Treatment of Prostatic Hyperplasia with Zhēn Wǔ Tāng

Lú Chónghàn [卢崇汉]

From ‘The Complete Interpretation of Case Studies from Chinese Medicines’ Fire Spirit School’


Case: Eto, 58 years old, Japanese patient, presented with prostatic hyperplasia, which manifested with frequent, urgent and difficult urination for six years. Symptoms had been increasing over the last two to three years. Symptoms were worse in the afternoon with an inability to hold his urine in and frequent urination. In addition, he suffered from nocturia up to fifteen-sixteen times a night, scanty urine and and a weak flow. Every time he would urinate, he would have to wait three to five minutes and this was accompanied by lower abdominal swelling and distention. 

Doctor Lu always treats based on the tongue, coating and pulse. [This patients] tongue body was pale and swollen with teeth marks along the edges, tongue coating was white, slippery and slimy, and pulse was deep and moderate with a lack of strength on deeper palpation. Doctor Lu felt that this was due to kidney yang weakness and debilitation as well as the settling and obstruction of water-dampness. Treatment method involved warming yang and disinhibiting water with Zhen Wu Tang [真武汤]. 

Zhi Fu Pian 75g (pre-cooked for two hours) 

Sheng Bai Zhu 15g

Fu Ling 25g

Yin Yang Huo 20g

Sheng Jiang 60g


After one package, his urine volume increased, frequency decreased, and flow was smooth. After three packages, his urination was very smooth, nocturia reduced to two times, but he still felt that the strength of his urination was not good. 

At the second consult, 25g of Gui Zhi was added, which had increased the strength of urinary flow. 

At the third consult, 15g of Sha Ren was added in order to absorb the qi of the five viscera into the kidneys. All together thirty packages were taken, at which point the condition had completely improved, urination was normal, nocturia occurred once a night, and urination felt more vigorous. 

Lu Chonghan believes that prostatic hyperplasia, occurs in middle aged and elderly patients, because middle aged and elderly patients’ yang qi has declined and qi transformation is deficient. Because qi transformation is deficient, this results in stoppage and obstruction of water-damp, which follows the Shaoyang triple warmer, descends, and settles in the anterior yin, eventually resulting in prostatic hyperplasia and swelling, leading to difficult urination. When serious this can cause blockage and stoppage which can result in dribbling urinary block. From the perspective of the root and branch, kidney yang vacuity and debilitation and deficient qi transformation are the root, while the pressure in the urinary tract, obstruction and lack of flow are the branch. Therefore, by grasping the root, we must warm yang, transform qi, disinhibit water and drain turbidity. Zhen Wu Tang is Zhongjing’s formula for Shaoyin yang vacuity, with water-damp collecting internally. When used for middle-aged and elderly patients with prostatic hyperplasia, the results are typically quite ideal. 


In clinical practice, Zhen Wu Tang is commonly used with variations, here using Yin Yang Huo as a substitute for Bai Shao. Acrid and majorly hot Fuzi is used to strengthen kidney yang, and is able to support and overcome kidney water, which causes the exuberance of the qi of true yang, so that qi transformation moves and turbid yin can be dispelled. Shengjiang can warm the stomach and dissipate water, as well as open and diffuse lung qi, which opens the upper water-gate, achieving the objective of opening the source of water (the lungs are the upper source of water). Baizhu can move the spleen and eliminate dampness. When the spleens’ function of moving dampness is improved, water can be properly controlled. Fuling is used to blandly percolate and disinhibit water, which regulates the middle burner. This leads to the outward expelling of turbid dampness. Yin Yang Huo guides yang into yin, frees and disinhibits the blood vessels and resolves hypertonicity in the sinews, thereby achieving the objective of freeing the waterways. When these medicinals are combined, the functions of the five viscera are all regulated and rectified, the yang of qi transformation is strengthened, and the qi transformation mechanism is initiated. 


How do we determine if the disease is caused by a yang vacuity? We can [diagnose it] based on the tongue, [tongue] coating, and pulse. If the tongue body is swollen and pale, with teeth marks, and the coating slippery, slimy, and white, or if the coating is white underneath and dry and yellow at the surface. From the perspective of the pulse, when the pulse is deep-slow, deep-moderate, or deep-weak, these all belong to Shaoyin yang vacuity and it can be determined that there is water-damp obstruction, which is yin cold obstruction. This is an extremely reliable pattern indicator. If turbid yin is not transformed and resolved, this easily causes settling and obstruction, which can manifest in the tongue. As a result, the tongue will commonly have teeth marks. If the tongue coating is white and slippery, this is a manifestation of a yang vacuity and loss of the warming and transformation function of true yang. When the tongue coating is white and slimy, this is a manifestation of yang vacuity cold damp obstruction in the lower burner. When the coating is white underneath and dry and yellow at the surface, this indicates that enduring damp depression is beginning to transform into heat. Although there is transformation into heat, the patient’s root pattern is still one of yang vacuity insufficiency, and in clinical practice, one must be aware of this. A deep pulse is due to yang vacuity. If all these tongue, [tongue] coating, and pulse signs exist, we can determine that the underlying patho-mechanism is one of yang vacuity damp obstruction. 

Huáng Yuányù on Guìzhī

桂枝 味甘、辛,氣香,性溫,入足厥陰肝、足太陽膀胱經。入肝家而行血分,走經絡而達營郁,善解風邪,最調木氣,升清陽脫陷,降濁陰沖逆,舒筋脈之急攣,利關節之壅阻,入肝膽而散遏抑,極止痛楚,通經絡而開痹澀,甚去濕寒,能止奔豚,更安驚悸。


Sweet and acrid flavour, with a fragrant qi and warm nature. Enters the foot Jueyin liver and foot Taiyang bladder channels. [By] entering the liver domain it moves the blood layer and the channels and network vessels, as well as outthrusts depressed nutritive [qi]. [It is] excellent at resolving wind pathogens, and most excellent at regulating wood qi. It ascends clear yang, which has fallen and deserted, as well as downbears turbid yin, which has resulted in turbid counterflow. Guìzhī soothes tension and hypertonicity in the sinews and disinhibits congestion and obstruction in the joints. By entering the liver and gallbladder it dissipates and restrains, which results in the resolution of pain. It frees the channels and network vessels thereby opening impediment, excels at eliminating damp-cold, is able to alleviate running piglet, and calms fright palpitations. 

The above short little ditty on this beautiful herb, is an example of some of the rich textual works we’ll be covering in my upcoming class on the Guìzhī formula family. For anyone interested in being notified about these classes and any upcoming ones, please feel free to add yourself to my newsletter list by clicking here!

On Gé Gēn 葛根

Gé Gēn (Radix Puerariae)

《神农本草经》: 味⽢,平。主消渴,⾝⼤热,呕吐,诸痹,起阴⽓,解诸毒。
[Shén Nóng Běn Cǎo Jīng]: Sweet flavour, and neutral Qi. Governs dispersion thirst, major body heat, vomiting, and various kinds of impediment. It raises the Yīn Qì and resolves all toxins.

[Míng Yī Bié Lù (Táo Hǒngjǐng – 456-536)]: “[It] has no toxicity. It governs the treatment of cold damage and wind strike headache; [it] releases the muscles, effuses the surface and promotes sweating; [it] opens the interstices, heals metal sores, stops pain and [treats] subcostal wind pain.”

Lǐ Dōngyuán (1180-1251) said: “Gé Gēn is sweet, neutral and warm; common people, at the onset of a taiyang disease pattern, give Gegen Shengma Tang, this is incorrect.”

(Wáng) Hǎogǔ (1200-1264) said: “It’s qi is neutral and flavour sweet, [for it] ascends, and is yang. Gé Gēn is a medicinal which moves the Yangming channel.”

Zhāng Zhìcōng (1616-1674): “sweet and acrid, white when powdered, therefore enters Yangming; the skin is black and flower red, and so unites with Taiyang. Therefore, Gé Gēn is able to diffuse and outthrust the qi of yangming center earth, and unite the taiyang channel on the exterior.”

[Essentials of the Materia Medica (Wáng Āng 1664)]: “[Gé Gēn] Lightly effuses and resolves the muscles, ascends yang, and scatters fire.”

(唐宗海 : “根深能引⽔⽓上达苗叶,故兼能升津液也.”
Táng Zōnghǎi (1846-1897): “[The] Deep roots [of Gé Gēn] are able to carry water qi upwards into the sprouts and leaves, [and is] therefore able to ascend fluids.”

According to Professor Huáng Huáng, patients that respond well to Gé Gēn formulas have the following characteristics.

  • Big, strong patients with thick, strong muscles
  • Slightly overweight
  • Heavy, cumbersome bodies
  • Coarse, thick skin
  • Hairy
  • Lazy appearance
  • Sallow, dark complexion

These patients have the following propensities:

  • Stiff neck and back due to tight muscles (tension in traps, levator scapula, sub-occipitals, etc.)
  • Headaches (Taiyang – Yangming)
  • Heavy Head (cloudy, foggy, etc.)
  • Dizziness
  • Loose Stools
  • Heavy and Cumbersome body

To learn more about Ge Gen and its various formulas, click here to check out my Gé Gēn class

Gé Gēn Tāng Case – Liú Dùzhōu

Selected Clinical Case Histories of Liu Duzhou《刘渡舟临证验案精选》

Li X, a 38-year-old male.

He had suffered with persistent migraines for 2 years that remained unresolved despite long periods of treatment. He was introduced to Doctor Liu by a good friend and brought in for a consultation.

Chief complaint: right sided headaches, which commonly extended to the forehead and supraorbital ridge. This was accompanied by an absence of sweating, chills, a runny nose with clear mucus, irritability, a red complexion, dizziness, and poor sleep. The range of motion in his back was limited and he reported tightness in his neck and occipital area that became more severe during his headaches. His tongue was pale with a white coat, and his pulse was floating and slightly rapid.

This was differentiated as being cold pathogen lodged in the taiyang channels, resulting in symptoms of inhibited flow of channel qi.

Treatment required the promotion of sweat to expel pathogens, and unblock taiyang qi, so Kudzu Decoction (gé gēn tāng) was given:

Ephedrae Herba (má huáng) 4g
Puerariae Radix (gé gēn) 18g
Cinnamomi Ramulus (guì zhī) 12g
Paeoniae Radix alba (bái sháo) 12g
Glycyrrhizae Radix praeparata (zhì gān cǎo) 6g
Zingiberis Rhizoma recens (shēng jiāng) 12g
Jujubae Fructus (dà zǎo) 12 pieces.

Ephedrae Herba (má huáng) and Puerariae Radix (gé gēn) were to be decocted first with the froth removed before adding the other ingredients. After taking the decoction, the patient was covered up so a slight sweat could be obtained. He was to avoid drafts and cold.

After taking 3 packets, his back felt warm, which was followed by a mild sweat throughout the body, and a reduction in his headache and neck tension. 15 packets of the same formula were prescribed again, which completely resolved his headaches and neck tension.

A Cháihú jiā lónggǔ mǔlì tāng case – Huáng Huáng

Wang, 58-year-old male, 186cm/64kg. 

Initial consultation on June 11, 2019. 

History: Patient had a history of stomach disease for over 30 years, accompanied by an inability to eat much food, stomach distention following meals, poor appetite, no desire to eat, coldness in the lower abdomen, a fear of cold, constipation, difficulty falling asleep, and a shallow, dream-disturbed sleep.  

Lab results: Gastroscopy on May 2, 2019, which revealed intermediate chronic atrophic gastritis with intestinal metaplasia in the lesser curvature of the gastric antrum and mild chronic atrophic gastritis with intestinal metaplasia in the greater curvature of the gastric antrum.  

Signs: Sallow complexion, distinct abdominal pulsations, a long face, indifferent expression, slightly thin build, red tip of the nose, and a thin-slippery pulse. 


Bupleuri Radix (chái hú) 15g, Scutellariae Radix (huáng qín) 10g, ginger-fried Pinelliae Rhizoma praeparatum (jiāng bàn xià) 10g, Codonopsis Radix (dǎng shēn) 15g, Cinnamomi Ramulus (guì zhī) 10g, Poria (fú líng) 15g, prepared Rhei Radix et Rhizoma (zhì dà huáng) 5g, Fossilia Ossis Mastodi (lóng gǔ) 15g, Ostreae Concha (mǔ lì) 15g, Zingiberis Rhizoma (gān jiāng) 5g, Jujubae Fructus (dà zǎo) 20g; 10 packets, 1 packet for 2 days. Taken right before bed. 

Second consultation on July 2, 2019: Patient now had a desire to eat, daily bowel movements, and decreased coldness in his lower abdomen. If he overate then he experienced abdominal distention, still had a fear of cold, woke easily due to a dream-disturbed sleep, and was fatigued. 

Prescription 1: Same formula; 1 packet to be taken over 2 days. 

Prescription 2: Bupleuri Radix (chái hú) 15g, Paeoniae Radix alba (bái sháo) 15g, Aurantii Fructus (zhǐ ké) 15g, Glycyrrhizae Radix (gān cǎo) 5g, dried Lilii Bulbus (bǎi hé gān) 30g; 10 packets of each, to be taken on an alternating basis. 

What is a Formula Presentation 方证?

The formula presentation is a theoretical model of herbal formula application that lies between the herbs and formulas on one hand, and the disease pattern on the other. It is the arrow aiming for the target in relation to disease treatment. The formula presentation is the guiding principle behind how a formula is selected. ‘Zheng’(证) refers to evidence, proof, results or efficacy (证验), and also symptoms (症状). Therefore, when all these definitions are taken together, the formula presentation refers to a formula’s key presentation, or instance where a formula displays its main efficacy or results.

Currently in China, many consider the earliest recording of this concept to be found in the Wu Shi Er Bing Fang (五十二病方, Prescriptions for Fifty-Two Diseases), yet many scholars believe that it wasn’t until Zhang Zhongjing’s (张仲景) writings that the concept really took hold, only to be further developed by later generations of physicians. The idea of a formula correspondence (方证相应) is seen in the postscript for line 317 of the Shang Han Lun (伤寒论, Treatise on Cold Damage) which states:

[Only when] the disease corresponds to the formula [can the formula] be taken.


This line offers the most succinct explanation and definition of a formula presentation and implies that all diseases have a corresponding formula, a ‘formula presentation.’ The Shang Han Lun also refers to specific ‘herb presentations’ (药证) such as a ‘Chai Hu (Bupleuri Radix) presentation’ (柴胡证), or a ‘Gui Zhi (Cinnamomi Ramulus) presentation’ (桂枝证). In addition, line 16 of the Shang Han Lun states: 

Observe the pulse and signs, know what error [you] have committed, [and then] treat according to the signs. 


The Shang Han Za Bing Lun (伤寒杂病论, Treatise on Cold Damage and Miscellaneous Diseases) was arguably the first text to suggest not just the concept of a formula presentation, but also the principle that became known as ‘determining treatment by patterns identified’ (辨证论治), which lays importance on not just simply knowing which formula treats specific signs, but also on having a clear understanding of the underlying pathomechanism involved. Once the pattern is clearly understood, the choice of the correct formula can be made. According to Professor Huang Huang (黄煌教授), once a formula presentation is clearly identified, not only will the formula be safe to use, but the treatment will also be effective. Following Zhang Zhongjing, physicians such as Sun Simiao (孙思邈), Zhu Gong (朱肱), Xu Lingtai (徐灵胎), Ke Qin (柯琴) and Yu Jiayan (喻嘉言) were highly influential in the ‘school of formula types’ (方类证派), adhering to the concept of ‘formula presentations with similar clauses’ (方证同条).  Song dynasty Zhu Gong referred to a formula presentation simply as a ‘herb presentation.’ The Japanese physician Todo Yoshimasu (吉益东洞) was a strict adherent to the model laid out by Zhang Zhongjing, and was a major contributor to the Japanese Classical Formula School (日本古方派). Although many of these physicians adhered to the formula presentation model, there are some differences in their overall approach and in the method with which they arrived at the presentation. For example, Ke Qin wrote: “Patterns are differentiated from the conformations, therefore the pattern is named after the formula” (证从经分,以方名证), referring to the six conformations (六经), while Xu Lingtai wrote: “In order to [determine] the formula presentation type, [one must] not differentiate according to the conformations” (以方类证,方不分经). While both used the formula presentation model as their method to choose a formula, Ke Qin recorded signs and symptoms exactly as they appear in the Shang Han Lun’s six conformations, while Xu Lingtai worked with general signs and symptoms.  Essentially, a formula presentation is experience: the experienced usage of herbs and formulas over thousands of years. 

Chén Xiūyuán on Gùi Líng Wǔ Wèi Gān Cǎo Tāng

Guì Líng Wǔ Wèi Gān Cǎo Tāng
Cinnamon Bark, Poria, Schisandra, and Licorice Decoction

治青龍湯下已, 多唾口燥, 寸脈沉, 尺脈微, 手足厥逆, 氣從少腹上衝胸咽, 手足痹, 其面翕熱如醉狀, 因復下流陰股, 小便難, 時復冒者, 與此湯, 治其氣衝。

A treatment for when after taking xiǎo qīng long tāng there is copious spittle, a dry mouth, a deep pulse at the inch opening and a faint pulse at the cubit position. [In addition] there is reverse counterflow in the hands and feet, qi surging up from the lower abdomen to the chest and throat, impediment in the extremities, a red flushed face as if drunk, and because of repeated downpour into the groin, there is difficult urination, and periodically recurring muddledness. Give this decoction to treat the surging qi.

按: 脈沉微, 支厥痹, 面如醉, 氣衝時復冒, 似少陰陰陽不交之症, 學者可於臨症時參辨之則可。

Commentary: [When there is] a deep and faint pulse, propping [rheum] with reversal impediment,
a face as if drunk, and qi surging with periodic muddledness, this resembles a pattern of
non-interaction between the yīn and yang of shaoyīn. When arriving at these patterns, students can
compare and differentiate these principles.

Guì Zhī 4 liǎng 桂枝
Fú Líng 4 liǎng 茯苓(各四兩)
Wǔ Wèi [Zǐ] 五味[子] 1/2 shēng(半升)
Zhì Gān Cǎo 3 liǎng 甘草(三兩, 炙)

上四味, 以水八升, 煮取三升, 去滓, 分溫三服。

Simmer the four ingredients above in 1,600ml of water, until reduced to 600ml. Remove the dregs, divide, and take warm in three doses.



Xiǎo Qīng Lóng Tāng may cause (further) depletion to the original (qì) of the kidney.
(Original kidney qi was debilitated, and (Xiǎo Qīng Lóng Tāng) was erroneously administered.  
This led to the stirring and surging of conception vessel fire,
which changed into one of the various patterns (which follow) administration].
Ascending counterflow with downpour, in addition to periodic muddledness,
[qi surging upward from the lower abdomen into the chest,
or a red flushed face as if drunk,
or warm qi flowing into the groin,
or difficult urination, and clouded veiling,
which fluctuate sharply, are (the result) of yáng not ruling,
and is unpredictable like the flickering of lightening].
100ml of wǔ wèi zǐ, twelve grams of fú líng and guì zhī,
and nine grams of gān cǎo, are suitable to support earth and settle the surging.

Commentary by (Chén) Yuánxī 男元犀按:

仲師五味子必與乾薑同用, 獨此方不用者, 以誤服青龍之後衝氣大動, 取其靜以制動, 故暫停不用也。 尤雲: 苓、 桂能抑衝氣使之下行, 然逆氣非斂不降, 故以五味之酸斂其氣, 土厚則陰火自伏, 故以甘草之甘補其中也。

Master (Zhàng) Zhōng Jǐng’s wǔ weì zǐ is always combined with gān jiāng (however) in this formula (gān jiāng) is not used. Following the erroneous administration of Xiǎo Qīng Lóng Tāng, there is major stirring of surging qì.  Take this (formula) to tranquilize in order to control the stirring, and once it stops, there is no need to (continue) taking it.  Yóu Zàijīng says: fú líng, and guì zhī are able to control surging qì allowing it to move downwards, and (if) counterflow qì fails to go down due to a lack of restraint, sour wǔ wèi zǐ is used to restrain it. (Once) earth is thickened, yīn fire will conceal on its own, and for this reason sweet gān cǎo is used to supplement earth.

Cáo Yǐngfǔ on the Use of Xiǎo Jiàn Zhōng Tāng 

Master Cao was a pivotal force in the classical formulas school (经方派) and was a true master in using the underlying principles and formulas found in the Shang Han Lun and Jin Gui Yao Lue. Master Cao felt that the medical texts, which followed were too insignificant to study and discuss, and therefore he attached great importance to the thorough study of these texts to his students, and felt that Zhang Zhongjing’s theories and formulas were the perfect framework for successful medical practice. In addition to being skillfully versed in these medical canons, Cao Yingfu was also an accomplished poet, often interweaving the two when attempting to convey his thought process in clinic, often instructing his students to compose a poem and matching it with a relevant line from the classics. This kind of inquiry and thought process truly shows the breadth of his skill and how his mind rarely waivered from the classical Chinese medicine concept of the human body being a reflection of his environment, the microcosm of the macrocosm.
However, master Cao was not completely strict in his formula choices and would often use formulas like Bu Zhong Yi Qi Tang, Xiao Yao San, and Liu Wei Di Huang Wan, in addition to herbs such as niu bang zi, qian hu and various others. This shows that he was obviously well read and did not quickly write off more modern formulas. His use of these non Zhang Zhongjing formulas displayed his deep understanding in the formula constructions and where they were applicable. He advocated that students must understand and study the root of the medical philosophies and not just pick the flowers, and it’s from this same feeling that he encouraged his students to read the Yue Fu (乐府诗集) poetry of the Han and Wei dynasties and specifically the poet Wang Yuyang (王漁洋).

When the Japanese invaded the south, his hometown of Jiangyin, Jiangsu province fell into enemy hands and on December 7th, 1937, he died heroically resisting the invaders. While master Cao died a hero, the world lost a great Chinese medicine master. We are very fortunate to have several of his books available in order for subsequent generations to learn from not just in China, but also around the world. It is my hope in translating some of his cases that this knowledge can spread. We are also very fortunate to have scholar-physicians like my teacher Dr. Huang Huang uphold this love and dedication to master Cao’s work and to classical literature.

Case 1
Female. Since delivering a child her cycles come every forty days, which are accompanied by distending pain in the epigastrium following meals. When the cycle arrives, there is pain extending from the stomach to the lower abdomen. During the pain she experiences a strong desire to have a bowel movement. After the bowel movement the pain would typically stop. Pain would return the following afternoon and stop during the menstrual flow, and once again come and go the following day. Both pulses were wiry.
This is liver and gall-bladder exploiting deficiency of the spleen viscera. In this case Xiao Jian Zhong Tang with Chai hu and Huang Qin is appropriate.

Gui Zhi 3 qian
Sheng Bai Shao 5 qian
Zhi (Gan) Cao 2 qian
Sheng Jiang 5 pcs
Hong Zao 12 pieces
Yi Tang 2 liang
Chai Hu 3 qian
Jiu (Huang) Qin 1 qian
Tai Wu Yao 1.5 qian

After one package, her pain stopped and the menses ceased. Patient continued with two more packages, after which the condition resolved.
The master (Zhang Zhongjing) in his great classic said:

“In cold damage, (when) the yang pulse is choppy and the yin pulse is wiry, as a rule there should be urgent pain in the abdomen. First give Xiao Jian Zhong Tang; if it does not reduce, Xiao Chai Hu Tang governs.”

Cao Yingfu (曹颖甫): Now here (in this case) I feel it goes without saying that there had not been a reduction and I immediately added Chai Hu and Huang Qin to treat her, why not? This woman’s situation was a menstrual disease and many belong to Chai Hu patterns, and so it was clearly obvious (to add it). The following day it was reported that the disease had resolved.

Case 2
Abdominal pain which liked pressure. During episodes of pain a distressing sensation of cold air was felt moving up and down (the body). Pulse was wiry-deficient. In addition there was an aversion to cold.
This is due to the liver exploiting the spleen and Xiao Jian Zhong Tang governs.
Gui Zhi 9g
Bai Shao 18g
Sheng Jiang 9g
Zhi Gan Cao 6g
Da Zao 6g
Yi Tang 30g

Liáo Shēng annotation: “This case is a pattern of abdominal pain (due to) central yang insufficiency with interior deficiency. The patient experienced abdominal pain, which liked pressure, the pulse was wiry-deficient and an aversion to cold was present. This signifies the overabundance of yin cold-qi, central yang insufficiency, and liver wood exploiting spleen (earth). Therefore Xiao Jian Zhong Tang was used to treat and resolve the condition.
The function of this formula is to supplement deficiency, quiet the center, moderate urgency and stop pain. The name of this formula is center fortifying (decoction). Fortify means to establish or set up, and because central qi is insufficient, it is very important to ‘establish’ or ‘set it up’. The formula contains sweat inducing (herbs) and not central effusing (herbs). It is referred to as a ‘minor’ (decoction) and only half (of the formula) resolves the exterior, so it does not completely secure the center. Xiao Jian Zhong Tang uses a heavy dose of Yi Tang, which is sweet, warm and serves as the sovereign to supplement the center. Bai Shao is the minister, which is sour and sweet to tonify yin. The assistant Gui Zhi is acrid-warm, which effuses and scatters. Combined with Bai Shao it regulates the nutritive and defense. In addition, Gan Cao, Da Zao and Sheng Jiang, which are sweet moderating and acrid warm, nourish the stomach and harmonize the center. Therefore (this formula) is able to warm and nourish central qi, calm and supplement yin and yang and regulate the nutritive and defense.”

*Xióng Liáo-Shēng (熊廖笙) style name Yǐ Xíng (以行) was born in 1905 in Ba County in Chongqing, Sichuan Province. Master Xióng was well versed in the classics, primarily the Nei Jing, Nan Jing, Shang Han Lun, and Jin Gui Yao Lue. The author of several books, Dr. Xióng possessed a deep and profound scholarship of the Shang Han Lun and was highly skilled in distilling the essence and precise details of various ancient doctors cases, which were found in his various annotations.

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Huáng Yuányù discusses Bǎi Hé

With today being the arrival of ‘Major Cold ‘(大寒 – the 24th solar term in the Chinese calendar lasting until Feb 3), what better day than today, to sit down with a cup of warm Wulong or Hongcha to translate passages from some of my favourite books.
The following is a direct translation from the Bǎi Hé section of Huáng Yuányù’s (1705-1758) excellent ‘Interpretation of Medicinals’ (黃元御藥解).

Huáng Yuányù discusses Bǎi Hé

– Translated from Huáng’s Interpretation of Medicinals (黃元御藥解)

百合 味甘、微苦,微寒,入手太陰肺經。涼金瀉熱,清肺除煩。

Bǎi Hé – Sweet flavour, slightly bitter and slightly cold. Enters the hand Taiyin lung channel. Cools metal, drains heat, clears the lungs and eliminates vexation.


The Jīn Guì’s Bǎi Hé Zhī Mǔ Tāng

Bǎi Hé 7 pieces
Zhī Mǔ 2 liǎng [listed as 3 liǎng in the Jīn Guì Yào Lüè]

Treats Bǎi Hé disease following the induction of sweat. Following cold damage, pathogenic qi shifts, and the hundred vessels are diseased. This is Bǎi Hé [disease]. Its symptoms present with disturbance to sleep and appetite, the occurrence of diarrhea and vomiting, difficulty differentiating between cold and heat, disquietude whether sitting or laying down, a bitter taste in the mouth, red urination, heart vexation, and a confused state of mind, with an inability to point to any specific channel or visceral disease. Now, the qi of the hundred vessels is received in the lungs, as the lungs are the ancestor of the hundred vessels. Thus, it is appropriate for the lungs to be clear. Following the promotion of sweat, the fluids [may be] desiccated and metal burned. Bǎi Hé clears the lungs and generates fluids. Zhī Mǔ cools metal and drains heat.


Huá Shí Dài Zhě Tāng

Bǎi Hé 7 pieces
Huá Shí 3 liǎng (broken)
Dài Zhě Shí (a pellet sized piece)

Treats Bǎi Hé disease following purgation. Purgation damages the yang of the central stomach duct, [resulting in] earth-damp counterflow [of the] stomach and depressed steaming lung heat. Bǎi Hé clears the lungs and drains heat; Huá Shí and Dài Zhě percolate dampness and downbear counterflow.


Bǎi Hé Jī Zǐ Tāng

Bǎi Hé 7 pieces
Boil the decoction and add one egg yolk, blend until smooth, and boil. Treats Bǎi Hé disease following vomiting. Vomiting damages the fluids of the lungs and stomach, resulting in the dryness of both metal and earth. Bǎi Hé clears the lungs and generates fluids. Jī Zǐ Huáng [egg yolk] supplements spleen essence and moistens dryness.


Bǎi Hé Dì Huáng Tāng

Bǎi Hé 7 pieces
Shēng Dì Huáng juice 1 jīn [listed as 1 shēng in the Jīn Guì Yào Lüè]
Add to Bǎi Hé decoction, boil and take. The stools should be like lacquer. Treats Bǎi Hé disease when neither sweating, vomiting or purgation have been used, and the disease appears as in the beginning. [Here] sweating, vomiting or purging have not been used and there is excess steaming of stasis heat [as well as] turbidity [which] has not been drained. Bǎi Hé clears the lungs and drains heat, while the juice of Shēng Dì cools and drains the stomach-intestines, and purges foul turbidity.


Bǎi Hé Xǐ Fāng [Lily bulb wash]

Bǎi Hé 1 jīn [listed as 1 shēng in the Jīn Guì Yào Lüè]
Use 1 dǒu of water and soak overnight. Use [the liquid] to bathe the body. After bathing, eat boiled cake, and avoid salt. Treats Bǎi Hé disease, which has not resolved within a month, and has resulted in thirst. [Here] fire flares and dries metal, resulting in lung heat which fails to resolve, leading to thirst. The lungs govern the skin and hair, and the Bǎi Hé is used to wash the skin and hair, thereby clearing lung heat.


Bǎi Hé Huá Shí Sǎn

Bǎi Hé 1 liǎng
Huá Shí 2 liǎng [listed as 3 liǎng in the Jīn Guì Yào Lüè]
Powder [the ingredients], and take a square-inch spoonful in liquid, three times per day. When there is slight diarrhea, stop taking, as [this indicates that] heat has been eliminated. Treats Bǎi Hé disease, which has transmitted into heat effusion. [When] dampness is stirred, the stomach runs counterflow, resulting in lung depression that generates heat. Bǎi Hé clears metal and drains heat; Huá Shí disinhibits water and eliminates dampness.


Bǎi Hé is a superior medicinal, which cools metal, moistens dryness, drains heat, disperses depression, and depurates the qi layer. It’s various treatments include stopping tearing, stopping sadness, opening throat impediment, disinhibiting welling-abscess of the lung, clearing lung heat, treating vomiting of blood, disinhibiting urination, lubricating the large intestine, controlling deafness and ear pain, rectifying subcostal and breast welling-abscesses, and effusing the back of various sores. Steep Bǎi Hé in water overnight. [When] white foam appears, discard the water, and then decoct with spring water and use.

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Huáng Huáng’s Use of Guì Zhī Fú Líng Wán in Respiratory Conditions

Cinnamon Twig and Poria Pill (guì zhī fú líng wán)

Indications: Bronchial asthma, chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension, pleurisy, pleural effusion, interstitial pneumonia, pulmonary fibrosis, and recurrent pulmonary infections typically manifesting with a dark-red complexion, a stifling sensation and pain in the chest, purple lips and a dark tongue. This formula has a blood invigorating, stasis transforming effect, which can improve the blood supply of the heart and lungs.

Usage & Modifications:

1. Patients for whom this formula is suitable tend to have a red or purple-red complexion, abdominal fullness, resistance to pressure in the lower left abdomen with possible tenderness, headaches, dizziness, insomnia, irritability, restlessness, stirring palpitations, and a dark tongue body with possible purple spots.

2. For patients that experience diarrhea after taking the formula, have them take in after meals or decrease the dosage.

3. Use with caution in pregnancy.

4. Modifications:

  • If there is a stifling sensation and pain in the chest, a chronic cough, and a wan and sallow complexion, add Angelicae sinensis Radix (dāng guī) 15g, Chuanxiong Rhizoma (chuān xiōng) 15g, and Salviae miltiorrhizae Radix (dān shēn) 15g
  • If there is a stifling sensation in the chest, abdominal distention, and an oily complexion, add Citri reticulatae Pericarpium (chén pí) 20g, Aurantii Fructus (zhǐ ké) 20g, and Zingiberis Rhizoma recens (shēng jiāng) 20g
  • If there is a stifling sensation in the chest  and constipation, add Aurantii Fructus (zhǐ ké) 20g, Allii macrostemi Bulbus (xiè bái) 20g, and Trichosanthis Fructus (quán guā lóu) 30g.

Representative Case History:

Yu, 74-year-old male, 160cm/70kg.

Initial consultation on June 5, 2018

Chief complaint: Recurrent cough and wheezing for 9 years, with dyspnea, an inability to climb stairs quickly, and abdominal distention following meals.

History: In April 2018 during a hospital visit, he was diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD), arrhythmia, atrial fibrillation, cardiac insufficiency, heart valve disease, and a fatty liver.

Signs: average build, dark, red and oily complexion, obvious bags under the eyes, purple-dark lips and tongue, stasis marks under the tongue, abdominal fullness, and resistance to pressure in the lower costal arch (flanks).

Prescription: Cinnamomi Ramulus (guì zhī) 10g, Cinnamomi Cortex (ròu guì) 10g, Poria (fú líng) 20g, Paeoniae Radix rubra (chì sháo) 20g, Moutan Cortex (mǔ dān pí) 15g, Persicae Semen (táo rén) 15g, Angelicae sinensis Radix (dāng guī) 15g, Chuanxiong Rhizoma (chuān xiōng) 15g, Salviae miltiorrhizae Radix (dān shēn) 15g, Aurantii Fructus (zhǐ ké) 30g, Citri reticulatae Pericarpium (chén pí) 30g, Zingiberis Rhizoma (gān jiāng) 10g; 15 packets.

Second consultation on June 25, 2018: After taking the herbs, his breathing was smooth and easy, however cough and wheezing were still present, but he was still able to play mah-jong. The same formula was continued.

Third consultation on August 20, 2018: No labored breathing when walking and he was able to climb 3 floors. The stasis marks under his tongue had improved.