In this text, it is my aim to highlight my own experiences with the classical Shang Han Lun formula Wu Mei Wan in clinical practice.
The idea came up during an e-mail conversation between Hila Yaffe and myself, where we were discussing the usage and modifications of this formula in detail. After some mailing back and forth, Hila asked me if I wanted to write an article about this topic for her website.
Well, here I am.
As a clinician, practicing for almost ten years now, I am able to look back on some experience with different types of Chinese medicine formulas. The Shang Han Lun formulas stand out to me generally, as they are following a completely different approach from most of the more modern formulas. Modern formulas seem to mostly combine the effects of the single herbs to achieve a certain main effect, for example to tonify blood, move qi, leech out dampness etc..
The Shang Han Lun approach of reinforcing the natural flow of qi, aiming to regain the physiological function of each of the six stages, is totally different. If the reader is not already familiar with the system of the six stages from the Shang Han Lun, I strongly recommend diving into Hila’s publications on this topic for more information.
The differences between the modern and the classical view from the Shang Han Lun are meaningful for the treatment, but also for the diagnostics involved. It seems to me that, rather than looking at the tree to find out what is ruining the bark, the Shang Han Lun is looking at the forest as a whole. The overall climate, the direction in which the wind is blowing, the amount of rainfall over the course of the year – that is what Zhang Zhong Jing was looking for. And that is, for me, the magic and the wisdom which is hidden in his formulas.
Before talking about the Wu Mei Wan – the Japanese Apricote Pill or Mume Pill – I have to clarify my understanding of the jue yin stage. In my personal clinical opinion, the jue yin stage is not the deepest of the six stages, as most Chinese medicine practitioners claim, but the middle one of the three yin-stages. While there are many reasons why I believe this, I will only give a brief sketch here.
First, the liver and the pericardium which form the jue yin stage are both organs of movement and regulation. The pericardium regulates the flow of emotions and blood towards and out of the heart. The liver plays an important role in moving the qi of the body and helping it reach into even the most distant branches of it.
Deep yin, in my understanding, means deep storage. So when we talk about the deepest yin position in the six stages, the stage should reflect the function of storage rather than the function of movement. By far the most important organs of storage are the heart and the kidneys. They store the shen and the jing – the mind and the essence. Without these two sacred entities, human life is impossible. That’s why they are stored way down below, in the deep and dark yin, the shao yin organs.
The jue yin, which literally means the collapsing yin, is, from my perspective, responsible for moving the qi from the upper yin stage tai yin down into the storage of shao yin. That’s why, if it doesn’t work properly, the qi of the body comes rushing upwards, like a “counterflow against the heart“, which forms an important part of the manifestation of the jue yin syndrome, as you can read in the chapter on the jue yin in the Shang Han Lun (line 326).1
Zhang Zhong Jing seems to have thought this way as well, as he put the chapter for the jue yin at the third place of the yin stages, comparable to the shao yang, the middle stage of the yang stages, which he put in the third place of the yang.
There are many more reasons to look at the jue yin this way. In another article, I might delve deeper into this topic.
Now for the Wu Mei Wan formula. The formula is composed of both very cold and very warm herbs, all dominated by wu mei, the mume, the Japanese apricot or black plum. This fruit is of a neutral or slightly warm energetic temperature and very sour in taste. Sour, according to the Fu Xin Jue, a text which includes parts that Zhang Zhong Jing probably relied on when writing the Shang Han Lun, belongs to the metal category.2 That’s because sour astringes, and that function belongs to the lung-metal. Metal controls wood in the five phase system. So if you take sour as your main taste in a formula, either you want to tonify metal, or you want to control wood. As Wu Mei Wan is the representative jue yin formula, Zhang Zhong Jing seems to have been interested mainly in the wood-controlling aspect.
Then there are the warm or even hot herbs, namely gan jiang, chuan jiao, xi xin, fu zi, gui zhi, ren shen and dang gui. All of these herbs, except for the ren shen, are directly related to the liver system. They are acrid in taste, which is the taste that classically (following the Fu Xing Jue) belongs to wood, and therefore to the liver and jue yin. As the nature of the acrid taste is to be moving and uprising, so are the herbs. They restore the physiological function of the liver of harmonizing the flow of qi and blood through the channels and the entire body.
The cold herbs in this formula, namely huang lian and huang bai, are used to tame the up-and out-flaring fire from the compromised jue yin system. Remember that the jue yin should transport the qi deeper inside to the kidneys and the heart. If that doesn’t happen, we get too much up-and out-flaring yang qi, which causes heat symptoms. At the same time, the jue yin fails to function properly, which causes reversal cold, cold hands and feet. (Shang Han Lun, Line 331)1
Compared to pathological fire in the yang-stages, this flaring-up of fire happens deep inside the body. That is why the main symptoms associated with the jue yin are wasting thirst, counter-flow qi against the heart, pain and heat in the chest, hunger without desire to eat and vomiting. (Shang Han Lun, Line 326)1 The heat is there, but it is not on the surface, where it would cause fever. It is still inside of the yin, where it irritates either the spleen, the heart, or the kidneys, and causes the aforementioned symptoms. That’s the jue yin syndrome.
We now have the warm herbs restoring the movement of jue yin and the cold herbs controlling the pathological fire. The ren shen acts as an intermediary between these two directions, being the earth herb of the earth category in the Fu Xing Jue. It tonifies the middle and thereby harmonizes the uprising and down-sinking forces.
Let’s get back to the main herb wu mei – the black plum. All the herbs we talked about are prescribed as dominated by the wu mei. What does this mean? It means that the main direction of the formula is downwards and inwards, astringing. It means that it is a yin formula overall, a yin formula composed of wood-warming and pathological fire-cooling herbs. In other words, a harmonizing agent to the yin stages, an intermediary between the upper and the lower parts of the yin, in the end, the jue yin itself.
Having described the formula and the systematics of proper jue yin function, I now want to talk about two cases from my own clinical practice to highlight the formula’s truly enormous clinical value.
The patient was a woman in her eighties, with a long history of allergies to all kinds of substances, especially antibiotics and many herbs and spices. She was also suffering from recurrent hay fevers with swollen hands and face, dyspnea, inhibited urination and constant dry coughing. She was always very thirsty, had cold hands and feet, had the feeling that her body temperature was never normal, always too hot or too cold, overall low appetite and an up-flaring feeling of heat in the chest and head. Western medicine diagnoses included heart-insufficiency (right), congestive kidneys and anemia.
When I was asked to treat her, she had just developed acute erysipelas in both lower legs and feet with fever up to 39.2°C (102.56°F). Antibiotics prescribed by her western physician did not work at all.
One of the main symptoms of the jue yin syndrome is of course vexation thirst. This woman did not stop drinking, even though she was not able to urinate properly. There must have been extreme heat trapped inside her. At the same time, there were the cold symptoms. It was a jue yin syndrome, so Wu mei Wan was the way to go.
I did some additional research on this formula and in a compendium by Prof. Heiner Frühauf I stumbled over the advice to lessen the fu zi and the gan jiang in cases where the heat is predominant.3 Because of the acute erysipelas, I let go of the fu zi completely, as I wasn’t allowed to prescribe it in Germany anyway. Xi xin is not allowed either, so I added more gui zhi and a bit more dang gui for additional warmth. I also added a fair amount of bai he. Prof. Frühauf states that bai he has a calming and soothing effect on an overreactive immune system, and I wanted make sure that no allergic reactions would occur during the treatment. It worked remarkably well.
Two weeks after starting to take the prescription, the inflammation in the patient’s legs was completely gone and the thirst had abated markedly.
The second patient was a woman in her early thirties, coming into the practice complaining about bad sleep, sporadic outbreaks of bad temper, hay fever, allergic reactions to pepper and chili, as well as any hot foods (with “hot” here referring to the food’s temperature at the time of eating). When she was stressed, she started feeling an oppression in her chest and pressure behind her eyeballs.
Her pulses were soggy and weak on the right and rather deep and thin on the left side, indicating both a tai yin and a jue yin problem. The tongue pointed in the same direction, as it was pale with white coating in the middle and shiny-red on the edges.
I needled tai chong (Liver 3) and da ling (Pericardium 7) for the jue yin and yin ling quan (Spleen 9) and chi zi (Lung 5) for the tai yin. All points were needled on both sides. I prescribed a modification of the Wu Mei Wan, where I left out the xi xin and fu zi and added bai he, mai men dong and bai shao yao. My additions were made to enhance the fire taming and yin supporting (bai he and mai men dong) and digestion harmonizing (bai shao yao) properties of the formula.
I saw the patient again two weeks later. She reported that, after taking the first dose of the medicine, she had an outbreak of alternating heat and cold feelings in her body. It vanished almost as soon as it had arisen. Right afterwards her hay fever symptoms were drastically reduced and she felt a lot better overall. She had used her corticoid-inhaler only two times since our first appointment, when normally she would need it multiple times a day in the summertime (when this treatment took place).
I think these two cases illustrate quite well the possible symptoms and, perhaps more importantly, the energetic circumstances in which the formula Wu Mei Wan is useful and should be used in the clinic.
When the jue yin of the body is too weak to regulate the uprising and down-sinking forces of the qi inside of the yin stages, when uncontrolled fire causes trouble within, and when (importantly) this is not due to a shao yin weakness, which we have to diagnostically exclude, Wu Mei Wan is the way to go.
I hope that this article has shed some light on this wonderful ancient formula and its use in clinical practice.
Helge Winckler is a Chinese medicine practitioner from Hamburg, Germany. His main focus is on the treatment of chronic inflammatory diseases with acupuncture, Chinese herbs and psychosomatic medicine.
In 2021 he opened his own practice and school “Liàn Yuán” in the countryside near Hamburg. He is happily married and father of three children.
- Zhang Zhong Jing, On Cold Damage. Oriental Healing Arts Institute, ISBN: 978-7-5426-5706-0, 2016
- Sabine Wilms, Celestial Secrets – A Dunhuang Manuscript Of Medicinal Decoctions For The Zangfu Organs, Happy Goat Productions, ISBN: 978-1-7321571-7-0, 2020
- Heiner Fruehauf, Chinese Herbal Formulas: A Clinical Handbook, Haishan Press, 2015