Class 9~10: Herbs and Formulas That Warm the Interior

1. Class 9~10: Herbs and Formulas That Warm the Interior Xianhui Li

2. Herbs that warm the interior • *Aconiti lateralis praeparata, Radix (Fu Zi) • Zingiberis, Rhizoma (Gan Jiang) • *Cinnamomi, Cortex (Rou Gui) • Evodiae, Fructus (Wu Zhu Yu) • Pericarp Zanthoxyli (Chuan Jiao) • Flos Caryophylatae (Ding Xiang) • Foeniculi, Fructus (Xiao Hui Xiang) • Alpinia officinarum, Rhizoma (Gao Liang Jiang)

3. Fu Zi (Prepared Aconite) • Taste and Property: Pungent and hot • Meridian Tropism: Heart, kidney and spleen • Actions: Rescue yang from collapse, Tonify fire and assist yang, Disperse cold and relieve pain • Applications • Collapse of yang: Marked by cold sweating, cold limbs, feeble and indistinct pulseFu Zi can assists the heart yang to promote flow of qi and blood in the vessels and tonify the kidney yang to supplement fire to rescue the depleting yang. Often used together with Gan Jiang and Gan Cao, i.e. Si Ni Tang • Yang deficiency patterns: Yang deficiency of the kidney, the spleen and the heart can all be treated with this herb. • Kidney Yang deficiency: Marked by aversion to cold, cold limbs, soreness and weakness of the loins and knees, impotence and frequent urination. Often used together with Rou Gui, Shu Di and Shan Zhu Yu, i.e. Jin gui shen qi wan • Spleen yang deficiency with excess of cold marked by cold pain in the abdomen, and loose stool, often used together with Bai Zhu, Ren Shen and Gan Jiang, i.e. Fu Zi Li Zhong Wan • Heart yang deficiency: Palpitation, shortness of breath, cardialgia due to CHD, often used together with Ren Shen and Gui Zhi • Arthralgia: More suitable for exuberance of cold dampness marked by pain of the joints of all over the body, often used together with Gui Zhi and Bai Zhu, i.e. Fu Zi Gan Cao Tang • Dosage: 3-15g. It should be decocted first for 30-60m to reduce its toxicity

4. Wu Tou (Radix Aconiti) Chuan Wu • Taste and Property: Pungent, bitter, warm and very toxic • Meridian Tropism: Heart, liver and spleen • Actions: Disperse wind dampness and disperse cold to relieve pain • Application: Arthralgia due to cold dampness, cold pain in the heart and abdomen, migraine, traumatic injury. This herb has a stronger cold-dispersing and pain-relieving effect than Fu Zi • Dosage: 3-9g. If used in the form of powder or with wine, 1-2g and prepared. • Attentions: • Not used for pregnant woman • Not used together with Ban Xia, Gua Lou, Bei Mu, Bai Ji and Bai Lian Cao Wu • The taste and property, actions, usage and attentions of this herb is the same as Chuan Wu but its toxicity is even stronger than Chuan Wu. • Dosage: 1.5-4.5g

5. Gan Jiang (Dried Ginger) (Rhizoma Zingiberis) • Taste and property: Pungent and hot • Meridian tropism: Spleen, stomach, heart and lung • Actions: Warm up the middle jiao, rescue yang from collapse and warm the lung and dissolve retained water • Application: • Cold patterns of the spleen and the stomach: • Marked by cold pain in the abdomen, vomiting and diarrhea. It can be used to treat the cold patterns of the spleen and the stomach, no matter whether it is an excessive type or a deficient type, • Used alone to treat sudden cold pain in the abdomen, • Vomiting caused by stomach cold: Used together with Ban Xia. • Deficiency cold of the spleen and the stomach: Used with Ren Shen, Bai Zhu and Gan Cao, i.e. Li Zhong Wan • Collapse of yang: Being pungent and hot, Gan Jiang can warm up the heart yang to eliminate the interior cold. When used together with Fu Zi, it can assist Fu Zi in strengthening its effect of rescuing yang from collapse and reduce the toxicity of Fu Zi. • Retention of cold water in the lung: Marked by cough, asthma, aversion to cold, cold back and much clear phlegm: Often used together with Ma Huang, Xi Xin and Wu Wei Zi, i.e. Xiao Qing Long Tang • Dosage: 3-10g • Attention: Carefully applied to pregnant woman

6. Rou Gui (Cinnamon Bark, Cortex Cinnamoni) • Taste and Property: Pungent, sweet and hot • Meridian tropism: Kidney, spleen, heart and liver • Actions: Tonify fire, assist yang, Disperse cold to relieve pain, Warm up and remove obstruction from collaterals • Indications: • Kidney yang deficiency marked by aversion to cold, cold limbs, soreness and weakness of the loins and knees, impotence and frequent urination or deficiency of both the spleen yang and the kidney yang marked by cold pain in the abdomen, poor appetite and loose stool. Often used together with Fu Zi, Shu Di and Shan Zhu Yu, I.e. Gui Fu Ba Wei Wan, or with Fu Zi, Gan Jiang and Bai Zhu, i.e. Gui Fu Li Zhong Wan. It can also be used to induce the heat from the floating deficient yang back to its origin • Cold pain in the abdomen, arthralgia due to cold dampness, pain in the lower back and cold stagnation in the blood marked by amenorrhea and dysmenorrhea. • Carbuncle that fails to rupture after formation of pus: This herb can disperse cold and warm up yang to promote flow of qi and blood, often used together with Shu Di, Lu Jiao Jiao and Ma Huang, i.e Yang He Tang • Deficiency of both qi and blood: Used in a small amount in herbs tonifying qi and blood, i.e. Shi Quan Da Bu Tang • Dosage: 2-5g, to be taken in powder with water. It should be decocted later when used in decoction • Attentions: Use this herb with great care for patients with fire exuberance due to yin deficiency, excessive heat, bleeding due to blood heat or pregnant woman

7. Wu Zhu Yu (Fructus Eoudiae) • Taste and Property: Pungent, bitter, hot and slightly toxic • Meridian tropism: Liver, spleen and stomach • Actions: Disperse cold to relieve pain, soothe flow of the liver qi and dry dampness • Applications: • Cold pain in the stomach or the abdomen, pain due to hernia and diarrhea due to cold dampness, i.e. Si Shen Wan, Wu Zhu Yu Tang, etc. • Pain in beriberi due to cold dampness: Often used with Mu Gua, i.e Zhu Yu Tang • Acid regurgitation and vomiting: It can dredge flow of the liver qi to relieve vomiting or rising of the stomach qi, often used with Sheng Jiang and Ban Xia for stomach cold, Huang Lian for fire transformed from stagnated liver qi • Application of this herb at the sole can induce fire to flow downward to treat ulcer of the tongue and mouth • Dosage: 1.5-5g • Attention: This herb is pungent, hot and dry, tending to impair qi and strengthen fire. Over use or long use should be avoided.

8. Hua Jiao (Sichuan peper) • Taste and Property: Pungent, hot and slightly toxic • Meridian tropism: Spleen, stomach and kidney • Actions: warm up the middle jiao, relieve pain, kill worms • Applications: • Cold pain, vomiting or diarrhea due to deficiency cold of the spleen and the stomach, often used together with Gan Jiang, Ren Shen and Yi Tang, i.e. Da Jiang Zhong Tang. Apply this herb to the painful area after it is stirred fried to treat the painful area. Diarrhea due to cold dampness, often used together with Cang Zhu, Hou Po and Chen Pi • Abdominal pain, vomiting or vomiting roundworm: Used alone or with Wu Mei, Gan Jiang and Huang Lian, Wu Mei Wan • Dosage: 2-5g

9. Ding Xiang (Cloves, Flos Caryophylli) • Taste and Property: Pungent and warm • Meridian tropism: Spleen, stomach and kidney • Actions: Warm up the middle jiao, relieve rising of qi, warm up the kidney yang • Applications: • Vomiting or hiccup or poor appetite and diarrhea due to stomach cold. This is a basic herb for vomiting due to stomach cold, often used together with Ren Shen and Sheng Jiang, i.e. Ding Xiang Shi Di San. • Impotence and beriberi due to kidney yang deficiency, often used together with Fu Zi, Rou Gui and Ba Ji Tian • Dosage: 2-5g • Attention: Can not be used with Yu Jin

10. Gao Liang Jiang (Galangal rhizome, Rhizoma Alpiniae Officinarum) • Taste and Property: Pungent and warm • Meridian Tropism: Spleen and stomach • Action: Warm up the middle jiao to relieve pain • Application: • Cold pain in the epigastrium and abdomen, vomiting and diarrhea. This herb is good at dispersing the cold pathogen in the spleen and stomach to relieve pain and vomiting, often used together with herbs warming the middle jiao and promoting flow of qi, i.e. Er Jiang Wan. • For cases with stagnation of the liver qi due to cold, it can be used together with Xiang Fu, i.e. Liang Fu Wan. • For cases with vomiting due to stomach cold, it can be used together with Ban Xia and Sheng Jiang. • Dosage: 3-10g

11. Xiao Hui Xiang (Common Fennel Fruit, Fructus Foeniculli) • Taste and Property: Pungent and warm • Meridian Tropism: Kidney, liver, spleen and stomach • Actions: Disperse cold to relieve pain, regulate flow of qi and harmonize function of the stomach • Application: • Pain in hernia of cold type or dropping of scrotum on one side: Often used together with the herbs warming up the liver and the kidney and these promoting flow of qi to relieve pain, such as Rou Gui, Chen Xiang and Wu Yao, ie. Nuan Gan Jian • Stomach cold marked by vomiting, poor appetite and distending pain in the stomach and abdomen, often used together with Gan Jiang and Mu Xiang • Cold pain in the lower abdomen can be treated by stirring the herb hot, then wrapping it and applying it to the lower abdomen • Dosage: 3-8g

12. Formulas That Warm the Interior • Formulas that Warm the Channels and Disperse Cold • Tangkuei Decoction for Frigid Extremities (dang guisini tang) • Formulas that Warm the Middle and Dispel Cold • Regulate the Middle Pill (li zhong wan) • Evodia Decoction (wuzhuyu tang) • Major Construct the Middle Decoction (da jianzhong tang) • Minor Construct the Middle Decoction (xiaojianzhong tang) • Formulas that Rescue Devastated Yang • Frigid Extremities Decoction (sini tang)

13. Tangkuei Decoction for Frigid Extremities (dang gui si ni tang) Ingredients: Dang gui, Shao yao, Gui zhi, Xi xin, Zhi gan cao, Da zao, Mu tong

14. Actions and indications of the formula • Actions • Warm the channels, disperse cold, nourish blood, and unblock blood vessels. • Indications • Long standing cold hands and feet that are both cold to touch and feel very cold to patient, a pale tongue with a white coating, and a submerged, thin pulse.

15. Analysis of Formula • Monarch: Dang gui • tonify and invigorate blood. • Depute: Bai shao, gui zhi • Bai shao---tonify yin and blood • Gui zhi---warm the channels and disperse cold. • Assistant: Zhi gan cao, Da zao • augment qi and strengthen spleen. • Envoy: Mu tong • facilitate the flow in channels and vessels.

16. Li Zhong Wan (Regulate the Middle Pill) Ingredients: Gan jiang Ren shen Bai zhu Zhi gan cao

17. Actions and indications of the formula • Actions • Warm the middle burner and strengthen the spleen and stomach. • Indications • Diarrhea with watery stool, nausea and vomiting, no particular thirst, loss of appetite, abdominal pain, a pale tongue with a white coating, and a submerged thin pulse.

18. Analysis of Formula • Monarch: Gan jiang • warm the spleen and stomach and eliminate interior cold. • Depute: Ren shen • tonify qi.. • Assistant: Bai zhu • tonify spleen and stomach, dry dampness. • Envoy: Zhi gan cao • tonify middle jiao and harmonize.

19. Wu Zhu Yu Tang (Evodia Decoction) Ingredients: Wu zhu yu, Sheng jiang, Ren shen, Da zao

20. Actions and indications of the formula • Actions • Warm and tonify the liver and stomach, direct rebellious qi downward and stop vomiting. • Indications • Vomiting immediately after eating, indeterminate gnawing hunger, and acid regurgitation with or without epigastric pain. • Dry heaves or spitting of clear fluids with headache at the vertex. • Vomiting and diarrhea with cold hands and feet, and agitation so severe that the patient wants to die. Pale red tongue, white slippery coating, thin slow or thin wiry pulse.

21. Analysis of Formula • Monarch: Wu zhu yu • warm the stomach, warm and sooth liver and direct rebellious qi downward.. • Depute: Sheng jiang • warm the stomach and direct rebellious qi downward. • Assistant: Ren shen • strengthen spleen, generate fluids and calm the spirit. • Envoy: Da zao---moderate the acrid, drying herb. Support the qi tonifying action.

22. Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) Ingredients: Yi tang, Gui zhi, Shao yao, Sheng jiang, Da zao, Zhi gan cao

23. Actions and indications of the formula • Actions • Warm and strengthen middle burner, moderate spasmodic abdominal pain. • Indications • Intermittent spasmodic abdominal pain that responds favorable to local application of warmth and pressure, a lusterless complexion, reduced appetite, a pale tongue with a white coating, and a thin wiry pulse. Low grade fever, palpitations, irritability, cold and sore extremities, a dry mouth and throat.

24. Analysis of Formula • Monarch: Yi Tang, Gui Zhi • Yi tang---tonify and moderate spasmodic abdominal pain. • Gui zhi---warm the middle jiao and disperse cold. • Deputy: Bai shao • nourish yin and blood, harmonize ying qi and wei qi. • Assistant: Zhi gan cao • tonify middle jiao and harmonize. • Envoy: Sheng jiang, Da zao • harmonize ying qi and wei qi.

25. Da Jian Zhong Tang (Major Construct the Middle Decoction) Ingredients: Chuan jiao, Gan jiang, Ren shen, Yi tang

26. Actions and indications of the formula • Actions • Warm and strengthen middle burner, direct rebellious qi downward alleviate pain • Indications • Epigastric and abdominal pain can not being touched. Feeling cold, severe vomiting, a white slippery tongue coating, and a thin tight or slow wiry pulse..

27. Analysis of Formula • Monarch: Chuan jiao • stimulate yang, dispel cold, relieve pain. • Deputy: Gan jiang • warm the interior. • Assistant: Ren shen • tonify spleen qi. • Envoy: Yi tang • tonify and moderate spasmodic abdominal pain.

28. Si Ni Tang (Frigid Extremities Decoction) Ingredients: Fu zi, Gan jiang, Zhi gan cao

29. Actions and indications of the formula • Actions • Rescue devastated yang, warm middle burner, and stop diarrhea • Indications • extremely cold extremities, cold pain in abdomen, vomiting, diarrhea, fatigue, no thirst, a pale tongue with white slippery coating, deep thin pulse

30. Analysis of Formula • Monarch: Fu zi • hot and acrid to tonifykidney yang. • Deputy: Gan jiang • warm the interior and middle jiao. • Assistant and Envoy: Zhi gan cao • tonify middle jiaoand harmonize.