Chapter Seventeen. Syndrome of dryness and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that moisten dryness by increasing body fluids or promoting the spreading of body fluids. They are used to treat the syndrome of dryness.
Syndrome of dryness
Dryness has a contracting and holding nature. It is associated with the Lung and predominates in the autumn. Pathogenic dryness can be divided into external dryness and internal dryness.
External dryness is one of the six exogenous pathogenic factors; it appears in the autumn and directly injures the Lung. In the early autumn, dryness is often combined with heat and it consumes the body fluid and Yin of the Lung – this syndrome is referred to as warm-dryness. In the late autumn, dryness is mainly combined with cold and causes obstruction of spreading of the body fluid of the Lung – this syndrome is referred to as cold-dryness.
Internal dryness is caused directly by the consumption of body fluids. Some diseases, medicines, herbs or food products can injure the body fluids and cause dryness. Long-term stress and emotional disturbance can also cause consumption of the body fluids. As the Lung, Stomach and Large Intestine are mainly involved, the syndrome of dryness can be respectively divided into dryness in the Upper-, Middle- and Lower-Jiao.
In clinical practice, external dryness and internal dryness can coexist.
1. Syndrome of external dryness
Syndrome of warm-dryness
Manifestations
Main symptoms
Dry nasal cavity, dry mouth and throat, thirst, dry cough without phlegm or with a small amount of scanty and thick phlegm.
Secondary symptoms
Headache and fever.
Tongue
Red with a thin, dry, white coating.
Pulse
Superficial, rapid.
Syndrome of cold-dryness
Manifestations
Main symptoms
Slight headache with chills, blocked nose, aversion to wind and cold, cough with thin sputum.
Secondary symptoms
Dry nasal cavity, dry skin.
Tongue
White and slightly dry coating.
Pulse
Superficial, wiry.
2. Syndrome of internal dryness
Manifestations
Main symptoms
Dry nasal cavity, dry throat, cough with scanty sputum, shortness of breath, dry mouth, thirst, acid regurgitation, constipation and hemorrhoids.
Secondary symptoms
Cough with blood-streaked sputum, a dry and sore throat, sadness, depression, tiredness, anxiety, mood swings, hot palms and soles, night sweats.
Tongue
Red with a dry, yellow, thin coating.
Pulse
Thready and rapid.
Associated disorders in western medicine
Common cold, influenza, recovery period of influenza, bronchitis, pneumonia, chronic rhinitis, tuberculosis and other infectious diseases caused by bacteria and viruses, diabetes, peptic ulcer, irritable bowel syndrome, constipation and hemorrhoids, skin diseases that are characterized by dryness of the skin lesions, such as disorders of keratinization and senile pruritus.
Analysis of the syndrome
The Lung is an organ that is directly exposed to the environment. It is a very fragile organ, which cannot bear warmth, cold and dryness. It needs fluid to nourish its light body and Qi to support its function. If these conditions are not fulfilled, symptoms of dysfunction immediately appear.
Warm-dryness
• Exogenous pathogenic warm-dryness can injure the Lung-Qi and fluid, block the Qi dispersing and descending, and directly cause cough with thin, scanty sputum.
• The nose is the passage and the throat is the gateway of the Lung. When the Lung-Qi is disturbed, nasal obstruction, dry nasal cavity and dry throat may occur.
• The Lung relates to the skin and controls the opening and closing of the pores. When dryness obstructs the superficial region of the body, slight headache, chills and aversion to wind and cold may exist.
• The warm-dryness consumes the fluids directly and causes thirst, a red and dry tongue and a superficial and rapid pulse.
Cold-dryness
• When exogenous pathogenic cold-dryness invades the superficial region of the body, closes the pores, obstructs the Qi movements there and further obstructs the Lung, it may cause dysfunction of dispersing and descending of Lung-Qi. The patient may have a slight headache with chills, aversion to wind and cold, a blocked nose and cough with thin and scanty sputum.
• When the distribution of fluid is blocked, and the fluid condenses and turns into phlegm, the patient may suffer from dry nasal cavities and dry skin, as well as cough with scanty, thin sputum. A white and slightly dry tongue coating and a superficial and wiry pulse are often seen in this syndrome.
Internal dryness
• In the syndrome of internal dryness due to Qi and Yin deficiency of the Lung, symptoms such as dry nasal cavity, dry cough, scanty sputum and thirst may exist.
• When Yin deficiency is accompanied by empty-fire, the fire may push the blood into leaving its pathway, and blood may appear in the sputum.
• As soon as the fluid fails to moisten the Lung, the Lung-Qi weakens and patients may feel sad, tired and depressed. If there is heat in the Lung at the same time, patients may have mood swings and feel anxious.
• When the Kidney-Yin is consumed severely, night sweats, dry and sore throat and hot palms and soles appear. In this syndrome, the tongue body is red, the coating is thin and the pulse is thready and rapid.
• The dryness arising in the Stomach and Large Intestine can be very severe and because they are Yang Ming organs, they are filled up with heat, the Yin and fluid are easily injured and acid regurgitation and constipation may occur.
• Hemorrhoids are often caused by dryness in the intestines, heat in the blood and stagnation of blood.
In this syndrome, the tongue is red, the coating is very dry and yellow, and the pulse is thready and rapid. They indicate dryness and heat in the body.
Treatment principles
• For treating warm-dryness syndrome: Slightly disperse the dryness, gently clear and moisten the Lung.
• For treating cold-dryness syndrome: Disperse cold-dryness, regulate the Lung-Qi and transform the phlegm.
• For treating internal dryness syndrome: Nourish the Yin and fluids of the Lung, Kidney, Stomach and Large Intestine.
CAUTIONS
1. Caution for using sweet herbs in an external syndrome:
Sweet and cold herbs with a sticky and cloying nature should not be used in the syndrome of external dryness as they may hold onto the pathogenic factors.
2. Consider the condition of the Spleen:
Patients with Spleen-Qi and Spleen-Yang deficiency should not use herbs that are cold and sweet as they may place an extra burden on the Stomach.
4. Avoid foods that may generate dryness:
Patients who suffer from the syndrome of dryness should avoid spicy food and food that induces heat, such as hot pepper, onion, cinnamon and deep-fried food. Very sour food, such as citrus fruits and vinegar, should not be consumed in excess as they may make the fluid distribution slow or even stop.
5. Avoid overstimulating the Qi:
In composing formulas, the use of herbs that are very pungent and aromatic, and have a drying nature to promote the Qi movement should be avoided as they may consume the Yin.
Although dryness should influence many organs, in the following sections, two syndromes are particularly discussed: the syndrome of dryness in the Lung, which links with climate, and the syndrome of dryness in the Stomach and Large Intestine, which links with physiological and pathological features of the Yang Ming organs and dietary habit. The dryness of internal organs can be also consulted in the sections on syndromes of Yin deficiency and syndromes of blood deficiency in Chapter 5.
Syndrome of dryness in the Lung
Herb selection principles and formula composition strategies
• To treat a syndrome of warm-dryness, sweet and cold herbs that enter the Lung meridian are selected to moisten the Lung.
• To treat a syndrome of cold-dryness, herbs that are slightly warm, pungent, bitter and moistening, and enter the Lung meridian are selected to disperse the Lung-Qi and expel cold.
• To treat a syndrome of internal dryness of the Lung, sweet, bitter and cold herbs are selected to nourish the Lung-Yin, generate the body fluids and clear Lung-heat.
• Along with these, herbs that regulate the Lung-Qi, stop cough and moisten the Lung are often used.
• Herbs that tonify the Lung-Qi in order to stimulate the generation and spreading of the Yin and fluids should be selected in the condition of Qi deficiency.
• Herbs that nourish the Kidney-Yin can be added in a chronic condition of Lung-Yin deficiency.
Structure of the formula and selection of herbs
Chief: Directly treat the main pathological change
Sang Ye ( Mori folium), Bo He ( Menthae herba) and Lian Qiao ( Forsythiae fructus)
These herbs are aromatic, light and cold, and enter the Upper-Jiao. Sang Ye and Bo He enter the Lung meridian and Lian Qiao enters the Heart meridian. Their aromatic smell can disperse the constrained Qi and heat in the Lung and their cold nature can reduce the heat and protect the Yin. They are often selected as chief in the formulas to treat the syndrome of warm-dryness.
Zi Su Ye ( Perillae folium) and Dan Dou Chi ( Sojae semen praeparatum)
These two herbs are pungent and warm, and enter the Lung meridian. They can gently and effectively disperse the cold-dryness from the superficial region and stimulate the Lung-Qi, thus accelerating the distribution of the Qi and fluid in the body. They are often used as chief in the formula to treat cold-dryness syndrome.
Bei Sha Shen ( Glehniae radix), Mai Men Dong ( Ophiopogonis radix), Tian Men Dong ( Asparagi radix) and Bai He ( Lilii bulbus)
These herbs are sweet and cold, and enter the Lung meridian. They can nourish the Yin of the Lung and moisten the dryness. They are often used as chief in the formula to treat dryness caused by internal heat.
Bei Sha Shen, Mai Men Dong and Bai He not only nourish the Yin, but also gently tonify the Qi. They are suitable for use in syndromes where the Qi and Yin are both weak. In addition, as Mai Men Dong and Bai He also enter the Heart meridian, they can be used when dry-heat injures the Yin of the Lung and Heart, causing anxiousness, restlessness and insomnia in the latter.
Tian Meng Dong is the coldest herb in this group and can effectively reduce heat. Since it also enters the Kidney meridian, it is often used in conditions when the Lung-Yin and the Kidney-Yin are both injured, particularly in chronic and severe syndromes of Lung-Yin deficiency.
Deputy: Regulate Lung-Qi, stop cough, eliminate phlegm and moisten the Lung
Xing Ren ( Armeniacae semen), Chuan Bei Mu ( Fritillariae cirrhosae bulbus) and Pi Pa Ye ( Eriobotryae folium)
Xing Ren, Chuan Bei Mu and Pi Pa Ye enter the Lung meridian. They are all able to remove phlegm and stop cough. Since they are moistening in nature, they eliminate phlegm without the likelihood of injuring the fluid of the Lung. They are the appropriate choice in the formula to treat dryness in the Lung in both internal and external syndromes.
Sang Ye ( Mori folium) and Xing Ren ( Armeniacae semen)
Sang Ye is sweet, bitter and cold, can gently disperse the Lung-Qi, disperse and clear the heat, and moisten the dryness of the Lung. Xing Ren is pungent, bitter and warm but moist in nature. It can disperse and descend the Lung-Qi and eliminate phlegm without the likelihood of injuring the fluid. These two herbs can be selected to gently disperse the Lung-Qi and expel the cold-dryness without leading to a drying side effect.
Xing Ren ( Armeniacae semen) and Qian Hu ( Peucedani radix)
Xing Ren and Qian Hu are pungent and bitter, and enter the Lung meridian. Xing Ren is warm and can disperse the Lung-Qi; Qian Hu is cold and can descend the Lung-Qi. They can eliminate phlegm and stop cough without the side effect of drying. They can be selected as deputies in a formula to regulate the Lung-Qi and relieve cough in an acute syndrome of external dryness.
Hei Zhi Ma ( Sesami semen nigricum), Li ( Pyri fructus), Li Pi ( Pyri pericarpium) and milk
Hei Zhi Ma is sweet and neutral, and enters the Kidney and Liver meridians. It can tonify the Kidney essence and Liver-blood. It can be selected as deputy in the formula to treat chronic or severe Lung-Yin and Kidney-Yin deficiency. Pear and its peel can moisten the Lung in a gentle but effective way. They are often used in the syndrome of Yin and fluid deficiency of the Lung. Since they are food products, they are often recommended in the diet.
Assistant: Clear the heat from the Lung and generate body fluids
Tian Hua Fen ( Trichosanthis radix), Lu Gen ( Phragmitis rhizoma) and Yu Zhu ( Polygonati odorati rhizoma)
These herbs are often used in formulas to treat the syndrome of warm-dryness.
Tian Hua Fen is sweet, bitter, sour and cold, and enters the Lung meridian. It can clear the heat and remove toxin in the Lung. It can also generate fluid of the Lung. Since it has no sticky and cloying nature, it is often used at the late stage of febrile disease where the pathogenic heat is not completely eliminated from the body and the fluid of the Lung is injured.
Lu Gen is sweet and cold, can clear heat and generate fluid of the Lung; it can also transform phlegm and pus. It can be used to treat thirst, dryness of the nasal cavities, mouth and throat when there is dry-heat in the Lung, and cough with green phlegm when phlegm-heat also accumulates in the Lung.
Yu Zhu is sweet and neutral, and enters the Lung meridian. This herb can gently nourish the Yin and moisten the Lung. It is often used in a chronic, mild syndrome of dryness.
Shi Gao ( Gypsum)
Shi Gao is sweet, pungent and cold, and enters the Lung meridian. It can intensively reduce the heat and protect the fluid of the Lung. It can be used in syndromes caused by both external and internal dryness. However, it is only used in these syndromes when the heat is strong and the Qi fails to descend. In these conditions, patients suffer from obvious shortness of breath, have a red tongue and a forceful and rapid pulse.
Zhi Mu ( Anemarrhenae rhizoma) and Sheng Di Huang ( Rehmanniae radix)
These are two cold herbs. Zhi Mu is bitter and cold, but is moist in nature. It enters the Lung and Kidney meridians, can strongly reduce heat and protects the Yin. Sheng Di Huang enters the Heart, Liver and Kidney meridians. It can nourish the Yin, clear heat and cool the blood. Since they are both strong in action and enter the Kidney meridian, they can be used in the syndrome of internal dryness when the Yin is severely injured with excess heat and empty-heat in the Lung and Kidney.
Examples of classical formulas
Xing Su San (Apricot Kernel and Perilla Leaf Powder) 
Source: Wen Bing Tiao Bian 
Composition
Xing Ren ( Armeniacae semen) 6 g
Zi Su Ye ( Perillae folium) 6 g
Jie Geng ( Platycodi radix) 6 g
Zhi Ke ( Aurantii fructus) 6 g
Qian Hu ( Peucedani radix) 6 g
Ban Xia ( Pinelliae rhizoma) 6 g
Chen Pi ( Citri reticulatae pericarpium) 6 g
Fu Ling ( Poria) 6 g
Sheng Jiang ( Zingiberis rhizoma recens) 6 g
Da Zao ( Jujubae fructus) 2 pieces
Gan Cao ( Glycyrrhizae radix) 3 g
Analysis of the formula
This formula gently disperses cold-dryness, regulates the Lung-Qi and transforms phlegm. It is used for treating exogenous pathogenic cold-dryness that invades the superficial region of the body and the Lung. It disturbs dispersing and descending of the Lung-Qi and fluid, leading to phlegm accumulation. The manifestations are slight headache, chills, aversion to wind and cold, cough with thin sputum, nasal obstruction and dry nasal cavities. The tongue coating is white and slightly dry, and the pulse is superficial and wiry.
In this formula:
• Zi Su Ye and Qian Hu are used as chief. The pungent and warm Zi Su Ye can slightly induce sweating and relieve the cold-dryness from the exterior. The pungent and bitter Qian Hu can descend the Lung-Qi, expel wind and remove phlegm in the Lung.
• Jie Geng and Xing Ren serve as deputies and regulate the Lung-Qi. Jie Geng moves upwards and can disperse the Lung-Qi; Xing Ren moves downwards and can descend the Lung-Qi. They can also eliminate phlegm and stop cough.
• Ban Xia and Fu Ling are used to dry dampness and transform phlegm; Chen Pi and Zhi Ke regulate the Qi in the Upper-Jiao. They are all used as assistants.
• Sheng Jiang, Da Zao and Gan Cao serve as assistants as well as envoys in the formula. They strengthen and harmonize the Nutritive-Yin and Defensive-Qi, and harmonize the functions of the herbs in the formula.
Commentary on strategies
• In this formula, the methods of releasing the exterior, regulating the Lung-Qi and transforming phlegm are applied in order to treat the different aspects of the syndrome.
• The selected herbs are light in nature and weight, but are active and sufficient to treat the syndrome. It shows a subtle way to spread and regulate the Qi and fluid without the likelihood of injuring this fragile organ.
Sang Xing Tang (Mulberry Leaf and Apricot Kernel Decoction) 
Source: Wen Bing Tiao Bian 
Composition
Sang Ye ( Mori folium) 3 g
Xing Ren ( Armeniacae semen) 4.5 g
Dan Dou Chi ( Sojae semen praeparatum) 3 g
Bei Sha Shen ( Glehniae radix) 6 g
Chuan Bei Mu ( Fritillariae cirrhosae bulbus) 3 g
Li Pi ( Pyri pericarpium) 3 g
Zhi Zi ( Gardeniae fructus) 3 g
Analysis of the formula
This formula gently disperses dryness and clears and moistens the Lung. It is a formula to treat the syndrome of warm-dryness. When exogenous pathogenic warm-dryness injures the Lung-Qi and fluid, symptoms such as dry throat and thirst, and dry cough without phlegm or with a small amount of scanty, thick phlegm arise. When the superficial region is blocked by dryness, fever and headache may occur. A red tongue indicates the existence of heat; a thin, dry and white coating indicates the existence of dryness; a floating pulse on the Lung position suggests that the Lung is disturbed.
In this formula:
• Sang Ye and Dan Dou Chi are used as chief. Sang Ye is sweet, bitter and cold, and can gently disperse the heat in the Lung. Dan Dou Chi, which is processed by Bo He and Qing Hao, is pungent and cold, and can also disperse the heat in the Lung.
• The deputy is Xing Ren, which can regulate the Lung-Qi as it can disperse and descend the Lung-Qi. Since it is a seed, it can also moisten the Lung.
• Bei Sha Shen, Chuan Bei Mu and Li Pi serve as assistants . Bei Sha Shen can moisten the Lung and generate the fluid; Chuan Bei Mu and Li Pi can moisten the Lung, stop cough and remove phlegm.
• Zhi Zi, another assistant, can clear the heat in the Upper-Jiao.
Commentary on strategies
• The characteristic of the composition of this formula is to put herbs with pungent, cold and moistening properties together to disperse and clear the Lung-heat on the one hand, and to protect and generate the fluid so as to treat the warm-dryness on the other hand.
• The dosages of the herbs in the formula are very small, indicating the principle of treating disorders of the Lung.
Qing Zao Jiu Fei Tang (Eliminate Dryness and Rescue the Lungs Decoction) 
Source: Yi Men Fa Lü 
Composition
Sang Ye ( Mori folium) 9 g
Shi Gao ( Gypsum) 7.5 g
Mai Men Dong ( Ophiopogonis radix) 3.6 g
E Jiao ( Asini corii colla) 2.4 g
Hei Zhi Ma ( Sesami semen nigricum) 3 g
Xing Ren ( Armeniacae semen) 2 g
Mi Zhi Pi Pa Ye (honey-fried Eriobotryae folium) 3 g
Ren Shen ( Ginseng radix) 2 g
Gan Cao ( Glycyrrhizae radix) 3 g
Analysis of the formula
This formula clears the warm-dryness and moistens the Lung. It is used for a syndrome where the warm-dryness injures the Lung and weakens the Lung-Qi and Lung-Yin. The symptoms are headache, fever, thirst, dry cough without phlegm, and dry throat and nasal cavities. When the Qi is disturbed in the Lung, fullness in the chest and irritability may occur. A dry tongue body without coating indicates a severe deficiency of Yin and fluid. A weak, thready and rapid pulse indicates that the Qi and Yin are both injured and that the pathogenic warm-dryness still exists.
In this formula:
• Sang Ye, which is bitter, cold and sweet, is used as chief. It gently and effectively disperses the Lung-Qi, moistens the dryness and clears heat in the Lung.
• A small amount of Shi Gao is used as deputy to enhance the ability of Sang Ye to clear heat and relieve dryness in the Lung.
• The sweet and cold Mai Men Dong is also used as deputy to nourish the Yin and fluid and reduce the heat.
• The assistants are divided into two groups. E Jiao, Hei Zhi Ma, Xin Ren and Pi Pa Ye are in the first group. The first two herbs can tonify the blood and essence, and moisten the Lung; the last two can clear heat and descend the Lung-Qi. Ren Shen and Gan Cao form the second group. They can tonify the Qi and are used to treat Qi deficiency caused by heat and dryness.
Commentary on strategies
• The composition of this formula is characterized by selecting sweet, bitter, cold and moistening herbs and by avoiding the common (but inappropriate) methods, namely, using pungent or aromatic herbs to disperse the Lung-Qi; using bitter and cold herbs to clear Lung-heat.
Yang Yin Qing Fei Tang (Nourish the Yin and Clear the Lungs Decoction) 
Source: Chong Lou Yu Yao 
Composition
Sheng Di Huang ( Rehmanniae radix) 6 g
Xuan Shen ( Scrophulariae radix) 4.5 g
Mai Men Dong ( Ophiopogonis radix) 3.6 g
Chao Bai Shao Yao (dry-fried Paeoniae radix lactiflora) 2.4 g
Mu Dan Pi ( Moutan cortex) 2.4 g
Chuan Bei Mu ( Fritillariae cirrhosae bulbus) 2.4 g
Bo He ( Menthae herba) 1.5 g
Gan Cao ( Glycyrrhizae radix) 1.5 g
Analysis of the formula
This formula nourishes the Lung-Yin, clears the heat and relieves toxicity. It treats the ‘white throat’ syndrome, which is caused by deficiency of Lung-Yin and Kidney-Yin, and infected by epidemic heat-toxin. The manifestations are fever, dry nasal cavities, a dry mouth, irritability, hoarse breathing, swollen and sore throat, and the development of a white, curd-like membrane in the throat that is difficult to scrape off. This syndrome shows a red tongue with a dry, yellow coating and a thready and rapid pulse.
In this formula:
• Sheng Di Huang and Mai Men Dong are used as chief to directly nourish the Yin and clear heat in the Lung.
• Xuan Shen and Mu Dan Pi are used as deputies. Xuan Shen can clear heat in the Lung and Kidney, and reduce fire-toxin. It dissipates hardness and reduces swelling of the throat. Mu Dan Pi can cool the blood, dissipate the constrained fire and therefore reduce fire-toxin.
• Bai Shao Yao, Chuan Bei Mu and Bo He serve as assistants. Bai Shao Yao can stabilize the Yin and reduce heat. It also softens the Liver and prevents the Liver insulting the Lung when the Lung is in a weak condition. Chuan Bei Mu can moisten the Lung, stop cough, and remove and dissipate phlegm. It enhances the function of Xuan Shen to reduce the swelling of the throat. Bo He can disperse the heat from the Lung and benefit the throat.
• The envoy is Gan Cao, which is sweet and moist, can drain the fire and remove fire-toxin.
Commentary on strategies
• In this formula, sweet, cold and moistening herbs are used together to nourish the Yin of the Lung and Kidney; the herbs that remove fire-toxin and the herbs that dissipate hardness and swelling are used together against the epidemic heat-toxin.
• Since an exogenous pathogenic factor should be eliminated, a small amount of Bo He is used for this purpose.
Bai He Gu Jin Tang (Lily Bulb Decoction to Preserve the Metal) 
Source: Yi Fang Ji Jie quoted from formula devised by Zhao Ji An 
Composition
Bai He ( Lilii bulbus) 6 g
Sheng Di Huang ( Rehmanniae radix) 6 g
Shu Di Huang ( Rehmanniae radix praeparata) 9 g
Mai Men Dong ( Ophiopogonis radix) 5 g
Xuan Shen ( Scrophulariae radix) 3 g
Dang Gui ( Angelicae sinensis radix) 3 g
Bai Shao Yao ( Paeoniae radix lactiflora) 3 g
Chuan Bei Mu ( Fritillariae cirrhosae bulbus) 3 g
Jie Geng ( Platycodi radix) 3 g
Gan Cao ( Glycyrrhizae radix) 3 g
Analysis of the formula
This formula nourishes Yin, clears heat, moistens the Lung and dissolves phlegm. It is used to treat internal dryness caused by deficiency of the Kidney-Yin and the Lung-Yin, and up-flaring of empty-fire. The manifestations and signs are cough with blood-streaked sputum, dry and sore throat, hot sensation in the palms and soles, bone steaming, night sweating, a red tongue without coating and a thready and rapid pulse.
In this formula:
• Bai He, Sheng Di Huang and Shu Di Huang are used as chief. Bai He moistens the Lung, clears heat in the Heart and calms the mind. Sheng Di Huang can nourish the Yin of the Lung and Kidney, and reduce the heat from these organs. Shu Di Huang nourishes the Yin and essence of the Kidney and Liver in order to control the empty-fire.
• Mai Men Dong and Chuan Bei Mu serve as deputies. Mai Men Dong nourishes the Yin of the Lung and Heart, and reduces the fire in the Upper-Jiao. Chuan Bei Mu moistens the dryness of the Lung and stops cough.
• There are five assistants:
– Xuan Shen is bitter, salty and cold. It can lift the Kidney-water from the Lower-Jiao to the Upper-Jiao to reduce the excess fire of the Heart, descend the heat from the Lung and therefore pacify the Lung.
– Dang Gui and Bai Shao Yao form a pair of herbs. They tonify the Liver-Yin and blood, and prevent the Liver attacking the Lung when the Liver-Qi stagnates. Moreover, Dang Gui regulates the blood and moistens the dryness because blood in the sputum is a sign that blood has left its pathway. Bai Shao Yao nourishes the Yin and softens the Liver, thereby benefiting the Yin in the Lung.
– Jie Geng can enhance the ability of Chuan Bei Mu to remove phlegm and stop cough. Together with Gan Cao, it dissipates the hardness and benefits the throat. It can also disperse Lung Qi.
Commentary on strategies
Several strategies are used in this formula.
• First of all, not only are there herbs that nourish the Yin and moisten the dryness of the Lung, but also herbs that tonify the Kidney essence and Liver blood. These herbs may make the function of moistening the dryness more stable and sufficient, especially in the severe condition of dryness in the Lung.
• Second, herbs that reduce dry-heat, dissipate the sticky phlegm and benefit the throat are used, such as Xuan Shen, Chuan Bei Mu, Jie Geng and Gan Cao.
• Moreover, the selection of Xuan Shen, Dang Gui and Bai Shao Yao enriches the treatment strategies by considering the relationship of the Lung, Kidney and Liver in the syndrome.
Syndrome of dryness in the Stomach and Large Intestine
Herb selection principles and formula composition strategies
• First, sweet and cold herbs that enter the Stomach and Large Intestine meridians and can moisten the Stomach and Large Intestine are selected.
• Second, sweet, bitter and cold herbs that enter the Stomach and Large Intestine meridians, can clear heat and generate body fluids are selected.
• Third, herbs that regulate the Qi, promote digestion, soothe the Stomach-Qi and promote bowel movement are selected.
Structure of the formula and selection of herbs
Chief: Moisten the Stomach and Large Intestine
Mai Men Dong ( Ophiopogonis radix), Sheng Di Huang ( Rehmanniae radix) and Shi Hu ( Dendrobii caulis)**
These three herbs are sweet and cold, and enter the Stomach meridian. They can nourish the Yin, generate the fluid, and thus moisten the Stomach and relieve thirst. Moreover, Sheng Di Huang and Shi Hu also enter the Kidney meridian. They can be selected in a severe condition of both Stomach-Yin and Kidney-Yin deficiency.
Huo Ma Ren ( Cannabis semen), Yu Li Ren ( Pruni semen), Xing Ren ( Armeniacae semen), He Shou Wu ( Polygoni multiflori radix), Dang Gui ( Angelicae sinensis radix), Xuan Shen ( Scrophulariae radix) and Feng Mi ( Mel)
These herbs are moist in nature and are particularly used for moistening the dryness of the intestines and treating mild constipation. Huo Ma Ren and Yu Li Ren are seeds and contain oil that can moisten the intestines and relieve the dryness. They are often used together to enhance each other’s function. Xing Ren is the seed of apricot and has a similar function to the first two herbs. However, it also has a dispersing tendency. As it can ascend the Lung-Qi, it can activate Qi movement in the Large Intestine.
He Shou Wu and Dang Gui are able to tonify the blood and can moisten the intestines. They are particularly suitable for use in the formula to treat constipation caused by blood deficiency.
Since the bitter, salty and cold Xuan Shen can reduce heat and increase the fluid in the intestines, it can soften the feces and treat constipation due to Yin deficiency with heat in the intestine.
The sweet and moist Feng Mi can be mixed with cold water and drunk in the morning on an empty stomach. It may stimulate the stomach and intestines and promote bowel movement. It is used to treat chronic and mild constipation.
Deputy: Clear heat from the Stomach and Large Intestine and generate the body fluids
Shi Gao ( Gypsum), Zhi Mu ( Anemarrhenae rhizoma) and Tian Hua Fen ( Trichosanthis radix)
These substances are cold and enter the Stomach meridian. They are able to clear heat and reduce fire there. In addition, they can all increase the fluid of the Stomach and relieve thirst. They are often used as deputies in the formula to treat dryness due to heat in the Stomach.
Assistant: Tonify and regulate the Qi, promote digestion, soothe the Stomach-Qi and promote bowel movement
Ren Shen ( Ginseng radix) and Huang Qi ( Astragali radix)
Ren Shen and Huang Qi are sweet and warm, and enter the Lung and Spleen meridians. They can be selected as assistants in the formula to tonify the Qi in order to generate the Yin. They can also be used in the condition where the Qi and Yin are both deficient.
Ge Gen ( Puerariae radix)
Ge Gen is sweet, pungent and slightly cold, and enters the Stomach meridian. It moves upwards, and can ascend and spread the fluid, thus relieving thirst.
Zhi Shi ( Aurantii fructus immaturus)
Zhi Shi is bitter and slightly cold, and enters the Spleen and Stomach meridians. This herb is able to promote the Qi movement. As it has a descending tendency, it can promote bowel movement and is often used in the formula for treating constipation.
Da Huang ( Rhei rhizoma) and Mang Xiao ( Natrii sulfas)
Da Huang and Mang Xiao are purgative herbs. The bitter and cold Da Huang can purge the intestines and the salty and cold Mang Xiao can soften the hard feces and moisten the intestines. They can be used together with herbs that nourish the Yin and moisten the intestines to treat severe constipation.
Examples of classical formulas
Mai Men Dong Tang (Ophiopogonis Decoction) 
Source: Jin Kui Yao Lue 
Composition
Mai Men Dong ( Ophiopogonis radix) 35 g
Ren Shen ( Ginseng radix) 6 g
Jing Mi (non-glutinous rice) 5 g
Da Zao ( Jujubae fructus) 4 pieces
Gan Cao ( Glycyrrhizae radix) 6 g
Ban Xia ( Pinelliae rhizoma) 5 g
Analysis of the formula
This formula can nourish the Stomach and generate body fluid. It can also direct rebellious Qi in the Stomach downwards. It treats the syndrome where the Qi and Yin of the Stomach and the Lung are deficient, and the empty-fire of these organs flares up. When the Lung and Stomach lose nourishment from the Yin and fluid, cough, spitting of saliva and dry mouth exist. When the Qi is weak in the Lung, wheezing and shortness of breath may occur. When the Stomach-Qi is weak, the empty-fire flares up and the Stomach fails to descend the Qi, a dry and uncomfortable sensation in the throat may emerge. In this case, the tongue is red with a thin coating and the pulse is thready and rapid.
In this formula:
• Mai Men Dong is used in a very large dosage as chief. It is sweet and slightly cold, can nourish the Yin and moisten dryness of the Lung, Heart and Stomach. It can also slightly tonify the Qi of these organs.
• Ren Shen is the deputy. It can strongly tonify the Qi of these organs, accelerate the Yin generation and therefore enhance the ability of Mai Men Dong.
• The assistants are Ban Xia, Jing Mi, Gan Cao and Da Zao. They tonify the Qi of the Middle-Jiao and enhance the ability of Ren Shen. Da Zao and Gan Cao are sweet herbs and may enhance the ability of Mai Men Dong to generate Stomach-Yin. Ban Xia can direct the Stomach-Qi downwards.
When the herbs are used together, the Yin and Qi become strong. As the Qi is then able to descend again, all the symptoms disappear.
Commentary on strategies
• In this formula, besides the method of directly tonifying the Yin of the Stomach, an indirect way of tonifying the Yin is also used too, namely, tonifying the Qi in order to generate Yin.
• In addition, a procedure of strengthening the Middle-Jiao so as to harmonize the Qi in the Middle- and Upper-Jiao is also applied.
Yu Ye Tang (Jade Fluid Decoction) 
Source: Yi Xue Zhong Zhong Can Xi Lu 
Composition
Shan Yao ( Dioscoreae rhizoma) 30 g
Huang Qi ( Astragali radix) 15 g
Zhi Mu ( Anemarrhenae rhizoma) 18 g
Tian Hua Fen ( Trichosanthis radix) 9 g
Ge Gen ( Puerariae radix) 4.5 g
Wu Wei Zi ( Schisandrae fructus) 9 g
Ji Nei Jin ( Gigeriae galli endothelium corneum) 6 g
Analysis of the formula
This formula can tonify Qi, generate body fluid, moisten dryness and relieve thirst. It treats ‘thirst and wasting’ syndrome, a syndrome known as diabetes in western medicine. It is caused by Yin deficiency of the Kidney, Stomach and Lung. When dryness occurs in the Stomach, the Qi is too weak to spread the fluid, and excessive thirst appears. Heat consumes the Qi and can directly lead to lassitude and shortness of breath. If the Kidney fails to control the Bladder and is unable to separate clean fluid from turbid, patients may pass large amounts of turbid urine frequently. Yin and Qi deficiency often show in a red tongue with a thin and dry coating, and a weak and thready pulse.
In this formula:
• Shan Yao is chief and is used in a large dosage. It is sweet, neutral and astringent, and enters the Spleen, Lung and Kidney meridians. It can tonify and stabilize the Qi and Yin of the Spleen and Kidney, and reduce frequent urination.
• Huang Qi, another chief herb, tonifies and ascends the Spleen-Qi, accelerates the fluid spreading to the Stomach and Lung, and therefore relieves thirst.
• Zhi Mu and Tian Hua Fen are used as deputies. They can nourish the Yin, reduce heat and moisten dryness, thus also relieving thirst.
• There are three assistants: Ji Nei Jin aids digestion in order to strengthen the Spleen; Ge Gen moves upwards, can ascend and spread the fluid, and enhance the ability of Huang Qi; Wu Wei Zi has a sour taste, can stabilize the Qi and Yin, and enhance the ability of Shan Yao, Zhi Mu and Tian Hua Fen.
Commentary on strategies
• This formula shows the principle of treating diabetes, which includes tonifying and stabilizing the Qi and Yin of the Kidney, Spleen and Lung.
• It also shows the strategies of treating diabetes by using herbs that move inwards and upwards. They demonstrate the methods of tonifying, stabilizing, ascending and spreading Qi and Yin.
Zeng Ye Cheng Qi Tang (Increase the Fluids and Order the Qi Decoction) 
Source: Wen Bing Tiao Bian 
Composition
Xuan Shen ( Scrophulariae radix) 30 g
Mai Men Dong ( Ophiopogonis radix) 25 g
Sheng Di Huang ( Rehmanniae radix) 25 g
Da Huang ( Rhei rhizoma) 9 g
Mang Xiao ( Natrii sulfas) 5 g
Analysis of the formula and commentary on strategies
This formula is able to nourish the Yin and fluid in the intestines, clear the heat and promote bowel movement. It is used for treating constipation where the fluid is dried up by the excess heat in the intestines. In this syndrome, if only purgatives are used, the Yin may be injured further and the constipation may get worse. This formula demonstrates the strategy that purgatives can be used without the side effect of injuring the fluid in the intestines.
In this formula, two groups of herbs are selected.
• In the first group, a large doze of salty and cold Xuan Shen is used. It can increase the fluid in the intestines, clear heat and soften the feces. The large doses of Mai Men Dong and S heng Di Huang are used to directly nourish the Yin and clear the heat.
• In the second group, Da Huang and Mang Xiao are used to stimulate the intestines and soften the stool respectively. They are used to treat constipation directly.
This formula is particularly useful for habitual constipation when there is Yin deficiency with heat in the intestines.
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| Figure 17.1 •. |
| Pathology of syndrome of dryness. |
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| Figure 17.2 •. |
| External dryness and internal dryness. |
