First, I would like to welcome all the new subscribers to Clinical mulch, and to all those who have shared the publication with others – I really appreciate the support. I haven’t been able to put in as much work into it as I would like, for various reasons, but I figured I would post something to acknowledge the spring season that we have entered in the northern hemisphere. This is the time of wood and liver-y things, and I have done a fair few posts on the liver in times past – two examples can be found below:
This time around, let’s return to a text I have been picking at for a while, Lèi Zhèng Zhì Cái [類證治裁, Differentiation and Classification of Patterns and Treatments, 1839] by Lín Pèiqín. This book is a sort of early-modern/pre-TCM compendium of pattern diagnosis and corresponding herbal medicine prescriptions, so in many respects it looks quite familiar to people who have been through a TCM-oriented program. There is also enough that differs such that I always find it interesting to peruse. It is a very straightforward presentation and thus attractive to people like me who have very little skill in Chinese; the version I present here is hopefully readable and at least mostly correct.
I will keep the commentary spare as the text runs about 4000 words, a longer read than I usually post.
肝氣肝火肝風
Determining Treatment for Liver Qì, Liver Fire, and Liver Wind
凡上升之氣，自肝而出。肝木性升散，不受遏郁，鬱則經氣逆，為噯，為脹，為嘔吐，為暴怒脅痛，為胸滿不食，為飧泄，為㿉疝，皆肝氣橫決也。且相火附木，木鬱則化火，為吞酸脅痛，為狂，為痿，為厥，為痞，為呃噎，為失血，皆肝火沖激也。風依於木，木鬱則化風，為眩，為暈，為舌麻，為耳鳴，為痙，為痹，為類中，皆肝風震動也。
All rising of qì issues from the liver. Liver wood's nature is rising and scattering, and it will not endure hindrance and depression; depression makes the channel qì run counterflow, which causes belching, distension, vomiting, rage and ribside pain, thoracic fullness and lack of appetite, food diarrhea, prominent mounting. This is liver qì breaching horizontally.
Moreover, ministerial fire attaches to wood, so wood depression transforms into fire, which causes acid swallowing and ribside pain, mania, wilting, reversal, glomus, hiccough, and blood loss; all are liver fire fiercely surging.
Wind accords with wood, so depressed wood transforms into wind and causes dizziness, vertigo, numbness of the tongue, tinnitus, tetany, impediment, and [things in] this category; all are liver wind shaking and stirring.
故諸病多自肝來，以其犯中宮之土，剛性難馴，挾風火之威，頂巔易到，藥不可以剛燥投也。經曰：肝苦急，急食甘以緩之；肝欲散，急食辛以散之。用辛補之，酸瀉之。古聖治肝，法盡於此。夫肝主藏血，血燥則肝急。凡肝陰不足，必得腎水以滋之，血液以濡之，味取甘涼，或主辛潤，務遂其條暢之性，則鬱者舒矣。凡肝陽有餘，必需介屬以潛之，柔靜以攝之，味取酸收，或佐酸降，務清其營絡之熱，則升者伏矣。
Therefore all the many diseases that come from the liver, [come] by way of attacking the central palace of the earth [phase], with an indomitable nature that is difficult to tame; it harbors the power of wind and fire, and easily reaches the vertex, [so] one cannot throw strong drying medicinals at it. The classic says: If the liver suffers tension, then eat sweet [flavors] to relax it; the liver wants to disperse, then eat acrid [flavors] to disperse it. Use acrid to supplement, and sour to drain. When the ancients treated the liver, the method was always thus. The liver governs blood storage, if the blood dries the liver will be tense. For all insufficiency of liver yīn one must enrich kidney water, moisten blood and fluids, using sweet and cold flavors, or mainly acrid and moistening, to satisfy its smooth and orderly nature and relieve depression. If the liver has a surfeit of yáng, it is essential to introduce the type [of medicinals] that subdue it, to soften and calm so as to contain it, using sour flavors to contract, or to assist with sour descending [substances], strive to clear heat in the provisioning networks [yíng luò], to subdue the ascendant [yáng].
Comment: I mentioned before in one of the posts linked above that sour and acrid pairings appear throughout the harmonizing section of the formulary, a prominent example being bái sháo [Radix Paeoniae Alba] and chái hú [Radix Bupleuri]. Both liver yīn-blood and liver qì are needed to aid the liver to thrive by orderly reaching [條達 tiáo dá], thus both coursing and restraining elements are often necessary in treating liver disharmonies.
治肝氣，先疏其鬱，宜逍遙散。因怒動肝，小柴胡湯加山梔、青皮。噯而吐沫，代赭旋覆湯。嘔而脹滿，三因七氣湯加枳殼、木香。怒傷脅痛，生白芍、金橘皮、山梔、枳殼、鬱金汁、降香末。腸鳴飧泄，則泄木安土，人參安胃散加半夏曲。㿉疝腫硬，則導滯和肝，橘核丸加減。若氣有餘便是火，治肝火實，吞酸脅痛，左金丸、抑青丸。脅大痛引腰背，汗泄，忌辛燥耗氣劫液，宜甘酸化陰，甘草、柏子仁、杞子、棗仁、阿膠、牡蠣、木瓜、生白芍、五味子、鱉甲、金橘皮。
To treat liver qì, first course its depression, Xiāo Yáo Sǎn [Free Wanderer Powder] is appropriate.
If caused by anger stirring the liver, Xiǎo Chái Hú Tāng [Minor Bupleurum Decoction] plus shān zhī [Fructus Gardeniae], qīng pí [Pericarpium Citri Reticulatae Viride].
If there is foaming spittle, use Dài Zhě Xuán Fù Tāng [Hematite and Inula Decoction].
If there is vomiting, distension and fullness, Sān Yīn Qī Qì Tāng [Three Causes Seven Qì Decoction] adding zhǐ ké [Fructus Citri Aurantii] and mù xiāng [Radix Aucklandiae Seu Vladimiriae].
Damage from anger and ribside pain, shēng bái sháo [Radix Paeoniae Alba Cruda], jīn jú pí [Pericarpium Fortunellae], shān zhī, zhǐ ké, yù jīn zhī [Radix Curcumae Succus], jiàng xiāng mò [Lignum Dalbergiae Pulverata].
Intestinal noises and food diarrhea, discharge wood and calm earth, Rén Shēn Ān Wèi Sǎn [Ginseng Stomach-Quieting Powder] plus bàn xià qū [Massa Pinelliae Fermentata]. Prominent mounting which is swollen and hard, abduct stagnation and harmonize the liver, use modified Jú Hé Wán [Tangerine Pip Pill].
If the qì is superabundant, then there will be fire; treat liver fire repletion, with acid swallowing and ribside pain, Zuǒ Jīn Wán [Left Metal Pill] or Yì Qīng Wán [Blue-Green-Repressing Pill].
Great pain in the ribside leading to the lumbar and waist, sweat discharge, avoid acrid and drying which consume the qì and plunder the fluids, use sweet and sour to transform yīn: gān cǎo [Radix Glycyrrhizae], bǎi zǐ rén [Semen Platycadi], qǐ zǐ [Fructus Lycii], zǎo rén [Semen Zizyphi Spinosae], ē jiāo [Colla Corii Asini], mǔ lì [Concha Ostreae], mù guā [Fructus Chaenomelis], shēng bái sháo, wǔ wèi zǐ [Fructus Schisandrae], biē jiǎ [Plastrum Testudinis], jīn jú pí.
Comment: Jīn jú is the kumquat, and jīn jú pí is its peel. The fruit is listed in Wiseman and Feng (2000) as acrid sweet and warm, in the qi-rectifying category. The Běncǎo Gāngmù [本草綱目] says “It is able to move qi and open the diaphragm, stops thirst and eliminates fishy smells, the peel is particularly good to use [能行氣開膈, 止渴除腥, 尤以果皮為佳]." (金橘, n.d.). Bàn xià qū is the fermented mass of pinellia rhizome, similar to bàn xià but used in cases where there is diarrhea.
虛痛久痛必入絡，宜理營絡，旋覆花湯加當歸鬚、丹皮、延胡、桃仁。濕熱火盛，脅痛筋痿溲血，龍膽瀉肝湯。火盛狂躁，胸痞咽阻便秘，當歸龍薈丸。陰虛痿弱，虎潛丸去鎖陽。厥逆，四逆散。痞滿，半夏瀉心湯。呃噎，橘皮竹茹湯。吐衄失血，犀角地黃湯加山梔、藕汁。
Vacuity pain or chronic pain has certainly entered the networks, it is appropriate to rectify the yíng luò; use Xuán Fù Huā Tāng [Inula Flower Decoction] plus dāng guī xū [Radix Tenuis Angelicae Sinensis], dān pí [Cortex Moutan], yán hú [Rhizoma Corydalis], táo rén [Semen Persicae].
Damp heat fire effulgence, ribside pain, sinew wilting, bloody urination, use Lóng Dǎn Xiè Gān Tāng [Gentian Liver-Draining Decoction].
Fire effulgence with manic agitation, thoracic glomus, throat obstruction, constipation, Dāng Guī Lóng Huì Wán [Chinese Angelica, Gentian and Aloe Pill].
Yīn vacuity wilting and debilitation, use Hǔ Qián Wán [Hidden Tiger Pill] removing suǒ yáng [Herba Cynomorii].
For reverse flow, use Si Ni Sǎn [Counterflow Cold Powder].
Glomus and fullness, Bàn Xià Xiè Xīn Tāng [Pinellia Heart-Draining Decoction].
Hiccough and dysphagia, Jú Pí Zhú Rú Tāng [Tangerine Peel And Bamboo Shavings Decoction].
Blood loss from vomiting or nosebleed, Xī Jiǎo Dì Huáng Tāng [Rhinoceros Horn and Rehmannia Decoction] plus shān zhī and ǒu zhī [Succus Rhizomatis Nelumbinis].
至於肝陽化風，上擾清竅，則巔痛頭暈，目眩耳鳴，心悸寤煩，由營液內虛，水不涵木，火動痰升，其實無風可散，宜滋液和陽。復脈湯去薑、桂，或用熟地、白芍、杞子、茯神、棗仁、炒甘菊、霜桑葉、牡蠣、石斛、五味。其由腎虛陽浮者，宜填髓補精。阿膠、龜甲、淡菜、青鹽、牛膝、萸肉、熟地、磁石。其由土弱木乘者，宜緩肝益胃。酸棗仁湯去川芎，加人參、山藥、小麥。
As for liver yáng transforming into wind, rising to disturb the clear orifices, with vertex pain and dizzy head, visual dizziness and tinnitus, palpitations and waking with vexation, this is due to internal vacuity of provisioning and fluids, water unable to moisten wood, fire stirring with ascending phlegm; in fact there is no wind one can scatter, one must enrich fluids and harmonize yáng. Use Fù Mài Tāng [Pulse-Restorative Decoction] removing jiāng [Rhizoma Zingiberis] and guì [zhī, Ramulus Cinnamomi], or use shú dì [Radix Rehmanniae Praeparata], bái sháo, qǐ zǐ, fú shén [Poria Pararadicis], zǎo rén, fried gān jú [Flos Chrysanthemi], shuāng sāng yè [Folium Mori Praeustum], mǔ lì, shí hú [Herba Dendrobii], and wǔ wèi [zǐ].
In cases due to kidney vacuity with floating yáng, it is appropriate to replenish marrow and supplement essence. Ē jiāo, guī jiǎ [Carapax et Plastrum Testudinis], dàn cài [Caro Mytili], qīng yán [Halitum], niú xī [Radix Achyranthis Bidentatae], yú ròu [Fructus Corni], shú dì, cí shí [Magnetitum].
In cases from wood exploiting debilitated earth, one should relax the liver and boost the stomach. Use Suān Zǎo Rén Tāng [Zizyphus Seed Decoction], remove chuān xiōng [Rhizoma Chuanxiong], and add rén shēn [Radix Ginseng], shān yào [Rhizoma Dioscoreae] and xiǎo mài [Fructus Tritici].
Comments: Shuāng sāng yè is the mulberry leaf picked after the first frost, which is considered superior quality. Dàn cài is the mussel; salty and warm, it enters liver and kidney, supplements liver and kidney essence-blood, and used in cases of vacuity taxation with emaciation and bleeding [Wiseman & Brand, 2020]. Qīng yán is salty and cold, enters heart, kidney and bladder; it cools blood and brightens the eyes [Wiseman & Brand, 2020].
其因怒勞，致舌麻肢痹，筋愓肉瞤，由五志過極，陽亢陰衰，風從火出，宜柔潤熄風。河間地黃飲子去桂、附、巴戟、菖蒲。其火風上郁，頭重脘痹，宜清金肅降。杏仁、鮮菖蒲根、栝蔞、鉤藤、菊葉、薄荷。其年高水虧，風火易升，頭暈便秘，宜壯水滋燥。還少丹去杜仲、巴戟、楮實、茴香，加桑葉、黑芝麻、柏子仁、炒甘菊、茯神、牡蠣。其陽明絡虛，風火易震，食少知飢，宜填實空際。人參、山藥、炙草、牡蠣、棗仁、茯苓、白芍、南棗。大抵肝為剛臟，職司疏泄，用藥不宜剛而宜柔，不宜伐而宜和，正仿《內經》治肝之旨也。
If the cause is anger taxation, it will result in numbness of the tongue and limb impediment, jerking sinews and twitching flesh. If it is due to the five minds exceeding extremes, there will be yáng hyperactivity and yīn debilitation, and wind will follow the appearance of fire, so it is good to soften and moisten [the liver] and extinguish wind. Use [Líu] Héjiān’s Dì Huáng Yǐn Zǐ [Rehmannia Drink] removing [ròu] guì [Cortex Cinnamomi], fù [zĭ , Radix Aconiti Lateralis Praeparata], bā jǐ [tiān, Radix Morindae], chāng pú [Rhizoma Acori].
If there is fire and wind arising from depression, there will be heaviness of the head and impediment of the stomach duct; it is appropriate to clear metal, depurate and downbear. Use xìng rén [Semen Armeniacae], xiān chāng pú gēn [Radix Acori Recens], guā lóu [Fructus Trichosanthis], gōu téng [Ramulus Uncariae Cum Uncis], jú yè [Folium Chrysanthemi], bò hé [Herba Mentha].
If there is depleted water from advanced age, wind and fire will easily ascend, causing dizzy head and constipation, [one should] invigorate water and enrich dryness. Use Huán Shǎo Dān [Rejuvenation Elixir], remove dù zhòng [Cortex Eucommiae], bā jǐ, chǔ shí [Fructus Broussonetiae], and huí xiāng [Fructus Foeniculi], and add sāng yè, hēi zhī ma [Semen Sesami Nigrum], bǎi zǐ rén [Semen Platycadi], fried gān jú, fú shén, and mǔ lì.
If there is vacuity in the yángming networks, wind and fire will easily strike, with little eating but feeling hungry; it is appropriate to stuff full the empty region. Use rén shēn, shān yào, zhì [gān] cǎo, mǔ lì, zǎo rén, fú líng, bái sháo, nán zǎo [Fructus Jujubae Australis].
Generally speaking, the liver, as the unyielding viscus, is charged with coursing and discharging, when using medicinals it is inappropriate to use strong and suitable to use soft, inappropriate to use quelling and suitable to harmonize, it is correct to imitate the Nèijīng’s decree in treating the liver.
Comments: Líu Héjiān is perhaps better known today as Líu Wánsù, who we encountered a short while ago [https://clinicalmulch.substack.com/p/the-mysterious-house]. Xiān chāng pú gēn is not separately listed in any sources I have found, and it appears to me that it is likely the same as fresh acorus rhizome, which Wiseman & Brand (2020) mention as being weaker acting than the dried plant.
丹溪曰：病人自言冷氣從下而上，非真冷也。此上升之氣，自肝而出，中挾相火，自下而上。其熱為甚，自覺冷者，火極似水，積熱之甚也。陽亢陰微，故見此症。又曰：氣從左邊起，肝火也。宜左金丸。氣從臍下起，陰火也。黃柏丸、坎離丸。氣從足下起入腹，虛之極也。滋陰降火湯，外用津調附子末，塗湧泉，引熱下行。
Dānxī said: A patient may report cold qì traveling from the lower to the upper [body], but this is not true cold. This is qì ascending upward, arising from the liver, harboring ministerial fire within, that goes lower to upper. Its heat is severe, but one feels cold; the extreme of fire is similar to water, when the accumulation of heat is severe. Yáng is hyperactive and yīn is slight, so you see this symptom. He also said: if the qì arises from the left side, this is liver fire. It is good to use Zuǒ Jīn Wán. If the qì arises from below the umbilicus, this is yīn fire. Huáng Bǎi Wán [Phellodendron Pill] or Kǎn Lí Wán [Fire and Water Hexagram Pill]. If the qì arises from underneath the foot to enter the abdomen, this is extreme vacuity. Zī Yīn Jiàng Huǒ Tāng [Yīn-Enriching Fire-Downbearing Decoction], externally use saliva mixed with ground fù zǐ, spread onto KD1 [Yǒng Quán], to draw the heat downward.
The appended formulary has been edited to trim the post length. I have included references to Scheid et al. (2009), otherwise known as Formulas and Strategies, 2nd edition, for most of the prescriptions that appear here, including only the ingredients for formulas that are not found in or differ from those in that text.
附方
Appended Formulas
〔疏郁〕 逍遙散。
〔Course depression〕 Xiāo Yáo Sàn. See Scheid et al. (2009), p120.
〔因怒〕 小柴胡湯。
〔Caused by anger〕 Xiǎo Chái Hú Tāng. See Scheid et al. (2009), p104.
〔噯氣〕 代赭旋覆湯。
〔Belching〕 Dài Zhě Xuán Fù Tāng. See Scheid et al. (2009), p542.
〔嘔脹〕 三因七氣湯。
〔Vomiting and distension〕 Sān Yīn Qī Qì Tāng [This is basically the same composition as Bàn Xià Hòu Pò Tāng, Pinellia and Magnolia Decoction. See Scheid et al. p519]
〔飧泄] 人參安胃散 參（一錢） 耆（二錢） 生草 炙草（各五分） 白芍（七分） 茯苓（四分） 陳皮（三分） 黃連（二分）
〔Food diarrhea] Rén Shēn Ān Wèi Sàn: Rén shēn (1 qián); huáng qí [Radix Astragali] (2 qián) ; shēng [gān] cǎo, zhì [gān] cǎo (each 5 fēn); bái sháo (7 fēn) fú líng [Poria] (4 fēn) chén pí [Pericarpium Citri Reticulatae] (3 fēn); huáng lián [Rhizoma Coptidis] (2 fēn) .
〔㿗疝〕 橘核丸。
〔Prominent mounting〕 Jú Hé Wán. See Scheid et al. (2009), p529.
〔肝火〕 左金丸。
〔Liver fire〕 Zuǒ Jīn Wán. See Scheid et al. (2009), p205.
〔脅痛〕 抑青丸 黃連一味，以茱萸湯浸一宿為丸。
〔Ribside pain〕 Yì Qīng Wán: Huáng lián as single ingredient, soak with decoction of zhū yú [Fructus Evodiae] overnight to make pills.
〔理絡〕 旋覆花湯 旋覆花 蔥管 新絳。
〔Rectify luò〕 Xuán Fù Huā Tāng: Xuán fù huā [Flos Inulae], cōng guǎn [Allii Fistulosi], xīn xiāng [Galeri Comitis Fascea]. [Note: Xīn xiàng is the red tassel from a Qīng official’s hat, dyed red with Hóng Huā (Fl Carthami). Presumably the spaghetti-like tassel resembles the luò vessels and thus can treat them.]
〔火盛〕 龍膽瀉肝湯。
〔Fire effulgence〕 Lóng Dǎn Xiè Gān Tāng. See Scheid et al. (2009), p199.
〔狂火〕 當歸龍薈丸。
〔Mania fire〕 Dāng Guī Lóng Huì Wán. See Scheid et al. (2009), p203.
〔痿弱〕 虎潛丸。
〔Weak wilting〕 Hǔ Qián Wán. See Scheid et al. (2009), p377.
〔陽厥〕 四逆散。
〔Yáng reversal〕 Sì Nì Sàn. See Scheid et al. (2009), p116.
〔胸痞〕 半夏瀉心湯。
〔Thoracic glomus〕 Bàn Xià Xiè Xīn Tāng. See Scheid et al. (2009), p127.
〔呃逆〕 橘皮竹茹湯。
〔Hiccough〕 Jú Pí Zhú Rú Tāng. See Scheid et al. (2009), p544.
〔吐衄〕 犀角地黃湯。
〔Blood ejection〕 Xī Jiǎo Dì Huáng Tāng. See Scheid et al. (2009), p165.
〔滋液〕 復脈湯。
〔Enrich fluids〕 Fù Mài Tāng. Scheid et al. (2009), p356.
〔益胃〕 酸棗仁湯。
〔Boost the stomach〕 Suān Zǎo Rén Tāng. See Scheid et al. (2009), p462.
〔類中〕 地黃飲子 熟地 桂心 附子 蓯蓉 巴戟 遠志 萸肉 石斛 麥冬 五味 薄荷 菖蒲 茯苓。
〔Wind-like strike〕 Dì Huáng Yǐn Zǐ: shú dì, guì xīn, fù zǐ, cōng róng [Herba Cistanches], bā jǐ yuǎn zhì [Radix Polygalae], yú ròu, shí hú, mài dōng, wǔ wèi, bò hé, chāng pú, fú líng. [Note this is a different prescription from that found in Scheid et al. (2009).]
〔老人〕 還少丹。
〔Elderly people〕 Huán Shǎo Dān. See Scheid et al. (2009), p404.
〔陰火〕 黃柏丸 黃柏一味，酒炒水丸。
〔Yīn fire〕 Huáng Bǎi Wán: huáng bǎi [Cortex Phellodendri], single ingredient, wine-fried, make water pills.
〔陰火〕 坎離丸 [坎離既濟丸] 生地 熟地 山萸 牛膝 天冬 麥冬（各四兩） 白芍 五味 山藥 龜板（各三兩） 當歸 知母 黃柏（各二兩） 川芎（一兩） 蜜丸，鹽湯下。
〔Yīn fire〕 Kǎn Lí Wán: shēng dì, shú dì, shān yú, niú xī, tiān dōng [Radix Asparagi], mài dōng [Tuber Ophiopogonis] (each 4 liǎng); bái sháo, wǔ wèi, shān yào, guī bǎn (each 3 liǎng) dāng guī [Radix Angelicae Sinensis], zhī mǔ [Rhizoma Anemarrhenae], huáng bǎi (each 2 liǎng); chuān xiōng (1 liǎng); honey pills, take with hot salted water.
〔滋火〕 滋陰降火湯。
〔Enrich fire〕 Zī Yīn Jiàng Huǒ Tāng. See Scheid et al. (2009), p388.
Okay, that’s all I have for now. I appreciate everyone who reads this publication, thanks for your attention and support.
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
金橘. (n.d.). Retrieved April 11, 2025 from https://www.zysj.com.cn/zhongyaocai/jinju/index.html
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.
Scheid, V., Bensky, D., Ellis, A., & Barolet, R. (2009). Chinese herbal medicine: Formulas & strategies (2nd ed.). Eastland Press.
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.