Musings on Bēn Tún Tāng

A formula I’ve been quite intrigued with for many years, and use quite often in clinic, is Bēn Tún Tāng from the Jīn Guì Yào Lüè. The following is a short translation from one of my favourite Qīng dynasty scholar/physicians Huáng Yuán-Yù, followed by some brief clinical musings written by myself. 

Huáng Yuán-Yù on Bēn Tún Tāng

Translated from the Cháng Shā Yào Jiě (长沙药解)

The Golden Cabinet’s Bēn Tún Tāng

Gān Cǎo  2 liǎng

Bàn Xià 4 liǎng

Shēng Jiāng 4 liǎng

Shēng Gé (Gēn) 5 liǎng

Huáng Qín 2 liǎng

Xiōng Qióng 2 liǎng

Dāng Guī 2 liǎng

Sháo Yào 2 liǎng

Gān Lǐ Gēn Bái Pí 1 jīn 

This formula treats Bēn Tún qi, with surging into the chest, abdominal pain, and alternating heat and cold. When yang collapses, and the spleen is vanquished, (this causes) sinking and obstruction in Liver-wood, wood qi depressed effusion, and surging from the umbilicus, abdomen, chest and diaphragm, (resulting in) pain and concurrent heat and cold. Because Liver-wood surges upwards, both the stomach and gall-bladder run counterflow, and the Shaoyang is depressed and distressed, this results in a struggle between the interior and the yin, and this ongoing battle manifests with alternating cold and heat. The qi of Jué Yīn is wind-wood. When wind stirs it consumes the blood, and when warmth is depressed, it results in heat. Gān Cǎo supplements the earth and moderates the center; Shēng Jiāng and Bàn Xià descend stomach and gall-bladder counterflow; Huáng Qín and Shēng Gé (Gēn) clear depressed heat in the stomach and gall-bladder; Xiōng Qióng and Sháo Yào course wood and moisten wood dryness; Gān Lǐ Gēn Bái Pí clears the liver and descends surging qi. 

Gān Lǐ Gēn Bái Pí is sweet, cold, collecting and astringent. It is excellent at descending the surging qi of Jué Yīn, which can therefore treat bēn tùn. It is mainly indicated for alleviating thirst, eliminating vexing counterflow, arresting dysentery, and stopping vaginal discharge. 


In my experience, Bēn Tùn (running piglet) can be both objective and subjective. Subjective in that the patient will feel some sort of rush that starts in the lower body, and rises either to the chest, throat, or face. It’s pretty hard to get a patient to tell you that they feel a surging sensation from their lower abdomen to their chest. Some do, but it’s not something I hear very often. Anxiety can manifest this way for some people, while some will tell you that they get facial redness, slightly dizzy or a bit of a rush when they are nervous. Another possibility for some is that this sensation, or ‘rush’ can cause patients to become anxious. I would interpret these manifestations as a form of running piglet. 

However, running piglet is also objective, manifesting in several ways such as; sudden sweating, facial redness, epigastric pain, chest tightness, shortness of breath, dizziness, headaches/migraines, premenstrual acne, etc.

This is due to a wood-earth pathology, where wood is abundant, which damages the earth, hence we see the abdominal pain. Since we have a Shào Yáng element here, there is alternating heat and cold (往来寒热), which can be interpreted the way Huáng Huáng (黄煌) does in that this alternating heat and cold can refer to anything that alternates, or occurs cyclically. This is a major feature of the Shào Yáng, and so having someone that breaks out into sweats, gets cyclical acne, cyclical migraines, anxiety attacks, etc., that is due to a wood-earth pathology, Bēn Tùn Tāng is a great choice. 

In addition, we have an element of a Jué Yīn pathology as well just to complicate things. Here, blood was affected which left a slight blood deficiency and when there is not enough blood and wood-qi tries to move, this can get stuck and lead to heat (which is the flaring of ministerial fire). 

Sāng Bái Pí is the most common substitute for the Gān Lǐ Gēn Bái Pí. Some doctors like Hu Xi-Shu used Chái Hú as they saw this pattern as a Shào Yáng-Tài Yīn concurrent pattern, and added Chái Hú to clear Shào Yáng heat from the chest. I personally use Sāng Bái Pí, as I feel that due to the flaring of ministerial fire, there is a bit of heat in the lungs and adding Sāng Bái Pí ensures that it gets cleared but also that metal descends. With the Spleen-earth affected, ascent and descent in the entire body is affected and we always need to make sure that the proper physiological wheel keeps turning. 

Zé Xiè Tāng from the Jīn Guì Fāng Gē Kuò

Zé Xiè Tāng
Alisma Decoction

治心下有支飲, 其人苦冒眩者, 主之。
A treatment for propping rheum below the heart, where the person suffers from veiling dizziness, (this formula) rules it.  

澤瀉五兩            白朮二兩
zé xiè
bái zhú
上二味, 以水二升, 煮取一升, 分溫再服。
Simmer the two ingredients above in 400 ml, until reduced to 200 ml.  Divide and take heated in two doses.   

Song 歌曰:

清陽之位飲邪乘, 眩冒頻頻苦不勝; 澤五為君朮二兩, 補脾制水有奇能。

The location of clear yáng has been overwhelmed by the presence of pathogenic rheum, causing (one to) suffer from frequent veiling dizziness which is difficult to endure; fifteen grams of the sovereign zé xiè and six of bái zhú, have the special ability of supplementing the spleen and controlling water.

Commentary by Lín Lǐfēng[1] 受業林禮豐按

心者, 陽中之陽。  頭者, 諸陽之會。  人之有陽氣, 猶天之有日也。  天以日而光明, 猶人之陽氣會於頭而目能明視也。  夫心下有支飲, 則飲邪上蒙於心, 心陽被遏不能上會於巔, 故有頭冒目眩之病。  仲師特下一“苦”字, 是水陰之氣\\盪漾於內, 而冒眩之苦有莫可言傳者, 故主澤瀉陽。  蓋澤瀉氣味甘寒, 生於水中, 得水陰之氣而能利水, 一莖直上, 能從下而上, 同氣相求, 領水陰之氣以下走, 然猶恐水氣下而復上, 故用白朮之甘溫土制水者以諸之, 猶治水者之必筑堤防也。  古聖用方之妙, 有如此者; 今人反以澤瀉利水伐腎, 多服傷目之說疑之。  其說創於宋元諸醫, 而李時珍、 張景岳、 李士材、 汪讱庵輩和之, 貽害至今弗熄。  然天下人信李時珍之《本草》者, 殆未讀《神農本草經》耶? 余先業師《神農本經小注》最詳, 願業斯道者, 三復之而後可。

The heart is yáng within yáng; the head is the gathering place of all yáng.  Humans have yáng qì, as heaven has the sun.  Heaven, by means of the sun is bright, as such human\’s yang qì gathers in the head and eyes providing bright vision.  When there is propping rheum below the heart, water rheum will ascend and cloud the heart obstructing heart yáng, which is (then) unable to gather at the top of the head, causing dizziness and dizzy vision.  Master Zhòng used the following character “” () to convey the suffering of dizziness, (resulting from) the qì of water yīn agitating and flowing into the interior. This is ruled by zé xiè tāng.  The qì and flavor of zé xiè tāng is sweet and cold, and since it grows in water, where it obtains the qi (of water yīn), it is able to disinhibit water.  (Similar to the way) the stalk ascends vertically it can (help) bring the qì together from the bottom to the top and guide the qì of water yīn in its downward movement.  However (with) fear of water rising again after it has descended, sweet and warm bái zhú is used so earth can restrain the various forms of water so while still treating water, an embankment is built.  The ancient sages were very clever in using formulas like these.  
People nowadays, are administering copious amounts of zé xièto disinhibit water and quell the kidneys, which damages the objective (of this) doctrine and (creates) doubt (of its effectiveness).  This doctrine began with the physicians of the Sóng[2]and Yuàn[3]dynasties, as well as contemporaries such as Lǐ Shízhēn[4], Zhāng Jǐngyuè[5], Lǐ Shìcái[6], and Wāng Rènān[7], who have left a legacy, which has yet to die even to the present day.  Even though people of the world trust the words of Lǐ Shízhēn’s Běn Cǎo, why have almost (none of them) read the Shén Nóng Běn Cǎo Jīng?  My passed masters’ copy of the classic was annotated with extreme detail, and it is my hope that one follows this way in their course of study, repeatedly returning to (the classic).

[1] Lín Lǐfēng was believed to be a student of Chén Xiūyuán. The characters 受業can be translated as ‘to receive instructions’, ‘to study’, ‘to learn from a master’, or as a first pronoun as ‘I’, or ‘your student’, often used as a title by a teachers’ disciple. I have opted to translate this as the latter, but in the interest of keeping the translation clean, have left is as commentary by Lín Lǐfēng, as opposed to ‘Commentary by I (your student) Lín Lǐfēng’.
[2] Sòng Dynasty (960–1179 A.D.)
[3] Yuán (Mongol) Dynasty (1260–1368 A.D.)
[4] Lǐ Shízhēn (1518-1593), Míng botanist and pharmacologist, as well as the author of the Compendium of medical herbs 本草綱目
[5]Late Míng dynasty physician who wrote several books including the ‘Rectification of the Materia Medica’本草正
[6] Míng dynasty phyisician who wrote several books including the ‘Essential Knowledge from the Inner Classic’經知要
[7] Wāng Áng (1615-1694), Late Míng and early Qīng dynasty physician who wrote the ‘Essentials of the Materia Medica’ 本草備要

膠艾湯 Jiāo Ài Tāng from the Jīn Guì Fāng Gē Kuò

The following is another teaser from the book, which will most likely be the last, as we are literally in the final stages of publishing.  The book should be set free into the world within the next few


Jiāo Ài Tāng

Donkey-Hide Gelatin and Mugwort Decoction


A treatment for women with [either] spotting, incessant blood descent following late miscarriage, or blood descent in pregnancy. If [there is] abdominal pain in pregnancy, [then] this is uterine obstruction, and this decoction rules it.

乾地黃(六兩)川芎   阿膠     甘草(各二兩)艾葉   當歸(各三兩)芍藥(四兩)

gān dì huáng



chuān xiōng



ē jiāo



gān cǎo



ài yè



dāng guī



sháo yào



上七味,以水五升、 清酒三升,合煮取三升,去滓,內膠令消盡,溫服一升,日三服,不差更作。

Simmer the seven ingredients above in 1,000ml of water with 600ml of clear wine, until reduced to 600ml. Remove the dregs, and dissolve the ē jiāo in the decoction. Take 200ml warm, three doses per day, and repeat if [the condition] fails to resolve.

Song 歌曰:


Abdominal fullness in pregnancy with fetal obstruction, this is called fetal obstruction, which is the result of qì and blood vacuity with cold, which hinders the growth and development of the fetus. Six grams chuān xiōng*,  gān cǎo, and ē jiāo, nine grams each of dāng guī and ài yè, twelve of sháo yào, and eighteen of dì huáng eliminates the tip of the branch.

Commentary by [Chén] Yuánxī男元犀按:

芎藭、 芍、 地,補血之藥也;然血不自生,生於陽明水谷,故以甘草補之。阿膠滋血海,爲胎産百病之要藥;艾葉暖子宮,爲調經安胎之專品,合之爲厥陰、 少陰、 陽明及衝任兼治之神劑也。後人去甘草、 阿膠 、艾葉,名爲四物湯,則板實而不靈矣。

Chuān xiōng , sháo yào, and dì huáng are blood-supplementing medicinals. Blood is not generated on its own, but is engendered from water and grains in yángmíng therefore, gān cǎo is used to supplement [yángmíng]. Ē jiāo enriches the sea of blood, and is a very important medicinal for treating various pregnancy related diseases. Ài yè warms the uterus, and is a specific medicinal to regulate menstruation and calm the fetus. This is a divine formula, which unites juéyīn, shàoyīn and yángmíng, and simultaneously treats the thoroughfare and controlling vessel. In later times, people have removed the gān cǎoē jiāo and ái yé, renaming it Sì Wù Tāng, making this formula stiff, bound and ineffective!

*Although the Chinese above says xiōng qiáng 芎藭, I have opted to translate this medicinal using its alternate, more common name chuān xiōng 川芎, and will appear as such in the remainder of the text.

溫經湯 Wēn Jīng Tāng (Channel Warming Decoction)

It’s been a while since I’ve posted anything up here. Now it’s not that I’ve been intentionally neglecting the site, but these days have been quite busy moving house, finishing up my book, and well, life!

Here’s another teaser from my upcoming translation of Chén Xiūyuán’s Jīn Guì Fāng Gē Kuò (Formulas from the Golden Cabinet with Songs), which should be released this summer. 

Wēn Jīng Tāng
Channel Warming Decoction
治婦人年五十所, 病下利數十日不止, 暮即發熱, 少腹裡急, 腹滿, 手掌煩熱, 唇口乾燥, 此屬帶下。  何以故? 曾經半產, 瘀血在少腹不去。  何以知之? 其証唇口乾燥, 故知之, 當以此湯主之。
A treatment for women in their fifties who suffer from incessant diarrhea more than ten times per day, with heat effusion in the evening, lesser abdominal urgency, abdominal fullness, vexing heat in the palms, and dry lips and mouth. This belongs to women’s diseases. What is the reason?  There was a history of late miscarriage and static blood now remains in the lesser abdomen.  How can one know this?  The pattern manifests with dry lips and mouth, and this is how one knows this, and this formula rules it.
吳茱萸(三兩)當歸   芎藭   芍藥   人參   桂枝   阿膠    丹皮    甘草(各二兩)生薑(三兩。  一本二兩)半夏(半升。  一本二升)麥冬(一升)
wú zhū yú
dāng guī
xiōng qióng
sháo yào
rén shēn
guì zhī
ē jiāo
dān pí
gān cǎo
shēng jiāng
bàn xià
mài dōng
十二味, 以水一斗, 煮取三升, 分溫三服。  亦主婦人少腹寒, 久不受胎; 兼治崩中去血, 或月水來多, 及至期不來。
Simmer the eleven ingredients above in 2,000ml of water until reduced to 600ml. Divide and take heated in three doses. It also rules (the treatment) of lesser abdominal cold in women, infertility, and simultaneously treats flooding, copious menstruation, as well as delayed menstruation.
Song 歌曰:
溫經芎芍草歸人, 膠桂丹皮二兩均, 八物各二兩  半夏半升麥倍用, 吳茱萸三兩對君陳。
For wēn jīng tāng (use) chūan xiōng, sháo yào, gān cǎo, dāng guī, rén shēn, ē jiāo, guì zhī, and dān pí each at six grams,  (6 grams for each of the eight medicinals). Use 100ml of bán xiá and double of mài dōng, plus nine grams each of shēng jiāng and wú zhū yú.
Commentary by (Chén) Yuánxī男元犀按:
方中當歸、芎藭、 芍藥、 阿膠, 肝藥也; 丹皮、 桂枝, 心藥也; 吳茱萸, 肝藥亦胃藥也; 半夏, 胃藥亦衝藥也; 麥門冬、 甘草, 胃藥也; 人參補五臟, 生薑利諸氣也。  病在經血, 以血生於心, 藏於肝也, 衝為血海也。  胃屬陽明, 厥陰衝脈麗之也。  然細繹方意: 以陽明為主, 用吳茱萸驅陽明中土之寒, 即以麥門冬滋陽明中土之燥, 一寒一熱, 不使偶偏, 所以謂之溫也; 用半夏、 生薑者, 以薑能去穢而胃氣安, 夏能降逆而胃氣順也; 其余皆相輔而成溫之之用, 絕無逐瘀之品。  故過期不來者能通之, 月來過多者能止之, 少腹寒而不受胎者並能治之, 統治帶下三十六病, 其神妙不可言矣。
Within the formula, dāng guī, chūan xiōng, sháo yào and ē jiāo are all liver medicinals; dān pí and guì zhī are heart medicinals; wú zhū yú is both a liver and stomach medicinal; bán xiá is both a stomach and thoroughfare (vessel) medicinal; mài dōng and gān cǎo are stomach medicinals; rén shēn supplements the five viscera, and shēng jiāng disinhibits all qì. Disease is in the menstrual blood. Blood is engendered in the heart, stored in the liver, and the thoroughfare vessel is the sea of blood. The stomach belongs to yáng míng, and is linked[3]to both the jué yīn and the thoroughfare vessel. Now (we must) carefully examine the meaning of the formula. As (the condition) is ruled by yáng míng, wú zhū yú is used to expel cold from yáng míng center earth, while mài dōngenriches dryness within yáng míng center earth – one cold and one hot medicinal. (While being) neither too cold nor too warm, (the formula) is (still) referred to as warm. As for the usage of bán xiá and shēng jiāng, shēng jiāng eliminates foulness and calms stomach qì, while bán xiá is able to downbear counterflow and smooth stomach qì. The remaining (medicinals) are used to assist in warming, and are by no means ingredients for expelling stasis. Therefore, with delayed menstruation, (this formula) is able to free it and with excessive menstruation, it is able to stop it.  It is (also) able to treat lower abdominal cold and infertility, and for the thirty-six women’s diseases, its marvel is too wonderful for words!

[1]Another edition uses 6g
[2]Another edition uses 400ml
[3]: , 此為相聯系。 Here the character (Lí) implies connection, integration, or linkage.

Kidney Fixity Disease (腎著病)

What is Kidney Fixity disease? %E9%99%B3%E4%BF%AE%E5%9C%93.jpg

Kidney fixity or as it is sometimes translated Kidney stickiness, is basically cold pain and heaviness in the lumbar region that prevents (one) from normal turning and is exacerbated by yīn-type (dull-wet) weather, attributed to kidney vacuity cold-damp becoming “fixed” in the inner body. 1

The typical formula used to treat this condition is Gān Cǎo Gān Jiāng Fú Líng Bái Zhú Tāng. I’d like to present a section from my upcoming translation of the Jīn Guì Fāng Gē Kuò (金匱方歌括)- Prescriptions from the Golden Cabinet with Songs and a couple case studies illustrating its use. 


Gān Jiāng Líng Bái Zhú Tāng

Licorice, Dried Ginger, Poria, and Ovate Atractylodes Decoction


Also called Kidney Fixity Decoction


A treatment for kidney fixity disease; where the patient experiences generalized heaviness and lumbar coldness, as if they are sitting in water.  Symptoms resemble those of water disease, yet there is no thirst, urination is uninhibited, and eating and drinking are normal. This means that the disease is in the lower burner.  Physical taxation with sweating leads to cold and dampness in the clothes, and over an extended period of time manifests with cold pain below the waist, and abdominal heaviness as if carrying five thousand coins.  This formula rules it.  

甘草    (各二兩)乾薑 茯苓(各四兩)

gān cǎo



bái zhú


gān jiāng



fú líng




Simmer the four ingredients above in 1000ml of water until reduced to 600ml.  Divide and take warm in three doses, until the lumbus feels warm. 

Song 歌曰:

腰冷溶溶坐水泉帶脈束於腰間腎著則腰帶病故溶溶如坐水中狀。  腹中如帶五千錢朮甘二兩薑苓四寒濕同驅豈偶然?

Lumbar coldness as if sitting in gently flowing water springs.

The girdling vessel binds around the lumbus.

With kidney fixity there is disease in the waist, which therefore brings the feeling as if one is sitting in water.

The abdomen feels as if it is carrying five thousand coins,

(With) six grams each of bái zhú and gān cǎo, and twelve of gān jiāng and fú ling,

is it by chance that both cold and dampness are expelled?

Quotation by Yóu Zàijīng 2 尤在涇雲:

寒濕之邪不在腎之中臟而在腎之外府故其治不在溫腎以散寒而在燠土以勝水。  若用桂、 則反傷腎之陰矣。

Cold-damp evils are not located in the kidney viscera but in the external dwelling of the kidneys.  Therefore, treatment need not involve warming the kidneys in order to dissipate cold, but to warm earth to prevail over water.  If guì zhī, or fù zǐ were used, then kidney yīn would be damaged!

Case #1

A fifty-four year-old male patient presented at the clinic with cold lumbar pain, which felt as if he were immersed and sitting in water. In addition, he had little desire to eat or drink, and his bowel movements were thin and loose.  Tongue coating was white and his pulse was soggy and moderate. This is a pattern of cold dampness fixed in the musculature of the lower back. The lumbus is the house of the kidney, and (this condition) is what is referred to in the jīn guì yào lüè as kidney fixity disease. It is suitable here to treat by warming the center, dissipating cold, strengthening the spleen and drying dampness with the formula gān cǎo gān jiāng fú líng bái zhú tāng (Licorice, Ginger, Poria and Atractrylodes Macrocephala Decoction).

gān jiāng (Zingiberis Rhizoma) 6g

gān cǎo (Glycyrrhizae Radix) 3g

fú líng (Poria) 10g

bái zhú (Atractylodis macrocephalae Rhizoma) 10g

Five packages were administered.  This patient also received local treatment with moxibustion.

Afterwards his appetite had increased and his bowel movements were now formed.

He was given another five packages of the formula above with 12g of dǎng shēn (Codonopsis Radix) added.

After finishing the formula his back pain had completely resolved.

Taken from page 193 of the ‘Simple Commentary on the Jīn Guì Yào Lüè’ (金匮要略浅述) by Tán Rì-Qiáng (谭日强)

Case #2

A fifty-year old male patient presented with aching pain in his lower back and legs.  In addition, he experienced a fear of cold, and heaviness of both legs after walking. His pulse was deep, moderate and lacking strength, and his tongue was slightly enlarged with a slippery-white coating. A yīn pulse is typically deep, and therefore this is a pattern of shào yīn yáng qì vacuity. A moderate pulse is typically associated with dampness, and therefore this is also a tài yīn spleen yáng weakness pattern. This pattern is what is referred to in the jīn guì yào lüè as kidney fixity disease. He was administered:

fú líng (Poria) 30g

bái zhú (Atractylodis macrocephalae Rhizoma) 15g

gān jiāng (Zingiberis Rhizoma) 14g

zhì gān cǎo (Glycyrrhizae Radix preparata) 10g

After taking twelve packages of the formula his legs started feeling warmer and his fear of cold, leg heaviness after walking, and pain had completely resolved.

Taken from page 145 from the Selected Clinical Case Studies of Liú Dù-Zhōu’ (劉渡舟臨証驗案)

1. (Practical Dictionary of Chinese Medicine, Wiseman et al. pg.326)

 2. Yóu Zàijīng (尤在涇) (?-1749), was a well known Qíng dynasty scholar-physician from cháng zhōu (modern day wú county in jiāngsū province), who had written several commentaries on hàn dynasty medical literature, including the Jīn Guì Yì (金匮翼), Appendices to the Golden Cabinet.

Yáng Dàn Tāng (陽旦湯) Yáng Dawn Decoction from the Jīn Guì Fāng Gē Kuò

As I am approaching close to 18 months of ardently working on the translation of the second volume of Chén Xiū-Yuàn’s Jīn Guì Fāng Gē Kuò (Formulas from the Golden Cabinet with Songs), I thought it was due time to share a small tidbit of the material.  I am getting quite close to finishing the text and it should be out sometime in the next few months.  

陽旦湯Jīn Guì Fāng Gē Kuò.jpg

Yáng Dàn Tāng

Yáng Dawn Decoction

治產後中風續續數十日不解頭微疼惡寒時時有熱心下悶乾嘔汗出 ,雖久陽旦症續在者可與之。  即桂枝湯增桂加附。  坊本謂加黃芩者未知《傷寒論》太陽篇中已明其方孫真人及各家俱誤。  桂枝湯見《傷寒論》。

A treatment for post-partum wind strike that remains unresolved for several tens of days with, a mild headache, aversion to cold, frequent heat effusion, oppression below the heart, dry retching, and sweating. Even though (the condition) has persisted for a long time, yáng dàn tāng signs are still present, and can be given. (This formula) is guì zhī tāng with increased guì zhī and the addition of fù zǐ.

An old block-printed version of the text refers to this formula as (guì zhī tāng) with the addition of huáng qín, but it is unknown whether this is the same tài yáng formula as in the Shāng hán lùn. Master Sūn Sīmiǎo and various others believed it to be so (for which) they were mistaken. For guì zhī tāng see the Shāng Hán Lùn.

 Commentary by (Chén) Yuánxī 男元犀按:

頭痛發熱、 惡寒汗出太陽表症也。  心下悶者太陽水邪彌漫心下而作悶也。  陽旦湯即桂枝湯倍桂枝加附子。  雖産後數十日不解其邪仍在於太陽之經故仍用桂枝湯解太陽之表邪加桂以化膀胱之水氣加附子以溫固水臟使經臟氣化則內外之邪出矣。  《傷寒論》桂枝加附子治漏汗加桂治氣從少腹上衝心去芍治胸滿俱有明文可據。  孫真人以桂枝湯加黃芩爲陽旦湯其意以心下悶爲熱氣誤矣。  夫有熱氣則當心煩今日心下悶則非熱可知矣。  況微惡寒時時有熱乾嘔汗出爲太陽桂枝湯之的症。  蓋太陽底面便是少陰續續至數十日不解顯系少陰之君火微而水寒之氣盛寒氣上淩陽位是以爲心下悶之苦。  故取桂枝湯增桂以扶君主之陽加附子以鎮水陰之逆使心陽振水臟溫則上逆之陰邪不攻而自散矣。

Headaches, heat effusion, aversion to cold, and sweating are symptoms associated with a tài yáng exterior pattern. (With) oppression below the heart, tài yáng water evils pervade (the area) below the heart and cause oppression. Yáng dàn tāng is guì zhī tāng with double the guì zhī and the addition of fù zǐ. Although there is a lack of resolution ten days post partum, evils are still located in the tài yáng channel, and it is for this reason that guì zhī tāng is used to resolve exterior evils in the tài yáng. Guì zhī is increased in order to transform water qì in the bladder.  Fù zǐ is added to the formula to warm and secure the water viscus, enabling the transformation of qì in the channels and viscera, and ensuring the expulsion of evils in both the interior and exterior. In the Shāng Hán Lùn, guì zhī jiā fù zǐ tāng is used to treat leaking sweat; increasing guì zhī treats surging qì from the lesser abdomen into the heart, and removing sháo yào treats chest fullness. These (principles) are in accordance with the (original) writings. (According to) master Sūn (sīmiǎo), yáng dān tāng is guì zhī jiā huáng qín tāng, (as he felt that) oppression below the heart was due to hot qì; this is a mistake! Now if there were hot qì, then there would be heart vexation, (but) presently with the oppression below the heart, we know there is no heat!  Moreover, slight aversion to cold, and frequent heat (effusion), dry retching, and sweating, is a guì zhī tāng tài yáng presentation. In all (cases) of tài yáng, there is shào yīn at the bottom, and with continuous (wind strike) reaching ten days without resolution, there is a clear relation to the debilitation of shào yīn sovereign fire, with exuberance of cold water qì. Cold qì ascends and encroaches into the position of yáng, resulting in oppression below the heart. Therefore, guì zhī tāng with increased guì zhī, supports sovereign yáng, and with the addition of fù zǐ counterflow of water yīn is settled, heart yáng is vitalized, and the water viscus is warmed.  Then, ascending counterflow of yīn evils will not attack, and dissipate on their own!

Xiè Xīn Tāng (Heart Draining Decoction)-泄心汤

From the ‘Interpretation of the Jīn Gùi Yào Lüè’ by Sòng Jiàn-Píng (2009)

I am currently in the process of translating the second volume of the Jīn Guì Fāng Gē Kuò (金贵方歌括) by Chén Xiū-Yuán. I have been so immersed in it lately, that I feel I’ve been neglecting this site, and figured I should work on something to put up. Because of the intense amount of work and dedication this book requires, I figured it would make more sense to translate something I’ve been using as reference, helping myself and others elucidate the deeper meaning behind the formulas discussed in the text. The following is the small section on Xìe Xīn Tāng, for which I recently worked on. I’ve had a bit of a hard time with the line “heart qi insufficiency” (心气不足), as I’ve read several commentaries, including the Qiān Jīn Fāng, which state that this is a typo, and the actual line should read, 心气不定 (heart qi instability/unsettled). Neither one of these still make immediate sense to me, but I am getting closer to understanding what it means and it’s pathological/physiological implications. Since I am still processing and working with this line, I’ll share my thoughts on a later date. I’d love to get other perspectives in the comments section.

[Original Text]  
“(When) heart qì is insufficient, with blood ejection and spontaneous external bleeding, Xiè Xīn Tāng masters it”. (JGYL 17)

Xiè Xīn Tāng also treats sudden turmoil (cholera) disease

Dà Huáng 2 liǎng
Huáng Lián 1 liǎng
Huáng Qín 1 liǎng

Use 3 shēng of water for the three ingredients above, boil until reduced to one shēng, and take in one single dose.

[Comparisons] Heart qì vacuity: In the Qiān Jīn Fāng it is written as heart qì instability/unsettled) (心气不定)

[Presentation] A treatment for patterns of blood ejection and spontaneous external bleeding due to exuberant heat.

[Explanation] Both blood ejection and spontaneous external bleeding are categorized as exuberant heat patterns. The heart stores the shén, and governs the blood vessels. If heart fire is exuberant, it will cause frenetic movement of the blood, which results in blood ejection and spontaneous external bleeding. If the spirit is harassed there will be vexation and disquietude. Xiè Xīn Tāng is the treatment of choice, which clears heat and discharges fire. Within the formula, Huáng Lián and Huáng Qín clear heat, downbear fire, and discharge heat from the heart channel, so heart blood can quiet down on it’s own. Dà Huáng is bitter, cold, downbearing and discharging. It causes the descent of fire qi so blood can be calmed and stop moving frenetically. When these three medicinals are combined, they directly break heat, downbear fire, and stop bleeding.

[Commentary] Xiè Xīn Tāng and Bǎi Yè Tāng both treat blood ejection, however, Bǎi Yè Tāng mainly treats blood ejection due to central qì vacuity cold. Typical signs seen with this presentation are a somber white facial complexion, lassitude of spirit and fatigue, pale tongue body with a white coating, and a vacuous weak pulse. Xiè Xīn Tāng treats blood ejection due to exuberant heat, which is typically accompanied with heart vexation and disquietude, a red complexion, red tongue body, vexation thirst, constipation, a rapid pulse, etc. The two prescriptions above introduce us to two major methods and treatment principles for the treatment of blood ejection. One to warm yáng and restore qì, and one to discharge fire and clear heat in order to stop bleeding. In regards to Xìe Xīn Tāngs’ treatment of blood heat with frenetic movement, bleeding can manifest in several different ways including, vomiting of blood (hematemesis), external bleeding, blood in the urine (hematuria), blood in the stools (hemafecia), etc. which can all be treated quite effectively.

This is a commonly used formula for treating exuberant heat in the three burners, and is used clinically for the congestion of pathogenic-toxic fire and heat causing disorders in either the upper or lower burners, or the exterior or interior. Examples being, the upward harassment of toxic heat causing a red complexion and tongue, ulcerations of the mouth and tongue, tooth swelling and pain, vexation heat, and oppression in the chest, or toxic heat manifesting on the exterior with skin damage due to swollen and toxic sores.

[Case Example] A sixty-year-old female patient presented on April 20, 1994. She has a history of a duodenal ulcer for many years, and has recently been quite fatigued, with unbearable epigastric pain. This morning after eating breakfast, she immediately felt nauseous and had a desire to vomit. Soon after she vomited approximately 300ml of fresh blood, which contained stasis clots but no food from her digestive tract. She has continued to feel nauseous and has been vomiting blood quite frequently up until the time of her consultation. Her tongue was red, with a thin yellow coating, and she had a wiry-slippery-rapid pulse. The diagnosis was blood ejection. The pattern belonged to heat accumulation in the stomach causing frenetic movement of the blood. Treatment involved clearing the stomach, discharging heat, transforming stasis, and stopping bleeding.


Dà Huáng 30g
Huáng Qín 9g
Huáng Lián 9g
Dài Zhě Shí 30g

The medicinals above were to be decocted (and drunk) quickly

After taking the formula, the vomiting of blood stopped, and the epigastric pain decreased. She was continued on two more packages of the formula to clear the remaining pathogens.

(Luó Wèi Dōng: Effective Treatments with Classical Formulas, vol. 4.)