Interior-warming formulas

Medicinal formulas that warm the interior and assist yáng, while dispelling cold and freeing the vessels in the treatment of interior cold patterns. They correspond to warming among the eight methods and are mainly treated with interior-warming agents.

Cold patterns are either exterior or interior patterns. Exterior cold is treated with warm acrid exterior-resolving formulas. Interior cold patterns are the target of interior-warming formulas.

Interior cold patterns are cold patterns affecting the bowels and viscera or channels and network vessels. They are characterized by cold without heat, liking for warmth and fear of cold, lassitude of spirit and cold limbs, bland taste in the mouth, absence of thirst, together with a pale tongue with white fur, and a pulse that is sunken and tight, sunken and stringlike, or sunken and slow. Cold evil damages yáng qì, and yáng vacuity gives rise to internal cold, creating a vicious circle where each aggravates the other. Cold patterns are mainly cold with differing degrees of yáng vacuity. When yáng vacuity is prominent, the pattern is considered to be one of vacuity to be treated with yáng-supplementing agents. Interior-warming formulas are based on the principle stated in the Sù Wèn (Chapter 74) that cold is treated with heat, cold excess is prevalent, it is quashed with hot acrid [agents], and when cold excess is in the internal [body], treat it with sweet and hot agents.

Interior cold can arise in any of the following ways:

• when yáng vacuity causes cold the arise from within;
• when external makes a direct strike on the interior;
• when inappropriate treatment causes exterior cold to exploit the vacuity and penetrate the interior; and
• when the patient ingests excessive quantities of cold and cool medicinals, damaging yáng qì.

In any event, the cold either arises from within or comes from without. Cold arising from within usually takes the form of vacuity cold, which is treated with hot acrid and hot sweet medicinals. Cold coming from without usually takes the form of repletion cold, which is treated with powerful acrid hot acrid medicinals, in some cases with qì-supplementing agents to the acrid and dispersing agents from damaging right qì.

Cautions

Interior-warming formulas are acid, warming, drying, and hot; hence the following points should be noted.

• True and false heat and cold have to be differentiated, so as to avoid inappropriate treatment. Interior-warming formulas should not be used for true heat and cold, otherwise they will add fat to the first with adverse consequences.
• People who constitutionally suffer from yin vacuity with internal heat or patients who have lost blood and suffered damage to yin as a consequence should not be given interior-warming formulas even if there is interior cold, since these could cause further damage to yīn or renew bleeding.
• Account should be taken of environmental factors that may affect the severity of the condition, e.g., temperatures in summer and southern regions
• In severe cases of yīn cold, hot medicinals can cause vomiting. In such cases, the dosage of hot agents should be toned down. Alternatively, cold agents like pig’s bile (Suis Bilis, 猪胆汁 zhū dǎn zhī2) or the decoction can be taken cold to prevent block and repulsion.
• If interior-warming treatment leaves the patient still suffering from cold signs, as may be the case in constitutional yang vacuity, this is likely to be due to yáng vacuity remaining after the interior cold has been treated, yáng-supplementing formulas can be given.

Subcategories

• Center-warming cold-dispelling formulas
• Yáng-returning counterflow-stemming formulas
• Channel-warming cold-dispersing formulas

Center-Warming Cold-Dispelling Formulas

Formulas that warm the center and dispel cold treat center burner yáng vacuity with cold. The spleen belongs to earth and resides in the central region; it governs movement and transformation and controls upbearing and downbearing. When there is constitutional spleen-stomach vacuity, cold arises from within. If additional contraction of external cold in the presence of spleen-stomach vacuity, signs include pain in the stomach duct and abdomen, that likes pressure and warmth, reduced eating, fatigued limbs, lack of warmth in the extremities, in some cases acid swallowing and vomiting of drool, nausea, and vomiting, bland taste in the mouth, absence of thirst, together with a tongue fur that is white glossy and a pulse that is sunken and fine or sunken and slow. Such patterns are usually due to vacuity cold and can be treated by a combination of warming and supplementing. Formulas have hot acrid interior-warming cold-dispersing agents.

Main agents

These can be complemented with agents to treat kidney vacuity, qì stagnation, cold-damp, or yīn-bleed depletion as necessary.

Representative formulas

• Center-Rectifying Pill (理中丸 lǐ zhōng wán)
• Evodia Decoction (吴茱萸汤 wú zhū yú tāng)
• Minor Center-Fortifying Decoction (小建中汤 xiǎo jiàn zhōng tāng)
• Major Center-Fortifying Decoction (大建中汤 dà jiàn zhōng tāng)

Yáng-Returning Counterflow-Stemming Formulas

Formulas that return yang and stem counterflow are used for exuberant internal yīn-cold and debilitation of kidney yáng, in severe cases giving rise to exuberant yīn repelling yáng or upcast yáng. Signs include counterflow cold of the limbs (cold extremities up to the elbows and knees), listlessness of essence-spirit, clear-grain diarrhea (undigested food in the stool), great dripping sweating, and a pulse that is faint and fine or faint and on the verge of expiration. Such conditions call for large amounts of warm and hot agents to return yáng and stem counterflow.

Main agents

For yáng collapse and qì desertion, qì-supplementing ginseng (Ginseng Radix, 人参 rén shēn) can be added. For debilitation of yáng qì, with exuberant yīn forcing yáng qì upward and repelling it outward, cold and cool agents should be added as a counteracting assistant, or else the formula should be taken cold to prevent the exuberant evil from repelling the medication.

Representative formulas:

• Counterflow Cold Decoction (四逆汤 sì nì tāng)
• Yáng-Returning Emergency Decoction (回陽救急湯 huí yáng jiù jí tāng)

Channel-Warming Cold-Dispersing Formulas

Formulas that warm the channels and disperse cold treat cold evil congealing and stagnating in the channels and vessels giving rise to blood impediment and yīn flat-abscesses. When yáng qì is insufficient and the channels and vessels contract cold, blood fails to move smoothly and the qì dynamic becomes depressed and stagnant, giving rise to reversal cold in the extremities, numbness of the limbs, and blood impediment, or in some cases yīn flat-abscesses.

Main agents

• Cinnamon twig (Cinnamomi Ramulus, 桂枝 guì zhī)
• Asarum (Asari Rhizoma et Radix, 细辛 xì xīn)
• Chinese angelica (Angelicae Sinensis Radix, 当归 dāng guī)
• White peony (Paeoniae Radix Alba, 白芍药 bái sháo yào)
• Astragalus (Astragali Radix, 黄芪 huáng qí)
• Cooked rehmannia (Rehmanniae Radix Praeparata, 熟地黄 shú dì huáng)

Representative formulas

• Astragalus and Cinnamon Twig Five Agents Decoction (黄芪桂枝五物汤 huáng qí guì zhī wǔ wù tāng)
• Astragalus and Cinnamon Twig Five Agents Decoction (黄芪桂枝五物汤 huáng qí guì zhī wǔ wù tāng)

See warming the interior and interior-warming medicinals.