Gao Tisan 高体三
Department of Formula Studies, Henan College of Chinese Medicine

Henan Chinese Medicine Journal, December 1978

Translated by Eran Even

In recent years, increasing numbers of physicians have used Wumei Wan from the Shanghan Lun to treat biliary ascariasis, achieving remarkable clinical results. Consequently, many people have come to regard Wumei Wan simply as the representative formula for expelling parasites. In reality, expelling parasites is only one of its functions and does not fully reflect the therapeutic capabilities of the formula.

In order to inherit, develop, and further advance the medical heritage of our country, thereby achieving the goal of “making the ancient serve the present,” I believe it is necessary to further investigate the therapeutic principles and clinical applications of Wumei Wan. In my opinion, such an investigation must begin with the following points.

I. The Physiology and Pathology of Jueyin Must Be Understood Through the Relationships of the Three Yin Channels of the Foot

Both traditional medical theory and clinical practice fully demonstrate the intimate relationship among the three yin channels of the foot. Concepts such as “Yi and Gui share the same source” (乙癸同源), “Spleen and Kidney Yang deficiency,” and the statement, “When disease is seen in the Liver, one knows that it will transmit to the Spleen; therefore, one should first strengthen the Spleen,” all describe the physiological and pathological relationships among these three systems.

The three yin channels of the foot refer to the Foot Jueyin Liver, Foot Shaoyin Kidney, and Foot Taiyin Spleen. Wumei Wan is one of the representative formulas of the Jueyin Liver channel. To fully understand its composition, therapeutic principles, and range of clinical applications, one must study it through the interrelationship of the Liver, Spleen, and Kidney. Only then can the full therapeutic significance of Wumei Wan be appreciated.

The opening line of the Jueyin chapter of the Shanghan Lun states:

When disease is in Jueyin, there is wasting thirst, Qi surges upward to strike the Heart, heat and pain in the Heart, hunger without desire to eat; if food is taken, vomiting of roundworms occurs; after purgation, diarrhea continues unabated.

Judging from the patterns described in this passage, it clearly encompasses more than a disorder confined solely to the Liver channel. It also includes the persistent diarrhea resulting from Spleen and Kidney deficiency cold, together with wasting thirst arising from upward blazing heat. Only by considering the interrelationship of the Liver, Spleen, and Kidney can one arrive at a comprehensive understanding of Wumei Wan.

The Foot Jueyin Liver governs wind and wood and occupies the position between water and fire. Water is the mother of the Liver, while fire is its child. Liver wood arises from Kidney water and gives rise to Heart fire, thereby assisting water in ascending to nourish fire.

The Foot Shaoyin Kidney transforms Gui water upward to communicate with Heart fire. Under normal physiological conditions, Kidney water ascends to unite with fire, while Heart fire descends to unite with water. Water and fire mutually support one another, Yin and Yang are rooted in each other, and the two qi harmonize. Consequently, fire does not flare upward and water does not descend into coldness. This is the physiological state of health.

The mutual communication of water and fire, however, depends to a certain extent upon the Liver’s ability to assist the ascent of water. If Liver wood fails to assist water in ascending to nourish fire, the characteristic Jueyin pattern of upper heat and lower cold develops.

The Liver belongs to wood. Whether cold or heat predominates depends upon the relative strength of opposing influences. When the influence of the child predominates, heat develops; when the influence of the mother predominates, cold develops. heat represents the potential for recovery, whereas reversal cold indicates the approach of serious disease. Between these two extremes, the strength or weakness of the Central Qi is the decisive factor.

When the Central Qi is abundant, Yang is restored. When the Central Qi declines, cold reversal develops.

The Central Qi belongs to Earth.

The Foot Taiyin Spleen governs Damp Earth. When healthy, no pathology arises, but once diseased it is characterized by Dampness and deficiency. Under normal circumstances, the Spleen not only transforms food and fluids and generates Qi and Blood, but also nourishes Liver wood and restrains Kidney water.

When Taiyin deficiency develops, however, the Spleen is no longer able to nourish wood or control water. Instead, water overacts upon Earth while wood is deprived of nourishment. Therefore, deficiency cold patterns of both the Liver and Kidney are closely related to deficiency of the Taiyin Central Earth.

Although Wumei Wan was established for disorders of the Jueyin Liver channel, the inclusion of Renshen, Fuzi, and Ganjiang is intended to supplement Spleen deficiency and warm Kidney Yang, thereby harmonizing the water and Earth of the Spleen and Kidney so that they may nourish and support the growth of Liver wood.

From this it is evident that the Wumei Wan pattern is by no means confined solely to the Liver channel. Rather, it bears a very close relationship to Taiyin Spleen deficiency and Shaoyin Kidney cold.

As the saying goes:

“The Liver belongs to wood. It is the residence of the generating Qi and the storehouse of Blood. Its nature is firm yet it delights in free coursing. It must be nourished by water and supported by Earth before it can fulfill its function of growth and development.”

This statement likewise illustrates the intimate relationship among the Liver, Spleen, and Kidney. Accordingly, the Wumei Wan pattern of the Jueyin channel necessarily involves both the pathology and therapeutic methods of the Taiyin and Shaoyin systems.

II. The Therapeutic Principles of Wumei Wan Must Be Understood Through the Physiology and Pathology of the Foot Jueyin Liver

The Liver governs ascending movement and prefers free coursing. It depends upon the supportive functions of the Spleen and Kidney so that it has an adequate source of nourishment, allowing it to flourish and grow freely with wood in harmony and wind remaining calm. The cold pattern of the Jueyin zang is closely related to the inability of the deficient Spleen and Kidney to nourish and support it.

Accordingly, Wumei is used as the chief herb because of its sour and warm nature, which enters the Liver. It is combined with the sweet, acrid, and warm Guizhi and Danggui to nourish the Blood and soothe the Liver. Renshen, which enters the Spleen, supplements the Central Qi and strengthens Spleen Earth. Fuzi, Ganjiang, Xixin, and Huajiao, all intensely warming herbs, warm Kidney Yang and dispel cold of the zang organs.

Since the Liver is unable to assist water in ascending to nourish fire, the pattern manifests as upper heat with wasting thirst. Therefore, Huanglian and Huangbo are added as bitter and cold medicinals to drain fire and treat the heat above.

This demonstrates that Wumei Wan primarily supplements the Liver and nourishes the Blood, secondarily warms the Spleen and Kidney, and additionally clears the upper heat. As for the formula’s ability to expel parasites, this will be discussed below.

III. The Clinical Applications of Wumei Wan Must Be Understood Through Its Therapeutic Principles

Supplementing the Liver, nourishing the Blood, expelling parasites, strengthening the Spleen, warming the Kidney, and clearing heat above constitute the fundamental therapeutic principles underlying Wumei Wan.

Because Liver disease readily overacts on the Spleen, Zhang Zhongjing stated in the Jingui Yaolue:

“When disease is seen in the Liver, know that it will transmit to the Spleen; therefore, one should first strengthen the Spleen.”

This makes it clear that in the cold pattern of the Jueyin zang, Wumei Wan must include medicinals that supplement the Center and strengthen the Earth.

Likewise, in discussing the treatment of Shaoyin disease, Zhang Zhongjing wrote in the Shanghan Lun:

“When Shaoyin receives Yang, it is favorable.”

This further illustrates that when Kidney water is cold, it is unable to nourish Liver wood and will inevitably overact upon Spleen Earth, leaving Liver wood without a source of nourishment. Therefore, in treating the cold pattern of the Jueyin zang, Wumei Wan necessarily includes herbs that warm the Kidney.

The Liver normally assists water in ascending to nourish above. When disease prevents this function, upper heat develops; consequently, Wumei Wan also contains herbs that clear the upper region.

Because cold within the zang organs is unfavorable for the survival of roundworms, and because roundworms prefer warmth, they flee the cold below and move upward toward the heat above, producing vomiting of roundworms. Although Wumei Wan contains no typical vermicidal herbs, an examination of the flavors of its ingredients reveals a definite antiparasitic effect.

Wumei is sour, and sourness restrains the worms.

Xixin and Huajiao are acrid, and acrid herbs drive out the worms.

Huanglian and Huangbo are bitter, and bitterness directs the worms downward.

For this reason, Wumei Wan has demonstrated remarkable efficacy in the treatment of biliary ascariasis.

Nevertheless, one must not overemphasize its antiparasitic action while overlooking its much broader functions of supplementing the Liver and nourishing the Blood, strengthening the Spleen, and warming the Kidney.

Accordingly, in addition to treating ascariasis, Wumei Wan may be modified for disorders arising from deficiency cold of the Liver, Spleen, and Kidney, including cold-type dysmenorrhea, deficiency-cold abdominal pain, chronic adnexitis, leukorrhea due to deficiency cold, chronic enteritis, chronic colitis, chronic dysentery, deficiency-cold stomach pain, chronic prostatitis, impotence, enuresis, sciatica, chronic trigeminal neuralgia, rectal prolapse, uterine prolapse, and similar disorders. Clinical experience has shown that the formula is frequently effective in such conditions.

This demonstrates that Wumei Wan is not merely an excellent prescription for biliary ascariasis, but an important formula for a wide range of chronic disorders resulting from deficiency cold of the Liver, Spleen, and Kidney.

Conclusion

In summary, the key to understanding both the therapeutic principles and the indications of Wumei Wan lies in approaching it through the relationship of the three yin channels of the foot. Once the physiology and pathology of the Liver, Spleen, and Kidney are understood, the rationale underlying the composition of Wumei Wan becomes clear.

Only then can one avoid the mistaken belief that Wumei Wan is merely a formula for expelling parasites while neglecting its powerful actions of supplementing the Liver, nourishing the Blood, strengthening the Spleen, and warming the Kidney.

In short, Wumei Wan was designed for roundworm disorders occurring in the presence of deficiency cold of the Liver, Spleen, and Kidney, rather than for all cases of roundworm disease regardless of constitutional state.

Therefore, in addition to treating zang cold with roundworm reversal, it may be modified for many chronic disorders arising from deficiency cold of the three yin systems. When upper heat is absent, Huanglian and Huangbo may be omitted.

Because it simultaneously employs both warming and cooling medicinals, Wumei Wan is particularly effective for patterns of upper heat and lower cold. Its clinical applications are broad and deserve continued attention and investigation.

Owing to the limitations of my knowledge and clinical experience, my understanding is undoubtedly incomplete. I respectfully welcome correction from my colleagues.

Gao Tisan 高体三 (November 1920–2011) was a renowned Chinese medicine physician, educator, and scholar from Yuanchang Village, Qinghua Township, Wolong District, Nanyang County, Henan Province (now part of Dengzhou City). A member of the Chinese Communist Party, he served as Professor and Chief Physician at Henan College of Chinese Medicine. He was a director of the Henan Branch of the China Association of Traditional Chinese Medicine, a member and consultant for the editorial committee of the Chinese medicine textbook series for the five central-southern provinces, a member of the Fifth and Sixth Henan Provincial Committees of the Chinese People’s Political Consultative Conference (CPPCC), and was recognized by the Ministry of Health, the Ministry of Personnel, and the State Administration of Traditional Chinese Medicine as one of China’s nationally renowned senior Chinese medicine experts and clinical mentors. He is regarded as the founding figure of the Formula Studies (Fangji) discipline at Henan College of Chinese Medicine.

Gao inherited his family’s medical tradition from an early age, studying under his father. In 1943, he established his own medical practice in Deng County. In 1958, he was recommended for advanced study at the Henan Provincial School of Chinese Medicine, where he remained after graduation in 1959 to join the faculty, serving as Head of the Department (later Division) of Formula Studies. He retired in 1990 but was subsequently reappointed to continue clinical practice at the National Medicine Clinic of the Third Affiliated Hospital of Henan College of Chinese Medicine.

Over more than sixty years of clinical practice, Gao developed the academic theory of “Water Warm, Earth Harmonized, Wood Flourishes” (水暖土和木达). He emphasized pattern differentiation based on the three yin channels of the foot (Taiyin, Shaoyin, and Jueyin) and was especially skilled in the use of classical formulas (Jingfang) and warming medicinals for the treatment of difficult and complex disorders.

He authored numerous textbooks and monographs, including Lecture Notes on Chinese Medical Formula Studies, Lecture Notes on Common Diseases in Chinese Medicine, Clinical Chinese Materia Medica, Treatment Methods and Formulas, and A New Interpretation of the Tangtou Gejue (Songs of Decoctions), the latter of which has been reprinted multiple times. His development of the Weijinkang Health Beverage (维金康保健饮料) received the Second Prize for Scientific and Technological Progress from the Henan Provincial Department of Light Industry in 1993. In 2008, he was awarded the Lifetime Achievement Award for Traditional Chinese Medicine in Henan Province by the Henan Provincial Administration of Traditional Chinese Medicine. His academic theories and clinical experience were also incorporated into China’s Tenth and Eleventh Five-Year National Key Science and Technology Support Programs.