WARM ACRID E XTERIOR R ESOLVING F ORMULAS
Indications: External contraction of wind-cold manifesting in an exterior repletion pattern, characterized by aversion to cold and heat effusion, headache, generalized pain,
pain in the joints, absence of sweating, and panting.
Tongue: thin and white. Pulse: floating and tight.
PATHOMECHANISM
麻黄汤 Má Huáng Tāng Ephedra Decoction
Source: Shāng Hán Lùn (On Cold Damage).
Ingredients
y Má huáng 麻 黄 Ephedrae Herba, ephedra (remove
nodes) 3 liǎng/9 g.
y Guì zhī 桂枝 Cinnamomi Ramulus, cinnamon twig 2
liǎng/10 g
y Xìng rén 杏仁 Armeniacae Semen, apricot kernel (remove skin and tips) 70 pieces/10 g
y Gān cǎo 甘草 l Glycyrrhizae Radix, licorice
Original Method: [For] the above four ingredients, use
nine shēng of water. First boil má huáng (Ephedrae
Herba) to reduce [the water] by two shēng. Remove the
foam [collecting] on top and add all the ingredients. Boil
to get two and a half shēng, remove the dregs and take
eight gě, warm. Take again, [if necessary] to obtain mild
sweating. It is not necessary to eat rice gruel [with the
decoction]. The rest of the directions are the same as for
guì zhī tāng (Cinnamon Twig Decoction) [i.e., the modern standard method].
Note: The nodes of this drug are traditionally considered
to have the ability to check sweating. Therefore, when it
is used in the promotion of sweating, the nodes should be
removed. On the basis of modern laboratory research, this
concept is now often considered to be unnecessary. The
foam, which is produced when má huáng (Ephedrae
Herba) is boiled, is traditionally removed because it is
thought to cause vexation.
This line introduces greater yang cold damage, although that name is not used in the text. One knows it is
cold damage because má huáng tāng (Ephedra Decoction)
is the suggested treatment. The key signs presented are no
sweating and panting. The lack of sweating, which indicates exterior repletion, is an important sign for the differentiation of greater yang cold damage and greater yang
wind strike. The evil qi is strong and the patient's right qi
is also strong. The right and evil qi contend and the right
qi cannot push out the evil qi, which becomes lodged in
the exterior and obstructs the effusion of sweat. Because
the evil cannot pass out through the exterior, it inhibits
the channel qi and the lung and impairs lung diffusion
and downbearing, causing the patient to pant.
Actions: Promotes sweating and resolves the exterior;
diffuses the lung and calms panting.
This formula was originally designed for the greater yáng
(tài yáng) cold damage pattern. This is external contraction of wind-cold manifesting as an exterior repletion
pattern.
Wind is swift and changeable; it is by nature light and
buoyant. It causes disease to arise suddenly, and affects
the outer and upper parts of the body. When wind and
other evils settle in the exterior, evil and right qì engage
in a struggle that manifests in heat effusion and a floating
pulse.
Cold is a yīn evil. It is congealing and stagnating in
nature; it causes contraction and tautness. Hence, when
wind-cold fetters the exterior, it
y depresses defense yáng; hence aversion to cold.
y causes the interstices (including pores) to tighten and
close; hence absence of sweating.
y causes construction-yīn to become depressed and stagnant, inhibiting flow through the channels; hence headache, generalized pain, and pain in the joints.
y obstructs lung qì impairing diffusion and downbearing;
hence panting.
FORMULA EXPLANATION
The formula as a whole promotes sweating and resolves
the exterior, thereby dissipating wind-cold. It also frees
construction and defense, as well as diffusing the lung
and calming panting.
ƒ Má huáng (sovereign)
y Promotes sweating and dissipates cold. It opens the
interstices and resolves the depression of defense qì,
thereby dissipating wind-cold from the exterior.
y Diffuses the lung and calms panting, relieving the depression of lung qì.
Má huáng is acrid and bitter in flavor and warm in nature. It enters the lung channel and bladder channels. …
ƒ Guì zhī (minister)
y Resolves the flesh and effuses the exterior, helping má
huáng’s effect of promoting sweating and dissipating
cold. (“Resolving the flesh” means eliminating external
evils from the fleshy exterior.) When paired with má
huáng, a function of “opening the interstices” and “resolving the flesh” emerges that has greater strength than
use of either medicinal alone.
y Warms the channels and dissipating cold, relieving the
depression of construction-yīn to relieve the headache,
generalized pain, and pain in joints. This latter action is
important because má huáng only addresses the depression of defense qì.
ASSOCIATED FORMULAS
Guì zhī is acrid and sweet in flavor and warm in nature.
ƒ Má huáng jiā zhú tāng (麻黄加朮汤 Ephedra Decoction Plus White Atractylodes). From the Jīn Guì Yào
Lǜe (Essential Prescriptions of the Golden Coffer).
Because guì zhī, in both of its actions, helps má huáng,
it serves as má huáng’s minister. The two are traditionally said to stand in a relationship of mutual need.
Ingredients: Má huáng (Ephedrae Herba) as above,
with 4 liǎng/12 g of bái zhú (Atractylodis Macrocephalae
Rhizoma).
The actions of guì zhī are often summed up as “outthrusting construction and defense. “Outhrusting defense” means resolving the flesh and effusing the exterior.
“Outthrusting construction” refers to warming the channels and dissipating cold.
Actions: Promotes sweating and resolves the exterior;
diffuses the lung and calms panting. Indications: Windcold-damp impediment (bì), vexing pain in the body, and
absence of sweating.
ƒ Xìng rén (assistant) downbears and disinhibits lung qì.
Its downbearing action complements the diffusing action
of lung qì, the two together restoring normal diffusion
and downbearing of lung qì.
ƒ Honey-fried gān cǎo harmonizes the diffusing and downbearing action of má huáng and xìng rén. It also also
moderates the harshness of má huáng and guì zhī, preventing excessive sweating that would damage right qì.
It is a courier and an assistant at the same time.
CLINICAL NOTES
Modifications: The formula can be modified when specific signs are more pronounced than normal when the
exterior pattern is complicated by other patterns, notably
the contraction of dampness with cold, and the presence
of internal heat arising as the external evils pass into the
interior and transform into heat.
y Nasal congestion and runny nose: Add cāng ěr zǐ (Xanthii Fructus) and xīn yí (Magnoliae Flos) to free the nasal orifices.
y Dampness complication giving rise to aching joints:
Add cāng zhú (Atractylodis Rhizoma) and yì yǐ rén
(Coicis Semen) to dispel wind and eliminate dampness.
y Concurrent internal heat with vexation and agitation
with dry mouth: Add shí gāo (Gypsum Fibrosum) and
huáng qín (Scutellariae Radix) to clear and drain the
depressed heat.
Modern Applications: Common cold, influenza, acute
bronchitis, and bronchial asthma when these take the
form of wind-cold exterior repletion patterns.
Warning: The Shang Han Lun warns that this formula is
contraindicated for certain patients even if an exterior
cold pattern is presesent, namely “patients suffering from
sores,” “patients who suffer from spontaneous external
bleeding (nosebleed),” “patients suffering from blood
collapse,” patients with spontaneous sweating due to
exterior vacuity in externally contracted disease, patients
with blood vacuity and a pulse that is “slow at the cubit,”
and patients with “generalized heaviness and heart palpitations” as a result of inappropriate precipitation.
ƒ Dà qīng lóng tāng ( 大 青 龙 汤 Major Green-Blue
Dragon Decoction):
y Má huáng (Ephedrae Herba), remove nodes soak, half
liǎng/6 g,
y Guì zhī (Cinnamomi Ramulus) 2 liǎng/6 g
y Gān cǎo (Glycyrrhizae Radix), mix-fried 2 liǎng/6 g
y Xìng rén (Armeniacae Semen), remove skin, 40
pieces/6 g,
y Shí gāo (Gypsum Fibrosum) 1 lump the size of a
chicken’s egg/18 g, crushed,
y Shēng jiāng (Zingiberis Rhizoma Recens) 3 liǎng/9 g
y Dà zǎo (Jujubae Fructus), 12 pieces/3 g
Actions: Promotes sweating and resolves the exterior;
clears heat and eliminates vexation.
Indications: External contraction of wind-cold with absence of sweating and with vexation and agitation, generalized pain,and a pulse that is floating and tight.
ƒ Sān ào tāng (三拗汤 Rough and Ready Three Decoction):
y Má huáng (Ephedrae Herba), do not remove nodes
y Gān cǎo (Glycyrrhizae Radix), (not mix-fried)
y Xìng rén (Armeniacae Semen), do not remove skin
Equal parts (30 g each) of the medicinals above, grind
and boil 5 qian (15 g) in one and a half sheng of water
with 5 pieces of ginger. When only one sheng remains,
remove the foam and drink it. Cover up with blankets
and go to sleep, slight sweating should occur.
Actions: Diffuses the lung and resolves the exterior.
Indications: External contraction of wind-cold with impaired diffusion of lung qi. There may be nasal congestion, “heavy voice” or loss of voice, cough, and chest
oppression.
STUDY NOTES
Key Points: Má huáng tāng is a basic formula for externally contracted wind-cold manifesting in exterior repletion. It treats aversion to cold, heat effusion, absence of
sweating, panting, and a pulse that is tight and floating.
y Má huáng tāng is a basic formula for wind-cold exterior
repletion with heat effusion, aversion to cold, headache
and generalized pain, and a pulse that is tight and floating, with absence of sweating and with panting.
y Má huáng promotes sweating and effuses the exterior to
treat depression of defense qì.
y Guì zhī helps it, and also relieves depression of construction-yīn to treat headache and generalized pain.
y Xìng rén treats panting.
y Gān cǎo harmonizes the nature of the medicinals.
Warning: Do not use in repletion heat or vacuity heat.
COMPARISONS
Five major patterns are described that may occur simulataneously with cold damage. These patterns are: inhibited channel qi, retching and vomiting, diarrhea, depressed heat in the interior and collected water-rhuem in
the interior.
When channel qi is inhibited in cold damage patterns,
there is distinct stiffness and pain in the neck and back.
This pattern is treated with gé gēn tāng (Pueraria Decoction), which engenders liquid and moistens the channels.
An exterior evil can enter the interior and harass the
yang brightness and/or directly impair the function of the
large intestine leading to diarrhea. This pattern can also
be treated with gé gēn tāng (Pueraria Decoction), which
upbears liquid and checks diarrhea.
If the evil instead impairs stomach function, causing
counterflow ascent of the stomach qi with signs such as
retching and vomiting, gé gēn jiā bàn xià tāng (Pueraria
Decoction Plus Pinellia), which downbears counterflow
and checks retching, is suggested.
When cold damage occurs and depressed heat is present in the interior, giving rise to signs such as vexation
and agitation, and generalized heaviness, it is necessary
to resolve the exterior and clear interior heat, for which
dà qīng lóng tāng (Major Green-Blue Dragon Decoction)
is suggested.
Xiǎo qīng lóng tāng (Minor Green-Blue Dragon Decoction), which flushes and transforms water-rheum, is suggested for a pattern in which cold damage and collected
water-rheum appear simultaneously, with signs such as
cough, panting and retching.
Xiǎo Qīng Lóng Tāng (小青龙汤 Minor Green-Blue
Dragon Decoction)
y Xì xīn (细辛 asarum, Asari Herba) 3 liǎng/6 g
y Gān jiāng ( 干 姜 dried ginger, Zingiberis Rhizoma)
liǎng/6 g
y Guì zhī (桂枝 Cinnamomi Ramulus, cinnamon twig)
(remove skin) 3 liǎng/9 g
y Zhì gān cǎo (炙甘草 mix-fried licorice, Glycyrrhizae
Radix cum Liquido Fricta) 3 liǎng/6 g
y Wǔ wèi zǐ (五味子 schisandra, Schisandrae Fructus) ½
sheng/6 g
y Bàn xià (半夏 pinellia, Pinelliae Rhizoma) (washed) ½
sheng/6 g
Original Method: Originally, one dou of water was used
to boil má huáng, after reducing the liquid by 2 sheng,
the foam was discarded and the other medicinals added.
Boil under three sheng remains, remove the foam, and
take one sheng. The modern method is to simply decoct
the formula and take it warm.
Actions: Resolves the exterior and dissipates cold, warms
the lung and transforms rheum.
Indications: External cold with internal rheum. There
may be aversion to cold and heat effusion, headache and
generalized pain, absence of sweating, panting and cough
with profuse clear thin phlegm-drool, and glomus in the
chest. Other possible signs include dry retching or
phlegm-rheum with panting and cough and inability to lie
flat. Other possibilities are heaviness and pain of the
body and puffy swelling of the head, face, and four limbs.
Tongue: White glossy coat. Pulse: Floating.
PATHOMECHANISM
When wind-cold fetters the exterior, the skin and body
hair are blocked. Defense yang is obstructed and construction-yin is depressed, causing aversion to cold and
heat effusion, absence of sweating, and generalized pain.
Water-rheum collecting in the lung produces two things:
Loss of diffusion and downbearing of the lung- causing
panting and cough, profuse clear thin phlegm, chest oppression, and white glossy tongue fur.
Spilling into the skin and flesh- causing puffy swelling
of the face and limbs, and/or generalized heaviness.
The chief pattern is wind-cold fettering the exterior,
while the concurrent pattern is water-rheum collecting in
the inner body. There is thus disease in both the exterior
and interior, with the exterior pattern being the chief
component.
Source: Shāng Hán Lùn (On Cold Damage).
TREATMENT METHOD
Ingredients
Dissipates cold and resolves the exterior, warms the lung
and eliminates rheum. (Also calms panting and relieves
cough.)
y Má huáng (麻黄 Ephedrae Herba, ephedra) (remove
nodes) 3 liǎng/9 g.
y Sháo yào (芍药 peony, Paeoniae Radix) 3 liǎng/9 g
KEY FEATURES IN PATTERN IDENTIFICATION
Aversion to cold and heat effusion, absence of sweating,
panting and/or cough with profuse thin clear phlegm,
white glossy tongue fur.
FORMULA EXPLANATION
ƒ Má huáng (sovereign)
y Promotes sweating, dissipates cold, and resolves the
exterior.
y Diffuses the lung and calms panting.
ƒ Guì zhī (sovereign)
y Dissipates cold, resolves the flesh, and effuses the exterior.
Modern Applications: Pneumonia, allergic rhinitis,
acute bronchitis, and asthma when these take the form of
exterior wind-cold with interior water-rheum.
Warning: This formula has many warm and drying
agents, so it is not suitable for yin vacuity with dry cough
and absence of phlegm, as well as patterns of phlegm
heat.
Chuān Xiōng Chá Tiáo Sǎn (川芎茶调散 Tea-Blended
Chuanxiong Powder)
Source: Tài Píng Huì Mín Hé Jì Jú Fāng (Tài-Píng Imperial Grace Pharmacy Formulas).
Ingredients
y Warms yang and promotes qi transformation to move
water and transform rheum.
y Bò hé (薄荷 mint, Menthae Herba) (never sees fire) 8
liǎng/240 g.
Má huáng and guì zhī are traditionally said to stand
in a relationship of mutual need. This combination increases their power to promote sweating, dissipate cold,
and resolve the exterior.
y Chuān xiōng (川芎 chuanxiong, Chuanxiong Rhizoma)
4 liǎng/120 g.
ƒ Gān jiāng and xì xīn are ministers; they warm the lung,
dissipate cold, and transform rheum.
ƒ Wǔ wèi zǐ is an assistant; it warms and constrains lung qi
to relieve panting and cough.
The combination of gān jiāng, xì xīn, and wǔ wèi zǐ
both dissipates and constrains. This combination dissipates lung cold and transforms cold rheum without damaging right qi, and constrains lung qi and relieves panting
and cough without trapping evil.
ƒ Sháo yào is also an assistant; it nourishes yin and harmonizes construction, and also prevents damage to yin from
excessive sweating induced by má huáng and guì zhī.
ƒ Zhì gān cǎo is the courier; it harmonizes the nature of the
other medicinals.
CLINICAL NOTES
y Jīng jiè ( 荆 芥 schizonepeta, Schizonepetae Herba)
(stem removed) 4 liǎng/120 g.
yXì xīn (细辛 asarum, Asari Herba)(remove skin and tips)
(neck removed) 1 liǎng/30 g.
y Fáng fēng (防风 saposhnikovia, Saposhnikoviae Radix)
(neck removed) 1.5 liǎng/45 g.
y Bái zhǐ (白芷 Dahurian angelica, Angelicae Dahuricae
Radix) 2 liǎng/60 g.
y Qiāng huó (羌活 notopterygium, Notopterygii Rhizoma
et Radix) 2 liǎng/60 g.
y Zhì gān cǎo (炙甘草 mix-fried licorice, Glycyrrhizae
Radix cum Liquido Fricta) 2 liǎng/60 g.
Original Method: Grind the above ingredients to a fine
powder. Take 2 qian (6 g) per dose after meals with tea.
The modern method is to take two 6-gram doses daily
with tea, though it can also be made into a decoction if
the dosage for making a large batch of powder is reduced.
Modifications: If the external cold is relatively light,
remove guì zhī and use zhì má huáng (mix-fried ephedra).
If there are concurrent heat signs such as vexation and
agitation, add shí gāo (Gypsum Fibrosum) and huáng qín
(Scutellariae Radix) to clear depressed heat.
Actions: Courses wind and relieves pain.
y Phlegm rale in the throat: add xìng rén (Armeniacae
Semen), shè gān (Belamcandae Rhizoma), and kuǎn
dōng huā (Farfarae Flos) to transform phlegm and
downbear qi.
Warning: Headache can have many causes, both external
or internal. This formula is not suitable for headache due
to qi vacuity or blood vacuity, as well as liver-kidney yin
vacuity with ascendant hyperactivity of liver yang or internal stirring of liver wind.
y Nasal congestion with profuse clear nasal mucus: Add
xīn yí (Magnoliae Flos) and cāng ěr zǐ (Xanthii Fructus)
to free the orifice of the nose.
y Concurrent water swelling: Add fú líng (Poria) and zhū
líng (Polyporus) to disinhibit water and disperse swelling.
Indications: Externally contracted wind evil with headache. There may also be neck pain, dizziness, and nasal
congestion, or aversion to wind with heat effusion.
Tongue: thin and white. Pulse: floating.
Guì Zhī Tāng (桂枝汤 Cinnamon Twig Decoction)
Source: Shāng Hán Lùn (On Cold Damage).
Ingredients
y Guì zhī (桂枝 Cinnamomi Ramulus, cinnamon twig)
(skin removed) 3 liǎng/9 g
y Sháo yào (芍药 Paeoniae Radix, peony) 3 liǎng/9 g
y Gān cǎo (甘草 Glycyrrhizae Radix, licorice) 2 liǎng/6 g
y Shēng jiāng (生姜 fresh ginger, Zingiberis Rhizoma
Recens) 3 liǎng/9 g
y Dà zǎo ( 大 枣 jujube, Jujubae Fructus) 12 pieces/4
pieces
Original Method: [For] the preceding five ingredients,
break the [first] three ingredients into small pieces and
use seven shēng of water. Boil over a mild flame to get
three shēng and remove the dregs. Take one shēng, warm
or cold.
secure and the construction cannot be contained, indicating a loss of harmony between construction and defense,
which results in aversion to wind and cold.
The construction cannot be contained, sweat effuses
and the nourishment normally provided by the construction qi is lost or diminished. This loss of nourishment
results in stiffness and pain. The evil may dry the lung
and/or stomach. If the evil attacks the lung, the lung qi
will become inhibited, resulting in cough. If the evil attacks the stomach, the qi will counterflow ascend, resulting in retching.
Immediately after taking [the first dose] drink approximately one shēng of hot, thin gruel to reinforce the
strength of the medicinals. Warm [the body] by covering
[with a blanket] for a short period, until the whole body is
moist, as if sweating very lightly. This is auspicious. One
cannot allow [the sweat] to flow like water, since the disease will not be eliminated.
SUPPLEMENT:
If one dose [causes] sweating and the disease is diminished, cease taking further [doses]. One need not finish
the whole packet. If there is no sweating, take another
dose according to the previous method. If there is again
no sweating, reduce the time between doses, finishing
three doses in half a day.
Latin Pharmaceutical: Ephedrae Herba.
If the disease is severe, take [doses] throughout the
whole day, continue to evaluate and after finishing one
packet [if] the disease signs are still evident, take again. If
there is no sweating, one can take up to two or three
packets.
Foods contraindicated [while taking the formula] include raw and cold foods, sticky and slimy foods, meat
and noodles, the five acrids, products made from animal
milk and liquor and foods with a peculiar or spoiled flavor or odor.
Actions: Resolves the flesh and effuses the exterior,
harmonizes construction and defense.
Indications: External contraction of wind-cold with exterior vacuity and disharmony of construction and defense. This pattern is characterized by headache, heat
effusion, aversion to wind, and sweating, possibly accompanied by “noisy nose,” absence of thirst, and/or dry
retching.
Tongue: White tongue fur. Pulse: floating and moderate or floating and weak.
PATHOMECHANISM
In this disease, wind-cold fetters the exterior and the exuberant defensive yang floats to the exterior. The struggle
between the exuberant defensive yang and the exterior
evil produces heat effusion. The defensive exterior is not
1.1.1 麻黄 Má Huáng
Ephedrae Herba
English: ephedra.
Source: Ephedra sinica Stapf., E. intermedia Schrenk et
C.A. Mey., E. equisetina Bge.
Nature and Flavor: Acrid, slightly bitter; warm.
Channel Entry: Lung, bladder.
ACTIONS AND INDICATIONS
y Promotes sweating and resolves the exterior: Common
cold due to external contraction of wind-cold with an
absence of sweating (exterior repletion).
Má huáng treats exterior repletion patterns due to externally contracted wind-cold. Such patterns manifest
with aversion to cold, heat effusion, absence of sweating,
headache and generalized pain, nasal congestion, and a
floating and tight pulse. In this application, má huáng
diffuses lung qì, opens the interstices, and dissipates
wind-cold, thereby achieving the effect of promoting
sweating and resolving the exterior. To powerfully promote sweating to resolve the exterior, it is often combined with guì zhī (Cinnamomi Ramulus), with which it
stands in a relationship of “mutual need.” This combination is used in má huáng tāng (Ephedra Decoction).
y Diffuses the lung and calms panting: Repletion patterns
of panting and cough due to wind-cold fettering the exterior, causing congestion of lung qì.
Má huáng enters the lung channel; it has acrid dissipating and bitter discharging qualities, and a warming and
freeing action. To diffuse the lung and calm panting,
combine it with xìng rén (Armeniacae Semen) and gān
cǎo (Glycyrrhizae Radix), as in sān ào tāng (Rough and
Ready Three Decoction). When there is concurrent cold
rheum, combine it with xì xīn (Asari Herba), gān jiāng
(Zingiberis Rhizoma), and bàn xià (Pinelliae Rhizoma),
to warm and transform cold rheum and to calm panting
and suppress cough. An example of this use is xiǎo qīng
lóng tāng (Minor Green-Blue Dragon Decoction). Although má huáng is warm in nature, it can be used for
heat patterns such as exuberant lung heat with high fever
and rapid panting. For this, it is combined with shí gāo
(Gypsum Fibrosum), xìng rén (Armeniacae Semen), and
gān cǎo (Glycyrrhizae Radix), to clear the lung and calm
panting. This combination appears in the formula má
xìng shí gān tāng (Ephedra, Apricot Kernel, Gypsum, and
Licorice Decoction).
y Disinhibits water and disperses swelling: Water swelling
with concurrent exterior pattern.
Má huáng not only diffuses lung qì in the upper body;
it also regulates the waterways and thereby encourages
the movement of water down to the bladder. It is thus a
major lung-diffusing urine-disinhibiting medicinal. We
use it to treat wind evil assailing the exterior, impairing
lung diffusion and downbearing, and giving rise to water
swelling and inhibited urination with exterior signs. For
this purpose, we often combine it with shēng jiāng
(Zingiberis Rhizoma Recens) and bái zhú (Atractylodis
Macrocephalae Rhizoma).
Finally, the ability of má huáng to warm and dissipate
cold evil enables it to treat wind-damp impediment (bì)
pain, yīn flat-abscesses, and phlegm nodes, when it is be
appropriately combined with other medicinals.
DOSAGE AND METHOD OF USE
3–10 g in decoctions. Use raw to promote sweating and
resolve the exterior; use mix-fried with honey or raw to
diffuse the lung and calm panting. Honey moderates the
diaphoretic effect of má huáng and moistens the lung.
Note that it is traditionally believed that the nodes of má
huáng weaken its effect of promoting sweating.
Warning: Contraindicated for exterior vacuity spontaneous sweating, yīn vacuity night sweating, and panting and
cough due to the kidney failing to absorb qì. Má huáng
contains ephedrine, which stimulates the heart and central
nervous system, causes vasoconstriction, and raises blood
pressure. It should be used with care in patients suffering
from hypertension or insomnia. Má huáng should not be
used for weight loss. Misuse of má huáng has led to a
variety of legal restrictions on its sale and use in certain
areas.
1.1.2 桂枝 Guì Zhī
Cinnamomi Ramulus
English: cinnamon twig.
Latin Pharmaceutical: Cinnamomi Ramulus.
Source: Cinnamomum cassia Presl.
Nature and Flavor: Acrid, sweet; warm.
Channel Entry: Lung, heart, bladder.
ACTIONS AND INDICATIONS
y Promotes sweating and resolves the exterior: Common
cold due to external contraction of wind-cold, manifesting with headache, heat effusion, and aversion to cold.
Guì zhī has acrid-dissipating and warm-freeing qualities; it moves through the fleshy exterior. It is used for
external contraction of wind-cold taking the form of exterior vacuity with sweating, heat effusion, and aversion to
cold, in which sweating fails to resolve the exterior. For
this purpose, it is often combined with bái sháo (Paeoniae
Radix Alba) to harmonize construction and defense, as in
the formula guì zhī tāng (Cinnamon Twig Decoction).
Guì zhī can also be used for exterior repletion without
sweating, where its ability to harmonize construction and
free yáng assists the action of má huáng (Ephedrae Herba)
to promote sweating. This use is exemplified by the formula má huáng tāng (Ephedra Decoction).
y Warms and frees the channels: Patterns of congealing
cold and blood stasis; wind-cold-damp impediment (bì)
patterns.
By its acrid-dissipating and warm-freeing qualities, guì
zhī can warm and dissipate cold evil in the channels. Although it is not a blood-quickening medicinal, it does
enter the blood aspect, where it warms and dissipates
congealing cold in the vessels. It can also enhance the
stasis-transforming and pain-relieving action of other
medicinals. For this reason, it is often used for menstrual
irregularities, menstrual pain, for concretions and conglomerations (abdominal masses), as well as for postpartum abdominal pain in women when these stem from
contraction of cold evil entering the vessels. It can also
be used to enhance stasis-transforming medicinals in the
treatment of external injuries.
To treat wind-cold impediment, guì zhī is often combined with medicinals that dispel wind-damp and dissipate cold. This helps to free impediment and relieve pain.
In contrast to ròu guì (Cinnamomi Cortex), the bark of
the cinnamon tree, guì zhī, which consists of the twigs, is
an upfloating medicinal; thus, it is often used for impediment pain in the upper limbs. Guì zhī (Cinnamomi
Ramulus) is also effective for headache, abdominal pain,
and yīn flat-abscesses that are caused by interior cold due
to contraction of wind-cold in the vessels.
y Warms and assists yáng qì: All heart, spleen, and kidney
yáng vacuity patterns, including a) chest impediment due
to heart yáng vacuity, b) diarrhea and phlegm-rheum due
to spleen yáng vacuity, and c) inhibited urination and
water swelling due to kidney yáng vacuity.
Guì zhī treats devitalized heart yáng with heart vessel
stasis obstruction, giving rise to painful heart impediment.
It also treats devitalized heart yáng that deprives the heart
of warmth and nourishment, giving rise to heart palpitations and a bound or intermittent pulse. Such conditions
can be divided into blood stasis, congealing phlegm, and
debilitation of right qì. Depending on which of these is
present, guì zhī can be combined with either bloodquickening, phlegm-dispersing, or warming and supplementing medicinals.
Guì zhī treats insufficiency of spleen yáng with waterdamp collecting internally, manifesting in diarrhea or
phlegm-rheum. For this purpose, it is combined with
spleen-supplementing, damp-eliminating, and phlegmtransforming medicinals.
Finally, guì zhī also treats yáng vacuity and congealing
cold in the kidney and bladder with impaired qì transformation, characterized by inhibited urination and water
swelling. For this purpose, it is combined with medicinals that disinhibit urine such as fú líng (Poria) and zhū
líng (Polyporus). This combination appears in the formula wǔ líng sǎn (Poria Five Powder), which warms
yáng and promotes qì transformation, disinhibits urine,
and abates swelling.
DOSAGE AND METHOD OF USE
3–10 g in decoctions. Guì zhī is also occasionally used
externally; it is frequently found in liniments for knocks
and falls, such as liniments used for martial arts injuries.
Warning: Guì zhī is acrid and warm and enters construction-blood. It is contraindicated in internal repletion heat
patterns, yīn vacuity with effulgent fire, and frenetic
movement of hot blood. Use with care in pregnancy.
13.2.1 杏仁 Xìng Rén
Armeniacae Semen
English: apricot kernel.
Latin Pharmaceutical: Armeniacae Semen.
Source: Prunus armeniaca L., P. armeniaca L. var. ansu
Maxim., P. sibirica L., P. mandshurica (Maxim.) Koehne.
Nature and Flavor: Bitter; slighty warm; slightly toxic.
Channel Entry: Lung, large intestine.
ACTIONS AND INDICATIONS
y Suppresses cough and calms panting: Cough and panting.
Xìng rén primarily enters the lung channel. It is bitter
and downbearing and is coursing, opening, and freeing in
nature. It is an important medicinal for cough and panting
because it downbears and diffuses lung qì while suppressing cough and calming panting. It is used for a wide va-
riety of cough and panting patterns by combining it with
medicinals that match the presenting pattern.
y Wind-cold cough and panting due to: Combine with
má huáng (Ephedrae Herba) and gān cǎo (Glycyrrhizae
Radix).
yWind-heat cough: Combine with sāng yè (Mori Folium)
and jú huā (Chrysanthemi Flos).
y Cold phlegm cough with copious thin clear phlegm:
Combine with xì xīn (Asari Herba), bàn xià (Pinelliae
Rhizoma), and gān jiāng (Zingiberis Rhizoma).
y Lung heat cough: Combine with shí gāo (Gypsum Fibrosum).
y Dry cough with scant phlegm due to damage to the lung
from dryness evil: Combine with shā shēn (Adenophorae seu Glehniae Radix) and chuān bèi mǔ (Fritillariae
Cirrhosae Bulbus).
y Enduring cough and panting due to the kidney failing to
absorb qì: Combine with gé jiè (Gecko) and rén shēn
(Ginseng Radix).
y Moistens the intestines and frees the stool: Intestinal
dryness constipation.
Xìng rén is used here because it is oily and moist, and
its bitter flavor downbears qì. To treat intestinal dryness
with constipation, it is often used with medicinals such as
dāng guī (Angelicae Sinensis Radix), huǒ má rén (Cannabis Fructus), yù lǐ rén (Pruni Semen), and zhǐ qiào (ké)
(Aurantii Fructus).
DOSAGE AND METHOD OF USE
3–10 g in decoctions; it should be crushed prior to use.
Some sources indicate that it should be added near the
end of the decoction.
Warning: Xìng rén possesses slight toxicity and should
not be taken in excessive quantities. It should be used
with care in infants. It contains amygdalin, which produces hydrocyanic acid in the stomach and intestines. In
large quantities it can cause poisoning; hence its dosage
has to be controlled.
ASSOCIATED MEDICINAL
y Tián xìng rén 甜杏仁 Armeniacae Semen Dulce, sweet
apricot kernel: Source: Prunus armeniaca L. var. ansu
Maxim., P. armeniaca L. Sweet and balanced in nature.
It is more moistening than xìng rén and lacks toxicity. It
is mainly used to moisten the lung and suppress cough in
the treatment of vacuity taxation cough and panting.
Note that xìng rén is sometimes referred to as 苦杏仁 kǔ
xìng rén, Armeniacae Semen Amarum, bitter apricot kernel, to distinguish it from the sweet apricot kernel.
17.1.9 甘草 Gān Cǎo
Glycyrrhizae Radix
English: licorice [root]; also spelled liquorice [root].
Latin Pharmaceutical: Glycyrrhizae Radix.
Source: Glycyrrhiza uralensis Fisch., G. inflata Batal., G.
glabra L.
Nature and Flavor: Sweet; balanced. (Raw form is
slightly cold; mix-fried form is slightly warm.)
Channel Entry: Gān cǎo is said to enter all twelve primary channels, but texts often specifically list the heart,
lung, spleen, and stomach channels.
ACTIONS AND INDICATIONS
y Pain and hypertonicity (tension) in the stomach duct
and abdomen due to spleen-stomach vacuity cold:
Combine with guì zhī (Cinnamomi Ramulus), yí táng
(Maltosum), and bái sháo (Paeoniae Radix Alba), as in
the formula xiǎo jiàn zhōng tāng (Minor CenterFortifying Decoction). In recent years, this use of gān
cǎo has expanded to treat peptic ulcers. For this it is either taken alone as a powder, or else in combination
with wǎ léng zǐ (Arcae Concha) and hǎi piāo xiāo (Sepiae Endoconcha) in powder form or decoction.
y Hypertonicity and pain of the extremities that prevents
normal bending a stretching due to insufficiency of yīnblood depriving the sinews of nourishment: Combine
with bái sháo (Paeoniae Radix Alba), as in sháo yào
gān cǎo tāng (Peony and Licorice Decoction).
y Supplements heart and spleen qì: Spleen qì vacuity;
heart qì vacuity.
y Harmonizes the nature of medicinals: Used in formulas
containing drastic and fierce-natured medicinals.
y Spleen qì vacuity with fatigue, lack of strength, reduced
eating, and sloppy stool: Combine with medicinals such
as dǎng shēn (Codonopsis Radix) and bái zhú (Atractylodis Macrocephalae Rhizoma).
Gān cǎo is used to moderate the nature of harsh medicinals. It is often used to reduce the toxicity and side effects of other medicinals; it also harmonizes the spleen
and stomach.
y Heart qì vacuity with palpitations and/or an irregular
(bound or intermittent) pulse: Use gān cǎo as the primary medicinal and combine with rén shēn (Ginseng
Radix), ē jiāo (Asini Corii Colla), and guì zhī (Cinnamomi Ramulus), as in zhì gān cǎo tāng (Honey-Fried
Licorice Decoction).
y In tiáo wèi chéng qì tāng (Stomach-Regulating QìCoordinating Decoction), gān cǎo is used to moderate
the nature of dà huáng (Rhei Radix et Rhizoma) and
máng xiāo (Natrii Sulfas). This prevents their precipitating effect from being too fierce, and avoids irritation
to the large intestine and the abdominal pain this causes.
y Dispels phlegm and suppresses cough: Cough (and
panting) with copious phlegm.
y In bàn xià xiè xīn tāng (Pinellia Heart-Draining Decoction), gān cǎo is combined with gān jiāng (Zingiberis
Rhizoma), bàn xià (Pinelliae Rhizoma), huáng qín
(Scutellariae Radix), and huáng lián (Coptidis Rhizoma). This combination produces a by harmonizing effect by balancing upbearing and downbearing and harmonizing heat and cold.
Gān cǎo is used extensively to dispel phlegm and suppress cough. It is most suited to treating cough with copious phlegm. However, it can be used for any type of
cough, whether appearing in cold, heat, vacuity, or repletion patterns, with or without phlegm, provided it is appropriately combined with other medicinals. Furthermore,
it also has a slight panting-calming action.
yWind-cold cough: Combine with má huáng (Ephedrae
Herba) and xìng rén (Armeniacae Semen).
y Lung heat cough: Combine with shí gāo (Gypsum Fibrosum). These two medicinals are used with má huáng
(Ephedrae Herba) and xìng rén (Armeniacae Semen) in
the lung-heat–clearing formula má xìng shí gān tāng
(Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction).
y Cold phlegm cough: Combine with xì xīn (Asari Herba)
and gān jiāng (Zingiberis Rhizoma).
y Damp phlegm cough: Combine with bàn xià (Pinelliae
Rhizoma) and fú líng (Poria).
y Relaxes tension and relieves pain: Pain in the stomach
duct and abdomen; hypertonicity and pain of the extremities.
y Clears heat and resolves toxin: Heat toxin sores, painful
swollen throat, and poisoning from medicinals or food.
For heat toxin sores, combine gān cǎo with medicinals
such as jīn yín huā (Lonicerae Flos) and lián qiào (Forsythiae Fructus).
y Painful swollen throat: Combine with jié gěng (Platycodonis Radix).
y Poisoning from medicinals or food: Use alone or in
combination lǜ dòu (Phaseoli Radiati Semen) and hēi
dòu (Sojae Semen Atrum).
DOSAGE AND METHOD OF USE
3–10 g in decoctions. To clear heat and resolve toxin, the
slightly cold raw form should be used. To supplement
heart or spleen qì, to dispel phlegm and suppress cough,
to relax tention and relieve pain, the slightly warm mixfried form processed with honey, mix-fried gān cǎo
(Glycyrrhizae Radix), is preferred.
Warnings: Gān cǎo is not suitable in exuberant dampness with distention and fullness or when there is puffy
swelling. It is traditionally said to clash with dà jǐ (Euphorbiae seu Knoxiae Radix), yuán huā (Genkwa Flos),
gān suì (Kansui Radix), and hǎi zǎo (Sargassum). Prolonged consumption of large quantities of raw gān cǎo
can give rise to puffy swelling.
17.3.4 白芍 Bái Sháo
Paeoniae Radix Alba
Alternative Chinese Name: 白芍药 bái sháo yào
English: white peony [root].
Latin Pharmaceutical: Paeoniae Radix Alba.
Source: Paeonia lactiflora Pall.
y Calms liver yáng: Headache or dizziness due to hyperactivity of liver yáng.
For this purpose, combine with shēng dì huáng (Rehmanniae Radix), niú xī (Achyranthis Bidentatae Radix),
and shí jué míng (Haliotidis Concha).
y Constrains yīn and checks sweating: Yīn vacuity night
sweating; construction-defense (yíng-wèi) disharmony
with exterior vacuity and spontaneous sweating.
Bái sháo constrains yīn while harmonizing construction and checking sweating.
y Construction-defense disharmony (see under Clinical
concepts, Chapter 1, Exterior-Resolving Medicinals)
with exterior vacuity and spontaneous sweating: Combine with guì zhī (Cinnamomi Ramulus).
Channel Entry: Liver, spleen.
y Yīn vacuity night sweating: Combine with shēng dì
huáng (Rehmanniae Radix), mǔ lì (Ostreae Concha),
and fú xiǎo mài (Tritici Fructus Levis).
ACTIONS AND INDICATIONS
DOSAGE AND METHOD OF USE
Nature and Flavor: Bitter, sour, sweet; slightly cold.
y Nourishes the blood and regulates menstruation: Menstrual irregularities or flooding and spotting due to blood
vacuity or to yīn vacuity with heat.
y Menstrual irregularities or flood and spotting due to
blood vacuity: Combine with dāng guī (Angelicae
Sinensis Radix) and shú dì huáng (Rehmanniae Radix
Praeparata).
y Advanced menstruation (early periods), profuse bleeding, or incessant flooding and spotting due to yīn vacuity with heat: Combine bái sháo with ē jiāo (Asini Corii
Colla) and dì gǔ pí (Lycii Cortex).
y Emolliates the liver and relieves pain: Liver yīn vacuity,
liver depression, or hyperactivity of liver yáng.
Bái sháo is commonly used because it nourishes liver
yīn-blood and regulates liver qì while relaxing tension
and relieving pain. Note that “emolliating the liver” (also
called “softening the liver”) refers to nourishing liver yīnblood.
y Rib-side pain due to blood vacuity and liver depression:
Combine with dāng guī (Angelicae Sinensis Radix), bái
zhú (Atractylodis Macrocephalae Rhizoma), and chái
hú (Bupleuri Radix), as in xiāo yáo sǎn (Free Wanderer
Powder).
y Tension and pain in the stomach duct and abdomen due
to liver-spleen disharmony or hypertonicity of the extremieis due to blood vacuity: Combine with gān cǎo
(Glycyrrhizae Radix).
y Abdominal pain and diarrhea due to liver-spleen disharmony: Combine with fáng fēng (Saposhnikoviae
Radix) and bái zhú (Atractylodis Macrocephalae Rhizoma) as in tòng xiè yào fāng (Pain and Diarrhea Formula).
10–30 g in decoctions. The raw form is generally used to
calm the liver or constrain yīn, while the stir-fried or
wine-fried forms are preferred for nourishing the blood
and regulating menstruation.
Warning: Bái sháo is traditionally said to clash with lí lú
(Veratri Nigri Radix et Rhizoma).
1.1.14 细辛 Xì Xīn
Asari Herba
English: asarum.
Latin Pharmaceutical: Asari Herba.
Source:
Asarum heterotropoides Fr. Schmidt var.
mandshuricum (Maxim.) Kitag., A. sieboldii Miq. var.
seoulense Nakai, A. sieboldii Miq.
Nature and Flavor: Acrid; warm; mildly toxic.
Channel Entry: Lung, kidney, heart.
ACTIONS AND INDICATIONS
y Dispels wind and dissipates cold: Wind-cold patterns of
common cold; externally contracted disease with yáng
vacuity
Xì xīn dispels wind and dissipates cold; it both outthrusts the exterior and enters the interior. Hence it is
used for wind-cold patterns of common cold, with heat
effusion and aversion to cold, absence of sweating, headache and generalized pain, and a floating pulse. It is effective in this context because it enters the lung channel
to dissipate exterior wind-cold. Combine it with fáng
fēng (Saposhnikoviae Radix), qiāng huó (Notopterygii
Rhizoma et Radix), and bái zhǐ (Angelicae Dahuricae
Radix) for this purpose.
Xì xīn also enters the kidney channel to eliminate cold
evil from the interior. It is thus used to treat external contractions with yáng vacuity, manifesting with aversion to
cold, absence of sweating, heat effusion, and a deep pulse.
For this purpose, combine xì xīn with má huáng (Ephedrae Herba) and fù zǐ (Aconiti Radix Lateralis Praeparata),
as in the formula má huáng fù zǐ xì xīn tāng (Ephedra,
Aconite, and Asarum Decoction).
y Relieves pain: Headache, deep-source nasal congestion,
toothache, and impediment pain.
Xì xīn is acrid and aromatic, with a penetrating and
mobile nature. It dispels wind-cold, frees the nasal orifices, and relieves pain.
y Externally contracted wind evil with hemilateral or medial headache: Combine with chuān xiōng (Chuanxiong Rhizoma), qiāng huó (Notopterygii Rhizoma et
Radix), and bái zhǐ (Angelicae Dahuricae Radix). This
combination is present in the formula chuān xiōng chá
tiáo sǎn (Tea-Blended Chuanxiong Powder).
y Wind-cold headache with splitting pain and a slightly
stringlike or tight pulse: Combine with má huáng
(Ephedrae Herba), fù zǐ (Aconiti Radix Lateralis Praeparata), and chuān xiōng (Chuanxiong Rhizoma).
y Deep-source nasal congestion or nasal congestion and
runny nose due to wind evil invading the lung: Combine with xīn yí (Magnoliae Flos), cāng ěr zǐ (Xanthii
Fructus), and bái zhǐ (Angelicae Dahuricae Radix).
y Toothache from wind-cold is treated with a mouthwash
made from xì xīn, either decocted alone or in combination with bái zhǐ (Angelicae Dahuricae Radix) or bì bō
(Piperis Longi Fructus). If the toothache is due to
stomach heat, xì xīn is instead combined with huáng
lián (Coptidis Rhizoma), shí gāo (Gypsum Fibrosum),
and xià kū cǎo (Prunellae Spica). Lastly, we use xì xīn
for toothache due to tooth decay as well; for this purpose, it is combined with fēng fáng (Vespae Nidus).
y Wind-cold–damp impediment with cold pain in the
lumbus and knees: combine with sāng jì shēng (Taxilli
Herba), dú huó (Angelicae Pubescentis Radix), and
fáng fēng (Saposhnikoviae Radix).
y Warms the lung and transforms rheum: Cold phlegm
and collecting rheum with qì counterflow, panting, and
cough.
Xì xīn downbears qì and disperses phlegm, and also
warms the lung and transforms rheum. It is acrid and
dissipating, as well as warm and drying, and hence has
the ability to dissipate exterior cold. It is thus used to
treat external wind-cold with water-rheum collecting internally, which presents with panting, cough, and copious
thin clear phlegm. Here it is combined with má huáng
(Ephedrae Herba), guì zhī (Cinnamomi Ramulus), and
gān jiāng (Zingiberis Rhizoma), as in the formula xiǎo
qīng lóng tāng (Minor Green-Blue Dragon Decoction).
In the absence of any exterior evil, when qì counterflow with panting and cough results from pure cold
phlegm and collecting rheum shooting into the lung, xì
xīn should be combined with fú líng (Poria), gān jiāng
(Zingiberis Rhizoma), and wǔ wèi zǐ (Schisandrae Fructus).
yOpens the orifices: Malignity strike and phlegm reversal.
Because xì xīn is an acrid and aromatic medicinal with
a moving and penetrating nature, it has the actions of
“freeing the gate” (this refers to freeing the jaw), opening
the orifices, and arousing the spirit.
Xì xīn is used to treat malignity strike or phlegm reversal, with sudden clenching of the jaw and qì congestion,
clouding loss of consciousness, a white face and somber
white complexion, as well as for clenched jaw ascribed to
block patterns or other repletion patterns. Here it may be
used alone or in combination with zào jiǎo cì (Gleditsiae
Spina). For this application, a small quantity is ground
into a powder and blown into the nose.
DOSAGE AND METHOD OF USE
2–5 g in decoctions, 0.5–1 g in powders; also used externally. Classical sources indicate that the dosage of xì xīn
should not exceed 1 qián. One qián was about 3.7 grams
from the Tang Dynasty until the 1950s in China, and qián
measurements in Western countries and Chinese communities outside of the PRC continue to use the 3.7-gram
qián as the standard up to the present day. In the PRC, 1
qián is set at 3.125 g, so it is often rounded down to 3 g.
Thus, many sources indicate that the maximum dose of xì
xīn is 3 g.
Warning: Contraindicated in headache from yīn vacuity
and yáng hyperactivity, as well as in dry cough from lung
dryness with yīn damage. Xì xīn is clashes with the medicinal lí lú (Veratri Nigri Radix et Rhizoma).
Additionally, xì xīn contains aristolochic acid and has
therefore been banned for internal consumption in the
United States. It is still sold in the US for external use.
Xì xīn is traditionally an important medicinal in Chinese
medicine, and it is still used in China and Táiwān.
7.3 干姜 Gān Jiāng
Zingiberis Rhizoma
English: dried ginger.
Latin Pharmaceutical: Zingiberis Rhizoma.
Source: Zingiber officinale (Willd.) Rosc.
Nature and Flavor: Acrid; hot.
Channel Entry: Spleen, stomach, heart, lung.
ACTIONS AND INDICATIONS
y Warms the center and dissipates cold: Cold pain in the
stomach duct and abdomen, cold vomiting, and cold diarrhea.
Gān jiāng is an effective medicinal for warming the
center and dissipating cold, due to its acrid and hot nature.
It is a dry and harsh medicinal that fortifies the movement of spleen yáng.
y Stomach cold with vomiting and cold pain in the stomach duct and abdomen: Combine with gāo liáng jiāng
(Alpiniae Officinarum Rhizoma).
y Spleen-stomach vacuity cold with cold pain in the
stomach duct and abdomen, vomiting, and diarrhea:
Combine with dǎng shēn (Codonopsis Radix) and bái
zhú (Atractylodis Macrocephalae Rhizoma), as in the
formula lǐ zhōng wán (Center-Rectifying Pill).
y Returns yáng and frees the pulse: Yáng collapse.
The hot acrid nature of gān jiāng enables it to return
yáng and free the pulse. Hence it treats yáng collapse
with reverse flow and a faint pulse verging on expiration,
which is caused by heart and kidney yáng vacuity with
exuberance of internal yīn cold. Gān jiāng is always
combined with fù zǐ (Aconiti Radix Lateralis Praeparata)
for this purpose, as these two medicinals have a relationship of mutual need. This combination forms the basis of
the formula sì nì tāng (Counterflow Cold Decoction),
which is indicated for this pattern.
y Warms the lung and transforms rheum: Cough and
panting due to cold rheum, with fear of cold, a cold back,
and copious thin clear phlegm.
Gān jiāng warms the lung and transforms rheum because of its hot acridity. We combine it with xì xīn (Asari
Herba), wǔ wèi zǐ (Schisandrae Fructus), and má huáng
(Ephedrae Herba) for this purpose, as in the formula xiǎo
qīng lóng tāng (Minor Green-Blue Dragon Decoction).
DOSAGE AND METHOD OF USE
3–10 g taken as a decoction.
Warning: Gān jiāng is hot, acrid, dry and harsh; it is
contraindicated in frenetic movement of hot blood and in
yīn vacuity heat.
18.2.1 五味子 Wǔ Wèi Zǐ
Schisandrae Fructus
English: schisandra [berry]; also called Chinese schisandra [berry].
Latin Pharmaceutical: Schisandrae Fructus.
Source: Schisandra chinensis (Turcz.) Baill., S. sphenanthera Rehd. et Wils.
Nature and Flavor: Sour, sweet, astringent; warm.
Channel Entry: Lung, heart, kidney.
ACTIONS AND INDICATIONS
y Constrains the lung and enriches the kidney: Enduring
cough and vacuity panting.
Wǔ wèi zǐ contrains lung qì in the upper body and enriches kidney yīn in the lower body. It suitable for enduring cough due to lung vacuity, as well as for panting
and cough due to dual vacuity of the kidney and lung. It
treats these conditions because it is sour and astringent,
and warm yet moist. Therefore it constrains lung qì above
while enriching kidney yīn below.
y Panting and cough due to dual vacuity of the kidney
and lung: Combine with shān zhū yú (Corni Fructus),
shú dì huáng (Rehmanniae Radix Praeparata), and shān
yào (Dioscoreae Rhizoma).
y Enduring cough due to lung vacuity: Combine with
yīng sù qiào (ké) (Papaveris Pericarpium).
y Cough and panting due to cold rheum: Combine with
warm and acrid, dissipating and diffusing medicinals
such as má huáng (Ephedrae Herba), xì xīn (Asari
Herba), and gān jiāng (Zingiberis Rhizoma).
y Engenders liquid and constrains sweating: Dispersionthirst or thirst due to damage to liquid; spontaneous
sweating; night sweating.
Dispersion-thirst or thirst due to damage to liquid:
Wǔ wèi zǐ is used for these conditions because it is sour
and sweet. It boosts qì, engenders liquids, and allays
thirst.
y Thirst with profuse sweating and heat damaging qì and
yīn: Combine with rén shēn (Ginseng Radix) and mài
dōng (Ophiopogonis Radix), as in the formula shēng
mài sǎn (Pulse-Engendering Powder).
y Dispersion-thirst patterns with yīn vacuity and internal
heat, accompanied by thirst with increased fluid intake:
Combine with qì-boosting, liquid-engendering medicinals such as shān yào (Dioscoreae Rhizoma), zhī mǔ
(Anemarrhenae Rhizoma), tiān huā fěn (Trichosanthis
Radix), and huáng qí (Astragali Radix).
Spontaneous sweating and night sweating: Wǔ wèi zǐ
(Schisandrae Fructus) is used here because it checks
sweating and constrains the lung. In this application, we
combine it with mǔ lì (Ostreae Concha) and má huáng
gēn (Ephedrae Radix).
y Astringes essence and checks diarrhea: Seminal emission and seminal efflux; incessant enduring diarrhea.
Seminal emission and seminal efflux: Wǔ wèi zǐ treats
these conditions because it astringes essence and supplements the kidney. For seminal emission or seminal efflux
due to kidney insecurity, combine it with jīn yīng zǐ
(Rosae Laevigatae Fructus), sāng piāo xiāo (Mantidis
Ootheca), and mǔ lì (Ostreae Concha).
Incessant enduring diarrhea: Wǔ wèi zǐ is used here
because it astringes the intestines and checks diarrhea.
We use it to treat vacuity cold of the spleen and kidney
with incessant enduring diarrhea, combining it with bǔ gǔ
zhī (Psoraleae Fructus), ròu dòu kòu (Myristicae Semen),
and wú zhū yú (Evodiae Fructus); this combination makes
the formula sì shén wán (Four Spirits Pill).
y Quiets the heart and spirit:
palpitations, and insomnia.
Profuse dreaming, heart
Wǔ wèi zǐ is used here to supplement the heart and kidney while quieting the heart and spirit. It is most appropriate for patterns of disquieted heart spirit caused by
damage to or depletion of heart-kidney yīn-blood, manifesting in palpitations, insomnia, and profuse dreaming.
However, wǔ wèi zǐ may be used in the treatment of insomnia from any cause.
Modern applications: In recent years, ground wǔ wèi zǐ
has been used for the treatment of chronic hepatitis with
elevated aminotransferase levels.
DOSAGE AND METHOD OF USE
3–6 g in decoctions (crush first); or 1–3 g per dose as
powder. It should be stir-fried for supplementing, but
raw for treating cough.
Warning: Wǔ wèi zǐ is not suitable for patterns of unresolved evils in the exterior, for internal repletion heat, or
for initial-stage cough or measles.
13.1.1 半夏 Bàn Xià
Pinelliae Rhizoma
English: pinellia [rhizome].
Latin Pharmaceutical: Pinelliae Rhizoma.
Source: Pinellia ternata (Thunb.) Breit.
má (Gastrodiae Rhizoma), as in the formula bàn xià bái
zhú tiān má tāng (Pinellia, White Atractylodes, and
Gastrodia Decoction).
y Cold phlegm with panting, cough, and rapid breathing,
bàn xià is used with medicinals that warm the lung and
dissipate cold, such as gān jiāng (Zingiberis Rhizoma)
and xì xīn (Asari Herba); these medicinals appear together in the formula xiǎo qīng lóng tāng (Minor
Green-Blue Dragon Decoction).
yDownbears counterflow and checks vomiting: Vomiting.
Bàn xià is an important medicinal for checking vomiting because it downbears counterflow stomach qì. It is
frequently combined with shēng jiāng (Zingiberis Rhizoma Recens); shēng jiāng empowers bàn xià and bàn
xià fears shēng jiāng. When used together, their ability to
check vomiting is increased (empowering), and the toxicity of bàn xià is reduced (because bàn xià fears shēng
jiāng). Because bàn xià is warm and good at transforming phlegm, it is particularly suited to treating vomiting
due to phlegm-rheum or stomach cold. It may also be
used to treat stomach heat patterns of vomiting by combining it with medicinals that clear stomach heat, such as
huáng lián (Coptidis Rhizoma) and zhú rú (Bumbusae
Caulis in Taenia).
y Disperses swelling and relieves pain: Goiter, phlegm
nodes, flat- and welling-abscesses, poisonous snakebites
When taken internally, bàn xià can disperse phlegm
and dissipate binds; when used externally, it can attack
toxin with toxin, disperse swelling, and relieve pain. For
goiter or phlegm nodes, it is taken internally with zhè bèi
mǔ (Fritillariae Thunbergii Bulbus), kūn bù (Laminariae/Eckloniae Thallus), and hǎi zǎo (Sargassum). To
treat flat- and welling-abscesses or poisonous snakebites,
the raw form is powdered and applied externally.
Nature and Flavor: Acrid; warm; toxic.
SPECIFIC FORMS
Channel Entry: Spleen, stomach, lung.
The term zhì bàn xià, processed pinellia, refers to any
processed form of pinellia. Processing usually involves
maceration (long rinsing) and boiling with other agents,
notably bái fán (Alumen), which powerfully eliminates
its toxicity. The two most important processed forms are:
ACTIONS AND INDICATIONS
y Dries dampness and transforms phlegm: Cough and/or
panting due to damp phlegm and cold phlegm.
Bàn xià is an important medicinal for drying dampness
and transforming phlegm because it is acrid, warm, and
dry. It is able to warm and transform cold phlegm. It is
used to treat phlegm-damp patterns of the bowels and
viscera. Some textbooks also ascribe it a coughsuppressing action.
y Phlegm-damp obstructing the lung, manifesting in
cough with copious thin phlegm: Combine with chén
pí (Citri Reticulatae Pericarpium), as in the formula èr
chén tāng (Two Matured Ingredients Decoction).
Damp phlegm causing dizziness, it is combined with
bái zhú (Atractylodis Macrocephalae Rhizoma) and tiān
y Fǎ bàn xià 法半夏 Pinelliae Rhizoma Praeparatum,
pro formula pinellia (or standard pinellia) is the most
commonly used form. It is pinellia processed with gān
cǎo (Glycyrrhizae Radix) and other adjuvants. It is best
for drying dampness and harmonizing the stomach to
treat spleen vacuity with damp encumberance and spleenstomach disharmony.
y Jiāng bàn xià 姜 半 夏 Pinelliae Rhizoma cum
Zingibere Praeparatum, ginger pinellia is made by
boiling bàn xià in shēng jiāng zhī (Zingiberis Rhizomatis
Succus) and bái fán. It is best for downbearing counter-
flow to check vomiting in patients with vomiting due to
stomach cold.
y Qīng bàn xià 清半夏 Pinelliae Rhizoma cum Alumine
Praeparatum, alum pinellia made by soaking and boiling bàn xià with bái fán (Alumen). It less acrid and drying than raw bàn xià, and is often used to transform damp
phlegm in weak patients with copious phlegm or to treat
food stagnation and phlegm obstruction in children.
y Bàn xià qū 半夏曲 Pinelliae Massa Fermentata, pinellia leaven is made by soaking bàn xià and sun-drying it,
grinding it to a powder, mixing it with shēng jiāng zhī
(Zingiberis Rhizomatis Succus) and wheat flour, and then
allowing it to ferment before a final drying. Bàn xià qū is
used to transform dampness and fortify the spleen while
dispersing food and checking diarrhea. It is used for
weakness of the spleen and stomach with damp obstruction and food stagnation, accompanied by slimy tongue
fur and nausea and vomiting.
DOSAGE AND METHOD OF USE
3–10 g in decoctions. It is always processed before internal use, but it is used raw for external application (the
raw form is highly toxic).
Warning: Bàn xià is traditionally said to clash with aconite, i.e., chuān wū (Aconiti Radix), cǎo wū (Aconiti
Kusnezoffii Radix), and fù zǐ (Aconiti Radix Lateralis
Praeparata). Because it is warm and dry, it should be
used with care in yīn vacuity dry cough, bleeding patterns,
heat phlegm, and dryness-phlegm.
For this application, bò hé is often combined with jú
huā (Chrysanthemi Flos), jīng jiè (Schizonepetae Herba),
and sāng yè (Mori Folium).
y Disinhibits the throat:
wind-heat.
Painful swollen throat due to
In this application, bò hé is often combined with jié
gěng (Platycodonis Radix), jiāng cán (Bombyx Batryticatus) and jīng jiè (Schizonepetae Herba).
y Outthrusts papules: Initial-stage measles or wind-heat
fettering the fleshy exterior, with papular rash failing to
erupt.
Being light, buoyant, diffusing and dissipating, bò hé
is effective in promoting the eruption of measles rash.
For this purpose, it is commonly combined with chán tuì
(Cicadae Periostracum), jīng jiè (Schizonepetae Herba),
niú bàng zǐ (Arctii Fructus), and lián qiào (Forsythiae
Fructus). This combination can also be used for the itching of wind-papules (German measles).
y Courses the liver and moves qì: Liver qì depression,
with oppression in the chest and pain and distention in the
rib-side.
For this purpose, bò hé is often combined with bái
sháo (Paeoniae Radix Alba) and chái hú (Bupleuri Radix),
as in the formula xiāo yáo sǎn (Free Wanderer Powder).
The stems harmonize the center.
SPECIFIC PARTS
English: mint; also called field mint.
The leaf is best for promoting sweating and resolving the
exterior, while the stem is best for moving qì and harmonizing the center. Note that this medicinal refers to Chinese field mint, which is botanically distinct from peppermint; the two differ in their chemical constituents as
well.
Latin Pharmaceutical: Menthae Herba.
DOSAGE AND METHOD OF USE
Source: Mentha haplocalyx Briq.
2–10 g in decoctions.
Nature and Flavor: Acrid; cool.
Warning: Bò hé is aromatic, acrid and dissipating. It
causes sweating and wears qì. It is not suitable for constitutional vacuity with profuse sweating.
1.2.1 薄荷 Bò Hé
Menthae Herba
Channel Entry: Lung, liver.
ACTIONS AND INDICATIONS
y Dissipates wind-heat: Initial-stage external contraction
of wind-heat and warm disease, with headache, heat effusion, and slight aversion to cold.
Being clear, light, cool, and dissipating, bò hé resolves
wind-heat evil. It is used in cool acrid exterior-resolving
formulas, often in combination with heat-clearing toxinresolving medicinals such as jīng jiè (Schizonepetae
Herba), lián qiào (Forsythiae Fructus), and jīn yín huā
(Lonicerae Flos). An example formula is yín qiào sǎn
(Lonicera and Forsythia Powder).
y Clears and disinhibits the head and eyes: Headache and
red eyes due to wind-heat attacking upward.
1.1.6 荆芥 Jīng Jiè
Schizonepetae Herba
English: schizonepeta.
Latin Pharmaceutical: Schizonepetae Herba.
Source: Schizonepeta tenuifolia Briq.
Nature and Flavor: Acrid; slightly warm.
Channel Entry: Lung, liver.
ACTIONS AND INDICATIONS
y Dispels wind and resolves the exterior: Wind-cold and
wind-heat exterior patterns.
Jīng jiè is slightly warm in nature and has acrid dissipating and light floating qualities. It is therefore effective
in dispelling wind and resolving the exterior. Note that it
is the most balanced of all the medicinals that dissipate
wind-cold.
y Wind-cold exterior patterns: Combine with warm acrid
exterior-resolving medicinals such as fáng fēng
(Saposhnikoviae Radix) and qiāng huó (Notopterygii
Rhizoma et Radix), as in jīng fáng bài dú sǎn
(Schizonepeta and Saposhnikovia Toxin-Vanquishing
Powder).
y Wind-heat exterior patterns: Combine with cool acrid
exterior-resolving medicinals such as bò hé (Menthae
Herba) and jīn yín huā (Lonicerae Flos), as in yín qiào
sǎn (Lonicera and Forsythia Powder).
y Outthrusts papules and relieves itching: Measles failing
to erupt; itchy papular rash in rubella (German measles,
traditionally called “wind papules” in Chinese medicine).
Because of its light, floating, outthrusting, and dissipating qualities, jīng jiè dissipates the toxin of papules
while dispelling wind and relieving itching.
y Measles failing to erupt in children: Combine with chán
tuì (Cicadae Periostracum), bò hé (Menthae Herba), and
zǐ cǎo (Arnebiae/Lithospermi Radix).
y Itchy rash of German measles, as well as pain and itching of eczema: Combine with kǔ shēn (Sophorae Flavescentis Radix), fáng fēng (Saposhnikoviae Radix),
and chì sháo (Paeoniae Radix Rubra).
y Disperses sores: Initial-stage sores with concurrent
exterior patterns.
Jīng jiè disperses sores, while also dissipating wind
and resolving the exterior. Hence, it is used to treat initial-stage sores with exterior patterns, especially windcold exterior. For this purpose, combine it with qiāng
huó (Notopterygii Rhizoma et Radix), chuān xiōng
(Chuanxiong Rhizoma), and dú huó (Angelicae Pubescentis Radix). For wind-heat, it is combined with jīn yín
huā (Lonicerae Flos), lián qiào (Forsythiae Fructus), and
chái hú (Bupleuri Radix).
y Stanches bleeding (in the charred form):
patterns.
Bleeding
In its charred form, jīng jiè treats frenetic movement of
hot blood with vomiting of blood or nosebleed. For this
purpose, combine it with medicinals such as shēng dì
huáng (Rehmanniae Radix Exsiccata seu Recens) and cè
bǎi yè (Platycladi Cacumen).
y Bloody stool or bleeding hemorrhoids: Combine it with
dì yú (Sanguisorbae Radix), huái huā (Sophorae Flos),
and huáng qín (Scutellariae Radix).
y Flooding and spotting in women: Combine it with zōng
lǘ tàn (Trachycarpi Petiolus Carbonisatus) and xuè yú
tàn (Crinis Carbonisatus).
DOSAGE AND METHOD OF USE
3–10 g in decoctions. It should not be decocted for long.
Use raw to effuse the exterior and outthrust papules and
to disperse sores. Use stir-fried or char-fried to stanch
bleeding.
ASSOCIATED MEDICINAL
y Jīng jiè suì 荆芥穗 Schizonepetae Flos, schizonepeta
spike: Source: same as for jīng jiè. This has the same
actions as the whole herb, but has a stronger winddispelling action.
1.1.7 防风 Fáng Fēng
Saposhnikoviae Radix
English: saposhnikovia [root]; also called ledebouriella
[root] siler.
Latin Pharmaceutical: Saposhnikoviae Radix.
Source: Saposhnikovia divaricata (Turcz) Schischk.
Nature and Flavor: Acrid, sweet; slightly warm.
Channel Entry: Bladder, liver, spleen.
ACTIONS AND INDICATIONS
y Dispels wind and resolves the exterior: External contraction of wind-cold manifesting in headache, generalized pain, and aversion to cold.
Fáng fēng dissipates wind evil from the exterior and
relieves pain. We often combine it with jīng jiè
(Schizonepetae Herba), qiāng huó (Notopterygii Rhizoma
et Radix), and qián hú (Peucedani Radix), as in jīng fáng
bài dú sǎn (Schizonepeta and Saposhnikovia ToxinVanquishing Powder). Being only slightly warm, it can
also be used for external contraction of wind-heat.
y External contraction of wind-heat, with heat effusion,
headache, and red eyes: Combine with jīng jiè
(Schizonepetae Herba), huáng qín (Scutellariae Radix),
bò hé (Menthae Herba), and lián qiào (Forsythiae Fructus).
y Wind-heat with papular eruption or itchy skin: Combine
with jīng jiè (Schizonepetae Herba) and bái jí lí (Tribuli
Fructus).
y Overcomes dampness and relieves pain: Wind-colddamp impediment (bì), with hypertonicity of the limbs.
Fáng fēng dispels wind-cold and at the same time
overcomes dampness and relieves pain. Hence, it is effective for wind-cold-damp impediment (bì). For this
purpose, combine it with qiāng huó (Notopterygii Rhizoma et Radix) and dāng guī (Angelicae Sinensis Radix),
as in juān bì tāng (Impediment-Alleviating Decoction).
y Resolves tetany: Lockjaw, with arched-back rigidity
(opisthotonos), clenched jaw, and convulsions.
Fáng fēng enters the liver channel and has the effect of
dispelling wind and resolving tetany. For this purpose,
combine it with tiān nán xīng (Arisaematis Rhizoma), bái
fù zǐ (Typhonii Gigantei Rhizoma), and tiān má (Gastrodiae Rhizoma).
Fáng fēng is mostly used for external wind, but can be
used for internal wind as well. For example, we use it to
treat bloody stool in intestinal wind patterns, as well as
for impediment (bì) pain. Fáng fēng is also valuable because it is less drying than many other medicinals that
treat similar conditions.
Radix), xì xīn (Asari Herba), and chuān xiōng (Chuanxiong Rhizoma), as in the formula qiāng huó shèng shī
tāng (Notopterygium Dampness-Overcoming Decoction).
For external contraction of wind-heat giving rise to severe exterior patterns, with pronounced aversion to cold,
heat effusion, and generalized aching pain, qiāng huó can
be added to medicinals that dispel wind-heat and clear
heat to produce an effective wind-dispelling and painrelieving action.
y Dispels wind-damp and relieves pain: Wind-cold-damp
impediment (bì) patterns.
Additionally, fáng fēng is used in patterns of liver qì
exploiting the spleen or liver-stomach disharmony, manifesting in diarrhea with abdominal pain that is relieved by
defecation. For this, it is combined with chén pí (Citri
Reticulatae Pericarpium), bái sháo (Paeoniae Radix
Alba), and bái zhú (Atractylodis Macrocephalae Rhizoma)
as in tòng xiè yào fāng (Pain and Diarrhea Formula). Finally, it may be used with huáng qí (Astragali Radix) to
prevent invasion of external wind.
Qiāng huó is acrid, bitter, and warm. Acridity dispels
wind, bitterness dries dampness, and warmth dissipates
cold. Hence, it is effective for wind-cold-damp impediment (bì). For this purpose, we often combine it with
other wind-damp–dispelling medicinals. Because it enters the foot greater yáng (tài yáng) bladder channel, it is
particularly effective for eliminating signs associated
with the pathway such as headache and pain in the nape,
shoulder, and back.
DOSAGE AND METHOD OF USE
DOSAGE AND METHOD OF USE
3–10 g. Used in decoctions, medicinal wines, pills, and
powders. For bleeding, it may be charred before use.
3–12 g in decoctions.
Warning: Use with care in tetany that is due to blood
vacuity, and in yīn vacuity with effulgent fire.
Warning: Qiāng huó is very warm and drying. Use
with care in yīn-blood depletion and in internally exuberant dryness-heat.
1.1.8 羌活 Qiāng Huó
Notopterygii Rhizoma et Radix
1.1.9 白芷 Bái Zhǐ
Angelicae Dahuricae Radix
English: notopterygium [rhizome and root].
English: Dahurian angelica [root].
Latin Pharmaceutical: Notopterygii Rhizoma et Radix.
Latin Pharmaceutical: Angelicae Dahuricae Radix.
Source: Notopterygium incisum Ting ex H.T. Chang, N.
forbesii Boiss.
Nature and Flavor: Acrid, bitter; warm.
Source: Angelica dahurica (Fisch. Ex Hoffm.) Benth. et
Hook f., A. dahurica (Fisch. ex Hoffm.) Benth. et hook
f. var. formosana (Boiss.) Shan et Yuan.
Channel Entry: Bladder, kidney.
Nature and Flavor: Acrid; warm.
ACTIONS AND INDICATIONS
Channel Entry: Lung, stomach.
y Dissipates wind-cold: Common cold due to externally
contracted wind-cold, with headache and generalized
pain.
Qiāng huó is acrid and warm. Its qì is traditionally described as virile and harsh. Qiāng huó is an important
medicinal for treating wind-cold exterior patterns, and it
is hailed as an immortal medicine for out-of-season cases
of common cold.
Because it also has the power to overcome dampness
and relieve pain, it is especially useful for external contraction of wind-cold that is complicated by dampness.
This pattern presents with aversion to cold, heat effusion,
and pain and heaviness of the limbs. For this purpose, it
is commonly combined with medicinals that dispel wind
and relieve pain, such as fáng fēng (Saposhnikoviae
ACTIONS AND INDICATIONS
y Resolves the exterior and dissipates wind: External
contraction of wind-cold, with headache and nasal congestion.
Bái zhǐ dissipates wind-cold with the special effect of
relieving headache; hence, it is especially suited for
wind-cold with headache and nasal congestion. For this
purpose, it is combined with fáng fēng (Saposhnikoviae
Radix) and qiāng huó (Notopterygii Rhizoma et Radix).
y Dispels wind and relieves pain: Yáng brightness (yáng
míng) channel headache; eyebrow bone pain; head wind
headache; toothache; and deep-source nasal congestion
(paranasal sinusitis, chronic rhinitis).
Bái zhǐ is aromatic and reaches upward, while at the
same time dispelling wind and relieving pain. Thus, it is
used for pain in various parts of the head. For this purpose, we often combine it with chuān xiōng (Chuanxiong
Rhizoma) and fáng fēng (Saposhnikoviae Radix), as in
chuān xiōng chá tiáo sǎn (Tea-Blended Chuanxiong
Powder).
In particular, it is an important medicinal for deepsource nasal congestion, for which we combine it with
cāng ěr zǐ (Xanthii Fructus) and xīn yí (Magnoliae Flos),
as in cāng ěr zǐ sǎn (Xanthium Powder).
y Disperses swelling and expels pus:
sores; welling-abscesses.
Painful swollen
Bái zhǐ treats toxin swelling of sores and wellingabscesses.
y Before before the rupturing stage, combine bái zhǐ with
heat-clearing toxin-resolving medicinals such as jīn yín
huā (Lonicerae Flos) and tiān huā fěn (Trichosanthis
Radix) to disperse swelling.
y After pus has formed, combine it with qì-supplementing
and blood-nourishing medicinals, such as rén shēn
(Ginseng Radix), huáng qí (Astragali Radix), and dāng
guī (Angelicae Sinensis Radix), to express toxin and
expel pus.
y Swollen mammary welling-abscesses: Combine with
guā lóu (Trichosanthis Fructus), zhè bèi mǔ (Fritillariae
Thunbergii Bulbus), and pú gōng yīng (Taraxaci Herba)
to resolve toxin, dissipate binds, and disperse swelling.
Finally, bái zhǐ also has an itch-relieving action that
makes it suitable for topical application to itchy skin.
DOSAGE AND METHOD OF USE
3–10 g in decoctions. Also used externally.
Warning: Contraindicated in yīn vacuity with blood heat.
17.1.10 大枣 Dà Zǎo
Jujubae Fructus
Alternative Chinese Names: 红枣 hóng zǎo
English: jujube; also called Chinese date.
Latin Pharmaceutical: Jujubae Fructus.
Source: Ziziphus jujuba Mill.
Nature and Flavor: Sweet; warm.
lodis Macrocephalae Rhizoma) to strengthen its action of
supplementing the center and boosting qì.
y Nourishes blood and quiets the spirit: Blood vacuity
with withered-yellow complexion; visceral agitation;
disquieted spirit-mind.
y Blood vacuity with withered yellow complexion due to:
Combine with shú dì huáng (Rehmanniae Radix Praeparata) and ē jiāo (Asini Corii Colla).
y Visceral agitation or disquieted heart spirit: Combine
with gān cǎo (Glycyrrhizae Radix) and fú xiǎo mài
(Tritici Fructus Levis), as in the heart-nourishing spiritquieting formula gān mài dà zǎo tāng (Licorice, Wheat,
and Jujube Decoction).
y Harmonizes the nature of medicinals: Used in formulas
to reduce the harsh nature and side effects of drastic
medicinals while protecting right qì.
An example of this application is the formula shí zǎo
tāng (Ten Jujubes Decoction), which uses dà zǎo to protect the spleen and stomach, and to moderate the drastic
precipitating and toxic nature of the medicinals gān suì
(Kansui Radix), dà jǐ (Euphorbiae seu Knoxiae Radix),
and yuán huā (Genkwa Flos).
Additionally, dà zǎo is combined with shēng jiāng
(Zingiberis Rhizoma Recens) in exterior-resolving formulas to treat construction-defense qì disharmony (see
Clinical Concepts in Chapter 1, Exterior-Resolving
Medicinals). This combination is also used in supplementing formulas to regulate and supplement the spleen
and stomach. In both instances, the effect of treatment is
strengthened by using this combination.
In recent years, it has been reported that dà zǎo has a
positive effect on the treatment of allergic purpura.
SPECIFIC FORMS
Dà zǎo comes in two forms, red and black, depending on
the method of processing used.
y Hóng zǎo 红枣 Jujubae Fructus Rubrus, red jujube:
This product is deep red or maroon in color. It is the type
most commonly used for medicinal purposes in China. It
nourishes the heart.
y Hēi zǎo 黑枣 Jujubae Fructus Ater, black jujube: It
supplements the kidney. This type is more commonly
seen in the USA.
Channel Entry: Spleen, stomach.
DOSAGE AND METHOD OF USE
ACTIONS AND INDICATIONS
3–12 pieces or 10–30 g in decoctions. It may also be
pounded to a pulp after removing the skin and seeds for
use in making pills.
y Supplements the center and boosts qì: Spleen vacuity.
For spleen vacuity with reduced eating, sloppy stool,
fatigue, and lack of strength, dà zǎo is often combined
with dǎng shēn (Codonopsis Radix) and bái zhú (Atracty-
Warning: Dà zǎo fosters dampness and heat, and easily
causes center fullness. It is contraindicated in patients
suffering from distention and fullness in the stomach duct
and abdomen due to exuberant dampness, from food or
worm acumulations, from tooth decay, or from phlegmheat cough.
(Perillae Folium), chén pí (Citri Reticulatae Pericarpium),
and bàn xià (Pinelliae Rhizoma).
1.1.4 生姜 Shēng Jiāng
Zingiberis Rhizoma Recens
Finally, shēng jiāng resolves the toxin of bàn xià
(Pinelliae Rhizoma) and tiān nán xīng (Arisaematis Rhizoma), as well as that of contaminated fish and crabs.
English: fresh ginger [rhizome]
DOSAGE AND METHOD OF USE
Latin Pharmaceutical: Zingiberis Rhizoma Recens.
3–10 g in decoctions. Alternatively, use the juice extracted by crushing. Note that the dried form of ginger,
gān jiāng (Zingiberis Rhizoma), has different properties,
which are discussed in Chapter 7, Interior-Warming.
Source: Zingiber officinale (Wild.) Rosc.
Nature and Flavor: Acrid; warm.
Channel Entry: Lung, spleen, stomach.
ACTIONS AND INDICATIONS
y Promotes sweating and resolves the exterior: Common
cold due to external contraction of wind-cold.
Shēng jiāng promotes sweating and resolves the exterior, as well as dispelling wind and dissipating cold.
However, owing to the weakness of its action, it is suitable only for mild patterns. In China, where ginger is a
household item, it is often decocted at home with brown
sugar and scallion whites (cōng bái) for someone who
has a cold coming on. It can also be added to warm acrid
exterior-resolving formulas as a secondary medicinal to
enhance the action of promoting sweating and resolving
the exterior, as in guì zhī tāng (Cinnamon Twig Decoction).
y Warms the center and checks vomiting: Stomach cold
vomiting.
Shēng jiāng warms the stomach and dissipates cold
while harmonizing the center, downbearing counterflow,
and checking vomiting. For this reason, it is traditionally
said to be a “holy medicinal for patients suffering from
vomiting.”
y Stomach cold vomiting: Combine with bàn xià (Pinelliae Rhizoma).
y Stomach heat vomiting: Combine with huáng lián
(Coptidis Rhizoma) and zhú rú (Bambusae Caulis in
Taenia).
y Other medicinals used to treat vomiting are processed
with ginger juice to enhance their properties, e.g., ginger-processed bàn xià (Pinelliae Rhizoma) and gingerprocessed zhú rú (Bambusae Caulis in Taenia).
y Warms the lung and suppresses cough: Wind-cold
cough.
Owing to its acrid, warm, effusing, and dissipating
qualities, shēng jiāng warms the lung and dissipates cold
while transforming phlegm and suppressing cough.
Hence, it is also used to treat wind-cold settling in the
lung, which manifests in copious phlegm and cough with
aversion to cold and headache. For this purpose, we
combine it with xìng rén (Armeniacae Semen), zǐ sū yè
Warning: Shēng jiāng can damage yīn and assist fire; it
is therefore contraindicated in yīn vacuity with internal
heat.
ASSOCIATED MEDICINALS
y Shēng jiāng pí 生姜皮 Zingiberis Rhizomatis Cortex,
ginger skin: Source: same as for shēng jiāng. Acrid in
flavor and cool in nature. Harmonizes the spleen, moves
water, and disperses swelling. Used to treat water swelling and inhibited urination. Dosage: 3–10 g in decoctions.
y Shēng jiāng zhī 生姜汁 Zingiberis Rhizomatis Succus,
ginger juice: Has the same actions as shēng jiāng, but is
better for transforming phlegm and checking vomiting.
Being readily available and easy to use, it is particularly
suitable for treating poisoning from consumption of tiān
nán xīng (Arisaematis Rhizoma) and bàn xià (Pinelliae
Rhizoma), manifesting in painful, numb, swollen throat
and tongue and incessant vomiting that prevents the patient from eating. For these uses, it can be mixed with
water and swallowed easily. It can furthermore be combined with zhú lì (Bambusae Succus) and poured down
the throat or administered by nasal feed in the treatment
of phlegm-heat wind strike (stroke) with clouded spirit.
Dosage: 3–10 g, mixed with water.
Chuān Xiōng Chá Tiáo Sǎn (川芎茶调散 Tea-Blended Chuanxiong Powder)
Source: Tài Píng Huì Mín Hé Jì Jú Fāng (Tài-Píng Imperial Grace Pharmacy Formulas).
Ingredients
y Bò hé (薄荷 mint, Menthae Herba) (never sees fire) 8 liǎng/240 g.
y Chuān xiōng (川芎 chuanxiong, Chuanxiong Rhizoma) 4 liǎng/120 g.
y Jīng jiè (荆芥 schizonepeta, Schizonepetae Herba) (stem removed) 4 liǎng/120 g.
y Xì xīn (细辛 asarum, Asari Herba)(remove skin and tips) (neck removed) 1 liǎng/30 g.
y Fáng fēng (防风 saposhnikovia, Saposhnikoviae Radix) (neck removed) 1.5 liǎng/45 g.
y Bái zhǐ (白芷 Dahurian angelica, Angelicae Dahuricae Radix) 2 liǎng/60 g.
y Qiāng huó (羌活 notopterygium, Notopterygii Rhizoma et Radix) 2 liǎng/60 g.
y Zhì gān cǎo (炙甘草 mix-fried licorice, Glycyrrhizae Radix cum Liquido Fricta) 2
liǎng/60 g.
Original Method: Grind the above ingredients to a fine powder. Take 2 qian (6 g) per
dose after meals with tea. The modern method is to take two 6-gram doses daily with tea,
though it can also be made into a decoction if the dosage for making a large batch of
powder is reduced.
Actions: Courses wind and relieves pain.
Indications: Externally contracted wind evil with headache. There may also be neck
pain, dizziness, and nasal congestion, or aversion to wind with heat effusion. Tongue:
thin and white. Pulse: floating.
Warning: Headache can have many causes, both external or internal. This formula is not
suitable for headache due to qi vacuity or blood vacuity, as well as liver-kidney yin
vacuity with ascendant hyperactivity of liver yang or internal stirring of liver wind.
ADDITIONAL DISCUSSION
There is some debate as to the medicinal roles in this formula. Some practitioners
emphasize the preponderance of warm, acrid wind-coursing medicinals and state that the
formula is best for wind-cold headache. Reflecting this view, the formula books of the
official Chinese curriculum from 1974–1979 stated that chuān xiōng (Chuanxiong
Rhizoma), bái zhǐ (Angelicae Dahuricae Radix), and qiāng huó (Notopterygii Rhizoma et
Radix) were the sovereign medicinals. These medicinals course wind and relieve pain.
Chuān xiōng treats lesser yang and reverting yin headache; qiāng huó treats greater yang
headache; bái zhǐ treats yang brightness headache.
Others take the view that the large doses of bò hé (Menthae Herba) used in the
source text indicate that the formula is best for wind-heat headache, and bò hé is the
sovereign. This is also supported by the fact that the formula is taken with tea, which is
bitter and cold. In the words of Wāng Áng, a 17th century commentator, the tea “upbears
and dissipates wind-heat”; Wāng also states that “bò hé and jīng jiè disperse wind-heat,
clear and disinhibit the head and eyes, and are therefore the sovereigns; they move
upward to raise clear yang and dissipate depressed fire…tea can rise to clear the head and
eyes.”
The different perspectives on sovereigns and ministers can be attributed to a
different emphasis on whether the formula primarily relieves pain or primarily resolves
the exterior. However, there seems to be common agreement that gān cǎo and tea are
both assistants and couriers. Gān cǎo harmonizes the other medicinals, while tea’s bitter,
cold, and downbearing nature clears the upper body. This controls the warm, drying,
upbearing and dissipating nature of the other medicinals, so that within the upbearing
there is also downbearing.
This formula differs from most exterior-resolving formulas in that it emphasizes
medicinals that dispel wind and relieve pain. It treats wind evil when headache is the
primary symptom; although typical signs of an exterior pattern can be seen, the formula
is not a typical exterior-resolving formula.
According to one traditional source, the powder was to be taken with cōng bái
(Allii Fistulosi Bulbus) and green tea; the juice from the cōng bái was applied to the point
tai yang to eliminate severe pain. Ground pò xiāo (朴硝 impure mirabilite, Natrii Sulfas
Non-Purus) was also used by insufflating it into the nose. For left-sided headache,
insufflate into the right side, for left-sided headache, insufflate into the left side.
The addition of jiāng cán (Bombyx Batryticatus) and jú huā (Chrysanthemi Flos)
to the base formula creates the formula jú huā chá tiáo sǎn (Tea-Blended
Chrysanthemum Powder). These additions control the warm dry nature of the acridwarm substances, and the new formula is especially suitable for dissipating wind-heat
and clearing the head and eyes.
Guì Zhī Tāng (桂枝汤 Cinnamon Twig Decoction)
Source: Shāng Hán Lùn (On Cold Damage).
Ingredients
y Guì zhī (桂枝 Cinnamomi Ramulus, cinnamon twig) (skin removed) 3 liǎng/9 g
y Sháo yào (芍药 Paeoniae Radix, peony) 3 liǎng/9 g
y Gān cǎo (甘草 Glycyrrhizae Radix, licorice) 2 liǎng/6 g
y Shēng jiāng (生姜 fresh ginger, Zingiberis Rhizoma Recens) 3 liǎng/9 g
y Dà zǎo (大枣 jujube, Jujubae Fructus) 12 pieces/4 pieces
Original Method: [For] the preceding five ingredients, break the [first] three ingredients
into small pieces and use seven shēng of water. Boil over a mild flame to get three shēng
and remove the dregs. Take one shēng, warm or cold.
Immediately after taking [the first dose] drink approximately one shēng of hot,
thin gruel to reinforce the strength of the medicinals. Warm [the body] by covering [with
a blanket] for a short period, until the whole body is moist, as if sweating very lightly.
This is auspicious. One cannot allow [the sweat] to flow like water, since the disease will
not be eliminated.
If one dose [causes] sweating and the disease is diminished, cease taking further
[doses]. One need not finish the whole packet. If there is no sweating, take another dose
according to the previous method. If there is again no sweating, reduce the time between
doses, finishing three doses in half a day.
If the disease is severe, take [doses] throughout the whole day, continue to
evaluate and after finishing one packet [if] the disease signs are still evident, take again.
If there is no sweating, one can take up to two or three packets.
Foods contraindicated [while taking the formula] include raw and cold foods,
sticky and slimy foods, meat and noodles, the five acrids, products made from animal
milk and liquor and foods with a peculiar or spoiled flavor or odor.
Actions: Resolves the flesh and effuses the exterior, harmonizes construction and
defense.
Indications: External contraction of wind-cold with exterior vacuity and disharmony of
construction and defense. This pattern is characterized by headache, heat effusion,
aversion to wind, and sweating, possibly accompanied by “noisy nose” (nasal congestion
with audible breathing), absence of thirst, and/or dry retching.
Tongue: White tongue fur.
Pulse: floating and moderate or floating and weak.
PATHOMECHANISM
In this disease, wind-cold fetters the exterior and the exuberant defensive yang floats to
the exterior. The struggle between the exuberant defensive yang and the exterior evil
produces heat effusion. The defensive exterior is not secure and the construction cannot
be contained, indicating a loss of harmony between construction and defense, which
results in aversion to wind and cold.
The construction cannot be contained, sweat effuses and the nourishment
normally provided by the construction qi is lost or diminished. This loss of nourishment
results in stiffness and pain. The evil may dry the lung and/or stomach. If the evil attacks
the lung, the lung qi will become inhibited, resulting in cough. If the evil attacks the
stomach, the qi will counterflow ascend, resulting in retching.
FORMULA BREAKDOWN
y Guì zhī is the sovereign; it resolves exterior wind and cold from the fleshy exterior and
interstices.
y Bái sháo is the minister; its sour cold nature contracts and penetrates the constructionyin. Its combination with guì zhī allows construction and defense to be harmonized;
this is an emergent new action that results from the combination of these two medicinals.
y Shēng jiāng assists guì zhī in resolving the exterior, and also downbears counterflow
and checks retching, which is useful when exterior evil impairs stomach function.
y Dà zǎo boosts the center and assists bái sháo in boosting yin and harmonizing
construction. The combination of dà zǎo and shēng jiāng supplements the spleen and
stomach, and the two are assistants in the formula.
y Zhì gān cǎo is said to be both an assistant and a courier. It harmonizes the nature of the
other medicinals and is said to help guì zhī to transform yang while simultaneously
helping bái sháo to transform yin.
ADDITIONAL DISCUSSION
Construction and Defense Disharmony: Under normal physiologic conditions, defense qi
moves outside the vessels and secures and protects the fleshy exterior. Construction-yin
stays inside and provides nourishment to defense yang, and construction and defense are
in harmony.
In the pathologic state addressed by guì zhī tāng (Cinnamon Twig Decoction),
vacuity of defense qi causes the interstices to be loose. Defense yang cannot secure and
protect the fleshy exterior, so there is aversion to cold. Construction-yin cannot stay in
the inner body and discharges outward, causing sweating. The combination of guì zhī
(Cinnamomi Ramulus) and bái sháo (Paeoniae Radix Alba) both dissipates and contracts.
This allows evil to be dispelled without damaging right while simultaneously nourishing
yin without lodging evil.
This formula is said to “transform qi and regulate yin and yang,” and it is used for
miscellaneous diseases in internal medicine that are ascribed to disharmony of yin and
yang, construction and defense, or qi and blood. It is especially suitable for conditions
following illness or childbirth, or for generalized weakness when the chief manifestations
are aversion to wind and sweating.
Within the original Shang Han Lun, there are uses of guì zhī tāng (Cinnamon
Twig Decoction) that do not manifest with greater yang wind-strike. For example, it is
mentioned for patients with periodic heat effusion and spontatneous sweating, in the
absence of other visceral diseases. Here, it is taken prior to the onset of heat effusion to
harmonize construction and defense.
Guì zhī tāng (Cinnamon Twig Decoction) is contraindicated in patients with
greater yang cold damage signs. Because it is too mild in comparison with má huáng
tāng (Ephedra Decoction), one will miss the best opportunity for dispelling evil.
Guì zhī tāng (Cinnamon Twig Decoction) is also contraindicated in interior
damp-heat patterns. This is alluded to in the Shang Han Lun in a discussion of its
adverse effects on “sick drinkers.” Because the formula is acrid and sweet, and acrid
flavors reinforce heat and sweet flavors reinforce dampness, there is a general caution
against the use of guì zhī tāng in the interior damp-heat conditions. The original meaning
of the phrase “sick drinkers” (jiǔ kè bìng 酒客病) is unclear, it may refer either to a
disease name (drinker’s sickness, i.e., alcoholism) or to a drinker (jiǔ kè) who is sick. If
it refers to the latter, it is unclear whether they are sick with greater yang wind-strike or
sick from drinking. The Yi Zong Jin Jian (Golden Mirror of Orthodox Medicine)
suggests the latter, while the scholar Wèi Lì-Tóng, also in the Qing Dynasty, suggests the
former.
Guì zhī tāng (Cinnamon Twig Decoction) is also inappropriate for patients with
exuberant interior heat, as well as in greater yang disease that has been erroneously
treated with purging and no exterior signs remain present.
The addition of gé gēn (Puerariae Radix) to this formula modifies it to treat
hypertonicity in the nape and back. This is a pattern of simultaneous greater yang wind
strike and constrained greater yang channel qi. The fluids are damaged and cannot
moisten and nourish the channels normally. The formula used here is guì zhī jiā gé gēn
tāng (Cinnamon Twig Decoction Plus Pueraria), which has been the subject of debate for
centuries.
In the original text, the formula listed contains má huáng (Ephedrae Herba) as
well as gé gēn (Puerariae Radix), making it essentially the same formula as gé gēn tāng
(Pueraria Decoction). However, at least as far back as the Song Dynasty, scholars have
debated whether má huáng was intended to be in this formula, or whether a mix-up had
occurred.
CLINICAL MODIFICATIONS
For marked insufficiency of defense yang with prominent aversion to cold, increase the
quantity of guì zhī and gān cǎo, or add fù zǐ (Aconiti Radix Lateralis Praeparata).
For incessant leaking sweat in cases of relatively severe defense qi vacuity, add
huáng qí (Astragali Radix) and bái zhú (Atractylodis Macrocephalae Rhizoma).
For profuse sweating and a thin pulse from weakness of construction, increase the
dose of bái sháo and gān cǎo.
Gé Gēn Tāng (葛根汤 Pueraria Decoction)
Source: Shāng Hán Lùn (On Cold Damage).
Ingredients
y Gé gēn (葛根 pueraria, Puerariae Radix) 4 liǎng
y Má huáng (麻黄 ephedra, Ephedrae Herba) (remove nodes) 3 liǎng
y Guì zhī (桂枝 Cinnamomi Ramulus, cinnamon twig) (bark removed) 2 liǎng
y Sháo yào (芍药 Paeoniae Radix, peony) 2 liǎng
y Zhì gān cǎo (炙甘草 mix-fried licorice, Glycyrrhizae Radix cum Liquido Fricta) 2
liǎng
y Shēng jiāng (生姜 fresh ginger, Zingiberis Rhizoma Recens) (slice) 3 liǎng
y Dà zǎo (大枣 jujube, Jujubae Fructus) 12 pieces
Original Method: [For] the above seven ingredients, use one dou of water. First boil gé
gēn and má huáng to reduce [the water] by two sheng. Remove the white foam and add
all the ingredients. Boil to get three sheng, remove the dregs and take one sheng, warm.
Take, [as necessary], to obtain mild sweating. The rest of the directions are the same as
for guì zhī tāng including the contraindications. In fact, all formulae based on guì zhī tāng
should be used according to this method.
Actions: Promotes sweating and resolves the exterior, engenders liquid and soothes the
channels.
Indications: Greater yang (tai yang) disease with “stretched stiff nape and back,”
absence of sweating, and aversion to wind. Stretched stiff nape and back refers to
hypertonicity of the neck and back and discomfort when looking up and down, as if the
neck were forcefully stretched, a condition that is considered more severe than simple
stiffness and pain in the neck).
Gé gēn tāng is also used for greater yang (tai yang) and yang brightness (yang
ming) combination disease, manifesting with diarrhea. The original text describes this as
“spontaneous diarrhea,” meaning that it is diarrhea that occurs without any known natural
or iatrogenic cause (such as inappropriate purging). This pattern is one of simultaneous
disease in the interior and exterior, with the exterior aspect being the most significant.
According to the Zhong Yi Yao Chang Yong Ming Ci Shu Yu Ci Dian, this
formula is also indicated for greater yang (tai yang) disease with absence of sweating,
scant urination, upward surging of qi into the chest, and clenched jaw preventing speech,
verging on hard tetany. Hard tetany is a pattern characterized by heat effusion, absence
of sweating, aversion to cold, rigidity of the neck, clenched jaw, and hypertonicity or
convulsions of the extremities (in severe cases, arched-back rigidity), and a tight
stringlike pulse.
SHANG HAN LUN COMMENTARY
The author tells us that this is greater yang disease, but does not explicitly state if it is
wind strike or cold damage. No sweating is indicative of cold damage, but aversion to
wind is more indicative of wind strike. Generally, in these situations, one must look at the
formula and work backwards. One can better understand a poorly described disease
pattern by looking at the prescribed treatment.
This formula is guì zhī tāng (Cinnamon Twig Decoction) plus má huáng
(Ephedrae Herba) and gé gēn (Puerariae Radix). The addition of má huáng promotes
sweating and dispels evil. It is this addition which tells the reader that this pattern belongs
to cold damage. Sweet and balanced gé gēn engenders liquid and soothes the channels. It
is able to raise clear yang qi and check diarrhea. It also reinforces the action of má huáng
and guì zhī in promoting sweating and resolving the exterior.
One may ask why a formula based on guì zhī tāng (Cinnamon Twig Decoction) is
chosen if this is greater yang cold damage. The answer sheds light on the author’s view
of the pathomechanism and his therapeutic approach. We already know that in cold
damage, wind-cold evil fetters the exterior, resulting in the depression and stagnation of
the construction and defense. In this pattern, normal diffusion of fluids through the
greater yang channel may be impaired. The fluids are insufficient to moisten and nourish
the channel; hence stiffness and discomfort are felt in the nape and back along the
channel pathway. In choosing a formula, one must be aware that although the exterior
must be resolved, normal fluid movement has already been disrupted and normal
moistening along the channel has been lost. Therefore, it is wise to promote sweating
moderately, not harshly and to harmonize construction and defense with guì zhī tāng
(Cinnamon Twig Decoction). Nevertheless, no sweating is observed, so má huáng is also
given, as in other cold damage situations. As above, gé gēn has the important action of
engendering fluids and raising the clear qi from the lower burner. In this way, it soothes
the channels that have been deprived of fluid nourishment.
Cōng Chǐ Tāng (葱豉汤 Scallion and Fermented Soybean Decoction)
Source: 肘后备急方 Zhǒu Hòu Bèi Jí Fāng (Emergency Standby Remedies), by Gě
Hóng in the Jìn Dynasty (281–341).
Ingredients
y Cōng bái (葱白 scallion white, Allii Fistulosi Bulbus) 1 handful
y Dàn dòu chǐ (淡豆豉 fermented soybean, Sojae Semen Praeparatum) 1 sheng
Original Method: Boil the formula and take it as a single dose. If there is no sweating
after taking the decoction, add 2 liǎng of gé gēn (Puerariae Radix) and 3 liǎng of shēng
má (Cimicifugae Rhizoma). Boil these and take it in two divided doses. If sweating is
still not produced, add 2 liǎng of má huáng (Ephedrae Herba).
Actions: Frees yang and resolves the exterior.
Indications: Initial stages of cold damage (first two days), with headache, heat in the
flesh, and a surging pulse.
COMMENTARY
In this formula, the acrid and warming nature of cōng bái is used to free yang and course
the fleshy exterior to dissipate exterior cold. The acrid and sweet nature of dàn dòu chǐ
diffuses and dissipates to resolve the exterior. Together, they form a mild formula that
promotes sweating and resolves the exterior.
Cāng Ěr Zǐ Sǎn (苍耳子散 Xanthium Powder)
Source: 济生方 Jì Shēng Fāng (Life-Saving Formulas).
Ingredients
y Cāng ěr zǐ (苍耳子 xanthium, Xanthii Fructus) 2.5 qián/7.5 g
y Xīn yí (辛夷 magnolia flower, Magnoliae Flos) ½ liǎng/15 g
y Bái zhǐ (白芷 Dahurian angelica, Angelicae Dahuricae Radix) 1 liǎng/30 g
y Bò hé (薄荷 mint, Menthae Herba) ½ qián/1.5 g
Original Method: Grind and take as a powder, 2 qián per dose, taken after meals with
green tea.
Actions: Dispels wind and clears heat, frees the orifice of the nose.
Indications: Deep source nasal congestion (bi yuan). There may be nasal congestion
and loss of the sense of smell, incessant turbid nasal mucus, and frontal headache.
COMMENTARY
This formula treats wind-heat deep source nasal congestion, but headache is a common
symptom. Therefore, the formula aromatically opens the orifice (of the nose) and
primarily dispels wind and dissipates heat. Paradoxically, other sources indicate that the
powder is taken with cōng (scallions) and green tea, and the formula disperses wind-cold
while freeing the orifice of the nose. Some texts treat this formula as a derivative of
chuān xiōng chá tiáo sǎn (Tea-Blended Chuanxiong Powder).
Xīn Yí Sǎn (辛夷散 Officinal Magnolia Flower Powder)
Source: 济生方 Jì Shēng Fāng (Life-Saving Formulas).
Ingredients
y Xīn yí (辛夷 magnolia flower, Magnoliae Flos) ½ liǎng
y Xì xīn (细辛 asarum, Asari Herba)
y Gǎo běn (藁本 Chinese lovage, Ligustici Rhizoma)
y Shēng má (升麻 cimicifuga, Cimicifugae Rhizoma)
y Chuān xiōng (川芎 chuanxiong, Chuanxiong Rhizoma)
y Mù tōng (木通 akebia, Akebiae Caulis)
y Fáng fēng (防风 saposhnikovia, Saposhnikoviae Radix)
y Qiāng huó (羌活 notopterygium, Notopterygii Rhizoma et Radix)
y Bái zhǐ (白芷 Dahurian angelica, Angelicae Dahuricae Radix)
y Zhì gān cǎo (炙甘草 mix-fried licorice, Glycyrrhizae Radix cum Liquido Fricta)
Original Method: Use equal parts of the above ingredients; grind and take as a powder,
2 qián per dose, taken after meals with tea.
Indications: Lung vacuity with contraction of wind, cold, damp, and/or heat, causing
nasal congestion and incessant runny nose, possibly with obstructed breathing and loss of
smell.
COMMENTARY
This formula is not mentioned in many mainstream Chinese formula textbooks. Even in
the context of ENT textbooks, the primary xīn yí-named formulas involve different
recipes- one contains xīn yí (Magnoliae Flos), xì xīn (Asari Herba), huā jiāo (Zanthoxyli
Pericarpium), gān jiāng (Zingiberis Rhizoma), chuān xiōng (Chuanxiong Rhizoma), wú
zhū yú (Evodiae Fructus), fù zǐ (Aconiti Radix Lateralis Praeparata), zào jiǎ (Gleditsiae
Fructus), and ròu guì (Cinnamomi Cortex).
The other is the more commonly used xīn yí qīng fèi tāng (Officinal Magnolia
Flower Lung-Clearing Decoction), which contains xīn yí (Magnoliae Flos), gān cǎo
(Glycyrrhizae Radix), shí gāo (Gypsum Fibrosum), zhī mǔ (Anemarrhenae Rhizoma), zhī
zǐ (Gardeniae Fructus), huáng qín (Scutellariae Radix), pí pá yè (Eriobotryae Folium),
shēng má (Cimicifugae Rhizoma), bǎi hé (Lilii Bulbus), and mài dōng (Ophiopogonis
Radix). This latter formula has a stronger heat-clearing and yin-protecting effect.
Xiāng Sū Sǎn (香苏散 Cyperus and Perilla Powder)
Source: Tài Píng Huì Mín Hé Jì Jú Fāng (Tài-Píng Imperial Grace Pharmacy Formulas).
Ingredients
y Xiāng fù zǐ (香附子 cyperus, Cyperi Rhizoma) (hairs removed, stir-fried till fragrant) 4
liǎng/120 g
y Zǐ sū yè (紫苏叶 perilla leaf, Perillae Folium) 4 liǎng/120 g
y Zhì gān cǎo (炙甘草 mix-fried licorice, Glycyrrhizae Radix cum Liquido Fricta) 1
liǎng/30 g
y Chén pí ( 陈 皮 tangerine peel, Citri Reticulatae Pericarpium) (retain the white) 2
liǎng/60 g
Original Method: Grind, take 3 qián (9 g) per dose. Boil it in one sheng of water until
it is reduced by 30%, remove the foam, take it hot at any time of day, 3 times per day.
Modern usage is simple decoction with a reduction in dosage.
Actions: Courses and dissipates wind-cold, rectifies qi and harmonizes the center.
Indications: Externally contracted wind-cold with qi depression. There may be aversion
to cold but generalized heat effusion, headache and absence of sweating, oppression in
the chest and stomach duct, no thought of food or drink.
Tongue: Thin white coat.
Pulse: Floating.
COMMENTARY
This formula treats an exterior pattern with concurrent qi stagnation. The aversion to
cold and heat effusion, headache and absence of sweating are typical exterior signs, while
the oppression in the chest and stomach duct, and no thought of food or drink signify qi
depression or damp stagnation. Because the tongue is thin white but not greasy, this
suggests that there is only qi depression present.
C OOL ACRID E XTERIOR R ESOLVING F ORMULAS
Sāng Jú Yǐn (桑菊饮 Mulberry Leaf and Chrysanthemum Beverage)
Source: Wēn Bìng Tiáo Bian (Systematized Identification of Warm Diseases). [1798 CE]
Ingredients
y sāng yè (桑叶 mulberry leaf, Mori Folium) 2.5 qián
(7.5 g)
y jú huā (菊花 chrysanthemum, Chrysanthemi Flos) 1
qián (3 g)
y xìng rén (杏仁 apricot kernel, Armeniacae Semen) 1
qián (6 g)
y lián qiáo (连翘 forsythia, Forsythiae Fructus) 1.5 qián
(4.5 g)
y bò hé (薄荷 mint, Menthae Herba) 8 fēn (2.5 g)
y jié gěng (桔梗 platycodon, Platycodonis Radix) 2 qián
(6 g)
ygān cǎo (甘草 licorice, Glycyrrhizae Radix) 8 fēn (2.5 g)
y lú gēn (芦根 phragmites, Phragmitis Rhizoma) 2 qián
(6 g)
Original Method: [Start with] two cups of water; boil
until one cup [remains]. Take twice a day. Modern
method: Decoct and take warm.
Actions: Courses wind and clears heat; diffuses the lung
and relieves cough.
Indications: Early stages of wind-warmth; mild exterior
heat patterns. There may be cough, generalized heat effusion that is not severe, mild thirst, and a floating rapid
pulse.
ANALYSIS
Warm-heat disease evil enters through the nose and
mouth. The evil invades the network vessels of the lung
and causes the lung to lose its clearing and depurative
functions; this leads to the principle symptom of cough.
Because the contracted evil in this pattern is mild and
superficial, there is generalized heat effusion that is not
severe and only mild thirst.
Sāng yè is sweet, bitter, and cool; it courses wind-heat
in the upper burner and also tends to travel to the network
vessels of the lung, so it can clear and diffuse lung heat
and relieve cough. Jú huā is acrid, sweet, and cold; it
courses wind-heat and clears the heat and eyes while diffusing the lung. Both of these medicinals are mild and
clearing, and travel directly to the upper burner; they
work together to course wind-heat from the lung, so they
are both considered to be sovereigns according to some
texts. Other texts link jú huā with xìng rén and jié gěng,
and consider it to be a minister to increase the diffusion
of lung qi and relieve cough.
Bò hé is sometimes grouped with the assistants lú gēn
and lián qiào, but it is sometimes classified as a minister.
Books that classify it as a minister emphasize its ability to
course wind-heat and strengthen the exterior-resolving
power of the sovereign medicinal(s). When listed as a
minister, it is associated with the other ministers jié gěng
and xìng rén.
Xìng rén is bitter and downbearing in nature, so it
promotes the lung’s depurative downbearing function.
Jié gěng opens and diffuses the lung qi with its acrid and
dissipating nature. Together the two form a pair that restores lung function by both diffusing and downbearing,
and they are classified as ministers.
Lián qiào outthrusts evil and resolves toxin, while lú
gēn clears heat and engenders liquid; these are assistants.
Gān cǎo harmonizes the nature of the other medicinals
and is the courier. In conjunction with jié gěng, it also
helps to disinhibit the throat. Together, all the medicinals
course wind-heat from the upper burner and diffuse and
downbear the lung qi, so that both the exterior pattern is
resolved and the cough is relieved.
y In comparison with yín qiào sǎn (Lonicera and Forsythia Powder), this formula is stronger at diffusing the
lung and relieving cough, but it is weaker at resolving
the exterior and clearing heat. This formula is sometimes known as a “acrid-cool mild formula,” while yín
qiào sǎn is known as an “acrid-cool balanced formula.”
y If qi aspect heat becomes gradually exuberant after two
or three days, shí gāo (Gypsum Fibrosum) and zhī mǔ
(Anemarrhenae Rhizoma) may be added.
y If there is relatively frequent coughing, lung heat is
more severe and huáng qín (Scutellariae Radix) should
be added.
y For cough with sticky yellow phlegm that is not easily
expectorated, add huáng qín (Scutellariae Radix), sāng
bái pí (Mori Cortex), bèi mǔ (Fritillariae Bulbus), and
guā lóu (Trichosanthis Fructus).
y If there is cough with expectoration of blood, add bái
máo gēn (Imperatae Rhizoma), qiàn cǎo (Rubiae
Radix), and mǔ dān pí (Moutan Cortex).
yFor severe thirst, add tiān huā fěn (Trichosanthis Radix).
Warning: This formula should not be decocted too long.
Because it is mild, it should not be used without modification if there is severe lung heat. It is also inappropriate
for wind-cold patterns of cough.
Chái Gé Jiě Jī Tāng (柴葛解肌汤 Bupleurum and Pueraria Flesh-Resolving Decoction)
Source: Shāng Hán Liù Shū (Cold Damage Book Six).
Ingredients
y chái hú (柴胡 bupleurum, Bupleuri Radix) 6 g
y gé gēn (葛根 pueraria, Puerariae Radix) 9 g
y gān cǎo (甘草 licorice, Glycyrrhizae Radix) 3 g
y huáng qín (黄芩 scutellaria, Scutellariae Radix) 6 g
y qiāng huó (羌活 notopterygium, Notopterygii Rhizoma
et Radix) 3 g
y bái zhǐ (白芷 Dahurian angelica, Angelicae Dahuricae
Radix) 3 g
y sháo yào (芍药 peony, Paeoniae Radix) 6 g
y jié gěng (桔梗 platycodon, Platycodonis Radix) 3 g
Method: No doses were given in the original text. The
formula is decocted with 3 pieces of shēng jiāng
(Zingiberis Rhizoma Recens), 2 pieces of dà zǎo (Jujubae
Fructus), and 12 grams of shí gāo (Gypsum Fibrosum),
and is taken warm.
Actions: Resolves the flesh and clears heat.
Indications: External contracted wind-cold with signs of
depression forming heat. In this pattern, aversion to cold
gradually becomes mild and generalized heat effusion
becomes more severe; there is absence of sweating and
headache, pain in the eyes and dry nose, heart vexation
and insomnia, dry throat and tinnitus, and pain in the eye
sockets.
Tongue: Thin yellow coat. Pulse: Floating and slightly
surging (hong).
ANALYSIS
This formula treats externally contracted tai yang windcold that is not resolved and instead transforms into heat
that enters the interior. Note that if tai yang disease has
not entered the interior, this formula is not suitable for
fear that it may conduct the evil into the interior. It is
also not suitable for yang ming bowel disease with bound
stool.
Externally contracted wind-cold initially has relatively
severe aversion to cold, but here the aversion to cold
gradually becomes milder and generalized heat effusion
becomes exuberant. This occurs because the cold depresses in the flesh and interstices and transforms into
heat. Because exterior cold is not resolved, there is still
aversion to cold, as well as headache and absence of
sweating.
The yang ming channel reaches both sides of the nose,
the root of the nost, and the eye sockets, while the shao
yang channel connects with the back of the ear, enters the
ear, and emerges at the front of the ear before reaching
the face and area below the eye sockets. The heat evil
initially enters the interior and invades the yang ming and
shao yang channels, causing eye pain and dry nose, pain
in the eye sockets, dry throat, and tinnitus. Heat harasses
the heart spirit, causing heart vexation and insomnia. The
floating and slightly surging pulse reflects the fact that
there is exterior evil in the outer body with concurrent
signs of heat evil in the interior.
This pattern has tai yang wind-cold that is unresolved;
it depresses and forms heat, which is gradually passed to
the yang ming and shao yang channels. Therefore, this
disease is a combined pattern affecting tai yang, yang
mind, and shao yang.
Treatment should resolve the exterior with coolness and
acridity while clearing interior heat. Chái hú and gé gēn
resolve the flesh and clear heat, so they are the sovereigns.
Because chái hú courses the inhibited qi dynamic, it helps
depressive heat be discharged to the outer body.
Qiāng huó and bái zhǐ diffuse exterior evils and relieve
headache. Huáng qín and shí gāo clear interior heat. All
of these are ministers.
Bái sháo and gān cǎo constrain yin and harmonize construction to prevent excessive coursing from damaging
yin. Jié gěng diffuses lung qi, while shēng jiāng and dà
zǎo harmonize construction and defense. These medicinals are all assistants. Gān cǎo also harmonizes all the
other medicinals, so it is considered to be a courier as
well.
Gé gēn, bái zhǐ, and shí gāo clear and outthrust yang
ming heat evil. Chái hú and huáng qín resolve evil heat
in the shao yang, while qiāng huó dissipates wind-cold
from the tai yang channel. Thus, all three channels are
treated simultaneously.
If there is absence of sweating and relatively severe
aversion to cold, huáng qín may be removed and má
huáng (Ephedrae Herba) may be added in its place to
increase the strength of dissipating exterior cold. If the
condition occurs in the summer or autumn, zǐ sū yè (Perillae Folium) can be used instead.
Shēng Má Gé Gēn Tāng (升麻葛根汤 Cimicifuga and
Pueraria Decoction)
Source: Tài Píng Huì Mín Hé Jì Jú Fāng (Tài-Píng Imperial Grace Pharmacy Formulas).
Ingredients
y shēng má (升麻 cimicifuga, Cimicifugae Rhizoma) 10
liǎng (300 g)
y sháo yào (芍药 peony, Paeoniae Radix) 10 liǎng (300
g)
y zhì gān cǎo (炙甘草 mix-fried licorice, Glycyrrhizae
Radix cum Liquido Fricta) 10 liǎng (300 g)
ygé gēn (葛根 pueraria, Puerariae Radix) 15 liǎng (450 g)
Original Method: Grind and take 3 qián (6 g) of powder each dose, boiled in one and a half sheng of water
until one sheng remains. Remove the foam and take it
hot, two to three times per day at any time. When the
disease qi is eliminated, the body will become cool.
Nowadays, this formula is taken as a normal decoction
with a reduction in the dosages above.
Actions: Resolves the flesh and outthrusts papules.
“Outthrusting papules” means promoting a papular eruption. In measles, outthrusting papules helps to speed the
disease along its natural course.
Indications: Early stages of measles. There may be noneruption of papules, generalized heat effusion and headache, cough, red eyes and tearing, thirst, a red tongue
with a thin dry coat, and a floating rapid pulse.
Tongue: red with a thin dry coat. Pulse: floating and
rapid.
Warning: Contraindicated if measles papules have already been outthrust or if the measles toxin falls into the
inner body, manifesting in rapid breathing, breathing with
raised shoulders, and flaring nostrils.
ANALYSIS
Measles is seen in children with brewing heat in the
stomach and lung when there is concurrent contraction of
a “seasonal epidemic of measles toxin.” In the early
stages of measles, the exterior evil may prevent the measles toxin from being outthrust, causing non-eruption of
papules or inhibited eruption of papules.
Measles toxin and exterior evil invades the lung, causing right and evil to contend. The lung loses its clearing
and depurative functions, so the early stages present with
lung and defense pathology, manifesting in generalized
heat effusion and headache, cough, and a floating rapid
pulse. The wind evil and measles toxin attack the head
and face, causing red tearing eyes. Heat scorches and
damages liquid, causing thirst and a red tongue with a dry
coat.
Treatment requires resolving the flesh with coolness
and acridity while outthrusting papules and resolving
toxin. Shēng má enters the lung and stomach and resolves the flesh and outthrusts papules while clearing heat
and resolving toxin; thus, it is the sovereign. Gé gēn enters the stomach; it resolves the flesh and outthrusts papules while engendering liquid and eliminating heat. It is
the minister.
Sháo yào (Paeoniae Radix) here refers to chì sháo,
which enters the blood aspect to clear heat and cool the
blood while quickening the blood. It resolves heat and
toxin in the blood and network vessels, and is an assistant.
Not all texts specify the use of chì sháo, however; some
discuss harmonizing construction instead, an action of bái
sháo. Zhì gān cǎo (Glycyrrhizae Radix cum Liquido
Fricta) harmonizes the nature of the other medicinals and
is a courier.
Bài Dú Sǎn (败毒散 Toxin-Vanquishing Powder)
Source: Some sources list the imperial compilation Tài Píng Huì Mín Hé Jì Jú Fāng (“Tài-Píng Imperial
Grace Pharmacy Formulas”) as the first mention of this formula, while others ascribe it to the physician
Qian Yi’s Xiǎo Ér Yào Zhèng Zhí Jué (“Key to Diagnosis and Treatment of Children's Diseases”). Both
books are from the Song Dynasty (960–1279 CE).
Ingredients
y chái hú (柴胡 bupleurum, Bupleuri Radix) [neck removed]
y qián hú (前胡 peucedanum, Peucedani Radix)
y chuān xiōng (川芎 chuanxiong, Chuanxiong Rhizoma)
y zhǐ qiào (ké) (枳壳 bitter orange, Aurantii Fructus)
y qiāng huó (羌活 notopterygium, Notopterygii Rhizoma et Radix)
y dú huó (独活 pubescent angelica, Angelicae Pubescentis Radix)
y fú líng (茯苓 poria, Poria)
y jié gěng (桔梗 platycodon, Platycodonis Radix) [stir-fried]
y rén shēn (人参 ginseng, Ginseng Radix)
y gān cǎo (甘草 licorice, Glycyrrhizae Radix)
Original Method: Some source texts specify 30 liǎng (1 liǎng during the Song Dynasty weighed 37.5 g)
of each medicinal. Other sources specify 1 liǎng of each medicinal except gān cǎo (Glycyrrhizae Radix),
which is used at a ½ liǎng. The ingredients were ground and taken in 2 qián (6–7 g) doses, decocted with a
small amount of shēng jiāng (Zingiberis Rhizoma Recens) and bò hé (Menthae Herba). It was taken hot if
cold predominated, or taken warm if heat predominated. Nowadays, it is used as a normal decoction.
Actions: Disperses cold and dispels dampness, boosts qi and resolves the exterior.
Indications: Externally contracted wind-cold-damp evil in patients with qi vacuity. Symptoms include
abhorrence of cold and vigorous heat effusion, absence of sweating, stiff painful neck and headache, aching
pain of the limbs, nasal congestion and heavy voice, cough with phlegm, glomus-fullness in the chest and
diaphragm. Tongue: pale with white greasy fur. Pulse: Floating, soggy, lacking force when pressed; may
be floating and rapid but forceless when pressed heavily.
ANALYSIS
Also called rén shēn bài dú sǎn (人参败毒散 Ginseng Toxin-Vanquishing Powder), this formula treats
external contraction of wind-cold-damp evil in patients with constitutional vacuity. It is especially
appropriate for children and patients who are elderly or have just given birth or experienced illness.
In this pattern, the evil and right qi contend in the fleshy exterior, causing abhorrence of cold, vigorous heat
effusion, and absence of sweating. Defense yang is obstructed and channel qi is inhibited, so the cold evil
depresses in the flesh and network vessels, causing stiff neck, headache, and aching limbs. Wind-cold
invading the lung causes non-diffusion of lung qi, leading to nasal congestion, heavy voice, and cough with
phlegm. The fullness, greasy tongue fur, and soggy pulse point show that there is concurrent dampness.
Qiāng huó (Notopterygii Rhizoma et Radix) and dú huó (Angelicae Pubescentis Radix) are the sovereigns;
they disperse wind-cold, eliminate dampness, and relieve pain.
Chuān xiōng (Chuanxiong Rhizoma) moves qi and quickens the blood, and can also dispel wind. Chái hú
(Bupleuri Radix) is acrid and dissipating, and resolves the flesh. These two medicinals are ministers that
assist the sovereign ingredients to resolve the exterior and expel evil, while also moving qi and blood to
help relieve pain.
Jié gěng (Platycodonis Radix) is acrid and dispersing, and helps to diffuse the lung. Zhǐ ké (Aurantii
Fructus) moves qi, and its downbearing nature combines with the upbearing nature of jié gěng to disinhibit
the qi dynamic. Qián hú (Peucedani Radix) dispels phlegm, and fú líng (Poria) percolates dampness; all are
assistants here.
Shēng jiāng (Zingiberis Rhizoma Recens), bò hé (Menthae Herba) are used as conductors that help increase
the exterior-resolving effect; gān cǎo (Glycyrrhizae Radix) is used to supplement the center and harmonize
the other medicinals. All are both assistants and couriers, though the placement of shēng jiāng and bò hé
varies in the Bensky text.
All of the above medicinals dispel the wind-cold-damp repletion element in the presentation, but the
disease here is occurring in a patient with qi vacuity. Rén shēn (Ginseng Radix) is here to support right qi
for several reasons. If right qi is too weak to drive the evil out, it will only be temporarily resolved, and
there is fear that the evil will recur. Sweating is the appropriate method to resolve the exterior evil;
although the herbs promote outward movement, if center qi is insufficient there will gradually be less
sweating and the exterior will not be able completely resolved. In severe cases, evil can exploit the vacuity
and enter the interior, making the disease difficult to cure. Finally, ginseng allows for supplementation
within the dispersing effect. Some sources even consider it to be the sovereign herb for this reason.
This formula was originally used to treat children, because the original qi of children is not yet full. Small
amounts of ginseng were used to “bank up the right qi, vanquish the evil toxin; thus, it is called vanquishtoxin powder.” This statement is how the formula got its name. Toxin is used primarily in three senses in
Chinese medicine: as a disease cause (such as epidemics), as a disease pattern (such as heat toxin), and
referring to medicinal toxicity. This use refers to the former, disease cause.
This formula strengthens right qi to help expel evil, and also prevents evil from entering the interior. Thus,
it is also used to treat exterior evil falling into the interior, causing dysentery. Because this formula
disperses exterior evil and allows the exterior qi to flow freely, the interior stagnation is also eliminated,
and the dysentery resolves on its own. This method is referred to as “hauling the boat upstream.”
Warning: This formula is contraindicated in externally contracted wind-heat, in evil that has already
entered the interior and formed heat, and in yin vacuity with external contraction. It should be used with
care in damp-heat dysentery.
ASSOCIATED FORMULAS
Jīng fáng bài dú sǎn (荆防败毒散 Schizonepeta and Saposhnikovia Toxin-Vanquishing Powder):
y chái hú (柴胡 bupleurum, Bupleuri Radix) [neck removed]
y qián hú (前胡 peucedanum, Peucedani Radix)
y chuān xiōng (川芎 chuanxiong, Chuanxiong Rhizoma)
y zhǐ qiào (ké) (枳壳 bitter orange, Aurantii Fructus)
y qiāng huó (羌活 notopterygium, Notopterygii Rhizoma et Radix)
y dú huó (独活 pubescent angelica, Angelicae Pubescentis Radix)
y fú líng (茯苓 poria, Poria)
y jié gěng (桔梗 platycodon, Platycodonis Radix) [stir-fried]
y gān cǎo (甘草 licorice, Glycyrrhizae Radix)
y jīng jiè (荆芥 schizonepeta, Schizonepetae Herba)
y fáng fēng (防风 saposhnikovia, Saposhnikoviae Radix)
This formula is the same as bài dú sǎn (Toxin-Vanquishing Powder), but here the rén shēn (Ginseng
Radix), shēng jiāng (Zingiberis Rhizoma Recens), and bò hé (Menthae Herba) have been removed, and jīng
jiè (Schizonepetae Herba) and fáng fēng (Saposhnikoviae Radix) have been added. While it is a major
formula for wind-cold conditions, it is also used to treat the early stages of sores and welling-abscesses
with redness, swelling, and pain, aversion to cold and heat effusion, and absence of sweating and lack of
thirst. The tongue fur is thin and white, with a floating rapid pulse.
This formula opens the pores and dispels wind-cold more strongly than the original formula, so it is used
for similar symptoms as bài dú sǎn (Toxin-Vanquishing Powder) in patients with a repletion presentation.
When the sores and welling-abscesses treated by this formula form, wind-cold evils invades the exterior
and cold stagnations in the channels. The movement of qi, blood, and fluids is inhibited, so there is
localized redness, swelling, and pain in addition to exterior signs. Thus, this formula is commonly used for
the early stages of sores when there is heat effusion, aversion to cold, and absence of sweating.
Má Huáng Xì Xīn Fù Zǐ Tāng (麻黄细辛附子汤 Ephedra, Asarum, and Aconite Decoction)
Source: 伤寒论 Shāng Hán Lùn (On Cold Damage).
Ingredients
y má huáng (麻黄 ephedra, Ephedrae Herba) [nodes removed] 6 g
y fù zǐ (附子 aconite, Aconiti Radix Lateralis Praeparata) [traditionally blast-fried, skin removed, one piece
broken into eight slices] 9 g
y xì xīn (细辛 asarum, Asari Herba) 3 g
Original Method: First boil ephedra and reduce by two shēng (about 400 ml). Remove the foam
[collecting] on top. Add all the ingredients and boil to get three shēng (600 ml). Remove the dregs. Take
one shēng warm, three times a day. The modern method is to simply make a water decoction, which is
taken warm.
Actions: Assists yang and resolves the exterior.
Indications: 1) External contraction of wind-cold in patients with constitutional yang vacuity. This
pattern is characterized by heat effusion, severe aversion to cold that does not resolve even with heavy
clothes and thick blankets, lassitude of spirit and desire for sleep, and a deep, faint pulse. 2) China’s 5th
edition textbook series adds that it can be used to treat sudden muteness (loss of voice). Here it is used for
sudden onset of hoarse voice, in severe cases with complete loss of voice, possibly with sore throat,
aversion to cold and heat effusion, lassitude of spirit and desire for sleep, a pale tongue with white fur, and
a deep, forceless pulse.
ANALYSIS
In constitutional yang vacuity, there should not be heat effusion. If there is heat effusion and severe
aversion to cold that cannot be overcome with clothing or bedding, it indicates wind-cold invasion with
contention of right and evil. Exterior patterns should have a floating pulse, but the deep, faint pulse,
lassitude of spirit and desire for sleep all show that the yang qi is already vacuous.
In yang vacuity with external contraction, there is cold in both the exterior and interior. If purely acrid,
warm, and dispersing methods are used, the vacuous yang will lack the strength to sweat, or if sweating is
achieved, yang qi may follow the fluids, leading to collapse. Thus, assisting yang and resolving the
exterior should be done simultaneously.
Má huáng (Ephedrae Herba) moves to the exterior, where it opens the skin and body hair to expel the evil
out. Fù zǐ (Aconiti Radix Lateralis Praeparata) warms the interior and vitalizes yang qi, causing the evil to
be outthrusted. These two herbs together have a complementary action and are often used together for
yang vacuity with external contraction. Xì xīn (Asari Herba) enters the lung and kidney, and has a mobile
and penetrating nature. It frees both the interior and the exterior, helping má huáng to resolve the exterior
while also helping fù zǐ warm the interior to assist the true yang qi of the kidney.
The throat is part of the lung system in Chinese medicine, and the kidney channel traverses the throat to
reach the root of the tongue. In sudden loss of voice, great cold strikes the lung and kidney directly,
blocking the orifices above and blocking kidney qi below. Thus, this formula not only simultaneously
treats exterior and interior, but also simultaneously treats upper and lower.
Jiā Jiǎn Wēi Ruí Tāng (加减葳蕤汤 Solomon’s Seal Variant Decoction)
Source: Chóng Dìng Tōng Sú Shāng Hán Lùn (重订通俗伤寒论“Revised Popular On Cold Damage”).
Ingredients
y yù zhú (玉竹 Solomon’s seal, Polygonati Odorati Rhizoma) [fresh] 9 g
y cōng bái (葱白 scallion white, Allii Fistulosi Bulbus) 2–3 pieces
y bái wēi (白薇 black swallowwort, Cynanchi Atrati Radix) 3 g
y dàn dòu chǐ (淡豆豉 fermented soybean, Sojae Semen Praeparatum) 3 g
y bò hé (薄荷 mint, Menthae Herba) 5 g
y zhì gān cǎo (炙甘草 mix-fried licorice, Glycyrrhizae Radix cum Liquido Fricta) 5 g
y dà zǎo (大枣 jujube, Jujubae Fructus) [red] 2 pieces
Actions: Nourishes yin and clears heat, promotes sweating and resolves the exterior.
Indications: Constitutional yin vacuity with external contraction of wind-heat. There may be headache
and generalized heat effusion, slight aversion to wind and cold, mild or absent sweating, cough, vexation,
thirst and dry throat, a red tongue and a rapid pulse.
ANALYSIS
The externally contracted wind-heat causes the lung and defense qi to become inhibited, so there is cough,
headache, generalized heat effusion, and slight aversion to wind and cold. Yin vacuity often causes internal
heat, so external contraction forms heat patterns. This causes the signs of dryness and vexation, as well as
the tongue and pulse. The key points in this pattern are yin vacuity with insufficiency of fluids, wind-heat
assailing the upper body, and concurrent internal heat.
Treatment is centered on enriching yin, clearing heat, dispersing wind-heat, and diffusing lung qi. To
prevent lodging evil, most yin supplementing agents are not used early on in unresolved exterior disorders.
However, if yin-fluids are insufficient, the “origin of sweat” is lacking, so sweating is difficult and may fail
to resolve the exterior while causing further damage to yin. Thus, this formula banks up yin with sweet and
moist substances in addition to resolving the exterior with coolness and acridity.
Gé Gēn Huáng Qín Huáng Lián Tāng (葛根黄芩黄连汤 Pueraria, Scutellaria, and Coptis Decoction)
Source: Shāng Hán Lùn (伤寒论“On Cold Damage”).
Ingredients
y gé gēn (葛根 pueraria, Puerariae Radix) 15 g
y gān cǎo (甘草 licorice, Glycyrrhizae Radix) 6 g
y huáng lián (黄连 coptis, Coptidis Rhizoma) 9 g
y huáng qín (黄芩 scutellaria, Scutellariae Radix) 9 g
Actions: Resolves the exterior and clears the interior.
Indications: Unresolved exterior disorders, in which evil heat enters the interior, causing hot dysentery.
There is generalized heat effusion, dysentery, vexing heat in the chest and stomach duct, thirst, panting and
sweating, a red tongue with yellow fur, and a rapid pulse or skipping pulse.
SHANG HAN LUN ANALYSIS
This pattern was originally perceived to be a result of iatrogenic treatment, in which a patient with a guì zhī
tāng (Cinnamon Twig Decoction) presentation was given purging methods instead of guì zhī tāng. As a
result, the evil enters the interior. The following detailed explanation comes from Shang Han Lun
commentary translated by Feng Ye, Nigel Wiseman, and Craig Mitchell, used here with permission.
When precipitation is used in cases of an exterior evil, the evil may sink inward, resulting in chest bind or,
as in this case, diarrhea. The action of precipitation, by causing downward movement in the body, actually
drags the evil into the body and down into the lower burner. On the basis of the formula, one can infer that
the evil qi has transformed into heat and harassed the intestines, causing persistent diarrhea.
Nevertheless, the patient's yang qi is exuberant and still has strength to contend with the evil in the exterior,
as indicated by a pulse that is skipping. This pulse also indicates that the exterior has not yet resolved and
heat is harassing the lung. Panting means that the lungs have lost the ability to depurate and downbear. The
heat evil steams the fluids and forces them to stray to the exterior, so sweat effuses.
Gé gēn (Puerariae Radix) is the most important ingredient in the formula. It resolves the fleshy exterior,
raises the clear yang and checks diarrhea. Also important to treat diarrhea are huáng qín (Scutellariae Radix)
and huáng lián (Coptidis Rhizoma), which clear interior heat, thicken the intestines and stomach and check
diarrhea. “Thickening” here refers to strengthening and fortifying stomach and intestinal function. gān cǎo
(Glycyrrhizae Radix) harmonizes the center, boosts the qi and moderates the actions of the other
ingredients. Although this formula is considered to resolve both the exterior and the interior conditions, it is
primarily a formula to clear interior heat and resolve diarrhea. It may also be used for persistent diarrhea
without exterior signs.
ANALYSIS
C OOL ACRID E XTERIOR R ESOLVING F ORMULAS
Yín Qiào Sǎn (银翘散 Lonicera and Forsythia Powder)
Source: Wēn Bìng Tiáo Bian (Systematized Identification of Warm Diseases). [1798 CE]
Ingredients
y jīn yín huā (金银花 lonicera, Lonicerae Flos) 1 liǎng
(30 g)
y lián qiáo (连翘 forsythia, Forsythiae Fructus) 1 liǎng
(30 g)
y bò hé (薄荷 mint, Menthae Herba) 6 qián (18 g)
y jié gěng (桔梗 platycodon, Platycodonis Radix) 6 qián
(18 g)
y gān cǎo (甘草 licorice, Glycyrrhizae Radix) 5 qián
(15 g)
y jīng jiè (荆芥 schizonepeta, Schizonepetae Herba) 4
qián (12 g)
y dàn zhú yè (淡竹叶 lophatherum, Lophatheri Herba) 4
qián (12 g)
y dàn dòu chǐ (淡豆豉 fermented soybean, Sojae Semen
Praeparatum) 5 qián (15 g)
y niú bàng zǐ (牛蒡子 arctium, Arctii Fructus) 6 qián
(18 g)
Original Method: Grind the ingredients and take 6
grams of powder per dose. Boil the powder in a decoction of fresh lú gēn (Phragmitis Rhizoma), and take it
immediately after it strongly gives off a fragrant aroma;
do not decoct it for too long. The lung medicinals are
light and clear; if decocted for too long, the thicker flavor
enters the middle burner instead. For comparatively severe illness, take one dose every two hours, or three doses
per day and one at night. For more mild cases, take one
dose every three hours, or twice per day and once per
night. If the illness is not resolved, continue taking it.
In the modern day, this formula is often made as a standard decoction, typically with a reduction in dose.
Actions: Outthrusts the exterior with warmth and acridity, clears heat and resolves toxin.
Indications: Early stages of warm disease. There may be
heat effusion, mild aversion to wind and cold, absence of
sweating or sweating that is slightly inhibited, headache
and thirst, cough and sore throat, red tipped tongue with a
thin white or thin yellow coat, and a floating, rapid pulse.
In initial stage warm disease, the evil is at the defense
aspect. The location of the lung is high and it opens at
the nose; evil enters through the nose and mouth and invades the upper body to affect the lung, causing loss of
the lung’s diffusing ability. Wind-heat can contend and
bind with qi and blood to brew and form toxin; the heat
toxin invades the lung system and manifests as sore swollen throat. Warm evil damages liquid, causing thirst.
Jīn yín huā (Lonicerae Flos) and lián qiào (Forsythiae
Fructus) are the sovereign medicinals. They are aromatic
medicinals that disperse wind-heat while also clearing
heat and resolving toxin.
Bò hé (Menthae Herba) and niú bàng zǐ (Arctii Fructus)
are ministers; they are acrid and cool, and disperse windheat while clearing and disinhibiting the head and eyes.
They also help to resolve toxin and disinhibit the throat.
Jīng jiè (Schizonepetae Herba) and dàn dòu chǐ (Sojae
Semen Praeparatum) are acrid and slightly warm. They
resolve the exterior and disperse evil. Although they are
acrid and warm, their acridity is not harsh and their
warmth is not drying; when incorporated into a cool acrid
exterior-resolving formula, they increase the strength of
acrid dispersion and help to outthrust the exterior. These
medicinals are also ministers.
Lú gēn (Phragmitis Rhizoma) and dàn zhú yè (Lophatheri Herba) clear heat and engender liquid. Jié gěng
(Platycodonis Radix) opens and diffuses the lung qi, relieves cough, and disinhibits the throat. These medicinals
are assistants.
Gān cǎo (Glycyrrhizae Radix) harmonizes the other
medicinals, and it also protects the stomach. When combined with jié gěng, it disinhibits the throat. It is regarded as both an assistant and a courier.
This formula emphasizes light and aromatic medicinals. It combines acrid cooling medicinals with a small
amount of acrid warming medicinals to increase the outthrusting of evil, without altering the formula’s basic
cooling nature. It also combines dispersing wind evil
with clearing heat and resolving toxin. Although it simultaneously disperses external wind-cold and clears
internal heat toxin, it emphasizes coursing the exterior.
Warning: This formula should not be used for wind-cold
or the initial stages of damp-heat disease. Many of the
medicinals are light and aromatic, so the formula should
not be decocted for too long.
Sāng Jú Yǐn (桑菊饮 Mulberry Leaf and Chrysanthemum Beverage)
Source: Wēn Bìng Tiáo Bian (Systematized Identification of Warm Diseases). [1798 CE]
Ingredients
y sāng yè (桑叶 mulberry leaf, Mori Folium) 2.5 qián
(7.5 g)
y jú huā (菊花 chrysanthemum, Chrysanthemi Flos) 1
qián (3 g)
y xìng rén (杏仁 apricot kernel, Armeniacae Semen) 1
qián (6 g)
y lián qiáo (连翘 forsythia, Forsythiae Fructus) 1.5 qián
(4.5 g)
y bò hé (薄荷 mint, Menthae Herba) 8 fēn (2.5 g)
y jié gěng (桔梗 platycodon, Platycodonis Radix) 2 qián
(6 g)
ygān cǎo (甘草 licorice, Glycyrrhizae Radix) 8 fēn (2.5 g)
y lú gēn (芦根 phragmites, Phragmitis Rhizoma) 2 qián
(6 g)
Original Method: [Start with] two cups of water; boil
until one cup [remains]. Take twice a day. Modern
method: Decoct and take warm.
Actions: Courses wind and clears heat; diffuses the lung
and relieves cough.
Indications: Early stages of wind-warmth; mild exterior
heat patterns. There may be cough, generalized heat effusion that is not severe, mild thirst, and a floating rapid
pulse.
ANALYSIS
Warm-heat disease evil enters through the nose and
mouth. The evil invades the network vessels of the lung
and causes the lung to lose its clearing and depurative
functions; this leads to the principle symptom of cough.
Because the contracted evil in this pattern is mild and
superficial, there is generalized heat effusion that is not
severe and only mild thirst.
Sāng yè is sweet, bitter, and cool; it courses wind-heat
in the upper burner and also tends to travel to the network
vessels of the lung, so it can clear and diffuse lung heat
and relieve cough. Jú huā is acrid, sweet, and cold; it
courses wind-heat and clears the heat and eyes while diffusing the lung. Both of these medicinals are mild and
clearing, and travel directly to the upper burner; they
work together to course wind-heat from the lung, so they
are both considered to be sovereigns according to some
texts. Other texts link jú huā with xìng rén and jié gěng,
and consider it to be a minister to increase the diffusion
of lung qi and relieve cough.
Bò hé is sometimes grouped with the assistants lú gēn
and lián qiào, but it is sometimes classified as a minister.
Books that classify it as a minister emphasize its ability to
course wind-heat and strengthen the exterior-resolving
power of the sovereign medicinal(s). When listed as a
minister, it is associated with the other ministers jié gěng
and xìng rén.
Xìng rén is bitter and downbearing in nature, so it
promotes the lung’s depurative downbearing function.
Jié gěng opens and diffuses the lung qi with its acrid and
dissipating nature. Together the two form a pair that restores lung function by both diffusing and downbearing,
and they are classified as ministers.
Lián qiào outthrusts evil and resolves toxin, while lú
gēn clears heat and engenders liquid; these are assistants.
Gān cǎo harmonizes the nature of the other medicinals
and is the courier. In conjunction with jié gěng, it also
helps to disinhibit the throat. Together, all the medicinals
course wind-heat from the upper burner and diffuse and
downbear the lung qi, so that both the exterior pattern is
resolved and the cough is relieved.
y In comparison with yín qiào sǎn (Lonicera and Forsythia Powder), this formula is stronger at diffusing the
lung and relieving cough, but it is weaker at resolving
the exterior and clearing heat. This formula is sometimes known as a “acrid-cool mild formula,” while yín
qiào sǎn is known as an “acrid-cool balanced formula.”
y If qi aspect heat becomes gradually exuberant after two
or three days, shí gāo (Gypsum Fibrosum) and zhī mǔ
(Anemarrhenae Rhizoma) may be added.
y If there is relatively frequent coughing, lung heat is
more severe and huáng qín (Scutellariae Radix) should
be added.
y For cough with sticky yellow phlegm that is not easily
expectorated, add huáng qín (Scutellariae Radix), sāng
bái pí (Mori Cortex), bèi mǔ (Fritillariae Bulbus), and
guā lóu (Trichosanthis Fructus).
y If there is cough with expectoration of blood, add bái
máo gēn (Imperatae Rhizoma), qiàn cǎo (Rubiae
Radix), and mǔ dān pí (Moutan Cortex).
yFor severe thirst, add tiān huā fěn (Trichosanthis Radix).
Warning: This formula should not be decocted too long.
Because it is mild, it should not be used without modification if there is severe lung heat. It is also inappropriate
for wind-cold patterns of cough.
Chái Gé Jiě Jī Tāng (柴葛解肌汤 Bupleurum and Pueraria Flesh-Resolving Decoction)
Source: Shāng Hán Liù Shū (Cold Damage Book Six).
Ingredients
y chái hú (柴胡 bupleurum, Bupleuri Radix) 6 g
y gé gēn (葛根 pueraria, Puerariae Radix) 9 g
y gān cǎo (甘草 licorice, Glycyrrhizae Radix) 3 g
y huáng qín (黄芩 scutellaria, Scutellariae Radix) 6 g
y qiāng huó (羌活 notopterygium, Notopterygii Rhizoma
et Radix) 3 g
y bái zhǐ (白芷 Dahurian angelica, Angelicae Dahuricae
Radix) 3 g
y sháo yào (芍药 peony, Paeoniae Radix) 6 g
y jié gěng (桔梗 platycodon, Platycodonis Radix) 3 g
Method: No doses were given in the original text. The
formula is decocted with 3 pieces of shēng jiāng
(Zingiberis Rhizoma Recens), 2 pieces of dà zǎo (Jujubae
Fructus), and 12 grams of shí gāo (Gypsum Fibrosum),
and is taken warm.
Actions: Resolves the flesh and clears heat.
Indications: External contracted wind-cold with signs of
depression forming heat. In this pattern, aversion to cold
gradually becomes mild and generalized heat effusion
becomes more severe; there is absence of sweating and
headache, pain in the eyes and dry nose, heart vexation
and insomnia, dry throat and tinnitus, and pain in the eye
sockets.
Tongue: Thin yellow coat. Pulse: Floating and slightly
surging (hong).
ANALYSIS
This formula treats externally contracted tai yang windcold that is not resolved and instead transforms into heat
that enters the interior. Note that if tai yang disease has
not entered the interior, this formula is not suitable for
fear that it may conduct the evil into the interior. It is
also not suitable for yang ming bowel disease with bound
stool.
Externally contracted wind-cold initially has relatively
severe aversion to cold, but here the aversion to cold
gradually becomes milder and generalized heat effusion
becomes exuberant. This occurs because the cold depresses in the flesh and interstices and transforms into
heat. Because exterior cold is not resolved, there is still
aversion to cold, as well as headache and absence of
sweating.
The yang ming channel reaches both sides of the nose,
the root of the nost, and the eye sockets, while the shao
yang channel connects with the back of the ear, enters the
ear, and emerges at the front of the ear before reaching
the face and area below the eye sockets. The heat evil
initially enters the interior and invades the yang ming and
shao yang channels, causing eye pain and dry nose, pain
in the eye sockets, dry throat, and tinnitus. Heat harasses
the heart spirit, causing heart vexation and insomnia. The
floating and slightly surging pulse reflects the fact that
there is exterior evil in the outer body with concurrent
signs of heat evil in the interior.
This pattern has tai yang wind-cold that is unresolved;
it depresses and forms heat, which is gradually passed to
the yang ming and shao yang channels. Therefore, this
disease is a combined pattern affecting tai yang, yang
mind, and shao yang.
Treatment should resolve the exterior with coolness and
acridity while clearing interior heat. Chái hú and gé gēn
resolve the flesh and clear heat, so they are the sovereigns.
Because chái hú courses the inhibited qi dynamic, it helps
depressive heat be discharged to the outer body.
Qiāng huó and bái zhǐ diffuse exterior evils and relieve
headache. Huáng qín and shí gāo clear interior heat. All
of these are ministers.
Bái sháo and gān cǎo constrain yin and harmonize construction to prevent excessive coursing from damaging
yin. Jié gěng diffuses lung qi, while shēng jiāng and dà
zǎo harmonize construction and defense. These medicinals are all assistants. Gān cǎo also harmonizes all the
other medicinals, so it is considered to be a courier as
well.
Gé gēn, bái zhǐ, and shí gāo clear and outthrust yang
ming heat evil. Chái hú and huáng qín resolve evil heat
in the shao yang, while qiāng huó dissipates wind-cold
from the tai yang channel. Thus, all three channels are
treated simultaneously.
If there is absence of sweating and relatively severe
aversion to cold, huáng qín may be removed and má
huáng (Ephedrae Herba) may be added in its place to
increase the strength of dissipating exterior cold. If the
condition occurs in the summer or autumn, zǐ sū yè (Perillae Folium) can be used instead.
Shēng Má Gé Gēn Tāng (升麻葛根汤 Cimicifuga and
Pueraria Decoction)
Source: Tài Píng Huì Mín Hé Jì Jú Fāng (Tài-Píng Imperial Grace Pharmacy Formulas).
Ingredients
y shēng má (升麻 cimicifuga, Cimicifugae Rhizoma) 10
liǎng (300 g)
y sháo yào (芍药 peony, Paeoniae Radix) 10 liǎng (300
g)
y zhì gān cǎo (炙甘草 mix-fried licorice, Glycyrrhizae
Radix cum Liquido Fricta) 10 liǎng (300 g)
ygé gēn (葛根 pueraria, Puerariae Radix) 15 liǎng (450 g)
Original Method: Grind and take 2 qián (6 g) of powder each dose, boiled in one and a half sheng of water
until one sheng remains. Remove the foam and take it
hot, two to three times per day at any time. When the
disease qi is eliminated, the body will become cool.
Nowadays, this formula is taken as a normal decoction
with a reduction in the dosages above.
Actions: Resolves the flesh and outthrusts papules.
“Outthrusting papules” means promoting a papular eruption. In measles, outthrusting papules helps to speed the
disease along its natural course.
Indications: Early stages of measles. There may be noneruption of papules, generalized heat effusion and headache, cough, red eyes and tearing, thirst, a red tongue
with a thin dry coat, and a floating rapid pulse.
Tongue: red with a thin dry coat. Pulse: floating and
rapid.
Warning: Contraindicated if measles papules have already been outthrust or if the measles toxin falls into the
inner body, manifesting in rapid breathing, breathing with
raised shoulders, and flaring nostrils.
ANALYSIS
Measles is seen in children with brewing heat in the
stomach and lung when there is concurrent contraction of
a “seasonal epidemic of measles toxin.” In the early
stages of measles, the exterior evil may prevent the measles toxin from being outthrust, causing non-eruption of
papules or inhibited eruption of papules.
Measles toxin and exterior evil invades the lung, causing right and evil to contend. The lung loses its clearing
and depurative functions, so the early stages present with
lung and defense pathology, manifesting in generalized
heat effusion and headache, cough, and a floating rapid
pulse. The wind evil and measles toxin attack the head
and face, causing red tearing eyes. Heat scorches and
damages liquid, causing thirst and a red tongue with a dry
coat.
Treatment requires resolving the flesh with coolness
and acridity while outthrusting papules and resolving
toxin. Shēng má enters the lung and stomach and resolves the flesh and outthrusts papules while clearing heat
and resolving toxin; thus, it is the sovereign. Gé gēn enters the stomach; it resolves the flesh and outthrusts papules while engendering liquid and eliminating heat. It is
the minister.
Sháo yào (Paeoniae Radix) here refers to chì sháo,
which enters the blood aspect to clear heat and cool the
blood while quickening the blood. It resolves heat and
toxin in the blood and network vessels, and is an assistant.
Not all texts specify the use of chì sháo, however; some
discuss harmonizing construction instead, an action of bái
sháo. Zhì gān cǎo (Glycyrrhizae Radix cum Liquido
Fricta) harmonizes the nature of the other medicinals and
is a courier.
H EAT-C LEARING F ORMULAS
Heat-clearing formulas clear internal heat. They can be
broadly divided into the approaches of clearing heat,
draining fire, cooling the blood, resolving toxin, and enriching yin while outthrusting heat. Within the “eight
methods” of treatment, heat-clearing falls under the heading of “clearing.”
Warmth, heat, and fire all share the same nature, but
they differ in degree. Severe warmth is heat, extreme
heat is similar to fire, and exuberant fire or heat can congest to form toxin.
Internal heat patterns are slightly complicated. Based
on its nature, heat is differentiated into vacuity heat and
repletion heat. Based on the disease cause and location,
externally-contracted heat disease can divided into divided into defense, qi, construction, and blood aspects,
while diseases of internal damage can be classified based
on the bowels and viscera that are affected. Treatment
can be divided into clearing qi aspect heat, clearing construction and cooling the blood, clearing heat and resolving toxin, clearing both qi and blood, clearing bowel and
visceral heat, and clearing vacuity heat.
Heat-clearing formulas are generally used when heat
has entered the interior. If heat evil is in the exterior, it is
generally treated by resolving the exterior. In interior
repletion heat, purging is often used. If the exterior evil
is not resolved but the heat has entered the interior, both
the interior and exterior must be resolved simultaneously.
Formulas that clear qi-aspect heat have actions of clearing heat and eliminating vexation, as well as engendering
liquid and relieving thirst. The pathomechanisms and
pathological changes associated with qi-aspect heat are
related to the intense struggle between right and evil, as
well as varying degrees of damage to yin and liquid.
When evil enters the qi aspect, it produces vigorous heat
effusion, vexation, and thirst, as well as great sweating
and aversion to heat. The pulse is surging and large.
In the aftermath of febrile disease, if surplus heat in the
qi aspect has not been cleared, there can be damage to qi
and yin. This produces generalized heat effusion and
profuse sweating, vexation and oppression in the heart
and chest, and a dry mouth with a red tongue. In the initial stages of febrile disease, there may be generalized
heat effusion and anguish, as well as vexation, agitation,
and insomnia.
Suitable treatments for qi aspect heat include clearing
heat, eliminating vexation, and safeguarding liquid.
Formulas are typically based on the acrid, sweet, and
very cold medicinal shí gāo (Gypsum Fibrosum), the cold,
bitter, and moist medicinal zhī mǔ (Anemarrhenae Rhi-
zoma), and the bitter, cold, vexation-eliminating medicinal zhī zǐ (Gardeniae Fructus). The sweet, bland, and
cold medicinal dàn zhú yè (Lophatheri Herba) is also
commonly used. Because heat evil easily damages qi and
yin, supplementing medicinals are commonly used as
well, particularly rén shēn (Ginseng Radix), mài dōng
(Ophiopogonis Radix), jīng mǐ (Oryzae Semen), and gān
cǎo (Glycyrrhizae Radix).
The most important classical formulas for qi-aspect
heat are: bái hǔ tāng (White Tiger Decoction), zhú yè shí
gāo tāng (Lophatherum and Gypsum Decoction), and zhī
zǐ chǐ tāng (Gardenia and Fermented Soybean Decoction).
Bái Hǔ Tāng (白虎汤 White Tiger Decoction)
Source: 伤寒论 Shāng Hán Lùn (On Cold Damage),
written in the Eastern Hàn Dynasty by Zhāng Jī 张机
[Zhòng-Jǐng 仲景]).
Ingredients
y Shí gāo ( 石 膏 gypsum, Gypsum Fibrosum)
crushed (50 g)
1 jīn,
y Zhī mǔ (知母 anemarrhena, Anemarrhenae Rhizoma) 6
liǎng (18 g)
y Gān cǎo (甘草 licorice, Glycyrrhizae Radix) 2 liǎng
(6 g) [processed, zhì]
y Gēng mǐ (粳米 non-glutinous rice, Oryzae Semen) 6 hé
(9 g)
Original Method: [For] the above four ingredients use
one dǒu of water. Boil until the rice is cooked. When the
decoction is ready [i.e., reduced to one shēng of water],
remove the dregs and take one shēng warm, three times a
day.
Actions: Clears heat and eliminates vexation, engenders
liquid and relieves thirst.
Indications: Yang brightness (yang ming) qi-aspect
exuberant heat (also known as yang ming channel disease
or qi-aspect heat). There is vigorous heat effusion, red
face, vexation and thirst with taking of fluids, sweating
and aversion to heat, and a flooding, large, forceful pulse.
ANALYSIS
This formula treats formless internal heat spreading
throughout the whole body, so that there is heat in both
the interior and the exterior. Shí gāo is acrid, sweet, and
very cold; it clears heat. Zhī mǔ is bitter, cold, and moistening; it discharges heat and enriches dryness. Together,
these two clear exuberant yang brightness heat and safeguard stomach liquid. Zhì gān cǎo and gēng mǐ together
boost qi and harmonize the center, since when qi is
sufficient, the fluids will be engendered. Furthermore,
these two ingredients help avoid damage to the stomach
from the use of cold medicinals. (This paragraph taken
from Shang Han Lun, Paradigm Publications, with permission.)
In this pattern, evil has already passed to the inner body,
so there is interior heat and exuberance of right qi; this
produces the vigorous heat effusion and red face, and also
explains the lack of aversion to cold. Scorching heat
damages liquid, which causes the vexation and thirst with
taking of fluids. The steaming of interior heat drives the
body’s liquid to be discharged outward, producing the
great sweating. Exuberant heat evil in the channels stirs
the vessels, causing the pulse to become large, surging,
and forceful.
Shí gāo is the sovereign medicinal because its great
cold clears yang ming (qi-aspect) heat; it clears heat and
eliminates vexation without damaging liquid. Zhī mǔ, the
minister, helps shí gāo to clear repletion heat from the
lung and stomach, and also enriches yin to engender liquid. They have a relationship of mutual need, and their
combination increases their heat-clearing and liquidengendering power. Zhì gān cǎo and gēng mǐ boost the
stomach and protect liquid while preventing the cold nature of the sovereign and minister from damaging the
center burner. Thus, they are both assistants and couriers.
Warning: This formula is contraindicated in cases with
absence of thirst and absence of sweating in exterior disorders that are not resolved. It is also contraindicated in
heat effusion due to blood vacuity or qi vacuity, with
liking of warm beverages and a surging pulse that is lacking substance when pressed heavily.
ASSOCIATED FORMULAS
Bái hǔ jiā rén shēn tāng (White Tiger Decoction Plus
Ginseng) is a modification of the main formula that also
appeared in the original Shāng Hán Lùn. It is the same
formula with the addition of 3 liǎng of rén shēn (Ginseng
Radix); 9 g is the modern dose used. This formula clears
heat, boosts qi, and engenders liquid. It is indicated for
basically the same presentation as the main formula, with
one key difference- in this formula, while there is profuse
sweating, the pulse is large but forceless because qi and
liquid have been damaged. This formula may also be
used for summerheat disease with damage to both qi and
liquid, manifesting in sweating of the upper back, slight
aversion to wind and cold, generalized heat effusion, and
thirst.
Bái hǔ jiā cāng zhú tāng (White Tiger Decoction Plus
Atractylodes) is a modification of the main formula that
has the addition of 3 liǎng (9 g in modern use) of cāng
zhú (Atractylodis Rhizoma) added. This addition allows
the formula to clear heat and dispel dampness. It is indicated for damp-warmth disease, with generalized heat
effusion, glomus in the chest, profuse sweating, and a red
tongue with white greasy fur. There may also be wind-
damp impediment (bì), great generalized heat effusion,
and swelling and pain of the joints.
Zhú Yè Shí Gāo Tāng (竹叶石膏汤 Lophatherum and
Gypsum Decoction)
Source: 伤寒论 Shāng Hán Lùn (On Cold Damage).
Ingredients
y Dàn zhú yè (淡竹叶 lophatherum, Lophatheri Herba) 2
bunches (6 g)
y Shí gāo (石膏 gypsum, Gypsum Fibrosum) 1 jīn (50 g)
y Bàn xià (半夏 pinellia, Pinelliae Rhizoma) ½ shēng
[washed] (9 g)
y Mài mén dōng ( 麦 门 冬 ophiopogon, Ophiopogonis
Radix) 1 shēng [heart removed] (20 g)
y Rén shēn (人参 ginseng, Ginseng Radix) 2 liǎng (6 g)
yGān cǎo (甘草 licorice, Glycyrrhizae Radix) [mix-fried,
zhì] 2 liǎng (6 g)
y Gēng mǐ (粳米 non-glutinous rice, Oryzae Semen) ½
shēng (10 g)
Method: [For] the above seven ingredients use one dǒu
of water. Boil [the first 6 ingredients] to get six shēng.
Remove the dregs and add rice. Boil until the rice is
cooked and it becomes a soup. Remove the rice and take
one shēng warm, three times a day.
Actions: Clears heat and engenders liquid, boosts qi and
harmonizes the stomach.
Indications: Patterns of cold damage, warm disease, or
summerheat disease with surplus heat that is not eliminated, and damage to both qi and liquid. There may be
generalized heat effusion and profuse sweating, vexation
and oppression in the heart and chest, qi counterflow with
desire to vomit, dry mouth and a liking for beverages, or
vacuity vexation and sleeplessness. The tongue is red
with scant coating, and the pulse is vacuous and rapid or
thin and rapid.
ANALYSIS
This formula and bái hǔ tāng (White Tiger Decoction)
both clear heat and engender liquid, and both can be used
for qi-aspect heat patterns with generalized heat effusion,
sweating, thirst, and a rapid pulse. However, bái hǔ tāng
is stronger for clearing heat, and is used for severe heat in
the qi-aspect; it is classified as a “very cold formula.”
Zhú yè shí gāo tāng is weaker at clearing heat but also
boosts qi and harmonizes the stomach. It is suitable for
surplus heat that has not been cleared, with damage to
both qi and yin. There is repletion evil but right vacuity,
and the formula is classified as a “clearing and supplementing formula.”
Sovereigns: Shí gāo clears heat and engenders liquid
while eliminating vexation and relieving thirst. Zhú yè
clears heat and eliminates vexation. Prior to the Ming
dynasty, black bamboo leaf (Bambusae Folium) was the
substance used as zhú yè; after the Ming dynasty, dàn zhú
yè (Lophatheri Herba) came into use. The two are similar,
but black bamboo leaf is stronger for clearing heat, while
lophatherum is stronger for disinhibiting urination.
Ministers: Rén shēn boosts qi and engenders liquid.
Mài dōng nourishes yin and engenders liquid, and also
helps to moderate the warm and dry nature of bàn xià,
which is present to downbear counterflow and harmonize
the stomach. In turn, bàn xià allows mài dōng to be used
without producing a cloying effect from its enriching
nature.
manifesting in glomus and fullness in the chest and diaphragm, and hunger but no desire to eat. The red tongue
with slightly yellow fur shows that heat is depressed in
the inner body.
Zhī zǐ clears the depressed heat and eliminates vexation,
and it is the sovereign medicinal. Dàn dòu chǐ (called
xiāng chǐ in the original source text) is the minister; its
mild diffusing nature opens congestion and dissipates
fullness while harmonizing the stomach.
Warning: The original formula uses raw zhī zǐ, which
easily causes vomiting; this can be avoided by stir-frying
it before use. This formula is not suitable for spleenstomach vacuity cold with sloppy stool.
Assistants: Bàn xià downbears counterflow and checks
vomiting, and also prevents cloying from the enriching
nature of mài dōng. Gēng mǐ nourishes the stomach and
harmonizes the center.
Qīng Yíng Tāng (清营汤 Construction-Clearing Decoction)
Courier: Zhì gān cǎo boosts qi and harmonizes the center, and also harmonizes the other medicinals.
Source: Wēn Bìng Tiáo Bian (Systematized Identification
of Warm Diseases). [1798 CE]
Ingredients
Zhī Zǐ Dòu Chǐ Tāng (栀子豆豉汤 Gardenia and Fermented Soybean Decoction)
Source: 伤寒论 Shāng Hán Lùn (On Cold Damage).
y Xī jiǎo (犀角 rhinoceros horn, Rhinocerotis Cornu) 3
qián (In modern times, shuǐ niú jiǎo (Bubali Cornu) is
substituted at a dose of 30 g)
Ingredients
yShēng dì huáng (生地黄 rehmannia, Rehmanniae Radix)
5 qián (15 g)
y Zhī zǐ (栀子 gardenia, Gardeniae Fructus) 14 pieces
[broken] (9 g)
y Xuán shēn (玄参 scrophularia, Scrophulariae Radix) 3
qián (9 g)
y Dàn dòu chǐ (淡豆豉 fermented soybean, Sojae Semen
Praeparatum) 4 gě [cotton-wrapped] (9 g)
y Zhú yè xīn (竹叶心 tender lophatherum leaf, Lophatheri
Folium Immaturum) 1 qián (3 g)
Original Method: [For] the above two ingredients use
four shēng of water. First boil zhī zǐ to get 2 ½ shēng.
Add dàn dòu chǐ and boil to get one shēng. Remove the
dregs. Divide into two doses and take one warm. (If
vomiting occurs, stop giving doses.)
y Mài mén dōng ( 麦 门 冬 ophiopogon, Ophiopogonis
Radix) 3 qián (9 g)
Actions: Clears and diffuses depressed heat.
Indications: Patterns of depressed heat in the chest or
diaphragm. There may be generalized heat effusion, anguish, vacuity vexation and insomnia, glomus and fullness in the chest and stomach duct, softness upon palpation, and clamoring stomach (like hunger but not hunger,
like pain but not pain); there is hunger but no desire to eat.
The pulse is rapid and the tongue is red with a slightly
yellow coat.
ANALYSIS
This formula treats formless heat evil that is lodged and
congested in the qi-aspect; the heat harasses the chest and
diaphragm. When heat depresses in the chest and diaphragm and harasses the inner body, mild cases cause
heart vexation and insomnia, while severe cases cause
generalized heat effusion and anguish. When the upper
burner is inhibited, there is disharmony of the stomach qi,
y Dān shēn (丹参 salvia, Salviae Miltiorrhizae Radix) 2
qián (6 g)
y Huáng lián (黄连 coptis, Coptidis Rhizoma) 1.5 qián
(4.5 g)
y Jīn yín huā (金银花 lonicera, Lonicerae Flos) 3 qián
(9 g)
y Lián qiáo (连翘 forsythia, Forsythiae Fructus) 2 qián
(6 g)
Method: Decoct the above formula in 8 cups of water,
boil until three cups remain. Take one cup three times
per day.
Actions: Clears construction and resolves toxin, outthrusts heat and nourishes yin.
Indications: This formula treats the early stages of heat
evil entering the construction aspect. There may be generalized heat effusion that is severe at night, vexation of
the spirit and little sleep, periodic delirious speech, either
thirst or absence of thirst, possibly with faint maculopapular eruptions, a crimson and dry tongue, and a thin,
rapid pulse.
ANALYSIS
This formula is used for the early stages of evil heat entering the construction aspect. Its aim is to clear construction and outthrust heat to the qi aspect. When heat
enters construction, it scorches construction-yin, causing
the generalized heat effusion that is severe at night and
the rapid pulse. The construction qi connects to the heart,
so when the heat harasses the heart-construction, it causes
derangement of the spirit, manifesting in vexation of the
spirit, little sleep, and periodic delirious speech. As the
heat starts to pass into the construction, heat remaining in
the qi aspect can cause thirst; as the heat enters the construction aspect, the thirst becomes less severe or even
absent. When heat evil enters construction, it starts to
affect the blood aspect, giving rise to faint maculopapular
eruptions and a crimson tongue.
Sovereign: Xī jiǎo (shuǐ niú jiǎo) is the sovereign. It
clears construction, resolves toxin, and cools the blood.
Ministers: Shēng dì huáng clears construction and resolves toxin, helping the sovereign to clear heat and toxin
in the construction aspect. It also nourishes yin and engenders liquid to treat construction heat damaging yin.
Xuán shēn enriches yin while clearing heat and resolving
toxin. Mài dōng clears heat, nourishes yin, and engenders liquid.
Assistants: Jīn yín huā and lián qiào clear heat and
resolve toxin; they are light and diffusing to outthrust the
evil. Dàn zhú yè and huáng lián clear the heart and
eliminate vexation. Dān shēn also clears the heart and
eliminates vexation, but it also quickens the blood to dissipate stasis and thus prevents the heat from binding the
blood. It also conducts the medicinals to enter the heart.
Warning: A white and glossy tongue is a sign of concurrent depression of dampness; in such circumstances, this
formula is contraindicated.
Xī Jiǎo Dì Huáng Tāng (犀角地黄汤 Rhinoceros Horn
and Rehmannia Decoction)
Source: 备急千金要方 Bèi Jí Qiān Jīn Yào Fāng (A
Thousand Gold Pieces Emergency Formulary), written
in the 7th century (Táng dynasty) by Sūn Sī-Miǎo 孙思
邈).
Ingredients
y Xī jiǎo (犀角 rhinoceros horn, Rhinocerotis Cornu) 1
liǎng (In modern times, shuǐ niú jiǎo (Bubali Cornu) is
substituted at a dose of 30 g)
yShēng dì huáng (生地黄 rehmannia, Rehmanniae Radix)
8 liǎng (30 g)
yChì sháo yào (赤芍药 red peony, Paeoniae Radix Rubra)
3 liǎng (12 g)
y Mǔ dān pí (牡丹皮 moutan, Moutan Cortex) 2 liǎng
(9 g)
Original Method: The modern method is to make a
water decoction, which is taken with a drenched concentrate of shuǐ niú jiǎo.
Actions: Clears heat and resolves toxin, cools the blood
and dissipates stasis.
Indications: This formula is indicated for heat entering
the blood aspect, which manifests in three main ways:
1) Heat entering the blood aspect: generalized heat effusion that is severe at night, with a crimson tongue.
2) Heat harassing the heart spirit: clouded spirit and
delirious speech.
3) Blood heat forcing the blood to move frenetically:
Vomiting of blood, nosebleed, or other types of
bleeding, purple-dark maculopapular eruptions.
This occurs in warm disease because heat and toxin
falling into the blood aspect can wear on the blood
and move the blood.
ANALYSIS
Both this formula and qīng yíng tāng (ConstructionClearing Decoction) clear construction and cool the blood,
and both treat heat entering construction-blood with generalized heat effusion, heart vexation, delirious speech,
and a crimson tongue. However, qīng yíng tāng is described as a “construction-clearing evil-outthrusting formula,” and it is used to treat the early stages of heat entering the construction aspect by outthrusting the heat so
that it passes into the qi aspect. Xī jiǎo dì huáng tāng
emphasizes cooling the blood and stanching bleeding
while quickening the blood to dissipate stasis. It is used
when heat evil enters the blood and causes the blood to
move frenetically, with signs such as vomiting of blood,
nosebleed, blood in the urine or stool, purple-dark maculopapular eruptions, and a deep crimson tongue. It is
described as a “blood-cooling blood-dissipating formula.”
Sovereign: Xī jiǎo (shuǐ niú jiǎo) is the sovereign. It
clears the heart and cools the blood, and also clears heat
and resolves toxin.
Minister: Shēng dì huáng clears heat and cools the
blood, and also nourishes yin and engenders liquid.
Assistants: Chì sháo and mǔ dān pí clear heat and cool
the blood, and also quicken the blood and dissipate stasis.
As a whole, this formula clears heat while nourishing
yin, and cools the blood while dissipating stasis. It allows the heat to be cleared and the blood to be calmed
without wearing on the blood, and it cools the blood and
stanches bleeding without causing stasis.
Warning: This formula cannot be used for blood loss
due to yang vacuity or qi vacuity. It is contraindicated in
weakness of the spleen and stomach.
Huáng Lián Jiě Dú Tāng (黄连解毒汤 Coptis ToxinResolving Decoction)
Source: This formula first appeared in the text Zhǒu Hòu
Bèi Jí Fāng (肘后备急方 Emergency Standby Remedies), by Gě Hóng 葛洪 (281–341 CE, Jìn dynasty).
However, the name did not exist until it appeared in the
text Wài Tái Mì Yào (外台秘要 Essential Secrets from
Outside the Metropolis), written in 752 CE (Táng dynasty), by Wáng Táo 王焘.
Ingredients
y Huáng lián (黄连 coptis, Coptidis Rhizoma) 3 liǎng
(9 g)
y Huáng qín (黄芩 scutellaria, Scutellariae Radix) 2 liǎng
(6 g)
y Huáng bǎi (黄柏 phellodendron, Phellodendri Cortex) 2
liǎng (6 g)
y Zhī zǐ (山栀子 gardenia, Gardeniae Fructus) 14 pieces
[split] (9 g)
Original Method: Cut the above four ingredients, and
add six shēng of water. Boil until two shēng remains,
and take [it in] two doses. The modern method is to
make a standard water decoction.
Actions: Clears fire and resolves toxin.
Indications: Patterns of fire toxin in all three burners.
There may be great heat [effusion], vexation, and agitation, as well as dry mouth and throat, disordered speech,
and insomnia. Other possibilities include warm disease
with vomiting of blood or nosebleed, as well as severe
heat with macular eruptions, generalized heat effusion
with diarrhea or dysentery, or damp-heat jaundice. In
external medicine, this formula is used for wellingabscesses, sores, and clove sore toxin (also known as
deep-rooted boils), accompanied by yellowish-red urine,
a red tongue with yellow fur, and a rapid, forceful pulse.
y Heat congests the flesh, causing swollen wellingabscesses and clove-sore toxin (deep-rooted boils).
y The red tongue with yellow fur and the rapid, forceful
pulse are signs of intense fire toxin.
All of the above signs are due to repletion heat and intense fire toxin, so the suitable treatment is to drain fire
and resolve toxin.
Within the formula, the greatly bitter and greatly cold
medicinal huáng lián is the sovereign. It clears and
drains heart fire while concurrently draining fire from the
middle burner. Huáng qín is a minister; it drains fire
from the upper burner. Huáng bǎi is classified as an assistant; it drains fire from the lower burner. Zhī zǐ is both
an assistant and a courier; it clears and drains fire from all
three burners and moves heat downward, conducting the
heat evil out via the urine. The combined effect of these
four medicinals is to directly eliminate fire evil from all
three burners while resolving heat toxin.
Warning: This formula is very bitter and very cold, so it
should not be used in excessive quantities or for prolonged periods of time to avoid damage to the spleen and
stomach. It is not suitable for cases without intense fire
toxin, as well as cases with severe damage to fluids.
ASSOCIATED FORMULAS
Xiè xīn tāng (泻心汤 Heart-Draining Decoction) is a
formula from the Jīn Guì Yào Lǜe (Essential Prescriptions of the Golden Coffer). It contains dà huáng (Rhei
Radix et Rhizoma) [10 g], huáng lián (Coptidis Rhizoma)
[5 g], and huáng qín (Scutellariae Radix) [5 g].
Xiè xīn tāng clears fire and resolves toxin while drying
dampness and discharging heat. It is indicated for:
y Intense internal fire evil that forces the blood to move
frenetically, manifesting in vomiting of blood, nosebleed, constipation, and reddish urine.
ANALYSIS
y Jaundice due to damp-heat brewing in the inner body,
with glomus in the chest, vexation, and heat, accompanied by yellow greasy tongue fur.
This formula treats rampant fire toxin in all three burners.
When there is intense fire toxin, there is heat in both the
inner body and the outer body.
y Accumulated heat surging into the upper body, manifesting in red swollen eyes and mouth and tongue
sores.
y In the upper body, it harasses the spirit; this produces
the vexation and the disordered speech.
y In external medicine, this formula is used for sores
with concurrent vexing heat in the heart and chest and
dry bound stool.
y Blood is driven by heat and it follows the fire upwards, counterflowing to produce vomiting of blood
and nosebleed.
y Heat damages the network vessels and causes blood
to spill into the skin and flesh, producing macular
eruption.
y Exuberant heat damages liquid, producing dry mouth
and throat.
This formula is similar to huáng lián jiě dú tāng (Coptis
Toxin-Resolving Decoction), but it has a stronger ability
to downbear fire because it contains dà huáng.
Pǔ Jì Xiāo Dú Yǐn (普济消毒饮 Universal Salvation
Toxin-Dispersing Beverage)
Source: 东 垣 试 效 方 Dōng Yuán Shì Xiào Fāng
(Dong-Yuan’s Tested Effective Formulas), by Li DongYuan (Jin dynasty, 13th century).
Ingredients
y Huáng qín (黄芩 scutellaria, Scutellariae Radix) [wineprocessed] 15 g
y Huáng lián (黄 连 coptis, Coptidis Rhizoma) [wineprocessed] 15 g
y Chén pí (陈皮 tangerine peel, Citri Reticulatae Pericarpium) [white removed] 10 g
y Gān cǎo (甘草 licorice, Glycyrrhizae Radix) [raw] 10 g
y Xuán shēn (玄参 scrophularia, Scrophulariae Radix)
10 g
y Chái hú (柴胡 bupleurum, Bupleuri Radix) 10 g
y Jié gěng (桔梗 platycodon, Platycodonis Radix) 10 g
y Lián qiáo (连翘 forsythia, Forsythiae Fructus) 5 g
y Bǎn lán gēn (板蓝根 isatis root, Isatidis Radix) 5 g
y Mǎ bó (马勃 puffball, Lasiosphaera seu Calvatia) 5 g
y Niú bàng zǐ (牛蒡子 arctium, Arctii Fructus) 5 g
y Bò hé (薄荷 mint, Menthae Herba) 5 g
y Jiāng cán (白僵蚕 silkworm, Bombyx Batryticatus) 3 g
y Shēng má (升麻 cimicifuga, Cimicifugae Rhizoma) 3 g
Method: Powder the above ingredients, mix into a decoction, and take periodically. It can also be formed into
pills with honey. The modern method is a simple water
decoction.
Actions: Clears heat and resolves toxin, courses wind
and dissipates evil.
Indications: “Massive head scourge.” This is a disease
that results from invasion of the spleen and stomach
channels by seasonal wind-warmth toxin and that is characterized by swelling and redness of the head, and sometimes by painful swelling of the throat, and, in severe
cases, signs such as deafness, clenched jaw, clouded
spirit, and delirious raving. In the presentation listed for
this formula, there may be aversion to cold and heat effusion, red swollen face and burning pain, inability to open
the eyes, inhibited throat, dry mouth and thirst, a red
tongue with yellow fur, and a rapid, forceful pulse.
ANALYSIS
This formula is indicated for externally contracted windheat epidemic toxin that congests in the upper burner and
erupts in the head and face. When wind-heat epidemic
toxin depresses in the fleshy exterior, it produces aversion to cold and heat effusion. Because the head is the
meeting of all yang, brewing epidemic toxin ascends to
the upper body, producing the red swollen face and burning pain, inability to open the eyes, and inhibited throat.
The thirst, dry mouth, and tongue and pulse presentation
all show the exuberant heat toxin.
The key feature in this pattern is the pathomechanism
of wind-heat epidemic toxin congesting in the head and
face. It moves out to depress in the fleshy exterior. Thus,
the disease location is said to be upper body, while the
disease dynamic moves in an outward direction. To treat
epidemic toxin, one must clear and resolve. To treat
wind-heat, one must course and dissipate. This formula
both clears heat and resolves toxin, and courses wind and
dissipates evil.
Warning: This formula has many acrid-dissipating and
bitter-cold medicinals, so it should be used with care in
cases of yin vacuity or spleen vacuity with sloppy stool.
Topical treatments can also be applied to the affected site
to strengthen the effect of clearing heat and dispersing
swelling.
Bai Tou Weng Tang
(Pulsatilla Decoction)
Summerheat-Clearing Formulas
By Eric Brand, M.S., L.Ac.
a Bai
Tou Weng Tang primarily treats
heat toxin dysentery
a It is distinguished from Shao Yao
Tang (Peony Decoction), which
treats damp-heat dysentery
Xiè Bái Sǎn (泻白散 White-Draining
Powder)
a
a
a
a
a
a
a
a
Source: Xiǎo Ér Yào Zhèng Zhí Jué (小儿药证直诀Key
to Diagnosis and Treatment of Children’s Diseases).
Ingredients
y Dì gǔ pí (地骨皮 lycium root bark, Lycii Cortex) 1 liǎng
(15 g)
y Sāng bái pí (桑白皮 mulberry root bark, Mori Cortex)
1 liǎng (15 g)
y Zhì gān cǎo (炙甘草mix-fried licorice, Glycyrrhizae
Radix cum Liquido Fricta) 1 qián (5 g) [One source text
says that the original dose was ½ liǎng]
In this formula, there is deep-lying (latent) fire in the
lung.
Signs of counterflow lung qi are cough, panting, and
rapid breathing, while signs of latent heat in the yin
aspect include steaming hot skin and increased
severity in the late afternoon.
When the lung has latent fire depressed within, heat
damages the yin aspect.
a
This causes lung qi to lose its downbearing, resulting in
cough and panting. Lung heat damages yin and causes
“heat steaming.”
a
a
a
a
a
a
Actions: Clears and drains lung heat, relieves cough
and calms panting.
Indications: Lung heat with panting and cough.
There will be cough, and severe cases have rapid
breathing and panting. The skin is steaming hot and
the condition is more severe in the late afternoon.
The tongue is red with a yellow coat and the pulse is
thin and rapid. Many texts describe this pattern as
one of latent (deep-lying) fire in the lung.
Sovereign: Sāng bái pí clears and drains lung heat while
calming panting and relieving cough.
Minister: Dì gǔ pí clears deep-lying fire from the lung
and helps the sovereign medicinal calm panting and
relieve cough. It also nourishes yin and abates vacuity
heat.
Assistant and courier: Jīng mǐ and zhì gān cǎo boost qi
and nourish the stomach, and harmonize the all the
medicinals. These ingredients bank up earth to
engender metal.
Warning: Contraindicated in externally contracted windcold or vacuity cold cough and panting.
1
Zuǒ Jīn Wán (左金丸 Left Metal Pill)
Source: Dān Xī Xīn Fǎ (丹溪心法Dān Xī's
Heart-Approach), written in 1481 CE
(Yuán Dynasty) by Zhū Zhèn-Hēng 朱震亨
[Dān-Xī 丹溪].
a Ingredients
a y Huáng lián (黄连 coptis, Coptidis
Rhizoma) 6 liǎng (18 g)
a y Wú zhū yú (吴茱萸 evodia, Evodiae
Fructus) 1 liǎng (3 g)
a
a
a
a
a
a
a
a
Indications: Liver fire invading the stomach.
There may be pain in the rib-sides
“Clamoring stomach” (like pain but not pain, like
hunger but not hunger)
Acid swallowing (upflow of acid that is immediately
swallowed)
Vomiting
Bitter taste in the mouth
A red tongue with yellow fur, and a wiry rapid pulse.
Method: Grind the herbs to a powder and
form into pills with water or by steaming the
powder to make a cake that is formed into pills.
Take 15 pills with rice soup. The modern
technique is to take 2–3 grams per dose as a
powder, but it can also be made as a decoction
(using the same ratio as the original formula).
a Actions: Clears and drains liver fire,
downbears counterflow and checks vomiting.
a
a
a
a
a
a
a
In the section on the 19 pathomechanisms, the Nèi Jīng states
that “all counterflow upsurging is ascribed to fire,” and also
states that “all sour retching and vomiting…is ascribed to
heat.”
Sovereign: Huáng lián (Coptidis Rhizoma) enters the heart,
liver, and stomach channels, and it directly clears liver fire.
When liver fire is cleared, it no longer invades the stomach. It
also drains stomach fire; when stomach fire is cleared, the
stomach qi downbears on its own. Additionally, huáng lián
drains heart fire, which corresponds to the principle of
“treating repletion by draining the child.”
a
a
a
This formula is used when liver depression forms fire
and counterflows transversely to invade the stomach,
causing liver-stomach disharmony.
Inhibited qi in the liver channel causes distention and
pain of the rib-sides, while liver fire invading the
stomach produces the loss of the stomach’s
harmonious downbearing, resulting in clamoring
stomach, acid swallowing, vomiting, and belching.
Internal exuberance of liver fire causes the tongue
and pulse presentation.
Assistant: If only bitter cold medicinals are used to
treat fire depressed in the liver channel, there is a fear
that the coolness will cause obstruction and make the
condition difficult to resolve.
Therefore, a small amount of wú zhū yú (Evodiae
Fructus) is used to open liver depression and
downbear stomach counterflow, which helps huáng
lián to harmonize the stomach and check vomiting
while also preventing damage to the stomach from the
large quantity of bitter-cold huáng lián.
Wú zhū yú also helps guide huáng lián to the liver
channel, so some texts consider it to be a courier in
addition to being a paradoxical assistant.
Warning: Contraindicated in vacuity cold.
2
Lóng Dǎn Xiè Gān Tāng (龙胆泻肝
a
a
a
a
a
a
a
a
a
a
a
a
a
a
a
汤 Gentian Liver-Draining
Decoction)
Ingredients
Method: The dosage of the ingredients was
not provided in the original source text. The
formula is typically taken as a decoction, but it
can also be made into pills, which are taken
with warm water in a dose of 6–9 grams per
dose, 2 times per day.
a Actions: Clears and drains repletion heat from
the liver and gallbladder; clears and disinhibits
damp-heat in the liver channel.
y
Lóng dǎn (龙胆 gentian, Gentianae Radix) [wine-fried] 6 g
y
Huáng qín (黄芩 scutellaria, Scutellariae Radix) [stir-fried] 9 g
y
Zhī zǐ (栀子 gardenia, Gardeniae Fructus) [wine-fried] 9 g
y
Zé xiè (泽泻 alisma, Alismatis Rhizoma) 12 g
y
Mù tōng (木通akebia, Akebiae Caulis) 6 g
y
Dāng guī (当归 Chinese angelica, Angelicae Sinensis Radix)
[wine-fried] 3 g
y
Shēng dì huáng (生地黄rehmannia, Rehmanniae Radix) [winefried] 9 g
y
Chái hú (柴胡 bupleurum, Bupleuri Radix) 6 g
y
Gān cǎo (甘草 licorice, Glycyrrhizae Radix) [raw] 6 g
y
Chē qián zǐ (车前子 plantago seed, Plantaginis Semen) 9 g
a
Indications: This formula has two major applications:
patterns upward flaming of liver-gallbladder repletion fire, and
patterns of liver channel damp-heat pouring downward.
Upward flaming of liver-gallbladder repletion fire: This may
present with headache and red eyes, rib-side pain, bitter taste
in the mouth, deafness, swelling of the ear, a red tongue with
yellow fur, and a wiry, rapid, and forceful pulse.
Liver channel damp-heat pouring downward: This manifests
in swelling of the genitals, itching of the genitals, wilting of
the sinews, sweating of the genitals, turbid strangury, or
yellow foul-smelling vaginal discharge. The tongue is red
with yellow greasy fur, and the pulse is wiry, rapid, and
forceful.
a
Sovereign: Lóng dǎn clears repletion fire
from the liver and gallbladder, and also
treats damp-heat in the liver and
gallbladder.
a Ministers: Huáng qín and zhī zǐ drain fire
and dry dampness, assisting lóng dǎn in
its ability to drain liver fire, dry dampness,
and clear heat.
a
a
a
This formula has several special features. It
combines the use of clearing and draining with
percolating and disinhibiting, and drains liver fire
above while disinhibiting damp-heat below.
Within its draining, it includes supplementing;
although it disinhibits, it also enriches. Within its
downbearing, there is upbearing. It dispels evil
without damaging right. Nonetheless, it is still
considered a bitter, cold formula that easily damages
the spleen and stomach.
Assistants: Zé xiè, mù tōng, and chē qián zǐ clear heat
and disinhibit dampness, causing damp-heat to move
downward to be eliminated via the waterways. Shēng dì
huáng and dāng guī supplement blood and yin to prevent
liver heat from damaging yin and blood. This provides
supplementing within drainage and prevents the bitterdrying and percolating-disinhibiting medicinals from
damaging yin. Chái hú courses the liver and clears heat;
by coursing qi, it resolves depressed heat. It also
conducts the medicinals into the liver and gallbladder, so
it has a concurrent role as a courier.
Courier: Gān cǎo harmonizes all the medicinals.
3
Bai Tou Weng Tang
(Pulsatilla Decoction)
a
Warning: This formula has many bitter-cold
ingredients, so it easily damages the spleen
and stomach. It is not suitable for spleenstomach vacuity cold or yin vacuity with yang
hyperactivity.
a Bai
Tou Weng Tang primarily treats
heat toxin dysentery
a It is distinguished from Shao Yao
Tang (Peony Decoction), which
treats damp-heat dysentery
Comparison
Bai Tou Weng Tang (cont’d)
a
Heat toxin dysentery presents with:
a More
blood than pus
a Abdominal pain
a Tenesmus
a Red tongue with yellow fur
a Slippery, rapid pulse
a
a
a
a
a
a
Bai Tou Weng Tang and Shao Yao Tang both treat dysentery
with abdominal pain, tenesmus, and a yellow tongue coating.
However, BTWT primarily treats heat toxin falling into the
blood aspect, manifesting in heat toxin dysentery with more
blood than pus, and a red tongue with yellow fur.
a
a
It primarily clears heat and resolves toxin while cooling the blood and
astringing the dysentery.
By contrast, SYT treats damp-heat obstruction with equal
blood and pus and a greasy yellow tongue coat.
a
It harmonizes qi and blood while clearing heat and drying dampness; it
follows the principles of “treating the unstopped by unstopping”
(treating diarrhea with diarrhea), and the principle that “moving blood
causes pus in the stool to heal on its own, and regulating qi causes
tenesmus to be eliminated on its own.”
Xie Qing San
(瀉青散Drain the Bluegreen
Powder)
Dang Gui, Long Dan Cao (called Long Nao/Dragon’s Brain in
original text), Chuan Xiong, Zhi Zi (seeds), Da Huang
(Sichuan product baked in moist paper), Qiang Huo, Fang
Feng (3 g each, made into honey pills the size of qian shi
(1.5g), decocted with zhu ye and sugar.
Clears the liver and drains fire
Treats fire depressed in the liver channel, with red painful
swollen eyes, vexation, agitation, and easy angering, inability
to lie down calmly, reddish urine and constipation, and a
flooding, replete pulse.
Also treats acute fright in children with extreme and
convulsions.
Long dan xie gan tang drains liver fire while
clearing and disinhibiting damp-heat. It also
concurrently nourishes yin-blood so that evil is
dispelled without damaging right.
a Xie qing wan drains liver fire and also courses
and disperses depressed liver/GB fire, so it is
suitable for liver fire depressed in the inner
body.
a
4
Wei Jing Tang苇茎汤
Phragmites Stem Decoction
a
a
a
a
a
a
Wei jing (lu gen) [fresh, predecocted] 60g
Yi yi ren 30g
Dong gua ren 24g
Tao ren 9g
Actions: Clears the lung and transforms phlegm, expels stasis
and pus
Indications: Lung abscess (yong), with heat toxin congestion
and mutual binding of phlegm and stasis.
a
Mild generalized heat effusion, cough with copious phlegm, and in
severe cases, expectoration of foul-smelling fishy pus and blood, dull
pain, and a red tongue with greasy yellow fur. Pulse is slippery and
rapid.
a
a
a
a
Nei Jing “[When there is] exuberant heat, the flesh putrifies; when the
flesh putrifies, pus is formed.” “热盛则肉腐，肉腐则成脓”
When heat evil invades the lung, it can damage the blood
vessels, causing congestion of heat with blood stasis. If it
endures and does not disperse, the blood will be vanquished
and the flesh will putrify, forming a lung abscess.
When the abscess ruptures, there is cough with foul fishysmelling yellow phlegm with pus and blood.
Phlegm, heat, and static blood obstruct the chest, causing the
dull chest pain.
Qing Wei San 清胃散
(Stomach-Clearing Powder)
a
a
a
a
a
Lu gen is cold, sweet, light, and floating in nature; it clears
lung heat and is an essential herb for lung abscess.
Dong gua ren clears heat and transforms phlegm, while also
expelling pus. It helps lu gen to clear the lung, diffuse
congestion, and expel pus.
Yi yi ren clears lung heat and expels pus in the upper body,
while also percolating (leaching out) dampness
Tao ren quickens the blood and disperses welling-abscesses
This is a concise, focused formula with a balanced nature, and
it has long been respected for its ability to treat lung abscess.
Yu Nu Jian
Jade Lady Decoction
a
a
a
a
a
a
a
Shi gao 9–15g
Shu di 9–30g
Mai dong 6g
Zhi mu 5g
Niu xi 5 g
Clears stomach heat and nourishes yin
Stomach heat with yin xu. Headache, toothache,
bleeding gums, vexation and heat, thirst.
a
a
a
a
Sheng di, dang gui, mu dan pi, huang lian, sheng ma
Toothache due to stomach fire. The tooth pain can
cause headache, and there may also be redness of the
cheeks and tooth pain that is worse with heat.
Other possibilities include bleeding (and gaping)
gums, red swollen ulcerated gums, red painful
swollen cheeks, lips, and tongue, hot foul breath, dry
mouth
Red tongue with yellow fur; slippery rapid pulse.
Qing Hao Bie Jia Tang
(Sweet Wormwood and Turtle Shell
Decoction)
a Originally designed for the advanced stages of
warm disease, with latent (deep-lying) evil in
the yin aspect.
a This
manifests in nighttime heat that abates by the
morning. The heat abates in the absence of
sweating, and there is a red tongue with scant
liquid and a thin rapid pulse.
a
This formula nourishes yin and outthrusts heat.
5
a
a
a
a
Bie jia directly enters the yin aspect to abate vacuity heat, and
also enters the network vessels to track down evil.
Qing hao clears heat and outthrusts the network vessels,
guiding evil outward.
Both are sovereign medicinals.
The combination of these two medicinals inspired the
following statement in the Wen Bing Tiao Bian:
a
a Sheng
di enriches yin, clears heat, and cools the
blood
a Zhi mu enriches yin and downbears fire
a Both
are ministers that help bie jia to nourish yin and
abate vacuity heat.
a Dan
pi is an assistant; it drains latent fire within
yin, and helps qing hao to clear and outthrust latent
heat in the yin aspect. When fire abates, yin is
engendered on its own.
“[It] has the mystery of first entering and later exiting. Qing hao cannot
directly enter the yin aspect, so bie jia leads it in. Bie jia alone cannot
exit to the yang aspect, so qing hao leads it out.”
Qing Gu San
Bone-Clearing Powder
Liu Yi San
Six to One Powder
a
a This
formula clears vacuity heat and abates
steaming bone.
a It treats internal heat from yin vacuity and patterns
of vacuity taxation with steaming bone.
This formula is a base formula for treating contraction of
summerheat-dampness, with summerheat-damp pouring
downward.
a
a
a Symptoms
include steaming bone tidal heat effusion or
enduring low-grade fever, emaciation, red lips and
cheeks, dry mouth and night sweating, thirst and heart
vexation, red tongue with scant fur and a thin, rapid
pulse.
a
Symptoms include generalized heat effusion, vexation and thirst,
inhibited urination, and/or diarrhea.
Summerheat is a yang evil that connects with the heart;
when there is damage from summerheat, it often causes
generalized heat effusion, vexation, and thirst.
When summerheat evil is complicated by dampness, it
pours downward to affect the bladder’s qi transformation
function (resulting in inhibited urination). If it seeps
downward into the large intestine, it can cause diarrhea.
Modifications
a
a
a
a
This formula is a mild formula with few ingredients,
so it is typically strengthened with other ingredients.
In the treatment of diarrhea, this formula follows the
principle of “disinhibiting urine to fill the stool.” For
diarrhea to dampness damaging the spleen and
stomach, add bai bian dou and bai zhu.
For damp-heat pouring downward with hot strangury
or stone strangury, add che qian zi, bai tong, zhi zi,
and jin qian cao.
Yi Yuan San (Origin-Boosting Powder) was the original name for Liu Yi
San. However, this name now refers to a modification of Liu Yi San that
contains the addition of zhu sha, taken with a decoction of deng xin cao.
a
a
a
Bi Yu San (Jasper Jade Powder) is Liu Yi San with the addition of qing dai;
this makes the powder a light blue-green color.
a
a
a
It clears the heart and dispels summerheat while quieting the spirit.
Yi Yuan San is indicated for summerheat dampness with concurrent fearful
throbbing or heart palpitations, insomnia, and profuse dreaming.
This modification clears the liver and dispels summerheat.
It treats summerheat-damp patterns with concurrent depressed heat in the livergallbladder.
Ji Su San (Mint Powder) is Liu Yi San with the addition of bo he.
a
a
This modification dispels summerheat and courses wind.
It treats summerheat-damp patterns with concurrent mild aversion to wind or
cold, with headache or distention of the head, and ungratifying cough.
6
Gui Ling Gan Lu Yin
Qing Shu Yi Qi Tang
(Cinnamon and Poria Sweet Dew Beverage)
Summerheat-Clearing Qi-Boosting Decoction
a
a
This formula dispels summerheat and clears heat
while transforming qi and disinhibiting dampness.
It treats summerheat strike with internal collection of
water-dampness.
a
a
This manifests in heat effusion, headache, vexation and
thirst with taking of fluids, inhibited urination, and sudden
turmoil with vomiting and diarrhea.
The pattern addressed is exuberant summerheat-damp
a
a
a
This formula clears summerheat and boosts qi while
nourishing yin and engendering liquid.
Note that the original dosage and cooking instructions were
not listed in the source text.
This formula treats summerheat strike with heat, and damage
to both qi and liquid.
a
a
Symptoms include generalized heat effusion and profuse sweating,
heart vexation and thirst, short voidings of reddish urine, fatigue and
shortage of qi, devitalized essence-spirit, and a vacuous rapid pulse.
Note: Shortage of qi refers to weak, short, hasty breathing, a weak
voice, and a tendency to take deep breaths in order to continue
speaking; mainly attributable to visceral qi vacuity, especially of center
and lung-kidney qi, but also observed in phlegm turbidity, water-rheum,
food stagnation, and qi stagnation.
Comparing the Qing Shu Yi Qi Tang
Formulas
a
The two variations of these formulas both clear
summerheat and boost qi, but the Wen Bing Jing Wei
version is stronger for nourishing yin and
engendering liquid.
a
a
It is more suited to summerheat-heat with damage to liquid
and wearing of qi.
The Pi Wei Lun version is more mild in its ability to
engender liquid, but it is stronger for boosting qi,
fortifying the spleen, and drying dampness.
a
It is more suited to constitutional qi vacuity with
contraction of summerheat-dampness.
Thank you for your attention !
7
Bai Tou Weng Tang
(Pulsatilla Decoction)
Summerheat-Clearing Formulas
By Eric Brand, M.S., L.Ac.
L.Ac.
a Bai Tou
Weng Tang primarily treats
heat toxin dysentery
a It is distinguished from Shao Yao
Tang (Peony Decoction), which
treats dampdamp-heat dysentery
Bai Tou Weng Tang (cont’d)
a
Heat toxin dysentery presents with:
a More blood than pus
Comparison
a
a
a Abdominal pain
a
a Tenesmus
a Red tongue with yellow fur
Bai Tou Weng Tang and Shao Yao Tang both treat dysentery
with abdominal pain, tenesmus, and a yellow tongue coating.
However, BTWT primarily treats heat toxin falling into the
blood aspect, manifesting in heat toxin dysentery with more
blood than pus, and a red tongue with yellow fur.
a
a Slippery, rapid pulse
It primarily clears heat and resolves toxin while cooling the blood
blood and
astringing the dysentery.
By contrast, SYT treats dampdamp-heat obstruction with equal
blood and pus and a greasy yellow tongue coat.
a
It harmonizes qi and blood while clearing heat and drying dampness;
dampness; it
follows the principles of “treating the unstopped by unstopping”
unstopping”
(treating diarrhea with diarrhea), and the principle that “moving blood
causes pus in the stool to heal on its own, and regulating qi causes
causes
tenesmus to be eliminated on its own.”
own.”
Qing Hao Bie Jia Tang
(Sweet Wormwood and Turtle Shell
Decoction)
a Originally designed for the advanced stages of
warm disease, with latent (deep(deep-lying) evil in
the yin aspect.
a This manifests in nighttime heat that abates by the
morning. The heat abates in the absence of
sweating, and there is a red tongue with scant
liquid and a thin rapid pulse.
a
This formula nourishes yin and outthrusts heat.
a
a
a
a
Bie jia directly enters the yin aspect to abate vacuity heat, and
also enters the network vessels to track down evil.
Qing hao clears heat and outthrusts the network vessels,
guiding evil outward.
Both are sovereign medicinals.
The combination of these two medicinals inspired the
following statement in the Wen Bing Tiao Bian:
Bian:
a
“[It] has the mystery of first entering and later exiting. Qing hao cannot
directly enter the yin aspect, so bie jia leads it in. Bie jia alone cannot
exit to the yang aspect, so qing hao leads it out.”
out.”
1
Qing Gu San
BoneBone-Clearing Powder
a Sheng di enriches yin, clears heat, and cools the
a This formula clears vacuity heat and abates
blood
a Zhi mu enriches yin and downbears fire
a It treats internal heat from yin vacuity and patterns
steaming bone.
of vacuity taxation with steaming bone.
a Both
are ministers that help bie jia to nourish yin and
abate vacuity heat.
a Symptoms
include steaming bone tidal heat effusion or
enduring lowlow-grade fever, emaciation, red lips and
cheeks, dry mouth and night sweating, thirst and heart
vexation, red tongue with scant fur and a thin, rapid
pulse.
a Dan pi is an assistant; it drains latent fire within
yin, and helps qing hao to clear and outthrust latent
heat in the yin aspect. When fire abates, yin is
engendered on its own.
Liu Yi San
Six to One Powder
a
This formula is a base formula for treating contraction of
summerheatsummerheat-dampness, with summerheatsummerheat-damp pouring
downward.
a
Symptoms include generalized heat effusion, vexation and thirst,
inhibited urination, and/or diarrhea.
Summerheat is a yang evil that connects with the heart;
when there is damage from summerheat, it often causes
generalized heat effusion, vexation, and thirst.
a When summerheat evil is complicated by dampness, it
pours downward to affect the bladder’
bladder’s qi transformation
function (resulting in inhibited urination). If it seeps
downward into the large intestine, it can cause diarrhea.
a
Modifications
a
Yi Yuan San (Origin(Origin-Boosting Powder) was the original name for Liu Yi
San.
San. However, this name now refers to a modification of Liu Yi San that
contains the addition of zhu sha,
sha, taken with a decoction of deng xin cao.
cao.
a
a
a
Bi Yu San (Jasper Jade Powder) is Liu Yi San with the addition of qing dai;
dai;
this makes the powder a light blueblue-green color.
a
a
a
It clears the heart and dispels summerheat while quieting the spirit.
spirit.
Yi Yuan San is indicated for summerheat dampness with concurrent fearful
throbbing or heart palpitations, insomnia, and profuse dreaming.
This modification clears the liver and dispels summerheat.
It treats summerheatsummerheat-damp patterns with concurrent depressed heat in the liverlivergallbladder.
Ji Su San (Mint Powder) is Liu Yi San with the addition of bo he.
he.
a
a
This modification dispels summerheat and courses wind.
It treats summerheatsummerheat-damp patterns with concurrent mild aversion to wind or
cold, with headache or distention of the head, and ungratifying cough.
This formula is a mild formula with few ingredients,
so it is typically strengthened with other ingredients.
a In the treatment of diarrhea, this formula follows the
principle of “disinhibiting urine to fill the stool.”
stool.” For
diarrhea to dampness damaging the spleen and
stomach, add bai bian dou and bai zhu.
a For dampdamp-heat pouring downward with hot strangury
or stone strangury, add che qian zi,
zi, bai tong,
tong, zhi zi,
zi,
and jin qian cao.
a
Gui Ling Gan Lu Yin
(Cinnamon and Poria Sweet Dew Beverage)
a
a
This formula dispels summerheat and clears heat
while transforming qi and disinhibiting dampness.
It treats summerheat strike with internal collection of
waterwater-dampness.
This manifests in heat effusion, headache, vexation and
thirst with taking of fluids, inhibited urination, and sudden
turmoil with vomiting and diarrhea.
a The pattern addressed is exuberant summerheatsummerheat-damp
a
2
Qing Shu Yi Qi Tang
SummerheatSummerheat-Clearing QiQi-Boosting Decoction
a
a
a
This formula clears summerheat and boosts qi while
nourishing yin and engendering liquid.
Note that the original dosage and cooking instructions were
not listed in the source text.
This formula treats summerheat strike with heat, and damage
to both qi and liquid.
a
a
Symptoms include generalized heat effusion and profuse sweating,
heart vexation and thirst, short voidings of reddish urine, fatigue
fatigue and
shortage of qi, devitalized essenceessence-spirit, and a vacuous rapid pulse.
Note: Shortage of qi refers to weak, short, hasty breathing, a weak
weak
voice, and a tendency to take deep breaths in order to continue
speaking; mainly attributable to visceral qi vacuity, especially of center
and lunglung-kidney qi, but also observed in phlegm turbidity, waterwater-rheum,
food stagnation, and qi stagnation.
Comparing the Qing Shu Yi Qi Tang
Formulas
a
The two variations of these formulas both clear
summerheat and boost qi, but the Wen Bing Jing Wei
version is stronger for nourishing yin and
engendering liquid.
a
a
It is more suited to summerheatsummerheat-heat with damage to liquid
and wearing of qi.
The Pi Wei Lun version is more mild in its ability to
engender liquid, but it is stronger for boosting qi,
fortifying the spleen, and drying dampness.
a
It is more suited to constitutional qi vacuity with
contraction of summerheatsummerheat-dampness.
Thank you for your attention !
3