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Wu Ling San “Five-Ingredient Powder with Poria”

This formula promotes urination, drains dampness, strengthens the Spleen, warms the yang, and promotes the transforming functions of qi. It has three indications:

1. Headache, fever, irritability, strong thirst but with vomiting immediately after drinking, urinary difficulty, and floating pulse. This group of symptoms are the original indications for this formula. They are manifestations of Xu Shui (water buildup or water accumulation) in which the pathogenic influences have not been released from the exterior (taiyang meridian disorder), but have penetrated to the Bladder (taiyang organ disorder). The headache, fever, irritability and floating pulse indicate an exterior condition. The pathogenic influences attack and disrupt the functions of the Bladder, resulting in urinary difficulty. Disruption of Bladder function also leads to water retention, which interferes with the upward transportation and downward elimination of fluids. Although it causes strong thirst, fluids cannot be transported downward and are vomited up. This is known as water rebellion disorder or Shui Ni Zheng.
2. Edema, generalized sensation of heaviness, diarrhea, urinary difficulty. This group of symptoms refer to Spleen deficiency described as earth failing to transport water. This causes internal accumulation of water and dampness which overflows into the muscles and skin and produces any kind of edema and a sensation of heaviness.
3. Throbbing pulsations just below the umbilicus, vomiting frothy saliva, vertigo, shortness of breath, and coughing. This group of symptoms reflects retention of congested fluids in the lower burner leading to upward rebellion of frothy saliva, yang obstruction, or congested fluids encroached on the Lungs.

Ingredients: Ze Xie (4g), Fu Ling (2.3g), Zhu Ling (2.3g), Bai Zhu (2.3g), Gui Zhi (1.5g).

• Ze Xie, chief, sweet, bland and cold. Leaches out dampness and promotes urination. Its cold nature enables it to enter the Bladder directly and eliminate heat.
• Fu Ling, deputy, leaches out dampness by promoting urination, strengthening the Spleen and assisting the yang.
• Zhu Ling, deputy, eliminates dampness and promotes urination.
• Bai Zhu, assistant, strengthens the Spleen qi.
• Gui Zhi, assistant and envoy, warms Kidney yang and helps to expel pathogenic influences from the exterior.

Variations:

• Si Ling San “Four Ingredient Powder with Poria”: Omit Gui Zhi for uncomplicated cases of dampness injuring the Spleen and Stomach characterized by loose stools and urinary difficulty.
• Wei Ling Tang “Calm the Stomach and Poria Decoction”: Take with Ping Wei San “Calm the Stomach Decoction” for epigastric distension and pain, diarrhea, and urinary difficulty.
• Yin Chen Wu Ling San “Artemisia Yinchenhao and Five Ingredients Decoction with Poria”: Combine two parts powdered Yin Chen Hao with one part of this formula for jaundice due to damp-heat with urinary difficulty and a slightly pale skin tone.

Zhu Ling Tang “Polyporus Decoction”

This formula promotes urination, clears heat, and nourishes yin. It is indicated for urinary difficulty accompanied by fever and thirst with desire to drink. There may also be diarrhea, cough, nausea, irritability, or insomnia.

According to the six meridian differentiation, this is injury from cold entering the yangming or shaoyin channels where it transforms into heat. The heat battles with the water, controlled by the Kidneys, which leads to clumping of water and heat. Heat also injures the fluids and disturbs the water pathways, resulting in urinary difficulty. This pattern is also possible to develop in patients with constitutional yin deficiency and invasion of heat to the lower burner.

Ingredients: Zhu Ling (3g), Fu Ling (3g), Ze Xie (3g), Hua Shi (3g), E Jiao (3g).

• Zhu Ling, chief, strongly reinforces the proper functioning of the water pathways and thereby promotes urination.
• Fu Ling and Ze Xie are the deputies. Fu Ling promotes urination, benefits the spleen, and harmonizes the stomach. Ze Xie promotes water metabolism, unblocks the deep parts of the water pathways that involve the kidneys, and aids the chief ingredient in promoting urination.
• Hua Shi, assistant, clears heat and unblocks painful urinary dysfunction.
• E Jiao is a moist substance that enriches the yin and prevents excessive urination.

Comparison with Wu Ling San “Five Ingredient Powder with Poria”: Both formulas treat urinary difficulty due to disturbances of the water pathways by promoting urination. The difference is that Wu Ling San treats a condition where the disease is still active in the exterior by focusing on unblocking the flow of yang to encourage the transformation of qi, while Zhu Ling Tang treats pathogenic influences which have transformed into heat in the interior by clearing the heat and nourishing the yin. Both formulas contain Fu Ling, Zhu Ling and Ze Xie. In Wu Ling San, Ze Xie is the chief ingredient whereas Fu Ling and Zhu Ling are the deputies. Ze Xie is strongest in promoting urination and has the largest dose (4g). Wu Ling San drains vigorous dampness, hence the use of Gui Zi and Bai Zhu as assistants. Zhu Ling Tang drains vigorous heat, hence the use of Hua Shi, without injuring the yin by adding E Jiao.

Wu Pi San “Five Peel Powder”

This formula resolves Dampness, reduces edema, regulates qi, and strengthens the Spleen. It is indicated for generalized skin edema with a sensation of heaviness, distention, and fullness in the epigastrium and abdomen, labored and heavy breathing, urinary difficulty, a white greasy tongue coating, and a submerged and moderate pulse. The focus of this formula is on leaching out dampness and promoting urination. It is interesting to note that the peel, rind, or “skin” of the herbs is used to treat skin edema. In traditional Chinese medicine, the peel or rind is considered to be especially effective in moving water just below the skin.

Ingredients: Sang Bai Pi (15g), Sheng Jiang Pi (6g), Fu Ling Pi (15g), Chen Pi (9g), Da Fu Pi (15g).