Chinese Herbal Formulas:

A Clinical Handbook
2nd edition

Heiner Fruehauf
haishan press
portland, oregon
2015
 3

Acknowlegements 7
Introduction 9
Organizational Structure 9
Herbal Alchemy: The Basics of
Chinese Herbal Formula Science 10
Classical to Modern Dosage Conversions 14

1
Cinnamon: Traditional Perspectives
Table of Contents & Formulas 15
Cinnamon (Guizhi): Cinnamoni ramulus 15
Guizhi Tang 18
B Gegen Tang 20
Xiao Qinglong Tang 21
Guizhi Shaoyao Zhimu Tang 23
Xiao Jianzhong Tang 25
Fuling Guizhi Baizhu Gancao Tang
(Ling Gui Zhu Gan Tang) 26
Fuling Guizhi Gancao Dazao Tang 28
Guizhi Jia Longgu Muli Tang 29
Danggui Si Ni Tang 30
Wuling San 31
Guizhi Fuling Wan 33
Wumei Wan 34

2
Aconite: Traditional Perspectives
& Formulas 37
Aconite (Fuzi): Aconiti tuber 37
Si Ni Tang 44
Zhenwu Tang 45
Wen Pi Tang 46
Qianyang Dan 47

3
Bupleurum: Traditional Perspectives
& Formulas 49
Bupleurum (Chaihu): Bupleuri radix  49
Xiao Chaihu Tang 51
Chaihu Guizhi Tang 53
Da Chaihu Tang 54
Si Ni San 56
Chaihu Jia Longgu Muli Tang 57
Chaihu Guizhi Ganjiang Tang 59
Xiaoyao San 60
Longdan Xiegan Tang 62
Chai Ge Jieji Tang 64
Chaihu Shugan San 66
4 Chinese Herbal Formulas: A Clinical Handbook (2nd Edition) · Heiner Fruehauf

4 8
Rhubarb: Traditional Perspectives Pinellia: Traditional Perspectives
& Formulas 67 & Formulas 105
Rhubarb (Dahuang): Rhei rhizoma 67 Pinellia (Banxia): Pinelliae tuber  105
Xiao Chengqi Tang 69 Xuanfu Daizhe Tang 107
Da Chengqi Tang 70 Banxia Xiexin Tang 108
Dahuang Mudanpi Tang 71 Banxia Houpo Tang 110
Yinchenhao Tang 72 Wen Dan Tang 110
Shaoyao Tang 74 Huoxiang Zhengqi San 113
Wu Ji San 115

5 San Ren Tang

Banxia Baizhu Tianma Tang
117
118
Coptis: Traditional Perspectives Suzi Jiangqi Tang 120
& Formulas 77
Dingchuan Tang 122
Coptis (Huanglian): Coptidis rhizoma 77
Baohe Wan 123
Xie Xin Tang 79 Maimendong Tang 124
Gegen Huangqin Huanglian Tang
(Gegen Qin Lian Tang)
Huanglian Jiedu Tang
80
81
9
Evodia: Traditional Perspectives
Puji Xiaodu Yin 82 & Formulas 127
Tianma Gouteng Yin 84 Evodia (Wuzhuyu): Evodiae Fructus 127
Liang Ge San 86
Wuzhuyu Tang 128
Wenjing Tang 129
6 Sishen Wan 131
Ginseng: Traditional Perspectives
& Formulas
Ginseng (Renshen): Ginseng radix 
87
87
10
Tang-Kuei: Traditional Perspectives
Lizhong Wan (Renshen Tang) 89 & Formulas 133
Si Junzi Tang 90 Tang-Kuei (Danggui): Angelicae radix 133
Shen Ling Baizhu San 91 Si Wu Tang 136
Guipi Tang 93 Ba Zhen Tang 138
Shiquan Dabu Tang 95 Danggui San 139
Danggui Shaoyao San 140
7 Xuefu Zhuyu Tang
Duhuo Jisheng Tang
142
144
Astragalus: Traditional Perspectives
& Formulas 97 Danggui Jian Zhong Tang 146
Astragalus (Huangqi): Astragali radix 97 Xiaofeng San 147
Baosheng Wuyou San 149
Yupingfeng San 98
Buzhong Yiqi Tang 100
Buyang Huanwu Tang 102
 Table of Contents 5

11 Lyme Disease: An In-Depth Interview

Rehmannia: Traditional Perspectives with Heiner Fruehauf 198
& Formulas 151 Su He Tang 208
Rehmannia (Dihuang): Rehmanniae radix 151 Jiajian Su He Tang 211
[Jingui] Shenqi Wan 154 Qinghao Biejia Tang 213
Liuwei Dihuang Wan 155
Yiguan Jian
Zhi Gancao Tang
157
158
15
Mini Formulas to Tonify Yin
Tianwang Buxin Dan 160 (for formula modifcation) 215
Yanghe Tang 162
Shengmai San 215
Baihe Gujin Tang 163
Baihe Dihuang Tang 217
Yunü Jian 165
Baihe Zhimu Tang 218
Xijiao Dihuang Tang 166
Shaoyao Gancao Tang 218

12 16
Forsythia: Traditional Perspectives Mini Formulas that Transform Phlegm,
& Formulas  167 Damp & Masses
Forysythia: Forsythiae Fructus 167 (for formula modifcation) 211
Yinqiao San 168 Erzhi Wan 211
Sang Ju Yin 170 Pingwei San 222
Suzi Lihou Tang 171 Er Chen Tang 224
Gualou Xiebai Banxia Tang 225
13 Weijing Tang 227
Other Formula Categories: Dai Ge San 228
Traditional Perspectives & Formulas 173 Sanzi Yangqin Tang 228
Zhi Zhu Wan 229
Ephedra: Traditional Perspectives  173
Er Miao San 230
Hoelen/Poria: Traditional Perspectives
& Formulas 175
Suanzaoren Tang 177 Index: English 231
Atractylodes: Traditional Perspectives  178 Index: Pinyin 234

14
Gu: History, Clinical Perspectives
& Representative Formulas 181
Driving Out Demons & Snakes:
Gu Syndrome, A Forgotten Clinical
Approach to Chronic Parasitism 181
Treating Chronic Inflammatory Disease with
Chinese Herbs: An Interview on the Practical
Application of Gu Syndrome 190
 9

We hope that this book, and its coming editions, will be

of use to you as you seek to come into a deeper, more vital
relationship with the study and practice of Chinese herbal
medicine. It has been specifically created as a clinical
handbook for students and practitioners interested in a
lineage based practice of herbal medicine. As such, this
volume has a different structure and different content than
most formulas textbooks. This introduction will outline
the basic philosophy that underlies the organization and
content of the book, and review some basic details about

Introduction the science of Chinese herbal formula prescribing.

Organizational Structure
B If you leaf through this volume, or even just peruse the
index, you will notice that it is organized differently from
most formulas textbooks. The prescriptions are listed by
herb families, instead of the more common method of
categorizing according to the “eight strategies” (bafa).
What is the advantage of discussing formulas according
to single herb categories rather than the standard bafa
approach?

Most Chinese herbal textbooks are structured in

accordance with the eight therapeutic strategies: sweating
(han), vomiting (tu), purging (xie), harmonizing (he),
warming (wen), clearing (qing), dissolving (xiao) and
tonifying (bu). Memorizing herbs and formulas in groups
that correspond with these eight methods is a simple way
to get a basic grasp of the herbs and their actions. When
Guizhi Tang is memorized as a diaphoretic formula, for
instance, one quickly understands the most basic clinical
situation in which this formula can be used.

However, consider another possibility – the one that

guides the organization of this book. The principle of
this text is to organize the herbs into “formula families”
associated with the chief, or most representative, herb in
the formula. In this case, one’s knowledge of the formula
exists alongside one’s knowledge of the single herb with
which it is associated. There are three main positive
benefits to learning formulas according to herb families –
I will illustrate each with an example.

1) Focusing on single herbs helps students gain deeper,

and more accurate understanding of associated formulas.
Consider the cinnamon herb family. In a standard
textbook, cinnamon remedies are found in virtually
every category of formulas. As a student, it is extremely
important to understand the multidimensional quality of
this herb - it has the potential to unfold profound benefits
for every organ system at every layer of the body. However,
if two important cinnamon formulas are presented in
very different categories, the standard bafa structure can
 Introduction 11

fang as square. In the cosmic map of China’s most ancient organizational backbone of ancient formula science.
Shang dynasty, the cosmic map of Earth is portrayed in One of the easiest ways to think about the structure of
five quadrants: top, bottom, left, right and center. The a formula, after all, is by determining the hierarchy of
Chinese term for square is thus a synonym for the cardinal herbal ingredients within it.
directions: north, south, east, west and center.
Ancient masters of alchemy compared the structure of a
Ancient medical masters thus viewed a formula as a tightly formula to the organization of an administrative entity.
organized collection of herbs coming together to produce How is a formula like a government?
the power of a specific direction - a formula emulating the
energetic quality of South, for instance. This can be used » Jun 君: Emperor
to enhance a balanced “Southern” state in a patient: warm
The emperor is irreplaceable and the “head of state” of
and luscious, but not too hot and damp.
a formula. If the emperor in a formula is changed, it
becomes a different formula altogether. The emperor
determines the entire direction of the formula and nests
it in one formula family or another. All of the other
members of the formula are working from the basic
functional direction set by the emperor herb. In learning
formulas, fully comprehending the nature of the emperor
will take you a long way in understanding the formula.
The chapters of this book are, in many cases, organized
In a clinical context, it can be very difficult to sift
by emperor herb.
through the vast body of formula knowledge and arrive
at the appropriate prescription for a patient. Novice
practitioners often find themselves paralyzed because the » Chen 臣: Minister
many thousands of possible formula combinations, with The minister is second in power behind the emperor. While
their attendant actions and indications, represent too large you could, in theory, change the minister of a formula and
a field of prospects. The meanings of fang, discussed here, still retain most of the important characteristics of that
help us to understand that we needn’t become paralyzed formula, the full depth of the power of a Classical formula
by the overwhelming amount of details and choices. The involves the function of all of the positions - particularly the
most important thing to do is to get in the right ballpark, or minister. Minister herbs are often used to complement the
in other words, to match the general direction the patient emperor in the major function of the formula. However,
requires. The two boats, moving in the correct direction they may be used to temper the emperor, making the
and working together closely, will get the recovery process formula more tolerable. They might also bring another
on track. major function (especially secondary symptom relief) into
the formula, expanding the scope of the formula.
This does not mean, of course, that very minute course
corrections are not necessary. They are - and sometimes, » Zuo 佐: Assistant
minor adjustments in formulas can make all the
difference. Some types of common formula modifications Assistant herbs are narrower in scope than either emperor
will be discussed at the end of this chapter, and again or minister. An assistant may, like the minister, be similar
at the end of the book. The most important thing for a in character to the emperor, thus increasing the strength
formula student to remember, however, is to focus on the of its major functions. Sometimes an assistant may address
directionality of the formula and to be certain that the a secondary or tertiary complaint not already addressed by
prescription is situated in the right ballpark. the emperor and minister. The assistant can also restrain
the intensity of both emperor and minister, lessening
B side effects and improving patient outcomes. While the
assistant herbs may seem to be less potent members of a
Order in Herbal Formulas and the Organizational formula, it is important not to minimize their role. The
Principle of Jun, Chen, Zuo, Shi emperor and minister herbs alone, in most cases, do not
create the kind of elegant formulas that characterize the
Classical formulas exhibit an inherent structure that highest practice of Chinese medicine. Assistants help the
is dictated by their intended effects. While many of us formulas to have a wider scope and more potent effect,
may have difficulty understanding this structure at first, while avoiding alchemical instability and uncomfortable
with study and practice it will become evident as the side effects.


1
15

Cinnamon: Traditional Perspectives

& Formulas

桂枝
Cinnamon Twig (Guizhi):
Ramulus cinnamomi
1) Cinnamon twig primarily enters the muscle layer at
the surface of the body. At the same time, it enters the
heart and liver channels. It is the branch of the cassia
tree which also yields cinnamon bark. Cinnamon twig is
light, its nourishing essence is pungent, and its color is red
(therefore its affinity to the heart).

The action of cinnamon twig is rising without descending.

Therefore, it can also enter the lung and facilitate
uninhibited movement of qi, and enter the bladder
channel and stimulate water metabolism. In a horizontal
direction, it enters the upper extremities, harmonizes ying
and wei, and thus treats pain in the arms and sides of the
chest.

Cinnamon twig controls restless sweating, dispels wind,

and disperses external pathogens. It is the primary herb
to relieve the muscles. Therefore, the books all say that
cinnamon twig can induce sweat if there is none; and that
it can astringe sweat if there is too much of it. Actually,
the type of sweat that can be induced or controlled by
cinnamon is caused by wei excess and ying deficiency,
refering to a situation where the yin is being advanced
upon by yang. Therefore, cinnamon can be used to
regulate the ying. If the ying is regulated, then the wei
will become harmonious by itself. Since now there will be
no place to go to for the wind pathogen, it will be relieved
via the sweat. This action is quite different from that
of ephedra, which can directly open the pores and thus
induce sweat.

The type of sweat that can be astringed by cinnamon is

caused by wind injury to the wei layer, which in turn
16 Chinese Herbal Formulas: A Clinical Handbook (2nd Edition) · Heiner Fruehauf

cannot attend to (holding) the ying (in place); the ying “spitting breath,” an ancient term for asthma, and thought
qi is weak, and the fluids and humors thus not secured that by removing cinnamon, the formula would not be
properly; therefore, the patient experiences symptoms of able to treat this problem anymore. Since many physicians
sweating, fever, and aversion to wind. This condition is nowadays fail to read the Herbal Classic, they only know
best treated with Cinnamon Combination (Guizhi Tang), that ephedra can drain the lung and calm asthma, but are
since this remedy contains peony to enter the ying and unaware of the fact that cinnamon can descend qi and
astringe the yin inside, and cinnamon to enter the wei and calm asthma.
eliminate the pathogens outside. In this way, the sweat will
stop naturally. This does not mean that cinnamon closes The cassia flowers blossom in mid-autumn, demonstrating
the sweat pores directly. In other words, if you just say that the plant’s functional nature becomes activated
that cinnamon induces sweat and controls sweat without as soon as it receives metal qi. At the same time, the
understanding why and under what conditions, you will nourishing essence of cinnamon is pungent, another
miss the meaning of cinnamon by far. indication that links it to metal. Cinnamon, therefore, is
able to keep the upflaring tendency of liver wood in check.
[from Huang Gongxiu, Bencao qiuzhen (Exploring the Also, the branches of the cassia tree grow in the form of
True Meaning of the Materia Medica), 1769] a deer antler (tree forms are generally differentiated into
deer antler form and crab claw form), going straight up
B without bending. Therefore, cinnamon twigs can regulate
the straightforward quality of the liver, and moderate its
2) The nourishing essence of cinnamon is pungent and
tendency to become bogged down and depressed.
slightly sweet, and its functional nature is warming.
It opens up the energy pathways, raises the ancestral qi
Since its essence is sweet, it is also a good herb to harmonize
upwards, descends counterflow of qi (such as flushing up,
the spleen and the stomach, causing collapsed spleen qi to
or liver qi flushing up), and disperses pernicious qi (as in
rise and rebellious stomach qi to descend. Once the spleen
wind cold situations).
and the stomach are properly regulated and in harmony,
accumulations of phlegm or stagnating food will naturally
Zhang Zhongjing’s Atractylodes and Hoelen Combination
disappear. Its circulating powers can also entice the force of
(Ling Gui Zhu Gan Tang) employs cinnamon to treat
the triple warmer to enter the bladder and thus disinhibit
shortness of breath, utilizing the herb’s ascending
urination (do not use cinnamon, however, if there is
properties. His Cinnamon Plus Cinnamon Combination
inhibited urination that is due to heat; you may, as some
(Guizhi Jia Gui Tang) employs cinnamon to treat
doctors do, use a little bit of cinnamon in combination
running piglet syndrome, utilizing the herb’s descending
with cooling herbs, in order to entice the herbal effects
properties. And his Ma-huang Combination (Mahuang
into the bladder). The only situation where cinnamon
Tang), Cinnamon Combination (Guizhi Tang), and
should be thoroughly avoided is heat in the upper burner,
Minor Blue Dragon Combination (Xiao Qinglong Tang)
or patients who regularly suffer from bleeding disorders.
all use cinnamon to treat external cold affliction, utilizing
the herb’s dispersing properties.
I should emphasize that cinnamon twig is not a sweat
inducing herb, just as it is not a sweat astringing herb. Its
Defining the properties of cinnamon twig, Shen Nong’s
circulating and surface dispersing force spirals in between
Herbal Classic states at the very beginning that cinnamon
the surface and the interior: it can thus harmonize ying
treats coughing and upward counterflow of qi, a fact
and wei, warm the flesh and the muscles, and invigorate
that seems to underscore once more that it is really the
movement within the blood vessels. It is due to these
descending quality of cinnamon that is its specialty.
actions, then, that wind cold resolves and surface paralysis
However, rarely do we find that one of the other materia
opens up.
medicas emphasizes this descending quality. This came
to foster a use of cinnamon which neglected its most
The essence of cinnamon is both pungent and sweet: the
outstanding feature.
pungent flavor disperses, the sweet flavor tonifies. The
function of cinnamon, therefore, is somewhere in between
Another example illustrating this point is the fact that in
dispersing and tonifying. Let’s say that somebody wants to
the context of Minor Blue Dragon Combination, ephedra
take Cinnamon Combination for the purpose of inducing
and cinnamon are used side by side. For patients suffering
sweat, the source book suggests that s/he must take some
from asthmatic breathing, the original source suggests
hot porridge along with it. This addendum illustrates that
to remove ephedra and add apricot seed, but not to
Cinnamon Combination by itself does not have a strong
remove cinnamon. The formula’s author had apparently
sweat inducing effect. On the other hand, if somebody
considered the Herbal Classic line that cinnamon treats
 Cinnamon: Traditional Perspectives & Formulas 21

Modern Modifications: For weak constitution, atypically deep pulse, cold/flu accompanied by sweat, remove or decrease
Mahuang (this will produce Guizhi Jia Gegen Tang); for nausea, add Banxia; for recurrent surface tension, add Xiao
Chaihu Tang (this will produce Chaihu Guizhi Tang with Mahuang and Gegen added); for sinus congestion, may add
Xinyinhua and Chuanxiong; for sinus congestion with secretion of yellow phlegm, heavily add Gualou; for early stage
of rheumatoid arthritis, add Yiyiren, Danggui, Baishao, and Baizhu (this will produce Yiyiren Tang with (Sheng) Jiang,
Dazao, and Gegen added); for back and leg pain, add Duhuo and (Sheng) Dihuang.

小青龍湯
Xiao Qinglong Tang
Minor Blue-Green Dragon Decoction
Source: On Cold Damage (Shanghan lun)

X iao Qinglong Tang first appeared in the classic formula compendium, Shanghan lun. It is a famous modification of both
Guizhi Tang and Mahuang Tang, specifically designed for lung congestion with clear phlegm in the yang deficient
patient. The Blue-Green Dragon is a stellar confirmation in the eastern sky, which is associated with spring and wind.
Spring is a period of frequent wind afflictions (such as colds and allergies). Also, it is the time when a developing yang
(warmth, light) gains superiority over a gradually diminishing yin (cold, darkness). If the human body cannot hold step
with this decisive move in nature, symptoms of pathological yin (phlegm) will appear and cause chills, water stagnation,
and coughing. The dragon, moreover, is the symbolic governor of water. Nature’s water metabolism has always been the
key to health and prosperity in agriculture based societies. According to traditional lore, the large dragon can dance in the
clouds and entice rain if there is not enough water, and the small dragon can submerge itself in the waves if there is too
much water. Major Blue Dragon Tang, therefore, is mostly used to induce sweat (“not enough water”) in patients with a
strong constitution, while Xiao Qinglong Tang is generally prescribed to remove stagnating fluids and phlegm (“too much
water”) in patients with a weak constitution. In modern Japan, this formula has become one of the prime remedies to
treat lung problems in children as well as allergic sinus problems characterized by profuse nasal discharge. In the original
Shanghan lun version, no prominent use of Banxia is recorded. In modern clinical practice, a daily dose usually consists of
10g of each of the herbs, but Wuweizi and Xixin are often used in more moderate amounts (3-6g).

Category: Formulas that release exterior cold

Therapeutic Principles: Relieve the surface and disperse cold, warm the lung and transform phlegm, control coughing,
asthma, and allergic sinus reactions

Typical Symptoms: Chills, possibly accompanied by fever, but without sweat; profuse production of clear, runny, or
sometimes foamy phlegm by the lungs and/or sinuses; runny eyes; cold feeling in upper back; coughing and/or asthmatic
wheezing; gurgling sounds or feeling of stagnation in epigastric region; dry mouth without desire to drink; nausea; stuffy
chest; heavy and painful feeling in body, puffy face and extremities; decreased urination

Pulse: Floating and tight, or floating and weak, or floating and rapid

Tongue: Pale, with white and slippery coating

Western Indications: Colds, flus, upper respiratory tract infections (including acute bronchitis or acute flare-up of chronic
bronchitis, pneumonia), bronchial asthma, allergic asthma, allergic rhinitis, hypertrophic rhinitis, whooping cough;
catarrhal ophtalmia, dacryocystitis; pleurisy, hydrothorax; high gastric acidity (only if accompanied by feeling of epigastric
stagnation); eczema, blisters (only if lots of clear secretions); arthritis, acute and chronic nephritis (only if puffy face and
extremities, decreased urination)
22 Chinese Herbal Formulas: A Clinical Handbook (2nd Edition) · Heiner Fruehauf

Herbs and Actions:

Classical Modern Common Name

Pinyin Action(s)
Dosage Dosage Latin Name
Perfuse lung qi, calm asthmatic breathing, and
Ephedra
3 liang 6-9 g Mahuang open up the sinuses; expel surface cold and induce
Ephedrae Herba
sweating
Cinnamon twig
3 liang 9-12 g Guizhi Expel surface cold and induce sweating
Cinnamomi Ramulus
Nourish yin and blood and astringe body fluids to
Peony root
3 liang 9-12 g Shaoyao balance the strongly diaphoretic action of Mahuang
Paeoniae Radix
and Guizhi
Dried ginger
3 liang 9-12 g (Gan) Jiang Warm the lung and disperse stagnating fluid
Zingiberis Rhizoma
Asarum
3 liang 6-9 g Xixin Warm the lung and disperse stagnating fluid
Asari Herba
Normalize mucous secretions, and protectively
Schizandra moisten and astringe the lung to balance the
0.5 sheng 6-9 g Wuweizi
Schisandrae Fructus strongly drying and dispersing action of Xixin and
Shengjiang
Pinellia
Enhance the anti-phlegm effect and counteract
0.5 sheng 9-12 g Banxia Pinelliae ternatae
nausea
Rhizoma
Harmonize yin (nourishing, moistening,
Honey-fried licorice astringing) and yang (warming, drying, dispersing)
0.5 sheng 3-6 g (Zhi) Gancao
Glycyrrhizae Radix actions of herbs; moderate diaphoretic and
dispersing effect of the formula

Traditional Modifications: (Shanghan lun 40)

• Thirst: minus Banxia, add Gualougen (Tianhuafen);
• Mild diarrhea: minus Mahuang, add Raohua (Wikstroemia canescens, dry-fried);
• Dysphagia: minus Mahuang, add (Zhi) Fuzi; inhibited urination and lower abdominal pain: minus Mahuang, add
Fuling;
• Panting: minus Mahuang, add Xingren.
Typical Modifications: for restlessness, thirst with desire to drink, yellow tongue coat, or other symptoms of secondary
heat, add Shigao (this will produce Xiao Qinglong Jia Shigao Tang); for severe coughing, add Xingren; for nausea,
combine with Er Chen Tang; for edema, add Fuling; for chronic bronchitis without surface symptoms, remove Mahuang,
Guizhi, Banxia, and Baishao, add Fuling (this will produce Ling Gan Wuwei Jiang Xin Tang; if pronounced coughing
and phlegm, do not remove Banxia, further add Xingren); for chronic asthma, add Taizishen and Zisuzi; for whooping
cough, add Nan Shashen, Wumei, Tianhuafen, and Fuling.
44 Chinese Herbal Formulas: A Clinical Handbook (2nd Edition) · Heiner Fruehauf

四逆湯
Si Ni Tang
Frigid Extremities Decoction
Source: On Cold Damage (Shanghan lun)

S i Ni Tang is the representative remedy for Shaoyin disorders in the classical formula manual, Shanghan lun. Traditionally,
it is known as a remedy that is used exclusively for the recapturing of the escaping life force in emergency situations,
such as elderly patients suffering from a heart attack. Due to the extreme toxicity of unprocessed aconite (Fuzi), it would
be important to boil the Fuzi thoroughly with the Ganjiang and Gancao (heat application greatly diminishes the toxin
aconitine in Fuzi) if used according to original specifications. More important for using this remedy in the age of modern
emergency medicine is to learn from the way how the Fire Spirit School of Sichuan herbalism has been using this remedy
for the last 150 years. Zheng Qin’an, the Qing dynasty physician who is regarded as the founder of the Huoshen lineage,
based all remedies for chronic patients requiring warming and at the same time consolidating action on the therapeutic
principle exemplified by Si Ni Tang, labeling it Si Ni Fa—the Si Ni Tang Method.

Category: Formulas that rescue devastated yang

Therapeutic Principles: Rescue escaping yang

Typical Symptoms: All shaoyin symptoms; fatigue, cold hands and feet, blue lips; loss of consciousness, or clouded
consciousness

Tongue: Fat and pale, with tooth marks

Pulse: Weak and slow, or feeble and rapid

Western Indications: Heart attack and other life-threatening diseases (acute usage); obvious immune deficiencies in the
elderly (long-term usage, especially in the Fire Spirit School of Chinese herbalism)

Herbs and Actions:

Classical Modern Common Name

Pinyin Action(s)
Dosage Dosage Latin Name
Fresh aconite
Draw escaping yang qi back into the lower
1 piece 10-15 g (Sheng) Fuzi Aconiti Radix lateralis
dantian; warm spleen and kidney yang
recens
Dried ginger Warm spleen and kidney yang; moderates the
1.5 liang 6-9 g (Gan) Jiang
Zingiberis Rhizoma potential toxicity of Fuzi
Honey-fried licorice
2 liang 10-15 g (Zhi) Gancao Moderate potential toxicity of Fuzi
Glycyrrhizae Radix

Traditional Modifications: (Shanghan lun 317)

• Red Facial Complexion: add Congbai;
• Abdominal Pain: add Shaoyao;
• Retching: add (Sheng) Jiang;
• Sore Throat: add Jiegeng;
• Diarrhea Ceases but Pulse does not Move Outward: add Renshen.
Modern Modifications: This is a formula that is not often used by modern TCM practitioners, especially as prescribed
in the original text (which according to most experts specifies raw, unprocessed Fuzi). For the The Fire Spirit School of
Sichuan herbalism (Huoshen Pai), however, it is the most important base formula for the treatment of chronic diseases,
and the base for many more complex remedies. This remedy generally calls for 18-120 g of Fuzi, albeit in processed form.


11
151

Rehmannia: Traditional Perspectives

& Formulas

地黃
Rehmannia (Dihuang): Rehmanniae radix
1) Dry rehmannia–that is the dried, unprocessed fresh
root–primarily enters the kidney, and it also enters the
heart and the spleen. Its nutritive essence is bitter and
sweet, and its functional nature is yin and cold. If we
consult the source book of Dr. Zhang Lu from Changzhou
(Comprehensive Medicine According to Master Zhang, Zhang
Shi Yi Tong), we read the following:

“At its very heart rehmannia is red and thus enters the
heart; inside it is yellow and thus enters the spleen; its skin
is black and thus enters the kidney. The nutritive essence
of rehmannia is strong, while its functional qi is weak.
Internally, it mostly cools the blood and enriches yin,
while externally it moistens the skin and promotes a glossy
appearance. The use of rehmannia is indicated in situations
when the patient is deficient and exhibits signs of heat
(if there are no heat signs, cooked rehmannia should be
used). Just as Dai Yuanli once stated: ‘In situations where
the yin is feeble and the yang exuberant, the ministerial
fire is generally flaring beyond its boundaries and invades
yin territory. There, it keeps steaming the yin, causing a
symptom complex of yin deficiency and fire flare-up. For
this type of disorder, one should use rehmannia to enrich
the yin and control upflaring yang.’

In combination with ginseng, hoelen, and honey,

rehmannia produces Jade Gelatin (Qiongyu Gao), a
remedy that treats tubercular coughing accompanied by
hacking blood (thus primarily tonifying the lung yin). In
combination with ophiopogon, cooked rehmannia, and
ginseng, raw rehmannia produces Stabilize the Root Pill
(Guben Wan), a remedy that treats conditions of dryed
up jing and blood in the elderly (while at the same time
stabilizing the kidney root). If we add lycium fruit gelatin
152 Chinese Herbal Formulas: A Clinical Handbook (2nd Edition) · Heiner Fruehauf

to this prescription, it is called Gather Spirit Gelatin filial people who conceal their mischief inside, but who
(Jiling Gao), a remedy that treats deficiency emaciation always wear a friendly face on the outside. All of those
accompanied by coughing and chronic fatigue (stabilizing famous scholars say that rehmannia is a prime herb to
all organ networks simultaneously). enrich yin and a magic remedy to control bleeding. Even
though rehmannia is often used this way, this is not
In simplified terms, the general principle for the use of what it is indicated for. It should really be used to gently
rehmannia is the following: males tend to be yin deficient, clear exuberant qi, and after intake it will bring about
and thus should take cooked rehmannia; females tend temporary peace.
to easily develop conditions of blood heat, and thus
should take raw rehmannia. Never forget, however, to This is quite different from the functional nature of
differentiate this usage according to the constitution of the ginseng, a yang and bright herb which is like a gentleman
individual patient! in nature: too much of it, and you will definitely notice it
(yang herbs are usually more intense than the disease that
Yu Bo once said: ‘Raw rehmannia cools the blood, but in is being addressed; so, if you use them inappropriately, you
patients with weak stomach qi it may cause symptoms of will know about it right away). This is precisely the reason
poor appetite. Cooked rehmannia tonifies the blood, but why many masters have a tendency to put their hands up
in patients with lots of phlegm-rheum it may gum up the their sleeves when it comes to the use of yang herbs like
diaphragm.’ Although these two potential complications ginseng–they are afraid of using it, just like most patients
are actually very, very important, contemporary doctors are sealing their mouths in fear of trying it. They rather
rarely bother to heed this principle in clinical practice. use the meekest and most yin of herbs, rehmannia and
ophiopogon, the affect of which the patient will not feel
Some people say that if raw rehmannia is fried in alcohol, until death occurs (when somebody gets killed due to the
then its appetite inhibiting affect will be neutralized, or affect of yin herbs, most people do not notice the cause and
that if cooked rehmannia is processed with ginger, then affect relationship; that is why most everybody likes to use
it will not gum up the diaphragm. But no matter what, yin substances).”
we should only use rehmannia after we have obtained a
detailed understanding of the varying degrees in which This discussion by Zhang Lu underscores the fact that if
source qi and pernicious qi are involved. For instance, the patient’s condition is not clearly understood, the use of
if we encounter a post-partum patient who suffers from rehmannia may bring about calamity. Where has such a
a pronounced aversion to food, diarrhea, pain caused thorough understanding of herbal usage been presented
by coagulations in the lower abdomen, taxation fatigue, before?
a constitutionally weak spleen/stomach manifesting in
chronically loose stools, profuse phlegm in the chest [from Huang Gongxiu, Bencao qiuzhen (Exploring the
and epigastric region, signs of inhibited respiration, True Meaning of the Materia Medica), 1769]
and symptoms that indicate an obstruction of the body’s
ascending/descending actions, one should definitely stay B
away from rehmannia.
2) The functional nature of fresh rehmannia is cold. Its
nutritive essence is slightly bitter and slightly sweet. It is
In post-partum situations, rehmannia primarily cools
an excellent substance to clear heat, cool blood, transform
blood and moistens dryness. If a patient’s source qi is
static blood, generate new blood, and treat blood ejection,
exhausted, and she suffers from [bowel] obstruction and
nosebleed, blood in the stool or urine, or other conditions
accumulation due to heat pathogens accompanied by a
that are due to blood heat causing rampant blood
dry and scorched black tongue, constipation and inhibited
movement. Rehmannia contains iron, and that is why it
urination, then this is a situation where the purgative
turns black as soon as it is dried or steamed. Its iron content
method is contraindicated. The best method to resolve
is also partly responsible for the affect of generating and
constipation in this particular circumstance is to add some
cooling blood.
rehmannia to a combination of heat clearing materials,
because a) rehmannia moistens dryness, and b) this patient
Dry rehmannia (called raw rehmannia in contemporary
does not exhibit signs of excess moisture involvement.
herb shops) refers to the fresh herb after it has been dried
under the sun. Its functional nature is cool but not cold. It
In Shen Nong’s Herbal Classic, rehmannia is categorized
boosts the vessels, generates jing and marrow, brightens
as a superior medicinal substance. Actually, its functional
the eyes and clears the ears, and treats bone steaming and
nature is yin and gentle, so rehmannia is really a kind
other forms of taxation heat, as well as kidney deficiency
of impostor! It can be compared to all those oh-so-
engendering heat symptoms.


14
181

Gu: History, Clinical Perspectives

& Representative Formulas
Driving Out Demons & Snakes:

蠱 Gu Syndrome, A Forgotten Clinical

Approach to Chronic Parasitism
As the field of Oriental medicine matures in a modern
environment, we are beginning to become aware of the
enormous dimensions that this field encompasses. While
ten years ago the Western public still thought of Oriental
medicine as a synonym for acupuncture, most practitioners
have now broadened their understanding of the term to
something that includes acupuncture, moxibustion, herbs,
dietetics and qigong exercises. Although other clinical
approaches that once shaped the face of Chinese medicine,
such as Daoist psychotherapy or the application of herbs to
acupuncture points, remain forgotten, there is good reason
to believe that in time they will be unearthed and put to use
in a modern clinical context.

This presentation is an attempt to participate in the process

of ‘medical archaeology’ by exploring one of the submerged
areas of Oriental medicine, namely the complex and
variegated clinical approach to the diagnosis and treatment
of Gu syndrome (gu zheng). A review of the modern
research literature shows that this topic has remained
virtually unexplored in both China and the West1. Although
there are too many classical references to entirely ignore
the phenomenon of Gu syndrome, mainland Chinese
scholars generally dismiss it as an “ancient, feudalist and
superstitious” belief in demons and exorcist practices that
has little or no value in modern clinical practice. However,
a close examination of the original texts illuminates the
mysterious concept of Gu syndrome as a valid clinical
approach that may potentially provide an answer to the
many invisible ‘demons’ that plague patients in a modem
190 Chinese Herbal Formulas: A Clinical Handbook (2nd Edition) · Heiner Fruehauf

or Gu syndrome, which essentially means “Possession

Syndrome”. Gu is a character that is very old, perhaps
one of the oldest characters in the Chinese textual record
altogether, since it is a hexagram in the Yijing. It is
literally the image of three worms in a vessel. This to me
is one of those strokes of brilliance that you find in the
symbolism of the ancient Chinese—that they recognized
3000 years ago that chronic parasitism can cause psychotic
or psychological symptoms. Because of the psychological,
emotional, and perhaps spiritual implications of this term,
Gu, when the Chinese standardized the classical record for
the much simplified barefoot doctor approach of the TCM
Treating Chronic Inflammatory system in the 1950’s, they threw out lots of complicated
and ideologically problematic topics, and obviously this
Disease with Chinese Herbs “Possession Syndrome” was one of the first ones to go.
There are of course magical modalities that are associated
an interview on the practical with the treatment of Gu syndrome—like Fu talismans,
application of gu syndrome mantras, and techniques such as visualizing thunder
and lightning in your abdomen, etc.—but the herbal
in the autumn of 2008 heiner fruehauf, phd, lac, treatment is quite practical and included a vast array of
sat down with two of his students, erin moreland, formulas that are unique and effective for the treatment of
lac., and bob quinn, daom, lac, to discuss the finer
severe parasitism. Due to that standardization of Chinese
points of gu syndrome treatment. this discussion is
best understood as a follow-up to and elaboration medicine that took place and a general state of ignorance
of the ideas presented in heiner’s earlier article about the clinical power of this approach, this syndrome
on gu syndrome published in The Journal of Chinese has been virtually erased from the record and no one
Medicine in may1998. thinks about it any more at all. Once I started using this
approach fifteen years ago in my own clinical practice, I
started making massive headway in cases that I couldn’t
Quinn: Heiner, first of all thanks for making time for the
treat before, and not all of these patients came with
interview. We want to discuss clinical treatment strategies
obvious signs of chronic parasitic infection.
for Gu syndrome, but before we get into the specifics, for
the sake of the people who did not read your article in The
Quinn: Just to be clear, you’re not saying that all instances
Journal of Chinese Medicine on Gu syndrome, could you
of parasitic infection equate to Gu. Someone comes back
quickly go over what Gu syndrome is and how you got
from Mexico, comes to a clinic and says I think I picked
started on the research?
up a parasite….
Heiner: Certainly. The phenomenon of Gu syndrome
Heiner: You are absolutely right, Gu syndrome does not
is for me a prime example of the clinical power that
equal acute parasitic infection. Not all cases that, from a
classical Chinese medicine carries, in a field where we
classical perspective, would be diagnosed as Gu syndrome
have thrown out so much and where the record has
would [also] be patients with parasites, and vice-versa, not
been truncated for the sake of standardization. My own
all people with a positive parasitic test from the Western
discovery of Gu syndrome came when there was a certain
perspective would be accurately diagnosed as Gu. Gu
number of cases that I was not making sufficient progress
syndrome actually means that your system is hollowed
with clinically, particularly with people I believed had
out from the inside out by dark yin forces that you cannot
parasites. I finally took literally a two-week time out and
see. This not seeing often includes Western medical tests
just immersed myself in ancient texts. From my reading
that come back negative for parasites. So from a certain
of the modern literature there were very few cases with
perspective, AIDS falls into this category, with body and
chronic parasites recorded—sure, there were some cases
mind being hollowed out from the inside out, without
of acute amoebic dysentery, but I felt that in a country
knowing what is happening. Gu syndrome originally
like China it shouldn’t be any different from Nepal
meant “black magic.” To the patient it felt as though
or India, where I knew that parasites have been a part
someone had put a hex on them, without anybody—
of the clinical landscape for hundreds of years. When I
whether it’s the Western medicine community or, in
looked at the classical textual record, it was a different
ancient times, the regular Chinese medicine approach—
story. I found chronic parasitism reflected in a huge area
being able to see what was really going on. Regular
of classical Chinese medicine that was called Gu zheng,
198 Chinese Herbal Formulas: A Clinical Handbook (2nd Edition) · Heiner Fruehauf

time to shift into research gear. After immersing myself

in a lot of clinical case studies preserved in pre-modern
China’s medical literature, I came across the concept of
Gu Syndrome. The word Gu is one of the oldest Chinese
characters. Hexagram Eighteen of the ancient Yijing
(Classic of Change) is entitled Gu 蠱: Rottenness. One
frequently comes across the word in Chinese language,
but never really considers it, including native Chinese
speakers. It is like the word “magic” in the English
language. You use it to conjure up an atmosphere, but
never think about what it really means.
Lyme Disease
As a clinical concept, I found Gu most interesting. Every
an in-depth interview
major medical book in ancient China, starting with the
with heiner fruehauf
Neijing (Yellow Emperor’s Classic of Medicine), mentions
Gu as something that is common, yet very entrenched and
in the spring of 2011 heiner fruehauf, phd, lac sat
down with his student and colleague, bob quinn, difficult to treat. The most remarkable diagnostic advice
daom, lac to discuss the finer points of “brain I gleaned from these texts is that our regular diagnostic
gu” syndrome, specifically as it pertains to the parameters won’t get traction in patients suffering from
treatment of lyme disease. this discussion is best Gu syndrome. Gu patients, for instance, manifest with
understood as a follow-up to and elaboration of symptoms that look like spleen qi deficiency, yet the
the ideas presented in heiner and quinn’s earlier normal methods to treat their fatigue, bloating, and
interview about gu syndrome published in the fall digestive issues do not work. As a matter of fact, they
of 2008. may get worse with conventional treatment. It is one of
the diagnostic parameters of Gu syndrome that the herb
Quinn: Welcome Heiner. It is nice to sit and have a cup of Renshen (ginseng), generally regarded as the prototypical
tea with you to discuss one of the most perplexing health spleen qi tonic, is contraindicated in this condition and
conditions of this time, Lyme disease. I wanted to start by will worsen symptoms. It appears that in a Gu patient,
establishing your own experience in this area. Renshen, Dangshen (codonopsis) and similar qi tonics
boost not only the immune system, but invigorate the
Heiner: I have been seeing Lyme patients since the time pathogen as well. Therefore, one classical Gu expert once
I started my practice, more than 20 years ago. At first I stated that “Gu syndrome may look like chronic diarrhea,
wasn’t aware of what I was treating. I was differentiating but if you treat it like the regular type of diarrhea it does
symptoms and tried to devise a traditional diagnosis not work. It may look like chronic constipation, but if you
that fit the overall picture as closely as possible. I see this treat it like regular constipation, it does not work.”
conversation as a follow-up to our earlier discussion on
Gu Syndrome. After many years of treating Lyme disease Incorporating this important yet forgotten clinical
with Chinese herbs, I can say with great certainty that, advice, I embarked on a journey of more than 15 years
from a classical Chinese perspective, Lyme is a specific of diagnosing and treating people suffering from Gu
type of Gu Syndrome. syndrome. In this process, I gradually zeroed in on a group
of remedies and herbs that are in a class of their own. Just
When I initially began my Gu Syndrome research, I as modern Chinese physicians have established an anti-
saw a number of patients who were young Peace Core cancer materia medica in recent years, I read through all
volunteers returning from Africa and South America relevant texts and worked to establish an anti-Gu—or,
with intestinal parasites. Most likely, they were suffering in the widest possible sense of meaning, an anti-chronic
from a combination of different protozoan infections. inflammatory syndrome—materia medica.
These infections wouldn’t go away with the conventional
Chinese treatments for parasitic diarrhea, or bloating and Quinn: You have an interesting way of differentiating Gu
constipation. In addition to a host of chronic digestive into brain and digestive Gu categories. Can you go into
symptoms, I found a prevalence of mental/cognitive that a bit?
symptoms in these patients, such as anxiety and insomnia.
I soon felt that the clinical methods I was familiar with at After a while, I discovered that there are two major groups
the time were not adequate to solve this clinical picture. of patients with Gu syndrome. I labeled them “Digestive
Fortunately, at this point in my career I still had plenty of Gu” and “Brain Gu”. Digestive Gu is characterized by a
 Index: Formulas (English) 231

A
Agastache Powder to Rectify the Qi 113
All Inclusive Great Tonifying Decoction 95
Angelica Decoction to Construct the Middle 146
Angelica & Peony Powder 140
Angelica Powder 139

Formulas Index Angelica Pubescens and Mulberry Mistletoe

Decoction 144

English Artemisia Annua and Soft-Shelled Turtle Shell

Decoction 213

B B
Banxia Decoction to Drain the Epigastrium;
Banxia Purge the Heart Decoction 108
Bupleurum and Cinnamon Twig Decoction 53
Bupleurum and Kudzu Relieve the Muscle Layer
Decoction 64
Bupleurum, Cinnamon Twig, and Ginger
Decoction 59
Bupleurum plus Dragon Bone and Oyster Shell
Decoction 57
Bupleurum Powder to Spread the Liver 66

C
Calm the Stomach Powder 222
Capillaris Decoction 72
Cinnamon Twig and Poria Pill 33
Cinnamon Twig Decoction 18
Cinnamon Twig Decoction plus Dragon Bone
and Oyster Shell 29
Cinnamon Twig, Peony and Anemarrhena
Decoction 23
Cool the Diaphragm Powder 86
Coptis Decoction to Relieve Toxicity 81

D
Danggui Decoction for Frigid Extremities 30
Drain the Epigastrum Decoction 79
Drive Out Stasis in the Mansion of Blood
Decoction 142