Formulas that Warm Interior Cold & Tonify

HBR class 10

Formulas that Warm Interior Cold

Tangkuei Decoction for Frigid Extremities (dang gui si ni tang)

C: Dang Gui, Gui Zhi Xi Xin, Bai Shao, Zhi Gan Cao, Da Zao, Mu Tong Pattern: Cold hands and feet caused by cold in the channels in a patient with underlying blood deficiency. Indications: Long-standing cold hands and feet that are both cold to the touch and feel very cold to the patient, a pale tongue with a white coating, and a submerged, thin pulse or pulse that is so thin that it is almost imperceptible.

*Regulate the Middle Pill (li zhong wan)

C: D: Gan Jiang Ren Shen

A:
E:

Bai Zhu
Zhi Gan Cao

Pattern: Middle burner cold from deficiency, also known as middle burner yang deficiency. Indications: Diarrhea with watery stool, nausea and vomiting, no particular thirst, loss of appetite, abdominal pain, a pale tongue with a white coating, and a submerged, thin pulse.

CAUTIONS AND CONTRAINDICATIONS: Because this formula contains ingredients that warm and dry, it should not be used for externally-contracted conditions with fever or yin deficiency. For sudden turmoil disorder, its use should be discontinued once the vomiting and diarrhea have stopped.

*Evodia Decoction (wu zhu yu tang)

C:
D: A:

Wu Zhu Yu
Sheng Jiang Ren Shen

E:

Da Zao

Pattern: Cold from deficiency of the Stomach (and Liver)

Indications: Used for three different presentations:

1) vomiting immediately after eating, indeterminate gnawing hunger, and acid regurgitation with or without epigastric pain due to cold from deficiency of the Stomach;

2) dry heaves or spitting of clear fluids with headache at the vertex due to cold from deficiency of the Stomach and Liver;
3) vomiting and diarrhea with cold hands and feet, and agitation so severe that the patient wants to die due to cold attacking the middle burner. In all cases the tongue is not red, but the tongue has a white, slippery coating, and the pulse is thin and slow or thin and wiry.

CAUTIONS AND CONTRAINDICATIONS: Do not use in cases of acid regurgitation or vomiting due to heat. In cases of severe vomiting, this formula should be taken at room temperature to help prevent vomiting of the formula. Possible side effects of this formula include dizziness, headache, and chest discomfort.

*Major Construct the Middle Decoction (da jian zhong C: Chuan Jiao tang)

D: A: Gan Jiang Ren Shen, Yi Tang Pattern: Weakness and deficiency of the middle burner yang (the root), and yin cold in the interior (the manifestation).

Indications: Excruciating epigastric and abdominal pain to the point that the patient cannot tolerate being touched, a strong sensation of cold in the epigastrium, vomiting to the point of being unable to eat, a white, slippery tongue coating, and a thin and tight or slow and wiry (or in especially severe cases, hidden) pulse. There may also be borborygmus.

CAUTIONS AND CONTRAINDICATIONS: This formula is contraindicated in cases with internal clumping, damp-heat, or yin and blood deficiency.

Minor Construct the Middle Decoction (xiao jian zhong C: Yi Tang, Gui Zhi tang)

Bai Shao, Zhi Gan Cao, Sheng Jiang, Da Zao Pattern: Spasmodic abdominal pain due to consumptive deficiency (xu lao); Deficiency Cold of middle burner.

Indications: Intermittent, spasmodic abdominal pain that responds favorably to local application of warmth and pressure, a lusterless complexion, reduced appetite, a pale tongue with a white coating, and a thin, wiry, and moderate pulse. There may also be low-grade fever, palpitations, irritability, cold and sore extremities with nonspecific discomfort, and a dry mouth and dry throat.

*Frigid Extremities Decoction (si ni tang)

C:
D: A:

Fu Zi

Gan Jiang Zhi Gan Cao

Pattern: Kidney yang and Spleen yang deficiency accompanied by an increase of internal cold.
Indications: Extremely cold extremities, aversion to cold, sleeping with the knees drawn up, a lethargic state with a constant desire to sleep, vomiting, diarrhea with undigested food particles, abdominal pain and cold, no thirst, a pale tongue with a white, slippery coating, and a submerged, thin or submerged, faint pulse.

Formulas that Tonify

*Four-Gentleman Decoction (si jun zi tang)

C: D: A: E: Ren Shen Bai Zhu Fu Ling Zhi Gan Cao

Pattern: Spleen Qi Deficiency

Indications: Pallid complexion, low and soft voice, reduced appetite, loose stools, and weakness in the limbs. The body of the tongue is pale, and the pulse is thin and/or frail.

CAUTIONS AND CONTRAINDICATIONS: The use of this formula for an overly prolonged period may result in a dry mouth, thirst, and irritability. It should not be used without modification in patients with high fever, heat from deficiency, or a combination of irritability, thirst, and constipation.

MODIFICATIONS / Associated Formula #1: Six-Gentleman Decoction (liu jun zi tang) To Si Jun Zi Tang, add: Chen Pi, Ban Xia

Strengthens the Spleen, transforms phlegm, and stops vomiting. For concurrent deficient Spleen qi and phlegm characterized by a loss of appetite, nausea or vomiting, focal distention and a stifling sensation in the chest and epigastrium, and often coughing of copious, thin, and white sputum.
COMMENTS: This formula is a combination of FourGentlemen Decoction (si jun zi tang) with Two-Cured Decoction (er chen tang), the primary phlegm-resolving formula.

Associated Formula #2:

Six-Gentleman Decoction with Aucklandia and Amomum (xiang sha liu jun zi tang)

To Si Jun Zi Tang, add: Chen Pi, Ban Xia, Sha Ren, Mu Xiang
Strengthens the Spleen, harmonizes the Stomach, regulates the qi, and alleviates pain. For Spleen and Stomach qi deficiency with damp-cold stagnating in the middle burner. Symptoms include reduced appetite with a feeling of surfeit after eating very little, belching, abdominal distention or pain, and sometimes vomiting and diarrhea.

Ginseng, Poria, & Atractylodes Macrocephala Powder (Shen Ling Bai Zhu San)
C: Ren Shen, Bai Zhu, Fu Ling, Zhi Gan Cao (Si Jun Zi Tang). D: Shan Yao, Yi Yi Ren, Bai Bian Dou, Lian Zi

A: Sha Ren

E: Jie Geng

Pattern: Spleen qi deficiency leading to internallygenerated dampness.

Indications: Loose stools or diarrhea, reduced appetite, weakness of the extremities, weight loss, distention and a stifling sensation in the chest and epigastrium, pallid and wan complexion, a pale tongue with a white coating, and a thin, moderate or deficient, moderate pulse. There may also be vomiting.

*Tonify the Middle and Augment the Qi Decoction (bu zhong yi qi tang)
C: D: A: Hu Huang Qi Ren Shen, Bai Zhu, Zhi Gan Cao Dang Gui, Chen Pi E: Sheng Ma, Chai

Pattern: SP/ST Qi Deficiency leading to sinking of the yang. Indications: Intermittent fever (that worsens upon exertion), spontaneous sweating, aversion to cold, a thirst for warm beverages, shortness of breath, laconic speech, a tendency to curl up, weak limbs, a shiny, pale complexion, loose and watery stools, a pale tongue with a thin, white coating, and a flooding, deficient pulse in general, or a deficient, rootless pulse at the middle position on the right.

COMMENTS: The flagship formula of the Tonify Earth school. Originally indicated for Qi deficiency fevers and now widely used for conditions involving prolapse. May be modified to suit a variety of Qi deficiency presentations, including those with concurrent Liver depression Qi stagnation. CAUTIONS AND CONTRAINDICATIONS: This formula is contraindicated for fever due to heat from yin deficiency. It should also be remembered that this formula is not indicated in all instances of prolapse, but only in those due to qi deficiency.

*Generate the Pulse Powder (sheng mai san)

C:
D: A:

Ren Shen
Mai Men Dong Wu Wei Zi

Pattern: Concurrent deficiency of Lung qi and yin

Indications: Chronic cough with sparse sputum that is difficult to expectorate, shortness of breath, spontaneous sweating, a dry mouth and tongue, a pale, red tongue with a dry, thin coating, and a deficient, rapid or deficient, thin pulse.

CAUTIONS AND CONTRAINDICATIONS: This formula should be used only with extreme caution in cases with high fever, or in which the pathogenic influence has not been resolved, or pathogenic influence has yet to injure the fluids. If it is used in cases where the external pathogenic influence remains in the system, it will prolong the disease.

Ginseng and Gecko Powder (ren shen ge jie san)

C: Ge Jie Ren Shen, Fu Ling, Sang Bai Pi, Xing Ren, Chuan Bei Mu, Zhi Mu, Gan Cao

Pattern: Lung Qi Deficiency w/ chronic Phlegm-Heat in the Lungs

Indications: Chronic coughing and wheezing, thick, yellow sputum, coughing of pus and blood, a sensation of heat and irritability in the chest, facial edema, gradual emaciation, a purple tongue with either a thin and white or a tongue with greasy, thin, and yellow tongue coating, and a floating, deficient pulse, especially at the distal position.

*Four-Substance Decoction (si wu tang)

Shu Di Huang, Bai Shao, Dang Gui, Chuan Xiong Pattern: Liver Blood Deficiency Indications: Dizziness, blurred vision, lusterless complexion and nails, generalized muscle tension, irregular menstruation with little flow or amenorrhea, periumbilical and lower abdominal pain, a pale tongue, and a thin and wiry or thin and choppy pulse. Also used for menorrhagia, hard abdominal masses with recurrent pain, restless fetus, or lochioschesis with a firm and painful abdomen and sporadic fever and chills.

CAUTIONS AND CONTRAINDICATIONS: This formula is appropriate for chronic conditions which are not too severe. It should not be used in treating acute, severe blood loss or other problems of blood deficiency which include severe weakness and labored breathing. In such cases one should heed the adage, For exhaustion of blood, tonify the qi; a formula such as Tangkuei Decoction to Tonify the blood (dang gui bu xue tang) should be used instead. Furthermore, if this formula is used in treating patients who have a constitutional deficiency of Spleen yang with a poor appetite and loose stools, it should be modified to include herbs which strengthen the middle burner.

MODIFICATIONS: Associated Formula #1: Four-Substance Decoction with Safflower and Peach Pit (tao hong si wu tang) To Si Wu Tang, add: Tao Ren, Hong Hua Tonifies the blood, invigorates the blood and regulates menstruation. For concurrent blood deficiency and blood stasis leading to a shortened menstrual cycle with copious bleeding of dark-purple, sticky blood with or with no clots. Also used when menstruation is accompanied by abdominal pain and distention due to the same mechanism.

Tang Kuei and Peony Powder (dang gui shao yao san)

C: Dang Gui, Bai Shao, Chuan Xiong

Fu Ling, Bai Zhu, Ze Xie Pattern: Liver-Spleen Disharmony with Blood Deficiency and Dampness Indications: Continuous, cramping pain in the abdomen which is not severe, urinary difficulty, and slight edema (primarily of the lower limbs). Originally used in pregnancy.

Peony and Licorice Decoction (shao yao gan cao tang)

Bai Shao Yao, Gan Cao Pattern: Spasms due to Deficiency of Yin-Blood

Indications: Irritability, slight chills, spasms of the calf muscles and lack of coating on the tongue. There may also be cramps and abdominal pain.

*Restore the Spleen Decoction (gui pi tang)

C: Ren Shen, Huang Qi, Bai Zhu, Zhi Gan Cao
D: Long Yan Rou, Dang Gui, Suan Zao Ren, Fu Shen, Yuan Zhi A: Mu Xiang E: Sheng Jiang, Da Zao

Pattern: SP & HT deficiency or Qi & blood deficiency due to fatigue or over-thinking Indications: Forgetfulness, palpitations (with or without anxiety), insomnia, dream-disturbed sleep, anxiety and phobia, feverishness, withdrawal, reduced appetite, a pallid and wan complexion, a pale tongue with a thin, white coating, and a thin, frail pulse.

Indications,continued: Chronic bleeding syndromes may also be part of the presentation. Women may experience early periods with copious, pale blood or prolonged, almost continuous periods with little flow. COMMENTARY: This formula is basically a modified combination of Si jun zi tang and Dang gui bu xue tang. It is used for three types of manifestations: 1) restless Heart spirit; 2) qi and blood deficiency; and 3) the inability of the Spleen to control the blood. All three patterns arise from the deficiency of qi and blood. Although the formula is used in treating deficiency of both the Heart and Spleen, it focuses primarily on the Spleen.

Honey-fried Licorice Decoction (zhi gan cao tang)

C: Zhi Gan Cao

Ren Shen, Da Zao, Sheng Di Huang, E Jiao, Mai Men Dong, Huo Ma Ren, Gui Zhi, Sheng Jiang
Pattern: Palpitation and intermittent pulse due to Qi and blood deficiency. Indications: Palpitations with anxiety, irritability, insomnia, emaciation, shortness of breath, constipation, a dry mouth and throat, a pale, shiny tongue, and a pulse which is consistently irregular, slow-irregular, or pulse that is thin, faint, and forceless. This is the principal formula for irregular pulses.

Eight Treasure Decoction (ba zhen tang)

C: Ren Shen, Shu Di Huang.

Bai Zhu, Fu Ling, Bai Shao, Dang Gui, Chuan Xiong, Zhi Gan Cao, Sheng Jiang, Da Zao
Pattern: Qi and blood deficiency, due to chronic disease or excessive blood loss. Indications: Pallid or sallow complexion, palpitations with anxiety that may be continuous, reduced appetite, shortness of breath, laconic speech, extremities which become easily fatigued, light-headedness and/or vertigo, a pale tongue with a white coating, and a pulse which is either thin and frail or a pulse that is large, deficient, and without strength.

*All-Inclusive Great Tonifying Decoction (shi quan da bu tang)

C: Ren Shen, Shu Di Huang
D: Bai Zhu, Fu Ling, Bai Shao, Dang Gui, Rou Gui, Huang Qi A: E: Chuan Xiong, Zhi Gan Cao Sheng Jiang, Da Zao

Pattern: qi and blood deficiency tending toward cold

Warms and tonifies the qi and blood. For qi and blood deficiency in consumptive disorders with coughing, reduced appetite, spermatorrhea, and weakness of the lower extremities. This is a very commonly used formula for qi and blood deficiency tending toward cold.

*Six-Ingredient Pill with Rehmannia (liu wei di huang wan)

C: D: A: Shu Di Huang Shan Zhu Yu, Shan Yao Ze Xie, Mu Dan Pi, Fu Ling

Pattern: Kidney and Liver yin deficiency Indications: Soreness and weakness in the lower back, light-headedness, vertigo, tinnitus, decreased hearing, night sweats, spontaneous and nocturnal emissions, a red tongue with little coating, and a rapid, thin pulse. The patient may also present with a variety of other symptoms including hot palms and soles, a chronic dry and sore throat, toothache, or wasting and thirsting disorder.

CAUTIONS AND CONTRAINDICATIONS: Despite its elegant design, this formula still has cloying properties and should be used with caution in cases with indigestion, diarrhea due to Spleen deficiency, or a white, greasy tongue coating.

MODIFICATIONS: Associated Formula #1:

Lycium Fruit, Chrysanthemum, and Rehmannia Pill (qi ju di huang wan)

To the original formula, add Gou Qi Zi and Ju Hua.

For dry eyes with diminished visual acuity, photophobia, tearing when exposed to drafts, or painful eyes...The use of this formula has been extended to include all conditions of Kidney and Liver yin deficiency in which Liver deficiency is the predominant aspect.

Associated Formula #2: Anemarrhena, Phellodendron, and Rehmannia Pill (zhi bai di huang wan) To the original formula, add Zhi Mu and Huang Bai. For yin deficiency with vigorous fire, consumptive heat, or steaming bone disorder characterized by night sweats, a dry mouth and dry tongue, and a large pulse only in the rear position.

Also for urinary difficulty and lower back pain from dampheat in the lower burner in patients with underlying Kidney yin deficiency.

Associated Formula # 3. Eight-Immortal Pill for Longevity (ba xian chang shou wan) (aka Mai Wei Di Huang Wan) to Liu Wei Di Huang Wan add Mai Men Dong, Wu Wei Zi Indicated for cough (possibly with blood), tidal fever, night sweats due to Lung and Kidney Yin deficiency.

Associated Formula #4: Pill for Deafness that is Kind to the Left Kidney (er long zuo ci wan) to Liu Wei Di Huang Wan add Ci Shi, Shi Chang Pu, Wu Wei Zi

For continuous tinnitus, deafness, irritability, vertigo, blurry vision, all symptoms worse at night.

Restore the Left [Kidney] Decoction (zuo gui yin)

C: Shu Di Huang

Shan Zhu Yu, Gou Qi Zi, Shan Yao, Fu Ling, Zhi Gan Cao
Pattern: Kidney Yin Deficiency with Essence depletion

Indications: Lower back soreness, spontaneous emissions, night sweats, a dry mouth and throat, thirst with a desire to drink, a peeled, shiny tongue, and a thin, rapid pulse. This formula is used for treating relatively pure conditions of deficiency with little fire

Restore the Left [Kidney] Pill (zuo gui wan) Shu Di Huang, Shan Zhu Yu, Gou Qi Zi, Shan Yao, Chuan Niu Xi, Tu Si Zi, Lu Jiao Jiao, Gui Ban Jiao Nourishes the yin, tonifies the Kidneys, supplements the essence, and benefits the marrow. This is a stronger version of the principal formula which is used in more severe cases.

Great Tonify the Yin Pill (da bu yin wan)

C: Shu Di Huang, Gui Ban Huang Bai, Zhi Mu

Pattern: Upward-rising of fire due to Liver and Kidney yin deficiency.

Indications: Steaming bone disorder with afternoon tidal fever, night sweats, spontaneous emissions, irritability, a sensation of heat and pain in the knees and legs which is sometimes accompanied by weakness, a red tongue with little coating, and a pulse which is rapid and forceful in the rear position. May also be accompanied by coughing of blood or constant hunger.

Linking Decoction (yi guan jian)

C: Sheng Di Huang, Gou Qi Zi

Sha Shen, Mai Men Dong, Dang Gui, Jin Ling Zi Pattern: Yin deficiency of the Liver and Kidneys with concurrent qi stagnation. Indications: Hypochondriac and chest pain, epigastric and abdominal distention, a dry and parched mouth and throat, acid regurgitation, a red and dry tongue, and a thin, frail or deficient, wiry pulse.

Two-Ultimate Pill (er zhi wan)

Nu Zhen Zi, Han Lian Cao
Pattern: Deficiency of Kidney and Liver Yin Indications: Weakness and soreness of the lower back and knees, or even weakness and atrophy of the lower extremities, dry and parched mouth and dry throat, dizziness and blurred vision, insomnia and dreamdisturbed sleep, spontaneous emissions, premature graying or loss of hair, and a red, dry tongue.

Seven-Treasure Special Pill for Beautiful Whiskers (qi bao mei ran dan)

C: He Shou Wu
Gou Qi Zi, Tu Si Zi, Huai Niu Xi, Fu Ling, Dang Gui, Bu Gu Zhi, Hei Zhi Ma Pattern: Deficiency of Kidney Yin and Liver Blood Indications: Premature graying of the hair or hair loss, loose teeth, spontaneous and nocturnal emissions, and soreness and weakness of the lower back and soreness and weakness of the knees.

*Kidney Qi Pill from the Golden Cabinet (jin gui shen qi wan)

C: Shu Di Huang
D: Shan Zhu Yu, Shan Yao, Fu Zi, Gui Zhi A: Ze Xie, Mu Dan Pi, Fu Ling

Pattern: Kidney Yang Deficiency

Indications: Lower back pain, weakness of the lower extremities, a cold sensation in the lower half of the body, tenseness in the lower abdomen, a pale, swollen tongue with a thin, white, and moist coating, and an empty or frail pulse which is submerged and faint at the proximal position.

Indications, continued: The patient may also be irritable to the point of having difficulty lying down, and will breathe most comfortably while leaning against something. There is either urinary difficulty with edema, or excessive urination, sometimes to the point of incontinence. CAUTIONS AND CONTRAINDICATIONS: Contraindicated in cases of yin deficiency with a dry mouth and dry throat and a red tongue with little coating.

Restore the Right [Kidney] Pill (you gui wan)

C: Fu Zi, Rou Gui, Lu Jiao Jiao Shu Di Huang, Shan Zhu Yu, Shan Yao, Gou Qi Zi, Tu Si Zi, Du Zhong, Dang Gui Pattern: Kidney yang deficiency with waning of the fire of the gate of vitality. Indications: Exhaustion from long-term illness, aversion to cold, coolness of the extremities, impotence, spermatorrhea, and aching and weakness of the lower back and knees. There may also be infertility, loose stools (sometimes with undigested food particles), incontinence, and edema of the lower extremities.

ASSOCIATED FORMULAS Restore the Right [Kidney] Decoction (you gui yin) Shu Di Huang, Shan Zhu Yu, Shan Yao, Gou Qi Zi, Zhi Gan Cao, Du Zhong, Fu Zi, Rou Gui Warms the Kidneys and replenishes the essence. This formula is slightly weaker than the principal formula.

Two-Immortal Decoction (er xian tang)

C: Xian Mao, Yin Yang Huo Ba Ji Tian, Huang Bai, Zhi Mu, Dang Gui Pattern: Deficiency of both Kidney yin and yang accompanied by a flaring-up of fire from deficiency. Indications: Symptoms of menopause including hypertension, menstrual disturbances such as amenorrhea, hot flushes, sweating, nervousness, fatigue, lassitude, depression, irritability, insomnia, palpitations, and urinary frequency. May also be used for other chronic disorders which present with signs and symptoms of Kidney yin and yang deficiency and flaring-up of fire from deficiency.