By Lawrence Hsiao, MD, MS, Eric Hsiao, MD, PhD and Wen-Shuo Wu, MPH, MSAOM, LAc
Wen dan tang (Warm the Gallbladder decoction) is a very popular and well-known formula in treating the symptoms of dizziness, vertigo, nausea/vomiting, insomnia, palpitation and anxiety caused by phlegm heat.
The name of the formula and the indications are frequently confused because "wen" means "warming." However, the indications and the actions of the ingredients in this formula are to clear phlegm heat. The purpose of this article is to find out the origins of this formula.
Wen Dan Tang for phlegm heat from the unification of the three etiologies (San Yin Ji Bing Zheng Fang Lun)
The chief ingredient, Caulis bambusae in taeniis (zhu ru), is perhaps the principal substance in the materia medica for clearing heat and phlegm from the gallbladder and stomach. It is used to reverse the rebellious flow of qi. The deputy, Fructus immaturus citri aurantii (zhi shi), assists in reversing the flow of rebellious qi and is also particularly effective in treating focal distention. Rhizoma pinelliae ternatae (ban xia) and Pericarpium citri reticulatae (chen pi) dry dampness and expel phlegm, while regaling the qi and harmonizing its circulation in the middle burner. These two herbs are quite effective in treating phlegm.
The assistants are Sclerotium poriae cocos (fu ling) and Radix glycyrrhizae uralensis (gan cao), which strengthens the spleen, leaches out dampness and calms the spirit. The addition of the envoy, Rhizoma zingiberis officinalis recens (sheng jiang), regulates the relationship between the gallbladder and the stomach, and assists the other herbs in stopping nausea. The origin of this formula came from "Discussion of Illnesses, Patterns and Formulas Related to the Unification of the Three Etiologies" (San Yin Ji Bing Zheng Fang Lun) of Wu-Zhi Chen in the Song dynasty, not from Si-Miao Sun, in Formulas and Strategies by Dan Bensky.1
Wen Dan Tang for cold phlegm from "Thousand Ducat Formulas" (Qian Jin Yao Fong)
Another formula named wen dan tang came from the "Thousand Ducat Formulas" (Qian Jin Yao Fong) of Si-Miao Sun in Tang Dynasty.2 The formula is prescribed for the following conditions: "After a severe illness, the patient suffers from fatigue and insomnia, which is caused by coldness in the gallbladder." However, it is found that this formula omits Sclerotium poriae cocos (fu ling), and increases the dosage of Rhizoma zingiberis officinalis recens (sheng jiang) to 12g, and Glycyrrhizae uralensis (gan cao) to 4.5g.3 In the analysis, we noticed that the indication of this formula is supposed to resolve cold phlegm and is not intended for phlegm heat. So, it seems that Sun's formula is equivalent in meaning "wen dan tang," because "wen" in this case, also means "warming."
In this formula, Caulis bambusae in taeniis (zhu ru), which is sweet and slightly cool, becomes the envoy to balance the warming herbs. The chief herbs are Rhizoma pinelliae ternatae (ban xia) and Rhizoma zingiberis officinalis recens (sheng jiang) for warming GB, dispelling phlegm and stopping nausea. The deputy, Pericarpium citri reticulatae (chen pi) assists the chief ingredients to harmonize the stomach and dispel phlegm. Use of Caulis bambusae in taeniis (zhu ru) is for balance. Citri aurantii (zhi shi) regulates the qi and reverses the rebellious qi. The envoy is Radix glycyrrhizae uralensis (gan cao), which harmonizes all the ingredients.4
When we analyzed this formula, we found that the properties of Sun's formula are acrid and warm, which tonify and warm GB and transport phlegm. It harmonizes the GB and descends the stomach qi. This formula does not have any calming or settling herb and can ascend the clear qi and descend the turbid qi, so it is very effective in treating insomnia caused by disharmony between yin and yang.5
We found an illustration of Sun's formula that was earlier than Chen's. The variation of this formula could provide us with a general idea of what kind of diseases could happen in ancient China. Most of us recognize Chen's formula (for phlegm heat), and it was classified under the catalog of drying phlegm. However, in some formula books, it is categorized into harmonizing formulas, such as in "Collection of Medical Formulas" (Ji Yin Fong) of Zeng-Yuan Yao (449-538 AD).6 This book included the most original text which mentioned wen dan tang, but unfortunately, we cannot find it any more. The only source is from the "Thousand Ducat Formulas" (Qian Jin Yao Fang) and "Arcane Essentials from the Imperial Library" (Wai Tai Bi Yao) of Wang Tao.
Wen dan tang can treat deficiency-cold of GB. It can also treat the stagnation qi of GB, and even stagnation of qi turning into fire. However, the essence is clearing and calming the GB, harmonizing the GB qi and then resolving the pathogen of phlegm, which causes different kinds of diseases. Clinicians need to distinguish the differences between these two formulas and understand the difficulty in comprehending the proper prescription.
Acknowledgement: The authors would like to thank Sivarama P. Vinjamury and Ju-Tzu Li for their input and review of this manuscript.
Table: Comparison of Different Origins of Wen Dan Tang
Wen dan tang
Wen dan tang
Wen dan tang
Sun Si-Miao (625)
Chen Wu-Zhi (1174)
Dan Bensky, Randall Barolet (1990)
Thousand Ducat Formulas
Discussion of Illnesses, Patterns and Formulas Related to the Unification of the Three Etiologies
After a severe illness, the patient suffers from fatigue and insomnia, which is caused by coldness in the gallbladder.
Heart deficiency with gallbladder timidity or nightmares causes qi stagnation and phlegm accumulation. Qi/phlegm produces a variation of symptoms, such as shortness of breath, heart palpitations, spontaneous sweating, swollen limbs, no appetite, and sleeplessness.
Dizziness; vertigo; nausea or vomiting; insomnia; palpations; anxiety; indeterminate gnawing hunger; seizure accompanied by copious sputum; focal distention; bitter taste in the mouth; slight thirst; a greasy, yellow coating on the tongue; and a rapid, slippery pulse1.
Bensky D, Barolet R. Formulas and Strategies. Seattle: Eastland Press, 1990:435-6.
Han J. The original source of the Wen Dan Tang. Hai Bei Zhong Yi, 2005;27(10):786-7.
Jai SC, Zhong J, Hui L, et al. Discussing the sources of Wen Dan Tang. Zhong Gui Zhong Yi Ji Chi Yi Xui, 1997;3(5):13-4.
Wang YC. The name and indication of Wen Dan Tang. Beijing Zhong Yi Xhu Yuan Xhu Bou, 1993;16(4):2-6.
Wang HT. Zang-heat and Fu-cold with the usage of Wen Dan Tang. An Hui Zhong Yi, 2000;12(1):1-2.
Xu, C.H. Dispute of the Wen Dan Tang. Hu Bai Zhong Yi Xhu Yuan Xhu Bou, 1999;1(1)23-4.
Dr. Lawrence Hsiao is an associate professor at the College of Acupuncture and Oriental Medicine, Southern California University of Health Sciences.
Dr. Eric Hsiao is an associate professor at the College of Acupuncture and Oriental Medicine, Southern California University of Health Sciences.
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