Shanghan Original Formula Zhigancao Decoction (Ginseng, Cinnamon Twig, Fresh Ginger, Honey-fried Licorice, Ophiopogon, Rehmannia, Donkey-hide Gelatin, Hemp Seed, Clear Wine) is mainly used to treat deficiency of both Yin and Yang with heart vessels losing nourishment.
Heavy use of honey-fried licorice and jujube
When both Yin and Yang are deficient, tonifying Yang exhausts Yin; purging Yin causes Yang to collapse. In such cases, sweet herbs can be used but not taken in large doses. — Ling Shu · End and Beginning
The remaining herbs, besides tonifying Yang and nourishing Yin, serve the following functions:
- Rehmannia strengthens the heart
- Hemp seed relieves constipation to prevent worsening of heart burden (constipation easily aggravates heart disease)
- Fresh ginger prevents external pathogens (external infections can also worsen heart disease)
- Wine opens the heart vessels, resolves the greasy nature of Yin herbs, and extracts active medicinal components
Ye Tianshi’s Clinical Guidelines and Medical Cases widely applied Zhigancao Decoction (Fumai Decoction) to external warm diseases, internal injury-induced consumptive diseases, stroke, and various women’s illnesses. Its main characteristic was a stronger emphasis on nourishing liver and kidney Yin and blood. Therefore, he often removed the pungent-hot substances like ginger and cinnamon twig, or added white peony to restrain Yin and nourish the liver, or added chicken egg yolk to nourish heart blood and calm the spirit, or added oyster shell to restrain sweating and stabilize collapse, or added turtle shell to nourish Yin, suppress Yang, and calm wind, or added wumei and schisandra to transform Yin and generate fluids. This transformed the original method of opening Yang and restoring pulse into a moist, sweet, salty, cold method of nourishing Yin and generating fluids. It was used for various signs of Yin deficiency and fluid depletion, with manifestations such as crimson fissured tongue, dark red tongue resembling ochre, thirst with preference for cold drinks, and virtual wind causing fainting, showing excellent effect.
Wu Jutong further improved Ye Tianshi’s method. In Wenbing Tiaobian · Lower Burner Section, the “Modified Fumai Decoction” was first listed. Zhigancao Decoction removed cinnamon twig and fresh ginger, added white peony, and was made from honey-fried licorice (licorice, dry rehmannia, fresh white peony, Ophiopogon, donkey-hide gelatin, hemp seed). It treated warm pathogen transmitted from the middle burner to the lower burner, injuring liver and kidney Yin, causing “large deficient pulse with more intense heat in the palms and soles than on their dorsum.” Also treated were “inner trembling of the heart, tongue rigidity and mental confusion,” “deafness,” and despite sweating and purging, “the pulse remained rapid and strong six to seven days later,” or “incorrect use of rising dispersing herbs, causing intermittent or simultaneous pulses,” or “after sweating and purging, dry mouth and throat, fatigue and desire to sleep, red tongue with old coating.”
- If all these symptoms are present but the patient has loose stools, hemp seed is removed and oyster shell is added, forming the Jia Fumai Decoction (First Modified Fumai Decoction).
- If there is “deep, rapid pulse; dry tongue with black teeth marks; fingers only twitching; urgent prevention of convulsions,” raw oyster shell and raw turtle shell are added to the Modified Fumai Decoction, forming the Erjia Fumai Decoction (Second Modified Fumai Decoction).
- If “heat is deep and fainting severe; pulse thin and rapid; heart palpitations severe and sometimes painful,” raw turtle shell is further added to the formula, forming the Sanjia Fumai Decoction (Third Modified Fumai Decoction).
- If the disease further progresses with “long-standing heat pathogen consuming true Yin, due to misusing exterior treatments or improper aggressive therapies, causing fatigue, trembling, weak pulse qi, crimson tongue with sparse coating, occasional fainting,” chicken egg yolk and schisandra are further added to the above formula, forming the Dadingfeng Zhu (Great Calm Wind Pearl).