Lingzhu Erchen Jian: A TCM Formula for Gastric Retention
Lingzhu Erchen Jian comes from volume 51 of the Jingyue Quanshu (Complete Works of Zhang Jingyue) by Zhang Jingyue, the outstanding Ming-dynasty physician. Its composition is: Zhuling (Polyporus) 1.5 qian; Baizhu (Atractylodis Macrocephalae Rhizoma) 1–2 qian; Zexie (Alismatis Rhizoma) 1.5 qian; Chenpi (Citri Reticulatae Pericarpium) 1 qian; Banxia (Pinelliae Rhizoma) 2–3 qian; Fuling (Poria) 1.5 qian; Zhigancao (honey-fried Glycyrrhizae Radix) 8 fen; Ganjiang (Zingiberis Rhizoma; dry-fried yellow) 1–2 qian. It is decocted with one and a half cups of water for oral use. This formula warms the middle and drains dampness, and is indicated for phlegm-rheum and water-qi lodging below the heart, with vomiting and acid regurgitation, or diarrhea with scant urine.These symptoms resemble gastric retention in modern medicine. This condition may be caused by pyloric obstruction due to peptic ulcer or gastrointestinal tumor; it may also result from uremia, acidosis, hypokalemia, hypocalcemia, systemic or intra-abdominal infection, severe pain, or severe anemia; it may even be an adverse effect of certain anti-tumor drugs, antipsychotics, or anticholinergic agents.The key to using this formula is to grasp the patient’s two main signs: first, nausea and vomiting, even acid regurgitation; second, scant urine or loose stools. TCM holds that this arises from deficiency-cold of the middle jiao, with spleen deficiency failing to transport and transform water-dampness. In modern medical terms, impaired gastric motility prevents timely emptying of gastric contents, so they become retained in the stomach; Lingzhu Erchen Tang markedly promotes gastric emptying.Lingzhu Erchen Jian is in fact a modified combination of Erchen Tang (Two-Aged Decoction) and Wuling San (Five-Ingredient Poria Powder). Erchen Tang is the premier TCM formula for nausea and vomiting due to phlegm-rheum, while Wuling San has the action of moving qi, promoting urination, and freeing strangury. Used together, they both descend the counterflow qi of the middle jiao and drive the fluid lodged in the stomach out through the urine. Once the waterways are opened, the spleen’s function of transporting and transforming water-dampness recovers, and gastric retention is naturally relieved.The common modern adult dose for treating gastric retention is: Zhuling (Polyporus) 10 g; Baizhu (Atractylodis Macrocephalae Rhizoma) 10–15 g; Zexie (Alismatis Rhizoma) 10 g; Chenpi (Citri Reticulatae Pericarpium) 6 g; Fabanxia (processed Pinelliae Rhizoma) 10 g; Fuling (Poria) 10 g; Zhigancao (honey-fried Glycyrrhizae Radix) 5 g; Ganjiang (Zingiberis Rhizoma; dry-fried yellow) 3–6 g. Dried ginger sometimes causes stomach pain or allergic reactions in some patients; if a patient does not tolerate it, 5–7 slices of fresh ginger (Shengjiang) may be substituted.