I. Prescription Source & History

1. Origin Background

Fuzi Lizhong Decoction It was first recorded in Taiping Huimin Hejiju Fang, an official medical classic promulgated in the Song Dynasty. . Its basic formula is derived from Lizhong Decoction in Treatise on Febrile Diseases by Zhang Zhongjing, and it is formed by adding prepared fuzi. It is mainly used to treat spleen and stomach deficiency-cold, yang deficiency with loss of warmth, cold limbs, vomiting and diarrhea. Its birth is closely related to the ancient physicians' understanding and treatment practice of spleen and stomach diseases. In ancient times, due to factors such as living conditions and medical levels, spleen and stomach diseases were relatively common. People continuously accumulated experience in the long process of struggling against diseases and gradually discovered some drug combinations that could effectively regulate diseases such as spleen and stomach deficiency-cold. Fuzi Lizhong Decoction is one of them.

2. Historical Evolution

It has a long history and has been passed down and developed by physicians of all generations. From its initial prototype to the gradually perfected and fixed formula composition, it condenses the wisdom of numerous physicians. Ancient physicians continuously verified clinically and adjusted the drug compatibility, making its curative effect more exact and its application scope gradually expanded. In different historical periods, Fuzi Lizhong Decoction has played an important role, relieving the pain of countless patients and becoming one of the classic prescriptions for treating spleen and stomach deficiency-cold syndrome in traditional Chinese medicine.

II. Composition Introduction (King, Minister, Assistant, Guide)

1. King Drug - Aconite Root

Fuzi is a drug with extremely pungent and hot properties. It moves but does not stay in one place and can circulate through the twelve meridians. It has powerful effects of restoring yang to rescue from collapse and tonifying fire to assist yang. In Fuzi Lizhong Decoction, fuzi acts as the monarch drug and plays a key role in warming yang. The fundamental cause of spleen and stomach deficiency-cold is often yang deficiency. Fuzi can quickly supplement the yang qi of the human body and dispel cold pathogens, just like lighting a raging fire in the cold winter, warming the spleen and stomach and restoring the normal transportation and transformation function of the spleen and stomach.

2. Minister Drug - Dry Ginger

Dry ginger is also a drug with warm properties. It has the effects of warming the middle-jiao to dispel cold and restoring yang to promote blood circulation. It assists fuzi to enhance the power of warming yang and dispelling cold. The two work together synergistically to more effectively warm the spleen and stomach. Dry ginger is good at dispersing cold pathogens in the spleen and stomach, enabling the yang qi of the spleen and stomach to be aroused and the transportation and transformation function to be restored to normal. Its combination with fuzi is like two like-minded partners, working together to dispel cold pathogens in the spleen and stomach and restore the yang qi of the spleen and stomach.

3. Assistant Drugs - Ginseng, Atractylodes Macrocephala (Fried)

Ginseng greatly tonifies primordial qi, restores pulse and secures collapse, invigorates the spleen and supplements the lung. In Fuzi Lizhong Decoction, ginseng can supplement the qi of the spleen and stomach, enhance the transportation and transformation function of the spleen and stomach, and provide sufficient healthy qi support for the recovery of the spleen and stomach. Atractylodes macrocephala (fried) invigorates the spleen and benefits qi, dries dampness and promotes diuresis, which can enhance the transportation and transformation ability of the spleen and stomach and remove dampness in the spleen and stomach. These two drugs, together with ginseng, assist fuzi and dry ginger to better play the role of warming yang and strengthening the spleen, and at the same time prevent fuzi and dry ginger from being too pungent and hot and damaging healthy qi.

4. Guide Drug - Honey-Fried Licorice Root

Prepared licorice has the effects of invigorating the spleen and harmonizing the stomach, supplementing qi and restoring pulse. On the one hand, it harmonizes all the drugs, making the medicinal effects of drugs such as fuzi, dry ginger, ginseng and atractylodes macrocephala coordinate with each other to achieve the best therapeutic effect; on the other hand, prepared licorice can also supplement the qi of the spleen and stomach and relieve the drastic properties of fuzi and dry ginger, making the whole prescription more mild and easier to be accepted by the human body while warming yang and dispelling cold.

III. Pathogenesis, Effects and Treatments

1. Pathogenesis

Spleen and stomach yang deficiency is the main pathogenesis targeted by the附子理中汤. The spleen and stomach are the foundation of acquired constitution and the source of qi and blood production. However, due to various reasons such as irregular diet, overeating raw and cold foods, external contraction of pathogenic cold, and prolonged illness with weakened constitution, the yang qi of the spleen and stomach is damaged, and internal cold pathogen is generated. After the spleen and stomach are deficient and cold, the transportation and transformation functions are abnormal, and a series of symptoms will appear, such as cold pain in the epigastrium, abdominal distension, diarrhea, loss of appetite, etc.

2. Effects

Decoction of Aconite Root to Regulate the Middle-Jiao It has the efficacy of warming the middle-jiao and strengthening the spleen. Through the extremely pungent and hot properties of aconite root and dried ginger in the formula, it can quickly warm yang and dispel cold, and stimulate the yang qi of the spleen and stomach; ginseng and atractylodes macrocephala strengthen the spleen and boost qi, enhancing the transportation and transformation functions of the spleen and stomach; roasted licorice调和各种药物并补益脾胃. When these herbs are used together, they jointly achieve the purpose of warming the spleen and stomach and restoring the normal transportation and transformation functions of the spleen and stomach.

3. Treatments

It is mainly used to treat various diseases caused by spleen and stomach yang deficiency. Common symptoms include cold pain in the epigastrium and abdomen, pain relieved by warmth, vomiting and diarrhea, cold hands and feet, etc. Whether it is due to the spleen and stomach being invaded by cold caused by eating raw and cold foods or spleen and stomach yang deficiency caused by prolonged illness with weakened constitution, the附子理中汤 can play a good therapeutic role. It can improve the digestive function disorder caused by spleen and stomach yang deficiency, enhance the body's ability to digest and absorb food, thus relieving related symptoms and improving the quality of life of patients.

IV. Analysis of Formula Principles

1. Power of Warming Yang and Dispelling Cold

Aconite root and dried ginger, as the core herbs for warming yang and dispelling cold, cooperate with each other, and their medicinal power is intense. Aconite root can assist the heart yang to promote blood circulation, warm the spleen yang in the middle to strengthen transportation, and supplement the kidney yang below to benefit fire, and it is an important herb for warming the interior and supporting yang. Dried ginger specializes in warming the yang of the spleen and stomach and dispelling the cold of the spleen and stomach. Their synergistic effect can quickly disperse the cold pathogen in the spleen and stomach, restore the yang qi of the spleen and stomach, and lay a foundation for the restoration of spleen and stomach functions.

2. Function of Tonifying Spleen and Boosting Qi

Ginseng and atractylodes macrocephala strengthen the spleen and boost qi, which is an important link in restoring the transportation and transformation functions of the spleen and stomach. Spleen and stomach yang deficiency leads to weak transportation. Ginseng greatly supplements primordial qi and can enhance the functional activities of the spleen and stomach, enabling the spleen and stomach to better digest and absorb food. Atractylodes macrocephala dries dampness and promotes diuresis, strengthens the spleen and boosts qi, and can improve the state of internal obstruction of damp pathogen in the spleen and stomach, promoting the normal transportation and transformation of the spleen and stomach. When combined with ginseng, they jointly enhance the transportation and transformation ability of the spleen and stomach, enabling the spleen and stomach to normally perform their functions of receiving, ripening, and transporting food essence.

3. Wonder of Harmonizing Medicinal Properties

Roasted licorice can not only harmonize the medicinal powers of aconite root, dried ginger, ginseng, atractylodes macrocephala and other herbs, enabling them to synergistically play their roles; but also alleviate the intense properties of aconite root and dried ginger, avoiding excessive pungency and heat from damaging healthy qi. At the same time, roasted licorice itself also has the effect of tonifying the spleen and harmonizing the stomach, helping to enhance the spleen-strengthening effect of the entire formula. It plays a key role of connecting the upper and lower and harmonizing various drugs in the formula, making the entire formula more mild and effective.

V. Comparison with Other Similar Formulas

1. Comparison with Lizhong Pills

Regulating the Middle Warmness Pill  It is also a classic prescription for treating deficiency-cold of the spleen and stomach. Compared with the Fu Zi Li Zhong Tang (Fuzi Lizhong Decoction), the drug compositions of the two are similar, but the Fu Zi Li Zhong Tang (Fuzi Lizhong Decoction) adds 附子 (Radix Aconiti Lateralis Preparata) on the basis of the理中丸 (Lizhong Pill). The addition of附子 (Radix Aconiti Lateralis Preparata) makes the温阳散寒 (warming yang and dispelling cold) effect of the Fu Zi Li Zhong Tang (Fuzi Lizhong Decoction) stronger. The理中丸 mainly focuses on warming the middle-jiao and strengthening the spleen, and is suitable for patients with relatively mild symptoms of deficiency-cold of the spleen and stomach; while the Fu Zi Li Zhong Tang (Fuzi Lizhong Decoction) is more suitable for patients with relatively severe symptoms of deficiency-cold of the spleen and stomach, accompanied by obvious cold manifestations, such as cold hands and feet, severe cold pain in the epigastrium and abdomen, etc.

2. Comparison with Xiaojianzhong Decoction

Xiaojianzhong Decoction It mainly warms the middle-jiao and supplements deficiency, and concurrently harmonizes yin and yang. It is mainly used to treat deficiency-cold in the middle-jiao and disharmony between the liver and spleen syndrome, manifested mainly by cramped pain in the abdomen, preferring warmth and pressure. Compared with the附子理中汤 (Fuzi Lizhong Decoction), the Xiaojianzhong Decoction focuses more on supplementing deficiency and relieving spasm and pain, and its effect of warming yang and dispelling cold is relatively weak. The附子理中汤 (Fuzi Lizhong Decoction) mainly targets deficiency-cold of the spleen and stomach, with the main effects of warming yang and strengthening the spleen, dispelling cold and relieving pain. Its effect on simple deficiency-cold abdominal pain may not be as good as the Xiaojianzhong Decoction, but it has a more significant effect on various digestive system symptoms caused by deficiency-cold of the spleen and stomach, such as vomiting and diarrhea.

VI. Clinical Applications and Indications

1. Digestive System Diseases

Clinically, the Fuzi Lizhong Decoction is often used to treat various digestive system diseases. For example, in patients with chronic gastritis, manifested as cold pain in the epigastrium, pain relieved by warmth, loss of appetite, tastelessness in the mouth and no thirst, etc., symptoms of deficiency-cold of the spleen and stomach, after taking the Fuzi Lizhong Decoction, it can effectively relieve the epigastric pain, improve the digestive function and increase the appetite. For peptic ulcer, if it belongs to the syndrome type of deficiency-cold of the spleen and stomach, with symptoms such as dull pain in the epigastrium, preferring warmth and pressure, vomiting clear water, etc., the Fuzi Lizhong Decoction can also play a good therapeutic role, promote ulcer healing and relieve symptoms. In addition, for diseases such as chronic enteritis and diarrhea, as long as it is differentiated as deficiency-cold of the spleen and stomach, the Fuzi Lizhong Decoction has a good curative effect, can regulate the intestinal function and relieve the diarrhea symptoms.

2. Other Conditions

In addition to digestive system diseases, the Fu Zi Li Zhong Tang (Fuzi Lizhong Decoction) is also applied in some other diseases. For example, for persistent diarrhea caused by yang deficiency diarrhea, especially the "diarrhea at the cockcrow" caused by deficiency-cold of the spleen and stomach, the Fu Zi Li Zhong Tang (Fuzi Lizhong Decoction) can warm and tonify the yang qi of the spleen and kidney, astringe the intestine and stop diarrhea. In diseases such as cold pain in the uterus and irregular menstruation in women, if it is辨证 (differentiated) as deficiency-cold of the spleen and stomach combined with cold in the uterus, the Fu Zi Li Zhong Tang (Fuzi Lizhong Decoction) can indirectly improve the state of cold in the uterus, relieve abdominal pain and regulate menstruation by warming yang and strengthening the spleen. In addition, for some people with a deficiency-cold constitution and prone to catching cold, the Fu Zi Li Zhong Tang (Fuzi Lizhong Decoction) can help prevent colds and improve the constitution by enhancing the yang qi of the spleen and stomach and raising the healthy qi of the human body.

VII. Modifications

1. Severe Cold Pathogen

If the cold pathogen is more severe and there is severe cold pain in the epigastrium and abdomen, the dosage of Fu Zi (Radix Aconiti Lateralis Preparata) and Dried Ginger (Rhizoma Zingiberis) can be appropriately increased to enhance the effect of warming yang and dispelling cold. Drugs such as Xiao Hui Xiang (Fructus Foeniculi) and Wu Zhu Yu (Fructus Evodiae) can also be added to strengthen the effect of dispelling cold and relieving pain.小茴香 (Fructus Foeniculi) can dispel cold, regulate qi and relieve pain, and Wu Zhu Yu (Fructus Evodiae) is hot in nature, with the effects of dispelling cold and relieving pain, reducing adverse qi and stopping vomiting. The combination of the two with Fu Zi (Radix Aconiti Lateralis Preparata) and Dired Ginger (Rhizoma Zingiberis) can better relieve the epigastric and abdominal pain caused by the cold pathogen.

2. Those with spleen deficiency and dampness

If the spleen is weak and dampness is excessive, with obvious diarrhea symptoms, the dosage of Atractylodes macrocephala can be increased to enhance the power of strengthening the spleen and drying dampness. Medicinal herbs such as Poria cocos and Coix lacryma-jobi can also be added. Poria cocos promotes diuresis and percolates dampness, strengthens the spleen and tranquillizes the mind; Coix lacryma-jobi promotes diuresis and percolates dampness, strengthens the spleen and stops diarrhea. When combined with Atractylodes macrocephala, they can effectively improve the symptoms of spleen weakness and dampness excess, and relieve diarrhea.

3. Those with frequent vomiting

If vomiting is frequent, Pinellia ternata and Zingiber officinale can be added to lower adverse qi and stop vomiting. Pinellia ternata dries dampness and transforms phlegm, lowers adverse qi and stops vomiting; Zingiber officinale relieves exterior syndrome and dispels cold, warms the middle-jiao and stops vomiting. When used together, they can enhance the anti-vomiting effect of the formula, relieve vomiting symptoms, and treat gastric adverse vomiting.

VIII. Dosage (Traditional and Modern Concentrated Granules)

1. Traditional Method

The traditional method of using the Frigid Extremities Decoction Regulating the Middle is to decoct the herbs with water. Generally, appropriate amounts of Radix Aconiti Lateralis Preparata, Rhizoma Zingiberis, Radix Ginseng, Atractylodes macrocephala, and Radix Glycyrrhizae Preparata are soaked in water and then slowly decocted over a low heat. The decocted medicinal liquid is taken warm in several doses. The specific dosage needs to be determined by the doctor according to factors such as the patient's condition and constitution. Usually, the dosage of Radix Aconiti Lateralis Preparata is 9 - 15 grams, Rhizoma Zingiberis is 6 - 9 grams, Radix Ginseng is 9 - 12 grams, Atractylodes macrocephala is 9 - 12 grams, and Radix Glycyrrhizae Preparata is 6 - 9 grams. However, due to the toxicity of Radix Aconiti Lateralis Preparata, it needs to be decocted first to reduce toxicity and ensure the safety of medication.

2. Modern Concentrated Granules

Nowadays, there is a concentrated granule dosage form of the Frigid Extremities Decoction Regulating the Middle, which is more convenient to take. Generally, according to the instructions or the doctor's guidance, it can be taken by diluting with boiling water. The dosage of the concentrated granules is different from that of the traditional decoction. Its dosage is scientifically formulated and produced in a standardized way. For example, for a certain brand of concentrated granules of the Frigid Extremities Decoction Regulating the Middle, the single-dose amount may be 1 - 2 bags, and the specific dosage also needs to be adjusted according to the individual situation of the patient. This dosage form retains the efficacy of the traditional formula, saves the patient's time and energy in decocting herbs, and is more suitable for the modern fast-paced lifestyle.

IX. Precautions and Taboos

1. Caution for using aconite

Radix Aconiti Lateralis Preparata is toxic, and when using it, the processing specifications and dosage must be strictly followed. Decocting Radix Aconiti Lateralis Preparata first is a crucial step to reduce its toxicity. Generally, it needs to be decocted first for 30 - 60 minutes to ensure that the toxic components of Radix Aconiti Lateralis Preparata are fully decomposed. At the same time, during the medication process, closely observe the patient's reaction. If uncomfortable symptoms such as numbness of the mouth and tongue, dizziness, and palpitation occur, stop taking the medicine immediately and inform the doctor.

2. Suitable population and taboos

The Frigid Extremities Decoction Regulating the Middle is suitable for patients with spleen and stomach yang deficiency syndrome, but not everyone is suitable. It is contraindicated for patients with excess syndrome and heat syndrome. For example, people with symptoms such as burning pain in the epigastrium, bitter taste in the mouth and dry throat, and dry and hard stools, which belong to excess heat syndrome, may aggravate their condition after taking it. Pregnant women should use it with caution because drugs such as Radix Aconiti Lateralis Preparata may have an impact on the fetus. In addition, people with yin deficiency constitution are not suitable for taking it for a long time to avoid damaging yin. During the period of taking the medicine, avoid eating raw, cold, greasy, spicy and other刺激性 foods to avoid affecting the efficacy of the medicine.

X. Modern Research Progress

1. Pharmacological Research

Modern research shows that the Fuzilizhong Decoction has various pharmacological effects. It can regulate gastrointestinal motility, enhance gastrointestinal peristalsis, promote the secretion of digestive juices, and improve the digestive function of the spleen and stomach. It has a protective effect on the mucosa of the digestive system, can reduce inflammatory reactions, and promote the repair of damaged mucosa. It also has a certain effect on regulating immune function, can enhance the body's resistance, and improve the body's defense ability against diseases. In addition, the Fuzilizhong Decoction also has a certain impact on the cardiovascular system, can improve cardiac function, regulate blood pressure, and has a certain conditioning effect on cardiovascular dysfunction caused by yang deficiency and cold constitution.

2. New Clinical Research

In clinical research, new applications and discoveries of the附子理中汤continue to emerge. For example, in the treatment of functional dyspepsia, research has found that the combination of the附子理中汤and western medicine can significantly improve the treatment effect and improve the symptoms and quality of life of patients. In the treatment of diabetic gastroparesis, there is also research indicating that the附子理中汤can improve gastric emptying disorders in diabetic patients and relieve related symptoms by regulating gastrointestinal function. In addition, for some chronic diseases such as chronic obstructive pulmonary disease and rheumatoid arthritis, when the syndrome differentiation belongs to spleen and stomach yang deficiency and cold, adding the附子理中汤for conditioning can also improve the overall condition of patients and enhance the body's disease resistance to a certain extent. With the continuous deepening of research, the application prospect of the附子理中汤in modern medicine will be broader.

Summary of Fuzilizhong Decoction

The Lizhong Decoction with Aconite (Fuzilizhong Tang) is made by adding aconite root to the Lizhong Decoction and is used to treat spleen and stomach yang deficiency and cold, and spleen and kidney yang deficiency, with the functions of warming the middle-jiao to dispel cold and strengthening the spleen to dry dampness. Patients often have aversion to cold and cold limbs. In the formula, there are aconite root (prepared, peeled, umbilicus removed, decocted first), dried ginger, ginseng, atractylodes macrocephala, roasted licorice root (licorice root), etc., decocted with two cups of water. The clinical dosage and usage need to be clear.