Ling Gui Zhu Gan Tang – how we think about formulas

Ling Gui Zhu Gan Tang   苓桂术甘汤   Poria, Cinnamon Twig, Atractylodes Macrocephalae and Licorice Decoction

Discussion:
This formula was first mentioned in the Shang Han Lun, or Discussion of Cold Induced Disorders.

Original Citations:
“When, in cold damage, after vomiting or precipitation, [there is] counterflow fullness below the heart, the qi4 surges upward to the chest, [the person experiences] dizzy head upon standing, and the pulse is sunken and tight, ([if] sweating is promoted, the channels will be stirred and there will be quivering and trembling) then Fu Ling Gui Zhi Bai Zhu Gan Cao Tang (Poria (Hoelen), Cinnamon Twig, Ovate Atractylodes, and Licorice Decoction) governs.” (Shang Han Lun, Line 67)   

“[When there is] phlegm rheum below the heart, propping fullness in the chest and rib-side, and dizzy vision, Fu Ling Gui Zhi Bai Zhu Gan Cao Tang (Poria (Hoelen), Cinnamon Twig, Ovate Atractylodes, and Licorice Decoction) governs.” (Jin Gui Yao Le, Chapter 12, Line 16)

“When [there is] disease with phlegm-rheum, [one] should use warm medicinals [in order] to harmonize.” (Jin Gui Yao Le, Chapter 12, Line 10)

Commentary:
“Phlegm rheum is a yin evil. It has form and when formed evil obstructs a vacuous [middle burner] there is fullness. When yin [evils] mask yang there is dizziness. Fu Ling Gui Zhi Bai Zhu Gan Cao Tang (Poria (Hoelen), Cinnamon Twig, Ovate Atractylodes, and Licorice Decoction) warms the center and expels dampness; it is an excellent formula for treating phlegm rheum. It is what is referred to as warm medicinals. Phlegm rheum is a bound evil; warming it makes it easier to dissipate. The interior [in this case] belongs to the spleen-stomach; warming it allows for movement.” (Core Scholarship of Essential Prescriptions from the Golden Coffer, You Zai-Jing)

“In this [pattern] the phlegm rheum is in the stomach. It obstructs so there is glomus. This [may affect] the chest and rib sides. In extreme [cases] causing propping fullness so that movement of the qi above and below is inhibited. The qi of the clear yang is blocked; thus, there is dizziness. Although this is phlegm rheum evil, it has not left the stomach. The disease qi invades, we already know this. [The pattern] is governed by Fu Ling Gui Zhi Bai Zhu Gan Cao Tang (Poria (Hoelen), Cinnamon Twig, Ovate Atractylodes, and Licorice Decoction). This is the first method: dry earth to upbear yang, abduct water to supplement the stomach, transform phlegm, and expel rheum. When the stomach is cold, it engenders phlegm; when the stomach is warm, it disperses phlegm. When the spleen is damp, rheum collects. When the stomach is dry, rheum is dispelled.” (The Original Meaning of Essential Prescriptions from the Golden Coffer, Wei Li-Tong)

Discussion of Ingredients:
Fu ling strengthens the spleen and drains damp, thereby transforming congested fluids and correcting the fluid dynamic
Gui zhi warms the yang and facilitates the transformation function of qi, which also helps in correcting rebellious qi and directing it downward
Bai zhu strengthens the transformation and transportation functions of the spleen
Zhi gan cao supplements the qi of the middle jiao