Zhi Zhu Tang and Zhi Zhu Wan for Abdominal Distension and Edema
Zhi Zhu Tang comes from Jin Gui Yao Lue (Essential Prescriptions of the Golden Chamber). In the section "On Pulse Patterns and Treatment of Water-Qi Diseases, Chapter 14," it is recorded: "Hardness below the heart, as large as a plate, with a rim like a turned plate, caused by water and fluid; Zhi Zhu Tang governs." Zhi Zhu Tang consists of "seven pieces of Zhishi (immature bitter orange; now 15 g), and two liang of Baizhu (Atractylodes; now 6 g)." The method: "Boil the above two herbs in five sheng (500 ml) of water to three sheng (300 ml); divide into three warm doses. When the abdomen becomes soft, it will disperse."In Zhang Zhongjing's Jin Gui Yao Lue, the amount of Zhishi in Zhi Zhu Tang is greater than that of Baizhu. Zhishi is the immature fruit of the sour orange or citrus; it breaks up qi, disperses accumulation, resolves phlegm, and dissolves stuffiness. Baizhu fortifies the spleen and boosts qi. In Zhi Zhu Tang, because Zhishi is used in greater amount than Baizhu, the formula primarily attacks, with supplementation as the auxiliary.Zhi Zhu Tang is a famous classical formula for abdominal distension and constipation caused by water and fluid. It is now often used for fatty liver, functional dyspepsia, gastric retention, and elderly habitual constipation, and can also treat fever caused by childhood food stagnation.Zhi Zhu Wan is an experienced formula of the Jin-Yuan physician Zhang Yuansu; his disciple Li Dongyuan included it in Discrimination of Internal and External Injuries. Zhi Zhu Wan consists of "two liang (60 g) of Baizhu and one liang (30 g) of Zhishi." The preparation: grind these two herbs into fine powder, wrap them in a lotus leaf, cook with millet into rice, and make into wutong-seed-sized (soybean-sized) pills; take 50 pills each time, twice daily, regardless of meals.Zhi Zhu Wan is a ready-made medicine for weak stomach qi, poor transportation and transformation, stagnation of food, and stuffiness below the heart. Many Chinese patent-medicine factories have made patent medicines based on Zhi Zhu Wan; the Qumai Zhi Zhu Wan and Xiangsha Zhi Zhu Wan sold on the market are modified versions. It is now often used for chronic dyspeptic diseases such as gastroptosis, duodenal ulcer, bile-reflux esophagitis or gastritis, and anorexia nervosa.In Zhi Zhu Wan, the amount of Zhishi is only half that of Baizhu, so unlike Zhi Zhu Tang, which primarily attacks, Zhi Zhu Wan primarily supplements. Zhi Zhu Tang is suitable for what TCM calls excess conditions, while Zhi Zhu Wan is suitable for what TCM calls deficiency conditions. Both treat spleen deficiency with dampness excess, but because the doses of the two herbs differ, the uses differ; this is the subtlety of TCM.Zhi Zhu Tang is suitable for acute abdominal conditions, but for some diseases causing acute abdominal conditions, although Zhi Zhu Tang can relieve them temporarily, it is hard to eradicate them; fatty liver, for example, requires a long course. For such diseases, after using Zhi Zhu Tang to resolve the acute abdominal condition, it is best to use Zhi Zhu Wan for gentle, slow regulation.