Chapter Fourteen. Syndrome of internal wind and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that treat internal wind syndrome. Internal wind syndrome is a collective term to describe the syndromes that are characterized by moving and changing in the symptoms and signs, such as dizziness, trembling, tingling and cramping of limbs and loss of balance in walking. Wind can be generated by Liver-Yang ascending, excess fire in the Heart and deficiency of the Yin and blood. Since the causes are different, the treatment principles and the compositions of the formulas are also different and will therefore be introduced separately.
1. Syndrome of Liver-wind
Manifestations
Main symptoms
Dizziness, tingling or numbness of the fingers and limbs, tremors or spasms of the limbs, headache, nausea, vomiting, loss of balance in standing or walking; in a severe case, loss of consciousness, hemiplegia, deviation of the eyes and mouth.
Secondary symptoms
Irritability, dream-disturbed sleep, distending pain in the hypochondriac region, preference for a quiet and relaxing environment.
Tongue
Red or only red on the border, with a thin, dry and yellow coating.
Pulse
Thready and wiry, or thready, wiry and rapid.
Associated disorders in western medicine
• Liver-Yang ascending: Hypertension, menopausal complaints, tinnitus, deafness, glaucoma, asthenopia, optic nerve atrophy, primary cataract and conjunctivitis.
• Liver-wind disturbance: Epilepsy, severe case of hypertension and glaucoma, facial paralysis, facial spasms, cerebrovascular accident and its sequelae.
Analysis of the syndrome
The syndrome of Liver-Yang ascending is caused mainly by Liver-Yin deficiency. It often exists in people who are over 50 years old when the Yin of the Liver becomes weak with age; people who are under persistent stress where the restrained heat in the Liver may easily injure the Yin; people who suffer from chronic diseases, use certain medicines or have a dietary habit that leads to injury of the Liver-Yin.
• When the Liver-Yin is too weak to control the Liver-Yang, the Yang rises, which disturbs the normal movement of Qi in the upper part of the body, especially the head, and causes dizziness, a slightly tight sensation in the head, headache, blurred vision and tinnitus.
• In a severe case, the Yang and heat may severely disturb the Qi movement of the Liver and also disturb the mind, leading to irritability, dream-disturbed sleep, distending pain in the hypochondriac region and a preference for a quiet and relaxing environment.
• If the Liver-Yang and heat disturb the Stomach, patients may have a red face, a dry and bitter taste in the mouth, nausea or belching.
• A red tongue or red border of the tongue indicates heat in the Liver; a thin, dry and yellow coating suggests heat accumulation but without obvious accumulation of food or phlegm. A thready pulse indicates deficiency of Yin, wiry indicates tension of Liver-Yang ascending and rapid is the sign of heat. These features of the pulse may become more distinct when the syndrome becomes more severe.
If the Liver-Yang is not controlled with appropriate treatment, it may turn into Liver-wind, especially under strong emotional disturbance and stress. At that time, the Liver-Yang rises rapidly and its speed stirs up the wind.
• The symptoms and signs of Liver-wind are characterized by constant movement and quick change. Because the Liver controls the tendons, symptoms such as tremors or spasms of the limbs, severe dizziness, tingling or numbness of the limbs, and loss of balance in standing or walking appear.
• In severe cases, the Liver-wind may disturb the Qi movement and blood circulation, and it pushes the Qi, blood, fire and phlegm to attack the head. The blood and phlegm may block the meridians and cover the mind. In this situation, the patient may suddenly lose consciousness, and afterwards suffer from hemiplegia and deviation of the eyes and mouth.
• In this acute excess condition, a red tongue with a yellow and dry coating, and a wiry, forceful and rapid pulse indicate heat, Yang ascending and Qi disturbance of the Liver; a yellow and sticky tongue coating and a rapid, slippery and wiry pulse are the signs of phlegm-heat obstruction.
(See Figure 14.1 on page 326.)
Treatment principle: Anchor the Liver-Yang, pacify the Liver-wind, tonify the Yin and spread the Qi
Herb selection principles and formula composition strategies
• In a severe and acute condition, the first priority is to choose minerals and herbs which enter the Liver and Heart meridians, and can directly and intensively anchor the Liver-Yang and pacify the Liver-wind.
• In a sub-acute or a chronic and mild condition of Liver-Yang ascending, the first priority is to select herbs that nourish the Liver-Yin in order to control the Liver-Yang.
• Second, herbs that regulate the Qi and blood, calm the mind, remove phlegm and promote digestion should be selected in both acute and chronic conditions.
• Herbs that can open up the collaterals, extinguish wind and relieve spasm should be selected in chronic and stubborn conditions.
CAUTIONS
1. Clear differentiation of the syndrome in the treatment process:
It is important to make a clear differentiation of the syndrome and arrange appropriate treatment in order to treat the cause and the manifestations of the syndrome. In the acute situation, treat the manifestation first; in a chronic and sub-acute condition, treat both the cause and the manifestations.
2. Caution when using ascending herbs:
In the formula, herbs that can stimulate the Qi and blood and have a strong ascending tendency should be used with caution because they may cause the Liver-Yang, heat, Qi and blood to ascend.
3. Provide lifestyle and dietary advice:
Patients should avoid the factors that may cause ascending of Liver-Yang in their lifestyle and diet, such as stress and strong emotions, spicy food and alcohol.
4. Caution when using minerals:
Since the mineral substances are heavy in weight, they are also heavy for the Stomach. For patients who are weak in the Spleen and Stomach, the mineral substances should be used in smaller dosage, with a shorter treatment course or combined with herbs that protect the Stomach. Moreover, the mineral substances should not be used in pregnant women.
5. Caution when using poisonous substances:
Of the substances that descend the Yang and extinguish wind of the Liver, Dai Zhe Shi ( Haematitum)*, Quan Xie ( Scorpio)* and Wu Gong ( Scolopendra)* are poisonous, thus the dosages should be carefully controlled.
Structure of the formula and selection of herbs
Chief: Anchor the Liver-Yang and extinguish the Liver-wind
Shi Jue Ming ( Haliotidis concha), Zhen Zhu Mu ( Concha margaritifera usta), Ci Shi ( Magnetitum), Long Gu ( Mastodi fossilium ossis) and Dai Zhe Shi ( Haematitum)
These substances are minerals, heavy in weight and strong in function. They have a descending tendency in action, can anchor the Liver-Yang, extinguish Liver-wind and direct the rebellious Qi and blood downward. These minerals can be selected separately or in a group as chief substances in the formula.
Shi Jue Ming is salty and slightly cold, and enters the Kidney and Liver meridians. It is able to intensively descend the Liver-Yang, clear the Liver-fire and therefore extinguish the Liver-wind. It is also able to improve vision by treating disorders of the eyes due to Liver-Yang ascending and up-flaring of Liver-fire. It is often selected as one of the chief substances in formulas in both acute and chronic conditions.
Zhen Zhu Mu is salty and cold, and enters the Heart and Liver meridians. Compared with Shi Jue Ming, it has the same function of descending the Liver-Yang and pacifying the Liver-wind, and can be used for the same indications, but the strength of this substance is weaker. However, the strong point of this substance is that, as it enters the Heart meridian, it can calm the mind and clear the heat there. In the formula that extinguishes the Liver-wind and anchors the Liver-Yang, it is particularly selected as chief in the condition of restless sleep, insomnia and palpitations.
Long Gu is sweet, astringent and neutral, and enters the Heart, Liver and Kidney meridians. It descends the Liver-Yang and calms the Liver-wind. Since it is sweet and neutral, and causes less irritation to the Stomach, it can be used for a longer period of time. Long Gu can also be used to calm the mind and treat restlessness.
Dai Zhe Shi is bitter and cold, and enters the Liver and Pericardium meridians. This mineral is the strongest of these four substances to anchor the Liver-Yang and extinguish the wind. As it can intensively and quickly descend the Yang, wind, fire, phlegm, Qi and blood, it is often used for acute situations. However, since Dai Zhe Shi is a heavy, cold and bitter substance, can easily injure the Stomach and contains a little bit of arsenic, it cannot be used in a large dosage or for a long period of time.
Tian Ma ( Gastrodiae rhizoma)** and Gou Teng ( Uncariae ramulus cum uncis)
Tian Ma and Gou Teng are sweet in nature and enter the Liver meridian. They are able to pacify the Liver and extinguish Liver-wind. They are used to treat dizziness, headache, convulsions, tremor and spasm caused by Liver-wind.
Tian Ma is sweet and neutral, and enters the Liver meridian. It has a moderate and moist nature. It is the first-line choice to extinguish Liver-wind because it not only pacifies the Liver and extinguishes wind, and treats the manifestations (dizziness, headache, dry and tired eyes), but also treats the cause (deficiency of Liver-Yin and blood). It can remove wind-phlegm and open the collaterals, and is used to treat dizziness with nausea and vomiting. If it is combined with herbs that promote the Qi movement and blood circulation, it can treat stiffness, pain, numbness and tingling of limbs, such as in the sequelae of cerebrovascular accident.
Gou Teng is sweet and cold, and enters the Liver and Pericardium meridians. It has a strong function of clearing and reducing the Liver-heat, whether or not it is excess heat or empty-heat, and thus can calm the wind. It is particularly used to treat dizziness, headache, tinnitus, irritability, and red and irritated eyes. Because it enters the Pericardium meridian, it is also very effective for cooling the Heart, relaxing the tendons and calming the mind.
Tian Ma and Gou Teng are often used together to accentuate their therapeutic actions in extinguishing Liver-wind and are often selected in the formula as chief to treat sub-acute and chronic conditions.
Deputy: Pacify the Liver-Yang, calm the mind, nourish the Liver-Yin and Kidney-Yin, reduce Liver-heat and descend the Qi and blood
Ci Shi ( Magnetitum), Long Gu ( Mastodi fossilium ossis), Mu Li ( Ostrea concha) and Zhen Zhu Mu ( Concha margaritifera usta)
These mineral substances can effectively and quickly descend the Liver-Yang and Heart-fire. In the formula to pacify the Liver in a sub-acute condition, they are particularly selected to strongly sedate the Heart-spirit and calm the mind. Since the Liver is the mother organ of the Heart, Liver-Yang ascending may cause up-flaring of Heart-fire, which manifests as restlessness, anxiety, irritability, insomnia, a bitter taste in the mouth and a red face.
Bai Shao Yao ( Paeoniae radix lactiflora), Tian Men Dong ( Asparagi radix) and Sheng Di Huang ( Rehmanniae radix)
Bai Shao Yao is sour and cold, and primarily enters the Liver meridian. It can effectively nourish the Liver-Yin and soften the Liver. It can be selected as deputy in the formula to pacify the Liver-wind and descend the Liver-Yang in a chronic condition.
Tian Men Dong and Sheng Di Huang are sweet and cold, and enter the Kidney meridian. Because the Liver and Kidney are closely related in physiology and pathology, deficiency of Liver-Yin and Kidney-Yin often exists at the same time. These herbs can indirectly tonify the Liver-Yin as well. Since Sheng Di Huang has a bitter taste, it can effectively cool the blood and reduce the fire.
Zhi Zi ( Gardeniae fructus) and Long Dan Cao ( Gentianae radix)
Zhi Zi and Long Dan Cao are bitter and cold. They are often selected in formulas when excess Liver-heat presents. They can directly treat irritability, a bitter taste in the mouth, red eyes, tinnitus and scanty urine due to Liver-heat.
Zhi Zi enters the Heart, Lung and San Jiao meridians, is able to drain heat from the San Jiao, especially the Heart, and lead the heat out of the body through urination . Long Dan Cao directly enters the Liver meridian. It can powerfully and quickly drain the Liver-fire. Since these herbs have a descending tendency in action, they can enhance the strength of the substances that descend the Liver-Yang.
Chuan Niu Xi ( Cyathulae radix), Yi Mu Cao ( Leonuri herba) and Dan Shen ( Salviae miltiorrhizae radix)
These three cold herbs all enter the Liver meridian, and have the functions of clearing heat in the blood, promoting blood circulation and removing congealed blood. They are selected in the formula to treat disturbance of blood circulation and blood stagnation.
Regulating blood circulation is important in the treatment process of extinguishing Liver-wind and descending Liver-Yang because disturbance of blood always coexists in the syndrome of Liver-Yang and Liver-wind; it needs to be treated as a secondary syndrome. Moreover, when the blood circulation is disturbed, congealed blood can be formed. This is pushed by rebellious Qi and Yang, attacks and blocks the meridians, and causes related symptoms, such as in a cerebrovascular accident and heart attack, which are regarded as wind-stroke and chest Bi syndrome respectively in traditional Chinese medicine. Furthermore, when the blood circulation is obstructed, blood may leave its pathway and bleeding starts. In order to prevent these serious consequences, the herbs that regulate and descend the blood, dissolve congealed blood and clear heat in the blood should be used in the formula.
Chuan Niu Xi is bitter, sour and neutral, and enters the Liver and Kidney meridians. It can effectively descend the blood, promote urination, remove congealed blood and open the meridians. It also has the function of strengthening the Kidney. It is often selected for treating acute and sub-acute conditions.
Yi Mu Cao is pungent, bitter and cold, and can promote blood circulation, clear heat and remove the congealed blood. It has a descending tendency in action and can promote urination. It is often selected for treating sub-acute and chronic syndromes of Liver-Yang ascending.
Dan Shen is bitter and slightly cold, and enters the Heart and Liver meridians. Besides promoting blood circulation, it can effectively cool the blood and remove congealed blood, and treat chest pain, hypochondriac pain, a stifling sensation in the chest and irritability, especially under stress.
All of these herbs help the chief to descend the Yang and pacify the wind in a more effective and quicker way. They are important deputies in the formula.
Chuan Lian Zi ( Toosendan fructus), Xiang Fu ( Cyperi rhizoma), Fo Shou ( Citri sarcodactylis fructus), Xiang Yuan ( Citri fructus) and Xuan Fu Hua ( Inulae flos)
These herbs can regulate the Qi, which is disturbed by the quick ascending of Liver-Yang and Liver-wind. As soon as the Qi descends or moves smoothly, Liver-wind is extinguished. For this reason, these herbs are often selected as deputies to treat the secondary syndrome.
Chuan Lian Zi is very bitter and cold. It enters the Liver meridian and can directly and powerfully drain the fire and descend the Qi of the Liver. It is particularly selected in an acute or sub-acute condition where severe hypochondriac pain and distension exist. Since it is a poisonous herb, it is used for only a short period of time in an acute condition.
Xiang Fu is pungent, bitter, sweet and neutral, and enters the Liver and San Jiao meridians. As Xiang Fu can spread and regulate the Liver-Qi in a moderate way, it can be used in both acute and chronic conditions.
Fo Shou and Xiang Yuan are able to harmonize the function of the Liver and Stomach. They are particularly used for the condition where the Liver-Qi attacks the Stomach. The manifestations are loss of appetite, belching and a full sensation in the upper abdomen and hypochondriac region.
Xuan Fu Hua is slightly warm, bitter, pungent and salty, and enters the Lung, Stomach and Large Intestine meridians. Since it can descend the Qi and eliminate phlegm from the Lung and Stomach, it can help the chief herbs and the herbs that regulate the Qi in the formula, especially when patients have such symptoms as shallow breathing, nausea, vomiting and belching.
Assistant: Open up the collaterals, improve vision and harmonize the Liver and Stomach
Quan Xie ( Scorpio)*, Wu Gong ( Scolopendra)*, Di Long ( Pheretima) and Jiang Can ( Bombyx batrycatus)
In traditional Chinese medicine, some worms are considered as being able to get into the small collaterals because they have the habit of drilling holes or passing through cracks. Worms that enter the Liver meridian can open the meridians and collaterals, and can therefore extinguish wind, relieve spasms and tremor, open the meridians and stop pain.
Quan Xie and Wu Gong are pungent and poisonous. Both are able to extinguish Liver-wind, relieve spasm, open the meridians and stop pain. The functions of these two substances are almost the same, but Wu Gong is stronger. They are often used together because these two substances can strongly accentuate each other’s actions and the dosage of each substance can be reduced. They are often used in the formula to treat severe cases of numbness, pain, tingling of the limbs and epilepsy attacks.
Di Long is salty and cold. Its function of extinguishing Liver-wind is weaker than that of Quan Xie and Wu Gong, but its function of clearing Liver-heat is stronger. It is more suitable for treating tremors with irritability or fever. Moreover, Di Long enters the collaterals and is able to open up the obstruction. It is often selected for treating hemiplegia when the limbs are stiff, weak, numb and painful.
Jiang Can is neutral and pungent. As it is able to remove the phlegm obstruction from the collaterals, it can treat spasms and numbness. It is often used in the formula to treat a chronic condition of Liver-wind.
Qing Hao ( Artemisiae annuae herba)
Qing Hao is bitter, cold and aromatic, and enters the Liver and Gall Bladder meridians. It can clear and disperse heat from these meridians, especially from the blood and Yin levels. In a formula that descends the Liver-Yang, Qing Hao is used as a corrective assistant to disperse and ascend the restrained Liver-Qi, which is suppressed by the heavy and cold descending minerals and herbs. Meanwhile, since Qing Hao can brighten the eyes, clear summer-heat and damp-heat, it can be selected if red and swollen eyes with blurred vision are present in the syndrome.
Mai Ya ( Hordei fructus germinatus), Shen Qu ( Massa medicata fermentata) and Zhi Gan Cao ( Glycyrrhizae radix preparata)
Mai Ya, Shen Qu and Zhi Gan Cao all enter the Spleen meridian. Mai Ya and Shen Qu are able to aid digestion and sweet Zhi Gan Cao can tonify the Spleen. In a formula for treating Liver-Yang ascending and Liver-wind disturbance, they are used to protect the Stomach from heavy mineral substances and cold herbs. They are also used as corrective assistants to moderate the conflict between the minerals in the formula and the Stomach-Qi. This is because, when the heavy minerals descend the Liver-Yang and sedate the Heart-shen, they can descend the rebellious Qi of the Stomach as well. On the other hand, when the action of minerals is too strong and too quick, it may suppress the Stomach-Qi.
Mai Ya can slightly ascend the Qi of the Stomach and Spleen, the pungent and warm Shen Qu can disperse the constrained Qi, and the sweet Zhi Gan Cao can ease the tension between the heavy mineral substance and the rebellious Stomach-Qi. With these assistants, the formula becomes balanced.
Examples of classical formulas
Zhen Gan Xi Feng Tang (Sedate the Liver and Extinguish Wind Decoction) 
Source: Yi Xue Zhong Zhong Can Xi Lu 
Composition
Dai Zhe Shi ( Haematitum) 30 g
Long Gu ( Mastodi fossilium ossis) 15 g
Mu Li ( Ostrea concha) 15 g
Huai Niu Xi ( Achyranthis bidentatae radix) 30 g
Gui Ban ( Testudinis carapax)** 15 g
Bai Shao Yao ( Paeoniae radix lactiflora) 15 g
Tian Men Dong ( Asparagi radix) 15 g
Xuan Shen ( Scrophulariae radix) 15 g
Chuan Lian Zi ( Toosendan fructus) 6 g
Mai Ya ( Hordei fructus germinatus) 6 g
Yin Chen Hao ( Artemisiae scopariae herba) 6 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 4.5 g
Analysis of the formula
This formula is able to anchor the Liver-Yang, extinguish the Liver-wind and nourish the Yin of the Liver and Kidney. It is used to treat acute, quick and intense ascending of Liver-Yang, which generates Liver-wind and causes dizziness, vertigo, distension of the eyes, tinnitus, a feverish sensation in the head, irritability, a flushed face and a wiry, forceful and long pulse. In an acute and severe condition, the Stomach-Qi, Liver-wind and Liver-Yang all move upwards, causing belching, severe headache, pressure in the chest, loss of balance in walking, and progressive motor dysfunction of the body or facial muscular cramp and twitch. In this condition the Liver-Yang and wind should be sedated immediately in order to prevent a dangerous condition – wind-stroke. This acute, excess pathological change is actually based on deficiency of Kidney-Yin and Liver-Yin, which are unable to control Liver-Yang.
In this formula:
• A large dosage of Huai Niu Xi is used as chief to directly descend the Liver-Yang and strengthen the Kidney. At the same time, it can lead water downwards and promote urination so as to cause the Liver-Yang to descend as well.
• Dai Zhe Shi, Long Gu and Mu Li are used as deputies. All of these minerals are heavy in weight and intense in function. They can vigorously descend the Yang and extinguish the wind as they all enter the Liver meridian. They are especially used in an acute condition.
• Gui Ban, Xuan Shen, Tian Men Dong and Bai Shao Yao are also used as deputies. This group helps Huai Niu Xi to nourish the Yin of the Kidney and Liver, and treat the cause of Liver-Yang ascending. They can also nourish the Yin, soften the tendons and relieve the cramp and trembling.
• Chuan Lian Zi is used as assistant to drain the Liver-fire and move the Liver-Qi, thus assisting the descent of the Yang.
• Yin Chen Hao is used as corrective assistant. As it ascends the Qi of the Gall Bladder, it can free the constraint of Liver-Qi, which exists as secondary syndrome and is worsened by applying herbs and minerals that have intensive descending actions. When Yin Chen Hao and Chuan Lian Zi are used together, one moves upwards and the other moves downwards; they can effectively regulate and ease the Liver-Qi.
• Mai Ya also serves as corrective assistant. It ascends and spreads the Stomach-Qi, which is suppressed by the heavy minerals and cold herbs that anchor the Liver-Yang.
• Zhi Gan Cao is used as both assistant and envoy to moderate the heavy and harsh substances in the formula and protect the Stomach.
Commentary on strategies
• This formula is characterized by strong action to anchor the Liver-Yang.
• There are three big groups with clear, specific actions to treat three aspects of the syndrome and they are organized in a very balanced way. They treat the cause and the manifestations at the same time; they focus on stopping the pathological development of Liver-Yang and Liver-wind but do not ignore the proper movement of the Qi, the condition of the Stomach and the Liver.
• These procedures enable herbs and minerals with strong actions to be accepted by the Stomach and the Liver without conflict in acute and excess conditions.
Tian Ma Gou Teng Yin (Gastrodia and Uncaria Decoction) 
Source: Za Bing Zheng Zhi Xin Yi 
Composition
Tian Ma ( Gastrodiae rhizoma)** 9 g
Gou Teng ( Uncariae ramulus cum uncis) 12 g
Shi Jue Ming ( Haliotidis concha) 18 g
Chuan Niu Xi ( Cyathulae radix) 12 g
Zhi Zi ( Gardeniae fructus) 9 g
Huang Qin ( Scutellariae radix) 9 g
Yi Mu Cao ( Leonuri herba) 9 g
Sang Ji Sheng ( Taxilli herba) 9 g
Du Zhong ( Eucomniae cortex) 9 g
Fu Shen ( Poriae cocos pararadicis) 9 g
Ye Jiao Teng ( Polygoni multiflori caulis) 9 g
Analysis of the formula
This formula is able to pacify the Liver-wind, clear heat and invigorate blood. It is used for treating the common syndrome or chronic condition of Liver-wind disturbance in a condition of Liver-Yin deficiency with Liver-Yang ascending. The main symptoms are headache, dizziness, irritability and insomnia.
In this formula:
• Tian Ma, Gou Teng and Shi Jue Ming are used as chief. Tian Ma is sweet and neutral, and can effectively extinguish Liver-wind in a condition of deficiency of Liver-Yin and blood. Gou Teng is sweet and cold, and can strongly clear and reduce either excess heat or empty-heat of the Liver, thereby pacifying Liver-wind. These two herbs can accentuate each other’s therapeutic actions. Shi Jue Ming can clear Liver-heat, descend the Yang and benefit the vision. When these three substances are used together, they can effectively treat dizziness, headache, blurred vision, and tired and dry eyes.
• Zhi Zi and Huang Qin are used as deputies. They are bitter and cold, and can clear the heat of the Liver and in the Upper-Jiao. Because they have a descending tendency, they enhance the chief substances to descend the Yang of the Liver. They can also treat irritability, a bitter taste in the mouth and scanty urine due to Liver-heat.
• Yi Mu Cao and Chuan Niu Xi are used as assistants in the formula. They regulate, descend and clear the heat in the blood.
• Du Zhong and Sang Ji Sheng also serve as assistants. They enter the Liver and Kidney meridians, can tonify the Liver and Kidney, and therefore prevent the ascending of Liver-Yang and generation of Liver-wind.
• Ye Jiao Teng and Fu Shen are used as assistants too. They calm the mind and improve sleep. Moreover, Sang Ji Sheng and Ye Jiao Teng relax the tendons and nourish blood, and are particularly suitable for treating insomnia with a sensation of discomfort in the body that is caused by high tension of the muscles.
Commentary on strategies
• This formula is used for treating a chronic, mild or common condition of Liver-Yang ascending and disturbance of Liver-wind.
• It is composed in a balanced way of descending Liver-Yang and extinguishing Liver-wind, together with tonifying the Liver and Kidney.
• It also considers the coexistence of Liver-heat that often disturbs sleep and brings an irritable mood.
• If comparing this formula with Zhen Gan Xi Feng Tang, the previous formula, in herb selection and dosage arrangement, an obvious difference can be found between treating a severe and acute condition and a common or chronic condition of Liver-Yang ascending with Liver-wind disturbance.
2. Syndrome of internal wind due to excess heat in the Heart and Liver
Manifestations
Main symptoms
High fever, irritability, restlessness, dizziness, vertigo, twitches and spasms of extremities, and even convulsions.
Secondary symptoms
Thirst, sweating, insomnia and restless sleep.
Tongue
Deep red with a dry coating.
Pulse
Wiry and rapid.
Associated disorders in western medicine
Convulsions, especially in infectious diseases.
Analysis of the syndrome
This syndrome is caused by exogenous pathogenic heat which invades the body and disturbs the Heart and Liver.
• The excess fire can directly generate wind that causes irritability, restlessness, dizziness and vertigo.
• The excess heat consumes the Liver-Yin, which is unable to moisten and ease the tendons; therefore wind, which is manifested as spasms and twitching, may appear.
• The signs of the tongue and pulse indicate an acute and excess heat syndrome.
(See Figure 14.2 on page 327.)
Treatment principle: Cool the Liver, nourish the Yin, eliminate phlegm-heat and congealed blood, and extinguish the internal wind
Herb selection principles and formula composition strategies
• First, cold and salty substances that enter the Liver and Heart meridians and can reduce excess heat, extinguish the wind and eliminate phlegm-heat are selected.
• Second, herbs that nourish the Yin so as to reduce heat are selected.
• Along with these, herbs that calm the mind, relax the tendons and regulate the Qi and blood are also prescribed.
Structure of the formula and selection of herbs
Chief: Cool the Liver and extinguish wind
Ling Yang Jiao ( Antelopis cornu)**/Shan Yang Jiao ( Naemorhedis cornu), Shi Jue Ming ( Haliotidis concha) and Zhen Zhu Mu ( Concha margaritifera usta)
Ling Yang Jiao is salty and cold, and enters the Liver and Heart meridians. It can effectively cool the Liver and extinguish wind, and is often selected in formulas to treat excess heat in the Liver meridian, which stirs up the internal wind.
Since Ling Yang Jiao is banned, Shan Yang Jiao can be used as a substitute. It has a weaker action compared with Ling Yang Jiao. Another substitute is the combination of Shi Jue Ming, which mainly clears the heat from the Liver, and Zhen Zhu Mu, which clears the heat from the Heart.
Gou Teng ( Uncariae ramulus cum uncis)
Gou Teng is sweet and slightly cold, and enters the Liver and Pericardium meridians. It can directly cool the Liver and extinguish wind. It can effectively relax the tendons because it is a type of vine that particularly enters the meridians and collaterals.
Qing Dai ( Indigo naturalis) and Da Qing Ye ( Isatidis folium)
Qing Dai and Da Qing Ye are very cold herbs. They can directly cool the blood and reduce fever so as to extinguish wind. They can be selected as chief in the formula to treat a severe condition.
Tian Zhu Huang ( Bambusae concretio silicea) and Zhu Li ( Bambusae succus)
These two herbs come from bamboo. They are sweet and cold, and have the functions of clearing heat and transforming phlegm. However, the meridians entered and their differences in strength create differences in their application in formulas.
Tian Zhu Huang enters the Heart and Liver meridians. It is effective in dislodging phlegm, clearing heat, cooling the Heart and controlling convulsions. It is often used in formulas that treat childhood convulsions with high fever, irritability and night crying when phlegm-heat disturbs the Heart and Liver.
Zhu Li is colder than Tian Zhu Huang. It enters the Heart, Lung and Stomach meridians. It has a lubricating nature and its function is characterized by strongly eliminating phlegm-heat, especially when the phlegm blocks the meridians and collaterals. The manifestations are numbness and tingling of limbs, and cramp and twitch of the muscles.
Deputy: Nourish Yin, reduce heat and soften the Liver
Bai Shao Yao ( Paeoniae radix lactiflora), Tian Men Dong ( Asparagi radix) and Sheng Di Huang ( Rehmanniae radix)
Bai Shao Yao is sour, bitter and cold, and enters the Liver and Spleen meridians. Tian Men Dong and Sheng Di Huang are sweet, bitter and cold, and enter the Kidney meridian. These herbs can effectively nourish the Yin, reduce the heat and extinguish internal wind. In addition, as Bai Shao Yao can soften the Liver and ease tendons, it is a good choice when there is muscle cramp and convulsions.
Assistant: Calm the mind and regulate the Qi and blood
Zhen Zhu Mu ( Concha margaritifera usta), Long Chi ( Mastodi fossilia dentis), Ye Jiao Teng ( Polygoni multiflori caulis) and Fu Shen ( Poriae cocos pararadicis)
Zhen Zhu Mu and Long Chi are mineral substances. They are cold in nature and enter the Heart and Liver meridians. They can intensively sedate the Heart-shen and calm the mind. They are especially used in the formula to treat restlessness and insomnia caused by excess heat in the Heart and Liver.
Ye Jiao Teng and Fu Shen have functions that are similar to those of Zhen Zhu Mu and Long Chi, but are gentler. They are often used in a less severe condition of internal wind to calm the mind and improve sleep. In addition, they can open the meridians and relax the tendons, and are particularly useful in treating spasms and twitching of extremities.
Sang Ye ( Mori folium), Ju Hua ( Chrysanthemi flos) and Bo He ( Menthae herba)
Sang Ye and Ju Hua are sweet, bitter and cold; Bo He is pungent and cold. They all enter the Lung and Liver meridians and have light dispersing and descending abilities. As assistants in formulas, they disperse constrained Liver-Qi and clear Liver-heat to treat secondary syndromes. They are particularly effective for treating dry eyes, blurred vision and headache.
Dan Shen ( Salviae miltiorrhizae radix) and Chi Shao Yao ( Paeoniae radix rubra)
Dan Shen and Chi Shao Yao are bitter and cold herbs. They can cool the blood, reduce the heat from the Liver and the Heart, prevent generation of congealed blood and remove the congealed blood that has already been formed. They can be selected as assistants in the formula to treat a condition where the heat enters the blood, consumes the blood and leads to blood stagnation.
Jiang Can ( Bombyx batrycatus), Chuan Bei Mu ( Fritillariae cirrhosae bulbus) and Zhu Ru ( Bambusae caulis in taeniam)
Jiang Can is neutral and pungent. As it is able to remove the phlegm that obstructs the collaterals, it can relieve spasms and treat numbness and paralysis.
Chuan Bei Mu and Zhu Ru are cold and have the functions of clearing heat and removing phlegm. They can be selected as assistants in the formula to remove phlegm-heat, a product from disturbed Qi and water movement in the body. When phlegm obstructs the meridians, spasms and twitches may start.
Examples of classical formulas
Ling Jiao Gou Teng Tang (Antelope Horn and Uncaria Decoction) 
Source: Tong Su Shang Han Lun 
Composition
Ling Yang Jiao ( Antelopis cornu)** 4.5 g
Sang Ye ( Mori folium) 6 g
Chuan Bei Mu ( Fritillariae cirrhosae bulbus) 12 g
Sheng Di Huang ( Rehmanniae radix) 15 g
Gou Teng ( Uncariae ramulus cum uncis) 9 g
Ju Hua ( Chrysanthemi flos) 9 g
Fu Shen ( Poriae cocos pararadicis) 9 g
Bai Shao Yao ( Paeoniae radix lactiflora) 9 g
Sheng Gan Cao (raw Glycyrrhizae radix) 2.4 g
Zhu Ru ( Bambusae caulis in taeniam) 15 g
Analysis of the formula
This formula is devised to treat internal wind stirred up by excess heat in the Liver and Heart. A high fever with irritability, convulsions with possible loss of consciousness, a deep red tongue with a dry coating and a wiry and rapid pulse indicate excess heat.
In this formula:
• Ling Yang Jiao and Gou Teng are used as chief substances to directly and intensively reduce the heat and extinguish wind.
• Sang Ye and Ju Hua are used as deputies to disperse the wind and heat, and cool the Liver.
• Bai Shao Yao and Sheng Di Huang are used as assistants to nourish the Yin, clear heat and ease and relax the tendons.
• Chuan Bei Mu and Zhu Ru also serve as assistants to eliminate phlegm-heat that is produced by the disturbed Qi and water movement and blocks the meridians.
• Sheng Gan Cao is used as assistant to reduce heat-toxin and as envoy to harmonize the herbs in the formula.
Commentary on strategies
• In this formula, herbs that cool, pacify and soften the Liver are used together, with emphasis on clearing heat of the Liver.
• In the formula, although there are only a few heavy minerals to descend the heat, there are a number of light and cooling herbs. They bring a quick, subtle and effective result.
• In conditions of loss of consciousness with convulsions, formulas that open the orifices should be used in the first instance.
3. Syndrome of internal wind generated by Yin deficiency
Manifestations
Main symptoms
Trembling fingers, dizziness, bone steaming, warm palms and soles; in severe conditions there may be muscular spasms or rigid extremities, even loss of consciousness.
Secondary symptoms
Dry mouth, afternoon fever, emaciation, blurred vision and headache.
Tongue
Deep-red with a dry coating.
Pulse
Thready, rapid, hollow or weak .
Associated disorders in western medicine
Infectious diseases, dehydration, convulsions, peripheral neuropathy and Parkinson’s disease.
Analysis of the syndrome
• This syndrome is usually seen in a warm-febrile disease. When the pathogenic heat has passed Wei, Qi, Ying and Xue levels, the heat is not very strong but the body’s resistance and the Yin of the body are severely weakened. This condition can also be seen after severe dehydration from sweating, diarrhea or vomiting in infectious diseases or after improper treatment.
• This pathological change has a special feature of fever, which may get worse in the Yin dominant time, such as in the afternoon and evening, or in the Yin regions of the body, such as the palms, soles and chest. Because the Yin and Qi are too weak to eliminate the pathogenic heat quickly, a lingering low-grade fever exists and the body is weak and thin.
• When the Yin is not able to nourish the tendons, trembling fingers appear.
• In a severe condition of Yin deficiency, dizziness, muscular spasms, rigid extremities and convulsion may occur.
• When Heart-Yin is also severely injured, patients may lose consciousness.
• The severe deficiency of Yin shows in a deep-red tongue with a dry coating, and a weak, thready, hollow and rapid pulse.
(See Figure 14.3 on page 327.)
Treatment principle: Nourish the Yin and extinguish the internal wind
Herb selection principles and formula composition strategies
• First, sweet, cold and salty substances that enter the Kidney, Liver and Heart meridians, and can nourish the Yin and moisten dryness of these organs and meridians are selected.
• Along with these, it is equally important to select cold and salty substances that enter the Liver meridian, can cool and soften the Liver, descend the Liver-Yang and relax the tendons, thereby extinguishing the wind.
• In a severe condition where the Qi is too weak to support the process of Yin generation, herbs that stabilize and tonify the Qi should be used.
• Finally, herbs that regulate the Liver-Qi and herbs that calm the mind are prescribed in all of these conditions.
Structure of the formula and selection of herbs
Chief: Nourish Yin in order to extinguish wind
Gui Ban ( Testudinis carapax)**, Bie Jia ( Trionycis carapax)**, E Jiao ( Asini corii colla), Ji Zi Huang (chicken egg yolk) and Huo Ma Ren ( Cannabis semen)
All of these substances can nourish the Yin and moisten dryness. They can be selected as chief in formulas to treat internal wind syndrome due to Yin deficiency.
Gui Ban is salty, sweet and cold, and enters the Kidney and Heart meridians; Bie Jia is salty and cold, and enters the Liver meridian. Both enter the Yin and blood levels and have similar functions. They can strongly tonify the Yin, reduce empty-heat, anchor the Yang and treat bone steaming, low-grade fever, five-palm fever, dizziness, irritation, nausea and convulsions. Of these two substances, Gui Ban is stronger in tonifying the Yin and Bie Jia is stronger in reducing empty-heat. Since they are animal products, their functions are stronger than those of herbs.
E Jiao is sweet and neutral, and enters the Liver and Kidney meridians. It can nourish the Yin and blood and moisten dryness. It has a similar function to Gui Ban in nourishing the Yin; however, unlike Gui Ban which can reduce heat, it can tonify the blood. Since it is also an animal product, its function is also stronger than that of herbs.
Ji Zi Huang is salty and cold. It is considered a substance to nourish the Yin and moisten dryness, thereby extinguishing internal wind. It is also an animal product and is more effective in tonifying the body than herbs.
Huo Ma Ren is able to moisten dryness and tonify the blood. In addition, it can moisten the intestines and promote bowel movement. It is very useful when constipation occurs in the condition of Yin and blood deficiency.
Bai Shao Yao ( Paeoniae radix lactiflora) and Zhi Gan Cao ( Glycyrrhizae radix preparata)
Bai Shao Yao is sour, bitter and slightly cold, and enters the Liver meridian. Sour and cold may generate the Yin, supplementing the Yin shortage and smoothing Liver-Qi movement. Moreover, since it can moisten the tendons and reduce the tension, it can indirectly extinguish wind. If the sweet Zhi Gan Cao is used together with Bai Shao Yao, the function of relaxing the tendons and smoothing the muscles will be enhanced. The bitter and cold properties of Bai Shao Yao can reduce the empty-heat that is produced by Yin deficiency.
Deputy: Nourish the Yin, clear heat, descend the Liver-Yang and extinguish wind
Shan Zhu Yu ( Corni fructus), Mai Men Dong ( Ophiopogonis radix) and Sheng Di Huang ( Rehmanniae radix)
These three herbs have the function of nourishing the Yin. Shan Zhu Yu particularly tonifies the Liver-Yin, Mai Men Dong nourishes the Heart-Yin and Sheng Di Huang supplements the Heart-Yin and Kidney-Yin. They are used as deputies in the formula to enhance the ability of the chief to nourish the Liver-Yin and Heart-Yin, moisten dryness, relax tendons and therefore extinguish wind.
Mu Li ( Ostrea concha) and Shi Jue Ming ( Haliotidis concha)
Since Kidney-Yin deficiency may lead to a tendency of Liver-Yang ascending, the cold and heavy Mu Li and Shi Jue Ming are often selected in the formula to descend the Liver-Yang and prevent the generation of Liver-wind. If Liver-wind has already been generated, these minerals can directly extinguish the wind, clear heat and descend the Liver-Yang.
Assistant: Calm the mind, relax tendons, open meridians and collaterals
Zhi Gan Cao ( Glycyrrhizae radix preparata) and Fu Shen ( Poriae cocos pararadicis)
Zhi Gan Cao is sweet and neutral, and enters all meridians. A large dosage of Zhi Gan Cao is excellent in tonifying Qi and harmonizing the Qi movement as it has a moderate action. As its sweet taste may release tension, this herb can be used in the condition of severe Yin and Qi deficiency if the Qi is too weak to generate and stabilize the Yin. The moderate nature of Gan Cao is also used to ease muscles and tendons, and relieve cramp that is caused by Liver-Yin deficiency.
Fu Shen is sweet, bland and neutral, and primarily enters the Heart meridian. In the formula for extinguishing wind, it can be used as assistant to calm the mind, thus smoothing the movement of Qi, and assist the function of the other herbs to relax the tendons and muscles.
Gou Teng ( Uncariae ramulus cum uncis) and Luo Shi Teng ( Trachelospermi caulis)
These herbs are cold in temperature and enter the Liver meridian. They are vines and are considered to particularly enter the meridians and collaterals. In the formula to extinguish wind, they are selected to relax the tendons and smooth the Qi movement and blood circulation in the collaterals so as to extinguish wind.
Zhu Ru ( Bambusae caulis in taeniam)
Zhu Ru is sweet and slightly cold, and enters the Lung, Stomach and Gall Bladder meridians. It is often used as assistant in the formula to ease the Stomach-Qi and remove phlegm-heat, which is produced by disturbed Qi and water movement in the body.
Xiang Fu ( Cyperi rhizoma), Sang Ye ( Mori folium) and Ju Hua ( Chrysanthemi flos)
These herbs are used as assistants in the formula to regulate the Liver-Qi and disperse the stagnation that is indirectly caused by Yin deficiency and heat disturbance.
Xiang Fu is pungent, slightly bitter, sweet and neutral, and enters the Liver and San Jiao meridians. It can effectively promote and smooth the Liver-Qi movement.
Sang Ye and Ju Hua are sweet, bitter and cold, and enter the Lung and Liver meridians. They have gentle dispersing and descending actions, and can be used as assistants to disperse the stagnant Liver-Qi and clear the heat. They can directly treat dry eyes, blurred vision and headache.
Examples of classical formulas
Da Ding Feng Zhu (Major Arrest Wind Pill) 
Source: Wen Bing Tiao Bian 
Composition
Sheng Bai Shao Yao ( Paeoniae radix lactiflora) 18 g
E Jiao ( Asini corii colla) 9 g
Sheng Gui Ban ( Testudinis carapax)** 12 g
Sheng Di Huang ( Rehmanniae radix) 18 g
Huo Ma Ren ( Cannabis semen) 6 g
Wu Wei Zi ( Schisandrae fructus) 6 g
Sheng Mu Li ( Ostrea concha) 12 g
Mai Men Dong ( Ophiopogonis radix) 18 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 12 g
Ji Zi Huang (Chicken egg yolk) 2 pieces
Bie Jia ( Trionycis carapax)** 12 g
Analysis of the formula
This formula is devised to treat the aftermath of a warm-febrile disease. The Yin is severely injured by pathogenic heat, which causes lassitude, trembling fingers and limbs, a weak pulse, a deep-red tongue without coating and having a tendency to lose consciousness.
In this formula:
• Ji Zi Huang and E Jiao are used as chief to directly tonify the Yin and moisten the dryness in order to extinguish wind.
• Sheng Di Huang, Bai Shao Yao, Mai Men Dong, Gui Ban and Bie Jia are used as deputies. They can nourish the Yin and clear heat. They enhance the ability of the chief to extinguish wind.
• Huo Ma Ren, as assistant, moistens the dryness and enhances the function of the substances that nourish the Yin.
• Mu Li, another assistant, clears heat and descends the Liver-Yang so as to prevent the generation of Liver-wind. It also enhances the function of the other substances to anchor and extinguish internal wind.
• Wu Wei Zi and Zhi Gan Cao also serve as assistants. They are able to generate and stabilize the Yin and Qi of the body.
Commentary on strategies
• The obvious feature of the composition of this formula is the use of animal products as chief and deputy substances. According to the concept of Chinese herbal medicine, humans, as a species, are closer to animals than to plants and therefore animal products can tonify the human body quicker and more efficiently than herbal products. In a severe condition of Yin deficiency, they are the better choice in a formula.
• Since some animal products are banned, it is advisable to include meat and eggs in the diet.
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| Figure 14.1 •. |
| Etiology and pathology of syndromes of Liver-Yang and Liver-wind. |
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| Figure 14.2 •. |
| Etiology and pathology of internal wind syndrome due to internal heat. |
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| Figure 14.3 •. |
| Etiology and pathology of internal wind syndrome due to Yin deficiency. |
