Source: Discussion of Cold-induced Disorders (Shang han lun)

Radix Bupleuri chai hu 24g

Radix Scutellariae huang qin 9g

Fructus Irnmaturus Citri Aurantii zhi shi 6-9g

Radix et Rhizoma Rhei da huang 6g

Radix Paeoniae Lactiflorae bai shao 9g

Rhizorna Pinelliae Ternatae ban xia 24g

Rhizoma Zingiberis Officinalis Recens sheng jiang 15g

Fructus Zizyphi Jujubae da zao 12 pieces

Preparation: The source text advises to decoct the ingredients in approximately 12 cups of water until six cups remain. The ingredients are removed and the strained decoction is further decocted until three cups remain. This is taken warm in three equal doses over the course of one day. Today usually prepared as a decoction in the usual manner. The above dosage is based on the source text. Today most practitioners use 12-15g of Radix Bupleuri (chai hu) and Rhizoma Pinelliae Ternatae (ban xia), 6-9g of Rhizoma Zingiberis Officinalis Recens (sheng jiang), and four pieces of Fructus Zizyphi Jujubae (da zao). Available in prepared form.

Actions: Harmonizes and releases the lesser yang, and drains internal clumping due to heat.

INDICATIONS: Alternating fever and chills, fullness in the chest and hypochondria (with or without pain), a bitter taste in the mouth, nausea, continuous vomiting, hard focal distention or fullness and pain in the epigastrium, burning diarrhea or no bowel movements, despondency, slight irritablity, a yellow tongue, coating, and a wiry, forceful pulse.

This is a concurrent lesser yang and yang brightness-stage disorder. The alternating fever and chills, sensation of fullness in the chest and hypochondria, bitter taste in the mouth, vomiting, and wiry pulse are indicative of a lesser yang-stage disorder. The sensation of firm masses or distention and pain in the epigastrium, absence of bowel movements or hot, buring diarrhea, yellow coating on the tongue, and forceful pulse are indicative of a yang brightness organ-stage disorder. It is not uncommon to find a flooding or excessive pulse. The symptoms of uncontrolled vomiting, despondency, and iritability will be more severe than the occasional vomiting and irritability associated with a purely lesser yang condition.

In terms of organ-pattern differentiation, this condition is viewed as heat excess in the Gallbladder and Stomach. One of the key symptoms from this perspective is the continuous vomiting. This reflects the concept that vomiting is not an intrinsic problem of the Stomach, but only occurs when the Stomach is attached by Gallbladder qi.

ANALYSIS OF FO RMULA: The chief herb, Radix Bupleuri (chai hu), vents the lesser yang. When com­bined with the deputy, Radix Scutellariae ( huang qin), its ability to clear heat from the Liver and Gallbladder is strengthened. Another deputy, Fructus Immaturus Citri Aurantii (zhi shi), a strong regulator of qi move­ment, breaks up qi stagnation and reduces focal dis­tention and fullness in the chest and abdomen. When combined with Radix Bupleuri (chai hu), its ability to facilitate the flow of qi is greatly strengthened. The third deputy, Radix et Rhizoma Rhei (da huang), drains heat excess from the Gallbladder and Stomach through the Intestines, transforms blood stasis, and facilitates the flow of bile. When combined with Fructus Immaturus Citri Aurantii (zhi shi), it drains the clump­ing of heat in the interior.

One of the assistants, Radix Paeoniae Lactiflorae (bai shao), nourishes the blood, softens the Liver, and treats abdominal pain and distention. In concert with Fructus Immaturus Citri Aurantii (zhi shi) and Radix et Rhizoma Rhei (da huang), it treats the pain from excess in the abdomen. The other assistant, Rhizoma Pinelliae Ternatae (ban xia), harmonizes the middle burner and directs the rebellious Stomach qi downward. When combined with one of the envoys, Rhizoma Zingiberis Officinalis Recens (sheng jiang), it effectively stops the vomiting. The other envoy, Fruc­tus Zizyphijujubae (da zao) , strengthens the ability of Radix Paeoniae Lactiflorae (bai shao) to soften the Liver and reduce abdominal spasms. This combination also protects the yin from injury by pathogenic heat, and from the harsh draining properties of Radix et Rhizoma Rhei (da huang) and Fructus Immaturus Citri Aurantii (zhi shi). The combination of Rhizoma Zingiberis Officinalis Recens (sheng jiang) and Fruc­tus Zizyphijujubae (da zao) mildly regulates the nutritive and protective qi, and assists in the release of the pathogenic influence.

COMMENTARY: This formula also appears in Essentials from the Golden Cabinet. Used for concurrent lesser yang and yang brightness organ-stage disorders, it is based on two formulas which separately treat each of these single-stage conditions: Minor Bupleurum Decoction (xiao chai hu tang) for lesser yang-stage, and Major Order the Qi Decoction (da cheng qi tang)for yang brightness organ-stage disorders. Radix Ginseng (ren shen) and honey-fried Radix Glycyrrhizae Uralensis (zhi gan cao) are omitted to prevent the tonifying and cloying properties of these herbs from obstructing the flow, thereby aggravating the problems of vomiting and defecation. Since the abdominal pain is more severe than the distention, Cortex Magnoliae Officinalis (hou po) and Mirabilitum (mang xiao) are omitted, and Radix Paeoniae Lactiflorae (bai shao), which reduces spasms and alleviates pain, is added. Although purging is generally inappropriate for lesser yang-stage disorders, concurrent lesser yang and yang brightness organ-stage conditions require the use of purgatives to attack the interior aspect of the problem.

This formula may be used to treat either diarrhea (due to accumulation of heat in the Intestines) or constipation. It may also be used for Liver and Gall­ bladder fire causing headache, tinnitus, diminished hearing and vision, red eyes, manic behavior, or palpitations with anxiety if the presentation also includes epigastric fullness and pain, a bitter taste in the mouth, a red tongue with yellow coating, and a fast, wiry pulse. In contrast to Bupleurum Decoction plus Mirabilite (chai hujia mang xiao tang), this formula focuses more on disorders of excess with hard focal distention of the epigastrium and an absence of injury to the Stomach qi.

With the appropriate presentation, this formula may be used in treating such biomedically -defined disorders as acute gastroenteritis, gastrointestinal flu, dysentery, cholecystitis, cholelithatitis, acute pancreatitis, hepatitis, pleurisy, peritonitis, migraine headache, trigeminal neuralgia, malignant hypertension, and malaria (especially with fever predominant).