Zhong Man Fen Xiao Tang - 中滿分消湯 - Separate and Reduce Fullness in the Middle Decoction

Author: Li Gao / Li Dong Yuan, 李杲 / 李東垣

Year: 1276

Source: Secrets from the Orchid Chamber (Lan Shi Mi Cang, 蘭室秘藏)

Category: Formulas that Expel Dampness

Pattern: Drum distention due to Cold, or Cold-type bulging disorders, or Running Piglet disorder (奔豚)

Key Symptoms: Can treat:
1. Drum-like abdominal distention, lack of urination or bowel movements, irritability and vomiting immediately after eating
2. Cold-type bulging disorders
3. Running Piglet Disorder with Periumbilical palpitations followed by an upsurge of Qi from the abdomen to the sternum.
Secondary Symptoms: Yin-type agitation, restless legs, cold limbs, cold abdomen, focal distention in the epigastrium

Tongue: White coat
Pulse: Tight
Abdomen: Distended and cold

Ingredients

Ze Xie

Pinyin: Dang Gui Chinese: 當歸 Pharmaceutical: Radix Angelicae sinensis Taxonomy: Angelica sinensis English: Chinese Angelica Root / Tang-Kuei / Dong Quai Root
Tastes: Sweet, Pungent, Warm Meridians Entered: Heart and Liver
Actions & Indications: Tonifies the Blood and regulates the menses Blood Deficiency, especially when affecting the Heart and Liver with pale, ashen complexion, lusterless nails, tinnitus, blurred vision and palpitations Blood Deficiency associated irregular menstruation, amenorrhea and dysmenorrhea Invigorates and harmonizes the Blood and disperses Cold (stops pain due to Blood Stasis) Blood Stasis causing abdominal pain and carbuncles and pain due to Blood Stasis from traumatic injury, especially when accompanied by Deficiency Cold Postpartum menstruation Pregnancy (use with caution) Blood Deficiency with chronic Wind-Damp-Bi Moistens the Intestines and unblocks the bowels Dry Intestines due to Blood Deficiency Reduces swelling, expels pus, generates flesh and alleviates pain Sores and abscess (Chuang Yung), internally and topically Stops coughing and treats dyspnea Used adjunctively for coughing Tonifies the Blood while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015)
Standard Dosage: 6-12g in decoction. Cautions: It is contraindicated in cases of Damp-Heat stagnating in the Middle, Lung Heat with Phlegm Fire, and Yin deficiency with effulgent Yang because it is warm and sweet in properties. In addition, it should be used with caution in cases of loose stool because it can moisten intestines to smooth stool. Many sources recommend using caution, avoiding or only taking under guidance of a TCM physician during pregnancy as it can cause uterine contractions. However, there are no studies supporting this and the only scientific literature seems to suggest that Z-Ligustilide has anti-spasmodic activities that alleviate dysmenorrhoea by inhibiting uterine contractions (Du et al., 2006; Dietz et al., 2016). Caution is also advised in breast cancer patients due to its oestrogen stimulating activity. This based upon Lau et al (2005) who found it may stimulate breast cancer growth in vitro, however Yue et al, (2019) demonstrated that it is not that stimulatory in breast cancer both in vitro and in vivo through a series of tests, although they suggested it should still be used with caution in estrogen receptor-positive breast cancer. Conversely, a large population study in Taiwan by Wu et al (2014) found it reduced the subsequent risk of endometrial cancer in breast cancer survivors taking tamoxifen, especially in those of reproductive age.

Sheng Jiang

Gan Jiang

Ma Huang

Pinyin: Ma Huang Chinese: 麻黄 Pharmaceutical: Herba Ephedrae Taxonomy: Ephedra sinica seu intermedia seu equisetina English: Ephedra Stem / Joint Pine / Joint Fir / Mormon Tea / Brigham Tea
Tastes: Pungent, slightly bitter, warm Meridians Entered: Lung and Bladder
Actions & Indications: Induces sweating and releases the Exterior Taiyang Stage Wind-Cold Invasion of the Lung, with anhidrosis, chills, fever, headache and a tight, floating pulse Disseminates and facilitates Lung Qi, calms wheezing and stops coughing Wind-Cold Obstructs Lung Qi Promotes urination and reduces oedema Externally generated oedema Warms and disperses Cold pathogens Wind-Cold Bi Cold extremities (Reynaud's disease) *Breaks up concretions, firmness, accumulations and gatherings (Shen Nong Ben Cao Jing)* Yin sores that are firm, deeply rooted and without a head
Standard Dosage: 1.5-9g in decoction to release the exterior, and 10-15g for the treatment of oedema. Maximum dose is 20g. Toxic dose is considered to be 30-45g but side effects and risks are possible at any dosage. Cautions: It is prohibited to be used for patients with deficient dyspnea without blockage of the lung qi and should be used with caution for patients with hypertension and insomnia because ephedrine can stimulate central nervous system and raise blood pressure. The Shang Han Lun recommends removing the nodes and decocting Ma Huang first, scooping the foam from the top of the decoction. It has been argued this is to reduce the "vexing" effects although the efficacy of this is debated and rarely done today. It should not be used in conjunction with MAOIs, central nervous system stimulants, alkaloids ergotamines and xanthines enhancing their effects by acting as a receptor level agonist. In the UK the maximum daily dose permitted without prescription is 1.8g daily in three 0.6g doses. This makes it difficult to achieve a pharmacologically active effect and must be complemented with other herbs that release the exterior and expel Wind-Cold such as Gui Zhi, Jing Jie, Fang Feng and Zi Su Ye. Huang Hua Zi (Sida cordifolia), more common in Ayurveda where it is known as Bala बला, also contains ephedrine at lower concentrations and has no legal restrictions placed on it by the UK MHRA. It is considered more cooling, Heat clearing and Damp draining without Exterior Releasing properties in Chinese medicine so best used as a substitute in Warm Diseases, especially Damp-Warm Disease, or supplemented with increased warm Exterior Releasing herbs like those described above.

Chai Hu

Pinyin: Chai Hu Chinese: 柴胡 Pharmaceutical: Radix Bupleuri Taxonomy: Bupleurum chinense (Nan Chai Hu) seu scorzoneraefolium (Bei Chai Hu) English: Hare's Ear Root / Thorowax Root
Tastes: Bitter, pungent, slightly cold Meridians Entered: Liver and Spleen
Actions & Indications: *Resolves Shaoyang* disorders and reduces fever (harmonizes the Exterior and Interior)** Shaoyang Stage with alternating chills and fever, a bitter taste,dizziness, tinnitus, flank pain, irritability, vomiting and a stifling sensation in the chest Deficiency Heat (auxiliary) Gallbladder Fire The Shen Nong Ben Cao Jing says "It weeds out the stale to bring forth the new." Spreads Liver Qi and relieves Stagnation Liver Qi Stagnation with dizziness, vertigo, chest and flank pain, emotional instability and menstrual problems Disharmony between the Liver and Spleen with epigastric and flank pain, a stifling sensation in the chest, abdominal bloating, nausea and indigestion Liver/Gallbladder Disharmony The Shen Nong Ben Cao Jing says "It mainly treats bound qi in the heart, abdomen, intestines, and stomach, food stagnation, cold and heat, and evil qi." Raises Yang Qi (specifically the Clear Qi of the Stomach and Gallbladder) Spleen and Stomach Yang Deficiency, Qi collapse (prolapse) with hemorrhoids, vaginal discharge, bleeding or exhaustion Disperses Wind-Heat and resolves Phlegm and congestion Wind-Heat *Guides herbs to the Shaoyang* aspects of the head** Shaoyang headaches Releases the Exterior and Drives Out Snakes Relieves the symptoms of Gu Sydnrome while suppressing parasites (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015) Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light, brighten the eyes and boost the Essence. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
Standard Dosage: Up to 3g to raise sinking Qi, 6-9g to relieve Liver Qi stagnation, 12-24g to release the exterior. Cautions: Anyone who has syndromes of yin deficiency with yang hyperactivity, stirring of liver wind, yin deficiency with effulgent fire and qi going upward adversely, this herb should be used with cautions.

15g

15g

15g

15g

15g

15g

Pinyin: Huang Qi Chinese: 黄芪 Pharmaceutical: Radix Astragali Taxonomy: Astragalus membranaceus English: Astragalus Root / Mongolian Milkvetch Root
Tastes: Sweet, warm Meridians Entered: Lung and Spleen
Actions & Indications: Tonifies Qi and Blood Postpartum fever due to Qi and Blood Deficiency Recovery from severe Blood loss Strengthens the Spleen and raises the Yang Qi of the Spleen and Stomach Spleen Qi Deficiency with anorexia, fatigue and diarrhoea Central Qi Sinking (prolapse) Lung and Spleen Qi Deficiency Qi Failing to contain Blood Qi and Blood Deficiency Fever from Qi Deficiency Tonifies Wei Qi, stabilizes the Exterior and tonifies the Lungs (aids circulation of moisture downward from the face) Wei Qi Deficiency with spontaneous sweating Lung Qi Deficiency with frequent colds or shortness of breath Excessive sweating associated with Qi, Yang or Yin Deficiency Dampness in the head Promotes urination and reduces oedema Spleen Deficiency oedema or superficial oedema with reduced urination (It can be used as a stand-alone herb for this) Promotes the discharge of pus, generates flesh and expels toxins Chronic ulcerations and sores that either have trouble forming pus or have formed pus but are not draining well Generates Body Fluids Wasting and thirsting disorder (消渴 Xiao Ke) Bi Syndrome with numbness of the limbs and paralysis Relieves numbness and pain Numbness and pain due to Deficiency of Qi and Blood Tonifies the Qi while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015)
Standard Dosage: 10-15g in decoction. Large dosages of up to 30g can be used for severe debilitation, Blood deficiency or unhealing sores (e.g. Dang Gui Bu Xue Tang). Cautions: It is contraindicated in cases of exterior excess with excessive pathogen, internal obstruction, yin deficiency with yang hyperactivity, early stage of sores and ulcers of excessive pathogen and no deficiency of heathy qi, because it can tonify qi, raise yang and strengthen superficial.Caution with patients on immunosuppressents due to its immune modulating effects.

Wu Zhu Yu

15g

Hou Po

15g

Huang Bai

15g

Cao Dou Kou

15g

Subsitutions:
In the UK Chuan Wu must be substituted with other Cold expelling herbs depending on the presentation. Xiao Hui Xiang could help with all three presentations. For more specific substitutions, Ding Xiang could help with distention and vomiting, Wu Yao could help with bulging disorders, and for Running Piglet Disorder adding Chaun Lian Zi would include most of Ben Tun Wan (Running Piglet Pill).

Preparation: Grind the ingredients into a fine powder and take warm as a draft in 3-9g doses before meals

Actions: Warms the Middle Jiao, moves the Qi, opens areas of constraint and reduces fullness

Contraindications: Damp-Heat

Notes:
Similar to Zhong Man Fen Xiao Wan, this appears to be a combination of multiple formulas. Some similar, older or contemporary formulas that may have influenced it include:

Hou Po Wen Zhong Tang (an earlier formula of Li Gao)
Qing Pi Tang
Gan Jiang Ren Shen Ban Xia Wan
Ban Xia Hou Po Tang
Wu Zhu Yu Tang

Research Links:

American Dragon

TCMWiki

Journal of Chinese Medicine

National Resource Centre for Chinese Materia Medica, China

TCM-ID Integrated Database, East China Normal University

TCM-ID Information Database, National University of Singapore

Pubmed

Science Direct

Google Scholar

Bai Du (Chinese)

A+ Medical Encyclopedia (Chinese)

Reference Notes: (click to display)

These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.

Herb Formulas Notebook

中 滿 分 消 湯  Zhong Man Fen Xiao Tang

Separate and Reduce Fullness in the Middle Decoction