Key Points for Differentiating Wu Mei Wan and Chai Hu Gui Zhi Gan Jiang Tang (Part 2)

Next, I will share thoughts on the heat of Wu Mei Wan and the heat of Chai Hu Gui Zhi Gan Jiang Tang. Wu Mei Wan uses Huang Lian (Coptis) combined with Huang Bai (Phellodendron) to clear heat (Jue Yin heat), while Chai Hu Gui Zhi Gan Jiang Tang uses Huang Qin (Scutellaria) to clear heat (Shao Yang heat). What are the differences between the two types of heat? According to the Shang Han Lun, Huang Lian, Huang Bai, and Huang Qin can all treat diarrhea. Both Huang Qin and Huang Bai can treat damp-heat jaundice. My personal experience: 1. Understanding from the compatibility rules of Zhong Jing‘s prescriptions: In Zhong Jing‘s formulas, the combinations of Huang Lian, Huang Qin, and Huang Bai include Huang Lian with Huang Bai, Huang Lian with Huang Qin, but not Huang Qin with Huang Bai. This indicates that Huang Qin and Huang Bai have strict usage indications, and it can also be understood that Huang Lian can enhance the heat-clearing effects of Huang Qin and Huang Bai. The combination of Huang Lian and Huang Bai is only found in Wu Mei Wan and Bai Tou Weng Tang, both of which can treat intestinal diarrhea. 2. Understanding from the perspective of disease location: Huang Lian focuses on clearing heat from the upper jiao (heart) and middle jiao (stomach), and also clears heat from the lower jiao (intestines); Huang Bai primarily clears heat from the lower jiao and intestinal heat; Huang Qin clears heat from both the exterior and interior, particularly from the gallbladder channel. 3. Understanding from the six meridians’ generation and control relationships:

1. Characteristics of the “Jue Yin Heat” in Wu Mei Wan

1. Disease location and mechanism

Essence of Jue Yin disease: Jue Yin is the end of the three Yin, where Yin is exhausted and Yang is born, easily presenting a state of “cold-heat mixed, Yin and Yang advancing and retreating”. The heat of Jue Yin can be either deficient heat or excess heat, often manifesting as Yang Ming heat.

Source of heat evil:

Heat from the liver channel: Jue Yin liver wood fails to disperse, leading to stagnation and transformation into fire, disturbing the channel (e.g., bitter mouth, irritability).

Lower jiao damp-heat: Liver heat presses down on the Yang Ming large intestine, causing damp-heat stagnation (e.g., heat diarrhea, anal burning).

Transmission relationship:

The syndrome of Wu Mei Wan is a superimposed state of “Jue Yin liver heat attacking Yang Ming” (wood stagnation and earth obstruction), manifested as upper heat (cleared by Huang Lian and Huang Bai) and lower cold (warmed by Fu Zi and Gan Jiang), primarily affecting the stomach and intestines, lower jiao.

2. Significance of the combination of Huang Lian and Huang Bai

Huang Lian: Clears heat from the upper jiao heart fire and middle jiao stomach heat (e.g., irritability, burning in the stomach).

Huang Bai: Clears lower jiao damp-heat, targeting the heat from liver pressing down on the large intestine (e.g., Bai Tou Weng Tang also uses Huang Bai to treat dysentery).

Compatibility logic:

The two work synergistically to enhance the clearing of Yang Ming heat (Yang Ming stomach heat and large intestine heat), as Jue Yin heat attacks Yang Ming, leading to Yang Ming being affected, thus Jue Yin heat often manifests as Yang Ming heat.

2. Characteristics of the “Shao Yang Heat” in Chai Hu Gui Zhi Gan Jiang Tang

1. Disease location and mechanism

Essence of Shao Yang disease: Shao Yang is the pivot, governing both the exterior and interior; when evil stagnates in Shao Yang, the Qi mechanism becomes obstructed, easily transforming into fire and generating heat.

Characteristics of heat evil:

Stagnant heat not reaching: The pivot of Shao Yang is not functioning well, heat stagnates in the gallbladder (e.g., bitter mouth, fullness and oppression in the chest and flanks).

Accompanied by Tai Yin: If Shao Yang heat is unresolved, it is accompanied by Tai Yin spleen cold (e.g., loose stools, abdominal distension), forming “upper heat and lower cold”.

Transmission relationship:

The syndrome of Chai Hu Gui Zhi Gan Jiang Tang is a concurrent state of “Shao Yang stagnant heat transmitting to Tai Yin” (pivot dysfunction + insufficient spleen Yang), primarily affecting the gallbladder and middle jiao.

2. Significance of Huang Qin‘s combination

Huang Qin: Clears stagnant heat from the Shao Yang gallbladder, targeting heat from both the exterior and interior (e.g., fullness and oppression in the chest and flanks, bitter mouth).

Compatibility logic:

Combined with Chai Hu, it resolves heat caused by stagnation, addressing heat stagnation in both the exterior and interior.

3. Comparison of the heat-clearing herbs and their disease mechanisms

1. The “superimposition” and “concurrence” of disease mechanisms

Formula Transmission Relationship Disease Mechanism Characteristics Heat-Clearing Herb Selection
Wu Mei Wan Jue Yin liver heat attacking Yang Ming (superimposition) Upper heat and lower cold, liver heat pressing down on the large intestine (damp-heat diarrhea) Huang Lian + Huang Bai (clearing Yang Ming damp-heat)
Chai Hu Gui Zhi Gan Jiang Tang Shao Yang stagnant heat transmitting to Tai Yin (concurrence) Stagnant heat in half exterior and half interior, accompanied by Tai Yin spleen cold (gallbladder heat and spleen cold) Huang Qin (clearing Shao Yang stagnant heat)

2. Targeting of herbs and disease location

Huang Lian and Huang Bai:

Enter the liver, stomach, and large intestine channels, primarily clearing the heat from the liver channel and lower jiao damp-heat, directly targeting the disease location of Jue Yin transmitting to Yang Ming (stomach and intestines, lower jiao).

Representative formulas: Wu Mei Wan treats mixed cold-heat with prolonged diarrhea, Bai Tou Weng Tang treats heat toxin dysentery (both belong to liver heat attacking earth).

Huang Qin:

Enters the gallbladder and lung channels, primarily clearing stagnant heat from the Shao Yang gallbladder, targeting the dysfunction of the half exterior and half interior (chest and flanks, gallbladder).

Representative formulas: Xiao Chai Hu Tang treats Shao Yang syndrome, Chai Hu Gui Zhi Gan Jiang Tang treats Shao Yang with Tai Yin cold-damp.

3. The progressive relationship of the six meridian disease mechanisms

Jue Yin disease: is the final stage of the six meridian transmission (Yin exhausted and Yang born), with complex mechanisms, often presenting as “cold-heat mixed, deficiency and excess coexisting”. Wu Mei Wan clears liver heat and gastrointestinal heat through Huang Lian and Huang Bai, combined with Fu Zi and Gan Jiang to warm Yang, reflecting the ultimate treatment method of “treating all three Yin together, balancing Yin and Yang”.

Shao Yang disease: is the intermediate link of the six meridian transmission (pivot transition), Chai Hu Gui Zhi Gan Jiang Tang clears Shao Yang stagnant heat through Huang Qin, combined with Gan Jiang to warm Tai Yin, reflecting the idea of “pivot transition, preventing transmission to the three Yin”.

Conclusion

  • Wu Mei Wan targets the superimposed disease mechanism of “Jue Yin liver heat attacking Yang Ming” (liver heat pressing down on the stomach and intestines), using Huang Lian and Huang Bai to clear lower jiao damp-heat, belonging to vertical transmission (from Jue Yin to Yang Ming).

  • Chai Hu Gui Zhi Gan Jiang Tang targets the concurrent disease mechanism of “Shao Yang stagnant heat transmitting to Tai Yin” (pivot dysfunction with accompanying spleen cold), using Huang Qin to clear heat from half exterior and half interior, belonging to horizontal transmission (Shao Yang and Tai Yin sharing the same disease).

Both reflect the differences between the vertical deepening and horizontal spreading of the six meridian disease mechanisms.

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