【Source】
《Shang Han Lun》 (Treatise on Cold Damage)
【Ingredients】
Bupleurum Root (Chai Hu), Scutellaria Root (Huang Qin), Pinellia Rhizome (Ban Xia), Ginseng Root (Ren Shen), (Honey-fried) Licorice Root (Gan Cao), Fresh Ginger (Sheng Jiang), Jujube Fruit (Da Zao)
(7)
【Category】
<Tonifying Spleen and Middle Jiao>：Licorice Root (Gan Cao), Jujube Fruit (Da Zao)
<Releasing Exterior with Acrid-Cool Herbs>：Bupleurum Root (Chai Hu)
<Clearing Heat and Drying Dampness>：Scutellaria Root (Huang Qin)
<Tonifying Qi>：Ginseng Root (Ren Shen)
<Releasing Exterior with Acrid-Warm Herbs>：Fresh Ginger (Sheng Jiang)
<Resolving Phlegm>：Pinellia Rhizome (Ban Xia), Licorice, Ginger, and Jujube
【Formula Analysis】
《Yi Fang》 (Prescriptions and Their Explanations): This is a Foot Shao Yang formula. The Gallbladder is the “clear organ,” with neither outflow nor inflow. Its meridian is located at the half-exterior, half-interior level, and it should not be treated with diaphoresis, emesis, or purgation; the appropriate method is harmonization. When pathogens enter this meridian, it indicates progression from the exterior towards the interior. One should thoroughly clear heat and release the exterior, meeting and seizing the pathogen to prevent it from transmitting to the Tai Yin. (1) Chai Hu (Bupleurum): Bitter in taste and slightly cold in nature, it is the chief herb for the Shao Yang, ascending Yang and reaching the exterior. (2) Huang Qin (Scutellaria): Bitter and cold, it nourishes Yin and clears heat as the deputy herb. (3) Ban Xia (Pinellia): Acrid and warm, it strengthens the Spleen and harmonizes the Stomach to dispel rebellious Qi and stop vomiting. (4) Ren Shen (Ginseng) and Gan Cao (Licorice): Tonify the upright Qi and harmonize the Middle Jiao, preventing the pathogen from further transmission to the interior as assistant herbs. When the pathogen is at the half-exterior, half-interior level, there is conflict between Ying and Wei, so Sheng Jiang (Ginger) and Da Zao (Jujube) are used for their acrid and sweet flavor to harmonize Ying and Wei as envoy herbs. 《Shan Bu》 (Supplemented and Revised Prescriptions): In this formula, Chai Hu (Bupleurum) spreads Liver Qi, allowing the pathogen at the half-exterior to be released outwards. Huang Qin (Scutellaria) clears fire, allowing the pathogen at the half-interior to be thoroughly cleared from within. Ban Xia (Pinellia) resolves phlegm and reduces the rebellious Qi in the interior. Ren Shen (Ginseng) tonifies long-term deficiency and assists the rising of Qi. Gan Cao (Licorice) assists Chai Hu and Huang Qin in harmonizing the interior and exterior. Ginger and Jujube assist Ginseng and Pinellia in unblocking Ying and Wei, working together synergistically to allow the pathogen to be resolved outwards without moving inwards. 《Han Dian》 (Chinese Medicine Dictionary): The chief herb in this formula, Chai Hu (Bupleurum), with the assistance of Huang Qin (Scutellaria), exerts its effects on the chest and hypochondriac region, having anti-inflammatory and detoxifying effects, while also clearing stagnation in the chest and hypochondriac region. Ban Xia (Pinellia) and Sheng Jiang (Ginger) can stop nausea and vomiting, increase appetite, and synergize with Chai Hu (Bupleurum) and Huang Qin (Scutellaria). Ren Shen (Ginseng), Gan Cao (Licorice), and Da Zao (Jujube) together strengthen Stomach function and alleviate the feeling of fullness in the chest and hypochondriac region. The Chai Xian Tang, which is a combination of this formula and Xiao Xian Xiong Tang (Minor Chest-Sinking Decoction), is indicated for conditions similar to <a href='https://whatsintcm.com/dt_articles/小柴胡湯/’>Xiao Chai Hu Tang syndrome, but with particular hardness and distension in the epigastric region, and tenderness upon palpation in that area. It is used for pleurisy, hepatitis, etc.
【Functions】
Ascends Yang to reach the exterior, nourishes Yin and clears heat, harmonizes Shao Yang, supports upright Qi and eliminates pathogenic influences, harmonizes the Stomach and descends rebellion.
【Indications】
Shao Yang syndrome of Cold Damage, characterized by alternating chills and fever, fullness in the chest and hypochondria, lack of appetite, irritability with vomiting, bitter taste in the mouth, dry throat, dizziness, headache, thin white tongue coating, and wiry and rapid pulse. Also used for women with Cold Damage invading the Blood Chamber, and for malaria with alternating chills and fever. It can also be used for internal miscellaneous diseases such as jaundice presenting with Shao Yang symptoms. When using this formula for patients with fever, it is targeted at intermittent chills and fever or body temperature due to Shao Yang disease, accompanied by fullness in the chest and hypochondria. 《Yi Fang》: (1) Treats Shao Yang syndrome of Cold Damage or Wind Stroke, with alternating chills and fever, fullness in the chest and hypochondria, silent disinclination to eat or drink, irritability with vomiting. Or irritability in the chest without vomiting, or thirst, or abdominal pain, or hardness and fullness below the ribs, or palpitations below the heart, and difficult urination; or no thirst with mild fever, or cough (Shang Han Lun, Shao Yang section). (2) Also treats seasonal coughs in the spring, malaria with alternating chills and fever, and women with Cold Damage with heat entering the Blood Chamber (Shang Han Lun, Shao Yang section). (3) Also treats Cold Damage five or six days in, with sweating from the head, slight aversion to cold, cold hands and feet, fullness below the heart, disinclination to eat or drink, hard stools, and thin pulse; this indicates Yang deficiency with binding (Shang Han Lun, Shao Yang section). 《Shan Bu》: Cold Damage five or six days in, with alternating chills and fever, fullness in the chest and hypochondria, silent disinclination to eat or drink, irritability with vomiting, bitter taste in the mouth, deafness, and wiry and rapid pulse. This is the half-exterior, half-interior syndrome of the Shao Yang meridian, and this formula is suitable for harmonizing it.
【Application】
This formula has a wide range of applications, including various febrile diseases, common colds that have not subsided after 3-5 days, cough with sticky phlegm, summer colds in children, liver and gallbladder and digestive system diseases, and high fever, infectious or inflammatory diseases, respiratory infections, acute and chronic bronchitis, pharyngitis, pleuritis, pneumonia, chest membrane inflammation, gastritis, hepatitis, liver dysfunction, biliary tract infection, urinary system infection, postpartum infection, allergic skin diseases, menopausal syndrome, hyperemesis gravidarum, trigeminal neuralgia, malaria, dengue fever. <a href='https://whatsintcm.com/dt_articles/小柴胡湯/’>Xiao Chai Hu Tang is one of the most widely used formulas in clinical practice.
【Contraindications】
(1) Avoid inducing sweating, urination, or bowel movements. (2) Avoid raw, cold, spicy foods. (3) Those with excess above and deficiency below, or with severe liver inflammation, should not take this formula if dizziness, blurred vision, or bleeding gums occur after taking it. It is not suitable for those with Yin deficiency with hemoptysis or hypertension due to hyperactivity of Liver Yang. (4) Patients with fullness in the chest and hypochondria: Generally, there must be some degree of tension in the abdomen, not weakness. If the pulse is weak and there is no abdominal strength, it is best not to use this formula.
【Mnemonic】
(1) Little Wealth’s Tsai Chin (Chai Hu, Huang Qin) — the erhu accompaniment annoys people (Hu Qin Ban Zao Jiang Ren Cao) #. (2) This summer, adults traveled the Jianghu — inspected (Qin Xia Da Zao Ren Cao Jiang Chai Hu) #
【Modifications】
《Yi Fang》: (1) For vomiting: add Sheng Jiang (Ginger) and Chen Pi (Citrus Peel). (2) For irritability without vomiting: remove Ban Xia (Pinellia) and Ren Shen (Ginseng), add Gua Lou (Trichosanthes Fruit). (3) For thirst: remove Ban Xia (Pinellia), add Hua Fen (Trichosanthes Root). (4) If there is no thirst but there is a slight fever: remove Ren Shen (Ginseng), add Gui Zhi (Cinnamon Twig), and cover to induce a slight sweat. (5) For cough: remove Ren Shen (Ginseng), Da Zao (Jujube), and Sheng Jiang (Ginger), add Wu Wei Zi (Schisandra Fruit) and Gan Jiang (Dried Ginger). (6) For deficiency vexation: add Zhu Ye (Bamboo Leaf) and Jing Mi (Rice). (7) For dry teeth: add Shi Gao (Gypsum). (8) For excessive phlegm: add Gua Lou (Trichosanthes Fruit) and Bei Mu (Fritillaria Bulb). (9) For abdominal pain: remove Huang Qin (Scutellaria), add Shao Yao (Peony Root). (10) For hardness and fullness below the ribs: remove Da Zao (Jujube), add Mu Li (Oyster Shell). (11) For pain below the ribs: add Qing Pi (Green Citrus Peel) and Shao Yao (Peony Root). (12) For palpitations below the heart and difficult urination: remove Huang Qin (Scutellaria), add Fu Ling (Poria). (13) For headache due to this meridian: add Chuan Xiong (Ligusticum Root). (14) For jaundice: add Yin Chen (Artemisia scoparia). 《Shan Bu》: If there is irritability in the chest without vomiting, remove Ban Xia (Pinellia) and Ren Shen (Ginseng), add Gua Lou Shi (Trichosanthes Fruit). If there is thirst, remove Ban Xia (Pinellia) and add Ren Shen (Ginseng) and Gua Lou Gen (Trichosanthes Root). If there is abdominal pain, remove Huang Qin (Scutellaria) and add Shao Yao (Peony Root). If there is hardness and fullness below the ribs, remove Da Zao (Jujube) and add Mu Li (Oyster Shell). If there are palpitations below the heart and difficult urination, remove Huang Qin (Scutellaria) and add Fu Ling (Poria). If there is no thirst but there is a slight fever, remove Ren Shen (Ginseng) and add Gui Zhi (Cinnamon Twig), and cover warmly to induce a slight sweat for recovery. If there is cough, remove Ren Shen (Ginseng), Da Zao (Jujube), and Sheng Jiang (Ginger), add Wu Wei Zi (Schisandra Fruit) and Gan Jiang (Dried Ginger). (1) If there is irritability in the chest without vomiting, remove Ban Xia (Pinellia) and Ren Shen (Ginseng) and add Gua Lou Ren (Trichosanthes Seed) to widen the chest and resolve phlegm. (2) If there is thirst, remove Ban Xia (Pinellia) and add Hua Fen (Trichosanthes Root) to moisten and generate fluids. Or remove Ban Xia (Pinellia), and add Ren Shen (Ginseng), decocting into 4 and a half liang, and Gua Lou Gen (Trichosanthes Root) 4 liang. (3) If there is abdominal pain, remove Huang Qin (Scutellaria), and add Shao Yao (Peony Root) to relax and relieve pain. (4) If there is hardness and fullness below the ribs, remove Da Zao (Jujube), add Mu Li (Oyster Shell) to soften hardness and dissipate nodules. (5) If there is fullness below the heart with difficult urination, remove Huang Qin (Scutellaria), add Fu Ling (Poria), to mildly percolate and promote urination. (6) If there is no thirst but there is a slight fever, remove Ren Shen (Ginseng), add Gui Zhi (Cinnamon Twig) to release the exterior. (7) If there is cough, remove Ren Shen (Ginseng), Sheng Jiang (Ginger), and Da Zao (Jujube), add Sang Bai Pi (Mulberry Root Bark), and Xing Ren (Apricot Kernel) to stop cough and resolve phlegm. (8) If there is headache due to this meridian, add Chuan Xiong (Ligusticum Root) to stop pain. (9) If there is jaundice, add Yin Chen (Artemisia scoparia) to clear damp heat. (10) This formula combined with <a href='https://whatsintcm.com/dt_articles/桂枝湯/’>Gui Zhi Tang (Cinnamon Decoction) is named Chai Hu<a href='https://whatsintcm.com/dt_articles/桂枝湯/’>Gui Zhi Tang《Shang Han Lun》, used for alternating chills and fever, more chills than fever or only chills without fever, occurring at regular intervals. (11) This formula combined with Bai Hu Tang (White Tiger Decoction) is named Chai HuBai Hu Tang《Shang Han Lun》, used for alternating chills and fever, more fever than chills or only fever without chills, occurring at regular intervals. (12) This formula removes Ban Xia (Pinellia) and adds Dang Gui (Angelica Root), Bai Shao (White Peony Root), and Da Huang (Rhubarb), which is Chai Hu Yin Zi, used for muscle heat, steaming heat, accumulated heat, residual heat after sweating, rapid, full, wiry, and rapid pulse, also treats malaria. (13) This formula removes Gan Cao (Licorice), adds Gui Zhi (Cinnamon Twig), Fu Ling (Poria), Long Gu (Dragon Bone), Mu Li (Oyster Shell), Qian Dan (Lead Oxide), and Da Huang (Rhubarb), which is <a href='https://whatsintcm.com/dt_articles/柴胡加龍骨牡蠣湯/’>Chai Hu Jia Long Gu Mu Li Tang 《Shang Han Lun》, used for Cold Damage eight or nine days in with purgation, with chest fullness, agitation, fright, difficult urination, delirium, and heavy body that cannot be turned. (14) This formula adds Mang Xiao (Sodium Sulfate), which is Chai Hu Jia Mang Xiao Tang, used for the same syndrome as this formula but with internal heat and tidal fever. (15) This formula adds Qiang Huo (Notopterygium Root) and Fang Feng (Ledebouriella Root), which is Chai Hu Qiang Huo Tang, used for Shao Yang syndrome in epidemic febrile diseases. (16) This formula removes Chai Hu (Bupleurum) and Huang Qin (Scutellaria) and adds Hou Po (Magnolia Bark), which is Hou Po Sheng Jiang Ban Xia Gan Cao Ren Shen Tang, used for abdominal distension after diaphoresis. (17) This formula removes Ren Shen (Ginseng) and Gan Cao (Licorice) and adds Shao Yao (Peony Root), Zhi Shi (Citrus aurantium Fruit), and Da Huang (Rhubarb), which is <a href='https://whatsintcm.com/dt_articles/大柴胡湯/’>Da Chai Hu Tang (Major Bupleurum Decoction)《Shang Han Lun》, used for combined Shao Yang and Yang Ming disease, with alternating chills and fever, fullness in the chest and hypochondria, incessant vomiting, mild irritability, fullness and hardness below the heart or fullness and pain below the heart, constipation, or diarrhea with heat and incomplete bowel movement, thick yellow tongue coating, and wiry and forceful pulse. (18) For anger stirring Liver Fire, toothache, chills and fever, add Shan Zhi (Gardenia) and Huang Lian (Coptis Rhizome). If there is aversion to cold, add Qiang Huo (Notopterygium Root) and Fang Feng (Ledebouriella Root); if there is fire, add Zhi Zi (Gardenia Fruit) and Huang Lian (Coptis Rhizome).
【Pharmacology】
Has liver-protective, choleretic, antipyretic, anti-inflammatory, anti-pathogenic, immune-regulating, pituitary-adrenocortical function-promoting, platelet aggregation-inhibiting, and in vitro smooth muscle-affecting effects.