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.
