Er Jia Fu Mai Tang

Author: Wu Tang / Wu Ju Tong, 吴瑭 / 吴鞠通

Year: 1798

Source: Systematic Differentiation of Warm Pathogen Diseases (Wen Bing Tiao Bian, 溫病條辨)

Category: Formulas that Expel Wind

Pattern: Slight stirring of Liver Wind due to damage of the true Yin in the Lower Jiao from to a Warm Pathogen Disorder (Wen Bing)

Key Symptoms: Mild trembling of the fingers

Ingredients

Zhi Gan Cao

18g

Pinyin: Gan Cao Chinese: 甘草 Pharmaceutical: Radix Glycyrrhizae Taxonomy: Glycyrrhiza uralensis seu glabra seu inflata English: Liquorice Root
Tastes: Sweet, slightly cold Meridians Entered: Heart, Lung and Spleen (and all 12 meridians)
Actions & Indications: Tonifies the Spleen and augments Qi Spleen Qi Deficiency with shortness of breath, lassitude and loose stools Qi and Blood Deficiency with an irregular pulse and/or palpitations Heart Qi Deficiency or Heart Yang Deficiency Moistens the Lungs, resolves Phlegm and stops coughing Lung Heat or Cold Productive or non-productive coughing Moderates spasms and alleviates pain Painful muscle spasms of the abdomen and legs Clears Heat and relieves Fire Toxicity Raw for Toxic Heat with sore throat or carbuncles and sores (Chuang Yung) Antidote for many toxic substances (internal and topical) Poisoning Bites (after washing the wound, chew Gan Cao and apply a thick layer on the bite wound, changing whenever it dries out; Bao Xiang-Ao, 1846, New Compilation of Proven Formulas) Moderates and harmonizes the harsh properties of other herbs and guides the herbs to all twelve channels Often added in small doses to harmonise formulas Tonifies the Qi while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015) Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
Standard Dosage: Typically 1.5-9g in decoction. Large doses can be up 30g. Cautions: It is contraindicated for combining with Hai Zao, Da Ji, Gan Sui and Yuan Hua because of "eighteen antagonisms". It is also contraindicated in cases of dampness obstruction in middle energizer and edema because it can help dampness obstruct qi, and it is prohibited from long-term usage in large dosage (more than 20g/day) and should be avoided or used with extreme caution in patients with high blood pressure because it may raise aldosterone levels in the blood causing retention of sodium. The NHS recommends avoiding during pregnancy.

18g

18g

15g

E Jiao

Mu Li

Pinyin: Mu Li Chinese: 牡蛎 Pharmaceutical: Concha Ostreae English: Oyster Shell
Tastes: Salty, astringent, slightly cold Meridians Entered: Liver and Kidney
Actions & Indications: Heavily settles and calms the Spirit Agitated Heart and Spirit with palpitations with anxiety, restlessness and insomnia Calms the Liver, benefits Yin and anchors Floating Yang Liver Yin Deficiency with Liver Yang Rising or Yin Deficiency with internal Heat with restlessness, irritability, palpitations and spontaneous sweating Prevents leakage of fluids Continuous sweat after febrile disease or in patients with steaming bone disorder Loss of fluids due to Deficiency with night sweats, spontaneous sweating, nocturnal emissions, spermatorrhea or vaginal discharge and uterine bleeding Softens hardness and dissipates nodules Various kinds of lumps particularly neck lumps such as goiter or scrofula Absorbs acidity and alleviates pain (calcined) Excessive Stomach pain with a sour taste in the mouth Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of animal parts which can, with protracted taking, fortify the bones and joints (骨节 Gu Jie), kill evil ghosts (邪鬼 Xie Gui), and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
Standard Dosage: 15-30g in decoction. Cautions: The high mineral content of this medication may prevent the oral absorption of the fluoroquinolone class of antibiotics. Caution should also be taken due to the possibility of heavy metal absorption from the oysters' environment. If decocting it is advisable to leave the dregs at the bottom as heavy metal particles will naturally sink. It is still probably advisable to avoid for long term use unless the source is known to be clean. Animal products are prohibited from use in the UK under the Medicines Act 1968 ch. 67 which restricts herbalists to the use of plant products only. It is generally substituted with Xuan Shen, Bai Shao and Wu Wei Zi or Tian Ma. If viewed from a western perspective as a source of calcium which may cause sleep disturbances, then supplementation or inclusion of high calcium/magnesium content herbs (e.g. Kun Bu which is also salty and softens nodulation) could be considered, especially if other signs such as oesteoporosis or muscle cramps are present and the risk of side effects from calcium/magnesium supplements are low (stones, calcified arteries, GI issues). However, this assumes a mechanism which does not match many of the traditional patterns for which it is prescribed.

Bie Jia

24g

Subsitutions:
In the UK both shells must be substituted due to the laws on using animal products. Some common substitutions include:
Mu Li == Bai Shao + Xuan Shen + Wu Wei Zi
Bie Jia == Qing Hao + Sheng Di Huang

Preparation: Decoction.

Actions: Nourishes the Yin, clears Heat, anchors the Yang, extinguishes Wind

Contraindications: Should not be used during pregnancy without removing Bie Jia (not a problem in the UK as they must be replaced anyway). Caution in patients with diarrhoea due to Spleen Yang or Stomach Qi deficiency.

Research Links:

American Dragon

TCMWiki

Journal of Chinese Medicine

National Resource Centre for Chinese Materia Medica, China

TCM-ID Integrated Database, East China Normal University

TCM-ID Information Database, National University of Singapore

Pubmed

Science Direct

Google Scholar

Bai Du (Chinese)

A+ Medical Encyclopedia (Chinese)

Reference Notes: (click to display)

These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.

Herb Formulas Notebook

Two Shell Decoction to Restore the Pulse