from the Register of Chinese Herbal Medicine

Three-Nut Decoction (san ren tang)

Source: Systemic Differentiation of Warm Diseases (Wen bing tiao bian)

Semen Pruni Armeniacae (xing ren) 15g

Fructus Amomi Kravanh (bai dou kou) 6g

Cortex Magnoliae Officinalis (hou po) 6g

Rhizoma Pinelliae Ternatae (ban xia) 9g

Semen Coicis Lachryma- jobi (yi yi ren) 18g

Medulla Tetrapanacis Papyriferi (tong cao) 6g

Herba Lophatheri Gracilis (dan zhu ye) 6g

Talcum (hua shi) [put in cheesecloth bag] 18g

I particularly like this formula for a few reasons. As briefly discussed below it is very useful and easily modified to treat a wide variety of problems. For the appropriate patients it deals with their core problem, a disruption of the qi mechanism. Finally, within the spectrum of Chinese herbs it tastes pretty good.

As an easily confused practitioner, I gravitate towards formulas that are designed for confusing situations. The author of this formula, Wu fuTong (also known as Wu Tang), designed it for people with a rather sticky problem. They have headache, chills, a heavy and achy body, and a stifling sensation in the chest as if they had contracted damp-cold. They also have afternoon feverishness which, even in the 18th century, lead practitioners to a knee-jerk diagnosis of yin deficiency. Wu details the disastrous consequences of using the sweating, purging, or moistening methods to treat these people. Wu's diagnosis for this problem is damp-warmth (shi-wen) and used this formula, noting that it is effective regardless of the season.

The problem here, and the reason why the formula has such a wide application, is that the qi mechanism is disrupted by dampness and heat. The qi mechanism in simple terms is the proper ascending and descending functions of the body which are rooted in the middle burner. This problem usually affects people with underlying Spleen deficiency which can be brought on by too much cold foods, rushing to eat, eating irregularly, and living life in such a rush that they do not know the meaning of the term 'pay attention'. If they contract damp-heat, have any number of different externally-contracted diseases that are suppressed with cold, bitter antibiotics, or just do not rest sufficiently while they are recovering from an externally contracted disease they can develop this type of problem.

For me, there are three keys to the diagnosis.

• First is a special tongue coating. While the source text just states that "the tongue coating is white and the person] is not thirsty". I have found for this formula to be effective the coating must be white, thin and very sticky. To me, it looks as if it has been painted on by Monet.
• Second is the pulse. It must be thin throughout. Almost always it is more soggy on the right than the left. The pulse position that is the soggiest (not necessarily the middle) is an important guide to deciding which burner you want to emphasise.
• Third, there are some clear afternoon symptoms. It may be a feeling of feverishness or a worsening of one particular symptom. I have also seen afternoon irritability and or fatigue.

When these three things are present I usually see other manifestations noted by Wu, including wan complexion, the stifling sensation in the chest (usually reported in America as difficulty in taking a creep breath), and a heavy, achy feeling in the body (often localised to one burner). Another thing to look for is a sense of a disruption of ascending and descending functions.