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Oksana Nachataia. Yang Sheng Xue as a variant of ancient biohacking.

Dear friends! Seeing how my friends are interested in bio-hacking, and what discrepancies are there in Western medicine about this, I decided to share my thoughts and thoughts of my teachers in terms of the concept of Yang Sheng and proximity to this topic. As I know, Yang Sheng subject is taught at almost all medical universities in China, but only for foreigners. It is believed that Chinese students do not need to listen to this course, as they receive the necessary knowledge through osmosis. While at Tianjin University, I also took this course. As you know, in the literal translation, “yang sheng” means “to nourish the nascent .” Developing over the centuries, to date, this doctrine is a set of certain rules regarding all aspects of human life – nutrition, climate, labor and rest, interaction with the outside world, sleep and wakefulness, and so on. This ancient knowledge of how to avoid disease and postponed and alleviate old age has existed in the Chinese people since ancient times. As is known, Yang Sheng system concerns not only maintaining the health of the body, but also maintaining mental health, nurturing the mind and spirit. Eastern medicine believes that man is organically integrated into the surrounding nature, is part of a single living matter, which cyclically changes according to its specific laws, using the energy of the Sun and the Earth. We know that some living organisms are food for us, others are medicine. Not to mention the closest connection with the innumerable bacteria living in our body, with which we mutually beneficially coexist. The so-called microbiota, which is now being actively studied. This holistic theory is rooted in the Taoist doctrine of the cyclical transformation of all life on earth, when, observing the laws of nature, a person can achieve longevity. Therefore, the phrase “Living in harmony with nature” in Chinese medicine is filled with rich and detailed content.

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Oksana Nachataia. Features of the classification of diabetes in Chinese medicine.

Dear Colleagues! I decided to write a few words about diabetes mellitus in TCM after reading the article, which was published in 2018 and share with you for discussion. «Five Types of Diabetes: Will New Classification Make Management Easier? Jay H. Shubrook, DO; Sumera Ahmed, MD» (https://www.medscape.com/viewarticle/897960 ). This article talks about the practicability of changing the classification of diabetes mellitus (both type 1 and type 2) with more types of diabetes in order to improve clinical practice and make treatment more accurate. The article immediately caused heated discussions in the comments, which clearly indicates the relevance of this topic. After all, the problem of diabetes is a very acute topic, this is not surprising. As you know, the number of people suffering from diabetes is growing from year to year – just look at the statistics according to WHO https://www.who.int/news-room/fact-sheets/detail/diabetes). We see that medicine is now developing at an enormous pace, many researchers say that exponential growth is characteristic of Western science. Indeed, as we can see, almost every month all the new recommendations for people with diabetes are published in terms of lifestyle, diet and physical activity. But these recommendations are still not unambiguous, they are fully suitable for some patients, but for others they do not always bring the expected benefits. Perhaps an integrative approach would be appropriate here, as Chinese medicine is also developing, it has its own classification of diabetes, and this classification of syndromes has undergone changes and has expanded significantly in recent years. As is known, the main difference in approaches is that in Chinese medicine an increase in blood glucose is considered as part of a single set of symptoms, which is a single syndrome. And each such syndrome is a separate pathogenic mechanism of a certain “breaking down” of metabolic processes. And it is well known to the respected reader. The importance of this classification seems to me in that the causes and starting factors for increasing sugar in each case are clearly visible. They can be completely different. According to TCM, for example, for a group of syndromes of “heat” (re zheng) overeating and stagnation of food, hot weather, inflammation in the intestines, excessive alcohol consumption, and so on provokes an increasing of glucose level. For syndromes associated with the stagnation of qi, the trigger factor for hyperglycemia is often stress, anger, disturbed cyclical sleep and wakefulness, and frustration. On the contrary, for patients with syndromes of “cold” and “emptiness” (exhaustion), as you know, danger of overworking, hypothermia, catarrhal diseases, eating cold raw food exchange metabolic indicates worsen. In a nutshell, according to current publications, a total of about 12 syndromes, including all conditions accompanied by hyperglycemia, are currently isolated in the TCM. This classification appeared relatively recently, when specialists in the field of TCM began to apply an integrative approach to the study of the metabolic syndrome in general and type 2 diabetes in particular. Yes, and when the metabolic syndrome was formed itself as a nosological unit in Western medicine. As is known, 10 or 15 years ago diabetes was considered in the TCM as “thirst and exhaustion syndrome” – “Xiao Ke”, divided into three types (upper, middle and lower thirst – according to the pathogenesis mechanism in upper, middle or lower jiao). Type 1 diabetes is more correlated with upper and middle “thirst”, and type 2 diabetes with “lower thirst” syndrome and partly middle one. Currently, this classification has not lost its significance for those syndromes that are described in it. But, moreover, today’s detailed classification of syndromes includes type 2 diabetes, insulin resistance disorders, and changes in carbohydrate metabolism associated with it, allows us to very accurately determine the trigger factors in terms of increasing glucose levels and, accordingly, preventive measures, diet and lifestyle recommendations. And experts widely use this approach. The TCM approach helps in combination with the methods of Western medicine, although there are still questions. Separately, it must be said that in the TCM, hereditary predisposition to diabetes, as is known, is considered as one of the reasons and is called the “weakness of the first palate” – xiang tian bu zu. Therefore, great hopes are placed on the diagnosis of the genome in terms of susceptibility to diabetes, when even moderately powerful trigger factors can play a decisive role. I would like to bring to your attention the classification of diabetes mellitus already familiar to many in the TCM and invite distinguished colleagues to discuss, since nobody has canceled the epidemic nature of this pathology. I deal in detail with the problems of metabolic syndrome, and your additions and comments will be very interesting to me.

Without pretending to be scientific, since all this information is borrowed from modern editions and lectures of colleagues dealing with diabetes in the TCM, and my own practice, I would like to express my thoughts on the importance of starting factors for increasing glucose levels, the causes of illness in each syndrome, to attempt to workout some recommendations. In my opinion, the subjective symptoms of the patient are undeservedly not given importance. I think that this information will be useful in practice. Too quickly some recommendations in classical Western medicine are replaced by others that deny the previous ones, which means that, in my opinion, the problem is far from being solved.

The first line of syndromes. More relevant to conditions of insulin resistance, type 2 diabetes, prediabetes, metabolic syndrome, NAFLD, combined endocrine pathology, including dysfunction of the thyroid gland, adrenal glands with a simultaneous increase in blood glucose and a violation of other indicators, in particular, mainly insulin and glucagon.

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The program of the course of Shang Han Lun.

  1. Scientific sources: comprehensive continuity of the basic theories and knowledge of TCM from ancient times to the Han period, a thorough study by the author of the Han and pre-Han pharmacology, and the clinical experience of Zhang Zhongjing himself.
  2. Shang Han Lun (hereinafter referred to as SHL) is the earliest in the history of TCM classic work that combines theory with practice.
  3. Shang Han Lun – the recognized “ancestor of the doctrine of prescriptions.” The contribution of this work to the further evolution of Chinese phytopharmacology and medicine in general.
  4. The person and the external environment. The causes of diseases, diagnosis and treatment of diseases caused by the external environment. SHL as a basis and foundation for the further development of the science of infectious diseases and climate lesions in TCM.
  5. Logical construction of Zhang Zhongjing in explaining the pathogenesis and development of diseases. The struggle between the protective Qi and the pathogenic source, the circulation of qi and blood, the exchange of fluids in the body, and others.
  6. The concept of ​​the “six meridians”, developed by Zhang Zhongjing, as a regulatory systems on the path of disease. The role in the body and the characteristics of each of them. Pathways of the pathogenic transition between the meridians. Interrelations of algorithms of clinical thinking on the system of “six meridians” and “eight fundamental principles”. The concept of a “direct attack” of the pathogenic source.
  7. Two methods for differential diagnosis to determine the prescription according to the Shang Han Lun syndrome.

“From the syndrome to the method of treatment and to the prescription.”

“From the recipe to the syndrome.”

The possibilities of using these methods in practice, the strengths and weaknesses of each method.

  1. Traditional Chinese pharmacology. 89 (93) of the TCM ingredients and 113 (112) recipes used in the treatise (according to different sources). Methods of treatment, initially systematized in a treatise.
  2. Features and trends of modern respiratory viral infections and their complications. Correlations between recipes used for the “six meridians” and “four barriers” (SHL and Wen Bing).
  3. Differentiation of syndromes according to the “six meridians”. “From Syndrome to Prescription.”
  4. Yang meridians syndromes and Yin meridians syndromes. General patterns of the course of the disease and the effect on health in the future.
  5. The concept of “combined”, “mixed”, “complicated” and “changed due to mistaken treatment” syndromes. The concept of “miscellaneous syndromes.”
  6. Shang Han Lun and modern medicine. Formation of integrative approach algorithms in the use of SHL recipes.
  7. Tai Yang. Syndromes of the meridian and syndromes of organs “fu”. Combined and mixed Tai Yang syndromes. Changed syndromes Tai Yang. Changed syndromes due to irrelevant (mistaken) treatment or way of life. Tai Yang with complications.
  8. Yang Ming. Syndrome of the meridian Yang Ming – syndrome of “Bai Hu Tang”, syndrome of “Zhi Zi Chi Tan.” Syndrome “Yang Ming Fu”. Combined syndromes Yang Ming, their varieties. Contraindications to the method of treatment through the purgation. Changed syndromes of Yang Ming.
  9. Shao Yang. Syndrome of the meridian Shao Yang. Syndromes “Shao Yang Fu”. Combined syndromes.
  10. Tai Yin. Tai Yin syndrome. Syndrome of Tai Yin in conjunction with external syndromes. Changed Tai Yin Syndrome.
  11. Shao Yin. Shao Yin Syndrome. Shao Yin with cold, its variety. Shao Yin with a heat. Syndrome Shao Yin in conjunction with the external syndrome.
  12. Jue Yin. Different options for mixing cold and heat. “The heat at the top, the cold at the bottom.” Return of the disease to the syndrome of Yang Ming – Jue Yin with a heat. Jue Yin with cold.
  13. Clinical thinking “from prescription to syndrome”. “Bai Hu Tang Syndrome”, “Gui Zhi Tang Syndrome” and so on.
  14. Recipes of Shang Han Lun. Category (family) of Gui Zhi Tang. Category of Ma Huang tang. Category of Ge Gen Tang. Category of Chai Hu Tang. Category of Zhi Zi Chi Tang. Category of Xie Xin Tang. Category of Cheng Qi Tang. Category of Bai Hu Tang. Category of Li Zhong Tang. Category of Zheng Wu Tang. Category of Wu Ling San. Category of Si Ni Tang. Category of different recipes.

Principles of treatment and prevention of the following diseases:

Arterial hypertension, chronic cerebral ischemia, encephalopathy.

Liver diseases and peculiarities of treatment from the positions of TCM (viral, toxic hepatitis, steatosis, chronic intoxications, treatment with decoctions and individual “wan yao”).

Pain in the lower back, pain in the joints.

Headache (including pain in sinusitis, sinusitis, headache with a feeling of cold).

Depression.

Diabetes. Physiology and pathology of diabetes 1 and 2 types from the position of TCM. Approaches to treatment. Combination with drugs of Western medicine.

Metabolic syndrome and obesity. Combination of TCM methods with modern methods of treatment, correction of lifestyle from the perspective of Chinese medicine.

Dysmenorrhea. Infertility at female and male.

Chronic diarrhea (including accompanying treatment of patients with ulcerative colitis by TCM methods).

Hyperthyroidism, hypothyroidism, (optional autoimmune thyroiditis, adjuvant support for oncology of the thyroid gland).

Edema. Differential diagnosis of syndromes.

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“Ingredients of Traditional Chinese Medicine”. Zhong Yao Xue.

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  1. Treatment with the use of ingredients in TCM – zhong yi. History of development, bibliography.
  2. Medicinal raw materials in TCM. Location, collection rules, types and purposes of processing.
  3. Properties and nature of TCM ingredients. “Five tastes” and “four characters.” A systematic approach to the classification of ingredients. Theory of holism and “resonance theory”. Principles of unity in nature.
  4. Force of action of the ingredients.
  5. Ways and mechanisms of action of ingredients.
  6. Tropism to the meridians.
  7. Principles of combination of ingredients.
  8. Dosage of ingredients in recipes.
  9. Modern classification of TCM ingredients by their mechanism of action. The key value of certain ingredients in recipes.
  10. Carrying out some parallels between the action of Western and Chinese medicines.
  11. Ingredients inducing sweat (“opening the outer”):

– sharp and warm

– sharp and cold

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Basic theory of TCM.

  1. A brief historical review.
  2. The paradigm of TCM – from diagnosis (syndrome) to treatment. The methods and means of Traditional Chinese Medicine.
  3. Methods of studying TCM, the ancient system of training “master – apprentice”, modern medical education on TCM.
  4. Bibliography of TCM (treatises “Huang Di Ney Jing”, “Shang Han Lun”, “Wen Bin” and others). Features of studying and understanding of classical works.
  5. The connection of ancient medicine with modernity, the formation of algorithms for the integrative approach of TCM and Western Medicine, interpenetration and mutual enrichment. The concept of the theory of holism, the theory of resonance.
  6. The concept of Yin-Yang, the unity and struggle of opposites. Philosophical and medical aspects.
  7. The concept of Wu Xing (Five Elements), the philosophical and medical aspect. Kinds of connections between elements, features of their use in medicine.
  8. International medical terminology of TCM, the rules of writing “pin yin”.
  9. The theory of dense and empty organs Zang Fu.

Five density organs.

– Heart (XIN)

– Lung (FEY)

– Spleen (PI)

– Liver (GAN)

– Kidney (SHEN)

Six empty organs.

– Gallbladder (DAN)

– Stomach (WEI)

– Thin intestine (XIAO CHANG)

– Thick intestine (DA CHANG)

– Bladder (PANG GUANG)

– Three Jiao (SAN JIAO)

A detailed description of each organ, its function, role in the body, features. The concept of “windows” and “mirrors” of dense organs.

  1. The concept of Qi and blood in the body. Types of Qi. Functions of various types of Qi. The ratio of Qi and blood. The concept of the normal fluids of the “Jin Ye”. Normal and pathological fluids.
  2. Mental and emotional status of a person from the position of TCM (“5 souls” and the connection between them).
  3. The path of movement of water in the body according to the theory of TCM.
  4. Interaction between Qi, blood and liquids in the body.
  5. Interrelations between organs in normal and pathological conditions (as one of the variants of pathogenesis of the disease).
  6. Interrelationships between dense bodies.
  7. Interrelationships between dense and hollow organs according to the Biao-Li rule.
  8. The doctrine of the meridians of the organism. 12 “main meridians” and 8 “unusual vessels.” External and internal course of meridians, the concept of acupuncture points. “Yang” and “yin” meridians, their course, functions, connections in the body, collaterals, time of maximum activity. Pair interconnections.
  9. Causes of diseases from the position of TCM. Internal causes. External causes. Features of modern pathogenic factors forming the profile of morbidity.
  10. The concept of “six pathogenic XIE” as external factors that affect the body. Features of each of them.
  11. “Five internal pathogenic factors” and the reasons leading to them. Features of each of them. “Five fatigues” and “six stagnations”, “stagnation of the seven senses” and other internal causes of the disease.
  12. Pathogenesis of the development of diseases. The relationship between the pathogenic principle and the protective forces of the body. The role of protective barriers Zheng Qi, Wei Qi and others.
  13. Development of the disease according to the system of “six meridians”, “four barriers”.
  14. The ratio between yin and yang at normal and at pathology.
  15. Pathology of Qi.
  16. The pathology of blood.
  17. Joint pathology of Qi and blood.
  18. The pathology of Jin Ye fluids, the formation of pathological fluids such as dampness and phlegm.
  19. Prevention of diseases. Features of methods for the prevention of diseases used in TCM. The concept of “health promotion” Yang Sheng (methods of maintaining and promoting health in everyday life) as a basis for disease prevention. Healthy eating, harmonious emotions, life in harmony with nature, distribution of loads according to age, sleep and rest regime, etc. from the perspective of Chinese medicine. The relationship between the contribution of a healthy lifestyle and health care in the formation of human health.
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The treatment of viral and toxic hepatitis in Chinese medicine. Oksana Nachataia.

Good day to all! The treatment of HCV infection, as well as toxic and alcoholic hepatitis is very complicated topic. We can say that this is a separate direction in medicine. It is interesting to note that quite literally in my eyes over the last 10-12 years in the relationship between Chinese and Western medicine in this area, there have been quite large changes. A physician who practices TCM now should keep his finger on the pulse, keeping track of current advances in the treatment of hepatitis. On the other hand, the ancient knowledge of TCM does not lose relevance, finding confirmation of its truth in modern studies. The highest analytics approaches the maximum generality. And it cannot but rejoice. During the practice at Tianjin University, I was fortunate enough to study the “middle jiao” treatment system using prescriptions. It is a logically harmonious, systematized principle of selecting Chinese ingredients and their stable combinations for simultaneous targeting of each syndrome, primarily for the liver and spleen in their Chinese sense. This clear algorithm allows you to assign personalized treatment to virtually every patient. As a result, multicomponent recipes are obtained, consisting of individual small stable combinations of ingredients, like a house of “bricks”. In some ways, the principle of their construction echoes with Tibetan medicine, but the basis of this system is the physiology and pathophysiology of BMT in terms of the interaction of organs in the “middle jiao”. Even taken separately, the physiology of TCM is of great interest, since it illuminates the life of the organism from a different angle. But this is by the way. As you know, the physiological connections between the organs of the “middle jiao” (for example, the controlling connections of the “wu xing,” the processes of “raising and lowering”, the distribution of qi, the deposition of blood, etc.) constitute a background, which is then affected by the pathogenic factor that causes hepatitis. According to the views of TCM, there are several factors, such as viruses, alcohol, various hepatotoxic substances. By their nature in Chinese medicine, they all belong to the pathogens “heat and poison,” as they cause a set of concrete specific syndromes in the liver. The main purpose of treating hepatitis of any etiology in TCM is the preservation of the liver – both its structure and function. Usually the basic set of ingredients in the prescription is the same for all situations, since for any hepatitis there is always a certain set of syndromes, both from the liver and spleen, from the blood and so on. Further to this “basic” recipe the ingredients with an emphasis on the main pathogenic factor are added . For example, with hepatitis C, these are plants with more pronounced antiviral properties. In case of toxic hepatitis there are the ingredients that remove toxins from the body. That is, the most important thing is to stop structural changes in liver tissue, the disintegration of hepatocytes, stop the inflammatory process and create a cirrhosis prevention. Not setting the main goal of eliminating the viral agent (with the help of herbs it is extremely difficult to do this), TCM recipes are good at the task of normalizing biochemical parameters, restoring normal liver size, improving well-being. That is, the patient in the process of treatment becomes a virus-carrying condition. For this, there is a certain system for prescribing recipes, taking into account seasonal biorhythms, gender, patient’s age, leading syndrome and other features.

Just 15 years ago, this system was truly a rescue for patients suffering from a persistent viral infection. But then Western medicine made a real breakthrough, learned how to deal with viruses by directly influencing it.(https://www.ncbi.nlm.nih.gov/pubmed/29377464; https://www.mdlinx.com/…/sofosbuvir-vel…/2018/03/29/7508571/) From year to year the drugs became more and more perfect, and now effective and safe drugs are being used, which in most cases solve the problem of eliminating the virus. And, it would seem, the methods of TCM recede into the background. But it is not so. It turns out that by the present moment two medical systems each solve their own task. In the case of viral hepatitis, in particular, hepatitis C, the main goal of TCM is to preserve and improve the liver before antiviral medicines begin treatment, normalize biochemistry, and remove intoxication. The same thing after the treatment – restore the liver tissue, if necessary. In difficult cases, when there is simultaneous infection with two strains of the virus, or there are severe kidney problems, there are contraindications to western treatment, TCM recipes, in my opinion, can be used as “insurance” and additional help for the patient. For cases of toxic and alcoholic hepatitis, as is known, Chinese medicine remains, as before, a pretty good choice to prevent or permanently delay the onset of cirrhosis. Moreover, according to statistics, the number of patients with toxic liver damage does not decrease. Toxic medicines, environmental factors, unhealthy diet contribute to this. (https://onlinelibrary.wiley.com/doi/abs/10.1111/liv.13662) This topic remains relevant. I am glad that more and more TCM recommendations on the way of life for patients with liver diseases find their confirmation in modern studies. This concerns, for example, a diet based on cereals and vegetables, as well as a complete rejection of alcohol – the traditional approaches of TCM in the treatment of hepatitis.(https://www.reuters.com/…/even-light-drinking-may-make-fatt…) Much attention in modern medicine has been given to daily biorhythms, their effect on health. Whereas in Chinese medicine, “the liver is responsible for cycles, for order in the body,” and the first one suffers from sleep and wakefulness, time zones, and the like. Of course, medicine does not stand still, various medical systems enrich each other due to the possibilities of information exchange. Therefore, I wish every success to all specialists and health care practitioners! Many thanks!

WU PI SAN

“Wu Pi San” and “Wu Pi Yin”. Oksana Nachataia.

Good afternoon, dear colleagues! If you had a minute of free time, and you wanted to clarify for yourself some vague questions related to TCM recipes, then here is one of them. At the recipe seminars, we try to focus on the differential diagnosis of prescriptions (by the way, very soon a workshop on TCM recipes is scheduled). As you can see, in the classics there are several such pairs of recipes with almost the same name, often very similar in mechanism of action. And in practice it is sometimes important to know accurate information on their purpose. One such pair is Wu Pi San and Wu Pi Yin. What are their differences and similarities?

As is known, the recipe for Wu pi san was invented in ancient times. We can find a description of this recipe from the famous classic Hua Tuo in the treatise Zhong Zang Jing, 220 (“Precious Classics”). The recipe consists of five ingredients. Sheng jiang pi – 9, sang bai pi – 9, chen pi – 6-9, da fu pi – 6-9, fu ling pi – 9.

The name Wu Pi San literally translates as “powder of five skins”. And the essence of the recipe lies in the presentation of the TCM about tropism and the similarity of everything in nature, that is, “the skin has the tropism to the skin.” Referring to the group that removes dampness and dispels swelling, this recipe expels water that has accumulated under the skin. Edema occurs against the background of a weak spleen, when its function as a “water source” is impaired. There are many recipes for the expulsion of edema. The indications for using Wu Pi San are water retention and skin pastos, when the relief lines of the body and limbs are smoothed, the contours of the figure loses its shape like wax. Even against the background of thinness, the whole body flabbiness is observed. The face is usually pale, pasty, slightly yellowish. These symptoms are accompanied by severe weakness, fatigue, exhaustion. At the same time we can see general edema, fluid retention in the body. Many other symptoms of deficiency of the spleen are present. The condition of emptiness is rather heavy. For example, such a syndrome often appears after chemotherapy at the treatment of tumors; in case of toxicosis of pregnant women, when the spleen was initially very weak; after severe mental fatigue.

The main ingredient (jun yao) is fu ling pi, as it removes swelling, removes dampness and strengthens the spleen. Fu ling has the ability to remove water from top to bottom, “wipe out” dampness, while carefully preserving qi. Sang bai pi has tropism to the lungs, removes both phlegm and dampness. According the theory of TCM the lungs are the “son” of the spleen. Therefore, normalizing the lungs, sang bai pi indirectly improves the exchange of water in the body, contributing to its excretion. Da fu pi, in addition to diuretic properties, still has the property of “loosening the chest.” That is, da fu pi removes the rigidity of the chest, which appears due to the accumulation of water. Chen pi moves qi in the middle Jiao, helps normalize spleen function, removes phlegm, removes swelling. Sheng jiang pi, sharp and warm in nature, removes water through diaphoretic action, “opens” the lungs, soothes the stomach, relieves nausea. The whole recipe is very soft, safe and has a narrow specificity in its action. In mild cases, it can be used in case of pasty face, swelling around the eyes against the background of various exhaustion, especially mental fatigue. In practice, this recipe is often used as part of the general medical course, as a separate unit in the general scheme. For example, if the body is affected by external dampness and wind (which happens quite often), add fang feng and qiang huo. Wu pi san goes well with recipes that bring out dampness from internal cavities when it is necessary, as well as with means that gently strengthen the spleen and move qi.

The recipe Wu Pi Yin is very similar in its action.

Di gu pi – 9, wu jia pi – 9, da fu pi – 9, fu ling pi – 9, sheng jiang pi – 9 (+ sang bai pi-3, chen pi – 3).

This recipe was included in “Tai Ping Hui Min He Ji Ju Fang” (“Recipes for the benefit of the civilian population”), the first state recipe guide in China (and probably all over the world), created in 1107 by Chen Shi Leng . This recipe is also mentioned in the “Ma Ke Huo Ren Quan Shu” edition (“Saving the lives of children with a rash”), dated 1748 and posted by Xie Yu Qiong. A distinctive feature is the addition of two ingredients – Di gu pi and Wu jia pi. Thise are also the skins. Both ingredients have a diuretic effect, so the main vector of the recipe does not change. But wu jia pi strengthens bones and ligaments against the background of a weak kidney and liver, and di gu pi has the property of treating fever “xu re” during prolonged exhaustion, hormonal imbalance, deficiency of yin, blood, normal fluids. Doses of sang bai pi and chen pi in this recipe are significantly reduced, or these ingredients are completely excluded from the recipe. Thus, the recipe Wu pi yin is also used for subcutaneous edema on the background of a weak spleen, but when there is still pain in the body, swelling is more in the joints, weakness of the ligaments and muscles. This recipe is more suitable for patients who have not only exhausted the spleen, but also have a lack of kidney and liver blood, especially against the background of hormonal disorders, after prolonged debilitating diseases, with a strong weather dependence with a tendency to retain fluids in the skin. The recipe Wu pi yin can be taken for a long time or several courses, since Wu jia pi has the property to strengthen the ligaments and bones, strengthen the heart muscle. By nature, it is warm, but in the recipe there is di gu pi, which prevents the occurrence of empty heat (“xu re”) and compensates for the warm properties of wu jia pi. I would be glad if this information will be useful for you!