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Pinellia Complex

CLINICAL APPLICATIONS

* Damp and phlegm accumulation with Spleen and Stomach qi deficiency

§ Damp and phlegm accumulation: profuse, white sputum that can be easily expectorated, a feeling of distension and a stifling sensation in the chest and epigastrium, nausea, vomiting, lassitude, weak extremities, possible vertigo, palpitations, white, moist or greasy tongue coating, and a slippery pulse

§ Spleen and Stomach qi deficiencies: pale face, sallow complexion, low voice, lassitude, weakness of the extremities, poor appetite, loose stools, pale tongue with teeth marks, and a fine, moderate pulse

* Mostly used as an adjunct formula to treat a variety of disorders if the diagnosis includes dampness and phlegm

 

WESTERN THERAPEUTIC ACTIONS

* Gastrointestinal activities to treat various digestive disorders

* Metabolic activities to treat obesity and diabetes mellitus

* Antitussive and expectorant functions to treat respiratory disorders

* Circulatory and cardiovascular effects to treat hyperlipidemia and atherosclerosis

 

CHINESE THERAPEUTIC ACTIONS

* Dries dampness and dissolves phlegm

* Regulates qi and harmonizes the middle jiao

* Tonifies Spleen qi

 

DOSAGE

Take 3 to 4 capsules three times daily on an empty stomach. The dosage may be increased up to 6 to 8 capsules every four to six hours as needed.

 

INGREDIENTS


Bai Zhu (Rhizoma Atractylodis Macrocephalae)

Ban Xia (Rhizoma Pinelliae)

Cang Zhu (Rhizoma Atractylodis)

Fu Ling (Poria)

Ju Hong (Exocarpium Citri Rubrum)

Sha Ren (Fructus Amomi)

Sheng Jiang (Rhizoma Zingiberis Recens)

Wu Mei (Fructus Mume)

Xiang Fu (Rhizoma Cyperi)

Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle)

Zhi Qiao (Fructus Aurantii)

Zhu Ru (Caulis Bambusae in Taenia)


 

BACKGROUND

Damp and phlegm disorders are closely related to the functions of the organs that control water: the Spleen, Lung, and Kidney. The Spleen transforms water, the Lung distributes water, and the Kidney eliminates water. Disorders in any of these three organs will lead to the accumulation of water and dampness, and eventually, the formation of phlegm. Once phlegm is formed, it may affect virtually any part of the body, including but not limited to the chest, diaphragm, stomach, intestines, all four extremities, and every channel and collateral. Presentations of phlegm disorders include signs and symptoms such as cough, wheezing, hurried respiration, dizziness, vertigo, nausea, vomiting, seizures, epilepsy, dian kuang (mania and withdrawal), formation of hardness and nodules, and many others. In short, phlegm is commonly described in traditional Chinese medicine as the “mother of hundreds of disorders,” causing imbalance in the zang fu organs as well as obstructions of the channels and collaterals. This is why herbal formulas that treat dampness and phlegm often have multiple pharmacological effects and can be used to address a wide range of indications.

 

FORMULA EXPLANATION

Pinellia Complex is based on Er Chen Tang (Two-Cured Decoction), the foundational formula for treating dampness and phlegm. According to traditional Chinese medicine theories, the Spleen sends clear fluids up to the upper jiao. If this function is impaired, dampness may accumulate in the Spleen and create phlegm. If the Spleen is deficient and full of dampness, its functions of transportation and transformation will be impaired, which will lead to insufficient supply of nutrients to the body and the extremities. The result will be lassitude and weak extremities. The Lung, on the other hand, stores phlegm. Phlegm accumulation in the Lung manifests as coughing with profuse sputum. A feeling of distension and oppression in the chest and epigastrium arises as a result of dampness and phlegm obstructing the chest. Nausea and vomiting are due to damp-phlegm obstructing Stomach qi and causing it to rise abnormally. If dampness and phlegm affect the ascent of yang qi, then palpitations and vertigo can occur.

        Ban Xia (Rhizoma Pinelliae) acts as the chief herb in this formula because it is the best herb to break up and dissolve phlegm stagnation. Its acrid and warm properties dissolve phlegm, dry dampness, and open pathways for the qi to flow. In addition, it corrects the reversed flow of Stomach qi to relieve nausea and vomiting. Ju Hong (Exocarpium Citri Reticulatae) activates and regulates qi to remove residual phlegm and dampness. Fu Ling (Poria), Bai Zhu (Rhizoma Atractylodis Macrocephalae), and Cang Zhu (Rhizoma Atractylodis) strengthen the Spleen and dispel dampness. Xiang Fu (Rhizoma Cyperi) and Sha Ren (Fructus Amomi) are used to resolve dampness and promote qi circulation. Zhu Ru (Caulis Bambusae in Taenia) and Zhi Qiao (Fructus Aurantii) are used to clear heat, regulate qi, and eliminate phlegm. Sheng Jiang (Rhizoma Zingiberis Recens) relieves nausea and vomiting by guiding Stomach qi downward, and helps to detoxify Ban Xia (Rhizoma Pinelliae). A small amount of Wu Mei (Fructus Mume) is used to astringe the Lung to prevent qi loss. The restraining effect of Wu Mei (Fructus Mume) also balances the dispersing nature of Ban Xia (Rhizoma Pinelliae), thereby minimizing the potential side effects of each others. Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) regulates the Lung and Spleen and harmonizes all of the herbs.

        In summary, Pinellia Complex is an excellent formula to strengthen the Spleen and Stomach, dry up dampness, and eliminate phlegm.

 

CAUTIONS & CONTRAINDICATIONS

* Pinellia Complex is contraindicated in cases of yin deficiency, yin-deficient heat, qi stagnation, excess heat, high fever, or thirst conditions.

* Discontinue this formula when the desired effect is achieved. Continued use may cause yin deficiency and symptoms of dry mouth, dry tongue, thirst, or irritability.

 

CLINICAL NOTES

* Because damp and phlegm cause a wide variety of disorders, treatment is most effective if Pinellia Complex is used to dispel damp and phlegm, while another formula is used to treat the subsequent disorder.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Deep taiyin pulse on the right cun. If the pulse is strong and deep, then there is damp-heat.

 

SUPPLEMENTARY FORMULAS

* For respiratory disorders with clear or white sputum, add Respitrol (Cold).

* For respiratory disorders with yellow sputum, add Pinellia XPT and/or Respitrol (Heat).

* For asthma in children caused by heat, add Respitrol (Heat).

* For nasal allergies, add Magnolia Clear Sinus or Pueraria Clear Sinus.

* For dry-phlegm characterized by sputum that is yellow, thick, and difficult to expectorate, add Nourish (Fluids).

* With nausea and vomiting due to cold in the Stomach and a deficient body constitution, add GI Tonic.

* With irritable bowel syndrome (IBS), add GI Harmony.

* If accompanied by depression, add Shine or Shine (DS).

* For nodules caused by phlegm obstructing the channels, add Resolve (AI).

* For severe Spleen and Stomach qi deficiencies, or with diarrhea, add GI Tonic.

* With edema due to Spleen deficiency, add Herbal DRX.

* With qi and blood deficiencies, combine with Imperial Tonic.

* With damp-type of lesions, add Dermatrol (Damp).

* For damp-heat in the lower jiao, add V-Support.

* For plum-pit syndrome, add Ban Xia Hou Po Tang (Pinellia and Magnolia Bark Decoction).

 

ACUPUNCTURE TREATMENT

Traditional points:

* Yinlingquan (SP 9), Taibai (SP 3), Zusanli (ST 36), Zhigou (TH 6), Taiyuan (LU 9), Lieque (LU 7), Zhongwan (CV 12)

 

Balance Method by Dr. Richard Tan:

* Left side: Yinbai (SP 1), Yangchi (TH 4), Sanjian (LI 3), Hegu (LI 4), Quchi (LI 11)

* Right side: Yuji (LU 10), Jingqu (LU 8), Lieque (LU 7), Fenglong (ST 40)

* Alternate sides with each treatment.

 

Ear Acupuncture:

* Stomach, Spleen, Lung, Endocrine, Adrenal, Shenmen

 

Auricular Medicine by Dr. Li-Chun Huang:

* Nasopharynx, Sympathetic, Allergic Area, Lung, Endocrine, Trachea. Bleed Ear Apex.

 

NUTRITION

* Avoid any and all foods containing sugar, such as cake, dessert, candy, chocolate, cake, soda, canned juice, soft drinks, stevia, sugar substitutes, agave, xylitol, and corn syrup.

* Avoid raw or cold food and beverages, such as sashimi, sushi, salads, steak tartar, and seared meat. Eat cooked vegetables and nothing straight from the refrigerator.

* Avoid carbohydrates like white rice or bread as they may damage the Spleen and in turn produce more dampness.

* Do not eat seafood, especially shellfish like crab, oyster, scallop, clam, lobster and shrimp, as they enter the yangming Stomach channel. This is especially important for individuals suffering from skin disorders.

* Avoid fermented foods like cheese or fermented tofu.

* Avoid dairy products, such as milk, cream, yogurt, cheese, and ice cream. Dairy products in general tend to create dampness and therefore should not be consumed. Milk, cheese and other dairy products should be avoided, especially if patients are lactose intolerant.

* Do not eat lamb, beef, goose or duck. Avoid deep-fried or greasy foods.

* Avoid the following foods that are cold in nature and may damage the Spleen: most melons (winter melon, watermelon, honeydew melon, etc.), nightshades (eggplant, potato, bell and spicy peppers, tomato), bitter melon, seaweed, cucumber, grapefruit, and citrus.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Hawthorn berries, papayas, oranges, apples, daikons, and parsley.

* Dry and age orange peel for about one month. Soak it in hot water to make tea and drink it after meals.

* Blend daikon radish juice and take after meals.

 

LIFESTYLE INSTRUCTIONS

* Always eat breakfast! According to the TCM clock, the most optimal time for the digestive system is in the morning from 8:00 to 10:00 a.m.

* Drink warm or hot liquids with your meal. Putting cold and ice on any part of the body will immediately constrict the flow of blood to that region. Similarly, drinking cold or iced drinks with meals will hinder the natural peristaltic movements of the digestive system.

* Sleep by 10:00 p.m. In traditional Chinese medicine (TCM), 11:00 p.m. to 1:00 a.m. is when the yin shifts to yang. It is crucial for the body to be at rest during this time for optimal health.

* Give the body two to three hours between the last meal of the day and bedtime. When a person sleeps, the digestive system slows down as well. Make sure the body has adequate time to digest the food before going into sleep mode.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

“Damp and phlegm” are concepts in traditional Chinese medicine that describe a myriad of dysfunctions affecting various organ systems in the body, including but not limited to gastrointestinal, metabolic, respiratory, cardiovascular, and neurological systems. Similarly, herbs that dry dampness and eliminate phlegm have a wide range of pharmacological effects as well as multiple clinical applications.

        “Damp and phlegm” are derived from foods that are fatty, oily, greasy, and/or deep-fried. These foods are low in nutrients, difficult to digest, and adversely affect the digestive system to cause symptoms such as indigestion, nausea, vomiting, pain, constipation, diarrhea, anorexia, and many others. Therefore, as a general principle, herbs that dry dampness and eliminate phlegm have remarkable gastrointestinal effects to treat various digestive disorders. Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Cang Zhu (Rhizoma Atractylodis) have excellent effects to regulate the gastrointestinal tract. Bai Zhu (Rhizoma Atractylodis Macrocephalae) has a dual effect on the gastrointestinal tract to treat either constipation or diarrhea.[1],[2],[3] Cang Zhu (Rhizoma Atractylodis) also has a balancing effect: it can relax the gastrointestinal tract to relieve spasms and cramps,[4] or it can stimulate the gastrointestinal tract to increase gastric emptying or intestinal motility.[5] Similarly, Sha Ren (Fructus Amomi) has a regulatory effect on the gastrointestinal system: it has a stimulating effect at low doses and an inhibiting effect at high doses.[6] Sheng Jiang (Rhizoma Zingiberis Recens) and Ban Xia (Rhizoma Pinelliae) have a significant antiemetic effect,[7],[8] and are commonly used to treat nausea and vomiting due to various causes.[9],[10] Wu Mei (Fructus Mume), Gan Cao (Radix et Rhizoma Glycyrrhizae) and Zhi Qiao (Fructus Aurantii) all have a gastroprotective effect. Wu Mei (Fructus Mume) reduces mucosal inflammation and protects against chronic atrophic gastritis.[11] Gan Cao (Radix et Rhizoma Glycyrrhizae) stimulates the growth of intestinal crypt cells to facilitate intestinal mucosa repair.[12] Zhi Qiao (Fructus Aurantii) protects the gastric mucosa against lesions induced by ethanol and non-steroidal anti-inflammatory drugs (NSAIDs) by increasing the gastric mucus production.[13] Lastly, many herbs in this formula have been used with great success to treat conditions such as gastric or duodenal ulcers,[14] atrophic gastritis,[15] epigastric pain,[16] and many others.

        After foods with “damp and phlegm” characteristics are absorbed, they directly affect the metabolic system by increasing body weight and blood glucose levels. Ban Xia (Rhizoma Pinelliae) and Bai Zhu (Rhizoma Atractylodis Macrocephalae) are two herbs with antiobesity effects. Ban Xia (Rhizoma Pinelliae) has been shown to decrease body weight by increasing thermogenesis and fatty acid oxidation.[17] Bai Zhu (Rhizoma Atractylodis Macrocephalae) reduces body weight associated with high fat diet by inhibiting adipogenesis.[18] Furthermore, many herbs in this formula have great functions to treat diabetes. Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Cang Zhu (Rhizoma Atractylodis) have antidiabetic effects to lower plasma glucose levels and treat diabetes.[19],[20] Fu Ling (Poria) has an antihyperglycemic effect to reduce postprandial blood glucose levels via enhanced insulin sensitivity.[21] Sheng Jiang (Rhizoma Zingiberis Recens) has multiple antidiabetic activities, including a marked effect to increase blood insulin level and enhance insulin sensitivity.[22] Finally, herbs in this formula have been shown to effectively treat diabetes mellitus as well as its complications, such as diabetic retinopathy, diabetic nephropathy, and “diabetic foot.” [23],[24],[25]

        Increased intake of “damp and phlegm” foods also increases risks of circulatory and cardiovascular disorders, such as hyperlipidemia and atherosclerosis. Gan Cao (Radix et Rhizoma Glycyrrhizae) is used for its antihyperlipidemic effect to lower plasma cholesterol levels,[26] and Zhi Qiao (Fructus Aurantii) is used for its antiatherogenic and anti-inflammatory properties to treat atherosclerosis.[27] Furthermore, many herbs in this formula have marked cardiovascular effects: Cang Zhu (Rhizoma Atractylodis) may decrease blood pressure,[28] Xiang Fu (Rhizoma Cyperi) may strengthen the heart beat and lower the heart rate,[29] Gan Cao (Radix et Rhizoma Glycyrrhizae) may restore normal heart rhythm,[30] and together, herbs in this formula may treat both acute episodes and sequelae of stroke.[31]

        Though “damp and phlegm” is a pathological concept in traditional Chinese medicine, the presence of “sputum and phlegm” in the lungs is literally a pathological condition in Western medicine. The presence of sputum and phlegm is indicative of respiratory disorders, and therefore, must be treated accordingly. Ban Xia (Rhizoma Pinelliae) and Gan Cao (Radix et Rhizoma Glycyrrhizae) have marked and prolonged antitussive and expectorant effects to facilitate the elimination of phlegm.[32] Ban Xia (Rhizoma Pinelliae) and Chen Pi (Pericarpium Citri Reticulatae) have antiasthmatic effects to facilitate breathing.[33] Synephrine from Zhi Qiao (Fructus Aurantii) has a moderate effect to relax and dilate the airways.[34] Clinically, herbs in this formula have been used to treat various respiratory tract disorders, such as asthma, bronchitis,[35] bronchiolitis,[36] tuberculosis,[37] and others.

        In summary, it has been said in TCM that “phlegm is the mother of hundreds of diseases.” Phlegm may literally indicate sputum expelled from the lungs, or it may figuratively refer to various disorders affecting the gastrointestinal, metabolic, respiratory, cardiovascular, and circulatory systems. Pinellia Complex is an excellent formula to dry “damp” and eliminate “phlegm,” and in turn, treat imbalances affecting these systems.

 



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[2] Shan Dong Zhong Yi Za Zhi (Shandong Journal of Chinese Medicine), 1982; 2:107.

[3] Xin Yi Yao Xue Za Zhi (New Journal of Medicine and Herbology), 1979; 6:27.

[4] Zhong Cheng Yao Yan Jiu (Research of Chinese Patent Medicine), 1983; (7):25.

[5] Kimura Y, Sumiyoshi M. Effects of an Atractylodes lancea rhizome extract and a volatile component β-eudesmol on gastrointestinal motility in mice. J Ethnopharmacol. 2012 May 7;141(1):530-6.

[6] Zhong Yao Xue (Chinese Herbology), 1998; 326:327.

[7] Haniadka R, Rajeev AG, Palatty PL, Arora R, Baliga MS. Zingiber officinale (Ginger) as an Anti-Emetic in Cancer Chemotherapy: A Review. J Altern Complement Med. 2012 May;18(5):440-4.

[8] Jiang Su Zhong Yi Za Zhi (Jiangsu Journal of Chinese Medicine), 1987; 3:16.

[9] Xin Zhong Yi (New Chinese Medicine), 1986; 12:24.

[10] Dissertation Abstr Interant, 1987, 8:3297.

[11] Enomoto S, Yanaoka K, Utsunomiya H, Niwa T, Inada K, Deguchi H, Ueda K, Mukoubayashi C, Inoue I, Maekita T, Nakazawa K, Iguchi M, Arii K, Tamai H, Yoshimura N, Fujishiro M, Oka M, Ichinose M. Inhibitory effects of Japanese apricot (Prunus mume Siebold et Zucc.; Ume) on Helicobacter pylori-related chronic gastritis. Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan. Eur J Clin Nutr. 2010 Jul;64(7):714-9.

[12] He Y, Zhang X, Zeng X, Huang Y, Wei JA, Han L, Li CX, Zhang GW. HuR-mediated posttranscriptional regulation of p21 is involved in the effect of Glycyrrhiza uralensis licorice aqueous extract on polyamine-depleted intestinal crypt cells proliferation. J Nutr Biochem. 2012 Jan 2.

[13] Moraes TM, et al. Effects of limonene and essential oil from Citrus aurantium on gastric mucosa: role of prostaglandins and gastric mucus secretion. São Paulo State University, Department of Physiology, Rubião Junior, cp 510, CEP 18618-000, Botucatu, São Paulo, Brazil. Chem Biol Interact. 2009 Aug 14;180(3):499-505.

[14] Zhong Yao Lin Chuan Xin Yong (New Clinical Applications of Chinese Medicine), 2001; 163.

[15] Bei Jing Zhong Yi (Beijing Chinese Medicine) 1990;1:5.

[16] Nei Meng Gu Zhong Yi Yao (Traditional Chinese Medicine and Medicinals of Inner Mongolia) 1998;3:19.

[17] Kim YJ, Shin YO, Ha YW, Lee S, Oh JK, Kim YS. Anti-obesity effect of Pinellia ternata extract in Zucker rats. Biol Pharm Bull. 2006 Jun;29(6):1278-81.

[18] Kim CK, Kim M, Oh SD, Lee SM, Sun B, Choi GS, Kim SK, Bae H, Kang C, Min BI. Effects of Atractylodes macrocephala Koidzumi rhizome on 3T3-L1 adipogenesis and an animal model of obesity. J Ethnopharmacol. 2011 Sep 1;137(1):396-402.

[19] Shan J.J. & Tian G.Y. Studies on physico-chemical properties and hypoglycemic activity of complex polysaccharide AMP-B from Atractylodes macrocephala Koidz. Yao Xue Xue Bao. 2003, 38(6): 438-441.

[20] Zhong Hua Yi Xue Za Zhi (Chinese Journal of Medicine), 19858; 44(2):150.

[21] Li TH, Hou CC, Chang CL, Yang WC. Anti-Hyperglycemic Properties of Crude Extract and Triterpenes from Poria cocos. Evid Based Complement Alternat Med. 2011;2011. pii: 128402.

[22] Iranloye BO, Arikawe AP, Rotimi G, Sogbade AO. Anti-diabetic and anti-oxidant effects of Zingiber Officinale on alloxan-induced and insulin-resistant diabetic male rats. Niger J Physiol Sci. 2011 Nov 23;26(1):89-96.

[23] Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine) 1994;1:9.

[24] Zhong Yao Lin Chuan Xin Yong (New Clinical Applications of Chinese Medicine), 2001; 309.

[25] Gao L. Qi-promoting and phlegm-resolving method for treatment of diabetic microvascular complications. Journal of Traditional Chinese Medicine 2000 Jun;20(2):104-9.

[26] Zhong Yao Xue (Chinese Herbology), 1998, 759:765.

[27] Liu L, et al. Naringenin and hesperetin, two flavonoids derived from Citrus aurantium up-regulate transcription of adiponectin. Pharmaceutical Informatics Institute, College of Pharmaceutical Sciences, Zijin'gang Campus, Zhejiang University, Hangzhou, 310058, China. Phytother Res. 2008 Oct;22(10):1400-3.

[28] Chang Yong Zhong Yao Cheng Fen Yu Yao Li Shou Ce (A Handbook of the Composition and Pharmacology of Common Chinese Drugs), 1994; 979:985.

[29] Zhong Guo Yao Ke Da Xue Xue Bao (Journal of University of Chinese Herbology), 1989; 20(1):48

[30] Ojha S, Golechha M, Kumari S, Bhatia J, Arya DS. Glycyrrhiza glabra protects from myocardial ischemia-reperfusion injury by improving hemodynamic, biochemical, histopathological and ventricular function. Exp Toxicol Pathol. 2011 Oct 3.

[31] Shan Xi Zhong Yi (Shanxi Chinese Medicine) 1995;16(9):393.

[32] Zhong Yao Xian Dai Yan Jiu Yu Ying Yong (Modern Study of Traditional Chinese Medicine) 1993;165, 199, 388, 490.

[33] Ok IS, Kim SH, Kim BK, Lee JC, Lee YC. Pinellia ternata, Citrus reticulata, and their combinational prescription inhibit eosinophil infiltration and airway hyperresponsiveness by suppressing CCR3+ and Th2 cytokines production in the ovalbumin-induced asthma model. Mediators Inflamm. 2009;2009:413270.

[34] Zhi Wu Yao You Xiao Cheng Fen Shou Ce (Manual of Plant Medicinals and Their Active Constituents), 1986; 1012.

[35] Jiang Xi Zhong Yi Yao (Jiangxi Chinese Medicine and Herbology) 1988;1:16.

[36] Zhong Ji Yi Kan (Medium Medical Journal) 1994;12:45.

[37] Jiang Xi Yi Yao (Jiangxi Medicine and Herbology), 1965; 1:562.