【Source】

《Treatise on Cold Damage》 (Shang Han Lun)

 【Composition】

Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig), (prepared)Gan Cao (Licorice Root), Xing Ren (Apricot Kernel)
(4 ingredients)

 【Classification Category】

<Tonifying Spleen and Middle Jiao>: Gan Cao (Licorice Root)

<Acrid-Warm Releasing Exterior>: Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig)

<Stopping Cough and Calming Asthma>: Xing Ren (Apricot Kernel)

【Formula Principles】

《Yi Fang》: This formula addresses the Foot Taiyang channel. (Yu Jiayan: Ma Huang has the strongest diaphoretic effect, Gui Zhi moderates it, Xing Ren moistens and descends qi to relieve asthma, Gan Cao harmonizes it.) (1)Ma Huang: hollow, acrid-warm with light qi, a specific herb for the Lung channel and goes to Taiyang, capable of opening the pores and dispelling cold. (2)Gui Zhi: acrid-warm, capable of guiding pathogenic factors from the Ying (Nutritive Qi) level to the superficial skin. (3)Xing Ren: bitter-sweet, disperses cold and descends qi. (4)Gan Cao: sweet-neutral, disperses and harmonizes the middle. (5) The Classic states: When cold invades internally, treat with sweet and hot, supplemented by bitter and acrid. This is it. 《Shan Bu》: Named Ma Huang Tang because Ma Huang is the monarch herb. Ma Huang is warm in nature, acrid and bitter in taste, its function is rapid ascent; Gui Zhi is warm in nature, acrid and sweet in taste, its function is to stabilize the exterior. The syndrome belongs to excess, so using Ma Huang as the principal herb is a sure win. Gui Zhi acts as a brilliant restraint. Xing Ren, bitter and warm, assists Ma Huang in expelling pathogens and descending rebellious qi; Gan Cao, sweet and neutral, assists Gui Zhi in harmonizing the interior and resisting external pathogens. When the decoction enters the stomach, it circulates qi through the primordial orifices and transports essences to the skin and hair, thereby harmonizing the pores and vessels, leading to profuse sweating. External pathogens will be completely expelled without residue, pain will stop, asthma will calm, and the chills and fever will quickly resolve. There is no need to consume porridge to induce sweat through grains. The reason ginger and jujube are not used is because ginger’s property is to widely disperse within the muscles, hindering Ma Huang‘s rapid ascent, and jujube’s property is to cause stagnation in the diaphragm, hindering Xing Ren‘s rapid descent. This formula aims for rapid, direct action; any slowness would impede its swiftness, and wide dispersion would prevent ascent. However, it is a purely Yang agent, overly dispersing. Like a general charging directly with a single sword, if used appropriately, it achieves success in one battle; if not, it can cause unrest and invite disaster. Therefore, it should be used once and not repeatedly. If symptoms persist after sweating, it should be replaced with Gui Zhi Tang. This formula is Zhang Zhongjing’s most potent diaphoretic and exterior-expelling medicine. Unskilled practitioners do not understand that its effect relies on warm covering to induce sweat; if not warmly covered to induce sweat, it will not be potent. 《Han Dian》: This formula consists of four ingredients: Ma Huang, Gui Zhi, Xing Ren, and Gan Cao. Ma Huang and Gui Zhi work together to dilate blood vessels, promote vigorous blood circulation, and induce sweating. Xing Ren also works with Ma Huang to treat coughing and asthma. Gan Cao combines with Gui Zhi to strengthen the heart, and with Ma Huang to promote sweating and diuresis.

 【Functions】

Induce sweating to release the exterior, ventilate the lungs to calm asthma.

 【Indications】

(1) Taiyang cold damage disease with anhidrosis (no sweating), body aches, chest fullness with asthma, and calming lung asthma. (2) External invasion of wind-cold with exterior excess pattern, presenting as aversion to cold, fever, headache, body aches, anhidrosis with asthma, no thirst, thin white tongue coating, and a floating-tight pulse. (3) This formula is used for Taiyang disease with exterior excess-heat pattern where there are no internal changes. Its target symptoms include aversion to cold, fever, floating-tight pulse with anhidrosis, and various joint pains, lower back pain, coughing, and wheezing accompanying the fever. These symptoms appear in the early stages of colds, flu, and other febrile diseases. This formula has diaphoretic and diuretic effects; after taking it, sweating will occur, alleviating various symptoms, increasing urine output, and leading to recovery. 《Yi Fang》: (1) Taiyang cold damage syndrome where pathogenic qi is on the exterior, with headache, fever, body aches, lower back pain, joint pain, stiffness in the neck and back, aversion to cold and wind, anhidrosis with asthma, and a floating-tight pulse (Shang Han Lun, Taiyang Middle Chapter). (2) Also treats combined Taiyang-Yangming disease with asthma and chest fullness (Shang Han Lun, Differentiation of Combined Diseases Chapter). (3) Also treats asthma syndrome. 《Shan Bu》: Taiyang wind-cold on the exterior, with severe headache and neck pain, fever, body aches, lower back pain, joint pain, aversion to wind and cold with anhidrosis, chest fullness and asthma, and a floating-tight or floating-rapid pulse. Use this to induce sweating. However, if these symptoms are present but the pulse is floating-weak, or there is spontaneous sweating, or the pulse in the chi (wrist) position is weak and slow, it should not be used. It is most suitable for bi syndrome formed by wind, cold, and dampness, with lung channel obstruction, confusion and inability to speak, and cold wind asthmatic wheezing.

 【Clinical Applications】

Common cold or influenza belonging to the wind-cold exterior excess pattern, bronchitis, bronchial asthma, rhinitis, fever in children, nasal congestion in infants, rheumatoid arthritis, early stages of joint rheumatism, etc.

 【Contraindications】

(1) Not suitable for external invasion with sweating. (2) The decoction should be taken warm, and stopped once sweating occurs and fever subsides. (2) As this formula is for exterior excess patterns, it is not suitable for cases of exterior deficiency with spontaneous sweating, or a floating-weak or deep-weak pulse. It should be used with caution in individuals with weak constitution, such as the elderly and young children.

 【Mnemonics】

(1) Ma’s heart and liver (Ma-Zhi-Xing-Gan). (2) Godmother’s surname is Gui (Gan-Ma-Xing-Gui).

 【Modifications】

《Han Dian》: Adding Bai Zhu (Atractylodes macrocephala) is effective for exterior heat combined with dampness (water toxicity) and can be used for rheumatism, arthritis, acute nephritis, and kidney sclerosis. (1) Removing Gui Zhi from this formula makes San Ao Tang (Three Stubborns Decoction) from He Ji Ju Fang. Its function is to ventilate the lungs and release the exterior. It treats common cold due to wind pathogens, with nasal congestion, heavy voice, headache, body aches, asthma, chest tightness, and clear thin phlegm. (2) Adding Shi Gao (Gypsum), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube) to this formula makes Da Qing Long Tang (Major Blue Dragon Decoction) from Shang Han Lun. Its function is to induce sweating to release the exterior, clear heat and relieve vexation. It treats exterior wind-cold excess pattern combined with internal heat, presenting as fever, aversion to cold, severe chills and fever, floating-tight pulse, body aches, anhidrosis with irritability, and also treats wind-water edema. (3) Removing Xing Ren and Gui Zhi and adding Shi Gao (Gypsum), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube) to this formula makes Yue Bi Tang (Crossing the Boundary Decoction) from Shang Han Lun. Its function is to induce sweating, promote diuresis, and reduce swelling. It treats facial and eye edema, accompanied by sweating with aversion to wind, slight fever, and thirst. (4) Adding Bai Zhu (Atractylodes macrocephala) to this formula makes Ma Huang Jia Zhu Tang (Ma Huang Decoction with Atractylodes) from Jin Gui Yao Lue. Its function is to induce sweating to release the exterior, dispel cold and eliminate dampness. It treats body aches and vexation in dampness patterns. (5) Removing Gui Zhi, reducing the dosage of the other ingredients, and adding Yi Ren (Coix Seed) to this formula makes Ma Xing Yi Gan Tang (Ma Huang, Apricot Kernel, Coix Seed, Licorice Decoction) from Jin Gui Yao Lue. Its function is to release the exterior and eliminate dampness. It treats rheumatism with whole-body pain, and fever that worsens in the afternoon. (6) Removing Gui Zhi and adding Sang Bai Pi (Mulberry Bark), Su Zi (Perilla Fruit), Fu Ling (Poria), and Chen Pi (Tangerine Peel) to this formula makes Hua Gai San (Flower Canopy Powder) from He Ji Ju Fang. Its function is to ventilate the lungs and release the exterior, resolve phlegm and stop cough. It treats external invasion of wind-cold, with coughing and gasping, difficulty expelling phlegm, wheezing sounds, and a floating-tight and soggy pulse. (7) Removing Xing Ren and adding Tao Ren (Peach Kernel), Hong Hua (Safflower), Chi Shao (Red Peony Root), Bai Zhi (Angelica Dahurica), Xi Xin (Asarum), Sheng Jiang (Fresh Ginger), and Cong Bai (Scallion White) to this formula makes Ma Huang Wen Jing Tang (Ma Huang Warm Meridian Decoction) from Shang Ke Bu Yao. Its function is to induce sweating to release the exterior and activate blood to dispel stasis. It treats cold invasion after injury, with aversion to cold, fever, anhidrosis, body aches, and joint pain. (8) For spontaneous sweating, remove Ma Huang and add Ge Gen (Kudzu Root) 2 liang.

 【Pharmacology】

Has diaphoretic, antipyretic, anti-hypothermic, antitussive and antiasthmatic, antiviral, and immune-modulating effects.