TCM Case Studies / Medical Discussions / Reference Articles for Clinical TCM Learning
Introduction: Mr. Tao Yufeng has compiled 24 clinical treatment principles for Cang Zhu (Atractylodes) based on ancient texts, the experiences of historical physicians, and his own clinical insights, which are worth learning and collecting. 1 Cang Zhu (Atractylodes) promotes sweating and is more effective than Bai Zhu (White Atractylodes); it supplements and eliminates dampness, but its strength is not as great as Bai Zhu.Generally, for the soil that is low and damp, it should be combined with Bai Zhu to nourish it; for the soil that is thick and rich, it should be combined with Cang Zhu to balance it.It is said that Bai Zhu retains while Cang Zhu disperses, hence Bai Zhu is good for supplementation, while Cang Zhu is good for dispersing. Cang Zhu aids digestion and stops vomiting and diarrhea similarly to Bai Zhu, but it uniquely excels at draining dampness and relieving stagnation. 2 Cang Zhu governs dampness in the upper, middle, and lower parts of the body.When dampness is in the upper jiao, it easily produces phlegm; thus, it dries dampness and resolves phlegm. When dampness is in the middle jiao, it causes stagnation and diarrhea; thus, it promotes digestion and strengthens the spleen. When dampness is in the lower part, it causes weakness in the legs and knees, and can be treated with Huang Bai (Phellodendron) for weakness (adding Niu Xi (Achyranthes) is even better), which can strengthen the legs and knees. 3 Cang Zhu combined with Huang Bai treats damp-heat in the lower jiao; Huang Bai is bitter, which overcomes heat, thus it can eliminate heat from dampness; Cang Zhu is drying, which overcomes dampness, thus it can eliminate dampness from heat. The two complement each other, hence the formula is called Er Miao (Two Marvels). 4 Cang Zhu and Chuan Xiong (Ligusticum) resolve various stagnations, adding other herbs according to the symptoms.It is said that Cang Zhu combined with Xiang Fu (Cyperus) and Chuan Xiong resolves various stagnations.It is also said that Cang Zhu with Xiang Fu opens up stagnation.Stagnation from phlegm, fire, dampness, food, qi, and blood arises from abnormal transformations, leading to failure in ascending and descending, with the disease located in the middle jiao, thus the herbs must assist in both ascending and descending.Cang Zhu is a herb of the Yangming meridian, with a pungent and strong flavor, it strengthens the stomach and spleen, promotes the qi of grains, can directly enter other herbs, dispel Yangming dampness, and regulate the flow; Xiang Fu is a herb that quickly moves qi in the yin, and thus the two herbs work together to disperse stagnation and balance. 5 Cang Zhu when combined with Huang Bai, Niu Xi, and Shi Gao (Gypsum) as downward-moving herbs, can eliminate damp phlegm from the lower part; when combined with Gan Cao (Licorice), Chen Pi (Tangerine Peel), and Hou Po (Magnolia Bark), it can eliminate dampness from the middle jiao and balance excess qi in the stomach; when combined with scallions, Ma Huang (Ephedra), and Xing Ren (Apricot Kernel), it can eliminate evils from the flesh to the skin surface. 6 Cang Zhu with Fang Feng (Saposhnikovia) promotes sweating; with Huang Bai, it overcomes dampness; with Shan Zhi Zi (Gardenia), it resolves the dryness of Cang Zhu. 7 Cang Zhu with Qiang Huo (Notopterygium) stops body pain; with Shu Di (Rehmannia) and Gan Jiang (Dried Ginger), it treats pale complexion and poor appetite; with Huang Bai, Niu Xi, Mu Guo (Papaya), and Shi Hu (Dendrobium), it can strengthen walking ability; with Ku Shen (Sophora) and Mu Li (Oyster Shell), it treats children’s stomach damp-heat, preventing the formation of muscle; combined with Mai Dong (Ophiopogon), Shi Hu, Huang Bai, Bai Shao (White Peony), Mu Guo, Yi Ren (Job’s Tears), and Wu Wei Zi (Schisandra), it is a key herb for treating weakness. 8 Cang Zhu is a holy herb for treating dampness, especially effective when paired with Ma Huang.Equal amounts of both herbs can induce profuse sweating; Cang Zhu in double the amount of Ma Huang induces mild sweating; Cang Zhu three times the amount of Ma Huang increases urination, having a diuretic effect; Cang Zhu four times the amount of Ma Huang may not induce obvious sweating or urination, but can transform dampness. 9 Cang Zhu has excellent qi-moving and stagnation-resolving properties, clinically indicated for abdominal distension, thick greasy tongue coating.For simple qi stagnation, 6-10 grams is appropriate; if qi stagnation is accompanied by dampness, 10-15 grams can be used.If it is due to liver qi stagnation transforming into fire harming yin, Cang Zhu can be stir-fried with black sesame; or combined with Shi Hu, Mai Dong, and Xuan Shen (Scrophularia) to avoid harming fluids and yin.Cang Zhu combined with a small amount of Gui Zhi (Cinnamon Twig) can disperse liver dampness; combined with Sheng Ma (Cimicifuga), it can promote clear qi upward and turbid qi downward; combined with Shu Di, it can tonify without stagnating, also supporting spleen function. 10 Gastric prolapse is often due to spleen deficiency and sinking of middle qi, often accompanied by dampness, leading to turbid qi that cannot rise. For this, Cang Zhu can be soaked in hot water and used as a tea, 20 grams daily, effective without harming yin or causing dryness. 11 Cang Zhu is quite effective for treating gastric prolapse.Li Dongyuan referred to Cang Zhu as a “key herb for treating weakness.”Weakness refers to the relaxation and weakness of the tendons and meridians. Gastric prolapse is caused by the relaxation of the supporting ligaments of the stomach or the relaxation of the stomach wall, which aligns with the TCM understanding of weakness of the spleen and stomach, leading to the sinking of middle qi and inability to lift. 12 Cang Zhu can reduce swelling in the lower limbs caused by dampness or damp-heat, often used with Huang Bai; for severe swelling, add Hou Po, Bi Xie (Dichroa), Fu Ling (Poria), Che Qian Zi (Plantago), Niu Xi, and Yi Ren, which enhances the function of dispelling dampness and reducing swelling. 13 Persistent edema responds well to increased use of Cang Zhu.Its mechanism is that “draining dampness and relieving stagnation, Cang Zhu excels,” which is one aspect; increasing the use of Cang Zhu supports spleen yang, and with sufficient yang, the spleen can function, leading to the resolution of edema, which is another aspect.For treating cardiac edema, which is due to insufficient spleen yang, Cang Zhu can be used with Gan Jiang; for lung and spleen qi deficiency, with stagnant dampness, Cang Zhu can be used with Ma Huang, with Cang Zhu’s dosage being three to four times that of Ma Huang; for heart yang deficiency, combined with Gui Zhi; for kidney yang deficiency, combined with Fu Zi (Aconite); for damp phlegm and blood stasis, combined with Tian Qi (Notoginseng) and Ting Li Zi (Descurainia), with Cang Zhu’s dosage between 15-20 grams. In observing a hundred patients, the edema was resolved satisfactorily.However, it should not be used recklessly in cases of severe heat in edema.Additionally, using Cang Zhu as the main herb, differentiated treatment for 10 cases of edema due to beriberi also showed good results. 14 One woman, aged fifty, initially suffered from painful urination, treated with Ba Zheng San (Eight Correcting Powder) and others, but her urination remained obstructed, and her body felt like it was pricked with needles.Wang Kentang diagnosed it as dampness from continuous rain, the evil still on the surface, thus used Cang Zhu as the chief herb, with Fu Zi as an assistant, to induce sweating; after one dose, she sweated, and urination was immediately relieved. 15 Cang Zhu combined with Xuan Shen has a blood sugar-lowering effect. Using Cang Zhu to treat diabetes takes advantage of its ability to “tonify spleen essence and stop leakage of turbid.”Although Cang Zhu is drying, when combined with Xuan Shen’s moistening properties, it can enhance its strengths while mitigating its weaknesses. 16 According to the “Compendium of Materia Medica,” Cang Zhu is said to “treat damp phlegm retention or phlegm with blood stasis forming cysts.”Phlegm turbidity and blood stasis are pathological products of diabetes, continuously affecting blood sugar biochemistry and metabolism.Cang Zhu can be added to tonifying lung and kidney, and major qi and yin tonics, not only to strengthen the spleen and open the middle, preventing the cooling and moistening herbs from harming the spleen and stomach, but also to invigorate the turbid and raise the clear, helping to lower blood sugar by resolving turbid fat and phlegm stasis.It has been used with 10-15 grams of Cang Zhu, combined with Huang Qi (Astragalus), Sha Shen (Glehnia), Tian Dong (Asparagus), Mai Dong, Xuan Shen, Sheng Di (Rehmannia), Shan Yao (Chinese Yam), Wu Wei Zi, etc., to form the “Jin Shui Xiang Sheng Yin” (Golden Water Generating Decoction), treating 52 cases of type II diabetes, one dose daily, while gradually reducing the original hypoglycemic Western medicine, and advising patients to control their diet, manage emotions, and balance work and rest.After taking 40 doses, according to the efficacy standards for diabetes set by the National Administration of Traditional Chinese Medicine, the total effective rate was 92%, and it was found that Cang Zhu played a crucial and indispensable role in the formula.In a selection of 12 patients, removing Cang Zhu while keeping other herbs and dosages unchanged resulted in a significant reduction in blood sugar levels; the original formula with Cang Zhu had better and faster hypoglycemic effects. 17 Cang Zhu treats bi syndrome, applicable for both cold and heat types.Generally combined with Fu Zi, Gui Zhi, and Gan Cao for cold damp pain; combined with Shi Gao, Qin Jiao (Gentiana), and Yi Ren for hot bi with joint redness and swelling; combined with Qiang Huo, Du Huo (Angelica), Fang Feng, and Wei Ling Xian (Clematis) for wind-cold-damp bi. 18 Cang Zhu is a key herb for treating gout.For acute gout attacks, with heat predominating over dampness, use Cang Zhu as the main herb, combined with Zhi Mu (Anemarrhena), Shi Gao, and Fang Ji (Stephania). For those with weak spleen and stomach, add glutinous rice and Gan Cao; for severe pain, add Yan Hu Suo (Corydalis).For acute gout attacks with equal heat and dampness, use Cang Zhu as the main herb, combined with Huang Bai, Niu Xi, and Yi Ren.For significant dampness and turbid phlegm, add Hou Po; for severe pain, add Liang Mian Zhen (Dichroa);for chronic recurrent gout attacks, with dampness and stasis obstructing the meridians, use Cang Zhu as the main herb, combined with Hong Hua (Carthamus), Tian Qi, and Chuan Shan Long (Dichroa). For qi and blood deficiency, add Dang Gui (Angelica) and Huang Qi; for severe pain, add Qi She (Agkistrodon);for wind-cold-damp obstruction of the meridians, combine Cang Zhu with Du Huo, Wei Ling Xian, and Mu Guo. For liver and kidney deficiency, add Guo Sui Bu (Dipsacus) and Xu Duan (Dipsacus); for severe pain, add Zhi Chuan Wu (Aconite) and Zhi Cao Wu (Aconite); for accompanying sand and painful urination, add Jin Qian Cao (Lysimachia) and Mao Xu Cao (Hedyotis). 19 Cang Zhu can treat chyluria, with good efficacy in short-term cases, often used with Bai Zhu, Bi Xie, Shan Yao, and Huang Qi. 20 For multiple neuritis, with a course of less than one month, with flaccid limbs and paroxysmal cramping pain, 6-9 grams of Cang Zhu can be added to strengthening herbs, effective for early paralysis; this method can also be used for early polio, aiding in recovery from weakness. However, it should not be used for hemiplegia caused by cerebral hemorrhage. 21 For erysipelas occurring in the lower limbs, known in TCM as flowing fire. For recurrent flowing fire, after the acute phase, use 1000 grams of Cang Zhu, decocted three times, combining the medicinal juices into a paste, then add 250 grams of honey, mix well and store in a bottle.Take one or two spoonfuls, dissolve in water, twice daily, for about half a month as one treatment course, then continue with the same method for 2-3 more courses to consolidate the results.Most patients gradually reduce occurrences, even completely stopping, achieving a curative effect.For milder cases, taking Er Miao Wan (Cang Zhu and Huang Bai), 9 grams each time, twice daily, can achieve similar effects. 22 Cang Zhu 10 grams, Liu Yi San (Six One Powder) 30 grams (in a bag), Bi Xie 10 grams, decocted for oral administration, treats damp-heat amenorrhea. Symptoms include amenorrhea with continuous discharge, profuse white discharge, scanty yellow discharge, thick yellow-white tongue coating, and slightly red tongue body.For amenorrhea due to deficiency, it is not advisable to use. 23 Cang Zhu is a commonly used herb for treating various ophthalmic disorders.For symptoms such as redness and ulceration of the eyelids, cloudy white spots on the cornea resembling “toothpaste” or “mold,” and swelling of the macula in the retina with symptoms of “distorted vision,” accompanied by a thick or greasy white tongue coating, Cang Zhu can be used as the main herb in the formula, yielding effective results. 24 Cang Zhu combined with Ze Xie (Alisma), Ban Xia (Pinellia), Chen Pi, Fu Ling, and Tian Ma (Gastrodia) is effective for treating inner ear vertigo.For symptoms with thick greasy or yellow greasy coating on the middle and root of the tongue, Cang Zhu is particularly suitable, with a dosage of 15-20 grams.If the coating is thin and white, Bai Zhu can be substituted.Note:Please follow medical advice for specific treatments and dosages!This article is excerpted from “Clinical Materia Medica,” authored by Tao Yufeng and published by the People’s Health Publishing House, March 2005.Recommended Reads, click to read the original text:Tao Yufeng: There is a special cooking method for Xia Ku Cao (Selfheal), you may not know! 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