Chapter Ten. Syndrome of Qi stagnation and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of the formulas that regulate, smooth or spread the Qi. They are used to treat the syndrome of Qi stagnation.
The characteristic of the syndrome of Qi stagnation is distension in the affected region. The quality of distension is determined by the degree of stagnation; generally speaking, fullness exists in a mild case, distension is seen in an advanced case and pain occurs in a severe condition.
The syndrome of Qi stagnation varies according to the affected organs and regions:
• If the Lung-Qi stagnates, the symptoms are breathlessness, stifling in the chest, cough and wheezing.
• If the Stomach-Qi and Spleen-Qi stagnate, the manifestations are fullness and distension of the entire abdomen, reduced appetite, belching, nausea, vomiting, abdominal pain and irregular bowel movement.
• If the Liver-Qi stagnates, the symptoms are hypochondriac distension and pain, pain in the lower abdomen and the lateral sides of the abdomen, irritability, depression, distension and pain in the breasts, and irregular menstruation.
• If the Qi stagnates in the meridians, the main symptoms are stiffness, heaviness, numbness or tingling of the limbs in the affected regions, or migrating pain in the limbs.
Stagnation of Qi is often caused by emotional disturbance and accumulation of internal cold, heat, phlegm, water and food. It also occurs in trauma and stagnation of blood.
The compositions of the formulas that regulate the Qi have the following characteristics:
1. Herbs with a pungent and warm nature are selected because pungency possesses a moving capacity and warmth may activate the Qi movement.
2. Herbs that enter the Liver, Spleen, Stomach, Large Intestine and Lung meridians are often used because these organs directly influence the Qi movement of the body.
3. Herbs that remove different obstructions in order to promote the Qi movement are used, such as herbs that eliminate phlegm, remove food stagnation, promote bowel movement, transform dampness, warm the interior, clear heat and release the exterior.
Although Qi moves in every organ of the body, the Liver, Spleen, Stomach, Large Intestine and Lung directly influence Qi movement. As the syndromes of Qi stagnation are more often seen in these organs, in this chapter the syndromes and compositions of formulas are introduced particularly for these organs.
CAUTIONS
1. Caution during pregnancy, heavy menstruation or in bleeding conditions:
Since the formulas can activate the blood circulation as well as the Qi movement, they can make the bleeding heavier or may cause miscarriage in early pregnancy.
2. Caution in conditions of Yin deficiency:
Formulas that regulate Qi contain many pungent and warm herbs and they easily injure the Yin and body fluids. Patients with Yin deficiency should not use these formulas in large dosage or for a very long period of time.
1. Syndrome of Liver-Qi stagnation
Manifestations
Main symptoms
Distension (even pain) in hypochondria and lateral sides of the lower abdomen, stiffness of the muscles and tendons, especially of the neck, shoulders and back, irregular menstruation, easily irritated, restlessness, dream-disturbed sleep and depression.
Secondary symptoms
Fullness in the chest, hoarseness, cough, distension in the stomach, obviously reduced or increased appetite, belching, nausea, vomiting, difficult urination, difficult bowel movement or diarrhea, dysmenorrhea, irregular menstruation.
Tongue
Normal, slightly pale, red or purple, with a white coating or a sticky coating if accompanied by accumulation of dampness, food or phlegm.
Pulse
Wiry, or wiry and thready if accompanied by blood or Yin deficiency.
Associated disorders in western medicine
Dysmenorrhea, irregular menstruation, premenstrual syndrome and menopause syndrome, hepatitis, peptic ulcer, duodenal ulcer, irritable bowel syndrome, colitis, cholecystitis and depression.
Analysis of the syndrome
The Liver is considered to be a very important organ for Qi movement throughout the entire body. The Liver-Qi moves freely through the San Jiao passage, promotes the Qi movement of all the other organs and accelerates their physiological functions. Pathologically, movement of the Liver-Qi can be disturbed by different factors, such as emotional disturbance, especially stress, anger and frustration, which can directly cause the stagnation.
• When the Liver-Qi is stagnant, patients usually lose their amiable manner and show symptoms such as irritability, quick temper, high tension of muscles and depression. In addition, distension and pain often occur in the hypochondriac region and lateral sides of the lower abdomen.
• Since the Liver houses the Hun (soul), patients may suffer from insomnia and dream-disturbed sleep when the Liver-Qi is stagnant.
• When the Liver-Qi and Liver-blood both stagnate, dysmenorrhea or irregular menstruation may appear.
• Stagnation of the Liver-Qi shows in a normal or slightly pale tongue with a white coating and a wiry pulse.
Once the Liver-Qi stagnates, it easily overacts or insults the other organs.
• When the Liver-Qi attacks the Spleen and Stomach, fullness, distension of the abdomen and obviously reduced or increased appetite may occur. In a severe condition where the Stomach-Qi cannot descend, belching, nausea and vomiting may present. When the Spleen-Qi fails to ascend, difficult bowel movement or diarrhea may occur.
• If the Liver-Qi attacks the Lung, shortness of breath, hoarseness and cough may start.
• When the Liver-Qi blocks the San Jiao passage, there may be difficult urination.
• If the Liver-Qi affects the Heart, restlessness and insomnia take place.
(See Figure 10.1 on page 269.)
Treatment principle: Regulate Liver-Qi; nourish Liver-Yin and Liver-blood; harmonize Qi movement of other involved organs
Herb selection principles and formula composition strategies
• First, herbs that are pungent and warm, enter the Liver meridian and can spread the Liver-Qi are selected.
• Second, herbs that promote the Qi movement or promote the functions of the Gall Bladder, Spleen, Stomach and Large Intestine are selected.
• Third, herbs that remove accumulation of food, dampness and phlegm are selected.
• It is also necessary to select herbs that enter the Liver, Heart and Lung meridians, and can improve sleep and calm the mind if depression and frustration are present.
• If the Liver-Qi is disturbed by Liver-fire, or uprising of Liver-Yang or Liver-wind, it is important to select herbs that can treat these disorders, thereby allowing the Qi to move smoothly.
• Herbs that tonify the Spleen-Qi and nourish the Liver-blood and Liver-Yin are selected when deficiency of these organs leads to stagnation of the Liver-Qi.
Structure of the formula and selection of herbs
Chief: Spread the Liver-Qi
Xiang Fu ( Cyperi rhizoma) and Chai Hu ( Bupleuri radix)
Xiang Fu is a very commonly used herb to regulate the Liver-Qi. It is pungent, sweet, slightly bitter and warm, and enters the Liver and San Jiao meridians. Xiang Fu is an effective and gentle herb to regulate Qi. It is warm and pungent without a harsh and drying nature. It promotes the Liver-Qi movement without the side effect of injuring the Yin and blood of the Liver. As it is somewhat bitter, it can reduce the slight Liver-heat that is generated by the Liver-Qi stagnation. The sweetness can soften the Liver and moderate the speed of the Qi movement. All these characteristics match the pathological changes in the syndrome of Liver-Qi stagnation. Because it enters the San Jiao meridian that is the passage of the Qi and water, it can effectively spread the Qi in the entire body.
Since Xiang Fu is gentle and effective in regulating the Liver-Qi, it is often selected in formulas for treating both excess and deficiency syndromes that are associated with Liver-Qi stagnation.
Chai Hu is another commonly used herb to regulate the Liver-Qi, and it is a gentle herb too. Unlike Xiang Fu, it is pungent and neutral. It has the function of dispersing and ascending the Liver-Qi rather than promoting the circulation of the Liver-Qi. It is particularly suitable for use as chief in formulas to treat constraint of the Liver-Qi, such as in stress, depression with anger and frustration, and chronic Liver and Gall Bladder diseases. Since it has an upward-moving tendency, it should be used with caution when treating syndromes where Qi, fire or Yang of the Liver move upwards, as it can easily cause headache or dizziness.
Qing Pi ( Citri reticulatae viride pericarpium), Chuan Lian Zi ( Toosendan fructus) and Wu Yao ( Linderae radix)
Qing Pi is the peel of unripe tangerines. It is warm and bitter, and enters the Liver, Gall Bladder and Spleen meridians. It can break up Qi stagnation and is effective in promoting the free flow of Liver-Qi and alleviating pain. It is often selected in a formula to treat distending pain in the chest, breasts and hypochondriac region. It can also dissolve phlegm accumulation. Because its action is strong, it may injure the Qi and Yin. Therefore this herb is only used for a short period of time and in excess conditions.
Chuan Lian Zi is very bitter and cold. It can intensively drain the Liver-fire and direct the Liver-Qi downwards. It is selected in formulas for treating syndromes where Liver-fire flares up and Liver-Qi movement is disturbed. The disorder is manifested as irritability, distension in the hypochondria, insomnia, quick temper, red eyes, headache, red tongue with a yellow coating and a forceful, wiry and rapid pulse. Because Chuan Lian Zi is very bitter and cold, it easily injures the Stomach. This herb should not be used for a long period of time or in large dosage, because it is a toxic herb. Overdose may cause nausea, vomiting, diarrhea, dyspnea and arrhythmia.
Wu Yao is pungent and warm, and enters the Lung, Spleen, Kidney and Bladder meridians. Wu Yao can warm these organs and expel the cold, regulate the Qi and release the pain. Since the Liver meridian passes the external genital region, Wu Yao can also regulate the Liver-Qi. It is particularly effective in relieving pain in the lateral sides of the lower abdomen and the genital area, and treats dysmenorrhea, hernia inguinalis, frequent urination and urinary incontinence due to cold in the Liver and Kidney meridians and stagnation of the Liver-Qi.
Bai Shao Yao ( Paeoniae radix lactiflora)
Since the Liver stores blood, which is the basis of free flow of the Liver-Qi, deficiency of blood can cause stagnation of Liver-Qi. However, as stimulating the Qi in treatment 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.
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. As well as the common symptoms of Qi stagnation, a thready and wiry pulse is often an indication for using this herb in the formula.
Deputy: Regulate the Qi movement and blood circulation in related organs
Chen Pi ( Citri reticulatae pericarpium), Zhi Ke ( Aurantii fructus) and Zhi Shi ( Aurantii fructus immaturus)
These herbs are selected to regulate the Qi. Chen Pi is dried tangerine peel. It is pungent, bitter and warm, and enters the Stomach and Spleen meridians. It is effective for regulating the Qi of these organs. In the formula for promoting Liver-Qi movement, it is often selected to enhance the chief by moving the Qi and eliminating the dampness and phlegm from the Middle-Jiao. Its aromatic smell can stimulate the Spleen, transform the dampness and soothe the Stomach-Qi. Chen Pi is often used for distension and pain in the abdomen, reduced appetite, fullness of the stomach, nausea and vomiting.
Zhi Ke has a similar function to Chen Pi but it is cold in nature and its function of regulating the Qi is gentler and slower. It moves horizontally in the Upper- and Middle-Jiao. In a formula that treats Liver-Qi stagnation with slight Liver-heat, Zhi Ke is very often used to open up the Qi obstruction in the chest, stomach and hypochondria to reduce fullness and distension.
Xiang Yuan ( Citri fructus), Fo Shou ( Citri sarcodactylis fructus) and Zi Su Geng ( Perillae caulis et flos)
These herbs are used when Liver-Qi attacks the Stomach. Xiang Yuan and Fo Shou are bitter, sour and slightly warm, and enter the Liver, Spleen and Stomach meridians. Both are very effective in promoting Liver-Qi movement and treating hypochondriac pain, distension and depression. Moreover, they are particularly effective in treating a condition where stagnant Liver-Qi disturbs the Stomach and leads to stifling in the chest and distension in the gastric and hypochondriac regions. They can soothe the Stomach-Qi, thereby improving appetite and stopping vomiting and belching.
Zi Su Geng is slightly pungent and warm, and enters the Lung and Spleen meridians. This herb has a similar function to Xiang Yan and Fo Shou, but it is gentler. It is particularly suitable for a weak person who suffers from Liver-Qi stagnation and Stomach-Qi disturbance. It can also calm the fetus and is useful for pregnant women who suffer from disharmony between the Liver and the Stomach.
Ju Luo ( Citri reticulatae fructus retinervus), Si Gua Luo ( Luffae fructus), Ju Ye ( Citri reticulatae folium) and Ju He ( Aurantii semen)
These herbs are used to dissipate nodules. Ju Luo is sweet, bitter and neutral, and enters the Liver and Lung meridians. According to the concept that the pith of fruit enters the collaterals of the human body, Ju Luo is able to regulate the Qi, open up the collaterals and remove phlegm there. It can be used with other herbs such as Si Gua Luo and Ju Ye to regulate the Liver-Qi in order to treat distending pain in the breasts and hypochondria, such as in premenstrual syndrome and mastopathy.
Ju Ye is pungent, bitter and neutral. Like Ju Luo, it enters the Liver meridian, particularly regulates the Liver-Qi and dissipates nodules. Its action is stronger than that of Ju Luo. It also enters the Stomach meridian and regulates the Stomach-Qi. Because the Liver and Stomach meridians pass the breasts, this herb is able to treat distending pain of the breasts.
Ju He is pungent, bitter and neutral, and enters the Liver and Kidney meridians. It is effective for regulating Qi, dissipating nodules and stopping pain. According to the concept that seeds move downwards, it is especially applied to treat cold accumulation in the Liver meridian that is manifested as cramping pain on the lateral sides of the lower abdomen with a cold sensation, such as in dysmenorrhea, amenorrhea, inguinal hernia and hydrocele of the testis.
Mu Xiang ( Aucklandiae radix)**
Mu Xiang is pungent, bitter, warm and aromatic, and enters the Gall Bladder, Spleen and Large Intestine meridians. It can strongly and quickly activate the Qi movement; it especially regulates Qi in the intestines and alleviates pain. It also strengthens the Spleen and promotes digestion. It is particularly effective in treating disorders where Liver-Qi overacts on the Spleen, causing stomachache, abdominal pain and distension, diarrhea, poor appetite and poor digestion, such as in colitis, peptic ulcer, hepatitis and irritable bowel syndrome. Since this herb is quite warm and pungent, and is strong in action, its dosage should be controlled carefully.
Mei Gui Hua ( Rosae flos), Chuan Xiong ( Chuanxiong rhizoma), Yu Jin ( Curcumae radix) and Yan Hu Suo ( Corydalidis rhizoma)
These herbs are selected to promote blood circulation. Mei Gui Hua has the function of harmonizing the Qi of the Liver and Stomach, and treating the syndrome of Liver-Qi attacking the Spleen and Stomach. Its function is quite similar to that of Xiang Yuan ( Citri fructus) and Fo Shou ( Citri sarcodactylis fructus). However, this herb can promote both Qi and blood circulation and is an appropriate herb to treat disorders due to both Qi and blood stagnation, such as in irregular menstruation and dysmenorrhea.
Chuan Xiong, Yu Jin and Yan Hu Suo are herbs that promote blood circulation. As they are able to move the Qi in the blood, they are considered as the Qi-moving herbs in the blood. In formulas that regulate the Liver-Qi, they may be selected in conditions of Qi and blood stagnation, or for the purpose of activating the blood in order to accelerate the Qi movement. As Chuan Xiong and Yan Hu Suo are warm in temperature and Yu Jin is cold, they should be selected according to the nature of the syndrome.
Gan Cao ( Glycyrrhizae radix) Mu Gua ( Chaenomelis fructus), and Bai Shao Yao
These herbs are selected to relax tendons. Gan Cao is sweet in nature and enters all meridians. It is often used together with sour herbs such as Bai Shao Yao ( Paeoniae radix lactiflora) and Mu Gua to generate Yin to soften the Liver, ease the muscles and tendons, relieve cramp and reduce high tension in the body.
Mu Gua is sour and warm, and can relieve cramp of the muscles. Its function is quite different from that of Bai Shao Yao, which is able to soften the Liver, nourish the Yin and ease the muscles. Mu Gua is able to remove dampness from the meridians, thus treating cramp of the muscles and tendons.
Assistant: Tonify the blood and Qi; reduce the excess in order to harmonize the Liver-Qi
Bai Shao Yao ( Paeoniae radix lactiflora) and Dang Gui ( Angelicae sinensis radix)
They are the most commonly used pair of herbs in a formula that treats Liver-Qi stagnation caused by blood deficiency. A thready and wiry pulse is an important sign of blood deficiency with stagnation of the Liver-Qi. Dang Gui is pungent, sweet and slightly warm; Bai Shao Yao is sour, bitter and slightly cold. When Dang Gui and Bai Shao Yao are used together, they can harmonize the blood circulation properly: the first is warm, and it can disperse and promote the blood circulation; the second is cold, and it can moderate and stabilize the blood circulation. Although both can tonify the blood, Dang Gui is focused on the promoting function of the blood while Bai Shao Yao is focused on nourishing the substantial part of the blood.
Dang Shen ( Codonopsis radix) and Bai Zhu ( Atractylodis macrocephalae rhizoma)
Dang Shen and Bai Zhu are able to tonify the Qi and strengthen the function of the Spleen. They are often used as assistants in a formula that treats Liver-Qi stagnation with Spleen-Qi deficiency. Another reason to use herbs which tonify the Spleen is that, as in a chronic condition of Liver-Qi stagnation, the Liver is almost always overacting on the Spleen. It is wise therefore to tonify the Spleen before it is badly weakened.
Bai He ( Lilii bulbus) and Suan Zao Ren ( Ziziphi spinosae semen)
These herbs can be used as assistants in formulas that spread the Liver-Qi when the Qi disturbs the mind and influences sleep. Bai He is sweet and slightly cold, and enters the Lung and Heart meridians. It can calm the mind and treat depression, anxiety and insomnia. Suan Zao Ren is able to nourish the blood of the Liver and improve sleep.
Zhi Zi ( Gardeniae fructus), Shi Jue Ming ( Haliotidis concha), Gou Teng ( Uncariae ramulus cum uncis) and Ju Hua ( Chrysanthemi flos)
Zhi Zi is bitter and cold, and enters the San Jiao meridian. It can clear the heat and reduce the excess fire from the Heart, Liver and Bladder by increasing urination. In formulas that regulate Liver-Qi, this herb can be used in cases of Liver-heat or Liver-fire presentation. A red tongue with a yellow coating and a wiry pulse suggest the existence of this disorder.
Shi Jue Ming is a mineral substance that can descend the Liver-Yang. It is used in a formula when the Liver-Yang ascends. Common symptoms are dizziness, dry eyes and blurred vision, and a wiry or tight pulse.
Gou Teng can cool the Liver and relieve convulsions. Ju Hua can disperse Liver-heat. Both can be applied in either an excess or a deficiency condition of Liver-heat syndrome.
Jiang Can ( Bombyx batrycatus), Di Long ( Pheretima) and Chan Tui ( Cicadae periostracum)
These substances particularly open up the meridians and collaterals, and treat numbness of the limbs caused by Liver-wind. Jiang Can and Chuan Tui are also used for itchy skin disorders caused by Liver-wind and Liver-heat.
Envoy: Harmonize the herbs in the formula
Zhi Gan Cao ( Glycyrrhizae radix preparata)
Zhi Gan Cao is sweet in nature and is used as envoy to harmonize the herbs that regulate the Qi by moving in different directions in the body.
Common accompanying symptoms and treatment
• Fullness in the stomach and reduced appetite due to Liver-Qi attacking the Spleen: use Bai Zhu ( Atractylodis macrocephalae rhizoma) and Fu Ling ( Poria) to strengthen the Spleen; use Hou Po ( Magnoliae cortex), Sha Ren ( Amomi xanthioidis fructus) and Mu Xiang ( Aucklandiae radix)** to regulate the Qi in the Spleen and Large Intestine; use Fang Feng ( Saposhnikoviae radix) to expel wind caused by tension in the Large Intestine; use Xiang Yuan ( Citri fructus) and Fo Shou ( Citri sarcodactylis fructus) to harmonize the Liver and Stomach.
• Nausea and belching due to Liver-Qi attacking the Stomach: use Zi Su Ye ( Perillae folium), Ban Xia ( Pinelliae rhizoma), Huang Qin ( Scutellariae radix) and Pi Pa Ye ( Eriobotryae folium) to soothe the Stomach-Qi.
• Distending pain of abdomen and irregular bowel movement due to Liver-Qi disturbing the function of the Large Intestine: add Mu Xiang ( Aucklandiae radix)** and Bing Lang ( Arecae semen) to regulate the Qi in the Liver and Large Intestine.
• Fullness in the chest, difficult urination and edema due to Liver-Qi blocking the San Jiao water passage: add Sang Bai Pi ( Mori cortex), Su Geng ( Perillae caulis) and Xing Ren ( Armeniacae semen) to descend and regulate the Qi in the Lung.
• Jaundice, reduced appetite, hypochondriac pain and fullness due to Liver-Qi disturbing the Gall Bladder: use Yin Chen Hao ( Artemisiae scopariae herba), Zhu Ru ( Bambusae caulis in taeniam) use Yu Jin ( Curcumae radix) to regulate the Qi and remove the damp-heat from the Gall Bladder.
• Distending pain in the breasts, especially before menstruation, due to Liver-Qi obstructing the collaterals: use Ju Luo ( Citri reticulatae fructus retinervus) and Si Gua Luo ( Luffae fructus) to open up the collaterals.
Examples of classical formulas
Si Ni San (Frigid Extremities Powder) 
Source: Shang Han Lun 
Composition
Chai Hu ( Bupleuri radix) 6 g
Zhi Shi ( Aurantii fructus immaturus) 6 g
Bai Shao Yao ( Paeoniae radix lactiflora) 9 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Analysis of the formula
This formula is able to free the constrained Liver-Qi and regulate the Spleen. It is a formula devised for stagnation of Liver-Qi, which may happen in a stressful situation. When Qi stagnates, the patient has fullness in the chest and distension of the hypochondria and abdomen. When Qi is not able to reach the extremities, the patient has cold fingers. If the Liver overacts on the Spleen, abdominal pain may also present. The patient may have a wiry pulse.
In this formula:
• Chai Hu is used as chief. It directly disperses the Qi and releases the constraint of the Qi in the Liver, Gall Bladder and San Jiao.
• Zhi Gan Cao is used as deputy to strengthen the Spleen and protect the Middle-Jiao. It is particularly useful when the Liver overacts on the Spleen.
• The sour Bai Shao Yao and sweet Zhi Gan Cao are used together as deputies to generate the Yin. They can soften the Liver, ease the muscles and release the cramp and stiffness so as to help Chai Hu spread the Liver-Qi.
• Zhi Shi is used as assistant to descend the Qi to help the chief regulate the Qi efficiently. It can also regulate the Qi in the intestines, and reduce distension and pain.
• Zhi Gan Cao is also used as envoy in the formula to harmonize the herbs that work on different aspects in the syndrome.
Commentary on strategies
Although there are only four herbs in this formula, it shows several treatment strategies to spread the Liver-Qi.
• First, Chai Hu is used to free the constrained Qi instead of using Xiang Fu ( Cyperi rhizoma), the most commonly used herb to regulate the Liver-Qi. Because Chai Hu moves upwards and outwards, it is more suitable in situations of Qi constraint.
• Second, the combination of ascending and descending herbs can activate the Qi movement more effectively than using herbs that move in only one direction.
• Third, herbs that soften the Liver are used to help spread the Qi smoothly.
• Fourth, herbs that harmonize the Liver and Spleen are used at the same time.
Chai Hu Shu Gan San (Bupleurum Powder to Spread the Liver) 
Source: Jing Yue Quan Shu 
Composition
Chai Hu ( Bupleuri radix) 6 g
Chen Pi ( Citri reticulatae pericarpium) 6 g
Xiang Fu ( Cyperi rhizoma) 4.5 g
Zhi Ke ( Aurantii fructus) 4.5 g
Chuan Xiong ( Chuanxiong rhizoma) 4.5 g
Bai Shao Yao ( Paeoniae radix lactiflora) 4.5 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 1.5 g
Analysis of the formula
This formula can spread the Liver-Qi and harmonize the blood. It is used for an acute and excess condition of stagnation of Liver-Qi. Patients suffer from hypochondriac pain, depression, irritability, fullness in the chest and distension in the abdomen. In female patients, dysmenorrhea and premenstrual tension syndrome may also exist. Patients often have a white tongue coating and a wiry pulse.
This formula can be considered a variation of Si Ni San (Frigid Extremities Powder):
• Chai Hu, Bai Shao Yao and Zhi Gan Cao are used for the same purpose of spreading the Liver-Qi and softening the Liver.
• At the same time, Xiang Fu is added to enhance the ability of Chai Hu to spread the Qi in the Liver, Gall Bladder and San Jiao meridians.
• Zhi Ke is used instead of Zhi Shi ( Aurantii fructus immaturus). It can broaden the chest and regulate the Qi in the chest and epigastria. Together with Chen Pi, it can reduce distension and pain.
• Moreover, Chuan Xiong is added to regulate the blood, enhance the herbs that regulate the Qi and stop pain.
Commentary on strategies
If comparing this formula with Shi Ni San (Frigid Extremities Powder), the herbs that move Liver-Qi are increased in number and strength, and a herb that regulates blood is added. This formula is therefore more powerful to spread the Qi and reduce the distension and pain. It is a formula not only for study, but also a formula that is often used effectively in clinical practice with a better and quicker result.
Tian Tai Wu Yao San (Top Quality Lindera Powder) 
Source: Yi Xue Fa Ming 
Composition
Wu Yao ( Linderae radix) 12 g
Mu Xiang ( Aucklandiae radix)** 6 g
Xiao Hui Xiang ( Foeniculi fructus) 6 g
Qing Pi ( Citri reticulatae viride pericarpium) 6 g
Gao Liang Jiang ( Alpiniae officinari rhizoma) 9 g
Bing Lang ( Arecae semen) 9 g
Jin Ling Zi/Chuan Lian Zi ( Toosendan fructus) 12 g
Ba Dou ( Crotonis fructus)* 70 pieces†
Alcohol
Analysis of the formula
This formula is able to promote the movement of Liver-Qi, scatter cold in the Lower-Jiao and alleviate pain. It is used to treat syndromes where the cold stays in the Liver meridian and blocks the Qi movement in the Lower-Jiao. The manifestations are cramping pain in the lower, lateral sides of the abdomen, which may radiate to the testicles. In female patients, there may be dysmenorrhea. Patients often have a pale tongue with a white coating and a wiry, deep and slow pulse.
In this formula:
• Wu Yao is used as chief to warm the Lower-Jiao, promote the Qi movement in the Liver, Kidney and Bladder meridians and thus relieve cramping pain.
• Qing Pi and Mu Xiang are used as deputies to regulate the Liver-Qi and relieve pain in lower abdomen.
• Xiao Hui Xiang and Gao Liang Jiang also serve as deputies to enhance the ability of the chief. They warm the Middle- and Lower-Jiao, scatter the cold and spread the Qi so as to relieve cramp.
• Bing Lang, as assistant, moves downwards, can break up the Qi stagnation and relieve pain.
• Jin Ling Zi, also named Chuan Lian Zi, is another assistant. It drains the Liver-Qi and breaks up Qi stagnation. It enhances the functions of Qing Pi and Mu Xiang to treat the pain. Its very cold nature is removed by processing with Ba Dou, which is hot and toxic, but is not used directly in this formula. This processing may neutralize the temperature but retains the function of Jin Ling Zi.
• This formula is taken with alcohol, which can quickly and powerfully expel cold and accelerate the speed of the herbs in the formula.
Commentary on strategies
In this formula, the chief has two functions: to spread the Qi and to warm the Lower-Jiao. These functions are enhanced in strength by two groups of herbs. The structure is very clear. In addition, the processing of Jin Ling Zi shows the strategy of using the function of a herb while at the same time avoiding its unnecessary nature.
Xiao Yao San (Rambling Powder) 
Source: Tai Ping Hui Min He Ji Ju Fang 
Composition
Chai Hu ( Bupleuri radix) 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) 4.5 g
Wei Sheng Jiang (roasted Zingiberis rhizoma recens) 6 g
Bo He ( Menthae herba) 3 g
Analysis of the formula
This well-known formula spreads the Liver-Qi, nourishes the blood and tonifies the Spleen. It is devised to treat Liver-Qi stagnation due to Qi and blood deficiency. The manifestations are hypochondriac pain, headache, vertigo, a bitter taste in the mouth, dry mouth and throat, fatigue, reduced appetite; in some cases alternating fever and chills, irregular menstruation or distending pain in the breasts. The tongue is pale or pink with a thin white coating and the pulse is wiry and deficient.
In this formula there are three groups of herbs that are used as chief and which form the main part of the formula:
• Dang Gui and Bai Shao Yao are chosen to nourish the Liver-blood and soften the Liver in order to promote the movement of the Qi.
• Bai Zhu and Fu Ling are used to tonify the Spleen-Qi to generate the blood, which is the basis of movement of Liver-Qi.
• Chai Hu is used to disperse constrained Liver-Qi, which is supported by sufficient Liver blood.
• Bo He disperses and clears the heat generated by the constrained Liver-Qi and serves as assistant to Chai Hu.
• Sheng Jiang can soothe the Stomach-Qi and promote digestion. It serves as assistant to Bai Zhu and Fu Ling.
Commentary on strategies
• In this formula, there is no herb that directly promotes Liver-Qi movement. The strategy to spread Liver-Qi works via the approach of softening the Liver and nourishing the blood. It is a balanced and gentle formula for treating a deficiency condition.
• Since each of the three aspects – deficiency of blood, deficiency of Spleen-Qi and stagnation of Liver-Qi – can be the cause or the consequence of each other, the roles and the dosages of the three groups of herbs that tonify the blood, tonify the Spleen and disperse the Liver-Qi can be changed according to the syndrome.
2. Syndrome of Qi stagnation in the Stomach, Spleen and Large Intestine
Manifestations
Main symptoms
Distension (even pain) in gastric and abdominal regions, nausea, vomiting, diarrhea or constipation.
Secondary symptoms
All the above-mentioned symptoms change with time, can start abruptly and disappear quickly. There may also be heartburn, thirst, bad breath and constipation; heaviness of the body, reluctance to move, tiring easily, reduced appetite and a sticky sensation in the mouth.
Tongue
Normal or slightly pale with a white coating or sticky coating if accompanied by accumulation of dampness, food or phlegm.
Pulse
Wiry; soft in the case of damp accumulation; slippery in the case of phlegm accumulation.
Associated disorders in western medicine
Acute and chronic gastritis, enteritis, peptic ulcer, duodenal ulcer and irritable bowel syndrome.
Analysis of the syndrome
The Stomach and Large Intestine are Fu organs and their physiological function is to transport the food and feces. Their characteristic is often explained as moving the Qi downwards and emptying the organ at the same time . The Stomach and Large Intestine are considered as the Yang Ming family, full of Yang and Qi, which are important for digestion. They prefer to be moistened rather than dried. Since they open directly to the outside environment, they are vulnerable to exterior pathogenic factors by taking food and drink.
• As soon as the Qi movement and the transportation functions of these organs are disturbed, fullness and distension (even pain) may start in the gastric and abdominal regions.
• In a severe disorder, if the Stomach-Qi is unable to descend and is forced to ascend because of the obstruction, reduced appetite and nausea (even vomiting) may occur.
• When the Qi is unable to descend in the Large Intestine, difficult bowel movement and constipation may present.
• When the Yin and fluid are injured and heat is very strong, heartburn, thirst, bad breath and constipation may present.
Moreover, physiologically, Liver-Qi may promote the digestion and ensure that the Qi moves smoothly in the Middle-Jiao.
• When Liver-Qi attacks the Stomach and Large Intestine, the Qi moves improperly in the digestive tract and the above-mentioned symptoms may arise suddenly. Alternatively, constipation and diarrhea may occur.
The Spleen’s physiological features are opposite to those of the Stomach. It is a Zang organ and its principal function is to transform food and drink into Qi and blood. Therefore its Qi should ascend and the organ prefers being dry rather than wet.
• If the function of the Spleen is not strong, food and drink can easily become stagnant, leading to accumulation of dampness, food or phlegm.
• When Qi is obstructed in the body, there may be symptoms such as heaviness of the body, reluctance to move, tiring easily, reduced appetite and having a sticky sensation in the mouth.
• A wiry pulse indicates the tension of the obstruction and the pain; a pale tongue indicates the Qi and blood deficiency of the Spleen; the sticky and thick tongue coatings indicate the degree of dampness, phlegm and food accumulation.
Treatment principle: Regulate and smooth the movement of Qi in the Stomach and Large Intestine
Herb selection principles and formula composition strategies
• First, herbs that are pungent and warm, enter the Stomach, Large Intestine and Spleen meridians, can promote Qi movement and direct the Qi downwards are selected.
• Second, herbs that promote the functions of the Spleen and remove the accumulation of food, dampness and phlegm are used.
• Third, herbs that increase the fluids in the Stomach and Large Intestine, reduce heat and promote bowel movement are often prescribed.
• Herbs that clear heat in the Stomach and Large Intestine, promote blood circulation and tonify the Spleen-Qi are often added.
• Finally, herbs that regulate the function of the Liver should be used to prevent the Liver-Qi attacking the Spleen, Stomach and intestines.
Structure of the formula and selection of herbs
Chief: Descend the Qi in the Stomach and Large Intestine; remove dampness and phlegm in the Middle-Jiao
Chen Pi ( Citri reticulatae pericarpium), Ban Xia ( Pinelliae rhizoma) and Zi Su Geng ( Perillae caulis et flos)
These three herbs all can descend the Stomach-Qi and are often selected in cases of Stomach-Qi stagnation.
Chen Pi is dried tangerine peel. It is pungent, bitter and warm, and enters the Stomach and Spleen meridians It is commonly used to regulate the Qi of the Stomach and it can treat poor appetite, distension in the epigastria, nausea and vomiting. As it is an aromatic herb, it can also transform dampness in the Middle-Jiao to treat Qi stagnation and dampness accumulation. It should be used with caution when there is Yin deficiency or heat in the Stomach as it can consume the Yin.
Ban Xia is pungent and warm, and enters the Spleen and Stomach meridians. Although this herb is mostly used for removing phlegm, it can effectively soothe the Stomach and treat nausea and vomiting. It is often used together with other herbs such as Chen Pi to regulate the Qi of the Stomach. Like Chen Pi, it can consume Yin and should be used with caution.
Zi Su Geng is pungent and warm, and enters the Lung and Spleen meridians. It can gently descend the Qi in the Middle-Jiao and is particularly suitable for treating fullness in the epigastria and chest due to Qi stagnation with food accumulation.
Hou Po ( Magnoliae cortex)
Huo Po is bitter, pungent and warm, and enters the Lung, Stomach and Large Intestine meridians. As well as its function of descending Qi, it can disperse obstruction and dry dampness, and is an excellent herb to reduce distension. It is often selected to treat Qi and dampness accumulation in these organs and the involved regions.
Tan Xiang ( Santali albi lignum)
Tan Xiang is pungent, aromatic and warm, and enters the Spleen, Stomach and Lung meridians. It has a strong function of scattering cold and opening Qi obstruction, thus relieving pain. It is particularly suitable to be selected for severe pain in the chest and stomach. It is often used with Sha Ren ( Amomi xanthioidis fructus) to enhance its function.
Ding Xiang ( Caryophylli flos), Shi Di ( Kaki diospyri calyx) and Sheng Jiang ( Zingiberis rhizoma recens)
The first two herbs are particularly effective for reducing the rebellious Qi of the Stomach and are used for treating belching and hiccup due to cold disturbing the Stomach. Ding Xiang is warm and its function to descend the Stomach-Qi is enhanced by Shi Di which is neutral in nature.
Sheng Jiang is pungent and warm, and enters the Stomach meridian. It particularly warms the Stomach, soothes the Stomach-Qi and disperses the cold fluid. It therefore treats fullness, cramp in the Stomach and even vomiting out clear fluid.
Xuan Fu Hua ( Inulae flos) and Dai Zhe Shi ( Haematitum)
These two substances can strongly descend the Stomach-Qi and are used for severe vomiting in an acute and severe case of rebellious Stomach-Qi.
Xuan Fu Hua is bitter, pungent, salty and slightly warm, and enters the Lung, Stomach and Large Intestine meridians. It can strongly descend the Qi and remove phlegm from the Stomach. Its function is enhanced by Dai Zhe Shi. Dai Zhe Shi is a mineral substance; it is bitter and cold, and enters the Liver meridian. As it moves downward rapidly, it can direct the rebellious Stomach-Qi downwards.
Hou Po ( Magnoliae cortex), Mu Xiang ( Aucklandiae radix)**, Sha Ren ( Amomi xanthioidis fructus), Bai Dou Kou ( Amomi fructus rotundus), Bing Lang ( Arecae semen) and Zhi Shi ( Aurantii fructus immaturus)
All of these herbs can regulate the Qi in the Large Intestine.
Hou Po is bitter, pungent and warm, and is the most often selected herb in formulas that reduce the fullness in the whole abdomen due to Qi and dampness obstruction.
Mu Xiang can strongly and effectively regulate Qi in the Large Intestine and alleviate pain. It is pungent, bitter, warm and aromatic. As well as regulating the Qi in the Large Intestine, it can effectively treat disorders of Liver-Qi overacting on the Spleen because it enters the Gall Bladder, Spleen and Large Intestine meridians. It treats cramping pain and distension in the abdomen and irregular bowel movement.
Sha Ren is pungent and warm, and enters the Spleen, Stomach and Kidney meridians. It particularly regulates the Qi in the Middle- and Lower-Jiao. Like Hou Po, it treats Qi stagnation which is combined with dampness. In addition, its aromatic smell can improve the digestion and remove dampness and food accumulation. It is often used with Mu Xiang because of their enhancing action of regulating the Qi from each other.
Bai Dou Kou is pungent and warm, and its functions are similar to those of Sha Ren. However, it is more effective for regulating the Qi in the Middle-Jiao and is also less warm and less dry in property than Sha Ren.
Bing Lang is bitter, pungent and warm, and enters the Stomach and Large Intestine meridians. It can strongly descend the Qi in the Middle- and Lower-Jiao and reduce food accumulation. It can effectively treat abdominal pain, distension and difficult bowel movement.
Zhi Shi is the only cold herb in this group of herbs to regulate the Qi in the Middle- and Lower-Jiao. Its cold and bitter property can strongly direct the Qi downwards. It has an intense action of opening the obstruction of the Qi and breaking up the accumulations of Qi, blood, food or phlegm. It is often selected to treat distending pain of the abdomen and constipation.
Deputy: Remove dampness in the Middle-Jiao and regulate the Liver-Qi
Pi Pa Ye ( Eriobotryae folium), Lu Gen ( Phragmitis rhizoma) and Mai Men Dong ( Ophiopogonis radix)
These three herbs are moist in nature. They can nourish the Stomach-Yin and descend the Stomach-Qi. They can be chosen as deputies in formulas that regulate the Stomach-Qi and treat nausea and reduced appetite in cases of fluid and Yin deficiency, such as after a febrile disease.
Yi Yi Ren ( Coicis semen), Fu Ling ( Poria) and Bai Zhu ( Atractylodis macrocephalae rhizoma)
These three herbs can leach out or dry dampness. They are used as deputies to treat dampness accumulation in the Middle- and Lower-Jiao. Yi Yi Ren is slightly cold and can be used in a damp-heat condition; Fu Ling and Bai Zhu can tonify the Spleen-Qi. Together they accelerate the transformation of dampness.
Xiang Yuan ( Citri fructus) and Fo Shou ( Citri sarcodactylis fructus)
Xiang Yuan and Fo Shou are bitter, sour and slightly warm, and enter the Liver, Spleen and Stomach meridians. They can effectively promote Liver-Qi movement, as well as soothing the Stomach-Qi. They are particularly used to treat the syndrome where Liver-Qi overacts on the Stomach and leads to distension in the gastric and hypochondriac regions, reduced appetite, vomiting and belching.
Assistant: Promote food digestion and enhance the ability of the chief; treat the causes and accompanying syndromes
Mai Ya ( Hordei fructus germinatus), Shen Qu ( Massa medicata fermentata), Shan Zha ( Crataegi fructus) and Lai Fu Zi ( Raphani semen)
These herbs can be selected in cases of food accumulation. Moreover, they can be used to prevent food accumulation, which often happens when the Stomach-Qi stagnates. The first three substances are often used together as they aid digestion of starch, cereal, fat and protein-rich food. Lai Fu Zi can effectively regulate the Qi and remove phlegm in the intestines; it aids the digestion of all types of food.
Da Huang ( Rhei rhizoma) and Mang Xiao ( Natrii sulfas)
Da Huang and Mang Xiao can be selected if constipation occurs due to dryness and heat in the Large Intestine. Da Huang can stimulate the Large Intestine and purge the feces; Mang Xiao can increase the fluid in the intestines and soften the feces. As both are cold in nature, they can also reduce heat in the intestines.
Huang Qin ( Scutellariae radix) and Lian Qiao ( Forsythiae fructus)
These two herbs are often selected to reduce heat from the intestines, as both are bitter and cold in nature. Huang Qin is particularly suitable for treating damp-heat in the intestines; Lian Qiao can disperse the constrained heat and is used to disperse the heat from accumulated food.
Mei Gui Hua ( Rosae flos), Chuan Xiong ( Chuanxiong rhizoma), Yu Jin ( Curcumae radix) and Yan Hu Suo ( Corydalidis rhizoma)
These herbs can stimulate the Qi and blood, and are used for treating severe Qi stagnation.
Mei Gui Hua can promote both Qi and blood circulation and is an appropriate herb to treat disorders due to Qi and blood stagnation, such as focal distending pain and cramping. Since it has the function of harmonizing the Qi in the Liver and Stomach, it treats the syndrome of Liver-Qi attacking the Spleen and Stomach. It is used when pain is present and gets worse in cases of stress.
Chuan Xiong, Yu Jin and Yan Hu Suo can promote blood circulation. As they are able to move the Qi in the blood, they are considered as the Qi-moving herbs in the blood. In formulas that regulate the Stomach-Qi, they are selected in cases of both Qi and blood stagnation. They can also be selected to move the blood in order to accelerate the Qi movement. Chuan Xiong and Yan Hu Suo are warm in nature and Yu Jin is cold. They should be selected according to treatment need.
Dang Gui ( Angelicae sinensis radix) and Bai Shao Yao ( Paeoniae radix lactiflora)
These two herbs are the most commonly used herbal combination in a formula to tonify the blood, which is the basis of the Qi. Dang Gui is pungent, sweet and slightly warm; Bai Shao Yao is sour, bitter and slightly cold. When Dang Gui and Bai Shao are used together, they can harmonize the blood circulation as Dang Gui focuses on tonifying and promoting the function of the Liver and Bai Shao Yao focuses on nourishing the substantial part of the blood. A pale tongue with a thin coating and a thready and wiry pulse are the important signs for selecting these two herbs.
Dang Shen ( Codonopsis radix) and Bai Zhu ( Atractylodis macrocephalae rhizoma)
Dang Shen and Bai Zhu are able to tonify the Qi and strengthen the function of the Spleen. They are often used as assistants in a formula that treats Qi stagnation when the Spleen-Qi is too weak to move in the Middle-Jiao. Another reason for using herbs that tonify the Spleen is when the Spleen is weak, the Liver can easily overact on the Spleen, and thus the Spleen should be strengthened at the same time.
Envoy: Harmonize the herbs in the formula
Zhi Gan Cao ( Glycyrrhizae radix preparata)
Zhi Gan Cao is sweet and is used as envoy in the formula to harmonize the herbs that regulate the Qi by moving it in different directions.
Common accompanying symptoms and treatment
• Heartburn due to Stomach-Yin deficiency with heat: use Sheng Di Huang ( Rehmanniae radix), Huang Lian ( Coptidis rhizoma), Mu Dan Pi ( Moutan cortex) and Sheng Ma ( Cimicifugae rhizoma) to reduce the heat and regulate the Qi and blood.
• Constipation due to dry-heat in the intestines: use Mai Men Dong ( Ophiopogonis radix) and Xuan Shen ( Scrophulariae radix) to increase the fluid; use Huo Ma Ren ( Cannabis semen) and Yu Li Ren ( Pruni semen) to moisten the intestines.
• Alternating diarrhea and constipation due to Liver-Qi overacting on the Stomach and Spleen: use Bai Zhu ( Atractylodis macrocephalae rhizoma) and Bai Shao Yao ( Paeoniae radix lactiflora) to harmonize the Spleen and Liver; use Fang Feng ( Saposhnikoviae radix) and Chen Pi ( Citri reticulatae pericarpium) to regulate the Qi.
Examples of classical formulas
Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction) 
Source: Jin Gui Yao Lue 
Composition
Ban Xia ( Pinelliae rhizoma) 12 g
Hou Po ( Magnoliae cortex) 9 g
Fu Ling ( Poria) 12 g
Sheng Jiang ( Zingiberis rhizoma recens) 9 g
Zi Su Ye ( Perillae folium) 6 g
Analysis of the formula
This formula can promote the movement of Qi, dissipate clumps, direct rebellious Qi downwards and transform phlegm. It was originally used to treat plum-pit Qi syndrome, a syndrome caused by Qi and phlegm obstructing the throat. Patients have a feeling that something blocks the throat that can neither be swallowed nor ejected, and a stifling sensation in the chest and hypochondria. This formula can also treat depression due to Qi and phlegm obstruction in the Middle- and Upper-Jiao. Patients may complain about loss of interest in doing things, tiredness, a heavy sensation in the body, and having a poor appetite with fullness in the epigastria and chest. The tongue coating is white and sticky and the pulse is wiry and slippery.
In this formula:
• Ban Xia and Hou Po are chief. They can descend the Qi in the Upper- and Middle-Jiao and eliminate phlegm. They treat the main pathological condition.
• Fu Ling, as deputy, can tonify the Spleen and increase urination, thus leaching out the dampness in the body.
• Sheng Jiang and Zi Su Ye soothe the Stomach-Qi and promote digestion so as to stop the production of dampness and phlegm.
When all these herbs are used together, they can open the obstruction of Qi, dampness and phlegm, and the symptoms disappear.
Commentary on strategies
• In this formula, there are only five herbs, all of which move downwards. They open the obstruction of Qi and phlegm via the approaches of descending the Qi, leaching out the dampness, transforming the phlegm and promoting digestion.
• Moreover, Sheng Jiang and Zi Su Ye have dispersing and ascending abilities besides descending the Qi. They can enhance the descending actions of all the herbs and activate the Qi movement efficiently.
Tong Xie Yao Fang (Important Formula for Painful Diarrhea) 
Source: Jing Yue Quan Shu quoted from Liu Cao Chuang 
Composition
Chao Bai Zhu (dry-fried Atractylodis macrocephalae rhizoma) 90 g
Chao Bai Shao Yao (dry-fried Paeoniae radix lactiflora) 60 g
Chao Chen Pi (dry-fried Citri reticulatae pericarpium) 45 g
Fang Feng ( Saposhnikoviae radix) 60 g
Analysis of the formula
This formula can harmonize the functions of the Liver and the Spleen and can treat a condition of Liver-Qi overacting on the Spleen with disturbance of Qi movement in the Middle-Jiao. The manifestations are borborygmi, abdominal pain, an urge to defecate, and diarrhea with abdominal pain subsiding after completion. The tongue coating is thin and white and the pulse is wiry.
In this formula:
• Bai Zhu is used as chief against the attack of the Liver and to strengthen the Spleen-Qi.
• Bai Shao Yao, as deputy, nourishes the Liver-Yin, softens the Liver and reduces the tension of the muscles and tendons when the Liver attacks the Spleen.
• Chen Pi, as assistant, regulates the disturbed Qi in the Middle-Jiao.
• Fang Feng also serves as assistant. It pacifies the wind generated by sudden cramp of the abdomen. It smoothes the muscles and reduces the speed of the disturbed Qi in the Middle-Jiao.
Commentary on strategies
• This formula, although containing only four herbs, clearly shows the specific function of each herb and the relationships between them.
• It suggests the basic strategies in the case of the Liver-Qi overacting on the Spleen – to strengthen the Spleen, to reduce the Liver and to soothe the Qi.
• Not only is it an excellent formula to study, it is also an effective formula that is frequently used in clinical practice.
Mu Xiang Bin Lang Wan (Aucklandia and Betel Nut Pill) 
Source: Dan Xi Xin Fa quoted from Zhang Zi He’s formula 
Composition
Mu Xiang ( Aucklandiae radix)** 30 g
Bing Lang ( Arecae semen) 30 g
Da Huang ( Rhei rhizoma) 15 g
Qian Niu Zi ( Pharbitidis semen)* 60 g
Qing Pi ( Citri reticulatae viride pericarpium) 30 g
Chen Pi ( Citri reticulatae pericarpium) 30 g
Chao Xiang Fu (dry-fried Cyperi rhizoma) 60 g
E Zhu ( Curcumae rhizoma) 30 g
Huang Lian ( Coptidis rhizoma) 30 g
Huang Bai ( Phellodendri cortex) 30 g
Analysis of the formula
This formula is devised for promoting the movement of Qi in the Large Intestine and for purging accumulation and heat. It is used for stagnation of food, which causes obstruction of Qi and accumulation of damp-heat. The manifestations are focal and general distension, fullness and pain in the epigastria and abdomen, constipation or dysenteric diarrhea with mucus and blood. The tongue is red or purple with a yellow, sticky coating and the pulse is strong.
This is an excess syndrome and the main disorder is accumulation, which obstructs the Qi and generates dampness and heat. The damp-heat injures the mucus in the intestines, leading to dysenteric diarrhea.
In the formula:
• Mu Xiang and Bing Lang are chief. They are bitter, pungent and warm, and enter the Large Intestine meridian. Since they can strongly move the Qi in the Middle- and Lower-Jiao and reduce the food accumulation, they can effectively treat abdominal pain, distension and difficult bowel movement.
• Da Huang and Qian Niu Zi are deputies. As they are bitter and cold purgatives, they can strongly descend the Qi and eliminate the accumulation and heat in the Large Intestines.
• The remaining herbs serve as assistants. Qing Pi, Xiang Fu and Chen Pi aid the function of the chief by promoting Qi movement of the Liver and Stomach and by reducing the distension. E Zhu can regulate the blood circulation and break up accumulation. Huang Lian and Huang Bai are bitter and cold, and clear the damp-heat in the Large Intestine.
When the accumulation is removed, Qi and blood move properly and the symptoms disappear.
Commentary on strategies
• In this formula, all the herbs are strong and active. They work on different aspects in treating the syndrome. Each group has a specific function and they work together to suit all the aspects of the pathological changes.
• This formula follows the principle of treating diarrhea by purging accumulations. Normally, when diarrhea occurs, one may first think to stop it by the natural choice of herbs that can stop diarrhea. However, this formula suggests to us that no matter how heavy the diarrhea, even with blood and mucus, and no matter how long the disorder lasts, the cause of the diarrhea should be treated first. To stop diarrhea by using astringent herbs in this case may prolong the accumulation. This would generate more heat and dampness, and the diarrhea could get worse. In this formula, herbs that intensively purge the Large Intestine and remove the accumulation are chosen to treat the cause primarily. In addition, herbs that regulate Qi and particularly reduce tenesmus are used.
• Herbs that regulate blood and remove heat and toxins are used as they can directly stop blood and mucus discharge.
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) 6 g
Huang Qin ( Scutellariae radix) 6 g
Huang Lian ( Coptidis rhizoma) 3 g
Ren Shen ( Ginseng radix) 6 g
Da Zao ( Jujubae fructus) 4 pieces
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Analysis of the formula
This formula can regulate the Qi in the Middle-Jiao, direct rebellious Qi downward, disperse clumping and eliminate distension. It treats a complicated condition where cold and heat and excess and deficiency coexist in the Middle-Jiao. The manifestations are epigastric fullness and tightness with very slight pain, nausea or vomiting, diarrhea, reduced appetite, a thin, sticky, yellow tongue coating and a wiry, rapid pulse.
This is a formula devised by Dr Zhang Zhong Jiang. It was originally used in a condition where Shao Yang syndrome was not treated by a harmonizing method, but by a purging method, which injured the Yang of the Middle-Jiao. In this pathological process, the heat sinks deeper, binds with cold caused by Yang deficiency, and the excess pathogenic factor binds with the weakened Qi. In the Middle-Jiao, as the Qi is blocked, nausea, vomiting, borborygmi and diarrhea appear.
In this formula:
• Ban Xia is used to disperse the obstruction of the Qi and soothe the Stomach-Qi so as to reduce distension.
• Gan Jiang warms the Middle-Jiao and disperses coldness.
• Huang Qin and Huang Lian are bitter and cold. They clear the pathogenic heat, descend the Qi and open the obstruction.
When the pungent-warm herbs and the bitter-cold herbs are used together, the bonding of cold and warm, as well as excess and deficiency, is dissolved and the Qi movement is harmonized in the Middle-Jiao.
• Ren Shen, Zhi Gan Cao and Da Zhao serve as assistants. They tonify the Spleen and thus prevent further pathological development.
When the seven herbs are used together, heat and cold are removed, the Spleen-Qi ascends, the Stomach-Qi descends, and the symptoms disappear.
Commentary on strategies
• This formula demonstrates using a combination of pungent-warm herbs with bitter-cold herbs to treat a complicated syndrome.
• The strategy of using pungent-warm herbs and bitter-cold herbs together is not only used in the original condition of mistreated Shao Yao syndrome, but is also used widely in similar conditions, such as acute and chronic gastroenteritis, hyperchlorhydria, prolapsed stomach, dilatation of the stomach, peptic and duodenal ulcer, nausea and vomiting due to nervousness, irritable bowel syndrome, allergies, and the side effects of western medicine.
3. Syndrome of Qi stagnation in the Lung
Manifestations
Main symptoms
Short and shallow breathing, a stifling sensation in the chest, cough and wheezing.
Secondary symptoms
Edema, puffiness, tiredness, reluctance to move, weak voice.
Tongue
Normal or slightly pale with a white coating or sticky coating if accompanied by accumulation of dampness, food or phlegm.
Pulse
Rapid, superficial in the first position on the right side; slippery in the case of phlegm accumulation.
Associated disorders in western medicine
Acute and chronic bronchitis, asthma, emphysema, pulmonary heart disease, heart failure.
Analysis of the syndrome
The Lung is one of the Zang organs and it governs respiration. It is exposed to the outside and can easily be attacked by exterior pathogenic factors. The Lung is also a very light and fragile organ, which cannot bear warmth, coldness and dryness. It needs fluid to nourish its light body and Qi to support its function. Qi must disperse and descend without obstruction in the Lung. As the Lung is located in the Upper-Jiao, the Qi should descend.
• As soon as the Lung-Qi is obstructed by exterior pathogenic factors or disturbed by other internal organs, it moves upwards instead of downwards, and patients can immediately feel a stifling sensation in the chest, the breath becomes quick and shallow, and the voice becomes weak.
• When the Qi is blocked in the Lung, fluid can accumulate and forms phlegm, frequently leading to cough with phlegm.
• When the Qi is not spread in the whole body by the Lung, patients may easily feel tired and reluctant to move.
• If the water passage is blocked in the Upper-Jiao, edema or puffiness occurs.
• The blockage of Lung-Qi shows in a normal or slightly pale tongue with a white coating. A sticky coating can be found if there is accumulation of phlegm or dampness. The pulse is rapid because of compensation for the blockage, and it is superficial in the Lung position. It can also be slippery in the case of phlegm accumulation.
Treatment principle: Regulate the Lung-Qi and eliminate the pathogenic factors in the Lung
Herb selection principles and formula composition strategies
• First, herbs that enter the Lung and San Jiao meridians, and herbs that can disperse or descend the Lung-Qi are selected.
• Second, herbs that expel exterior pathogenic factors and remove dampness and phlegm are selected.
• Herbs that regulate the Liver-Qi can be used in conditions of stress and to prevent the Liver-Qi attacking and obstructing the Lung.
• Herbs that tonify the Kidney-Qi so as to grasp the Lung-Qi can be selected.
• Herbs that tonify the Lung-Qi and Spleen-Qi should be prescribed when the Lung-Qi is deficient.
Structure of the formula and selection of herbs
Chief: Descend the Lung-Qi and remove phlegm and dampness
Ting Li Zi ( Lepidii/Descurainiae semen) and Sang Bai Pi ( Mori cortex)
Ting Li Zi and Sang Bai Pi are cold in nature and enter the Lung meridian. They are able to direct the Lung-Qi downwards, eliminate phlegm and accumulated water, thus reducing the obstruction of the Lung-Qi and arresting wheezing. They are used together in conditions of cough, wheezing, fullness in the chest, edema and difficult urination.
Ting Li Zi is very pungent, bitter and cold, and is much stronger than Sang Bai Pi in directing the Lung-Qi downwards and draining water. It is more suitable for treating the excess syndromes of phlegm and water accumulation in the Lung. As it also enters the Large Intestine meridian, it can drain heat, water and phlegm via bowel movement. However, since Ting Li Zi is a harsh, cold herb and easily injures the Qi, it is only used in excess syndromes for a short period of time.
Sang Bai Pi is sweet, bland and cold. It can clear heat and leach out dampness without the side effect of Yin consumption. Sang Bai Pi is gentler than Ting Li Zi in directing the Qi downwards and eliminating the accumulation of water and phlegm. It therefore has fewer side effects and can be used for a longer period of time.
Zi Su Zi ( Perillae fructus) and Xing Ren ( Armeniacae semen)
Zi Su Zi and Xing Ren are warm in temperature and enter the Lung meridian. They are seeds and can effectively descend the Lung-Qi and arrest wheezing. They contain oil and can moisten the Lung and intestines, descend the Qi and eliminate phlegm. As Zi Su Zi can also broaden the chest, and Xing Ren can stop cough, they can be selected for slightly different situations. Xing Ren is bitter, warm and slightly poisonous, and the dosage should be controlled carefully.
Deputy: Regulate the Lung-Qi; eliminate phlegm, dampness, heat or cold from the Lung
Bai Qian ( Cynanchi stauntonii radix) and Qian Hu ( Peucedani radix)
Bai Qian and Qian Hu are often prescribed together. Both are pungent and enter the Lung meridian. They are effective for relieving cough, and can disperse as well as descend the Lung-Qi. They are often selected as assistants to treat fullness in the chest, cough and wheezing due to obstruction of the Lung-Qi.
Bai Qian is a warm herb and its action of descending the Lung-Qi is stronger than that of Qian Hu. It is suitable for treating damp-phlegm syndrome. Qian Hu is cold in nature and is more suitable for clearing heat in the Lung and treating phlegm-heat syndrome.
Huang Qin ( Scutellariae radix) and Shi Gao ( Gypsum)
Huang Qin and Shi Gao are cold in nature and enter the Lung meridian. As they can clear heat of the Lung, they can descend the Qi and relieve the stifling sensation.
Huang Qin is bitter and cold. As it can dry dampness, it is often selected in the condition of damp-heat or phlegm-heat in the Lung. When it is used with a small amount of dispersing herbs, such as Ban Xia ( Pinelliae rhizoma), its function of clearing heat becomes more active.
Shi Gao is pungent, sweet and cold. It can clear dry-heat of the Lung, as well as generating the Yin. It is a mineral substance and has a strong function in descending the Lung-Qi. When it is used with herbs that open the Lung-Qi, such as Ma Huang ( Ephedrae herba)*, its functions of clearing heat and arresting wheezing become more effective.
Pi Pa Ye ( Eriobotryae folium) and Gua Lou ( Trichosanthis fructus)
Pi Pa Ye and Gua Lou are cold in nature and enter the Lung meridian. They can effectively eliminate phlegm and clear the heat in the Lung. They are often selected in formulas because they are used not only to treat these secondary symptoms, but also to descend the Lung-Qi and moisten the Lung.
Ban Xia ( Pinelliae rhizoma) and Sheng Jiang ( Zingiberis rhizoma recens)
Ban Xia and Sheng Jiang are pungent and warm, and enter the Lung meridian. They can descend the Lung-Qi and warm the Lung. They are selected in conditions where the Lung-Qi is obstructed by damp-cold or phlegm-cold. Comparing the functions of the two herbs, Sheng Jiang can disperse the cold, release the exterior and transform accumulated fluid in the Lung; Ban Xia specifically transforms cold-phlegm.
Assistant: Regulate the Liver; tonify the Spleen and Lung; warm the Kidney; stabilize the Lung-Qi
Chai Hu ( Bupleuri radix) and Bai Shao Yao ( Paeoniae radix lactiflora)
The combination of Chai Hu and Bai Shao Yao can be used in the formula. They regulate the Liver-Qi as well as smooth the Lung-Qi in stressful conditions. They also prevent the Liver attacking the Lung when the Lung-Qi and Liver-Qi are both obstructed. Chai Hu can ascend and disperse the Liver-Qi and promote the Qi to move freely in the San Jiao passage; Bai Shao Yao is used to nourish the Yin and blood and can therefore soften the Liver because Liver-blood is the basis of free flow of Liver-Qi.
Ren Shen ( Ginseng radix)
Ren Shen is sweet and slightly warm. It can strengthen the Source-Qi and the Lung-Qi. It can be selected in the condition where the Lung and Kidney are both deficient, which manifests as shallow breath, tiredness and a weak voice.
Rou Gui ( Cinnamomi cassiae cortex)
Rou Gui is sweet and warm, and enters the Kidney meridian. It can warm the Kidney-Yang and strengthen the fire of the vital gate. It is selected to treat the syndrome where the Kidney-Yang is too weak to grasp the Qi that descends from the Lung. The manifestations are cold back and lower abdomen, weakness of the legs, shortness of breath and a weak voice.
Wu Wei Zi ( Schisandrae fructus), Bai Guo ( Ginkgo semen) and Wu Mei ( Mume fructus)
These herbs have a sour taste and are only used where Lung-Qi disperses excessively, such as in severe wheezing, cough and asthma. Since a sour taste may keep the phlegm inside and make the syndrome more difficult to treat, these herbs have to be used in a small dosage and in a well-organized formula.
Jie Geng ( Platycodi radix)
Jie Geng is pungent, bitter and neutral, and enters the Lung meridian. Jie Geng is light in weight and in nature, and can ascend the Lung-Qi gently but sufficiently. It is also able to transform phlegm and stop cough. In the formula to regulate the Lung-Qi, most of the herbs move downwards. A small amount of Jie Geng can ascend and open the Lung-Qi in order to accelerate the herbs that descend the Qi, thereby regulating the Lung-Qi more effectively.
Envoy: Harmonize the herbs in the formula
Zhi Gan Cao ( Glycyrrhizae radix preparata)
Zhi Gan Cao is sweet and is used as envoy in the formula to reduce the stress caused by breathlessness and to harmonize the herbs that regulate the Lung-Qi to move in different directions.
Common accompanying symptoms and treatment
• Lung-Qi is obstructed by exterior wind-cold: use Jing Jie ( Schizonepetae herba) and Fang Feng ( Saposhnikoviae radix) to expel the wind-cold.
• Lung-Qi is obstructed by exterior wind-heat: use Jin Yin Hua ( Lonicerae flos), Lian Qiao ( Forsythiae fructus), Jing Jie ( Schizonepetae herba) and Sang Ye ( Mori folium) to expel wind-heat.
• Shortness of breath and hoarseness caused by exterior dryness: use Sang Ye ( Mori folium), Tian Hua Fen ( Trichosanthis radix), Lu Gen ( Phragmitis rhizoma) and Bai He ( Lilii bulbus) to moisten the Lung.
• Constipation due to obstruction of the Lung-Qi: use Xing Ren ( Armeniacae semen), Zi Su Zi ( Perillae fructus), Gua Lou Ren ( Trichosanthis semen) and a small amount of Jie Geng ( Platycodi radix) to regulate the Qi and moisten the intestines.
Examples of classical formulas
Su Zi Jiang Qi Tang (Perilla Fruit Decoction for Directing the Qi Downward) 
Source: Tai Ping Hui Min He Ji Ju Fang 
Composition
Zi Su Zi ( Perillae fructus) 9 g
Ban Xia ( Pinelliae rhizoma) 9 g
Dang Gui ( Angelicae sinensis radix) 6 g
Hou Po ( Magnoliae cortex) 6 g
Qian Hu ( Peucedani radix) 6 g
Rou Gui ( Cinnamomi cassiae cortex) 3 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Zi Su Ye ( Perillae folium) 5 pieces
Sheng Jiang ( Zingiberis rhizoma recens) 2 pieces
Da Zao ( Jujubae fructus) 1 piece
Analysis of the formula
This formula directs rebellious Qi downwards in the Lung, arrests wheezing, stops cough and transforms phlegm-cold. It is used to treat a syndrome where the Kidney-Yang is too weak to support the Yang and Qi of the Lung and therefore the cold-phlegm remains in the Lung for a long time. When the patient catches a cold, the Lung is obstructed by the exterior wind-cold and the cold-phlegm. The manifestations are cough with watery, copious sputum, a stifling sensation in the chest, shallow breath, shorter inhalation and longer exhalation, tiredness, weakness of the back, edema, a white and sticky tongue coating and a rapid and restless pulse.
In this formula:
• The pungent and warm Zi Su Zi is used as chief to descend the Qi directly and eliminate phlegm in order to arrest wheezing.
• Ban Xia, Hou Po and Qian Hu are used as deputies. They can descend the Qi, dry the cold-phlegm and enhance the strength of the chief. Qian Hu can also stop cough.
• There are several assistants:
– Rou Gui warms the Yang, accelerates water metabolism to eliminate phlegm, warms the Kidney-Yang and grasps the Qi to arrest wheezing.
– Dang Gui can nourish the Liver-blood. It is used together with Rou Gui to improve the Liver and Kidney.
– Zi Su Ye disperses the Lung-Qi and expels wind-cold in the superficial region.
– Sheng Jiang and Da Zao promote digestion, strengthen the Middle-Jiao and prevent generation of phlegm.
• Zhi Gan Cao is used as envoy to harmonize the functions of the herbs in the formula.
Commentary on strategies
• In this formula, the moving herbs and the tonifying herbs are used together; the drying herbs and the moistening herbs are used together; both Upper- and Lower-Jiao are involved; and both the manifestations and the cause of the disorder are treated.
• It is clear from the herb selections and dosages that this formula focuses more on treating the manifestations than the cause. It is devised for an acute condition of wheezing.
Ding Chuan Tang (Arrest Wheezing Decoction) 
Source: She Sheng Zong Miao Fang 
Composition
Bai Guo ( Ginkgo semen) 9 g
Ma Huang ( Ephedrae herba)* 9 g
Zi Su Zi ( Perillae fructus) 6 g
Gan Cao ( Glycyrrhizae radix) 3 g
Kuan Dong Hua ( Tussilaginis farfarae) 9 g
Xing Ren ( Armeniacae semen) 9 g
Sang Bai Pi ( Mori cortex) 9 g
Huang Qin ( Scutellariae radix) 6 g
Ban Xia ( Pinelliae rhizoma) 9 g
Analysis of the formula
This formula is able to descend the Lung-Qi, eliminate phlegm-heat and arrest wheezing. It is used for an acute condition of wheezing caused by phlegm-heat obstruction in the Lung. Originally, these patients had hidden phlegm in the Lung from unbalanced functions of internal organs. The phlegm turns to phlegm-heat and obstructs the Lung in the condition of wind-cold invasion in the superficial region.
In this formula:
• Ma Huang is used as chief. It is very warm and very pungent, enters the Lung meridian and can quickly and efficiently disperse the Lung-Qi. It also enters the Bladder meridian and can eliminate the exterior pathogenic wind and cold, thus relieving cough and wheezing.
• The sweet and astringent Bai Guo is also used as chief. It can eliminate phlegm as well as stabilize the Lung-Qi, and therefore arrests wheezing. When Ma Huang and Bai Guo are used together, one disperses the Lung-Qi and the other stabilizes the Lung-Qi. This combination can regulate the function of the Lung effectively.
• The deputies are Zi Su Zi, Xing Ren, Ban Xia and Kuan Dong Hua. They all direct the Qi downward and eliminate phlegm, as well as stopping cough.
• Gan Cao is also used as envoy to harmonize the herbs in the formula.
Commentary on strategies
In this formula, the dispersing herbs and the stabilizing herbs are used together; the upward-moving herbs and the downward-moving herbs are used together; the warm herbs and the cold herbs are used together. This formula treats pathological changes in an acute excess condition of the Lung in patients with pre-existing phlegm-heat
