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Interior-warming formulas
温里剂 〔溫裡劑〕 wēn lǐ jì
Medicinal formulas that warm the interior and assist yáng, while dispelling cold and freeing the vessels in the treatment of interior cold patterns.
Interior-warming formulas 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 cold is treated with heat,
and
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
zhū dǎn zhī2 (猪胆汁 Suis Bilis, pig’s bile) 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
1. 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
Main agents
Gān jiāng (干姜 Zingiberis Rhizoma, Dried ginger) Gú zhū yú (吴茱萸 Evodiae Fructus, Evodia) Guì zhī (桂枝 Cinnamomi Ramulus, Cinnamon twig)
These can be complemented with agents to treat kidney vacuity, qì stagnation, cold-damp, or yīn-bleed depletion as necessary.
Representative formulas
Lǐ zhōng wán (理中丸 Center-Rectifying Pill) Wú zhū yú tāng (吴茱萸汤 Evodia Decoction) Xiǎo jiàn zhōng tāng (小建中汤 Minor Center-Fortifying Decoction) Dà jiàn zhōng tāng (大建中汤 Major Center-Fortifying Decoction)
2. 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
Fù zǐ (附子 Aconiti Radix Lateralis Praeparata, Aconite) Gān jiāng (干姜 Zingiberis Rhizoma, Dried ginger) Ròu guì (肉桂 Cinnamomi Cortex, Cinnamon bark)
For yáng collapse and qì desertion, qì-supplementing
Representative formulas:
Sì nì tāng (四逆汤 Counterflow Cold Decoction) Huí yáng jiù jí tāng ( 回陽救急湯 Yáng-Returning Emergency Decoction)
3. 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,
Main agents
Guì zhī (桂枝 Cinnamomi Ramulus, Cinnamon twig) Xì xīn (细辛 Asari Rhizoma et Radix, Asarum) Dāng guī (当归 Angelicae Sinensis Radix, Chinese angelica) Bái sháo (白芍 Paeoniae Radix Alba, White peony) Huáng qí (黄芪 Astragali Radix, Astragalus) Shú dì huáng (熟地黄 Rehmanniae Radix Praeparata, Cooked rehmannia)
Representative formulas
Dāng guī sì nì tāng ( 当归四逆汤 Chinese Angelica Counterflow Cold Decoction)Dāng guī sì nì jiā wú zhū yú shēng jiāng tāng ( 当归四逆加吴茱萸生姜汤 Chinese Angelica Counterflow Cold Decoction Plus Evodia and Fresh Ginger)Huáng qí guì zhī wǔ wù tāng (黄芪桂枝五物汤 Astragalus and Cinnamon Twig Five Agents Decoction)
See
Interior-Warming Formulas
Center-Warming Cold-Dispersing Formulas
- Lǐ zhōng wán (理中丸 Center-Rectifying Pill)
- Fù zǐ lǐ zhōng wán (附子理中丸 Aconite Center-Rectifying Pill)
- Lǐ zhōng huà tán wán (理中化痰丸 Center-Rectifying Phlegm-Transforming Pill)
- Guì zhī rén shēn tāng (桂枝人参汤 Cinnamon Twig and Ginseng Decoction)
- Wú zhū yú tāng (吴茱萸汤 Evodia Decoction)
- Xiǎo jiàn zhōng tāng (小建中汤 Minor Center-Fortifying Decoction)
- Huáng qí jiàn zhōng tāng (黄芪建中汤 Astragalus Center-Fortifying Decoction)
- Dà jiàn zhōng tāng (大建中汤 Major Center-Fortifying Decoction)
Yáng-Returning Desertion-Stemming Formulas
- Sì nì tāng (四逆汤 Counterflow Cold Decoction)
- Sì nì jiā rén shēn tāng (四逆加人参汤 Counterflow Cold Decoction Plus Ginseng)
- Bái tōng tāng (白通汤 Scallion Yáng-Freeing Decoction)
- Tōng mài sì nì tāng (通脉四逆汤 Vessel-Freeing Counterflow Cold Decoction)
- Shēn fù tāng1 (参附汤1 Ginseng and Aconite Decoction1)
- Huí yáng jiù jí tāng (回阳救急汤 Yáng-Returning Emergency Decoction)
- Rén shēn fù zǐ tāng (人参附子汤 Ginseng with Aconite Decoction)
- Shēn fù lóng mǔ tāng (参附龙牡汤 Ginseng, Aconite, Dragon Bone, and Oyster Shell Decoction)
Channel-Warming Cold-Dispersing Formulas
- Dāng guī sì nì tāng (当归四逆汤 Chinese Angelica Counterflow Cold Decoction)
- Dāng guī sì nì jiā wú zhū yú shēng jiāng tāng (当归四逆加吴茱萸生姜汤 Chinese Angelica Counterflow Cold Decoction Plus Evodia and Fresh Ginger)
- Huáng qí guì zhī wǔ wù tāng (黄芪桂枝五物汤 Astragalus and Cinnamon Twig Five Agents Decoction)
- Guì zhī gān cǎo tāng (桂枝甘草汤 Cinnamon Twig and Licorice Decoction)