【Source】
Shang Han Lun (Treatise on Cold Damage), Jin Gui Yao Lue (Synopsis of Prescriptions of the Golden Chamber)
【Ingredients】
Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig), (Zhi) Gan Cao (Licorice, Honey-Fried), (Bai) Shao Yao (White Peony Root), Xi Xin (Asarum), Gan Jiang (Dried Ginger), Wu Wei Zi (Schisandra Fruit), Ban Xia (Pinellia Rhizome)
(8)
【Category】
<Blood Tonifying>: Shao Yao (Peony Root)
<Spleen and Middle Qi Tonifying>: Gan Cao (Licorice)
<Acrid-Warm Exterior Releasing>: Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig)
<Warming Interior>: Xi Xin (Asarum), Gan Jiang (Dried Ginger)
<Phlegm Resolving>: Ban Xia (Pinellia Rhizome)
<Astringing and Stabilizing>: Ma Huang (Ephedra), Wu Wei Zi (Schisandra Fruit)
【Formula Analysis】
《Medical Formulas》: Medicine for the Foot Taiyang channel. (1) Because the exterior is unresolved, Ma Huang (Ephedra) is used to induce sweating as the chief ingredient. (2) Gui Zhi (Cinnamon Twig) and Gan Cao (Licorice) assist in resolving the exterior as assistant ingredients. (3) For cough and wheezing, which indicate rebellious lung Qi, Shao Yao (Peony Root), with its sour and cold properties, and Wu Wei Zi (Schisandra Fruit), with its sour and warm properties, are used to astringe it. (4) When water accumulates below the heart, causing kidney dryness, Xi Xin (Asarum) and Gan Jiang (Dried Ginger), being pungent and warm, can moisten the kidneys and promote water metabolism. (5) Ban Xia (Pinellia Rhizome), being pungent and warm, can subdue rebellious Qi and disperse water retention, serving as the envoy ingredient. By releasing sweat externally and promoting water metabolism internally, the pathogenic factors in both the exterior and interior can be dispersed.《Deleted and Supplemented》: There are two types of water retention in the Taiyang channel: one is due to wind-stroke, with exterior deficiency and sweating, indicated by Wu Ling San (Five-Ingredient Powder with Poria); the other is due to cold damage, with exterior repletion and no sweating, indicated by Xiao Qing Long Tang (Minor Blue Dragon Decoction). Because of exterior repletion and no sweating, Ma Huang (Ephedra) and Gui Zhi (Cinnamon Twig) are combined to resolve the exterior. Da Zao (Jujube) is removed because of its cloying nature. Xing Ren (Apricot Kernel) is removed because there is no wheezing; add it back if wheezing is present. Sheng Jiang (Fresh Ginger) is removed because Gan Jiang (Dried Ginger) is already present, but it can still be used if vomiting occurs. Gan Jiang (Dried Ginger) and Xi Xin (Asarum) are extremely warming and dispersing, allowing cold and water to be resolved through sweating. Ban Xia (Pinellia Rhizome) eliminates phlegm and fluid retention to clear unresolved fluids. Wu Wei Zi (Schisandra Fruit) astringes lung Qi to contain depleted Qi. If there is thirst, remove Ban Xia (Pinellia Rhizome) and add Hua Fen (Trichosanthes Root) to generate fluids and avoid dryness. If there is slight diarrhea or difficulty swallowing, with urinary difficulty and lower abdominal distension, remove Ma Huang (Ephedra) to focus on the interior. Add Fu Zi (Aconite) to dispel cold and stop difficulty swallowing. Add Fu Ling (Poria) to promote urination and eliminate slight diarrhea and lower abdominal distension. This formula and Yue Bi Tang (Maidservant Decoction) both treat water accumulation overflowing to the exterior, causing skin distension and edema, which can be resolved by inducing sweating and releasing the exterior. Yue Bi Tang (Maidservant Decoction) treats cases with heat, so Shi Gao (Gypsum) is the chief ingredient to disperse yang water. Xiao Qing Long Tang (Minor Blue Dragon Decoction) treats cases with cold, so ginger and Gui Zhi (Cinnamon Twig) are added to eliminate yin water. 《Han Canon》: Gui Zhi (Cinnamon Twig) and Ma Huang (Ephedra) together can dispel exterior pathogens. Ma Huang (Ephedra), Xi Xin (Asarum), and Ban Xia (Pinellia Rhizome) have the effect of eliminating water toxins and promoting urination. Gan Jiang (Dried Ginger) dispels interior cold. Wu Wei Zi (Schisandra Fruit), Ma Huang (Ephedra), and Xi Xin (Asarum) together can treat cough. Shao Yao (Peony Root) and Gui Zhi (Cinnamon Twig) together can promote blood circulation and dispel blood stasis.
【Functions】
Releases the exterior, transforms phlegm-fluids, stops cough, calms wheezing, induces sweating, promotes water metabolism, dispels cold, warms the lungs.
【Indications】
External contraction of wind-cold, internal retention of water fluids, manifested as aversion to cold, fever without sweating, cough with white, clear, and thin sputum, slight wheezing, severe cases with shortness of breath and inability to lie down, no thirst, or facial and limb edema, white and slippery tongue coating, and a floating and tight pulse. Those with exterior pathogens and internal water toxins. Various symptoms induced by external pathogens in individuals with pre-existing water toxins in the chest and hypochondria are often treated with this formula. Such patients, when contracting a cold, are prone to bronchitis or asthmatic bronchitis, with frequent coughing, wheezing, and expectoration of foamy sputum.《Medical Formulas》: Cold damage with unresolved exterior, water accumulation below the heart, nausea, fever, and cough, or difficulty swallowing, wheezing, thirst, diarrhea, urinary difficulty, lower abdominal distension, shortness of breath, and inability to lie down (Shang Han Lun, Taiyang chapter). 《Deleted and Supplemented》: Cold damage with unresolved exterior, water accumulation below the heart, nausea, fever, and cough. Or thirst, diarrhea, difficulty swallowing, urinary difficulty, lower abdominal distension, or wheezing. Also for skin distension and edema in miscellaneous diseases, using this formula to induce sweating and promote water metabolism.
【Applications】
Acute and chronic bronchitis, bronchial asthma, pneumonia, cough, pertussis (whooping cough), chronic cough, common cold, allergic rhinitis, pleurisy (effusive type), pulmonary edema, edema in the early stages of nephritis, conjunctivitis.
【Contraindications】
Use with caution in cases of long-standing edema, as it may lead to adverse outcomes. Contraindicated in cases of high fever and crimson tongue.
【Mnemonic】
Xiao Qing Long (Minor Blue Dragon) has less water-moving power than Da Qing Long (Major Blue Dragon), so <a href='https://whatsintcm.com/dt_articles/Ma Huang (Ephedra) Tang/’>Ma Huang (Ephedra) Tang removes Xing Ren (Apricot Kernel). Stir-fry vegetables with a little spicy ginger, five-flavor vinegar for dressing (Shao, Xin, Jiang, Wu Wei, Ban).
【Modifications】
《Medical Formulas》: (1) For thirst, remove Ban Xia (Pinellia Rhizome) and add Hua Fen (Trichosanthes Root). (2) For wheezing, remove Ma Huang (Ephedra) and add Xing Ren (Apricot Kernel). (3) Also remove Ma Huang (Ephedra) for body swelling. (4) For difficulty swallowing, remove Ma Huang (Ephedra) and add Fu Zi (Aconite). (5) For urinary difficulty, remove Ma Huang (Ephedra) and add Fu Ling (Poria). 《Deleted and Supplemented》: If there is thirst, remove Ban Xia (Pinellia Rhizome) and add Gua Lou Gen (Trichosanthes Root) 3 liang. If there is difficulty swallowing, remove Ma Huang (Ephedra) and add Fu Zi (Aconite) (炮-pao, prepared) one piece. If there is urinary difficulty and lower abdominal distension, remove Ma Huang (Ephedra) and add Fu Ling (Poria) 4 liang. If there is wheezing, remove Ma Huang (Ephedra) and add Xing Ren (Apricot Kernel) (去皮尖-qu pi jian, peeled and pointed) half a sheng. If there is slight diarrhea, remove Ma Huang (Ephedra) and add Nao Hua (Wikstroemia Flower) the size of a chicken egg (熬令赤色-ao ling chi se, decocted until red). “Adding Nao Hua the size of a chicken egg, decocted until red” is likely a scribal error. According to the Materia Medica, Nao Hua is similar to Yuan Hua (Daphne Flower) and has a strong action of attacking water. Even five fen can cause dozens of bowel movements, so how can it be used to treat slight diarrhea due to fluid retention in such a large amount? It should be changed to add Fu Ling (Poria) 4 liang. 《Han Canon》: Add Shi Gao (Gypsum) for those with Xiao Qing Long Tang (Minor Blue Dragon Decoction) syndrome accompanied by irritability. (1) If aversion to cold is severe, with cough, shortness of breath, abundant white and clear sputum, greasy or slippery white tongue coating, and wiry pulse, it indicates severe cold and yang deficiency with internal retention of phlegm-fluids. Emphasize warming and dispersing, and descending Qi. Increase the dosage of Xiao Qing Long Tang (Minor Blue Dragon Decoction) of Ma Huang (Ephedra), Gui Zhi (Cinnamon Twig), Gan Jiang (Dried Ginger), Xi Xin (Asarum), and Ban Xia (Pinellia Rhizome), and lightly use Wu Wei Zi (Schisandra Fruit), Bai Shao (White Peony Root), and Gan Cao (Licorice). Also add San Zi Yang Qin Tang (Three-Seed Decoction to Nourish One’s Parents) (Zi Su Zi (Perilla Seed), Bai Jie Zi (White Mustard Seed), Lai Fu Zi (Radish Seed)). (2) If, in addition to the main symptoms, there is cough with thick yellow sputum, add Xiao Qing Long Tang (Minor Blue Dragon Decoction) with Huang Qin (Scutellaria Root) and Yu Xing Cao (Houttuynia) to clear heat. (3) If cough and wheezing have been present for a long time, with white and thin sputum, shortness of breath, lower back pain, cold limbs, white tongue coating, and deep and thin pulse, indicating both lung and kidney deficiency, add kidney-tonifying and Qi-astringing herbs to Xiao Qing Long Tang (Minor Blue Dragon Decoction), such as Rou Gui (Cinnamon Bark) and Yin Yang Huo (Epimedium), or replace Gui Zhi (Cinnamon Twig) with Rou Gui (Cinnamon Bark) to strengthen the kidney-warming effect. (4) If there is accompanying irritability, add Shi Gao (Gypsum) to clear heat and eliminate irritability. (5) If there is thirst, remove Ban Xia (Pinellia Rhizome) from the formula and add Tian Hua Fen (Trichosanthes Root) to clear heat and generate fluids, or remove Ban Xia (Pinellia Rhizome) and add Gua Lou Gen (Trichosanthes Root) 3 liang. (6) If there is labored breathing, add Xing Ren (Apricot Kernel) to benefit the lungs and calm wheezing. (7) Removing Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), and Gan Cao (Licorice) from this formula and adding She Gan (Belamcanda Rhizome), Zi Wan (Aster Root), Kuan Dong Hua (Coltsfoot Flower), and Da Zao (Jujube) creates <a href='https://whatsintcm.com/dt_articles/She Gan (Belamcanda Rhizome) <a href='https://whatsintcm.com/dt_articles/Ma Huang (Ephedra) Tang/’>Ma Huang (Ephedra) Tang/’>She Gan (Belamcanda Rhizome) <a href='https://whatsintcm.com/dt_articles/Ma Huang (Ephedra) Tang/’>Ma Huang (Ephedra) Tang, which functions to disseminate the lungs, resolve phlegm, descend Qi, and stop cough, and is indicated for cough with upward-rebellious Qi and gurgling sounds in the throat. (8) If there is slight diarrhea, remove Ma Huang (Ephedra); if there is difficulty swallowing, remove Ma Huang (Ephedra) and add Fu Zi (Aconite) 1 piece (炮-pao, prepared); if there is urinary difficulty and lower abdominal distension, remove Ma Huang (Ephedra) and add Fu Ling (Poria) 4 liang; if there is wheezing, remove Ma Huang (Ephedra) and add Xing Ren (Apricot Kernel) half a jin (去皮尖-qu pi jian, peeled and pointed). If the pulse is floating, do not use Fu Zi (Aconite).
【Pharmacology】
Antiasthmatic, antiallergic, dilates peripheral blood vessels, increases skin temperature, improves adrenocortical function and lung function, affects blood rheology, and promotes erythrocyte glycolysis.