Herb Board Review Formulas 3

7/29/2019 Herb Board Review Formulas 3

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Formulas that Warm

Interior Cold & TonifyHBR class 10


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Formulas that WarmInterior Cold


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Tangkuei Decoction for Frigid

Extremities (dang gui si ni

tang) C: Dang Gui, Gui Zhi Xi Xin, Bai Shao, Zhi Gan Cao, Da Zao, Mu Tong

Pattern: Cold hands and feet caused by cold in thechannels in a patient with underlying blood deficiency.

Indications: Long-standing cold hands and feet thatare both cold to the touch and feel very cold to the

patient, a pale tongue with a white coating, and a

submerged, thin pulse or pulse that is so thin that it is

almost imperceptible.


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*Regulate the Middle Pill

(li zhong wan) C: Gan Jiang D: Ren Shen A: Bai Zhu E: Zhi Gan Cao Pattern: Middle burner cold from deficiency, also known

as middle burner yang deficiency.

Indications: Diarrhea with watery stool, nausea andvomiting, no particular thirst, loss of appetite, abdominalpain, a pale tongue with a white coating, and a

submerged, thin pulse.


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CAUTIONS AND CONTRAINDICATIONS: Becausethis formula contains ingredients that warm and dry, it

should not be used for externally-contracted conditions

with fever or yin deficiency.

For sudden turmoil disorder, its use should bediscontinued once the vomiting and diarrhea have

stopped.


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*Evodia Decoction

(wu zhu yu tang) C: Wu Zhu Yu D: Sheng Jiang

A: Ren Shen E: Da Zao Pattern: Cold from deficiency of the Stomach (and

Liver)

Indications: Used for three different presentations: 1) vomiting immediately after eating, indeterminate

gnawing hunger, and acid regurgitation with or without

epigastric pain due to cold from deficiency of the

Stomach;


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2) dry heaves or spitting of clear fluids with headacheat the vertex due to cold from deficiency of the

Stomach and Liver;

3) vomiting and diarrhea with cold hands and feet, andagitation so severe that the patient wants to die due tocold attacking the middle burner.

In all cases the tongue is not red, but the tongue has awhite, slippery coating, and the pulse is thin and slowor thin and wiry.


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CAUTIONS AND CONTRAINDICATIONS: Do not usein cases of acid regurgitation or vomiting due to heat.

In cases of severe vomiting, this formula should betaken at room temperature to help prevent vomiting ofthe formula.

Possible side effects of this formula include dizziness,headache, and chest discomfort.


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Decoction (da jian zhong

tang) C: Chuan Jiao D: Gan Jiang A: Ren Shen, Yi Tang

Pattern: Weakness and deficiency of the middle burneryang (the root), and yin cold in the interior (themanifestation).

Indications: Excruciating epigastric and abdominal painto the point that the patient cannot tolerate beingtouched, a strong sensation of cold in the epigastrium,

vomiting to the point of being unable to eat, a white,

slippery tongue coating, and a thin and tight or slow and

wiry (or in especially severe cases, hidden) pulse. There

may also be borborygmus.


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CAUTIONS AND CONTRAINDICATIONS: Thisformula is contraindicated in cases with internalclumping, damp-heat, or yin and blood deficiency.


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Minor Construct the Middle

Decoction (xiao jian zhong

tang) C: Yi Tang, Gui Zhi Bai Shao, Zhi Gan Cao, Sheng Jiang, Da Zao Pattern: Spasmodic abdominal pain due to

consumptive deficiency (xu lao); Deficiency Cold ofmiddle burner.

Indications: Intermittent, spasmodic abdominal painthat responds favorably to local application of warmth

and pressure, a lusterless complexion, reduced

appetite, a pale tongue with a white coating, and athin, wiry, and moderate pulse. There may also be

low-grade fever, palpitations, irritability, cold and sore

extremities with nonspecific discomfort, and a dry

mouth and dry throat.


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*Frigid Extremities Decoction

(si ni tang) C: Fu Zi D: Gan Jiang A: Zhi Gan Cao

Pattern: Kidney yang and Spleen yang deficiencyaccompanied by an increase of internal cold.

Indications: Extremely cold extremities, aversion tocold, sleeping with the knees drawn up, a lethargic

state with a constant desire to sleep, vomiting,diarrhea with undigested food particles, abdominal

pain and cold, no thirst, a pale tongue with a white,

slippery coating, and a submerged, thin or submerged,

faint pulse.


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Formulas that Tonify


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*Four-Gentleman Decoction

(si jun zi tang) C: Ren Shen D: Bai Zhu A: Fu Ling E: Zhi Gan Cao Pattern: Spleen Qi Deficiency Indications: Pallid complexion, low and soft voice,

reduced appetite, loose stools, and weakness in the

limbs. The body of the tongue is pale, and the pulse is

thin and/or frail.


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CAUTIONS AND CONTRAINDICATIONS: The use ofthis formula for an overly prolonged period may result

in a dry mouth, thirst, and irritability.

It should not be used without modification in patientswith high fever, heat from deficiency, or a combination

of irritability, thirst, and constipation.


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MODIFICATIONS / Associated Formula #1:

Six-Gentleman Decoction (liu jun zi tang)

To Si Jun Zi Tang, add: Chen Pi, Ban Xia

Strengthens the Spleen, transforms phlegm, and stopsvomiting. For concurrent deficient Spleen qi and phlegmcharacterized by a loss of appetite, nausea or vomiting,

focal distention and a stifling sensation in the chest and

epigastrium, and often coughing of copious, thin, and white

sputum.

COMMENTS: This formula is a combination of Four-Gentlemen Decoction (si jun zi tang) with Two-Cured

Decoction (er chen tang), the primary phlegm-resolving

formula.


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Associated Formula #2:

Six-Gentleman Decoction with Aucklandia andAmomum (xiang sha liu jun zi tang)

To Si Jun Zi Tang, add: Chen Pi, Ban Xia, Sha Ren, Mu

Xiang

Strengthens the Spleen, harmonizes the Stomach, regulatesthe qi, and alleviates pain. For Spleen and Stomach qi

deficiency with damp-cold stagnating in the middle burner.

Symptoms include reduced appetite with a feeling of surfeitafter eating very little, belching, abdominal distention or

pain, and sometimes vomiting and diarrhea.


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C: Ren Shen, Bai Zhu, Fu Ling, Zhi Gan Cao (Si Jun ZiTang).

D: Shan Yao, Yi Yi Ren, Bai Bian Dou, Lian Zi

A: Sha Ren E: Jie Geng Pattern: Spleen qi deficiency leading to internally-

generated dampness.

Indications: Loose stools or diarrhea, reduced appetite,weakness of the extremities, weight loss, distention and astifling sensation in the chest and epigastrium, pallid and

wan complexion, a pale tongue with a white coating, and a

thin, moderate or deficient, moderate pulse. There may

also be vomiting.

Ginseng, Poria, & Atractylodes

Macrocephala Powder

(Shen Ling Bai Zhu San)


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*Tonify the Middle and Augment the Qi

Decoction (bu zhong yi qi tang)

C: Huang Qi D: Ren Shen, Bai Zhu, Zhi Gan Cao A: Dang Gui, Chen Pi E: Sheng Ma, Chai

Hu

Pattern: SP/ST Qi Deficiency leading to sinking of theyang.

Indications: Intermittent fever (that worsens upon exertion),

spontaneous sweating, aversion to cold, a thirst for warmbeverages, shortness of breath, laconic speech, a

tendency to curl up, weak limbs, a shiny, pale complexion,

loose and watery stools, a pale tongue with a thin, white

coating, and a flooding, deficient pulse in general, or a

deficient, rootless pulse at the middle position on the right.


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COMMENTS: The flagship formula of the TonifyEarth school. Originally indicated for Qi deficiencyfevers and now widely used for conditions involving

prolapse. May be modified to suit a variety of Qi

deficiency presentations, including those with

concurrent Liver depression Qi stagnation.

CAUTIONS AND CONTRAINDICATIONS: Thisformula is contraindicated for fever due to heat from

yin deficiency.

It should also be remembered that this formula is notindicated in all instances of prolapse, but only in those

due to qi deficiency.


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*Generate the Pulse Powder

(sheng mai san) C: Ren Shen D: Mai Men Dong

A: Wu Wei Zi Pattern: Concurrent deficiency of Lung qi and yin Indications: Chronic cough with sparse sputum that is

difficult to expectorate, shortness of breath, spontaneous

sweating, a dry mouth and tongue, a pale, red tongue with a

dry, thin coating, and a deficient, rapid or deficient, thin

pulse.


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CAUTIONS AND CONTRAINDICATIONS: This formulashould be used only with extreme caution in cases with

high fever, or in which the pathogenic influence has not

been resolved, or pathogenic influence has yet to injure

the fluids.

If it is used in cases where the external pathogenicinfluence remains in the system, it will prolong the

disease.


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Ginseng and Gecko Powder

(ren shen ge jie san) C: Ge Jie Ren Shen, Fu Ling, Sang Bai Pi, Xing Ren, Chuan Bei Mu,

Zhi Mu, Gan Cao

Pattern: Lung Qi Deficiency w/ chronic Phlegm-Heat in theLungs

Indications: Chronic coughing and wheezing, thick, yellowsputum, coughing of pus and blood, a sensation of heat andirritability in the chest, facial edema, gradual emaciation, a

purple tongue with either a thin and white or a tongue with

greasy, thin, and yellow tongue coating, and a floating,

deficient pulse, especially at the distal position.


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*Four-Substance Decoction

(si wu tang) Shu Di Huang, Bai Shao, Dang Gui, Chuan Xiong Pattern: Liver Blood Deficiency

Indications: Dizziness, blurred vision, lusterlesscomplexion and nails, generalized muscle tension,

irregular menstruation with little flow or amenorrhea,

periumbilical and lower abdominal pain, a pale tongue,

and a thin and wiry or thin and choppy pulse. Also used

for menorrhagia, hard abdominal masses with recurrent

pain, restless fetus, or lochioschesis with a firm and

painful abdomen and sporadic fever and chills.


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CAUTIONS AND CONTRAINDICATIONS:

This formula is appropriate for chronic conditionswhich are not too severe. It should not be used intreating acute, severe blood loss or other problems of

blood deficiency which include severe weakness and

labored breathing. In such cases one should heed the

adage, For exhaustion of blood, tonify the qi; a formulasuch as Tangkuei Decoction to Tonify the blood (dang

gui bu xue tang) should be used instead.

Furthermore, if this formula is used in treating patients

who have a constitutional deficiency of Spleen yang

with a poor appetite and loose stools, it should be

modified to include herbs which strengthen the middle

burner.


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MODIFICATIONS: Associated Formula #1:

Four-Substance Decoction with Safflower andPeach Pit (tao hong si wu tang)

To Si Wu Tang, add: Tao Ren, Hong Hua

Tonifies the blood, invigorates the blood and regulatesmenstruation. For concurrent blood deficiency and

blood stasis leading to a shortened menstrual cycle

with copious bleeding of dark-purple, sticky blood withor with no clots. Also used when menstruation is

accompanied by abdominal pain and distention due to

the same mechanism.

T K i d P


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Tang Kuei and Peony

Powder (dang gui shao yao

san) C: Dang Gui, Bai Shao, Chuan Xiong Fu Ling, Bai Zhu, Ze Xie Pattern: Liver-Spleen Disharmony with Blood

Deficiency and Dampness

Indications: Continuous, cramping pain in theabdomen which is not severe, urinary difficulty, andslight edema (primarily of the lower limbs). Originally

used in pregnancy.


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Peony and Licorice Decoction

(shao yao gan cao tang)

Bai Shao Yao, Gan Cao

Pattern: Spasms due to Deficiency of Yin-Blood Indications: Irritability, slight chills, spasms of the calf

muscles and lack of coating on the tongue. There

may also be cramps and abdominal pain.


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*Restore the Spleen

Decoction (gui pi tang) C: Ren Shen, Huang Qi, Bai Zhu, Zhi Gan Cao D: Long Yan Rou, Dang Gui, Suan Zao Ren, Fu Shen,

Yuan Zhi

A: Mu Xiang E: Sheng Jiang, Da Zao Pattern: SP & HT deficiency or Qi & blood deficiency due to

fatigue or over-thinking

Indications: Forgetfulness, palpitations (with or withoutanxiety), insomnia, dream-disturbed sleep, anxiety and

phobia, feverishness, withdrawal, reduced appetite, a pallid

and wan complexion, a pale tongue with a thin, white coating,

and a thin, frail pulse.


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Indications,continued: Chronic bleeding syndromesmay also be part of the presentation. Women may

experience early periods with copious, pale blood orprolonged, almost continuous periods with little flow.

COMMENTARY: This formula is basically a modifiedcombination of Si jun zi tang and Dang gui bu xue

tang.

It is used for three types of manifestations: 1) restlessHeart spirit; 2) qi and blood deficiency; and 3) the

inability of the Spleen to control the blood. All three

patterns arise from the deficiency of qi and blood.Although the formula is used in treating deficiency of

both the Heart and Spleen, it focuses primarily on the

Spleen.


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Honey-fried Licorice

Decoction (zhi gan cao tang) C: Zhi Gan Cao Ren Shen, Da Zao, Sheng Di Huang, E Jiao, Mai Men

Dong, Huo Ma Ren, Gui Zhi, Sheng Jiang Pattern: Palpitation and intermittent pulse due to Qi

and blood deficiency.

Indications: Palpitations with anxiety, irritability,insomnia, emaciation, shortness of breath,constipation, a dry mouth and throat, a pale, shiny

tongue, and a pulse which is consistently irregular,

slow-irregular, or pulse that is thin, faint, and forceless.

This is the principal formula for irregular pulses.


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Eight Treasure Decoction

(ba zhen tang) C: Ren Shen, Shu Di Huang. Bai Zhu, Fu Ling, Bai Shao, Dang Gui, Chuan Xiong, Zhi

Gan Cao, Sheng Jiang, Da Zao

Pattern: Qi and blood deficiency, due to chronic disease orexcessive blood loss.

Indications: Pallid or sallow complexion, palpitations with

anxiety that may be continuous, reduced appetite,shortness of breath, laconic speech, extremities which

become easily fatigued, light-headedness and/or vertigo, a

pale tongue with a white coating, and a pulse which is

either thin and frail or a pulse that is large, deficient, and

without strength.

*All I l i G t T if i


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*All-Inclusive Great Tonifying

Decoction (shi quan da bu

tang) C: Ren Shen, Shu Di Huang D: Bai Zhu, Fu Ling, Bai Shao, Dang Gui, Rou Gui,

Huang Qi

A: Chuan Xiong, Zhi Gan Cao E: Sheng Jiang, Da Zao Pattern: qi and blood deficiency tending toward cold Warms and tonifies the qi and blood. For qi and blood

deficiency in consumptive disorders with coughing,

reduced appetite, spermatorrhea, and weakness of the

lower extremities. This is a very commonly used formula

for qi and blood deficiency tending toward cold.


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*Six-Ingredient Pill with Rehmannia

(liu wei di huang wan)

C: Shu Di Huang D: Shan Zhu Yu, Shan Yao A: Ze Xie, Mu Dan Pi, Fu Ling

Pattern: Kidney and Liver yin deficiency Indications: Soreness and weakness in the lower

back, light-headedness, vertigo, tinnitus, decreased

hearing, night sweats, spontaneous and nocturnal

emissions, a red tongue with little coating, and a rapid,

thin pulse. The patient may also present with a variety

of other symptoms including hot palms and soles, a

chronic dry and sore throat, toothache, or wasting and

thirsting disorder.


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CAUTIONS AND CONTRAINDICATIONS: Despite itselegant design, this formula still has cloying properties

and should be used with caution in cases with

indigestion, diarrhea due to Spleen deficiency, or a

white, greasy tongue coating.


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MODIFICATIONS: Associated Formula #1:

Lycium Fruit, Chrysanthemum, and Rehmannia Pill(qi ju di huang wan)

To the original formula, add Gou Qi Zi and Ju Hua.

For dry eyes with diminished visual acuity,photophobia, tearing when exposed to drafts, or

painful eyes...The use of this formula has been

extended to include all conditions of Kidney and Liver

yin deficiency in which Liver deficiency is the

predominant aspect.


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Anemarrhena, Phellodendron, and Rehmannia Pill (zhibai di huang wan)

To the original formula, add Zhi Mu and Huang Bai.

For yin deficiency with vigorous fire, consumptive heat, orsteaming bone disorder characterized by night sweats, adry mouth and dry tongue, and a large pulse only in the rear

position.

Also for urinary difficulty and lower back pain from damp-heat in the lower burner in patients with underlying Kidneyyin deficiency.


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Associated Formula # 3.

Eight-Immortal Pill for Longevity (ba xian changshou wan) (aka Mai Wei Di Huang Wan)

to Liu Wei Di Huang Wan add Mai Men Dong, Wu WeiZi

Indicated for cough (possibly with blood), tidal fever,

night sweats due to Lung and Kidney Yin deficiency.


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Pill for Deafness that is Kind to the Left Kidney (erlong zuo ci wan)

to Liu Wei Di Huang Wan add Ci Shi, Shi Chang Pu, WuWei Zi

For continuous tinnitus, deafness, irritability, vertigo, blurry

vision, all symptoms worse at night.


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Restore the Left [Kidney]

Decoction (zuo gui yin) C: Shu Di Huang Shan Zhu Yu, Gou Qi Zi, Shan Yao, Fu Ling, Zhi Gan

Cao

Pattern: Kidney Yin Deficiency with Essence depletion Indications: Lower back soreness, spontaneous

emissions, night sweats, a dry mouth and throat, thirst

with a desire to drink, a peeled, shiny tongue, and a

thin, rapid pulse.

This formula is used for treating relatively pureconditions of deficiency with little fire


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Restore the Left [Kidney] Pill (zuo gui wan)

Shu Di Huang, Shan Zhu Yu, Gou Qi Zi, Shan Yao,Chuan Niu Xi, Tu Si Zi, Lu Jiao Jiao, Gui Ban Jiao

Nourishes the yin, tonifies the Kidneys, supplementsthe essence, and benefits the marrow. This is a

stronger version of the principal formula which is used

in more severe cases.


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C: Shu Di Huang, Gui Ban Huang Bai, Zhi Mu Pattern: Upward-rising of fire due to Liver and Kidney

yin deficiency.

Indications: Steaming bone disorder with afternoontidal fever, night sweats, spontaneous emissions,

irritability, a sensation of heat and pain in the knees

and legs which is sometimes accompanied byweakness, a red tongue with little coating, and a pulse

which is rapid and forceful in the rear position. May

also be accompanied by coughing of blood or constant

hunger.

Great Tonify the Yin Pill

(da bu yin wan)


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Linking Decoction (yi guan

jian) C: Sheng Di Huang, Gou Qi Zi Sha Shen, Mai Men Dong, Dang Gui, Jin Ling Zi Pattern: Yin deficiency of the Liver and Kidneys with

concurrent qi stagnation.

Indications: Hypochondriac and chest pain, epigastric

and abdominal distention, a dry and parched mouthand throat, acid regurgitation, a red and dry tongue,

and a thin, frail or deficient, wiry pulse.


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Two-Ultimate Pill (er zhi wan)

Nu Zhen Zi, Han Lian Cao

Pattern: Deficiency of Kidney and Liver Yin

Indications: Weakness and soreness of the lower backand knees, or even weakness and atrophy of the lower

extremities, dry and parched mouth and dry throat,

dizziness and blurred vision, insomnia and dream-

disturbed sleep, spontaneous emissions, prematuregraying or loss of hair, and a red, dry tongue.


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Seven-Treasure Special Pill for

Beautiful Whiskers (qi bao mei ran dan)

C: He Shou Wu Gou Qi Zi, Tu Si Zi, Huai Niu Xi, Fu Ling, Dang Gui, Bu

Gu Zhi, Hei Zhi Ma

Pattern: Deficiency of Kidney Yin and Liver Blood Indications: Premature graying of the hair or hair loss,

loose teeth, spontaneous and nocturnal emissions,and soreness and weakness of the lower back and

soreness and weakness of the knees.

*Kidney Qi Pill from the


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Kidney Qi Pill from the

Golden Cabinet (jin gui shen

qi wan) C: Shu Di Huang D: Shan Zhu Yu, Shan Yao, Fu Zi, Gui Zhi

A: Ze Xie, Mu Dan Pi, Fu Ling Pattern: Kidney Yang Deficiency Indications: Lower back pain, weakness of the lower

extremities, a cold sensation in the lower half of thebody, tenseness in the lower abdomen, a pale,

swollen tongue with a thin, white, and moist coating,

and an empty or frail pulse which is submerged and

faint at the proximal position.


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Indications, continued: The patient may also beirritable to the point of having difficulty lying down, and

will breathe most comfortably while leaning against

something. There is either urinary difficulty with

edema, or excessive urination, sometimes to the pointof incontinence.

CAUTIONS AND CONTRAINDICATIONS:Contraindicated in cases of yin deficiency with a dry

mouth and dry throat and a red tongue with little

coating.


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Restore the Right [Kidney]

Pill (you gui wan)

C: Fu Zi, Rou Gui, Lu Jiao Jiao Shu Di Huang, Shan Zhu Yu, Shan Yao, Gou Qi Zi, Tu

Si Zi, Du Zhong, Dang Gui

Pattern: Kidney yang deficiency with waning of the fireof the gate of vitality.

Indications: Exhaustion from long-term illness, aversionto cold, coolness of the extremities, impotence,

spermatorrhea, and aching and weakness of the lower

back and knees. There may also be infertility, loose

stools (sometimes with undigested food particles),

incontinence, and edema of the lower extremities.


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ASSOCIATED FORMULAS

Restore the Right [Kidney] Decoction (you gui yin)

Shu Di Huang, Shan Zhu Yu, Shan Yao, Gou Qi Zi, ZhiGan Cao, Du Zhong, Fu Zi, Rou Gui

Warms the Kidneys and replenishes the essence. Thisformula is slightly weaker than the principal formula.


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Two-Immortal Decoction

(er xian tang)

C: Xian Mao, Yin Yang Huo Ba Ji Tian, Huang Bai, Zhi Mu, Dang Gui Pattern: Deficiency of both Kidney yin and yang

accompanied by a flaring-up of fire from deficiency.

Indications: Symptoms of menopause includinghypertension, menstrual disturbances such as

amenorrhea, hot flushes, sweating, nervousness,

fatigue, lassitude, depression, irritability, insomnia,

palpitations, and urinary frequency. May also be usedfor other chronic disorders which present with signs

and symptoms of Kidney yin and yang deficiency and

flaring-up of fire from deficiency.

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Herb Board Review Formulas 3