Source

Shang Han Lun (Treatise on Cold Damage)

Composition

Ma Huang (Ephedra), Xi Xin (Asarum), Fu Zi (Aconite) (3 ingredients)

Categories

<Warm-Acrid Exterior-Releasing>: Ma Huang (Ephedra)

<Warming the Interior>: Xi Xin (Asarum), Fu Zi (Aconite)

Formulation Rationale

Yi Fang (Medical Prescriptions): A formula for the Foot Shaoyin channel. (1) In Taiyang disorders, fever is present, and the pulse should be superficial (floating). Now, it is paradoxically deep (submerged). In Shaoyin disorders, the pulse is deep, and there should be no fever. Now, there is fever, hence “paradoxically”. The fever indicates an exterior evil that requires sweating, while the deep pulse indicates Yin, thus requiring warming. (2) Therefore, Fu Zi (Aconite) warms the Shaoyin channel. (3) Ma Huang (Ephedra) dispels the Taiyang cold and induces sweating. (4) Xi Xin (Asarum), an exterior-releasing herb for the Kidney channel, connects these actions, making this a potent diaphoretic formula.

Shan Bu (Revised and Supplemented): Ke Qin said: “When there is fever without sweating, the exterior of Taiyang must be opened. A deep pulse indicates an interior condition, thus the pivot of Shaoyin must be stabilized. If Ma Huang (Ephedra) is used to open the pores and Xi Xin (Asarum) to dispel superficial heat, but without Fu Zi (Aconite) to consolidate the primordial Yang, then the Shaoyin’s fluid will extravasate, and the Taiyang’s subtle Yang will dissipate externally, making recovery distant. Only by using Fu Zi (Aconite) and Ma Huang (Ephedra) together can cold evil be dispersed without losing Yang. This is a case where the internal illness affects the exterior, and despite a deep pulse, sweating is required—a distinct situation from superficial exterior illness with a floating pulse that requires sweating. If the exterior fever is slight, the cold exposure is also mild, so Gan Cao (Licorice) replaces Xi Xin (Asarum) to induce mild sweating, using its sweetness to moderate, which is quite different from the acridness used for dispersion.”

Han Dian (Chinese Dictionary of Herbal Medicine): Fu Zi (Aconite) and Xi Xin (Asarum) are both warming herbs that can promote blood circulation and warm the body, creating a sensation of warmth. Therefore, Fu Zi (Aconite), Xi Xin (Asarum), and Ma Huang (Ephedra) are combined to treat those with a deep, thready pulse and a lack of strength.

Functions

Dispelling exterior evil, warming channels and scattering cold, invigorating Yang and releasing the exterior.

Indications/Applications

(1) Individuals with a pre-existing Yang deficiency who contract wind-cold, exhibiting severe aversion to cold without sweating, mild fever, headache without sweating, cold limbs, fatigue, desire to lie down, a pale tongue with a thin white coating, and a deep, thready pulse instead of a floating one. (2) Used in the early stages of Shaoyin disorders when exterior symptoms are present. Therefore, it can be used for ailments such as common colds, bronchitis, and bronchial asthma in weakened individuals or the elderly. (3) The target symptoms for this formula include aversion to cold, mild fever, deep and thready pulse, general fatigue, lack of strength, and desire to lie down. Upon administration, the aversion to cold subsides, strength returns, and all symptoms alleviate.

Yi Fang (Medical Prescriptions): For Shaoyin stage cold damage, where there is initial paradoxical fever with a deep pulse (Shang Han Lun, Shaoyin chapter).

Shan Bu (Revised and Supplemented): For initial Shaoyin disorder presenting with paradoxical fever and a deep pulse, with no interior symptoms after two or three days.

Therapeutic Applications

Common cold in debilitated individuals and the elderly, influenza, fever, headache, bronchitis, asthma, pneumonia, sick sinus syndrome.

Contraindications

(1) All ingredients in this formula are acrid and drying, which can easily injure Yin fluids and consume body liquids. Prolonged use or excessive dosage may cause symptoms such as dry mouth and throat, insomnia, and irritability. (2) It is contraindicated in pregnant women, and in cases of excess syndromes, heat syndromes, or dryness syndromes. (3) Raw Fu Zi (Aconite) is toxic. It should be decocted for at least 1 hour to reduce its toxicity. Its dosage should be determined according to the patient’s constitution and the severity of the condition.

Mnemonic

The formula name is its composition. Ma Huang Fu Zi Xi Xin Tang is a three-ingredient formula that combines to invigorate Yang and release the exterior.

Modifications

Han Dian (Chinese Dictionary of Herbal Medicine): Adding Fang Feng (Saposhnikovia Root) and Chuan Xiong (Sichuan Lovage Rhizome) to this formula can treat cold pain in the head.

(1) For Qi deficiency, add Dang Shen (Codono-psis Root) and stir-fried Gan Cao (Licorice) to tonify Qi. (2) For severe Yang deficiency, add Rou Gui (Cinnamon Bark) and Gan Jiang (Dried Ginger) to enhance the warming Yang effect. (3) For more severe exterior cold, it is advisable to add Gui Zhi (Cinnamon Twig) and Qiang Huo (Notopterygium Root) to strengthen the exterior-releasing and cold-dispersing effects. (4) For concomitant asthma, coughing with excessive phlegm, it is advisable to add Ban Xia (Pinellia Tuber), Fu Ling (Poria), and Chen Pi (Tangerine Peel) to resolve phlegm and stop coughing. (5) For concomitant chest impediment (Bi syndrome), it is advisable to add Gua Lou (Trichosanthes Fruit) and Xie Bai (Allium Macrostemum Bulb) to broaden the chest and unblock Yang.

Pharmacology

Possesses anti-inflammatory, anti-allergic, and antioxidant effects.