Author | Mu Jin Editor | Chun Feng Reviewer | Xiao Ye
In clinical practice, we often encounter a group of individuals who have internal heat, frequently experiencing symptoms of heat such as acne, sore throat, swollen gums, oral ulcers, and dry mouth with a bitter taste. However, when they consume cooling foods to “extinguish the fire,” they immediately suffer from diarrhea and abdominal pain, creating a significant contradiction in their bodies.
This “strange syndrome” has troubled many people; heat is not acceptable, and cold is also not acceptable. This condition can be understood in TCM as “upper heat and lower cold,” which simply means that the upper part of the body has heat, while the lower part has cold.
What causes this phenomenon? It is closely related to poor dietary and lifestyle habits, such as staying up late, overeating, consuming cold foods, not avoiding cold, and lack of exercise, which disrupts the original balance of yin and yang in the body, leading to the confusion of cold and heat.
What should be done in the face of such symptoms? Today, I will introduce a formula that can treat upper heat and lower cold: **Zhi Zi Gan Jiang Tang** (Gardenia and Dried Ginger Decoction).
Zhi Zi Gan Jiang Tang
**Zhi Zi Gan Jiang Tang** comes from the “Shang Han Lun” (Treatise on Cold Damage) written by the medical sage Zhang Zhongjing during the Eastern Han Dynasty. The formula is quite simple, as its name suggests, consisting of **Zhi Zi** (Gardenia) and **Gan Jiang** (Dried Ginger), forming a potent combination that is the smallest formula for clearing the upper and warming the lower in the “Shang Han Lun”.
Typical composition: **Zhi Zi** 15g, **Gan Jiang** 10g.
Effects: Used to treat heat obstructing the chest with concurrent middle jiao deficiency and cold syndrome, primarily manifesting as body heat, irritability, easy to develop acne, oral ulcers, diarrhea or loose stools, abdominal distension, cold pain in the stomach, and fear of cold.
Precautions: Not suitable for patients with spleen and stomach deficiency-cold, or qi and yin deficiency syndromes.
Zhang Zhongjing used this formula to treat “cold damage, and the physician used pills to purge it, but the body heat did not subside, and there was slight irritability.”
If a person catches a cold due to exposure to cold, the correct treatment method should be to sweat out the cold evil from the body. Once the sweat is out, the heat will also subside. However, if a purging method is mistakenly used, not only will the heat not subside, but it will also be trapped in the chest, and the purging medicine, being too cold, will further damage the yang qi of the spleen and stomach, leading to the manifestation of upper heat and lower cold.
▋Zhi Zi
**Zhi Zi** is the mature fruit of the plant **Gardenia jasminoides**, belonging to the Rubiaceae family. It enters the heart, lung, and san jiao meridians, and has a bitter and cold nature. It functions to drain fire, relieve irritability, clear heat, promote urination, and cool the blood to detoxify. This seemingly fiery red fruit can actually help cool the body down.
Among many heat-clearing and fire-draining herbs, **Huang Lian** excels at clearing heart fire, while **Huang Qin** is good at clearing lung fire, each with its strengths. Zhang Zhongjing valued **Zhi Zi** for its ability to clear the fire from the three jiao, as the upper heat can be from both heart-lung fire and liver-gallbladder heat, thus using **Zhi Zi** to eliminate it all at once.
**Zhi Zi** clears heat and drains fire in a unique way; it directs the heat downwards into the bladder, allowing it to be expelled through urination, thus alleviating symptoms such as body heat, irritability, facial acne, and oral ulcers.
When discussing fire, it is essential to differentiate between real fire and false fire, as many people have a misconception that upon seeing fire, they should indiscriminately use fire-draining herbs, which can sometimes lead to poor results.
Real fire: This occurs when yang is excessively strong while yin remains unchanged, resulting in a tangible excess of heat. It primarily manifests as fever, flushed face, red eyes, bitter mouth, bad breath, preference for cold drinks, yellow urine, dry stools, red tongue with yellow greasy coating, etc.
False fire: This occurs when yin is deficient while yang remains unchanged, meaning that yin cannot restrain yang. Simply put, there is not enough water to extinguish the fire, leading to the emergence of false fire, which primarily manifests as five hearts heat, palpitations, dry and painful throat, insomnia with vivid dreams, tidal fever with night sweats, weight loss, yellow urine, dry stools, and red tongue with little coating.
For those with real fire, we use heat-clearing and fire-draining herbs, while for those with false fire, we need to nourish yin to restore the missing yin to restrain yang. If we only use fire-draining herbs at this time, the problem cannot be resolved. Although the symptoms of heat appear minor, careful differentiation and cautious use of herbs are necessary.
▋Gan Jiang
We are all familiar with ginger, as we encounter it almost daily. Adding some ginger while cooking not only enhances flavor but also stimulates the taste buds. A bite of spicy ginger can create a warming sensation. In this formula, the spicy and warming **Gan Jiang** plays a role in warming the cold.
There are different types of ginger: fresh ginger, dried ginger, and processed ginger, each with varying effects.
Fresh ginger: This is the fresh rhizome of ginger, which has the effects of releasing the exterior to disperse cold, warming the middle to stop vomiting, and transforming phlegm to stop cough. When we catch a cold and experience sneezing and runny nose, making a pot of fresh ginger soup can help sweat out the cold and alleviate symptoms significantly. Fresh ginger can also stop vomiting; it can be used to address nausea and vomiting.
Dried ginger: This is the dried rhizome of ginger. As the saying goes, “Old ginger is spicier,” the older the ginger, the spicier and warmer it becomes. Therefore, dried ginger has the effects of warming the middle, dispersing cold, reviving yang, and unblocking the meridians. This formula primarily addresses cold symptoms of the spleen and stomach, making dried ginger the most suitable choice.
Processed ginger: This is the processed product of dried ginger, which has the effects of warming the middle, dispersing cold, and stopping bleeding. It is particularly helpful for women experiencing excessive bleeding or blood loss.
In this formula, **Zhi Zi** and **Gan Jiang**, one cold and one warm, complement each other, effectively clearing heat and relieving irritability while warming the middle and tonifying the spleen. Zhang Zhongjing cleverly resolved this dilemma.
In clinical practice, other formulas for treating mixed cold and heat syndromes include **Wu Mei Wan** (Mume Pill), **Ban Xia Xie Xin Tang** (Pinellia Decoction to Drain the Heart), **Jiao Tai Wan** (Jiao Tai Pill), **Huang Lian Tang** (Coptis Decoction), **Fu Zi Xie Xin Tang** (Aconite Decoction to Drain the Heart), and **Gan Jiang Huang Qin Huang Lian Ren Shen Tang** (Dried Ginger, Scutellaria, Coptis, and Ginseng Decoction). The common feature of these formulas is the combined use of cold and heat herbs.
Next, let’s look at other common combinations of cold and heat herbs besides **Zhi Zi** and **Gan Jiang**.
**Jiao Tai Wan** consists of **Huang Lian** and **Rou Gui** (Cinnamon), specifically treating heart-kidney disharmony leading to irritability, insomnia, vivid dreams, and soreness in the lower back and knees. Heart fire and kidney water, although one is above and the other below, must maintain the balance of yin and yang in the body. They communicate with each other, whether through letters or phone calls, promoting the nurturing of kidney yang by heart fire and the nourishing of heart yin by kidney water.
If heart fire remains high while kidney water remains low, problems will inevitably arise. As mentioned earlier, **Huang Lian** excels at clearing heart fire, while **Rou Gui** can warm and tonify kidney yang, also drawing down the fire from the upper jiao, thus restarting the body’s self-circulation, naturally alleviating symptoms of irritability and insomnia.
Similar to **Rou Gui**, another warming yang herb is **Fu Zi**, which is a powerful warming herb with the effects of tonifying fire, strengthening yang, guiding fire back to the source, warming the spleen and stomach, and dispersing cold. It is suitable for symptoms of cold pain in the lower back and knees, abdominal pain, and loose stools due to insufficient yang qi of the spleen and kidney.
Additionally, **Huang Qin**, **Huang Lian**, and **Gan Jiang** are also commonly used combinations. In the “Shang Han Lun,” **Ban Xia Xie Xin Tang**, **Sheng Jiang Xie Xin Tang**, and **Gan Cao Xie Xin Tang** all feature these herbs, and they have been continuously used to effectively treat upper heat and lower cold.
Such conditions are quite complex, and it is advisable to consult a professional physician.
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The content of this article is for reference only. Non-TCM professionals should not attempt to use the herbs.Original submission: [email protected] (email), chunfeng52566 (WeChat)