Zhi Shi Li Zhong Wan — Aurantium Regulate the Middle Pill

On this page

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

Overview

Zhi Shi Li Zhong Wan is a classical modification of Li Zhong Wan — the foundational formula for Spleen Yang deficiency — by adding Zhi Shi to address concurrent Qi stagnation. It is used for Cold in the Spleen and Stomach with focal distention and stagnation.

The combination addresses the picture where Cold-deficient digestion is complicated by Qi-stagnation focal distention — not uncommon in older adults, post-gastric-surgery patients, those with chronic stress overlaid on cold-deficient digestion, and post-viral chronic gastritis patterns.

I prescribe Zhi Shi Li Zhong Wan as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Zhi Shi Li Zhong Wan is prescribed for Spleen Yang deficiency with Qi stagnation and focal distention:

• Cold lower abdomen
• Focal epigastric distention
• Reduced appetite
• Loose stools
• Cold extremities
• Fatigue
• Mild belching or hiccup
• Tongue — pale, swollen, white coat
• Pulse — deep, slow, possibly wiry

Key herbs

1. Ren Shen — tonifies Spleen Qi
2. Gan Jiang — warms the middle
3. Bai Zhu — tonifies Spleen and dries Damp
4. Zhi Gan Cao — harmonises and tonifies
5. Zhi Shi — moves Qi and breaks stagnation

Formula actions

1. Warms and tonifies Spleen Yang
2. Moves stagnant Qi
3. Resolves focal distention
4. Restores digestive function

Conditions treated

1. Chronic functional dyspepsia with cold pattern and bloating — see digestive disorders
2. Post-gastric-surgery dysmotility with cold pattern
3. Chronic gastritis with cold and Qi stagnation
4. IBS with cold-deficient pattern and bloating — see IBS
5. Chronic enteritis with cold pattern
6. Post-chemotherapy digestive dysfunction
7. Cold-deficient morning sickness with bloating (under specialist supervision) — see morning sickness

Cautions

Not appropriate for Heat-pattern dyspepsia or Yin-deficient patterns.

Use cautiously in pregnancy — consult a qualified practitioner.

Persistent digestive symptoms with weight loss, blood in stool, dysphagia or vomiting need urgent gastroenterology assessment.

Always consult a qualified Chinese herbalist registered with the RCHM.

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