【Source】

Shang Han Lun (Treatise on Cold Damage)

 【Composition】

Hirudo, Tabanus, Semen Persicae, (wine-processed) Radix et Rhizoma Rhei
(4)

 【Classification】

<Purgative>: Radix et Rhizoma Rhei

<Blood-activating and stasis-resolving>: Hirudo, Semen Persicae, Tabanus

【Formula Actions and Indications】

Yi Fang: This is a formula for the Taiyang channel. (1) Cheng Shi comments: Bitter enters the blood, salt permeates the blood. Tabanus and Hirudo, with their bitter and salty properties, remove blood stasis. (2) Sweet moderates stagnation, bitter expels heat. Semen Persicae and Radix et Rhizoma Rhei, with their sweet and bitter tastes, descend stagnation and heat. Shan Bu: Leeches are good at drinking blood and are effective in water. Horseflies are good at sucking blood and are potent on land. Both are used to attack blood stasis, their similar nature reinforcing their action. Semen Persicae, with its bitter-sweet taste, promotes the removal of the old and the generation of the new. Radix et Rhizoma Rhei, with its bitter-cold nature, clears evil heat. Thus, it is named Dǐdāng (blood dissipating). If the heat is intense but without delirium, and the lower abdomen is full but not hard, a smaller dose in pill form is recommended for gentle treatment. If the external symptoms have resolved, but the lower abdomen is distended and hard, and the patient exhibits delirium, it indicates a转属阳明 (transition to the Yangming channel). In such cases, use Tiaowei Chengqi Decoction with the addition of Semen Persicae and Ramulus Cinnamomi to invigorate blood, and administer gently. When the stomach is harmonious, recovery will follow. This is the gentle approach of Semen Persicae Chengqi Decoction. Han Dian: The Hirudo and Tabanus in this formula both have the effect of dissolving congealed blood and blood clots, clearing blockages, and expelling old, non-physiological blood. Radix et Rhizoma Rhei is a purgative for congealed old waste materials, and also has anti-inflammatory and stomach-strengthening effects.

 【Functions】

To purge and expel blood stasis, break blood, eliminate blood stasis, and purge accumulated blood.

 【Indications】

(1) Accumulation of blood in Shang Han (Cold Damage), with lingering heat in the interior. Blood accumulation in the lower jiao leading to delirium or apparent delirium, forgetfulness, distention and hardness of the lower abdomen, spontaneous urination, black stools, jaundice, deep and firm pulse. Also for women with irregular menstruation, amenorrhea, and distention and hardness of the lower abdomen with tenderness upon palpation, with both pulse and symptoms being substantial. (2) This formula has the power to eliminate old and stagnant blood, and can expel stagnant blood, hematoma, blood clots, blockages, and thrombi in the pelvic cavity. It is used for abdominal distention, resistance and tenderness upon palpation, rapid urination, black stools, accompanied by forgetfulness and various neurological symptoms, with a predominantly deep pulse. Yi Fang: Six or seven days after Shang Han, with persistent external symptoms, a weak and deep pulse, but no accumulation of phlegm-heat in the chest, and delirium, indicates heat in the lower jiao. If the lower abdomen is distended and urination is spontaneous, there must be blood stasis, causing forgetfulness, because the Taiyang channel’s collateral heat has accumulated in the interior. Shan Bu: Shang Han with blood stasis, also treats abdominal masses, and is excellent for expelling parasites and clearing toxins.

 【Main Indications】

(1) Amenorrhea and dysmenorrhea due to blood stasis in women; (2) Amnesia, psychosis, schizophrenia; (3) Prostatitis, intestinal obstruction, chyluria, hemorrhoids, urinary system stones, orchitis, incarcerated hernia, penile hematoma, thrombocythemia, cerebral thrombosis, thrombophlebitis, and other conditions.

 【Mnemonic】

Brother naturally wants to beat up the escaped water insects (Dǐdāng, dà táo shuǐ chóng – indicating the key ingredients: Dǐdāng, Da Huang, Tao Ren, Shui Zhi, Chong).

 【Modifications】

(1) If there is heat, add Radix Bupleuri.