Wu Zhu Yu Tang — Evodia Decoction

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Comparisons with related formulas
7. Modifications
8. Cautions

Overview

Wu Zhu Yu Tang — Evodia Decoction — is one of the foundational formulas of Zhang Zhongjing’s Shang Han Lun (c. 220 CE), the foundational text of TCM internal medicine. It is the classical formula for Cold invading the Liver channel and Stomach, producing the highly specific combination of vertex headache, vomiting of clear fluid, and cold extremities.

The formula is small but powerful — just four herbs — built around the chief herb Wu Zhu Yu (Evodia rutaecarpa), a warm, bitter, pungent herb that specifically warms the Liver and Stomach, descends rebellious Qi and disperses Cold. Few other herbs in the materia medica can stop the upward flooding of Cold-pattern Stomach Qi as reliably.

The formula appears in three places in the Shang Han Lun, treating: (1) the Yang Ming pattern of Cold-Stomach vomiting; (2) the Shao Yin pattern of vomiting with diarrhoea, cold extremities and irritability; (3) the Jue Yin pattern of vertex headache with vomiting of clear fluid. Modern clinical use covers all three.

I prescribe Wu Zhu Yu Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Wu Zhu Yu Tang is prescribed for Cold invading the Stomach and Liver channel:

• Vomiting of clear, watery fluid — the cardinal sign; sometimes vomiting of food taken with chilled drink
• Vertex (top-of-head) headache — the most specific Liver-channel Cold sign in TCM
• Acid regurgitation, sour stomach
• Cold extremities
• Cold lower abdomen
• Hypochondriac pain or epigastric pain — dull, fixed, relieved by warmth and pressure
• Diarrhoea — watery, possibly with cold extremities
• Irritability and restlessness from Cold trapping Yang
• Worse with cold drinks, ice, or cold weather
• Tongue — pale, slightly purplish, white moist coat
• Pulse — deep, slow, possibly wiry or thin

Key herbs

1. Wu Zhu Yu (Evodia rutaecarpa, 4-12g) — chief; warm and pungent; warms the Liver and Stomach, descends rebellious Qi, disperses Cold
2. Ren Shen (Rx. Ginseng, 3-12g) — tonifies Stomach Qi to support the warming action
3. Sheng Jiang (large dose, 6-21g) — warms the Stomach and stops vomiting
4. Da Zao (Ziziphus jujuba, 3-12g) — harmonises and tonifies the Spleen

Formula actions

1. Warms the Liver and Stomach
2. Descends rebellious Qi
3. Disperses Cold
4. Stops vomiting
5. Tonifies Stomach Qi

Conditions treated

1. Cold-pattern vomiting — especially of clear fluid — see nausea and vomiting
2. Vertex migraine with vomiting — a distinctive presentation; see migraines
3. Tension headache at the top of the head with Cold pattern
4. Morning sickness with cold pattern (vomits clear fluid, cold extremities) — see morning sickness
5. Hyperemesis gravidarum with cold pattern (under specialist supervision)
6. Functional dyspepsia with cold trigger and acid regurgitation
7. Gastroparesis with cold pattern
8. Chronic acid reflux with cold pattern (vomits acid clear fluid, worse with cold drinks)
9. Chronic gastritis with cold and food-stagnation overlay
10. Period pain with vomiting from cold uterus pattern — see period pain
11. Gallstone pain with cold pattern
12. Trigeminal neuralgia with cold trigger — see trigeminal neuralgia

Comparisons with related formulas

• Li Zhong Wan — for Cold in the Spleen and Stomach with diarrhoea and abdominal pain but without prominent vomiting or vertex headache.
• Da Jian Zhong Tang — for severe Cold in the abdomen with strong abdominal pain.
• Xiao Ban Xia Tang — for vomiting of clear fluid without prominent Cold pattern; milder.
• Ban Xia Bai Zhu Tian Ma Tang — for Phlegm-Damp vertigo with nausea and vomiting; different pattern.
• Chuan Xiong Cha Tiao San — for wind-induced headache from the exterior, not Cold from interior.

Modifications

• For severe acid regurgitation, add Huang Lian (small dose) and Wu Bei Zi
• For prominent diarrhoea with Yang collapse, add Fu Zi and Gan Jiang
• For prominent abdominal pain, add Bai Shao and Gan Cao (move toward Shao Yao Gan Cao Tang)
• For vertex headache, increase Wu Zhu Yu and add Chuan Xiong and Bai Zhi
• For Spleen Qi deficiency overlay, combine with Li Zhong Wan
• For morning sickness, use the smallest effective dose with careful monitoring

Cautions

Not appropriate for Yin-deficient Heat patterns, Stomach Fire or any Heat pattern — the warming herbs will aggravate Heat dramatically.

Wu Zhu Yu is mildly toxic and warming; use at proper dose and not for prolonged courses without reassessment. Modern pharmaceutical-grade granules are standardised; only use from reputable suppliers.

Stop and seek advice if symptoms of Heat appear (red face, thirst, irritability worsening, sore throat).

Use cautiously in pregnancy — consult a qualified practitioner; for morning sickness use minimal dose under supervision.

Persistent vomiting in pregnancy needs medical assessment to exclude hyperemesis gravidarum.

Always consult a qualified Chinese herbalist registered with the RCHM.

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