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Cangzhu (Atractylodis Rhizoma) has a bitter and pungent flavor with a strong aroma, whereas Baizhu (Atractylodis Macrocephalae Rhizoma) has a bitter and sweet flavor with a mild aroma. Since the Song Dynasty, they have begun to be used separately. Those harvested in autumn are of superior quality; those harvested in spring are void and soft, prone to deterioration. Cangzhu is found everywhere, while Baizhu is found in the Wu-Yue region. The variety produced in Zhejiang is called "Yuntou Shu" (Cloud-Head Atractylodes), which is quite large and fat due to heavy fertilization during cultivation; it tends to become moist and oily. The variety from She County is named "Goutou Shu" (Dog-Head Atractylodes); although small and thin, it absorbs ample earth qi, making it very dry, and its white interior surpasses that of the Zhejiang variety. Those from Ningguo, Changhua, and Chizhou are similar to the She variety due to their adjacent locations.

Baizhu: Flavor is sweet, slightly pungent and bitter; nature is warm. The flavor is dense while the aroma is light; it belongs to yang containing yin. It can ascend and descend. It enters the Foot Yangming Stomach Meridian, Foot Taiyin Spleen Meridian, Foot Jueyin Liver Meridian, Foot Shaoyin Kidney Meridian, Hand Taiyang Small Intestine Meridian, and Hand Shaoyang Sanjiao Meridian. Its main functions are to dispel dampness, tonify primordial qi, harmonize the middle jiao, tonify yang, regulate the stomach, benefit the spleen, promote appetite, digest food, generate spleen fluids, and clear stomach heat. (This is because if spleen yin fails to transform, fluids are not generated, qi does not move, and heat returns to the stomach.) It stops thirst, eliminates damp-phlegm and deficiency-phlegm, drives out fluid retention, removes old stagnation, treats epigastric fullness due to dampness or fluid retention, epigastric pain due to deficiency-cold, abdominal distension and fullness, edema and abdominal fullness, stops vomiting and regurgitation due to spleen deficiency, treats damp diarrhea and watery diarrhea, as well as dysentery, chronic qi-dysentery. It clears heat from the skin, cures fatigue and lethargy of the four limbs, inability to open the eyes, drives out wind-water swelling in the skin, reduces edema of the lower legs, treats cold qi accumulation and mass formation, promotes blood circulation in the waist and umbilical region, and treats diseases of the Wei Mai (Defensive Vessel) such as rebellious qi with urgency, umbilical and abdominal pain. It tonifies liver wind-deficiency, warms the middle to stop sweating, and promotes water passages. Its effects reach the skin and hair above, the chest and heart in the middle, and the waist and umbilicus below. In the qi level, it governs qi; in the blood level, it governs blood. (Li Dongyuan/Haizang note) Paired with Huangqin (Scutellariae Radix), it calms the fetus; paired with Zhishi (Immature Bitter Orange), it dissipates痞 (fullness); combined with Erchen Tang (Two-Aged Decoction), it strengthens the spleen, aids digestion, transforms phlegm, and dispels dampness. Used together with Guizhi (Cinnamon Twig), Shaoyao (Peony Root), and Shengdi Huang (Rehmanniae Radix), it tonifies the blood of the spleen. Combined with Ganjiang (Dried Ginger), it expels cold-dampness from the spleen. Combined with Zhishi, Ganjiang, and Huanglian (Coptidis Rhizoma), it clears damp-heat from the spleen.

Attached Formulas: Jiegu Zhi Zhu Wan (Jiegu Atractylodes and Immature Bitter Orange Pill): Dissipates fullness and strengthens the stomach; long-term use naturally maintains appetite. Take Baizhu (stir-fried with yellow wall soil) 1 liang, Zhishi (bran-stir-fried) 1 liang, grind into powder. Wrap in lotus leaves with rice, roast until cooked, mash, and mix to form pills the size of wutong seeds. Take 50 pills with plain boiled water each time. For qi stagnation, add 1 liang of Chenpi (Tangerine Peel); for fire, add 1 liang of Huanglian; for phlegm, add 1 liang of Banxia (Pinellia Rhizome); for cold, add 5 qian of Ganjiang and 3 qian of Muxiang (Aucklandia Root); for food stagnation, add 5 qian each of Shenqu (Medicated Leaven) and Maiya (Germinated Hordeum). Due to the vast number of formulas using Baizhu, they cannot all be recorded. Here, only those treating diarrhea are excerpted. Since the causes differ and the accompanying herbs vary, one can infer other uses, thereby mastering the application of Baizhu.

1. Spleen-deficiency diarrhea: Baizhu 5 qian, Shaoyao 1 liang. In winter, add roasted Roudoukou (Nutmeg). Grind into powder, make pills with rice drink, take 50 pills per dose, twice daily.
2. Dampness-diarrhea and summerheat-diarrhea: Equal parts Baizhu and Cheqianzi (Plantago Seed), stir-fried and ground into powder, take 2-3 qian with plain boiled water.
3. Chronic diarrhea leading to intestinal slipping: Stir-fried Baizhu and Fuling (Poria) each 1 liang, stir-fried Glutinous Rice 2 liang. Grind into powder, mix with date paste for eating, or make into pills.
4. Slipping diarrhea in elderly and children: Baizhu 8 liang (stir-fried with yellow earth), Shanyao (Chinese Yam) 4 liang. Stir-fry and grind into powder, make rice pills, dosage according to age, take with rice soup. Can add 3 qian of Renshen (Ginseng).
5. Frequent diarrhea in the elderly: Baizhu 2 liang (steamed with yellow earth, dried, earth removed), Cangzhu 5 qian (soaked in rice wash water and stir-fried), Fuling 1 liang. Grind into powder, make pills with rice paste, size of wutong seeds, take 70-80 pills with rice soup each time.
6. Bloody diarrhea, sallow complexion, wind-intestinal hemorrhoids, rectal prolapse, chronic cases not healing: Baizhu 1 jin (stir-fried with yellow earth and ground), Dihuang (Rehmannia Root) 0.5 jin (steamed over rice until cooked), mash and mix, add a little wine if too dry, make pills size of wutong seeds. Take 50 pills with rice drink each time, three times daily.

[Discussion] Human yuanqi (primordial qi) is often hindered by dampness; when dampness is removed, qi increases. Only Baizhu possesses the compliant nature of Kun (Earth) yet exerts the vigorous function of Qian (Heaven), differing from bland-draining dampness herbs and wind-dispelling drying herbs. Thus, Zhang Jiuguo attributes the dampness-dispelling and qi-tonifying effects of Baizhu primarily to this category. The Spleen governs dampness; dampness hindering the Spleen means the yang within yin is trapped. If it does not receive the vigorous yang of the Stomach to summon it, how can the Stomach transport qi to the Three Yang and Three Yin meridians? Only Baizhu can strengthen Stomach-yang to transform Spleen-yin, thereby summoning the yang within yin, achieving correspondence between interior and exterior, and mutual attraction between water and fire, allowing yuanqi to flow freely and increase. Furthermore, the Spleen governs earth qi, and the Stomach governs heaven qi. If the Spleen does not receive the summons of heaven qi, earth qi cannot ascend; if the Stomach does not receive the harmony of earth qi, heaven qi cannot descend. (The Neijing emphasizes the distinction between heaven and earth qi regarding the Spleen and Stomach, stating they govern transformation through ascending and descending.) When earth qi ascends and harmonizes with heaven qi, it is said that the Upper Jiao merges to nourish all yang, ultimately returning to the ability of yang to exert and transform. Therefore, in all its therapeutic actions, although yin plays a role within yang, it does not monopolize the merit. Moreover, various syndromes either result from yang's inability to move vigorously or yin's failure to be transformed by yang. (Generally, the use of Baizhu lies in dispelling dampness; the Stomach's function acts upon the Spleen. Dispelling dampness tonifies qi, moving from Spleen back to Stomach. Tonifying qi harmonizes blood, reflecting interior-exterior correspondence and water-fire mutual attraction. Li Dongyuan's statement "governs qi in the qi level, governs blood in the blood level" should not be taken literally side-by-side, as yin follows yang transformation without monopolizing merit.) Baizhu enters the meridians first via the Stomach and Spleen, and other meridians are reached through them. Examining all treatments, they all involve promoting heaven-yang to transform earth-yin; when yin and yang harmonize, qi moves. From true qi transforming grain qi, and grain qi replenishing true qi, the central earth qi performs ascending-descending transformations, serving as an excellent tonic for acquired constitution, especially for the elderly. Jiuguo stated that Baizhu descends; this is because the Three Yin Meridians of the Foot originate from below. Tonifying the Spleen benefits the Liver and Kidneys together. (Because the Stomach receives earth-harmony to descend, it also involves the lower part.) Reaching the yin of the Liver and Kidney from the Spleen and Stomach, Haizang thus said it tonifies Liver meridian wind-deficiency and treats Chong Mai rebellious qi with urgency and umbilical-abdominal pain. However, for those with yin-deficiency and blazing yang, administering this herb is contrary like ice and charcoal. (If yin is already deficient, using drying herbs further harms it; if yang is already blazing, tonifying it further exacerbates it. Is this acceptable?) It is common to see incompetent physicians treating yin-deficiency syndromes with Renshen and Baizhu to regulate the Spleen, which is utterly confused. The Classic states: Organs and viscera receive qi from the Yangming Meridian through their respective channels, so the Stomach transports fluids for them. Qi is yang; the yang of each organ derives from the Stomach Meridian. Blood vessels are yin; the yin of each organ originates from the Spleen. Each organ receives qi from Yangming via the Spleen channel because yang originates from within yin. Because the Spleen channel must transport fluids, and meridians are formed from fluids... (When the Spleen suffers from dampness, yin does not transform, and fluids are not generated. Baizhu regulating the Stomach and benefiting the Spleen generates fluids to unblock meridians, allowing qi to reach via meridians.) The Classic states: The four limbs receive qi from the Stomach. Now, if the Spleen cannot transport fluids for the Stomach, the four limbs do not receive water-grain qi, qi declines daily, vessel pathways become obstructed, sinews, bones, muscles lack qi to generate. Pondering these words, we see Baizhu regulates the Stomach by strengthening yang, merging true qi with grain qi, enabling movement to all organs. Its ability to reach organs stems from strengthening Stomach-yang, transforming Spleen-yin, generating fluids, and nourishing blood vessels and meridians. The Classic states: The Five Zang organs receive qi from the Stomach but cannot reach the meridians directly; they must rely on the Spleen to receive it. These words reveal profound principles. Baizhu functions by dispelling dampness and tonifying qi; does this mean all dampness syndromes use Baizhu? Answer: Dampness is divided into internal and external, and crucially distinguished by cold and heat. Cold-type dampness is yang trapped in yin unable to ascend; accumulated yin leads to qi-deficiency. Heat-type dampness is yin trapped in yang unable to descend; prevailing yang leads to qi-excess. Both excess and deficiency relate to qi; qi excess/deficiency both transform into dampness. But excess here refers to pathogenic excess; can one still use Baizhu to tonify qi? Dampness is earth qi. Yang accumulating in yin means earth qi fails to transform due to heaven-qi depression. Yin trapping yang means earth qi fails to transform due to heaven-qi prevalence. Ultimately, transforming dampness involves yin, but the reason yin transforms dampness lies in yang's inability to transform. One is deficiency, one is excess, so treatments differ. Deficiency requires tonifying righteous qi to boost qi, e.g., Baizhu, Fuling. Excess requires eliminating pathogens to boost qi, e.g., Huanglian, Huangbai, Zhizi, Dahuang can all dry dampness; one should not rigidly stick to the two Atractylodes. Qi is generated by water, yin generates yang; fluids are transformed by qi, yang transforms yin. If qi can transform fluids, where is dampness? If qi-deficiency prevents transformation, tonifying yang allows fluids to transform naturally. (Fluid transformation is where qi arrives.) As for qi-excess failing to transform, it is not due to lack of true qi, but injury to true qi. One must first eliminate the injuring pathogen. Suppressing yang allows yin to transform. (If yin is merged into yang, it also fails to transform, hence suppressing yang is needed.) When yin transforms, fluids move; when fluids move, dampness is removed; when dampness is removed, qi increases. (Qi and dampness cannot exist apart as root; dispelling dampness and tonifying qi cannot be separated as function, but tonifying righteousness and eliminating pathogens must be appropriate to the situation.) Thus, the use of Baizhu for cold/heat and excess/deficiency is clear. Why is it said to treat wind syndromes? Answer: Wind also differs. Yang-deficiency with yin-accumulation: yin is not true yin; prolonged non-transformation of yin causes yang to transform into wind, called wind-deficiency. Suitable to invigorate blood (as qi transforms fluids) to transform yin and tonify wind-deficiency. (Baizhu tonifies liver wind-deficiency.) Yang-excess with yin-trapping: yang is not true yang; prolonged non-transformation of yang causes yin to transform into wind, called wind-excess. Suitable to clear qi to transform yang and disperse wind-excess. (Wind belongs to yang; wind-deficiency involves yang following yin to affect blood, so treat blood; wind-excess involves yin following yang to affect qi, so treat qi.) Whether this herb suits these two treatments depends on careful consideration. In summary, dampness transforming into heat, or heat transforming into dampness, both suffer from yin failing to be transformed by yang. The Taiyin Spleen fails to transport fluids to unblock meridians, increasing dampness, causing Stomach qi to fail to reach Three Yin/Yang, increasing heat, creating a vicious cycle worsening the disease. The Classic states: Meridians are the pathways of qi and blood. When qi-blood pathways are blocked and meridians severed, such as in stroke, who is not suffering from heat transforming dampness, dampness transforming heat, destroying yin? Similarly, reverse vomiting and abdominal fullness, are they not all caused by gradual accumulation of damp-heat to extremes? Hence Danxi said most human diseases are damp-heat. Regarding Baizhu's indications, abdominal fullness and vomiting are indeed not damp-heat? Answer: These are exact matches for yang-deficiency transforming dampness. For yang-excess transforming dampness, one must address the heat root. However, since all stem from yang's inability to transform yin, even when using heat-clearing formulas to enable yin transformation, whether attacking or tonifying, one must not damage true yang to cut off the source of transformation, hence there are times Baizhu cannot be abandoned. Among damp-heat syndromes, those injured by seven emotions are complex. Injury to yin preventing yang transformation leads to qi-stagnation forming dampness, dampness stagnating turning to heat. Investigating the root, it is yin-qij injury, unlike damp-heat from yin-excess storing yang. Although cold-depressants are unsuitable, and damp-resolving/Spleen-regulating is preferred, can one administer the pungent-drying Er Shu to destroy yin? This syndrome relates to spirit/thought, an injury to yin within yang. Although one should not aggressively tonify yang, but rather enrich yin and harmonize qi, one cannot use purely yin-nourishing moistening agents to cut off the transformation source; even Dongdong (Tianmaifeng/Maidong) is feared to stagnate yang. Recent Cheng Ruoshui often uses Fushen, Shizao, Danpi to nourish yin and descend fire; Fuling, Yiren, Mugua, Cheqian to strengthen spleen and move dampness; assisted by Shanzha, Shichangpu to move damp-stagnation, which is very logical. This syndrome is most common, and many die from misdiagnosis, so it is specially highlighted. Among human diseases, phlegm is most numerous and harmful. For fire-phlegm from true-yin deficiency, urgently tonify true yin first. For qi-phlegm from external six evils, urgently dispel external pathogens first. For depression-phlegm from food accumulation, urgently guide and scatter stagnation first. Additionally, any deficiency-phlegm or damp-phlegm from internal injury to middle qi must fundamentally regulate middle qi. If Spleen qi is not tonified, fluids do not transform, phlegm does not move; non-moving and non-transforming will further困 (trap) Spleen-Stomach qi, preventing qi movement in yin/yang, blocking meridians, failing to circulate Ying-blood to the Sea of Blood, causing Lower Jiao primal yin to become more deficient, Upper Jiao deficiency-heat to arise again, true yin declining daily, true yang becoming exhausted, most severe in the elderly. At this time, nothing exceeds Baizhu for strengthening spleen and moving phlegm. However, one must carefully examine if it is suitable before administering; perhaps initially unsuitable but later suitable, so that confidence yields results. Miao Shi said: Shu dries Kidney and closes qi; if Liver/Kidney have moving qi or throbbing at the umbilicus, do not take. Liu Juanzi said: For carbuncles and ulcers, taking it反而 (instead) generates pus and pain.

[Processing] Do not use oily varieties. Remove peel, slice, soak thoroughly in rice wash water, sun-dry. Wrap in aged wall soil, steam and sun-dry nine times, wash clean, sun-dry again. This method steals earth qi to assist the Spleen. Moisten with milk to control its nature. For Spleen disease, stir-fry with aged wall soil. For Spleen-deficiency with qi-stagnation, soak in Zhishi decoction then stir-fry, or soak in Xiangfu decoction then stir-fry. For Zhi Zhu Wan, Baizhu must be boiled in Zisu, Bohe, Huangqin, Rougui decoction.