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Boli Zhou
Abstract: This article discusses Zhang Zhongjin’s “Feng Yin Tang” (Wind Drawing Decoction), which is characterized by the prominent use of six types of stone medicines. Although it includes some warming herbs, it primarily emphasizes cold and cool herbs. This decoction is designed to treat internal wind-heat conditions and aims to firmly suppress and submerge the yang, clear heat, and eliminate phlegm. It laid the foundation for the development of formulas that emphasize the calming of internal wind in later generations. It remains an effective prescription for treating contemporary conditions such as seizures and wind-stroke caused by heat.
The Jin Gui Yao Lue-Chapter 5 prescribes the Wind Drawing Decoction for treating a condition with fever, twitching in the extremities, violent seizures, tugging and slackening, epilepsy, and paralysis.
The basic composition of this is:
Four liang of Da Huang (Rhubarb)
Four liang of Long Gu (Fossilized Bone)
Four liang of Gan Jiang (Dried Ginger)
Two liang of Mu Li (Oyster Shell)
Three liang of Gui Zhi (Cassia Twig)
Two liang of Gan Cao (Licorice Root)
Six liang each of Chi Shi Zhi (Halloysitum Rubrum), Bai Shi Zhi (Kaolinr), Zi Shi Ying ( Fluorite), Han Shui Shi (Calcite), Shi Gao (Gypsum), and Hua Shi (Talcum)
All these ingredients are ground into a fine powder, mixed with honey to form pills. Each pill weighs nine grams. Take one pill in the morning and one in the evening, or use the formula as a decoction. The total amount of the formula is 55 liang, with 42 liang of mineral substances.
Wind stroke may be categorized as cold and hot patterns. For hot patterns, Feng Yin Tang is employed.
When wind arises from the extremities, it causes hemiplegia. When wind affects the head, it leads to dizziness, vertigo, blurry vision, and numbness. If wind, carrying yang energy, surges upward, the body’s qi and blood simultaneously rush into the brain. This sudden rush may cause a sudden loss of consciousness, with phlegm fluids rushing upward leading to death. When hot blood surges into the brain and ruptures the meninges, this is referred to in Western medicine as a cerebral hemorrhage. If blood moves counterflow, it can disrupt the various vessels throughout the body, leading to conditions like infantile convulsions. These conditions typically it is caused by the presence of hot phlegm in the chest, and when external wind combines with this hot phlegm, it can force hot blood upward into the brain, causing a surge akin to wind-driven water in a storm.
Feng Yin Tang is discussed in relation to the pathogenesis and treatment principles for conditions where there is repletion of internal, internal heat is engendered, and there is hyperactivity of the yang of the five viscera. Due to the invasion of wind-heat internally or unrestrained extreme anger, an excessive accumulation of turbid qi and intense internal heat can cause the blood to become hot and surge upwards, leading to symptoms such as facial redness, red eyes, and a state of delirium. The stagnant circulation of Qi and blood in the four limbs can result in paralysis and an inability to move. The excess heat injures the Yin and blood, leading to the inability to nourish the tendons and vessels, which can cause convulsions. As the heat accumulates, it can transform body fluids into phlegm, contributing to symptoms like convulsions, sudden loss of consciousness, and epilepsy. In cases of diseases related to excessive internal heat in the five Zang organs leading to conditions such as stroke, paralysis, epilepsy, and pediatric convulsions, Feng Yin Tang is an appropriate treatment.
Why is it named “Feng Yin Tang”? Yu Jiayan explains: “There is righteous Qi drawing in pathogenic factors, but the right path is not followed. Adults will suffer from internal heat caused by wind, while children will suffer from sudden seizures, convulsions, which occur several times a day, so the prescription is named after Feng Yin. Feng Yin Tang treats wind invading the interior of the body. It can help clear and cool the excessive heat, guiding the inner fire to subside.”
The explanation of the prescription
Wang Renan said:“Feng Yin Tang uses Da Huang as the chief medicinal, used to drain heat, not to open up stagnation. This, along with Xie Xin Tang, treats vomiting blood for the same reason, an expedient referred to as ”snatching the fire from under the cauldron“. This formula primarily consists of six types of stone herbs, most of which are fierce and cold in nature. Gan Cao warms and supplements the spleen and stomach, it moderates other cold or cooling herbs by counteracting their coldness with its warmth and by controlling their astringency. Even though it is used alongside pungent, hot herbs like Gan Jiang and Gui Zhi, when combined with Da Huang, Shi Gao, Shi Gao and the rest, the overall herbal properties are balanced, with an emphasis on clearing heat and suppressing yang. This prescription is specifically used to treat conditions where internal heat generates wind and cases where qi and fire are ascending. It is a potent remedy for clearing heat and reining in excessive upward movement of the yang, especially in cases where heat has damaged yin and caused turmoil in the body (a condition of deficiency). The combination of Long Gu and Mu Li helps to calm and restrain excessive upward yang energy, as the heart and kidneys mutually interact. This calms the shen and stabilizes the liver and kidneys, controlling the rushing upwards of the yang to the brain. Additionally, Mu Li has the ability to help dispel phlegm. Overall, this formula can address a variety of conditions resulting from imbalances involving qi, heat, wind, phlegm, blood, and stagnation in cases of deficiency.
Zhang Xichun believed that the Feng Yin Tang serves to clear heat, reduce excessive fire, calm the spirit, and relieve wind. He emphasizes the use of six mineral-based substances to anchor and settle, including Hua Shi, Shi Gao, and the rest. These minerals are combined with Long Gu and Mu Li calm the spirit, and effectively control the surging of yang. When used in conjunction with Gui Zhi, it helps balance liver qi, preventing it from rising excessively, which allows blood to gradually flow downward. Da Huang, with its strong downward action, is particularly effective in guiding the upward-moving blood downward, and when combined with Gui Zhi, it facilitates the downward flow of blood, promoting the circulation of blood vessels. This combination is key in reducing upward reversal and draining the excess heat, thereby addressing conditions where heat leads to seizures. The use of Gan Jiang, when prepared appropriately, can help stop the upward surge of blood in the brain.
This prescription can be adjusted according to the specific conditions of the illness:
1. If there is an excess of wind pathogens internally, then internal heat is engendered and the yang of the five viscera becomes out of place, and it moves inappropriately into the heart, so additional Gui Zhi and Gan Cao is used. The reason for using Gui Zhi is that it can expel pathogenic wind, which is the original purpose of Gui Zhi Tang. However, in the context of the Feng Yin Tang formula, Gui Zhi Tang primarily targets the expulsion of pathogenic wind that affects the muscle layer, which is based on the assumption that the nutritive Qi is not deficient. If the nutritive Qi is originally deficient, and the Yang Qi is rising excessively, with the upward surging of rebellious Qi, merely boosting the middle burner without fortifying its defenses may not be sufficient to control the rebellion. In such cases, phlegm and hot blood might rush into the brain temporarily. When there’s excessive sweating, palpitations below the heart, and a desire for pressure, Gui Zhi Gan Cao Tang is the preferred choice. If there are palpitations below the navel resembling a racing piglet, Ling Gui Gan Cao Tang is administered to prevent the condition from invading the middle-epigastrium.
The other ingredients used in the prescription, such as the heavy mineral substances, primarily serve to clear and cool, stabilizing the vital energy of the various organs and blood vessels, preventing them from being affected by external wind. Hence, Gui Zhi, Gan Cao, Long Gu, and Mu Li are the main components, with their specific roles in addressing the condition: Gui Zhi, Gan Cao, and Long Gu work together to promote the circulation of yang energy, calm the spirit, and consolidate the liver and kidney functions, controlling the upward surging of yang energy and preventing it from harming the spleen. Da Huang is used to expel wind, dampness, and excess heat. It plays a crucial role in cleansing the body from these pathogenic factors and is considered the main component of the formula. Gan Jiang and Gan Cao are used to address and counteract imbalances due to the cold ingredients effects on the body. Hua Shi is used to facilitate the flow of fluids and promote the circulation of yang energy. Shi Gao helps clear heat. Chi Shi Zhi and Bai Shi Zhi work to balance the earth element, addressing dampness. Mu Li and Han Shui Shi primarily help with water metabolism and balance yang energy. 〖JP2〗Zi Shi Ying helps to support the spirit of the heart. This prescription is suitable for both adults and children suffering from conditions related to wind disorders and seizures.If the nourishment of the heart and kidneys is insufficient, then Huang Lian Ejiao Tang is more appropriate. It addresses the root of the problem by nourishing the Kidney and Heart systems. If there is lingering heat, deficiency with exhaustion, and signs resembling weakness, then Zhu Ye Shi Gao Tang can be used to clear and nourish the body.
2. The combination of Da Huang, Shi Gao, Mu Li, and Han Shui Shi primarily serves to clear heat, control excessive upward movement of the yang, and address the generation of wind and heat internally. However, there’s a concern that the excessive coldness of the formula may harm the stomach Qi, therefore, Gan Jiang and Gan Cao can be used to warm the spleen and stomach, harmonize and replenish qi, and restrain the coldness of various minerals.
Among the minerals used, Chi Shi Zhi and Bai Shi Zhi are particularly effective in treating cold and damp conditions causing diarrhea. Chi Shi Zhi is especially important as it addresses diarrhea due to dampness and has a distinctive role in stopping diarrhea. For cases of Wind-Heat Cold-Damp Diarrhea, Yu Yu Liang Tang is used. For diarrhea with a Cold-Damp pattern, Tao Hua Tang is employed. Chi Shi Zhi is a key ingredient, and its primary function is to stop diarrhea.
The core of the Feng Yin Tang prescription is addressing strong internal wind in combination with heat, resulting in symptoms like numbness, dizziness, seizures, and muscle spasms in the extremities. The unique feature of this prescription is the significant use of Da Huang as the principal herb and the combination with various mineral-based ingredients, along with Gui Zhi and Gan Cao to regulate yang and nourish the heart and kidneys.
Analyzing the cause and effect of this prescription, it’s evident that it starts with the wind as the initial cause, which triggers the internal heat factor. This, in turn, leads to the emergence of various factors such as qi, fire, blood, deficiency, and stasis. This interplay of causes and effects makes the condition complex and challenging to diagnose.
When the cause of the illness is understood, along with the pathological mechanisms at play, the multiple causes and multiple effects can be addressed effectively using a single prescription, thus resolving the complex condition.
Zhang Xichun formulated Jian Ling Tang (Construct the Water-Jar Decoction), which significantly utilizes Zhu Sha, Long Gu, and Mu Lil, and at times, adds Shi Gao. This cleverly follows the principles of the Feng Yin Tang.
The Jian Ling Tang prescription uses unprepared Shan Yao, unprepared Niu Xi, unprepared Zhu Sha, unprepared Long Gu, unprepared Mu Li, Sheng Di Huang, Hang Shao, and Bai Zi Ren. This selection of herbs is pure and uncomplicated, providing a more stable approach compared to the original prescription. With appropriate modifications, Jian Ling Tang can effectively treat conditions related to Liver Wind, Liver Fire agitation leading to high blood pressure, strokes, and cerebral congestion. For cases of excessive Liver Fire, Da Huang is still used to great effect.
While the Jian Ling Tang appears to be a more cautious and balanced approach compared to the Feng Yin Tang, it may indeed not be as potent in terms of its herbal composition. However, it’s essential to emphasize that the choice of the right prescription depends on the specific clinical presentation and the overall condition of the patient. In traditional Chinese medicine, the skill lies in diagnosing the intricate interplay of various factors, identifying the root cause of the illness, and selecting or modifying the herbal prescription accordingly. In clinical practice, after a comprehensive and accurate assessment of the patient’s symptoms and condition, it’s possible to precisely pinpoint the pathological mechanisms at play and adjust the herbal prescription accordingly. By doing so, the modified Feng Yin Tang can potentially surpass the original formula in terms of its effectiveness, and it can even surpass Jian Ling Tang. The key is to tailor the treatment to the individual patient, ensuring the best possible outcomes.
Feng Yin Tang case:
Luo, male, 15 years old, a third-year junior high school student.
First diagnosis on August 6, 1992. The patient had been suffering from epilepsy for 5 years, which was caused by being frightened when I saw two snakes entangled. The condition initially began with seizures occurring every four months, but subsequently, it escalated to every two months. He often lost his temper, and had headaches, dizziness, excessive phlegm, excessive sweating, distention in the right rib side, abdominal fullness in the epigastric area, and variable bowel movements which alternated between constipation and diarrhea. The initial attacks were frequent in March, with one attack at every 3-4days. Each attack occurred over half an hour, where the patient became unconscious. Before the attack, he was briefly dizzy, and the upper body was hot and sweaty. Then the right fingers became numb and twitched, and soon he screamed. The whole body spasmed, and he produced yellowish phlegm in excess, He exhibited labored and heavy breathing, a bluish face, and his tongue protruded. His tongue coating is slightly yellow, and his pulse is slippery in both wrist positions.
This case appears to be a result of internal heat and was triggered by a frightening experience, over time causing disruptions in the functioning of multiple organ systems. It involves various pathological factors, including wind, qi, and phlegm, affecting the liver, lungs, spleen, stomach, intestines, and brain.
Diagnosis: Epilepsy.
Pattern Identification: Damp-heat stagnation with phlegm-heat rising.
Treatment Principles: Clear heat, eliminate phlegm, and open the orifices.
Prescription:20 grams each of Da Huang, Gan Jiang, and Long Gu, 25 grams each of Gui Zhi, Gan Cao, and Mu Li, 15 grams of Han Shui Shi, 30 grams each of Hua Shi, Chi Shi Zhi, Bai Shi Zhi, Zi Shi Ying, and Shi Gao, 10 grams of Tian Ma, and 15 grams of Jiang Can. 20 grams of Bai Ji Li, 20 grams of Fu Ling. Instructions for Use: Boil the herbs in water and take the decoction. After taking the medicine, the patient experienced diarrhea 6-9 times a day for the course of 12 doses. After that, the seizures gradually decreased, occurring every 12-15 days.
As a student, it was inconvenient for him to take the medicine as a decoction. Forty five grams of Hu Po and 45 grams of Ji Nei Jin were added and it was ground into a powder to make honey pills. Each pill is 6 grams, one pill in the morning, at noon and in the evening. After one round of pills, the seizures stopped, and the pills were then continued without further seizures.
About the Author:
Boli Zhou: Doctor of Chinese medicine Ren Shou County, Meishan City, Anhui Province.
論風引湯
周伯禮
摘要：本文討論了張仲景的風引湯，其特點是重用六種石藥，雖有溫藥，尤以寒涼為主，主治熱因內風，意在重鎮潛陽，清熱祛痰。 是後世醫家創立重鎮息風方劑的基礎。 仍是當今治療因熱所致癲癇等中風證的良方。
《金匱要略·中風歷節病脈證並治第五》載風引湯，治療發熱，手足抽搐，驚癎，瘛瘲，癲癇，癱瘓。
药方組成：
大黃四兩，龍骨四兩，乾薑四兩，牡蠣二兩，桂枝三兩，甘草二兩，赤石脂、白石脂、紫石英、寒水石、石膏、滑石各六兩。 共為細末，煉蜜為丸，每丸九公克， 早晚各一丸。 或煎服 （總量55兩，礦石藥佔42兩）。
中風分寒證、熱證兩型，熱證用風引湯。
風起於四末則為偏中風，風中於頭則為眩暈，頭暈眼花，麻木。
若風陽浮衝於上則一身之氣血，一時並（迸）入於腦，故有卒然暈倒，痰涎上湧而死。 熱血菀於腦而腦膜為之暴裂者，西醫叫腦溢血。血逆行於上，則百脈為之牽掣，小兒所以病瘈遊戲者，亦由於此。 蓋此類病證，胸中先有熱痰，外風引熱痰則熱血沖上入於腦，勢如風起水湧一般。
風引湯論述風邪內盛，火熱內生，五臟陽亢病風的辨證論治。 由於風熱內侵，或盛怒不止，髒氣亢甚，血熱迸心，上逆於頭，故面紅、目赤、神誌昏迷。 氣血不行於四肢，故癱瘓不能運動。 熱傷陰血，無法滋養筋脈，故抽搐。 熱盛則煉液成痰，故見驚風癲癇。 凡是五臟火熱熾熱，血熱上升，引起中風癱瘓、癲癇、小兒驚風、瘈瘲等病均宜用風引湯。
因何命名風引湯? 喻嘉言雲：有正氣引邪，喎僻不遂，大人風引內熱發病，小兒則發驚癎瘈瘲，日數發，故立方即以風引名之。 風引湯治入髒之風，游刃有餘，可清涼除熱，引火潛陽。
方解
汪讱庵說：「風引湯用大黃為君，用以洩熱，非以通滯，此與瀉心湯治吐血同理，所謂釜底抽薪也」。 方用六味石藥，居其大半，屬猛劑寒涼之品；甘草溫補脾胃，監製它藥寒涼以熱監寒，以澀駕馭，雖有乾薑、桂枝之辛熱，而與大黃、石膏、寒水石、滑石並用，藥性混合，清熱潛陽，仍以涼論。 專治內熱生風（風、熱），氣火上升之病（火），重鎮清熱，收攝浮陽（熱傷陰而髒氣上亢：虛）。 龍白二味收攝浮陽，心腎相交，鎮驚安神，固斂肝腎鎮浮陽之沖腦，而牡蠣又有達痰下行之力（痰）。 合計病之多因有：氣、熱（火）、風、痰、血、瘀，虛。
張錫純認為：風引湯清熱降火，鎮驚息風，“方以六種石藥下沉為主”，滑石、石膏、寒水石、紫石英、赤石脂、白石脂而合之龍骨、牡蠣與紫石英同用，鎮靜安神，善斂沖氣；與桂枝同用，善平肝氣，肝沖之氣不上乾，則血之上充者自能徐徐下降。 大黃性尤下降，原能引逆上之血使之下行，大黃配桂枝引血下行，通行血脈，降逆瀉火，瀉血分實熱，為除熱致癱癇的主藥。 用乾薑炮用能止腦中上溢之血。
此方根據病情，君藥可以變動：
1.風邪內盛，則火熱內生，五臟亢甚，迸歸入心，所以用桂枝、甘草者，桂枝湯方治原所以祛邪風，而於本方風引之義，蓋桂枝湯發脾氣而出之肌理，原為營氣不虛者而設，若營氣本虛，陽氣張發於上，沖氣被吸引而上逆，非扶中土而厚其堤防，不足以製衝逆，而痰與熱血將一時迸入於腦，此即發汗過多，心下悸欲得按，主以桂枝甘草湯。 臍下悸欲作奔豚，主以苓桂甘棗湯，欲其不能寓中脘而上冒也。
其餘所用寒水石、滑石、紫石英、石膏，不過清涼重鎮，使諸藏百脈之氣不受外風牽引而已。 故以桂甘龍白通陽氣安心腎，為君；然厥陰風木與少陽相火同居，火發必風生，風生必挾木勢侮其脾土，故脾氣不行，聚液成痰，流註四末，因成癱瘓，故用大黃以蕩滌風火濕熱之邪，為臣；遂用砲姜、甘草之止而不行者以補之為反佐；又取滑石以利竅通陽、石膏清金以伐其木，赤白石脂，厚土以除其濕，牡蠣同寒水石濟水之主而鎮陽光，以助腎水之陰；紫石英以補心神之虛，為使。 故大人小兒風引驚癇，皆主之。 若補心腎不及者宜黃連阿膠湯，從少陰之本以救之；餘熱不除，虛羈少氣，近於痿證者，以竹葉石膏湯清補之。
2.以大黃、石膏、牡蠣、寒水石諸寒藥為君者，重鎮清熱、收攝浮陽，因時令熱風之製，恐寒涼太過，致傷胃氣，故用乾薑、甘草溫暖脾胃，和中益氣，且佐諸石之寒。
方中惟赤石脂、白石脂二味治寒濕下利，頗有特效。 傷寒利在下焦者用禹餘糧湯，寒濕下利者用桃花湯。赤石脂並為要藥，其功在止澀。
風引湯核心：風+熱+麻木暈花+手足抽搐+癲癇。 配伍特色：重用大黃為君，配伍石藥，用桂甘龍白通陽氣且安心腎。
分析此方之因果可知：先為一因“風”，引動體內的“熱因”，再生“變數：氣、火、血、虛、 瘀”，這就是“因果互擾”產生了“擾 因」使病情複雜而疑難。 病因即明，病機所悟，則「多因多果」以一方同絞而除。
張錫純擬之建瓴湯，重用赭石、龍骨、牡蠣，且有加石膏之時，實巧師風引湯之義。 建瓴湯方用生懷山藥、懷牛膝、生赭石、生龍骨、生牡蠣、生地黃、生杭芍、柏子仁，用藥清純不雜，較之原方，更為穩妥。 以建瓴湯加減，治肝風上旋、肝火妄動致高血壓、中風、腦充血諸證，確有良效。 肝火熾盛者，仍用大黃，取效尤捷。
分析建瓴湯似乎比風引湯穩妥，其組方用藥不及風引湯之峻效。 若在全面準確收集臨床症狀資料後，提掣病機，精準掌握藥物功效等基礎之上，將風引湯在多因分析、準確加味之後，可勝原方風引湯，更可勝建瓴湯！
風引湯醫案：
羅xx，男，15歲，國中三年級學生。
1992年8月6日初診。 患癲癇已5年，由見兩蛇絞纏受驚後引起。 患病之初，每4個月發作一次，隔年每2月發作一次，常發脾氣，頭痛頭昏，痰多，頭後多汗，右脅脹，脘腹脹滿，大便時乾時稀， 今年3月初始發作頻繁，3~4日發作一次，每次發作半小時以內，昏不知人，發作前頭短暫暈眩，先現上身熱汗，接著右手指麻，抽搐，較快悶叫一聲， 遂全身抽搐，口吐微黃痰沫、偏多，氣粗喘息，臉青吐舌，苔滑微黃，兩關脈滑。
這是素有內熱，被驚嚇引發多臟腑氣機紊亂之病，屬於一因「驚」致多果「風、氣、痰」纏身，涉及肝、肺、脾、胃、腸、腦。
辨病：癇證。
辨證：濕熱氣滯，痰熱風升。
治則：清熱滌痰開訣竅。
處方：大黃、乾薑、龍骨各20克，桂枝、甘草、牡蠣各25克，寒水石15克，滑石、赤石脂、白石脂、紫石英、石膏各30克，天麻10克，僵蠶15 克，白蒺藜20克，茯苓20g。 煎服。
服後每天洩瀉6~9次，12劑後安靜，發作逐漸變稀，12~15天發作。
學生服藥不方便，因此方有效，加琥珀45克，雞內金45克，以2劑打粉，做蜜丸，每丸6克，早中晚各一丸，服完一料丸劑後，發作停止，續服丸料，未再發作。
作者簡介:
周伯禮,中医师，安徽省眉山市，仁壽郡周禮伯診所
