Gui Zhi / Fu Ling: Transforms fluids and treats upsurge

Ling Gui Zhu Gan Tang (SHL67)

• Fu Ling 12/30  (SHL/HH)
• Gui Zhi 9/15
• Zhi Gan Cao 6/10
• Bai Zhu 6/10

SS: Spleen yang def/dampness, Water upsurge dizziness.

After the application of vomiting or purging for cold damage, there is fullness in the epigastrium, qi surging upward to the chest from the epigastrium, dizziness when standing up, as well as deep and tight pulses. If sweating is promoted, qi in the channels will be disturbed, leading to quivering and trembling. Poria, Cinnamon Twig, Atractylodes and Licorice Decoction (fú líng guì zhī bái zhú gān cǎo tāng) should be prescribed.

Liu Du-Zhou and colleagues have added some very valuable information to identify this syndrome in terms of observing the tongue and face: Because yang in the heart is primarily deficient, the tongue body is tender and pale. Since retained water attacks upward, the tongue coating looks slippery and watery. The quintessence of the heart presents on the face. Water is yin and attacks the heart, leading to stagnation of the nutritive qi and the defensive qi, making blood in the heart unable to nourish the face. Therefore, the color of the face is dark, or there are black pigments or black spots on the forehead, cheek, nose and corners of the mouth.

According to the footnote for Poria, Cinnamon Twig, Atractylodes and Licorice Decoction (fú líng guì zhī bái zhú gān cǎo tāng) in Chapter 12 of Essentials and Formula Discussions from the Golden Cabinet (金匱要略方論 jīn gùi yào lüè fāng lùn), the patient is supposed to have increased urination after taking the formula in this line.

Based on analysis of 158 ancient and contemporary cases treated by this formula, Zhang Qi, a professor from Chengdu University of Traditional Chinese Medicine, has classified the manifestations of the syndrome treated by the formula into two groups: main diagnostic indexes and reference diagnostic indexes. The main diagnostic indexes are: dizziness, poor appetite, lassitude, fullness and distention in the chest and hypochondriac region, nausea, vomiting, palpitation, cough, a pale and puffy tongue with a white and sticky or white and slippery coating and deep, wiry, slippery and moderate pulses (combinations of different pulses often present). The reference diagnostic indexes are: fullness in the epigastric region and abdomen, shortness of breath, intolerance to cold, panting, loose stool, scant urine, fatigue, edema in the lower limbs, spitting of sputum and insomnia.

Ling Gui Zao Gan Tang (SHL 65)

• Fu Ling 24
• Gui Zhi 12
• Zhi Gan Cao 6
• Da Zao 15p

SS: Undernourished Heart yin and yang. Upsurge of water: feeling impending doom.

Original text translated After promotion of sweating, the patient has a violent, pounding feeling below the umbilicus and it is about to develop into a running piglet [symptom]. Poria, Cinnamon Twig, Licorice and Jujube Decoction (fú líng guì zhī gān cǎo dà zǎo tāng) should be prescribed.

Zhang Zhi-Min thought that a pale and moist tongue as well as deep and wiry pulses are also main manifestations for differentiation and applications of the formula in this line.690 According to Hu Xi-Shu, the spasm in the lower abdomen can be one of the important symptoms associated with a violent-pounding feeling below the umbilicus when using the formula in this line.691

Fu Ling Gan Cao Tang (SHL 73, 356)

• Fu Ling 6
• Gui Zhi 6
• Zhi Gan Cao 3
• Sheng Jiang 6

SS: Stomach water. Absence of thirst and fullness in the epigastric region, could have palpitation, a cold feeling on the fingertips, sloshing in the stomach, slight aversion to cold along with fever, vomiting of clear fluid, a moist tongue with a white coating and a wiry pulse.

Original text translated: In cold damage, if there is thirst after sweating, Five-Ingredient Powder with Poria (wù líng sǎn) should be prescribed; if thirst is absent, Poria and Licorice Decoction (fù líng gān cǎo tāng) should be prescribed.

Boil these four ingredients in 800 ml water to get 400 ml decoction, then strain the decoction. Divide the decoction into three portions and administer about 133 ml decoction three times when it is lukewarm.
This describes the major differences between water retention in the urinary bladder and in the stomach, in which thirst occurs in the first condition but is absent in the second, leaving out the information such as a floating pulse, slight fever and abnormal urination as discussed in line 71.

Fu Ling Yin (JGYL 12.31)

• Chen Pi 9
• Zhi Shi 6
• Sheng Jiang 9
• Fu Ling 9
• Ren Shen 9

SS: Fluids causing glomus and chest fullness/distension. Treats collecting phlegm and abiding water in the heart and chest, which after spontaneous vomiting of water, manifests as vacuity in the heart and chest, qi fullness, and inability to eat. It disperses phlegm qi and enables the person to eat.

Gui Zhi Fu Ling Wan (JGYL 20.2)

• Gui Zhi 9
• Fu Ling 9
• Mu Dan Pi 9
• Bai/Chi Shao 12
• Tao Ren 9

SS: Stagnant fluids with upsurge. Blood stagnation in Ren Vessel.

Invigorating blood and removing stasis.

1. Pain in a fixed location
2. Bleeding of blackish purple blood that congeals easily
3. Restlessness, irritability, and even mania
4. Dark purple tongue body and a dark, lusterless complexion

Pressure pain with masses in the lower abdomen, especially on either side of the navel, is a characteristic sign of blood stasis.

In practice this formula is often modified to include other herbs such as chai hu, tu bie chong, hong hua and niu xi.

Wu Ling San (SHL 71,72,73,74,156,386,12.31.13.4,13.5)

• Gui Zhi 6
• Bai Zhu 9
• Fu Ling 9
• Zhu Ling 9
• Ze Xie 15

SS: Thirst without the desire to drink. Inhibited urination. Floating pulse. Agitation. Slight fever.

Original text translated After the promotion of sweating for tai yang disease, because of profuse sweating, there is dryness in the stomach, leading to vexation, agitation and the inability to fall asleep. If there is a desire to drink water, a small amount of water might be given to harmonize qi in the stomach and ensure recovery from the disease. If there is a floating pulse, abnormal urination, slight fever and thirst, Five-Ingredient Powder with Poria (wù líng sǎn) should be prescribed.
The urinary bladder is the organ that contains water and it is a place where qi and body fluid are transformed. The organ corresponds to the pores on the skin and takes this transformation as its basic function. Water is cold in nature, and therefore tai yang is called the channel of cold and water. The urinary bladder and kidney stand in an exterior-interior relationship. In physiological conditions, the water in the urinary bladder is steamed by the fire from the life gate and it would not be cold. Rather, it would be steamed and transformed into qi to warm zang-fu organs internally and nourish the skin and the hairs externally. In the pathological condition, pathological cold can easily combine with the water, interrupting the steaming and transforming process from the fire of the life gate, leading to the accumulation of cold and water and the failure of this qi transformation, resulting in water retention in the urinary bladder.772

Because dryness in the stomach and water retention in the urinary bladder share the same symptom, which is thirst, one should be clear about their difference clinically. Thirst due to dryness in the stomach is caused by intense heat, scorching the body fluid and causing dryness; therefore, there must be remarkable interior heat symptoms and signs. Thirst due to water retention in the urinary bladder is caused by the failure of qi transformation, causing the urinary bladder to be unable to steam the body fluid upward to moisten the mouth; therefore, there must be urination problems without interior heat symptoms and signs.

The sweating induced by Five-Ingredient Powder with Poria (wù líng sǎn) might not be mild and this is an indication that qi transformation in the urinary bladder and three burners has returned to normal after sweating, because according to Chapter 47 of Spiritual Pivot (靈樞經 líng shū jīng), “the three burners and urinary bladder correspond with the interstices and the hairs on the skin.”778 Once water retention is gone after taking this formula, qi can move normally among the skin, the three burners and the urinary bladder, and sweating must present on the skin. Obviously, the purpose of taking this formula is not to eliminate the exterior syndrome in tai yang but rather to recover the normal function in the three burners and urinary bladder. The sweating induced by Ephedra Decoction (má huáng tāng) and Cinnamon Twig Decoction (guì zhī tāng) aims at eliminating the exterior syndrome in tai yang and must be mild sweating; otherwise, anti-pathogenic qi might be damaged by profuse sweating.7

Chai hu Jia Long Gu Mu Li Tang (SHL107)

• Chau Hu 12
• Huang Qin 3
• Gui Zhi 6
• Ban Xia 6
• Ren Shen 4
• Sheng Jiang 4
• Fu Ling 4
• Long Gu 4
• Mu Li 4
• Da Huang 6

SS: Shao Yang/Yang Ming block. Tai Yang upsurge (fright, palpitations, vexation, dry retching, nasal blockage) After suffering from cold damage for eight or nine days, purging has been used. If there is fullness in the chest, vexation, fright, abnormal urination, delirious speech and heaviness of the entire body that makes a patient unable to turn his or her body, Bupleurum plus Dragon Bone and Oyster Shell Decoction (chái hú jiā lóng gǔ mǔ lì tāng) should be prescribed.

Fright The patient is very sensitive to hearing someone visit, sounds, light (i.e. feels frightened when a slightly loud sound is heard), dislike for exposure to light, insomnia, a lot of dreams or even nightmares, and strange sounds. •Delirious speech At the beginning, the patient is more talkative than they used to be, constantly want to tell what happened in the past, what is hidden in the heart, what grievances they had. The patient often talks in their sleep, or even cries out in fear and has absurd speech.
After analyzing 130 cases treated by this formula, Wei Xiang-Long and colleagues reported: The syndrome treated by Bupleurum plus Dragon Bone and Oyster Shell Decoction (chái hú jiā lóng gǔ mǔ lì tāng) often occurs in the patient who is more than 30 years old. Its causes are mainly related to emotional imbalance and its course is long. The diseases this formula treats are mainly related to mental disorders. Its manifestations are fullness in the chest and hypochondriac region, vexation, insomnia, constipation, a dull expression, twitching of the muscles and the sinews, palpitation, fear and fright. A red tongue with a yellow and sticky coating, as well as wiry and slippery pulses, often present.