Wu Ji San - 五积散 - Five Accumulations Powder

Source: Secret Formulas to Manage Trauma and Reconnect Fractures Received from an Immortal (c. 846)

Category: Formulas that Release Exterior-Interior Excess

Pattern: Externally contracted Wind-Cold with internal injury due to Cold (usually pre-existing from improper diet)

Key Symptoms: Fever and chills without sweating, headache, body aches, stiff neck and back, a sensation of fullness in the chest and abdomen, nausea and aversion to food, vomiting, abdominal pain and cold, diarrhoea with borborygmus

Tongue: White and greasy coating
Pulse: Submerged and wiry or floating and slow

Ingredients

Ma Huang

1.5-4.5g

Pinyin: Ma Huang Chinese: 麻黄 Pharmaceutical: Herba Ephedrae Taxonomy: Ephedra sinica seu intermedia seu equisetina English: Ephedra Stem / Joint Pine / Joint Fir / Mormon Tea / Brigham Tea
Tastes: Pungent, slightly bitter, warm Meridians Entered: Lung and Bladder
Actions & Indications: Induces sweating and releases the Exterior Taiyang Stage Wind-Cold Invasion of the Lung, with anhidrosis, chills, fever, headache and a tight, floating pulse Disseminates and facilitates Lung Qi, calms wheezing and stops coughing Wind-Cold Obstructs Lung Qi Promotes urination and reduces oedema Externally generated oedema Warms and disperses Cold pathogens Wind-Cold Bi Cold extremities (Reynaud's disease) *Breaks up concretions, firmness, accumulations and gatherings (Shen Nong Ben Cao Jing)* Yin sores that are firm, deeply rooted and without a head
Standard Dosage: 1.5-9g in decoction to release the exterior, and 10-15g for the treatment of oedema. Maximum dose is 20g. Toxic dose is considered to be 30-45g but side effects and risks are possible at any dosage. Cautions: It is prohibited to be used for patients with deficient dyspnea without blockage of the lung qi and should be used with caution for patients with hypertension and insomnia because ephedrine can stimulate central nervous system and raise blood pressure. The Shang Han Lun recommends removing the nodes and decocting Ma Huang first, scooping the foam from the top of the decoction. It has been argued this is to reduce the "vexing" effects although the efficacy of this is debated and rarely done today. It should not be used in conjunction with MAOIs, central nervous system stimulants, alkaloids ergotamines and xanthines enhancing their effects by acting as a receptor level agonist. In the UK the maximum daily dose permitted without prescription is 1.8g daily in three 0.6g doses. This makes it difficult to achieve a pharmacologically active effect and must be complemented with other herbs that release the exterior and expel Wind-Cold such as Gui Zhi, Jing Jie, Fang Feng and Zi Su Ye. Huang Hua Zi (Sida cordifolia), more common in Ayurveda where it is known as Bala बला, also contains ephedrine at lower concentrations and has no legal restrictions placed on it by the UK MHRA. It is considered more cooling, Heat clearing and Damp draining without Exterior Releasing properties in Chinese medicine so best used as a substitute in Warm Diseases, especially Damp-Warm Disease, or supplemented with increased warm Exterior Releasing herbs like those described above.

Bai Zhi

1.5-4.5g

Gan Jiang

1.5-4.5g

Rou Gui

1.5-4.5g

Pinyin: Rou Gui Chinese: 肉桂 Pharmaceutical: Cortex Cinnamomi Taxonomy: Cinnamomum cassia English: Cinnamon Bark
Tastes: Pungent, sweet, hot Meridians Entered: Kidney, Spleen, Heart and Liver
Actions & Indications: Warms the Kidneys, Spleen and Heart and strengthens Yang and Ming Men Fire Kidney Yang Deficiency and Deficiency of Ming-Men Fire with aversion to Cold, cold limbs, weak back, impotence and urinary frequency Spleen and Kidney Yang Deficiency with abdominal pain and Cold, reduced appetite and diarrhoea Kidney Unable to Grasp Qi Heart Yang Deficiency, particularly with chest Bi Disperses deep Cold, warms the channels, unblocks the channels and vessels and alleviates pain Deep Cold causing Qi Stagnation or Blood Stasis with Cold in the Blood causing amenorrhea or dysmenorrhea, Cold-Damp Bi, Yin-type boils (chronic sores that are usually concave and ooze a clear fluid) and sores or abscesses that do not heal It enters the Blood aspect and, in small amounts, enhances the Blood moving action of other substances Leads the Fire back to its source Upward Floating of Deficient Yang (False Heat, True Cold or Heat Above and Cold Below) with flushed face, wheezing, severe sweating (the sweat pours out like oil), weak and cold lower extremities and a deficient and rootless pulse Any condition with Heat in the Upper body (dry mouth, sore throat, or teeth which is worse at night) and Cold in the Lower body (Lower back pain, cold lower extremities, diarrhoea and weakness in the proximal portion of the pulse) Assists in the generation of Qi and Blood Chronic Qi and Blood Deficiency (auxiliary) Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, enable one to communicate with spirits, make the body light, and prevent forgetfulness. 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: 1-5g in decoction. It should be decocted later. Cautions: It is contraindicated for syndrome of yin deficiency with fire effulgent, haemorrhage due to blood heat and pregnant women. It is incompatible with Chi Shi Zhi (nineteen incompatibilities).

Cang Zhu

3-9g

Hou Po

1.5-4.5g

3-9g

3-9g

3-9g

3-9g

Zhi Ke

1.5-4.5g

Dang Gui

1.5-4.5g

Pinyin: Dang Gui Chinese: 當歸 Pharmaceutical: Radix Angelicae sinensis Taxonomy: Angelica sinensis English: Chinese Angelica Root / Tang-Kuei / Dong Quai Root
Tastes: Sweet, Pungent, Warm Meridians Entered: Heart and Liver
Actions & Indications: Tonifies the Blood and regulates the menses Blood Deficiency, especially when affecting the Heart and Liver with pale, ashen complexion, lusterless nails, tinnitus, blurred vision and palpitations Blood Deficiency associated irregular menstruation, amenorrhea and dysmenorrhea Invigorates and harmonizes the Blood and disperses Cold (stops pain due to Blood Stasis) Blood Stasis causing abdominal pain and carbuncles and pain due to Blood Stasis from traumatic injury, especially when accompanied by Deficiency Cold Postpartum menstruation Pregnancy (use with caution) Blood Deficiency with chronic Wind-Damp-Bi Moistens the Intestines and unblocks the bowels Dry Intestines due to Blood Deficiency Reduces swelling, expels pus, generates flesh and alleviates pain Sores and abscess (Chuang Yung), internally and topically Stops coughing and treats dyspnea Used adjunctively for coughing Tonifies the Blood while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015)
Standard Dosage: 6-12g in decoction. Cautions: It is contraindicated in cases of Damp-Heat stagnating in the Middle, Lung Heat with Phlegm Fire, and Yin deficiency with effulgent Yang because it is warm and sweet in properties. In addition, it should be used with caution in cases of loose stool because it can moisten intestines to smooth stool. Many sources recommend using caution, avoiding or only taking under guidance of a TCM physician during pregnancy as it can cause uterine contractions. However, there are no studies supporting this and the only scientific literature seems to suggest that Z-Ligustilide has anti-spasmodic activities that alleviate dysmenorrhoea by inhibiting uterine contractions (Du et al., 2006; Dietz et al., 2016). Caution is also advised in breast cancer patients due to its oestrogen stimulating activity. This based upon Lau et al (2005) who found it may stimulate breast cancer growth in vitro, however Yue et al, (2019) demonstrated that it is not that stimulatory in breast cancer both in vitro and in vivo through a series of tests, although they suggested it should still be used with caution in estrogen receptor-positive breast cancer. Conversely, a large population study in Taiwan by Wu et al (2014) found it reduced the subsequent risk of endometrial cancer in breast cancer survivors taking tamoxifen, especially in those of reproductive age.

Bai Shao

1.5-4.5g

Chuan Xiong

1.5-4.5g

Gan Cao

1.5-4.5g

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.

Preparation: Grind the ingredients into a powder and set Rou Gui and Zhi Ke aside. Fry the remaining ingredients over a low heat until the powder changes colour, allow to cool and add the Rou Gui and Zhi Ke. Take 9g as a draft with 3 slices of Sheng Jiang. Can also be prepared as a decoction with the doses given.

Actions: Releases the Exterior, warms the Interior, smoothes the flow of Qi, transforms Phlegm, invigorates Blood, reduces accumulation

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

五 积 散  Wu Ji San

Five Accumulations Powder