Class 8: Harmonize Liver and

Spleen, Resolve Depression

Fayi Wu

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Herbs
 Bupleurum (Chaihu) MM: pp 73-78
 Immature Bitter orange (Zhishi) MM: pp 516-519
 Bitter orange (Zhi Ke) MM: pp 519-520
 Cyperus tuber (Xiangfu) MM: pp 527-529
 Mentha (Bohe) MM: pp 47-49
 Capejasmine fruit (Zhizi) MM: pp 95-98
 Medicated Leaven (Shen Qu) MM: pp 495-497

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Chai hu (Bupleurum)
 Categories: herbs that release exterior
 Taste and Property: Bitter, pungent and slightly cold
 Meridian Tropism: Pericardium, Liver, triple jiao and gallbladder
 Actions: Reduce fever by harmonizing and relieving shaoyang, Relieve
stagnation of liver qi, Lifting yang Qi
 Applications:
 Used as the most important herb for shaoyang pattern marked by alternate attack of
fever and chills, fullness in the hypochondrium, bitter taste in the mouth, dry mouth and
vertigo
 For liver qi stagnation marked by distending pain in the hypochondrium, headache,
irregular menstruation, dysmenorrhea,
 Prolapse of rectum or uterus or shortness of breath or lassitude due to sinking of
deficient qi
 Dosage: 3-10g
 Contraindications: Not used for true yin deficiency with hyperactivity of liver
yang

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Zhi shi (Immature Bitter orange )
 Categories: herbs that regulate qi
 Taste and Property: Bitter, pungent and slightly cold
 Meridian Tropism: Spleen, stomach and the large intestine
 Actions: Break up stagnated qi to remove food retention, dissolve phlegm to relieve the
obstruction
 Applications:
 Retention of food marked by abdominal pain and constipation or unsmooth discharge of stool and
tenesmus in diarrhea or dysentery
 Distension and fullness in the chest and epigastrium due to obstruction of qi by phlegm
 Used for prolapse of stomach, uterus, and rectum
 Elevating blood pressure
 Dosage: 3-10g
 Attention: Used with great care for weakness of the spleen and the stomach and pregnant
woman

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Zhi Ke (Bitter orange )
 Categories: herbs that regulate qi
 Taste and Property: Bitter, pungent and slightly cold
 Meridian Tropism: Spleen, stomach and the large intestine
 Actions: Promotes the flow of qi, for qi stagnation leading to
problems in the flow of qi such as cough, distention or constipation
 Applications:
 Used with gui zhi, for stabbing pain in the chest and flank
 Used with jie geng to regulate the flow of qi in the chest an aid in the
transforming of phlegm
 Used with sheng ma to relax the bowels and encourage the
downward flow of turbid yin
 Dosage: 3-10g
 Attention: Used with great care for weakness of the spleen and the
stomach and pregnant woman

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Xiang fu (Cyperus tuber )
 Categories: herbs that regulate qi
 Taste and Property: Pungent, slightly bitter and slightly sweet
 Meridian Tropism: Liver and triple jiao
 Actions: Spreads and regulates liver qi, regulates menstruation to
relieve pain
 Applications:
 Stagnation of the Liver Qi:
 Hypochondric pain
 Attack of liver qi on the stomach
 Stomach ache due to stagnation of cold and qi
 Abdominal pain due to cold
 Irregular menstruation, dysmenorrhea or distending pain in the breasts:
 Xiang Fu is a commonly used herb in treatment of gynecologic diseases,
especially the diseases caused by stagnation of the liver qi such as irregular
menstruation accompanied with distension in the breast and abdomen
 Dosage: 6-12g

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Bo he (Mentha)
 Categories: herbs that release exterior
 Taste and Property: acrid, aromatic, cool
 Meridian Tropism: lung, liver
 Actions: facilitates the dispersal of upper burner wind heat, cools and clears the
eyes and head, soothes the throat, facilitates the flow of liver qi and expels
turbid filth
 Applications:
 For patterns of wind-heat with fever, cough, headache, red eyes and sore throat,
 Used early stages of rashes to induce the rash to come to the surface as a means of
venting the wind and heat and thereby speed recovery
 For constrained liver qi stagnation
 For summertime exposure to unclean qi leading to summerheat gastric disturbance,
with abdominal pain, vomiting, diarrhea, and a thick, greasy, yellow tongue coating
 Dosage: 3-6g
 Contraindications: Not used for debilitated patients who sweat profusely or for
those with ascendant liver yang

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Zhi zi (Capejasmine fruit)
 Categories: herbs that clear heat
 Taste and Property: Bitter and cold
 Meridian Tropism: Heart, lung, stomach and Triple Jiao
 Actions: Purge fire to relieve restlessness, Clear heat and drain
dampness, Cool blood and remove toxic materials
 Applications
 For restlessness, an oppression feeling and fidget in febrile disease with Dan
Dou Chi,
 For restlessness, coma and delirium due to high fever in febrile disease,
 Used for accumulation of damp heat in the liver and the gallbladder marked
by jaundice, fever and scanty dark urine
 Used for hemoptysis, epistaxis or hematuria due to blood heat
 Subdue swelling and reducing pain: For external use.
 Dosage: 3-10g.
 Contraindications: Spleen deficiency with diarrhea

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Shen Qu (Medicated Leaven)
 Categories: herbs that relieve food stagnation
 Taste and Property: Sweet, pungent and warm
 Meridian Tropism: Spleen and stomach
 Actions: Promote digestion and harmonize function of the stomach
 Applications:
 Indigestion marked by fullness in the epigastrium and abdomen,
poor appetite, borborygmus and diarrhea
 Dosage: 6-15g

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Formulas
 Si Ni San, Chai Hu Shu Gan San FS: pp 145-
146
 Xiao Yao San, Dan Zhi Xiao Yao San, Hei
Xiao Yao San FS: pp 147-149

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Frigid Extremities Powder (si
ni san)
Categories: formulas that harmonize
Ingredients: chai hu, Zhi shi, Bai shao, Zhi
gan cao

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Actions and indications of the formula
 Actions
 Harmonize and release Lesser Yang-Stage Disorders
 Indications
 Cold fingers and toes (although the body is warm),
sometimes accompanied by a sensation of irritability and
fullness in the chest and epigastrium. A red tongue with a
yellow coating, and a wiry pulse.
 There may also be abdominal pain and/or severe diarrhea.
Hypochondriac pain and distention, epigastric pain and
fullness, a bitter taste in the mouth, belching, reduced
appetite, and a wiry forceful pulse due to liver qi stagnation
invading spleen

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Analysis of Formula
 Chief: Chai hu
 Release the constraint and vent heat.
 Deputy: Zhi shi
 Remove stagnation
 Assistant: Bai shao
 Nourish liver and preserve yin
 Envoy: Zhi gan cao
 Harmonize and relieve pain

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Modern application and modifications

 Modern application
 Chronic gastritis and peptic ulcer
 Hepatitis
 Fibrocystic breasts
 Modifications
 Chai hu shu gan san : Add chen pi, chuan xiong,
xiang fu, substitute zhi shi with zhi ke.

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Attention
 Differentiation of Jue syndrome which is
marked by loss of consciousness or/and
coldness of the extremities.

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Rambling Powder (xiao yao
san)
Categories: formulas that harmonize
Ingredients: Chai hu, Dang gui, Bai zhu, Bai
shao, Fu ling, Zhi gan cao

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Actions and indications of the formula
 Actions
 Spread liver qi, strengthen spleen, and nourish blood
 Indications
 Hypochondriac pain, headache, vertigo, a bitter taste in
mouth, dry mouth and throat, fatigue, poor appetite, pale-
red tongue, a wiry deficient pulse.

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Analysis of Formula
 Chief: Chai hu
 Soothe liver.
 Deputy: Bai shao, dang gui
 Nourish liver blood and preserve yin
 Assistant: Fu ling, Bai zhu
 Tonify spleen
 Envoy: Zhi gan cao, wei jiang, bo he
 Zhi gan cao: harmonize and relieve pain
 Wei jiang: harmonize stomach
 Bo he: relieve liver constraint and disperse heat

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Modern application and modifications
 Modern application
 Irregular menstruation
 PMS

 Chronic gastritis and peptic ulcer

 Mental problems

 Modifications
 Jia wei xiao yao san: add dan pi, zhi zi
 For liver qi stagnation with spleen deficiency that transforms into heat
 Irritability, a short temper, tidal fever and sweating, red eyes, dry
mouth, palpitations, lower abdominal pressure, difficult, painful
urination, an increased menstrual flow,
 Hei xiao yao san: add sheng di huang or shu di huang
 For liver qi stagnation, spleen deficiency, blood deficiency
 For the same presentation as xiao yao san, but with more severe
blood deficiency characterized by premenstrual cramps or excessive
menstrual bleeding, and a wiry, deficient or wiry, rapid pulse

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Formula Comparisons
between Chai hu shu gan san and Xiao yao
san
Formula Chai hu shu gan san Xiao yao san

Ingredient Chai hu, Bai shao, Zhi gan cao

Chen pi, Zhi ke, Bai zhu, dang gui,

Chuan xiong, Xiang fu Fu ling,
Wei jiang, Bo he

Actions Spread liver qi

Harmonize blood and Strengthen spleen and

alleviate pain nourish blood

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