Lian Li Tang (连理汤) — Coptis Regulate the Middle Decoction
On this page
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[9], 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
- Ren Shen (Rx. Ginseng, 3-15g) — tonifies Spleen Qi (Li Zhong Wan core)
- Gan Jiang (Rz. Zingiberis, 3-9g) — warms the middle and Spleen Yang
- Bai Zhu (Rz. Atractylodis Macrocephalae, 3-9g) — tonifies Spleen; dries Damp
- Zhi Gan Cao (Fried Rx. Glycyrrhizae, 3-9g) — tonifies and harmonises
- Huang Lian (Rz. Coptidis, 1.5-10g) — clears the localised Stomach or upper-burner Heat
Formula actions
- Warms and tonifies Spleen Yang
- Clears mild Stomach or upper-burner Heat
- Harmonises the middle burner
Conditions treated
- Chronic gastritis with cold below and mild Heat above
- Recurrent mouth ulcers with loose stools and cold extremities
- Crohn’s disease with Spleen-Yang deficient pattern and mild upper Heat — see Crohn’s disease
- IBS[5] mixed type with cold lower pattern and mild upper Heat
- Chronic recurrent canker sores with cold lower jiao
- 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.
Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide.
References
[5] Liu Q, Shi Z, Zhang T, Jiang T, Luo X, Su X, Yang Y, Wei W. Efficacy and Safety of Chinese Herbal Medicine Xiao Yao San in Functional Gastrointestinal Disorders: A meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials. Front Pharmacol. 2022 Jan 19;12:821802. https://doi.org/10.3389/fphar.2021.821802. PMID: 35126152.
[9] Wang YY, Li XX, Liu JP, Luo H, Ma LX, Alraek T. Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials. Complement Ther Med. 2014 Aug;22(4):826-33. https://doi.org/10.1016/j.ctim.2014.06.004. PMID: 25146086.
