苓桂术甘汤 Ling Gui Zhu Gan Tang

Warm the Center, Move the Water

Líng Guì Zhú Gān Tāng — Poria, Cinnamon Twig, White Atractylodes, and Licorice Decoction — is Zhang Zhongjing’s four-herb answer to fluid that pools when the center runs cold: it warms the Spleen’s yang, transforms the retained fluid, and guides it out through the urine.

The trouble here is phlegm-fluid (痰飲, tán yǐn) — a thin, watery accumulation that gathers below the heart when Spleen yang is too weak to move it. From there it clouds the head as dizziness, harries the Heart as palpitations, and floods the Lung as a cough with clear, thin sputum. Rather than forcing the water out, this formula warms the center so the body can transform and move it on its own.

From Zhang Zhongjing’s Canon

The formula comes down from the Han-dynasty canon of Zhāng Zhòng-Jǐng, appearing in both the Shāng Hán Lùn (Treatise on Cold Damage) and the Jīn Guì Yào Lüè (Essentials from the Golden Cabinet), in its chapter on phlegm-fluid. It is the root of the celebrated “Líng-Guì” family of formulas — the prescriptions built on the pairing of Fú Líng and Guì Zhī.

Phlegm-Fluid from Spleen-Yang Deficiency · 痰飲

The pattern is a cold, weak center that can no longer transform water. Fluid gathers below the heart, giving fullness in the chest and flanks — sometimes an audible splash in the epigastrium — while the clear yang can no longer rise to the head.

Classical tongue & pulse: a pale, swollen tongue with a white, slippery coating; a wiry and slippery — or deep — pulse.

Four Herbs: Warm, Drain, Strengthen, Harmonize

Fú Líng takes the largest share — strengthening the Spleen and leaching the accumulated fluid downward and out through the urine, while quieting the Heart the fluid disturbs. Guì Zhī warms the yang and transforms qi, evaporating the cold, stagnant fluid like sun on standing water, and settling the qi that surges up toward the chest and head.

Bái Zhú strengthens the Spleen and dries Dampness at its source, so new fluid stops forming. And Zhì Gān Cǎo supports the Spleen qi and harmonizes the whole; with Guì Zhī it forms the classical acrid-and-sweet pairing said to generate yang, and it tempers Fú Líng’s draining so the normal fluids are spared. Fú Líng drains from below while Guì Zhī warms from above — the renowned Líng-Guì pairing, one moving the water out, the other restoring the warmth that keeps it moving.

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