Chapter Eighteen. Syndrome of disharmony and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that treat some specific bodily disorders using the method of harmonizing.
Formulas that harmonize are mainly used to treat disharmony between internal organs, disharmony between Qi and blood, and syndromes characterized by the coexistence of heat and cold, or by the coexistence of deficiency and excess. By adopting the approach of harmonizing the involved aspects, further pathological development can be prevented. Some of the syndromes and classical formulas presented here have already been introduced in other chapters, but it will become apparent that the treatment methods and strategies adopted in these formulas can be viewed from other perspectives and inspire the creation of new formulas.
1. Syndrome of disharmony between the Liver and Spleen (Stomach and Large Intestine)
Manifestations
Main symptoms
Hypochondriac pain and distension, fullness in the chest, stomach and abdomen, irritability, depression and frustration, dream-disturbed sleep, irregular menstruation, a bitter taste in the mouth, dry mouth and throat, headache, vertigo, fatigue, reduced appetite, nausea, vomiting and diarrhea, cold hands and fullness in the chest when subject to strong emotional disturbance.
Tongue
Pale or pink, with a thin white coating.
Pulse
Wiry and deficient.
Associated disorders in western medicine
Acute and chronic gastroenteritis, hyperchlorhydria, prolapsed stomach, dilatation of the stomach, peptic and duodenal ulcers, stress-related belching and vomiting, irritable bowel syndrome, allergies, hepatitis, cholecystitis, and the side effects of some medicines.
Analysis of the syndrome
This syndrome is generally referred to as disharmony between the Liver and Spleen. In fact, it can be divided into several sub-syndromes besides disharmony between the Liver and Spleen, such as disharmony between the Liver and Stomach, and disharmony between the Liver and Large Intestine. Since the Stomach and Large Intestine are directly linked to the transportation function of the Spleen, and both belong to Earth in the Five-Element theory, the Liver often attacks these organs if it overacts on the Spleen. Hence they are often considered and discussed as one syndrome under the name of disharmony between the Liver and Spleen.
The Liver is an important organ in human physiology. The free flow of Liver-Qi drives the functions of the internal organs. One of these is the Spleen’s function of transportation and transformation. The proper flow of Liver-Qi depends on an adequate supply of Liver-blood, which is generated from the food essence and is transformed by the Spleen. These physiological features mean that there is a special relationship between the Liver and the Spleen. In pathological conditions, any of these three factors (Liver-Qi stagnation, Liver-blood deficiency or Spleen-Qi deficiency) can impact on, or be influenced by, the other two. This may lead to disharmony between the organs and cause the following manifestations:
• If Liver-Qi stagnation is the causative factor, there is obvious hypochondriac pain and distension, and fullness in the chest, stomach and abdomen arises because the Liver and Gall Bladder meridians spread through the hypochondriac region, and the Qi of these organs moves through the pathways of the San Jiao.
• When Liver-Qi is stagnant, patients get angry easily, and are prone to irritability, depression and frustration. They tend to have dream-disturbed sleep, and female patients may have irregular menstruation. Furthermore, the Liver-Qi can easily generate heat if it stagnates, even if only for a very short time.
• Liver-fire gives rise to a bitter taste in the mouth and dry mouth and throat. In most cases, the stagnation of Liver-Qi has a clear causative factor, usually stress.
• If there is obvious Liver-Qi stagnation but the cause is unclear, it is most likely caused by Liver-blood deficiency. In that situation, the Liver-blood is too weak to nourish the Liver, so the Qi moves slowly and tends to become stagnant. The syndrome of Liver-blood deficiency manifests as dizziness, vertigo, headache, migraine, tiredness, pale complexion, brittle nails and hair, irregular menstruation, irritability and mood swings.
• In the case of Spleen-Qi deficiency, the Qi is unable to ascend properly to the head, and patients often have chronic headaches, vertigo, fatigue and poor appetite.
• As soon as the Spleen becomes weak, it becomes vulnerable to attack from the Liver. When the Liver-Qi overacts on the Spleen, the Qi is blocked in the Middle-Jiao. The Stomach-Qi cannot descend, thus fullness in the stomach, nausea and vomiting may occur; the Spleen-Qi is unable to ascend, thus giving rise to diarrhea.
• When there is strong emotional disturbance, the Qi is obstructed in the chest, so it cannot spread and is unable to reach the extremities, resulting in cold hands and fullness of the chest.
• Liver-Qi stagnation does not manifest in a distinct tongue sign; however, if heat is generated, a red border can be observed on the tongue.
• If Liver-Qi overacts on the Spleen and Stomach, a thick coating can be found on the tongue, showing that the digestion is impaired.
• When blood is deficient, the tongue is pale or a delicate pink color. If there is Spleen-Qi deficiency, the tongue is pale with teeth marks.
• The typical Liver-Qi stagnation pulse is wiry. If there is also blood deficiency, a thready pulse can be felt. If there is obvious Qi deficiency, the pulse can be weak, particularly in the Spleen position.
(See Figures 18.1 and 18.2 on page 378.)
Treatment principle: Harmonize the Liver and Spleen; regulate the Qi
Herb selection principles and formula composition strategies
• In most cases, herbs that can spread the Liver-Qi and reduce mental and physical tension are selected, along with herbs that nourish the Liver-blood.
• Herbs that strengthen the Spleen are often selected, first to provide a blood supply so as to maintain the proper function of the Liver, second to allow the Spleen to resist attack by the Liver-Qi, and third to treat Spleen-Qi deficiency.
• Pungent-warm herbs that can ascend the Qi and bitter-cold herbs that can descend the Qi are often used together to harmonize these involved organs and reduce tension.
Structure of the formula and selection of herbs
Chief and Deputy: Harmonize the Liver and Spleen; regulate the Qi in the Middle-Jiao
Note
Since each of the three factors – Liver-Qi stagnation, Liver blood deficiency and Spleen-Qi deficiency – can be a causative factor as well as a consequence of the others, the chief is used to treat the direct cause and the deputies treat the developed conditions and the consequences. Thus, the chief and the deputies can be selected from the following three groups of herbs.
Xiang Fu ( Cyperi rhizoma), Chai Hu ( Bupleuri radix), Qing Pi ( Citri reticulatae viride pericarpium) and Mu Xiang ( Aucklandiae radix)**
These herbs are often selected to spread the Liver-Qi.
Chai Hu is another commonly used herb to regulate the Liver-Qi and is also a gentle herb. Unlike Xiang Fu, it has the function of dispersing and ascending the Liver-Qi rather than promoting its circulation. It is particularly suitable for use as chief in formulas to spread constrained Liver-Qi that is directly caused by stress, depression and frustration. Since the tendency of its action is upwards, it should be used with caution in syndromes of ascending of Qi, fire or Yang of the Liver.
Qing Pi is warm and bitter, and enters the Liver, Gall Bladder and Spleen meridians. It can break up the Qi stagnation and effectively promote the free flow of Liver-Qi and alleviate pain. It is often selected in a formula to treat distending pain in the chest, breasts and hypochondriac region. Because its action is strong, it may injure the Qi and Yin, and therefore it is used only for a short period of time and mainly in excess conditions.
Mu Xiang is pungent, bitter, warm and aromatic, and enters the Gall Bladder, Spleen and Large Intestine meridians. It can strongly and quickly activate Qi movement, and can especially regulate Qi of the Liver and Large Intestine and alleviate pain. It also strengthens the Spleen and promotes the digestion. It is especially effective in treating disorders where the Liver-Qi overacts on the Spleen, causing stomachache, abdominal pain and distension, diarrhea, poor appetite and poor digestion. As this herb is quite warm and pungent, and is strong in action, its dosage should be controlled carefully.
Dang Gui ( Angelicae sinensis radix) and Bai Shao Yao ( Paeoniae radix lactiflora)
These two herbs are often used to tonify the blood. Dang Gui is sweet, pungent and warm, and enters the Heart, Liver and Spleen meridians. It can tonify the blood, warm the blood and promote the blood circulation. Bai Shao Yao is bitter, sour and cold, and enters the Liver and Spleen meridians. It nourishes the Liver-Yin, tonifies the blood and stabilizes the blood circulation. Since Bai Shao Yao is able to soften the Liver and relax the tendons, it can reduce the aggression of the Liver. These two herbs tonify the Yang and Yin aspects of the blood and are therefore very often used together as one unit to nourish the blood, soften the Liver and keep the Liver-Qi moving steadily.
Ren Shen ( Ginseng radix), Bai Zhu ( Atractylodis macrocephalae rhizoma) and Fu Ling ( Poria)
These herbs are often selected to strengthen the Spleen.
Ren Shen and Bai Zhu are sweet and warm, and Fu Ling is sweet, neutral and bland. They all enter the Spleen meridian. They can directly tonify the Spleen and are selected as chief in the formula when the disharmony is caused directly by chronic Spleen deficiency. Moreover, they can also be used as deputies as they generate the Qi and blood, and can maintain the proper function of the Liver. In addition, they strengthen the Spleen in order to stimulate its resistance at the same time that the Liver-Qi is attacking the Spleen.
Assistant: Regulate the Liver-Qi, strengthen the Spleen, clear heat and remove phlegm in the Middle-Jiao
Xiang Yuan ( Citri fructus), Fo Shou ( Citri sarcodactylis fructus) and Mei Gui Hua ( Rosae flos)
These three herbs are often used in formulas to treat the syndrome of disharmony between the Liver and Stomach. Xiang Yuan and Fo Shou enter the Liver, Spleen and Stomach meridians. They are bitter, sour and slightly warm. Both are very effective in promoting the Liver-Qi movement and treating hypochondriac pain, distension and depression. Moreover, they are particularly effective in the condition where the stagnant Liver-Qi disturbs the Stomach and leads to distension in the gastric and hypochondriac regions. They can soothe the Stomach-Qi so as to improve appetite and stop vomiting and belching.
Mei Gui Hua has the function of harmonizing the Qi in the Liver and Stomach, and treats the syndrome of Liver-Qi attacking the Spleen and Stomach. As well as having functions similar to those of Xiang Yuan and Fo Shou, this herb can also promote the blood circulation and is an appropriate herb to treat disorders due to Qi and blood stagnation, such as irregular menstruation and dysmenorrhea.
Zhi Gan Cao ( Glycyrrhizae radix preparata) and Bai Shao Yao ( Paeoniae radix lactiflora)
Zhi Gan Cao is sweet and warm, and primarily enters the Spleen meridian. It can both tonify and moderate the movement of the Qi. It is often used with herbs that nourish the Yin such as Bai Shao Yao to strongly soften the Liver and relax the tendons. It is often used to protect the Stomach in the condition of Liver attacking the Stomach.
Bai Shao Yao is the most commonly used herb to soften the Liver. It is sour, bitter and slightly cold. It is able to nourish the Yin and blood of the Liver, and its cold and bitter nature can reduce heat, which is caused by deficiency of blood and stagnation of the Liver-Qi. It is often used in a formula to treat Liver-Qi stagnation, which is caused by Yin and blood deficiency. Besides the common symptoms of Qi stagnation, a thready and wiry pulse is the indication for using this herb in the formula. Moreover, Bai Shao Yao is also often used as corrective assistant. In the treatment, since the herbs that stimulate Qi may injure the blood and cause further stagnation of the Qi, it is necessary to nourish the blood in order to spread the Liver-Qi.
Jing Jie ( Schizonepetae herba) and Bo He ( Menthae herba)
Jing Jie and Bo He have a pungent taste, and enter the Liver meridian. They possess a light and subtle dispersing ability and can disperse the constrained Liver-Qi. They are selected as assistants in formulas to enhance the function of the chief in spreading the Liver-Qi and treating excess and deficiency conditions where Liver-Qi stagnation is involved.
Fang Feng ( Saposhnikoviae radix), Chen Pi ( Citri reticulatae pericarpium) and Zhi Shi ( Aurantii fructus immaturus)
These three herbs all enter the Spleen meridian. They can regulate the Spleen-Qi and Stomach-Qi. They are often selected as assistants in formulas to treat disharmony between the Liver and Spleen. Fang Feng enters the Liver and Spleen meridians, can effectively disperse Qi stagnation and relieve cramp and distension when the Liver attacks the Spleen. Since it ascends and spreads the Spleen-Qi, it can treat borborygmi and diarrhea. Chen Pi can promote Qi movement in the Stomach, reduce the sensation of fullness in the Stomach and improve appetite. Zhi Shi can descend the Qi in the intestines and reduce pain and distension in the abdomen.
Zhi Zi ( Gardeniae fructus) and Mu Dan Pi ( Moutan cortex)
When stagnant Liver-Qi generates heat and the heat disturbs the blood, these two herbs can be used in the formula.
Zhi Zi is cold and enters the San Jiao meridian. It can drain the excess heat from the Liver and the San Jiao passage, and leach out the heat by promoting urination. Mu Dan Pi is cold in nature and enters the blood level of the Liver meridian. It can cool the blood, promote the blood circulation and thus moderate the Qi movement. Its pungent taste can also disperse the stagnation of blood.
Qing Hao ( Artemisiae annuae herba) and Zhu Ru ( Bambusae caulis in taeniam)
These two herbs are cold in nature and can be used in formulas in conditions where damp-heat or phlegm-heat is generated in the Middle-Jiao.
Qing Hao is aromatic and enters the Liver and Gall Bladder meridians. It can disperse dampness and heat, spread Liver-Qi and is often used in damp-heat obstruction in the Liver and Gall Bladder. The manifestations are chills, fever, reduced appetite, nausea, and a sticky and bitter taste in the mouth.
Zhu Ru enters the Stomach and Gall Bladder meridians. It can soothe the Stomach-Qi and eliminate phlegm-heat. It treats nausea, vomiting, fullness in the Stomach and irritability.
Sheng Jiang ( Zingiberis rhizoma recens) and Da Zao ( Jujubae fructus)
Sheng Jiang is pungent and slightly warm, and enters the Stomach and Spleen meridians. It can soothe the Stomach-Qi, subtly disperse accumulation of dampness, fluid and phlegm in the Stomach, and can therefore promote digestion. Da Zao is sweet and warm, and can tonify the Qi and blood. These two herbs are often selected as assistants in the formula as a pair of herbs to gently strengthen the function of the Spleen and Stomach.
Examples of classical formulas
Xiao Yao San (Rambling Powder) 
Source: Tai Pi Hui Min He Ji Ju Fang 
Composition
Chai Hu ( Bupleuri radix) 6–9 g
Dang Gui ( Angelicae sinensis radix) 9 g
Bai Shao Yao ( Paeoniae radix lactiflora) 9 g
Bai Zhu ( Atractylodis macrocephalae rhizoma) 9 g
Fu Ling ( Poria) 9 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Wei Sheng Jiang (roasted Zingiberis rhizoma recens) 6 g
Bo He ( Menthae herba) 3 g
Analysis of the formula
This formula is able to harmonize the Liver and Spleen. It is used for treating Liver-Qi stagnation, Liver-blood deficiency and Spleen-Qi deficiency. The Liver overacts on the Spleen. The manifestations are hypochondriac pain, headache, vertigo, a bitter taste in the mouth, dry mouth and throat, fatigue and reduced appetite. In some cases, there may be alternating fever and chills, irregular menstruation, or breast distension and pain. The tongue color is often pale or pink with a thin white coating and the pulse is wiry and deficient.
In this syndrome, each of the three factors (Liver-Qi stagnation, Liver-blood deficiency and Spleen-Qi deficiency) can influence, or be influenced by, the other two. This may lead to disharmony between the functions of the Liver and Spleen and cause related manifestations.
In this formula, there are three groups of herbs that treat the pathological changes from the three factors involved.
• The first group is used to directly spread the Liver-Qi which can then further promote blood circulation and boost the function of the Spleen. This strategy is represented by the selection of Chai Hu and is enhanced by Bo He.
• The second group serves to tonify the Liver-blood and therefore to soften the Liver and promote its Qi movement; it is represented by Dang Gui and Bai Shao Yao.
• The third group is selected to tonify the Spleen-Qi so as to produce enough blood to support the function of the Liver. This strategy is carried out by using Bai Zhu and Fu Ling and is further enhanced by Sheng Jiang and Zhi Gan Cao.
With regard to the structure of this formula, Liver-Qi stagnation predominates and Chai Hu is used as the chief herb. If blood deficiency is obvious and is the cause of the Liver-Qi stagnation, Dang Gui and Bai Shao should be used as chief herbs. When the Spleen-Qi has been very weak for a long period of time, and has led to blood deficiency and Liver-Qi stagnation, herbs that tonify the Spleen should be used as chief herbs.
Commentary on strategies
This formula is characterized by harmonizing the functions of the Liver and Spleen through the understanding of the relationship between the Qi and blood, the material aspect and the functioning aspect of the Liver, and the relationship of the Liver and Spleen. It is a gentle and well-organized formula. It is not only a good example for study, but also a good formula that can be used for a long period of time.
Si Ni San (Frigid Extremities Powder) 
Source: Shang Han Lun 
Composition
Chai Hu ( Bupleuri radix) 6–9 g
Zhi Shi ( Aurantii fructus immaturus) 9–12 g
Bai Shao Yao ( Paeoniae radix lactiflora) 12–24 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6–9 g
Analysis of the formula
This formula can spread constrained Liver-Qi, soften the Liver and regulate the function of the Spleen. It is used for treating an acute excess condition where the Liver-Qi is stagnant and overacts on the Spleen. When strong emotions disturb the Qi movement, the Liver-Qi is obstructed and unable to spread throughout the entire body, especially to the extremities. This leads to cold fingers and toes, stiff and painful muscles, irritability and fullness in the chest. When Liver-Qi is severely stagnant, it can overact on the Spleen and Stomach, causing fullness and pain in the epigastrium and abdomen, and even severe diarrhea. In this syndrome, patients often show a red tongue with a yellow coating, and have a wiry pulse.
In this formula:
• Chai Hu is used as chief to spread the Liver-Qi directly.
• Bai Shao Yao is used as deputy. Since it can nourish the Liver-Yin and blood, soften the Liver and relax the tendons, it can reduce the aggression of the Liver. In addition, it can also stabilize the Spleen-Qi and bind up the intestines, thereby reducing the abdominal pain and diarrhea. When Chai Hu and Bai Shao Yao are used together, they can effectively regulate the Qi of the Liver.
• Zhi Shi serves as assistant. It descends the Qi in the intestines and reduces the distension and pain. When the ascending Chai Hu and the descending Zhi Shi are used together, they can properly regulate the Liver-Qi and the Qi in the intestines.
• Zhi Gan Gao also serves as assistant. On the one hand, it can enhance the function of Bai Shao Yao to soften the Liver and reduce the abdominal pain; on the other hand, it can strengthen and protect the Spleen, which is suppressed by the Liver, in order to restore the balance between these two organs.
Commentary on strategies
Although there are only four herbs in the formula, the interrelationships that result from their combination enable the formula to reduce the Liver, strengthen the Spleen, open the Qi obstruction and harmonize the Liver and Spleen. It is therefore a very good example for the study of herbal combinations.
Tong Xie Yao Fang (Important Formula for Painful Diarrhea) 
Source: Jing Yue Quan Shu 
Composition
Bai Zhu ( Atractylodis macrocephalae rhizoma) 90 g
Bai Shao Yao ( Paeoniae radix lactiflora) 60 g
Chen Pi ( Citri reticulatae pericarpium) 45 g
Fang Feng ( Saposhnikoviae radix) 60 g
Analysis of the formula
This formula is able to reduce the Liver and strengthen the Spleen. It is used for severe abdominal pain, borborygmi and diarrhea due to Liver-Qi overacting on the Spleen. A thin, white tongue coating and a wiry pulse are present in this syndrome.
In this formula:
• Bai Zhu and Bai Shao Yao are used as chief. Bai Zhu can strengthen the Middle-Jiao and tonify the Spleen-Qi so as to boost its resistance when under attack by the Liver-Qi. Bai Shao Yao is used to nourish the Yin, soften the Liver and relax the tendons, thereby reducing the aggression of the Liver. When these two herbs are used together, the relationship between the Liver and Spleen will return to balance.
• Chen Pi is used as assistant. It activates Qi movement and transforms dampness in the Middle-Jiao, thereby assisting Bai Zhu to tonify the Spleen-Qi. At the same time, it can also assist Chai Hu to spread the Liver-Qi.
• Fang Feng also serves as assistant. It enters the Liver and Spleen meridians, expels wind, reduces tension between the Spleen and Liver, and can assist Bai Shao Yao and Chen Pi to spread the Liver-Qi, while also ascending and spreading the Spleen-Qi to treat borborygmi and diarrhea.
Commentary on strategies
There are only four herbs in the formula, but each of them has a clear role in the treatment and they help each other in restoring the balance between the Liver and Spleen. The selection of Fang Feng, in particular, is an inspirational one, as in this context, it perfectly fits the treatment strategy of spreading the Liver-Qi and reducing the obstruction of the Spleen-Qi.
2. Syndrome of disharmony at the Shao Yang level
Manifestations
Main symptoms
Alternating fever and chills.
Secondary symptoms
Hypochondriac distension, reduced appetite, dry throat, bitter taste in the mouth.
Tongue
Normal or slightly pale.
Pulse
Wiry.
Associated disorders in western medicine
Acute and chronic gastroenteritis, prolapsed stomach, dilatation of the stomach, peptic and duodenal ulcers, stress-related vomiting, irritable bowel syndrome, food allergies and intolerances, and the side effects of some medicines.
Analysis of the syndrome
According to the Six-Meridian differentiation theory for diseases induced by cold, when a cold pathogenic factor penetrates beyond the Tai Yang meridian (level), it enters the Shao Yang meridian (level) (domain of the San Jiao and Gall Bladder), which is located between the Tai Yang and the Yang Ming meridians (levels).
• When the body’s resistance attempts to fight off the pathogenic cold, chills and fever are manifest.
• When the pathogenic cold is stronger than the body’s resistance, cold predominates.
• If the body’s resistance is stronger than the pathogenic cold, heat arises.
Alternating fever and chills is a characteristic symptom that indicates the fight between the body’s resistance and the pathogenic cold at the Shao Yang level.
• As the Gall Bladder meridian runs through the chest and the hypochondriac region, fullness of the chest and hypochondriac region are also experienced.
• When the Qi is obstructed, it can invade the Stomach and cause nausea and reduced appetite.
• The Gall Bladder is an extraordinary organ where the minister fire resides. When the Qi is obstructed, it can quickly generate heat, causing dry throat and a bitter taste in the mouth.
• A wiry pulse indicates the stress between the body’s resistance and the pathogenic factor. A tongue that is normal in color with a thin white coating indicates an acute but mild illness, while a pale tongue often indicates weak bodily resistance.
(See Figures 18.3 and 18.4 on page 379.)
Treatment principle: Harmonize the Shao-Yang level
Herb selection principles and formula composition strategies
• Two herbs that have different functions yet are equally important are selected as chief. Each regulates one aspect of the disharmony at the Shao Yao level.
• Herbs that have similar qualities are selected as assistants to enhance the functions of the chief.
• Herbs that tonify the weakness or protect the Stomach are also often prescribed so as to prevent further pathological changes from developing.
Structure of the formula and selection of herbs
Chief: Harmonize the Shao Yang level
In a syndrome of disharmony at the Shao Yang level, excess and heat often coexist with deficiency and cold. The excess and heat are generated from the fight between the pathogenic factor and the body’s resistance. The cold and weakness are caused by the deficiency of the body’s resistance or the damage done by the pathogenic factor. To treat only heat may increase the cold and weaken the body, and vice versa. Special herbal combinations are required in this complicated condition.
Chai Hu ( Bupleuri radix) and Huang Qin ( Scutellariae radix)
Chai Hu is pungent and neutral, and enters the Gall Bladder and Liver meridians. It has ascending and dispersing abilities. It disperses and expels the pathogenic cold from the Shao Yang level, and disperses and spreads the Qi of the Shao Yang as well. Huang Qin is bitter and cold, and enters the Gall Bladder meridian. It can clear the heat at the Shao Yang level and reduce the fire from stress. When these two herbs are used together, the obstruction of Qi, heat and cold are separated and eliminated, and the free flow of the Qi at the Shao Yang level is restored.
Ban Xia ( Pinelliae rhizoma) and Huang Qin ( Scutellariae radix)
This combination is used to open the Qi obstruction that is caused by conflict between cold and warm, and excess of exogenous pathogenic factor and the weakened body resistance in the Middle-Jiao.
Ban Xia is pungent and warm, and enters the Stomach and Spleen meridians. It can disperse the obstructed Qi in the Middle-Jiao and soothe the Stomach-Qi. Huang Qin is bitter and cold, and enters the Spleen and Gall Bladder meridians. Since it can clear heat and descend Qi, it can reduce the Qi obstruction.
This combination of warm Ban Xia and cold Huang Qin can reduce the conflict between cold and heat in the Middle-Jiao. At the same time, the pungent Ban Xia can disperse the Qi and bitter Huang Qin can descend the Qi. In this way, the Qi becomes harmonized in the Middle-Jiao.
Ren Shen ( Ginseng radix)
The sweet and warm Ren Shen can directly tonify the Qi, especially the weakened body resistance, and thus can stop further pathological change in the body. Ren Shen is often used with the combination of Chai Hu and Huang Qin, or Ban Xia and Huang Qin, which regulate the Qi and harmonize the cold and heat at the Shao Yang level. These combinations can reduce the excess pathogenic factor and strengthen the weakness of the body’s resistance.
Assistant: Enhance the function of the chief and harmonize the Shao Yang level
Huang Lian ( Coptidis rhizoma), Sheng Jiang ( Zingiberis rhizoma recens) and Gan Jiang ( Zingiberis rhizoma)
These herbs are often used to enhance the functions of the chief and deputies in harmonizing Shao Yang and are particularly selected in severe cases.
Huang Lian is bitter and cold, and enters the Liver, Gall Bladder, Spleen and Large Intestine meridians. It enhances the function of Huang Qin in descending the Qi and clearing heat.
Sheng Jiang and Gan Jiang are pungent and warm. They enhance the ability of Chai Hu and Ban Xia to disperse the constrained Qi, warm the Middle-Jiao and strengthen the body’s resistance. In this way the harmonizing action of the formula is stronger.
Zhi Gan Cao ( Glycyrrhizae radix preparata)
Zhi Gan Cao is sweet in nature and primarily enters the Spleen meridian. It can tonify the Spleen-Qi and strengthen the Middle-Jiao. It is used as assistant in the formula to help Ren Shen in stopping the further development of pathological changes. At the same time, it can also moderate the Qi movement and its sweet taste may protect the Stomach. For these reasons it is very useful in the condition of Liver attacking the Spleen.
Examples of classical formulas
Xiao Chai Hu Tang (Minor Bupleurum Decoction) 
Source: Shang Han Lun 
Composition
Chai Hu ( Bupleuri radix) 9 g
Huang Qin ( Scutellariae radix) 6 g
Ban Xia ( Pinelliae rhizoma) 9 g
Sheng Jiang ( Zingiberis rhizoma recens) 4.5 g
Ren Shen ( Ginseng radix) 4.5 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 4.5 g
Da Zao ( Jujubae fructus) 6 g
Analysis of the formula
This formula is recorded in the Shang Han Lun, the classical text by Dr Zhang Zhong Jing which has been in use for more than 2000 years. The primary purpose of this formula is to relieve disorder at the Shao Yang level.
In this formula:
• Chai Hu is one of the two chief herbs. It is pungent and neutral, and enters the Gall Bladder and Liver meridians. Chai Hu has ascending and dispersing properties and can disperse and expel pathogenic cold from the Shao Yang level. At the same time, it also disperses and spreads the Qi.
• Huang Qin is the other chief herb in this formula. It is bitter and cold, and enters the Gall Bladder meridian. Huang Qin can clear heat from the Shao Yang level and reduce the heat generated by the stagnation of Qi.
When these two herbs are used together, they open up the obstruction of Qi, heat and cold, allowing the Qi to move freely in the Shao Yang meridians.
The other herbs serve as assistants in the formula.
• Ban Xia, which is pungent and warm, can disperse the Qi stagnation and directly soothe the Stomach-Qi, thereby reducing the Qi obstruction caused by the Gall Bladder overacting on the Stomach.
• Ren Shen strengthens the body’s resistance and prevents the pathogenic factor from entering deeper into the body.
• Sheng Jiang and Da Zao enhance the ability of Ren Shen to strengthen the Spleen and generate the Qi. Sheng Jiang also enhances the ability of Ban Xia to disperse the pathogenic factor and soothe the Stomach-Qi.
• Zhi Gan Cao serves as both assistant and envoy, tonifying the Qi and harmonizing the herbs in this formula.
When the above herbs are combined, the pathogenic cold can be eliminated and the heat reduced, the movement of Qi in the Shao Yang meridians and Stomach is harmonized, and all the symptoms disappear.
Commentary on strategies
• This formula shows clearly how to treat a complex condition at the Shao Yang level by simultaneously expelling cold, clearing heat and strengthening the body’s resistance. In this way, the Qi movement through the Shao Yang meridians becomes smooth.
• In clinical practice, this formula is used not only to relieve Shao Yang syndrome, but also to treat Qi stagnation in the Liver and Gall Bladder meridians when Liver-Qi overacts on the Stomach, impairing digestion and weakening the body’s resistance.
Ban Xia Xie Xin Tang (Pinellia Decoction to Drain the Epigastrium) 
Source: Shang Han Lun 
Composition
Ban Xia ( Pinelliae rhizoma) 9 g
Gan Jiang ( Zingiberis rhizoma) 9 g
Huang Qin ( Scutellariae radix) 9 g
Huang Lian ( Coptidis rhizoma) 3 g
Ren Shen ( Ginseng radix) 9 g
Da Zao ( Jujubae fructus) 6 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Analysis of the formula
This is another formula devised by Dr Zhang Zhong Jing. It was originally used for a condition in which a Shao Yang syndrome had previously been treated, not by the harmonizing method, but by the purging method – an erroneous treatment strategy which had injured the Qi and Yang of the Middle-Jiao. However, the body’s resistance is still struggling to expel the pathogenic cold, and this process generates heat. The pathological changes result in Qi stagnation, which leads to epigastric fullness and distension, with mild pain and reduced appetite. Since the Qi movement is disturbed in the Middle-Jiao, nausea, vomiting, borborygmi and diarrhea may be experienced. A thin, sticky, yellow tongue coating and a wiry and rapid pulse are the characteristic signs of this syndrome.
In this formula:
• Ban Xia is used as chief to disperse the Qi stagnation, open the obstruction and soothe the Stomach-Qi. It can directly reduce the fullness and tightness in the epigastric region. In combination with the assistant Gan Jiang, it warms the Middle-Jiao and disperses the cold.
• Huang Qin and Huang Lian also serve as chief. They are bitter and cold, have a downward-moving tendency and can clear heat.
When pungent-warm herbs and bitter-cold herbs are combined, the cold and heat complex, which knots up the Qi and causes obstruction, is dissipated.
• Ren Shen, Zhi Gan Cao and Da Zao are used as assistants. They tonify the Spleen, and prevent the pathogenic cold from entering into deeper levels of the body. They can also protect the Stomach and promote digestion so as to treat the weakness of the body’s resistance.
When these seven herbs are used together, the heat and cold are separated and eliminated, the Middle-Jiao becomes stronger, the Spleen-Qi can ascend and the Stomach-Qi can descend properly, and all the symptoms disappear.
Commentary on strategies
• This formula is used to treat a complex condition in which cold and heat coexist, alongside both excess and deficiency in the Middle-Jiao.
• It demonstrates how a combination of pungent-warm herbs and bitter-cold herbs can treat a complicated syndrome in which heat and cold are mixed together.
• This strategy is used not only in treating Shao Yang syndrome, but also in similar conditions where the Spleen-Qi is weak and the Liver-Qi stagnates, thus producing cold and heat, such as in cases of acute and chronic gastroenteritis, irritable bowel syndrome, food allergy and intolerance.
3. Syndrome of disharmony between Ying-Qi and Wei-Qi
Manifestations
Main symptoms
Mild fever, aversion to wind, slight sweating and, in some cases, skin rashes and urticaria.
Secondary symptoms
Headache, sensations of discomfort in the body, blocked nose and cough.
Tongue
Normal tongue with a white coating.
Pulse
Superficial and soft.
Associated disorders in western medicine
Recurrent colds, spontaneous sweating with slight fever and aversion to wind after illness, surgery or childbirth, chronic sinusitis, allergies, and morning sickness in early pregnancy.
Analysis of the syndrome
Ying-Qi, the Nutritive-Qi, is directly generated by food and drink through the function of the Spleen, and it nourishes the body. Since it carries out the functions of blood and Yin, it is often directly called Ying-Yin. Wei-Qi, the Defensive-Qi, is originally derived from Kidney-Qi and is enhanced by the Spleen-Qi. Both Ying-Yin and Wei-Qi are lifted by the Spleen-Qi to the Upper-Jiao and are spread throughout the entire body by means of the Lung’s dispersing function.
Ying-Yin and Wei-Qi move together as a Yin-Yang couple, the Wei-Qi guards the Ying-Yin and Ying-Yin nourishes the Wei-Qi. The Ying-Yin moves inside the meridians while the Wei-Qi travels just outside the meridians. They circulate in the superficial region of the body, bringing warmth and nutrition to this region, and control the proper opening and closing of the pores.
Disharmony between Ying and Wei can arise in several conditions. First of all, Spleen-Qi deficiency may cause weakness in the Ying-Qi and Wei-Qi directly. Second, when external pathogenic wind and cold attack the superficial region of the body, the Defensive-Qi may be unable to close the pores tightly enough, allowing the pathogenic wind and cold to invade the body and disturb the relationship between the Ying and Wei.
Furthermore, if wind disturbs the superficial region of the body, the pores may lose control, allowing the body fluid to leak out as sweat, which directly weakens the Ying-Yin and causes disharmony between Ying and Wei. Moreover, if blood and Yin are deficient, Ying-Yin is also weak and is unable to accompany the Wei-Qi properly, so disharmony between Ying and Wei rises.
• When the Ying-Qi and Wei-Qi are unable move properly in a harmonized way, symptoms in the superficial region of the body may appear, such as fever, aversion to wind, sensations of discomfort in the body, skin rashes or allergies which are characterized by symptoms which arise quickly and change rapidly.
• A floating but soft pulse and a white tongue coating are signs of this disharmony.
Treatment principle: Strengthen and Harmonize the Ying-Qi and Wei-Qi
Herb selection principles and formula composition strategies
• The first priority is to select warm, sweet and pungent herbs that can strengthen and stimulate the Wei-Qi.
• Along with these, it is equally important to select sour and cold herbs that can nourish the Ying-Yin, or sweet and warm herbs that can tonify the Spleen-Qi and blood.
• These two groups of herbs are used together to harmonize Ying and Wei.
• The second priority is to select herbs that can tonify the Spleen and promote digestion so as to promote the generation of Ying-Yin and Wei-Qi.
• Herbs that regulate the Qi and blood are often used.
Structure of the formula and selection of herbs
Chief: Harmonize Ying and Wei
Gui Zhi ( Cinnamomi cassiae ramulus), Huang Qi ( Astragali radix) and Dang Gui ( Angelicae sinensis radix)
These three herbs are chosen separately to work with either Bai Shao Yao or Sheng Di Huang to regulate and strengthen the function of Wei-Qi so as to harmonize Ying and Wei.
Gui Zhi is warm, pungent and sweet, and enters the Heart, Lung and Bladder meridians. It has the function of warming and strengthening the Heart-Yang, promoting blood circulation, spreading Yang-Qi and unblocking the meridians. Since its pungent and warm nature is stabilized by its sweet taste, its function of stimulating the Yang and Qi is effective and stable. It is often used to strengthen and stimulate the Wei-Qi in the condition of disharmony of Ying and Wei. It is often used with Bai Shao Yao ( Paeoniae radix lactiflora), which is able to stabilize the Ying-Yin.
Huang Qi is sweet and slightly warm, and enters the Spleen and Lung meridians. It can strongly tonify the Spleen-Qi and promote transformation of Qi and blood so as to strengthen the Wei-Qi. Since it can also strengthen the Lung-Qi, promote the spreading of the Wei-Qi on the surface of the body and control the opening and closing of the pores, it can control the Ying-Yin, stop sweating and stabilize the exterior. It can be used in conditions of Wei-Qi deficiency and disharmony of Ying and Wei.
Dang Gui is pungent, sweet and slightly warm. Its sweet and warm properties can tonify the blood, and its pungent and warm nature may promote the blood circulation. It plays a role in harmonizing Ying and Wei through generating the Ying-Yin and promoting the movement of Ying-Qi. It is particularly used in the condition of blood deficiency, which leads to disharmony of Ying and Wei. It is often used with Bai Shao Yao to nourish and stabilize the Ying-Yin in this situation.
Bai Shao Yao ( Paeoniae radix lactiflora) and Sheng Di Huang ( Rehmanniae radix)
These two herbs are chosen separately to work with Gui Zhi or Huang Qi or Dang Gui to nourish the Ying-Yin so as to harmonize Ying and Wei.
Bai Shao Yao is sour, bitter and slightly cold. Sour and cold may generate the blood and Yin, and supplement the shortage of the substantial part of the blood and the Ying-Yin. Bitter and cold properties can clear heat and reduce empty-heat in the blood caused by deficiency of blood and Yin. In this way, the blood can circulate in a moderate way. It is considered an important herb in harmonizing the Ying and Wei by nourishing and stabilizing the Ying-Yin.
Zhi Gan Cao ( Glycyrrhizae radix preparata)
Zhi Gan Cao enters the 12 regular meridians, but primarily enters the Spleen meridian. It can tonify the Spleen-Qi, and although the function is not very strong, its steady and moderate characteristics are often the favorite in selection to treat chronic and complicated conditions. Owing to its sweet and neutral properties, it can be combined with warm and pungent herbs to generate the Wei-Qi, and can be combined with cold and sour herbs to nourish the Ying-Yin. This sweet herb, which primarily enters the Middle-Jiao, as a central force, can tonify, stabilize and connect Yin, Yang, Qi and blood in the body, especially in weak and complicated conditions.
Assistant: Tonify and regulate the Qi; promote digestion in order to generate Ying-Qi and Wei-Qi
Shan Yao ( Dioscoreae rhizoma) and Huang Qi ( Astragali radix)
Shan Yao is neutral and sweet, and enters the Lung, Spleen and Kidney meridians. Although the function of tonifying the Spleen-Qi is not very strong, it can either tonify the Qi or the Yin as it has an astringent taste. It can be selected as assistant to tonify and stabilize the Spleen so as to promote generation of Ying-Qi and Wei-Qi. It is especially suitable for use in the treatment of sweating.
Huang Qi is sweet and slightly warm, and enters the Spleen and Lung meridians. It can strongly tonify the Spleen-Qi and promote the transformation of the Qi and blood so as to strengthen the Wei-Qi. As it can control the opening and closing of the pores, it can control the Ying-Yin, stop sweating and stabilize the exterior.
Jing Jie ( Schizonepetae herba), Fang Feng ( Saposhnikoviae radix) and Chai Hu ( Bupleuri radix)
Jing Jie and Fang Feng are pungent and slightly warm. They can expel wind and are commonly used for mild exterior wind-cold syndrome. In the syndrome of disharmony of Ying and Wei, they can be selected as assistants to expel wind and directly relieve aversion to wind.
Moreover, Jing Jie can expel wind in the blood so it is often used in skin disorders when itch exists due to wind invasion, such as eczema, urticaria and food allergy. Fang Feng is less strong in dispersing the wind on the surface of the body than Jing Jie because Fang Feng is sweet and this moderates its pungent taste. However, as Fang Feng is warmer than Jing Jie and enters the Spleen meridian, it is especially good at expelling dampness and cold in the regions that are deeper than the body surface, such as the subcutaneous region and muscles which are controlled by the Spleen. It is often used in food allergy and food intolerance when the Qi and blood are weak and are not in harmony.
Chai Hu is pungent and neutral, and enters the Liver and Gall Bladder meridians. It possesses a dispersing and ascending capacity. Chai Hu is particularly effective in spreading Qi in Shao Yang meridians. It is selected in the condition where there are alternating chills and fever, dry throat, a bitter taste in the mouth and fullness in the chest and hypochondriac region.
Sheng Jiang ( Zingiberis rhizoma recens) and Da Zao ( Jujubae fructus)
In the formula for treating the syndrome of disharmony of Ying and Wei, Sheng Jiang and Da Zao, as assistants, are often used as one unit. The pungent and warm Sheng Jiang is selected to assist the chief to expel wind and cold, and to enhance the force of the Wei-Qi. As it enters the Spleen and Stomach meridians, it can soothe the Stomach-Qi, warm the Middle-Jiao, aid digestion and therefore enhance the source of the Wei-Qi. The sweet and warm Da Zao enters the Spleen meridian, and can tonify the Spleen-Qi and nourish the blood. It enhances and strengthens the chief to nourish and stabilize Ying-Yin and Ying-Qi.
Examples of classical formulas
Gui Zhi Tang (Cinnamon Twig Decoction) 
Source: Shang Huan Lun 
Composition
Gui Zhi ( Cinnamomi cassiae ramulus) 9 g
Bai Shao Yao ( Paeoniae radix lactiflora) 9 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Sheng Jiang ( Zingiberis rhizoma recens) 9 g
Da Zao ( Jujubae fructus) 12 pieces
Analysis of the formula
This formula was devised by Dr Zhang Zhong Jing. It was originally used to treat disharmony between Ying and Wei in an exterior deficiency syndrome of the Tai Yang meridian, which, in Zang Fu differentiation theory, equates to a wind-cold syndrome. The manifestations are fever with irregular sweating and aversion to wind, a blocked nose, headache, a white tongue coating and a superficial, weak or slow pulse. However, this formula can also be used to treat different disorders directly caused by disharmony between Ying and Wei.
In this formula:
• Gui Zhi and Bai Shao Yao are paired as chief. The warm and sweet Gui Zhi promotes blood circulation and strengthens the Yang and Qi in the superficial region of the body, while the sour and cold Bai Shao Yao nourishes the Yin and body fluids, thereby strengthening the Ying-Yin. They perfectly match each other to address the condition of deficiency and imbalance between the Wei-Qi and the Ying-Yin in the superficial region of the body, restoring the physiological balance between the two.
• The assistants are Sheng Jiang, Da Zao and Zhi Gan Cao. The pungent and warm Sheng Jiang assists Gui Zhi, enhancing the power of the Wei-Qi to expel wind and cold. It enters the Spleen and Stomach meridians, soothes the Stomach-Qi, warms the Middle-Jiao, aids digestion and boosts the Wei-Qi. The sweet and warm Da Zao enters the Spleen meridian, nourishes the blood and supports the function of Bai Shao Yao. Together Da Zao and Zhi Gan Cao tonify the Spleen-Qi, thus strengthening both the Ying-Qi and the Wei-Qi.
Commentary on strategies
There are several characteristic features of this formula.
• First of all, Gui Zhi and Bai Shao Yao are used to harmonize and tonify the Wei-Qi and Ying-Yin and they focus on the main pathological changes.
• Second, the combination of Sheng Jiang and Da Zao is used to strengthen the Middle-Jiao in order to promote the generation of Wei-Qi and Ying-Qi.
• Third, the formula utilizes well-balanced herbal pairings. Thus Gui Zhi and Sheng Jiang tonify the Yang and Qi, while Bai Shao Yao and Da Zao tonify the Yin and blood. When combined in this way, these pairings bring balance and ensure safe use, enabling their application in many types of disorder that are caused by disharmony between Ying and Wei.
• Finally, four of the five ingredients in this formula (the exception being Bai Shao Yao) are often used as ingredients in cooking, so this formula is easily accepted by patients and can be widely used.
4. Syndrome of disharmony between the Yin, Yang, Qi and blood of the internal organs
Manifestations
Main symptoms
Cold and sore extremities, desire for warmth, a dry mouth and throat, low-grade fever, a pale complexion, tiredness, reduced appetite.
Secondary symptoms
Abdominal pain, palpitations, irritability.
Tongue
Pale, with a thin coating.
Pulse
Thready.
Associated disorders in western medicine
Insomnia, arrhythmia due to weak constitution or chronic disease, gastritis and peptic ulcer.
Analysis of the syndrome
This is a complicated syndrome where the five internal organs are all weak, and the Qi, blood, Yin and Yang are all deficient. This syndrome often occurs in people with a weak constitution or patients suffering from chronic illness.
• The deficiency of Yang manifests as cold and painful extremities, a desire for warmth and intermittent, spasmodic abdominal pain that is alleviated by warmth and pressure.
• The deficiency of Qi causes tiredness and reduced appetite.
• The deficiency of blood may lead to a lusterless complexion, palpitations, a pale tongue and a thready pulse.
• The deficiency of Yin manifests as low-grade fever, dry mouth, dry throat and irritability.
(See Figure 18.8 on page 381.)
Treatment principle: Use sweet herbs to tonify the Spleen and strengthen the Middle-Jiao so as to tonify and harmonize the Qi, blood, Yin and Yang of the body
Note
In this syndrome, the Qi, blood, Yin and Yang are all deficient, but to different degrees, which makes the treatment more complicated. Tonifying the Yang by using pungent and hot herbs may injure the Yin and blood; nourishing the Yin and blood by using cold and sour herbs may injure the Yang and Qi. Therefore a special principle is developed for this complicated syndrome:
1. Tonify the Spleen as it is the source of all the essential materials of the body and it is also the foundation of other organs.
2. Use sweet herbs as the basic flavor in the composition of these herbs can tonify the body without having the side effect of injuring the Yin or Yang, and can be readily combined with cold and warm herbs in order to tonify the Yin and Yang of the body.
Herb selection principles and formula composition strategies
• First, herbs that are sweet and warm, enter the Spleen meridian and tonify deficiency in general without the side effects of injuring Qi, blood, Yin and Yang, are selected.
• Second, herbs that are sweet, pungent and warm and that can gently and steadily tonify the Qi and Yang are chosen, along with sour and cold herbs that can nourish the blood and Yin.
• Third, herbs that regulate the Spleen-Qi and promote digestion are selected to strengthen the source of Qi and blood.
• Finally, herbs that integrate and stabilize the actions of the tonic herbs are added.
Structure of the formula and selection of herbs
Chief: Tonify the weakness
Yi Tang ( Maltose) and Zhi Gan Cao ( Glycyrrhizae radix preparata)
Yi Tang and Gan Cao are sweet and neutral. They enter the Spleen meridian. They are often used as chief in formulas to treat general weakness of Yin, Yang, Qi and blood of all the internal organs.
• First of all, they can directly tonify the Spleen-Qi, the source of Qi and blood, the foundation of life. It is particularly sensible for these herbs to be selected in an extremely weak condition of the internal organs.
• Second, compared with the herbs that tonify the Spleen, they have an obviously advantage in the selection. Because they have gentle actions of tonifying, they carry out a steady but effective function that has no side effects to harm the Yin or the Yang. They are particularly useful in chronic deficiency conditions.
• Third, their neutral property can be used in either cold or heat syndromes, which often exist in chronic deficiency conditions. Their sweet taste can combine with warm herbs to tonify the Yang and combine with cold herbs to generate the Yin.
• Finally, their sweet, nourishing nature can perfectly moderate the movement of Qi and blood, reduce tension due to disharmony in the body and slow down pathological development. Their sweet taste can also ease the muscles and relieve cramping pain of the Stomach and intestines.
Deputy: Nourish blood and Yin, tonify Qi and Yang
Gui Zhi ( Cinnamomi cassiae ramulus)
Gui Zhi is warm, pungent and sweet, and enters the Heart, Lung and Bladder meridians. It can strengthen and stimulate the Heart-Yang, promote the blood circulation and spread the warmth of Yang in the body. Since its pungent and warm nature is stabilized by its sweet taste, its function of stimulating the Yang and Qi is effective and stable. It can be used as deputy in the formula to strengthen the Yang and Qi in the body.
Dang Gui ( Angelicae sinensis radix)
Dang Gui is pungent, sweet and slightly warm. It can tonify the blood and promote blood circulation. It is often selected as deputy in the formula to tonify the blood, enhance the herbs that stimulate the Yang and Qi, and generate blood.
Bai Shao Yao ( Paeoniae radix lactiflora)
Bai Shao Yao is sour, bitter and slightly cold. It can generate the blood and Yin. This function can be enhanced by sweet herbs. In addition, its bitter and cold properties can clear heat and reduce empty-heat in the blood caused by deficiency of blood and Yin. In this way, the blood can circulate in a moderate way. Bai Shao Yao is often used as deputy in the formula to tonify the substantial part of the blood and Yin and reduce heat.
Shu Di Huang ( Rehmanniae radix praeparata)
Shu Di Huang is sweet and slightly warm, and enters the Kidney and Liver meridians. It is the most important herb for tonifying the blood as well as tonifying the Kidney-essence. Since its function is strong and quick, it can be used as deputy in the formula to treat severe deficiency of the Yin and essences. However, Sheng Di Huang is very cloying in nature and can easily obstruct the Qi movement. When the Spleen-Qi is weak, it can easily cause distension in the abdomen and reduced appetite. As such, it is often used with herbs that promote digestion and regulate Qi in the Middle-Jiao.
Ren Shen ( Ginseng radix)
Ren Shen is sweet, bitter and slightly warm, and enters the Lung and Spleen meridians. Since Ren Shen can strongly tonify the Yuan-Qi (the Source-Qi), it can tonify the Qi of all the internal organs. For instance, it tonifies the Heart-Qi, calms the mind and therefore treats palpitations and restlessness. It can tonify the Spleen-Qi and treat poor appetite, tiredness and diarrhea. It can tonify the Lung-Qi so as to treat shortness of breath. Moreover, it also promotes the generation of the blood, body fluids and Yin. It can be used as deputy to treat a severe condition of Qi deficiency.
Assistant: Promote digestion in order to generate Qi, blood, Yin and Yang
Chen Pi ( Citri reticulatae pericarpium)
Chen Pi is dried tangerine peel. It is pungent, bitter and warm, and enters particularly the Spleen and Stomach meridians. It regulates the Qi in the Middle-Jiao and promotes digestion. It is often selected as corrective assistant in formulas to reduce the cloying nature of the sweet tonifying herbs. It can directly treat distension in the Stomach and reduced appetite caused by Qi stagnation in the upper abdomen.
Fu Ling ( Poria)
Fu Ling is neutral and bland, and enters the Heart, Spleen and Kidney meridians. It can gently tonify the Qi of these organs, and can be used in either heat or cold syndromes of deficiency. It is often used as assistant to eliminate dampness in the Middle-Jiao. The dampness can be generated by deficiency of Spleen-Qi or from the cloying nature of the sweet tonifying herbs. Fu Ling can also tonify the Heart-Qi and calm the mind.
Sheng Jiang ( Zingiberis rhizoma recens) and Da Zao ( Jujubae fructus)
Sheng Jiang is pungent and warm, and enters the Spleen and Stomach meridians. It is selected to assist the chief and deputies to soothe the Stomach-Qi, warm the Middle-Jiao, aid digestion and therefore enhance the source of the Qi. It is also often used to enhance the ability of the deputy to stimulate and warm the Yang in the body.
Da Zao is sweet and warm, and enters the Spleen meridian. It can tonify the Spleen-Qi and nourish the blood. It is often used to enhance the ability of the deputy to nourish blood. Sheng Jiang and Da Zao are used as one unit in the formula.
Examples of classical formulas
Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) 
Source: Shang Han Lun 
Composition
Yi Tang ( Maltose) 18–30 g
Gui Zhi ( Cinnamomi cassiae ramulus) 9 g
Bai Shao Yao ( Paeoniae radix lactiflora) 9 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Sheng Jiang ( Zingiberis rhizoma recens) 10 g
Da Zao ( Jujubae fructus) 4 pieces
Analysis of the formula
This formula primarily treats Spleen-Qi and Yang deficiency. In fact, it treats a chronic syndrome of deficiency of the Middle-Jiao, where not only Qi and Yang are deficient, but also the Yin and blood, on account of the debilitating effects of the long-term weakness of Yang and Qi. The Yang and Qi deficiency manifests as intermittent, spasmodic abdominal pain that is relieved by warmth and pressure, reduced appetite, and cold and sore extremities. The Qi and blood deficiency manifests as a lusterless complexion, palpitations, a pale tongue and a thready pulse; the Yin deficiency manifests as low-grade fever, dry mouth, dry throat and irritability.
The Qi, blood, Yin and Yang in the Middle-Jiao are all deficient, but to different degrees, and this makes the treatment more complicated. Tonifying the Yang by using pungent and hot herbs may injure the Yin and blood; nourishing the Yin and blood by using cold and sour herbs may injure the Yang and Qi. The formula Xiao Jian Zhong Tang demonstrates some important strategies by which all four aspects can be tonified in a balanced and effective way.
• A large amount of Yi Tang is applied as the chief ingredient. Since it is sweet and neutral and enters the Spleen meridian, it can tonify the Spleen directly without the risk of harming the Yin or the Yang. Since its nourishing nature makes it perfect for easing the muscles, it can relieve cramping pain.
• When Yi Tang is used with Gui Zhi, one of the deputy herbs which is pungent, sweet and hot, the Spleen-Yang can be tonified and stimulated. As the pungent and hot nature of Gui Zhi is modified by the large amount of Yi Tang, it will not injure the Yin and blood.
• When Yi Tang is used with Bai Shao Yao, the other deputy which is sour, bitter and cold, the Yin can be generated and the blood and Yin deficiency can be treated. As the cold nature of Bai Shao Yao is minimized by the large amount of Yi Tang, the Yang and Qi will not be injured.
• The pungent and hot Sheng Jiang stimulates the Yang, and assists Gui Zhi to warm the Middle-Jiao. It also soothes the Stomach-Qi, disperses the cold and fluid accumulation, and improves digestion.
• The sweet and warm Da Zao can tonify the blood and Spleen-Qi, and serves as assistant to Bai Shao Yao.
• Zhi Gan Cao serves as assistant as well as envoy. On the one hand, it can tonify the Spleen and soothe the muscles, thus assisting the chief; on the other hand, it moderates the action of the other herbs in its role as envoy.
Commentary on strategies
The composition of this formula has several distinctive characteristics.
• First of all, sweet herbs are used to directly tonify the Spleen.
• Second, the combinations of sweet and warm herbs and sweet and cold herbs are used to generate the Yang and the Yin respectively.
• Third, the herbal combinations and dosage ratios are arranged in a thoughtful way so as to avoid causing injury to other aspects in the process of tonifying one aspect.
In this way, the Yin, Yang, Qi and blood are generated gradually, steadily and sufficiently. As soon as the Yin and blood can nourish the internal organs, the functions of the Yang and Qi are boosted and all symptoms gradually disappear. This formula is a very good example of treating a chronic condition of deficiency.
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| Figure 18.1 •. |
| Relationship between Liver and Spleen in pathology. |
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| Figure 18.2 •. |
| Liver overacting on Spleen. |
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| Figure 18.3 •. |
| Pathology of disharmony in Shao Yang regions. |
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| Figure 18.4 •. |
| Disharmony in Shao Yang regions in a severe condition. |
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| Figure 18.5 •. |
| Defensive-Qi and its development. |
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| Figure 18.6 •. |
| Etiology of disharmony of Ying and Wei. |
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| Figure 18.7 •. |
| Pathology of disharmony of Ying and Wei. |
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| Figure 18.8 •. |
| Disharmony of Yin, Yang, Qi and blood. |
