Promotes urination, drains Dampness, strengthens the Spleen, warms the Yang and promotes Qi transformation

For Greater Yang (Tai-Yang) stage disorder

1. Headache, fever, irritability and a strong thirst but vomiting immediately after drinking.
   Urinary difficulty and a floating pulse. A Greater Yang (Tai-Yang) stage disorder.
2. Oedema, generalised sensation of heaviness, urinary difficulty, diarrhoea.
   Possible vomiting and diarrhoea due to ‘sudden turmoil disorder’.
3. Throbbing pulsations just below the umbilicus, vomiting frothy saliva.
   Vertigo, shortness of breath and coughing.

• Ze Xie (chief) sweet, bland and cold, leaches Dampness and promotes urination by entering the Bladder and clearing Heat (which all pathogenic influences in the Bladder become).
• Fu Ling (deputy) is very effective at leaching Dampness by strengthening the Spleen Yang to promote urination in cases of deficiency.
• Zhu Ling (deputy) leaches Dampness and promotes urination.
• The chief and deputies work together to drain Dampness, unblock and regulate the urinary pathways and drain Heat from the Bladder. The Spleen is averse to Dampness, and the retention of fluids impairs the Spleen Qi’s ability to transform and transport fluids.
• Bai Zhu (assistant) strengthens the Spleen and aids the T & T of fluids to reduce Dampness.
• Gui Zhi (assistant & envoy) warms the ‘Fire of the Gate of Vitality’ to assist the Bladder in transforming and discharging urine, it also helps the Spleen Qi to raise up Dampness and assist the Kidney Yang ‘steam’ and move fluids.

• Severe oedema: add Sang Bai Pi, Chen Pi and Da Fu Pi
• Cold-Damp urinary obstruction with thirst and urinary difficulty: add Qiang Huo
• Damp-Heat diarrhoea: omit Bai Zhu and Gui Zhi, and add Yin Chen Hao and Jin Yin Hua
• Concurrent oedema and Qi obstruction due to excessive water retention: take with Wu Pi Yin

• This formula is for disorders of water metabolism marked by the inability of Qi to transform Dampness, however, the formula was originally for a Greater Yang (Tai-Yang) stage disorder:
• 1. Water build-up when pathogens have not been released from the Exterior but penetrate to the Greater Yang organ, the Bladder. The headache, fever, irritability and floating pulse indicate an Exterior condition. The pathogen disrupts the Bladder function causing water retention and the obstruction of upward water movement and excretion. This creates a strong thirst but fluids are vomited as they cannot be transported downwards.
• 2. Spleen Qi deficiency leads to a failure to transport water, leading to accumulation and internal Dampness, which flows into the muscles and skin, causing oedema and a sensation of heaviness. The Spleen’s failure to transform and transport fluids may cause urinary difficulty and diarrhoea. The Triple Burner can become obstructed, preventing the ascent of clear Yang and descent of turbid Yin, resulting in the simultaneous vomiting and diarrhoea of ‘sudden turmoil disorder’.
• 3. Retention of fluids in the lower Jiao causes a throbbing pulsation below the umbilicus. The congested fluids cause a rebellion (vomiting) of frothy saliva. Obstruction of the clear Yang causes vertigo, and congested fluids affecting the Lungs cause shortness of breath and coughing.
• With the appropriate presentation, the formula may be used for acute or chronic nephritis, chronic renal failure, congestive heart failure, ascites from liver cirrhosis, Meniere’s disease, infectious hepatitis, gastroptosis, acute gastroenteritis, gastrectasis, acute enteritis, genitourinary infections, neurogenic bladder syndrome and hydrocele.

• In Spleen or Kidney Qi deficiency cases, the dosage and duration must be carefully limited.
• In deficiency cases this formula is often paired with Qi tonics to prevent injury to the normal Qi
• In cases of Yin deficiency urinary difficulty the formula needs modification to protect the Yin
• Symptoms of overdose include dizziness, vertigo, a bland taste and reduced appetite

Dries Dampness, improves the Spleen transporting function, promotes Qi movement, harmonises the Stomach

• Distension and fullness in the epigastrium and abdomen, acid reflux
• Loss of taste and appetite
• Nausea, belching or vomiting
• A heaviness to the limbs
• Loose stools and diarrhoea
• A lack of energy and a greater wish to sleep
• A swollen tongue with a thick, greasy white coating
• A moderate or slippery pulse

• Cang Zhu (chief) acrid, bitter and warm, is excellent at dispelling Dampness and strengthening the Spleen transporting function.
• Hou Po (deputy) dispels Dampness and fullness, and works with Cang Zhu to dry Dampness and strengthen the Spleen.
• Chen Pi (assistant) regulates QI and transforms Dampness by promoting Qi and fluid movement. It also assists Hou Po to direct rebellious Qi downwards and eliminate distension.
• Zhi Gan Cao (envoy) tonifies the Spleen, enhancing their Spleen strengthening properties and harmonising the actions of the other herbs.
• Sheng Jiang and Da Zao gently regulate the Stomach and Spleen relationship

• Severe Damp-Cold with generalised cold and pain: add Rou Gui and Gan Jiang
• Damp-Heat with a bitter taste, dry throat with no thirst and a yellow greasy tongue coating: add Huang Qin and Huang Lian
• Food stagnation with severe distension and constipation: add Lai Fu Zi, Da Fu Pi and Zhi Ke
• Severe vomiting: add Ban Xia
• Severe Spleen deficiency with no appetite with less distension and fullness: swap Cang Zhu for Bai Zhu, and add Huang Qi and Shan Yao
• Stones in the bile duct: add Yin Chen Hao, Zhi Zi and Yu Jin

• This is the most popular formula for Damp-Cold stagnating in the Spleen and Stomach. The cardinal symptoms are distension and fullness in the epigastrium and abdomen, and a thick, greasy white tongue coating.
• When deficiency is the main driver of the accumulation of Dampness, Bai Zhu should be used in place of Cang Zhu (see Adaptations).
• With the appropriate presentation, the formula may be used for chronic or acute gastroenteritis, gastric neurosis, peptic ulcer, infantile indigestion, and to induce labour

• The formula is warm and drying and could injure Yin and Blood; the formula needs modification to protect the Yin or Blood in cases of Yin or Blood deficiency.
• Use with caution during pregnancy.

Releases the Exterior, transforms Dampness, regulates the Qi and harmonises the middle Jiao

• Fever and chills, headache
• A feeling of fullness and stifling oppression in the chest
• Pain in the epigastrium and abdomen
• Nausea and vomiting, borborygmus, diarrhoea, loss of taste
• A white, greasy tongue coating
• A moderate, soggy pulse
• Also for ‘miasmic malarial disorder’ with intermittent fever and chills, disorientation, and madness with delirious speech or loss of voice

• Huo Xiang (chief) acrid and aromatic, addresses all major aspects of this condition by dispelling Wind-Cold, transforming turbid Dampness, reviving the Spleen and stopping vomiting.
• Hou Po and Chen Pi (deputies) reinforce Huo Xiang’s actions in the middle Jiao by moving Qi and transforming fluids to reduce the feelings of fullness and oppression.
• Zi Su Ye and Bai Zhi (deputies) assist Huo Xiang dispel External Cold, with Zi Su Ye also harmonising the middle Jiao, and Bai Zhi treating headaches.
• Ban Xia (assistant) harmonises the Stomach and Spleen and stops vomiting.
• Da Fu Pi (assistant) moves QI and promotes water metabolism (in the lower Jiao).
• Bai Zhu and Fu Ling (assistants) strengthen the Spleen and transform Dampness.
• Jie Geng (assistant) promotes Lung and diaphragm function.
• Zhi Gan Cao, Sheng Jiang and Da Zao (envoys) harmonise the other herbs actions and regulate the Spleen and Stomach.

• Severe Wind-Cold: increase the dose of Zi Su Ye
• Food stagnation: omit Gan Cao and Da Zao and add Shen Qu and Ji Nei Jin
• Severe Dampness with very thick tongue coating: swap Bai Zhu for Cang Zhu
• Brief, scanty urination: add Mu Tong and Ze Xie

• For externally-contracted Wind-Cold with significant internal turbid Dampness.
• The traditional cardinal symptoms are abdominal pain, vomiting and diarrhoea, with signs of an exterior condition.
• The formula is also effective for post-viral syndrome with turbid Yin obstructing the sensory organs of the head causing tiredness, vertigo, loss of taste and smell and body aches.
• The herbal groupings are well balanced and (i) release the Exterior, (ii) promote internal Qi movement, (iii) promote an ascending action, and (iv) cause turbid rebellious QI to descend.
• The Systematic Differentiation of Warm Diseases (Wen Bing Tiao Bian) has five associated formulas.
• With the appropriate presentation, the formula may be used for cases of ‘flu, intestinal ‘flu, non-specific acute colitis and acute gastroenteritis.

The formula contains warm and drying herbs, and it should not be used in cases of Wind-Heat or deficiency Fire without significant modification.

Disseminates the Qi, facilitates the Qi mechanism and clears Damp-Heat

Clears Damp-Heat from the Qi Level

• Headache, chills, afternoon fever
• A heavy sensation in the body, generalised pain
• A pale-yellow complexion, a stifling sensation in the chest
• Loss of appetite and an absence of thirst
• A white tongue coating
• A wiry, thin and soggy pulse

• Xing Ren (chief) bitter, warm unblocks the flow of Lung Qi and allows it to descend to correct the function of the ‘upper source of water’ and encourages urination.
• Bai Dou Kou (chief) acrid, warm transforms turbid Dampness in the middle Jiao and revives the Spleen dynamic.
• Yi Yi Ren (chief) sweet, bland, sl. cold, leaches Damp-Heat from the lower Jiao and promotes urination while strengthening the Spleen to transform Dampness.
• These three ‘nut’ herbs act together to open the flow of Qi through the three Jiao and Qi level.
• Hou Po and Ban Xia bitter, warm and drying (deputies) treat epigastric and abdominal distension due to Dampness or Phlegm and have a descending action to assist the chiefs to move Qi and free up the Qi dynamic.
• Tong Cao, Dan Zhu Ye and Hua Shi (assistants) resolve Dampness by promoting urination and also clear Heat.

• Severe headache and aversion to cold: add Huo Xiang and Zi Su Ye
• Severe fever, dark urine and red tongue: add Yin Chen Hao, Zhi Zi and Huang Qin
• Alternating fever and chills: add Qing Hao and Cao Guo
• Extreme stifling sensation in the chest and focal distension in the epigastrium: add Qian Hu and Huo Xiang

• Damp-Heat in the Protective and Qi Levels with Dampness predominant (esp in the upper Jiao)
• The condition is most common in the late summer or early autumn, but it can linger for long periods of time, appear to resolve and reappear during humid weather or when normal Qi is weakened.
• Mistreatment of the condition can be disastrous:
• 1. As an exterior condition with diaphoretics, the Dampness will rise up and create confusion, irritability and reduced sensory acuity
• 2. As an accumulation disorder with purgatives, the Spleen Yang will collapse and result in severe diarrhoea
• 3. As Yin deficiency due to the afternoon fever, the cloying herbs will push the pathogen to a deeper level, where it will stubbornly resist treatment
• With the right presentation, this formula is appropriate for enteric fever, nephritis, post-operative fever, bronchitis, Cytomegalovirus and Bruscellosis

Clears Heat, resolves Dampness and reduces jaundice

• Whole-body jaundice, with a ‘fresh tangerine’ colour
• Slight abdominal distension
• Urinary difficulty
• Thirst (with the ability to only take sips)
• Sweating only from the head (also)
• A greasy yellow tongue coating
• A slippery, rapid pulse

• Yin Chen Hao (chief) bitter, sl cold, can be used to treat all forms of jaundice, but especially Damp-Heat type.
• Zhi Zi (deputy) clears Heat from the three Jiao and drains Damp-Heat via the urine.
• Da Huang (assistant) clears Heat to support the other two herbs. It also invigorates the Blood to encourage smooth flow through the Liver and benefits the Gallbladder to help reduce jaundice.

• High fever and other signs of extreme heat: add Long Dan Cao, Ban Lan Gen and Hu Zhang
• Fever and chills: add Lian Qiao and Ye Ju Hua
• Difficult and irregular bowel opening with loose stools: add Pei Lan
• Hypochondriac pain and other LQS symptoms: add Chai Hu, Chuan Lian Zi, Xiang Fu and Bai Shao
• Nausea, vomiting and reduced appetite: add Zhu Ru, Ban Xia and Shen Qu
• Gall stones: add Jin Yin Hua

• For Damp-Heat jaundice in the middle Jiao, especially when Heat is predominant.
• Da Huang can easily injure the normal Qi and should be discontinued as soon as bowel movements become smooth. If there is rebound constipation, it should be replaced with a milder laxative (Qin Jiao or Dong Gua Ren)
• With the appropriate presentation the formula may be used for acute hepatitis, hepatic necrosis, cirrhosis, cholecystitis, gallstones, malaria, typhoid fever and leukaemia

• Contraindicated for Yin-type jaundice or Damp-predominant jaundice without modification
• Da Huang should be used with extreme caution during pregnancy

Clears Heat, promotes urination, and unblocks the urinary passages

• Dark, scanty, turbid, difficult and painful urination
• A dry mouth and throat
• Severe cases involve urinary retention, lower abdominal distension and pain
• A yellow tongue coat
• A slippery, rapid pulse

• Mu Tong (chief) bitter & cold, clears Heat, promotes urination, and effectively removes stagnation due to Damp stagnation.
• Hua Shi, Qu Mai and Bain Xu (deputies) clear Damp-Heat by promoting urination to assist the chief in unblocking painful urinary dysfunction.
• Zhi Zi, Da Huang (assistants) indirectly treat painful urinary dysfunction by draining Heat, via the urine and stool respectively.
• Deng Xin Cao (envoy) guides Heat downwards.
• Gan Cao harmonises the actions of the other herbs and relieves abdominal pain, and with Hua Shi helps to relieve irritability.

• Add Mu Xiang to increase the Bladder Qi transforming function and prevent the Cold herbs from injuring Yang Qi (Zhu Dan-Xi)
• Bloody painful urinary dysfunction: increase the dose of Bian Xu and add Bai Mao Gen and Xiao Ji
• Stony painful urinary dysfunction: add Jin Qian Cao, Hai Jin Sha and Huai Niu Xi
• Cloudy painful urinary dysfunction: add Bie Xi and Chang Pu
• Urinary retention: increase Mu Tong, Hua Shi and Bian Xu and add Huang Bai and Rou Gui
• Stomatitis: add Dan Zhu Ye and Sheng di Huang

• For clumping of Damp-Heat in the lower Jiao and commonly used for hot or bloody urinary dysfunction.
• Also indicated for Heat in the Heart channel with a parched throat, severe thirst, irritability, red and painful eyes, scorched lips and sores in the mouth, tongue and throat.
• With the appropriate presentation, the formula may be used for glomerulonephritis, cystitis, urethritis, urinary tract calculi, prostatitis and stomatitis.

• Long-term use can cause weakness, vertigo, palpitations and loss of appetite
• It shouldn’t be used for deficiency Cold conditions or in pregnancy

Clears Heat and dries Dampness

A wide range of complaints involving scanty yellow urine and a greasy yellow tongue coating:
1. Pain in the lower back or extremities
2. Weakness in the lower back or extremities
3. Red, hot, swollen and painful knees and or feet
4. A thick, yellow, foul-smelling vaginal discharge
5. Sores on the lower limbs due to dampness

• Huang Bai bitter & cold treats Damp-Heat in the lower Jiao.
• Cang Zhu bitter & warm dries Dampness.
• Together they elegantly and powerfully clear Damp-Heat from the lower Jiao.

• Pain in the lower back: add Huai Niu Xi, Mu Gua and Wu Jia Pi
• Atrophy disorder as the main complaint: add Xi Xian Cao and Wu Jia Pi
• Leg Qi as the main complaint: add Yi Yi Ren, Chi Xiao Dou and Bing Lang
• Leukorrhoea: add Chi Fu Ling and Qian Shi
• Sores on the lower limbs as the main complaint: add Long Dan Cao, Yi Yi Ren and Chi Xiao Dou

• For Damp-Heat lodging in the lower Jiao; it’s this is usually the basis for a larger formula and is very effective at treating atrophy disorders due to Damp-Heat.
• With the appropriate presentation, it’s effective for urinary tract infections, vaginitis, cervicitis, hepatitis, rheumatoid arthritis, gouty arthritis, gonococcal arthritis and beriberi.

The formula should not be used without modification in cases of Liver and Kidney deficiency or Lung Heat

Warms the Yang and promotes urination

For Greater (Tai) Yang Stage disorders

• Abdominal pain that’s made worse with the cold
• Urinary difficulty
• Deep aching heaviness in the extremities
• Generalised oedema, loose stools
• Dizziness, a heavy sensation in the head
• Palpitations
• Coughing, vomiting
• A pale or dark swollen tongue with tooth marks and a slippery white coating
• A submerged, thin and forceless pulse
• [Kidney Yang deficiency or Spleen & Kidney Yang deficiency with retention of pathogenic water]

Also for:

• Externally-contracted disorders with sweating that doesn’t reduce the fever
• Palpitations in the epigastrium
• Dizziness
• Shivering and trembling with an unsteady appearance
• A white, slippery tongue coating
• A deep, thin and forceless pulse
• [Externally-contracted Wind-Cold at the Greater (Tai) Yang Stage]

• Fu Zi (chief) very hot and acrid, restores the Kidney Yang and enables the Kidneys to resume their function of transforming water.
• Bai Zhu and Fu Ling (deputies) strengthen the Spleen, promote urination and drain Dampness.
• Sheng Jiang (assistant) warms and dispels pathogenic water to support the deputy herbs. It also warms the Stomach, disseminates Lung Qi and assists Fu Zi by dispelling the Dampness that has overflowed into the skin and flesh.
• Bai Shao prevents the hot, dry herbs from injuring the Yin and alleviates pain.

• Greater Spleen Yang deficiency: omit Bai Shao and add Gan Jiang
• Coughing: add Wu Wei Zi, Xi Xin and Gan Jiang
• Frequent urination: omit Fu Ling
• Palpitations, wheezing or coughing of copious watery sputum: add Wu Wei Zi and Xi Xin
• Unremitting spontaneous sweating due to Yang deficiency and Exterior instability: add Ren Shen, Huang Qi and Wu Wei Zi
• Painful obstruction of the chest: add Gua Lou Ren, Xie Bai, Gui Zhi and Dan Shen
• Leucorrhoea due to Damp-Cold: add Gui Zhi and Dang Shen
• Chronic bronchitis with Kidney and Spleen Yang deficiency: swap Sheng Jiang for Gan Jiang
• Rheumatoid arthritis: add Gui Zhi and Dang Shen

• 1. For retention of pathogenic fluids with Kidney Yang deficiency, where the Kidney Qi is unable to transform water, which accumulates in a pathogenic state in the lower Jiao and causes urinary difficulty and abdominal pain worsened by cold.
• Kidney Yang is the root of the body’s Yang Qi and supports the transformative and generative processes of other organs, and as a result, Spleen Yang deficiency usually accompanies Kidney Yang deficiency.
• Spleen Yang deficiency results in an inability to transform and transport water and Dampness, which can spill over into the skin and flesh, causing oedema, aching, heaviness and loose stools.
• The water and Dampness prevent the ascent of clear Yang and the descent of turbid Yin, resulting in dizziness, a heavy head and abdominal pain
• 2. Also for externally-contracted Greater (Tai) Yang Stage disorders when sweating fails to reduce the fever, and palpitations in the epigastrium.
• The continuous loss of fluids causes the body to wither and severely depletes Yang Qi. The sinews, muscles and channels are deprived of nourishment and warmth, manifesting as shivering, trembling and unsteadiness.
• With the appropriate presentation, the formula may be used for chronic nephritis, rheumatic valvular heart disease, congestive heart failure, liver cirrhosis & other chronic hepatic disorders and other causes of oedema and ascites, chronic enteritis, intestinal tuberculosis, chronic diarrhoea, Meniere’s disease, primary hypertension, rheumatoid arthritis, and chronic bronchitis.

Expels Wind and overcomes Dampness

• A heavy and painful head
• A generalised sensation of heaviness or pain, especially in the back
• Difficulty rotating or bending the trunk
• Chills, mild fever
• A white tongue coating
• A floating pulse

• Qiang Huo (chief) expels Wind-Dampness from the upper section of the Greater (Tai) Yang channel.
• Du Huo (chief) expels Wind-Dampness from the lower section of the Greater (Tai) Yang channel and together the chiefs effectively treat Wind-Dampness.
• Gao Ben and Fang Feng (deputies) expel Wind and Dampness from the Exterior aspects of the Greater (Tai) Yang channel and reinforce Qiang Huo’s ability to treat headaches.
• Chuan Xiong (assistant) treats the headaches and invigorates Blood to help relieve heaviness and pain.
• Man Jing Zi (assistant) also teats headache.
• Gan Cao (envoy) harmonises the actions of the other herbs.

• Hot, painful joints: add Cang Zhu, Huang Bai, Guang Fang Ji and Yi Yi Ren
• Severe cases: add Fu Zi

• For Wind-Dampness in the exterior and muscle layer, especially affecting the upper body, where the Exterior symptoms are less severe than the generalised aches, pain and heaviness.
• The required response is a mild sweat to avoid injuring fluids or Yang.
• With the appropriate presentation, the formula may be used for upper respiratory tract infections, rheumatic fever and muscular headaches.

Use with caution in cases with Heat or constitutional Yin deficiency

Expels Wind-Dampness, disperses painful obstruction and tonifies deficiency

• Heaviness and pain in fixed locations in the lower back and legs
• Stiffness and weakness of the lower back and legs
• Possible numbness and paresthesia
• An aversion to cold and a desire for warmth
• Palpitations and shortness of breath
• A pale tongue with a white coating
• A thin, weak pulse

• Du Huo (chief) expels Wind, Dampness and Cold from the lower Jiao, bones and sinews.
• Xi Xin (deputy) scatters Cold in the channels and scours Wind-Dampness from the sinews and bones to stop pain.
• Fang Feng (deputy) expels Wind and overcomes Dampness.
• Qin Jiao (deputy) relaxes the sinews and expels Wind and Dampness.
• Sang Ji Sheng, Du Zhong and Huai Niu Xi (assistants) expel Wind-Dampness and tonify the Liver and Kidneys, with Niu Xi also acting as an envoy and directing the formula to the lower extremities.
• Rou Gui (assistant) warms and unblocks the channels and fortifies Yang to open up and strengthen the lower back.
• Dang Gui, Chuan Xiong, Shu di and Bai Shao (Si Wu Tang) nourish and invigorate the Blood.
• Dang Shen and Fu Ling strengthen the Spleen to promote the transformation of fluids.
• Zhi Gan Cao tonifies the middle Jiao and harmonises the actions of the herbs in the formula.

• Severe pain: add Bai Hua She, Di Long and Hong Hua
• Severe Cold: add Fu Zi and Gan Jiang
• Severe Dampness: add Guang Fang Ji and Cang Zhu
• Few signs of deficiency: omit Dang Shen. Bai Shao and Sheng di
• Sequelae of poliomyelitis: add San Qi, Wei Ling Xian and Mu Gua

• For painful obstruction (Bi) syndrome with Liver and Kidney deficiency, and atrophy disorder with wasting in the lower limbs.
• With the appropriate presentation, the formula can be used for osteoarthritis, rheumatoid arthritis, chronic lower back pain, sciatica and sequelae of poliomyelitis.