Zhi Shi Li Zhong Wan (枳实理中丸) — Aurantium Regulate the Middle Pill
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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
- Ren Shen — tonifies Spleen Qi
- Gan Jiang — warms the middle
- Bai Zhu (Rz. Atractylodis Macrocephalae, 6-9g) — tonifies Spleen and dries Damp
- Zhi Gan Cao — harmonises and tonifies
- Zhi Shi (Fr. Aurantii Immaturus, 9-15g) — moves Qi and breaks stagnation
Formula actions
- Warms and tonifies Spleen Yang
- Moves stagnant Qi
- Resolves focal distention
- Restores digestive function
Conditions treated
- Chronic functional dyspepsia with cold pattern and bloating — see digestive disorders
- Post-gastric-surgery dysmotility with cold pattern
- Chronic gastritis with cold and Qi stagnation
- IBS[5] with cold-deficient pattern and bloating — see IBS
- Chronic enteritis with cold pattern
- Post-chemotherapy digestive dysfunction
- 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[12] need urgent gastroenterology assessment.
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.
[12] Zhai X, He Q, Chen M, Yu L, Tong C, Chen Y, et al. Pinellia ternata-containing traditional Chinese medicine combined with 5-HT3RAs for chemotherapy-induced nausea and vomiting: A PRISMA-compliant systematic review and meta-analysis of 22 RCTs. Phytomedicine. 2023 Jul;115:154823. https://doi.org/10.1016/j.phymed.2023.154823. PMID: 37099981.
