Fire

Noon
Summer
South

Wood Metal
Morning Evening
Spring Autumn
East West

Water
Midnight
Winter
North

Jue Yin Disease 

Wu Mei Wan (Mume Pill) defined

by Arnaud Versluys ministerial fire (xiang huo4 ). Jue yin is

The jue yin chapter of the Shang Han Lun is one of the most
enigmatic in Han-dynasty clinical literature. The chapter is
apparently confused and many attempts at explaining it fail in the
face of the seeming disconnect between the standard description
of jue yin disease in these lines1 and the formulas contained within
the actual chapter. Even if one succeeds with an intellectual
understanding of the chapter and its core concept of jue yin
disease, most practitioners still fail to gain a visceral compre-
hension of the identification and treatment of jue yin disease in
everyday clinic.
Jue yin physiology
Jue yin jing ( ) is the jue yin conform­
ation of the wind wood of the east. Its
branches (biao ) on the body’s periphery
are the foot jue yin Liver and hand jue yin
Pericardium channels, while its root (ben2
) is wind. Contained within jue yin is the
middle qi (zhong qi3 ) of the shao yang
the unity of wind and ministerial fire. It is
the fanning force behind the circulation of
ministerial fire in the hollow yang realm, as
well as the warm rising of blood within the
solid yin realm in the body. Jue yin contains
and steers blood, which it spreads freely in
all four directions: up, down, in and out.
The driving force behind this distribution
of blood is the moving warm qi contained
within the blood, or in other words shao
yang within jue yin.
Jue yin is born from water and gives birth to
fire.As such it is the bridge between water and
fire and the eastern pathway through which
rising water of the north communicates and
connects with descending fire of the south.
The yin segment of the jue yin tract belongs
to the Liver, which stores and moves blood.
The yang segment of the jue yin tract belongs
to the Pericardium which stores the nutritive
(ying/rong ) ������������������������������
which it holds closely around
the Heart to provide protection and cooling
to the emperor.
In the separation and union (li he )

28 Vol 5–3

sequence of yin and yang, the function of
jue yin is to close (he5 ) yin. Jue yin is the
resolution of yin, the death of yin. As such it
is the precursor to the birth of yang just as
on a material level blood is the mother of qi.
Yang is born from the water within the earth
at the midnight (zi6 ) time as represented
by the hexagram (fu )or “the recovery”7.
Jue yin wood fans the birth of this initially
lesser fire allowing it to increasingly warm
and ascend the steaming and boiling fluids
of the northern water element. The ascent of
this decreasingly yin and increasingly warm
water will ultimately spur the growth of shao
yang Gallbladder wood and the consecutive
birth of tai yang fire. Hence the Shang Han
Lun says that the resolution time of jue yin,
or in other words the period during which
jue yin fulfills its function of resolving yin
and fanning yang, happens from chou
time to mao time.8 This is the end of night
until the break of dawn, during which time
yang rises from within the water upwards
through the earth to arise from the horizon
and form the yang conformations. Of all
yin conformations, jue yin thus holds the
most yang and the least yin, and its overall
direction is upward and outward, such is
the quality of its root qi wind.
Jue yin pathology
Jue yin and yang ming are the only exceptions
to the first two rules of biao-ben-zhong
qi transformation as outlined in chapter
seventy-four of the Su Wen9. That is, they do
not follow the first rule and transform from
the root, nor do they follow the second rule
and transform from either from the branch
or from the root. Rather, due to the opposing
yin and yang natures of jue yin’s biao and
ben qi, i.e. yin branch jue yin channels and
yang root wind qi, jue yin transforms from
its middle qi of shao yang ministerial fire.
Physiologically this means that the warming
and moving qualities of the ministerial fire
are exclusively responsible for the warming
of the yin channels of jue yin as well as the
production of wind wood internally. In
pathology, this means that jue yin disease
is a disease of ministerial fire, precisely
ministerial fire contained within jue yin.
From a functional anatomical perspective,
jue yin disease manifesting either too much
feature
or too little ministerial fire always occurs
from the jue yin organ within shao yang
ministerial fire, i.e. the Pericardium.
The second rule of biao-ben-zhongqi
pathophysiology could conceivably be
applied to jue yin disease, for example in
relation to a peripheral jue yin channel
pathology as treated by Dang Gui Si Ni
Tang (Dang Gui Decoction for Frigid
Extremities) or an internal jue yin wind
pathology as treated by Wu Mei Wan. But
even when this is the case, the expression
of the pathology inevitably revolves around
the Pericardium’s inability to warm the
blood and the experience of cold extremities
due to the lack of fire within the blood, or
alternatively a reversal flow of qi striking
the Pericardium, the Heart’s proxy, due to
an excess of internal wind. Consequently,
when ministerial fire is stirred in jue yin
disease, the flaring fire can invade metal
along the control cycle of the phases and
either lead to suppuration and bleeding n Dr Versluys joins Dan Bensky
from the metal Lung as is treated with and Craig Mitchell in present-
Ma Huang Sheng Ma Tang (Ephedra and ing next year’s seminar series
Cimicifuga Decoction)10 or will invade the in Australia, Core patterns of
metal Large Intestine and create dysentery the Shang Han Lun – a clinical
with pus and bleeding as is treated by Bai approach. See Page 39.
Tou Weng Tang (Pulsatilla Decoction)11. The
relationship and sequence between the n Dr Versluys is one of the very
aforementioned throat obstruction (hou bi few Western scholars to have
) and the latter pus and blood in the received his full medical training
stool (bian nong xue ) are evident in in China. He respectively spent
line 334 of the original text.
12
more than 10 years at the Chinese
From the perspective of jue yin’s function medical universities of Wuhan,
of closing yin to prepare for the birth of the Beijing and Chengdu, where
yang conformations through the pivot of he consecutively pursued his
shao yang, when jue yin closes too much, Bachelor, Master and Doctorate
or too prematurely, yang is not born due to degrees in Chinese medicine.
absence of resolution of the yin stage. This He also trained in traditional
results in blood remaining too cold and too Shanghan Lun discipleship for
stagnant, unable to rise and float and failing many years. Dr Versluys’ scho-
to warm and nourish the extremities and lastic passion is the Han-dynasty
the surface such as in Dang Gui Si Ni Tang. canonical style of Chinese medi-
When jue yin fails to close, the upward rising cine. During the past five years,
of internal wind as the fanning force of the he worked as assistant professor
rising blood will be left uncontrolled and at the School of Classical Chinese
thus will stir excessively. This then results in Medicine at the National College
the upward rising of reversal qi striking the of Natural Medicine in Portland,
Heart13; the fanning of disturbing fire in the OR, USA. He is in private practice
Pericardium with vexing heat and pain14; in Portland, and teaches seminars
vomiting or at least the inability to get domestically and internationally.
food down15; and the upward crawling of Arnaud can be reached at info@
restlessly moving roundworms16 disquieted arnaudversluys.com.
The Lantern 29
 feature
‘’
by the fanning wind, all as treated with Wu
Mei Wan. Jue yin reversal or counterflow
is internal wind. As internal wind fans the
flare-up of shao yang ministerial fire, it
As internal wind fans consecutively produces more hot wind. This
the flare-up of shao is a perpetuating vicious cycle that requires
immediate and precise treatment. Much can
yang ministerial fire, it
go wrong. For example, since jue yin wood
consecutively produces
relates to the functions of tai yin earth along
more hot wind. This is a the control cycle of the phases, when the
perpetuating vicious cycle pattern is purged with bitter herbs, jue yin
that requires immediate will not only fail to close but its ability to
and precise treatment. close can be broken permanently. When this
happens, like a closed door kicked open by
force, the controlled opening function of tai
yin will be damaged, and this can result in
incessant downpour diarrhea.17 In the worst
case scenario this can result in irreparable
damage not only to tai yin but also to the
shao yin pivot, such that yin perishes from
below and separates from yang, leading
not only to diarrhea but the incessant
downpour of clear fluids and undigested
food (xia li qing gu18, 19 ) typical of
certain shao yin patterns.
Wind
Wind in nature does not exist as an
independent force but is rather the natural
effortless product of the interplay between
opposing forces. When in one region
there is a dominant cold front with low
temperatures and low barometric pressure,
while in another not-too-distant location
there is a predominant heat front with
higher temperatures and higher barometric
pressure, then a current is created from
the low-pressured front towards the high-
pressured front, or in other words from
the cold locale to the hot locale. This
movement in nature is called wind. It is
exactly the same in the human body: all
upward moving forces are the product of
the temperature and pressure differential
between the human body’s cold and hot
fronts, i.e. the water element and the fire
element. Nothing in human physiology has
to do anything actively to produce wind, as
it suffices to merely possess a healthy Heart
in the hot south and healthy Kidneys in
the colder north of the body. Wind is then
created because of their opposing qualities
and their relative proximity to each other.
30 Vol 5–3
A current will then move from the lower
burner to the upper burner, causing qi and
blood to ascend. This is exactly like the
pumping mechanism of a tree, in the way
that it can draw water from the ground to
the tips of the leaves on its branches high
in the sky.
Any change, however, in this temperature
differential will lead to a change in this
current of upward-flowing qi. When the fire
element of the south drops in temperature
due to yang deficiency of the Heart, the
temperature difference between Heart and
Kidneys equalises and wind stills, resulting
in the cold stagnation of blood failing to
ascend and spread. This is a Dang Gui Si Ni
Tang pattern. But when the temperature of
the Kidney water drops and the temperature
differential between fire and water therefore
increases, then the subsequent current of
upward surging wind gains pathological
strength. This is the actual mechanism
behind a Wu Mei Wan pattern pathology
which manifests with a multitude of internal
wind symptoms and reversal upward flow of
qi and blood. This is the explanation of the
working mechanism behind the common
understanding of jue yin disease being cold
below with heat on top.
The functional treatment of wind wood is
specified in the Huang Di Nei Jing. According
to chapter 22, encouraging the dispersing
movement of the Liver is fulfilled through
the administration of a pungent flavour,
while the reduction of such movement, in
other words the stilling of Liver’s wind, is
achieved through the application of a sour
flavour.20 And from the six qi perspective
presented in chapter 74, when wind is in
the spring (which is when wind is internal)
treatment is to be conducted with a sour
and bitter combination.21 In even greater
detail, the treatment of dominant internal
wind is done through the carefully balanced
administration of a sour formula of warm qi
with the assistance of bitter and sweet, along
with the check-and-balance of a pungent
flavour.22 The mechanism of redressing
deficient jue yin closure is through the sour
astringing of wind directly, assisted by the
bitter descent of fire and sweet tonification
of earth accompanied with mild pungent
dispersal to prevent excessive therapeutic
closure of the circulation of qi and blood.
 feature

The warmth of the overall formula is created
by choosing a majority of warm herbs
as well as through the pungent flavour of
these herbs. But since too much fire can also
create wind, the warmth of the formula is
balanced by choosing cold-natured bitter
herbs to lead physiological fire downwards
and inwards. The internalisation of the
physiological fire needs to be done to re-
establish the physiological warming of the
water specifically and the yin conformations
in general.
Wu Mei Wan architecture
From the original text in the Shang Han
Lun it is obvious that Wu Mei Wan can
treat the acute proliferation of roundworm
infestation23 in the human body. But every
serious practitioner must have wondered at
some point as to whether this prescription
could not have a broader clinical application
than in the field of parasitology and the
occasional “long-standing diarrhea”24.
Line 338 of the Shang Han Lun starts by
‘’
clearly distinguishing between Roundworm
Reversal (hui jue ) pattern and Visceral
Reversal (zang jue ) pattern. It is made
clear that Wu Mei Wan does not exclusively
treat Visceral Reversal since that treatment
Encouraging the dispersing
is in the realm of shao yin disease. However,
movement of the Liver
the fact that the opening part of the clause
makes this distinction indicates the need to is fulfilled through the
clarify and prevent this kind of confusion. administration of a
This is mainly because, as the second pungent flavour, while
sentence implies, Roundworm Reversal the reduction of such
occurs on the basis of Cold Viscera (zang han movement, in other words
)25 or cold yin organs. Cold yin organs the stilling of Liver’s wind,
are the condition of cold of the deepest is achieved through the
solid yin level in the body. In the Shang Han application of a sour
Lun this is mentioned in one other location, flavour.
namely in Tai Yin chapter’s line 277 where
cold of the solid organs is to be treated with
prescriptions of the Si Ni family (si ni bei
Frigid Extremities formulas).26 Tai yin
�����������������������������
is the ultimate yin. It contains both water
and earth and is also identified in Su Wen
chapter four as the Ultimate Yin (zhi yin
),27 which is even more yin than Kidney
water which is identified as “just” yin within

Chinawest Concentrated Chinese Herbs Exclusively for TCM Practitioners

Are you using patent pills? Why not dispense your own herbs with your
own clinic label and give your patients Chinaʼs hospital grade herbs.
Over 600 leading Chinese Hospitals use our herbs.

$0* Dispensary start-up!

(For new graduates and established TCM practitioners)

“.... my patients are VERY happy with the herbal medicine and so am I.

This is the first time I have found granules similar to actual raw herbal decoctions.”
LB, Sydney.

*conditions apply. Ask about our 10% Discount.

www.chinawest.com.au Free Call: 1800 888 198 e-mail: info@chinawest.com.au

The Lantern 31
 feature
‘’
yin.28 As such, when: 1) yin organs are cold,
2) this visceral cold in the Shang Han Lun
is considered to belong to tai yin, and 3) its
treatment is performed by treating the shao
Interestingly enough, yin mother of earth; then: 4) healthy wood
wind does not exclusively cannot be generated by ice water inside
move up in the body. The a frozen earth, which will 5) result in the
pattern called Cold Viscera, thus increasing
temperature differential
the fire-water temperature differential,
exists not only along a
and 6) function as the foundation for
vertical axis between Roundworm Reversal.
Heart and Kidney, but also With the northern waters freezing over,
along an in-and-out axis internal wind is thus engendered due to
between solid (yin) organs an increase in the temperature differential
and hollow (yang) organs. between north and south. And due to this
temperature difference, the rising current
in the body increases furiously and rushes
to the relatively warmer region of the south,
creating the upwards surging of wind
from lower to upper burner. This surge of
wind then stirs a pathological flare-up of
ministerial fire in the Pericardium, as well
as thrusting upward at earth and impeding
the proper descent of food, thus leading to
an inability to get food down.
But, interestingly enough, wind does
not exclusively move up in the body. The
temperature differential exists not only
along a vertical axis between Heart and
Kidney, but also along an in-and-out axis
between solid (yin) organs and hollow
(yang) organs. The internal wind stirs
ministerial fire which also circulates in the
hollow realm of the yang conformations as
qi. The solid yin organ interior is cold and
the hollow exterior realm becomes hotter,
thus also producing the outward movement
of wind. This is treated with cold-natured
bitter herbs that will drive ministerial fire
inwards and downwards. So it becomes clear
that the nominal concept of clearing heat
with a bitter cold herb is nothing more than
to drive fire inwards and downwards and
submerse it within water. This is why, in Nei
Jing chapter 22, a bitter flavour is considered
to tonify the water element since this refers
to the function of communicating fire with
water by symbolically benefiting water with
a fire flavour. This is echoed in the Decoc-
tion Classic (Tang Ye Jing )29 from
which Zhang Zhong-Jing drew most of his
formulaic knowledge and in which bitter
herbs like Huang Lian (Coptis) and Huang
Qin (Scutellaria) and so on are considered
32 Vol 5–3
to be functional Kidney tonics and are listed
as bitter water-category herbs.30
Zhang Zhong-Jing’s prescriptions are in
large part the fruit of his lifelong study and
research of all formula and prescription
literature available to him. Research31,32,
33,34,35,36
has shown that the formulas for
the treatment of the six conformations
are to a large extent based on six pairs of
prescriptions named after star constellations
whose celestial movements were deemed to
govern the six types of qi of this planet’s
weather patterns. This is evident in remnant
prescription names such as Qing Long Tang
(Blue-Green Dragon Decoction ), Bai
Hu Tang (White Tiger Decoction ),
and Shen Wu Tang (Black (True) Warrior
Decoction ).
The research mentioned above shows that
these prescriptions were originally listed
in identical or slightly varied form in the
aforementioned work named the Decoction
Classic (Tang Ye Jing) written by unidentified
authors in the western Han dynasty. This
book was lost to the ravages of time but
parts of it were preserved in Tao Hong-
Jing’s37 writings called Secret Instructions
for Assisting the Body and Essential
Methods for the Application of Herbs for
Yang and Yin Organs (Fu Xing Jue Zang
Fu Yong Yao Fa Yao )38
retrieved in the 1930s from the Dun Huang
caves in Northwest China. In this book, the
authors list a table of 25 herbs outlined
along a five phase-five flavours grid. Of
these categories, the wood category of herbs
is a collection of pungent herbs to stir wind
with the objective of reviving fire through
the functional tonification of its wood
mother. The herbs in this category then
each have an elemental affinity through
their respective signatures conditioned by
their natural appearance in the phenomenal
world. The five herbs of the wood class
are: Gui Zhi (Cinnamomi Ramulus) as
the wood herb of the wood class and the
governor of the category through its woody
branch-like signature; Shu Jiao or Chuan
Jiao (Zanthoxyli Pericarpium) is the most
spicy fire herb of the wood class linked with
the Heart through its hollow, chamber-like
shape and red color; Jiang, ginger, both raw
and dried, is the earth herb of the wood
class because of its yellow colour and earth

warming action; Xi Xin (Asari Herba) is
the metal herb of the wood class with its
Lung affinity conditioned by its leaves; and
Fu Zi (Aconiti Radix Lateralis Preparata) is
the water herb of the wood class, pungent
hot to warm the Kidneys through its black
colour of the water element. These five
herbs are the core herbs to warm Wu Mei
Wan and provide the necessary pungency
to balance the strong dominant sour and
bitter flavours. Since in Wu Mei Wan all five
solid organs of the yin conformations are
cold as established in the aforementioned
line 338 of the Shang Han Lun, these five
herbs warm the five solid organs, one each.
And then finally the formula contains sweet
herbs in compliance with Nei Jing chapter
22 instructions on flavour architecture to
moderate the Liver39 and nourish earth40.
Dang Gui (Angelicae Sinensis Radix) is the
core jue yin blood nourishing and wood
urgency moderating herb, while Ren Shen
(Ginseng) is the sweet earth herb of the
herb class41 to replenish nutritive qi within
the tai yin conformation.
Expanded clinical use of Wu Mei Wan
The Shang Han Lun indicates the use of Wu
Mei Wan for the treatment of visceral cold
resulting in Roundworm Reversal. It also
mentions its applicability in the treatment
of chronic diarrhoea (the latter indication
being unverifiable as to whether this was
added during the later editions of the Shang
Han Lun by other authors). But in clinic,
once the mechanism of jue yin disease
and the treatment of wind is understood
properly, the application of Wu Mei Wan can
be opened up to a larger variety of disorders.
A quick glance at recent research literature
from China reveals articles pertaining to
the use of Wu Mei Wan in the treatment of
the following selection of illnesses, to name
but a few: roundworm infection42, chronic
cholecystitis43, chronic diarrhoea44, chronic
asthma45, diabetic gastroparesis46, chronic
atrophic gastritis47,48, chronic renal failure49,
chronic colitis50, ulcerative colitis51,52,53,
angina54, urticaria55, menorrhagia56, etc.
Following are three anecdotal case
histories from personal practice illustrating
the use of Wu Mei Wan in greatly differing
conditions.
feature
‘’
Case 1:
Interstitial cystitis and idiopathic vertigo
A female patient, 55, presented with severe
lower abdominal pain and urinary frequency. The wood category of
The pain was strongly contracting. Urinary herbs is a collection of
frequency was about once every half hour
pungent herbs to stir
during daytime and up to 10 times at night.
wind with the objective of
The urine was clear. She also suffered from
insomnia with some difficulty falling asleep reviving fire through the
and frequent waking. Furthermore, she functional tonification of
had an idiopathic “vestibular disturbance” its wood mother.
causing severe bouts of vertigo. The vertigo
could be severe at times causing loss of
balance and falling over. Accompanying
the vertigo was a sense of vibration in the
thoracic and cervical spine contributing
to the restlessness and insomnia at night.
Lastly, the patient suffered from heartburn
due to acid reflux, often feeling a sense of
pressure on the stomach. Pulses overall
were weak. There was a wiry and slightly
hollow quality on the left guan (medial
pulse), along with a deep cun (distal pulse)
and deep but slightly tight chi (proximal
pulse). The right hand pulses were thin
wiry at guan with a deeper cun and thin
wiry deeper chi position. The diagnosis was
jue yin disease with visceral reversal: zang
jue. The prescription was Wu Mei Wan with
Zhen Wu Tang (True Warrior Decoction)
incorporated as modification. Ban Xia
(Pinellia) was added to introduce the core
structure of Ban Xia Xie Xin Tang to drain
the epigastrium, treat reflux and promote
sleep.
Wu Mei 48g Mume Fructus
Huang Lian 3g Coptidis Rhizoma
Huang Qin 9g Scutellariae Radix
Gui Zhi 3g Cinnamomi Ramulus
Chuan Jiao 1g Zanthoxyli Pericarpium
Xi Xin 3g Asari Herba
Fu Zi 15g Aconiti Radix Lateralis Prep.
Gan Jiang 9g Zingiberis Rhizoma
Ren Shen 3g Ginseng Radix
Ban Xia 12g Pinelliae Rhizoma Prep.
Dang Gui 3g Angelicae Sinensis Radix
Bai Shao 9g Paeoniae Radix Alba
Bai Zhu 9g Atractylodis Macrocephalae
Fu Ling 9g Poria
The patient returned after one week and
had experienced great improvement. The
The Lantern 33
 feature
‘’
abdominal pain was all but gone. Urination
had reduced to about five or six times per
day; nocturia was still four to five times per
night. The dizziness was slightly better. The
In clinic, once the vibrations in the spine were slightly better.
mechanism of jue yin The insomnia had improved, although
disease and the treatment the patient still used sleeping medication.
The heartburn had recently flared up with
of wind is understood
some increased pressure in the chest but
properly, the application
this might have been due to diet. The pulse
of Wu Mei Wan can be showed overall similar qualities with slight
opened up to a larger less hollow left guan, though wiriness
variety of disorders. was now more emphasised. The same
prescription was dispensed.
On the next visit, the patient reported no
more abdominal pain. Urination during the
day had normalised. Night-time urination
varied between two and four times per
night. The daytime loss of balance was less
noticeable. Night-time vibrations in the
spine still persisted but had also improved.
Insomnia was on and off. Some nights
she slept well, even without medication.
Other nights she needed her medication.
The problem now was mostly with falling
asleep. The pulses were overall less excessive
and softer though the main trend was still
the same. The actual shao yin conformation
quality of faintness and depth was starting
to appear more prominently.
The patient was advised to continue taking
this prescription. After a period of about two
more months, the improvements had mostly
stabilised. The stomach was now completely
normal. Now the main problem was clearly
the dizziness, poor balance and occasional
insomnia. Pulses showed an overall deep
thin wiry left guan. Left cun was deep and
weak. Left chi was deep and slightly tight.
All pulses were weak. Right hand cun was
deep weak, guan was thin wiry and chi was
deep weak and slightly tight. Left guan was
weaker than right guan. Wu Mei Wan was
continued for another few months with
increased emphasis on Zhen Wu Tang and
Fu Zi (Aconiti Radix Lateralis Preparata) in
particular through its increased dosage to
30 grams. After the use of Wu Mei Wan was
halted, the treatment then carried on with
variations of Zhen Wu Tang, sometimes
combined with Dang Gui Shao Yao San
(Dang Gui and Peony Powder). The patient
is still under continued care. The urinary
bladder flares less than once a year.
34 Vol 5–3
Case 2:
Hypertension and diabetes
A male patient, 65, presented with chronic
hypertension unresponsive to treatment.
He was diabetic and suffered mild drug-
induced kidney function impairment as
evident in blood tests. Hypertension was
diagnosed 20 years ago, while the diagnosis
of diabetes was made 10 years previously.
Average blood pressure was 180/95 mmHg
with spikes of up to 250/140 mmHg. The
patient was taking multiple medications
for hypertension such as Benicar 20 mg qd
(Olmesartan Medoxomil, ACE inhibitor),
Corec 20 mg qd (Carvedilol Phosphate,
beta-blocker) and Aldectone 75 mg qd
(Spiro­nolactone, aldosterone antagonist),
but all to limited or no avail. Currently the
patient was trying to manage his diabetes
with proper diet but glucose levels hovered
around 300 mg/100ml fasting. He had
seen an unrelenting increase in both blood
pressure and blood glucose in the past six
months. The patient suffered asymptomatic
brachycardia and arrhythmia of which
he was mostly unaware but discovered
when he saw a cardiologist for his fatigue
and shortness of breath. However, further
findings were inconclusive. The patient
urinated three to five times per night; urine
colour was generally clear. Pulses showed a
deep left cun, with tight wiry and somewhat
hollow left guan, and a deep tight left chi.
Right hand pulses showed a deep tight cun,
with a deep thin and wiry tight guan, and
a deep chi position. Diagnosis was jue yin
disease with visceral reversal: zang jue. The
prescription was Wu Mei Wan plus Zhen Wu
Tang to address Kidney water metabolism.
Wu Mei 48g Mume Fructus
Huang Lian 6g Coptidis Rhizoma
Huang Bai 3g Phellodendri Cortex
Gui Zhi 6g Cinnamomi Ramulus
Chuan Jiao 1g Zanthoxyli Pericarpium
Gan Jiang 3g Zingiberis Rhizoma
Xi Xin 3g Asari Herba
Fu Zi 6g Aconiti Radix Lateralis Prep.
Ren Shen 3g Ginseng Radix
Dang Gui 3g Angelicae Sinensis Radix
Bai Shao 6g Paeoniae Radix Alba
Bai Zhu 6g Atractylodis Macrocephalae
Fu Ling 12g Poria

The patient returned after one week and
reported a steady decline in blood pressure
readings to an average of 160/90 mmHg
with occasional drops as low as 145/85
mmHg. Blood glucose averaged 180 mg/100
ml about three hours after his meals. His
nocturia had decreased to once or twice
per night. The left pulse showed a deep cun
failing to rise, along with a deep wiry tight
guan, and a deep tight chi. Right pulses
displayed a deep tight cun, with a deep
wiry tight guan, and a deep weak chi. The
pulses also showed an emphatic knotted (jie
) quality. The previous prescription was
continued.
At week two, the patient returned and
reported an average blood pressure of
140/85 mmHg with occasional lows of
135/80 mmHg. The heart rate however had
slowed to around 40 bpm with lows of 35
bpm. The overall pulse quality was similar
to the previous two weeks but there was
again an emphatic knotted quality. It was
concluded that the sour flavour of Wu Mei
strongly reduced the wind of the wood
element and as a result slowed down the
heart rate. Wood is the mother of fire and
direct reduction of wood here seemed to
negatively influence fire. The prescription
was modified to support Heart yang by
increasing Gui Zhi to 12 grams.
The patient returned at week three and
reported an average blood pressure of 115/75
mmHg. Heart rate had picked up to an
average of 65 bpm. The patient’s physician
had decreased the dose of Spironolactone
to 50 mg qd. The same prescription was
continued.
The next week, the patient was reporting
a steady average blood pressure of 110/75
mmHg with lows of sometimes 100/70
mmHg. The treatment with Wu Mei Wan
was continued for another six months after
which it was decided to shift treatment to
focus more on management of diabetes and
recovery of Kidney functions. Ultimately, the
patient was taken off of Spironolactone and
received decreased doses of his two other
medications. Even if he was never fully taken
off the drugs, there is obvious causality
detectable between the introduction of
Chinese herbs into his picture and the
steady but rapid decline in his blood
pressure. Although the use of Wu Mei Wan
feature
‘’
in the treatment of diabetes is suggested in
contemporary Chinese literature,57 in this
patient’s case, the ultimate prescription that
lowered blood glucose to satisfactory levels
as well as decreased creatinine and BUN The heart rate however
values to within normal was Shen Qi Wan had slowed to around
(Kidney Qi Pill). 40 bpm with lows of
35 bpm. It was concluded
Case 3:
that the sour flavour of
Myoclonus and spontaneous orgasm
Wu Mei strongly reduced
Myoclonus is a symptom and not a the wind of wood element
diagnosis of a disease. It is the sudden and and as a result slowed
involuntary jerking of a muscle or group of down the heart rate. Wood
muscles. Myoclonic jerks usually are caused is the mother or fire and
by sudden muscle contractions, called direct reduction of wood
positive myoclonus. The twitching cannot here seemed to negatively
be controlled by the person experiencing it. influence fire.
Commonly the symptom is of neurological
nature, caused by the central nervous
system.
Presenting at the clinic was a female
patient, 28, who had been experiencing
negative myoclonus triggered by muscle
relaxation for an undefined number of years.
Physicians suspected a case of cortical reflex
myoclonus but tests were inconclusive.
The myoclonus manifested with a sudden
strong contraction of the rectus abdominis
muscles that looked as if the person was
trying to sit up from lying down. She also
suffered spontaneous repetitive orgasms
during the night without any external
stimulation whatsoever. She was personally
unaware of the fact but her partner noticed
the events up to 20 times per night. She
had mild acid reflux and heartburn. She
also suffered poor balance with a tendency
to fall over, as well as vertigo. On the first
visit, pulses were slippery rolling upwards
from both cun onto the thumbs. The initial
diagnosis was Running Piglet (Bentun
) and Ben Tun Tang (Running Piglet
Decoction) was prescribed. This Jin Gui
Yao Lue prescription treats adverse flow of
internal wind and ministerial fire rushing
upward.
After one week the patient returned with
only mild improvement, mostly on the
level of more relaxed back muscles. The
myoclonus was unchanged. The patient was
experiencing bloating in the lower abdomen
and slow bowel movements. Pulses were
similar to the first week and displayed an
The Lantern 35
 feature
‘’
additional wiry quality across all positions.
The diagnosis now was changed to jue yin
disease with visceral reversal: zang jue. The
prescription was Wu Mei Wan plus Zhi Shi
One can only gain mastery Shao Yao San (Unripe Bitter Orange and
Peony Powder) for the lower abdominal
of the full breadth of
fullness and pain, along with the addition
a prescription’s clinical of Zhi Gan Cao to encourage Shao Yao Gan
applicability when one has Cao Tang (Peony and Licorice Decoction)
a thorough understanding to relax muscle spasms.
of the pathophysiology of
a conformation from all Wu Mei 48g Mume Fructus
possible angles. Huang Lian 6g Coptidis Rhizoma
Huang Bai 3g Phellodendri Cortex
Gui Zhi 6g Cinnamomi Ramulus
Chuan Jiao 1g Zanthoxyli Pericarpium
Gan Jiang 3g Zingiberis Rhizoma
Xi Xin 3g Asari Herba
Fu Zi 6g Aconiti Radix Lateralis Prep.
Ren Shen 3g Ginseng Radix
Dang Gui 3g Angelicae Sinensis Radix
Bai Shao 15g Paeoniae Radix Alba
Zhi Gan Cao 9g Glycyrrhizae Radix Prep.
Zhi Shi 9g Aurantii Fructus Immaturus
The patient returned at the end of the
second week reporting good progress. The
muscles in her lower back were more relaxed
and her bowel movements much easier.
The abdominal pain had disappeared. She
was still having the myoclonus but both
frequency and intensity had decreased
markedly. The pulses were less slippery and
rolling upwards onto the cun positions on
both hands. The left hand guan position
showed an increased wiry and hollow
quality while the right hand guan was
hollow overall but weak and empty. Wu
Mei Wan was refilled with the original
modifications, but since internal wind was
still strong it was decided to increase Shao
Yao Gan Cao Tang in the prescription by
increasing Bai Shao to 30 grams.
At week three, the patient was reporting
continued improvement of the myoclonus
to the point where some days it was hardly
noticeable. The pulse, however, was still
very wiry and hollow and Bai Shao in the
prescription was increased to the same
amount as Wu Mei – 48 grams. This
prescription with occasional modifications
was continued for six more months until
the patient experienced no more myoclonus.
The spontaneous orgasms decreased in
36 Vol 5–3
frequency with the addition of Long Gu and
Mu Li but never fully disappeared.
Conclusion
This article has hopefully succeeded in
demonstrating that jue yin disease deserves
as much attention as any other chapter in
the Shang Han Lun, and that its premier
prescription Wu Mei Wan (Mume Pill) is
clinically applicable for much more than
simply roundworm infection or chronic
diarrhoea. Knowing the mechanisms
involved in the pathology is the key. One
can only gain mastery of the full breadth of
a prescription’s clinical applicability when
one has a thorough understanding of the
pathophysiology of a conformation from
all possible angles.
Endnotes
1. Shang Han Lun, line 326: “In jue yin disease,
there is consumptive thirst (xiao ke), qi surging
upwards striking the heart, painful heat in the
heart, hunger without desire to eat, vomiting of
roundworms after eating, and if purged there will
be incessant diarrhea.”
2. Huang Di Nei Jing Su Wen, chapter 68: “Over
shao yang, fire qi rules, and in the middle is seen
jue yin. Over yang ming, dry qi rules, and in the
middle is seen tai yin. Over tai yang, cold qi rules,
and in the middle is seen shao yin. Over jue yin,
wind qi rules, and in the middle is seen shao yang.
Over shao yin, heat qi rules, and in the middle is
seen tai yang. Over tai yin, damp qi rules, and in
the middle is seen yang ming.”
3. Ibid.
4. Ibid.
5. Huang Di Nei Jing Su Wen, chapter 6: “So it is
that in the separation and union of the three yin,
tai yin opens, jue yin closes and shao yin pivots.”
6. Huang Di Nei Jing Su Wen, chapter 49: “Taiyin is
zi, for in the 11th [lunar] month the ten thousand
things are all stored within the centre.”
7. In the Yi Jing hexagram 24, Fu, is “zhen
[earthquake] below and kun [earth] above”
gang zhen xia kun shang. It is also known
as “thunder within the earth” lei zai di
zhong. Kun is the second hexagram and indicates
earth. As the Yi Jing states: “earth is power of kun”
di shi kun. While the 51st hexagram Zhen
or earthquake, is considered to be “thunderous like
flowing water” jian lei, thus forming the overall

picture of the thunderous stirring of quelling water
from within the earth and the recovery of yang-like
upward movement from silent yin-like inactivity. In
Fu, one solid line appears under five broken lines,
and is the result of the extreme yin that engenders
lesser yang. This one yang line represents shao yang
ministerial fire within the earth, and resonates with
the Gallbladder.
8. Shang Han Lun, line 328: “Jue yin disease tends
to resolve between chou time [1am] to mao time
[7am].”
9. Huang Di Nei Jing Su Wen, chapter 74: “The
emperor says: The branch and root of the six qi
follow different [rules], how so? Qi Bo answers:
The qi can follow the root, some follow branch and
root, and some do not follow branch or root. The
emperor says: I would love to finally hear about
this. Qibo says: Shao yang and tai yin follow the
root; shao yin and tai yang follow the root or the
branch; yang ming and jue yin do not follow root or
branch but follow the middle qi. So for those that
follow the root, the transformation is engendered
from the root, those that follow branch and root,
can transform from branch or root, and those that
follow the middle, will transform as their middle
qi.”
10. Shang Han Lun, line 357: “When in cold
damage that has lasted six or seven days, after
great purgation, when the cun pulse is deep and
slow, and there is mild reversal flow of hands and
feet, and the lower division pulses fail to arrive, the
throat is obstructed, and there is spitting up of pus
and blood, along with incessant diarrhea, then this
is difficult to treat, and Ma Huang Sheng Ma Tang
governs.”
11. Shang Han Lun, line 371: “For hot diarrhea, with
downward heaviness, Bai Tou Weng Tang governs.”
12. Shang Han Lun, line 334: “In cold damage,
when there first is reversal and then fever, then
diarrhea imperatively will arrest spontaneously.
But when there adversely is sweating, for who has
a sore throat, then this is throat obstruction. When
there is fever without sweating, then downpour
imperatively arrests spontaneously, if it does not
stop, then there imperatively will be pus and blood.
For who has pus and blood, the throat will not
obstruct.”
13. See Endnote 1.
14. Ibid.
15. Ibid.
16. Ibid.
17. Ibid.
18. Shang Han Lun, line 225: “When the pulse is
floating but slow, there is fever on the surface but
cold in the interior, and downpour of clears and
grains, Si Ni Tang governs.”
19. Shang Han Lun, line 317: “In shao yin disease,
feature
there is downpour of clears and grains, with cold
on the interior and fever on the exterior, the hands
and feet have reversal flow, and the pulse is faint
with a tendency to expire…”
20. Huang Di Nei Jing Su Wen, chapter 22: “Liver
disease is better at dawn and worse at dusk; it is
peaceful at midnight. When the Liver desires to
disperse, swiftly eat pungent to disperse, for it is
tonified with pungent and reduced with sour.”
21. Huang Di Nei Jing Su Wen, chapter 74: “When
jue yin is in the spring … its treatment is [with]
sour and bitter…” …
22. Huang Di Nei Jing Su Wen, chapter 74: “When
wind steers the earth … treat with sour warm,
assisted by bitter sweet, and balanced by pungent.”
23. Shang Han Lun, line 338: “When in cold
damage, there is a faint pulse and reversal, and at
seven or eight days the skin is cold and the person
does not have even temporary periods of peace,
this indicates visceral reversal, not roundworm
reversal. In roundworm reversal, the person should
vomit roundworms. Now the person is still,
and then has periodic vexation, which indicates
visceral cold. Roundworms ascend and enter
one’s diaphragm, so there is vexation, but wait a
moment and it will stop. After receiving food,
there is retching and again vexation, because the
roundworms smell the malodor of food, and the
person often spontaneously vomits roundworms.
For roundworm reversal, Wu Mei Wan governs. It
also governs long-standing diarrhea.”
24. Ibid.
25. Ibid.
26. Shang Han Lun, line 277: “Spontaneous diarrhea
without thirst belongs to tai yin, for there is cold in
the solid organs, which needs to be warmed, and
for which the Si Ni family is indicated.”
27. Huang Di Nei Jing Su Wen, chapter 4: “The
abdomen is yin, the ultimate yin within yin, is the
Spleen.”
28. Huang Di Nei Jing Su Wen, chapter 4: “The
abdomen is yin, and yin within yin is the Kidney.”
29. Decoction Classic (Tang Ye Jing ) – also
referred to as Yi Yin Decoction Classic (Yi Yin Tang
Ye Jing ) or Methods of the Decoction
Classic (Tang Ye Jing Fa ) – is Chinese
medicine’s first formula classic written in Western-
Han dynasty by unknown authors. The book Ante Babic’s
is named after Yi Yin who was a Shang (1766
BCE–1027 BCE) dynasty historical figure and Tips for running
the patriarch of Chinese cuisine. The book was a successful clinic ...
structured along three classes (san pin ) of
prescriptions in similar fashion as its counterpart
Divine Farmer’s Classic of Materia Medica and
Study the classics!
recorded a total of 360 formulas. It is considered
The Lantern 37
 feature

the blueprint for Zhang Zhong-Jing’s work. ment of 11 Cases of Roundworms in the Bile- with Modified Wu Mei Wan
There is no extant copy of the work but duct with Wu Mei Wan Modified . New Journal of
records of up to 56 of its prescriptions were . New Journal of Traditional Chinese Medicine (Xin Zhong Yi
included in the works of Tao Hong-Jing, Traditional Chinese Medicine (Xin Zhong Yi 2007-1.
which were subsequently unearthed from ) 1995-1. 53. Gao, Xian-Zheng , Guo, Xing
the Cave for Sutra Storage (cang jing dong 43. Yang, Jin-Huan , (2006). (2006). Fructus Mume Pills in the Treatment
) at the Dun Huang cave complex in The Treatment of 69 Cases of Chronic of Chronic Ulcerative Colitis: Therapeutic
NW China. Cholecystitis with Modified Wu Mei Wan Effect Observation of 120 Cases
30. Cullen, Lo (eds) (2005). Medieval Chinese . Henan . Modern
Medicine, pp. 293-305. London & New York: Journal of Traditional Chinese Medicine Traditional Chinese Medicine (Xian Dai
Routledge Curzon, London & New York. (Henan Zhong Yi ) 2006-1. Zhong Yi Yao )2006-5.
31. Ibid. 44. Zhang, W. (2006). The Treatment 54. Liu He-Qiang (1994). The
32. Versluys, A. (2006). The Transmission of 48 Cases of Chronic Diarrhea with Wu Treatment of One Case of Recalcitrant
Lineage of the Canonical Formulas: An Mei Wan . Yunnan Angina with Wu Mei Wan
Investigation into the Source of Zhong Jing’s Journal of Traditional Chinese Medicine and . New Journal of Traditional
Formulas (Jing Fang Zhi Chuan Cheng Mai Materia Medica (Yunnan Zhong Yi Zhong Yao Chinese Medicine (Xin Zhong Yi )
Luo: Zhong Jing Fang Tan Yuan) Za Zhi ) 2006-6. 1994-3.
Beijing: China 45. Peng, X , Wang, Hong-Bei et 55. Lao, Chang-Hui (1995). The
State Library, Collection of Postgraduate al, (2005). Experimental Research on Zhang Treatment of 27 Cases of Chronic Urticaria
Dissertations. Zhong Jing Formulas with Wu Mei Wan
33. Ma, Ji-Xing. (1988). Philological pp. 592-593. Beijing: China Medical Science . New Journal of Traditional Chinese
Study of the Ancient Dun Huang Medical and Technology Publishing House (Zhong Medicine (Xin Zhong Yi ) 1995-6.
Texts (Dun Huang Gu Yi Ji Kao Shi Guo Yi Yao Ke Ji Chu Ban She 56. Han, Mei-Ying , Zhang, M. ,
). Nanchang: Jiangxi Science and ). Zhang, Lan-Ju (1998). The Treatment
Technology Press. 46. Zou, Shi-Chang (2002), Treatment of Menorrhagia and Oligomenorrhea
34. Jiang, Chun-Hua. (1985). Shang of Diabetic Gastroparesis by Wu Mei Pill: with Wu Mei Wan . Inner
Han Lun and Tang Ye Jing Shang Han Lun A Clinical Observation of 42 Cases Mongolia Journal of Traditional Chinese
Yu Tang Ye Jing . Journal of . New Medicine (Nei Meng Gu Zhong Yi Yao
Traditional Chinese Medicine (Zhong Yi Za Journal of Traditional Chinese Medicine )1998-3.
Zhi 10, p.61. (Xin Zhong Yi ) 2002-2. 57. Liu, Li-Hong (2002). Contemp­
35. Xu, Chun-Lin (1984). Discussing 47. Yang, Kuo-Mei. (2004). The lating Chinese Medicine pp. 458-
Yi Yin Decoctions (Lun Yi Yin Tang Ye Treatment of 78 Cases of Chronic Atrophic 459. Guilin: Guangxi Normal University
). Journal of Chinese Medicine History Gastritis with Wu Mei Wan Modified Publishing House (Guangxi Shi Fan Da Xue
(Zhong Hua Yi Shi Za Zhi , 14 . Shaanxi Chu Ban She ).
(3), p. 150. Journal Traditional Chinese Medicine
36. Wang, Shu-Min. (1991). (Shaanxi Zhong Yi ) 2004-1.
Examination of the Dun Huang Scroll of 48. Li, S. (2004). Clinical Observation of
Assisting the Body and Essential Methods Modified Wu Mei Decoction in the Treatment Bibliography
for the Application of Herbs for Hollow and of 46 Cases of Chronic Atrophic Gastritis Meng, Jing-Chun , Wang, Xin-Hua ,
Solid Organs (Fu Xing Jue Zang Fu Yong Yao Fa et al (1987). Translation and Explanation of the Plain
Yao ), Shanghai Journal . Hunan Guiding Journal of Traditional Questions of the Yellow Emperor’s Internal Canon
of Traditional Chinese Medicine (Shang Hai Chinese Medicine and Pharmacology (Huang Di Nei Jing Su Wen Yi Shi
Zhong Yi Yao Za Zhi , 3, (Hunan Zhong Yi Yao Dao Bao ). Edition used is edited by the Nanjing University
of Chinese Medicine, Taipei: Taiwan Wenguang
p.36. ) 2004-8. Book Company, Ltd (Wen Guang Tu Shu You Xian
37. Tao, Hong-Jing. (456-536 CE). 49. Yang, Kuo-Mei (2006). The Gong Si ).
Southern Dynasty herbal medicine scholar Treatment of 71 Cases of Chronic Renal Liu, Du-Zhou et al (1991). Shang Han Lun
and Daoist layman responsible for the Failure with Wu Mei Wan Modified Revision and Annotation (Shang Han Lun Jiao Zhu
preservation of and the elaboration upon the . Henan ). Beijing: People’s Medical Publishing
Shen Nong Ben Cao Jing. His most famous Journal of Traditional Chinese Medicine House (Ren Min Wei Sheng Chu Ban She
works include Separate Recordings of Famous (Henan Zhong Yi) 2006-2. ).
Physicians Ming Yi Bie Lu , and 50. Liu, Gui-E (2001). The Treatment Qian, Chao-Chen , Wen, Chang-Lu
Collected Annotations on the Materia Medica of 32 Cases of Chronic Colitis with Wu Mei , et al, (2004). Zhang Zhong-Jing Research
Classic Ben Cao Jing Ji Zu . Wan Modified Compendium (Zhang Zhong-Jing Yan Jiu Ji Cheng
38. See Endnote 36. . Anhui Clinical Journal of Traditional ). Beijing: China Medical Classic
39. Huang Di Nei Jing Su Wen, chapter 22: Chinese Medicine (Anhui Zhong Yi Yao Lin Publishing House (Zhong Guo Gu Yi Ji Chu Ban
“The Liver rules spring, and governs the foot Chuang Za Zhi ) 2001- She ).
jue yin and shao yang channels, its days are 4. Qiu, Pei-Ran , et al, (2002). Great
jie and yi, for when the Liver suffers urgency, 51. Chen, Ya-Bing Chen, Yi-Feng Encyclopedia of Chinese Medical Works (Zhong
Guo Yi Ji Da Ci Dian .) Shanghai:
swiftly eat sweet to moderate.” (2005). The Treatment of 46 Cases Shanghai Science and Technology Press (Shanghai
of Ulcerative Colitis with Wu Mei Wan Ke Xue Ji Shu Chu Ban She ).
Compared with Control Group of 45 cases Yang, L. (1989). Zhouyi and Chinese Medicine
40. Huang Di Nei Jing Su Wen, chapter 22: of Western Medicine Treatment (Zhou Yi Yu Zhong Yi Xue ). Beijing:
“[When] the Spleen desires to be moderated, Beijing Science and Technology Press (Beijing Ke
swiftly eat sweet to moderate, for bitter is . Zhejiang Journal of Traditional Chinese Xue Ji Shu Chu Ban She ).
used to drain, and sweet is used to tonify.” Medicine (Zhejiang Zhong Yi Za Zhi) 2005- Mitchell, C., Wiseman, N., Feng, Y. (1999). Shang Han
10. Lun: On Cold Damage. Brookline, MA: Paradigm
52. Yang, Hong-Bo , Luo, Yu-Mei Lo, V., Cullen, C. et al (2005). Medieval Chinese
41. See Endnote 36. , Wang, Jing-Bo (2007) The Medicine: The Dunhuang Medical Manuscripts.
42. Yin, You-Xue. (1995). The Treat­ Treatment of 44 Cases of Ulcerative colitis London and New York: Routledge Curzon.

38 Vol 5–3