【Source】

“Shanghan Lun (Treatise on Cold Damage)”

 【Composition】

Gardenia Fruit (Zhizi), Prepared Soybean (Dandouchi)
(2 ingredients)

 【Categories】

<Acrid-Cool Exterior-Releasing>: Prepared Soybean (Dandouchi)

<Clearing Heat and Draining Fire>: Gardenia Fruit (Zhizi)

【Formula Rationale】

“Yifang (Medical Formulas)”: This is a medicine for Taiyang and Yangming channels. (1) Vexation signifies exuberant heat. Gardenia Fruit (Zhizi) is bitter and cold, its red color enters the Heart, hence it is considered the sovereign herb. (2) Prepared Soybean (Douchi) is bitter and can induce heat (sweating), its fermented nature can overcome scorching heat, assisting Gardenia Fruit (Zhizi) in inducing vomiting for vexation due to deficiency, hence it is considered the minister herb. (3) Bitter and sour flavors that induce vomiting and discharge are yin; this formula induces vomiting for insubstantial vexation due to deficiency. (4) If there is substantial pathogenic qi in the diaphragm, Guati San should be used. “Shanbu (Supplement and Revision)”: Gardenia Fruit (Zhizi) is bitter and can induce vomiting and discharge, cold and can overcome heat. Its form resembles the Heart, and its red color penetrates the Heart, thus it treats all conditions of vexation in the Heart, both superior and inferior. The soybean’s form resembles the Kidney, and its black color enters the Kidney. When processed into Douchi (prepared soybean), it becomes light and floats upward, allowing the turbid pathogenic qi from the Heart and abdomen to be expelled through the mouth. A single emesis relieves the Heart and abdomen, resolving all vexation and heat, both exterior and interior. The reason for this is to promptly clear heat from outside the Stomach, preventing the Stomach from becoming excessive, thus Zhizi Chih Tang is a sacred remedy for relieving exterior conditions in Yangming disease. “Chengfang Bian Du (Detailed Explanation of Ready-Made Formulas)”: Gardenia Fruit (Zhizi) is red and enters the Heart, bitter and cold, able to descend. It excels at guiding the vexatious heat of the Heart and Lung in the upper jiao to descend in a winding manner. It is decocted first to achieve its gentle and moderate action. Prepared Soybean (Douchi) is made from black beans through fermentation; its qi is fragrant and transformative, its nature is floating and heat-inducing, its taste is sweet yet turns bitter. Therefore, its therapeutic action clears heat, transforms decay, and disperses pathogenic qi from the upper jiao. Using it to induce vomiting is thus appropriate, and adding it later is to harness its potent and strong action, fearing that prolonged decoction would diminish its efficacy. “Handian (Chinese Materia Medica)”: This formula consists of Gardenia Fruit (Zhizi) and Fermented Soybean (Xiangchi). Gardenia Fruit (Zhizi) has anti-inflammatory, hemostatic, and sedative effects; Fermented Soybean (Xiangchi) also has sedative effects. Therefore, the two ingredients are combined to treat vexation and agitation in the chest, and to eliminate body heat.

 【Functions】

Clears Heat and Eliminates Vexation

 【Indications / Therapeutic Effects】

(1) After external cold-damage treated by sweating, vomiting, or purging, with vexation due to deficiency and insomnia, vexation and agitation in the chest (心中懊憹), epigastric distention and fullness, inability to eat due to hunger, rapid pulse, thin yellow greasy tongue coating. (2) This formula targets vexation and agitation in the chest and body heat as its main indications. “Vexation and agitation in the chest (心中懊憹)” refers to an indescribable state of depression and stuffiness in the heart and chest, often leading to insomnia. “Body heat (身熱)” refers to a feeling of heat in the body without aversion to cold; body temperature may not necessarily be elevated, and the heat may sometimes be localized to a part of the body. “Yifang (Medical Formulas)”: (1) Treats vexation due to deficiency and insomnia after cold-damage treated by sweating, vomiting, or purging, with severe cases involving restless tossing and turning, and vexation and agitation below the heart (Shanghan, Taiyang Middle Chapter). (2) For Yangming disease treated with purgation, with exterior heat, warm hands and feet, no chest binding, vexation and agitation in the heart and chest, inability to eat due to hunger, and only sweating on the head (Shanghan, Yangming Chapter). (3) For cold-damage where a physician administered a strong purgative pill, but body heat persists, with painful結痛 (mass/knotting) below the heart, or slight vexation due to phlegm in the diaphragm (Shanghan, Taiyang Middle Chapter). “Shanbu (Supplement and Revision)”: For Yangming disease with a floating and tight pulse, dry throat and bitter taste in the mouth, abdominal fullness with wheezing, fever with sweating, no aversion to cold but aversion to heat, heavy body with irritability, confusion and mental distress in the heart, apprehension and vexation, eye pain, dry nose, and inability to lie down (sleep).

 【Clinical Applications】

Cold with alternating chills and fever, headache and body aches; pediatric measles or chickenpox, vexation due to deficiency with palpitations and insomnia, neurasthenia. Hepatitis, jaundice, skin diseases, insomnia, stomatitis, hemorrhoids, esophagitis.

 【Contraindications】

For all uses of Zhizi Tang, it should not be administered to patients who previously had mild loose stools.

 【Mnemonic / Interesting Note】

The formula name itself.

 【Modifications】

“Shanbu (Supplement and Revision)”: (1) If there is shortness of qi, add Licorice Root (Gancao) two liang. (2) If there is vomiting, add Fresh Ginger (Shengjiang) three liang. (3) If after purgation there is vexation in the heart and abdominal fullness, with restless tossing and turning, remove Fermented Soybean (Xiangchi) and add Magnolia Bark (Houpo) four liang, and Immature Bitter Orange (Zhishi) four pieces. (4) If a physician administered a purgative pill, but body heat persists with painful結痛 (mass/knotting) in the heart, remove Fermented Soybean (Xiangchi) and add Dried Ginger (Ganjiang) two liang. (5) If body heat presents with jaundice, remove Fermented Soybean (Xiangchi) and add Licorice Root (Gancao) one liang, and Phellodendron Bark (Huangbai) two liang. “Handian (Chinese Materia Medica)”: (1) Add Fresh Ginger (Shengjiang) for Zhizi Chih Tang patterns with vomiting. (2) Add Licorice Root (Gancao) for Zhizi Chih Tang patterns with urgency.