Lian Li Tang — Coptis Regulate the Middle Decoction

On this page

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

Overview

Lian Li Tang — the “Coptis Regulate the Middle Decoction” — is from the Ming-dynasty Zhang Shi Yi Tong. It is a modification of Li Zhong Wan with Huang Lian added to address the clinical situation where Spleen Yang deficiency (cold loose stools, fatigue, poor appetite) coexists with mild Stomach Heat (mouth ulcers, slight burning, irritability). Pure Li Zhong Wan would aggravate the upper Heat; pure cold draining would worsen the Spleen Yang. Lian Li Tang resolves the contradiction by warming below and clearing above.

I prescribe Lian Li Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Lian Li Tang is prescribed for Spleen Yang deficiency with mild Stomach Heat:

• Loose stools, abdominal pain relieved by warmth
• Poor appetite, fatigue
• Cold extremities
• Mouth ulcers or mild burning epigastric sensation
• Mild bitter taste, mild irritability
• Tongue — pale body with red tip; mixed coat
• Pulse — deep, possibly slightly rapid in the upper position

Key herbs

1. Ren Shen — tonifies Spleen Qi (Li Zhong Wan core)
2. Gan Jiang — warms the middle and Spleen Yang
3. Bai Zhu — tonifies Spleen; dries Damp
4. Zhi Gan Cao — tonifies and harmonises
5. Huang Lian — clears the localised Stomach or upper-burner Heat

Formula actions

1. Warms and tonifies Spleen Yang
2. Clears mild Stomach or upper-burner Heat
3. Harmonises the middle burner

Conditions treated

1. Chronic gastritis with cold below and mild Heat above
2. Recurrent mouth ulcers with loose stools and cold extremities
3. Crohn’s disease with Spleen-Yang deficient pattern and mild upper Heat — see Crohn’s disease
4. IBS mixed type with cold lower pattern and mild upper Heat
5. Chronic recurrent canker sores with cold lower jiao
6. Chronic functional dyspepsia with mixed pattern

Cautions

Not appropriate for pure Heat patterns or for Damp-Heat in the middle — the warming herbs aggravate Heat.

Persistent mouth ulcers without resolution warrant medical assessment to exclude Behçet disease, autoimmune disease or other systemic cause.

Always consult a qualified Chinese herbalist registered with the RCHM.

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