Author | Liuzi Editor | Chunfeng Reviewer | Xiaoye
When it comes to pain, everyone can say “no flow, no pain,” but the reasons for blocked meridians and blood vessels are varied.
After the age of fifty, we are easily afflicted by conditions such as shoulder periarthritis and cervical spondylosis, leading to shoulder and arm pain, limb numbness, and body edema. While these conditions may not be life-threatening, they significantly affect life experience and quality, leaving one feeling uncomfortable.
Generally, people believe that this is due to wind, cold, dampness, or blood stasis blocking the meridians, resulting in “no flow, no pain.” However, methods to invigorate blood circulation and eliminate wind-dampness often yield little effect, indicating that the treatment may not be appropriate. Could it be possible that the blockage in the meridians is not due to blood stasis, but something else? Today, I will introduce a specialized formula that opens up new perspectives.
Pinghe Fuling Wan (Phlegm-Resolving Poria Pill)
The Pinghe Fuling Wan, also known as Fuling Wan, is derived from the “Shizhai Baiyi Xuanfang – Quansheng Zhimifang,” and is often referred to as Zhimifuling Wan in later generations.
This formula primarily functions to dry dampness, promote qi flow, soften hardness, and resolve phlegm. It is used to treat conditions caused by phlegm-dampness obstructing the middle jiao, leading to pain in the arms, limb edema, excessive phlegm cough, chest tightness, and a white greasy tongue coating.
The original formula converted to modern dosage units is: Fuling (Poria) 6g, Zhike (Bitter Orange) 3g (stir-fried), Banxia (Pinellia) 12g, Fenghua Puxiao (Dehydrated Glauber’s Salt) 1g, and 3-5 slices of Shengjiang (Fresh Ginger) (where Puxiao should be dissolved). This dosage is for reference only; specific adjustments should be made under the guidance of TCM diagnosis!
Since it is clear that the “blockage” is due to phlegm-dampness, the first step of the Fuling Wan is to eliminate phlegm, hence the heavy use of Banxia to dry dampness and resolve phlegm.
Phlegm generally arises when the spleen and stomach cannot properly transform and transport fluids, leading to stagnant water in the body, which becomes phlegm-dampness.
Banxia is pungent, dispersing, warming, and drying, primarily acting on the spleen and stomach meridians, making it suitable to dry out this phlegm-dampness.
However, Banxia is toxic, so to mitigate its toxicity, fresh ginger is added to the Fuling Wan. Ginger can counteract the toxicity of Banxia while also promoting appetite and resolving phlegm, achieving two benefits.
If the Fuling Wan is taken in decoction form, slices of ginger can be added and boiled with the other herbs. If the Fuling Wan is to be made into pills, ginger juice can be mixed with the powdered herbs to form pills, or ginger juice can be used to swallow the pills.
Even after drying out the excess phlegm-dampness with Banxia, the spleen and stomach may still be producing phlegm-dampness. At this point, we need to strengthen the spleen and stomach to prevent further production of “stagnant water,” which is the role of Fuling.
Fuling not only eliminates dampness, allowing phlegm-dampness to be expelled through urination, but also strengthens the spleen and stomach. Once the spleen and stomach’s function of transforming and transporting fluids is restored, phlegm-dampness will not be generated.
These two herbs are derived from the classic formula “Xiao Banxia Jia Fuling Tang” and are the core and foundation of the Fuling Wan. If symptoms are mild, these two herbs alone may suffice. The other herbs in the Fuling Wan serve to assist.
Zhike’s role is to regulate qi and relieve the middle jiao, allowing the qi that is blocked in the spleen and stomach to flow downwards. When the qi flows smoothly, phlegm-dampness will naturally be expelled.
Some phlegm is stubborn, like a dogskin plaster, especially the stubborn phlegm lodged in the middle jiao and spleen. Conventional dampness-eliminating herbs may not be effective against it, so we add a herb called Fenghua Puxiao. Fenghua Puxiao is dehydrated Glauber’s salt, primarily composed of anhydrous sodium sulfate.
Its most well-known function is to purge fire and promote bowel movements in the Dachengqi Decoction, but actually, from the ancient “Shennong Bencao Jing,” we find that Glauber’s salt can also open meridians, break blood stasis, and eliminate phlegm turbidity.
This is the brilliance of its use in the Fuling Wan, as it can soften hardness and disperse masses to eliminate stubborn phlegm, while also opening meridians and alleviating numbness and pain in the limbs.
These herbs work together not only to address the symptoms by eliminating stubborn phlegm and alleviating limb numbness but also to treat the root cause by restoring the spleen’s function of transforming and transporting fluids.
In clinical practice, conditions such as shoulder periarthritis, insomnia, lung masses, thick and sticky phlegm cough, chest fullness, dizziness, and plum pit qi may all be caused by stubborn phlegm. The application of Fuling Wan can clear away stubborn phlegm, restore the spleen and stomach’s functions, and naturally eliminate symptoms like limb numbness and edema.
When using Fuling Wan, it is important to note that if the righteous qi is already damaged, this formula should be used with caution, and it is necessary to add herbs that tonify the spleen and qi to ensure that phlegm is eliminated without harming the righteous qi.
Before using Fuling Wan, it is essential to clarify the symptoms of phlegm-dampness. If caused by wind-cold-dampness, a formula to dispel wind-dampness and open the meridians should be used.
If caused by qi and blood stagnation, a formula to invigorate blood and eliminate stasis should be used. If caused by qi and blood deficiency, tonifying herbs should be used. Only by matching the appropriate herbs to the specific symptoms can effective results be achieved.
Pain is often caused by two reasons: one is “no flow, no pain,” where external pathogens such as wind, cold, and dampness invade the meridians, or internal pathogens like qi stagnation, blood stasis, and phlegm-dampness obstruct the meridians, leading to impaired qi flow; the other is “no nourishment, no pain,” where insufficient qi, blood, and body fluids fail to nourish the meridians.
Typically, limb numbness and pain are often treated from the perspective of invasion by wind, cold, and dampness, or qi and blood stagnation, using various methods such as dispelling wind and dampness, invigorating blood and eliminating stasis, and opening the meridians to relieve pain. Common formulas include Qianghuo Shengshi Decoction, Duhuo Jisheng Decoction, Huoluo Xiaoling Dan, Shentong Zhi Yu Decoction, and Ganjiang Lingzhuzhu Decoction.
In fact, regarding the cause of “blockage,” in addition to wind, cold, dampness, and blood stasis, we must also consider phlegm as a pathological product. Strange diseases often arise from phlegm.
Phlegm can rise and fall with qi; wherever qi can reach, phlegm can also reach. When phlegm is lodged in the middle jiao, qi stagnation prevents it from descending. The spleen governs the limbs, so it can ascend to the meridians of the arms, and phlegm can also attack and obstruct the meridians, causing pain. Moreover, prolonged obstruction of the meridians leads to further qi stagnation, making phlegm turbidity more likely to congeal. Therefore, the formula must also include ingredients that resolve phlegm and disperse masses.
The creation of Fuling Wan arose from the author’s observation of rigid thinking among practitioners, hoping to break traditional thought patterns and inform the world that the causes of limb numbness and pain are not limited to wind, cold, dampness, and blood stasis, but also include phlegm. Fuling Wan is centered on treating phlegm and opening the meridians.
This innovative approach reflects the diversity of TCM syndromes and the sophistication of herbal prescriptions. For example, Puxiao, which many people rigidly associate with use only in purgative formulas for constipation, can actually be traced back to its efficacy in breaking masses and relieving obstruction.
This formula is not only outstanding in itself, but its underlying significance is also profound, reminding practitioners to seek the root cause of diseases and not be led by disease names.
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The content of this article is for reference only; non-professionals in TCM should not attempt to use the herbs.Original submission: [email protected] (email), chunfeng52566 (WeChat)