycodon grandiflorum (Jie geng) 6-9 gms

Pungent, bitter and neutral, enters the Lung meridian,; It treats the lung, removing congestion, treating either wind-cold or wind-heat. It also helps eliminate pus.

11. Mature citrus peel (chen pi) (Citrus reticulata) (Tangerine peel) 3-6 gms

Pungent, bitter and warm; enters the Lung and Spleen meridians. It promotes regulates Qi, digestion, dries and clears dampness.

12. Cyperus rotundus (Xiang Fu) 6-9 gms

spicy, slightly bitter, neutral to warm energy, regulates Qi and has carminative and blood moving properties. It removes food, Qi and Blood stagnation.

13. Dried ginger Zingiberis officinalis (Gan Jiang) 6-9 gms

Removes Cold, Damp stagnation

14. American ginseng (Panax quinquefolium) (Xi Yang Shen) 6 gms

Protects the Yin which can be exhausted and depleted from the other strong moving and drying herbs in the formula.

15. Honey-fried licorice (Glycyrrhiza uralensis) (Zhi gan cao) 3-6 gms

Tonifies Qi, protects the Qi from being exhausted from the combined effects of the other strong moving herbs in the formula.

1. QI STAGNATION

The immune system (Wei Qi) is part of the normal (Zheng Qi) energy of the body. The normal Qi can be deranged by bad breathing, bad food and water. Food Qi (Gu Qi) must ascend while the impure Qi descends to the colon (this can also include parasites). From 75% to 80% of all people have toxicity which in turn effects the circulation of Qi through the meridian system (includes the nervous system) whose energy is produced from the pure essence of food. In this respect acupuncture which manipulates the circulation of energy through the meridians can be effective in relieving toxicity and stagnation. After a patient receives radiation treatments their meridian is devastated and it may take many treatments to restore it. Ancestral Qi is the inherited, constitutional energy that one is born with and it can be nurtured through the Eight Extra Meridian systems.

Toxicity is anything that that body-mind is unable to use or is no longer available. There can be both physical toxins from food, air and water and mental toxins that are generated hormonally and through other subtle internal secretions as a result of psychological stress. Accompanying therapies such as special cleansing fasts, restricted diet, sweating, therapeutic massage, withdrawal from worldly concerns, meditation, special exercises that tend to relieve stagnation, play and recreation all are essential to relieve the underlying cause of stagnation.

The Five Stagnations are listed according to their accumulation in the Triple Warmer or “three jiao’s. The Triple warmer is an organ function representing the coordination and functional activities of the three major areas of the body, the Upper warmer located from the top of the head to the sternum, the Middle warmer from base of the sternum to the navel and the lower warmer from the navel down.

The general signs of Qi Stagnation are:

• feeling of distention, distending pain that moves from place to place -- can affect hypochondrium, epigastrium throat, abdomen & hypogastrium.
• abdominal masses that appear & disappear
• mental depression
• irritability
• gloomy feeling
• frequent mood swings
• frequent sighing
• Pulse: The pulse is similar to Blood Stagnation feeling “difficult” or “choppy” (thready, slow and short, entering and exiting with difficulty), “knotted” (slower than 60 BPM with occasional irregular pauses), “accelerated” (rapid (faster than 80 BPM with irregular pauses).
• Tongue: slightly purple

Upper Warmer Symptoms: Emotional and mental symptoms, depression, hysteria, Headache, dizziness, vertigo, etc., chest pains that change location and/or irregularly recur.

Middle Warmer Symptoms: Burping, gas, tightness in Stomach, full feeling in the abdomen, pains the move or come and go.

Lower Warmer Symptoms: Stiffness, heaviness, tightness in lower abdomen and lower extremities, pains that move or come and go.

Causes:

1. Deficiency of Qi: over a long time can make it too weak to move properly
2. Deficiency of Blood: over a long term can induce a Deficiency of Qi
3. Stagnation of Blood: can cause Qi Stagnation

Liver is the Organ most affected by Qi Stagnation

QI STAGNATION (Qi Tai ) is called the ‘mother of all Stagnations. It is usually caused by a disharmony of the 7 emotions. Each emotion has its own particular vice and a virtue

Organ	Vice	Virtue
Liver	anger, frustration	benevolence, forgiveness, esteem, respect
Heart	over excitement. (over achieving)	compassion. care for one's self
Lung	grief, sadness	conscientiousness, correctness, feeling good about one's self
Spleen	obsession, over thinking	empathy, centeredness
Kidney	fear, paranoia, worry	courage, wisdom

In ancient times, part of a physicians’ job was to help  change vices into virtue. This was called "Culturing the virtue". Healing occurred when vices were changed to virtue. Taoism, the underlying philosophy of Traditional Chinese Medicine focused on changing personalities. The Seven Emotions, fear, anxiety, pleasure, anger, sympathy, fright and sadness were all considered the main part of Chinese medicine until the early 1800's. Thus, anger stimulates qi; pleasure calms qi; anxiety obstructs qi; brooding coagulates qi; grief reduces qi; fear suppresses qi; and shock disturbs qi. During the Han dynasty the 5 elements were used to transform the emotions. The famous clinician, Sun Szu Miao, used one emotion to overcome another.

REBELLIOUS QI

Rebellious Qi is a type of Qi Stagnation in which Qi flows in the opposite direction from its normal functional flow. Following is a chart summarizing all the normal Directions of Qi flow and their Pathological manifestations as Rebellious Qi. The following chart is from The Foundations of Chinese Medicine by Giovanni Maciocia, page. 192.

Organ Normal Qi Pathological Qi Symptoms & Signs

Direction Direction

Stomach Downwards Upwards Belching, hiccup,

nausea, vomiting

Spleen Upwards Downwards Diarrhea, prolapse

Liver Upwards i)Excessive upwards

ii) Horizontally:

• --to Stomach Nausea, belching, vomiting
• --to Spleen Diarrhea
• --to Intestines Dry stools

Lungs Downwards Upwards Cough, asthma

Kidneys Downwards Upwards Asthma

Heart Downwards Upwards Mental restlessness, insomnia

There is no acupuncture or herbal formula that works on only one jiao. Example: Citrus and Perilla Combination (Fen Xin Qi Yin) treat injuries caused by 7 emotions (which means it does not only work on middle jiao).

Formula:

Citrus and Perilla Combination (Fen Xin Qi Yin)

Citrus aurantium (Chen pi) 6 gms	Cinnamon twigs (Gui zhi) 4 gms	White peony (Bai shao) 4 gms
Akebia (Mutong) 4 gms	Pinellia (Ban xia) 4 gms	Areca seed (Bin lang) 6 gms
Poria (Fuling) 6 gms	Notopterygium (Qiang huo)6 gms	Morus leaf (Sang Ye) 6 gms
Juncus (Deng xin cao) 4 gms	Perilla seed (Zi su zi) 6 gms	Jujube date (Da zao) 4 gms
Green citrus (Zhi ke) 6 gms	Prepared licorice (Zhi Gan cao)4 gms	Ginger (Jiang) 4 gms

Indications: vomiting, distention, vertigo, dizziness, fatigue, dry tongue, loss of appetite, emaciation, anxiety caused by stress.

It can be used for nervous exhaustion, edema, peritonitis, mastitis, cough during pregnancy and anorexia.

Explanation: Citrus, green citrus and Areca are carminatives and remove abdominal distention. Pinellia and Morus are expectorants and remove phlegm. Cinnamon and peony dispel stagnant blood. Poria dispels stagnant ‘water’ under the heart. Perilla is expectorant, stops cough, regulates Qi (carminative). Notopterygium clears wind and dampness and relieves pain. Akebia and juncus clear internal heat of the lungs. Ginger and jujube date are harmonizing to the other herbs in the formula.

HERBS FOR QI STAGNATION

Carminatives and digestives are herbs that remove Qi stagnation and include the following:

Mandarin Orange peel (citrus reticulata) (chen pi) -- spicy, bitter, warm; goes to the spleen, stomach and lungs. Essential oil contains limonene, linalool, perpineol, hesperidin, carotene, cryptosanthin, vitamins B1 and C.

It is carminative, expectorant, aromatic and tonic. It treats indigestion, gas, lung mucus. Dose: 3-9 gms. The best quality is longer aged. It is commonly prescribed in small amount with tonics such as ginseng to aid their utilization.

Green Citrus (unripe mandarin orange peel) --- pungent, bitter, warm; goes to the liver and gall bladder. It contains various flavonoids and other ingredients similar to the ripened variety. It is carminative, cholagogue, analgesic for hernia-like pains. Treats food stagnation, bile congestion, abdominal distention, food stagnation, lung mucus. dose: 3 to 9 gms.

Bitter Orange (Citrus aurantium) (Zhi ke) bitter, slightly cold; goes to the spleen and stomach. The immature fruit is used. It contains neohesperidin, naringin, rhoifolin, lonicerin, vitamin C and flavonoids. It is carminative, expectorant and laxative. It is for epigastric and abdominal pains, food stagnation, gas with constipation. It relieves Liver Qi stagnation and helps to treat breast lumps.

Cyperus (sedge root) -- spicy, bitter, sweet, slightly warm; goes to the Liver and triple warmer. The rhizome is used. It contains 0.5% essential oil comprised of cyperol, cyperene, cyperone, pinene and sesquiterpenes. It is carminative, antispasmodic, emmenagogue. It is used for all digestive problems, food stagnation, colds, irregular menses, depression and moodiness. It is similar to Bupleurum in its ability to regulate Liver Qi. and is one of the best herbs to use to help regulate menstruation.

Vitex (V. Agnus-castus) -- acrid, spicy, warm; goes to the Liver and Spleen. It contains essential oil, fatty oil, flavonoid casticin, iridoglyside and aucubin. It is used for menstrual irregularities and irregular symptoms associated with menopause. It stimulates progesterone production and regulates the menses. It effectively treats ovarian cysts and non-cancerous breast lumps. Dose: 3-9 gms

Bupleurum (Chai Hu)

Bupleurum is a primary herb to consider for any stagnation conditions. It is the basis for many harmonizing formulas that treat opposing patterns such as a combination of Excess and Deficiency, Hot and Cold, External and Internal conditions.

Radix Bupleuri Chinense Chai Hu

Common name: Bupleurum, Hare’s Ear

Family: Umbelliferae

Energy and Flavor: acrid, bitter and cool

Organ Meridian Affected: Liver, Gallbladder, Pericardium and Triple warmer

Actions: 1. Relieves fever associated with Lesser Yang diseases; 2. Moves the Liver Qi and relieves Liver Qi stagnation; 3. Lifts the Yang Qi of the Spleen and Stomach.

Indications: 1. For successive fever and chills associated with Lesser Yang diseases with symptoms of bitter taste in the mouth, irritability, vomiting or congested feeling in the chest; 2. For Liver Qi stagnation with symptoms of menstrual difficulties, mood swings, dizziness or pain in the chest or flanks; 3. For prolapse of anus or uterus due to deficiency of the Yang Qi of the Spleen or Stomach; 4. For diarrhea due to deficient Spleen Qi.

Contraindications: This herb should not be used by those with Yin deficiency or by those with extreme headaches or eye diseases such as conjunctivitis when caused by Liver Fire.

Dosage: 3 - 12 grams

Individuals with stagnant Liver Qi, often have problems making priorities and consequently are prone to experience frustration. Some people experience more anger while taking formulas with Bupleurum. Some Chinese doctors feel that Bupleurum consumes one’s Yin (substance) reserves and causes one to experience more empty nervous energy. Other practitioners believe that while it may be good to lessen the dose of Bupleurum, there is also value in continuing its use with the addition of Yin nourishing herbs such as American ginseng or Rehmannia root to counterbalance the Bupleurum.

The classic Bupleurum formulas are:

Minor Bupleurum (Xiao Chai Hu Tang)

Bupleurum (Chai Hu) 12-15gms Bupleurum chinense

Scutellaria (Huang Qin) 9-12gms Scutellaria baicalensis

Pinellia (Ban Xia) 9-12gms Pinellia ternata

Fresh Ginger (Sheng Jiang) 3-6gms Zingiberis officinalis

Ginseng (Ren Shen) 6-9gms Panax ginseng

Licorice (Gan Cao) 3-6gms Glycyrrhiza uralensis

Jujube Dates (Da Zao) 3-5pcs Zizyphus jujuba

Properties and Actions:

a) Treats the Lesser Yang (Xiao Yang) channel (Gall Bladder and Triple Warmer)

b) Harmonizing: regulates the Liver and Spleen functions, addresses combined Yin-Yang symptoms of external and internal, excess and deficiency, and Hot and Cold.

Indications: Treats symptoms that may have begun with acute-external complex and have penetrated to an intermediate, lingering stage. Thus there may be alternating fever and chills, stuffy full feeling in the chest, bitter flavor in the mouth, dizziness, lack of appetite, fatigue and nausea. It can be used for lingering colds, coughs, bronchitis and asthma. Because of its broad action it can also be considered for conditions such as malaria, cholecystitis, hepatitis, jaundice and irregular menstruation. Recently it is being viewed as a good general immune tonic and has been studied and beneficially employed for the treatment of HIV and AIDS conditions.

Variations:

1. To strengthen immunity add Astragalus (Huang Qi) 9-12 gms, Schizandra (Wu Wei Zi) 6-9gms, Ligustrum (Nu Zhen Zi) 6-9gms.
2. For malaria add Dichroa Root (Chang Shan) and Cardamom Seed (Cao Ko).
3. For Yin deficiency add Tortoise Shell (Bie Jia) and Sweet Wormwood (Qing Hao)
4. For bloating with abdominal pain add Corydalis (Yan Hu Suo), Cyperus (Xiang Fu) and Immature Bitter Orange (Zhi shi).

Major Bupleurum (Da Chai Hu Tang)

Bupleurum (Chai Hu) 9-12gms Bupleurum chinense

Scutellaria (Huang Qin) 9-12gms Scutellaria baicalensis

Bitter orange (Zhi Shi) 6-9gms Citrus aurantium

Rhubarb (Da Huang) 6-9gms Rheum officinalis

Pinellia (Ban Xia) 6-9gms Pinellia ternata

White Peony (Bai Shao) 6-9gms Paeonia officinale

Fresh Ginger(Sheng Jiang)3-6gms Zingiberis officinalis

Jujube Dates (Da Zao) 3-5pcs Zizyphus jujuba

Properties and Actions:

a) Treats Lesser Yang (Xiao Yang) (Gall Bladder) excess conditions

b) Laxative, purges internal Heat

Indications: For Lesser Yang (Xiao Yang) and Sunlight Yang (Yang Ming) conditions with symptoms of alternating fever and chills, constipation or diarrhea, bitter taste in the mouth, nausea and vomiting, a blocked, full feeling in the abdomen with spasmodic pain. It can be considered for constipation, acute pancreatitis, acute cholecystitis, biliary calculus (gallstones).

Tongue: yellow coat

Pulse: wiry/tight and forceful

Variations:

1. With jaundice and hepatitis, add Capillaris (Yin Chen Hao), Gardenia Fruit (Zhi Zi) and Phellodendron (Huang Bai).
2. For vomiting and nausea, add Coptis (Huang Lian) and Evodia Fruit (Wu Zhu Yu).
3. With more severe constipation add Mirabilitum (Mang Xiao).

Bupleurum and Chih shih formula (Si Ni San or Frigid Extremities Powder)

Bupleurum (Chai Hu) 9-12gms Bupleurum chinense

Immature Bitter Orange (Zhi Shi) 6-9gms Citrus aurantium

White Peony (Bai Shao) 9-12gms Paeonia alba

Licorice (Gan Cao) 3-6gms Glycyrrhiza uralensis

Properties and Actions:

a) Regulates Liver and Spleen

b) Eliminates internal Heat

Indications: loss of consciousness caused by Heat exposure, chronic hepatitis, nervous stomach, chest neuralgia, worms in the liver and bile duct, hernia, inflammation of the pancreas or the appendix.

Tongue: pale with white coat

Pulse: tight and bowstring

Explanation of the Formula:

This formula is characterized by herbs that have opposite directional influences in the body. Bupleurum is an upward rising herb that enters the Liver, Immature Bitter Orange is descending and also enters the Liver, Peony is internal and Licorice effects the center. The effect of the different directions is to disentangle Heat in the Liver, Stomach and Spleen territories. This Heat locked internally is the cause of frigid extremities in this case. By releasing the internal Heat, the external limbs are warmed.

Symptoms of Liver and Stomach disharmony that are relieved with this formula include painful fullness in the hypochondrium and Stomach, acid regurgitation, belching, nausea, vomiting. There will be a thin yellowish coat on the tongue and the pulse tends to be wiry.

Bupleurum and Cinnamon Combination (Chai Hu Gui Zhi Tang)

Bupleurum (Chai hu) 15gms Bupleurum falcatum

Pinellia (Ban Xia) 12gms Pinellia ternata

Ginseng (Ren Shen) 6gms Panax ginseng

White Peony (Bai Shao) 6gms Paeonia alba

Scutellaria (Huang Qin) 6gms Scutellaria baicalensis

Cinnamon Twigs (Gui Zhi) 6gms Cinnamomum cassia

Fresh Ginger (Sheng Jiang) 3gms Zingiberis officinalis

Licorice (Gan Cao) 3gms Glycyrrhiza uralensis

Jujube Dates (Da Zao) 3-5pcs Zizyphus jujuba

One of the most frequently indicated formulas useful for 100's of conditions. This is because is harmonizes internal and external symptoms, Cold and Heat, excess and deficiency. It is a combination of both Miner Bupleurum and Cinnamon Combination (Xiao Chai Hu Gui Zhi Tang).

Properties and Actions:

a) Antipyretic, treats upper respiratory problems

b) Carminative and hepatic

c) Neuromuscular: intercostal neuralgia, headache, arthralgia, nephritis, pyelitis,

d) Nervine tonic

Indications: For the common cold, influenza, pneumonia, TB, pleuritis, indigestion, gas, hepatitis, neurosis, nervous exhaustion, headache, irritability, insomnia, female disorders, hysteria, epilepsy and cardiac disorders.

Pulse: wiry and bowstring

Bupleurum and Dang Gui Formula

(Xiao Yao San or Rambling Powder)

Bupleurum (Chai Hu) 6-9gms Bupleurum falcatum

Dang Gui (Dang Gui)6-9gms Angelica sinensis

White Peony (Bai Shao) 8-12gms Paeoniae alba

Poria (Fu Ling) 9-15gms Poria cocos

Mentha (Bo He) 1-3gms Mentha haplocalyx

Fresh Ginger (Sheng Jiang) 1-3gms Zingiberis officinalis

Baked Licorice (Zhi Gan Cao)3-6gms Glycyrrhiza uralensis

Properties and Actions:

a) Harmonizes the function of Liver and Spleen

b) Relieves Liver Qi stagnation

c) Nourishes the Blood

Indications: Used for Blood deficiency with disharmony of Liver and Spleen. Symptoms include chest fullness and pain, anemia, dizziness, headache, dry mouth and throat, tiredness, loss of appetite, irregular menstruation, leucorrhea, tiredness, breast distention, malarial symptoms with alternate chills and fever. It can also be given for chronic hepatitis.

Tongue: pale red

Pulse: thready, tight and weak

Bupleurum and Dragon Bone Combination

(Chai Hu Jia Lung Gu Mu Li Tang)

Bupleurum (Chai Hu) 9-12gms Bupleurum falcatum

Poria (Fu Ling) 4.5gms Poria cocos

Dragon Bone (Long Gu) 4.5gms Stegodon orientalis

Oyster Shell (Mu Li) 4.5gms Ostrea testa

Pinellia (Ban Xia) 6-9gms Pinellia ternata

Rhubarb (Da Huang) 6gms Rheum palmatum

Cinnamon Twigs (Gui Zhi) 4.5gms Cinnamomum cassia

Scutellaria (Huang Qin) 4.5gms Scutellaria baicalensis

Ginseng (Ren Shen) 4.5gms Panax ginseng

Fresh Ginger (Sheng Jiang) 4.5gms Zingiberis officinalis

Properties and Actions:

a) Harmonizes interior and exterior

b) Relieves stagnation

c) Sedative

Indications: The Qi is not transforming and therefore floats upward. This causes symptoms of anxiety, nervousness, and palpitations. Symptoms of all three Yang stages are present. It is a condition caused by all three Yang stages. These may include chest fullness, irritability with palpitations, urinary difficulty, constipation, nervous, anxiety, hysteria, body heaviness and stiffness, and epilepsy.

This formula was originally prescribed to remedy the adverse reaction resulting from the use of Rhubarb (Da Huang) (a purgative), inappropriately given during the early stages of colds and flus. It would weaken the outer defenses further and drive the external pathogenic influence deeper, causing heat to concentrate itself in the chest. Bupleurum (Chai Hu) is the principle herb for resolving chest oppression caused by stagnant Liver Qi. Because the Yang is driven inward with the inappropriate use of purgatives, it is unable to maintain the exterior causing a feeling of stiffness and heaviness.

Tongue: red with a moist coat

Pulse: wiry and rapid

Bupleurum and Peony Combination (Jia Wei Xiao Yao San)

Bupleurum (Chai Hu) 6-9gms Bupleurum falcatum

Dang Gui (Dang Gui) 6-9gms Angelica sinensis

White Peony (Bai Shao) 8-12gms Paeoniae alba

Poria (Fu Ling) 9-15gms Poria cocos

Dry-fried Atractylodes (Zhi Bai Zhu) 3gms Atractylodes alba

Moutan Peony (Mu Dan Pi) 1.5gms Paeonia suffruticosa

Gardenia Fruit(Zhi Zi) 1.5gms Gardeniae jasminoides

Baked Licorice (Zhi Gan Cao) 3-6gms Glycyrrhiza uralensis

Properties and Actions:

a) Harmonizes Liver and Spleen stagnation

b) Digestive, tonifies Spleen

c) Alterative, clears deficient Heat

Indications: Spleen Qi deficiency with Liver Qi stagnation changes to Heat causing increased irritability, short temper, tidal fever, sweating, blood shot eyes, palpitations, increased menstrual flow, uterine bleeding, dry mouth, lower abdominal pressure and painful urination. This formula is taken with a small amount of Fresh Ginger (Sheng Jiang) and Mint (Bo He). For difficult and painful urination add Plantain Seeds (Che Qian Zi). Compare with Bupleurum and Peony Formula (Xiao Yao San) which is less tonifying and less detoxifying.

Bupleurum and Schizonepeta Formula (Shih Wei Pai Tu Tang)

Bupleurum (Chai Hu) 9gms Bupleurum falcatum

Fresh Ginger (Sheng Jiang) 3gms Zingiberis officinalis

Ledebouriella (Fang Feng) 6gms Ledebouriella seseloides

Angelica Du Huo (Du Huo) 6gms Angelica pubescens

Poria (Fu Ling) 6gms Poria cocos

Platycodon (Jie Geng) 9gms Platycodon grandiflorum

Schizonepeta (Jing Jie) 3gms Schizonepeta tenuifolium

Ligusticum (Chuan Xiong) 9gms Ligusticum wallichii

Licorice (Gan Cao) 3gms Glycyrrhiza uralensis

Cherry Bark Japanese 9gms Prunus yedoensis

Properties and Actions:

a) Detoxifying, aids Liver detoxifying function

b) Clears the skin

Indications: For lymphadenitis, carbuncles, furuncles, boils, mastitis, skin diseases such as dermatitis, urticaria, eczema, acne, ophthalmia, nasal congestion, external and middle ear infection.

Tongue: red with a yellow coat

Pulse: rapid

Bupleurum, Cinnamon Twig and Fresh Ginger Combination (Chai Hu Gui Zhi Gan Jiang Tang)

Bupleurum (Chai Hu) 24gms Bupleurum falcatum

Cinnamon Twigs (Gui Zhi) 9gms Cinnamomum cassia

Fresh Ginger (Sheng Jiang) 6 gms Zingiberis officinalis

Trichosanthes (Tian Hua Fen) 12gms Trichosanthes kirilowii

Scutellaria (Huang Qin) 9gms Scutellaria baicalensis

Oyster Shell (Mu Li) 6gms Ostrea testa

Honey-Baked Licorice(Zhi Gan Cao)6gms Glycyrrhiza uralensis

Properties and Actions:

a) Treats recurring fevers and chills

b) Resolves phlegm and relieves chest fullness and congestion

c) Warms the extremities

Indications: This formula is used for more sensitive type individuals with intermittent fever, with chills, chest fullness, stress and anxiety, heart palpitations, thirst, cold hands and feet, loose stool or diarrhea. It can be considered for the common cold, TB, pneumonia, bronchitis, pleurisy, peritonitis, insomnia, hepatitis and inflammation of the gall bladder.

Bupleurum Formula (Yi Gan San)

Atractylodes (Bai Zhu) 3gms Atractylodes alba

Poria (Fu Ling) 3gms Poria cocos

Angelica (Dang Gui) 3gms Angelica sinensis

Ligusticum (Chuan Xiong) 3gms Ligusticum wallichii

Gambir (Gou Teng) 3gms Uncaria cum uncis

Bupleurum(Chai Hu) 1.5gms Bupleurum falcatum

Licorice (Gan Cao) 1.5gms Glycyrrhiza uralensis

Properties and Actions:

a) Antispasmodic, Calms Liver Wind

b) Tonifies Liver Blood and Qi

Indications: Used for many types of spasmodic conditions including Liver Wind problems with symptoms of nervousness, irritability, insomnia caused by over-excitement, seizure disorders, hysteria, night fears, spasms, feverishness, abdominal swelling, reduced appetite, restless sleep caused by Wood over dominating Spleen-Earth.

Note: To aid assimilation, it is usually taken with 2 1/2 grams of Citrus Peel (Chen Pi).

Patterns:

Liver Qi Stagnation

This is one of most common patterns in body. It is a pattern of excess.

Clinical Manifestations: Feelings of distention of hypochondrium and chest, hypochondriac pain, sighing, hiccup, melancholy, depression, moodiness, nausea, vomiting, epigastric pain, poor appetite, sour regurgitation, belching, feeling of pulsation in epigastrium, “churning feeling in the stomach,” abdominal distention, borborygmi, diarrhea, unhappiness, “feeling wound-up,” feeling of lump in the throat, feeling of difficulty in swallowing, irregular and/or painful periods, distention of breasts before periods, pre-menstrual tension and irritability. Pulse: wiry, especially on the left side; Tongue: body color may be normal.

Causes: emotional problems, long-term frustration, repressed anger or resentment

Formulas:

Powder to Disperse Vital Energy in Liver (Chai-Hu-Su-Kan-San):

Chai Hu (Bupleurum) 9-12 gm. Bupleurum chinense

Bai Shao Yao (White peony 6- 9 gm. Paeonia lactiflora

Zhi Ke (Bitter orange) 6- 9 gm. Citrus aurantium

Chuan Xiong (Ligusticum) 3- 6 gm. Ligusticum wallichii

Xiang Fu (Cyperus tuber 6- 9 gm. Cyperus rotundus

Gan Cao (Licorice) 1- 3 gm. Glycyrrhiza uralensis

Indications: For a person with stagnancy of Qi and Blood in the liver. The symptoms are mental depression, upset easily, hypochondriac distention and pain, chest fullness, belching, indigestion, abdominal distention, constipation. Pulse: wiry/taught; Tongue: with thin white coating.

Pinellia & Magnolia Combination (Pan-Hsia-Hou-Pu-Tang):

Ban Xia (Pinellia tuber) 6- 9 gm. Pinellia ternata

Hou Po (Magnolia Bark) 6- 9 gm. Magnolia officinalis

Zi Su Ye (Perilla leaf) 6- 9 gm. Perilla frutescens

Fu Ling (Poria; Hoelen) 9-12 gm Poria cocos

Shen Jiang (Fresh ginger 10-15 gm Zingiber officinale

Indications: for a person with globus hystericus. The symptoms are blockage in

the throat, difficulty in swallowing or vomiting, cough with profuse sputum.

Pulse: wiry/taught, or wiry and slippery; Tongue: white and moist, or slippery

and greasy.

Liver Invading the Spleen

Clinical manifestations: Irritability, abdominal distention and pain, alternation of constipation and diarrhea, stools sometimes dry and small and sometimes loose, flatulence, tiredness. Pulse weak on the right and wiry on the left; Tongue red on the sides or pale.

Pathology: When Liver Qi stagnates it can invade the Spleen & disturb its function. When Liver Qi Stagnation predominates there is constipation with dry, difficult and small stools. When Spleen Qi Deficiency predominates, there are loose stools.

Causes: Most often from emotional problems or long-standing anger, resentment or frustration usually combined with irregular diet & overwork

Formula: Dang Gui and Peony (Xiao Yao San) (see above)

Liver Invading the Stomach

Clinical manifestations: Irritability, distention and pain in epigastrium and hypochondrium, fullness in epigastrium, sour regurgitation, belching, nausea, vomiting. Pulse: weak on the right and wiry on the left; Tongue red on sides or pale.

Pathology: This pattern is characterized by Stagnation of Liver-Qi invading the Stomach and interfering with the descending of Stomach Qi: This results in the ascending of Stomach Qi, hence the belching, nausea and vomiting.

Causes: Emotional problems combined with irregular diet and overwork

Formula: Dang Gui and Peony (Xiao Yao San) (see above) with Shen Qu

Small Intestine Qi Tied

Clinical Manifestation: violent abdominal pain, dislike of pressure, abdominal distention, constipation, vomiting, borborygmi, flatulence. Pulse: deep, wiry;. Tongue: thick white coating.

Pathology: Always acute pattern, characterized by great obstruction and stagnation in the Small Intestine.

Causes: Excessive consumption of cold and raw foods

Formula:

Pills of Tangerine Seed (Chu-Ho-Wan):

Ju He (Tangerine seed) 9-12 gm. Citrus reticulata

Chuan Lian Zi (Sichuan chinaberry) 3- 6 gm. Melia toosendan

Yan Hu Suo (Corydalis tuber) 6- 9 gm. Corydalis yanhusuo

Hou Po (Magnolia bark) 6- 9 gm. Magnolia officinale

Zhi Shi (Immature bitter orange) 6- 9 gm. Citrus aurantium

Rou Gui (Cinnamon bark) 1- 3 gm. Cinnamomum cassia

Kun Bu (Ecklonia) 6- 9 gm. Ecklonia kurome

Hai Zao (Sargassum) 6- 9 gm. Sargassum fusiforme

Tao Ren (Persica seed) 3- 6 gm. Prunus persica

Mu Tong (Akebia stem) 6- 9 gm. Akebia trifoliata

Mu Xiang (Saussurea) 3- 6 gm. Saussurea lappa

Indications: for a person with stagnancy or depression of vital energy in the small intestine. The symptoms are: distention and spasmodic pain in the lower abdomen, with tenesmus, swollen testis, hernia, radiating pain to the lower spine. Pulse: deep and wiry/taught; Tongue: with white coating.

2. BLOOD STAGNATION

The general signs of Blood Stagnation are:

• fixed pain that is stabbing or boring in character perhaps as a consequence of a trauma or operation; degenerated spinal disks and scar tissue are also considered Blood Stagnation..
• dark complexion, older people can have liver spots on the skin and/or varicosity’s
• purple lips (cyanosis)
• purple nails
• abdominal masses that do not move
• bleeding with dark blood and dark clots
• Pulse: The pulse can feel “difficult” or “choppy” (thready, slow and short, entering and exiting with difficulty), “knotted” (slower than 60 BPM with occasional irregular pauses), “accelerated” (rapid (faster than 80 BPM with irregular pauses). choppy or knotted (slow and stops at irregular intervals which reflects presence of Interior Cold; Tongue: purple.

Upper warmer: Discoloration, venous protrusion, “blueness,” heaviness of head and arms. Other symptoms include shoulder pains, angina, congestive heart failure, TB, lung stagnation and breast lumps. Bleeding in the lungs is called “dry blood”.

Middle Warmer Symptoms: “Oketsu” (Blood stagnation felt as a lump) in the abdomen.

Lower Warmer Symptoms: “Oketsu” in lower abdomen, palpable lumps caused by cysts and fibroids, menstrual problems, varicose veins.

Causes of Blood Stagnation:

1. Stagnation of Qi: most common cause as Qi moves Blood & if it stagnates Blood congeals
2. Deficiency of Qi: over long term may make it too weak to move blood & Blood congeals
3. Heat in Blood: may cause Blood to coagulate & stagnate
4. Blood Deficiency: over long term can induce Qi Deficiency & subsequent stasis of Blood
5. Interior Cold: slows the circulation of Blood which can then stagnate

The Liver is the organ most affected by Blood Stasis.

The following chart shows the Comparison between Stagnation of Qi and Stasis of Blood, from The Foundations of Chinese Medicine, by Giovanni Maciocia, Page 193.

Stagnation of Qi Stasis of Blood

Pain/distention More distention than pain More pain than distention

Location Moving pain Fixed pain

Character Distending pain, feeling of fullness Boring or stabbing pain

Abdominal masses Appearing and disappearing Fixed

Skin Not appearing on skin May manifest with purple blotches or bruises

Face May be unchanged Dark color or bluish-green

Tongue Normal color or slightly purple Definitely purple and possibly with purple spots

Pulse Only slightly wiry Wiry, firm or choppy

Patterns:

Liver Blood Stagnation: purple nails, dark face, irregular/painful periods with dark menstrual blood and dark clots, premenstrual pain, vomiting of blood, epistaxis, abdominal pain, fixed masses in abdomen. Pulse: wiry; Tongue: purple, especially on sides.

Causes: Always derives from Liver Qi Stagnation--from emotional problems. When Liver Blood Stagnates, Blood in Directing & Penetrating Vessels (Chong Mai and Ren Mai) affects menstrual function.

Formula:

Decoction to Remove Blood Stasis below Diaphragm (Ke-Chia-Chu-Yu-Tang)

Dang Gui (Chinese angelica) 6-9 gm. Angelica sinensis

Chuan Xiong (Ligusticum) 6-9 gm. Ligusticum wallichii

Tao Ren (Persica seed) 6-9 gm. Prunus persica

Hong Hua (Carthamus; safflower) 6-9 gm. Carthamus tinctorius

Wu Ling Zhi (Pteropus 6-9 gm. Pteropus excrement

excrement)

Wu Yao (Lindera) 6-9 gm. Lindera strychnifolia

Yan Hu Suo (Corydalis) 3-6 gm. Corydalis yanhusuo

Xiang Fu (Cyperus tuber) 3-6 gm. Cyperus rotundus

Chi Shao Yao (Red peony) 6-9 gm. Corydalis yanhusuo

Mu Dan Pi (Moutan bark) 6-9 gm. Paeonia suffruticosa

Zhi Ke (Bitter orange 3-6 gm. Citrus aurantium

Gan Cao (Licorice) 1-3 gm. Glycyrrhiza uralensis

Indications: For a person with stagnancy of Qi and Blood Stasis. The symptoms are: abdominal pain (fixed) with hardenings, hypochondriac pain (piercing), irritable, indigestion, constipation. Pulse: wiry/taut and hesitant; Tongue: purple with spots on the side.

Heart Blood Stasis: purple lips, stabbing or pricking pain in the heart region which may radiate to inner aspect of left arm or to the shoulders; may come in repeated bouts and is elicited by exertion or cold weather, palpitations, discomfort or feeling of oppression or constriction of chest, cold hands, cyanosis of nails. Pulse: choppy or knotted; Tongue: purple on the sides and toward the front, purple and distended veins under the tongue,

Formulas:

Decoction for Removing Blood Stasis in Chest (Xue-Fu-Chu-Yu Tang):

Tao Ren (Persica seed) 9-12 gm. Prunus persica

Hong Hua (Carthamus) 6- 9 gm. Carthamus tinctorius

Dan Gui (Chinese angelica) 6- 9 gm. Angelica sinensis

Chuan Xiong (Ligusticum) 3- 6 gm. Ligusticum wallichii

Chi Shao Yao (Red peony) 6- 9 gm. Paeonia lactiflora

Chuan Niu Xi (Cyathula) 6- 9 gm. Cyathula officinalis

Chai Hu (Bupleurum) 3- 6 gm. Bupleurum chinense

Jie Geng (Platycodon) 3- 6 gm. Platycodon grandiflorum

Zhi Ke (Bitter orange) 6- 9 gm. Citrus aurantium

Di Huang (Raw rehmannia) 6- 9 gm Rehmannia glutinosa

Gan Cao (Licorice) 3- 6 gm. Glycyrrhiza uralensis

Indications: for a person with pain in the head and chest due to blood stasis or poor circulation. The symptoms are: chronic pain in the head and chest (fixed and piercing), chronic hiccup, irritability, insomnia, emotional upset, increased body temperature especially in the afternoon. Pulse: hesitant or wiry and tight; Tongue: dark red with purple spots.

Lung Blood Stasis: stuffiness of chest, coughing of dark blood, pain in head and chest (fixed and piercing), chronic hiccup, irritability, insomnia, emotional upset, increased body temperature especially in the afternoon. Pulse: hesitant, or wiry and tight; Tongue: purple in front part or the sides in the center section, purple & distended veins under the tongue.

Formula:

Decoction for Removing Blood Stasis in Chest (Xue-Fu-Chu-Yu-Tang)

(Refer to formula under Heart Blood Stasis)

Stomach Blood Stasis:

Clinical Manifestation: stabbing pain in epigastric which is worse with heat and pressure, pain after eating, vomiting of dark blood, dark blood in stools. Pulse: wiry or choppy; Tongue: purple in center or with purple spots.

Causes: a chronic condition from Stagnant Fire, Liver Qi invading Stomach, Food Stagnation, or Qi Stagnation over a long period of time (due to long-standing emotional problems such as anger, frustration, resentment & depression)

Intestine Blood Stasis: severe abdominal pain, dark blood in stools.

Formulas:

1. Pathogenic Heat in Blood: Xi Jiao Di Huang Tang; An Gong Niu Huang Wan; Tao He Cheng Qi Tang.
2. Presence of Cold in the Blood vessels: Dang Gui Si Ni Tang
3. Qi Stagnation and Blood Stasis: In the face and head: Tong Qiao Huo Xue Tang; in the chest and hypochondriac region: Xue Fu Shu Yu Tang; in the abdomen (lateral): Shao Fu Zhu Yu Tang; in the channels and collaterals: Tao Hong Si Wu Tang.
4. Blood stasis with decreased vital energy: With Qi deficiency: Bu Yang Huan Wu Tang; with deficiency of Yin and Yang, with hard lumps: Gui Zhi Fu Ling Wan.

Rhinoceros and Rehmannia Combination (Xi Jiao Di Huang Tang)

Rhinoceros Horn (Xi Jiao) 3-6 gms Rhinoceros unicornis

Unprepared Rehmannia (Sheng Di Huang) 8 gms Rehmannia glutinosa

Red Peony (Chi Shao) 3 gms Paeonia lactiflora

Moutan Peony (Mu Dan Pi) 2 gms Paeonia suffruticosa

Properties and Actions:

a) Treats severe fevers and Heat in the Blood system

b) Removes Blood stagnation

Indications: For severe high febrile diseases, delirium, spitting of blood, epistaxis, hematuria, dark black stools (blood in the feces). It can be used for high fevers with bleeding, acute leukemia, uremia, hepatic coma, septicemia, boils and severe local inflammations.

Tongue: dark red tongue with prickly coating

Pulse: thing and rapid

Note: For ecological reasons, today Water Buffalo or Cow’s Horn is used in triple the amount in substitution for Rhinoceros Horn.

Variations:

1. For spitting of blood and nosebleeds add Imperata (Bai Mao Gen) and Biota Tops (Ce Bai Ye).
2. For blood in the feces add Sophora Flower (Huai Hua) and Lithospermum (Zi Cao).
3. For delirium and mania add Scutellaria (Huang Qin) and Rhubarb (Da Huang).

Bezoar Resurrection Pills (An gong Niu Huang Wan)

Bos Calculus (Niu Huang) 30 gms Bos Taurus Domesticus

Rhinoceros Horn (Xi Jiao) 30 gms Rhinoceros unicornis

(Substitute 4 times the amount with water buffalo horn)

Musk (She Xiang) 7.5 gms Moschus moschiferus

Coptis (Huang Lian) 30 gms Coptis Chinensis

Scutellaria (Huang Qin) 30 gms Scutellaria baicalensis

Gardenia (Zhi Zi) 30 gms Gardenia jasminoides

Curcuma (Yu Jin) 30 gms Curcuma longa

Realgar (Xiong Huang) 30 gms Arsenic disulfide

Borneol (Bing Pian) 7.5 gms Dryobalanops Aromatica

Cinnabar (Zhu Sha) 30 gms Red Mercuric Sulfide

Pearl (Zhen Zhu) 15 gms Pteria Margaritifera

Gold leaf (Jin Bo) three small sheets

Preparation: Grind to a fine powder. Mix with honey and make into 3 gram pills. Take 1 pill 2 or 3 times a day with warm water. Children should be half the adult dose. If the patient is unconscious administer with a gastric tube.

Properties and Actions:

a) Clears Heat Toxin

b) Revives unconsciousness

a) Indications: High fever with coma, delirium, convulsions. It can be considered for encephalitis, meningitis, infantile convulsions, hepatic coma, cerebral vascular injury, stroke, dysentery and uremia.

Contraindications: do not use long term or during pregnancy and do not subject to cooking or high heat.

Persica and Rhubarb Combination (Tao He Cheng Qi Tang)

Persica Seed (Tao Ren) 6-9gms Prunus persica

Cinnamon Twigs (Gui Zhi) 3-6gms Cinnamomum cassia

Rhubarb (Da Huang) 6-9gms Rheum palmatum

Mirabilitum (Mang Xiao) 3-6gms Sodium sulfate

Baked Licorice (Zhi Gan Cao) 3-6gms Glycyrrhiza Uralensis

Properties and Actions:

a) Dispels Heat and Blood stagnation in the Lower Warmer (especially indicated for symptoms of the lower left abdomen while Rhubarb and Moutan Combination (Da Huang Mu Dan Tang) is for the lower right abdomen)

Indications: Sharp lower abdominal pains, nervousness and anxiety, delirium, thirst, hard stool, difficult urination, elevated temperature at night. It may be considered for irregular menstruation, dysmenorrhea, amenorrhea, retained placenta, acute pelvic inflammation, intestinal obstruction and constipation.

Tongue: red and dry

Pulse: deep, strong but with difficulty

Variations:

1. For severe Blood stagnation add Dang Gui and Carthamus (Hong Hua).
2. For stagnation of Qi add Green citrus (Qing Pi) and Cyperus (Xiang Fu).
3. For retention of the placenta add Trogopterus feces (Wu Ling Zhi) and Cattail Pollen (Pu Huang).

Dang Gui Decoction for Frigid Extremities (Dang Gui Si Ni Tang)

Angelica (Dang Gui) 9-12 gms Angelica sinensis

White Peony (Bai Shao Yao) 9-12 gms Paeonia alba

Cinnamon twigs (Gui Zhi) 9 gms Cinnamomum cassia

Asarum (Xi Xin) 3-6 gms Asarum heterophylii

Prepared Licorice (Zhi Gan Cao) 3-6 gms Glycyrrhiza uralensis

Jujube dates (Da Zao) 12-15 pcs. Zizyphus jujuba

Properties And Actions:

c) Warms the channels and dispels Cold

d) Tonifies Blood

Indications: For Yang Deficiency with Blood Deficiency and Cold invasion. It can be used for a wide variety of Cold disorders ranging from general poor circulation, dysmenorrhea, raynaud’s disease, fibromyalgia, sciatica, chilblains, frostbite, gangrene, hernia, calluses and corns, thromboangiitis obliterans, varicose veins, peptic ulcer and testicular pains.

Contraindications: Do not use for Yin conditions of Yin Deficiency. Use with caution during the warm climates.

Variations:

For painful menstruation add cyperus, fennel, lindera, alpinia

For painful menstruation with Yin Deficiency remove akebia and add prepared rehmannia.

For hernia and testicular pains add fennel seeds

For chronic sciatica add prepared aconite, dipsacus, eucommia, cibotii and rhubarb

Tong Qiao Huo Xue Tang (Invigorate Blood Circulation and Open the Orifices Decoction)

Musk (She Xiang) .1-.2 gms. Moschus moschiferus

Peach seed (Tao Ren) 6-9 g Prunus persica

Carthamus (Hong Hua) 6-9 g Carthamus tinctorius

Ligusticum (Chuan Xiong) 3-6 g Ligusticum wallichii

Red Peony (Chi shao yao) 3-6 g Paeonia rubra

Garlic (Cong) 3 pcs. Allium fistulosum

Jujube dates (3-5 pcs. Zizyphus jujuba

Rice Wine

Action: invigorates Blood circulation and opens the orifices

Indications: Blood stagnation in the head and face. Symptoms include headache, dizziness, deafness, loss of hair, pale or cyanotic face, phthiasis, weakness of the muscles. It can be considered for cerebral concussion, post-concussion syndromes, infantile malnutrition.

Shao Fu Zhu Yu Tang (Remove Blood Stasis from the Lateral Abdomen Decoction)

Dang gui 6-9 g Angelica Sinensis

Ligusticum (Chuan xiong) 3-6 g Ligusticum wallichii

Red peony (Chi shao yao) 6-9 g Paeonia lactiflora

Fennel seeds (Xiao hui xiang) 3-6 Foeniculum vulgare

Corydalis (Yan hu suo) 3-6 g Corydalis yanhusuo

Trogopterus (Wu ling zhi) 3-6 g Trogopterus xanthipes

Myrrh (Mo Yao) 3-6 g Commiphora myrrha

Cinnamon bark (Rou gui) 3-6 g Cinnamomum cassia

Dry ginger (Gan jiang) 3-6 g Zingiber officinale

Bulrush pollen (Pu huang) 6-9 g Typha angustata

Action: 1. Invigorates blood circulation and removes stasis

2. warms the channels and relieves pain

Indications: For blood stagnation in the lateral abdomen. Symptoms are abdominal pain with no lumps, or with lumps but no pain, abdominal distention, irregular menstruation, lumbago during menses, blood color is purple, or black with clots, or uterine bleeding with abdominal pain.

Uses: dysmenorrhea, amenorrhea, irregular menstruation, uterine bleeding.

Dang Gui Four Combination (Si Wu Tang)

Prepared Rehmannia (Shu Di Huang) 10-15gms Rehmannia glutinosa

Dang Gui (Dang Gui) 9-12gms Angelica sinensis

Ligusticum (Chuan Xiong) 6-9gms Ligusticum wallichii

White Peony (Bai Shao) 9-12gms Paeonia lactiflora

Actions and Indications:

a) Restores and nourishes Blood

b) Stimulates blood circulation.

Indications: Anemia, pale, sallow complexion and fingernails, dizziness, vertigo, irregular menstruation, ringing in the ears, stopped menstruation, threatened miscarriage, post-partum anemia.

Tongue: pale

Pulse: thready and weak

Note: This is the mother formula for all Blood Deficiency disorders.

Variations:

1. For increased Blood stagnation add Peach Seeds (Tao Ren) and Carthamus Flowers (Hong Hua), this becomes Tao Hong Si Wu Tang
2. For uterine bleeding add Donkey-Hide Gelatin (E Jiao) and Mugwort (Ai Ye). A version of this is commercially available as Tang Kwei Gin.
3. Painful menstruation with anemia and stagnation, add Blood and Qi moving herbs including Motherwort (Yi Mu Cao), cyperus (Xiang Fu), Corydalis (Yan Hu Suo).

Bu Yang Huan Wu Tang (Reinforcing the vital function and restoring normal function of the five viscera’s decoction)

Astragalus (Huang qi) 10-15 g Astragalus membranaceus

Dang gui 6-9 g Angelica sinensis

Ligusticum (Chuan xiong) 6-9 g Ligusticum wallichii

Red peony (Chi shao yao) 6-9 g Paeonia lactiflora

Earthworm (Di long) 3-6 g Pheretima aspergillum

Peach seed (Tao ren) 6-9 g Prunus Persica

Carthamus (Hong hua) 6-9 g Carthamus tinctorius

Action: Replenishes Qi, invigorates blood circulation, activates circulation in the collaterals

Indications: for post-cerebral apoplexy syndromes with symptoms of hemiplegia, deviation of the mouth and eyes, difficulty of speech, salivation, frequent urination or incontinence of urination.

Tongue: white coat

Pulse: moderate

Uses: for apoplexy, hemiplegia, cerebral vascular accident, infantile paralysis.

Variations:

1. if there are cold extremities add prepared aconite (fu zi)
2. For Spleen deficiency add ginseng (ren shen) and atractylodes (Bai Zhu)
3. With sputum add Pinellia (Ban Xia)

Cinnamon and Poria Combination (Gui Zhi Fu Ling Wan)

Cinnamon Twig (Gui Zhi) 6-9gms Cinnamomum cassia

Poria (Fu Ling) 6-9gms Poria cocos

Moutan Peony (Mu Dan Pi) 6-9gms Paeonia suffruticosa

Persica Seed (Tao Ren) 6-9gms Prunus persica

Red Peony (Chi Shao Yao) 6-9gms Paeonia lactiflora

Properties and Actions:

a) Promotes blood and lymphatic circulation, thus removing stagnant Blood.

b) Softens and resolves hard lumps such as cysts and fibroids.

Indications: It is used for Blood and fluid stagnation especially of the female reproductive organs. Symptoms may include fibroids and cysts in the lower abdomen, painful, spasmodic and irregular menstruation characteristic of endometriosis. It is used for infertility, dysmenorrhea, post-partum bleeding, retention of the placenta.

Representative formula for Blood circulation and tonification:

Dang Gui Four Combination (Si Wu Tang)

Prepared Rehmannia (Shu Di Huang) 10-15gms Rehmannia glutinosa

Dang Gui (Dang Gui) 9-12gms Angelica sinensis

Ligusticum (Chuan Xiong) 6-9gms Ligusticum wallichii

White Peony (Bai Shao) 9-12gms Paeonia lactiflora

Actions and Indications:

a) Restores and nourishes Blood

b) Stimulates blood circulation.

Indications: Anemia, pale, sallow complexion and fingernails, dizziness, vertigo, irregular menstruation, ringing in the ears, stopped menstruation, threatened miscarriage, post-partum anemia.

Tongue: pale

Pulse: thready and weak

Note: This is the mother formula for all Blood Deficiency disorders.

Variations:

1. For increased Blood stagnation add Peach Seeds (Tao Ren) and Carthamus Flowers (Hong Hua), this becomes Tao Hong Si Wu Tang
2. For uterine bleeding add Donkey-Hide Gelatin (E Jiao) and Mugwort (Ai Ye). A version of this is commercially available as Tang Kwei Gin.
3. Painful menstruation with anemia and stagnation, add Blood and Qi moving herbs including Motherwort (Yi Mu Cao), cyperus (Xiang Fu), Corydalis (Yan Hu Suo).

HERBS FOR BLOOD STAGNATION

These herbs are classified as Emmenagogues and Blood Regulating or Blood Moving. They are very important to use for relieving various painful conditions.

Wild Ginger (Asarum species) -- bitter, spicy, warm; goes to the Liver, Heart and Lungs. It contains essential oils including asarone, acids, tannin, flavonoids and resin. It is emmenagogue, stimulant, diuretic and carminative. It opens the meridians, stimulates the circulation of Blood and Qi, aids digestion and treats colds and influenza symptoms.

Tansy (Tanacetum vulgare) -- bitter, acrid, warm; goes to the Liver and Pericardium. It contains essential oil, possibly thujone. It is emmenagogue, carminative and vermifuge. It is used to bring on delayed menses and to eliminate worms. The oil can be used externally to treat bruises and rheumatic complaints.

Radix Angelicae Sinensis Dang Gui

Common Name: Dong Quai, Chinese Angelica

Family: Umbelliferae

Energy and Flavor: sweet, acrid, bitter and warm

Organ Meridian Affected: Heart, Liver and Spleen

Actions: 1. Tonifies the Blood; 2. Lubricates the Intestines; 3. Promotes circulation and dispels bi pain.

Indications: 1. For deficiency of Blood with symptoms of pale complexion, blurred vision, menstrual disorders and palpitations; 2. For constipation due to Blood deficiency; 3. Promotes circulation and nourishes the Blood for painful obstruction caused by Cold and stagnation of Blood.

Contraindications: Not for those with diarrhea, abdominal distention caused by Dampness or by those with Yin deficiency with Heat signs.

Dosage: 3 - 9 grams

Radix Paeoniae Lactiflorae Bai Shao

Common Name: White Peony

Family: Ranunculaceae

Energy and Flavor: bitter, sour and slightly cold

Organ Meridian Affected: Liver and Spleen

Actions: 1. Tonifies the Blood and preserves the Yin; 2. Nourishes the Liver assists in the smooth flow of Qi.

Indications: 1. For menstrual disorders associated with deficiency of Blood and stabilizes the Yin for exterior Wind-Cold conditions that due not resolve with sweating and Yin deficiency where there is sweating; 2. For deficiency of Liver Blood or Yin where the Liver Yang is aggressive causing symptoms of pain in the flanks or abdomen, pain associated with menses, spasms throughout the body or “Liver attacking Spleen” conditions.

Contraindications: This herb should not be used by those with diarrhea and Spleen and Stomach deficiency.

Dosage: 3 - 12 grams

Radix Ligustici Chuanxiong Chuan Xiong

Common Name: Ligusticum, Szechwan Lovage Root, Cnidium

Family: Umbelliferae

Energy and Flavor: acrid and warm

Organ Meridian Affected: Liver, Gallbladder, Pericardium

Actions: 1. Regulates and moves the Blood; 2. Relieves Wind-Cold and pain; 3. Circulates the Qi in the Upper Burner, relieving headaches.

Indications: 1. Relieves dysmenorrhea, amenorrhea, difficult labor and retained placenta; 2. Relieves blood stagnation in the chest with symptoms of flank pain, chest pain and Blood stagnation anywhere in the body; 3. Alleviates pain caused by external Wind-Cold with symptoms of body ache, headache, dizziness and headaches; 4. Treats various skin problems associated with Wind.

Contraindications: Not to be used for headaches that occur because of deficiency of Yin or from raising Liver Yang, it should not be used when there is abnormal bleeding or during pregnancy.

Dosage: 3 - 9 grams

Radix Salviae Miltiorrhiza Dan Shen

Common Name: Salvia Root, Red Sage Root

Family: Labiatae

Energy and Flavor: bitter and slightly cold

Organ Meridian Affected: Heart, Liver, Pericardium

Actions: 1. Invigorates the Blood and breaks up stasis; 2. Clears Heat and calms restlessness

Indications: 1. For delayed or slow menses, any pain due to Blood stasis such as chest pain or menstrual cramps; 2. For inflammations including ulcers, boils and carbuncles also for heat and stagnant Blood associated with insomnia, palpitations and irritability.

Contraindications: Do not be use if there is no Blood stasis. It should not be used in conjunction with Radix Veratri.

Dosage: 3 - 12 grams

Rhizoma Corydalis Yanhusuo Yan Hu Suo

Common Name: Corydalis

Family: Papaveraceae

Energy and Flavor: acrid, bitter and warm

Organ Meridian Affected: Liver, Lung, Spleen and Heart

Actions: 1. Moves the Blood, breaks stasis and reduces associated pain; 2. Regulates stagnant Qi and reduces associated pain.

Indications: 1. For stagnation of Blood with symptoms such as blocked menses, cramping due to Blood stasis and traumatic injury; 2. For conditions of stagnant Qi and pain such as epigastric pain, chest pain and menstrual pain.

Contraindications: This herb should not be used during pregnancy.

Dosage: 3 - 9 grams

Rhizoma Curcumae Longae Jiang Huang

Common Name: Turmeric Rhizome

Family: Zingiberaceae

Energy and Flavor: acrid, bitter and warm

Organ Meridian Affected: Liver and Spleen

Actions: 1. Moves Blood and unblocks stasis; 2. Facilitates the movement of Qi and eases pain; 3. Clears the meridians, expels Wind and moves Blood to relieve pain.

Indications: 1. For stagnation of Blood associated with Cold with symptoms of late or slow menstruation, chest pain and abdominal pain; 2. For stagnation of Liver Qi with symptoms of pain in the abdomen and epigastric region; 3. For Wind-Damp bi pain caused by stagnation of Blood and Qi with symptoms of chronic pain such as arthritis, rheumatoid arthritis and other kinds of painful obstruction.

Contraindications: This herb should be avoided during pregnancy, it should not be used when there is Blood deficiency with signs of stagnation of Blood or Qi.

Dosage: 3 - 9 grams

Herba Leonuri Heterophylli Yi Mu Cao

Common Name: Chinese Motherwort

Family: Labiatae

Energy and Flavor: acrid, bitter and slightly cold

Organ Meridian Affected: Heart, Liver and Urinary Bladder

Actions: 1. Moves and regulates Blood, breaks stasis and regulates the menses; 2. Increases the flow of urine and reduces stagnation of water.

Indications: 1. For stagnation of Blood with symptoms of pain from Blood stasis, late or slow menstruation, infertility, uterine bleeding, post partum pain and masses caused by Blood stagnation; 2. For retention of water with symptoms of acute edema with or without Heat in the Kidney or Bladder causing Blood in the urine.

Contraindications: Motherwort should not be during pregnancy or by those with Blood deficiency or Yin deficiency.

Dosage: 9 - 30 grams

Herba Lycopi Lucidi Ze Lan

Common Name: Bugleweed

Family: Labiatae

Energy and Flavor: acrid, bitter and warm

Organ Meridian Affected: Liver, Spleen and Urinary Bladder

Actions: 1. Moves Blood, regulates the menstruation and breaks stasis; 2. Increases the flow of urine.

Indications: 1. For stasis of Blood with symptoms of blocked menstruation, post partum pain, irregular menstruation, abdominal pain and stasis caused by traumatic injury; 2. For edema of any kind especially when Blood stagnation is present, also for dripping of urine.

Contraindications: This herb should be used with caution during pregnancy and not be used when there is no Blood stasis.

Dosage: 3 - 9 grams

Radix Paeoniae Rubrae Chi Shao

Common Name: Red Peony Root

Family: Ranunculaceae

Energy and Flavor: sour, bitter and slightly cold

Organ Meridian Affected: Liver and Spleen

Actions: 1. Moves Blood, relieves pain and reduces swelling; 2. Cools the Blood and the Liver.

Indications: 1. For stagnation of Blood with or without swelling accompanied by symptoms of blocked menstruation, inflammation with pain, pain in the abdomen and pain caused by traumatic injury; 2. For Heat in the Blood or Liver with symptoms of fever, rashes, red and swollen eyes and bleeding due to Blood Heat.

Contraindications: This herb should not be used by those with Blood deficiency.

Dosage: 6 - 12 grams

Semen Persicae Tao Ren

Common Name: Peach Kernel, Persica

Family: Rosaceae

Energy and Flavor: sweet, bitter and neutral

Organ Meridian Affected: Liver, Heart, Lung and Large Intestine

Actions: 1. Moves Blood and breaks up stasis; 2. Moistens the Intestines.

Indications: 1. For stagnation of Blood with symptoms of blocked menstruation, pain due to traumatic injury, pain in the abdomen and flanks and Lung and Intestinal abscesses; 2. For constipation due to dryness, especially good for the elderly.

Contraindications: This herb should not be used by pregnant women.

Dosage: 5 - 10 grams

Flos Carthami Tinctorii Hong Hua

Common Name: Safflower, Carthamus

Family: Compositae

Energy and Flavor: acrid, bitter and warm

Organ Meridian Affected: Heart and Liver

Actions: 1. Moves stagnant Blood and regulates menses; 2. Relieves pain caused by Blood stasis.

Indications: 1. For Blood stagnation causing irregularity in the menses or pain and masses in the abdominal region caused by stagnation of Blood; 2. For pain due to traumatic injury with stagnation of Blood or any other pain caused by stagnation of Blood.

Contraindications: This herb should not be used by pregnant women.

Dosage: 3 - 9 grams

Resina Myrrha Mo Yao

Common Name: Myrrh

Family: Burseraceae

Energy and Flavor: bitter and neutral

Organ Meridian Affected: Heart, Liver and Spleen

Actions: 1. Moves Blood and relieves stasis and pain caused by Blood stasis; 2. Assists in wound healing.

Indications: 1. For any kind of Blood stagnation including traumatic injury, blocked menses and pain obstruction; 2. Can by applied externally for chronic non healing wounds and sores.

Contraindications: This herb should not be used by pregnant women, it should not be taken internally for extended periods of time.

Dosage: 3 - 9 grams

Resina Olibanum Ru Xiang

Common Name: Frankincense, Mastic

Family: Burseraceae

Energy and Flavor: acrid, bitter and warm

Organ Meridian Affected: Heart, Liver, Spleen

Actions: 1. Moves Blood and Qi and relieves pain; 2. Disperses Wind-Damp from the meridians and relaxes the sinews; 3. Reduces swelling and aids in wound healing.

Indications: 1. For pain caused by either or both stagnation of Blood and Qi with symptoms of menstrual pain, abdominal pain, traumatic injury, sores and swellings; 2. For Wind-Damp painful obstruction with symptoms of tight and spasmodic joints; 3. Applied externally for pain and swelling such as traumatic injury, inflammation in the mouth or throat, carbuncles or chronic non healing sores.

Contraindications: This herb should not be used by pregnant women and should be used with caution by those with Spleen deficiency.

Dosage: 3 - 9 grams

An Ayurvedic preparation specifically useful for Blood Stagnation is as follows:

Guggul

Guggul (Commiphora mukul) is prepared from the resin of a special kind of myrrh-like plant. It is particularly indicated for increased bodily stiffness, arthritis and rheumatic complaints In Ayurveda these are considered symptoms of aging when the body has a tendency to accumulate toxins called Ama. It is generally believed that Ama at least refers to the accumulation of harmful cholesterol and high blood lipids which gradually impair circulation.

3. FLUID STAGNATION

In general Fluid stagnation is often associated with Qi deficiency or low energy. It is accompanied by a general appearance of edema or tissue swelling, especially seen on the abdomen, face, enlarged glands, nodules and/or any other puffy, swollen areas of the body. The tongue reflects this will show generalized edema by appearing enlarged swollen, scalloped on the sides and very moist. The pulse feels “slippery”, gliding or “rolling”, whichever description aptly describes it manifestation.

Upper Warmer Symptoms: Edema, Dampness of head and chest, phlegm congestion, Damp tongue with tooth mark, etc.

Middle Warmer Symptoms: “Shin-Sui-On,” (the Japanese Kanpo name for the sound of abdominal fluid) Damp abdomen, Ascites, etc.

Lower Warmer Symptoms: Edema, pitting, Dampness, etc.

Edema: arises from Deficiency of Spleen, Lung or Kidney, or all three

From Lung Qi Deficiency: edema in top part of body such as face & hands or from invasion of Exterior Wind-Cold which interferes with Lung function of dispersing & descending Body Fluids

From Spleen Qi Deficiency: edema in middle part of body, such as abdomen (Ascites)

From Kidney Yang Deficiency: edema in lower part of body, such as legs and ankles

Phlegm: mainly arises from Spleen Deficiency as it fails to transform and transport Body Fluid. Lung and Kidney can also be involved if Lung fail to disperse and lower fluids and if Kidney fail to transform and excrete fluids, they can then accumulate into Phlegm. There are 2 types: substantial, which can be seen, and non-substantial which can’t be seen.

Patterns:

Following is the representative formula and variations for Dampness and Phlegm that can be adopted for most conditions:

Citrus and Pinellia Combination (Er Chen Tang or Two Cured Decoction)*

Pinellia (Ban Xia) 15gms Pinellia ternata

Citrus Peel (Chen Pi) 15gms Citri reticulatus

Poria (Fu Ling) 9gms Poria cocos

Baked Licorice (Zhi Gan Cao) 4gms Glycyrrhizae uralensis

Preparation: Prepare as a decoction adding 3gms of Fresh Ginger (Sheng Jiang) and 1pc of Umeboshi Plum (dried or salt preserved).

Properties and Actions:

a) Dries Damp and dispels Phlegm

b) Regulates Qi and harmonizes the middle warmer (Stomach and Spleen).

Indications: Cough with Damp-Cold Phlegm caused by Cold- Damp of the Spleen and Stomach. Symptoms may include chest and epigastric fullness, nausea, vomiting, lassitude, feeling of heaviness (from Excess mucus), possibly vertigo and palpitations in extreme cases. May be considered for upper respiratory tract infection, chronic bronchitis, cough, goiter, chronic gastritis, peptic ulcer and Meniere's disease.

Tongue: moist, greasy white coat

Pulse: slippery

Variations:

1. For Damp-Heat of the Upper Warmer add Scutellaria (Huang Qin), Gardenia (Zhi Zi), Apricot Seed (Xing Ren) and Platycodon (Jie Geng).
2. For Damp-Heat in the Lower Warmer add Sophorae (Ku Shen), Phellodendron (Huang Bai) and Talcum (Hua Shi).
3. For Wind-Dampness add Clematis (Wei Ling Xian), Gentiana (Qin Jiao), Xanthium (Cang Er Zi) and Cinnamon Twigs (Gui Zhi).
4. For cough with copious sputum caused by External Cold in the Lungs add Ephedra (Ma Huang) and Apricot Seed (Xing Ren).
5. For vomiting caused by a Cold Stomach add Dried Ginger (Gan Jiang) and Cardamon (Sha Ren).
6. For vomiting of clear fluids add Black Atractylodes (Cang Zhu) and White Atractylodes (Bai Zhu).
7. For chronic Phlegm in the channels and flesh leading to rubbery nodules add Oyster Shell (Mu Li), Scrophularia (Xuan Shen), Laminaria (Kun Bu) and Sargassi (Hai Zao).
8. For Spleen and Kidney Yang Deficiency characterized by coughing of thin, watery sputum, deep pulse and urinary problems, add Cinnamon Bark (Rou Gui) and prepared aconite (Fu Zi).
9. For insomnia and sleepiness after meals add White Atractylodes (Bai Zhu) and Sweet Flag (Shi Chang Pu).
10. For severe coughing at night caused by Phlegm and Blood Deficiency add Angelica (Dang Gui).
11. For Damp-Phlegm obstructing the womb with irregular menstruation and copious leukorrhea add Ligusticum (Chuan Xiong) and Angelica (Dang Gui).
12. For Phlegm and dryness together, substitute Trichosanthis (Gua Lou) and Fritillary Bulb (Chuan Bei Mu) for Pinellia (Ban Xia).
13. For dizziness or vertigo, headache, full, stifling feeling in the chest, nausea, vomiting, headache;

Tongue: white greasy coat; Pulse: slippery, wiry or bowstring, add: Gastrodia (Tian Ma) and 1 slice of fresh Ginger (Sheng Jiang) and 3-4 pcs of Jujube Date (Da Zao). This becomes Pinellia and Gastrodia Combination (Ban Xia Bai Zhu Tian Ma Tang). It is used to dry and dissolve Phlegm and smooth the Liver and quiet Liver-Wind (antispasmodic).

This formula forms the basis for countless other combinations that deal with Phlegm and fluid accumulation or what in Ayurvedic medicine is called "kapha", or mucus humour.

For instance Six Gentlemen Decoction (Liu Jun Zi Tang) combines Pinellia, Poria, Licorice and Citrus with Ginseng and White atractylodes as a Spleen tonic. This reflects the relationship of the Spleen Qi to fluid metabolism.

Another variation is Pinellia and Gastrodia Combination that combines Gastrodia (Tian Ma) and Atractylodes (Bai Zhu) to calm Liver-Wind and dissolve Dampness. It is used for symptoms associated with dizziness, vertigo, heaviness of the head, headache, and other central neurological symptoms caused by Wind and Phlegm.

Bamboo and Poria Combination (Wen Dan Tang) adds Bamboo Shavings (Zhu Ru) 6gms, Green Citrus (Zhi Shi) 6gms and Fresh Ginger (Sheng Jiang) 3-6gms to clear Hot-Phlegm with symptoms of coughing of copious thick, yellow sputum that is difficult to expectorate.

Artemisia Annua and Scutellaria Decoction to Clear the Gallbladder (Hao Qin Qing Dan Tang) is another formula variation that adds Sweet Annie (Qing Hao) 6-9gms, Scutellaria (Huang Qin) 6-9gms, Bamboo Shavings (Zhu Ru) 9g and Bi Yu San 9-12gms (a combination of equal parts Talcum, Indigo and Licorice). It is used to clear Heat from the Gallbladder, relieve acute conditions of the Gall Bladder as well as symptoms of acute hepatitis, acute gastritis, pneumonia, hypertension, coronary artery disease, pyelonephritis, and Meniere’s disease, all associated with acute damp Heat syndromes.

Apricot Kernel and Perilla Leaf Powder (Xing su san) adds Perilla Leaf (Zi Su Ye), Peucedani (Qian Hu), Apricot Seed (Xing Ren), 3pcs of Jujube Date (Da Zao) and 3gms of Licorice (Gan Cao). It is used to disperse and lubricate dryness to treat deep coughs with associated symptoms of watery sputum, stuffy nose, slight headache, chills without sweating, but a dry throat and a dry tongue with a white coating and a wiry pulse.

Upper Warmer Symptoms

Damp Phlegm Obstructing the Lungs:

Clinical Manifestations: Chronic cough coming in bouts, profuse white sputum which is easy to expectorate, white-pasty complexion, stuffiness of the chest, feeling “clogged up,” shortness of breath, dislike of lying down. Pulse: slippery or weak-floating and fine; Tongue: thick-sticky white coating.

Pathology: Excess- Interior-Cold pattern, usually from Phlegm retained in the Lungs but also from chronic dysfunction of Spleen in transforming and transporting Fluids.

Causes: Spleen Qi or Spleen Yang Deficiency; recurrent attacks of Exterior Pathogenic Factors weakening Lungs and Spleen to cause formation of Phlegm which settles in Lung. Excessive consumption of greasy foods &/or cold and raw foods.

Formula:

Perilla Seed Decoction:

Zi Su Zi (Perilla seed) 6-9 gm. Perilla frutescens

Ban Xia (Pinellia tuber 6-9 gm. Pinellia ternata

Hou Po (Magnolia Bark) 6-9 gm. Magnolia officinalis

Qian Hu (Peucedanum root) 6-9 gm. Peucedanum praeruptorum

Rou Gui (Cinnamon Bark) 3-6 gm. Cinnamomum cassia

Dang Gui (Chinese angelica 6-9 gm. Angelica sinensis

Gan Cao (Baked licorice) 3-6 gm. Glycyrrhiza uralensis

Chen Pi (Citrus peel) 3-6 gm. Citrus reticulata

Phlegm-Heat Obstructing Lung:

Clinical manifestations: barking cough, profuse yellow or green or dark sputum which is foul-smelling, shortness of breath, asthma, stuffiness of the chest. Pulse: slippery, rapid, full; Tongue: red body, thick-sticky yellow coating.

Pathology: Similar to previous pattern but combined with Heat with underlying Deficiency of Spleen Qi, an Excess-Hot-Interior condition.

Causes: excessive consumption of greasy & hot foods, smoking, invasion of Exterior Wind Heat.

Formula: Ephedra and Apricot Seed Combination (Ma Xin Shi Gan Tang)

Ephedra (Ma huang) 6-9 gms Ephedra sinica

Apricot seed (Xing ren) 6-9 Prunus armeniaca

Gypsum (Shi gao) 15-30 Calcium sulfate

Baked licorice (Zhi gan cao) 3-6 Glycyrrhiza uralensis

Properties and Actions: a) Clears External conditions, b) anti-asthmatic

Indications: For External Wind Heat and Interior Lung Heat. Symptoms include fever, with or without perspiration, asthma, thirst and dryness.

Tongue: either a thin white or yellow coat

Pulse: floating, rapid and slippery

Contraindication: not for asthma caused by Wind Cold.

Morus and Chrysanthemum Combination (Sang Ju Yin)

Mulberry Leaf (Sang Ju Yin) 6-9gms Morus Alba

Chrysanthemum (Ju Hua) 3-6gms Chrysanthemum morifolium

Mentha (Bo He) 3-6gms Mentha arvensis

Apricot Seed (Xing Ren) 6-9gms Prunus Armeniaca

Platycodon (Jie Geng) 6-9gms Platycodon grandiflorum

Forsythia (Lian Qiao) 6-9gms Forsythia Suspensa

Phragmites (Lu Gen) 6-9gms Phragmites communis

Licorice (Gan Cao) 3-6gms Glycyrrhiza Uralensis

Properties and Actions:

a) Cooling diaphoretic

b) Dispels Wind-Heat

c) Antitussive, relieves cough

Indications: Wind-Heat conditions with symptoms of the common cold, influenza, coughs, acute stages of bronchitis and throat infections, conjunctivitis.

Tongue: thin white coat

Pulse: floating and rapid

Contraindications: Not for upper respiratory conditions associated with Wind-Cold.

Phlegm Fluids Obstructing the Lungs:

Clinical Manifestations: cough, breathlessness, splashing sounds in chest, vomiting of white-watery-frothy sputum, chilliness, cough which may be elicited by a scare. Pulse: fine and slippery or weak-floating; Tongue: pale body, thick-sticky white coating.

Pathology: chronic condition of Phlegm in Lung which is very watery, dilute and frothy. There also exists Spleen Yang Deficiency.

Causes: Chronic Spleen Yang Deficiency, over-exertion, long-term poor diet, excessive consumption of greasy & cold-raw food.

Formula: Citrus & Pinellia Combination:

Middle Warmer Formulas:

Phlegm and Dampness caused by Deficient Spleen:

Clinical Manifestations: Low energy, poor appetite, weak digestion, phlegm, watery diarrhea, dyspnea, vomiting, acid regurgitation, Chest fullness. Tongue: pale with white greasy coat, Pulse: soft and weak

Causes: Improper diet, eating too much raw, cold food.

Formula: Six Gentlemen Decoction (Liu Jun Zi Tang)

(see above under Citrus and Pinellia)

Magnolia and Ginger Formula (Ping Wei San)

Black Atractylodes (Cang Zhu) 6-9gms Atractylodes lancea

Magnolia Bark (Hou Po) 3-6gms Magnolia officinalis

Citrus Peel (Chen Pi) 3-6gms Citrus reticulata

Licorice (Gan Cao) 1.3gms Glycyrrhizae uralensis

Jujube Dates (Da Zao) 3-5pcs Zizyphus jujuba

Properties and Actions:

a) Carminative, relieves bloating and clears Spleen Dampness

b) Promotes the function of the Stomach and digestion

Indications: Bloated abdomen, lack of appetite, nausea and vomiting, belching with acid regurgitation, loose stool and diarrhea, dull, heavy feeling. It can be used for chronic stomach problems including gastritis and nervous stomach.

Tongue: greasy, white and swollen

Pulse: slippery

Variations:

1. To further augment the properties of the formula add Pinellia (Ban Xia) and Agastache (Huo Xiang).
2. For indigestion add Medicated Leaven (Shen Qu) and Sprouted Barley (Mai Ya).
3. For bloated abdomen with constipation add Areca Seed (Bing Lang) and Radish Seeds (Lai Fu Zi).
4. For abdominal bloating caused by Cold-Damp with a preference for warmth add Dry Ginger (Gan Jiang), Cinnamon Bark (Rou Gui) and Cardamom Seed (Cao Dou Kou).

Magnolia and Hoelen Combination (Wei Ling Tang)

Alisma (Ze Xie) 2.5gms Alisma plantago-aquatica

Poria (Fu Ling) 2.5gms Poria cocos

Polyporus (Zhu Ling) 2.5gms Polyporus umbellatus

Cinnamon Twig (Gui Zhi) 2.0gms Cinnamomum cassia

White Atractylodes (Bai Zhu) 2.5gms Atractylodes alba

Black Atractylodes (Cang Zhu) 2.5gms Atractylodes lancea

Magnolia Bark (Hou Po) 2.5gms Magnolia officinalis

Citrus Peel (Chen Pi) 2.5gms Citrus reticulata

Licorice (Gan Cao) 1.0gms Glycyrrhizae uralensis

Fresh Ginger (Sheng Jiang) 1.5gms Zingiberis officinale

Jujube Dates (Da Zao) 3-5pcs Zizyphus jujuba

Properties and Actions:

a) Eliminates Dampness of the Spleen (relieves bloating)

b) Carminative, restores the function of the Stomach and assists digestion.

Indications: Abdominal bloating and fullness, loss of appetite, dull heavy feeling in the head and body, watery diarrhea, decreased urination. It is more diuretic and generally for a more chronic condition than Magnolia and Ginger Combination (Ping wei san) but has similar uses in that it can be used for chronic gastritis, nervous stomach, ascites, edema caused by Heart or Kidney malfunction, gastro-enteritis, swollen testicles and urinary retention.

Tongue: white with a greasy coat

Pulse: slippery and thready

One of the most frequently used formulas for regulating fluid retention is the following:

Poria Five Herbs formula (Wu Ling San)

Poria (Fu Ling) 6-9gms Poria cocos

Water Plantain (Ze Xie) 9-12gms Alisma plantago-aquatica

Polyporus (Zhu Ling) 6-9gms Polyporus umbellatus

Cinnamon twig (Gui Zhi) 6-9gms Cinnamomum cassia

White Atractylodes (Bai Zhu) 6-9gms Atractylodes alba

Properties and Actions:

a) Diuretic, clears edema

b) Diaphoretic

c) Digestive, strengthens the Spleen

Indications: This is the primary diuretic formula. It is used for Spleen dampness conditions, edema, thirst, headache, nausea and vomiting after drinking water, urinary retention, ascites, cardiac edema, digestive problems including acute gastritis, gastrectasis, ascites caused by liver cirrhosis, acute enteritis with diarrhea as well as swollen testicles.

Tongue: white and moist

Pulse: floating, slippery

Variations:

1. For jaundice and/or blood in the urine, hepatitis, add Capillaris (Yin Chen Hao).

Modified Poria Five Herbs formula (Wu ling san) with curculiginis (Xian mao) 15 gms, epimedium (Yin yang huo) 15 gms, astragalus root (Huang qi) 15 gms, cuscuta seed (Tu si zi) 15 gms and ginseng (Ren shen) 9 gms.

For Deficient Spleen and Kidney Yang type Lupus with symptoms of a pale complexion, edema of the face and limbs, distended and full abdomen, cold extremities, shortness of breath, loose stool, frequent urination, pale, possibly swollen and scalloped tongue with moist fur, deep and thready or thready and weak pulse.

Obstruction of Spleen by Dampness with Stagnation of Liver Qi:

Clinical Manifestations: stuffiness and fullness of the epigastrium, nausea, no appetite, loose stools, feeling of heaviness, thirst with desire to drink in small amounts, sallow complexion, hypochondriac pain, jaundice, bitter taste. Tongue: thick-stick yellow coating; Pulse: slippery & wiry.

Causes: excessive consumption of greasy foods

Formula: Capillaris Combination (Yin Chen Hao Tang)

Capillaris (Yin Chen Hao) 9gms Artemisia capillaris

Gardenia Fruit (Zhi Zi) 6gms Gardenia jasminoides

Rhubarb (Da Huang) 6-9gms Rheum palmatum

Properties and Action:

Clears Internal Damp-Heat

Indications: For Internal damp Heat with symptoms of jaundice and yellowish eyes, abdominal fullness and discomfort, thirst, decreased urination. It is indicated for acute infectious hepatitis, cholecystitis and cholelithiasis (gallstones).

Tongue: red body with a thick yellow coat

Pulse: slippery and rapid

Variations:

1. For fullness and discomfort in the chest and abdomen add Turmeric Tuber (Yu Jin) and Immature Bitter Orange (Zhi Shi).
2. With intermittent fever, malaria, headache, bitter mouth taste add Bupleurum (Chai Hu), Scutellaria (Huang Qin) and Coptis (Huang Lian).
3. For accompanying nausea, vomiting and indigestion add Black Bamboo Shavings (Zhu Ru) and Massa Fermentata Medicinalis (Shen Qu).

Stagnation of Phlegm in the Gall Bladder:

(The following formula and its indications describe both the condition and treatment.)

Bamboo and Poria Combination (Wen Dan Tang)

(Gall Bladder Warming Decoction)

Pinellia (Ban Xia) 6-9gms Pinellia ternata

Citrus Peel (Chen Pi) 6-9gms Citrus reticulata

Poria (Fu Ling) 9-12gms Poria cocos

Immature Bitter Orange (Zhi Shi) 6-9gms Citrus aurantium

Bamboo Shavings (Zhu Ru) 6-9gms Bambusa phillostachys nigra

Licorice root (Gan Cao) 1-3gms Glycyrrhiza uralensis

Jujube Dates (Da Zao) 3-5pcs Zizyphus jujuba

Properties and Actions:

a) It is expectorant, eliminates white, frothy mucus

b) Sedative for restlessness, insomnia, anxiety and nausea

Indications: For mucus conditions, pulmonary emphysema, restlessness, insomnia, anxiety, shyness and timidity, liver and stomach disharmony, nausea, dizziness, palpitations. It can be considered for upper respiratory conditions including bronchitis and emphysema. In addition. since the Gall Bladder influences courage in the traditional sense, it is also useful for timidity and shyness as well as insomnia.

Tongue: white, greasy-looking coat

Pulse: gliding and slippery

Stephania and Astragalus Combination (Fang Qi Huang Qi Tang)

Stephania (Fang Ji) 6gms Stephania tetrandra

Astragalus (Huang Qi) 9gms Astragalus membranaceus

White Atractylodes (Bai Zhu) 6gms Atractylodes alba

Dry Ginger (Gan Jiang) 6gms Zingiberis officinalis

Jujube Dates (Da Zao) 3-5pcs Zizyphus jujuba

Licorice (Gan Cao) 1.5gms Glycyrrhiza uralensis

Properties and Actions:

a) Diuretic, clears Excess fluid and removes edema

b) Tonifies the Spleen Qi

c) Calms External Wind

Indications: For swollen abdomen, ascites, edema with a Deficient exterior. Other symptoms include spontaneous perspiration, pale and puffy skin, obesity (especially useful with Ledebouriella and Platycodon Combination), arthritis and rheumatic problems. It can be considered for congestive heart conditions and nephritic edema.

Tongue: pale with a white coat

Pulse: floating, weak, soft or thready

Contraindications: Not used if there are no signs of fluid retention.

Variations:

1. With low energy add either Ginseng (Ren Shen) or Codonopsis (Dang Shen).
2. If there is severe abdominal distention add Citrus Peel (Chen Pi) and Bitter Orange (Zhi Ke).
3. For extreme Dampness and heaviness add Poria (Fu Ling) and Coix (Yi Yi Ren).

Lower Warmer Formulas

Two Effective Ingredients (Er Miao San)

Phellodendron (Huang Bai) 6-9gms Phellodendron amurense

Black Atractylodes (Cang Zhu) 9-12gms Atractylodes lancea

Properties and Actions: Clears Damp-Heat.

Indications: Lower back pain caused