Dingyu Lizhong Tang: Warming the Interior, Harmonizing the Stomach, Downbearing Counterflow and Stopping Vomiting

Dingyu Lizhong Tang comes from the Yizong Jinjian. It is built on the Lizhong Wan formula of the Shanghan Lun by adding dingxiang (Clove) and wuzhuyu (Evodia), and changing the pill to a decoction. It consists of six herbs—dingxiang, wuzhuyu, dangshen (Codonopsis), chao baizhu (fried Atractylodes), ganjiang (Dried ginger) and zhi gancao (Honey-fried Licorice). The usual adult daily dose: dingxiang 6 g, wuzhuyu 3 g, dangshen 15 g, baizhu 10 g, ganjiang 6 g, zhi gancao 6 g. This formula warms the middle and dispels cold, harmonizes the stomach and downbears counterflow, fortifies the spleen and opens the stomach. It is used for stomach-reflux (fan wei) due to deficiency-cold of the middle jiao, presenting with vomiting only long after eating, or morning eating and evening vomiting, or evening eating and morning vomiting, with vomitus being thin, clear phlegm-water or undigested food residue. The patient has poor appetite, pale complexion, fatigued spirit and lassitude, cold limbs, abdominal pain with loose stool, pale tongue with white coat, and a slow, weak pulse.

This constellation of symptoms is often seen in patients with peptic ulcer, reflux esophagitis, chronic superficial gastritis, chronic atrophic gastritis, pancreatitis and cholecystitis, and also in esophageal and gastric cancer patients. Certain infectious diseases, such as viral gastroenteritis and viral pneumonia, can also leave similar sequelae after recovery. Lizhong Wan is made of equal parts renshen (Ginseng), ganjiang (Dried ginger), zhi gancao (Honey-fried Licorice) and chao baizhu (fried Atractylodes), prepared into pills, each about 10 g in modern weight, taken 2–3 times daily. Lizhong Wan resolves indigestion from middle-jiao deficiency-cold, abdominal pain relieved by pressure, vomiting and diarrhea, poor appetite, and a bland mouth without thirst. Dingxiang and wuzhuyu are both dedicated herbs for downbearing counterflow and stopping vomiting, both warm in nature; while downbearing counterflow and stopping vomiting, they also dispel cold and stop pain. Adding dingxiang and wuzhuyu to Lizhong Wan strengthens the anti-vomiting effect.

I often use this formula to resolve the “stomach reflux” seen in gastric- and esophageal-cancer patients. TCM holds that the typical symptom of stomach reflux is “morning eating and evening vomiting, evening eating and morning vomiting”—in today’s words, food eaten in the morning is vomited in the evening, and food eaten in the evening is vomited the next morning. This closely resembles the constellation of symptoms caused by pyloric obstruction in modern medicine, whose causes are complex: gastritis, gastric cancer, gastric ulcer, gastroptosis, esophagitis and esophageal cancer can all cause pyloric obstruction.

Dingyu Lizhong Tang can serve as a pattern-based formula for pyloric obstruction of the middle-yang-deficiency-exhaustion type. To achieve better results, one must, based on the patient’s condition, further add some disease-specific herbs; combining pattern-based and disease-based treatment yields better results. For esophageal and gastric cancer, add on the basis of this formula anti-cancer herbs such as sanleng (Sparganium), ezhu (Curcuma), jianghuang (Turmeric), banmao (Mylabris), baiji (Bletilla) and huzhang (Reynoutria). For peptic ulcer with excess stomach acid, add acid-neutralizing herbs such as walengzi (Cowrie shell) and wuzeigu ( cuttlebone). For patients with poor appetite and loose stools, consider adding spleen-fortifying, dampness-draining herbs such as huaishanyao (Chinese yam), baibiandou (White hyacinth bean), chao yiyiren (fried Coix) and fuling (Poria). For severe vomiting and counterflow, add banxia (Pinellia) and shidi (Persimmon calyx) to further strengthen the anti-vomiting action.