Wu Ling San: A Classic TCM Formula for Fluid Balance and Edema Relief

Wu Ling San, a revered Traditional Chinese Medicine (TCM) formula, is a gentle yet effective remedy for promoting fluid balance, relieving edema, and supporting kidney function.

Originating from Zhang Zhongjing’s Shanghan Lun (Treatise on Febrile Diseases) in the Eastern Han Dynasty, this time-honored prescription addresses water retention and urinary issues caused by spleen and kidney imbalances. Its carefully blended herbs reflect ancient TCM wisdom, offering a natural solution for modern-day fluid metabolism challenges.

Wu Ling San

Origins and Background of Wu Ling San

Developed by Zhang Zhongjing, a legendary physician, Wu Ling San was crafted to treat conditions where the body’s water metabolism is disrupted, leading to symptoms like edema, bloating, or difficulty urinating.

In an era plagued by epidemics and poor living conditions, this formula became a vital tool for restoring balance. Its focus on the spleen and kidneys—the key organs for fluid regulation—makes it a versatile remedy for today’s health concerns, from swelling to digestive discomfort.

Wu Ling San

Ingredients and Their Benefits

Wu Ling San combines five herbs, each contributing to its diuretic and balancing effects:

• Poria (Fu Ling): Mild and sweet, poria strengthens the spleen, promotes urination, and clears excess dampness, reducing edema and bloating.

• White Atractylodes (Bai Zhu): Warm and sweet, atractylodes fortifies the spleen, dries dampness, and supports digestion, helping to regulate fluid metabolism.

• Polyporus (Zhu Ling): Neutral and mild, polyporus enhances urination, clears heat, and reduces water retention, aiding kidney function.

• Alisma (Ze Xie): Cool and sweet, alisma promotes urination, drains dampness, and clears heat, relieving swelling and urinary issues.

• Cinnamon Twig (Gui Zhi): Warm and spicy, cinnamon twig warms the kidneys, promotes energy flow, and supports fluid circulation.

Together, these herbs restore spleen and kidney function, eliminate excess water, and promote healthy fluid balance.

Wu Ling San

Benefits and Conditions Treated

Wu Ling San excels at treating conditions caused by water retention and spleen-kidney imbalances, particularly “Taiyang water retention syndrome” in TCM. Its key effects include:

• Promoting Urination: It clears excess water, relieving edema and bloating.

• Strengthening the Spleen: It supports digestion, reducing dampness-related symptoms like heaviness or loose stools.

• Clearing Heat: It cools internal heat, easing thirst or irritability tied to fluid stagnation.

• Supporting Kidney Function: It enhances the kidneys’ ability to regulate water, aiding urinary flow.

Common Symptoms

This formula is ideal for:

• Edema or swelling in the limbs, face, or body.

• Difficulty urinating or scanty urine.

• Bloating, heaviness, or poor appetite.

• Thirst with no desire to drink or vomiting after drinking.

• Pale tongue with a white coating and a floating pulse.

Practical Applications

• Edema and Swelling: Wu Ling San reduces puffiness in the face, legs, or abdomen caused by water retention.

• Urinary Issues: It helps with scanty or difficult urination due to kidney or bladder imbalances.

• Digestive Discomfort: It eases bloating, heaviness, or loose stools from spleen dampness.

Clinical Uses

Wu Ling San is widely used for:

• Edema from kidney dysfunction, heart failure, or liver cirrhosis.

• Urinary disorders like urinary retention or urinary tract infections.

• Digestive issues such as ascites or chronic diarrhea.

• Acute conditions like gastroenteritis or motion sickness with vomiting.

• Chronic conditions like nephritis or hydrocephalus with fluid retention.

Modern research supports its benefits: poria and alisma have diuretic and anti-inflammatory effects, atractylodes aids digestion, and cinnamon twig improves circulation, making this formula a versatile tool for fluid balance.

Dietary Support

Pairing Wu Ling San with simple recipes can enhance its diuretic and spleen-supporting effects:

1. Poria Porridge

   • Ingredients: 15g poria, 100g rice.

   • Method: Boil poria in water for 10 minutes, strain, cook rice in the liquid until soft, serve warm.

   • Benefits: Clears dampness and supports spleen health.

2. Barley Soup

   • Ingredients: 50g barley (coix seed), 1 carrot, sliced.

   • Method: Boil barley and carrot in water until tender, season lightly.

   • Benefits: Promotes urination and reduces water retention.

3. Adzuki Bean Porridge

   • Ingredients: 50g adzuki beans, 100g rice.

   • Method: Boil beans and rice in water until soft, serve warm.

   • Benefits: Drains dampness and supports kidney function.

4. Cinnamon Twig Tea

   • Ingredients: 5g cinnamon twig.

   • Method: Steep in boiling water for 5 minutes, drink warm.

   • Benefits: Warms the kidneys and promotes fluid flow.

Massage Support

Massage can complement Wu Ling San by stimulating fluid movement and spleen function:

• Shuifen Point: One inch above the navel. Massage for 5 minutes to promote water metabolism.

• Zusanli Point: Three inches below the knee, on the outer shin. Massage for 5 minutes to boost spleen qi.

• Yinlingquan Point: On the inner leg, below the knee in the depression. Massage for 5 minutes to clear dampness.

• Sanyinjiao Point: Three inches above the inner ankle. Massage for 5 minutes to support kidney function.

Precautions

Wu Ling San is effective but requires caution:

• Avoid in Yin Deficiency: If you have dry mouth, red tongue, or night sweats, consult a practitioner, as it may worsen dryness.

• Pregnant Women: Use only under medical guidance due to its diuretic effects.

• Prolonged Use: Avoid long-term use without supervision, as it may deplete qi or fluids.

• Medical Supervision: Always follow a TCM practitioner’s advice for safe use.

Conclusion

Wu Ling San is a TCM treasure, blending poria, alisma, and other herbs to relieve edema, promote urination, and restore fluid balance. Whether you’re battling swelling, urinary issues, or digestive discomfort, this formula offers natural relief.

Enhance its effects with barley soup or poria porridge, and consult a TCM practitioner for personalized guidance. Let this ancient remedy bring clarity and balance to your modern life.

Chinese Name	五苓散
Phonetic	Wu Ling San
English Name	Five Substances Powder with Poria
Classification	Dampclearing formulas
Source	《Treatise on Cold Damage》Shang Han Lun《傷寒論》
Combination	Polyporus (Zhu Ling) 18 zhu (9g), Alismatis Rhizoma (Ze Xie) 1 liang and 6 zhu (15g), Atractylodis Macrocephalae Rhizoma (Bai Zhu) 18 zhu (9g), Poria (Fu Ling) 18 zhu (9g), Cinnamomi Ramulus (Gui Zhi) 0.5 liang (6g)
Method	Grind the ingredients into powder and take 6-10g. It can also be prepared as a decoction. After ingestion, drink hot water to induce a light sweat.
Action	Promotes urination and percolates dampness, warms yang and promotes qi transformation.
Indication	Wu Ling San is indicated for water amassment syndrome due to dysfunction of bladder qi transformation. The symptoms are dysuria, headache with mild fever, thirst and desire to drink, vomiting as soon as drinking, throbbing below the navel, spitting, dizziness, shortness of breath, cough, edema, and diarrhea. The tongue coating is white and the pulse is either floating or floating and rapid.
Pathogenesis	While the indications are various this pattern has the same pathogenesis of excessive internal water-dampness and dysfunction of bladder qi transformation. In the《Treatise on Cold Damage》, this formula is used for water amassment syndrome. It is caused by external pathogens in the taiyang entering the corresponding fu-organ along the channels that leads to a disease involving both the taiyang channel and its fu-organ. External pathogenic contraction in the taiyang gives rise to headache and mild fever. The failure of bladder qi transformation leads to dysuria. Retention of water blocks yang qi and results in qi failing to diffuse fluids. This in turn leads to the failure of fluid ascending into the mouth causing thirst with a desire to drink. Water stagnation in the lower jiao hinders the ability for fluids that are drunk to distribute. This causes water counterflow marked by vomiting as soon as drinking. It is also called water-up rushing pattern. Excessive water-dampness spills over the skin manifesting edema. When water-dampness descends into the large intestine, diarrhea is the result. When water-dampness accumulates in the stomach and intestine, a disharmony between the ascension and descending will result. In this case, a conflict between the clear and turbid will manifest vomiting and diarrhea. When water accumulates in the lower jiao, water and zheng qi conflict with each other and cause throbbing below the navel. When water up rushes and invades the upper jiao, lung qi is blocked. This causes shortness of breath and coughing. The therapeutic methods are to promote urination and percolate dampness; however, methods to warm yang and promote qi transformation are also used.
Application	1. Essential pattern differentiation Wu Ling San is a common formula used to promote urination and qi transformation. This clinical pattern is marked by dysuria, white tongue coating, floating or slow pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of retention of water and dampness: edema in acute or chronic nephritis, ascites in liver cirrhosis, cardiac edema, acute enteritis, urinary retention, and hydrocephalus.
Additonal formulae	1. Si Ling San (Four Substances Powder with Poria 四苓散) [Source]《Teachings of [Zhu] Dan-xi》Dan Xi Xin Fa《丹溪心法》 [Ingredients] Wu Ling San minus gui zhi [Preparation and Administration] Grind the medicinals into a fine powder. One dose is 4 qian (12g). Prepare it as a decoction. [Actions] Fortifies the spleen and percolates dampness. [Applicable Patterns] Retention of water-dampness due to deficiency of the spleen and stomach. Symptoms include: scanty dark urine and loose stool. 2. Wei Ling Tang (Stomach-Calming Poria Decoction 胃苓湯) [Source]《Effective Formulas from Generations of Physicians》Shi Yi De Xiao Fang《世醫得效方》 [Ingredients] Wu Ling San plus Ping Wei San [Preparation and Administration] Mix these medicinals and decoct them with su zi and wu mei. [Actions] Dispels dampness and harmonizes the stomach, moves qi, and promotes urination. [Applicable Patterns] Cold damage of the spleen and stomach in-between summer and autumn leading to the failure to separate the clear and turbid. Symptoms include: watery diarrhea, edema, abdominal distension, and dysuria. 3. Yin Chen Wu Ling San (Five Substances Powder with Poria Plus Virgate Wormwood 茵陳五苓散) [Source]《Essentials from the Golden Cabinet》Jin Gui Yao Lue《金匱要略》 [Ingredients] Wu Ling San plus double yin chen [Preparation and Administration] Prepare it as a decoction. [Actions] Drains dampness and relieves jaundice. [Applicable Patterns] Damp-heat jaundice with dysuria with more dampness than heat .

Wu Ling San