bubble_chart Efficacy

Warming and activating spleen yang, purgation of cold-accumulation.

bubble_chart Indications

Spleen yang deficiency, cold accumulation constipation, or chronic dysentery with red and white discharge, abdominal pain, cold extremities, and deep, wiry pulse.

bubble_chart Formula Principles

This syndrome is caused by spleen yang deficiency, internal exuberance of pudendal coldness, and obstruction of cold accumulation in the middle. Cold and solid accumulation obstructs the intestines, leading to stagnation of fu-qi, hence constipation, abdominal pain, and continuous pain around the navel; spleen yang deficiency results in the lack of warmth in the extremities, leading to cold hands and feet; a deep, wiry, and slow pulse is a sign of yin exuberance and interior excess. Although this syndrome belongs to cold accumulation constipation, spleen yang deficiency is the root cause of the disease. If only purgative methods are used, it will further damage the middle yang; if only warming and tonifying methods are used, the cold accumulation will be difficult to remove. Only by combining the expulsion of cold accumulation with warming and activating spleen yang can both aspects be addressed. In the formula, Aconite Lateral Root paired with Rhubarb Rhizoma serves as the sovereign, using the strong pungent and hot properties of Aconite Lateral Root to warm and strengthen spleen yang, dispelling cold coagulation, and paired with Rhubarb Rhizoma to purge the accumulated cold. Mirabilite moistens the intestines and softens hardness, assisting Rhubarb Rhizoma in purging and attacking accumulation; Dried Ginger warms the middle and assists yang, helping Aconite Lateral Root in warming the middle and dissipating cold, both serving as minister medicinals. Ginseng and Chinese Angelica tonify qi and nourish blood, ensuring that purgation does not harm the righteous qi, serving as assistant medicinals. Liquorice Root not only assists Ginseng in tonifying qi but also harmonizes the various medicinals, serving as the envoy. Together, these medicinals work to expel cold pathogens, promote the movement of retained food, and restore spleen yang. Overall, this formula consists of warming and activating spleen yang medicinals combined with cold purgative medicinals to attack accumulation, encompassing the three methods of warming and unblocking, purging, and tonifying, embedding warming and tonifying within purgation, characterized by warming yang to dispel cold and purging without harming the righteous qi.

Abdominal pain, constipation, cold extremities, white tongue coating, deep and wiry pulse.

bubble_chart Formula Modification

For distending pain in the abdomen, add Magnolia Bark and Aucklandia Root to move qi and relieve pain; for cold pain in the abdomen, add Cassia Bark and Evodia Fruit to enhance the power of warming the middle and dispelling cold.

bubble_chart Documentation

1. Zhu Liang-chun et al. Tangtou Gejue detailed explanation: "Spleen-Warming Decoction is composed of Cold-Extremities Decoction (ginger, aconite, licorice) plus ginseng, Chinese angelica, rhubarb rhizome, and mirabilite. The function of Cold-Extremities Decoction is to warm the spleen and dispel cold. The addition of rhubarb rhizome and mirabilite is for their purgative and accumulative-removing effects, while the addition of ginseng and Chinese angelica is for their qi-tonifying and blood-nourishing effects. Since the reversal cold of limbs is of a warm and hot nature, it can alter the bitter and cold properties of nitrum and rhubarb. Therefore, this formula is specifically designed to expel cold accumulation and falls under the category of warm purgation. If there is heat and solidity with internal binding, and fluid damage leading to constipation, a cold purgative formula should be used, and this formula is not suitable."
2. Through clinical observation, Spleen-Warming Decoction has been found to improve renal function and hemorheological indicators. In the treatment of chronic renal failure (CRF) characterized by spleen and kidney deficiency and internal dampness turbidity, the whole blood viscosity, plasma viscosity, erythrocyte aggregation index, and erythrocyte electrophoresis were significantly reduced in patients treated with Spleen-Warming Decoction, while the control group did not show significant effects in these areas. This indicates that Spleen-Warming Decoction has the effect of improving hyperviscosity in CRF. The mechanism of action may be through regulating the overall state, improving renal function, and improving the internal state of "viscosity, aggregation, accumulation, and coagulation," thereby achieving the effect of improving hyperviscosity in CRF patients. Since increased whole blood viscosity can increase peripheral vascular resistance, leading to elevated blood pressure and even inducing hypertensive encephalopathy, reducing whole blood viscosity while improving renal function is very meaningful for the treatment of CRF. "Xu Shuli. The effect of Spleen-Warming Decoction on hemorheology in patients with chronic kidney failure. Chinese Medicine Research 1999; 12(6): 22]
3. Xue used this formula as the main treatment for 9 cases of pediatric paralytic ileus. The children's ages ranged from 3 to 16 months, with an average of 9.8 months. The causes of the disease were toxic dyspepsia in 4 cases, severe pneumonia and fungal enteritis with II-degree malnutrition in 2 cases each, and acute bacillary dysentery with acute enteritis in 1 case, with 5 cases being critically ill. After 1-3 doses of medication, borborygmus returned, and defecation and abdominal distension and fullness basically disappeared in 7 cases, with 2 cases being ineffective. (Xue Changsen. Spleen-Warming Decoction as the main treatment for 9 cases of pediatric paralytic ileus. Journal of Traditional Chinese Medicine 1993; (1): 24]

bubble_chart Modern Application

Strengthens the heart and promotes blood circulation. Commonly used for abdominal pain caused by roundworms, indigestion, cirrhosis ascites, acute simple intestinal obstruction or incomplete obstruction, etc., belonging to middle yang deficiency with cold and internal obstruction.

bubble_chart Comparison

This formula, along with Rhubarb and Aconite Decoction, belongs to the category of warm purgative formulas, both primarily treating cold accumulation constipation. The composition of this formula is derived from Rhubarb and Aconite Decoction by removing Asarum and adding Dried Ginger, Ginseng, and Liquorice Root, which is essentially Cold-Extremities Decoction with the addition of Ginseng and Rhubarb Rhizoma. Both formulas predominantly use large doses of warm and hot herbs, hence they are classified as warm purgation formulas. This formula is designed for cases where spleen yang is insufficient and middle qi is deficient and cold, leading to the stagnation of cold accumulation. The syndrome is characterized by deficiency with underlying excess, hence the formula includes Dried Ginger, Ginseng, and Liquorice Root to protect and support middle yang. In contrast, Rhubarb and Aconite Decoction is used for cold accumulation with interior excess pattern, where the condition is purely excess without deficiency, hence it includes Asarum to disperse cold and relieve pain, assisting Aconite Lateral Root in dissipating cold to alleviate pain.

There are three other versions of Spleen-Warming Decoction, with slight variations in ingredients, but the principles and primary treatments are similar. One version, found in the "Cold Dysentery" section of the fifteenth volume of Qianjin Fang, includes Cassia Central Bark but omits Liquorice Root. Although the primary treatment is similar, it is more suitable for cases with severe cold pattern accompanied by rebellious symptoms and signs. Another version, found in the "Heart and Abdominal Pain" section of the thirteenth volume of Qianjin Fang, adds Chinese Angelica and Mirabilite to the original formula, enhancing its purgative effect. It is primarily used for cold accumulation constipation with symptoms such as "abdominal pain, umbilical colic, and persistent pain around the navel." Additionally, Benshi Fang also has a Spleen-Warming Decoction, which uses Aconite Lateral Root, Dried Ginger, Cassia Central Bark, Liquorice Root, Magnolia Bark (each two taels), and Rhubarb Rhizoma (four qian). This version omits Ginseng and adds Cassia Central Bark and Magnolia Bark. It is primarily used for "chronic cold in the intestines and stomach, with yearly episodes of abdominal pain and diarrhea, occurring intermittently." Although both Benshi Fang and Qianjin Fang Spleen-Warming Decoction belong to the category of warm purgative formulas, the latter is more focused on treating dysentery with red and white discharge and severe food retention, hence it heavily uses Rhubarb Rhizoma to purge food retention, and the "Heart and Abdominal Pain" version further includes Mirabilite for assistance. At the same time, due to prolonged dysentery leading to deficiency-cold of the spleen and stomach and declining yang qi, it uses Ginseng, Liquorice Root, Dried Ginger, and Aconite Lateral Root to warm and activate spleen yang. Benshi Fang's version is used for cold accumulation diarrhea, where cold is severe and accumulation is mild, hence it emphasizes warming the middle. Although it uses Rhubarb Rhizoma for purging, it only constitutes 1/26 of the total formula. The same Rhubarb Rhizoma, due to different combinations of medicinals and dosages, has varying emphases in its effects. This illustrates that in formulating prescriptions, the selection of medicinal combinations and the determination of dosages must align with the syndrome and treatment principles to avoid the pitfalls of reinforcing excess or depleting deficiency.