Zhi Shi Li Zhong Wan - 枳实李中丸 - Immature Bitter Orange Pill To Regulate The Middle

English:	Immature Bitter Orange Pill to Regulate the Middle
Also Known As:

Herbs And Actions

Pharmaceutical Latin	Pin Yin	Dosage	Actions
Fr. Aurantii Immaturus	Zhi Shi	9-30g	Breaks up Stagnant Qi, reduces accumulation, descends Qi, unblocks the bowels, removes Stagnant Food, transforms Phlegm, reduces distention and resolves hardenings. With Bai Zhu, for distention in the epigastrium and abdomen due to Spleen and Stomach Deficiency with Food Stagnation.
Rz. Zingiberis	Gan Jiang	9-60g	Warms the Spleen and Stomach and eliminates interior Cold. With Zhi Gan Cao, for vomiting and epigastric pain due to Spleen and Stomach Deficiency Cold. With Bai Zhu, for diarrhea due to Spleen Deficiency. With Bai Zhu and Ren Shen, for Spleen Yang Deficiency with a cold abdomen, vomiting and diarrhea. With Fu Ling and Bai Zhu, for Cold-Dampness in the Lower Jiao leading to a sense of heaviness and Cold in the lower back.
Rx. Ginseng	Ren Shen	15-60g	Tonifies Spleen Qi and harmonizes the Middle Jiao. With Bai Zhu, tonifies the transformation and transportation functions of the Spleen.
(Rx. Codonopsis)	(Dang Shen)	(15-60g)	(May substitute for Ren Shen.)
Dry-fried Rz. Atractylodis Macrocephalae	Chao Bai Zhu	15-60g	Strengthens the Spleen and dries Dampness. With Ren Shen, tonifies the Spleen and Stomach. With Ren Shen and Gan Jiang, for Middle Jiao Deficiency Cold with abdominal pain, distention, vomiting and diarrhea.
Poria	Fu Ling	12-60g	Promotes urination, leaches out Dampness, strengthens the Spleen and harmonizes the Middle Jiao. With Ren Shen and Bai Zhu, for weak and deficient Spleen with fatigue, anorexia and loose stools.
Rx. Glycyrrhizae Preparata	Zhi Gan Cao	6-60g	Tonifies the Spleen and augments Qi, moderates and harmonizes the harsh properties of other herbs and guides the herbs to all twelve channels. With Dang Shen, for anorexia, fatigue and loose stools due to Spleen Deficiency. With Ren Shen, Fu Ling and Bai Zhu, strengthens the Spleen and augments Qi.

Formula Actions

• Tonifies the Spleen and Stomach
• Tonifies Qi
• Strengthens Yang
• Resolves Dampness

Syndromes

• Spleen and Stomach Deficiency Cold

Clinical Manifestations

Mild constant epigastric pain; relieved by warmth and pressure Anorexia Abdominal pain and fullness after meals Nausea Vomiting Loose, unformed stools Excessive salivation Cold limbs Lassitude

Weakness Sallow or pale, dull complexion Maybe edema Maybe scanty urination Maybe clear, watery, copious vaginal discharge T: Pale C: White and greasy or Greasy-dirty P: Deep, thready and forceless or Firm

Treats

Abdominal fullness and distention Abdominal pain Oliguria Acute and chronic gastroenteritis Food intolerance Celiac disease Hiatus hernia Weakness

Post-surgical intestinal dysfunction Chronic peptic ulcer Dumping syndrome Functional weakness of the Stomach Eating disorders Chronic colitis Anorexia Edema

Contraindications And Herb/Drug Interactions

Notes

Modifications

For severe Cold intolerance:		For Dampness:
+ 6-12g Rx. Aconiti Lateralis Preparata	Zhi Fu Zi	+ 9g Rz. Atractylodis	Cang Zhu
For severe abdominal distention:
+ 3g Cx. Cinnamomi	Rou Gui	+ 6-9g Rx. Aucklandiae	Mu Xiang
For foggy-headedness or sleepiness:		+ 6-9g Fr. Amomi	Sha Ren
+ 6-9g Rz. Acori Tatarinowii	Shi Chang Pu
+ 6-9g Rx. Polygalae	Yuan Zhi