The Formulas of Li Dong-yuan: Complex Formulas for Complex Conditions

Bob Flaws, Dipl. Ac. & C.H., FNAAOM Li Gao (1180-1251 CE), zi name Dong-yuan, was one of the four great masters of Chinese medicine of the Jin-Yuan dynasties and arguably the greatest of these four. It was Li who elevated the spleen and stomach to the pivotal role they play today in Chinese medicine. However, in his book, the Pi Wei Lun (A Treatise on the Spleen & Stomach), Li was not primarily talking about digestive diseases like diarrhea and constipation. Rather, he was talking about complex, difficult to treat allergic, autoimmune, and immune deficiency diseases. In Chinese, there is a saying which, when translated, goes, "For internal damage disease, Li is the ruler." However, to understand the formulas of Li Dong-yuan, one must first understand his theory of yin huo or yin fire. Yin fire is not the same as vacuity heat (xu re) but does include vacuity heat. Basically, yin fire has five causes or mechanisms. These are spleen qi vacuity, liver depression/depressive heat, damp heat, yin and blood vacuity with vacuity heat, and stirring of ministerial fire.[1]Typically, three, four, or even five of these disease mechanisms occur simultaneously. However, according to Li, it is spleen vacuity and the resulting qi depression and chaos of upbearing and downbearing which is the crux of the matter, at least in terms of treatment. Based on analyzing Lis formulas, we can identify a definite five part protocol for dealing with such complex, multi faceted conditions. These five principles can be enumerated as follows[2]: 1. Fortify the spleen & supplement the qi using sweet, warm medicinals, thus supporting the original qi 2. Regulate upbearing & downbearing with acrid, qi-rectifying medicinals 3. Clear heat with bitter, cold medicinals as necessary 4. Treat whatever other disease mechanisms & symptoms are present 5. Evaluate the relative priorities and importance between these five principles and weight the treatment plan accordingly These five principles are not five steps to be accomplished one by one in sequence. They are five principles for composing a single treatment protocol or Chinese medicinal formula. When patients have complex, multi-pattern conditions, the patterns they display tend to group themselves based on Lis five disease mechanisms of yin fire. The above five principles are the necessary ones for dealing with such complex, multi-pattern presentations in real-life patients.

In terms of principle #5 specifically, what it means is that, depending on the presenting condition, principle #1 may not be the most important aspect of the treatment plan. The relative importance of the first four principles in the erection of an individualized treatment plan depends on the fifth evaluation. However, typically, all of these first four issues will be addressed within a single formula. One will need to supplement the spleen, one will need to rectify the qi, one will need to clear some kind of heat somewhere in the body, and one will need to do something else besides these first three principles. This means that, in addition to liver depression qi stagnation, there may be blood stasis or food stagnation, while, in addition to spleen vacuity, there may be phlegm and dampness, blood vacuity, yin and/or yang vacuity, easy contraction of external evils, or retained or hidden evils. Since all of these disease mechanisms are interconnected, they all need to be addressed at the same time. If not, either one will not be able to eliminate the single mechanism targeted or, if they do, the remaining disease mechanisms will quickly re-establish the mechanism which was, temporarily, cured. The two most famous books written by Li Dong-yuan are the Pi Wei Lun and the Lan Shi Mi Cang (Secret Treasury of the Orchid Chamber). The Pi Wei Lunis available in translation from Blue Poppy Press. It is one of the most important premodern books on Chinese medicine extant today. The Lan Shi Mi Cang is not currently available in English, though an excerpt from it is posted at Blue Poppys Web site at www.bluepoppy.com. I have compiled this collection of Lis most famous formulas because I find his formulas such good examples of complex prescriptions for real -life

complex situations. Lis formulas typically supplement and dra in at the same time and contain both warm-hot and cool-cold medicinals. Likewise, many of them contain both moistening and drying medicinals. Therefore, I think they serve as good models for the kinds of Chinese medicinal formulas most Western patients with complex chronic diseases require. Representative formulas from the Pi Wei Lun (Treatise on the Spleen & Stomach) Bu Pi Wei Xie Yin Huo Sheng Yang Tang (Supplement the Spleen & Stomach, Drain Yin Fire & Upbear Yang Decoction) Radix Bupleuri (Chai Hu) mix-fried Radix Glycyrrhizae (Gan Cao) Radix Astragali Membranacei (Huang Qi) Radix Panacis Ginseng (Ren Shen) Rhizoma Atractylodis (Cang Zhu) Radix Et Rhizoma Notopterygii (Qiang Huo) Rhizoma Cimicifugae (Sheng Ma) Radix Scutellariae Baicalensis (Huang Qin) Rhizoma Coptidis Chinensis (Huang Lian) Gypsum Fibrosum (Shi Gao) Functions:Fortifies the spleen and boosts the qi, rectifies the qi and upbears the clear, and drains yin fire Indications:Spleen vacuity with yin fire. In this case, Notopterygium and Cim icifuga strengthen Bupleurums function of upbearing clear yang. Sheng Yang Yi Wei Tang (Upbear Yang & Boost the Stomach) Radix Astragali Membranacei (Huang Qi) Radix Panacis Ginseng (Ren Shen) mix-fried Radix Glycyrrhizae (Gan Cao) Rhizoma Pinelliae Ternatae (Ban Xia) Radix Albus Paeoniae Lactiflorae (Bai Shao) Radix Ledebouriellae Divaricatae (Fang Feng) Radix Et Rhizoma Notopterygii (Qiang Huo) Radix Angelicae Pubescentis (Du Huo) Pericarpium Citri Reticulatae (Chen Pi) Sclerotium Poriae Cocos (Fu Ling) Rhizoma Alismatis (Ze Xie) Radix Bupleuri (Chai Hu) Rhizoma Coptidis Chinensis (Huang Lian) Functions:Supplements the spleen and boosts the qi, harmonizes the liver and relaxes tension, dispels wind and eliminates dampness, clears heat Indications: Spleen vacuity with a combination of malnourishment of the sinews and vessels and wind damp impediment pain complicated with heat in the liver, stomach, and/or heart. Originally this formula was for the treatment of spleen vacuity resulting in lung disease or, more specifically the lungs easy contraction of disease in the fall. Tong Qi Fang Feng Tang (Free the Flow of the Qi Ledebouriella Decoction) Radix Astragali Membranacei (Huang Qi) Radix Panacis Ginseng (Ren Shen) Radix Glycyrrhizae (Gan Cao) Radix Bupleuri (Chai Hu) Rhizoma Cimicifugae (Sheng Ma) Radix Et Rhizoma Notopterygii (Qiang Huo)

Radix Ledebouriellae Divaricatae (Fang Feng) Pericarpium Citri Reticulatae (Chen Pi) Pericarpium Citri Reticulatae Viride (Qing Pi) Fructus Cardamomi (Bai Dou Kou) Radix Et Rhizoma Ligustici Chinensis (Gao Ben) Cortex Phellodendri (Huang Bai) Functions:Fortifies the spleen and boosts the qi, dispels wind and eliminates dampness, harmonizes the stomach and clears heat Indications:Spleen qi vacuity with damp encumbrance and qi stagnation complicated by wind damp impediment and some damp heat Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction) Radix Astragali Membranacei (Huang Qi) Radix Panacis Ginseng (Ren Shen) Rhizoma Atractylodis Macrocephalae (Bai Zhu) mix-fried Radix Glycyrrhizae (Gan Cao) Radix Angelicae Sinensis (Dang Gui) Radix Bupleuri (Chai Hu) Rhizoma Cimicifugae (Sheng Ma) Pericarpium Citri Reticulatae (Chen Pi) Functions:Fortifies the spleen and boosts the qi, warmly and sweetly eliminates heat, upbears yang and lifts the fallen Indications:1) Spleen qi vacuity with marked fatigue, 2) downward fall of central qi with various types of dizziness and prolapse, 3) qi vacuity emission of heat or fever[3] Huang Qi Ren Shen Tang (Astragalus & Ginseng Decoction) Radix Astragali Membranacei (Huang Qi) Radix Panacis Ginseng (Ren Shen) Rhizoma Atractylodis Macrocephalae (Bai Zhu) Rhizoma Atractylodis (Cang Zhu) mix-fried Radix Glycyrrhizae (Gan Cao) Rhizoma Cimicifugae (Sheng Ma) Pericarpium Citri Reticulatae (Chen Pi) Massa Medica Fermentata (Shen Qu) Radix Angelicae Sinensis (Dang Gui) Tuber Ophiopogonis Japonici (Mai Dong) Fructus Schisandrae Chinensis (Wu Wei Zi) Cortex Phellodendri (Huang Bai) Functions: Fortifies the spleen and boosts the qi, dries dampness, upbears the clear, and abducts stagnation, nourishes the blood and enriches heart, lung, and stomach yin, and clears heat Indications:Spleen vacuity with dampness plus food stagnation, yin vacuity, and some vacuity and/or damp heat. [4] Originally, this formula was for summerheat damaging the latter heaven source qi. It can also be used to prevent fall season allergic rhinitis when taken prophylactically in the late summer. Chu Feng Shi Qiang Huo Tang (Eliminate Wind Dampness Notopterygium Decoction) Radix Et Rhizoma Notopterygii (Qiang Huo) Radix Ledebouriellae Divaricatae (Fang Feng) Radix Et Rhizoma Ligustici Chinensis (Gao Ben) Radix Angelicae Pubescentis (Du Huo)

Radix Ligustici Wallichii (Chuan Xiong) Radix Astragali Membranacei (Huang Qi) Rhizoma Atractylodis (Cang Zhu) mix-fried Radix Glycyrrhizae (Gan Cao) Radix Bupleuri (Chai Hu) Rhizoma Cimicifugae (Sheng Ma) Pericarpium Citri Reticulatae (Chen Pi) Sclerotium Poriae Cocos (Fu Ling) Sclerotium Polypori Umbellati (Zhu Ling) Rhizoma Alismatis (Ze Xie) Cortex Phellodendri (Huang Bai) Rhizoma Coptidis Chinensis (Huang Lian) Functions: Dispels wind and eliminates dampness, fortifies the spleen and rectifies the qi, clears heat and seeps dampness Indications: Damp heat impediment pain complicated by possible lower burner damp heat vaginitis or cystitis, spleen vacuity and liver depression Tiao Zhong Yi Qi Tang (Regulate the Center & Boost the Qi Decoction) Radix Astragali Membranacei (Huang Qi) Radix Panacis Ginseng (Ren Shen) Radix Glycyrrhizae (Gan Cao) Rhizoma Atractylodis (Cang Zhu) Radix Bupleuri (Chai Hu) Rhizoma Cimicifugae (Sheng Ma) Pericarpium Citri Reticulatae (Chen Pi) Radix Auklandiae Lappae (Mu Xiang) Functions: Fortifies the spleen and boosts the qi, dries dampness and rectifies the qi Indications:Spleen vacuity with damp exuberance and either liver depression qi stagnation or stomach and intestine qi stagnation resulting in inhibition of the throat and diaphragm, burping and belching, nausea and vomiting, chest fullness and bodily heaviness, somnolence and lack of strength Qing Shu Yi Qi Tang (Clear Summerheat & Boost the Qi Decoction) Radix Astragali Membranacei (Huang Qi) Radix Panacis Ginseng (Ren Shen) Rhizoma Atractylodis (Cang Zhu) Rhizoma Atractylodis Macrocephalae (Bai Zhu) mix-fried Radix Glycyrrhizae (Gan Cao) Rhizoma Cimicifugae (Sheng Ma) Pericarpium Citri Reticulatae (Chen Pi) Pericarpium Citri Reticulatae Viride (Qing Pi) Massa Medica Fermentata (Shen Qu) Cortex Phellodendri (Huang Bai) Radix Puerariae (Ge Gen) Tuber Ophiopogonis Japonici (Mai Dong) Fructus Schisandrae Chinensis (Wu Wei Zi) Radix Angelicae Sinensis (Dang Gui)

Functions:Fortifies the spleen and boosts the qi, dries dampness and rectifies the qi, enriches yin, clears heat, and disperses accumulation

Indications: Spleen vacuity due to enduring damp heat with damaged fluids and an element of qi and food stagnation[5] Sheng Yang Chu Shi Fang Feng Tang (Upbear Yang & Eliminate Dampness Ledebouriella Decoction) Rhizoma Atractylodis (Cang Zhu) Rhizoma Atractylodis Macrocephalae (Bai Zhu) Sclerotium Poriae Cocos (Fu Ling) Radix Ledebouriellae Divaricatae (Fang Feng) Radix Albus Paeoniae Lactiflorae (Bai Shao) Functions:Harmonizes the liver and spleen, dries dampness and relaxes cramping Indications:Diarrhea and/or constipation with intestinal wind and mucus in the stools due to liver-spleen disharmony and dampness Sheng Yang San Huo Tang (Upbear Yang & Scatter Fire Decoction) Radix Panacis Ginseng (Ren Shen) uncooked Radix Glycyrrhizae (Gan Cao) mix-fried Radix Glycyrrhizae (Gan Cao) Radix Bupleuri (Chai Hu) Rhizoma Cimicifugae (Sheng Ma) Radix Ledebouriellae Divaricatae (Fang Feng) Radix Et Rhizoma Notopterygii (Qiang Huo) Radix Angelicae Pubescentis (Du Huo) Radix Puerariae (Ge Gen) Radix Albus Paeoniae Lactiflorae (Bai Shao) Functions: Fortifies the spleen and boosts the qi, harmonizes the liver and nourishes the sinews, dispels wind and eliminates dampness, clears heat Indications:Spleen vacuity resulting in qi and blood vacuity with malnourishment of the liver and sinews with simultaneous wind, dampness, and heat due to blood and fluid vacuity dryness. Originally, this formula was meant to resolve, scatter, and clear interior heat and emit fire depression when yang qi was depressed and blocking the spleen and stomach. Qing Yang Tang (Clear Yang Decoction) Flos Carthami Tinctorii (Hong Hua) Lignum Sappan (Su Mu) Radix Angelicae Sinensis (Dang Gui) Cortex Phellodendri (Huang Bai) Ramulus Cinnamomi Cassiae (Gui Zhi) uncooked Radix Glycyrrhizae (Gan Cao) mix-fried Radix Glycyrrhizae (Gan Cao) Radix Astragali Membranacei (Huang Qi) Rhizoma Cimicifugae (Sheng Ma) Radix Puerariae (Ge Gen) Functions: Quickens the blood and dispels stasis, fortifies the spleen and supplements the qi, moistens the sinews and clears heat Indications: Blood stasis complicated by spleen vacuity resulting in qi and blood vacuity with malnourishment of the sinews and vacuity heat Wei Feng Tang (Stomach Wind Decoction)

Fructus Viticis (Man Jing Zi) dry Rhizoma Zingiberis (Gan Jiang) Semen Alpiniae Katsumadai (Cao Dou Kou) Cortex Phellodendri (Huang Bai) Radix Et Rhizoma Notopterygii (Qiang Huo) Radix Bupleuri (Chai Hu) Radix Et Rhizoma Ligustici Chinensis (Gao Ben) Herba Ephedrae (Ma Huang) Radix Angelicae Sinensis (Dang Gui) Rhizoma Atractylodis (Cang Zhu) Radix Puerariae (Ge Gen) Radix Angelicae Dahuricae (Bai Zhi) mix-fried Radix Glycyrrhizae (Gan Cao) Rhizoma Cimicifugae (Sheng Ma) Fructus Zizyphi Jujubae (Da Zao) Functions: Dispels wind and eliminates dampness, frees the flow of the channels and supplements the center, clears heat Indications:Internal stirring of wind due to vacuity resulting in one-sided paralysis or wind damp impediment complicated by an element of heat Qing Zao Tang (Clear Dryness Decoction) Rhizoma Coptidis Chinensis (Huang Lian) Cortex Phellodendri (Huang Bai) Radix Bupleuri (Chai Hu) Tuber Ophiopogonis Japonici (Mai Dong) Fructus Schisandrae Chinensis (Wu Wei Zi) Radix Angelicae Sinensis (Dang Gui) uncooked Radix Rehmanniae (Shu Di) Radix Astragali Membranacei (Huang Qi) Radix Panacis Ginseng (Ren Shen) mix-fried Radix Glycyrrhizae (Gan Cao) Sclerotium Polypori Umbellati (Zhu Ling) Sclerotium Poriae Cocos (Fu Ling) Rhizoma Alismatis (Ze Xie) Rhizoma Atractylodis Macrocephalae (Bai Zhu) Rhizoma Atractylodis (Cang Zhu) Massa Medica Fermentata (Shen Qu) Rhizoma Cimicifugae (Sheng Ma) Pericarpium Citri Reticulatae (Chen Pi) Functions: Fortifies the spleen and boosts the qi, both dries and seeps dampness, clears heat, nourishes yin, rectifies the qi, and disperses food Indications:Spleen vacuity with enduring damp heat damaging yin fluids complicated by qi and food stagnation Sheng Yang Chu Shi Tang (Upbear Yang & Eliminate Dampness Decoction) Radix Glycyrrhizae (Gan Cao) Fructus Germinatus Hordei Vulgaris (Mai Ya) Massa Medica Fermentata (Shen Qu) Rhizoma Pinelliae Ternatae (Ban Xia) Pericarpium Citri Reticulatae (Chen Pi) Sclerotium Polypori Umbellati (Zhu Ling) Rhizoma Atractylodis (Cang Zhu) Rhizoma Alismatis (Ze Xie) Fructus Alpiniae Oxyphyllae (Yi Zhi Ren)

Radix Bupleuri (Chai Hu) Rhizoma Cimicifugae (Sheng Ma) Radix Et Rhizoma Notopterygii (Qiang Huo) Functions: Fortifies the spleen and supplements the qi, transforms and seeps dampness, abducts stagnation and moves the qi Indications:Spleen qi vacuity and dampness enduring diarrhea complicated by qi and food stagnation Yi Wei Tang (Boost the Stomach Decoction) Radix Astragali Membranacei (Huang Qi) Radix Panacis Ginseng (Ren Shen) Rhizoma Atractylodis Macrocephalae (Bai Zhu) Rhizoma Atractylodis (Cang Zhu) Rhizoma Pinelliae Ternatae (Ban Xia) Radix Bupleuri (Chai Hu) Rhizoma Cimicifugae (Sheng Ma) Pericarpium Citri Reticulatae (Chen Pi) Extremitas Radicis Angelicae Sinensis (Dang Gui Wei) Fructus Alpiniae Oxyphyllae (Yi Zhi Ren) Radix Scutellariae Baicalensis (Huang Qin)

Functions:Fortifies the spleen and boosts the qi, clears the lungs, liver, stomach, and intestines, transforms dampness and rectifies the qi Indications: Spleen qi vacuity with damp heat in the stomach and intestines diarrhea with dampness heavier than heat Qiang Wei Tang (Strengthen the Stomach Decoction) Radix Astragali Membranacei (Huang Qi) Radix Panacis Ginseng (Ren Shen) Radix Glycyrrhizae (Gan Cao) Radix Angelicae Sinensis (Dang Gui) Rhizoma Pinelliae Ternatae (Ban Xia) Pericarpium Citri Reticulatae (Chen Pi) Radix Bupleuri (Chai Hu) Rhizoma Cimicifugae (Sheng Ma) Massa Medica Fermentata (Shen Qu) Fructus Alpiniae Katsumadai (Cao Dou Kou) uncooked Rhizoma Zingiberis (Sheng Jiang) Cortex Phellodendri (Huang Bai) Functions: Fortifies the spleen and boosts the qi, dries dampness, abducts stagnation, and clears vacuity heat Indications:Taxation malaria-like disease due to spleen vacuity and dampness with vacuity heat Unnamed formula Radix Bupleuri (Chai Hu) Radix Ledebouriellae Divaricatae (Fang Feng) Radix Albus Paeoniae Lactiflorae (Bai Shao) Cortex Cinnamomi Cassiae (Rou Gui) Radix Et Rhizoma Notopterygii (Qiang Huo) Radix Angelicae Pubescentis (Du Huo)

Cortex Phellodendri (Huang Bai) Rhizoma Anemarrhenae Aspheloidis (Zhi Mu) Gypsum Fibrosum (Shi Gao) Rhizoma Cimicifugae (Sheng Ma) Sclerotium Polypori Umbellati (Zhu Ling) Talcum (Hua Shi) Rhizoma Alismatis (Ze Xie) Radix Et Rhizoma Ligustici Chinensis (Gao Ben) Radix Ligustici Wallichii (Chuan Xiong) Herba Asari Cum Radice (Xi Xin) Fructus Viticis (Man Jing Zi) Radix Angelicae Dahuricae (Bai Zhi) Functions:Dispels wind, eliminates dampness, and clears heat, rectifies the qi and frees the flow of the network vessels Indications:Liver depression qi stagnation complicated by dampness and heat in the stomach and intestines, urinary bladder, and/or channels and vessels Ju Pi Zhi Zhu Wan (Orange Peel, Aurantium & Atractylodes Pills)[6] Fructus Immaturus Citri Aurantii (Zhi Shi) Pericarpium Citri Reticulatae (Ju Pi) Rhizoma Atractylodis Macrocephalae (Bai Zhu) Functions: Fortifies the spleen and transforms stagnation Indications: Pediatric (latter heaven) source qi vacuity weakness with undigested food and drink Representative formulas from the Lan Shi Mi Cang (Secret Treasury of the Orchid Chamber) Liang Xue Di Huang Tang (Cool the Blood Rehmannia Decoction) Radix Scutellariae Baicalensis (Huang Qin) Herba Schizonepetae Tenufoliae (Jing Jie) Cortex Phellodendri (Huang Bai) Rhizoma Anemarrhenae Asphodeloidis (Zhi Mu) Herba Asari Cum Radice (Xi Xin) Radix Ligustici Wallichii (Chuan Xiong) Rhizoma Coptidis Chinensis (Huang Lian) Radix Et Rhizoma Notopterygii (Qiang Huo) Radix Bupleuri (Chai Hu) Rhizoma Cimicifugae (Sheng Ma) Radix Ledebouriellae Divaricatae (Fang Feng) uncooked Radix Rehmanniae (Sheng Di) Radix Angelicae Sinensis (Dang Gui) Radix Glycyrrhizae (Gan Cao) Flos Carthami Tinctorii (Hong Hua) Functions:Dispels wind, eliminates dampness, and clears heat, quickens the blood and frees the flow of the network vessels Indications:Wind damp heat impediment complicated by blood stasis