1. Prescription Source & History

1. Recorded in Classic Works

Wu Mei Wan is from Treatise on Cold Damage Disorders written by Zhang Zhongjing in the Eastern Han Dynasty and is one of the classic prescriptions in traditional Chinese medicine. As the foundational work on the syndrome differentiation and treatment of exogenous febrile diseases in traditional Chinese medicine, Treatise on Cold Damage Disorders has had a profound impact on the clinical practice and theoretical development of traditional Chinese medicine. Wu Mei Wan occupies an important position in this work and provides a valuable prescription example for later generations of doctors to treat various diseases.

2. Historical Evolution

Since the publication of Treatise on Cold Damage Disorders, Wu Mei Wan has gone through the clinical practice and theoretical interpretation of doctors in various dynasties, and its application scope has been continuously enriched and improved in the treatment of cold-heat complex syndrome. On the basis of inheriting Zhang Zhongjing's academic thoughts, later generations of doctors combined their own clinical experience and carried out expansion and innovation on Wu Mei Wan. For example, it has developed in aspects such as the addition and subtraction application of prescriptions and dosage form improvement, enabling it to play an important therapeutic role in different historical periods.

2. Introduction to Ingredients (King, Minister, Assistant, Courier)

1. King Ingredient - Dark Plum

Fructus Mume tastes sour and astringent, and is of neutral nature. It belongs to the liver, spleen, lung, and large intestine meridians. It has the effects of astringing the lung to stop coughing, astringing the intestine to stop diarrhea, promoting the production of body fluid to quench thirst, and expelling ascaris to relieve pain. In Wu Mei Wan, the dosage of Fructus Mume is particularly heavy and it is the monarch drug. On the one hand, the sour taste of Fructus Mume can control ascaris and relieve the abdominal pain caused by the disturbance of ascaris; on the other hand, its astringent and sour nature can astringe healthy qi and prevent the further invasion of pathogenic factors, playing a dual role of strengthening healthy qi and eliminating pathogenic factors.

2. Minister Ingredients - Coptis, Phellodendron

Rhizoma Coptidis tastes bitter and is of cold nature. It belongs to the heart, spleen, stomach, liver, gallbladder, and large intestine meridians. It has the functions of clearing heat and drying dampness, purging fire and detoxifying. Cortex Phellodendri tastes bitter and is of cold nature. It belongs to the kidney, bladder, and large intestine meridians. It can clear heat and dry dampness, purge fire and remove steaming, and detoxify and treat sores. Rhizoma Coptidis and Cortex Phellodendri are used in combination to enhance the power of clearing heat and drying dampness. In Wu Mei Wan, the two can clear the heat in the upper and middle jiao to eliminate various diseases caused by the internal accumulation of damp-heat, and at the same time also help to relieve the heat transformation phenomenon caused by the disturbance of ascaris.

3. Assistant Ingredients - Aconite, Ginger, Cinnamon Twig

Radix Aconiti Lateralis Preparata tastes pungent and sweet, is extremely hot in nature and poisonous. It belongs to the heart, kidney, and spleen meridians. It can restore yang from collapse, reinforce fire and assist yang, dispel cold and relieve pain. Rhizoma Zingiberis tastes pungent and is of hot nature. It belongs to the spleen, stomach, kidney, heart, and lung meridians. It has the effects of warming the middle jiao to dispel cold, restoring yang and promoting blood circulation, and warming the lungs to resolve fluid-retention. Ramulus Cinnamomi tastes pungent and sweet, is of warm nature. It belongs to the heart, lung, and bladder meridians. It can induce sweating to relieve the exterior, warm the channels and vessels, and assist yang to transform qi. These three herbs are extremely pungent and hot, and mainly focus on warming the interior to dispel cold. Radix Aconiti Lateralis Preparata warms the kidney and strengthens yang, Rhizoma Zingiberis warms the middle jiao to dispel cold, and Ramulus Cinnamomi warms the heart yang. They can disperse the cold pathogens in the body, restore the yang qi in the middle jiao, make the yang qi excited, create a suitable internal environment for expelling ascaris, and at the same time prevent yang collapse caused by excessive cold pathogens.

4. Courier Ingredients - Asarum, Prickly Ash, Ginseng, Angelica

Asarum sieboldii tastes pungent and is of warm nature. It belongs to the heart, lung, and kidney meridians. It has the abilities of inducing sweating to dispel cold, expelling wind and relieving pain, opening the nasal cavity, and warming the lungs to resolve fluid-retention. Zanthoxylum bungeanum tastes pungent and is of warm nature and poisonous. It belongs to the spleen, stomach, and kidney meridians. It can warm the middle jiao to relieve pain and kill insects and relieve itching. Ginseng tastes sweet and slightly bitter, is of slightly warm nature. It belongs to the spleen, lung, heart, and kidney meridians. It greatly tonifies primordial qi, restores the pulse and secures collapse, invigorates the spleen and benefits the lung, promotes the production of body fluid and nourishes blood, and soothes the nerves and improves intelligence. Angelica sinensis tastes sweet and pungent, is of warm nature. It belongs to the liver, heart, and spleen meridians. It has the effects of enriching blood and promoting blood circulation, regulating menstruation and relieving pain, and moistening the intestines and relaxing bowel movements. Asarum sieboldii and Zanthoxylum bungeanum can enhance the power of expelling insects, and Asarum sieboldii can also play a role in promoting qi movement. Ginseng and Angelica sinensis reinforce healthy qi and tonify deficiency. Ginseng greatly tonifies primordial qi to make the healthy qi sufficient, which helps to expel pathogenic factors; Angelica sinensis enriches and nourishes blood to nourish the body and prevent the healthy qi from being deficient due to excessive consumption of qi and blood during the process of expelling insects. At the same time, these four herbs can also harmonize the properties of all the herbs in the prescription, enabling the medicinal effects of the whole prescription to work synergistically.

Pathogenesis, Efficacy & Treatment

1. Pathogenesis (Cold & Heat Complex)

Wu Mei Wan The pathogenesis of the diseases treated is relatively complex. It is mostly due to the weakness of healthy qi, deficiency-cold of the spleen and stomach, recurrence of damp-heat pathogens, or the long-term internal disturbance of roundworms, resulting in the upward movement of roundworms into the diaphragm, disorder of qi movement, and disharmony between yin and yang. The disturbance of roundworms can cause intermittent abdominal pain; deficiency-cold of the spleen and stomach and the failure of transportation and transformation lead to symptoms such as cold pain in the epigastrium and abdomen, vomiting of clear saliva, etc.; the internal accumulation of damp-heat can present manifestations such as restlessness and bitter taste in the mouth.

2. Efficacy

Wumei Pills It has the effects of warming the viscera and calming roundworms, strengthening healthy qi and eliminating pathogens. By using a large amount of Fructus Mume to control roundworms, Rhizoma Coptidis and Cortex Phellodendri to clear heat, Radix Aconiti Lateralis Preparata, Rhizoma Zingiberis Recens, and Ramulus Cinnamomi to warm yang and dispel cold, Herba Asari and Fructus Zanthoxyli to kill insects, and Radix Ginseng and Radix Angelicae Sinensis to strengthen healthy qi and tonify deficiency, the combination of these herbs can not only remove roundworms in the body but also regulate the yin and yang of the zang-fu organs, restore the functions of the spleen and stomach, and achieve the purpose of treating both the principal and secondary aspects of the disease.

3. Treatment

Wumei Pills are mainly used to treat roundworm syncope syndrome. The symptoms include intermittent abdominal pain, restlessness and vomiting, occurring intermittently, often with self-vomiting of roundworms, and cold limbs. It is also used to treat chronic dysentery and diarrhea, belonging to the syndrome of intermingled cold and heat with deficiency of healthy qi. In clinical application, whenever the above symptoms appear and the syndrome differentiation belongs to the syndrome of intermingled cold and heat, deficiency and excess, Wumei Pills can be considered for treatment.

IV. Analysis of Wumei Pills

1. Combine Cold & Heat

In Wumei Pills, Rhizoma Coptidis and Cortex Phellodendri are bitter and cold for clearing heat, and Radix Aconiti Lateralis Preparata, Rhizoma Zingiberis Recens, and Ramulus Cinnamomi are pungent and hot for dispersing cold, reflecting the compatibility feature of combining cold and heat herbs. This compatibility method aims at the intermingled cold and heat appearance in the pathogenesis, enabling cold and heat to restrict each other and achieving the purpose of balancing yin and yang. Cold herbs can clear the heat in the upper and middle jiao, preventing excessive heat pathogens; hot herbs can warm the interior and dispel cold, stimulate yang qi, and eliminate the internal obstruction of cold pathogens. The combination of cold and heat herbs helps to restore the normal coordination of the functions of the zang-fu organs and make the yin and yang of the human body return to balance again.

2. Combine Reinforcement & Reduction

In the formula, Radix Ginseng and Radix Angelicae Sinensis supplement qi and blood, strengthen healthy qi and tonify deficiency, which is the method of supplementation; herbs such as Rhizoma Coptidis, Cortex Phellodendri, Herba Asari, and Fructus Zanthoxyli clear heat and kill insects, removing pathogens, belonging to the method of purgation. The compatibility of supplementation and purgation not only takes into account the damage of healthy qi caused by roundworms as the disease but also pays attention to protecting healthy qi while expelling pathogens, avoiding the collapse of healthy qi due to excessive expulsion of roundworms. Through the synergistic effect of strengthening healthy qi and eliminating pathogens, healthy qi can be restored and pathogens can be removed, thus achieving the purpose of curing the disease.

3. Combine Sour, Bitter & Pungent

Fructus Mume is sour, Rhizoma Coptidis and Cortex Phellodendri are bitter, and Radix Aconiti Lateralis Preparata, Rhizoma Zingiberis Recens, Ramulus Cinnamomi, Herba Asari, and Fructus Zanthoxyli are pungent. The whole formula combines sour, bitter, and pungent flavors. The sour herb Fructus Mume controls roundworms and astringes healthy qi; the bitter herbs Rhizoma Coptidis and Cortex Phellodendri clear heat and dry dampness, strengthen yin and thicken the intestine; the pungent herbs Radix Aconiti Lateralis Preparata, Rhizoma Zingiberis Recens, Ramulus Cinnamomi, Herba Asari, and Fructus Zanthoxyli disperse cold and relieve pain, kill insects and promote yang qi. The combination of sour, bitter, and pungent flavors enables the formula to have multiple effects, comprehensively regulate the complex pathogenesis of roundworm syncope syndrome, and give full play to the therapeutic effect of the formula.

V. Comparison with Other Similar Formulas

1. Comparison with Lizhong Pills

Li Zhong Pill With dried ginger as the monarch drug, it focuses on warming the middle-jiao to dispel cold, strengthening the spleen and drying dampness, and is mainly used for treating the syndrome of deficiency-cold in the middle-jiao, manifested mainly by cold pain in the epigastrium and abdomen, vomiting and diarrhea. Although Wu Mei Pill also contains drugs for warming yang and dispelling cold, it combines cold and heat, tonifying and purging, and has the effect of calming roundworms and relieving pain, and is mainly used for treating roundworm syncope syndrome and chronic dysentery and diarrhea with intermingled cold and heat and deficiency of healthy qi. There are obvious differences in their effects and main treatments. Li Zhong Pill focuses on simply regulating deficiency-cold in the middle-jiao, while Wu Mei Pill targets more complex syndromes with intermingled cold, heat, deficiency and excess.

2. Comparison with Baitouweng Decoction

Bai Tou Weng Decoction Clears heat and detoxifies, cools the blood and stops dysentery, and is mainly used for treating heat-toxin dysentery, manifested by dysentery with purulent and bloody stools, abdominal pain, tenesmus, burning sensation in the anus, etc. Although Wu Mei Pill can also be used for chronic dysentery, the pathogenesis is intermingled cold and heat and deficiency of healthy qi, and it has the effect of calming roundworms. Bai Tou Weng Decoction mainly clears heat and detoxifies and cools the blood, while Wu Mei Pill combines cold and heat and tonifies and purges. There are differences in their etiological pathogenesis, effects and main treatments, and accurate syndrome differentiation should be made according to the specific condition for clinical application.

Wu Mei Pill: A classic prescription for regulating chronic diarrhea, abdominal pain, vomiting and gastrointestinal discomfort HJMEDICAL">

VI. Clinical Applications and Indications

1. Ascariasis Syncope

Wu Mei Pill is a classic prescription for treating roundworm syncope syndrome. Patients often suddenly experience severe pain around the umbilicus, which occurs intermittently and is unbearable, accompanied by nausea and vomiting, and even vomiting roundworms, with cold limbs. The tongue coating is mostly white and greasy, and the pulse is string-taut. At this time, applying Wu Mei Pill can quickly relieve the symptoms of roundworm syncope, calm the roundworms, relieve abdominal pain, and warm the cold limbs.

2. Chronic Dysentery and Diarrhea

For chronic dysentery and diarrhea with a long course, manifested by dysentery with purulent and bloody stools or incessant diarrhea, accompanied by dull pain in the abdomen, preference for warmth and pressure, fatigue, loss of appetite, pale tongue with white coating, deep and thready pulse, etc., showing manifestations of intermingled cold and heat and deficiency of healthy qi, Wu Mei Pill can play the roles of warming the viscera and calming roundworms, strengthening healthy qi and eliminating pathogenic factors, and regulating cold, heat, deficiency and excess, effectively improving symptoms and promoting the recovery of the disease.

3. Other Digestive System Diseases

In clinical practice, Wu Mei Pills can also be used to treat some other digestive system diseases, such as chronic gastritis, gastric ulcer, etc. with the syndrome of intermingled cold and heat. Patients often present with epigastric pain that is relieved by warmth, or accompanied by symptoms such as bitter taste in the mouth, dry mouth, nausea, vomiting, etc. Wu Mei Pills can relieve the discomfort symptoms in the epigastric region and improve digestive function by regulating the cold and heat of the spleen and stomach, strengthening the healthy qi and tonifying deficiency.

Wu Mei Pills: A classic formula for regulating chronic diarrhea, abdominal pain, vomiting and gastrointestinal discomfort HJMEDICAL">

VII. Modifications

1. If very cold

The dosage of aconite root, dried ginger and cassia twig can be increased to enhance the power of warming yang and dispelling cold. If the pathogenic cold is more severe and the abdominal pain is intense, evodia rutaecarpa can be added to enhance the effect of warming the middle-jiao and stopping pain.

2. If very hot

The dosage of coptis chinensis and phellodendron amurense can be appropriately increased to enhance the effect of clearing heat and drying dampness. If restlessness is obvious, gardenia can be added to clear heat and remove vexation.

3. If many roundworms

Insecticidal drugs such as quisqualis indica and areca nut can be added to enhance the insecticidal effect.

4. If chronic dysentery with rectal prolapse

Astragalus membranaceus and cimicifuga foetida can be added to benefit qi and promote elevation.

Wu Mei Pills: A classic formula for regulating chronic diarrhea, abdominal pain, vomiting and gastrointestinal discomfort HJMEDICAL">

VIII. Dosage (Traditional and Modern Concentrated Granules)

1. Traditional method

The traditional usage of Wu Mei Pills is to make them into pills for taking. Generally, 6 - 9 grams are taken each time, 2 - 3 times a day. The specific preparation method is: grind 300 wu mei, 6 liang of asarum, 10 liang of dried ginger, 16 liang of coptis chinensis, 4 liang of angelica sinensis, 6 liang of aconite root (processed, peeled), 4 liang of zanthoxylum bungeanum (with the pungent smell removed), 6 liang of cassia twig, 6 liang of ginseng, and 6 liang of phellodendron amurense into fine powder, and make honey pills as big as firmiana simplex seeds.

2. Modern concentrated granules

In modern clinical practice, Wu Mei Pills concentrated granules are also used. Its administration method is more convenient. Generally, the dosage is determined according to the doctor's advice based on the condition. The concentrated granules are made by extracting and concentrating the drugs in the traditional formula, retaining the effective components of the drugs. When taking them, just dissolve them directly with boiling water, saving the time and procedures of making traditional pills and being more suitable for the modern fast-paced lifestyle.

Wu Mei Pills: A classic formula for regulating chronic diarrhea, abdominal pain, vomiting and gastrointestinal discomfort HJMEDICAL">

IX. Precautions and Taboos

1. Drug Dosage

When taking Wu Mei Pills, the prescribed dose should be strictly followed. Since the aconite in the formula is toxic, overdose may cause poisoning reactions such as palpitation, shortness of breath, nausea, vomiting, etc. Therefore, it is necessary to accurately master the dosage of the drug to avoid adverse reactions caused by improper dosage.

2. Dietary Taboos

During the medication period, consumption of raw, cold, greasy, spicy and other stimulating foods should be avoided. Raw and cold foods are likely to damage the yang qi of the spleen and stomach. Greasy foods are not easy to digest and may increase the burden on the spleen and stomach. Spicy foods are likely to help generate fire and heat, which is not conducive to the recovery of the condition. The intake of these foods may affect the therapeutic effect of Wu Mei Pills and even induce recurrence of the condition.

3. Special Populations

Pregnant women should use Wu Mei Pills with caution. Because some drugs in the formula have certain medicinal properties and may have an impact on the fetus. The elderly, the weak and those with extremely weak spleen and stomach functions should be cautious when using Wu Mei Pills. The dosage can be adjusted appropriately according to the specific situation, and the reaction after medication should be closely observed.

Wu Mei Pills: A classic formula for regulating chronic diarrhea, abdominal pain, vomiting and gastrointestinal discomfort HJMEDICAL">

Ten. Modern Research Progress

1. Pharmacological Research

Modern pharmacological studies have shown that Wu Mei Pills have various pharmacological effects. It has a dual regulatory effect on intestinal smooth muscle, which can not only relieve intestinal spasm but also promote intestinal peristalsis, helping to improve digestive function. The heat-clearing drugs such as Coptis chinensis and Phellodendron amurense in the formula have antibacterial and anti-inflammatory effects and can inhibit the growth and reproduction of harmful bacteria in the intestine. The warm-natured drugs such as aconite and dried ginger can enhance the body's immunity and improve the body's cold resistance. In addition, Wu Mei Pills also have certain analgesic and sedative effects and can relieve symptoms such as pain caused by cold-induced syncope due to ascariasis.

2. Clinical Research

In terms of clinical research, more and more studies have confirmed the effectiveness of Wu Mei Pills in the treatment of various diseases. In addition to the traditional cold-induced syncope due to ascariasis and chronic dysentery and diarrhea, Wu Mei Pills have also achieved good clinical efficacy in the treatment of digestive system diseases such as functional dyspepsia and irritable bowel syndrome. Through the observation and analysis of a large number of clinical cases, the scope of application and mechanism of action of Wu Mei Pills have been further clarified, providing a more scientific basis for its clinical application.

3. Dosage Form Improvement Research

With the development of modern pharmaceutical technology, the research on the dosage form improvement of Wumei Pills has been continuously deepened. In addition to the above-mentioned concentrated granules, some people have also tried to make Wumei Pills into new dosage forms such as capsules and tablets. While maintaining the efficacy of the prescription, these new dosage forms have the advantages of convenient administration and easy storage, which better meet the needs of modern clinical treatment and provide new ways for the wide application of Wumei Pills.

总结

Wumei Pills is a prescription that combines cold and heat, which comes from the Jueyin chapter of Treatise on Febrile Diseases. It is a representative prescription for treating Jueyin disease, the syndrome of intermingled cold and heat, roundworm syncope, and visceral syncope. It has the effects of combining cold and heat, tonifying the liver and regulating cold and heat, sour astringency, warming the liver yang (five pungent and hot herbs warm the liver yang), and ginseng tonifying the liver qi. Patients often show symptoms such as feeble pulse and syncope, vomiting roundworms, liver cold, visceral cold, stagnation of liver qi, deficiency of yang qi, weakness of liver yang, and deficiency of liver yang. In the prescription, Wumei is soaked in bitter vinegar and combined with ginseng, aconite, dried ginger, asarum, Chinese prickly ash, etc., to be taken three times a day. Clinical experience shows that this prescription has good effects on syndromes such as wasting-thirst, internal stagnation of ministerial fire, and transformation of ministerial fire into heat. It is often used in reference to Sini Decoction and Danggui Sini Decoction, reflecting the subtlety of the liver governing spring and sour astringency. For the syndrome of intermingled cold and heat with roundworm syncope and weakness of yang qi, Wumei Pills are the main treatment. In the prescription, Wumei is soaked in bitter vinegar, combining cold and heat.