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Formulas for clearing ying and cooling blood are suitable for disease syndromes of warm diseases with pathogenic heat entering ying or heat entering the blood aspect. For pathogenic heat entering into ying , scorched ying yin causes disturbed shen with symptoms of generalized fever severe in the night, vexation and sleeplessness, frequent delirious speech, faintly visible macules or papules, crimson and dry tongue and thready and rapid pulse; for heat entering the blood aspect, exhaustion and abnormal flow of blood will aggravate the condition of the disease with symptoms of haematemesis, spontaneous external bleeding, haemafaecia, haematuria, or even macular eruption, and crimson tongue with raised red spots, besides the syndromes in the ying . Though syndromes in the ying and blood aspect are different in the degree of the diseased region and the syndrome condition, their pathogenesis, treatment and medicinals are very much alike. Formulas for clearing ying and cooling the blood are often composed of salty and cold medicinals for cooling ying and resolving toxicity or sweet and cold medicinals for cooling blood and nourishing yin such as shuĭ niú jiăo (Cornu Bubali), xuán shēn (Radix Scrophulariae), shēng dì (Radix Rehmanniae), and mài dōng (Radix Ophiopogonis). The combinations in these types of formulas include the following aspects according to different pathogenic conditions:
For example, shí gāo (Gypsum Fibrosum), zhī mŭ (Rhizoma Anemarrhenae), huáng lián (Rhizoma Coptidis), yín huā (Flos Lonicerae Japonicae), lián qiào (Fructus Forsythiae), zhú yè (Herba Lophatheri). Generally speaking, pathogenic heat in the ying is transported from the qi aspect, thus syndromes of heat in the qi aspect also exist when the heat pathogen enters into the ying in the early stage; while nonclearance of pathogenic heat in the qi aspect leads to stagnation of the qi dyanmic, which directly affects the dispersing of the heat in the ying to the exterior. Therefore, for unresolved pathogens in the qi aspect when the pathogen enters into the ying in the early stage, formulas for cooling ying should be combined with the proper medicinals for clearing heat, draining fire and resolving toxicity according to the degree of concurrent heat syndromes in the qi aspect. Thus, pathogenic heat is kept from entering the ying by clearing the residual heat in the qi aspect on the one hand; and on the other hand, the medicinals light and clearing in property that can disperse qi and diffuse and smooth the qi dynamic may open the way for the heat in the ying to be expelled out, which will benefit the resolution of the heat in the ying by being pushed out to the qi aspect. Therefore, Ye Gui noted that: “ Heat entering ying can still be pushed out and transported into the qi aspect ” (入营犹可透热转气), cited from Writings on External Contraction of Warm - Heat ( Wài Găn Wēn Rè Piān , 外感温热篇), which creates the general treatment methods for syndrome differentiation and treatment of the heat entering ying in warm disease. Zhao Shaoqin held that: “ For syndromes of heat pathogen entering the ying aspect, the reason why heat in the ying cannot be pushed out to the qi aspect smoothly is because there is an hindrance between the ying and qi. On the basis of clearing heat in the ying aspect and nourishing yin in the ying aspect, heat entering ying can be transported out to the qi aspect and then be resolved if the hindrance of dispelling heat in the ying to the exterior is eliminated ” (热邪入营，营热之所以不能顺利透达到气分来，是因营与气之间有阻碍. 在清营热、养营阴的基础上，若再能排除营热外达的障碍，那么已入营之热就可迅速运转出气分而解), cited from Comprehensive Discussion on Warm Diseases . It indicated that the combination of medicinals for clearing the qi in formulas for cooling ying and nourishing yin is the crucial condition for“ outthrusting heat by transporting it to the qi aspect ” (透热转气). Otherwise, expelling heat by transporting it to the qi aspect is impossible if pathogenic heat in the qi aspect cannot be cleared and resolved in time. For example, Qīng Yíng Tāng ( Ying -Clearing Decoction, 清营汤) and Huà Bān Tāng (Macule-Transforming Decoction, 化斑汤) in the Systematic Differentiation of Warm Pathogen Diseases , the main indications of the former is syndromes of pathogenic heat just entering the ying aspect. The application of shuĭ niú jiăo (Cornu Bubali) and shēng dì (Radix Rehmanniae) is for clearing ying and cooling the blood, xuán shēn (Radix Scrophulariae) and mài dōng (Radix Ophiopogonis) are for nourishing yin and clearing heat, the formula is combined with yín huā (Flos Lonicerae Japonicae), lián qiào (Fructus Forsythiae), huáng lián (Rhizoma Coptidis), and zhú yè (Herba Lophatheri) for clearing heat and resolving toxicity, pushing heat out to the exterior, and resolving heat pathogen by transporting it to the qi aspect, thus becoming the typical formula for clearing ying and pushing out heat. The main indication of the latter is syndromes of overabundant heat in both the qi aspect and ying aspect caused by pathogenic heat entering the ying aspect from the qi aspect. This formula comprises shuĭ niú jiăo (Cornu Bubali) and xuán shēn (Radix Scrophulariae)for cooling ying and blood, shí gāo (Gypsum Fibrosum), zhī mŭ (Rhizoma Anemarrhenae), jīng mĭ (Semen Oryza Sativa), gān căo (Radix et Rhizoma Glycyrrhizae) (namely Bái Hŭ Tāng , White Tiger Decoction) for clearing heat to engender body fluid, in order to eliminate the heat in the qi aspect, becoming the typical formula for clearing the heat in both the qi and ying aspect. Accordingly, the combination dosage of medicinals for clearing heat in the qi aspect is decided according to the degree of heat syndromes in the qi aspect and the characteristics of equal attention to the qi aspect and the ying aspect, cooling ying as the main treatment combined with cooling qi, or cooling qi as the main treatment combined with cooling ying qi, or equal attention to cooling qi and the ying aspect. If compared with relevant formulas, Qīng Yíng Tāng ( Ying -Clearing Decoction) is mainly for cooling ying in combination with cooling qi, Huà Bān Tāng (Macule-Transforming Decoction) is mainly for cooling qi combined with cooling ying , while Qīng Wēn Bài Dú Yĭn (Scourge-Clearing Toxin-Vanquishing Beverage)in Achievements Regarding Epidemic Rashes ( Yì Zhĕn Yī Dé , 疫疹一得) is the formula with equal attention to cooling qi and ying qi.
For the selection of medicinals for clearing heat in the qi aspect in this combination: Firstly, it is suitable to choose medicinals light and clearing in property with the function of diffusing and dispersing in medicinals for clearing heat in the qi aspect such as yín huā (Flos Lonicerae Japonicae), lián qiào (Fructus Forsythiae), zhú yè (Herba Lophatheri), etc. As the pathogenic heat in the ying aspect can be resolved through being pushed out to the qi aspect, medicinals of this kind, light and clearing in property, with a concurrent pushing out effect in clearing, cannot only clear evil heat in the qi aspect but also push out evil to the exterior, to achieve the effect of smoothing the qi dyanmic, thus these are always the first choice medicinals in formulas for cooling heat in the ying aspect and nourishing yin. Secondly, it is suitable to choose medicinals with the combined effects of clearing the heat in the qi aspect and nourishing yin to engender body fluid such as shí gāo (Gypsum Fibrosum), and zhī mŭ (Rhizoma Anemarrhenae), etc. The intense heat in the qi aspect not only leads to the stagnation of the qi dynamic, which effects the dispersing of heat in the ying aspect to the exterior, and aggravates the heat in the ying aspect by burning body fluid and damaging yin. The medicinals of this kind combine the effect of clearing heat and draining fire with nourishing yin to engender body fluid, giving simultaneous attention to the right qi and the pathogen; thus it is mostly applied in formulas for cooling heat in both the qi and ying aspect. All in all, under the precondition of cooling ying and nourishing yin, the proper combination of medicinals for clearing qi is the key to “dispersing heat by transporting it to qi aspect”.
For example, huá shí (Talcum), zhú yè (Herba Lophatheri), jīn yín huā lù (Lonicerae Distillatum Floris), gān căo shāo (甘草梢, Radix Glycyrrhizae Tenuis). For the heart governs the blood and belongs to the ying , moreover the heart and small intestine stand in an interior-exterior relationship, the heat in the heart ying always shifts down to the small intestine, the intense heat of which can conduct upward and in turn disturb the heart ying . Therefore, heat syndromes in the ying aspect not only can be resolved by cooling ying and dispersing heat out to the qi aspect, but also can be dispelled by the combination of medicinals for clearing and freeing the small intestine in the light of its general tendency to conduct the heat in the heart- ying out from the small intestine. When discussing the syndrome differentiation and treatment of the heat falling into the pericardium, Liu Bao-yi noted: “ For this type of severe pattern, the priority is to conduct a passage for heat pathogen, which can be resolved through perspiration for heat in the channels, or which is drained through urine and stool for heat in the fu organs ” (凡遇此等重证，第一先为热邪导出路，如在经者，从斑汗解；在腑者，从二便出是也), cited from the Getting to the Bottom of Warm-Heat ( Wēn Rè Féng Yuán , 温热逢原).It can be said that clearing and freeing the small intestine is also one of the effective methods for dispersing the heat out from the ying aspect to the exterior. The therapy of the combination with medicinals for clearing and freeing the small intestine, in formulas for cooling ying , can be referred to as the general application, through the analysis of the clinical formulas, though it was not proposed clearly by warm disease specialists in past dynasties. For example, when Ye Gui treated the heat syndromes in the ying aspect, he combined proper medicinals for clearing and freeing the small intestine such as zhú yè (Herba Lophatheri), yín huā lù (Floris Lonicerae Distillatum), jīn zhī (金汁, Hominis Excrementi Liquidum Extractum), rén zhōng huáng (人中黄, Radix Glycyrrhizae cum Excremento Hominis Praeparatum) or huá shí (Talcum), gān căo shāo (Radix Glycyrrhizae Tenuis) in formulas for clearing the ying qi, which follows this theory. It was noted by Shao Xian-gen that: “ Tongue tip that is red with raised red spots is due to the heart fire flaming upward, which should be treated with xī jiăo (Cornu Rhinocerotis), huáng lián (Rhizoma Coptidis)produced in Sichuan Province combined with Dăo Chì Săn (Red-Abducting Powder) for draining the fire fu of the small intestine ” (舌尖赤而有刺，心火上炎也，宜犀角、川连合导赤散，泻小肠火腑), cited from the Thorough Understanding of Cold Damage . Dăo Chì Săn (Red-Abducting Powder) consists of four medicinals, shēng dì (Radix Rehmanniae), mù tōng (木通, Caulis Akebiae), zhú yè (Herba Lophatheri), and gān căo shāo (Radix Glycyrrhizae Tenuis), it is a formula for clearing the heart and freeing the small intestine. Master Shao used shuĭ niú jiăo (Cornu Bubali) and chuān lián (Rhizoma Coptidis) with the function of clearing ying and draining heat to combine with Dăo Chì Săn (Red-Abducting Powder), it shows that medicinals for clearing and freeing the small intestine are also a compatible method in formulas for clearing ying qi.
It is necessary to note that medicinals with the concurrent function of cooling ying and nourishing yin such as jīn yín huā lù (Floris Lonicerae Distillatum), zhú yè (Herba Lophatheri), huá shí (Talcum), gān căo shāo (Radix Glycyrrhizae Tenuis) are recommended in the selection of medicinals for clearing and freeing the small intestine because heat entering the ying aspect can burn the yin-blood, and bitter and cold medicinals for clearing and freeing or sweet and bland medicinals for alleviating and freeing can also damage yin. Moreover, the dosage and amount of the medicinals used should be less to cool heat in the ying aspect without doing damage to yin.
For example, dān shēn (Radix et Rhizoma Salviae Miltiorrhizae), chì sháo (Radix Paeoniae Rubra), dān pí (Cortex Moutan), zĭ căo (Radix Arnebiae), and hŭ pò (Succinum). For pathogenic heat penetrating the ying -blood, regardless of whether it is scorched blood- ying forming stasis or blood being forced from the channels causing stasis, blood stasis exists concurrently in different aspects; the simple application of medicinals for clearing ying and cooling the blood has the disadvantage of cooling and then deep-lying evil heat or cold stagnation lodges causing stasis. Medical experts in the past wrote many treaties regarding this. Wang Qing-ren held that: “ Internal scourge toxin scorches the blood; once the blood is scorched it will certainly be static ” (瘟毒在内烧炼其血，血受烧炼，其血必凝), cited from Correction of Errors in Medical Classics ( Yī Lín Găi Cuò , 医林改错). He Bing-yuan also stated: “ As latent heat stasis steams the blood and fluid, the blood decocts and become static ” (因伏火郁蒸血液，血被煎熬而成瘀), recorded from the Revised and Expanded Discussion on Warm-Heat Pathogen Diseases . These statements not only emphasize the universality of static blood in the ying -blood syndromes, but also indicate that positive effects can be achieved by simultaneously treating stasis and heat by the combination of medicinals for quickening the blood and dispelling stasis in formulas for clearing the ying and cooling the blood. Take Sháo Yào Dì Huáng Tāng (Peony and Rehmannia Decoction) in the Essay on Formulas as an example, shuĭ niú jiăo (Cornu Bubali) for clearing heat, cooling the blood and resolving toxicity is used as the chief medicinal, and shēng dì (Radix Rehmanniae) for nourishing yin, clearing heat, cooling the blood and stopping bleeding as the deputy medicinal, with chì sháo (Radix Paeoniae Rubra) and dān pí (Cortex Moutan) for cooling the blood and dissipating the stasis as the assistant medicinals. Thus, the heat and bound blood can be avoided while the stasis is removed and the heat is cleared from the residual blood, not leaving the channels without the incubation of the heat and the formation of the stasis. Therefore, it has been taken as the representative formula for syndromes of heat entering the blood aspect by experts on warm disease in later generations. The use of dān shēn (Radix et Rhizoma Salviae Miltiorrhizae) in Qīng Yíng Tāng ( Ying -Clearing Decoction) in the Systematic Differentiation of Warm Pathogen Diseases and the combination of chì sháo (Radix Paeoniae Rubra), dān pí (Cortex Moutan), and táo rén (Semen Persicae) in Shén Xī Dān (Spirit-Like Rhinoceros Horn Elixir, 神犀丹)in the Warp and Woof of Warm - Heat Pathogen Diseases ( Wēn Rè Jīng Wĕi , 温热经纬) both belong to this kind of compatible method.
Regarding the selection of medicinals for quickening the blood and dispelling stasis in this combination, firstly, medicinals with the effects of quickening the blood and dispelling stasis and the concurrent function of nourishing the blood are recommended, such as dān shēn (Radix et Rhizoma Salviae Miltiorrhizae), which can quicken and nourish the blood as well having the reputation of “ the simple application of dān shēn(Radix et Rhizoma Salviae Miltiorrhizae) can achieve the same effect as that of Sì Wù Tāng(Four Agents Decoction) ” (一味丹参饮，功同四物汤), cited from Treaties on Understanding the Reasoning of Treating Married Women ( Fù Rén Míng Lĭ Lùn , 妇人明理论). Thus, it is always used as the first choice for treating syndromes of yin damage due to heat in the ying aspect. Secondly, medicinals with the function of quickening the blood and dispelling stasis with the concurrent effect of clearing heat and cooling the blood are recommended, such as chì sháo (Radix Paeoniae Rubra), dān pí (Cortex Moutan), zĭ căo (Radix Arnebiae), etc. As the pathogenesis of static blood in the syndromes of the ying and blood aspect are caused by heat or stasis and heat binding together; heat intensifies when associated with stasis, and stasis becomes firmer due to the flaming of the heat, cold medicinals with the clearing heat effect are often chosen in the combination of medicinals for quickening the blood and dispelling stasis in formulas for clearing the ying and cooling the blood. Thirdly, the selection of medicinals with the effects of quickening the blood and dispelling stasis and the concurrent function of settling the heart and quietening the mind are recommended like hŭ pò (Succinum), which is especially suitable for the syndrome of ying yin damage by heat with a disturbed mind because of its double effects of quickening the blood and dispelling stasis, and settling the heart and quietening the mind. This is reflected by the proper combination of hŭ pò (Succinum) by Ye Gui in the formulas for clearing ying and cooling the blood. It is easy to see that the combination of medicinals with the effects of quickening the blood and dispelling stasis are indispensable to the treatment of concurrent diseases and syndromes, as well as to the improvement of the curative effects of formulas for clearing ying and cooling the blood.
It should be noted that the compatible proportion of medicinals for quickening the blood and dispelling stasis in formulas for clearing ying and cooling the blood depends on the degree of the disease condition and the concurrent blood stasis. Generally speaking, for minor diseases with evil heat entering the ying aspect and blood that is not yet stirred, medicinals for quickening the blood and dispelling stasis may be used in small amounts accordingly, as in the simple application of dān shēn (Radix et Rhizoma Salviae Miltiorrhizae) in Qīng Yíng Tāng (Ying-Clearing Decoction). For relatively obvious static blood syndromes due to the consumption and stirring of the blood after the heat has entered the blood aspect, medicinals for quickening the blood and dispelling stasis should be increased, like the combination of chì sháo (Radix Paeoniae Rubra) and dān pí (Cortex Moutan) in Sháo Yào Dì Huáng Tāng (Peony and Rehmannia Decoction). Wu Qian noted in his analysis of the modified application of Xī Jiăo Dì Huáng Tāng (Rhinoceros Horn and Rehmannia Decoction)that: “ Dà huáng (Radix et Rhizoma Rhei) and táo rén (Semen Persicae) should be added to dispel stasis for pain in the chest due to the blood stasis ” (血瘀胸痛，则加大黄、桃仁以逐瘀也), cited from Golden Mirror of the Medical Tradition - Discussions of Selected Formulas from Eminent Physician . Ye Gui stated: “ The heat entering the ying-blood of the patient with original blood stasis in the chest and diaphragm will fight with the stasis, … one should add some medicinals for dissipating blood stasis such as hŭ pò (Succinum), dān shēn (Radix et Rhizoma Salviae Miltiorrhizae), táo rén (Semen Persicae), dān pí (Cortex Moutan), and so on ” (热传营血，其人素有瘀伤宿血在胸膈中，夹热而搏，……当加入散血之品，如琥珀、丹参、桃仁、丹皮等), cited from Writings on External Contraction of Warm-Heat . The combination proportion of the medicinals for quickening the blood and dispelling stasis is increased, which is based on experience.
For example, yù jīn (郁金, Radix Curcumae), shí chāng pú (石菖蒲, Rhizoma Acori Tatarinowii), shè xiāng (麝香, Moschus), bīng piàn (冰片, Borneolum Syntheticum), etc. The pericardium is the palace of the heart. Intense evil heat in ying aspect and the blood aspect scorches the body fluid into phlegm, which then sinks into the pericardium and clouds the orifices of the heart. Alternatively, the blockage of the orifices of the heart can aggravate the disease condition with symptoms of generalized fever, limb reversal, clouded spirit and delirious speech because the heat in the pericardiac network and heart ying cannot be pushed out to the exterior. According to the causality between evil heat and concurrent phlegm in the ying and blood aspect and the blockage of the orifices of the heart, medicinals for opening the orifices sometimes are combined in formulas for clearing the ying and cooling the blood. This is treating syndromes of blockage of the orifices of the heart and clouded spirit on the one hand, while diffusing and smoothing the qi dynamic to benefit the dispersal of the heat in the pericardiac network and heart ying to the exterior on the other hand. This achieves the effects of cooling ying and opening the orifices simultaneously. Ye Gui stated that:“ A crimson and moist tongue indicates the disease of the pericardiac network, and xī jiăo(Cornu Rhinocerotis), fresh shēng dì (Radix Rehmanniae), lián qiào (Fructus Forsythiae), yù jīn (Radix Curcumae), shí chāng pú (Rhizoma Acori Tatarinowii), and so on, should be applied ” (（舌质）纯绛鲜泽者，包络受病也. 宜犀角、鲜生地、连翘、郁金、石菖蒲等), cited from Writings on External Contraction of Warm-Heat. Wu Kun-an also noted: “ Evil entering the pericardiac network leads to clouded spirit and internal blockage, and yù jīn (Radix Curcumae)and shí chāng pú (Rhizoma Acori Tatarinowii)should be combined for opening ” (邪入心包络，则神昏内闭，须加郁金、石菖蒲以开之。)( Thorough Understanding of Cold Damage ). These statements indicate the importance of the combination of medicinals for opening the orifices in the formulas for clearing ying and cooling the blood. The combinations of shí chāng pú (Rhizoma Acori Tatarinowii) in Shén Xī Dān (Spirit-Like Rhinoceros Horn Elixir), from Seceret Formulas with Distinguished Therapeutic Effects ( Yī Xiào Mì Chuán , 医效秘传) and Xī Dì Qīng Luò Yĭn (Rhinoceros Horn and Rehmannia Network-Clearing Beverage, 犀地清络饮), from the Revised Popular Guide to the Discussion on Cold Damage , and the combination of yù jīn (Radix Curcumae) and shí chāng pú (Rhizoma Acori Tatarinowii)in Shí Shì Xī Dì Tāng (Rhinoceros Horn and Rehmannia Decoction by Maser Shi, 石氏犀地汤), from the Revised and Expanded Discussion on Warm - Heat Pathogen Diseases , all belong to the compatible method above. The teaching material for medical colleges and universities stated that Ān Gōng Niú Huáng Wán (Peaceful Palace Bovine Bezoar Pill, 安宫牛黄丸) or Zĭ Xuĕ Dān (Purple Snow Elixir, 紫雪丹), Zhì Băo Dān (Supreme Jewel Elixir, 至宝丹)should be taken with Qīng Gōng Tāng (Palace-Clearing Decoction, 清宫汤) to treat syndromes of heat sinking into the pericardium, which is also because the combination of shè xiāng (Moschus), bīng piàn (Borneolum Syntheticum), yù jīn (Radix Curcumae), and other aromatic medicinals for opening the orifices in the above“ Sān Băo (Three Gems) ” formulas reflects the treatment theory of simultaneous application of clearing the ying and cooling the blood, while opening the orifices with aroma.
Regarding the selection of medicinals for opening the orifices in this combination, firstly, medicinals with effects of opening the orifices and the concurrent function of transforming phlegm are recommended such as yù jīn (Radix Curcumae), shí chāng pú (Rhizoma Acori Tatarinowii), etc. This is because heat burns the ying yin and clouds the pericardium, and is often combined with turbid phlegm, yù jīn (Radix Curcumae) and shí chāng pú (Rhizoma Acori Tatarinowii) are used with the combined effects of transforming phlegm in various degrees while also opening the orifices. It was stated by Wang Shi-xiong that: “ Although a crimson and moist tongue is the syndrome of heat in the ying aspect, it is in fact caused by phlegm, …yù jīn (Radix Curcumae) and shí chāng pú(Rhizoma Acori Tatarinowii) are the most appropriate choices for this” (（舌质）绛红泽者，虽为营热之证，实因有痰，……菖蒲、郁金亦为此设), cited from Warp and Woof of Warm - Heat Pathogen Diseases . Yù jīn (Radix Curcumae) and shí chāng pú (Rhizoma Acori Tatarinowii) are often the first choice in the combination of medicinals for opening the orifices in formulas for clearing the ying and cooling the blood. Secondly, it is suitable to apply cold medicinals for opening the orifices such as bīng piàn (Borneolum Syntheticum), which is acrid, bitter, and cool, it cannot only open the orifices and revive the spirit-mind, but also can diffuse depressed heat. Thus, it is more suitable for the syndrome of clouded spirit and blocked orifices due to heat entering the pericardium. As for acrid and warm shè xiāng (Moschus), which is good for opening the orifices, it can be combined in small doses in groups of medicinals for clearing heat and cooling the blood. This combination can prohibit acridity and warmth from contributing further to the heat and achieve the effect of opposing each other but also complementing each other.