Chapter 2: Clearing, Precipitating Formulas

{ {
Predominantly Made Up of Clearing, Precipitating Herbs
That Function to: Free Stool
Clear Heat
Formulas Are Referred to as: Clearing, Precipitating Formulas
Expel Water
(Correspond to "Precipitation Method" Within the 8 Methods)
Attack Accumulations
That Regulate Treatment of Interior Repletion Patterns

《Jing Yue Quan Shu·Chuan Zhong Lu》: "Interior Patterns: Illness Located Internally, Illness Located in Zang"
《Yi Xue Xin Wu》: "If an Illness Lacks Sweat, Abdominal Distention Does Not Decrease, Pain Refuses Pressure, Onset is Acute,
Granary is Thick, Pulses are Replete, Strong: This is Repletion"

Internal Replete Patterns: External Pathogen Entering Interior, Transforming Heat, Binding in the Stomach, Intestines
(Vigorous Heat, Vexation Thirst, Abdominal Pain, Constipation ...) Fu Organ Repletion Symptoms
Internal Qi, Blood Depression, Binding, Phlegm Collecting, Food Accumulation, Worm Accumulation ... Patterns

Internal Repletion Pattern Formation Involves: Flourishing Zheng Qi Contracting a Flourishing External Pathogen
Replete Pathogen and Flourishing Zheng Qi Fight

Differences in Interior Locations Divide Patterns into Zang and Fu Replete Patterns

Differences in Pathogenic Cause Result in Differences in { Heat, Cold

Qi Stagnation
Blood Stasis
Water, Rheum
Phlegm Accumulation
Food Accumulation
Worms
…

There are a Broad Range of Interior Repletion Patterns: Stomach, Intestinal Replete Accumulation
Fu Organ Qi Impairment
Interior Heat Repletion Patterns
Stasis Blood
Water, Rheum Internally Collecting
Binding Stones
Worm Accumulation …

Replete Pathogenic Depression, Binding in the Interior

Impaired Fu Organ Qi
{ Resulting in { Fecal
Abdominal Distention, Pain
Binding (Constipation)
This Chapter Focuses on:
Water, Rheum Collecting, Gathering in the Interior Resulting in: Chest, Abdominal Edema
There are Many Causes of Internal Repletion Patterns Resulting in Constipation, Abdominal Pain, and Edema:
Interior Heat Accumulating, Stagnating, Internally Binding Yang Ming
Damp Heat Depressing, Steaming
Qi, Blood Congealing, Collecting in Intestinal Fu Organs
Heat Binding, Not Dissipating
Cold Repletion Internally Binding
Yang Vacuity Cold Collecting, Obstructing Within the Intestines
Intestinal, Stomach Dry Heat, Spleen Liquid Insufficiency
Water, Rheum Congesting, Flourishing, Obstructing Qi Dynamic …
∴ Clinical Manifestations are Divided into: Heat Binding
Cold Binding
Dryness Binding
Water Binding
Differences Also Exist in Constitutional Strength

∴ Methods and Formulas Follow These Differences:

Heat Binding in the Interior Suits: Cold Precipitation

Cold Accumulating, Internal Binding Suits: Warm Precipitation
Intestinal Dryness Constipation Suits: Moist Precipitation
Water, Rheum Internally Collecting Suits: Expelling Water
Internal Repletion + Zheng Weakness Suits: Attacking, Supplementing Together
 Precipitating Downwards Formulas

Main Treatment: Interior Replete Constipation Pattern

Difficulty Defecating, Constipation, Decreased Frequency of Defecation (once every 3-5 (or more) days),
Desire for Defecation (but Difficult, Painful), Dry, Hard Stool

Eight Methods: Precipitating Method

Causes: Heat Binding
Cold Binding
Dryness Binding
Divisions: Cold Precipitation (Heat Binding Constipation)
Hot Precipitation (Cold Binding Constipation)
Moisten Precipitation (Dry Binding Constipation)

Expel Water (Water Binding)

Precipitation + Supporting Right (Replete + Vacuous Constipation)

Cautions:
1. If There is Unresolved Exterior Pathogen, and Internal Replete Pattern has Yet to Form, Do NOT Use This Method
If There is Unresolved Exterior Pathogen, and Internal Replete Pattern has Already Formed, Combine with Resolving
Exterior Formulas (First Resolve Exterior, Then Precipitate Interior, or Treat Together)
2. Moisten Precipitation is the Only Non-Drastic / Harsh Group: Use This Method for the Weak, Young, Old, Vacuous…
3. Use With Caution for Pregnant or Postpartum Women, During Menstrual Period, on the Old / Weak, Chronic Illness
with Liquid Damage, Blood Desertion… Use Moisten Precipitation for Patients with a History of Downward Bleeding
4. Precipitating Formulas Easily Damage Stomach Qi: Stop as Soon as Effective, Do Not Overuse
5. Pay Attention to Diet: Do Not Quickly Re-Introduce Oily or Thick Foods, or Foods that are Difficult to Digest (to
Prevent Damage to Stomach Qi)

Section 1: Cold Precipitation Formulas

Da Cheng Qi Tang
Xiao Cheng Qi Tang
Tiao Wei Cheng Qi Tang
Da Huang Mu Dan Tang
Da Xian Xiong Tang

Cold Precipitation Formulas Suit: Interior Heat Accumulation, Stagnation: Repletion Patterns
Repletion Patterns With Hot Natures

Dry Stool
Water, Rheum
Abnormal Gastrointestinal Conveyance, Transformation
Their Pathomechanism Involves Interior Heat Binding With Qi Stagnation :
Qi Dynamic Obstruction, Stagnation
Stasis Blood
Lodged Food

Clinical Manifestations Often Include: Bound Stool

Abdominal Distention / Fullness / Pain
Possible Tidal Heat
Thick Yellow Tongue Coating
Deep, Replete Pulse …

Cold Precipitation Formulas Predominantly Use Clearing, Precipitating Herbs, Commonly: Da Huang
Mang Xiao …
Cold Can Overcome Heat Draining Heat
Since Cold Precipitation Formulas Are Also Effective at:
Precipitation Can Disperse Accumulation Attacking Accumulation

Ke Qin: “Interior Patterns Caused By Depressed Heat: If Precipitating Herbs Don’t Make Use of Bitter, Cold: Stasis Heat Does Not Eliminate
Pathogens Lack An Exit Route
∴ Attacking Formulas Must Use Da Huang: Attacking Interior Does Not Stray From Cold”
《Shang Han Lai Su Ji·Shang Han Fu Yi》
These (Bitter, Cold, Attacking Interior) Herbs are Paired With:
1. Moving Qi Herbs (Zhi Shi, Hou Po, Mu Xiang, Bing Lang …)
Dry Stool … Interior Repletion Internally Binding Often Influences Qi Dynamic Upbearing, Downbearing, Freeing
Qi Dynamic Obstruction, Stagnation Can Also Increase the Severity of Dry Stool Patterns
Ke Qin: “Multiple Illnesses are Caused by Qi: Dirty Matter Unable to Exit Results From Qi Incompliance
Thus Attacking Accumulation Formulas Must Predominantly Use Moving Qi Herbs” 《Shang Han Lai Su Ji》
e.g. Da Cheng Qi Tang, Xiao Cheng Qi Tang Using Zhi Shi, Hou Po …

2. Clearing Heat Herbs (Bai Jiang Cao, Huang Qin, Zhi Zi, Yin Hua, Lian Qiao …)
Bitter, Cold, Clearing, Precipitating Herbs Normally Have Relatively Efficacious Clearing Heat Efficacy
(Raking the Firewood From Beneath the Cauldron)
Patterns Where Interior Heat is Relatively Spread Out, However, Require Pairing With Clearing Heat Herbs to Increase Efficacy
e.g. Yi Yi Fu Zi Bai Jiang San: Bai Jiang Cao Lan Wei Qing Hua Tang, Lan Wei Qing Jie Tang: Jin Yin Hua, Pu Gong Ying …

 3. Expelling Water Herbs (Gan Sui, Da Ji, Yuan Hua, Qian Niu Zi …)
Pathogenic Heat and Water, Rheum Mutually Binding in the Chest (Replete Heat Patterns) Require Pairing With Attacking,
Expelling Water Medicinals to Enable Water, Heat Pathogens to Discharge Downwards, Faster, Smoother Recovery
You Yi: “Pathogenic Qi Internally Binding With Heat And Repletion: Pulse Deep and Tight, Appearing Like Da Cheng Qi Pattern,
Binding in the Epigastrum and Not in the Abdomen: No Stool, Painful: This is Added Replete Water Mutually Binding
This is Different From Yang Ming Dry Stool: Thus Suits Gan Sui’s Breaking Rheum
Not Zhi (Shi), (Hou) Po’s Dissipating Qi” 《Shang Han Guan Zhu Ji》
e.g. Da Xian Xiong Tang: Gan Sui …

4. Quicken Blood, Transform Stasis Herbs (Mu Dan Pi, Chi Shao, Tao Ren …)
Gastrointestinal Replete Heat Accumulation, Stagnation Easily Influences Qi, Blood Flow, Resulting in Stasis Blood Obstructing
Clearing, Precipitating Accumulation, Heat Should be Paired With Dispelling, Eliminating Stasis Blood
(Cooling Blood Quickening Blood Herbs are Best)
e.g. Da Huang Mu Dan Tang: Mu Dan Pi, Tao Ren …

5. Warm Yang, Dissipate Cold Herbs (Fu Zi, Gan Jiang …)

Long Term, Non-Dispersing Interior Repletion Patterns Damage Yang Qi: Yang Vacuity Engenders Cold Patterns
∴ Warming Yang, Dissipating Cold Herbs Must Be Paired In
e.g. Yi Yi Fu Zi Bai Jiang San: Fu Zi …

6. Harmonize Middle, Nourish Stomach Herbs (Gan Cao, Da Zao, Bai Mi …)

Interior Repletion Patterns Requiring Clearing, Precipitating Formulas Predominantly Centre on Middle Jiao: Spleen, Stomach
Clearing, Precipitating Formulas (Especially Cold Precipitation Formulas) Easily Damage Stomach Qi
∴ Cold Precipitation Formulas Sometimes Pair With Harmonize Middle, Nourish Stomach Medicinals to Prevent Middle Damage
Ke Qin (Discussing Tiao Wei Cheng Qi Tang Pairing With Gan Cao): “Using Gan Cao to Engender Stomach Family Liquid
Delivering New Within Pushing Out of the Old”
《Shang Han Lai Su Ji·Shang Han Fu Yi》
e.g. Tiao Wei Cheng Qi Tang: Gan Cao …

Representative Cold Precipitation Formulas Include: Da Cheng Qi Tang

Da Xian Xiong Tang
Da Huang Mu Dan Tang
Yi Yi Fu Zi Bai Jiang San …

 ⼤大承⽓气汤
*** Da Cheng Qi Tang ***
《Shang Han Lun》

Da Huang 4 Liang (12g), Washed in Alcohol, Hou Po 8 Liang (24g), Remove Skin, Mix-Fried, Zhi Shi 5 Mei (12g), Mix-Fried, Mang Xiao 3 He (6g)
Drastic(ly) Precipitate Heat Binding 1: Yang Ming Fu (Organ) Replete Pattern
Symptoms: Tidal Heat Delirious Speech, Frequent Turning of Gas,
Constipation, Hand, Foot Streaming Sweat, Abdominal
Fullness (Hard), Tongue Coat: Burnt Yellow with Prickles,
or Burnt, Dark, Cracked, and Dry, Pulse: Deep Slippery,
or Deep Slow
2: Heat Binding Bypass Pattern
Symptoms: Downward Uninhibited Clear Water, Navel, Abdominal
Pain, Hard (Lumps) to the Touch, Dry Mouth & Tongue,
Pulse: Rapid Slippery or Slippery Replete (Strong)
3: Heat Reversal, Tetanus, Mania, (Interior Replete Heat Patterns)
Constipation —
Hard Abdominal —
Swelling Dry, Replete
Internal Binding (in)
Pain (Refuses — Intestines,
Pressure Stomach
Deep, Replete — Da Huang 12 : Discharge Heat Free Stool
Pulse Forcefully Flush Stomach,
Drastically Precipitate Intestines
Hand, Foot — Heat Distressing Liquid’s Yang Ming Fu Repletion Heat Binding
Sweating External Discharge Mang Xiao 6 : Salt, Cold, Soften Hardness
Moisten Dryness Free Stool
— Stomach, Intestine Heat
Tidal Heat Qi, Blood Steaming
Delirious Speech— Fire, Heat Rising
Manic Agitation to Disturb
Yellow, Dry — Heat Accumulating
Tongue Fur Liquid Damaged
Stomach Duct,
Abdomen — Inhibited Fu (Organ) Qi Zhi Shi 12 : Dissipate Binding
Glomus, Fullness Dissipate Binding Disperse Glomus
Qi Stagnation Disperse Glomus
Frequent Turning — Hou Po 24 : Move Qi Eliminate Fullness
of Fecal Gas
This is the Main Formula Used to Treat Yang Ming Fu Replete Pattern

The Cause Follows Either the:

Shang Han System: Shang Han Pathogen Internally Transmits to the Yang Ming Organ System, Entering Interiorly and Transforming Heat, or
Febrile Diseases System: Wen Bing Pathogen Enters the Stomach and Intestines, Heat Flourishes, Scorching Liquid, Drying Stool.
Either Way, Pathogenic Heat and Intestinal Dry Stool Mutually Bind to Form Repletion.
Replete Heat Internally Binds, Stomach and Intestinal Qi Stagnate, Fu Organ Qi is Impaired Leading to: Constipation, Frequent Passing of
Flatus (Gas), Stomach Duct and Abdominal Glomus, Fullness, Distention, and Pain.
Dry Stool Binds, Collects in Intestines, Thus: Abdominal Pain Refuses Pressure, is Hard to the Touch.
Interior Heat Flourishing, Upwardly Disturbing Shen Brightness, Thus Delirious Speech.
Four Limbs All Receive Qi From Yang Ming, Yang Ming Meridian Flourishes in Shen (3-5 pm), You (5-7pm) Time Periods: Heat Binds in Interior,
Depressing, Steaming Outwards, Thus Tidal Heat, Hand, Foot Sweating Outwards.
Tongue Coating: Dry Yellow or Burnt Black, Dry, Cracked, Pulse: Deep, Replete; Symptoms of Heat Flourishing Liquid Damaged, Dry
Repletion Internally Binding.

Previous Doctors Summarized the Symptoms of This Formula Pattern as: “痞 Pi (Glomus), 满 Man (Fullness), 燥 Zao (Dryness), 实 Shi
(Repletion)”.
痞 Pi (Glomus): (Self) Awareness of Chest, Solar Plexus Oppression, Blockage, Unfree (Heavy Pressing Feeling).

满 Man (Fullness): Solar Plexus, Abdominal Distention, Fullness, Resistance in Response to Pressure.

燥 Zao (Dryness): Intestinal Dry Stool Binding, Not Precipitating.

实 Shi (Repletion): Replete Heat Internally Binding, Abdominal Pain Refusing Pressure, Stool Not Free, Possible Precipitation, Disinhibition of
Clear Water With No Alleviation in Abdominal Pain, As Well As Tidal Heat Delirious Speech, Replete Pulse…

Heat Binding Bypass Pattern: Dry Stool Hardness Binding in Interior, Stomach, Intestines Unable to Excrete, Forcing Liquid to Bypass Out From
the Stool.

Heat Reversal, Tetany, Mania… Due to Replete Heat Internally Binding, Possible Qi Dynamic Obstruction, Stagnation, Yang Qi Obstructed,
Unable to Externally Reach Four Limbs; Possibly Heat Flourishing, Damaging Liquid, Sinews, Vessels Losing Nutrition and Hypertonicity;
Possibly Stomach, Intestinal Turbid Heat Upwardly Harassing Heart Shen, Shen Brightness Chaotic…

Despite the Symptoms Manifesting Differently, The Pathomechanism is the Same: Internal Hat Binding Repletion Severe Pattern.
Method: Drastic Precipitation of Heat Binding, Acutely Precipitate to Preserve Yin, “Remove Firewood From Under Cauldron”
Da Huang: Cold, Freeing, Downbearing, Drain Heat Free Stool, Forceful Elimination of Stomach, Intestinal Replete Heat Accumulation,
Stagnation.
Mang Xiao: Salty, Cold, Moistening, Downbearing, Drain Heat Free Stool, Soften Hardness Moisten Dryness to Eliminate Dry Hardness.

Xiao, Huang Paired: Used to Mutually Enhance, Drain, Precipitate Heat Binding Efficacy Drastic.

Replete Heat Internally Obstructing, Fu Organ Qi Not Moving, Thus Hou Po is Used to Downbear Qi Eliminate Fullness, Zhi Shi to Move Qi
Disperse Glomus. Used Together, They Can Disperse Glomus Eliminate Fullness and Enable Stomach, Intestinal Qi Dynamic to Free, Downbear,
Precipitate, Move to Assist Draining, Precipitating, Freeing Stool.

Four Herbs Used Together All Assist in Drastically Precipitating Heat Binding Efficacy

This Formula Drastically Precipitates Heat Binding, Carrying Stomach Qi to Precipitate Downwards, Thus the Name ⼤大承⽓气 Da Cheng Qi “Large
Carry/Bear/Hold Qi”.

Wu Tang《Wen Bing Tiao Bian》”Cheng Qi: Carrying Stomach Qi … Called Da Cheng Qi, Combine Four Herbs and Observe, Can Be Called No
Hardness (it) Cannot Break, No Slightness (it) Cannot Enter, Thus Called Da (Large)”.

Treating Heat Binding Bypass Using Da Cheng Qi Tang is Due to the Phenomenon of “Bypass” : Dry Stool Hardness, Binding is its Inherent
Nature, Thus Using Drastic Precipitation Enables Heat Binding to Exit, “Bypassing Liquid” Can Stop (通因通⽤用法 Tong Yin Tong Yong Fa:
Freeing Cause, Freeing Use Method).

Treating Heat Reversal Using Da Cheng Qi Tang =: Four Limb Reversal Cold is a Fake Sign, Internal Replete Heat is the Intrinsic Nature. “Heat
Extreme, Reversal Also Severe”: Despite four Limbs Having Reversal Cold, (One) Must See Constipation, Abdominal Pain Which Refuses
Pressure, Dry Mouth, Dry Tongue, Surging Replete Pulse… Symptoms. Using Cold Precipitation Can Enable Heat Binding to Precipitate, Qi
Dynamic Diffuses, Frees, Yang Qi Distributes, Arrives Outwards, Reversal Can Return. This Use of Cold Precipitation to Treat Reversal Cold
Pattern is Called 寒因寒⽤用 Han Yin Han Yong: Cold Cause Cold Use.

The Decoction Method For This Formula is to: First Decoct Zhi Shi, Hou Po,
Later Add Da Huang,
Mang Xiao Dissolve When Drinking.

Since Unprocessed Da Huang is Used, its Draining, Precipitation Efficacy is Drastic: Long Decoction Would Moderate it’s Efficacy
《Shang Han Lun Lai Su Ji . Shang Han Fu Yi》”Unprocessed Qi Sharp and First Moves, Processed Qi Blunt and Moderate”
Differential Diagnostic Keys: Is the Foundation Formula to Treat Yang Ming Fu Replete Pattern
Is the Representative Formula for the Cold Precipitating Method

{
Clinically Used to Treat: Glomus (痞 Pi)
Fullness (满 Man)
（Four Symptoms)
Dryness (澡 Zao)
Repletion (实 Shi)
Red Tongue, Yellow Coating
Deep, Replete Pulse
Modern Usage: Acute Simple Intestinal Obstruction
Roundworm Intestinal Obstruction
Acute Cholecystitis (Gallbladder Inflammation)
Acute Pancreatitis
Pyloric Stenosis (Pyloric Obstruction)
Heat Illnesses With Symptoms of: High Fever
Clouded Spirit and Delirious Speech
Fright Reversal (Sudden Loss of Consciousness After Strong Emotional Stimulus)
Mania
Unfree Stool (Constipation)
Yellow Tongue Coating
Replete Pulses

Important Points: This Formula is Draining Precipitating Drastic Formula ∴ Use With Caution for: Qi Vacuity Yin Depletion
Dry Binding Not Severe
Elderly Patients
Weak Patients
Contraindicated in Pregnancy
“Cease Treatment As Soon As Illness is Struck” to Prevent Damaging Zheng Qi

Supplement Qi
Qi Vacuity (Deficiency) Ren Shen
(Prevent Qi Desertion From Precipitate Downwards Actions)

Xuan Shen
Yin, Liquid Vacuity Nourish Yin, Moisten Dryness
Sheng Di

Xiao Cheng Qi Tang
《Shang Han Lun》
Tiao Wei Cheng Qi Tang
《Shang Han Lun》
Fu Fang Cheng Qi Tang
《Zhong Xi Yi Jie He Zhi Liao Ji Fu Zheng》
Yang Ming Fu Light Pattern
Da Huang Symptoms: Delirious Speech, Hardness Stool,
Hou Po Light Precipitate Heat Binding Tidal Heat, Chest, Abdominal Fullness, Glomus,
Zhi Shi Old, Yellow Tongue Fur, Replete Racing Pulse
(Glomus, Fullness, Replete)
Yang Ming Dry Heat Pattern
Da Huang Symptoms: Heat Aversion, Thirst, Constipation,
Mang Xiao Moderate Precipitate Heat Binding Abdominal Fullness (Refuses Touch), Yellow
Gan Cao Tongue Fur, Slippery Rapid Pulse
(Dry, Replete)
Da Huang
Mang Xiao
Hou Po Simple Intestinal Obstruction
Drain Fire Free Stool
Zhi Shi (Stronger Quicken Blood Disperse Stasis Than
Move Qi Quicken Blood
Lai Fu Zi Other 2 Cheng Qi Tangs)
Tao Ren
Chi Shao
 ⼤大⻩黄牡丹丹汤
*** Da Huang Mu Dan Tang ***
《Jin Gui Yao Lue》

Da Huang 4 Liang (12g), Mu Dan Pi 2 Liang (3g), Tao Ren 50 (9g), (Dong) Gua Ren 0.5 Sheng (30g), Mang Xiao 3 He (9g)

Drain Fire, Break Stasis Intestinal Abscess (Initial Stage), Damp Heat Stasis, Stagnation
Dissipate Binding, Disperse Swelling Symptoms: Lower Abdomen Touch-Averse Pain, Strangury-Like
Pain to the Touch, Possible Local Glomus, Swelling,
Impairment of Right Leg Extension (Pain on Extension),
Self-Regulating Urination, Possible Occasional Heat
Effusion, Sweating, Cold Aversion, Thin Sticky Yellow
Tongue Coating, Slippery Rapid Pulse
Pressure-Averse
Lower Abdominal — Damp Heat, Qi, Blood Da Huang 12 : Bitter, Cold Attacking Downwards
Pain Mutually Binding, Drain Heat Expel Stasis
Glomus — Forming Abscesses
Swelling Forcefully Flush Intestinal Damp
Heat Stasis Binding Pathogen
Strangury-Pain
to the Touch —
Not Strangury Pattern Mu Dan Pi 3 : Bitter, Acrid, Slightly Cold
(But): Lack of Clear Heat Cool Blood
Urinary Dribbling — Intestinal AbscessDrain Fire Quicken Blood Dissipate Stasis
Aversion to Break Stasis
— Leg-Flexing Intestinal
Extension of Damp Heat Stasis, Dissipate Binding Mang Xiao 9 : Salt, Cold
Right Leg Welling-Abscess Stagnation Disperse Swelling Drain Heat Abduct Stagnation
Soften Hardness Dissipate Binding
Welling-Abscess
Sweating, Already Formed,
— Qi, Assist Da Huang to Forcefully Flush
Cold Aversion Blood Depressed Replete Heat Downwards
Unharmonized Ying, Wei
Thin, Sticky Yellow — Tao Ren 9 : Quicken Blood Break Stasis
Tongue Coating Assist Mu Dan Pi to Dissipate Stasis
Damp Heat
Slippery Rapid Disperse Swelling
Pulse —

Gua Ren 30 : Sweet, Cold, Disinhibiting (Freeing)

Clear Intestines Free Dampness
Lead Damp Heat Out From Small
Intestine
Expel Pus, Disperse Wellling-Abscess
This Formula is Used to Treat Intestinal Abscesses, Often Due to Intestinal Damp Heat Depressing, Steaming, Qi, Blood Congealing,
Accumulating.

Damp Heat and Qi, Blood Mutually Bind, Creating Abscesses, Not Moving Creating Pain, Therefore Right Lower Abdomen Pain Refuses
Pressure, Possibly Becoming Edema, Glomus.

Under Pressure, The Pain is Like Strangury, But Urination is Unimpeded, No Feeling of Impaired Urination, Thus Not Strangury Pattern.

Desire to Flex Right Leg and Not Extend (Extension Causes Severe Pain): “Leg Flexing Intestinal Welling-Abscess”

Possible Frequent Heat Effusion, Spontaneous Sweating, Cold Aversion: Intestinal Abscesses Already Formed, Qi, Blood Depression,
Stagnation, Ying, Wei Losing Harmony.

Yellow Slimy Tongue Coating, Slippery Rapid Pulse: Damp Heat Internally Brewing Symptoms.

《Cheng Fang Bian Du》”Illness Already Internal, Treatment Differs From That Used For External Abscesses. Intestinal Binding Accumulation Not
Dissipating, Toxins Swelling (Edema), Do Not Use Precipitation Method, Cannot Use Resolving, Dissipating.”

Treatment Method: Drain Heat Dispel Dampness, Break Stasis Disperse Abscesses

Da Huang: Bitter, Cold, Attacking, Precipitating; Drain Heat Expel Stasis, Forcefully Flush Intestinal Damp Heat Stasis Binding Toxicity.

Mu Dan Pi: Bitter, Acrid, Slightly Cold, Can Clear Heat Cool Blood, Quicken Blood Dissipate Stasis.

Both Herbs used Together Drain Heat Break Stasis.

Mang Xiao: Salty, Cold, Drain Heat Abduct Stagnation, Doften Hardness Dissipate Binding, Assist Da Huang to Forcefully Flush Replete Heat,
Precipitate Downwards.

Tao Ren: Quicken Blood Break Stasis, Combine With Mu Dan Pi to Dissipate Stasis Disperse Swelling

Dong Gua Ren: Sweet, Cold, Slippery, Disinhibiting, Clear Intestines Disinhibit Dampness, Direct Damp Heat to Exit Via Urination, Can Also
Expel Pus Disperse Abscesses: Treating Internal Abscesses “Needed Medicinal”.

Entire Formula Combines Draining, Precipitating, Clearing, Disinhibiting, Breaking Stasis Together, Damp Heat is Cleared, Stasis, Stagnation is
Dissipated, Intestinal Fu Organs are Freed, Thus Abscesses are Dispersed, Pain Stops: Effective Formula for Treating Damp Heat Stasis
Stagnation Intestinal Abscesses.
《Jin Gui Yao Lue》States: “Surging Large Pulse, Pus Already Formed, Cannot Precipitate.” But For This Formula, the Method States: “When
(There is) Pus: Should Precipitate, If No Pus, Should Precipitate Blood”. Later Doctors Disagree on The Meaning of This Passage: Nowadays
Most Believe if Intestinal Abscesses are in the Initial Stage, and the Pattern is Damp Heat Blood Stasis Repletion, this Formula Can Be Used
Regardless of Whether Pus Is or Isn’t Formed.

Differential Diagnostic Keys: Is a Commonly Used Formula to Treat Damp Heat Blood Stasis Intestinal Abscesses
Clinically Used to Treat: Right Lower Abdominal Pain (Refuses Pressure)
Yellow Slimy Tongue Coating
Slippery Rapid Pulse

{
Modern Usage: Simple Appendicitis
Intestinal Obstruction
Acute Biliary Tract Infection
Biliary Tract Roundworms Belonging to Damp Heat Stasis Stagnation Patterns
Pancreatitis
Acute Pelvic Inflammatory Disease
Infection Following Tubal Ligation …

Important Points: Contraindicated or Use With Caution for Ruptured Intestinal Welling-Abscesses,
Elderly,
Pregnant,
Postpartum, or
Overly Weak Patients

Pu Gong Ying
Jin Yin Hua
Severe Heat Toxicity Strengthen Clear Heat Resolve Toxin Effects
Zi Hua Di Ding
Bai Jiang Cao

Chi Shao
Severe Blood stasis Ru Xiang Quicken Blood Dispel Stasis
Mo Yao
 ⼤大陷胸汤
* Da Xian Xiong Tang *
《Shang Han Lun》

Da Huang 6 Liang (9g), Remove Skin, Mang Xiao 1 Sheng (6g), Gan Sui 1 Qian Bi (1g)

Drain Heat Expel Water Break Binding Binding Chest Pattern

Symptoms: Hard, Painful Fullness From Under the Heart to the
Lower Abdomen (Can Not Approach), Constipation,
Slight Tidal Heat from 3 to 5 pm, Occasional Shortness
of Breath or Vexing Agitation, Thirst, Dry Tongue Coating,
Deep, Tight Pulse (Strength Under Pressure)

Intestinal Dry
Constipation —
Water, Heat Binding Together
Thirst, Dry Liquid Failing to Distribute Gan Sui 1 : Attack, Expel Water, Rheum
Tongue Coating — Discharge Heat,
Hard, Painful Dissipate Binding
Fullness From Water and Heat Mutual Binding Drain Heat
Under Heart to — Obstructing Internally of Water, Heat Expel Water Da Huang 9 : Forcefully Flush
Pathogenic Heat
Lower Abdomen
3-5pm Tidal Heat — Heat in Yang Ming Mang Xiao 9 : Moisten Dryness,
Deep, Tight Pulse Soften Hardness
(Strength Under — Interior Replete
Pressure)

Shortness of Pathogen Harassing

Breath, Vexation — Chest, Diaphragm
Agitation Qi Losing Up- and Down-
Bearing
 Replete Heat Binding Chest
Symptoms: Hard, Painful Fullness in Chest,
Neck / Nape Stiff, Sweating, Constipation, Deep,
Da Huang
Da Xian Xiong Wan Replete Pulse
Ting Li Zi
Expel Water Break Binding (Location Slightly Higher than Da Xian Xiong
《Shang Han Lun》 Mang Xiao
Tang, Treatment More Moderate: Ting Li Zi
Xing Ren
Drains Lung Moves Water, Gan Sui’s Drastic
Action Removed)
Section 2: Warm Precipitation Formulas

Da Huang Fu Zi Tang
Wen Pi Tang

Warm Precipitation Formulas Suit: Interior Cold Accumulation, Stagnation: Repletion Patterns
Interior Repletion Patterns With Cold Natures

Their Pathomechanism Results From Pathogenic Cold Binding With Accumulation, Stagnation in the Stomach, Intestines

Clinical Manifestations Primarily Involve: Abdominal Pain

Constipation

Cold Precipitation Formulas Predominantly Use Clearing, Precipitating Herbs Like: Da Huang
Ba Dou …

Pairing Methods Primarily Involve Pairing With:

1. Warming Interior, Dispelling Cold Herbs (Fu Zi, Xi Xin, Gan Jiang …)
Cold Repletion Patterns Result From Pathogenic Cold and Accumulation Stagnation Mutually Binding:
Replete Accumulation Does Not Exit Without Precipitation
Pathogenic Cold Does Not Transform Without Heat
∴ Clearing, Precipitating Herbs are Ideally Paired With Warming Interior, Dispelling Cold Herbs
e.g. Da Huang Fu Zi Tang: Fu Zi, Xi Xin San Wu Bei Ji Wan: Gan Jiang Wen Pi Tang: Fu Zi, Gan Jiang …

2. Supplement Qi, Assisting Yang Herbs (Ren Shen, Dang Shen, Fu Zi …)

Cold Accumulation Due to Spleen Yang Insufficiency: Yang, Qi Vacuity: Cold Congeals Resulting in Abdominal Pain, Constipation
Prolonged Diarrhea, Dysentery: Spleen Yang is Damaged
Warming, Supplementing Spleen Yang Alone: Accumulation, Stagnation Does Not Exit
Freeing, Abducting Alone: Middle Yang is Further Damaged
∴ Abducting, Precipitating Cold Accumulation Herbs are Ideally Paired With Warming, Supplementing Spleen Yang Herbs
e.g. Da Huang Fu Zi Tang: Fu Zi Wen Pi Tang: Ren Shen, Gan Cao, Fu Zi San Wu Bei Ji Wan: Gan Jiang…

Representative Warm Precipitation Formulas Include: Da Huang Fu Zi Tang

Wen Pi Tang
San Wu Bei Ji Wan …
 ⼤大⻩黄附⼦子汤
** Da Huang Fu Zi Tang **
《Jing Gui Yao Lue》

Da Huang 3 Liang (9g), Fu Zi 3 Mei (9g), Blast-Fried, Xi Xin 2 Liang (3g)

Warm Meridians Dissipate Cold Cold Accumulation Abdominal Pain

Free Stool Relieve Pain Symptoms: Abdominal Pain, Constipation, Costal Underside or
Waist / Inguinal Pain, Heat Effusion, Hand Foot Reversal,
Sticky White Tongue Fur, Deep Wiry or Tight Pulse

Fu Zi 9 : Very Acrid, Very Hot

Constipation — Cold Accumulation
in Interior + Yang Warm Interior Dissipate Cold
Abdominal — Qi Inhibition
Cold Pain
Warm Meridians Da Huang 9 : Forcefully Flush Intestines,
Hand, Foot Yin, Cold
— Accumulating Cold Accumulation Dissipate Coldness Stomach
Reversal Internally Interior Replete Free Stool Precipitate Downwards,
Sticky White Relieve Pain Free Stool
— Cold
Tongue Fur
Xi Xin 3 : Acrid, Warm, Diffuse, Free
Deep Wiry / — Cold, Pain
Tight Pulse Dissipate Cold, Stop Pain
Sub-Costal Cold Qi Upward
Pain — Counterflow

— Yang Qi Depressed
Heat Effusion / Blocked
 温脾汤
*** Wen Pi Tang ***
《Bei Ji Qian Jin Yao Fang》

Da Huang 4 Liang (15g), Dang Gui (9g), Fu Zi 1 Large Mei (6g), Gan Jiang 2 Liang (9g), Ren Shen 2 Liang (6g), Gan Cao 2 Liang (9g), Mang Xiao (6g)

Warm, Supplement Spleen Yang Cool Accumulation Constipation

Attack, Expel Cool Accumulation Symptoms: Chronic Red White (Pus & Blood) Dysentery, Abdominal
Pain, Cold Hands and Feet, Deep Wiry Pulse

Fu Zi 6 : Warm Interior Dissipate Cold

— Spleen Yang Vacuity Da Huang 15: Drain, Precipitate Downwards,

Constipation Cold Congealing Free Stool
Abdominal Qi Stagnating
— Normal Conveyance Cool Accumulation Attack, Precipitate Mang Xiao 6 : Moisten Intestines,
Cold Pain Collecting Internally Cool Accumulation Soften Hardness
Function Impaired
Deep, Wiry Assist Da Huang Drain
— Cold, Pain Downwards Attack Accumulation
Pulse
Gan Jiang 9 : Warm Middle, Dissipate Cold

Cold Hands, Yang Qi Vacuity, Not

— Reaching Warm, Supplement Ren Shen 6 Boost Qi, Nourish Blood
Feet Four Limbs Spleen Yang Vacuity Spleen Yang Dang Gui 9 : Prevent Precipitation From
Damaging Right Qi
Gan Cao 3 : Harmonize Middle
Chronic Dysentery Harmonize Other Herbs
Chronic Blood, — Damaging Yang
Pus Dysentery Accumulation,
Stagnation Not Leaving
This Formula Pattern is Caused by Spleen Yang Insufficiency, Yin Cold Internally Flourishing.

Cold Repletion Internally Obstructs Intestines, Fu (Organ) Qi Unfree, Thus Constipation, Abdominal Pain, Pain Around the Umbilicus, not
Stopping.
Spleen Yang Insufficiency, Four Limbs Lacking Warmth, Thus Hand, Foot Cold
Deep Wiry Slow Pulse: Yin Flourishing Internal Repletion Sign.

Despite the Formula Pattern Being Cold Accumulation Constipation, the Root Cause is Spleen Yang Vacuity:
Only Using Forceful Precipitation: Must Further Damage Middle Yang.
Only Using Warming, Supplementing: Difficult to Expel Cold Accumulation
Only By Using Attacking, Expelling Cold Accumulation With Warming, Supplementing Spleen Yang Together Can Both Functions Be Achieved.

Fu Zi Pairs With Da Huang: Fu Zi’s Lage Acridity, Large Heat Warms, Invigorates Spleen Yang, Resolves, Dissipates Cold Congealing, Paired
with Da Huang Drains, Precipitates Already Formed Cold Accumulation.
Mang Xiao Moistens Intestines, Softens Hardness, Assists Da Huang to Drain, Precipitate, Attack Accumulation.
Gan Jiang Warms Middle, Assists Yang, Assists Fu Zi to Warm Middle Dissipate Cold.
Ren Shen, Dang Gui Boost Qi Nourish Blood, enabling Precipitation to Not Damage Zheng.
Gan Cao Both Assists Ren Shen Boosting Qi and Regulates, Harmonizes Other Herbs.

Multiple Herbs Join Efficacies to Expel Cold Pathogen, Move Accumulation, Stagnation, Recover Spleen Yang.
Warm, Supplementing Herbs Pair With Cold Precipitating Attacking Accumulation Herbs to Achieve Warm Freeing, Clearing Precipitating With
Supplementing, Boosting Together (Warm Supplementing Within Attacking Precipitation).

Characteristics: Warming Yang to Dispel Cold

Attacking Precipitation Without Damaging Zheng.

This Formula and Da Huang Fu Zi Tang Are Both Warming Precipitating Formulas, Both Can Treat Cold Accumulation Constipation.

Wen Pi Tang (Pattern) is Due to Spleen Yang Insufficiency, Middle Qi Cacuous Cold Leading to Cold Accumulating, Internally Collecting
(Pattern is Repletion Within Vacuity, so the Formula Pairs Gan Jiang, Ren Shen, Gan Cao to Protect Middle Yang).

Da Huang Fu Zi Tang (Pattern) is Cold Accumulating Interior Replete Pattern (Pattern is Repletion Without Vacuity, so the Formula Pairs Xi
Xin’s Acrid, Warming, Diffusing, Freeing to Assist Fu Zi Dissipate Cold Stop Pain)
Differential Diagnostic Keys: Is a Commonly Used Formula to Treat Spleen Yang Vacuity, Cold Accumulating Middle Obstruction
Clinically Used to Treat: Abdominal Pain
Constipation
Hands, Feet Not Warm
White Tongue Coating
Deep, Wiry Pulse

Modern Usage: Acute, Simple Intestinal Obstruction

Complete Obstruction…
{ Middle Yang Vacuous Cold, Cold Accumulating, Internal Obstruction Patterns
 +

Hou Po
Abdominal Distention, Pain Move Qi, Relieve Pain
Mu Xiang

Rou Gui
Abdominal Cold Pain Strengthen Warming Middle, Dispel Cold Action
Wu Zhu Yu
Section 3: Moist Precipitation Formulas

Ma Zi Ren Wan
Ji Chuan Jian

Moist Precipitation Formulas Suit: Intestinal Dryness, Liquid Depletion, Bound Stool Patterns

Their Pathomechanism Results From: Pathogenic Heat Damaging Liquid

Constitutional Fire Flourishing, Gastrointestinal Dryness: Heat Binding, Liquid Depleted
Kidney Vacuity Qi Weakness, Disinhibited Pass Gate
Vacuity, Damage Following Illness, Jing, Liquid Insufficient, Intestinal Conveyance,
Transformation Lack Strength, Stool Dry, Bound

Clinical Manifestations Can Involve: Dry, Bound Stool
Foul Breath, Lip Sores
Red Face, Body Heat
Short, Reddish Urinary Voidings
Yellow, Dry Tongue Coating
Slippery, Replete Pulse
or: Constipated Stool
Clear, Long Urinary Voidings
Blue-Green, White Face
Lumbar, Knee Soreness, Softness
Hand, Foot Lack of Warmth
Pale Tongue, White Coating
Deep Pulse

Left Pattern: Replete Gastrointestinal Dry Heat: “Heat Constipation”

Commonly Treated With: Moistening, Precipitating Herbs (Ma Zi Ren, Xing Ren, Yu Li Ren …)
Paired With: Cold Natured Clearing, Precipitating Herbs (Da Huang, Mang Xiao …)
Clearing Heat While Increasing Clearing, Precipitating Efficacy
Enriching Yin, Nourishing Blood Herbs (Bai Shoa, Dang Gui …)
Moisten Intestines As Well As Enrich, Supplement, Enabling Zheng Qi to Strengthen, Flourish

e.g. Ma Zi Ren Wan: Ma Zi Ren, Xing Ren + Da Huang, Shao Yao Wu Ren Wan: Xing Ren, Yu Li Ren + Bai Zi Ren, Song Zi Ren

Right Pattern: Kidney Qi Vacuity, Weakness: “Vacuity Constipation”

Warming Kidney, Boosting Jing
Commonly Treated With: Herbs (Rou Cong Rong,Niu Xi, Dang Gui …)
Nourishing Blood, Moistening Intestines

Paired With: Upbearing Clear, Downbearing Turbid Medicinals (Sheng Ma, Ze Xie, Zhi Ke …)
Kidney Vacuity: Qi Transformation Lacks Authority, Liquid Metabolism Abnormal
(Resulting in Turbid Yin Not Downbearing, Stool Not Free)
∴ Pair With Ze Xie, Zhi Ke: Enter Kidney, Discharge Turbidity, Downbear Qi, Loosen Intestines
Enable Turbidity to Downbear, Fu Organ Freeing, Stool to Precipitate
Turbid Yin Not Downbearing is Also Caused by Clear Yang Not Upbearing
∴ Pair With Sheng Ma: Upbear Clear to Downbear Turbid
e.g. Ji Chuan Jian: Sheng Ma, Zhi Ke, Ze Xie
“Heat Constipation” Often Results From: Liver Fire Flourishing
Gastrointestinal Dry Binding
Liquid Depletion

Bitter, Cold, Yin, Softening Lu Hui

∴ Pair: To: Moisten Dry Binding, Drain Fire Free Stool
Clearing Heat, Eliminating Vexation, Heavy Weighing Zhu Sha

e.g. Geng Yi Wan: Lu Hui, Zhu Sha

Representative Moist Precipitation Formulas Include: Wu Ren Wan

Geng Yi Wan
Ji Chuan Jian
Ma Zi Ren Wan …

 麻⼦子仁丸
*** Ma Zi Ren Wan ***
《Shang Han Lun》

Ma Zi Ren 1 Sheng (21g), Xing Ren 1 Sheng (9g), Remove Skin Tip, Cook, Remove Oil/Fat, Zhi Shi 0.5 Jin (9g), Mix-Fry, Da Huang 1 Jin (12g), Remove Skin,
Hou Po 1 Chi (9g), Mix-Fry, Remove Skin, Shao Yao 0.5 Jin (9g), Bai Feng To Make Pill

Moisten Intestines Free Stool Spleen Retention Pattern

Symptoms: Intestinal, Stomach Dry Heat, Constipation, Increased
Urination, Possible Hemorrhoids, Possible Abdominal
Distention, Fullness, Yellow Tongue Fur, Fu Yang* Pulse
Floating, Rough

* 1.5 Cun in Front of Jie Xi (ST41)

Stomach, Middle Dry Heat

Constipation — Spleen Restricted / Bound Ma Zi Ren 21: Moisten Intestines, Free Stool
Liquid Not Distributing
↑ Urination — (Only Transporting in / to
Dry Heat in Stomach Moisten Intestines Xing Ren 9 : Downbear Qi, Moisten Intestines
Bladder (Organ)) Spleen Liquid Vacuity Drain Heat
Yellow Tongue — Heat Shao Yao 9 : Nourish Yin, Harmonize Middle
Fur Relax Tension, Relieve Pain
Rough Pulse — Liquid Vacuity

Da Huang 12 Drain Fire Eliminate Fullness

Zhi Shi 9
Hou Po 9 : Disperse Glomus Free Stool
Abdominal
Distention, — Obstruction, Stagnation
Qi Stagnation Move Qi Drain Stomach, Intestinal Excess
Fullness of Qi Dynamic Free Stool Dry Heat
Bai Feng : Moisten, Lubricate Intestinal Tract
Harmonize Other Herb Natures
This Formula Pattern is Caused By Stomach, Intestinal Dry Heat, Spleen Liquid Insufficient.
《Shang Han Lun》Referred to it as 脾约 Pi Yue：Spleen Restriction

Cheng Wu Ji Stated “Restriction: Restricted Binding, Restricted Fettering. Classics State: Spleen Regulates Liquid Moving in Stomach, Now
Stomach is Strong, Spleen is Weak, Restriction Fettered Liquid Cannot Distribute to the Four (Limbs/Directions), But Connects to the Bladder,
Leading to Frequent Urination and Hard Defecation, Thus Called Spleen Restriction”

《Shang Han Ming Li Lun》According to “Dryness: Mosten”, “Lodging: Attack” Principles, Should Moisten Intestines Drain Repletion, Using
Moisten Intestines Herbs Together With Clearing Precipitating Herbs.

Ma Zi Ren: Nature, Flavour Sweet, Neutral, Quality Moistening, Oily, Efficacy Moistening Intestines, Freeing Stool
Xing Ren: Upwardly Downbearing Lung Qi, Downwardly Moistening Large Intestine
Bai Shao: Nourish Blood Encouraging Yin, Moderating Tension Stopping Pain
Da Huang, Zhi Shi, Hou Po are Xiao Cheng Qi Tang: Mild Precipitating Heat Binding, Eliminating Stomach, Intestinal Dryness, Heat
Feng Mi: Sweet, Moderating, Can Both Assist Ma Zi Ren Moisten Intestines Free Stool As Well As Moderate, Harmonize Xiao Cheng Qi
Attacking, Precipitating Efficacy.

For the Formula as a Whole, Despite Using Xiao Cheng Qi to Drain, Precipitate, Clear Heat, Free Stool, Da Huang, Hou Po Dosages Are Slightly
Smaller, And Copious Oily Moistening Ma Ren, Xing Ren, Shao Yao, Bai Feng … are Added in Order to:
1. Boost Yin Increase Liquid to Moisten Intestines Free Stool, Enabling Fu (Organ) Qi to Free, Liquid to Move
2. Sweet, Moisten, Decrease, Moderate Xiao Cheng Qi’s Attacking Precipitation Efficacy

Characteristics: Precipitating Without Damaging Zheng

Moistening Without Being Greasy / Slimy
Attacking, Moistening Together…
(In Order to Achieve Moistening Intestines, Free Stool, Moderate Precipitation Efficacy, Promoting Expulsion of Dry Heat, Recovery of Yin Liquid,
And Spontaneous Regulation of Stool)

This Formula is a Wan (Pill) Formula, Consuming 10 Small Pills, Successively Increasing In Order to Achieve Moderate Precipitation, Moistening
Intestines, Free Stool.
Differential Diagnostic Keys: Is a Commonly Used Formula to Treat Stomach, Intestinal Dry Heat, Spleen Liquid Insufficiency Pattern
(Called 脾约 Pi Yue：Spleen Restriction / Straightening Pattern)
Is the Representative Formula for Moistening Precipitating Method
Clinically Used to Treat: Constipation
Frequent Urination
Slightly Yellow Tongue Coating With Scant Liquid

{
Modern Usage: Vacuous / Geriatric Intestinal Dryness Constipation
Habitual Constipation
Belonging to Stomach, Intestinal Dry Heat Patterns
Postpartum Constipation
Post Hemorrhoid Surgery Constipation …

Important Points: Despite Being a Moisten Intestines Moderate Formula, This Still Contains Offensive Precipitation Break Stagnation Herbs
∴ It Cannot Be Commonly (Continuously) Used for Elderly / Weak Bodied Patients
Liquid Depleted Blood Scant Patients
Use With Caution During Pregnancy
 +

Tao Ren Nourish Blood, Harmonize Blood

Hemorrhoids, Constipation
Dang Gui Moisten Intestines Free Stool

Hemorrhoid Bleeding Huai Hua

Cool Blood Stop Bleeding
(Stomach, Intestinal Dry Heat) Di Yu

Sheng Di Huang
Dry Heat Damaging Liquid Severe Xuan Shen Increase Humor (Liquid) Free Stool
Shi Hu

Tao Ren Liquid Desiccated Intestines Dry

Xing Ren Symptoms: Difficult Defecation, Elderly / Post-
Wu Ren Wan Bo Zi Ren Partum Blood Deficiency Constipation
Moisten Intestines Free Stool
《Shi Yi De Xiao Fang》 Song Zi Ren (Herbs are Sweet, Balanced, Oily, Moistening,
Yu Li Ren Often Used to Moisten Dryness, Lubricate
Chen Pi Intestines Concurrent with Moving Qi)
 济川煎
*** Ji Chuan Jian ***
《Jing Yue Quan Shu》

Dang Gui 3~5 Qian (9~15g), Niu Xi 2 Qian (6g), Rou Cong Rong Alcohol Washed, Remove Salt, 2~3 Qian (6~9g),
Ze Xie 1.5 Qian (4.5g), Sheng Ma 0.5~0.7 / 1 Qian (1.5~2.1~3g), Zhi Ke 1 Qian (3g)

Warm Kidney Boost Jing Kidney Deficiency Constipation

Moisten Intestines Free Stool Symptoms: Constipation, Long Voidings of Clear Urine, Waist
(Lumbus), Knee Aching, Softness, Pale Tongue,
White Tongue Fur, Deep Slow Pulse

Kidney Yang Vacuity,

Weakness Rou Cong Warm, Supplement Kidney Yang +
Constipation — No Warming or Rong 6~9 : Moisten Intestines Free Stool
Long Voidings — Transforming Strength
Liquid Not Distributing Dang Gui 12 : Acrid, Sweet, Warm, Moisten
of Clear Urine Intestines Lose Moisture,
Nourishment Kidney Vacuity Moisten Intestines Nourish Blood, Harmonize Blood
Sore, Soft Constipation Drain Heat Moisten Intestines
Waist, Knees — Kidney Nourishment ↓
Niu Xi 6 : Strengthen Waist, Tonify Kidney
Cold Limbs — Yang Qi Vacuity
Excels at Moving Downwards
Impaired Warming
Deep, Slow Enter Kidney to Nourish Jing
— Vacuity, Cold
Pulse
Ze Xie 4.5 : Enter Kidneys, Drain Turbidity
with Niu Xi: Free, Discharge
Downwards
Move Qi to Zhi Ke 3 : Loosen Intestines, Downbear Qi
Assist Stool
Sheng Ma 2 : Upbear Clear Yang
“First Upbear in Order to Downbear”
Supplement Without Stagnation
This Formula Pattern is Caused by Kidney Vacuity: Opening, Closing Regulation Lost.

Kidney Regulates the Five Liquids (Humours), Regulates Opening, Closing. Kidney Yang Insufficiency: Qi Transformation Lacks Strength, Liquid
Does Not Distribute: Thus Clear Long Urinary Voidings
Intestines Lost Moistening, Irrigation, Propagation Impaired: Constipation
Kidney Vacuity, Jing Depleted: Lumbar, Knee Soreness, Softness
Clear Orifice Lacking Nutrition: Head, Eye Dizziness
Kidney Yang Depletion, Damage: Tongue Pale, Coating White, Pulse Deep, Slow

Kidney Vacuity, Opening, Closing Losing Regulation, Turbid Qi Not Downbearing, Intestinal Tract Losing Nutrition ∴ Treatment Method Should
Warm Kidneys Boost Jing, Moisten Intestines Free Stool.

Rou Cong Rong: Flavour Sweet, Nature Warming, Efficacy Warming Kidney Boosting Jing, Warming Lumbus Moistening Intestines.
Dang Gui Supplements Blood Moistens Dryness, Moistens Intestines Frees Stool
Niu Xi Supplements, Boosts Liver, Kidney, Invigorates Lumbus, Knees, Nature Excels at Moving Downwards.
Zhi Ke Downbears Qi Loosens Intestines, Assists Freeing Stool
Ze Xie Percolates, Disinhibits Urination and Discharges Kidney Turbidity
Sheng Ma is Fried to Upbear Clear Yang, Clear Yang Upbears Thus Turbid Yin Spontaneously Downbears (Mutually Opposing, Mutually
Complementing), to Assist Freeing Stool Efficacy.

Multiple Herbs Used Together Can Both Warm Kidney Boost Jing (Treat Root), as Well as Moisten Intestines Free Stool (Treat Branch).

Characteristics: Dexterous Herb Use:

Draining Within Supplementation
Upbearing Within Downbearing
“Housing Freeing Within Supplementation, Sending Downbearing Within Upbearing”
Differential Diagnostic Keys: Is a Commonly Used Formula to Warm, Moisten, Free Stool, Treating Kidney Vacuity Constipation Patterns
Clinically Used to Treat: Constipation
Clear Long Urinary Voidings
Lumbar, Knee Soreness, Softness
Pale Tongue, White Coating
Deep, Slow Pulse

{
Modern Usage: Habitual Constipation
Geriatric Constipation Belonging to Kidney Vacuity Jing Depletion Intestinal Dryness Patterns
Postpartum Constipation…

Important Points: Contraindicated in Cases of Heat Pathogen Damaging Liquid or Yin Vacuity
 +

Qi Vacuity Ren Shen * Can Eliminate Zhi Ke if Severe

Fire (Heat) Symptoms Huang Qin

Kidney Vacuity (Stronger) Shu Di Huang

Section 4: Expel Water Formulas

Shi Zao Tang

 ⼗十枣汤
*** Shi Zao Tang ***
《Shang Han Lun》

Da Zao 10 Mei, Gan Sui, Da Ji, Yuan Hua Cooked, Each in Equal Amounts (0.5-1g)

Attack, Expel Water, Rheum 1. Suspended Rheum

Symptoms: Coughing, Spitting with Chest, Costal Tight Pain,
Glomus, Hardness Under the Heart, Dry Retching,
Shortness of Breath, Headache, Eye Dizziness,
Possible Chest-Back Pulling Pain (Impaired Breathing),
Glossy Tongue Fur, Deep Wiry Pulse
2. Water Swelling
Symptoms: Swelling Edema Over Entire Body, More Severe Below
the Waist, Abdominal Distention, Panting, Fullness,
Constipation / Urinary Block
Coughing,
Shortness of —
Breath
Water, Rheum
Chest, Costal — Threatening Lungs,
Tight Pain Inhibited Lung Qi
Chest-Back —
Pulling Pain Gan Sui 1 : Move Channel Passage Water, Damp
Water, Rheum
Glomus, Hard — Rheum Collecting Congesting, Attack, Expel Da Ji 1 : Discharge Organ Water, Damp
Under Heart Under the Heart Accumulating, Water, Rheum
Full Body Water Overflowing Internal, External Yuan Hua 1 : Disperse Chest, Costal Deep-Lying
— Muscle, Overflow / Flood
Water Swelling Flesh Rheum, Phlegm Aggregation
Constipation + Water Not Following
— Proper
Urinary Block (Normal) Pathway
Glossy Tongue —
Fur Water, Dampness
Deep, Wiry —
Pulse
Da Zao 10 : Boost Qi, Protect Stomach
Moderate, Harmonize Drastic, Harsh
Herb Natures
This Formula Pattern is Caused By Water, Rheum Congesting, Flourishing in the Interior, Collecting in the Chest, Costal Region, and
Possible Water, Rheum Overflowing Into the Limbs.

Water Collects in the Chest, Costal Region, Qi Dynamic is Obstructed, Stagnant: Chest, Costal Tight Pain

Water, Rheum Upwardly Attacking Lungs, Lung Qi Impaired: Coughing Pulling Chest, Costal Region, Pain, Possible Chest, Back Pulling
Pain Preventing Breathing.

Rheum is a Yin Pathogen, Follows Qi Movement, Collects Under Heart, Qi Binds in Middle: Solar Plexus Hard Glomus, Distention, Fullness,
Dry Retching, Shortness of Breath

Rheum Pathogen Upwardly Harasses Clear Yang: Headache, Eye Dizziness

Rheum Pathogen Binds, Accumulates, Chest Costal Pain: Deep Wiry Pulse

Water, Rheum Overflow into Limbs, Internally Accumulates in Solar Plexus, Abdomen, San Jiao Water Pathway is Obstructed: Full Body
Swelling (Edema), Abdominal Distention, Panting, Fullness, Impaired Urination and Defecation.

This Formula Pattern is Water, Rheum Congesting, Flourishing; Replete Pattern, Treatment Should be Attack, Expel Water, Rheum, Abduct
Water Pathogen (to) Quickly Precipitate Downwards.

Gan Sui Excels at Moving Meridian Pathway Water, Dampness

Da Ji Excels at Discharging Zang Fu Water, Dampness
Yuan Hua Excels at Dispersing Chest, Costal Latent Rheum, Phlegm Aggregation,

3 Herbs are Drastic, Harsh, Each Has its Corresponding Attack, Used in Combination: Meridian Path, Zang Fu, Chest, Costal Accumulated Water
is All Expelled, Attacked

3 Herbs are Drastic, Harsh, Toxic, Can Easily Damage Zheng Qi ∴ 10 Da Zaos are Used, Decocted into a Soup and Drunk to “Send” in Order to:
Moderate, Harmonize Multiple Herbs’ Toxic Natures
Boost Qi Protect Stomach
Decrease Side Effects of Herbs
Bank Up Earth to Curb Water (Pathogen, Zheng Addressed Together)
Differential Diagnostic Keys: Is the Representative Formula For Draining, Precipitating, Expelling Water
Is a Commonly Used Formula to Treat Suspended Rheum (悬饮：Xuan Yin)
Yang Water Replete Pattern
Clinically Used to Treat: Coughing Spittle
Chest, Costal Pulling Pain
Possible Edema, Abdominal Distention
Inhibited Urination, Defecation
Deep, Wiry Pulse

Important Points: This Formula is Drastic / Harsh: It Can Only Be Used Temporarily, Cannot Be Consumed For Extended Periods
If Jing Shen, Stomach Acceptance is Healthy and Water / Rheum Still Remains, Can Continue Using This Formula
If, After Drainage, Jing Shen is Fatigued, Desire for Food Diminishes, Temporarily Stop Offensive Expulsion
If the Constitution is Weak, Pathogen is Replete, You Must Attack:
Use This Formula Alternating With Tonify Spleen Supplementing, Boosting Formulas:
(Either First Attacking, Then Supplementing, or First Supplementing, then Attacking)

4 Important Points:
1. 3 of the 4 Herbs are Ground to a Powder, The Fourth (Da Zao) is Decocted in Order to “Send” the Others
2. Consume on an Empty Stomach in the Morning; Start By Consuming in Small Amounts (in Order To Prevent Large
Precipitation Damaging Zheng Qi). If, After Consuming the Herbs, Precipitation is Scant, the Dosage Can Double
The Second Day.
3. After Quick Disinhibitiion Has Been Achieved, Can Consume Congee in Order to Protect the Spleen Stomach
4. Use With Caution For Elderly or Weak Patients, Contraindicated in Pregnancy.

Kong Xian Dan
《San Yin Ji Yi Bing Zheng Fang Lun》
Phlegm-Rheum Collecting in Chest / Costal
Gan Sui
Region, Flowing to Limbs’ Tendon, Bone,
Da Ji Flush Phlegm Expel Water
Resulting in Nape, Chest-Back, Waist, Inguinal
Bai Jie Zi
Crease Tight Pain
Section 5: Concurrent Attacking, Supplementing Formulas

Huang Long Tang


Concurrent Attacking, Supplementing Formulas Are Formulas Which Combine { Clearing, Precipitating Actions
Supplementing, Boosting Actions

They Suit Patterns Involving { { Combined

Interior Repletion, Accumulation, Stagnation
Zheng Qi Internal Vacuity

Internal Repletion, Accumulation, Stagnation Tend to Involve {

Yang Ming Fu Organ Repletion
Heat Binding With Circumfluence *
* Hard Stool in the Intestines, Allowing Looser Stool to Pass Around it (Constipation Followed by Foul-Smelling Diarrhea)

Zheng Qi Internal Vacuity Tends to Involve { Qi, Blood Insufficiency

Yin, Liquid Depletion, Damage

Pathomechanisms { Constitutional Qi, Blood Vacuity, Contracting Yang Ming Fu Replete Pattern
Mistaken Treatment Resulting in Qi, Blood Vacuity, Weakness, With Dry Stool Not Removing
Yang Ming Wen Bing: Heat Binding, Yin Depleted, Leading to Dry Stool Not Moving *
* Lack of Movement After Precipitating Refers to “Wu Shui Zhou Ting” (No Water: Boat Stops)

{
Constipation, Abdominal Fullness
Clinical Manifestations of { Yang Ming Fu Repletion
Qi, Blood Vacuity, Weakness
{ Include (Or Spontaneous Disinhibition of Clear Water)
Shen Fatigue, Lack of Strength
Vacuous Pulse

{
Dry Stool (Not Moving)
Precipitating (Methods) Not Freeing
Clinical Manifestations of { Yang Ming Wen Bing
Heat Binding, Liquid Depleted
{ Include Tidal Heat, Vexation, Thirst
Red Tongue, Scant Coating
Thin, Rapid Pulse

Concurrent Attacking, Precipitating Formulas Predominantly Use { Clearing, Precipitating Herbs

Supplementing, Boosting Herbs
Together *
* Emphasis Focuses on Clearing, Precipitating

Commonly Used Herbs Include { Da Huang, Mang Xiao

Ren Shen, Dang Gui, Sheng Di Huang, Mai Dong …

These Herbs are Often Paired With:

1. Supplementing, Nourishing Qi, Blood Herbs (Ren Shen, Dang Shen, Gan Cao, Dang Gui …)
Internal Repletion Patterns Complicated by Qi, Blood Vacuity:
Attacking Pathogen (Alone): Zheng Qi is Unable to Sustain
Supporting Zheng (Alone): Replete Pathogen Congests
 Constitutional Zheng Vacuity Treated With Clearing, Precipitating Formulas to Attack, Expel:
Since Zheng Qi is Rendered More Vacuous, Dry Stool Settles, and Doesn’t Precipitate
If Damaged Qi, Blood is Able to Attack, Expel Replete Pathogen, Zheng Qi Vacuity Desertion is Liable to Occur
∴ Bitter, Cold, Clearing, Precipitating Herbs Paired With Supplementing, Nourishing Qi, Blood Herbs Can Treat Both Issues
e.g. Huang Long Tang: Ren Shen, Gan Cao, Dang Gui …

2. Enriching Yin, Increasing Liquid Herbs (Sheng Di Huang, Xuan Shen, Mai Dong …)
Yang Ming Wen Bing: Heat Pathogen, Liquid Damage, Heat Binding, Liquid Depleted (Precipitating Without Freeing)
(Lack of Water: Boat Stopping Patterns):
Using Bitter, Cold, Attacking, Precipitating Herbs Alone: Not Only is the Dry Binding Not Removed, Liquid is Further Damaged
Using Nourishing Yin Herbs Alone: Warm Pathogen is Not Removed, Replete Binding is Difficult to Precipitate
Regarding These Patterns: “If Freeing is Desired, Must First Fill” (Suiting the “Increasing Liquid to Move the Boat” Method)

Moistening Yin and Clearing, Precipitating Used Together: Yin, Liquid Returns, Binding Heat is Precipitated, Stomach, Intestines
Free, Downbear, Pathogen Removes, Zheng Recovers (Leading to Spontaneous Recovery)
e.g. Zeng Ye Cheng Qi Tang: Sheng Di Huang, Xuan Shen, Mai Dong …

Representative Concurrent Attacking, Supplementing Formulas Include: Huang Long Tang

Zeng Ye Cheng Qi Tang …
 ⻩黄⻰龙汤
** Huang Long Tang **
《Shang Han Liu Shu》

Da Huang (12g), Mang Xiao (9g), Zhi Shi (9g), Hou Po (12g), Gan Cao (3g), Dang Gui (9g), Ren Shen (6g), Jie Geng (3g), Sheng Jiang, Da Zao
Drain, Precipitate Heat Binding Yang Ming Fu Replete, Qi Blood Vacuous Pattern
Boost Qi, Nourish Blood Symptoms: Spontaneous Clear-Water (Greenish) Diarrhea or Constipation, Abdominal
Distention, Fullness, Pressure-Averse Pain, Body Heat, Thirst, Lassitude of
Spirit, Shortness of Breath, Clouded Spirit Delirious Speech, Limb Reversal
→ Picking at Bedclothes (Carphology), Groping Air Pulling (Imaginary)
Strings, Red Tongue, Burnt Yellow Tongue Fur, Deep Thin Pulse
Abdominal
Distention, —
Fullness
Clouded Spirit —
Delirious Speech
Pressure-Averse — Da Huang 12 : Discharge Heat Free Stool
Pain
Forcefully Flush Stomach,
Spontaneous
Yang Ming Fu Replete Drain
Replete Heat Heat Intestines
Clear-Water — Binding Internally Free Stool
Diarrhea Mang Xiao 9 : Salt, Cold, Soften Hardness
Constipation — Moisten Dryness Free Stool
Body Heat, —
Thirst
Limb Reversal —
Red Tongue,
Burnt Yellow Fur —
Zhi Shi 9 : Move Qi Dissipate Binding
Hou Po 12 : Disperse Glomus Eliminate
Abdominal Free Qi Fullness
Distention, — Impaired Qi Dynamic Qi Stagnation
Eliminate Distention
Fecal Qi Jie Geng 3 : Diffuse Lungs
Free Large Intestine
Spirit Lassitude —
Breath Shortness Ren Shen 6 : Supplement Qi, Engender Liquid
Carphology —
Qi, Blood Worn, Vacuous Qi Vacuous Boost Qi Dang Gui 9 : Nourish Blood, Supplement Blood
Groping Air Scant Blood Nourish Blood
Pulling Strings — Sheng Jiang Tonify Spleen Harmonize Middle
Deep Thin Pulse — Da Zao :
Gan Cao 3 : Harmonize Other Herb Natures
This Formula Pattern is Caused by Pathogenic Heat and Dry Stool Internally Binding, Fu (Organ) Qi Not Free, Qi, Blood Insufficiency

The Formula was Originally Used to Treat Heat Binding Liquid Bypass Mixed with Qi, Blood Both Vacuous
Later Doctors Used to to Treat Wen Bing Lack of Precipitation (When Called For), Pathogen Replete, Zheng Vacuous.

Pathogenic Heat Entering Interior and Dry Stool Mutually Binding, Fu (Organ) Qi Not Free: Constipation, Solar Plexus, Abdominal Distention,
Fullness, Pain (Refuses Pressure), Body Heat, Thirst, Tongue Coating Burnt Yellow or Burnt Black, Possible Spontaneous Disinhibition
of Clear Water (Blue-Green Colour) “Heat Binding Liquid Bypass Pattern”
Constitutional Insufficiency or Internal Heat Replete Pattern Incorrect Treatment Leading to Damaging of Qi Blood: Fatigue, Scantness of
Breath, Vacuous Pulse
Pathogenic Heat Scorching, Flourishing, Heat Harassing Heart, Shen, Zheng Qi Tending to Desertion: Clouded Shen Delirious Speech, Limb
Reversal, Rubbing Clothing Empty Picking…

This Pattern is Replete Pathogen, Zheng Vacuous, Should Attack Replete Pathogen, Supplement Vacuous Zheng, Thus Treatment Method
Should: Drain Heat Free Stool, Supplement Qi Nourish Blood

Da Huang, Mang Xiao, Zhi Shi, Hou Po, (Da Cheng Qi Tang): Attack, Precipitate Heat Binding, Forcefully Flush Intestinal, Stomach
Accumulation, Stagnation, Acutely Precipitate in Order to Protect Zheng Qi.
Ren Shen, Dang Gui: Boost Qi Supplement Blood, Support Right to Disinhibit Dispelling Pathogen, Enable Attack Without Damaging Zheng.
Lungs and Large Intestine are Relative Biao-Li (Exterior-Interior), If Freeing Stomach, Intestines is Desired, Must First Open, Diffuse Lung Qi:
Jie Geng Open Lung Qi to Disinhibit Large Intestine to Assist Freeing Fu (Organ) Da Huang: Upwardly Diffusing, Downwardly Freeing (Mainly
Downbearing)
Jiang, Zao, Cao Supplement, Boost Spleen, Stomach, Assist Shen, Gui, Supplement Vacuity, Gan Cao Also Regulates, Harmonizes Multiple
Herbs.

Multiple Herbs Used Together Can Attack, Precipitate Heat Binding, as Well as Supplement, Boost Qi, Blood, Allowing Dispelling of Pathogen
Without Damaging Zheng, Supporting Zheng Without Hindering Pathogen.

Overall, This is an Effective Formula for Treating Pathogen (Xie) and Right (Zheng) Together.
Differential Diagnostic Keys: Is the Representative Formula to Attack + Supplement Together
Is a Commonly Used Formula to Treat Yang Ming Fu Replete + Qi, Blood Insufficiency Pattern
Clinically Used to Treat: Constipation
Possible Spontaneous Disinhibition of Clear Water
Solar Plexus, Abdominal Distention, Fullness
Body Heat, Thirst
Spirit Lassitude, Scantness of Breath
Burnt Yellow or Black Tongue Coating
Vacuous Pulse

{
Modern Usage: Typhoid
Paratyphoid
Epidemic Meningitis
Geriatric Constipation
Encephalitis B
Belonging to Yang Ming Fu Replete + Qi, Blood Insufficiency Patterns
Geriatric Intestinal Obstruction…
 － +

↑ Ren Shen
Old / Weak / Deficient Body Mang Xiao Strengthen Supplement Vacuity Supporting Right Ability
↑ Dang Gui

Xi Sheng Di
Sheng Gan Cao Heat Binding Interior Replete, Qi, Yin Vacuous
Ren Shen
Symptoms: Constipation, Lassitude of Spirit,
Sheng Da Huang
Xin Jia Huang Long Tang Shortness of Breath, Dry Mouth and Throat,
Mang Xiao Drain Heat Free Stool
Cracked Lips, Burnt Tongue, Burnt Yellow
《Wen Bing Tiao Bian》 Xuan Shen Enrich Yin Free Stool
Tongue Fur, Vacuous Pulse
Mai Dong
Dang Gui (Emphasis on Enriching Yin, Increasing Liquid,
Hai Shen Increase Water to Move (Free) the Boat (Stool))
Jiang Zhi