【Source】

From “Waitai Miyao” (Medical Secrets of an Official) (752 AD), Volume 1, citing 15 prescriptions from “Cui Shi Fang” (Cui’s Prescriptions).

 【Composition】

Coptis (Huanglian), Scutellaria (Huangqin), Phellodendron (Huangbai), Gardenia (Zhizi)
(4 herbs)

 【Classification Category】

<Clearing Heat and Drying Dampness>: Coptis (Huanglian), Phellodendron (Huangbai), Scutellaria (Huangqin)

<Clearing Heat and Purging Fire>: Gardenia (Zhizi)

【Formula Principles】

From ‘Yifang’ (Medical Prescriptions): A formula for Hand Yangming, Foot Yangming, and Hand Shaoyang channels.

(1) Accumulation of heat in the three jiaos, and uncontrolled pathogenic fire.

(2) Therefore, Scutellaria (Huangqin) is used to purge lung fire from the Upper Jiao.

(3) Coptis (Huanglian) purges spleen fire from the Middle Jiao.

(4) Phellodendron (Huangbai) purges kidney fire from the Lower Jiao.

(5) Gardenia (Zhizi) broadly purges fire from all three jiaos, allowing it to exit via the bladder.

(6) When Yang is excessive, Yin declines; when fire is excessive, Water declines. Thus, extremely bitter and cold herbs are used to suppress Yang and support Yin, purging the excessive fire and rescuing the declining Water. However, it should not be administered lightly unless there is true excess heat. From ‘Shanbu’ (Additions and Corrections): Wang Ang said: Extreme cold is called Yin Toxicity, and extreme heat is called Yang Toxicity. This formula is named Huanglian Jiedu Tang (Coptis Detoxification Decoction), with Coptis (Huanglian) as the chief herb directly resolving fire toxin in the Heart channel. Scutellaria (Huangqin) purges fire toxin in the Lung channel, Phellodendron (Huangbai) purges fire toxin in the Kidney channel, and Gardenia (Zhizi) broadly purges fire toxins from the three jiaos, allowing all these fire toxins to exit via the bladder. Huanglian Jiedu Tang, Baihu Tang (White Tiger Decoction), Sanhuang Shigao Tang (Three Yellows and Gypsum Decoction), and Daqinglong Tang (Major Bluegreen Dragon Decoction) all treat syndromes with both exterior and interior heat. However, Daqinglong Tang treats robust exterior excess heat with superficial interior heat in the muscles; Sanhuang Shigao Tang treats robust exterior excess heat with deep interior heat in the stomach.

Therefore, one uses Gypsum (Shigao) to assist Ephedra (Mahua) and Cinnamon Twig (Guizhi), while the other uses Gypsum (Shigao) to assist Ephedra (Mahua) and Fermented Soybean (Douchi), both for releasing the Taiyang exterior and clearing the Yangming interior. Daqinglong Tang further uses Apricot Kernel (Xingren), Licorice (Gancao), Ginger (Shengjiang), and Jujube (Dazao) to assist Ephedra (Mahua), specifically aiming to vent heat stagnation in the muscles. Sanhuang Shigao Tang further uses Scutellaria (Huangqin), Coptis (Huanglian), Gardenia (Zhizi), and Phellodendron (Huangbai) to assist Gypsum (Shigao), specifically aiming to purge deep heat in the stomach. Baihu Tang treats exterior heat in the muscles and interior heat in the stomach, thus it does not use Ephedra (Mahua) or Cinnamon Twig (Guizhi) to release the Taiyang exterior, but focuses on Gypsum (Shigao) to clear the Yangming interior.

Jiedu Tang treats exterior heat in the three Yang channels and interior heat in the three jiaos, thus it also does not use Ephedra (Mahua) or Cinnamon Twig (Guizhi) to release the Taiyang exterior, nor does it use Gypsum (Shigao) to clear the Yangming interior, but exclusively uses the three ‘Huang’ herbs (Coptis, Scutellaria, Phellodendron) to purge excess fire from above, below, interior, and exterior.

These are all cases where Taiyang pathogens have invaded Yangming but have not yet entered the fu organs to form excess. If they have already entered the fu organs and formed excess, then the three Chengqi Tang formulas should be used to purge the heat. From ‘Han Dian’ (Chinese Materia Medica Dictionary): Coptis (Huanglian) and Scutellaria (Huangqin) in this formula reduce inflammation and congestion, treating epigastric fullness and discomfort. Gardenia (Zhizi) and Phellodendron (Huangbai) are anti-inflammatory and diuretic, assisting Coptis (Huanglian) and Scutellaria (Huangqin).

 【Functions】

Clears heat and resolves toxicity, clears and drains damp-heat.

 【Clinical Uses】

(1) All syndromes of excess heat and fire toxicity, with exuberant heat in the three jiaos, manifesting as high fever with vexation and delirium, dry mouth and throat, red eyes with pain, incoherent speech and insomnia, or nosebleeds/vomiting blood in febrile diseases, severe heat causing skin rashes, surgical sores and toxic swellings, carbuncles, boils, red tongue with yellow coating, and a rapid, forceful pulse.

(2) This is a prescription for Yang excess syndrome, composed entirely of anti-inflammatory herbs. It has the effects of reducing congestion and alleviating mental restlessness. It can also resolve lingering residual heat during the course of various febrile diseases. Patients presenting with this formula may experience mental restlessness and vexation due to inflammation and congestion. Symptoms include dark urine, or various types of bleeding. The pulse is deep and forceful, and there is epigastric fullness and resistance.

From ‘Yifang’: All fire-heat syndromes, with exuberance of both exterior and interior heat, manifesting as manic restlessness, vexation, dry mouth and throat, high fever with dry heaving, incoherent speech and insomnia, vomiting blood or nosebleeds, and severe heat causing skin rashes. From ‘Shanbu’: All syndromes of exuberant Yang heat and fire, manifesting as red face, dry mouth, manic restlessness, vexation, incoherent speech and insomnia, high fever with dry heaving, vomiting blood or nosebleeds, and loose stools after purgation with persistent heat.

 【Indications】

Hepatitis B, sepsis, dysentery, pneumonia, nephritis, urinary tract infections. Various febrile diseases, hematemesis (vomiting blood), hemoptysis (coughing blood), epistaxis (nosebleeds), melena (blood in stool), hematuria (blood in urine), gynecological bleeding disorders, mania, palpitation, insomnia, neurological disorders, mental disorders. Biliary tract infections, impetigo, eczema, urticaria, pruritus, purulent sores belonging to syndromes of exuberant excess heat and fire toxicity.

 【Mnemonic】

A mnemonic: ‘Three Huangs know’ (referring to Scutellaria, Coptis, Phellodendron, and Gardenia).

 【Modifications】

(1) For constipation, add Rhubarb (Dahuang), Mirabilite (Mangxiao), etc., to purge fire and unblock the bowels, guiding heat out.

(2) For scanty, dark, difficult urination, add Akebia (Mutong), Talc (Huashi), Plantain Seed (Cheqianzi) to promote urination.

(3) For dysentery with tenesmus, add Costus Root (Muxiang), Areca Seed (Binlang), White Peony Root (Baishao), etc., to regulate Qi and harmonize blood.

(4) For vomiting blood, nosebleeds, or skin rashes, add Rehmannia Root (Shengdi), Scrophularia Root (Xuanshen), Imperata Root (Baimao Gen), etc., to cool blood and stop bleeding.

(5) For boils and toxic swellings, add Dandelion (Pugongying), Honeysuckle Flower (Yinhua), Forsythia (Lianqiao), etc., to enhance the effects of clearing heat and resolving toxicity.

(6) For jaundice due to stagnated heat, add Artemisia Scoparia (Yinchen), Rhubarb (Dahuang), etc., to clear heat, drain dampness, and reduce jaundice.

(7) If Phellodendron (Huangbai) and Gardenia (Zhizi) are removed from this formula and Rhubarb (Dahuang) is added, it becomes Sanhuang Xiexin Tang (Three Yellows Heart-Purging Decoction) from ‘Jinkui Yaolue’ (Synopsis of Prescriptions of the Golden Cabinet), used for excess heat in the three jiaos, high fever, vexation, delirium, constipation, red face, red eyes, oral sores, and damp-heat jaundice.

(8) If Rhubarb (Dahuang) is added to this formula, it becomes Zhizi Jinhua Tang (Gardenia and Golden Flower Decoction).

 【Pharmacology】

It has strong antibacterial, antipyretic, anti-inflammatory, hypotensive, and hemostatic effects. It also influences adrenal cortical function and can reduce serum transaminases in mice with toxic hepatitis.