It's time for our first Herb Fact!

I hope you’re not feeling too rebellious! Let’s talk about rebellious Stomach qi…

HERB FACT:

Wu Zhu Yu (evodiae fructus) warms the interior and is especially useful for redirecting rebellious Stomach qi back downwards to stop vomiting.

You can remember this because “Wu Zhu Yu stop vomiting?” sounds like, Would you stop vomiting?

EXPLANATION:

Wu Zhu Yu comes from the category Herbs that Warm the Interior and Expel Cold. It warms both the Liver and the Stomach.

In warming the Liver (or really, the Liver channel), it can be used to treat Shan disorder (hernia pain), or it can treat painful menses and infertility due to cold. This shows up in the formula Wen Jing Tang (warm the menses decoction).

But Wu Zhu Yu has a very famous action of warming the middle to stop vomiting. That’s why we say, “Wu Zhu Yu stop vomiting?”

When cold gets into the Stomach, it can cause stagnation and pain. Because of this stagnation, the Stomach can no longer downbear food into the Small Intestine, and things rebel back upwards, causing nausea and vomiting.

Wu Zhu Yu is hot in temperature, so it can disperse the cold, but it also has a bitter flavor that redirects things back downwards.

(Remember, the bitter flavor has a downward direction.)

USE IN FORMULAS:

So Wu Zhu Yu of course appears in the formula Wu Zhu Yu Tang (evodia decoction). This is a Shang Han Lanformula that treats vomiting due to various patterns of cold.

YANG MING:

So it can be used for a Yangming pattern with Stomach deficiency cold. A key symptom here is vomiting immediately after eating.

(Because the Stomach is deficient, it is “unable to accept food.” So as soon as you eat, the food rebels right back upwards.)

JUE YIN:

But another interesting use for this formula is vomiting with headache.

If the patient has a vertex headache that extends to the temples, this is a sign of a Jueyin pattern: cold in the Liver is attacking the Stomach. Cold in the Liver is blocking its ability to raise the clear, and cold in the Stomach is blocking its ability to descend the turbid. So the result is vertex headache and dry heaves or vomiting of clear fluids.

SHAO YIN:

And then Zhang Zhong-Jing also used this for a Shaoyin pattern characterized by vomiting and diarrhea, cold hands and feet, and agitation so severe that the patient wants to die.

The idea here is, Kidney yang is so deficient that it can no longer warm the limbs (cold hands and feet) and it can no longer warm the middle (diarrhea and vomiting). The combination of symptoms is so unbearable that the patient feels that they want to die.

So ZZJ uses Wu Zhu Yu to treat several different patterns of cold, but the common theme with all of them is vomiting.

VOMITING DUE TO HEAT?

Like we said, Wu Zhu Yu is in the Warm the Interior category, so it is best used for vomiting due to cold in the middle.

But it turns out that Wu Zhu Yu is so good at stopping vomiting that it can even be used for vomiting due to heat, we just have to combine it with other cold herbs.

An example of this is Zuo Jin Wan (left metal pill).

Here, a small amount of Wu Zhu Yu is combined with a large amount of Huang Lian (usually in a 1:6 ratio).

So Wu Zhu Yu stops the vomiting, but it’s the wrong temperature. Huang Lian is added to make the overall formula cold.

(This is formula is actually for a pattern of Liver heat attacking the Stomach, but the explanation is kind of funny. Huang Lian doesn’t actually enter the Liver channel, but it does clear Heart heat. And because the Liver and Heart have a mother-son relationship along the five phases, by draining the Heart that will in turn drain the Liver. I think it’s easier to just say that Wu Zhu Yu is hot, so you add a large amount of Huang Lian to make it cold.)

DOSAGE:

Wu Zhu Yu is one of the few herbs in our materia medica that is marked “hot” in temperature, so it should be used cautiously.

According to Bensky, the dosage is smaller than normal (1.5-4.5g), and it should not be taken long term.

Even for Wu Zhu Yu Tang, this formula has some interesting cautions:

For particularly severe vomiting, the decoction will be easier to keep down if taken cool. Rarely, patients may experience a transitory sensation of discomfort in the chest, dizziness, and a worsening of the headache after taking the decoction. These symptoms will disappear once the formula begins to take effect (within 30 minutes). 

So those are the anti-emetic effects of Wu Zhu Yu. 

I hope learning these herb facts doesn’t upset your Liver or give you a headache!

See you in the next one!

(When you're ready, click the "Complete and Continue" button below to go to the next fact!)

Sources: 

• Bensky, D. (2004). Chinese Herbal Medicine: Materia Medica. Seattle, WA: Eastland Press. pp. 688-689
• Scheid, V. (2009). Formulas & Strategies 2nd Edition. Seattle, WA: Eastland Press. pp. 261-262, 205