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Minor Cinnamon & Peonia Combination (Xiao Jian Zhong Tang)

By Steve Clavey

Formula Constituents

Gui Zhi (cinnamon twigs) and Sheng Jiang (raw ginger slices) are both Pungent, Warm and diaphoretic: Zhi Gan Cao (licorice root prepared with honey), Da Hong Zao (big red dates), and malt sugar (yi tang) are Sweet, Warm, and tonify the Spleen. Bai Shao (Peony) is slightly Cold, Sour, nourishing to Liver Blood, and analgesic.

This formula is obviously Gui Zhi Tang (Cinnamon Combination) with increased Bai Shao, plus malt sugar. One ancient commentator (Wang Ang) stresses the importance of the malt sugar by noting:

The malt sugar is actually the sovereign herb in this formula, as is shown by the fact that it is not called "Gui Zhi Shao Yao", but Jian Zhong (meaning "strengthening the centre"). But these days when people use Xiao Jian Zhong Tang, they never use malt sugar, and thereby miss Zhong Jing's point. 1

The formula contains warm natured herbs to expel Cold, Sweet herbs to calm acuteness, and Pungent herbs to open Qi flow. The malt sugar, as we have seen above, is the main constituent, and is used to tonify Spleen Qi. Used with warm pungent herbs like Gui Zhi and Sheng Jiang, the sweet and pungent flavors combine to form Yang, promoting Yang's rising, warming, and moving qualities. The malt sugar, Da Zao, and Gan Cao, with the increased Bai Shao, combine as sour and sweet flavors to form Yin, increasing Yin's contracting, quiet nature. This harmonizes Yin and Yang. Zhang Zhong Jing warns, however, that this formula should not be used if there is vomiting, as it is too sweet.

Formula Indications

Palpitations, Anxiety, abdominal pain, tiredness, white moist tongue coat, pulse choppy and wiry, or weak and languid. Auxiliary indications include restless Heat in the hands and feet, dry throat and mouth, nosebleeds, aching limbs, spermatorrhoea, and urgency to move the bowels. (These symptoms are from the Jin Gui Yao Lue).

Pathology

The disease mechanism here is Spleen Yang deficiency, leading to abdominal pain, or to Yin-Fire flaring up. The basis of Xiao Jian Zhong Tang syndrome is a constitutional Spleen Yang deficiency, or a Yang deficiency brought about by illness. Throughout the ages, however, commentators have expressed different opinions, some saying the symptoms are due to "Spleen and Heart deficiency", others that they are from "Spleen deficiency overcome by Liver", while yet others explained them as a result of "Qi and Blood xu". All of these syndromes can result from Spleen deficiency, and in fact all commentators are unanimous in recognizing the Spleen Yang deficiency. So we would be justified in attributing the symptoms characteristic of Xiao Jian Zhong Tang to a generalized deficiency of Yin and Yang, Qi and Blood, but with Spleen Yang deficiency the most outstanding and obvious.

If, in the middle Jiao, Yin is greater than Yang, then Yin's congealing, quiescent nature has the tendency to occlude the flow of Qi and Blood, producing symptoms like abdominal pain and a choppy wiry pulse. Weak Yang has insufficient rising, warmth, and movement, leading to tiredness, shortness of breath, and weak pulse.

On the other hand, when Spleen Qi and Yang become seriously deficient, Yin and Yang will be thrown out of harmony, leading to deficient Fire. This "deficient Fire" is not the Yin-deficient Fire that results from lack of body fluids, but a low-grade fever resulting from Qi or Yang deficiency, and producing the symptoms listed in the Jin Gui Yao Lue. The mechanism works like this:- Normally Qi should reach the upper Jiao from the middle Jiao and then circulate throughout the body and limbs. Ministerial "Yin" Fire should be smoldering in the Kidneys, warming the various Qi-transformation processes necessary for proper Kidney function.

But when the Qi of the middle Jiao is deficient, it may drop, and with it Damp may pour down into the lower Jiao, causing blockage and forcing the Yin-Fire to rush up and occupy the original place of the Qi in the middle Jiao. This is why Li Dong-Yuan calls this type of Fire "the thief of Yuan Qi", saying "Qi and Fire cannot both occupy the same place". 2

It is a matter of Yin and Yang shifting places; of disturbance in ascending and descending functions. It could also be described, in simplified fashion, in terms of Water rebelling back into Earth, which normally should itself control Water, in the Wu Xing Sheng cycle.

Symptoms of this type of Qi or Yang-deficient Fire will be fever, spontaneous sweating, desire for warm drinks, tiredness, shortness of breath, pale tongue, and weak enlarged pulse, as well as the "dry throat and mouth, restless hands and feet, spermatorrhoea", and so on described in the Jin Gui Yao Lue. Li Dong-Yuan, in the Pi Wei Lun, is credited with the most complete and influential description of this phenomenon, and the formula he designed to deal with the problem "Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination) is still widely used today. But his theory and treatment were in turn originally based on Zhang Zhong Jings' Xiao Jian Zhong Tang. The idea is to warm and nourish Spleen Yang, encouraging it to rise, so that Damp no longer descends into the lower Jiao. When the lower Jiao is opened and unblocked by Damp, the Yin Fire will return to its place of concealment in the lower Jiao, thus eliminating the fever. If the fever is mistaken for Yin-deficient Xu-Fire, however, the Sweet Cold moistening Yin-tonic herbs, which are very rich and greasy, are used to build up the Yin, this will of course further increase Spleen Damp and weaken Spleen Yang, and make the problem worse. 3

Locus Classicus

In the Shang Han Lun it states:

"Two or three days after an invasion by Cold, if there are palpitations and an anxious feeling in the chest, Xiao Jian Zhong Tang should be used. (Clause 102) There is no mention here of previous treatment by sweating or purging, which means that the surface condition is still present. Palpitations without having undergone sweating or purging means that the Zheng Qi is weak; an anxious feeling in the chest shows disturbance by the pathogen. Together they suggest that the Zheng Qi is weak and the pathogen is indicating a tendency to go internal. Xiao Jian Zhong Tang is used to support Zheng Qi and clear the pathogen from the surface."

The Shang Han Lun also states:

"After a Cold invasion, when the Yang pulse is choppy, and the Yin pulse is wiry, this shows that there is acute pain in the abdomen. First use Xiao Jian Zhong Tang; then if the problem is not completely cleared up, use Xiao Chai Hu Tang".
This indicates a treatment method for abdominal pain from Spleen Yang deficiency, using first Xiao Jian Zhong Tang, then, if necessary, Xiao Chai Hu Tang. While there is controversy about the exact meaning of "Yang pulse" and "Yin pulse" (Yang being either "superficial" or "the cun position"; Yin being either "deep" or "the chi position"), it is clear that in acute abdominal pain both a wiry pulse and a choppy pulse will be present. Wiry, straight, thin, long, and strong, shows severe pain; choppy, thready, slow, short, arrhythmic, and rough shows impeded Qi and Blood circulation. Together, they show a stagnation of Qi and Blood leading to acute pain. If the Yin pulse is taken to mean "the chi position" then the pulse is also indicating the location of the pain: the lower abdomen. The choppy pulse would be demonstrating the situation in the rest of the body: blockage of Qi and Blood circulation, which had only reached crisis point in the lower abdomen. The interesting method of first using Xiao Jian Zhong Tang, and then Xiao Chai Hu Tang is commented upon by Ke Qin: "Pain in the abdomen is always a (potentially) dangerous symptom. One dose of Xiao Jian Zhong Tang may not be successful. Planning for the event, Xiao Chai Hu Tang should be used to lead the pathogen into Shao Yang and provide a route of escape (i.e. out of Yin and into Yang). This is what is meant in the saying: When (it) comes out of Yin into Yang, it means a cure". Ke Qin goes on to stress, though, that the use of Xiao Chai Hu Tang is only necessary if the abdominal pain is not relieved with Xiao Jian Zhong Tang. 4

Notes

1. Shang Han Lun Fang Jie (Explanation of the Formulas of the Shang Han Lun), page 13. Edited by the Jiang Su Provincial TCM Research Institute. Published by the Jiang Su Science and Technology Press, 1978.

2. Zhong Yi Ge Jia Xue Shuo ("Theories of the Different Schools of Thought in TCM"), page 105-107. Bei Jing College of TCM. Published by the Shanghai Science and Technology Publishing House, 1983.

3. In Chinese, an explanation of the pathological mechanism for the Qi or Yang deficient fever is generally difficult to find, most authors being satisfied with quoting Li Dong Yuan's "Qi and Fire cannot both occupy the same place". In English, the phenomenon is never discussed at all, as far as I know, except for brief listings in tables of symptom differentiation, (under fever), with no explanation. This in spite of the fact that Qi deficient fever is quite common clinically. The detailed explanation found above comes from Zhong Yi Ti Jie ("Explanation of Questions in TCM"), page 41 and 50. Published by the Fu Jian Science and Technology Publishing House, 1982.

4. Shang Han Lai Su Ji, by Ke Qin in 1666 (Ching Dynasty). The above quotes are from page 138 of the Shanghai Science and Technology Publishing House edition, 1978.

 


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