Introduction: Learn the application experience of Wumei Pills.

Li Shimao's Experience

Professor Li Shimao often said that Zhang Zhongjing's prescription formulation aimed at establishing therapeutic principles, using formulas to demonstrate methods. In clinical practice, we examine symptoms to identify causes, differentiate syndromes to infer mechanisms, derive methods based on the mechanisms, and apply treatments according to the methods. Whenever the condition aligns with the applicable pathogenesis of Wumei Pills—liver deficiency with a mixture of cold and heat—regardless of the specific syndrome, Wumei Pills can be widely applied.

The essence of Jueyin disease is actually liver-wood deficiency and cold, with a mixture of cold and heat.

Due to individual differences, various pathological changes may arise. In clinical application of Wumei Pills, modifications are naturally made according to the syndrome.

On one hand, adjust the proportion of sour, bitter, pungent, and sweet herbs based on the relative strength of yin, yang, qi, and blood, as well as the severity of cold and heat. On the other hand, modify the prescription according to the clinical manifestations and deviations in the pathogenesis.

If there is no upper heat, reduce Coptis chinensis and Phellodendron amurense; if there is no lower cold, reduce Sichuan pepper and aconite; if the body is not deficient, reduce ginseng and angelica; for bitter taste and epigastric heat pain, increase the dosage of dark plum and Coptis chinensis to clear fire and relieve fullness; for middle cold with vomiting, add Evodia rutaecarpa and Pinellia ternata to warm the middle, lower adverse qi, and stop vomiting; for liver qi stagnation, yin-blood deficiency, and pain radiating to the chest and hypochondrium, add Bupleurum chinense, white peony root, and Sichuan chinaberry to soothe the liver, relieve urgency, and alleviate pain; for liver qi deficiency, add Astragalus membranaceus; for kidney yang deficiency, add cinnamon; for kidney essence deficiency, add Cistanche deserticola and deer antler glue; for spleen dysfunction, add Poria cocos and Atractylodes macrocephala; for spleen yang deficiency, add Epimedium brevicornum and Morinda officinalis; for constipation, add rhubarb and mirabilite to clear heat and promote bowel movements; for concurrent qi stagnation, add Aucklandia lappa and bitter orange to promote qi flow and soothe the liver.

Application indications should first be determined by pulse diagnosis.

In Jueyin disease with liver wood deficiency and cold, the pulse should be wiry and unable to withstand heavy pressure. However, due to individual clinical differences and changes in the disease mechanism, many combined pulse patterns may appear.

If the pulse is combined with slippery and rapid qualities, indicating a predominance of heat signs, the dosage of Coptis chinensis and Phellodendron amurense can be increased; if the pulse is combined with slow, tense, or tight qualities, indicating severe yang deficiency and cold, the dosage of Sichuan pepper and aconite can be increased, or Evodia rutaecarpa and cinnamon can be added; if the pulse is combined with weak and feeble qualities, indicating liver qi deficiency, Astragalus membranaceus can be added to tonify it; if the pulse is combined with thin qualities, indicating liver yin deficiency, white peony root and Cornus officinalis can be added to nourish the liver substance; if the pulse is combined with soft and soggy qualities, indicating spleen deficiency with impaired transportation, Poria cocos, Atractylodes macrocephala, and Alisma orientale can be added to invigorate the spleen and resolve dampness; if the pulse is combined with soggy and stagnant qualities, indicating blood stasis obstruction, peach kernel, safflower, and Salvia miltiorrhiza can be used to dispel stasis and unblock collaterals.

In summary, the deficiency-cold of the Jueyin Liver Wood presents with diverse pathological changes. However, from the perspective of pulse diagnosis, a wiry and weak pulse upon pressure is always observed. Regardless of the accompanying pulse manifestations, Wumei Pills can be selected, with modifications based on the characteristics of the accompanying pulses.

Case of Chest Impediment

Patient Tian, male, 60 years old, retired cadre. Initial consultation on June 12, 1997, due to chest tightness and palpitations for 3 years, aggravated in the past half month.

Three years ago, the patient experienced sudden chest tightness and spasms in the precordial area due to anger, accompanied by palpitations, sweating, and fatigue. He was subsequently admitted to a provincial hospital for treatment of coronary heart disease, which provided relief. However, he was unable to discontinue medication. In the past half month, his symptoms worsened, and he sought consultation upon referral.

Professor Li Shimao diagnosed his pulse as wiry and tense, yet weak upon pressure.

The syndrome differentiation indicated chest impediment, liver cold in the jueyin channel, and insufficient chest yang.

The prescription used was Wumei Wan: 4g of black plum, 12g of prepared aconite (decocted first), 4g of Sichuan pepper, 5g of dried ginger, 3g of asarum, 12g each of cinnamon twig and Chinese angelica, 5g of coptis, 4g of phellodendron, 12g of red ginseng, and 3g of cinnamon bark.

After 7 doses, the symptoms significantly improved. Western medicine was then discontinued, and the same formula was continued for another 7 doses, leading to remission. Later, the treatment was switched to Guizhi Jia Fuzi Tang for further regulation. Follow-up over one year showed no recurrence.

[Wang Jinbang, Liang Baoli. A Brief Discussion on Professor Li Shimao's Experience in Applying Wumei Pills. Hebei Journal of Traditional Chinese Medicine, 1999, 14(3): 33]

Hong Guangxiang's Experience

Analyzing the composition of Wumei Pills, the author believes there are three distinct characteristics:

First, it combines cold and warm properties while addressing both pathogenic factors and healthy qi, indicating that Wumei Pills are designed for conditions of internal deficiency with mixed cold and heat patterns

Second, the emphasis on pungent-heat, pungent-warm, and sweet-warm herbs indicates that the primary focus of Wumei Pills is "warming the organs and tonifying deficiency."

Third, the predominance of herbs that enter the spleen-stomach (large intestine) channels suggests that the core focus of Wumei Pills is centered on the spleen-stomach (large intestine).

This demonstrates that the scope of Wumei Pills primarily addresses spleen-stomach disorders characterized by "internal deficiency with cold-heat complexity."

It is important to emphasize here that when pathogenic factors penetrate deeply into the Jueyin, liver-wood disharmony occurs, leading to complex clinical manifestations, often marked by alternating cold and heat patterns, with liver-stomach symptoms being particularly common.

The relationship between the Jueyin liver and the spleen-stomach is very close, and they can influence each other pathologically.

For example, liver hyperactivity can restrict the spleen, while spleen deficiency can lead to liver restriction.

This results in liver-spleen disharmony, internal deficiency with wind stirring, and a complex pattern of cold and heat in the Jueyin syndrome.

The author believes that Wumei Pills were originally designed for roundworm-induced syncope. However, their formulation characteristics—such as combining cold and heat, treating deficiency and excess simultaneously, clearing the upper and warming the lower, attacking and tonifying together; blending sour, bitter, pungent, and sweet flavors; balancing rigidity and flexibility; using pungent and bitter flavors to open and descend; and regulating both the wood (liver) and earth (spleen)—provide a relatively broad scope for clinical application.

Therefore, its clinical application is quite broad. As long as the pathological mechanism of mixed cold-heat and deficiency-excess is identified, and treatment is adjusted according to the syndrome, good efficacy can be achieved.

Patient Hu, male, 52 years old, initial consultation on November 8, 1986. The patient first experienced stomach pain in March of last year, with no clear relationship between the pain and diet.

During episodes of stomach pain, the patient could not consume food or water, as intake would lead to vomiting. The patient preferred warmth and feared cold, had difficulty with bowel movements, experienced bitter taste in the mouth upon waking, and had slightly yellow urine.

After the stomach pain subsided, abdominal distension would follow, which worsened after eating. Each episode typically involved alternating stomach pain and abdominal distension: when there was pain, there was no distension, and when there was distension, there was no pain.

However, the pain occurs only 3 to 5 times per month, while abdominal distension is present daily. The tongue is pale red with a white coating, and the pulse is wiry and thin. Initially, it was suspected to be "disharmony between the liver and stomach with impaired spleen function," and a formula to soothe the liver, harmonize the stomach, and promote spleen function was prescribed, but the symptoms worsened instead.

Upon careful reconsideration of the symptoms during the follow-up visit, the patient presented with alternating episodes of stomach pain and abdominal distension, a preference for warmth and aversion to cold, vomiting immediately after eating, difficulty with bowel movements, bitter taste in the mouth, and yellow urine. These manifestations clearly resulted from deficiency-cold of the spleen and stomach, impaired movement of middle yang, failure of the stomach to descend, obstruction of the pivot mechanism, and stagnation transforming into heat. Consequently, the symptoms exhibited a complex pattern of cold, heat, deficiency, and excess. Therefore, Wumei Wan was prescribed to warm the organs, tonify deficiency, dispel cold, and clear heat.

Wumei (Mume Fructus) 9g, Xixin (Asari Radix et Rhizoma) 3g, Guizhi (Cinnamomi Ramulus) 6g, Shufuzi (Aconiti Lateralis Radix Praeparata) 9g, Shujiao (Zanthoxyli Pericarpium) 3g, Ganjiang (Zingiberis Rhizoma) 6g, Dangshen (Codonopsis Radix) 9g, Danggui (Angelicae Sinensis Radix) 6g, Huanglian (Coptidis Rhizoma) 3g, Huangbai (Phellodendri Chinensis Cortex) 3g.

Second Visit: After taking three consecutive doses of the above formula, the patient returned for a follow-up visit, reporting significant relief of abdominal distension and no recurrence of stomach pain. A total of 15 consecutive doses of this formula were administered, and all symptoms resolved. During a six-month follow-up, there was no recurrence of stomach pain or abdominal distension.

This case involved symptoms of abdominal distension, stomach pain, and vomiting. Abdominal distension was the primary symptom, with stomach pain and distension alternating during episodes—pain occurred without distension, and distension occurred without pain. When stomach pain occurred, drinking fluids would immediately induce vomiting.

It indicates that the disorder of qi movement and imbalance of ascending and descending are the fundamental pathogenesis in this case.

Pain without distension is a specific manifestation of the pathological principle "obstruction leads to pain." The patient prefers warmth and fears cold, experiences significant abdominal distension after eating, and presents with a white tongue coating and a thin pulse, clearly indicating "visceral cold," which is caused by deficiency-cold of the spleen and stomach.

Yang deficiency with internal cold, cold stagnation of qi movement, qi stagnation, and imbalance of ascending and descending, leading to symptoms such as abdominal distension, stomach pain, and vomiting.

Bitter taste in the mouth, yellow urine, and difficulty in bowel movements indicate internal stagnant heat. This fully aligns with the pathogenesis of Wumei Pills, which is "internal deficiency with cold-heat complexity."

Therefore, Wumei Pills were used to warm the organs, tonify deficiency, and regulate both cold and heat, achieving remarkable efficacy.