Li Zhong Wan — Regulate the Middle Pill

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Conditions treated
5. Cautions

Overview

Li Zhong Wan — Regulate the Middle Pill — is the foundational formula in Chinese herbal medicine for warming and tonifying Spleen and Stomach Yang deficiency — the condition where Cold has lodged in the Middle Jiao and the Spleen Yang is too weak to warm and transform. It originates from Zhang Zhongjing’s Shang Han Lun and represents the primary warming strategy for the Middle Jiao, in the same way that Liu Wei Di Huang Wan is the primary Yin-nourishing strategy for the Kidney. While Xiao Jian Zhong Tang nourishes and warms through sweetness, Li Zhong Wan uses direct warming and Qi-tonifying herbs to more powerfully restore Spleen Yang. It is both a standalone formula and the base for several derivative formulas including Fu Zi Li Zhong Wan (with added Aconitum for more severe Yang deficiency).

TCM pattern

Prescribed for Spleen and Stomach Yang deficiency with Cold in the Middle Jiao, characterised by: cold pain in the epigastrium and abdomen that is relieved by warmth and pressure, vomiting and/or diarrhoea with undigested food, a feeling of cold in the abdomen, poor appetite, fatigue, a pale and moist tongue with white coating, and a slow, weak pulse in the middle position.

Key herbs

1. Gan Jiang (Zingiber officinale dried rhizome) — the principal herb; the most important herb for warming the Middle Jiao; expels Cold from the Spleen and Stomach and warms Spleen Yang
2. Ren Shen (Panax ginseng root) — powerfully tonifies Spleen and Stomach Qi; supports Gan Jiang in restoring Middle Jiao function
3. Bai Zhu (Atractylodes macrocephala rhizome) — tonifies Spleen Qi and dries Dampness; strengthens the Spleen’s transforming and transporting function
4. Zhi Gan Cao (honey-fried Glycyrrhiza root) — tonifies Qi, warms and harmonises the formula; moderates the drying action of Gan Jiang

Conditions treated

1. Cold abdominal pain relieved by warmth from Spleen and Stomach Yang deficiency — the formula’s classical primary indication
2. Chronic diarrhoea with undigested food from Spleen Yang failing to warm and transform
3. Nausea and vomiting from Cold in the Middle Jiao
4. Poor appetite and digestive weakness from Spleen Yang deficiency
5. IBS with cold-sensitive abdominal pain and loose stools from Spleen Yang deficiency
6. Gastroparesis and gastric atony from Middle Jiao Yang deficiency
7. Post-illness digestive weakness where Cold has invaded the Middle Jiao

Cautions

Always consult a qualified Chinese herbalist registered with the Register of Chinese Herbal Medicine (RCHM). Online herbal consultations are available. See the prices page for costs.