Finding A Guiding Herb Makes Easier to Find the Most Efficient Formula ⑧ Fu Ling(茯苓)

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△A patient with sleeping related difficulties and Yin-natured tend to be often used formulas mainly using Fu Ling. imageⓒenvato-amenic181.

A patient Needed To Use Fu Ling Tend To Be Yin Natured or in between.

Complaints Are Compared To Patient Who Needed To Be Used Huang Lian.

By Hyunchang Cho, L.Ac., Ph.D ([email protected])

Fu Ling

Symptom Indicator Score++

Frequency of Use+++

Main symptoms

① Yin-natured or in between (mixed), often with signs of sleep difficulty, especially problems with falling asleep (common in Ling Gui Gan formulas).
(For patients who normally sleep well) suppose external stimuli are present, such as an important event next day, environmental changes (i.e. sleeping in a hotel), anxiety, worry, or stress. In that case, they will have trouble falling asleep for 1 to 2 hours or longer.

Possible symptoms

② Heart palpitations

③ (When used w/ water regulating herbs) dizziness, localized tremors, urinating problems, mild edema due to Water Toxin

CAPE

④ Yin-nature or in between (mixed)

⑤ Main emotions are worry and doubt, sensitivity, nervousness, and anxiety. They tend to be timid and worry too much. Hypochondria is a case in point.

TIP ⑥Clinical signs are similar to those of Hwang Lian but compared to Yang-natured Hwang Lian patients, Fu Ling patients are Yin-natured or in between (mixed). They tend to complain of various symptoms, but such symptoms are usually mild in severity, especially compared to Huang Lian’s.

 

  1. Pharmacological Hypotheses of Huang Lian and Fu Ling

Overall hypoactivity of the autonomic nerve system → the gap between sympathetic and parasympathetic systems becomes wider → main problem is the hypoactivity of parasympathetic nerve system → symptoms of hypoactive parasympathetic system are similar to those of hyperactive sympathetic nerve system → manifests as autonomic dysfunction

Fu Ling is used for Yin-natured or in between (mixed) patients, and insomnia w/ difficulty to fall asleep is common.

–  Suppose there are important events the following day. In that case, environmental changes (i.e., sleeping in a hotel), anxiety, worries, or stress, Fu Ling patients will have difficulty falling asleep, even if they try.

 

The main emotion is worry. Secondary emotions are tension, sensitivity, and anxiety.

 

Heart palpitations or dizziness would sometimes appear.

Fu Ling’s clinical expressions are similar to those of Huang Lian, but they are usually milder in terms of severity. (→lower VAS scores)

 

  1. Guiding Signs of Fu Ling

The most common symptom of Fu Ling is difficulty falling asleep. If difficulty to fall asleep is absent, it is very hard, even impossible, to recognize Fu Ling’s signs in clinical practice. In Shang Han Lun and Jin Kui Yao Lue, we can categorize Fu Ling formulas into three types 1) formulas w/ difficulty to fall asleep 2) formulas w/o difficulty to fall asleep, and 3) formulas w/ or w/o difficulty to fall asleep.

(1) Fu Ling formulas w/ difficulty to fall asleep

  • ①Ling Gui Gan formulas: Ling Gui Zhi Gan Tang, Fu Ling Gan Cao Tang, Ling Gui Gan Zao Tang, Fu Ling Ze Xie Tang, Fang Ji Fu Ling Tang, Wu Ling San
  • ②Formulas that target the chest: Fu Ling Xing Ren Gan Cao Tang (w/Xing Ren’s asthma, chest fullness, heart pain), Ban Xia Hou Po Tang (w/Hou Po and Su Ye’s chest fullness, mild asthma), Fu Ling Yin (w/Ju Pi’s food stagnation in the chest, chest obstruction, asthma), Mu Fang Ji Qu Shi Gao Jia Ling Xiao Tang (asthma)
  • ③Formulas for digestive disorders: Fu Ling Si Ni Tang, Li Zhong Jia Fu Ling Tang, Fu Ling Yin, Zhen Wu Tang, Fu Zi Tang
  • ④Others: Chai Hu Qu Huang Qin Jia Fu Ling Tang, Si Ni Jia Fu Ling San, Zhu Ling Tang, Suan Zao Ren Tang

(2) Fu Ling formulas w/ or w/o, or w/o difficulty to fall asleep

  • ①Shao Yao formulas or formulas that target the stomach: Fu Ling Rong Yan Tang, Ling Jiang Zhu Gan Tang, Zhu Ling San, Ba Wei Wan, Gua Lou Ku Mai Wan, Gui Zhi Fu Ling Wan, Dang Gui Shao Yao San
  • ②Formulas with small amounts of Fu Ling: Yin Chen Wu Ling San
  • ③Pills and powders: Ba Wei Wan, Gua Lou Ku Mai Wan, Gui Zhi Fu Ling Wan, Dang Gui Shao Yao San, Kui Zi Fu Ling San, Chi Huan, Wu Ling San
  • ④Others: Chai Hu Jia Long Gu Mu Li Tang, Ling Gan Jiang Wei Xin Xia Tang formulas

Fu Ling’s Yin personality and emotions of worry, nervousness, and anxiety are more prominent in Fu Ling formulas w/ difficulty to fall asleep and less prominent in Fu Ling formulas w/o difficulty to fall asleep. This is because sleep is the reflection of our mental status.

It is difficult to detect Fu Ling in clinical practice without sleep difficulty. Other Fu Ling symptoms such as dizziness, muscle tremor, urinating problems, and mild edema are not highly indicative symptoms. So, without sleep difficulty, it is hard to correctly diagnose Fu Ling formulas using Fu Ling as an indicator/guiding herb. 

Fu Ling patients tend to insist that they are suffering from many conditions at once and therefore their medical charts can become very lengthy, but once you look into them, you’ll find out that most of them are not really serious or severe enough to constitute actual illnesses. Also, keep in mind that Fu Ling patients may complain of various symptoms, but most of them are mild in terms of severity. In other words, most symptoms of Fu Ling patients are rated VAS 5 or lower.

(1) Main Symptoms

①Yin-natured or in between (mixed), often with signs of sleep difficulty, especially problems with falling asleep (common in Ling Gui Gan formulas).
(For patients who normally sleep well) suppose external stimuli are present, such as an important event next day, environmental changes(i.e. sleeping in a hotel), anxiety, worries, or stress. In that case, they will have trouble falling asleep for 1 to 2 hours or longer.

Fu Ling’s insomnia manifests as difficulty falling asleep. This means the insomnia patterns of Fu Ling and Huang Lian are almost identical. This is why, in clinical practice, we must distinguish Fu Ling from Huang Lian (and sometimes from Xiang Chi + Zhi Zi as well) when difficulty to fall asleep is present.

While insomnia may or may not be present in Fu Ling formulas, it is almost always present in Huang Lian formulas. As I mentioned earlier, in Fu Ling formulas w/ difficulty falling asleep, Fu Ling’s mental aspects such as personality and emotion become more prominent. Therefore, when difficulty to fall asleep is present, the most important distinguishing point between Fu Ling and Huang Lian would be the mental aspects of personality and emotion.