Work continues on parsing the case records of Qing-era physician Wáng Xùgāo [王旭高 1798-1862]. I ran across some cases involving the extraordinary vessels [奇經八脈, EV] which I thought I’d analyze. Wáng did not record many cases in which he identified EV patterns, but those that he did showed a thorough understanding of incorporating medicinals that had been said to treat them. I wrote about one such case previously:

Case 1

The first case is from Wang Xugao’s Clinical Records [王旭高臨證醫案Wáng Xùgāo Lín Zhèng Yī Àn, 1761].

丁　血虛木橫，兩脅氣撐痛，腹中有塊，心蕩而寒熱。病根日久，損及奇經。經云：衝脈為病，逆氣裡急，任脈為病，男疝女瘕。陽維為病苦寒熱；陰維為病苦心痛。合而參之，謂非奇經之病乎？調之不易。

Dīng: Blood vacuity with wood [rebelling] horizontally, both ribsides with bursting qì pain, lumps in the abdomen, pounding heart and chills and fever. The disease took root over time, damaging the extraordinary channels. The classic says: “When the chōngmài falls ill, there is counterflow qì with internal urgency, when the rènmài falls ill, in men there is shàn and in women there are conglomerations. When the yángwéi falls ill one suffers chills and fever, when the yīnwéi falls ill one suffers heart pain.” Putting all this together, can we say this is not a disease of the extraordinary channels? Regulating it is not easy.

Mulch comments: In terms of formula actions, the prescription supplements qì and nourishes blood, quiets the spirit and settles fright, courses the liver, downbears the stomach, clears vacuity heat, supplements the kidney and secures essence. However, since the case itself focuses on extraordinary vessel diseases, this analysis would seem to have limited use in understanding the selection of ingredients. Looking at it in terms of medicinals that connect to the EV proves to be more revealing.

So a-digging I did go.

Most of the passages below come from Materia Medica of Combinations [Dépèi Běncǎo 得配本草, 1761] , with some also from Seeking Truth in the Materia Medica [Běncǎo Qiúzhēn本草求真 , 1769 ] , Encountering the Origin of the Materia Medica Classic [Běnjīng Féngyuán 本經逢原 , 1695] , Essentials of Materia Medica [Běncǎo Bèiyào, 本草備要, 1694], A Clinical Guide with Case Histories [Línzhèng Zhǐnán Yī’àn 臨證指南醫案, 1746] , plus a couple of modern texts as noted. I suspect Wáng was familiar with most if not all of the pre-modern texts above, and the modern texts are based on research into premodern texts.

• Huángqí: “Governs yángwéi becoming ill, suffering chills and fever, and dūmài becoming ill with counterflow qì and internal urgency [主陽維為病苦寒熱。督脈為病。逆氣裡急, Materia Medica of Combinations]”

• Dǎngshēn: Not specifically referred to for EV, but Materia Medica of Combinations says “with huángqí, solidifies the defensive [wèi] qì [得黃耆，實衛]”.

• Fúshén: Not specifically associated with EV, but treats fright palpitations and so aids in treating the chōngmài- yīnwéimài imbalance.

• Báiwēi: “Bitter, salty and cold, a medicinal for the yīn and yáng, chōng, and rèn [苦鹹而寒，陰陽、沖、任之藥, Essentials of Materia Medica].”

• Gǒuqǐzǐ: “Supplements essence-blood of chōng and dū [補沖督之精血, Materia Medica of Combinations]”. Liú & Sū (2017) says “Enriches yīn and replenishes essence so as to boost chōng and rèn, and can engender marrow so as to fill the bone structure and replenish the brain marrow; boosts yáng to strengthen the dūmài and warm the chōng and rèn [滋陰能填精以益 任,併能生髓以充骨骼、填腦髓:益陽能壯督脈、溫沖任。].”

• Báisháo: “Governs yángwéi chills and fever, and dàimài abdominal pain [主陽維寒熱。帶脈腹痛。Materia Medica of Combinations]” . Liu & Su (2017) says it “nourishes blood and constrains yīn as well as secures and contains the chōng, rèn, and dàimài; emolliates yīn and moderates urgency as well as regulates the dū, qiāo, and wéimài [養血斂陰而固攝沖、任、带脈, 陰柔緩急而調督、蹺、維脈。]”.

• Dāngguī: “Governs chōngmài falling ill with counterflow qì and internal urgency, and dàimài falling ill with abdominal fullness, and [feeling] the low back broadening as if sitting in water [主衝脈為病。逆氣裡急。帶脈為病。腹滿腰溶溶如坐水中, Materia Medica of Combinations].”

• Chénpí: Not specifically associated with EV, but aids in moving the qì with xiāngfù.

• Xiāngfù: “Enters chōngmài. [入衝脈, Materia Medica of Combinations]”. Liu & Su (2017): “Governs treatment of depressed qì mechanism in the extraordinary channels with patterns of qì stagnation and blood stasis [主治奇經氣機鬱滯、氣滯血瘀證].”

• Zǐshíyīng: “When the chōngmài becomes ill, use zǐshíyīng to settle counterflow。[紫石英: 沖脈為病，用紫石英以為鎮逆 Clinical Guide with Case Histories]” Also according to Chace & Shima (2010), Yè Tiānshì considered that zǐshíyīng enters the rènmài. Liu & Su (2017) says “it descends to guide qì and blood to return to the origin so as to secure the chōng [下引氣血歸原以固冲].”

• Shāyuànzǐ: According to Chace & Shima (2010), Yè Tiānshì would use shāyuànzǐ to treat the wéimài.

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The case goes on:

又　和營衛而調攝奇經，病勢皆減。惟腹中之塊未平。仍從前法增損。

Return visit: By harmonizing yíng and wèi as well as regulating and containing the extraordinary channels, the patient’s condition improved. But the lumps in the abdomen did not flatten out. Still follow the previous method, adding and subtracting.

前方去枸杞子，加砂仁、冬朮。

Use the previous formula, remove gǒuqǐzǐ, and add shārén [Amomi Fructus], dōngzhú [Atractylodis Macrocephalae Rhizoma Praeustum].

Mulch comments: The modifications are perhaps more understandable in view of treating abdominal accumulation. Still, there are EV connections here as well:

• Shārén: Liú & Sū (2017) write that shārén “governs treatment of patterns of cold-dampness or cold rheum internally binding in the uterus, essence chamber, chōngmài, and so forth... [主治寒濕或寒飲內結胞宮、精室、冲脈等證...]”

• Dōngzhú is frostbitten ovate atractylodes [báizhú], said in Materia Medica of Combinations to be more sweet and soft [冬朮甘而柔軟] . Báizhú is “truly effective for internal urgency and counterflow qì due to the chōngmài falling ill [并衝脈為病逆氣裏急之功, Seeking Truth in the Materia Medica].”

Case 2

This is a case by Wáng Xùgāo that was published in Liǔ’s Selected Medical Cases from Four Practitioners [柳選四家醫案, Liǔ Xuǎn Sìjiā Yī’ān] by Liǔ Bǎoyí [柳寶詒], 1882. There is a comment by Liǔ at the end of the case.

陽維為病。苦寒熱。陰維為病。苦心痛。陽維維於陽。陽氣弱。則腹痛而便溏。陰維維於陰。營陰虛、則心痛而舌紅也。脈微形瘦。陰陽並損。損及奇經。當以甘溫。

If yángwéi falls ill, one will suffer chills and fever. If yīnwéi falls ill, one will suffer heart pain. Yángwéi links the yáng. If yángqì is weak, there will be abdominal pain as well as sloppy stool. Yīnwéi links the yīn. If yíngyīn is vacuous, there will be heart pain as well as a red tongue. The pulse is faint and the form emaciated. Yīn and yáng are equally injured. This is injury to the extraordinary vessels. Sweet and warm [medicinals] should be used.

再診　但寒不熱。便溏脈細。肢體面目俱浮。悉屬陽虛見象。惟舌紅無苔。此屬陰傷之候。但口不乾渴。乃君火之色外露。治當引火歸元。

Return visit: Only chills with no fever, sloppy stool, and fine pulse. Limbs, body, face and eyes are all puffy. These are all visible manifestations belonging to yáng vacuity. But the tongue is red with no coating, this belongs to the condition of yīn damage. Yet the mouth is not dry, so the color reveals sovereign fire. Treatment should guide fire to return to its source.

附桂八味丸　加鹿角霜　黨參　冬朮

Fùguì Bāwèi Wán, add lùjiǎoshuāng, dǎngshēn, dōngzhú

詒按（論病貫串。認症真切。至用藥之淺深輕重。亦覺步步穩實。）

Yí comments: The discussion of the illness is coherent. His recognition of the pattern is truly incisive. Even his use of medicinals, shallow and deep, light and heavy, is also solid and practical at every step.

Mulch comments: In addition to the above-cited medicinals entering the extraordinary vessels, Materia Medica of Combinations lists the following ingredients of the case prescription:

• Guìzhī: “Goes to the yángwéi. [走陽維。Materia Medica of Combinations]”

• Gāncǎo: “Harmonizes counterflow in the chōngmài, moderates urgency in the dàimài. [和衝脈之逆。緩帶脈之急。Materia Medica of Combinations].”

• Chuānbèi: Not specifically associated with EV, it clears heat from the upper burner and protects the lung yīn.

• Lùjiǎoshuāng: Treats yáng vacuity and “frees the qì abiding in the dūmài. [通督脈之氣舍。Materia Medica of Combinations].” “The deer’s nature is yáng, and it enters the dūmài [鹿性陽，入督脈 Clinical Guide with Case Histories] ”

For the return visit, the injury to yīn has been rectified, and only yáng vacuity remains. Any heat signs are attributed to floating fire, which must be returned to the dāntián. The formula is Aconite and Cinnamon Eight-Flavor Pill [Fùguì Bāwèi Wán], which is another name for Golden Cabinet Kidney Qì Pill [Jīnguì Shènqì Wán] with added degelatinated deer antler, codonopsis, and frostbitten ovate atractylodes, all mentioned above. Fùguì Bāwèi Wán itself has a number of ingredients connected to the EV, but can also be explained as a means to “guide fire to return to its source”.

That’s all for now. Thanks for reading. For those interested, here is an earlier post on Chinese herbal medicine for EV:

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Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Chace, C., & Shima, M. (2010). An exposition on the eight extraordinary vessels: Acupuncture, alchemy, and herbal medicine. Eastland Press.

Huang, G.X. (1769). Seeking truth in the materia medica [本草求真] Retrieved October 30, 2026 from https://jicheng.tw/tcm/book/%E6%9C%AC%E8%8D%89%E6%B1%82%E7%9C%9F_1/index.html

Liu, X.Y, & Su, F.Z. (2017). Chinese medicine system of extraordinary organs and extraordinary vessels: New clinical theories (中医奇腑奇经系统: 临症新论). People’s Medical Publishing House.

Wang, A. (1694). Essentials of Materia Medica [本草備要]. Retrieved October 22, 2023 from https://jicheng.tw/tcm/book/%E6%9C%AC%E8%8D%89%E5%82%99%E8%A6%81/index.html

Wang, X.G. & Fang, R.Y. (1897). Wang Xugao’s clinical records [王旭高臨證醫案.. https://jicheng.tw/tcm/book/%E7%8E%8B%E6%97%AD%E9%AB%98%E8%87%A8%E8%AD%89%E9%86%AB%E6%A1%88/index.html

Yan, J., Shi, W., Hong, W. (1761). Materia Medica of Combinations [得配本草]. Retrieved September 24, 2025, from https://jicheng.tw/tcm/book/%E5%BE%97%E9%85%8D%E6%9C%AC%E8%8D%89/index.html1

Ye, T.S. (1746). A clinical guide with case histories [臨證指南醫案]. Retrieved December 5, 2022, from https://jicheng.tw/tcm/book/%E8%87%A8%E8%AD%89%E6%8C%87%E5%8D%97%E9%86%AB%E6%A1%88/index.html

Zhāng, L. (1695). Encountering the Origin of the Materia Medica Classic [本經逢原]. Retrieved November 4, 2023 from https://jicheng.tw/tcm/book/%E6%9C%AC%E7%B6%93%E9%80%A2%E5%8E%9F/index.html

Essentials of Materia Medica [Běn Cǎo Bèi Yào, 本草備要, 1694], Wāng Áng 汪昂

A Clinical Guide with Case Histories [Línzhèng Zhǐnán Yī’àn 臨證指南醫案, 1746] by Yè Tiānshì [葉天士].

Rotator cuff injuries are a frequent cause of shoulder pain and dysfunction, and their prevalence increases with age. In East Asian medicine, the term “fifty-year-old shoulder” is commonly used to describe the condition of pain, weakness and reduced range of motion that develops in people of late middle-age and elder years, though traumatic or overuse injuries can cause tendinous damage in younger patients as well. Typical treatments in biomedicine consist of physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDS), steroid injections, and, if necessary, surgery (Liu et al., 2025).

However, not everyone who suffers this type of injury would be considered a good candidate for rotator cuff repair surgery; people with shoulder arthritis, depression, obesity, diabetes, severe stiffness or multiple previous shoulder surgeries, or those who use tobacco or opioid medications are unlikely to benefit (Matsen & Warme, 2013).

Exterior therapies, such as channel-based acupuncture with the addition of local shoulder points, works well for the treatment of shoulder injuries, but information on how to support patients suffering from rotator cuff pathology using internal medicine is less available. So off I went in search of some ideas on the subject at hand.

Internal Treatment for External Injuries

Often in internal medicine courses, we teach treatment of musculoskeletal pain (including shoulder pain) according to the theory of wind-cold-damp bì [痹impediment] patterns. In a nutshell, the problem begins with the invasion of wind-cold-camp disease evils at the skin and fleshy exterior, and if the correct qi can’t get rid of the invaders, they move on to the channels and vessels, and finally to the vital organs. Treatment can then be roughly divided into three stages:

• Initial-stage presentations emphasize use of warm acrid surface-resolving and wind-damp-dispelling herbs

• Second-stage emphasizes qì stagnation and blood stasis

• Third stage shifts to addressing chronic qì and blood and/or liver and kidney vacuity

Variations of this idea can be found in Riley (2003), Wu & Fischer (1997), and Maciocia (2025).

In searching for ideas on internal formulas for rotator cuff injuries, I found mostly papers regarding post-surgical treatment rather than discussions of the disorder itself. However, I did find a specific paper, Liu et al. (2025), which fit the bill, and which I will summarize here.

Pathogenesis of Rotator Cuff Injury

According to Liu et al. (2025), Professor Shī Qǐ [施杞] of Shànghǎi, a leading figure with over 60 years of experience in establishing the field of TCM orthopedics, classifies rotator cuff injury [肩袖損傷] as taxation detriment [勞損], the core pathomechanisms being qì and blood disharmony [氣血失和] and phlegm-stasis obstruction [痰瘀痹阻] internally, with sinew-bone imbalance [筋骨失衡] externally. The treatment is to regulate both interior and exterior: internally to regulate qì and blood and dispel phlegm-stasis [内調氣血、祛痰瘀] and externally to regulate sinew and bone and disinhibit the joints [外調筋骨、利关節]. Based on the progression of disease, the balance between right qì and disease evil, and the degree of severity of injury to the sinew and bone, he developed a three-stage model of diagnosis and treatment for rotator cuff injuries.

In the Essential Categories of Correcting the Body [Zhèngtǐ Lèiyāo 正體類要], Xuē Jǐ 薛己 wrote:

Similarly, the decline of the zàngfǔ function leads to undernourished sinew and bone, making such injuries more likely. Once the structural component is disrupted, a vicious cycle may be activated which leads to further deterioration internally and externally.

Part of the disruptive process is the formation of turbidity as fluids stagnate at the site of injury; this can easily transform into phlegm, which intertwines with blood stasis, manifesting as stiffness, pain, weakness and lack of joint mobility in the shoulder. Professor Shī posits shoulder function as harmony between systems of motive force [動力], represented by the sinews, and static force [靜力] represented by the bones. Injury to the rotator cuff interferes with the motive force, upsetting the harmony with the static force, thus creating a sinew-bone imbalance.

This is characterized by “motive force imbalance as the initial stage, static force imbalance as the main factor [動力失衡為先，靜力失衡為主]”. The imbalance occurs in the sinews at the onset, as microtrauma and tissue deterioration creates a disequilibrium between the muscles of the shoulder. Over time the static elements are displaced, bony structures begin to shift, the joint space narrows, adhesions begin to form and what was moving can no longer move.

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Sagacious Cure Decoction [Shèngyù Tāng]

Before we get into the diagnostic and treatment differentiation, I wanted to mention that, according to Zhu et al. (2026), Professor Shī relies on a particular base formula to treat musculoskeletal disorders, namely Sagacious Cure Decoction [Shèngyù Tāng] from Golden Mirror of Our Medical Ancestors [Yīzōng jīnjiàn 醫宗金鑑] by Wú Qiān [吳謙], 1742.

The earliest reference I could find to this formula comes from Secret Stash of the Orchid Chamber [Lánshì Mìcáng 蘭室秘藏 1276] by Lǐ Dōngyuán. It appears in the chapter on the treatment of external sores [chuāngyáng 瘡瘍]:

The version from Golden Mirror simplifies the description of the ingredients:

A couple of things I find interesting about this formula. First, it is listed as an external medicine/surgery [wàikē 外科] formula, a category that includes both skin and musculoskeletal diseases, but you would be hard pressed to identify it as such; it is basically a qì and blood tonic. Also interesting is that Professor Shī pulled this from a chapter on skin sores to treat joint problems. And, especially with regard to the description in Golden Mirror, it is quite simple to remember as a base formula – this is no small matter when you’ve got 10 minutes between patients to put a prescription together.

Three-Stage Classification

Professor Shī follows the standard of classifying the disease into three [acute, subacute, and chronic] stages.

1 Acute Stage

Manifestations: Severe sharp pain of relatively fixed location, pressure elicits pain, aggravated by shoulder elevation and weight bearing. Swelling and nighttime pain may also be present. Tongue may present as dark with stasis signs, pulse is thin, wiry or rough.

Pattern: Qi stagnation and blood stasis

Treatment principles: Move qi, quicken blood, transform stasis and free the network vessels

Formula is Shèngyù Tāng combined with Generalized Pain Stasis-Expelling Decoction [Shēntòng Zhúyū Tāng 身痛逐淤湯] with modifications.

• 黃芪 Huángqí [Astragali Radix] 15 g

• 當歸 Dāngguī [Angelcae Sinensis Radix 9 g

• 白芍 Báisháo [Paeoniae Alba Radix] 15 g

• 川芎 Chuānxióng [Chuanxiong Rhizoma] 12 g

• 地黃 Dìhuáng [Rehmanniae Radix] 9 g

• 柴胡 Cháihú [Bupleuri Radix] 9 g

• 乳香 Rǔxiāng [Olibanum] 9 g

• 羌活 Qiānghuó [Notopterygii Radix] 12 g

• 秦艽 Qínjiāo [Gentianae Macrophyllae] 12 g

• 制香附 Zhìxiāngfù [Cyperi Rhizoma Praeparatum] 12 g

• 川牛膝 Chuānniúxī [Cyathulae Radix] 12 g

• 地龍 Dìlóng [Lumbricus] 9 g

• 炙甘草 Zhìgāncǎo [Glycyrrhizae Radix Praeparatum] 6 g

Formula explanation: Huángqí supplements qì and lifts the yáng; the combination with Sìwù Tāng supplements both qì and blood. In combination with rǔxiāng, Sìwù Tang quickens blood, transforms stasis, frees the network vessels, and stops pain. Qínjiāo and qiānghuó dispel wind and eliminate dampness, and combined with báisháo they relax the sinews and quicken the network vessels, emolliate the sinews and moderate spasms. Cháihú and xiāngfù regulate the qì mechanism, freeing the three burners, moving qì and quickening blood. Chaun̄niúxī quickens blood, frees the network vessels, and strengthens sinew and bone, combined with dìlóng it increases the formula’s ability to quicken blood and transform stasis.

External treatment focuses on nourishing and softening the sinews with gentle manipulation: grasping and kneading, with gentle acupressure. The dregs from the herb formula may be heated, wrapped into a cloth compress and applied to the affected shoulder. Acupuncture is indicated as well.

2 Subacute Stage

Manifestations: Heavy aching pain in the shoulder joint, often with muscle weakness. The range of motion is further reduced. Tongue pale with white greasy coating, pulse wiry and slippery.

Pattern: Stasis and stagnation in the channels and vessels, internal brewing of phlegm-damp

Treatment principles: Boost qì, transform stasis, dispel phlegm, free network vessels

Formula: Shèngyù Tāng combined with Arctium Seed Decoction [Niúbàngzǐ Tāng 牛蒡子湯]

• 黃芪 Huángqí [Astragali Radix] 15 g，

• 當歸 Dāngguī [Angelicae Sinensis Radix] 9 g，

• 白芍 Báisháo [Paeoniae Alba Radix] 12 g，

• 川芎 Chuānxióng [Chuanxiong Rhizoma] 12 g，

• 地黃 Dìhuáng [Rehmanniae Radix] 9 g

• 柴胡 Cháihú [Bupleuri Radix] 9 g

• 炒牛蒡子 Chǎo niúbàngzǐ [Arctii Fructus Frictus] 9 g

• 僵蠶 Jiāngcán [Bombyx Batryticatus] 9 g

• 細辛 Xìxīn [Asari Radix] 6 g

• 蒺藜 Jílí [Tribuli Fructus] 9 g

• 獨活 Dúhúo [Angelicae Pubescentis Radix] 9 g

• 秦艽 Qínjiāo [Gentianae Macrophyllae] 9 g

• 半夏 Bànxià [Pinelliae Rhizoma] 9 g

• 白芷 Báizhǐ [Angelicae Dahuricae Radix] 9 g

• 桑枝 Sāngzhī [Mori Ramulus] 12 g

Formula explanation: Shèngyù Tāng boosts qì and nourishes blood, quickens blood and frees the network vessels. Niúbàngzǐ, bànxià, jiāngcán, xìxīn, jílí eliminate wind and transform phlegm, free the network vessels and relieve pain. Qínjiāo and dúhuó soothe the sinews and quicken the network vessels; báizhí eliminates wind and relieves pain. Sāngzhī guides all the other ingredients directly to the diseased area, frees and disinhibits the joints.

Modifications:

• Severe wind-damp, add qīngfēngténg [Sinomenii Caulis], hǎifēngténg [Piperis Kadsurae Caulis], and jīxuèténg [Spatholobi Caulis].

• Severe cold-damp, add chuānwū [Aconiti Radix], fùzǐ [Aconiti Radix Lateralis Praeparatum], guìzhī [Cinnamomi Radix].

• Pronounced phlegm-damp, add zhì tiānnánxīng [Arisaematis Rhizoma Praeparatum].

External treatment: At this point the injury has stabilized and tissue repair is largely complete, so exercises to restore strength to the surrounding muscles is indicated, along with tuīná techniques such as kneading [róu 揉], stretching [zhǎn 展], loosening [sōng 松], knocking [zhuàng 撞], and shaking [yáo 摇] to unblock the joint and harmonize sinew and bone. Acupuncture at distal sites with active shoulder joint movements is also beneficial.

3 Chronic Stage

Manifestations: Persistent lingering dull shoulder pain, maybe worse after exercise or exposure to wind, cold or damp. Range of motion is severely restricted, muscle atrophy and significant adhesion.

Pattern: Vacuity of upright qì with residual evils

Treatment principles: Pattern: Support the upright, eliminate evils

Formula: Shèngyù Tāng combined with Pubescent Angelica and Mistletoe Decoction [Dúhuó Jíshēng Tāng 獨活寄生湯] with modifications

• 炙黃芪 Zhìhuángqí [Astragali Radix Praeparatum] 15 g

• 黨參 Dǎngshēn [Codonopsis Radix] 12 g

• 當歸 Dāngguī [Angelicae Sinensis Radix] 9 g

• 白芍 Báisháo [Paeoniae Alba Radix] 12 g

• 川芎 Chuānxióng [Chuanxiong Rhizoma] 12 g

• 熟地黃 Shúdìhuáng [Rehmanniae Radix Praeparatum] 12 g

• 柴胡 Cháihú [Bupleuri Radix] 9 g

• 獨活 Dúhúo [Angelicae Pubescentis Radix] 12 g

• 桑寄生 Sāngjìshēng [Taxilli Herba] 12 g

• 秦艽 Qínjiāo [Gentianae Macrophyllae] 12 g

• 防風 Fángfēng [Saposhnikoviae Radix] 12 g

• 桂枝 Guìzhī [Cinnamomi Ramulus] 12 g

• 茯苓 Fúlíng [Poria] 12 g

• 杜仲 Dùzhòng [Eucommiae Cortex] 12 g

• 川牛膝 Chuānniúxī [Cyathulae Radix] 12 g

• 炙甘草 Zhìgāncǎo [Glycyrrhizae Radix Praeparatum] 6 g

Formula explanation: In the formula, Shèngyù Tāng supplements qì and blood and helps boost the liver and kidney. Dúhúo, sāngjìshēng, qínjiāo. and fángfēng eliminate wind-damp residual evils, unblock impediment and relieve pain. Adding guìzhī warms the channels and frees yáng, resolves the exterior and scatters cold. Fúlíng disinhibits water and seeps dampness, fortifies the spleen and calms the heart. Dùzhòng and chuānniúxī supplement liver and kidney and strengthen sinew and bone. Zhìgāncǎo regulates and harmonizes the other ingredients, supplements the spleen and boosts qì.

External treatment: At this stage the main issue is tissue adhesions; manual joint mobilization is indicated, along with tuīná and acupuncture.

Acupuncture Treatment

In terms of acupuncture for shoulder joint disorders, I typically apply what I learned from Shudō Denmei, an approach that is summarized in his Fifty years in practice: The case studies of Shudo Denmei (Shudo, 2022).

Important points:

• Jiānqián [extra point] for anterior pain

• SI-9 Jiānzhēn and SI-11 Tiānzōng for posterior pain

• LI-15 Jiānyú for restricted motion (horizontal insertion, needling straight in along the tendon, apply slight sparrow pecking three times)

• Check points along the three hand yáng channels for reactivity and needle if reactive

• Start with three-month course of treatment and reassess

Conclusion

On examining Professor Shī’s prescriptions, it is clear to see the foundation of Sìwù Tāng plus huángqí [rēnshēn is omitted throughout and dǎngshēn is included only in the third stage formula]. As mentioned above, this is a very simple and effective combination which not only supplements qì and blood, but also quickens blood and emolliates the sinews.

Let’s also not forget that huángqí is a musculoskeletal herb as well.

Additional ingredients follow whatever other pathology is present at each stage, whether it be wind-damp, phlegm accumulation, blood stasis, yáng vacuity, and so forth. There is a lot we can do to support the patient with musculoskeletal injuries beyond external therapies; hopefully we can benefit from applying the approaches of experienced physicians such as Professor Shī and Doctor Shudō.

That’s all for now. Thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

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References

Li, D.Y. (1276). Secret Stash of the Orchid Chamber (蘭室秘藏). Retrieved May 4, 2023 from https://jicheng.tw/tcm/book/%E8%98%AD%E5%AE%A4%E7%A7%98%E8%97%8F/index.html

Liu, S., Shi, Q., Da, W.W., Xue, C.C., & Li, X.F. (2025). Clinical experience of national TCM master Shi Qi in three-stage treatment of rotator cuff injury. Shanghai Journal of Traditional Chinese Medicine, 59(9). DOI: 10.16305/j.1007-1334.2025.z20241030008

Maciocia, G. (2025). The practice of Chinese medicine (3rd ed.). Elsevier Health Sciences (US).

Matsen, F.A., & Warme, W.J. (January 25, 2013). Rotator cuff tear: When to repair and when to smooth and move the shoulder. University of Washington Department of Orthopaedic Surgery and Sports Medicine. https://orthop.washington.edu/patient-care/articles/shoulder/rotator-cuff-tear-when-to-repair-and-when-to-smooth-and-move-the

Riley, D. (2003). Treating pain with traditional Chinese medicine. Paradigm Publications.

Shudo, D. (2022). Fifty years in practice: The case studies of Shudo Denmei (S. Brown, Trans.). Eastland Press.

Wu, Q. (1742). 醫宗金鑑 (Golden Mirror of Our Medical Ancestors). Retrieved August ‎18, ‎2026 from https://jicheng.tw/tcm/book/%E9%86%AB%E5%AE%97%E9%87%91%E9%91%91_1/index.html

Wu, Y., & Fischer, W. (1997). Practical therapeutics of traditional Chinese medicine. Paradigm Publications.

Xue, J. (1529). Essential Categories of Correcting the Body (正體類要). Retrieved April 13, 2026 from https://jicheng.tw/tcm/book/%E6%AD%A3%E9%AB%94%E9%A1%9E%E8%A6%81/index.html

Zhu, W.H., Yao, Z.X., Wu, X.Q., Mo, W., Tang, D.Z., & Shi, Q. (2026). Clinical experience of master of traditional Chinese medicine Shi Qi in treating chronic musculoskeletal diseases with the “mind-body treatment” approach. Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology.

A week or so ago the Broward County Health Department confirmed a locally-acquired case of dengue fever [DF]. This is added to the over 350 additional locally acquired cases throughout the state of Florida, which is looking like the largest outbreak of dengue in the U.S. in the last several decades (DiMichele, 2026). As I live in Broward county, I did some research into DF and how it might be viewed through the lens of Chinese medicine. I found quite a bit of information which I aim to summarize here; I will also focus on the pathomechanisms and pattern differentiations from a couple of the articles in particular.

What is Dengue Fever [DF]?

From the World Health Organization (2025)

• Dengue, A.K.A. “break-bone fever” is caused by the dengue virus (DENV) which is transmitted to humans by mosquitos.

• It is most commonly found in tropical or subtropical climates.

• The majority of people are either asymptomatic or have mild symptoms. When symptoms manifest, they most commonly involve high fever, headache, body aches, nausea and skin rashes.

• Normal course of the disease is 1-2 weeks. In severe cases, hospitalization is needed.

• Onset of symptoms is generally 4-10 days after infection.

  • High fever

  • Severe headache with pain behind the eyes

  • Muscle and joint pain

  • Nausea and vomiting

  • Lymphatic swelling

  • Skin rash

• Severe dengue symptoms can involve abdominal pain, dyspnea, bleeding, severe thirst, vexation, pallor, weakness and fatigue.

• Repeated infections raise the risk for severe dengue

• After recovering from the illness, the patient may feel significant fatigue for weeks

• There is no particular treatment for dengue besides pain management, usually with acetaminophen

• In 2024 the WHO reported almost 15 million cases

TCM Views of Dengue

According to Huang et al (2026), the TCM community in China lacks consensus on the patterns and treaments for dengue. Sun & Duan (2026) published a review of research on DF from 2016 to 2025 which demonstrated that, indeed, there have been differences between leading physicians in the treatment staging and formulas for DF, though there seems to be a broad agreement on viewing DF through the lens of warm disease theory. All the papers I reviewed referenced the 2018 National Guidelines that were published in Zhang et al (2018), so that would be a good place to start.

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2018 National Guidelines (Zhang et al., 2018)

Under section 4 of the Chinese National Guidelines for Clinical Diagnosis and Treatment of Dengue Fever [Zhōngguó Dēnggérè Línchuáng Zhěnduàn hé Zhìliáo Zhǐnán中国登革热临床诊断和治疗指南], dengue fever is classified in TCM as a scourge epidemic [瘟疫 wēnyì], and the pattern differentiation and determination of treatment can be referenced under the categories of epidemic papules [疫疹 yìzhěn], damp warmth [濕溫shīwēn], summerheat warmth [暑溫shǔwēn], and lurking summerheat [伏暑 fúshǔ] in warm disease theory.

The Guidelines give the following outline of diagnostic and treatment stages for the disease:

1. Heat effusion stage:

Warm heat depression with dampness, wèi and qì [aspects] are both afflicted.

Clinical manifestations: In the initial stages, there is heat effusion [fever], headache, lumbar pain, muscle aches, aversion to cold, no sweating, lack of strength, fatigue, frequently accompanied by nausea, vomiting, poor food intake, and diarrhea. At this stage one may see skin rashes on some patients.

Tongue and pulse images: Tongue body is red or light red, tongue coat is greasy or thick. Pulse is slippery and rapid.

Treatment method: Clear heat and transform dampness, resolve toxin and outthrust evils.

• Reference formulas and medicinals: Gānlù Xiāodú Dān [Sweet Dew Toxin-Dispersing Elixir] or Dáyuán Yǐn [Membrane-Source-Opening Beverage] with modifications. Xiāngrú [Moslae Herba]

• Huòxiāng [Pogostemonis Herba]

• Gégēn [Puerariae Radix]

• Qīnghāo [Artemisiae Annuae Herba]

• Qiānghuó [Notopterygii Radix]

• Báikòurén [Amomi Fructus Rotundus]

• Bànxià [Pinelliae Rhizoma]

• Huáshí [Talcum]

• Chìsháo [Paeoniae Rubra Radix]

• Yīnchén [Artemisiae Scopariae Herba]

• Cǎoguǒ [Tsaoko Fructus]

• Shēnggāncǎo [Glycyrrhizae Radix Crudum]

• If heat effusion is evident add cháihú [Bupleuri Radix]

Prepared formulas: Huòxiāng Zhèngqì [Pogostemon Qi-Righting] series of prepared medicines.

2. Peak stage:

i) Toxin and stasis bind together, harassing the yíng and stirring the blood:

Clinical manifestations: Fever abates or is prolonged, vexation and agitation, insomnia, thirst, the appearance of scarlet papules that look like blood, often accompanied by nosebleed, bleeding gums, coughing blood, bloody stool, bloody urine, or abnormal vaginal bleeding.

Tongue and pulse images: Tongue body is red, coat is yellow and lacks moisture, pulse is flooding and large or sunken, fine, slippery, and rapid.

Treatment method: Resolve toxin, transform stasis, clear the yíng and cool blood.

Reference formulas and medicinals: Qīngwēn Bàidú Yǐn [Scourge-Clearing Toxin-Vanquishing Beverage] with modifications.

• Shēngshígāo [Gypsum Crudum]

• Shēngdì [Rehmanniae Radix]

• Shuǐniújiǎo [Bubali Cornu]

• Jīnyínhuā [Lonicerae Flos]

• Huánglián [Coptidis Rhizoma]

• Huángqín [Scutellariae Baicalensis Radix]

• Chìsháo [Paeoniae Rubra Radix]

• Qiàncǎo [Rubiae Radix]

• Dānpí [Moutan Cortex]

• Chǎo Shānzhī [Gardeniae Fructus Praeparatum]

• Qīnghāo [Artemisiae Annuae Herba]

• Shēnggāncǎo [Glycyrrhizae Radix Crudum]

ii) Summerheat-damp damaging yáng, qì failing to contain blood:

Clinical manifestations: Fever abates or is prolonged, fatigue and lack of strength, faint papules on skin or dark-colored stasis macules, frequently accompanied by nosebleed, bleeding gums, coughing blood, bloody stool, bloody urine, or abnormal vaginal bleeding.

Tongue and pulse images: Tongue is dark, coat is greasy, pulse is fine, weak and lacks force.

Treatment method: Warm yáng, boost qì, contain blood.

Reference formulas and medicinals: Modified Fùzǐ Lǐzhōng Tāng [Aconite Center-Rectifying Decoction] combined with Huángtǔ Tāng [Yellow Earth Decoction].

• Zàoxīnhuángtǔ [Terra Flava Usta]

• Páofùzǐ [Aconiti Radix Lateralis Tosta]

• Dǎngshēn [Codonopsis Radix]

• Páojiāng [Zingiberis Rhizoma Praeparatum]

• Huángqín [Scutellariae Baicalensis Radix]

• Jīngjiètàn [Schizonepetae Herba Carbonisatus]

• Chǎobáizhú [Atractylodes Macrocephalae]

• Zhìgāncǎo [Glycyrrhizae Radix Praeparatum]

3) Recovery stage:

Incomplete elimination of residual evils, damage to both qì and yīn.

Clinical manifestations: Fatigue and lack of strength, nausea, poor food intake, thirst, irregular bowel movements, frequently there are itching papules on the skin.

Tongue and pulse images: Tongue is light red, coat is white and greasy, pulse is empty and rapid.

Treatment method: Clear heat, transform damp, fortify the spleen and harmonize the stomach.

Reference formulas and medicinals: Zhúyè Shígāo Tāng [Lopatherum and Gypsum Decoction] combined with Shēngmài Sǎn [Pulse-Engendering Powder].

• Zhúyè [Lopatheri Herba]

• Nánshāshēn [ Adenophorae Radix]

• Shēngyìmǐ [Coicis Semen Crudum]

• Shēngshānyào [Dioscoreae Rhizoma Crudum]

• Bànxià [Pinelliae Rhizoma]

• Lúgēn [Phragmitis Radix]

• Màidōng [Ophiopogonis Radix]

• Shēngdào Màiyá [Oryzae Seu Hordei Fructus Germinatus Cruda]

• Shārén [Amomi Fructus]

• Xīyángshēn [Panacis Quinquefolii Radix].

  ---

Integrating Cold Damage and Warm Disease Theories

A 2024 team investigating an outbreak of DF in Fóshān, Guǎngdōng established a diagnostic and treatment system based on integration of the six-channel differentiation from Discussion on Cold Damage [Shānghán Lùn] with warm disease theory (Huang et al. 2026). According to this paper, the core pathomechanism of DF is lurking evils causing disease, effusing outward to the three yáng and sinking inward to the three yīn [伏邪致病，外發三陽、內陷三陰].

The pathomechanism in Huang et al. (2026) refers to an earlier publication (Xu et al., 2019) highlighting the approach of Professor Rú Qīngjìng [茹清靜]. Professor Rú largely adheres to the 2018 Guidelines but maintains that there is a distinction in terms of etiology and pathogenesis from the classic conception of epidemic toxin: the specific pathogen [DENV] and vector [transmission through mosquito bites] have both been identified. Therefore, instead of epidemic toxins being introduced through the mouth and nose, the toxins invade directly through the exterior into the muscle layer.

Professor Huáng Làpíng (Huang et al. 2026), looking at cases from 2024 outbreak, believes the core disease mechanism to be lurking evils causing disease [伏邪致病] located primarily in the shàoyáng channel in six channel differentiation and the membrane source - triple burner [móyuán-sanjiāo 膜原-三焦] in warm diseases. In the first place, the initial manifestations of DF such as alternating chills and fever and pain and fullness in the chest and ribside are indicative of a shàoyáng pattern. In the second place, after the epidemic toxin is introduced through the skin by the mosquito bite, the evils hide in the membrane source, or gateway to the triple burner [三焦之門戶]. Together the membrane source and shàoyáng represent the pivot between exterior and interior, where the lurking evils can effuse outwardly to the three yáng or sink inwardly to the three yīn [伏邪外發三陽、内陷三陰].

Membrane Source [Móyuán]

Located between the thoracic and abdominal viscera, below the diaphragm and above the stomach duct, the membrane source is located deep and it is an ideal place for lurking evils to hide (Huang et al., 2026). Wú Yòukě [吳又可, 1582-1652], in Discussion on Warm Epidemics [溫疫論 Wēnyì Lùn, 1642], said warm epidemic evils lurk and effuse in the membrane source [溫疫之邪伏發膜原] and that the membrane source itself is half exterior and half interior [半表半裡] and that the method of treatment was to open to reach the membrane source [開達膜原]. Qing era author Dài Tiānzhāng [戴天章, 1644-1722] proposed that the membrane source could be treated by coursing and disinhibiting the shàoyáng pivot [疏利少陽樞機], thus forming an important link between the two systems of warm diseases and cold damage (Huang et al., 2026).

Huang et al. (2026) states that móyuán function is comparable to immune system function. Some scholars have proposed that móyuán includes peritoneal, lymphatic, and immune barrier structures, and that it can serve as a defensive layer, to protect and help eliminate pathogenic factors either internal or external. However, in cases of right qì vacuity the móyuán cannot outthrust the lurking evils which accumulate and eventually diffuse through the membrane to the viscera, channels, and other body structures (Zhou et al., 2023).

Linking móyuán and shàoyáng

The shàoyáng is layered between tàiyáng and yángmíng and governs the pivotal transmission of the qì mechanism to the exterior and interior, thus it is often referred to as midstage or half-exterior, half-interior. The móyuán has been similarly referred to by scholars, for example Hé Xiùshān’s [何秀山] annotation to his contemporary Yú Gēnchū’s [俞根初1734-1799] Revised and Expanded Popular Treatise on Cold Damage [增訂通俗傷寒論 ] (Yu, 1934):

Huáng Làpíng’s DF Patterns

According to Huang et al (2026), Professor Huáng Làpíng’s system of integrating cold damage and warm disease on the diagnosis and treatment of DF can be summarized as follows:

Tàiyáng-shàoyáng pattern

• If the five zàng are regulated and harmonious, and the right qì is flourishing, the epidemic toxin lurking in the membrane source may emerge through the tàiyáng layer, which manifests as a combination tàiyáng-shàoyáng pattern.

• Signs and symptoms may include alternating chills and fever, stiff neck and headache, aching limbs and joints, retching and loss of appetite.

• Obstruction in the shàoyáng pivot leads to rising gallbladder fire, causing dry throat with bitter taste and retching; it also disrupts the triple burner’s management and distribution of water.

• Obstruction in the tàiyáng exterior causes aching in the muscle layer and limbs, and exterior symptoms such as chills and fever.

• The recommended prescription is modified Cháihú Guìzhī Tāng [Bupleurum and Cinnamon Twig Decoction].

  • In the formula, cháihú and huángqín course and disinhibit shàoyáng and clear gallbladder fire

  • Guìzhī [Cinnamomi Ramulus] and báisháo [Paeoniae Alba Radix] regulate and harmonize the yíng and wèi and resolve tàiyáng.

  • Shēngjiāng [Zingiberis Rhizoma Recens], dàzǎo [Jujubae Fructus], and gāncǎo harmonize the center.

  • In all the formula facilitates and outthrusts the pivot mechanism, courses the exterior and frees the interior [暢達樞機、疏表通里] to vent the evil and stabilize the right qì [邪透正安].

Three yáng pattern

• In patients with a constitutional predisposition to yángmíng dry heat, evils lurking in the body after contraction of epidemic toxin can easily stir heat in the channels, causing a simultaneous tàiyáng-shàoyáng- yángmíng or three- yáng disease pattern.

• Symptoms here may be high fever with aversion to wind, vexing pain of the limb joints, red face and eye pain especially affecting the forehead and eye orbits, thirst and dry mouth with a bitter taste.

• The core disease mechanism is depression of the tàiyáng exterior causing aversion to wind and body aches; stagnation of the shàoyáng pivot causing bitter taste and dry throat; and rising yángmíng channel heat attacking the forehead and orbits causing scorching pain, and red face as if one is drunk. At this stage the heat is still in the channels and has not yet reached the organs.

• Treatment should regulate the three yáng channels with Cháigé Jiějī Tāng [Bupleurum and Pueraria Flesh-Resolving Decoction].

  • In the formula, cháihú courses and discharges the shàoyáng stagnation, gégēn vents and resolves the yángmíng channel heat, qiānghuó opens and discharges the evils at the tàiyáng exterior

  • They are assisted by huángqín to clear gallbladder fire, and shígāo to drain qì aspect heat.

  • In all the formula courses the exterior and vents the evils, resolves the muscle layer and clears heat.

Tàiyáng-shàoyáng- tàiyin Pattern

• Patients with a constitutional tàiyīn insufficiency (spleen-stomach vacuity cold), after contracting the epidemic toxin the disease mechanism easily transforms into cold, forming a combined tàiyáng-shàoyáng-tàiyīn channel pattern.

• In this pattern one commonly sees persistent alternation of chills and fever, cold pain of the limb joints, sloppy stool or duck slop diarrhea, or stools that are first hard then sloppy, this is actually because of inhibited shàoyáng pivot mechanism, with a concurrent tàiyīn vacuity cold condition.

• Treatment should simultaneously harmonize and resolve the shàoyáng pivot mechanism and warm and transport the tàiyīn.

• The formula here is Cháihú Guìzhī Gānjiāng Tāng [Bupleurum, Cinnamon Twig, and Dried Ginger Decoction].

  • In the formula, cháihú and huángqín course and discharge depressive heat from the shàoyáng to treat the alternation chills and fever

  • Guìzhī and gānjiāng [Zingiberis Rhizoma] warm and free the tàiyáng and tàiyīn from cold and dampness, to treat the joint pain and diarrhea;

  • Tiānhuāfěn [Trichosanthis Radix] engenders fluids to restrain dryness;

  • Mǔlì [Ostreae Concha] disperses binds and disinhibits water.

  • In all, the formula combines cold and warm medicinals to clear heat, regulate the pivot mechanism, and warm both the surface and interior.

Lurking damp heat pattern

• In tropical and subtropical regions, the hot and humid climate together with the consumption of cold food and drink can lead to a condition of spleen-stomach vacuity with combined interior and exterior dampness.

• After epidemic toxins enter the body, the dampness and heat glue and bind in the móyuán and triple burner. The dampness traps the heat into latency forming a dense miasma that is difficult to resolve [濕遏熱伏、氤氳難解].

• As Wú Jūtōng [吴鞠通, 1758-1836] said: “If one merely clears the heat, the dampness becomes more stubborn, if one merely removes the dampness, the heat becomes more intense.” “徒清其熱則濕愈錮，徒祛其濕則熱愈熾”

• Common disease manifestations are fluctuating generalized fever, temporarily resolved by sweating, with fever returning soon thereafter; accompanying manifestations include clouded heavy head, reddish urine and sloppy stools, yellow greasy tongue coating, all typical signs of damp-heat.

• Treatment should diffuse and facilitate the triple burner, separate and disperse, mobilize and discharge.

• The recommended formula is Èrgēn Huángqín Huáshí Tāng [Two-Root, Scutellaria and Talcum Decoction], a modification of Huángqín Huáshí Tāng from Systematized Identification of Warm Diseases [Wēnbìng Tiáobiàn 温病条辨, 1798] by way of adding lúgēn and báimáogēn [Imperatae Rhizoma].

  • In this formula, bitter cold huángqín clears and disinhibits central burner damp heat, and sweet cold huáshí seeps and disinhibits lower burner damp turbidity; the two medicinals mutually combine to eliminate the heat and dampness.

  • Sweet, cold, light and clear lúgēn diffuses and vents the upper burner depressive heat without damaging the fluids; sweet cold báimáogēn enters the blood aspect, guiding the dampness and heat out through the bladder.

  • They are assisted by fúlíngpí [Poria Cutis] and dàfùpí [Arecae Pericarpium] which move qì and disinhibit water, and aid in the triple burner’s qì transformation.

  • Taken all together, the formula clears heat, disinhibits dampness, and outthrusts qì.

Ying-blood aspect patterns

• If a patient with constitutional yīn vacuity contracts epidemic toxins, the evils tend to transmit through the four aspects of wèi, qì, yíng and xuè to fall inward to the shàoyīn, either scorching and damaging the yíngyīn or penetrating to enter the blood aspect, triggering the appearance of a critical pattern.

• Upon initial entry of the epidemic toxins to the yíng aspect, the manifestations include fevers which worsen at night, faint maculopapular eruptions, heart vexation and insomnia, crimson tingue with scanty coating, indicating that the epidemic toxins have transformed into fire, plundering and damaging the yíngyīn.

• The governing formula is Qīngyíng Tāng [Provisioning-Clearing Decoction].

  • In the formula, the sovereign medicinals shuǐniújiǎo and shēngdìhuáng clear the yíng and cool the blood;

  • The ministers xuánshēn [Scrophulariae Radix] and màidōng nourish yīn and engender fluids;

  • Jīnyínhuā, liánqiáo [Fructus Forsythiae] and zhúyè [Lopatheri Folium] lightly clear, outthrust and discharge, causing the yíng heat to vent outward to the qì aspect. This gives the evils an exit route and allows the yíngyīn to recover.

• However, if the epidemic toxin goes further and sinks deeper into the blood aspect, resulting in manifestations of vigorous fever that does not abate, clouded spirit and delirious speech, patches of purple stasis macules, deep-red tongue and rapid pulse, it corresponds to a pattern of blood aspect exuberant heat toxin forcing the blood to move frenetically.

• The situation calls for Xījiǎo Dìhuáng Tāng [Rhinoceros Horn and Rehmannia Decoction] to cool blood and dispel stasis.

  • In the formula the sovereign medicinal shuǐniújiǎo cools blood and resolves toxins;

  • The minister shēngdìhuáng nourishes yīn and clears heat;

  • The assistant and courier chìsháo and dānpí quicken blood and dispel stasis.

  • All combined they cool blood, dispel blood and resolve toxin.

Heart yáng vacuity-desertion pattern

• If there is a constitutional heart yáng root vacuity, complicated by contraction of epidemic toxin evils which sink inward to the shàoyīn, they will transform into cold and damage the yáng, causing the heart yáng to wane to the point of desertion, developing into a heart yáng vacuity desertion pattern.

• This pattern is frequently seen in the severe stages of dengue fever; its disease mechanism belongs to the shàoyīn cold transformation pattern [寒化證] from Discussion on Cold Damage. It is actually a critical condition of fulminant desertion of heart and kidney yángqì [心腎陽氣暴脫].

• Clinical manifestations include recurring heat effusion that does not abate, dripping cold sweat, counterflow [cold] reversal of the four limbs, palpitations and fearful throbbing, pallid facial color, faint pulse on the verge of expiry.

• Treatment must urgently return yáng and stem counterflow, support the right qì and secure desertion.

• The selected formula is called Pògé Jiùxīn Tāng [Exceptional Heart-Rescuing Decoction]. It skillfully blends the Discussion on Cold Damage formula Sìnì Tāng [Counterflow Cold Decoction] to return yáng and stem counterflow with Zhāng Xīchún’s [張錫純, 1860-1933] Láifù Tāng [Return Again Decoction] to constrain the origin and secure desertion.

  • The formula makes heavy use of fùzǐ [Aconiti Radix Lateralis] to warm and invigorate original yáng, gānjiāng to warm the center and scatter cold, combined with shānzhūyú [Corni Fructus], lónggǔ [Mastodi Ossis Fossilia], and mǔlì to restrain yáng and secure desertion, and rēnshēn [Ginseng Radix] to greatly supplement the original qì.

  • All of the medicinals mutually combined warm yáng and stem counterflow, restrain yīn and secure desertion.

• This is a critical situation requiring emergency measures to resuscitate the patient and thus outside the scope of most practices.

Acupuncture treatment

No mention of acupuncture and moxibustion was made in any of the papers I reviewed. In terms of the four-aspect patterns, lurking evils, the membrane source, etc., I have written a fair bit about it in the past. Those interested may want to have a look at the posts linked below:

Points for the membrane source:

Venting techniques:

Points for the wèi aspect:

Points for qì aspect lung patterns

Points for qì aspect spleen patterns

Points for the yíng aspect

Points for the xuè aspect

Conclusion

I would probably need two or three more posts to cover the various views on differentiation of patterns for DF; I just highlighted the reference guidelines and another system I thought was particularly interesting for its integration of the Cold Damage and Warm Disease thought streams. As useful as guidelines are, in clinic, of course, its best to adapt to the needs of each patient. Overall, the severe cases of DF are uncommon, and most who are afflicted with it experience mild to moderate symptoms, or may be asymptomatic. Still, those of us in the tropics or subtropics should take note. I found out when I moved from cold and dry Illinois to hot and humid Florida just how important warm disease theory can be.

That’s all for now. Thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

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References

DiMichele, A. (2026, October 5). Case of locally acquired dengue fever confirmed in Broward. South Florida Sun Sentinel. https://www.sun-sentinel.com/2026/10/05/case-of-locally-acquired-dengue-fever-confirmed-in-broward/

Huang, J.W., Yu, X.L., Wu, Y.F., & Huang, L.P. (2026). Exploring Traditional Chinese Medicine Syndrome-Based Therapeutic Strategies for Dengue Fever from the Perspective of Six-Meridian Syndrome Differentiation. New Chinese Medicine, 58(4). DOI: 10.13457/j.cnki.jncm.2026.04.024

Sun, H.R.,& Duan Z.Y. (2026). The latest research progress of traditional Chinese medicine on the prevention and treatment of dengue fever from 2016 to 2025. Journal of Tropical Medicine, 26(3). DOI:10.3969/j.issn.1672‐3619.2026.03.029

World Health Organization. (2025, August 21). Dengue. https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

Xu, X.L., Ru, Q.J., & Sun, T. (2019). Ru Qingjing’s experience in the diagnosis and treatment of dengue fever based on the “two stages and four types” model. Zhejiang Journal of Integrated Traditional Chinese and Western Medicine, 29(3).

Yu, G.C. (1934). Revised and expanded popular treatise on cold damage [增訂通俗傷寒論] (L.C. He, Ed,). Retrieved July 9 2023 from https://jicheng.tw/tcm/book/%E5%A2%9E%E8%A8%82%E9%80%9A%E4%BF%97%E5%82%B7%E5%AF%92%E8%AB%96/index.html . (Original work published late 18th century)

Zhang, F., He, J., Peng, J., Tang, X., Qin, C., Lu, H., Li, X., Liu, Q., Zhao, H., Sheng, J., & Wang G. (2018). Chinese National Guidelines for the Clinical Diagnosis and Treatment of Dengue Fever [中国登⾰热临床诊断和治疗指南]. Chinese Journal of Pediatrics, 57(9).

Zhou, Z., Tang, Z., Chen, X., Shang, Y., Liu, Y., Liu, Y., Hu, X., & Chen, Y. (2023). Systematic analysis of moyuan theory based on “pericardium-triple energizer-membrane” system. Acta Chinese Medicine, 38(307).

I’ll begin this piece with an introduction and a couple of brief stories.

Back in the 1990s, when I was a student in acupuncture school, I became especially interested in Japanese styles. This was largely because of the subtle techniques used by many prominent Japanese practitioners, whose work was highlighted in books such as Five Elements and Ten Stems, Extraordinary Vessels, and Hara Diagnosis by Matsumoto and Birch, and Chasing the Dragon’s Tail by Manaka, Itaya, and Birch. The latter two books featured the work of Manaka Yoshio, a visionary Japanese physician who may be best-known in the west as the inventor of the ion-pumping cords [IPC]. The cords themselves are a sort of jumper-cable device to regulate the channel system. They have been the subject of much debate over the years but, as I have found repeatedly, they can be astoundingly effective.

Story 1

I was still a student, living on the top floor of a three-story walkup on the North Side of Chicago. I got a call from a friend who told me his back was really hurting, and could he drop by to get a treatment. Sure, I said, and shortly afterwards I heard a noise on the stairs outside my door. My friend was literally crawling up three flights of stairs (man, why didn’t you tell me you were downstairs? I could have helped you up!) and I quickly got him onto a futon. His back was spasming and he was in a tremendous amount of pain. I wasn’t about to ask him to disrobe in that condition, so I just treated the dàimài pair [GB-41 and TB-5] with four needles, hooking up the IPC like I had read about in the books. We watched TV for about 15 minutes, then I pulled the cords and needles and asked him to gently range his back and see if it was better. He very carefully sat up, then stood up, then rotated at the waist. “Ummm… it’s gone,” he said. 15 minutes of ion pumping eliminated back pain so severe that my friend could barely walk.

Story 2

I was a student clinic supervisor at a college in Miami. A patient presented with acute back pain. I took the students in to examine him. In looking at his abdomen, there was a noticeable shift on the position of his navel, about one inch to his left, presumably due to the torque in his back muscles. I gently palpated a few points on his belly and anterior neck. I decided to treat him with IPC for a cross-syndrome pattern, chōngmài - yīnwéimài [SP-4 and PC-6] on the right and dàimài-yángwéimài [GB-41 and TB-5] on the left. The muscles on the right anterior neck were especially indurated, so I added some contact needling – not inserting but just touching the needle tip to a few of the tight points in that area. As the students watched, the navel began to shift back to the right. After about five minutes, it had moved about an inch and was nearly centered again, and the patient indicated that the back pain was significantly relieved.

Over the years, I have had numerous fascinating experiences with these types of treatment: a patient dropping off into sleep in mid-sentence as soon as the IPC were connected, another with TMJ having to get a custom mouth guard remade after one treatment with magnets on distal points shifted her bite. I find these episodes even more remarkable when I reflect on the fact that I was just applying the techniques by piecing them together from books I’d read or passing discussions with other practitioners. The early books, as engrossing and thought-provoking as they were, often lacked detailed clarity and left a lot of questions unanswered.

Now, thirty years after Chasing the Dragon’s Tail, we finally have a detailed, step-by-step book written by an international team of Manaka Style Acupuncture [MSA] practitioners, with decades of experience in practicing and teaching this approach. The book is called Manaka Made Simple: A Step-By-Step Guide to Dr Manaka’s System of Japanese Acupuncture and Moxibustion, by Oran Kivity, Stephen Birch, Marian Fixler, Brenda Loew, and Paul Movsessian.

I was excited to read through the book, and here is a brief summary.

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Manaka Made Simple: A Review

Part one of the book starts with a detailed discussion of Manaka’s system.

Chapter one begins with a look at Manaka’s theory of embryonic development and the structural aspects of the eight extraordinary vessels [EV]; it also offers answers as to why the subtle low-stim Japanese styles can be so remarkably effective. This section also introduces the ideas of multi-step treatment staging and root treatment that will be more fully fleshed out as the book proceeds.

Chapter two then goes into these ideas and the all-important emphasis on treating the root condition. The four steps, simply put, are

1. treating the anterior/yin side of the body, especially as regards any anomalous palpatory findings on the abdomen

2. treating the posterior/yang side of the body, especially as it relates to the findings of step 1

3. addressing structural imbalances, and

4. treating the presenting symptoms, which will likely be reduced after the previous steps are completed.

Chapters three and four offer background on Japanese acumoxa and palpation. This is mostly geared toward those new to the style, but those who are more acclimated can also learn a thing or two from reading through it.

Chapter five gets into the nuts and bolts of the abdominal examination, looking at the reactive areas of the EV and Manaka’s variations on the mu-alarm points. Chapter six is devoted to the treatment of the diagnostic findings. The confluent points - A.K.A. the jiāohuì points of Dòu Hànqīng - are presented with specific instructions on how to palpate to best locate them specifically for treatment with the tools used in Manaka’s style. The chapter goes on to introduce the most important of these tools, the ion-pumping cords [IPC]. You’ll learn how to apply them, what to expect, and what to do when what you expect doesn’t quite work out as expected. Mixed patterns of EV imbalance are also addressed in chapter seven, which is much needed because such findings are not uncommon.

Chapter eight moves on to step 2, and what to look for on the dorsal side based on what was found on the ventral side in step 1. The instructions on palpation and needling in this chapter are quite useful even outside the context of MSA. For example, there is more in-depth exposition on kyuutoushin [moxa on top of the needle] than most of us likely got in acupuncture school.

Chapter nine progresses to step 3, structural imbalances, with a look at Sotai, the Japanese physical medicine system developed by Hashimoto Keizo. It is about as well-written as it can be though anyone wishing to really apply Sotai would do well to take some in-person training. The dynamics can be difficult to comprehend through words and still pictures alone. In chapter ten we come to step 4, symptom control, with some very useful discussion on intradermal needles, press tacks, and magrain pellets; again, probably more than any of us had in school. It closes with discussion on auricular and hand microsystems.

The remainder of the book offers rich detail on Japanese moxibustion, valuable insights on fine-tuning the diagnostic process presented in chapter five, and further tools to explore beyond the IPC. There are illustrative case presentations throughout, which gives one a feel for how this type of treatment plays out in a clinical setting. Helpful summaries are included at the conclusion of each chapter, to aid in retaining the wealth of information contained in every section of the book.

I highly recommend the book to anyone who is interested specifically in Manaka’s work, or Japanese acupuncture styles as a whole. As mentioned, it offers a lot of detailed knowledge on techniques that often get little or no explanation in many acupuncture programs, and for that it can also be of interest to anybody looking to expand their treatment repertoire. Be advised though, that once you start to apply things like ion-pumping clinically, you may very well see some strange and astonishing results.

Note: I have no financial interest in this book and received no compensation for this review. I personally regard Dr Manaka as a true genius and believe that his ideas deserve to be more widely known. I hope this book helps to make that possible, and both patients and practitioners will benefit from his life’s work.

Okay, I’m off to work on some more mulch, which I will post when I am able. Thanks, as always, for reading.

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References

Kivity, O., Birch, S., Fixler, M., Loew, B., & Movsessian, P. (2026) Manaka Made Simple: A Step-By-Step Guide to Dr Manaka’s System of Japanese Acupuncture and Moxibustion, Volume 1. Sayoshi Books.

Manaka, Y., Itaya, K., & (1995). Chasing the dragon’s tail : The theory and practice of acupuncture in the work of Yoshio Manaka. Paradigm Publications.

Matsumoto, K., & Birch, S. (1983). Five elements and ten stems: Nan ching theory, diagnostics and practice. Paradigm Publications.

Matsumoto, K., & Birch, S. (1986). Extraordinary vessels. Paradigm Publications.

Matsumoto, K., & Birch, S. (1988). Hara diagnosis: Reflections on the sea. Paradigm Publications.

I’ve been away from the mulch for a bit, and I figured I would check back in. Amongst all of the current life stuff and things happening on the local-national-international scene (which is a lot), I have been hanging out with the written work of noted Qing-era physician Wáng Xùgāo [王旭高 1798-1862]. Over the years I’ve put together draft translations of a fair bit of his oeuvre, but more recently I’ve focused on his case reports.

If you want to get to know what goes on in a doctor’s mind, reading his or her case reports gives you a doorway. I was inspired by Lorraine Wilcox’s talk Befriending the Author through Case Studies:

Lorraine has translated reams of case reports by various physicians and really picks up on aspects of their personality. I’m nowhere near as experienced nor as perspicacious as she, but I do enjoy looking at the doctors’ diagnoses and analyzing their prescriptions. I can’t claim to know precisely why they diagnosed or prescribed a certain way, but I can speculate and try to spot frequent patterns, favored medicinals, relied-upon formulas and so forth.

So here are a few cases with some commentary. I chose them to illustrate the method of combining two (or more) standard formulas, with some additions. This is a method I’ve often used during times when I had a granule dispensary, so it is interesting to me to read about a similar approach in the historical literature. In many cases, the author refers to the idea of a formula with additions and subtractions, but there are some where an entire formula is used or can be seen within the list of ingredients.

These are case reports from Liǔ’s Selected Medical Cases from Four Practitioners [柳選四家醫案 Liǔ Xuǎn Sìjiā Yī’ān, 1882] by Liǔ Bǎoyí [柳寶詒 1842-1901]. Liǔ, a well-known physician in his own right, anthologizes and comments on case reports from four prominent doctors. One of the four is Wáng Xùgāo, and these cases come from him.

Vacuity Detriment 虛損

左寸關搏指。心肝之陽亢。右脈小緊。脾胃之虛寒。是以腹中常痛。而大便不實也。病延四月。身雖微熱。是屬虛陽外越。近增口舌碎痛。亦屬虛火上炎。津液消灼。勞損何疑。今商治法。當以溫中為主。稍佐清上。俾土厚則火斂。金旺則水生。古人有是論。幸勿為世俗拘也。

The left cùn and guān [pulses] are throbbing; this points to yáng hyperactivity of the heart and liver. The right pulse is small and tight. This is vacuity cold of the spleen and stomach. Hence there is frequent pain in the abdomen as well as loose stool. The illness has lasted four months. Although the body is slightly hot, this pertains to vacuous yáng straying outward. Additionally there has recently been cracking and pain of the mouth and tongue; this pertains to vacuity fire flaming upward, dispersing and scorching the fluids. Why would one doubt that this is taxation detriment? Now I reckon that the treatment method should prioritize warming the center, with a few assistants to clear the upper, so that if earth is solidified, then fire is constrained, and if metal is effulgent then water is engendered. The ancients have discussed this matter; fortunately we are not restrained by common convention.

黨參　於術　茯苓　甘草　炮姜　五味子　麥冬　燈心

Dǎngshēn [Codonopsis Radix], yūzhú [Atractylodis Macrocephelae Rhizoma], fúlíng [Poria], gāncǎo [Glycyrrhizae Radix], páojiāng [Zingiberis Rhizoma Praeparatum], wǔwèizǐ [Schisandrae Fructus], màidōng [Ophiopogonis Radix], dēngxīn [Junci Medulla]

詒按（此陰虧而虛火上炎之症也。方以理中合生脈法。溫中清上。兩面都到。所云土厚則火斂。金旺則水生。見理極精。非淺學所能學步。）

Yí comments: This is a pattern of yīn depletion as well as vacuity fire flaming upward. The formula uses the Lǐzhong [Tāng] combined with the Shēngmài [Sǎn] methods to warm the center and clear the upper. It fully accomplishes both aspects of what was said: if earth is solidified, then fire is constrained, and if metal is effulgent then water is engendered. One can see that this principle is extremely refined, not something those with only superficial learning can emulate.

Notes:

• The formula does indeed use a combination of Center-Rectifying Decoction [Lǐzhong Tāng] and Pulse-Engendering Powder [Shēngmài Sǎn], though the inclusion of poria [fúlíng] could be said to incorporate Four-Gentlemen Decoction [Sìjūnzǐ Tāng] as well. These three formulas together accomplish the principal methods: Warming the center with Lǐzhong Tāng, solidifying earth by means of Sìjūnzǐ Tāng, and effulging metal to engender water through Shēngmài Sǎn.

• Clearing the upper [清上] in this case is not done by outthrusting and effusing, which would be the case if there was lung heat. Instead, it is the heart fire that is cleared, but much of the clearing is draining it downward through the small intestine. For this, Wáng added juncus pith [dēngxīncǎo], which homes to both heart and small intestine channels. Its sweet and bland nature percolates urine; its flavors mutually enhance fúlíng. It works well in the formula to drain heart fire without bitterness, thus averting harm to the spleen and stomach. It assists ophiopogon [màidōng] in clearing the heart and eliminating vexation, and can also address the mouth sores that are part of the pattern. It is the sole ingredient in the prescription not derived from the three base formulas mentioned, an elegant and well-considered addition.

• What of the hyperactive liver yáng? According to Classic of Difficulties [Nànjīng], chapter 69, repletion in a zàng organ can be drained through its child. Since the heart is of the fire phase, it is the child of liver-wood and draining its fire will drain that of the liver as well.

• Yūzhú is white atractylodes [báizhú] grown in the Yūqián [於潜] region of Zhèjiāng province. It is considered to be of the finest quality that “provides a strong but harmonious tonification of the Spleen” (Bensky et al. 2004).

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Internal Damage and Miscellaneous Diseases 內傷雜病 #1

思慮傷脾之營。勞碌傷脾之氣。歸脾湯、補脾之營也。補中益氣湯、補脾之氣也。今將二方。併合服之。

Thought and preoccupation damage the spleen yíng. Taxation and overwork damage the spleen qì. Guīpí Tāng supplements the spleen yíng. Bǔzhōng Yìqì Tāng supplements the spleen qì. Now combine the two formulas to be taken together.

黨參　黃耆　冬朮　茯神　歸身　炙甘草　砂仁　棗仁　升麻　柴胡　木香　半夏　陳皮

Dǎngshēn, huángqí [Astragali Radix], dōngzhú [Atractylodis Macrocephalae Rhizoma Praeustum], fúshēn [Poria Pararadicis], guīshēn [Angelicae Sinensis Radicis Corpus], zhìgāncǎo [Glycyrrhizae Radix Praeparatum], shārén [Amomi Fructus], zǎorén [Zizyphi Semen], shēngmá, cháihú [Bupleuri Radix], mùxiāng [Aucklandiae Radix], bànxià [Pinelliae Rhizoma], chénpí [Citri Reticulatae Pericarpium]

詒按（同是脾病。而病原用藥。確有氣營之別。一經指點。便覺頭頭是道。）

Yí comments: Both are illnesses of the spleen, yet the pathogenesis and medicinals used do indeed differentiate qì and yíng. Once this is pointed out, one realizes how clear and logical it is.

Notes:

• The two formulas have quite a bit of overlap. The entirety of Center-Supplementing Qì-Boosting Decoction [Bǔzhōng Yìqì Tāng] is present in this prescription. Two ingredients of Spleen-Returning Decoction [Guīpí Tāng] have been omitted: lóngyǎnròu [Longan Arillus] and yuǎnzhì [Polygalae Radix].

• Added to the formula combination are shārén and bànxià. This, like the above example, makes for a third formula in the mix: Aucklandia and Amomum Six-Gentlemen Decoction [Xiāngshā Liùjūnzǐ Tāng] – which one could say contains within it another formula, namely Two Matured Ingredients Decoction [Èrchén Tāng]. It could be that Wáng was cautious about the weakened spleen qì’s ability to transform the supplementing medicinals in the prescription, or that there were some signs of phlegm-damp that went unmentioned in the case report.

Internal Damage and Miscellaneous Diseases 內傷雜病 #2

左脈空大。腎水虧也。倦怠無力。脾氣弱也。食少則陰虛。陰虛生內熱。症屬內傷。

The left pulse is empty and large; this is depletion of kidney water. Fatigue and lack of strength; this is weakness of spleen qì. Eating little results in yīn vacuity; yīn vacuity engenders interior heat. The pattern pertains to internal damage.

補中益氣湯加黑山梔　白芍

另六味丸每朝服四錢

Bǔzhōng Yìqì Tāng [Center-Supplementing Qi-Boosting Decoction], add hēi shānzhī [Gardeniae Fructus Carbonisatus, charred gardenia fruit] and báisháo [Paeoniae Alba Radix].

In addition, take four qián of Liùwèi Wán [Six-Ingredient Pill] every morning.

淵按：陰虛有二，有營中之陰虛，有腎中之陰虛。營陰虛故從東垣，若六味地黃則治腎陰虛。

Yuān comments: There are two types of yīn vacuity; there is vacuity of the yīn within the yíng, and vacuity of the yīn within the kidney. Yíng-yīn vacuity therefore follows Dōngyuán, like Liùwèi Dìhuáng is the standard treatment for kidney yīn vacuity.

詒按（補中益氣、補脾氣。六味補腎陰。立法頗切實。惟左脈空大。方中升柴兩味。尚宜斟酌耳。）

Yí comments: Bǔzhōng Yìqì supplements spleen qì. Liùwèi supplements kidney yīn. The treatment method is set up to be quite practical. Because the left pulse is empty and large, the two ingredients shēng [má] and chái [hú] in the formula still ought to be carefully considered.

Notes:

There are a few things I find interesting about this case report:

• The pulse reading is large and empty on the left, where the viscera most pertaining to yīn-blood are diagnosed [kidney, liver, heart]. Very often we’re taught that a thin rapid pulse indicates yīn vacuity, though there are alternative views [Maciocia (2015), for example, would describe a yīn vacuity pulse as floating and empty]. The thinness of the pulse is more a measure of yīn as fluid volume, where a large and empty yīn vacuity pulse might be an indicator of a lack of substantiality or ability to check the expansiveness of yáng, especially if it is found on the left. Thus, I think, the note of caution in the commentary by Liǔ Bǎoyí regarding the yáng-lifting properties of shēngmá and cháihú.

• The additions to Bǔzhōng Yìqì Tāng nudge the formula into harmonizing territory. The introduction of báisháo into a formula already containing cháihú, dāngguī, and báizhú gives it a strong resemblance to Free Wanderer Powder [Xiāoyáo Sǎn], and furthermore the inclusion of shānzhī draws it nearer to Moutan and Gardenia Free Wanderer Powder [Dānzhī Xiāoyáo Sǎn].

• The first comment, by Wáng’s disciple Fāng Rényuān [方仁淵 1844-1926], reminds us that both Bǔzhōng Yìqì Tāng and Six-Flavor Rehmannia Pill [Liùwèi Dìhuáng Wán] are indicated for vacuity heat. Since the yíng [nutritive/provisioning] is associated with the blood, and Bǔzhōng Yìqì Tāng contains within it the ingredients of Chinese Angelica Blood-Supplementing Decoction [Dāngguī Bǔxuè Tāng] – and, in this modification, báisháo as well – it supplements the yīn within the yíng. That’s my take on it, anyway.

• Liùwèi Dìhuáng Wán is here given in a fairly light dose [about 12 grams by modern weight] in the morning. Oftentimes yīn vacuity manifestations occur at night, when there should be sufficient yīn to control the yáng. Taking it only in the morning is perhaps aimed at seeking yīn during the yáng time of day and aid in treating the vacuity heat. Or perhaps by taking the formula during the morning, a time normally associated with the tàiyīn and yángmíng channels, the spleen is boosted along with the kidney. As Wáng wrote of Liùwèi Dìhuáng Wán in his formula book, Compilation of Verses on Medical Formula Patterns and Treatments [醫方證治彙編歌訣 Yīfāng zhèngzhì huìbiān gējué, 1897]:

Reading through cases like these can help us understand how physicians of the past applied the formulary we all inherited, by flexibly combining, adding, subtracting, and substituting formulas and medicinals. I believe reflecting on them can help us to become more effective practitioners. And, by hanging out with them, so to speak, we can strengthen our connection with our medical ancestors, and open the doorway to better understand how they saw matters of health and disease, life and death.

That’s all for now. Thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Bensky, D., Clavey, S., Stöger, E., & Gamble, A. (2004). Chinese herbal medicine: Materia medica (3rd ed.). Eastland Press.

Liu, B.Y. (1882). Liu’s Selected Medical Cases from Four Practitioners [柳選四家醫案 ]. Retrieved November 23^rd, 2022 from https://jicheng.tw/tcm/book/%E6%9F%B3%E9%81%B8%E5%9B%9B%E5%AE%B6%E9%86%AB%E6%A1%88/index.html

Maciocia, G. (2015). Foundations of Chinese Medicine: A Comprehensive Text (3rd Edition). Elsevier Health Sciences.

Wang, T.L. (1897). Compilation of Verses on Medical Formula Patterns and Treatments (醫方證治彙編歌訣). Retrieved May 3^rd, 2023, from https://jicheng.tw/tcm/book/%E9%86%AB%E6%96%B9%E8%AD%89%E6%B2%BB%E5%BD%99%E7%B7%A8%E6%AD%8C%E8%A8%A3/index.html

It’s been a while since I put up a materia medica post, almost a year in fact. The last one by my reckoning was the post on wēilíngxiān. So I thought I’d put one together for your edutainment.

Tùsīzǐ, Cuscuta Seed

One herb I’ve thought about writing up for a while is tùsīzǐ, Cuscutae Semen, the seed of the dodder plant, Cuscuta chinensis. I looked at entries from some of the older as well as more modern texts and picked a few to highlight.

Its use is very old. It was ranked in the upper class of herbs in the Divine Farmer’s Materia Medica Classic [Shénnóng Běncǎo Jīng 神農本草經]; the upper class is made up of substances that nourish life and correspond to heaven, are non-toxic and may be taken for a prolonged time. The original entry is as follows:

An expanded entry from the Shénnóng Běncǎo Jīng is followed by commentary in this passage from Explanation of the Divine Farmer’s Materia Medica Classic [ Shénnóng Běncǎo Jīng Shū 神農本草經疏, 1625] by Miào Xīyōng 繆希雍

菟絲子

味辛、甘，平，無毒。主續絕傷，補不足，益氣力，肥健。汁去面䵟，養肌，強陰，堅筋骨。主莖中寒，精自出，溺有餘瀝，口苦燥渴，寒血為積。久服明目，輕身延年。（得酒良，宜丸不宜煮。）

Tùsīzǐ:

Its taste is acrid and sweet, it is balanced, it is non-toxic. Governs rejoining severance injuries, supplements insufficiency, boosts qì and physical strength, makes one well-nourished and healthy. Its juice removes moles on the face. It nourishes the muscles, strengthens yīn, and firms sinew and bone. Governs coldness in the stalk [the penis], spontaneous seminal emission, dribbling after urination, bitterness in the mouth and parching thirst, cold in the blood forming accumulations. Taking it long-term brightens the vision, lightens the body, and extends one’s years.

So we can see that, in the ensuing eras, the list of actions and indications grew a bit – not unsurprising given that 1500 years or so had passed between the original and this commentary.

Plant energetics and medicinal properties

The properties of tùsīzǐ in the older works have not changed much in modern textbooks.

Miào Xīyōng (1625) commented:

菟絲子君，稟春末夏初之氣以生，凝乎地之沖氣以成，感秋之氣而實。故《本經》言其味辛平，《別錄》益之以甘者，正雷公所謂稟中和凝正陽之氣而結者也。其為無毒明矣。五味之中，惟辛通四氣，復兼四味。

The noble tùsīzǐ is endowed with the qì of spring’s end and summer’s beginning in order to grow, consolidates the surging qì of the earth in order to mature, and resonates with the qì of autumn to then bear fruit. Thus the Materia Medica Classic says its taste is acrid and balanced. As for the Additional Records [of Famous Physicians名醫別錄] adding sweet to that, this is precisely that which Léigōng said regarding it being endowed with central harmony and consolidation of the upright yángqì. That it is nontoxic is clear. Among the five flavors, only acrid communicates with the four qì and also concurrently the four tastes.

The additional identification of the sweet taste in tùsīzǐ brings with it the associations of the earth phase: the center, the spleen and stomach, the action of consolidation and holding.

In the Běncǎo Jīng Jiě (Materia Medica Explanation), attributed to Yè Tiānshì in 1724 (from Yao, 1926), the acrid taste is explained as an association with the lung:

菟絲子氣平。稟天秋平之金氣。入手太陰肺經。味辛甘無毒。得地金土二味。入足太陰脾經、足陽明燥金胃經。氣味升多於降。陽也。

Tùsīzǐ‘s qì is balanced. It is endowed by heaven with autumn’s balanced metal qì. It enters the hand tàiyīn lung channel. Its taste is acrid and sweet and it is nontoxic. It gets from the soil the two flavors of metal and earth. It enters the foot tàiyīn spleen channel and foot yángmíng dry metal stomach channel. Its qì and taste are more upbearing than downbearing. It is yáng.

In the Materia Medica of Combinations [Dé pèi běncǎo 得配本草, 1761], the channel entry is the same as is given in modern texts, i.e. spleen, liver and kidney, though the spleen association is still strong:

辛、甘、平。性溫。入足三陰經血分。稟中和之氣，凝正陽之性，溫而不燥。

Acrid, sweet, balanced; its nature is warm; enters foot three yīn channels and blood aspect. Endowed with the harmonious qì of the center, its nature is to consolidate upright yáng, it is warming but not drying.

Regarding the tastes, acrid would seem to be an unusual flavor for something well-known to have a holding, stabilizing presence; acrid substances are typically used to scatter, move, and dry. Miào Xīyōng (1625) comments on this:

經曰：腎苦燥，急食辛以潤之。菟絲子之屬是也。與辛香燥熱之辛，迥乎不同矣。學者不以辭害義可也。

The classic says: “If the kidney suffers from dryness, quickly eat acrid [substances] to moisten it.” Tùsīzǐ is in that category. This is entirely different from the acridity of acrid, aromatic, dry and hot medicinals. A scholar must not permit the use of such language to interfere with the meaning.

In Essentials of Materia Medica [Běncǎo Bèiyào, 本草備要, 1694], Wāng Áng writes:

凝正陽之氣，入足三陰（脾、肝、腎）。強陰益精，溫而不燥，不助相火。

Consolidates the qì of upright yáng, enters the three foot yīn (spleen, liver and kidney). Strengthens yīn and boosts essence, warms without drying, does not assist ministerial fire.

Materia Medica of Combinations [Dé pèi běncǎo 得配本草, 1761] contains this passage, referring to the Cuscuta plant, a parasitic vine which nourishes itself by taking from its host:

The character jiǎ 假 is translated by Wiseman as “false”, [as in true cold and false heat, zhēn hán jiǎ rè 真寒假熱] giving the image that tùsīzǐ, lacking its own root structure runs on “false qì” i.e. not its own; but it can also mean “borrowed”, in the sense that tùsīzǐ borrows its nourishment from its host.

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Actions and indications

Joins that which is severed by injury

This is the first indication listed in the original Běncǎo Jīng, and it has largely disappeared from modern usage. The texts from the late imperial period still included it, however.

From Explanation of the Materia Medica Classic [Běncǎo Jīngjiě 本草經解, 1724] attributed to Yè Tiānshì:

其主續絕傷者。肺主津液。脾統血。辛甘能潤。潤則絕傷續也。

Regarding its governance of joining severance injuries: the lung governs liquids and humors, and the spleen controls blood. Acrid and sweet flavors are able to moisten, when [the body is] moist then the severance injuries will rejoin.

Promotion of healing from injuries is closely related to the properties of nourishing the flesh and strengthening sinew and bone, which are found in the expanded list of actions and indications noted above.

From Miào Xīyōng (1625):

為補脾腎肝三經要藥。主續絕傷，補不足，益氣力。肥健者，三經而俱實，則絕傷續而不足補矣。脾統血，合肌肉而主四肢，足陽明、太陰之氣盛則力長而肌健。補脾故養肌。益肝腎故強陰、堅筋骨。

[Tùsīzǐ] is an essential medicinal for supplementing the three channels of the spleen, liver, and kidney. Governs rejoining severance injuries, supplements insufficiency, boosts qì and physical strength. In those who are well nourished and healthy the three channels are all replete, then severance injuries are joined and insufficiency is supplemented. The spleen controls blood, unites the muscles and flesh and governs the four limbs; if the qì of the foot yángmíng and tàiyīn are exuberant then one’s strength will increase and the muscles will be strong. Supplementing the spleen therefore nourishes the muscles. Boosting the liver and kidney therefore strengthens the yīn and firms the sinews and bones.

Materia Medica of Combinations (1761) says:

Wāng Áng (1694) writes:

These indications, as I have said, seem to have largely gone missing over the years, though tùsīzǐ shares the yáng-supplementing category with some of the more commonly used herbs for healing tears and fractures, such as gǔsuìbǔ [Drynariae Rhizoma] and xùduàn [Dipsaci Radix].

Consolidates and secures the lower burner

An important set of actions and indications in later materia medica texts (though not directly stated in the original Běncǎo Jīng) concern tùsīzǐ’s ability to warm, hold and consolidate, especially as regards the lower burner.

From Miào Xīyōng (1625):

From Materia Medica of Combinations (1761):

Brightens the eyes

An early and still important indication for tùsīzǐ is diminished vision. For tùsīzǐ this can be seen as a broader action of supplementing liver and kidney and increasing vitality; what today might be termed “anti-aging” properties.

From Miào Xīyōng (1625):

久服明目輕身延年者，目得血而能視，肝開竅於目，瞳子神光屬腎，肝腎實則目自明，臟實精滿則身自輕，延年可必矣。

Regarding taking long-term to brighten the eyes, lighten the body, and extend one’s years: when the eye receives blood it can see, the liver opens into the orifice of the eye, the pupil spirit light belongs to the kidney. If the liver and kidney are replete then the eyes are naturally bright, when the viscera are replete and full of essence then the body is naturally lightened, and one’s years may surely be extended.

Blood stasis accumulation

This is an uncharacteristic indication for a supplementing substance that stops leakage. Miào Xīyōng (1625) connects this to taxation injury and yángqì exhaustion:

寒血為積者，勞傷則血瘀，陽氣乏絕則內寒，血隨氣行，氣弱不能統血以行，久而為積矣。凡勞傷皆脾腎肝三臟主之。肝脾氣王則瘀血自行也。

Regarding accumulation from cold in the blood: taxation injury results in blood stasis, and yángqì is exhausted and cut off resulting in internal cold. Since blood follows the movement of qì, if the qì is weak it cannot control the movement of blood, and over time there will be accumulation. Generally taxation injury is governed by all three viscera of the spleen, liver and kidney. If liver and spleen qì rule then stagnant blood will move by itself.

Dispersion-thirst [xiāokě]

Parching thirst is not among the original indications listed in the Materia Medica Classic, but it is found in the later texts, for example in Miào Xīyōng (1625):

口苦燥渴者，脾腎虛而生內熱，津液因之不足也。二髒得補則二病自愈。

Regarding bitterness in the mouth and parching thirst, this is spleen and kidney vacuity that engenders internal heat, causing insufficiency of the liquids and humors. If these two viscera are supplemented then these two illnesses are naturally cured.

In Běn Cǎo Bèi Yào (1694), Wāng Áng noted

…口苦燥渴（脾虛腎燥而生 內熱，菟絲益陰清熱）。

… bitter taste in the mouth and parching thirst (for spleen vacuity and kidney dryness engendering internal heat, tùsī boosts yīn and clears heat).

And in Jingyue’s Complete Compendium [Jǐngyuè Quánshū 景岳全書, 1640] by Zhāng Jǐngyuè [張介賓] listed this herb function as “enriches dispersion thirst [滋消渴]”; Dispersion-thirst [xiāokě 消渴] in modern terms is often equated with diabetic diseases, an indication which can be found in modern texts such as Chen & Chen (2004) and Wiseman & Brand (2020).

Quiets the fetus

This is an indication that appeared in none of the materia medica texts I reviewed. It appears to have come from Zhāng Xīchún. In Records of Chinese Medicine with Reference to Western Medicine [Yīxué Zhōngzhōng Cānxī Lù醫學衷中參西錄, 1909], he presented Fetal Longevity Pill [Shòu Tāi Wán 壽胎丸], with tùsīzǐ as the sovereign herb. In his discussion of the formula, he gives this opinion based on his considerable clinical experience:

誠以保胎所用之藥，當注重於胎，以變化胎之性情氣質，使之善吸其母之氣化以自養，自無流產之虞。... 由斯而論，愚於千百味藥中，得一最善治流產之藥，乃菟絲子是也。

In truth, the medicinals used to protect the fetus should focus on the fetus, transmuting and transforming the nature and qì-disposition of the fetus to improve absorption of its mother’s qì transformation to nourish itself, so one need not be apprehensive about miscarriage ... from this [clinical observation] and from medical doctrine, I, from among multitude of medicinal ingredients, have found the best one for treating miscarriage: it is tùsīzǐ.

Rather than trying to simply boost the kidney of the mother, the priority is on helping the fetus to adjust to its environment in order to better absorb the mother’s qì. The securing and consolidating action as well as the balanced and harmonious nature of tùsīzǐ makes it ideal for this purpose.

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Combinations

A list of medicinal combinations from the sources I consulted:

Yè Tiānshì [1724]:

• Taking tùsīzǐ alone supplements blood. 菟絲子單服。補血。

• With Shúdì Wán [Prepared Rehmannia Pills], treats yīn detriment. 同熟地丸。治陰損。

• With Dùzhòng Wàn [Eucommia Pills], treats yáng vacuity. 同杜仲丸。治陽虛。

• With báifú[líng] [Poria Alba] and shílián[ròu] [Nelumbinis Semen], treats white turbidity. 同白茯、石蓮。治白濁。

• With Màidōng Wàn [Ophiopogon Pills], treats insufficiency of heart and kidney, with dry mouth and fearful throbbing. 同麥冬丸。治心腎不足。口乾怔忡。

• With niúxī [Achyranthis Radix], treats pain of the low back and knees. 同牛膝。治腰膝痛。

Materia Medica of Combinations (1761):

• With yuánshēn [Scrophulariae Radix], it supplements kidney yīn without drying. 得元參，補腎陰而不燥。

• Matched with shúdì [Rehmanniae Praeparata Radix], supplements yíngqì without being hot. 配熟地，補營氣而不熱。

• Matched with màidōng [Ophiopogonis Rhizoma], it treats red turbidity. 配麥冬，治赤濁。

• Matched with ròudòukòu [Myristicae Semen], enhances appetite (when the stomach is warm, it will open.) 配肉豆蔻，進飲食。（胃暖則開。）

• Assisting yìzhìrén [Alpiniae Oxyphyllae Fructus], it warms the wèiqì. 佐益智仁，暖衛氣。

• As envoy to chēqiánzǐ [Plantaginis Semen], treats transverse birth. 使車前子，治橫生。

• Mixed with jīzǐbái [Galli Albumen, egg white], treats dim vision. 調雞子白，治目暗

Contraindications

A list of contraindications from Materia Medica of Combinations (1761):

孕婦，（其性滑。）血崩，（溫能行血。）陽強，便結，腎藏有火，陰虛火動，六者禁用。。

Pregnant women (its nature is slippery), blood flooding (warmth can move blood), rigid yáng [persistent erection], bound stool, concealed kidney fire, yīn vacuity fire stirring, these six are prohibited to use [this medicinal].

Nowadays, tùsīzǐ is a commonly used herb in fertility and obstetric prescriptions, so this particular contraindication goes largely unheeded.

Representative formulas

Since it is balanced [or slightly warm, depending on the source] and supplements yīn and essence as well as yáng, tùsīzǐ can be found in formulas aimed at replenishing these vital substances and functions. Examples are

• Tùsīzǐ Wán [Cuscuta Seed Pill]: Kidney essence vacuity with leakage

• Fú Tù Dān [Poria and Cuscuta Elixir]: Spleen and kidney vacuity with leakage of essence

• Zhùjǐng Wán [Long Vistas Pill]: Liver and kidney yīn vacuity with diminished vision

• Shòu Tāi Wán [Fetal Longevity Pill]: Threatened miscarriage due to kidney vacuity

• Zuǒguī Wán [Left-Restoring Pill] and Yòuguī Wán [Right Restoring Pill]: Kidney yīn-essence and yáng-essence vacuity respectively

• Qībǎo Měirán Dān [Seven-Jewel Beard-Blackening Elixir]: Liver-kidney yīn-blood-essence vacuity with graying or falling hair

• Wǔzǐ Yǎnzōng Wàn [Five-Seed Progeny Pill]: Much used today for fertility and andrology issues

One final thought

What has piqued my interest in tùsīzǐ for so long is its role in a pill I frequently give to patients who are having difficulty sleeping (and which I take fairly regularly): Ānshén Bǔxīn Wán [Spirit-quieting Heart-supplementing Pill]. There are several variations on the formula, but all of them I have found contain tùsīzǐ. The brand I prefer is NuHerbs Herbal Times; below is a picture of the label

The formulation contains fewer ingredients than the other brands I’ve seen, and, like most of the Herbal Times line, works very well. Tùsīzǐ, typically relegated to an assistant role in other formulations, here takes up 20% of the total ingredients; this has long intrigued me and I have periodically nosed around trying to figure out why. What little commentary I have seen on the formula typically says something generic about tùsīzǐ balancing yīn and yáng – which, okay, sure, maybe as an assistant, but as a primary ingredient?

In digging the rabbit hole for this post, I kept my eyes peeled for an answer, and I mostly came up empty. I say mostly, because there is a passing mention in Jǐngyuè Quánshū where Zhāng Jǐngyuè ends a list of indications for tùsīzǐ with

Whether the two here are related, I cannot say. Ghost intercourse is typically a phenomenon associated with dreaming, and, in men, is associated with seminal emission while dreaming, which is clearly a common indication for tùsīzǐ. But I always assumed that tùsīzǐ was specifically preventing the emission, and had not so much to do with the dreaming. So this may hint at an answer, for which I will keep looking.

Okay, that’s enough for now. Thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Chen, J.K., & Chen, T.T. (2004). Chinese medical herbology and pharmacology. Art of Medicine Press.

Miao, X. (1625). Shénnóng běncǎo jīng shū. Retrieved November ‎5, ‎2023 from https://jicheng.tw/tcm/book/%E7%A5%9E%E8%BE%B2%E6%9C%AC%E8%8D%89%E7%B6%93%E7%96%8F/index.html

Shénnóng běncǎo jīng. (n.d.). Retrieved August 24, 2026 from https://jicheng.tw/tcm/book/%E7%A5%9E%E8%BE%B2%E6%9C%AC%E8%8D%89%E7%B6%93_2/index.html

Wang, A. (1694). Běncǎo bèiyào. Retrieved October 22, 2023 from https://jicheng.tw/tcm/book/%E6%9C%AC%E8%8D%89%E5%82%99%E8%A6%81/index.html

Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.

Yan, J., Shi, W., & Hong, W. (1761). Dé pèi běncǎo. Retrieved September 24, 2025, from https://jicheng.tw/tcm/book/%E5%BE%97%E9%85%8D%E6%9C%AC%E8%8D%89/index.html

Yao, Q. (1926). Jīng xiào Yè Tiānshì běn cǎo jīng jiě. Guǎng Yì Book Company. Retrieved December 14, 2022, from https://jicheng.tw/tcm/book/%E6%9C%AC%E8%8D%89%E7%B6%93%E8%A7%A3/index.html

Zhang, J.B. (1640). Jǐngyuè quánshū. Retrieved August 24, 2026 from https://jicheng.tw/tcm/book/%E6%99%AF%E5%B2%B3%E5%85%A8%E6%9B%B8/index.html

Zhang, X.C. (1909). Yīxué zhōngzhōng cānxī lù. Retrieved August 24, 2026 from https://jicheng.tw/tcm/book/%E9%86%AB%E5%AD%B8%E8%A1%B7%E4%B8%AD%E5%8F%83%E8%A5%BF%E9%8C%84/index.html

From translation practice today. I’m working on Clinical Case Reports of Wáng Xùgāo [Wáng Xùgāo Línzhèng Yī’àn 王旭高臨證醫案, 1897]. This is from the chapter on vacuity taxation [xūláo 虛勞]. I thought this one was interesting, and I think the translation turned out okay. Brief commentary follows the case.

趙　血不養心，則心悸少寐。胃有寒飲，則嘔吐清水。虛火燥金，則咽痛。肝木乘中，則腹脹。此時調劑，最難熨貼。蓋補養心血之藥，多嫌其滯；清降虛火之藥，又恐其滋。欲除胃寒，慮其溫燥劫液；欲平肝木，恐其克伐耗氣。今仿胡洽居士法，專治其胃。以胃為氣血之鄉，土為萬物之母，一舉而三善備焉。請試服之。

Zhào [patient’s surname]:

Blood is not nourishing the heart, resulting in palpitations and little sleep. There is cold rheum in the stomach, resulting in vomiting of clear water. Vacuity fire dries metal, resulting in sore throat. Liver wood exploits the center, resulting in abdominal distension. At this point settling on a perfect prescription is most difficult. I say this because I highly suspect medicinals that supplement and nourish the heart blood will cause stagnation; I am also afraid medicinals to clear and downbear vacuity fire will be too enriching. I want to eliminate the stomach cold, but I worry that warming and drying will plunder the humors; I want to calm liver wood, yet I fear restraining and quelling [substances] will consume the qì. Presently I will imitate the method of Hú Qià the Recluse, and focus on treating the stomach. Regarding the stomach as the village of qì and blood and earth as the mother of the ten thousand things, with one stroke we’ve done three good deeds. I will ask him to try taking it.

黨參　冬朮　茯苓　半夏　棗仁　扁豆　陳皮　懷山藥　秫米

Dǎngshēn [Codonopsis Radix], dōngzhú [Atractylodes Macrocephalae Praeustum Radix], fúlíng [Poria], bànxià [Pinelliae Rhizoma], zǎorén [Zizyphi Spinosae Semen], biǎndòu [Lablab Semen], chénpí [Citri Reticulatae Pericarpium], huái shānyào [Dioscoreae Rhizoma], shúmǐ [Panici Miliacei Semen].

淵按：土虛木燥，積飲內生。原木之所以燥，由脾不運化精微而生營血以養肝木耳。治胃一言最扼要。

Yuān comments: If earth is empty and wood is dry, rheum accumulation is engendered internally. Originally wood’s dryness is caused by the spleen’s inability to transport and transform the subtle essence and engender yíng blood so as to nourish liver wood. To treat the stomach is, in one brief sentence, the most essential point.

Mulch comments

Hú Qià the Recluse was a physician of the Liú Sòng 劉宋 period (429-470 CE). Zheng et al. (2018) mention him as a “legendary immortal... who is said to have practiced medicine on his own and sold pharmaceutical substances in the market”. He left behind a book of formulas and a book of dietary therapy, the latter of which may have been the reference Wáng made in the case report.

The prescription here is a nice take on Liù Jūnzǐ Tāng [Six Gentlemen Decoction, without licorice] with elements of Shēn Líng Báizhú Sǎn [Ginseng, Poria, and White Atractylodes Powder], namely the inclusion of shānyào and biǎndòu, and sticky rice to fortify the center and preserve the qi. The chef’s kiss here is the inclusion of suānzǎorén, whose sourness enters the liver to both harmonize juéyīn and benefit heart blood.

References

Wang, X.G., & Fang, R.Y. (1897). Wáng Xùgāo línzhèng yī’àn. https://jicheng.tw/tcm/book/%E7%8E%8B%E6%97%AD%E9%AB%98%E8%87%A8%E8%AD%89%E9%86%AB%E6%A1%88/index.html Retrieved April 15, 2023.

Zheng, J.S., Kirk, N., Buell, P.D., & Unschuld, P.U.U. (2018). Ben Cao Gang Mu Dictionary, Volume Three: Persons and Literary Sources. University of California Press.

For a lot of us who’ve been working in the Chinese medicine field for a while, it’s common to sort of forget about a formula that we learned, only to run across it again somewhere. That happened recently while I was reading through a Qīng era text. It sent me down a little rabbit hole and I figured I’d put together a post about it.

Cháihú Sìwù Tāng

The formula in question is Cháihú Sìwù Tāng [Bupleurum Four Substance Decoction]. It is an amalgam of two different formulas:

Xiào Cháihú Tāng [Minor Bupleurum Decoction], from Treatise on Cold Damage [Shānghán Lùn]

• Cháihú [Bupleuri Radix]

• Rēnshēn [Ginseng Radix]

• Bànxià [Pinelliae Rhizoma]

• Gāncǎo [Glycyrrhizae Radix]

• Shēngjiāng [Zingiberis Rhizoma Recens]

• Dàzào [Jujubae Fructus]

Sìwù Tāng [Four Substance Decoction] from Taiping Imperial Grace Pharmacy Formulas [Tàipíng Huìmín Héjì Júfāng]

• Shúdìhuáng [Rehmanniae Radix Praeparata]

• Dāngguī [Angelicae Sinensis Radix]

• Sháoyào [Paeoniae Radix]

• Chuānxiōng [Chuanxiong Rhizoma]

Both of these formulas are well-known and used regularly. Xiào Cháihú Tāng is generally cited as one of the most frequently prescribed formulas throughout East Asia; I’ve long heard it discussed as the most popular herbal formula in Japan, for example. Sìwù Tāng is the basis for most of the commonly-used blood tonic and blood stasis formulas. I won’t go into detail about either of these constituent prescriptions here, except to note that each treats a variety of complex conditions, which makes their combination seem like something very useful in treating chronic knotty diseases.

Formula Origin

The earliest extant text in which Cháihú Sìwù Tāng appears is the Collection on Disease Mechanisms and the Appropriateness of Qì to Protect Life, from Simple Questions [Sùwèn Bìngjī Qìyí Bǎomìng Jí ] by Liú Wánsù 劉完素, published in 1188, Jīn era. It is listed there under two different names: Cháihú Sìwù Tāng and Sānyuán Tāng [Three-Origin Decoction]. The dosages differ but the ingredients are identical.

治日久虛勞。微有寒熱。脈沉而浮。宜服柴胡四物湯。

川芎　熟地黃　當歸　芍藥（各一兩半）　柴胡（八錢）　人參　黃芩　甘草　半夏曲（以上各三錢）

上為粗末。同四物煎服。

To treat prolonged vacuity taxation with slight chills and fever. The pulse sinks and then floats. It is appropriate to give Cháihú Sìwù Tāng.

Chuānxiōng, shúdìhuáng, dāngguī, sháoyào (each 1.5 liǎng); cháihú (8 qián); rēnshēn, huángqín, gāncǎo, bànxiàqū [Pinelliae Massa Fermentata] (each of the preceding use 3 qián).

Coarsely grind the above medicinals. Decoct as with Sìwù and take.

and

治產後日久虛勞。雖日久而脈浮疾者。宜服三元湯。

柴胡（八錢）　黃芩　人參　半夏（洗）　甘草（炙以上各三錢）　川芎　芍藥　熟地黃　當歸（各二錢半）

上為粗末。同小柴胡湯煎服。

To treat cases of prolonged postpartum vacuity taxation, where even if it is prolonged, the pulse is floating, it is appropriate to give Sānyuán Tāng.

Cháihú (8 qián); huángqín, rēnshēn, bànxià (wash), gāncǎo (honey-fry, each of the preceding use 3 qián); chuānxiōng, sháoyào, shúdìhuáng, dāngguī (each 2.5 qián).

Coarsely grind the above medicinals. Decoct as with Xiǎo Cháihú Tāng and take.

As mentioned, the dosages vary with the clinical picture, though the basic application is vacuity taxation, whether postpartum or not. The chills and fever [or more properly aversion to cold and heat effusion] are assumed to be alternating, as that is an important indication for Xiào Cháihú Tāng.

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Later uses, expanded indications and modifications

The formula appeared in numerous texts in later eras, mainly during the Míng and Qīng dynasties. An extensive review of the formula’s history and applications (Liu et al., 2021) notes over a half-dozen mentions during that time period.

Most of the discussion I found in the old texts tended to be quite brief. However, an interesting commentary on the formula can be found in Revised and Expanded Popular Treatise on Cold Damage [Zēngdìng Tōngsú Shānghán Lùn] a late 18^th-century work by Yú Gēnchū 俞根初, later edited by Hé Liánchén 何廉臣 and published in 1916:

柴胡四物湯　和解兼補血法　俞氏經驗方

Cháihú Sìwù Tāng: Method of harmonizing and resolving with concurrent blood supplementation. Mister Yú’s* experiential formula.

柴胡（八分）　仙半夏（一錢）　歸身（一錢）　生白芍（二錢）

條芩（八分）　清炙草（六分）　生地（錢半）　川芎（七分）

Cháihú (8 fēn), xiān bànxià (1 qián), guīshēn (1 qián), shēng báisháo (2 qián), tiáo qín (8 fēn), qīng zhìcǎo (6 fēn), shēngdì (1.5 qián), chuānxiōng (7 fēn)

秀按　少陽證初病在氣，久必入絡，其血在將結未結之間，而寒熱如瘧，胸脅串痛，至夜尤甚者，陷入於足厥陰之肝絡也。若但據寒熱現狀，便投小柴胡原方，則人參、薑、棗，溫補助陽，反令血愈虧而熱愈結，熱結則表裡閉固，內火益熾，立竭其陰而肝風內動矣。此方君以柴胡入經和氣，即臣以川芎入絡和血，妙在佐以歸、地、白芍之養血斂陰，即使以半夏、甘草之辛甘化陽，庶幾陰陽和，俾陰液外溢則汗出，而寒熱脅痛自止矣。此為疏氣和血，妊婦寒熱之良方。

Xiù** comments: Shàoyáng pattern; in the beginning the illness is at the qì, but over time it will certainly enter the networks. The blood is in a state between being partly bound and not bound, and in cases with chills and fever like malaria, with pain along the chest and ribside which worsens especially at night, it has sunken into the foot juéyīn liver networks. If one only goes by the status quo of chills and fever, and in that case gives the original Xiǎo Cháihú formula, then rēnshēn, jiāng, and zǎo, which warm and supplement to assist yáng, will instead further deplete the blood which the heat will then further bind. Once the heat binds then the exterior and interior will be firmly shut. Interior heat will increase until it blazes, promptly exhausting the yīn, and then liver wind will stir internally. This formula uses cháihú as the sovereign to enter the channels and harmonize the qì. Its minister is chuānxiōng which enters the networks and harmonizes the blood. Its excellence depends on using guī, dì, and báisháo as assistants to nourish blood and constrain yīn, even as it uses the acrid and sweet bànxià and gāncǎo to transform yáng so that yīn and yáng are harmonized. This enables yīn liquid to flow outward in the form of sweating, and then the chills and fever and ribside pain will naturally cease. This formula courses qì and harmonizes blood; it is effective for chills and fever in pregnancy.

*俞根初 Yú Gēnchū, author of the original text

**何秀山 Hé Xiùshān, grandfather of the editor, who was a famous doctor in his own right.

Xiān bànxià is the product of soaking the pinellia tubers in a mixture of other herbs (Pharmnet.com, n.d.). Tiáo qín is the young scutellaria root, considered to be higher quality (Wiseman & Brand, 2020). Of note here are the omissions from the original Xiǎo Cháihú formula, namely the warm supplementing constituents of ginseng, fresh ginger, and jujube. As can be seen above, Liú Wánsù had left out ginger and jujube, but had kept ginseng in the prescription. Yú also opts for the colder, more moving raw rehmannia rather than the prepared rehmannia in the original.

Further truncation of the formula appear in various chapters of Golden Mirror of Medical Orthodoxy [Yīzōng Jīnjiàn, 1742], by Wú Qiān 吴謙: .

煩躁: 如煩躁脅痛，宜用柴胡四物湯。

Vexation and agitation: If there is vexation and agitation with ribside pain, one should use Cháihú Sìwù Tāng.

柴胡四物湯即四物湯加柴胡、黃芩。

Cháihú Sìwù Tāng is Sìwù Tāng with added cháihú and huángqín.

and in another instance:

傷損出血: 如血蘊於內而嘔血者，用四物湯加柴胡、黃芩。

Injury with bleeding: if there is blood accumulated in the interior with vomiting of blood, use Sìwù Tāng with added cháihú and huángqín.

Neither of these instances would cry out for warming and supplementing. Vexation is typically a heat manifestation. Blood accumulation is a repletion issue, and the term yùn 蘊 implies the presence of heat or fermentation; Wiseman (2020) translates it as “brewing” in some instances. In cases such as these, cháihú and huángqín would likely prove sufficient.

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On the other hand, some authors added ingredients to the original formula combination. For example, in Guidebook of Benevolence [Rénshù Biànlǎn, 1585] by Zhāng Jié張潔:

Heat effusion (not limited to fever) later in the day is usually a manifestation of vacuity heat, and herbs which clear heat from vacuity and cool the blood are added to the formula.

One of the more well-known indications of the formula is catching cold during the menstrual period, as mentioned in Zhāng’s Clear View of Medicine [Zhāngshì Yītōng 1695], by Zhāng Lù 張璐:

Heat entering the blood chamber is evil heat exploiting internal vacuity during menses or after childbirth, with “hardness and fullness of the abdomen, alternating chills and fever and nonsensical talk at night” (Wiseman & Feng, 1998)

Summary of Indications

Based on the text citations given above and further noted in Liu et al (2021), we can summarize the uses of Cháihú Sìwù Tāng:

• Postpartum vacuity taxation with invasion by exteriorly contracted disease evils: basically exhaustion from depleted blood and yīn after giving birth, leaving the body vulnerable to the six exterior evils. The chills and fever are mild and alternate. The pulse may be sunken or floating.

• Blood- or yīn-vacuity fever: typically the heat is felt in the afternoon or at night. There may or may not be sweating. There will likely be accompanying manifestations of blood- or yīn-vacuity. The pulse may be empty, wiry, and rapid.

• Lingering heat after externally-contracted rash. There may be a background of blood- or yin-vacuity. The rash may coincide with the menstrual period or other episode of blood depletion. The internal vacuity leaves the body unable to fully evacuate the pathogen, which then remains smoldering on the interior.

• Menstrual contraction of exterior evils, leading to heat in the blood chamber. Similar to the post-partum scenario, depletion in the sea of blood leaves one open to exterior evils. The patient may be able to think clearly during the day, but becomes delirious or agitated at night.

• Pain in the chest and ribside. The pain may be caused by evils entering the shàoyáng channels, which then sink into the juéyīn and obstruct the network vessels; or it may be due to trauma.

• In general, where there is a complex of heat in the shàoyáng with underlying yīn-blood vacuity, or depressive heat in the liver and gallbladder channels complicated by blood vacuity and stasis, this formula can be applied.

• The action of Xiào Cháihú Tāng [or even just the combination of cháihú and huángqín] can outthrust evils lodged in the midstage and restore the shàoyáng pivot. Depending on the application, rēnshēn, shēngjiāng, bànxià, gāncǎo, and dàzào may be omitted.

• The presence of Sìwù Tāng can nourish and harmonize the blood and resolve stasis in the network vessels. In cases with more blood vacuity, báisháo may be used; where there is more pronounced heat and stasis, chìsháo [Paeoniae Radix Rubra] may be a better option.

WXG Variation

Finally, I wanted to look at the passage which sent me down this particular rabbit hole in the first place. It was an entry from Compilation of Verses on Medical Formulas, Patterns And Treatments [Yīfāng Zhèngzhì Huìbiān Gējué, 1897] by Wáng Xùgāo.

柴胡四物（湯川芎、當歸、白芍、生地各一錢半，柴胡一錢。）參（人參）耆（黃耆）草，（甘草各三錢。一方有半夏。）和衛調營達少陽。日久虛勞有寒熱，脈沉而數（沉數為熱在裡，陰尚未虧，故用此湯調和營衛，以散其熱；若脈細數，則當全用滋陰壯水矣。）最相當。（柴胡加入補藥，俱不相合，獨此為宜。柴胡疏通少陽，調和營衛，非專於散風也。）

Cháihú Sìwù (Tāng, chuānxiōng, dāngguī, báisháo, shēngdì, each 1.5 qián; cháihú 1 qián.), shēn (rénshēn), qí (huángqí) cǎo (gāncǎo each 3 qián. Another version of the formula has bànxià.) Harmonizes wèi, regulates yíng, outthrusts shàoyáng. For prolonged vacuity taxation with [aversion to] cold and heat [effusion], sunken and rapid pulse (sunken and rapid indicates heat in the interior, yīn is not yet depleted. Use this decoction to regulate and harmonize yíng and wèi, so as to disperse its heat; if the pulse is thin and rapid, then one should use purely yīn-enriching and water-invigorating [medicinals]) it is most suitable. (Mixing cháihú in with supplementing medicinals, together they are mutually incompatible; only in this [formula] is it appropriate. Cháihú courses and frees shàoyáng, regulates and harmonizes yíng and wèi; it is not exclusively for dispersing wind.)

Beyond the interest of the discussion of the formula, the remarkable thing about this entry is that it contains astragalus [huángqí, Astragali Radix] in place of huángqín, or scutellaria. Thinking this must have been an error in transmission, I checked a related version of the text, Revised and Expanded Verses on Medical Formulas [Zēngdìng Yīfāng Gējué, 1897]. There I found an editorial comment on the formula explanation:

鎮按：原方無黃耆有黃芩，但《蘭臺軌範》亦作黃耆，或有所本，今仍之。

Zhèn comments: The original formula did not contain huángqí, it contained huángqín. However Lántái Guǐfàn also had it written as huángqí, so perhaps [the change] is well-founded, and I’m keeping it for now.

Lántái Guǐfàn [Model of the Orchid Terrace, 1764] is a work by Xú Dàchūn 徐大椿. I consulted an e-text of it, and listed in the ingredients was huángqín rather than huángqí, so perhaps the e-text was a revised edition.

In any event, the substitution does open up some interesting possibilities. With huángqí’s lifting and mobilizing actions complementing cháihú and chuānxiōng and its supplementing function augmenting rénshēn and dāngguī, Wáng’s version could be applied in cases of more pronounced qì and blood vacuity fever, or perhaps a yīn fire situation as something of a cousin to Bǔzhōng Yìqì Tāng [Center-Supplementing Qì-Boosting Decoction].

Commercial Availability and Final Thoughts

For those who might want to give the formula in pre-made form, about the only way would be to combine the two base formulas of Xiào Cháihú Tāng and Sìwù Tāng in pills or granules. I seem to recall the formula being produced by Kan Herbs, specifically the Alembic line by Professor Z’ev Rosenberg, but that has apparently been discontinued.

To wrap things up, Cháihú Sìwù Tāng is a sleeper of a formula, worth remembering especially in treating menstrual and menopausal maladies, or any complex problem involving heat in the midstage with concurrent depletion or stasis in the blood aspect .

Okay, that’s enough for now. Thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

仙半夏. (n.d.). Pharmnet.com. https://www.pharmnet.com.cn/tcm/knowledge/detail/118303.html

Liu, L., Liu, S.L., Yue, Y.Y., Xu, L.S., Zhou, X., & Lin, Y.Y. (2021). Analysis of origin, adaptation syndrome and characteristics of Chaihu Siwu Decoction. Acta Chinese Medicine, 36(277).

Liu, W.S. (1188). Collection on disease mechanisms and the appropriateness of qì to protect life, from Simple Questions [素問病機氣宜保命集] . Retrieved April 27 2023 from https://jicheng.tw/tcm/book/%E7%B4%A0%E5%95%8F%E7%97%85%E6%A9%9F%E6%B0%A3%E5%AE%9C%E4%BF%9D%E5%91%BD%E9%9B%86/index.html

Wang, T.L. (1897). Compilation of verses on medical formulas, patterns and treatments [醫方證治彙編歌訣]. Retrieved May 3 2023 from https://jicheng.tw/tcm/book/%E9%86%AB%E6%96%B9%E8%AD%89%E6%B2%BB%E5%BD%99%E7%B7%A8%E6%AD%8C%E8%A8%A3/index.html

Wang, T.L. (1897). Revised and expanded verses on medical formulas [增訂醫方歌訣]. Retrieved June 4 2023 from https://jicheng.tw/tcm/book/%E5%A2%9E%E8%A8%82%E9%86%AB%E6%96%B9%E6%AD%8C%E8%A8%A3/index.html

Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.

Wiseman, N., & Feng, Y. (1998). A practical dictionary of Chinese medicine. Paradigm Publications.

Wu, Q. (1742). Golden mirror of medical orthodoxy [醫宗金鑒]. Retrieved August 15 2026 from https://jicheng.tw/tcm/book/%E9%86%AB%E5%AE%97%E9%87%91%E9%91%91_1/index.html

Xu, D.C. (1764). Model of the orchid terrace [蘭臺軌範]. Retrieved August 15 2026 from https://jicheng.tw/tcm/book/%E8%98%AD%E8%87%BA%E8%BB%8C%E7%AF%84/index.html

Yu, G.C. (1934). Revised and expanded popular treatise on cold damage [增訂通俗傷寒論] (L.C. He, Ed,) . Retrieved July 9 2023 from https://jicheng.tw/tcm/book/%E5%A2%9E%E8%A8%82%E9%80%9A%E4%BF%97%E5%82%B7%E5%AF%92%E8%AB%96/index.html . (Original work published late 18^th century)

Zhang, J. (1585). Guidebook of benevolence [仁術便覽]. Retrieved August 16 2026 from https://jicheng.tw/tcm/book/%E4%BB%81%E8%A1%93%E4%BE%BF%E8%A6%BD/index.html

Zhang, L. (1695). Zhāng’s Clear View of Medicine [張氏醫通]. Retrieved August 15 2026 from https://jicheng.tw/tcm/book/%E5%BC%B5%E6%B0%8F%E9%86%AB%E9%80%9A/index.html

It’s been a while since I posted here, and during that time I have had some new subscribers, so I wanted to welcome all the newcomers to the mulch. I have been a little more active on Substack Notes, where I post shorter items more frequently. I have a few different long posts in the works, but I thought I would string together a few of my Notes-style posts and publish it to the list in the interim.

Lurking Summerheat

It’s summer in the northern hemisphere, and the temperatures have been high across North America and Europe. I’ve been getting back to my ongoing project of translating what I can of the works of Qīng era physician Wáng Xùgāo (王旭高, 1798-1862). Longtime readers of Clinical mulch may remember many previous posts featuring Master Wáng. A few years back, I presented his discussion on treating summerheat.

I have been working through the e-text of Clinical Case Reports of Wáng Xùgāo [Wáng Xùgāo Línzhèng Yī’àn 王旭高臨證醫案], published in 1897. Here are a few short cases on the chapter concerning lurking summerheat [伏暑 fúshǔ]. Lurking pathogens was a subject I wrote a series about in the early years of the mulch; you can find an introduction here:

Anyway, here are three brief cases. Translation and commentary is by me, with properties and functions from Wiseman and Brand’s Comprehensive Chinese Materia Medica, 2020.

1. She lives on a boat

Prescription analysis

• Qīnghāo is sweet wormwood, Artemisiae Annuae Herba. It is bitter, acrid, and cold; it enters the liver, gallbladder, and kidney channels. It clears vacuity heat and resolves summerheat. It is used in lurking pathogen situations to vent [tòu 透] or outthrust the disease evil through the exterior.

• Dàfùpí is the betel nut husk, Arecae Pericarpium. It is acrid and slightly warm; it enters the spleen, stomach, and large and small intestine channels. It moves qì and abducts stagnation. Its name, which can be rendered as “big belly husk”, attests to its ability to move qì in the abdomen. It also disinhibits water, and so is able to eliminate some dampness through the lower burner as well.

• Bànxià is pinellia, Pinelliae Rhizoma. It is acrid and warm; it enters the spleen, stomach, and lung channels. It dries dampness and transforms phlegm, downbears counterflow and checks vomiting. It is a key phlegm-resolving herb in Chinese herbal medicine.

• Fúlíng and chìlíng [or chìfúlíng] are layers of the poria fungus, Poria Alba and Poria Rubra. Poria is sweet and bland and enters the heart, spleen and kidney channels. It percolates dampness, fortifies the spleen, and quiets the spirit. The red layer, chìfúlíng, disinhibits damp-heat.

• Chuānpǔ is magnolia bark from Sìchuān, Magnoliae Oficinalis Cortex Sichuanensis. It is bitter, acrid and warm; it enters the spleen, stomach, lung, and large intestine channels. It moves qì, dries dampness, and disperses accumulations. Magnolia bark is to be used with great caution in pregnancy; ordinarily it might prove too risky but in this case there was apparently a strong possibility of miscarriage if the pathogen went unresolved.

• Dànqín is steam-processed scutellaria root, Scutellariae Radix. Raw scutellaria [huángqín] is bitter and cold; it enters the lung, stomach, gallbladder and large intestine channels. It clears heat and dries dampness, drains fire and resolves toxin. It is one of the fetal-calming herbs, given in cases of threatened miscarriage due to heat. The steaming lightens the yellow color and takes the edge off the cold, so it isn’t as hard on the spleen and stomach.

• Jiāoliùqū is scorch-fried medicated leaven, Massa Medicata Fermentata Usta. It is acrid, sweet and warm; it enters the spleen and stomach channels. It disperses food and harmonizes the stomach. Scorch-frying the medicinal makes it better able to strengthen the spleen, remove accumulation, move qì and dispel phlegm.

• Sūgěng is the perilla stem, Perillae Caulis. It is sweet, acrid and slightly warm; it enters the lung, spleen and stomach channels. It loosens the chest, disinhibits the diaphragm, normalizes qì and quiets the fetus.

• Chénpí is the aged tangerine peel, Citri Reticulatae Pericarpium. It is acrid, butter and warm; it enters the lung and spleen channels. It moves qì and fortifies the spleen, dries dampness and transforms phlegm. With bànxià and fúlíng, it makes a core three-herb combination that can be found in many of the most commonly used phlegm-transforming formulas.

• Xiān fóshǒu is the finger citron or “Buddha’s Hand”, Sacrodactylis Fructus. It is acrid, bitter, and warm; it enters the liver, lung, spleen and stomach channels. It courses the liver, rectifies qì and harmonizes the center, dries dampness and transforms phlegm. It has a relatively mild action which enhances the qì-moving and aromatic damp-drying herbs in the prescription.

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2. Not completely gone

Prescription analysis

• Xiān shíhú is fresh dendrobium orchid, Dendrobii Herba Recens. It is sweet and cold, and enters the stomach and kidney channels. It treats damage to liquid with heart vexation and mild heat effusion.

• Chìlíng is the red part of the poria fungus, Poria Rubra, introduced in the first case, above. It is sweet, bland, and balanced, and enters the heart, spleen, and bladder channels. It moves water and disinhibits damp heat to treat turbid strangury.

• Liánqiáo is the forsythia fruit, Forsythiae Fructus. It is bitter and slightly cold, and enters the lung, heart, and gallbladder channels. It clears heat from the pericardium in warm disease.

• Xiāngchǐ is the fermented soybean, Sojae Semen Fermentatum, acrid sweet and slightly bitter, entering lung and stomach channels. It resolves the exterior and eliminates vexation from heat lingering in the chest.

• Guālóurén is the trichosanthis seed, Trichosanthis Semen. It is sweet and cold, and enters the lung, stomach, and large intestine channels. It moistens the lung and transforms phlegm-heat.

• Dàzhúhuáng is, I believe, a miscopied entry for tiānzhúhuáng or bamboo sugar, Bambusae Concretio Silicea. It is sweet and cold, and enters the heart and liver channels. Clears heat, transforms phlegm, clears the heart and treats clouded spirit in febrile diseases.

• Dànqín, Scutellariae Baicalensis Radix, is discussed in the first case, above.

• Shānzhī is the gardenia fruit, Gardeniae Fructus. It is bitter and cold, and enters the heart, lung, stomach, and triple burner channels. It drains fire and eliminates vexation [with fermented soybean it eliminates vexation and heat from the chest] and clears damp-heat from the three burners.

• Chāngpú is the acorus rhizome, Acori Rhizoma, which is bitter, acrid and warm, and enters the heart and stomach channels. It opens the orifices, quiets the spirit, and sweeps turbidity with spirit clouding and confusion.

• Zhúrú is bamboo shavings, Bambusae Caulis in Taenia. It is sweet, cool, and enters the lung, stomach, and gallbladder channels. It clears heat, transforms phlegm, and eliminates vexation.

• An important feature of this prescription is the interplay of bitter cold medicinals to clear heat and dry dampness with the sweet cold ingredients to engender fluids and guard against dryness.

3. Not easy to outthrust

Prescription analysis

• Qínjiāo is the large-leaf gentian, Gentianae Macrophyllae Radix. It is bitter, acrid, and slightly cold; it enters the stomach, liver, and gallbladder channels. It dispels wind-damp and relieves pain from impediment [bì 痹], abates deep-lying vacuity heat [”steaming bone”] and clears damp heat. It can both help outthrust the pathogen and treat the pain.

• Chìlíng is described in the first case, above.

• Qīnghāo is described above.

• Sūgěng is described above.

• Xìngrén if the apricot kernel, Armeniacae Semen. It is bitter, slightly warm and slightly toxic; it enters the lung and large intestine channels. It downbears qì, moves phlegm and scatters nodulation.

• Gānjúhuā is the chrysanthemum flower, Chrysanthemi Flos. It is acrid sweet, bitter, and slightly cold; it enters the liver and lung channels. It disperses externally-contracted heat, clears the liver and brightens the eyes, and calms liver yáng. It treats headache and flowery vision while helping to vent the pathogen outward.

• Zhǐshí is the unripe bitter orange, Aurantii Fructus Immaturus. It is bitter, acrid, and slightly cold; it enters the spleen and stomach channels. It breaks qì and eliminates glomus [pǐ 痞, a subjective feeling of fullness and blockage], transforms phlegm and disperses accumulation.

• Dùzhōng is the eucommia bark, Eucommiae Cortex. It is sweet and warm; it enters the liver and kidney channels. It supplements the liver and kidney and strengthens sinew and bone. Stir frying in ginger helps its ability to treat back pain (Bao et al, 2024).

• Dòuchǐ is the fermented soybean, see xiāngchǐ above. The salted fermented soybean is known as xiāngchǐ, and the unsalted variety is dàndouchǐ.

• Sāngyè is the mulberry leaf, Mori Folium. It is acrid, sweet and cold; it enters the lung and liver channels. It disperses externally-contracted heat, clears the liver and brightens the eyes. It is frequently paired in early stage warm disease with gānjúhuā.

• When a pathogen is deep-lying and lodged on the interior, a key strategy is to dislodge it and bring it to one or more of the body’s natural exits so it can be pushed out. Outthrusting or venting is requires bringing the pathogen from the interior to the surface, and if, as in this case, the interior is depleted, it can be difficult to accomplish. Strengthening the liver and kidney is thus an important principle here, and it mostly relies on dùzhōng. The bulk of the prescription is focused on rectifying the qì mechanism to open the chest and restore upbearing and downbearing [xìngrén, zhǐshí, sūgěng] to dislodge the disease evil, and then bringing it to the surface to vent or outthrust [qínjiāo, qīnghāo, gānjúhuā, sāngyè, dòuchǐ] or down to the lower burner to be expelled in the urine [chìlíng].

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Okay, that’s all from the mulch pile for now. Until next time, thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Bao, L., Sun, Y.L., Wang, J.M., Li, W.B., Liu, J., Li, T.Y., & Liu, Z.Q. (2024). A review of “plant gold” Eucommia ulmoides Oliv.: A medicinal and food homologous plant with economic value and prospect. Heliyon, 10(2). doi: 10.1016/j.heliyon.2024.e24851

Wang, X.G., & Fang, R.Y. (1897). Wang Xugao linzheng yi’an. https://jicheng.tw/tcm/book/%E7%8E%8B%E6%97%AD%E9%AB%98%E8%87%A8%E8%AD%89%E9%86%AB%E6%A1%88/index.html Retrieved April 15, 2023.

Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.

First off, I would like to take a moment to welcome all the new subscribers to the mulch. I haven’t posted recently, as the mulch has been fermenting, so to speak. I’ve been immersed in research mostly on the eight extraordinary vessels [or EV for short] and the extraordinary fǔ organs [which I shorthand as EFU], the relationship between them, and their treatment with acumoxa and Chinese medicinals. I’ve written and developed some course materials on the brain over the last year or so, and this is a continuation of that work.

EV and EFU

Very briefly, the EV and extraordinary fǔ are distinct from the 12 regular channels (also called meridians) and their associated yīn and yáng organs (the zàng and fǔ, respectively) although their functions interact and are interdependent with them. Many TCM practitioners don’t pay much attention to them, except in certain situations. I’ve been a big proponent of EV since I was a student back in the 90s, and in later years I have had a growing interest in the extraordinary fǔ organs as well.

One of the most common ways acupuncturists treat EV is by using a group of points sometimes known as the confluent points (jiāohuì xué交會穴) of the extraordinary vessels; these points are paired together in a certain way, and the combination of points is also known as the master and coupled points of the extraordinary vessels. There have been numerous books published in English on the subject of EV, and every acupuncture textbook includes these confluent points, so I won’t go into the locations or indications and all. But I wanted to kick off this series with a brief look at the origins and early references to this point category.

Dòu Hànqīng’s Eight Points

Dòu Mò [竇默], courtesy name Dòu Hànqīng [竇漢卿] （1196-1280）was a famous acupuncturist from Héběi who lived during the Jīn-Yuán period. He wrote two works which were later compiled into Guide to the Acupuncture Classic [Zhēnjīng Zhǐnán針經指南] (Liu et al., 2022).

In Zhēnjīng Zhǐnán, the eight EV points make their first appearance in the surviving Chinese literature as the “Eight Flowing and Pooling Points [流注八穴]”. They are presented as four two-point upper-lower combinations. Dòu’s preface to this section of the book alludes to the method’s mysterious origins and miraculous effects:

[Note: Bó Lún was the courtesy name of Liú Líng [劉伶] (221-300 CE), a scholar and poet who was famous for his drunkenness. The wars mentioned were likely around the time that the Jīn dynasty was driven from Kāifēng by the invading Mongols. Thanks to Lorraine Wilcox for filling in the historical details for me. Sometimes, when I think about the state of the world today and the seeming futility of doing healing work in the face of so much worldwide turmoil and destruction, I remember that many of our medical ancestors lived, practiced medicine, and wrote books – the books that we still study today -- during periods of extreme mass violence and upheaval.]

This preface is followed by an extensive description of locations and indications of the eight points. There is, however, no mention in this section of any connection to the eight extraordinary vessels. A brief mention of the EV appears in another part of the compiled Zhēnjīng Zhǐnán, entitled Ode to Elucidate Mysteries [標幽賦 ]:

This passage has itself been the subject of some controversy, which we will elaborate on in a moment.

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Whether Dòu identified the eight flowing and pooling points with the EV or not, by the late Yuán and early Míng periods, authors such as Wáng Guóruì [王國瑞] and Xú Fèng [徐鳳] had begun to further develop the method by matching the points to the trigrams of the Yìjīng [a.k.a. Book of Changes] and, perhaps inspired by the biorhythmic acupuncture method known as Midnight-Noon Flowing and Pooling [Zǐwǔ Liúzhù子午流注], created two different time-based methods using Dòu’s point combinations: Eight Methods of Soaring [Fēiténg Bāfǎ飛騰八法 ] and Eight Methods of the Mysterious Tortoise [Língguī Bāfǎ靈龜八法 ] (Liu et al., 2022).

Eight Vessels, Eight Meetings

In addition to the latter, Xú Fèng, in the Complete Collection of Acumoxa [針灸大全 Zhēnjiǔ Dàquán 1439, Míng period] clearly associated the EV with Dòu’s eight methods:

In the next passage, however, Xú elaborates on a passage from Dòu and presents a different view of the points associated with the EV:

Here Xú makes a clear reference to the eight meeting points [bāhuì xué 八會穴] from Classic of Difficulties [Nánjīng 難經] chapter 45. The original passage from Nánjīng reads as follows:

Yáng Jìzhōu Concurs

These passages are echoed in the Great Compendium of Acupuncture and Moxibustion [Zhēnjiǔ dàchéng 針灸大成] by Yáng Jìzhōu [楊繼洲] in 1601. He references the Dàquán verse quoted above, linking Dòu’s eight points to the EV:

And then he adds in the reference to the eight meetings from Nánjīng 45:

Wú Kūn Emphatically Disagrees

A decade or so later, Wú Kūn [吳昆] in his Six Collections of Acupuncture Prescriptions [Zhēnfāng Liùjí 針方六集, 1618, Míng era], pushes back on this idea of the Nánjīng meeting points association with EV:

Over time, the idea of the meeting points (also commonly referred to as “influential points”) as having a connection to the EV largely faded away and the master-coupled points are generally thought of as the main method of opening the EV system, even if it is debatable that those point combinations were originally intended to be used for that purpose. Why would Dòu have linked the term “Eight Meetings” to the EV if he originally termed the point set “Eight Flowing and Pooling Points”?

Even so, I, and I suppose a majority of my colleagues, use Dòu Hànqīng’s eight points in their original combinations to address the EV in clinic. I’ve had the opportunity to study with some EV experts from Japan, Europe, and the Americas and to apply the points literally every day I am in the clinic. And, it must be said, I frequently employ the eight meeting/influential points as well, probably as often as I use the master-coupled points. Looking into this historical material, however, has made me think a little more deeply about the eight meetings and their possible relationship to the EV and EFU. I hope to post some of my speculations on this subject soon.

Until then, thanks for reading.

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Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Dou, H.Q. (1295). Zhenjing zhinan. Retrieved July 31, 2023 from https://jicheng.tw/tcm/book/%E9%87%9D%E7%B6%93%E6%8C%87%E5%8D%97/index.html

Liu, M.J., Yang, X.G., Gao X.Y., Xue, J.J., Zhang, W.X., Zhang, Z.Z., & Han, F.Z. (2022). Study on Dou Han-qing’s school of ‘eight confluent points’ inheritance. Chinese Journal of Traditional Chinese Medicine, 37( 7).

Nanjing. (n.d.). Retrieved October 30, 2025, from https://jicheng.tw/tcm/book/%E5%85%AB%E5%8D%81%E4%B8%80%E9%9B%A3%E7%B6%93/index.html

Wu, K. (1618). Zhenfang liuji. Retrieved January 13, 2024, from https://jicheng.tw/tcm/book/%E9%87%9D%E6%96%B9%E5%85%AD%E9%9B%86/index.html

Xu, F. (1439). Zhenjiu daquan. Retrieved December 6, 2023, from https://jicheng.tw/tcm/book/%E9%87%9D%E7%81%B8%E5%A4%A7%E5%85%A8/index.html

Yang, J. (1601). Zhenjiu dacheng. Retrieved December 26, 2023 from https://jicheng.tw/tcm/book/%E9%87%9D%E7%81%B8%E5%A4%A7%E6%88%90/index.html

Overview

Concussion, also known as mild traumatic brain injury (mTBI), refers to a transient disruption of brain function which occurs after a blow to the head by an exterior force. It accounts for 81% of all traumatic brain injuries worldwide (Ahmed et al., 2024).

Clinical manifestations may include brief unconsciousness (or no loss of consciousness), retrograde amnesia, headache, dizziness, nausea, and vomiting. Neurologic exam is typically without abnormal findings, and imaging generally displays no substantial changes (Li et al., 2019). Patients, though, may suffer chronic neurological dysfunction which has considerable impact on their daily lives.

Current treatment for concussion in biomedicine is largely limited to prescribed rest and analgesics; however, rest has been shown to delay long-term recovery in the post-acute phase and analgesics may lead to increased headaches due to medication overuse (Ahmed et al., 2024). Traditional Chinese medicine (TCM) may provide patients with additional options to help expedite recovery.

TCM Treatment of Concussion

Li et al (2019) analyzed TCM diagnoses and prescription patterns in 54 concussion patients (32 male and 22 female). All cases were diagnosed and their prescriptions written by the chief physician at the concussion department of Beijing Temple of Heaven hospital, Professor Fán Yǒngpíng. Patient ages ranged from 5-87 years old, with 70% between ages 20 and 50. The most common etiology was motor vehicle accidents, with other causes including knocks and falls, and falls from height. Most common symptoms were dizziness (67%), headache (63%), insomnia (56%), memory issues (52%), irritability (43%), and mood disorders (33%).

Etiology and Pathogenesis

Though the terms concussion and mTBI are modern disease entities and do not appear in the literature of the classical period, one can determine the treatment according to the clinical manifestations of dizziness, headache, forgetfulness, etc.

According to Li et al (2019), the acute stage of concussion is mainly characterized by repletion patterns. After exterior injury to the head, blood stasis obstructs the network vessels of the brain and blocks the brain orifices [nǎoqiào], the qì and blood lose harmony, fluid transport and distribution becomes irregular, and phlegm dampness is engendered. Thus, the early stages of concussion are predominantly marked by the pathogenic factors of phlegm and blood stasis; treatment should quicken blood and dispel stasis, transform phlegm and free the network vessels.

Over time a significant number of patients may develop post-concussion syndrome, with a mixture of vacuity and repletion symptoms.

• If pathogenic factors damage qì and blood, the patient may develop spleen and heart vacuity. Treatment should supplement qì, transform phlegm, quicken blood, strengthen the spleen and nourish the heart.

• If chronic stasis affects the kidneys, it may lead to either kidney essence vacuity, or depleted water below and repletion fire above due to non-interaction of kidney and heart. Depending on the clinical picture, treatment should nourish essence or harmonize heart and kidney, along with quickening blood and dispelling stasis.

• External injury disrupts qì and blood circulation, causing the liver to lose its orderly reaching and fail to store blood, which leads to liver depression with rising yáng and/or internal stirring of wind. Treatment should emolliate the liver and course depression, extinguish wind, transform phlegm, quicken blood and dispel stasis.

Pattern Differentiation

The TCM patterns given in Li et al (2019) are as follows:

• Qì vacuity with phlegm and [blood] stasis [氣虛痰瘀] (38%): dizziness or headache, heavy head, lack of strength and fatigue, facial complexion without luster, reduced affect, phlegm in the throat, no pleasure in eating, tendency to produce thin stools, pale red tongue body with stasis speckles on the sides, thin white or greasy white tongue coating, pulse fine and weak.

• Non-interaction of heart and kidney, with internal blood stasis obstruction [心腎不交，瘀血內阻] (13%): dizziness or headache, tinnitus, forgetfulness, vexation, agitation, irascibility, insomnia, dry throat, yellow urine, tendency to produce dry stools, red tongue body with stasis speckles on the side, scanty tongue coat, fine pulse.

• Liver depression with phlegm and [blood] stasis [肝鬱痰瘀] (11%): dizziness or headache, reduced affect, phlegm in the throat, ribside distension, breast distension and pain in women, abdominal distension, poor food intake, easily awakened from sleep, profuse dreaming, tendency to produce thin stools, red tongue body with stasis speckles on the sides, white tongue coating, fine stringlike [i.e. wiry] pulse.

• Kidney vacuity with phlegm and [blood] stasis [腎 虛 痰 瘀] (9%): headache, dizziness, tinnitus, forgetfulness, frequent urination or incontinence, dry stools, insomnia and profuse dreaming, red tongue, scanty coating, fine pulse which is sunken at the proximal position.

Materia Medica

Li et al (2019) analyzed the medicinals prescribed in the study. Some of the most important findings are given below.

Nature, flavor, and channel entry:

• Mostly warm and neutral natured medicinals

• Bitter, sweet, and acrid were the most common flavors

• Channels entered were mainly liver, heart, spleen, and kidney

The most frequently prescribed medicinals overall in the study:

• Táorén [Semen Persicae]: Bitter, sweet, balanced; quickens blood, transforms stasis

• Shíchāngpú [Rhizoma Acori]: Bitter, acrid, warm; opens orifices, quiets the spirit, penetrates turbidity

• Fúlíng [Poria]: Sweet, bland, balanced; percolates dampness, strengthens spleen, quiets the spirit

• Chuānxiōng [Rhizoma Chuanxiong]: Acrid, warm; quickens blood, moves qì, dispels wind, ascends to the head

• Bànxià [Rhizoma Pinelliae]: Acrid, warm; dries dampness, transforms phlegm, downbears counterflow and checks vomiting

For the leading pattern of qì vacuity with phlegm and stasis, the most common medicinals were:

• Huángqí [Radix Astragali]: Sweet, slightly warm; boosts qì and upbears yáng, disinhibits water and disperses swelling

• Táorén [see above]

• Shíchāngpú [see above]

• Chuānxiōng [see above]

• Niúxī [Radix Achyranthis] : Bitter, sour, sweet, balanced; quickens blood, supplements liver and kidney, strengthens sinew and bone, conducts blood downward

• Yìmǔcǎo [Herba Leonuri]: Acrid, biitter, slightly cold; quickens blood, disinhibits water and disperses swelling

• Bànxià [see above]

• Hónghuā [Flos Carthami]: Acrid, slightly warm; quickens blood, dispels stasis, relieves pain

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Orifice-freeing Blood-quickening Decoction

Tang et al. (2008) wrote a brief paper on using Tōngqiào Huóxuè Tāng [Orifice-freeing Blood-quickening Decoction, 通竅活血湯]. The formula is from Yīlín Gǎicuò (Correction of Errors among Physicians, 醫林改錯 1830) by Wáng Qīngrèn.

The formula is as follows:

• Táorén [see above]

• Hónghuā [see above]

• Chuānxiōng [see above]

• Chìsháo (Radix Paeoniae Rubra): Bitter, slightly cold; quickens blood, transforms stasis, clears heat and cools blood

• Dàzӑo (Fructus Jujubae): Sweet, warm; supplements center, boosts qì, nourishes blood, quiets the spirit, harmonizes the formula

• Shēngjiāng (Rhizoma Zingiberis recens): Acrid, warm; resolves exterior, warms the center and checks vomiting, reduces toxicity of other ingredients

• Cōngbái (Bulbus Allii Fistulosi): Acrid, warm; resolves exterior, unblocks yáng qì, ascends to the head

• Shèxiāng (Moschus): Acrid, warm; opens orifices, arouses the spirit, quickens blood, disperses binds, relieves pain.

There is considerable crossover between the ingredients of the formula and the most frequently-cited medicinals in Li et al (2019). Though not in the top five, chìsháo also appears on the list in Li et al (2019).

As noted in an earlier post on the formula, Mayway uses shíchāngpú in its formulation, making it a good option for those who prefer to administer teapills. Combining the formula with Èrchén Tāng [Two Aged Ingedients Decoction] in pre-made form will quicken blood, dispel stasis, open orifices, dry dampness, transform phlegm, strengthen the spleen, and downbear counterflow.

Acupuncture for mTBI

Wang et al. (2025b) published a randomized controlled trial of acupuncture for mTBI (verum vs. sham vs. wait-list). Verum acupuncture was performed on points of the governing vessel (dūmài), foot tàiyáng, foot yángmíng, and foot juéyīn channels, all of which either directly or indirectly enter the brain (Wang et al., 2025a). Wang et al. (2025b) showed that “acupuncture improved the white matter integrity at MRI, which was associated with relief of long-term postconcussion symptoms”.

In my own clinic, I have seen promising results using the Manaka whiplash protocol (Matsumoto & Birch, 1988, pp 391-392), either with or without ion-pumping cords (IPC), though using IPC does seem to produce quicker results. The cord configuration is:

I will often follow with light scatter needling (sanshin) on the head to help unblock the xuánfǔ-nǎoqiào complex, as well as on the antero-medial and posterior aspects of the neck and shoulders to help drain the turbid yīn so the clear yáng may ascend. Treating the brain-gut axis can also be helpful for longer-term cases.

That’s all for now. Thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Ahmed, Z., Chaudhary, F., Fraix, M. P., & Agrawal, D. K. (2024). Epidemiology, pathophysiology, and treatment strategies of concussions: A comprehensive review. Fortune Journal of Health Sciences, 7(2), 197–215. https://doi.org/10.26502/fjhs.178

Li, K., Fan, Y., & Wang, L. (2019). Study on traditional Chinese medicine treatment based on syndrome differentiation and prescription regularity of concussion practiced by Prof. Fan Yongping. Journal of Capital Medical University, 40(2). doi: 10.3969/j.issn.1006-7795.2019.02.025

Matsumoto, K., & Birch, S. (1988) Hara diagnosis: Reflections on the sea. Paradigm Publications.

Tang, Y., Jin, B., & Li, J. (2008). Tongqiao huoxue decoction for the treatment of post-concussion syndrome. Chinese Journal of Integrated Traditional and Western Medicine in Critical Care, 15(5).

Wang, R., Zeng, H., & Liu, B. (2025a). Discussion on the multi-dimensional pathways of acupuncture treatment for encephalopathy. Journal of Nanjing University of Traditional Chinese Medicine, 41(2)

Wang, Z.N., Ding, J.R., Li, X., Shi, L., Yin, B., Bai, G.H., Fang, M., Lao, L.X., Tian, J., & Bai, L.J. (2025b). Acupuncture improves MRI brain microstructure with postconcussion symptoms in mild TBI: A randomized controlled trial. Radiology, 316(1). doi: 10.1148/radiol.250315

Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.

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First I want to welcome all the recent subscribers to Clinical mulch. I haven’t been mulching much as of late; clinic, life, and other projects have been filling up the time. I thought I would touch base here with a piece that I have been working on.

This is an excerpt from Comprehensive Guide to Channels and Network Vessels [經絡全書, Jīngluò Quánshū, 1576], by Shěn Zǐlù and Xú Shīcéng. It is an interesting volume, particularly the first half of the book which is a survey of all the channel connections to 88 various regions of the body. The references range from the canonical works of the Huángdì Nèijīng Sùwèn and Língshū [Yellow Emperor’s Inner Classic Simple Questions and Spiritual Pivot] and Nánjīng [Classic of Difficulties] to the later Sòng-Jīn-Yuán and Míng eras. Many of the references are paraphrased and I wasn’t able to track down all of them. Still, it should give the reader a taste of what the book contains, and the comprehensiveness of the treatment. I have included the section on the head as a whole, but the surrounding sections go into detail about the different areas of the head – vertex, forehead, temples, occiput, brow, etc – and the sense orifices (different parts of the eyes, the nose, the ears, and so forth). The chapters following continue down the neck and nape, and pretty much every body region down to the bottoms of the feet.

The chapter follows, with some annotations of my own here and there.

二、〔頭〕

2 The head

屬足太陽膀胱經、督脈之交會（《靈樞》曰：足太陽之脈，是動則病，沖頭痛，目似脫，項似拔。《素問》曰：傷寒一日，巨陽受之，故頭痛。七日，巨陽病衰，頭痛少愈。又曰：熱病始於頭首者，刺項太陽而汗出止。又曰：巨陽之厥，則腫首頭重，足不能行，發為眴僕）。

[The head] pertains to the intersection of the foot tàiyáng bladder channel and dūmài (Língshū [10] states: “When the foot tàiyáng vessel is stirred there are diseases such as surging head pain, eyes bulging, and nape [feeling] as if it is being painfully stretched.” Sùwèn [31] says: “On the first day of cold damage, jùyáng receives it, therefore there is head pain. On the seventh day, jùyáng disease wanes, and the headache improves slightly.” It also says [Sùwèn 32]: “When [exogenous] heat illness begins at the head, pierce the nape at tàiyang, there will be sweating and the illness will cease.” It also says [Sùwèn 45]: “If there is reversal at jùyáng, there is swelling in the head and the head feels heavy, the feet cannot move, and the appearance of dim vision and toppling forward.”)

Mulch note: Jùyáng is another name for tàiyáng.

又屬足陽明胃經。（《靈樞》曰：足陽明之別，循脛骨外廉，上絡頭項。又曰：胃氣上注於肺，其悍氣上衝頭者，循咽，上走空竅。《素問》曰：陽明所謂客孫脈，則頭痛、鼻鼽、腹腫。婁全善曰：病在胃而頭痛者，必下之，方愈也）。

It also pertains to the foot yángmíng stomach channel. (Língshū [10] says: “The foot yángmíng diverges following the outer ridge of the shinbone and rises to net the head and nape.” It also says [Língshū 62]: “Stomach qì ascends to pour into the lungs, its fierce qì rises and surges to the head, follows the throat, and rises to go to the empty orifices.” Sùwèn [49] says: “When a guest [evil] intrudes on the grandchild vessels of the yángmíng, then there is headache, nasal congestion, and abdominal swelling.” Lóu Quánshàn said: “If there is pain in the stomach and headache, one must purge it and they will recover.”).

Mulch note: “Empty orifices” are the sensory orifices, i.e. eyes, nose, etc. Lóu Quánshàn is also known as Lóu Yīng 樓英, an author of the early Míng period.

又屬足少陽膽經（《靈樞》曰：厥頭痛，頭痛甚，耳前後脈湧有熱，瀉出其血，後取足少陽。李東垣曰：頭痛耳鳴，氣虛頭痛也，以人參 、黃耆主之。朱丹溪曰：東垣青空膏，治少陽頭痛）。

It also pertains to the foot shàoyáng gallbladder channel (Língshū [24] says: “[For] reversal headache, the headache will be severe with swelling and heat in front of and behind the ear; let their blood and afterward select foot shàoyáng [to treat].” Lǐ Dōngyuán said: “Headache with ringing in the ears is qì vacuity headache, use rénshēn [Radix Ginseng] and huángqí [Radix Astragali] to govern it.” Zhū Dānxī said: “Dōngyuán’s Qīngkōng Gāo [Blue Sky Paste] treats shàoyáng headache.”).

Mulch note: Lǐ Dōngyuán and Zhū Dānxī are two of the four great masters of Sòng-Jīn-Yuán era medicine. Qīngkōng Gāo consists of chuānxiōng [Rhizoma Chuanxiong], cháihú [Radix Bupleuri], huánglián [Rhizoma Coptidis], huángqín [Radix Scutellariae Baicalensis], fángfēng [Radix Saposhnikoviae], qiānghuó [Radix Notopterygii], zhìgāncǎo [Radix Glycyrhizzae Praeparata].

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又總屬手足三陽經、陽維之脈（《靈樞》曰：手之三陽從手走頭，足之三陽從頭走足。又曰：頭半寒痛，先取手少陽、陽明，後取足少陽、陽明。

Also, [the head] pertains to the hand and foot three yáng channels and the yángwéi vessel together (Língshū [38] says: “The three yáng [channels] of the hand run from the hand to the head, the three yáng [channels] of the foot run from the head to the feet.” It also [Língshū 24] says: “For one-sided cold pain in the head, first select hand shàoyáng and yángmíng, and afterward select foot shàoyáng and yángmíng.”

《素問》曰：頭上五行，行五者，以越諸陽之熱逆也。王啟玄曰：三陽之脈，盡上放頭。頭者，三陽之會也。張子和曰：頭痛不止，乃三陽受病也。孫景思曰：今人頭風，亦由陽氣虛弱。

Sùwèn [61] says: “Atop the head there are five lines, each with five points which are used to dissipate the counterflow heat from all the yáng channels.” Wáng Qǐxuán said: “The three yáng vessels, all ascend to the head. The head is the meeting of the three yáng.” Zhāng Zǐhé said: “Unceasing headache is the three yáng falling ill.” Sūn Jǐngsī said: “If people of today have head wind, it can also be due to yángqì vacuity.”

Mulch note: Wáng Qǐxuán is better known as Wáng Bīng王冰, annotater of the Inner Classic Simple Questions. Zhāng Zǐhé is another of the four great masters of the Sòng-Jīn-Yuán era. Sūn Jǐngsī is a commentator from the Míng period.

沈承之曰：頭有五行，中行前自發際，循頂下項至大椎，屬督脈。前髮際上一寸，名神庭穴，屬足太陽膀胱、陽明胃經、督脈之會。後髮際上一寸，名風府穴；五分，名啞門穴，並屬督脈、陽維之會。第二行，去中行左右各開一寸五分，前後各以髮際為度，屬足太陽膀胱經。第三行，左右各直目瞳子上，前後亦以髮際為度，屬足太陽膀胱、少陽膽經、陽維之會）。

Shěn Chéngzhī said: “There are five lines on the head, the center line follows from the anterior to the vertex and descends the nape to Dàzhuī [GV-14]; it belongs to the dūmài. One cùn above the front hairline is a point called Shéntíng [GV-24], which is a meeting point for the foot tàiyáng bladder and yángmíng stomach channels with the dūmài. One cùn above the rear hairline is a point called Fēngfǔ [GV-16]; at five fēn [above the rear hairline] is a point called Yǎmén [GV-15], both are meeting points for the dūmài and yángwei. The second line is one cùn five fēn away from the center line on each of the left and right sides; each use the front and rear hairlines as their boundary, they belong to the foot tàiyáng bladder channel. The third line goes straight up from the pupil of both the left and right eyes, also using the front and rear hairlines as their boundaries, and are the meetings of the foot tàiyáng bladder, shàoyáng gallbladder, and yángwéi [vessel].”)

Mulch note: Shěn Chéngzhī is the author of the Comprehensive Guide, he is also known as Shěn Zǐlù. The notes concerning him are likely placed by Xú Shīcéng, who revised and edited the work. Consider that the last few snippets above are a single parenthetical note that I have broken up to comment on, and you can get an idea about how intricate this text is.

又屬足厥陰肝經（《靈樞》曰：厥頭痛，頭脈痛，心悲善泣，視頭動脈及甚者，刺盡出血，後調足厥陰。《素問》曰：肝熱病者，其逆則頭痛員員，脈引沖頭也。又曰：徇蒙招尤，目眩耳聾，下實上虛，過在足少陽、厥陰。

In addition, [the vertex] pertains to the foot juéyīn liver channel (Língshū [24] says: “For reversal headache with pain in the vessels of the head, grief in the heart and tendency to weep, in severe cases one can see the vessels stirring in the head, pierce it to completely remove the [malign] blood, and afterward regulate foot juéyīn.” Sùwèn [32] says: “In liver heat disease there is reversal causing headache and dizziness, which causes the vessels to surge to the head.” It also [Sùwèn 10] says: “Clouding giddiness and severe shaking of the head, dizzy vision and deafness is repletion below and vacuity above; the fault lies with the foot shàoyáng and juéyīn.”

注：徇蒙者，如以物蒙其首，招搖不定；目眩耳聾，皆暈之狀也，此為肝厥，宜鉤藤散。王海藏曰：酒浸當歸，治諸頭痛。蓋頭痛皆屬肝木，故以血藥主之。朱丹溪曰：血虛頭痛，從魚尾上攻，相連頭痛者，當歸、川芎主之，蓋在足太陽、足厥陰也）。

Note: Clouding giddiness is as if something was used to cover one’s head, severe shaking is inability to settle down; dizzy vision and deafness are both descriptions of dizziness, this is on account of liver reversal, [for this] one should use Gōuténg Sǎn [Uncaria Powder] . Wáng Hǎicáng said: “Wine-soaked dāngguī [Radix Angelicae Sinensis] treats all headaches. Headaches all pertain to liver wood, so use blood medicinals to govern it.” Zhū Dānxī said: “Blood vacuity headache attacks from the fishtails [i.e., the corners of the eyes] upward with pain connecting to [the top of the] head; dāngguī and chuānxiōng govern it, it is in the foot tàiyáng and foot juéyīn [channels])”.

Mulch note: Gōuténg Sǎn is from the Sòng era Formulas of Universal Benefit [Pǔ jì běnshì fāng 普濟本事方]; it consists of gōuténg [Ramulus cum Uncis Uncariae], chénpí [Pericarpium Citri Reticulatae], bànxià [Rhizoma Pinelliae], màiméndōng [Radix Ophiopogonis], fúlíng [Sclerotium Poriae], fúshén [Poria Pararadicis], rénshēn, gānjúhuā [Flos Chrysanthemi], fángfēng, gāncǎo, and shígāo [Gypsum]. Wáng Hǎicáng is otherwise known as Wáng Hǎogǔ [王好古], a student of Zhāng Yuánsù [張元素] and Lǐ Dōngyuán.

兼屬足少陰腎經（《靈樞》曰：厥頭痛，員員頭重而痛，瀉頭上五行，先取手少陰，後取足少陰。許知可曰：肝虛為上虛，虛則頭暈；腎虛為下虛，虛則頭痛。李東垣曰：有厥逆頭痛者，所犯大寒，內至骨髓。髓以腦為主，腦逆，故令腦痛齒亦痛，宜羌活附子湯）。

At the same time, [the head] pertains to the foot shàoyīn kidney channel (Língshū [24] says: “For reversal headache with dizziness, heaviness of the head and pain, drain the five lines at the top of the head; [then] first select hand shàoyīn, and after that select foot shàoyīn.” Xǔ Zhīkě said: “Liver vacuity is vacuity above, vacuity causes dizzy head; kidney vacuity is vacuity below, vacuity causes headache.” Lǐ Dōngyuán said: “The great cold which invades penetrates to the bones and marrow is reversal counterflow headache. Marrow takes the brain as its governor, there is brain counterflow, thus it causes brain pain that also causes pain in the teeth, for which one should use Qiānghuó Fùzǐ Tāng [Notopterygium and Aconite Decoction].”).

Mulch note: Xǔ Zhīkě I believe is Xǔ Shūwēi, author of Formulas of Universal Benefit. Dongyuan’s Qiānghuó Fùzǐ Tāng consists of máhuáng [Radix Ephedrae], hēifùzǐ [Radix Aconiti Lateralis Denigrata], qiānghuó, cāngzhú [Rhizoma Atractylodis], fángfēng, huángqí, gāncǎo, shēngmá [Rhizoma Cimicifugae], bāizhǐ [Radix Angelicae Dahuricae], báijiāngcán [Bombyx Batryticatus], and huāngbǎi [Cortex Phellodendri].

又分屬足六經（李東垣曰：頭痛須用川芎。如不應，各加引經藥。太陽川芎、陽明白芷、少陽柴胡、太陰蒼朮、少陰細辛、厥陰吳茱萸。

又曰：太陽頭痛，脈浮緊者，川芎、羌活、麻黃主之。少陽頭痛，脈弦細，寒熱往來者，柴胡、黃芩主之。陽明頭痛，自汗，發熱不惡寒，脈浮長者，升麻、葛根、石膏、白芷主之。太陰頭痛，必有痰，體重、腹痛、為痰癖，蒼朮、半夏主之。少陰頭痛，三陰三陽不流行，足寒氣逆為寒厥，其脈沉細，麻黃附子細辛湯主之。厥陰頭痛，或吐痰沫，冷厥，脈沉緩，吳茱萸湯主之）。

Moreover, this pertains to the six channels of the foot (Lǐ Dōngyuán said: “For headache chuānxiōng must be used; if the patient does not respond, add channel-conducting medicinals. For tàiyáng [use] chuānxiōng, for yángmíng use báizhǐ, for shàoyáng use cháihú, for tàiyīn use cāngzhú, for shàoyīn use xìxīn, for juéyīn use wúzhūyú [Fructus Evodiae].”

[Lǐ] also said: “For tàiyáng headache with a floating and tight pulse, chuānxiōng, qiānghuó, and máhuáng govern it. Shàoyāng headache with a wiry thin pulse and alternating cold and heat, cháihú and huángqín govern it. Yángmíng headache with spontaneous sweat and heat effusion without aversion to cold and with a floating long pulse, shēngmá, gégēn [Radix Puerariae], shígāo, and báizhǐ govern it. Tàiyīn headache, [in which] there will surely be phlegm, heaviness of the body, and abdominal pain, is caused by phlegm aggregation; cāngzhú and bànxià govern it. Shàoyīn headache, the three yīn and three yáng are not flowing freely, the feet are cold, [there is] qì counterflow that is reversal cold, and the pulse is sunken and thin, Máhuáng Fùzǐ Xìxīn Tāng governs it. Juéyīn headache, perhaps with spitting up of foamy phlegm, reversal cold, and a sunken moderate pulse, Wúzhūyú Tāng governs it.”)

Mulch note: Máhuáng Fùzǐ Xìxīn Tāng is máhuáng, fùzǐ, and xìxīn [Herba Asari]. Wúzhūyú Tāng is wúzhūyú, shēngjiāng [Rhizoma Zingiberis Recens], rénshēn, and dàzǎo [Fructus Jujubae].

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As can be seen, the cataloging of the channel connections in Jīngluò Quánshū is fairly extensive and covers both acumoxa and medicinal applications. A full rendering in English would be of benefit to serious students of channel-based therapeutics in the West.

Anyway, that’s all for now, thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Shen, Z., & Xu, S. (1576). Jingluo Quanshu. Retrieved August 18, 2023 from https://jicheng.tw/tcm/book/%E7%B6%93%E7%B5%A1%E5%85%A8%E6%9B%B8/index.html

It’s been a while since I posted, and even longer since I did a formula post. I’ve gotten some requests to put together a course on premade (sometimes referred to as “patent”) formulas, so I’m going over some materials I had worked on over the last few years, particularly for musculoskeletal disorders. Here’s a brief entry on a formula which, while popular in East Asia, hasn’t achieved such widespread application in the U.S.; namely Shūjīng Huóxuè Tāng [疏經活血湯, Channel-coursing Blood-quickening Decoction].

The Source of the Formula

The formula first appears in the Ming era text Wànbìng Huíchūn [萬病回春, Return of Spring for All Diseases, 1587] by the author Gōng Tíngxián [龔廷賢, 1522-1619]. It is listed under the chapter on painful wind [痛風]. The introduction to the chapter states:

痛風者，遍身骨節走注疼痛也。謂之白虎歷節風，都是血氣、風濕、痰火，皆令作痛。或勞力，寒水相搏；或酒色醉臥，當風取涼；或臥卑濕之地；或雨、汗濕衣蒸體而成。痛風在上者，多屬風；在下者，多屬濕。治用活血疏風、消痰去濕… 凡治痛風，用蒼朮、羌活、酒芩三味散風行濕之妙藥耳。

遍身骨節疼痛者，皆是血氣、風濕、痰火也。

In painful wind, there is pain and soreness moving and infusing into the joints over the whole body. In what’s known as ‘White Tiger joint running wind’, blood and qì, wind and damp, phlegm and fire, all cause pain. Or from physical taxation, cold, and water mutually contending; or exposure to wind or catching cold while lying in a drunken stupor after drinking and sex; or lying down on the damp earth; or it can happen when rain- or sweat-soaked clothing steams the body. Painful wind in the upper often pertains to wind; if in the lower, it often pertains to dampness. Treat using blood-quickening, wind-coursing, phlegm-dispersing, and damp-eliminating [medicinals] … Whenever treating painful wind, using the three ingredients cāngzhú [Rhizoma Atractylodis], qiānghuó [Radix et Rhizoma Notopterygii], and wine-fried huángqín [Radix Scutellariae Baicalensis] to scatter wind and move dampness is miraculous.

Pain and soreness over the joints of the whole body is all from qì and blood, wind-damp, and phlegm-fire.

The formula is found a bit later in the chapter. The entry reads:

疏經活血湯

Shūjīng Huóxuè Tāng

治遍身走痛如刺，左足痛尤甚。 左屬血，多因酒色損傷，筋脈虛空，被風寒濕熱感於內，熱包於寒，則痛傷筋絡，是以晝輕夜重。 宜以疏經活血行濕。 此非白虎歷節風也。

Treats moving pain of the whole body as if one were being stabbed, with the left leg worst of all. The left pertains to blood; [the condition is] frequently caused by damage due to excessive drinking and sex, leaving the sinews and vessels vacuous and empty, allowing contraction of wind-cold-damp and heat to move in. The heat is wrapped in the cold, resulting in painful damage to the sinews and network vessels, hence the pain is lighter in the day and heavier at night. It is appropriate to course the channels, quicken the blood, and move dampness. This is different from the White Tiger joint running wind.

當歸（酒洗，一錢二分）　白芍（酒炒，錢半）　生地（酒洗）　蒼朮（米泔浸）　牛膝（去蘆，酒洗）　陳皮（去白）　桃仁（去皮，煎炒）　威靈仙（酒洗，各一錢）　川芎草（六分）　漢防己（酒洗）　羌活　防風（去蘆）　白芷（各六分）　龍膽草（六分）　茯苓（去皮，七分）　甘草（四分）

Dāngguī [Radix Angelicae Sinensis] (wash in wine, 1 qián 2 fēn); báisháo [Radix Paeoniae Alba] (wine-fry, 1.5 qián); shēngdì [Radix Rehmanniae] (wash in wine), cāngzhú (soak in rice water), niúxī [Radix Achyranthis] (remove tops, wash in wine), chénpí [Pericarpium Citri Reticulatae] (remove white part), táorén [Semen Persicae] (remove skin, fry in a little oil), wēilíngxiān [Radix Clematidis] (wash in wine; each 1 qián); chuānxiōngcǎo [Radix Chuanxiong] (6 fēn); hànfángjǐ [Radix Stephaniae] (wash in wine), qiānghuó, fángfēng [Radix Ledebouriellae] (remove tops), báizhǐ [Radix Angelicae Dahurica] (each 6 fēn); lóngdǎncǎo [Radix Gentianae] (6 fēn); fúlíng [Poria] (remove skin, 7 fēn); gāncǎo [Radix Glycyrrhizae] (4 fēn)

上銼一劑，生薑三片，水煎，空心溫服。忌生冷濕物。有痰加南星、半夏各一錢；如身上及臂痛加薄桂三分；如下身並足痛加木瓜、木通。鹽炒黃柏、薏苡仁各一錢；如氣虛加人參、白朮、龜板各七分；如血虛倍四物湯，以薑汁酒浸炒，用紅花一錢。

Grate the above into one dose, with three pieces of shēngjiāng [Rhizoma Zingiberis Recens], decoct in water, take warm on an empty stomach. Avoid raw, cold, and damp things. If there is phlegm, add nánxīng [Rhizoma Arisaematis] and bànxià [Rhizoma Pinelliae], 1 qián each; if there is pain in the upper body and arms, add báoguì [Ramulus Cinnamomi], 3 fēn; if there is lower body and leg pain, add mùguā [Fructus Chaenomeles], mùtōng [Radix Akebiae], salt-fried huángbǎi [Cortex Phellodendri] and yìyǐrén {Semen Coicis}, each 1 qián; if there is qì vacuity, add rénshēn [Radix Ginseng], báizhú [Rhizoma Atractylodis Macrocephalae], and guībǎn [Plastrum Testudinis], each 7 fēn; if there is blood vacuity, double the [ingredients of] Sìwù Tāng [Four Substance Decoction], as well as using jiāngzhī [Succus Zingiberis] and wine to soak and fry hónghuā [Flos Carthami], 1 qián.

肢節腫痛者，腫是濕、痛是火也。

As for swollen and painful limb joints, the swelling is dampness and the pain is fire.

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Modern applications of the formula

Modern applications of Shūjīng Huóxuè Tāng include second or third stage traumatic injuries “where wind-cold-damp and blood stasis have settled into the trauma site” (Ellis, 2003). For trauma, add rǔxiāng [Olibanum] and mòyào [Myrrha] along with hónghuā. The addition of the latter is recommended in the original text and completes the presence of Táo Hóng Sìwù Tāng [Persica and Carthamus Four Substance Decoction] in the formula. If the problem is chronic, one might consider adding yang tonics such as dùzhòng [Cortex Eucommiae] and/or xùduàn [Radix Dipsaci], or ingredients that strengthen sinew and bone such as wǔjiāpí [Cortex Acanthopanacis].

The prescription supplements blood but does not supplement qì unless modified; the original text above can be followed, or one might consider adding huángqí [Radix Astragali], since it is indicated for qì vacuity with external contraction and is a key ingredient of modern musculoskeletal formulas.

Comparison with Dúhuó Jìshēng Tāng [Pubescent Angelica and Mistletoe Decoction]

Probably the most commonly-used musculoskeletal formula in the U.S. is Dúhuó Jìshēng Tāng [Pubescent Angelica and Mistletoe Decoction], which in its unmodified form has more ability to treat qi and blood vacuity than Shūjīng Huóxuè Tāng, as it includes rénshēn along with the ingredients of Sìwù Tāng. The former also contains dùzhòng, which gives it a mild yáng-supplementing capability, and in combination with sāngjìshēng [Herba Taxili], makes it more useful in cases of liver-kidney vacuity.

Shūjīng Huóxuè Tāng, on the other hand, is better equipped to dispel dampness with cāngzhú and hànfángjǐ, and has more blood-quickening capability with the inclusion of táorén. It is also more effective at treating wandering impediment (with wēilíngxiān) including upper-body pain (with qiānghuó and báizhǐ). In addition, it has some heat-clearing action, with lóngdǎncǎo.

Use in kampō medicine

The formula is one which has made its way into the Japanese kampō repertoire as well. Interestingly enough, the classic school (kōhōha), known for its devotion to Zhāng Zhòngjǐng’s formulas, adopted a number of prescriptions from Wànbìng Huíchūn, including Shūjīng Huóxuè Tāng. According to Dharmananda (n.d.), one of Gōng’s students emigrated to Japan, bringing Wànbìng Huíchūn with him and helping to spread its popularity. Gōng’s formulas, while typically lengthy, are characterized by combinations of smaller formulas found in Shāng Hán Lùn and Jīn Guì Yào Lüè, with a limited corpus of materia medica that overlaps significantly with those found in Zhāng Zhòngjǐng’s works (Dharmananda, 2000). Whatever the reason, Gōng’s writings found an eager audience in Japan. Aricanli (2022) notes that there were 18 Japanese editions of Wànbìng Huíchūn published between the years 1611 and 1714.

Shibata & Wu (1997) include Shūjīng Huóxuè Tāng in their exposition of menopausal treatments with kampō, listing signs and symptoms of arthralgia, myalgia, neuralgia, edema, muscle and joint stiffness and impeded motion, lusterless skin, paresthesias, spasm, and abdominal blood stasis signs. They note is “may be applied broadly in all rheumatic conditions with features of blood and fluid imbalances”.

Prepared versions

Shūjīng Huóxuè Tāng is available in prepared form, especially granules, given its use in Japanese medicine. There are also a few tableted or encapsulated versions available in the U.S. Here is a summary of the differences I found in surveying online suppliers:

• KPC uses the original formula.

• Evergreen uses the original formula but eliminates gāncǎo.

• Golden Flower Course and Quicken Formula eliminates wēilíngxiān and hànfángjǐ and replaces them with qínjiāo [Radix Gentianae Macrophyllae] and wǔjiāpí. It also subtracts shēngjiāng. The modfications make the formula less damp-drying and less able to treat moving pain, but better for long-term use or chronic conditions.

• Health Concerns Mobility 2 replaces báisháo with chìsháo [Radix Paeoniae Rubra], cāngzhú with báizhú, and adds qínjiāo and mànjīngzǐ [Fructus Viticis] while eliminating hànfángjǐ, lóngdǎncǎo and shēngjiāng. It is somewhat less blood-supplementing and damp-drying than the original.

• Herbal Times replaces báisháo with chìsháo, cāngzhú with báizhú, wēilíngxiān with dúhuó [Radix Angelicae Puescentis], and táorén with jīxuèténg [Caulis Spatholobi], and eliminates hànfángjǐ. It is less damp-drying and less able to treat moving pain, though the substitutions offset any loss of blood-supplementing or blood-quickening – chìsháo is more quickening and less supplementing than báisháo, but jīxuèténg is more supplementing than táorén, and still quickens blood, though not as strongly.

• Sun Ten replaces cāngzhú with báizhú, wēilíngxiān with qínjiāo, and hànfángjǐ with yánhúsuǒ [Rhizoma Corydalis]. The addition of yánhúsuǒ ups the blood-quickening and pain-relieving ability, but the formula is less damp-drying.

Okay, that’s all for now. Thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Aricanli, S. (2022). Continuities in state–society interactions across broad spatio-temporal realms: Gong Tingxian as both an author of popular medical texts and an imperial medical secretary in early modern China. Social History of Medicine, 35(1), pp. 302–322.

Dharmananda, S. (n.d.). Kampo medicine: The practice of Chinese herbal medicine in Japan. Retrieved April 2, 2026 from http://www.itmonline.org/arts/kampo.htm

Dharmananda, S. (2000). Chinese herbs for lymphedema: exploring the principles of treating phlegm-damp accumulation. http://www.itmonline.org/arts/lymphedema.htm

Ellis, A. (2003). Notes from South Mountain: A guide to concentrated herb granules. Thin Moon Publishing.

Shibata, Y., & Wu, J. (1997). Kampo treatment for climacteric disorders. Paradigm Publications.

Two articles I wanted to share with readers of the mulch are related to the eight extraordinary vessels [奇經八脈 qíjīng bāmài], or EV. In my recent research on classical Chinese views of the brain, I focused on acumoxa and the channels and points that were associated with it. The EV are closely associated with the brain and marrow; however their therapeutic application is not limited to acumoxa. The use of medicinals to treat EV has been explored in numerous key texts, such as Grand Materia Medica [Qíjīng Bāmài Kǎo 奇經八脈考, 1577] , the Materia Medica of Combinations [Dé pèi běncǎo 得配本草, 1761], and A Clinical Guide with Case Histories [Línzhèng Zhǐnán Yī’àn 臨證指南醫案, 1746]. The latter was the subject of a 2019 paper by Hú et al., which presented a summary analysis of the diagnosis and treatment of EV disorders according to the book’s author, Yè Tiānshì [葉天士].

Yè Tiānshì’s Treatment of EV

Yè Tiānshì saw EV pathology primarily in terms of vacuity patterns, according to Hú et al. (2019). This is because of the EV relationship to the liver and kidneys (which are associated pre-heaven essence) as well as the spleen and stomach (which are the root of post-heaven essence).

These connections were noted in the later Qīng author Yè Lín, in his commentary Rectified Interpretation of the Classic of Difficulties [Nánjīng Zhèngyì 難經正義, 1895]:

If there is depletion in either essence and blood of the liver and kidneys, or in the engenderment of qì and blood in the spleen and stomach, the EV will become depleted as well. Vacuity requires supplementation; however, the matter is not the same as simply nourishing qi and blood. Yè Tiānshì’s methods can be further differentiated, according to Hú et al. (2019), depending on the pattern:

• Warming supplementation 溫補 wēnbǔ

• Enriching supplementation 滋補 zībǔ

• Replenishing supplementation 填補 tiánbǔ

• Freeing supplementation 通補 tōngbǔ

• Containing supplementation 攝補 shèbǔ

• Upbearing supplementation 升補 shēngbǔ

Of all these, the most consistently applied is freeing supplementation; as Yè Tiānshì wrote “When extraordinary channels become ill, rely on freeing as the sole method” 奇經為病，通因一法].

This means that for EV, the use of heavy, thick, cloying medicinals is problematic in that they easily cause stagnation. Yet substances which are hot and drying [e.g., fùzǐ, Radix Aconiti Lateralis Praeparata] or bitter and cold [e.g. huángbǎi, Cortex Phellodendri] can be also be counterproductive as they tend to consume essence and blood. Instead, Yè spoke of employing “gentle formulas with yáng medicinals to free the extraordinary vessels without causing stagnation [柔劑陽藥，通奇脈不滞].”

In practice, “blood and flesh” mainly refers to animal products such as lùjiǎo [Cornu Cervi], lùjiǎo jiāo [Cornu Cervi Gelatinatum], lùjiǎo shuāng [Cornu Cervi Degelatinatum], ējiāo [Colla Corii Asini], and bone marrow from various mammals.

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Guiding Agents

In order for any therapeutic agents to enter the EV, guiding agents are employed. One frequentlly cited substance is fúlíng [Sclerotium Poriae]:

Guiding agents for the EV include:

• Dūmài [Governing Vessel]: Lùjiǎo /lùjiǎo jiāo /lùjiǎo shuāng “The deer’s nature is yáng, and it enters the dūmài [鹿性陽，入督脈]”

• Rènmài [Conception or Controlling Vessel]: Guījiǎ [Carapax et Plastrum Testudinis] “The form of the tortoise in yīn, and it goes through the rènmài [龜体陰，走任脈].”

• Chōngmài [Thoroughfare Vessel]: Zǐshíyīng [Fluoritum] “When the chōngmài becomes ill, use zǐshíyīng to settle counterflow [沖脈為病，用紫石英以為鎮逆].”

• Dàimài [Belt Vessel]: Dāngguī [Radix Angelicae Sinensis] “When the dàimài becomes ill, use dāngguī as a channel-guiding medicinal [帶脈為病，用當歸為引經藥]”

• Yángwéi [Yáng Linking Vessel]: Guìzhī [Ramulus Cinnamomi], huángqí [Radix Astragali]

• Yīnwéi [Yīn Linking Vessel]: Guījiǎ, biējiǎ [Carapax Trionycis]

• Qiāomài [Yáng and Yīn Springing or Heel Vessels]: Báisháo [Radix Paeoniae Alba], shānzhūyú [Fructus Corni], guījiǎ

Treating Brain Marrow Diseases with EV

The second paper I wanted to share is Fú & Sūn (2004), which came up in my brain course research. It concerns the thoughts and methods of treating the brain via EV by Professor Zhāng Xuéwén, whose work we have looked at recently:

EV have a particularly close relationship to the brain marrow, especially the dūmài, which transports essence from the kidneys to the sea of marrow and the spinal marrow

The article quotes Lǐ Tìng [李梃] in Entering the Gate of Medicine [Yīxué Rùmén 醫學入門, 1575]:

The EV have the functions of communicating [溝通], connecting [連絡], commanding [統率], guiding [主導], permeating [滲灌], and regulating [調節] the 12 principal channels. When the qì of channels and organs is exuberant, the EV store the surplus; when it is required, the EV permeate and provide. Thus the EV have the function of regulating and storing the qì of the regular channels. If the EV become depleted, the brain marrow will lack warmth and nourishment, leading to disease.

The Spiritual Pivot, [Língshú 靈樞] chapter 10 says: “The vessel of the liver, foot juéyīn... meets with the dūmài at the vertex [肝足厥陰之脈...與督脈會於巔].”

The article quotes Treatise on the Origins and Indicators of Disease [Zhū Bìngyuán Hòu Lùn 諸病源候論, 610] by Cháo Yuánfāng [巢元方]: “The kidney governs bone and engenders marrow, and the brain is the marrow sea; if the kidney qì is insufficient, then the marrow and brain will be insufficient [肾主骨生髓，而腦为髓海，肾氣不足，則髓腦不足].”

Thus the EV and the brain marrow share a close relationship with the liver and kidneys. Professor Zhāng takes this into account, regulating EV by harmonizing the liver and kidneys.

Some of the medicinals that Professor Zhāng uses for the EV are given in the article as follows:

• Dūmài: Fùzǐ, cāng’ěrzǐ [Fructus Xanthii], xìxīn [Herba Asari], lùjiǎo shuāng, lùjiǎo jiāo, gǎoběn [Rhizoma Ligustici], gǒuqǐzǐ [Fructus Lycii], ròuguì [Cortex Cinnamomi], lùxiáncǎo [Herba Pyrolae], huángqí [Radix Astragali]

• Rènmài and chōngmài: Guībǎn [Plastrum Testudinis], wángbùliúxíng [Semen Vaccariae], bājǐtiān [Radix Morindae], xiāngfù [Rhizoma Cyperi] , chuānxiōng [Radix Chuanxiong], biējiǎ, mùxiāng [Radix Aucklandiae Seu Vladimiriae], dāngguī, bīngláng [Semen Arecae], cāngzhú [Rhizoma Atractylodis], wúzhūyú [Fructus Evodiae], gǒuqǐzǐ, dānshēn [Radix Salviae Militiorrhizae], lùxiáncǎo

• Dàimài: Dāngguī, báisháo [Radix Paeoniae Alba], chuānduàn [Radix Dipsaci], lónggǔ [Os Draconis], àiyè [Folium Artemisiae Argyi], shēngmá [Rhizoma Cimicifugae], wǔwèizǐ [Fructus Schisandrae]

• Yīnqiāomài, yángqiāomài: Ròuguì, fángjǐ [Radix Stephaniae], chuǎnshǎnjiǎ [Squama Manitis]*

• Yángwéimài: Guìzhī [Ramulus Cinnamomi], báisháo, huángqí

• Yīnwéimài: Dāngguī, chuānxiōng

* Note: Chuǎnshǎnjiǎ, pangolin scales, comes from an endangered species and is protected under the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES).

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EV Treatment of Brain Diseases

The article went on to give several examples of Professor Zhāng’s EV treatments for various brain and neurological conditions.

Stroke

Yīnwéimài, yīnqiāomài, and rènmài all reach the throat, so Professor Zhāng posits that post-stroke dysphagia is related to these three vessels. He uses Dìhuáng Yǐnzǐ [Rehmannia Drink] to regulate the EV, and combines it with modified Huìyàn Zhúyū Tāng [Epiglottis Stasis-Expelling Decoction] to address the post-stroke dysphagia.

• Dìhuáng Yǐnzǐ consists of shúdìhuáng [Radix Rehmanniae Praeparata], shānzhūyú [Fructus Corni], shíhú [Herba Dendrobii], ròucōngróng [Herba Cistanches], fùzǐ, wǔwèizǐ, guànguì [Cortex Cinnamomi Tubiformis], báifúlíng [Poria Alba], màiméndōng [Radix Ophiopogonis], chāngpú [Rhizoma Acori Graminei], and yuǎnzhí [Radix Polygalae]. In addition to the above-noted medicinals that enter the EV, chāngpú and yuǎnzhí are both mentioned in Materia Medica of Combinations as entering the qiāomài.

• Huìyàn Zhúyū Tāng consists of táorén [Semen Persicae], hónghuā [Flos Carthami], gāncǎo [Radix Glycyrrhizae], jiégěng [Radix Platycodi], shēngdì [Radix Rehmanniae], dāngguī, xuánshēn [Radix Scrophulariae], cháihú [Radix Bupleuri], zhǐqiào [Fructus Citri Aurantii], and chìsháo [Radix Paeoniae Rubra].

To treat cerebral edema following stroke, Professor Zhāng also uses his own Brain-Orifice-Freeing Formula [腦竅通方 Nǎoqiào Tōngfāng]: shèxiāng [Moschus], dānshēn, táorén, chuānxiōng, báimáogēn [Rhizoma Imperatae], chìsháo, chāngpú, and sānqī [Radix Notoginseng].

Tremors

Tremors are related to the liver; Simple Questions [Sùwèn素問] chapter 74 says “All wind, shaking, and dizziness pertains to the liver [諸風掉眩, 皆屬於肝]”. As noted above, the liver channel intersects the dūmài at the vertex, and the qiāomài enter the brain as well. Professor Zhāng uses modified Dà Dìngfēng Zhū [Major Wind-Stabilizing Pearl] for liver-kidney insufficiency; for kidney yáng vacuity, he uses Jīnguì Shènqì Wán [Golden Cabinet Kidney Qì Pill] with added tiānmá [Rhizoma Gastrodiae], gōuténg [Ramulus Uncariae Cum Uncis], wúgōng [Scolopendra], etc.

Dà Dìngfēng Zhū consists of báisháo, dìhuáng, màiméndōng, márén [Semen Cannabis], wǔwèizǐ, guībǎn, mǔlì [Concha Ostreae], gǎncǎo, biējiǎ, ējiāo, and jīzǐhuáng [Vitellus Galli].

Jīnguì Shènqì Wán consists of dìhuáng, shānyào [Rhizoma Dioscoreae], shānzhūyú , fúlíng, mǔdānpí [Cortex Moutan], zéxiè [Rhizoma Alismatis], guìzhī, and fūzǐ.

Wilting (Atrophy)

Simple Questions [Sùwèn 素問] chapter 44 says:

A common adage in TCM is that wilting (i.e. atrophy) predominantly involves the yángmíng channels. However, we can see from this passage that it involves the chōngmài, dàimài, and dūmài as well. Differentiation and Classification of Patterns and Treatments [Lèi Zhèng Zhì Cái, 類證治裁, 1839] states one “must rectify the dūmài while nourishing the ancestral sinew [須理督脈兼養宗筋]” and that one “should regulate and supplement yíng-blood in order to fill the extraordinary vessels [當調補營血, 以實奇經]”.

Professor Zhāng mainly uses Hǔ Qián Wán [Hidden Tiger Pill], adding shānyào, shānzhā [Fructus Crataegi], etc. If the patient tends toward yáng vacuity use Lùjiǎojiāo Wán [Deer Antler Gelatin Pill], adding huángqí, ròuguì, yínyánghuò [Herba Epimedii], zǐhéchē [Placenta Hominis], bājǐtiān, etc to warm and nourish the yángqì.

Hǔ Qián Wán consists of huángbǎi [Cortex Phellodendri], guībǎn, chénpí [Pericarpium Citri Reticulatae], zhīmǔ [Rhizoma Anemarrhenae], shúdìhuáng, báisháo, suǒyáng [Herba Cynomorii], hǔgǔ [Os Tigris]**, and gānjiāng [Rhizoma Zingiberis].

Lùjiǎojiāo Wán consists of lùjiǎojiāo, lùjiǎoshuāng, shúdìhuáng, chuān niúxī [Radix Cyathulae], bái fúlíng, tùsīzǐ [Semen Cuscutae], rénshēn [Radix Ginseng], dāngguī, báizhú [Rhizoma Atractylodis Macrocephalae], hǔgǔ, and guībǎn.

**Note: Hǔgǔ (tiger bone) is also a prohibited substance under CITES.

Conclusion

EV are part of the classical channel system, and primarily addressed through acumoxa and other channel-based therapies. Their treatment by way of the materia medica is also an established modality, and studying the work of Yè Tiānshì and Zhāng Xuéwén can give valuable insight into treating complex diseases. The emphasis on “blood and flesh” substances may be a potential stumbling block in the West, where the use of certain animal products may be prohibited by law or patient dietary restrictions. Substitutions for banned or unwanted medicinals may be difficult as they may not reach the desired channels. For example, wángbùliúxíng is often substituted in everyday practice for the prohibited chuǎnshǎnjiǎ; however the former is said to enter the rènmài and chōngmài, where the latter enters the qiāomài. Similarly, wǔjiāpí [Cortex Acanthopanacis] can be a ready substitute for hǔgǔ, tiger bone, but wǔjiāpí is to my knowledge not said to enter any of the EV. The lists given above, though, do contain numerous plant-sourced options which may be explored.

That’s all for now, thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Fu, W., & Sun, J. (2004). Treating cerebral diseases based on the eight extra meridians: Clinical insights from Professor Zhang Xuewen. Modern Chinese Medicine, 2.

Hu, M., Tang, Y., Huang, Y., Zhu, X., Kong, B., & Liu, X. (2019). Analysis of Ye Tianshi’s diagnosis of extraordinary vessels and his prescriptions. Journal of Traditional Chinese Medicine, 60(13).

Lìn, P. (1839). Lèi Zhèng Zhì Cái. Retrieved January 14, 2024, from https://jicheng.tw/tcm/book/%E9%A1%9E%E8%AD%89%E6%B2%BB%E8%A3%81/index.html

Yan, J., Shi, W., Hong, W. (1761). Dé pèi běncǎo. Retrieved September 24, 2025, from https://jicheng.tw/tcm/book/%E5%BE%97%E9%85%8D%E6%9C%AC%E8%8D%89/index.html

Ye, L. (1895). Nanjing Zhengyi. Retrieved October 30, 2025, from https://jicheng-tw.translate.goog/tcm/book/%E9%9B%A3%E7%B6%93%E6%AD%A3%E7%BE%A9/index.html

Before we get going, a brief announcement: I’m giving a free online lecture this weekend for a course I’ve put together with TCM Academy. The course is called Navigating the Sea of Marrow and this weekend’s live lecture (entitled The Brain in Chinese Medicine: Historical Theory and Clinical Pathways) is the first hour. If you know of anyone who might be interested, here’s the link to register.

Mulch in, mulch out

The course came about as an idea for what to do with a bunch of research I had done for Clinical mulch. I’ve written a number of posts on the subject of the brain, and there’s always stuff that doesn’t get used in the final drafts. I took some of that research, and added more to it to construct the course. Inevitably, a bunch of the research for the course gets cut – you can only cram so much into a lecture – and finds its way back here to the mulch pile. Hence, the topic of this edition: Dūmài disease.

What is Dūmài Disease?

According to Sun & Zhang (2017), Dūmài disease [督脈病 dūmài bìng] refers to pathology resulting from abnormalities of the dūmài, or governing vessel. First mentioned in the Yellow Emperor’s Inner Classic [Huángdì Nèijīng] as well as the Classic of Difficulties [Nánjīng], the concept was later expanded upon by Wáng Shūhé in the Pulse Classic [Màijīng 脈經] and Wāng Kěntáng in Criterion for Patterns and Treatments [Zhèngzhì Zhǔnshéng 證治准绳].

The pathology as given in Nèijīng is closely related to the trajectory of the vessel:

素問·骨空論: “督脈為病，脊強反折。督脈者，起於少腹以下骨中央，女子入系廷孔，其孔溺孔之端也，其絡循陰器……上额交巅上，入絡腦，還出別下項，循肩髆内，俠脊抵腰中……上貫心，入喉，上頤環唇，上系两目之下中央。此生病，從少腹上衝心而痛……女子不孕，癃痔遺溺嗌干。”

Simple Questions: Treatise on Bone Hollows [Sùwèn: Gǔkōng Lùn, SW60]: “When the dūmài falls ill, there is arched-back rigidity. The dūmài begins at the lower abdomen under the center [pubic] bone. In women it enters the connector to the courtyard opening; its opening is at the end of the urinary opening, its network proceeds to the yīn organ... it ascends to the forehead to intersect on top of the vertex where it enters to network at the brain. A branch also emerges below at the nape and follows inside of the scapula lining the spine to arrive at the center of the small of the back... arises to pass through the heart, enter the throat, ascend to the cheek and encircle the lips, rises to the connectors below and between the two eyes. If it engenders disease, there will be pain surging up to the heart from the lower abdomen... in women [it leads to] infertility, dribbling urine, hemorrhoids, incontinence, and a dry throat.”

We can list the dūmài disease manifestations as such:

• 脊強反折 arched-back rigidity

• 衝疝 surging mounting (pain surging up to the heart)

• 不孕 infertility

• 癃 dribbling urinary block

• 痔 hemorrhoids

• 遺溺 enuresis

• 嗌干 dry throat

• 脊強而厥 spinal rigidity with reversal [from Nánjīng]

So basically we’re seeing diseases of the spine, throat, and pelvic floor, as well as of the organs along the channel pathway.

Wáng Shūhé added epilepsy (a clear indication of brain involvement) to the list, and various Míng and Qīng authors added diarrhea, headache, sores, nosebleed and nasal discharge, miscarriage, and tortoise back [guībèi 龟背, the spine is arched like that of a tortoise].

Modern physicians have applied the concept of dūmài disease to encompass

• Spinal disorders

• Brain disorders

• Organ disorders, typically more lower-burner types of problems: urogenital and anorectal problems along with asthma and reflux syndromes.

• Disorders of the head and sensory orifices

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Dūmài Disease Patterns

A very interesting paper by Liu et al. (2001) applied modern pattern differentiation to dūmài disease. Here is the summary:

1) Wind evil invading the dūmài pattern 風邪犯督證

Etiology: Wind assails the nape, neck and upper back along the dūmài.

Manifestations: Headache with no fixed location, stiff nape and upper back, aversion to cold and heat effusion, tearing on exposure to wind, heavy limbs.

Wind cold: Severe aversion to cold with mild heat effusion, coldness and pain in head, neck and back, floating tight pulse.

Wind-damp: Dizziness, heaviness and pain in the head, stiffness and heaviness of the back along the spine, and swelling of the face and limbs. White greasy tongue coat, floating slow pulse.

Wind-heat: High fever, mild aversion to cold, stiff neck and back with heat, sweating, dry mouth and throat, dark urine, thin yellow coat, floating rapid pulse.

Heat-toxin: Seizures, arched-back rigidity. Gānlù Xiāodú Dān [Sweet Dew Toxin-Dispersing Elixir] with modifications.

Principle: Disperse wind, expel evils, free the dūmài

Formula: Wind cold: Jīngfáng Bàidú Sǎn [Schizonepeta and Saposhnikovia Toxin-Vanquishing Powder] with modifications.

Wind-damp: Qiānghuó Shèngshī Tāng [Notopterygium Dampness-Overcoming Decoction] with modifications.

Wind-heat: Cháigé Jiějī Tāng [Bupleurum and Pueraria Flesh-Resolving Decoction] with modifications.

Acumoxa: Drain Dàzhuī GV-14, Fēngfǔ GV-16, Táodào GV-13

2) Fire and heat scorching the dūmài pattern 火熱灼督證

Etiology: Heat toxin directly invades dūmài or develops from internal fire brewing in zangfu which spreads to dūmài.

Manifestations: High fever, headache, heat and pain in nape and spine, rigidity, dryness, constipation, red eyes, thirst for cold drinks, dark scanty urine. Red tongue with dry yellow or dark red tongue with scant coating.

Principle: Clear heat, drain fire

Formula: Wǔwèi Xiāodú Yǐn [Five-Ingredient Toxin-Dispersing Beverage] or Huánglián Jiědú Tāng [Coptis Toxin-Resolving Decoction] with modifications.

Acumoxa: Drain Dàzhuī GV-14, Táodào GV-13, Rénzhōng GV-26

3) Cold congealed in the dūmài pattern 寒凝督脈證

Etiology: Direct invasion of cold evil into the dūmài, with damage to yáng qì

Manifestations: Cold pain in the nape, the back along the spine, and the waist; the pain may radiate to shoulders and buttocks; there is inability to turn or bend the spine, aversion to cold, cold limbs, white tongue coat, and deep slow pulse.

Principle: Scatter cold, free the dūmài

Formula: Lónghǔ Sǎn [Dragon-Tiger Powder, consisting of cāngzhú (Rz Atractylodis), quánxiē (Scorpio), cǎowū (Rx Aconiti), fùzǐ (Rx Aconiti Lateralis Praeparata), tiānmá (Rz Gastrodiae)] with modifications.

Acumoxa: Yāoyángguān GV-3, Mìngmén GV-4, Rénzhōng GV-26, Bǎihuì GV-20; use warm needle or moxa

4) Damp stagnation in the dūmài pattern 濕滯督脈證

Etiology: Exposure to damp environment seeps into dūmài and disrupts qì flow

Manifestations: Heaviness and pain in the spine, heavy head, somnolence, chest oppression.

Damp-cold: Cold pain and heaviness in head, neck, spine, waist; cold hands and feet, aversion to cold, greasy tongue coat, slow or moderate or deep tight pulse.

Damp-heat: Heaviness, stiffness and heat in head, neck, spine, waist; body heat failing to surface, dark urine, yellow greasy tongue coat, slippery rapid pulse.

Principle: Resolve dampness, free the dūmài

Formula: Damp-cold: Shènshī Tāng [Dampness-Percolating Decoction, consisting of cāngzhú, báizhú (Rz Atractylodis Macrocephalae), gāncǎo (Rx Glycyrrhizae), fúlíng (Scl Poriae), gānjiāng (Rz Zingiberis), júhóng (Pc Citri Reticulatae Rubrum), dīngxiāng (Fl Caryophylli)]

Damp-heat: Sìmiào Wán [Mysterious Four Pill] with modifications.

Acumoxa: Drain Dàzhuī GV-14, Jǐzhōng GV-6, Mìngmén GV-4

5) Dūmài qì stagnation pattern 督脈氣滯證

Etiology: Affect damage, depression, worry, or twisting and spraining [the spine].

Manifestations: Distending pain in the head, neck, waist and spine, relieved by passing gas. Severe cases have abdominal distension with inability to bend the spine, chest oppression and heart pain. There may be abdominal cramping, constipation, testicular pain or swelling, irregular menstruation, dysmenorrhea.

Principle: Regulate qì, disperse stagnation

Formula: Tiāntāi Wūyào Sǎn [Tiantai Lindera Powder] with modifications.

Acumoxa: Táodào GV-13, Yāoyángguān GV-3, Jǐzhōng GV-6, Zhìyáng GV-9, Rénzhōng GV-26; use even method

6) Blood aggregation obstructing the dūmài pattern 癖血阻督證

Etiology: Frequently caused by knocks and falls, i.e. traumatic injury

Manifestations: Stabbing pain at site of injury aggravated by pressure, inhibited rotation of the spine, inability to flex or extend the spine, numbness in the extremities below the spinal injury, possible swelling. There may be distended abdomen, scanty urine with strangury, and constipation. In severe cases there may be chest oppression, immobility of the limbs below the injury, and impotence. Tongue is dark purplish with stasis macules, deep slow or weak pulse.

Principle: Quicken blood, dispel stasis, unblock the dūmài.

Formula: Shēntòng Zhúyū Tāng [Generalized Pain Stasis-Expelling Decoction] with modifications.

Acumoxa: Āshì points, Yāoyángguān GV-3, Táodào GV-13, Rénzhōng GV-26, estim

7) Influx of phlegm into the dūmài pattern 痰注督脈證

Etiology: Interior organ disharmony leading to formation of phlegm. Phlegm follows qì to infiltrate and obstruct the dūmài.

Manifestations: Heaviness, stiffness, numbness and pain in the nape, back, and spine. There may be heavy head, dizziness, swelling and numbness of the legs, chest fullness and abdominal distension. Possible seizure activity. If cold phlegm, there will be coldness and pain in the neck, back and spine radiating to the shoulders and buttocks, with a swollen tongue and white greasy coating, and slow pulse. If phlegm-heat, there will be stiffness and heat in the neck, back and spine, yellow greasy tongue coat, slippery rapid pulse.

Principle: Transform phlegm, open binds, diffuse and free the dūmài.

Formula: Zhǐmí Fúlíng Wán [Pathfinder Poria Pill, consisting of bànxià (Rz Pinelliae), fúlíng, zhǐqiào (Fr Aurantii), fēnghuà pòxiāo (Natrii Sulfatis Non-Purii Efflorescentia)] with modifications. For phlegm-heat, add dǎnnánxīng [Rhizoma Arisaematis cum Felle Bovis] and huánglián [Rz Coptidis].

Acumoxa: Rénzhōng GV-26, Chángqiáng GV-1, Fēngfǔ GV-16, Mìngmén GV-4, Yāoyángguān GV-3: use even method

8) Dūmài yáng vacuity pattern 督脈陽虛證

Etiology: Often from inherited constitutional weakness or sexual taxation which leads to insufficiency of life gate fire which cannot warm and nourish the Dūmài. Dūmài governs yáng qì, including functions of maintaining body warmth and circulating defensive qì to resist exterior pathogenic invasion. If Dūmài’s yáng qì is depleted, warmth cannot reach throughout the body.

Manifestations: Aversion to cold, cold limbs, cold chest and abdomen, lower abdominal cramping, loose stools, somnolence, dizziness, cold uterus, penile wilting, seminal emission, pale tongue with white coating, and deep weak pulse.

Principle: Warm and supplement dūmài’s yáng qì.

Formula: Bānlóng Wán [Striped Dragon Pill, consisting of lùjiǎo jiāo (Cornus Cervi Gelatinum), lùjiǎo shuāng (Cornus Cervi degelatinum), tùsīzǐ (Sm Cuscutae), bǎizǐrén (Sm Platycadi), shúdìhuáng (Rx Rehmanniae Praeparatae), fúlíng, bǔgǔzhī (Fr Psoraleae)] with modifications.

Acumoxa: Mìngmén GV-4, Yāoyángguān GV-3, Bǎihuì GV-20 warm needle with supplementing technique, or moxibustion

9) Dūmài essence-blood insufficiency pattern 督脈精血不足證

Etiology: Primarily due to constitutional weakness, taxation fatigue or sexual taxation which leads to vacuity of liver-kidney essence-blood when then fails to nourish the dūmài. The dūmài is then unable to nourish the organs and sensory orifices along its pathway.

Manifestations: Dizzy head and vision; deteriorating or blurry vision; limp aching back, neck, and spine with lack of strength with persistent dull pain in the back and spine radiating to the shoulders and arms, weakness in the buttocks and legs, lassitude of essence-spirit, wilting, weakness and emaciation of the body and limbs, pallid complexion, lusterless lips, and palpitations. Men may have scant semen and penile shrinking and wilting. Women may have scant menses, late menses, menstrual block, and infertility. Children may manifest the five slownesses or the five limpnesses; adults may have cognitive impairment or epilepsy, with a pale tongue and a fine weak pulse.

Principle: Replenish essence, supplement marrow, boost the dūmài .

Formula: Modify Zuǒguī Wán [Left-Restoring Pill] as needed.

Acumoxa: Bǎihuì GV-20, Mìngmén GV-4, Yāoyángguān GV-3, Chángqiáng GV-1; supplement or apply moxibustion.

Another view of Dūmài disease

Féng Zhāngróng (2025) cites the paper by Liu et al. (2001) summarized above, but differentiates into just two patterns: Repletion due to exterior invasion or trauma, and vacuity due to aging, taxation, inherited constitution, and zàngfǔ disorders. In reality, most presentations are mixed. In terms of therapeutics, the author cites the principle (from Yè Tiānshì) to treat extraordinary vessels by freeing:

Freeing, according to the author, has four steps: rectifying [理 lǐ], righting [正 zhèng], warming [溫 wēn], and nourishing [養 yǎng]

1. Rectifying: For this, Féng recommends tuíná techniques: pressing [按 àn], rubbing [揉 róu], plucking [彈撥 tánbō], and pinching [捏脊 niējǐ] over the spine and to the scapulae and sacroiliac joints to rectify the sinews supporting the spine and dūmài

2. Righting: Spinal adjustment and qìgōng exercises for the dūmài

3. Warming: Including warm needle, dūmài moxa, and acumoxa techniques to support yáng

4. Nourishing: Qìgōng exercises for the dūmài, and moxa to the lower dāntián

Conclusion

Disease differentiation based on the channel system is one of the oldest therapeutic lenses we have in Chinese medicine, obviously relevant to acumoxa but also applicable to medicinal agents as well. Yet channel patterns are largely ignored in teaching and practicing Chinese medicine in the West. We rely on eight-principle, organ, substance, and pathogen patterns, even when we work with channels on a regular basis. Further investigation and conceptualization of channel-based pathology is an important aspect of advancing the practice of East Asian medicine.

If you’re interested in seeing more about the dūmài I’ve got some additional stuff in the works, as well as the upcoming lecture and course which features material specifically focusing on the dūmài’s relationship to the brain.

Okay, that’s all for now. Thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Feng, Z. (2025). Clinical insights on treating governing vessel disorders with the method of supporting the right and freeing the governing vessel. Zhejiang Journal of Traditional Chinese Medicine, 60(12). DOI:10.13633/j.cnki.zjtcm.2025.12.008

Liu, X., Shi, H., & Shi, K. (2001). Identification and analysis of governing vessel disease patterns and treatment: Identification and analysis of extraordinary vessels disease patterns and treatment (Part one). Hunan Journal of Traditional Chinese Medicine and Pharmacy, 7 (1). DOI: 10.13862/j.cnki.cn43-1446/r.2001.01.004

Sun, Z., & Zhang, J. (2017). Ancient definitions and modern categories of du meridian pathologies. Chinese Acupuncture & Moxibustion, 37(10). DOI:10.13703/j.0255-2930.2017.10.013

In our last edition we discussed two papers that focused on the work of Zhāng Xuéwén [张学文]; the first was on the treatment of difficult diseases and the second on methods and Chinese herb combinations for blood stasis. One of the ideas Professor Zhāng proposed was that difficult diseases frequently involve both blood stasis and phlegm. Since some mulch readers indicated that they would like to see additional discussion of Professor Zhāng’s work, I thought I would present my notes from a related article, by Yan et al. (2023).

11 Methods for Treating Phlegm

In Differentiation and Classification of Patterns and Treatments (Lèi Zhèng Zhì Cái, 類證治裁, 1839), Lín Pèiqín says

“痰則隨氣升降，遍身皆到。...在肺則咳，在胃則嘔，在心則悸，在頭則眩，在背則冷，在胸則痞，在脅則脹，在腸則瀉，在經絡則腫，在四肢則痹，變幻百端，昔人所謂怪症多屬痰...。”

Phlegm follows the ascending and descending of qì, it reaches everywhere throughout the body... if it is in the lung then there is cough; if in the stomach, there is vomiting; if in the heart, there are palpitations; if in the head, there is dizziness; if in the back there is cold; if in the chest, there is glomus; if in the ribside, there is distension; if in the intestines, there is diarrhea; if in the channels, there is swelling; if in the four limbs there is impediment [bì]; it changes erratically in a hundred different ways, so that the people of the past would say that the strange diseases often pertain to phlegm...

Professor Zhāng has proposed eleven methods for treating phlegm, with corresponding medicinal pairs. Medicinal pairs, used appropriately, can give twice the result with half the effort.

1. Dānshēn + Bànxià: Quicken blood and transform phlegm

Dānshēn [Radix Salviae Miltiorrhizae] is slightly cold and acrid, excelling at quickening blood and dispelling stasis, and freeing the flow of blood in the vessels. The Great Compendium of Materia Medica [Běncǎo Gāngmù 本草綱目, 1596] by Lǐ Shízhēn says: “[Dānshēn] can break abiding blood and supplement new blood [能破宿血, 補新血]”.

Bànxià [Rhizoma Pinelliae Praeparata] is warm and acrid and is particularly good at treating cold phlegm and damp phlegm in the zàngfǔ. Phlegm and stasis are distinct entities: one comes from fluids, the other from blood. However, fluids and blood have the same origin [津血同源] and phlegm and stasis often intertwine. The combination of these two medicinals quickens blood, transforms stasis, frees the channels, cools blood, dispels stasis and engenders the new, while it also dries dampness, transforms phlegm, warms and transforms cold phlegm, and is particularly good at treating phlegm in the zàngfǔ. The combined coolness and warmth treats both phlegm and stasis, and is effective at treating wind-phlegm, feeble-mindedness (i.e., dementia), dizziness, and stubborn headache.

2. Huángqín + Bànxià: Clear the lung and transform phlegm

Huángqín [Radix Scutellariae Baicalensis] is bitter and cold, and enters the lung channel; its bitterness dries phlegm and clears heat in the lung. Yunnan Materia Medica [Diānnán Běncǎo 滇南本草, 1436] says it “moves upward to drain lung fire, and moves downward to drain bladder fire [上行瀉肺火, 下行瀉膀胱火]”.

Bànxià is acrid and warm with a drying nature, it enters the spleen and stomach channels, transforms rheum and dispels phlegm, harmonizes the stomach and checks vomiting. The combination treats both the lung and spleen, stops the engendering of phlegm at its source, and clears accumulated phlegm from its container, thus clearing the lung, transforming phlegm and stopping vomiting. Professor Zhāng uses this combination to treat conditions such as phlegm heat obstructing the lung, cough with copious yellow phlegm from lung qì counterflowing upward as well as vomiting from phlegm heat glomus binding with non-descent of counterflow qì.

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3. Gānjiāng + Bànxià: Warm the lung and transform phlegm

Gānjiāng [Rz Zingiberis] is acrid and hot, enters the lung and spleen channels and excels at warming the lung, scattering cold and transforming rheum.

Bànxià is acrid and warm, making it an essential herb to warm and transform cold phlegm. Bag of Pearls says it “eliminates phlegm-drool and cold phlegm in the chest [除痰涎, 胸中寒痰].” This combination was frequently used by Zhāng Zhòngjǐng to resolve the toxicity of bànxià, as well as to take advantage of the herbs’ mutual ability to effuse and scatter, warm the lung, and transform rheum. Cold is a yīn pathogen that easily damages yáng qì; depletion of yáng qì leaves the body unable to warm and transport the fluids, resulting in the formation of phlegm. The combination of these two medicinals warms both the lung and spleen, and transforms phlegm-rheum, making it ideal to treat patterns of cold phlegm obstructing the lung with coughing and panting, and cough with clear watery phlegm.

4. Guālóu + Chuānbèimǔ: Moisten dryness and transform phlegm

Guālóu [Fructus Trichosanthis] is sweet, cold, and moistening; it clears heat, abducts phlegm, and moistens dryness, and is a top-rank medicinal substance for treating dry phlegm.

Chuānbèimǔ [Bulbus Fritillariae Cirrhosae] is bitter, sweet and cold, enters the lung channel; it is used to moisten the lung and transform phlegm, stop cough, and open binding depression of phlegm and qì.

The lung is the delicate viscus [嬌臟] that loves moisture and abhors dryness. Dry evils damage the lung, so that it loses its function of diffusion and downbearing, leading to abnormal metabolism of fluids and subsequent formation of phlegm. Bèimǔ focuses more on moistening the lung, opening depression and draining heat. Guālóu leans toward clearing heat, transforming phlegm, loosening the chest and dispersing binds. The combination, one moistening and one clearing, has an opening and scattering nature, thus doubling up its effects to clear heat, transform phlegm, and disperse binds. Professor Zhāng uses this pair to treat patterns of dry phlegm damaging the lung, scorched liquids transforming into phlegm, and coughing with inhibited expectoration and dry throat.

5. Júhóng + Bànxià: Dry dampness and transform phlegm

Júhóng [Pericarpium Citri Reticulatae] is acrid and bitter with a warm nature; it excels at regulating qì and loosening the center, drying dampness and transforming phlegm. Bànxià is acrid, warm, and drying; it dries dampness, transforms phlegm, descends counterflow and checks vomiting. The combination synergistically eliminates phlegm and regulates qì; when the qì is normalized, phlegm will naturally disperse. Aberrant flow of qì – ascending, descending, exiting, and entering – is a primary driver of phlegm accumulation, along with spleen vacuity that leads to the formation of turbid dampness. Phlegm and dampness often appear together as pathogenic co-factors, and these two herbs are often paired in phlegm-resolving formulas. Professor Zhāng frequently uses this combination in formulas to treat patterns of cough with copious phlegm, glomus and oppression of the chest and diaphragm, and fatigue of the limbs and body due to phlegm-dampness.

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6. Tiānmá + Bànxià: Dispel wind and transform phlegm

Tiānmá [Rhizoma Gastrodiae] has a sweet taste and a moistening quality; its nature is balanced and harmonious. It enters the liver channel and is effective at extinguishing wind and checking tetany, so it excels at dispelling liver wind, and can treat all kinds of diseases caused by internal stirring of liver wind. It can also dispel exterior wind and free the channels and networks, so it treats wind strike with paralysis of the limbs.

Bànxià is acrid and warm, dries dampness and transforms phlegm, and is an essential medicinal for treating dampness and phlegm. The liver has the characteristic of being “yīn in substance and yáng in function [體陰而用陽]” its nature is unyielding [剛], it governs movement and ascending [主動主升]; therefore if the liver’s function is imbalanced, the primary image is one of exuberant yáng heat. Uncontrolled ascent of exuberant liver yáng can lead to scorching of fluids with transforms into phlegm; wind and yáng combined with phlegm then rise to harass the clear orifices, manifesting as diseases such as dizziness and headache. These two herbs are often combined to dispel wind and transform phlegm. Professor Zhāng uses this pair to treat disease patterns of dizziness, headache and clouded heavy head.

7. Chuānbèimǔ + Hòupò: Move qì and transform phlegm

Chuānbèimǔ is bitter, sweet and slightly cold, and enters the lung and heart channels; it clears heat and transforms phlegm, stops cough, disperses binds, and is strongly moistening to the lung. Hòupò [Cortex Magnoliae] is bitter, acrid, warm and drying; it can move qì and disperse fullness, warm the center and dry dampness. If dampness is eliminated then phlegm will be dispersed, and the lung qì can depurate and downbear, freeing respiration so that coughing will naturally stop. The combination of medicinals works together to transform phlegm, downbear qì, relieve cough, open depression, disperse food, and eliminate swelling. Professor Zhāng uses this pair to treat patterns of binding depression of phlegm and qì and phlegm depression inhibiting lung qì.

8. Hǎizǎo + Kūnbú: Disperse binds and transform phlegm

Hǎizǎo and kūnbú are similar in nature and flavor; their nature is cold and their flavor is salty. They enter the liver and kidney channels and have the ability to disperse phlegm and soften hardness, disinhibit water and disperse swelling. The combination is mutually reinforcing and is found in formulas such as Kūnbú Sǎn and Kūnbú Wán from Secrets of a Frontier Official [Wàitái Mìyào外臺秘要 752], to transform phlegm, disperse binds, and treat such conditions as scrofula, phlegm nodes, goiter and tumors, abdominal swellings, and swollen painful testicles. Phlegm is categorized as a yīn evil, with a thick, sticky nature; it is stagnant, rough, and non-dispersive, often binding beneath the skin or within the abdominal cavity or the interior viscera, and can manifest as masses and nodules. Used mainly for goiter, phlegm swellings, and so forth.

9. Shíchāngpú + Dǎnnánxīng: Open orifices and flush phlegm

Shíchāngpú [Rhizoma Acori Tatarinowii] is acrid and warm; it transforms phlegm and opens the orifices.

Dǎnnánxīng [Rhizoma Arisaematis cum Felle Bovis] is bitter, acrid and warm; it dries dampness, transforms phlegm, disperses binds, dispels wind and checks tetany. It is processed to reduce its drying nature, and it canclear and transform phlegm-heat, extinguish wind and stabilize fright.

Professor Zhāng believes that brain illnesses have a long disease course, and phlegm-turbidity evils easily obstruct the brain orifices as part of the various disease transformations. The combination of the two herbs uses the acrid warmth of shíchāngpú, aromatic and mobilizing, to diffuse qì and sweep phlegm, open the orifices, awaken the spirit and sharpen the wits, transform dampness, awaken the spleen and open the stomach. Dǎnnánxīng is bitter and acrid with a cool nature, and it can clear heat, transform phlegm, extinguish wind and stabilize fright. Used together, the aromatic nature and combination of warm and cool are effective at flushing and sweeping phlegm, opening the orifices and awakening the spirit, extinguishing wind and stabilizing fright, and is mainly used with notable efficacy for phlegm turbidity obstructing the brain and viscera in wind strike, withdrawal patterns, epilepsy patterns, mania patterns, and so forth.

10. Tiānzhúhuáng + Bànxià: Clear the heart and flush phlegm

Tiānzhúhuáng [Concretio Bambusae] is sweet and cold, and excels at clearing heat , sweeping phlegm, clearing the heart, and stabilizing fright.

Bànxià is acrid, opening, bitter, downbearing, warming and drying; it has a propensity to dry dampness, fortify the spleen, harmonize the stomach, downbear counterflow. When the spleen is fortified and earth is dry, phlegm-drool cannot form. Turbid phlegm obstructs the clear orifices, and over time will transform into heat. The combination clears heat and transforms phlegm, clears the heart and stabilizes fright; Professor Zhang uses it for patterns of phlegm-drool congestion in diseases such as lack of speech after wind stroke, phlegm-heat fright convulsions, withdrawal and epilepsy.

11. Dìlóng + Jiāngcán: Free the networks and tranform phlegm

Dìlóng [Pheretima] is salty and cold, with a downward-moving disposition to downbear and discharge and a propensity to mobilize and penetrate. It enters the liver channel to clear heat, extinguish wind, and stabilize fright, and moreover it frees the networks, relieves pain, and calms panting.

Jiāngcán [Bombyx Batryticatus] is acrid and salty, its qì and flavor are both thin, it is more ascending than descending, possessing a floating, upbearing nature; it excels at extinguishing wind, transforming phlegm, checking tetany, dispelling wind, relieving pain, and it can dispel exterior wind as well as extinguishing interior wind. When wind-phlegm obstructs the networks, the illness is already quite deep, and at that point botanicals may prove ineffective, and one needs to employ flesh-and-blood-natured insect medicinals to go directly to the disease location, in order to track wind, dispel phlegm, free the networks, dredge evils, transform stasis and relieve pain. The combination of descending and ascending actions regulates the upward and downward movement of qi, and together the pair extinguish wind, check tetany, transform phlegm, disperse binds, free the networks and relieve pain. Professor Zhāng uses this pair to treat patterns of wind phlegm obstructing the networks in diseases like headache and trigeminal neuralgia.

Conclusion

The paper closes by saying that phlegm is a common feature of many diseases, but its manifestations may be complex and varied. Moreover, intangible phlegm may be difficult to identify. Phlegm is also a key component of many difficult diseases (as we discussed in the last post). In biomedical terms, phlegm is often present in many respiratory ailments, neurological and psychiatric disorders, benign and malignant tumors, etc. For strange and difficult diseases which are resistant to treatment, using phlegm-dispelling strategies often brings improvement.

Okay, that’s all for now; as always, thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Yan, Y., Tong, W., Bai, H., & Zhou, H. (2023). Master Zhang Xuewen’s couplet medicines in phlegm syndrome treatment. Acta Chinese Medicine, 38(297). DOI: 10.16368/j.issn.1674-8999.2023.02.056

During a recent literature search I undertook on treatment of brain disorders and cognitive impairment, there were a few names that kept coming up. One of those I frequently encountered was Professor Zhāng Xuéwén [张学文], born in 1935. Professor Zhāng is a renowned master of Chinese medicine with over 70 years in practice, from a lineage of physicians that goes back at least five generations. I reviewed a half-dozen or so articles on his thoughts and treatments, and I decided to share my notes on two of them here.

Treating Difficult Diseases

The first article (Bai et al., 2020) focuses on Professor Zhāng’s insights into treating “doubtful and difficult diseases [疑難病 yínán bìng]”.

The paper begins with a discussion of just what “doubtful and difficult” means with regard to diseases:

Professor Zhāng gives four major characteristics of doubtful and difficult diseases:

1. Intertwining disease causes [病因交錯]: Etiology is multi-factorial, for example there may be the presence of exterior contraction of the six evils alongside interior phlegm or blood stasis, and/or underlying vacuity of vital substances, binding depression, internal injury from the seven affects, dietary irregularities, mistaken treatment for pre-existing ailments, and so forth.

2. Highly varied conditions [病情多變]: The disease course itself may take many turns and transform or engender secondary pathogens. Heat or cold may transmute into their opposites, repletion gives rise to vacuity, heat may accumulate and engender fire toxin, depression may progress to blood stasis or phlegm-damp accumulation.

3. Opposing pathomechanisms [病機相反]: There may be contradictory pathologies in the same patient, with heat above and cold below or vice-versa, exterior vacuity with intrior repletion or vice-versa, simultaneous vacuity and repletion, or depletion of both yīn and yáng.

4. Congruence of numerous diseases [數病相合]: In biomedical terms, there may be multiple diseases at hand: diabetes, heart disease, kidney disease, liver disease, autoimmune diseases, and so on. Layer that onto the Chinese medicine pathomechanisms, and it makes for a confusing picture and prone to errors such as neglecting key aspects of the patient’s condition in favor of others, or trying to address all presenting issues with a chaotic and unfocused prescription.

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From his years of study, research, and clinical experience, Professor Zhāng recommends considering the following:

Adept use of stasis-transforming medicinals [善用化瘀藥]: It is axiomatic in Chinese medicine that enduring illness tends to cause stasis [久病多瘀]. Yè Tiānshì famously said:

Professor Zhāng has observed that blood stasis is a frequent element of difficult diseases and recommends blood-quickening stasis-dispelling medicinals in cases with signs and symptoms of blood stasis. Even in chronic cases without significant blood stasis manifestations but that do not respond to treatment, consideration should be given to moving blood, though in these circumstances it is best to start with smaller doses of milder blood-harmonizing agents such as dānshēn [Rx Salviae Miltiorrhizae], shānzhā [Fr Crataegi], dāngguī [Rx Angelicae Sinensis], chuānniúxī [Rx Cyathulae], sānqī [Rx Notoginseng], chìsháo [Rx Paeoniae Rubrae], yìmǔcǎo [Hb Leonuri], zélán [Hb Lycopi] and so forth before moving up to larger doses and more vigorous stasis-dispelling and blood-breaking substances like táorén [Sm Persicae], hónghuā [Fl Carthami], sān léng [Rz Sparganii], ézhú [Rz Curcumae], rǔxiāng [Olibanum], mòyào [Myrrha] and such like.

Preferential use of phlegm-dispelling medicinals [喜用祛痰藥]: Phlegm, as we know, has substantial and insubstantial forms; the former being characterized as relatively thick expectorated fluids and the latter as the internal consequence of the failure of fluids to properly transform and transport which leads to accumulation and obstruction. Phlegm by its very nature tends to confound the diagnostic process, since its manifestations can be so varied, mutable and elusive. Zhū Dānxī remarked that it “appears like a malevolent ghost [似邪鬼]”. Phlegm follows qì, and qì goes everywhere, which means phlegm can end up interfering in any physiologic process, from surface to depth, upper to lower, in the channels and networks, organs, and the hundred joints of the body. It is also axiomatic that “phlegm and stasis have the same origin [痰瘀同源]”, thus using phlegm-dispelling and stasis-transforming medicinals in combination is frequently indicated in treating chronic intractable diseases. Prof Zhāng frequently uses substances such as júhóng [Pc Citri Reticulatae Rubrum], bànxià [Rz Pinelliae], fúlíng [Sclerotium Poriae], zhúlì [Succus Bambusae], tiānzhúhuáng [Concretio Bambusae Silicea], zhúrú [Caulis Bambusae in Taeniam], and dǎnnánxīng [Asisaema cum Bile].

Artful use of insect medicinals [巧用蟲類藥]: Yè Tiānshì said: “If illness is chronic then evil wind will make things murky during that time and one cannot see results with botanicals, so one should use insects and ants to course the network vessels and expel evils. [病久則邪風混处期間，草木不能見其效，當以蟲蟻疏絡逐邪]”. Insect medicinals include quánxiē [Scorpio]、wúgōng [Scolopendra], jiāngcán [Bombyx Batryticatus], dílòng [Pheretima], shuǐzhì [Hirudo], méngchóng [Tabanus], chántuì [Periostracum Cicadae], báihuāshé [Agkistrodon], wūshāoshé [Zaocys], etc. They tend to be potent in action, drying, and have varying degrees of toxicity; therefore they should be used judiciously, paying strict attention to dosage. Since they tend to harm right qì, supplementing medicinals such as dǎngshēn [Rx Codonopsis], báizhú [Rz Atractylodes Macrocephalae], dāngguī, and shēngdìhuáng [Rx Rehmanniae] may be added to balance their harsh nature.

Clever use of qì-regulating medicinals [妙用理氣藥]: Disrupted flow of qì frequently results in depressed affect; this can be both an etiological factor as well as a consequence of chronic illness. Patients often become demoralized, anxious and irritable during the course of long-standing disease. Regulating qì can aid in alleviating both physical and emotional manifestations of chronic illness. Medicinals such as chāngpú [Rz Acori Tatarinowii], yùjīn [Rx Curcumae], guālóu [Fr Trichosanthis], qīngpí [Pc Citri Reticulatae Viride], chénpí [Pc Citri Reticulatae], and chuānxiōng can help rectify the qì and course depression.

In summary, treating doubtful and difficult diseases involves identifying etological factors, addressing contradictory manifestations, determining the complex pathomechanisms and how they relate to one another, choosing appropriate medicinals in appropriate dosages, and remaining steadfast and patient in treatment. Professor Zhāng advises against being too hasty in treatment, either by constantly switching the treatment strategy or by using large doses of herbs in chasing after rapid results. Pay attention to the pathomechanisms, regardless of whether new symptoms come up; as long as the disease mechanism remains unchanged, one should stick to the treatment plan and aim for consistency.

12 Methods for Blood Stasis

The second article (Yan et al., 2020) focused on Professor Zhāng’s medicinal combinations for blood stasis. The paper began with a general overview of blood stasis pathogenesis and manifestations with which I think readers here are familiar. So I will cut to the chase and list the combinations for Professor Zhāng’s “12 methods for treating blood stasis”.

1. Xiāngfù + chuānxiōng: Regulate qì and dispel stasis. Xiāngfù [Rz Cyperi] is acrid, scattering, bitter, downbearing and sweet; chuānxiōng is acrid, scattering, warm and freeing. The combination harmonizes qì and blood, resolves depression, and relieves pain. Primarily for pain due to qì and blood stagnation.

2. Guìzhī + chuānxiōng: Warm the channels and transform stasis. Guìzhī [Rm Cinnamomi] is acrid, warm, floating and scattering; it penetrates to reach the area between the muscle layer and the surface to scatter wind cold, expel exterior evils, effuse sweat and warm the channels to assist yáng. Chuānxiōng is ascending to rise to the vertex and descending to reach the Sea of Blood, and circulates to reach the surface and the limbs. The combination courses wind-cold, frees the channels and networks, opens impediment, moves qì and quickens blood. Use for disorders characterized by cold obstructing the channels.

3. Mǔdānpí + dānshēn: Clear heat and transform stasis. Dānpí is bitter, acrid, and cold; its clear and aromatic nature enters the blood aspect to clear heat and transform stagnation, as well as penetrating the yīn aspect to clear lurking fire. Dānshēn is bitter and slightly cold with a discharging nature; it can free the flow of stagnant blood, cool and disperse blood heat, clear the heart and calm the spirit, and dispel stasis to engender new blood. The combination cools blood, quickens blood, dispels stasis, engenders the new, and clears and outthrusts evil heat. Used for gynecological patterns or heat-predominant joint pain with blood heat and stasis.

4. Wēilíngxiān + chuānniúxī: Dispel wind and transform stasis. Wēilíngxiān [Rx Clematidis] is acrid and scattering with a propensity to mobilize, its nature is warming freeing and disinhibiting, it penetrates and moves through the 12 channels, can guide and diffuse; it can dispel wind-damp and free the channels and networks to stop pain. Chuānniúxī has a tendency to descend, to quicken blood, free the channels and disinhibit the joints. It combination they reinforce each other’s effects eliminating wind and dispelling damp, quickening blood, freeing the networks and stopping pain. Primarily for cold-dampness obstructing the channels, especially in the lower limbs.

5. Bànxià + dānshēn: Transform phlegm and quicken blood. Bànxià is acrid, warm and drying; it is a key herb for drying dampness, transforming phlegm, and warming cold phlegm. Dānshēn is slightly cold with a moderate nature, good at dispelling stasis to engender new blood without injuring the right qì. The combination eliminates dampness, transforms phlegm, quicken blood and transform stasis. When phlegm is transformed, stasis is dispersed, when stasis is removed, phlegm will scatter. Mainly for difficult diseases such as chest pain, stroke, masses and stubborn headache caused by phlegm and blood stasis mutually obstructing.

6. Fúlíng + chìsháo: Percolate dampness and quicken blood. Fúlíng is sweet and bland, with a balanced and harmonious nature. It can support the right, and disinhibit water without harming the right qì. Chìsháo is bitter and slightly cold, it can clear heat and cool blood, scatter stasis and stop pain. The combination regulates water and blood, quickens blood and strengthens the spleen, disinhibits water and disperses swelling. This pair is used to treat edema, lumbar pain, and other issues marked by water swelling and blood stasis.

7. Dàhuáng + táorén: Drain downward and transform stasis. Dàhuáng [Rx et Rz Rhei] is bitter and cold, with a strongly drying nature; it is good at purging heat toxin, breaking accumulation and stagnation, and treating constipation from repetion heat. It can enter the blood aspect to quicken blood and free the menses, break stagnant blood, and treat blood heat bound with stasis. Táorén is bitter, sweet, and balanced, with and emolliating and moistening nature; it is a blood aspect herb with a propensity to break blood and move stasis, and it can moisten dry intestines. The combination enters the blood aspect to break blood accumulations and purge blood stasis as well as moisten the intestines and move the stool. For blood stasis with heat, bowel obstruction, and acute abdominal conditions.

8. Biējiǎ + dānshēn: Nourish yīn and transform stasis. Biējiǎ [Carapax Trionycis] enriches yīn, nourishes blood, disperses binds and softens hardness. Dānshēn quickens blood and dispels stasis. The combination dispels stasis without injuring the right, nourishes yīn without leading to stagnation, and disperses masses. Mainly used to treat masses and enlarged liver or spleen.

9. Huángqí + chuānxiōng: Supplement qì and transform stasis. Huángqí [Rx Astragali] is sweet and slightly warm, it supplements qì and raises the yáng. Chuānxiōng is acrid and warm; it can quicken blood and move qì, dispel wind and stop pain. The combination boosts qì and quickens blood; when qì is invigorated, the blood will move, and when blood moves, the qì is invigorated.

10. Dānshēn + sānqī: Dispel stasis and stop bleeding. Dānshēn is bitter and slightly cold. It quickens blood and dispels stasis, cools blood and reduces swelling; it can transform stasis without injuring the qì and blood. Sānqī is sweet and slightly bitter, it quickens blood and transforms stasis, stops bleeding and relieves pain; it can stop bleeding without leaving behind stasis. The combination quickens blood and transforms stasis, stops bleeding and stops pain. Especially useful for chest and abdominal pain due to blood stasis.

11. Shèxiāng + dānshēn: Open orifices and quicken blood. Shèxiāng [Moschus] is acrid and warm, its qì is extremely aromatic and its nature is intensely mobile and penetrating. It strongly opens orifices, frees blocks, repels foulness and transforms turbidity to arouse the spirit and restore consciousness. Dānshēn is bitter and slightly cold, and excels at freeing the blood vessels, dispelling stasis and stopping pain. Shèxiāng can guide dānshēn’s blood-quickening action directly to the brain orifices. Especially for hydrocephalus or traumatic brain injury with blood stasis obstructing the brain orifices.

12. Fùzǐ + chuānxiōng: Warm yáng and transform stasis. Fùzǐ [Rx Aconiti Lateralis Praeparata] is acrid, sweet and hot, and is an upper-echelon medicinal for returning yáng and stemming counterflow. It strongly scatters cold and stops pain. Chuānxiōng is warm and acrid, and it quickens blood and moves qì, dispels wind and stops pain; it excels at treating pain due to blood stasis and qì stagnation. The combination is used in cases of yáng vacuity with interior cold and inhibited blood flow. Used for yáng vacuity with congealing cold causing impaired blood flow and stasis obstruction.

Conclusion

I found both of these articles very interesting (which is why I wanted to share them) and worthy of study and reflection. The herb combinations are quite practical, using medicinals that, for the most part, would be found in a well-stocked office or school pharmacy in the U.S. (though some might be problematic in the U.K., from what I understand). And with Chinese medicine in the West being an option that many patients will try only after every other measure has failed, Professor Zhāng’s thoughts on treating chronic intractable diseases are well worth keeping in mind. I was given similar advice by the Japanese senior teachers I studied acupuncture with: if you’re sure of the pattern, keep chipping away at it. Follow the pathomechanism and don’t go chasing every new symptom.

That’s all for now. If you’re interested in seeing some more about Professor Zhāng’s treatments and herb combinations, let me know. And as always, thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

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References

Bai, H., Yan, Y., & Zhang, X. (2021). A study on the characteristics of medicinal herb prescriptions used by master Zhang Xuewen in the treatment of difficult diseases. Chinese Journal of Traditional and Integrative Medicine, 36(1).

Yan, Y., Zhang, Q., Zhou, H., Bai, H., & Qi, J. (2020). TCM master Zhang Xue-wen’s commonly used couplet medicines in the treatment of blood stasis syndrome. Chinese Journal of Traditional and Integrative Medicine, 35(12).

Happy New Year

First off, I want to wish everyone a happy new year, and welcome all the new subscribers to the mulch. I’m happy that you’ve subscribed and I appreciate the likes, comments, restacks, emails, etc.

I took a break from the mulch for a few weeks while I put together a new CEU course for TCM Academy of Integrative Medicine. The course is about the brain in Chinese medicine, something I have written about off and on in the mulch. It’s very acupuncture-centric, and I did quite a bit of research in building the course, which means that there is a bunch of information that I didn’t manage to work in… so at least some of it will filter into the posts here. I have a lot planned for 2026, both in terms of courses and publishing, so I will be posting updates on that as time goes on. But for now…

Oh, the places you’ll go…

One of my favorite things about doing research is the places it takes me, either to concepts that are completely novel to me or to re-examine information I have already encountered. In researching treatment of brain fog and cognitive impairment, I came across both. Today I want to touch on the latter. Among the methods that came up in my search was something I learned (and taught) a long while ago but hadn’t really thought much about in the intervening years: the host-guest point combination method.

The Host-Guest Method

As I learned it, the host-guest method is the combination of the yuán-source point of a channel [the host] and the luò-network point of its interiorly-exteriorly paired channel [the guest]. As point combination formulas go, it is a relatively late addition, having first been laid out in the Great Compendium of Acupuncture and Moxibustion [Zhēnjiǔ dàchéng 針灸大成] by Yáng Jìzhōu in 1601.

It is a simple and straightforward point combining method, though how it is normally taught makes it less likely to be used by acupuncturists and students, and it just becomes another data point to memorize for the exams.

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Lit review – East and West

I learned (and, for many years, taught) the method as it was written in The Practical Application of Meridian Style Acupuncture by John Pirog (1996). Pirog touches on the method during a discourse on network points, where he states that treatment of concurrent presentation of exterior and interior symptoms is “perhaps the most important clinical role that luo points serve.” Exterior-interior has a more expansive definition in acupuncture than in herbal medicine, he says, in that it can be applied to fǔ-bowels [exterior] and zàng-viscera [interior] as well as, say, a wind-cold contraction [exterior] with organ disharmony [interior].

The method he explains is this: use the source point on the channel first affected [host] and the network point on the channel that is affected after [guest]. To summarize the two examples he gives:

• Chronic kidney vacuity results in depleted right qì leading to wind damp impediment in the low back: KD-3 [source/host] and UB-58 [network/guest]

• Wind-heat attacks the nose, which leads to chronic cough: LI-4 [source/host] and LU-7 [network/guest].

The acupuncturist must determine which of the channels is replete and which is vacuous in order to apply supplementing and draining; this assumes a “see-saw” relationship between interior-exterior paired channels, i.e. when one channel is full, its paired channel is empty.

Deadman et al., in A Manual of Acupuncture (2007), reiterate this usage of first- and later-affected paired channels. The authors mention that the technique “seems to have been little used” through the history of acupuncture. They cite contemporary usage, which appear to be mostly based on point functions. I summarize the list here:

• LI-4 + LU-7: Exterior pathogen invasion

• LU-9 + LI-6: Exterior invasion of wind water with upper body swelling

• SP-3 + ST-40: Spleen vacuity with phlegm damp

• HT-7 + SI-7 Spirit disorders

• KD-3 + UB-58: Yīn vacuity with ascending yáng

• LR-3 + GB-37: Eye disorders

While further research does indeed confirm that this 1-2 approach is a common one in modern usage, I find it curious that neither of these sources refer to the symptomology in the original source, the Great Compendium:

A later explanation, from the Golden Mirror of Our Medical Ancestors: Essential Heart Methods of Needling and Moxibustion [Yīzōng jīnjiàn: Cìjiǔ xīnfǎ yào, 醫宗金鑑·刺灸心法要 ] by Wú Qiān, 1742:

The points given in the passage are:

While there are certainly exterior symptoms here, there are also gastrointestinal, neurological and urinary manifestations, and no mention of facial swelling.

Encountering the Origins of Acumoxa [Zhēnjiǔ féngyuán, 針灸逢源 ] by Lǐ Xuéchuān, published in 1815, gives us a brief list of the host-guest points without indications, but ends the passage with these general remarks:

Giovanni Maciocia, in The Channels of Acupuncture: Clinical Use of the Secondary Channels and Eight Extraordinary Vessels (2006), did summarize the original symptomology from the Great Compendium, and while he did mention the 1-2 sequence as an indication for use of the method, the conclusion was more general: the combination strengthens the effect of the source point in channel disorders. He pointed out that network point symptoms often reflect symptoms of its paired channel.

It is also clear that the indications given for the host-guest combination in the pre- and early-modern sources have significant overlap with those of the channels in Yellow Emperor’s Inner Classic Spiritual Pivot [Huángdì Nèijīng Língshū黃帝內經靈樞] chapter 10:

As Lǐ Xuéchuān pointed out in the passage cited earlier, the source point of each channel is a representative of the source qì, and thus it can treat any problem of its channel. One modern criticism (Zhi et al., 2019) of the 1-2 method is that clinical cases often lack a clear etiology and pathogenesis, making the determination of which channel was first affected problematic. Also the common assumption is that source points are always supplemented and network points always drained; if the original source for the symptomology is Língshū 10, which gives both repletion and vacuity manifestations, then this assumption needs re-examination. Harmonizing and regulating techniques may be called for, depending on the presenting pathology. In general, Zhi et al. (2019) say, the current clinical indications for this method are too narrow.

What’s the why?

If the host-guest simply treats problems of a given channel, why favor them over whatever other points are on the same paired channels? I can think of a few reasons, both ancient and modern.

As for the modern research literature, researchers using complex network analysis techniques to investigate point combinations (Wu et al., 2012) cited studies that looked at EEGs and lab biomarkers when testing points used alone and in various combinations. Some of the point combinations they tested, while not antagonistic, weren’t found to produce additional benefit over that of the individual points. Other combinations, however, did exhibit synergistic effects; the two categories mentioned as having these effects were back-shù with front-mù points, and the source-network point pairing method.

In addition, as Zhang et al. (2015) mention, treating complex diseases can result in a large and varied number of points selected, which can cause significant patient discomfort. Picking effective combination strategies can aid in making needling more effective and reduce chances of adverse events.

In terms of ancient reasoning, Classic of Difficulties [Nánjīng, 難經] 66 says the source qì comes from the moving qì between the kidneys, and the source points are said to be the place on each of the channels where the source qì stops and abides [留止]. The source qì is responsible for powering the functional activities of the zàngfǔ organs and channels (Dai et al., 2021), meaning that the source points represent the most fundamental physiologic level of the body.

Network points connect paired channels, but they are also connected to the wider scheme of network vessels. Network vessels are a key driver of chronic pathology. Yè Tiānshì said in Clinical Guidelines to Medical Cases [Línzhèng zhǐnán yī’àn, 臨證指南醫案, 1746] that

Thus, the host-guest combination method not only mobilizes the source qì, it activates the blood. This makes it useful in a wide array of chronic conditions (which tend to be characterized by mixed vacuity and repletion) but most especially those in which there are signs of underlying yáng vacuity mutually engendering blood stasis.

Back to the mysterious house

Several of the papers surveyed were co-authored by Sūn Yuǎnzhēng [孙远征]. Professor Sūn has formulated a method called the “source-network channel-freeing needling method [yuánluò tōngjīng zhēnfǎ, 原絡通經針法]” which uses various exterior-interior paired source and network points, depending on the pathology. Of the papers I read, the one that most caught my eye was a clinical paper (You et al., 2025) on the treatment of diabetic retinopathy [DR]. In it, the authors postulate on the most important elements of the pathogenesis of DR.

In the early stage, spleen vacuity is the primary pattern, which may be accompanied by phlegm-turbidity as well as liver blood vacuity and/or liver depression qì stagnation. This makes for lack of nourishment to the eye networks, which are tiny and deep, and thus easily stopped up by turbidity and blood stasis. Kidney yáng vacuity characterizes the middle stage of the disease process. Once the kidney yáng is unable to circulate through the dūmài [governing vessel], the xuánfǔ [mysterious house] shuts down, cutting off the communication between the eye connectors and the visual lining [視衣 shìyī, analogous to the retina].

Professor Sūn’s strategy for this is to

1. Rouse and mobilize [鼓动] the qì and blood of the zàngfǔ [basically summoning the source qì through the source points]

2. Stimulate network points to activate circulation and free the network vessels

3. Regulate the yáng qì of the governing vessel [primarily by using the most yáng point of the body, GV-20]

His point selection, depending on the disease stage and presenting pathology, may include one or more of the following source-network pairs:

• LR-3 + GB-37, KD-3 + UB-58, SP-3 + ST-40.

• To this, add GV-20

• He will often add LR-5 and/or HT-5, both network points which connect to the eye’s network vessels.

For me, with a keen interest in xuánfǔ theory and especially how it might be addressed with acupuncture, perhaps the most interesting takeaway was in the way Professor Sūn approached this matter. First, the use of source and network points can be seen to rally the source qì and free the network vessels to unblock the pathways through which the nourishment can flow to the mysterious house, while the dūmài, a powerful conduit of yáng which itself is produced from the source qì (Larre & Rochat de la Vallée, 1997, p.46), can push the circulation of the source qì upward to warm the xuánfǔ and restore its harmonious opening and closing.

Conclusion

The source-network combining method is one that is too often learned and forgotten, but it can be a potent option in the treatment of chronic diseases, in addition to its more commonly-cited uses, such as first- and later-affected illnesses of paired channels. I have started to apply it more in clinic, especially in more stubborn cases.

Okay, that’s it for now. Thanks for reading, and again, I wish you all the best in the new year.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

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References

Dai, Y., Si, L., Lü, Y., Tao, X., Zhao, L., & Gu, L. (2021). Clinical application of original meridian and collateral point combination method in treating multisystem diseases. Asia-Pacific Traditional Medicine, 17(7). DOI:10.11954/Ytctyy.202107055

Deadman, P., Al-Khafaji, M., & Baker, K. (2007). A manual of acupuncture, 2nd ed. Journal of Chinese Medicine Publications

Huángdì Nèijīng Língshū. (n.d.). Retrieved March 22, 2024 from https://jicheng.tw/tcm/book/%E9%9D%88%E6%A8%9E/index.html.

Larre, C., & Rochat de la Vallée, E. (1997). The eight extraordinary meridians. Monkey Press.

Li, X. (1815). Zhēnjiǔ féngyuán. Retrieved December ‎16, ‎2022, from https://jicheng.tw/tcm/book/%E9%87%9D%E7%81%B8%E9%80%A2%E6%BA%90/index.html

Maciocia, G. (2006). The channels of acupuncture: Clinical use of the secondary channels and eight extraordinary vessels. Elsevier Health Sciences.

Pirog, J.E. (1996). The practical application of meridian style acupuncture. Pacific View Press.

Wu, Q. (1742). Yīzōng jīnjiàn: Cìjiǔ xīnfǎ yào. retrieved April 26, 2024 from https://jicheng.tw/tcm/book/%E9%86%AB%E5%AE%97%E9%87%91%E9%91%91/%E5%88%BA%E7%81%B8%E5%BF%83%E6%B3%95%E8%A6%81%E8%A8%A3/index.html

Wu Q., Zhang, C., Chen, Q., & Yu, S. (2012). On feasibility of researching acupoint combination by using complex network analysis techniques. Acupuncture Research, 37(3). DOI:10.13702/j.1000-0607.2012.03.017

Yang, J. (1601). Zhēnjiǔ dàchéng. Retrieved December 26, 2023 from https://jicheng.tw/tcm/book/%E9%87%9D%E7%81%B8%E5%A4%A7%E6%88%90/index.html

You, H., Sun, Y., Li, J., & Zhang, Y. (2025). Sun Yuanzheng’s original network-connecting meridian acupuncture method for treating diabetic retinopathy: A summary of clinical experience. Chinese Acupuncture & Moxibustion, 45(4). DOI:10.13703/j.0255-2930.20240524-k0002

Zhang, L., Guan, Y., Wang, L., & Sun, Y. (2015). Professor Sun Yuanzheng’s experience in treating cognitive impairment with the original meridian and collateral acupuncture method. Information on Traditional Chinese Medicine, 32(4). DOI:10.19656/j.cnki.1002-2406.2015.04.024

Zhi, N. , Wu, X., Wu, B. , Luo, Y. , Yang, S. (2019). Clinical research progress of the matching method of original points and collateral points. Journal of Traditional Chinese Medicine of Liaoning, 46(6). DOI:10.13192/j.issn.1000-1719.2019.06.064.

Recently I have been researching and putting together materials for a course on brain physiology and pathology in Chinese medicine. Among the earliest descriptions of this subject are those found in the two extant books of the Huángdì Nèijīng, Sùwèn and Língshū (Yellow Emperor’s Inner Classic, Simple Questions and Spiritual Pivot). A well-known example is the 33^rd chapter of Língshū, the Treatise on the Seas. I mulched the commentary on this chapter in Zhēn Jiǔ Féng Yuán (針灸逢源, Encountering the Origins of Acumoxa) by Lǐ Xuéchuān, written in 1815, and present it here with some notes of my own. The text in parentheses is Lǐ’s commentary, and the brackets are my own interpolations]

靈樞海論

Língshū, Treatise on the Seas

人亦有四海。十二經水。經水者。皆注於海。（四海者百川之宗）

Humans also have four seas, and twelve water channels. The water channels all flow into the sea. (The four seas are the ancestors of the hundred rivers)

胃者。水穀之海。其輸上在氣街。下至三里。（水穀入口。藏於胃以養五臟氣。其胃氣運行之輸上者在氣衝。下者在三里。）

The stomach is the sea of water and grain. Its upper shū [transport point] is at the qì street [氣街 qìjiē]. It descends to Sānlǐ [ST-36]. (Water and grain enters through the mouth. It is stored in the stomach to nourish the qì of the five viscera. The upper shū that transports the stomach qì is at Qìchòng [ST-30]. The lower [shū point] is Sānlǐ [ST-36])

Note: In this passage, the points are specific, Qìjiē being an alternate name for Qìchòng. As we will see momentarily, the main pathology for this sea is non-movement of ingested food and fluids, whether from repletion or vacuity. Pirog (1996) posits ST-30 as a gateway to open up the downbearing of qì to the lower body. Though this can be a sensitive area for patients, treatment here can be quite beneficial. When I was first training in Japanese meridian therapy I spent a few years studying with Fukushima Kodo’s organization; superficial needling at this area (known as muno chiryō) was frequently done for almost any affliction of the lower abdomen or lower limbs.

衝脈者。為十二經之海。其輸上在於大杼。下出於巨虛之上下廉。（此即血海也。衝脈起於胞中。其前行者。並足少陰之經俠臍上行。至胸中而散。其後行者上循背裡。為經絡之海。故其輸。上在於足太陽之大杼。下在於足陽明之巨虛上下廉。水穀之海者。言水穀盛貯於此。營衛由之而化生也。血海者。言受納諸經之灌注。精血於此而蓄藏也。）

The chōngmài [thoroughfare vessel] is the sea of 12 channels. Its upper shū is at Dàzhù [UB-11], and below it emerges at the upper and lower ridges of Jùxū [ST-37 and ST-39]. (This is called the blood sea. The chōngmài arises from within the bāo [womb]; its anterior line coincides with the foot shàoyīn channel ascending alongside the navel until it disperses in the chest. Its posterior line ascends internally along the back and becomes the sea of channels and network vessels. Its upper [limit] is located at the Dàzhù [UB-11] point of foot tàiyáng. Its lower point is located at the upper and lower ridges of Jùxū [ST-37 and ST-39] of foot yángmíng. The sea of water and grain refers to the place where water and grain are contained and stored, where the yíng and wèi [qì] are generated. The blood sea refers to [where] the inflow of all the channels is received. Here is where the essence and blood are gathered and stored.)

Note: The blood sea is identified with the chōngmài here, though the trajectory differs from other early accounts such as Huángdì Nèijīng Sùwèn chapter 60. Lǐ’s comments fuse the two. The points here are specific as well. I frequently use what I term the “stomach line”, which is to say the line of the foot yángmíng channel that includes ST-36 through ST-39. I first learned it as a student of Japanese meridian therapy, and later saw it discussed by Shimamura Tsuyoshi sensei in a course on Master Nagano’s treatment style (it can be found here). I’ve always thought of it as a treatment for boosting post-heaven essence, but as Lǐ hints at here, essence and blood are of the same source (jīng xuè tóng yuán 精血同源). UB-11, as Pirog (1996) points out, is at the top of the thoracic branch of the foot tàiyáng, and can be seen as a point which opens up circulation to the head and balances upper and lower as well as exterior (tàiyáng) and interior (yángmíng) distribution of qì and blood (these two channels being abundant in both substances). In a community or seated setting, these points are also relatively easy to needle; I favor simple insertion (insert and remove) for UB-11 before the patient leans back, followed by retention of ST-37 and ST-39.

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膻中者。為氣之海。其輸上在於柱骨之上下。前在於人迎。（膻中胸中也宗氣積於胸中。出於喉嚨以貫心脈而行呼吸。故膻中謂之氣海。氣海。運行之輸一在頏顙之後。即柱骨之上下謂督脈之喑門大椎也。一在頏顙之前。謂足陽明之人迎也。）

Shānzhōng [CV-17] is the sea of qì. Its upper shū is located above and below the pillar bone. In front it is at Rényíng [ST-9]. (Shānzhōng is the center of the chest, where the ancestral qì [zōngqì] accumulates. It emerges at the throat via a link with the heart vessel and activates respiration. Thus Shānzhōng is known as the sea of qì. One of the sea of qì’s shū circulates behind the nasopharynx, namely the pillar bone; its upper and lower are Yīnmén [GV-15] and Dàzhuī [GV-14] of the so called governing vessel [dūmài]. Another runs in front of the nasopharynx, it is at the Rényíng [ST-9] point of the foot yángmíng)

Note: For the sea of qì, the named points are CV-17 and ST-9. Otherwise, opinions differ on the unnamed points. Deadman et al. (2001), for example, concur with Lǐ’s choices above. Pirog (1996) names UB-10 [Tiānzhù 天柱], “Celestial Pillar”, which refers to the “pillar bone” [zhùgǔ 柱骨] named in the text. Unschuld (2016) has the pillar bone as C7. Pirog (1996) does open up the possibility of a wider area of treatment for the sea of qì, namely the anterior and posterior neck. This includes the sternocleidomastoid muscle [SCM] and surrounding area on the front, above the clavicle; as an aside, Wiseman (2022) has pillar bone as the “collar bone”, which supports this opinion. Personally, I like this idea. Similar to the muno treatment described above, Fukushima’s group frequently uses naso chiryō, which targets the anterior neck area with superficial needling. I do this type of treatment quite often, not only for respiratory problems, but any upper body problem when it is accompanied by tension in the SCM, scalenes, and upper trapezius.]

腦為髓之海其輸上在於其蓋下在風府。（諸髓皆屬於腦。腦為髓之海。蓋腦蓋骨也。即督脈之囟會風府。此皆髓海之上下輸也。）

The brain is the marrow sea, its upper shū is located at the lid and the lower is at Fēngfǔ [GV-16]. (All marrow pertains to the brain. The brain is the marrow sea. The lid is the bone covering the brain, namely Xìnhuì [GV-22] and Fēngfǔ [GV-16] on the dūmài. This is the upper and lower shū of the marrow sea.)

Note: The “lid” or “cover” here likely references the parietal bones. The point is often identified as GV-20 (see for example Deadman et al., 2001), but Lǐ gives it as the bregma or fontanelle, GV-22. I prefer the latter, for reasons I mentioned in an earlier post:

This is a point combination I use quite often in treating vertigo, brain fog, etc. The dūmài enters the brain and depending on the context I may fold this into an extraordinary vessel treatment.

The remainder of the passage delineates the pathology of the four seas.

氣海有餘者氣滿胸中悗息。面赤。（邪氣實也。）

If there is superabundance in the sea of qì, qì will stagnate in the chest, making respiration difficult, and the face will turn red. (This is repletion of evil qì.)

氣海不足。則氣少不足以言。（正氣虛也。）

If there is insufficiency in the sea of qì, it results in scant qì, not enough to speak. (This is vacuity of upright qì.)

Note: The pathology here is primarily respiratory, although it may also describe some cardiac symptoms as well – shortness of breath and red face, for example. Lǐ hints at this above when he mentions the actions of the ancestral qì, which depends on both heart and lungs.

血海有餘。則常想其身大。怫然不知其所病。（怫怫鬱也重滯不舒之貌）

If there is superabundance in the sea of blood, it results in a frequent feeling that the body is enlarged. [One is] glowering but doesn’t know what the affliction is. (This is anger, dejection, and depression, one appears heavy, sluggish and uncomfortable)

血海不足亦常想其身小。狹然不知其所病。（狹隘狹也。索然不廣之貌。病在血者徐而不顯故茫然不覺其所病。）

If there is insufficiency in the sea of blood, similarly one often feels as if the body is smaller. One feels restrained but does not know what the affliction is. (Restrained means narrowed. One appears depleted and shrunken. Illness in the blood appears gradually and insidiously, thus one is unaware and doesn’t know what is wrong.)

Note: These are curious symptoms, which are largely perceptual and emotional. One feels as if their body is growing or diminshing in size or volume. In the repletion scenario, one is angry or depressed; in the vacuity scenario, one feels constrained, “squeezed” (Unschuld, 2016). In both cases, one has difficulty identifying just what is going in in their body. Pirog (1996) proposes that the patient’s energy is increasing or diminishing, thus one might see chronic fatigue, blood sugar imbalances and so forth. Blood pressure might apply here as well, since, as was mentioned above, the points given can be seen to balance blood distribution between the upper, middle, and lower body.

水穀之海有餘。則腹滿。（水穀留滯於中。故腹為脹滿。）

If there is superabundance in the sea of water and grain, it results in abdominal fullness. (Water and grain sit and stagnate in the middle burner, so there is abdominal distension and fullness.)

水穀之海不足。則飢不受穀食。（胃虛則不能納故雖飢不受穀食）

If there is insufficiency in the sea of water and grain, it results in hunger with the inability to eat grains. (Stomach vacuity results in inability to receive [food] so although one is hungry they cannot ingest grains)

Note: As mentioned above, the pathology here is primarily non-movement of ingestate, and corresponds to the functioning of stomach qi. The vacuity case also suggests possible food sensitivity, since grain foods are specified.

髓海有餘。則輕勁多力。自過其度。（骨髓充足之徵。）

If there is superabundance in the sea of marrow, it results in [one feeling] light and vigorous with ample strength, exceeding one’s limits. (A sign of abundant bone marrow.)

髓海不足。則腦轉耳鳴。脛酸眩冒。目無所見。懈怠安臥。（髓為精類精衰則氣去而諸症見矣。）

If there is insufficiency in the sea of marrow, it results in spinning brain and ringing ears, aching shins and veiling dizziness, sluggishness and somnolence. (Marrow is a type of essence, and weakened essence makes the qì depart and all these symptoms will appear.)

Note: Translation and commentary on the superabundance passage here diverges somewhat. Unschuld (2016) has it that one “overexerts himself” and includes a commentary that the lifespan is extended, with which Pirog (1996) concurs. Lǐ himself takes this as a positive indicator of plentiful essence. I wonder, though, if this could not be applicable to manic or delusional states, or thrill-seeking behaviors. I previously speculated on the idea that essence which does not circulate can lead to fearful states:

As Shudo Denmei sensei used to say, too much of a good thing is good for nothing. The vacuity symptoms all indicate depleted brain marrow, which can occur in senile dementia or a variety of chronic illnesses.

審守其輸。而調其虛實。無犯其害。順者得復。逆者必敗。（凡此四海。俱有順逆順者。知所養者也不知所養則逆矣。故審察其俞穴。如上文無犯其害無盛盛無虛虛也。）

Examine and observe the shū, and regulate vacuity and repletion without inflicting harm. Follow this advice and they will recover. Going against this spells defeat. (For all the four seas, one can go along or go against. There are those who know what is to be nourished, and to be ignorant of this is to go against [the principles]. Therefore pay close attention to the shū points. As mentioned above, do not inflict harm, overfill or over-deplete.)

Okay, that’s all I’ve got for now. Thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Deadman, P., Al-Khafaji, M., & Baker, K. (2001). A manual of acupuncture, 2nd ed. Journal of Chinese Medicine Publications

Li, X. (1815). Zhēn jiǔ féng yuán. Retrieved December ‎16, ‎2022, from https://jicheng.tw/tcm/book/%E9%87%9D%E7%81%B8%E9%80%A2%E6%BA%90/index.html

Pirog, J.E. (1996). The practical application of meridian style acupuncture. Pacific View Press.

Unschuld, P.U. (2016). Huang di nei jing ling shu: The ancient classic on needle therapy, the complete Chinese text with annotated English translation. University of California Press.

Wiseman, N. (2022). Chinese-English Dictionary of Chinese Medical Terms. Paradigm Publications.

A few weeks back we looked at the Dōngyuán acupuncture method as presented in Gatherings from Acumoxa Heroes [Zhēnjiǔ Jùyīng針灸聚英, more commonly known as Gatherings from Eminent Acupuncturists] by Gāo Wǔ [高武] from 1529. In going through the Jùyīng I came across another passage that I found interesting: an adaptation of material from the Classic of Difficulties [Nánjīng].

I’ve written on Nánjīng several times before, as it is the text most closely associated with the Japanese meridian therapy [keiraku chiryō] style, which is the foundation of my approach to acupuncture. With its rigorous application of yīn-yáng and five-phase theory, Paul Unschuld called Nánjīng “the mature classic of systematic correspondence [emphasis from original]” (Unschuld, 1985). In terms of diagnostics, Nánjīng is often celebrated for its multiple innovations in pulse diagnosis – which, if you are curious, I highly recommend Z’ev Rosenberg’s excellent commentary Ripples in the Flow (Rosenberg, 2020) – but another chapter has, in my mind, an equally illustrious place in the development of keiraku chiryō.

Difficulties 16 and 68

Nánjīng chapter 16 gives us actual pattern-based diagnostics and therapeutics based on yīn-yáng and five-phase theory. There are external and internal symptoms, along with signs such as pulse and abdominal palpation that can confirm the diagnosis. This is the source of the patterns [shō] used in keiraku chiryō.

Other chapters in the text give us a multidimensional view of not only pulse diagnosis, but also etiology and pathogenesis, and an expanded discussion of extraordinary vessels. Later chapters lay out a system of therapeutics distinct from the Yellow Emperor’s Inner Classic: Spiritual Pivot [Huángdì Nèijīng Língshū], focusing tightly on five-phase dynamics. One such chapter is difficulty 68, which we discussed in a post from a few years back.

This section from Zhēnjiǔ Jùyīng combines difficulties 16 and 68, with some influence from later commentators.

臟腑井滎俞經合主治

假令得弦脈。病人善潔。（膽為清淨之府故耳）面青善怒。此膽病也。若心下滿當刺竅陰。（井）身熱當刺俠谿。（滎）體重節痛刺臨泣。（俞）喘咳寒熱刺陽輔。（經）逆氣而泄刺陽陵泉。（合）又總取丘墟。（原）

Indications for the five transport points of the zàngfǔ

In case of a wiry pulse, where the patient inclines toward fastidiousness (because the gallbladder is the fǔ of purity), the facial complexion is greenish, and there is a tendency to anger. This is gallbladder disease.

• If there is fullness below the heart, one should needle Qiàoyīn [GB-44] (jǐng-well);

• if there is heat in the body, one should needle Xiáxī [GB-43] (yíng-spring);

• if there is heaviness of the body and joint pain, one should needle Línqì [GB-41] (shù-stream);

• if there is panting and coughing, cold and heat, one should needle Yángfǔ [GB-38] (jīng-river);

• if there is counterflow qì and leakage, one should needle Yánglíngquán [GB-34] (hé-sea).

• In every case, select Qiūxū [GB-40] (yuán-source).

假令得弦脈。病人淋溲難。轉筋。四肢滿閉。臍右有動氣。此肝病也。若心下滿當刺大敦。（井）身熱刺行間。（滎）體重節痛刺太衝。（俞）喘嗽寒熱刺中封。（經）逆氣而泄刺曲泉。（合）

In case of a wiry pulse, where the patient has [symptoms such as] difficulty urinating, cramping sinews, fullness and obstruction in the four limbs, and stirring qì to the right of the navel [note: this is a typo, Nánjīng 16 has “left of the navel 齊左” here], this is liver disease.

• If there is fullness below the heart, one should needle Dàdūn [LR-1] (jǐng-well);

• if there is heat in the body, one should needle Xíngjiān [LR-2] (yíng-spring);

• if there is heaviness of the body and joint pain, one should needle Tàichòng [LR-3] (shù-stream);

• if there is panting and coughing, cold and heat, one should needle Zhōngfēng [LR-4] (jīng-river);

• if there is counterflow qì and leakage, one should needle Qūquán [LR-8] (hé-sea).

Note: in Nánjīng 16, the zàng organs are the only ones mentioned, thus all of the exterior and interior signs are allocated to the zàng. Later commentators, such as Lǚ Guǎng [呂 廣], ascribed the exterior signs – facial appearance, outward behavior, emotional states, and a few more superficial physiological phenomena – to the corresponding fǔ (Unschuld, 1986). Thus greenish complexion, anger and fastidiousness are assigned to the gallbladder, where symptoms involving organ function and abdominal palpation belong to the liver.

Urinary block as a liver symptom is explained by Xú Dàchūn (Xu, 1727) in his Commentary on Classic of Difficulties [Nánjīng jīngshì 難經經釋]:

The point selection in this and all following examples is mostly adapted from Nánjīng difficulty 68. The yuán-source point is added to the examples on yáng channels. They are not added to the yīn channels because on those channels the yuán-source and shù-stream points are, of course, identical.

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假令得浮洪脈。病人面赤口乾喜笑。此小腸病也。若心下滿刺少澤。（井）身熱刺前谷。（滎）體重節痛刺後谿。（俞）喘嗽寒熱刺陽谷。（經）逆氣而泄刺小海。（合）又總刺腕骨。（原）

In case of a floating and full pulse, where the patient has [symptoms such as] a red face, dry mouth, and a tendency to laugh, this is small intestine disease.

• If there is fullness below the heart, one should needle Shàozé [SI-1] (jǐng-well);

• if there is heat in the body, one should needle Qiángǔ [SI-2] (yíng-spring);

• if there is heaviness of the body and joint pain, one should needle Hòuxī [SI-3] (shù-stream);

• if there is panting and coughing, cold and heat, one should needle Yánggǔ [SI-5] (jīng-river);

• if there is counterflow qì and leakage, one should needle Xiǎohǎi [SI-8] (hé-sea).

• In every case, select Wànggǔ [SI-4] (yuán-source).

假令得浮洪脈。病人煩心。心痛。掌中熱而噦。臍上有動氣。此心病也。若心下滿刺少衝。（井）身熱刺少府。（滎）體重節痛刺神門。（俞）喘嗽寒熱刺靈道。（經）逆氣而泄刺少海。（合）

In case of a floating and full pulse, where the patient has [symptoms such as] vexation, heart pain, heat in the palms, and vomiting, with stirring qì above the navel, this is heart disease.

• If there is fullness below the heart, one should needle Shǎochòng [HT-9] (jǐng-well);

• if there is heat in the body, one should needle Shǎofǔ [HT-8] (yíng-spring);

• if there is heaviness of the body and joint pain, one should needle Shénmén [HT-7] (shù-stream);

• if there is panting and coughing, cold and heat, one should needle Língdào [HT-4] (jīng-river);

• if there is counterflow qì and leakage, one should needle Shàohǎi [HT-3] (hé-sea).

Note: I do find it interesting that the behavioral and psychoemotional signs, because of their outward nature, are considered to indicate the fǔ organs. The heart stores the shén-spirit, and I think many would regard the shén as being a deeper aspect of the organ. However, these signs (anger, laughter, fussiness) show up as part of our interface with the outside world, and thus are given as external signs. Vexation, as Gāo Wǔ explains in another passage in Jùyīng, is experienced inwardly, where agitation is apparent from the outside:

Also note that there is no mention of the pericardium or triple burner. The pericardium channel is generally substituted for the heart channel in standard consensus Japanese keiraku chiryō. One could make a case that the triple burner, which Nánjīng identifies as the thoroughfare for the source qì, is involved when one needles the yuán point, which we are here advised to do when treating the other fǔ organ patterns.

假令得浮緩脈。病人面黃。善噫善思善沫。此胃病也。若心下滿刺厲兌。（井）身熱刺內庭。（滎）體重節痛刺陷谷。（俞）喘嗽寒熱刺解谿。（經）逆氣而泄刺三里。（合）又總刺衝陽。（原）

In case of a floating and moderate pulse, where the patient has [symptoms such as] a yellowish face; and a tendency to belch, to ponder, and to drool, this is stomach disease.

• If there is fullness below the heart, one should needle Lìduì [ST-45] (jǐng-well);

• if there is heat in the body, one should needle Nèitíng [ST-44] (yíng-spring);

• if there is heaviness of the body and joint pain, one should needle Xiàngǔ [ST-43] (shù-stream);

• if there is panting and coughing, cold and heat, one should needle Jièxī [ST-41] (jīng-river);

• if there is counterflow qì and leakage, one should needle Sānlǐ [ST-36] (hé-sea).

• In every case, select Chòngyáng [ST-42] (yuán-source).

假令得浮緩脈。病人腹脹滿。食不消。體重節痛。怠隋嗜臥。四肢不收。當臍有動氣。按之牢若痛。此脾病也。若心下滿刺隱白。（井）身熱刺大都。（滎）體重節痛刺太白。（俞）喘嗽寒熱刺商丘。（經）逆氣而泄刺陰陵泉。（合）

In case of a floating and moderate pulse, where the patient has [symptoms such as] abdominal distension, lack of appetite, heaviness of the body, joint pain, fatigue [note: Nánjīng has this as 怠惰] and a habit of lying down, inability to retract the four limbs, with stirring qì at the navel, this is spleen disease.

• If there is fullness below the heart, one should needle Yǐnbái [SP-1] (jǐng-well);

• if there is heat in the body, one should needle Dàdū [SP-2] (yíng-spring);

• if there is heaviness of the body and joint pain, one should needle Tàibái [SP-3] (shù-stream);

• if there is panting and coughing, cold and heat, one should needle Shāngqiū [SP-5] (jīng-river);

• if there is counterflow qì and leakage, one should needle Yīnlíngquán [SP-9] (hé-sea).

Note: Here the symptomology does reflect some of the stomach organ functions, such as belching. In contrast, the small intestine symptoms listed above are extensions of fire phase manifestations, with no mention of urinary difficulty or any connection with the separation of clear and turbid, as is usually ascribed to the small intestine in TCM.

假令得浮脈。病人面白。善嚏。悲愁不樂欲哭。此大腸病也。若心下滿刺商陽。（井）身熱刺二間。（滎）體重節痛刺三間。（俞）喘嗽寒熱刺陽谿。（經）逆氣而泄刺曲池。（合）又總刺合谷。（原）

In case of a floating pulse, where the patient has [symptoms such as] a white face, tendency to sneeze, sorrow and anxiety, unhappiness, and a desire to cry, this is large intestine disease.

• If there is fullness below the heart, one should needle Shāngyáng [LI-1] (jǐng-well);

• if there is heat in the body, one should needle Èrjiān [LI-2] (yíng-spring);

• if there is heaviness of the body and joint pain, one should needle Sānjiān [LI-3] (shù-stream);

• if there is panting and coughing, cold and heat, one should needle Yángxī [LI-5] (jīng-river);

• if there is counterflow qì and leakage, one should needle Qūchí [LI-11] (hé-sea).

• In every case, needle Hégǔ [LI-4] (yuán-source).

假令得浮脈。病人喘嗽。灑淅寒熱。臍右有動氣。按之牢若痛。此肺病也。若心下滿刺少商。（井）身熱刺魚際。（滎）體重節痛刺太淵。（俞）喘嗽寒熱刺經渠。（經）逆氣而泄刺尺澤。（合）

In case of a floating pulse, where the patient has [symptoms such as] panting and coughing, [aversion to] cold and heat [effusion] as after a soaking, stirring qì to the right of the navel, with pain upon firm pressure, this is lung disease.

• If there is fullness below the heart, one should needle Shǎoshāng [LU-11] (jǐng-well);

• if there is heat in the body, one should needle Yújì [LU-10] (yíng-spring);

• if there is heaviness of the body and joint pain, one should needle Tàiyuān [LU-9] (shù-stream);

• if there is panting and coughing, cold and heat, one should needle Jīngqú [LU-8] (jīng-river);

• if there is counterflow qì and leakage, one should needle Chǐzé [LU-5] (hé-sea).

Note: Large intestine manifestations here are largely emotional, with a very superficial upper-respiratory symptom included: sneezing, well-explained by the course of the hand yángmíng channel. The lung conformation also includes a surface manifestation of chills and fever.

假令得沉遲脈。病人面黑。善恐欠。此膀胱病也。若心下滿刺至陰。（井）身熱刺通谷。（滎）體重節痛刺束骨。（俞）喘嗽寒熱刺崑崙。（經）逆氣而泄刺委中。（合）又通刺京骨。（原）

In case of a sunken and slow pulse, where the patient has [symptoms such as] a blackish face, a tendency to fearfulness and yawning, this is urinary bladder disease.

• If there is fullness below the heart, one should needle Zhìyīn [UB-67] (jǐng-well);

• if there is heat in the body, one should needle Tōnggǔ [UB-66] (yíng-spring);

• if there is heaviness of the body and joint pain, one should needle Shùgǔ [UB-65] (shù-stream);

• if there is panting and coughing, cold and heat, one should needle Kūnlún [UB-60] (jīng-river);

• if there is counterflow qì and leakage, one should needle Wěizhōng [UB-40] (hé-sea).

• In general, needle Jīnggǔ [UB-64] (yuán-source).

假令得沉遲脈。病人逆氣。小腹急痛。泄如下重。足脛寒而逆。此腎病也。若心下滿刺湧泉。（井）身熱刺然谷。（滎）體重節痛刺太谿。（俞）喘嗽寒熱刺復溜。（經）逆氣而泄刺陰谷。（合）。

In case of a sunken and slow pulse, where the patient has [symptoms such as] counterflow qì, urgency and pain in the lower abdomen, heavy diarrhea, and counterflow cold of the feet and lower legs, this is kidney disease.

• If there is fullness below the heart, one should needle Yǒngquán [KD-1] (jǐng-well);

• if there is heat in the body, one should needle Rángǔ [KD-2] (yíng-spring);

• if there is heaviness of the body and joint pain, one should needle Tàixī [KD-3] (shù-stream);

• if there is panting and coughing, cold and heat, one should needle Fùliū [KD-7] (jīng-river);

• if there is counterflow qì and leakage, one should needle Yīngǔ [KD-10] (hé-sea).

Note: Heavy diarrhea, which one may associate with the large intestine or spleen, and counterflow qì, which one might associate with the liver or lung, here both pertain to the kidney; difficult urination, which one might associate with kidney or lung, is ascribed to the liver.

此五臟六腑井滎俞經合刺法。深得素、難之旨。學者不可不知。

This is the needling method for jǐng-well, yíng-spring, shù-stream, jīng-river, and hé-sea points of the five zàng and six fǔ. To achieve its profundity is an aim both simple and difficult, scholars cannot be ignorant of it.

Summary

The Nánjīng gave us a rigorous and relatively consistent framework with which to approach needle therapy especially from a five-phase perspective. Later commentators and authors from China, Japan, and Korea further developed its innovations. The Zhēnjiǔ Jùyīng passage above presented a combination of diagnostics and therapeutics based on both the original Nánjīng text and its annotated versions that is worthy of consideration and may prove useful when applied clinically.

Okay, that’s all for now. Thanks for reading.

Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.

References

Gao, W. (1529). Zhenjiu juying. Retrieved October 11, 2025, from https://jicheng.tw/tcm/book/%E9%87%9D%E7%81%B8%E8%81%9A%E8%8B%B1/index.html

Rosenberg, Z. (2020). Ripples in the flow: Reflections on vessel dynamics in the Nán Jīng. Singing Dragon.

Unschuld, P.U. (1985). Medicine in China: A history of ideas. University of California Press.

Unschuld, P.U. (1986). Medicine in China: Nan Ching: The classic of difficult issues. University of California Press.

Xu, D.C. (1727). Nanjing jingshi. Retrieved October 29, 2025, from https://jicheng.tw/tcm/book/%E9%9B%A3%E7%B6%93%E7%B6%93%E9%87%8B/index.html