A two-ingredient "qing-gan xie-huo, jiang-ni zhi-ou" (clear the liver and drain fire, descend counterflow and stop vomiting) formula from Zhu Danxi's Yuan-dynasty "Danxi's Experiential Therapy", perhaps the most distilled classical OTC formula for "liver-fire invading the stomach".
Cultural reference - how this formula has been discussed in Chinese medical tradition. Not medical advice.
Background & origin
Compiled by Zhu Danxi (朱丹溪) in his Yuan-dynasty "Danxi's Experiential Therapy" (《丹溪心法》, 1347), it is one of the most compact classical prescriptions in the entire TCM canon, only two ingredients, in a 6:1 ratio. The "Left" (左) in the name is a sophisticated five-elements reference: liver belongs to wood (associated with "left"), and "metal" (金) overcomes wood, so "left metal" means "use metal to control wood" (i.e., use the lung-metal/clearing-quality of Coptis to control the liver-wood fire). In Japan, 左金丸 (さきんがん / Sakin-gan) is sold by Kracie (クラシエ) as the standard OTC formula for "liver-fire + stomach" indications. The formula is, in short, the most distilled classical "liver-fire + stomach" formula.
From the source text
This page is cultural documentation, not medical advice.
From the source text · 《丹溪心法》卷三·火·左金丸
Classical text
左金丸，治肝火。黄连六两，吴茱萸一两。为末，水丸或蒸饼丸，白汤下五十丸。
Modern Chinese rendering
左金丸是中医方剂里"简洁而精"的极致代表,方仅 2 味药,黄连六两、吴茱萸一两,按 6:1 配比,却能成方治大病。黄连为君,量大至六两,清肝火、泻胃热,直折上炎之肝火;吴茱萸为佐,仅一两,一者开胃气、引热下行,二者制黄连之苦寒过甚,三者取"以热引热"之反佐,引药入肝经。方名"左金"是中医五行理论的精巧运用：肝属木、对应"左";金克木,故"左金"意为"以金制木",即用黄连之清金(肺金)之力来制约肝木之火(肺金清肃下行以制肝木上亢),而非字面意义的"左边的金属"。本方治"肝火犯胃"所致嘈杂吞酸、胁肋胀痛、呕吐泛酸,中医方剂学关于"苦寒为主 + 少量温热"反佐配伍的经典示范。
Editorial translation
Zuǒ Jīn Wán is the ultimate representative of "conciseness and refinement" in TCM formulas, only 2 ingredients, Huáng Lián (Coptis) at 6 liǎng and Wú Zhū Yú (Evodia) at 1 liǎng, in a 6:1 ratio, yet capable of addressing serious disorders. Huáng Lián is the sovereign at the large dose of 6 liǎng, to clear liver-fire and drain stomach-heat, directly quelling the flaring liver-fire; Wú Zhū Yú is the assistant at only 1 liǎng, with three roles: first, it opens the stomach-qi and guides fire downward; second, it moderates the extreme bitter-coldness of the Coptis; third, it serves as a "heat-inviting-heat" (以热引热) reverse-assistant that guides the formula into the liver channel. The name "Zuǒ Jīn" (Left-Metal) is a sophisticated application of the TCM five-elements theory: the liver belongs to wood, associated with "left"; metal overcomes wood, so "Left-Metal" means "use metal to control wood" — that is, use the clearing-metal (lung-metal, descending) quality of the Coptis to control the excessive liver-wood fire, rather than any literal "left side of metal" meaning. The formula is used for the "liver-fire invading the stomach" pattern with noisy discomfort, acid regurgitation, hypochondriac pain, and vomiting of sour fluid, the classical TCM example of the "bitter-cold dominant + minor warming reverse-assistant" combination.
In tradition
In TCM framing, traditionally used in the context of "liver-fire invading the stomach", burning epigastric pain, acid reflux, bitter taste in the mouth, irritability, distension in the chest and flanks, and a red tongue with a yellow coating. The formula is the most distilled version of the "liver-fire + stomach" idea, just Coptis root (Huáng Lián) and Evodia fruit (Wú Zhū Yú) in a 6:1 ratio. The "Left" (左) in the name refers to the liver (五行中肝属木，对应"左"；"金"则对应肺，金克木，故"左金"意为"以金制木"), a clever metaphorical name. In Japan, 左金丸 (Sakin-gan) is sold by Kracie (クラシエ) as the standard OTC formula for "liver-fire + stomach" presentations.
Formula composition
Monarch1
- Coptis root (Huáng Lián / 黄连) — clears liver-fire, drains stomach-heat (6 parts)
Assistant1
- Evodia fruit (Wú Zhū Yú / 吴茱萸) — warms the stomach, opens the stomach, guides the Coptis downward (1 part)
International availability
Japan (Kampo)
- Tsumura & Co.ツムラOTC左金丸Sakin-gan
Korea (Hanbang)
- Kyungdong경동OTC좌금환Jageum-hwan
Taiwan & Hong Kong
- 順天堂OTC左金丸Zuo Jin Wan
Cautions & context
- Contains Coptis (Huáng Lián) at a 6:1 ratio to Evodia (Wú Zhū Yú), the formula is "bitter-cold dominant" and "warming-minor". Long-term daily use is considered inappropriate in TCM framing.
- Not appropriate for "spleen yang deficiency with cold" presentations (cold limbs, loose stools, severe fatigue), the Coptis is too cold for such patients.
- Persistent epigastric pain, acid reflux, or weight loss should be evaluated by a clinician, these can be symptoms of peptic ulcer, GERD, or other conditions requiring evaluation.
- Pregnant or breastfeeding people should consult a qualified practitioner before use.
Related formulas
Other formulas from this text· "Danxi's Mastery of Medicine"
Other formulas by this contributor· Zhu Danxi
Related concerns
Concern · digestion
Digestion
Upper-abdominal heaviness, bloating, sour reflux, loose stools, traveler's stomach, and the aftermath of a meal that was richer, spicier, or larger than usual.
Editorial note
Compiled from "Danxi's Mastery of Medicine" (1347).
Last reviewed: July 18, 2026
Three layers of evidence
Classical source
≈ 700 years · "Danxi's Mastery of Medicine" (1347)
Pharmacopoeia indication
"Drain fire, soothe the liver, harmonize the stomach, and relieve pain. Used for liver fire invading the stomach: epigastric and hypochondriac pain, bitter taste, gastric discomfort, and vomiting of sour fluid."
Modern research status
As of 2026-07-18, a PubMed search using the formula name and the Latin / Korean / Japanese transliterations together with "systematic review" and "meta-analysis" did not identify a dedicated systematic review for this formula. Any clinical evidence that does exist is fragmented across small individual trials or covered in broad herbal-medicine umbrella reviews, which do not allow a per-formula evidence assessment; the absence of a dedicated SR is itself the relevant editorial fact here.
References
References reviewed on July 18, 2026 · PubMed search on 2026-07-18
- 01ClassicalZhū Zhènhēng (朱震亨, styled Yànxiū 彦修, self-styled Dān Xī 丹溪, 1281–1358), 《丹溪心法》 (Dān Xī Xīn Fǎ / Danxi's Mastery of Medicine), compiled by his disciples around 1347, vol. 3 (卷三), the "fire" (火) section, the entry for Zuǒ Jīn Wán (左金丸), the canonical "clear-liver-drain-fire" (清肝泻火) formula in TCM, with the elegant two-ingredient, 6:1-ratio structure and the sophisticated five-elements "left-metal / metal-controls-wood" naming; the present-day 中成药 form (丸 / 胶囊) is the modern industrial production of the classical water-pill formula.
- 02TextbookDuan Fuqin (段富津) et al. (eds.), 《方剂学》 (Fāngjìxué / Science of Formulas), 2nd edition, Shanghai Scientific and Technical Publishers, 2011, the standard modern university-level formula textbook in mainland China, with Zuǒ Jīn Wán analysed in the "clearing formulas" (清热剂) chapter as the representative "clear-liver-drain-fire" formula, the canonical entry for "liver-fire invading the stomach" (肝火犯胃), the textbook example of "bitter-cold dominant + minor warming reverse-assistant" (苦寒为主、佐以温热) combination.
- 03PharmacopoeiaPharmacopoeia Commission of the PRC, 《中华人民共和国药典》 2020 edition, vol. 1 (Zhōnghuá Rénmín Gònghéguó Yàodiǎn, Pharmacopoeia of the People's Republic of China, 2020 ed., vol. 1), China Medical Science Press, 2020, the official national monograph for Zuǒ Jīn Wán (丸), "functional indication" reads "drain fire, soothe the liver, harmonize the stomach, and relieve pain, used for liver-fire invading the stomach with epigastric and hypochondriac pain, bitter taste, gastric discomfort, and vomiting of sour fluid".