1 Class 8: Harmonize Liver and Spleen, Resolve Depression Fayi Wu

2 Herbs Bupleurum (Chaihu) MM: pp Immature Bitter orange (Zhishi) MM: pp Bitter orange (Zhi Ke) MM: pp Cyperus tuber (Xiangfu) MM: pp Mentha (Bohe) MM: pp Capejasmine fruit (Zhizi) MM: pp Medicated Leaven (Shen Qu) MM: pp

3 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

4 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

5 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

6 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

7 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

8 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

9 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

10 Formulas Si Ni San, Chai Hu Shu Gan San FS: pp Xiao Yao San, Dan Zhi Xiao Yao San, Hei Xiao Yao San FS: pp

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

12 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

13 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

14 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.

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

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

17 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.

18 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

19 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

20 Formula Comparisons between Chai hu shu gan san and Xiao yao san FormulaChai hu shu gan sanXiao yao san IngredientChai hu, Bai shao, Zhi gan cao Chen pi, Zhi ke, Chuan xiong, Xiang fu Bai zhu, dang gui, Fu ling, Wei jiang, Bo he ActionsSpread liver qi Harmonize blood and alleviate pain Strengthen spleen and nourish blood