Chapter Sixteen. Syndromes caused by external wind, damp, cold or heat and formula composition
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that expel exterior wind, damp, cold and heat from the skin, subcutaneous region, meridians and collaterals. They are used to treat Bi syndrome, Wei syndrome and certain skin disorders.
Syndromes caused by external wind, damp, cold or heat
Manifestations
Main symptoms
Pain of the body and headache, which worsen in cold, humid and windy weather; tingling, heavy, swollen, stiff and numb limbs and joints; swelling of joints with a red color and a warm or burning sensation; weakness of muscles and joints, difficulty with moving and walking for a long period of time; facial paralysis or facial spasm; skin disorders that are characterized by itchy, weeping, red skin lesions that are influenced by changes in the weather.
Secondary symptoms
Weakness, stiffness and numbness of muscles and joints and deep pain in the bones, which lead to difficulty in moving and walking; recurrent skin disorders.
Tongue
Purple or bluish tongue with a white coating, or pale and flabby with a white coating.
Pulse
Wiry or tight, weak or thready.
Associated disorders in western medicine
Rheumatic arthritis, rheumatoid arthritis, cervical or lumbar spondylosis, osteoarthritis, sciatica, Raynaud’s disease, vasculitis, pulmonary heart disease, rheumatic heart disease, coronary heart disease, migraine, hemiplegia after cerebrovascular accident, paralysis, facial paralysis, facial spasm, skin diseases that are influenced by changes in the weather and are characterized by itchy, weeping, red or dry skin lesions.
Analysis of the syndrome
The exogenous pathogenic wind, dampness, cold or heat can cause different syndromes, such as Bi syndrome (painful obstruction syndrome), Wei syndrome (weakness of muscles and paralysis) and skin diseases. They are often seen in cold, humid and windy places, among people who are weak in Defensive-Qi due to poor constitution or a weakened health condition.
• As soon as pathogenic wind, cold or heat, and dampness invade the body and have passed the superficial region, they may obstruct the Qi movement and blood circulation in the meridians and collaterals, and cause pain of associated muscles and joints in the related regions.
• If wind is predominant, the symptoms show a moving feature, such as pain migrating from one place to another, tingling, spasm and twitch of muscles and itch of skin.
• In conditions where cold is predominant, pain is severe and worsens in cold weather.
• If dampness is predominant, the symptoms show a heavy and lingering feature – for example, chronic heaviness and swelling of limbs and joints, chronic itchy and weeping skin disorder.
• If damp-heat invades the body, or is transformed from stagnation of other pathogenic factors, it may obstruct the meridians and cause swelling of the joints with a red color and a warm or burning sensation, and red and weeping skin lesions.
When the pathogenic factors have remained in the body for a long period of time, deficiency of the Kidney, Liver, Qi and blood may coexist with the exogenous pathogenic factors.
• When the muscles and joints are not nourished and supported by Qi and blood, they become weak, stiff and numb, and the skin disorders become recurrent and chronic.
• If the Kidney and Liver are injured, patients will suffer from stiffness of the joints and deep pain in the bones, which lead to difficulties with moving and walking.
• A purple, bluish tongue and a wiry or tight pulse indicate the heaviness of the obstruction; a pale, flabby tongue and a weak, thready pulse indicate the deficiency. A yellow and moist tongue coating and a rapid pulse indicate the existence of wind, damp and heat.
(See Figure 16.1 on page 345.)
Treatment principle: Expel exogenous pathogenic factors, promote Qi and blood circulation, tonify the Kidney and Liver, and tonify Qi and blood
Herb selection principles and formula composition strategies
First priority
• If wind, dampness and cold invade the skin, muscles and meridians, it is important to select pungent, bitter and warm herbs that enter the Bladder, Liver and Kidney meridians, and can directly expel wind, dampness and cold.
• If wind, dampness and heat invade the skin, muscles and meridians, it is important to select pungent, bitter and neutral herbs to expel wind-dampness along with cold herbs to clear heat.
Second priority
• Select herbs that promote blood circulation, open up the meridians and collaterals, and remove the obstructions of stagnant blood, dampness and phlegm.
Third priority
• Select herbs that nourish the Yin and blood, tonify the Qi and warm the Yang in order to establish body resistance.
• For treating chronic conditions, herbs that tonify the Kidney and Liver, break up congealed blood and invigorate the collaterals are selected.
CAUTIONS
1. Pay attention to the conditions of Yin, blood and body fluids:
Because the herbs that expel wind, damp and cold are mostly warm, pungent and bitter, and have a drying nature, they should be used with caution in patients who suffer from deficiency of Yin, blood or body fluids.
2. Caution when using toxic herbs:
Although herbs that expel wind, damp and cold have very good results in alleviating pain and relieving the suffering of patients, some of these are toxic and overdose may lead to poisoning and even death. As toxicity is influenced by the growing habitat of the herbs, the processing method and the patient’s sensitivity, this may vary greatly. Another feature is that the toxic dose is very close to the therapeutic dose, thus the dosage and therapeutic duration should be controlled carefully.
Structure of the formula and selection of the herbs
Chief: Directly expel wind-cold-dampness or wind-damp-heat
Qiang Huo ( Notopterygii rhizoma) and Du Huo ( Angelicae pubescentis radix)
Qiang Huo and Du Huo are commonly used to expel wind, dampness and cold from the body and to treat Bi syndrome. They are often used together to treat pain, heaviness, stiffness, tingling sensations and numbness of the affected regions of the body.
Qiang Huo is pungent, bitter and warm. It enters the Bladder meridian primarily and the Liver and Kidney meridians secondly. Its pungent and warm nature gives Qiang Huo strong dispersing and ascending abilities. It is very effective and quick in expelling wind, dampness and cold in the superficial regions of the body such as the skin, subcutaneous region and muscles, especially in the upper half of the body. It is suitable for selection as chief in the formula for treating general pain, headache and stiffness of the back.
Du Huo is also pungent, bitter and warm, but much gentler in nature than Qiang Huo. It enters the Kidney meridian and is especially effective in eliminating wind, dampness and cold from the deeper regions of the body, particularly the lower half. Because of its nature, Du Huo eliminates pathogenic factors from the body in a more constant and gentle way. It is more suitable for chronic cases of arthritis and other disorders of the muscles and joints when patients complain that the pain is deep in the bones and joints. Because it enters the Kidney meridian and treats Bi syndrome, Du Huo is more effective for treating disorders of the knees, back and heels.
Comparing their function, Qiang Huo is warmer and has better results in eliminating cold and relieving pain; Du Huo is more effective in eliminating damp and has better results in treating heaviness and numbness of the body and joints. Qiang Huo and Du Huo are often used together to expel the wind, dampness and cold in the entire body and in acute, sub-acute and chronic conditions.
Fu Zi ( Aconiti radix lateralis preparata)*, Chuan Wu ( Aconiti carmichaeli radix)*, Cao Wu ( Aconiti kusnezoffii radix)*, Xi Xin ( Asari herba)*, Wei Ling Xian ( Clematidis radix) and Gui Zhi ( Cinnamomi cassiae ramulus)
These six herbs are effective for treating Bi syndrome as a result of cold. They are very hot and pungent, and have strong ascending and dispersing abilities. They can strongly disperse wind, cold and dampness, intensively warm the meridians, accelerate the movement of Qi and blood, and thus effectively relieve pain.
Fu Zi enters the Heart, Spleen and Kidney meridians. It is swift and violent in its action of spreading warmth, scattering cold, drying dampness and warming the meridians. Because of its strength, it is considered a herb that enters the 12 regular meridians. It is used as chief to treat Bi syndrome, especially when cold is predominant with symptoms of severe cramping pain.
Chuan Wu and Cao Wu have functions similar to those of Fu Zi but they are stronger in expelling cold and warming the interior. They are also stronger in opening the meridians and stopping pain. They are suitable to treat Bi syndrome when wind and cold are predominant.
Xi Xin is very pungent and warm, and enters the Lung, Heart and Kidney meridians. Its pungent and aromatic smell gives it a penetrating ability, allowing it to enter the deeper regions of the body. No matter how deep the wind and cold invade, and how tight the tissues may be, Xi Xin is very effective in eliminating them and opening the meridians and collaterals, thereby alleviating pain. It is often selected as chief when the pain is severe and deep in the bones, accompanied by a purple or bluish tongue with a white coating, and a deep, slow and wiry pulse. They indicate that cold is predominant and has entered the Kidney meridian.
Wei Ling Xian is pungent, salty and warm, and enters the Bladder meridian. It has dispersing, moving and opening abilities. It moves very quickly and has quite a strong action of expelling wind and transforming dampness. Wei Ling Xian is very effective in opening up the meridians and collaterals, and it can treat numbness and tingling sensations of the limbs.
Gui Zhi is pungent, sweet and warm, and enters the Heart, Lung and Bladder meridians. Unlike Fu Zi, which spreads the warmth quickly, and unlike Xi Xin, which expels cold from deep regions, it expels wind and alleviates pain by warming the meridians, activating and tonifying the Heart-Yang, promoting the blood circulation and relaxing the tendons. It has a sweet taste, which makes this herb move more slowly than the others, but since it can tonify the Heart and its action lasts longer, the condition of the patients can be improved steadily.
Except for Gui Zhi, these herbs are poisonous, especially Cao Wu. They must be used after processing, and even then the dosage must be controlled carefully. Large dosage or long-term use may consume the Yin and further injure the Yang, especially when the Yang of the internal organs is weak. Again except for Gui Zhi, these herbs are pungent and hot, move quickly and recklessly, and can consume the Qi and Yin. They can improve the condition of patients quickly but briefly. For these reasons, it is recommended that some sweet and warm herbs can be added to the formula to tonify the Qi and Yin in order to reduce the side effects of these harsh herbs.
Huang Bai ( Phellodendri cortex) and Yi Yi Ren ( Coicis semen)
These two herbs are usually used for Bi syndrome caused by wind, dampness and heat. They are also selected for treating some skin disorders caused by damp-heat.
Huang Bai is bitter and cold, and enters the Kidney and Bladder meridians. It can dry dampness and reduce heat in the Lower-Jiao. It is suitable for use when the joints in the lower part of the body are red, warm and swollen and the skin lesions are red, itchy and weeping.
Yi Yi Ren is sweet, bland and slightly cold, and enters the Spleen, Stomach and Lung meridians. This herb can eliminate dampness, promote urination and clear heat. It is suitable for use when the joints are swollen with a burning sensation and the skin lesions are red, itchy and weeping.
Sang Zhi ( Mori ramulus), Luo Shi Teng ( Trachelospermi caulis) and Xi Xian Cao ( Sigesbeckiae herba)
These herbs are usually used to treat Bi syndrome caused by wind, dampness and heat.
Sang Zhi is bitter and neutral, and enters the Liver meridian. It is the twig of the plant, and can open the meridians and expel wind and dampness. It is particularly selected when edema and cramp of the limbs are present.
Xi Xian Cao is pungent, bitter and cold, and enters the Liver and Kidney meridians. It enters the deep regions of the body, the tendons and the bones. It searches out and expels wind, dampness and heat. It is selected when a Bi syndrome is at the active stage and the joints are swollen and painful with a burning sensation. Moreover, it can eliminate wind-dampness and treat heaviness and numbness of the limbs. Because it enters the Liver and Kidney meridians, Xi Xian Cao is especially effective in treating weakness and stiffness of the knees and back, pain of the bones, numbness and a tingling sensation of the limbs.
Deputy: Invigorate blood, open up the meridians and collaterals
Dang Gui ( Angelicae sinensis radix), Chuan Xiong ( Chuanxiong rhizoma) and Hong Hua ( Carthami flos)
These herbs are warm and pungent, and enter the Heart and Liver meridians. They can invigorate the blood and promote blood circulation. They are used for treating chronic Bi syndrome that is characterized by stubborn pain, numbness, and cold, weak and stiff limbs. They can also be selected to treat chronic skin disorders when the skin lesions are purple, dark in color, itchy, dry and thick.
Dang Gui is sweet, warm and pungent, can tonify the blood and promote blood circulation. Because of its tonifying function, it is particularly selected for long-term use. Chuan Xiong is pungent and warm. It moves quickly and is considered as a herb that moves the Qi in the blood. Because of its speed, it can effectively stop pain in a Bi syndrome and soften hard, thick skin lesions in skin diseases. Hong Hua is also pungent and warm. It can effectively dissolve congealed blood and promote blood circulation, and therefore can also relieve pain. It is often selected in a formula that is used for this condition.
Di Long ( Pheretima), Dang Gui Wei ( Angelicae sinensis radix extremitas) and Lu Lu Tong ( Liquidambaris fructus)
These substances are selected particularly to open up collaterals. Di Long is salty and cold, has drilling and moving abilities, and can enter the Liver, Kidney and Lung meridians. It is able to open the meridians and collaterals and treat pain, numbness, tingling and cramp of the limbs.
Dang Gui Wei is considered as having a strong function of invigorating the blood; its fine fibrils can particularly open the collaterals. It can be used to treat chronic Bi syndrome and skin disorders when the blood is deficient.
Lu Lu Tong is pungent, bitter and neutral, and enters all the meridians. Lu in Chinese means road; Tong means open. The name indicates that this herb is able to open the meridians and collaterals, expel wind-dampness and treat stiffness and numbness of the limbs in Bi syndrome.
Hai Feng Teng ( Piperis caulis) and Qing Feng Teng ( Sinomenii caulis)
These two herbs are commonly used for expelling wind-dampness and unblocking the meridians. When stiffness and pain of the joints and muscles are present, they can both be applied. They are vines, which are considered as entering the collaterals.
Hai Feng Teng is pungent, bitter and slightly warm, and enters the Liver and the Kidney meridians. It is usually used for Bi syndromes characterized by cramping pain and stiffness. Qing Feng Teng is bitter and neutral, and enters the Liver meridian. It treats Bi syndrome caused by wind-dampness. It can also promote urination, and is especially suitable for use when joints and limbs are swollen with edema and there is scanty urine.
Bai Hua She ( Agkistrodon acutus)* and Wu Shao She ( Zaocys)
Bai Hua She and Wu Shao She are two types of snake. They have the function of expelling exogenous wind from different areas of the body no matter how long the wind has been present and how deep it has penetrated. Both substances enter the Liver meridian. It is believed that they can reach any part of the body in spite of the depth owing to their drilling and moving abilities.
Bai Hua She is sweet, salty, warm and poisonous; its function of expelling wind is very strong and quick. Wu Shao She is sweet and neutral; its function is gentler and slower. They are important substances for treating chronic Bi syndrome due to wind invading the meridians. They are also used to treat dry, thick and itchy skin lesions.
Assistant: Expel wind, cold, dampness and relax tendons, tonify the Qi and blood, strengthen tendons and bones
Fang Feng ( Saposhnikoviae radix), Gao Ben ( Ligustici sinensis radix), Ma Huang ( Ephedrae herba)* and Xing Ren ( Armeniacae semen)
They are usually used during the onset of Bi syndrome when the exogenous pathogenic factors are in the superficial region of the body, especially the upper part of the body. The symptoms are sudden onset of pain, swelling of joints, fever, chills and general pain. These herbs can disperse the Lung-Qi and regulate the Qi of the Bladder meridian. For these reasons they can expel exogenous pathogenic wind, dampness and cold.
Shen Jin Cao ( Lycopodii herba), Tou Gu Cao ( Tuberculate speranskia herba) and Hai Tong Pi ( Erythrinae cortex)
These herbs are selected particularly for treating disorders related to tendons, bones and muscles. Shen Jin Cao is a pungent, bitter and warm herb, but it is not dry in nature. It enters the Liver meridian and is especially effective in treating disorders of the tendons. It is able to expel wind, open the meridians, promote blood circulation and relax the tendons. It is mostly used for chronic Bi syndrome, which manifests as stiff limbs, difficulty with moving and walking, soreness of the tendons and bones, and numbness of the skin.
Tou Gu Cao is able to reach the bones, expel wind and eliminate dampness from the bones. It is bitter and warm, and enters the Liver and Kidney meridians. When wind, dampness and cold stay in the body for a very long period of time, and the tendons become very stiff and the joints and the bones are very painful, Tou Gu Cao can be applied.
Hai Tong Pi is bitter, pungent and neutral, and enters the Liver and Kidney meridians. It has functions of expelling wind-dampness and treating numbness of the limbs. It is characterized by opening up the meridians and collaterals, and directly reaching the affected region. It is used particularly for stiffness and numbness of the back and knees. As it is a neutral herb, it can be used for Bi syndrome with either cold or heat in the pathological changes.
Di Long ( Pheretima) and Jiang Can ( Bombyx batrycatus)
In traditional Chinese medicine, worms are considered as being able to get into the small collaterals because they have the habit of drilling holes or passing through cracks. They are often used to open the meridians, extinguish wind, relieve spasms and control tremor. In particular, they are often used together with herbs that remove phlegm which obstructs the collaterals. They can relieve spasms and twitch such as in facial paralysis or facial spasm.
Di Long is salty and cold, and has the function of extinguishing wind and clearing Liver-heat. Di Long particularly enters the collaterals and is able to open up the obstruction, so 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 phlegm obstruction from the collaterals, it can relieve spasms, numbness and paralysis.
Mu Gua ( Chaenomelis fructus) and Bai Shao Yao ( Paeoniae radix lactiflora)
Mu Gua and Bai Shao Yao are sour in nature and enter the Liver meridian. They can regulate the Liver and relax the tendons. They can be used together to relieve cramping pain of the muscles and tendons of the limbs. However, there are some differences in their actions.
Mu Gua relaxes the muscles by transforming dampness and invigorating the collaterals; it treats cramps and stiffness, which are caused by dampness. Bai Shao Yao is able to nourish the Yin and blood and therefore relax the muscles and tendons; it treats cramp or spasm. In the condition when cramp is caused by dampness obstruction as well as Yin deficiency, Mu Gua and Bai Shao Yao should be used together. In addition, they can be applied as corrective assistants in the formula to prevent the pungent and hot herbs consuming the Yin.
Dang Shen ( Codonopsis radix), Huang Qi ( Astragali radix), Dang Gui ( Angelicae sinensis radix) and Bai Shao Yao ( Paeoniae radix lactiflora)
Dang Shen and Huang Qi can effectively tonify the Qi and strengthen the muscles; Dang Gui and Bai Shao Yao can tonify the blood. They are often selected in the condition of Wei syndrome when the muscles are thin and weak. They are also selected in the formula to treat chronic Bi syndrome in the condition of deficiency of Qi and blood. They are also often used in elderly people or people with a weak constitution.
Xu Duan ( Dipsaci radix), Sang Ji Sheng ( Taxilli herba) and Gou Ji ( Cibotii rhizoma)**
These three herbs are bitter and warm, and enter the Liver and Kidney meridians. They have the functions of expelling wind-dampness, tonifying the Liver and Kidney and strengthening the tendons and bones. Although they can all treat chronic Bi syndrome and Wei syndrome characterized by stiff joints, sore and painful back and knees, weakness of the muscles of the legs and difficulty with walking, there are some differences in their functions:
• Xu Duan can invigorate the blood and promote the healing process of the bones and tendons; it is especially suitable to treat trauma and fracture.
• Sang Ji Sheng is a gentle herb, neutral and moist; it can nourish the blood, relax the tendons and is especially suitable for treating chronic Bi syndrome.
• Gou Ji enters not only the Liver and Kidney meridians, but also the Du meridian; it is especially effective in strengthening the bones, opening the obstruction and treating stiffness, weakness and pain of the back or the whole spinal column.
In chronic Bi and Wei syndromes, because both the Liver and Kidney are weak, and the bones, tendons and muscles are all weak, these herbs can be used together to strengthen the therapeutic effects.
Examples of classical formulas
Qiang Huo Sheng Shi Tang (Notopterygium Decoction to Overcome Dampness) 
Source: Nei Wai Shang Bian Huo Lun 
Composition
Qiang Huo ( Notopterygii rhizoma) 6 g
Du Huo ( Angelicae pubescentis radix) 6 g
Fang Feng ( Saposhnikoviae radix) 3 g
Gao Ben ( Ligustici sinensis radix) 3 g
Chuan Xiong ( Chuanxiong rhizoma) 3 g
Man Jing Zi ( Viticis fructus) 2 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 3 g
Analysis of the formula
This formula expels wind and eliminates dampness from the superficial and subcutaneous regions of the body. It treats wind-dampness in the superficial level of the body together with blockage of Qi movement and blood circulation – an acute and excess condition. This syndrome is manifested as stiffness and pain of the neck, back and shoulders, headache, heaviness of the body, aversion to cold with mild fever, a white, slightly sticky tongue coating and a superficial pulse.
In this formula:
• The pungent, bitter and warm Qiang Huo and Du Huo are chief; they can expel wind, cold and dampness from the upper and lower parts of the body respectively.
• The deputies are Fang Feng and Gao Ben. Because Fang Feng enters the Spleen meridians, it especially expels wind-dampness from the superficial and subcutaneous regions. Gao Ben enters the Bladder meridian, expels wind and cold, and can effectively relieve headache as its aromatic smell can quickly reach the top of the head.
• Man Jing Zi, as helping assistant, can expel wind-dampness, regulate the Qi in the head and relieve headache. Chuan Xiong also serves as assistant and is used to activate the Qi and blood, expel wind and relieve headache.
• Zhi Gan Cao is used as envoy in the formula to harmonize the herbs in the formula.
Commentary on strategies
In this formula, several features are shown:
• The pungent, warm and aromatic herbs are used to expel wind, dampness and cold; their dosages are quite small. This suggests that a gentle dispersing action in the superficial region should be induced at this moment because the heavy and lingering dampness cannot be expelled by a quick action.
• In this formula, a group of herbs that treats headache are mentioned. Depending on the meridian entered, they treat headache in different regions of the head – Qiang Huo enters the Bladder meridian and treats headache specifically on the back of the head; Gao Ben also enters the Bladder meridian but treats pain on the top of the head; Chuan Xiong enters the Liver and Gall Bladder meridians and treats headache specifically on the lateral sides of the head.
Da Qin Jiao Tang (Major Gentiana Qinjiao Decoction) 
Source: Su Wen Bing Ji Qi Yi Bao Ming Ji 
Composition
Qin Jiao ( Gentianae macrophyllae radix) 90 g
Qiang Huo ( Notopterygii rhizoma) 30 g
Du Huo ( Angelicae pubescentis radix) 60 g
Fang Feng ( Saposhnikoviae radix) 30 g
Bai Zhi ( Angelicae dahuricae radix) 30 g
Xi Xin ( Asari herba)* 15 g
Dang Gui ( Angelicae sinensis radix) 60 g
Bai Shao Yao ( Paeoniae radix lactiflora) 60 g
Shu Di Huang ( Rehmanniae radix praeparata) 30 g
Chuan Xiong ( Chuanxiong rhizoma) 60 g
Bai Zhu ( Atractylodis macrocephalae rhizoma) 30 g
Fu Ling ( Poria) 30 g
Huang Qin ( Scutellariae radix) 30 g
Shi Gao ( Gypsum) 60 g
Sheng Di Huang ( Rehmanniae radix) 30 g
Sheng Jiang ( Zingiberis rhizoma recens) 7–8 pieces
Zhi Gan Cao ( Glycyrrhizae radix preparata) 60 g
Analysis of the formula
This formula can expel wind and dampness, clear heat and nourish and invigorate blood. It is used for treating the initial stage of a syndrome where wind and dampness invade the meridians and collaterals in a condition of Qi and blood deficiency. The pathogenic wind and dampness obstruct the Qi and blood and generate heat, and all the pathological factors block the meridians and collaterals. The manifestations are deviation of the mouth and eyes, stiffness of the tongue, and difficulty with moving the arms and legs.
In this formula:
• Qin Jiao, as chief, is used with a large dosage. It can expel wind and dampness, and open the meridians and collaterals.
• Qiang Huo, Du Huo, Fang Feng, Xi Xin, Sheng Jiang and Bai Zhi serve as deputies. They are pungent, aromatic and warm, and can expel wind, damp and cold, thus freeing the movement of the Qi and circulation of the blood.
• Dang Gui, Bai Shao Yao and Shu Di Huang, as assistants, tonify the weakness of blood. Chuan Xiong with Dang Gui can promote blood circulation.
• Bai Zhu, Fu Ling and Zhi Gan Cao are also used as assistants. They can tonify the weakness of the Qi.
• Huang Qin, Shi Gao and Sheng Di Huang serve as both helping assistants and corrective assistants. They can clear heat in the body, as well as reduce the side effects of the pungent and warm herbs.
• Zhi Gan Cao is used as envoy to harmonize the herbs in the formula.
Commentary on strategies
Although it is a large formula, it has a clear and balanced structure. The features of this formula are as follows:
• A large number of herbs are used to expel wind and dampness quickly and sufficiently to treat an acute condition.
• Some cold herbs are used to clear heat, which is at its initial stage, to stop the pathological change and prevent a more complicated condition.
• The use of tonifying herbs insures the formula works sufficiently without the side effect of injuring Qi and Yin.
Du Huo Ji Sheng Tang (Angelica Pubescens and Taxilli Decoction) 
Source: Bei Ji Qian Jin Yao Fang 
Composition
Du Huo ( Angelicae pubescentis radix) 9 g
Qin Jiao ( Gentianae macrophyllae radix) 6 g
Fang Feng ( Saposhnikoviae radix) 6 g
Xi Xin ( Asari herba)* 6 g
Sang Ji Sheng ( Taxilli herba) 6 g
Du Zhong ( Eucomniae cortex) 6 g
Huai Niu Xi ( Achyranthis bidentatae radix) 6 g
Bai Shao Yao ( Paeoniae radix lactiflora) 6 g
Chuan Xiong ( Chuanxiong rhizoma) 6 g
Shu Di Huang ( Rehmanniae radix praeparata) 6 g
Ren Shen ( Ginseng radix) 6 g
Fu Ling ( Poria) 6 g
Rou Gui ( Cinnamomi cassiae cortex) 6 g
Gan Cao ( Glycyrrhizae radix) 6 g
Analysis of the formula
This formula has the function of expelling wind, dampness and cold, stopping pain, tonifying the Qi and blood, and strengthening the Liver and Kidney. It is used to treat chronic Bi syndrome due to wind and damp with a chronic condition of blood and Qi deficiency.
In this formula:
• Du Huo is used as chief. It is able to expel wind, dampness and cold, and can tonify the Liver and Kidney.
• Xi Xin, Qin Jiao and Fang Feng are used as deputies. They enhance the ability of Du Huo to expel cold, dampness and wind respectively, thus relieving pain and heaviness of the limbs.
• Dang Gui, Bai Shao Yao, Shu Di Huang and Chuan Xiong are used as assistants. They tonify the blood and promote the circulation of the blood.
• Ren Shen and Fu Ling are used to tonify the Qi; Rou Gui warms the Kidney; Sang Ji Sheng, Du Zhong and Huai Niu Xi can strengthen the Kidney and relax the tendons. They are all used as assistants.
• Gan Cao is used as envoy to harmonize the functions of different herbs in the formula.
Commentary on strategies
This formula contains many herbs, yet it is clear in structure and strong in function. Since it can tonify the weakness, it is suitable to be used for chronic Bi syndrome and for a reasonably long period of time.
Qian Zheng San (Lead to Symmetry Powder) 
Source: Yang Shi Jia Cang Fang 
Composition
Bai Fu Zi ( Typhonii rhizoma praeparatum)*
Jiang Can ( Bombyx batrycatus)
Quan Xie ( Scorpio)*
The three substances are applied in equal dosage and the powder is mixed with warm alcohol.
Analysis of the formula
This formula can expel wind and phlegm, and thus relieve spasm. It is used when wind attacks the face where phlegm has accumulated. The wind stirs the phlegm, blocking the collaterals and causing spasm of muscles or facial paralysis.
In this formula:
• The pungent and hot Bai Fu Zi is used as chief to disperse the wind and eliminate phlegm in the collaterals and subcutaneous region, particularly on the face.
• Jiang Can and Quan Xie are used as deputies. They particularly expel wind, invigorate the collaterals and relieve spasm.
• Alcohol will stimulate these substances to spread in the affected regions and also enhances the action of this formula. It is considered as assistant and envoy in the formula.
Commentary on strategies
This is a very small formula but it is very strong in function and quick in action.
• It focuses on treating wind and phlegm, especially on the face.
• In clinical practice, it is used not only to treat facial paralysis and spasm, but also epilepsy due to wind and phlegm.
• As Bai Fu Zi and Quan Xie are very poisonous, the dosage and treatment course should be controlled carefully.
Xiao Feng San (Eliminate Wind Powder) 
Source: Wai Ke Zhong Zong 
Composition
Dang Gui ( Angelicae sinensis radix) 3 g
Sheng Di Huang ( Rehmanniae radix) 3 g
Fang Feng ( Saposhnikoviae radix) 3 g
Chan Tui ( Cicadae periostracum) 3 g
Zhi Mu ( Anemarrhenae rhizoma) 3 g
Ku Shen ( Sophorae flavescentis radix) 3 g
Hei Zhi Ma ( Sesami semen nigricum) 3 g
Jing Jie ( Schizonepetae herba) 3 g
Cang Zhu ( Atractylodis rhizoma) 3 g
Niu Bang Zi ( Arctii fructus) 3 g
Shi Gao ( Gypsum) 3 g
Gan Cao ( Glycyrrhizae radix) 1.5 g
Mu Tong ( Mutong caulis)* 1.5 g
Analysis of the formula
This formula is able to expel wind, nourish the blood, clear heat and eliminate dampness. It is used for treating skin lesions that are caused by invasion and accumulation of wind, dampness and heat in the skin, subcutaneous region, muscles and blood, which are manifested as itchy and red skin rashes that weep after being scratched, a white or yellow tongue coating and a superficial and rapid pulse.
In this formula:
• The pungent and dispersing Jing Jie, Fang Feng, Niu Bang Zi and Chan Tui are used as chief. They can directly expel wind and relieve itch.
• Cang Zhu, Ku Shen and Mu Tong are used as deputies. They can eliminate damp-heat from the body and treat itchy and weeping skin disorders. Among them, the bitter and warm Cang Zhu has a strong drying nature, particularly enters the Spleen meridians and can effectively eliminate dampness from the muscles; the bitter and cold Ku Shen enters the blood and can cool and regulate the blood so as to treat red skin lesions; Mu Tong, which is very bitter and cold, can clear heat and increase urination in order to eliminate damp-heat from the body.
• Shi Gao and Zhi Mu also serve as deputies. They can strongly clear heat, especially from the muscles, and are used when red rashes appear.
• Wind-heat easily injures the Yin and blood, and dryness of blood can make the itch worse. Dang Gui, Sheng Di Huang and Hei Zhi Ma are used as assistants to tonify the blood, nourish the Yin, cool the blood and moisten dryness so as to treat this condition. In addition, since the chief and deputies are drying in nature and can weaken the Yin and blood, these three herbs can reduce the side effects.
• Gan Cao is used as assistant and envoy to clear heat, remove toxins and harmonize the herbs in the formula.
Commentary on strategies
• This formula contains the main treatment aspects for skin disorders, e.g. expel wind, eliminate dampness, clear heat, cool the blood and nourish Yin. As such, it is considered a principal formula to treat general conditions of common skin disorders.
• Since it treats many aspects, it is not very strong in action. It is often used for chronic conditions after varying the formula to generate clearer and stronger actions in one or two specific aspects to treat a specific syndrome.
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| Figure 16.1 •. |
| Pathology of Bi syndromes. |
