保和丸

• Thick, greasy tongue coating.
• Slippery pulse.

3. Tongue and pulse

• Tongue: Thick, greasy coating, possibly slightly yellow.
• Pulse: Slippery.

4. Common modifications

• Marked food accumulation with pronounced distension and pain: Add Zhi Shi (immature bitter orange) and Bing Lang (areca seed) to strengthen the action of moving qi and guiding out stagnation.
• Pronounced heat transformation, with yellow coating and bitter taste in the mouth: Add Huang Qin (scutellaria root) and Huang Lian (coptis rhizome) to strengthen heat clearing.
• Pronounced Spleen deficiency, with fatigue and lack of strength: Add Bai Zhu (white atractylodes rhizome), which turns the formula into Da An Wan (Great Peace Pill), addressing digestion while also supporting the Spleen.
• Constipation: Add Da Huang (rhubarb root) and Zhi Shi (immature bitter orange) to unblock the bowels and drain heat.

5. Cautions and clinical notes

• Contraindications:
  • This formula is mainly for guiding out and dispersing accumulation; it is contraindicated in patterns of pure deficiency without excess (i.e., Spleen-stomach weakness without food accumulation).
  • During treatment, the diet should be light, meals should be eaten to about seven-tenths fullness, and greasy, cold, raw, and hard-to-digest foods should be avoided, to support recovery of the Spleen and stomach.
  • Because the formula contains Ban Xia (pinellia rhizome), it should not be taken in excess or over a long period.

6. Granule conversion and dose

• Calculation of the total raw herb weight of the original formula (including Mai Ya):
  • Shan Zha (hawthorn fruit) 18 g + Shen Qu (medicated leaven) 6 g + Lai Fu Zi (radish seed) 6 g + Ban Xia (pinellia rhizome) 9 g + Chen Pi (aged tangerine peel) 6 g + Fu Ling (poria) 9 g + Lian Qiao (forsythia fruit) 6 g + Mai Ya (germinated barley) 6 g = 66 g.
• Conversion to 5:1 granules:
  • 66 g raw herb ÷ 5 = 13.2 g granules.
• Recommended dose:
  • One dose daily, taken in 2 divided portions after breakfast and dinner, dissolved in warm water, about 7 g per dose.
  • Or as directed by a physician. When this formula is used as a patent pill preparation, it is usually taken according to the product label. If a physician prescribes a decoction with modifications, the dose should be recalculated based on the adjusted total raw herb weight.