Li Dongyuan's Development of His Teacher Zhang Yuansu's Zhizhu Wan
Li Dongyuan, one of the four great Jin-Yuan masters and founder of the Spleen-Stomach school, lived in an age of plague and war. Poor conditions and epidemics caused many spleen-stomach diseases—then the epidemic disease. This gave him rich clinical experience and made him the school's founder.
Li studied under Zhang Yuansu, founder of the Yishui school, who excelled at spleen-stomach disease and summarized its treatment: drain excess earth, supplement deficient earth, remove root dampness, percolate branch dampness, drain excess stomach, supplement deficient stomach, clear root heat, resolve branch heat. Li inherited and further developed and refined Zhang's approach.
Zhang's classic for spleen-stomach disease was Zhizhu Wan (Immature Bitter Orange-Atractylodes Pill): Baizhu (Atractylodes) two liang, Zhiqi (immature orange fruit, pith removed, wheat-bran fried) one liang; grind extremely fine, bind with lotus-leaf-wrapped rice, form pellets the size of a wutong seed; take 50 each time. It treats stuffing, aids digestion, and strengthens the stomach—a classic for indigestion.
Zhiqi is the immature fruit of the rue-family sour orange; it breaks qi, disperses food stagnation, and resolves phlegm nodules, treating stagnation, stuffing/pain, diarrhea with tenesmus, constipation, phlegm-obstructed qi, and organ prolapse (gastrectasis, gastroptosis, uterine prolapse, rectal prolapse). Zhang Zhongjing's Dachengqi Tang uses it to guide stagnation.
Baizhu is TCM's foremost herb for supplementing qi, strengthening the spleen, drying dampness, and promoting diuresis; it also stops sweating and calms the fetus. Used for spleen-qi deficiency, poor appetite, fatigue, abdominal distension, diarrhea, phlegm-rheum dizziness, edema, and leukorrhea. Pharmacology shows its decoction promotes gastric emptying and small-intestine propulsion in mice and prevents experimental gastric ulcers; atractylodes lactone enhances salivary amylase, aids nutrient absorption, and regulates GI function.
Lotus leaf also opens the stomach and aids digestion; the Bencao Tongxuan says it opens the stomach, aids digestion, stops bleeding, and secures essence. Southerners cook rice or chicken wrapped in lotus leaf in summer, for it clears summerheat and aids digestion.
Thus Zhiqi, Baizhu, and lotus leaf together address many problems of indigestion; simple as it is, its effect is not small. Li was deeply influenced by his teacher and often used Zhizhu Wan, developing it into nine formulas: Jupi Zhizhu Wan, Qunie Zhizhu Wan, Muxiang Zhizhu Wan, Banxia Zhizhu Wan, Caodoukou Wan, Sanhuang Zhizhu Wan, Chushi Yiqi Wan, Zhishi Daozhi Wan, and Baizhu Wan.
Jupi Zhizhu Wan: Jupi (tangerine peel) and Zhiqi (bran-fried, pith removed) one liang each, Baizhu two liang; made like Zhizhu Wan with lotus-leaf rice, wutong-sized. Li used it for weak original qi in the old and young with indigestion or disharmony and epigastric stuffiness. It adds qi-moving Jupi to Zhizhu Wan, strengthening its effect; Jupi is milder than Zhiqi, which can damage the righteous if overused. Li said internal-injury treatment should thicken stomach qi so that even heavy, rich meals do not harm; taken long-term it aids stomach qi. It suits long-term use by those with poor gastric motility.
Qunie Zhizhu Wan: Zhiqi (bran-fried, pith removed), damai nie (barley sprout, bran-fried), Shenqu (medicated leaven, fried) one liang each, Baizhu two liang; lotus-leave rice pellets, wutong-sized. Li used it for indigestion from being urged to overeat—epigastric fullness and discomfort. Barley sprout and Shenqu aid digestion; alongside Zhizhu Wan's stagnation-guiding, this suits weak digestion with easy food stagnation and bloating.
Muxiang Zhizhu Wan: Muxiang (Aucklandia) and Zhiqi one liang each, Baizhu two liang; lotus-leaf rice pellets. Li used it to break stagnant qi, disperse food, and open the stomach. Muxiang moves qi and stops pain, strengthens the spleen, and aids digestion; adding it strengthens Zhizhu Wan, and the pattern includes epigastric pain.
Banxia Zhizhu Wan: Banxia (boiled-washed seven times, dried) and Zhiqi one liang each, Baizhu two liang; lotus-leaf rice pellets, mung-bean sized. Take 50 with warm water; increase if weak. Li used it for injury from cold foods—epigastric fullness and discomfort from raw/cold intake. Banxia is warm-drying, drying dampness and resolving phlegm, descending rebellion and stopping vomiting, dispersing stuffing—Er Chen Wan is based on it. Overeating cold/damp causes damp obstruction in the middle jiao and, over time, phlegm, hence Banxia. But Banxia is highly toxic and must be properly processed; inexperienced people should not make these pills at home—use decoction instead, as boiled Banxia is much less toxic.
Caodoukou Wan: Caodoukou (round cardamom, wrapped in dough and baked, skin removed), Zhiqi (bran-fried, pith removed), Baizhu one liang each; barley sprout (bran-fried yellow), Banxia (boil-washed seven times, sun-dried), Huangqin (scraped, raw), Shenqu (fried yellow) five qian each; dried ginger, Jupi, Qingpi two qian each; fried salt five fen. Grind extremely fine, bind with soaked steamed cake into mung-bean pellets; take 50 with plain water. It treats autumn-winter injury from cold foods causing epigastric radiating pain to both flanks and throat obstruction. The composition is complex—Banxia Zhizhu Wan plus Qunie Zhizhu Wan plus additions—for a more complex condition: not just epigastric pain but flanks drawing inward, plus dysphagia. Various GI and neurotic disorders can cause it; Li's having invented it shows he used it. Alas, no manufacturer makes it now, though I have seen such patients.
Sanhuang Zhizhu Wan: Huangqin two liang; Huanglian (wine-washed), Dahuang (wrapped in wet paper and baked), Shenqu (fried), Jupi, Baizhu one liang each; Zhiqi (bran-fried, pith removed) five qian. Grind fine, bind with steamed cake into pellets twice mung-bean size; take 50 with plain water, dose by injury. It treats stuffing and discomfort from rich, spicy, meaty, and doughy foods. In effect it combines Zhizhu Wan with Sanhuang Xiexin Tang, adding Shenqu and Jupi. Used for indigestion and epigastric stuffing from acute/chronic gastroenteritis, cholecystitis, hepatitis.
Li also had Zhishi Zhizi Dahuang Tang, of Zhiqi, Zhizi, Dan-douchi, and Dahuang—Dachengqi Tang minus Houpo and mangxiao, plus Zhizi and dan-douchi—for epigastric distending pain with vexation and heat after food injury. Similar to Sanhuang Zhizhu Wan, it combines Zhizhu Wan with a Zhang Zhongjing formula; Zhizi-dandouchi treats vexation, so it addresses that.
Chushi Yiqi Wan: Zhiqi (bran-fried, pith removed), Shenqu (fried yellow), Huangqin (raw), Baizhu one liang each; Laifuzi (radish seed, fried to remove odor) five qian; Honghua (safflower) three fen; made like Zhizhu Wan with lotus-leaf rice, mung-bean pellets; take 50. Li used it for injury from damp dough causing abdominal stuffiness and heavy limbs. TCM sees heavy limbs as damp excess; Zhizhu Wan strengthens the spleen and dries damp but not strongly enough, so Laifuzi promotes diuresis and reduces bloating, Huangqin clears damp-heat, and Honghua activates blood. The small amount of Honghua may reflect Li's view that heavy dampness also involves blood stasis; this formula can treat ascites and gout.
Zhishi Daozhi Wan: Dahuang one liang; Zhiqi (bran-fried, pith removed), Shenqu (fried) five qian each; Fuling (peeled), Huangqin (scraped), Huanglian (picked clean), Baizhu three qian each; Zexie two qian. Grind fine, bind with steamed cake into wutong pellets; take 50-70 with warm water between meals, adjust by deficiency/excess. Li used it for injury from damp-heat foods causing unresolved stagnation, stuffing, and vexation. It combines Sanhuang Xiexin Tang (clearing fire) with Zhizhu Wan (guiding stagnation), plus Baizhu, Fuling, Zexie (draining dampness); together they clear heat, transform dampness, and guide stagnation. Modern clinicians use it for intestinal adhesions and obstruction, whose mechanism matches.
Baizhu Wan: Zhiqi (bran-fried, pith removed) one liang one qian; Baizhu, Banxia (soaked), Shenqu (fried yellow) one liang each; Jupi (pith removed) seven qian; Huangqin seven qian; Bai fan (dried alum) three fen. Grind extremely fine, bind with steamed cake into pellets twice mung size; take 50 with plain water, adjust by injury. Li used it for injury from bean, starch, and greasy foods, noting such patients commonly take dried ginger, so he added Huangqin to drain. In practice it suits patients fond of spicy/greasy food, who often develop gallbladder problems.
From one Zhizhu Wan grew nine formulas. In the subtle changes one sees how meticulous Li Dongyuan, grandmaster of the spleen-stomach school, was in clinic—adding or removing a single herb deliberately. No wonder his results were so admired.