Prescriptions that have the function of mediating or regulating, and are applied to febrile diseases caused by pathogenic factors in Shaoyang, cases of disharmony between the liver and the spleen, the intermingling of cold and heat, and coexistent exterior and interior syndromes of both the exterior and the interior, are called “Mediation Prescriptions.” According to the location of the chief syndromes which they treat, Mediation Prescriptions can be subdivided into four categories. There are Prescriptions for mediating Shaoyang, Prescriptions for regulating the liver and spleen, Prescriptions for harmonizing cold and heat syndrome, and Prescriptions for expelling both exterior and interior pathogenic factors.
(i) Xiao Chai Hu Tang
(Minor Bupleurum Decoction)
|Composition:||Bupleurum root (Chai Hu, )||12 g|
|Scutellaria root (Huang Qin, )||9 g|
|Ginseng (Ren Shen, )||6 g|
|Pinellia tuber (Ban Xia, )||9 g|
|Baked licorice (Zhi Gan Cao, )||5 g|
|Fresh ginger (Sheng Jiang, )||9 g|
|Jujube (Da Zao, )||4 pcs|
Preparation: The herbs are decocted twice in water.
Function: To harmonize the Shaoyang Meridians.
Indications: Febrile diseases in the Shaoyang Meridian, marked by alternate attacks of chills and fever, fullness in the chest, hypochondriac discomfort, dysphoria, retching, a bitter taste in the mouth, dry throat, or women with heat in the blood phase, a thin whitish tongue coating, and a taut pulse.
Formula Analysis: This is the commonly used formula for pathogenic factors invading the Shaoyang Meridian and fighting against healthy Qi in the area between the exterior and the interior portion of the body. The method of treatment involves harmonizing the Shaoyang Meridians. As the chief herb, Chai Hu dispels the pathogenic factors located in the half exterior part of the body and restores the function of the Shaoyang Meridian. Huang Qin with bitter taste and cold properties, acting as the assistant herb, purges the heat located in the interior part of the body. These two herbs are the primary ones for treating Shaoyang disease, the former for dispelling pathogenic factors and the latter for clearing the accumulated heat. As for the remaining herbs, Ban Xia mediates the stomach to descend adverse stomach-Qi and disperses stagnation to remove fullness, and Sheng Jiang benefits the stomach-Qi, while Ren Shen , Zhi Gan Cao , and Da Zao supplement Qi and strengthen body resistance to eliminate pathogenic factors and enhance the interior so as to prevent the invasion of pathogenic factors. The five herbs are adjuvant herbs. In addition, Zhi Gan Cao coordinates other the herbs’ properties and serves as the guiding herb.
Applications in Bio-medicine: Common cold, flu, chronic hepatitis, acute or chronic cholecystitis, pleuritis, gastric ulcer, and other diseases that manifest with the above symptoms and pertain to febrile disease in the Shaoyang Meridian.
(a)In cases of dysphoria where there is no vomiting, replace Ban Xia with Richosanthes fruit (Gua Lou, ).
(b)In cases where there is thirst, replace Ban Xia and Ren Shen with Trichosanthes root (Tian Hua Fen, ).
(c)If accompanied by abdominal pain, replace Huang Qin with White peony root (Bai Shao, ).
Cautions: Since Chai Hu possesses a lifting and dispersing action, and Ban Xia and Huang Qin have a dry nature, this formula should be used with great caution for patients with Shaoyang disease accompanied by yin and blood deficiency.
(ii) Hao Qin Qingdan Tang
(Sweet Wormwood and Skullcap Gall Bladder-Clearing Decoction)
|Composition:||Sweet wormwood (Qing Hao, )||6 g|
|Bamboo shavings (Zhu Ru, )||9 g|
|Pinellia tuber (Ban Xia, )||5 g|
|Red Poria (Chi Fu Ling, )||9 g|
|Scutellaria root (Huang Qin, )||6 g|
|Bitter orange (Zhi Qiao, )||5 g|
|Citrus peel (Ju Pi, )||5 g|
Preparation: The herbs are cooked in water for drinking.
|Functions:||(a)||To clear heat and dampness in the gall bladder;|
|(b)||To harmonize the stomach and resolve phlegm.|
Indications: Syndromes of excessive damp-heat in the Shaoyang Meridian, marked by alternate attacks of mild chills and severe fever, a bitter taste in the mouth, chest distress, vomiting of bitter and sour water or vomiting with sticky yellowish saliva, retching and hiccupping, a reddened tongue with a greasy whitish coating or a greasy yellowish coating, and a taut smooth rapid pulse.
Formula Analysis: This is a commonly used formula for excessive gall bladder heat in the Shaoyang Meridian concomitant with phlegm retention caused by damp-heat in the middle Jiao. The syndrome should be treated by clearing heat from the gall bladder with the concurrent method of descending the adverse Qi, regulating the stomach to resolve the phlegm retention, and removing dampness via promoting diuresis. Qing Hao with its fragrant nature disperses heat from the Shaoyang Meridian and removes phlegm as well. Huang Qin purges the accumulated fire from the Gall Bladder Meridian and dries dampness. These two herbs share the role of chief herb. Zhu Ru and Ban Xia regulate the stomach to arrest vomiting and remove phlegm to eliminate dampness, while Ju Pi and Zhi Qiao regulate the stomach and dissolve phlegm, and promote the flow of Qi to relieve chest distress. These four act as the assistant herbs. Chi Fu Ling is used as the adjuvant herb to eliminate damp-heat and descend the accumulated heat. Gan Cao also functions as the guiding herb, with the action of mediating the properties of the other herbs.
Applications in Bio-medicine: Acute cholecystitis, acute icterohepatitis, acute gastroenteritis, chronic gastritis, pelvic inflammation, and other diseases which pertain to the Shaoyang Syndrome due to damp-heat accumulation in the Shaoyang Meridian.
(a)For severe nausea and vomiting, add Zuojin Wan (a combination composed of Coptis root (Huang Lian ) and Evodia fruit (Wu Zhu Yu, ).
(b)If concomitant with jaundice, replace Ju Pi and Ban Xia with Oriental wormwood (Yin Chen Hao, ) and Cape jasmine fruit (Zhi Zi, ).
(i) Sini San
(Cold Limbs Powder)
|Composition:||Baked licorice (Zhi Gan Cao, )||6 g|
|Bupleurum root (Chai Hu, )||6 g|
|Immature bitter orange (Zhi Shi, )||6 g|
|White peony root (Bai Shao, )||9 g|
Preparation: The herbs are ground into powder, or directly decocted for use.
Functions: To soothe the liver and regulate the spleen.
Indications: Spleen-Qi stagnation due to the liver-Qi stagnation, or cold limbs due to Yang-Qi stagnation, manifested as hypochondriac distension and fullness, epigastric and abdominal pain, or diarrhea with tenesmus, a thin whitish tongue coating, and a taut pulse.
Formula Analysis: This is the commonly used formula for treating cold limbs due to yang-Qi stagnation. When exogenous pathogenic factors invade the interior via meridians, Yang-Qi will be blocked inside the body. The disorders should be treated by expelling pathogenic factors and stagnation, and regulating functional activities. Chai Hu is the chief herb, with the functions of releasing stagnated liver-Qi and driving out the pathogenic factors. Bai Shao , as the assistant herb, preserves Yin by its astringent property, nourishes blood, and soothes the liver. These two herbs — one is dispersing, and the other is astringent — are used in one formula to assist and protect the liver. Zhi Shi , the adjuvant herb, supports Chai Hu in regulating liver-Qi to remove stagnation and in regulating Qi movement of the liver and spleen. Zhi Shi is used to raise the lucid and descend the turbid. Zhi Gan Cao , the guiding herb, relieves spasms in combination with Bai Shao , and regulates the middle Jiao in combination with Zhi Shi It also coordinates the properties of the other herbs.
Applications in Bio-medicine: Chronic hepatitis, cholecystitis, cholelithiasis, gastric ulcer, gastritis, gastrointestinal neurosis, and other diseases which pertain to syndromes of stagnated Qi in the liver and gall bladder, or to disharmony between the liver and the spleen, or between the gall bladder and the stomach.
(a) For severe hypochondriac pain, add Curcuma root (Yu Jin, ), Cyperus tuber (Xiang Fu, ), and Chuan Xiong rhizome (Chuan Xiong, ).
(b) For jaundice, add Oriental wormwood (Yin Chen Hao, ) and Curcuma root (Yu Jin, ).
(c) In the case of a bitter flavor and dry mouth, add Cape jasmine fruit (Zhi Zi, ) and Sichuan chinaberry (Chuan Lian Zi, ).
(ii) Xiaoyao San (Ease Powder, )
|Composition:||Bupleurum root (Chai Hu, )||30 g|
|Chinese Angelica root (Dang Gui, )||30 g|
|White peony root (Bai Shao, )||30 g|
|White Atractylodes (Bai Zhu, )||30 g|
|Poria (Fu Ling, )||30 g|
|Baked licorice (Zhi Gan Cao, )||15 g|
|Mentha (Bo He, )||3 g|
|Fresh ginger (Sheng Jiang, )||3 g|
Preparation: The herbs are ground into powder, or cooked by decoction.
|Functions:||(a)||To promote Qi circulation in the liver and remove stagnation;|
|(b)||To nourish blood and invigorate the spleen.|
Indications: Liver-Qi stagnation with blood deficiency and asthenia of the spleen, marked by hypochondriac pain, headache, dizziness, dry mouth and throat, mental fatigue, and poor appetite, or alternate attacks of chills and fever, or irregular menstruation, breast distension, a reddish tongue, and a taut thready pulse.
Formula Analysis: This is the commonly used formula for the result of protracted stagnation of liver-Qi consuming blood, Liver Wood depression subjugating Spleen Earth, and dysfunction of the spleen in transportation and transformation. All the disorders should be treated by dispersing liver-Qi and nourishing the blood, and invigorating the spleen to promote its transportation and transformation capability. In the formula, Chai Hu is employed as the chief herb to disperse the stagnated liver-Qi. Shao Yao and Dang Gui are used as assistant herbs for nourishing blood to retain Yin, and soothing the liver to relieve spasms. Particularly, the aroma of Dang Gui promotes blood circulation without hindering Qi flow; the sweet property of Dang Gui relieves spasm. As adjuvant herbs, Fu Ling , Bai Zhu , and Zhi Gan Cao can supplement Qi, strengthen the middle Jiao, reinforce the spleen to prevent the liver from subjugating it, remove dampness to enhance the transporting function, and complement the source of Qi and blood. Zhi Gan Cao invigorates Qi and relieves emergency of the liver, and also mediates the effects of the other herbs and acts as the guiding herb. Bo He and Sheng Jiang respectively assist in dispersing the stagnated liver-Qi, and in warming and regulating the middle Jiao.
Applications in Bio-medicine: Chronic hepatitis, neurosis, functional uterine bleeding, anemia, mastopathy, and premenstrual tension, the symptoms of which are hypochondriac distension and pain, mental fatigue, and poor appetite. The symptoms pertain to stagnation of liver-Qi with deficiency of blood as well as failure of the spleen’s transportation and transformation functions.
(a)In cases with a bitter flavor and dry mouth, add Moutan bark (Mu Dan Pi, ) and Cape jasmine fruit (Zhi Zi, ). The formula is named Danzhi Xiaoyao San.
(b)For severe blood deficiency, add prepared Rehmannia root (Shu Di Huang ), creating a formula known as Hei Xiaoyao San.
(1) Ban Xia Xiexin Tang
(Pinellia Heart-Draining Decoction )
|Composition:||Pinellia tuber (Ban Xia, )||9 g|
|Scutellaria root(Ban Xia, )||6 g|
|Dried ginger (Gan Jiang, )||6 g|
|Ginseng (Ren Shen, )||6 g|
|Licorice (Gan Cao, )||6 g|
|Coptis (Huang Lian, )||3 g|
|Jujube (Da Zao, )||4 pcs|
|Functions:||(a)||To Regulate cold and heat;|
|(b)||To disperse the accumulation so as to relieve fullness.|
Indications: Disorder of the stomach-Qi marked by epigastric fullness and distension due to the intermingling of cold and heat, manifested as epigastric fullness without pain, retching or vomiting, borborygmus and diarrhea, a thin yellowish greasy tongue coating, and a taut rapid pulse.
Formula Analysis: This is the commonly used formula for the deficient Yang in the middle Jiao, intermingling of cold and heat, and disorder of ascending and descending. The syndrome should be treated by regulating cold and heat, and dispersing accumulation to relieve fullness. Huang Lian and Huang Qin , which are bitter and cold in their properties to clear away the heat, act as the chief herbs. Ban Xia and Gan Jiang with acrid and warm properties dispel cold and are used as the assistant herbs. Ren Shen , Zhi Gan Cao , and Da Zao replenish Qi and resolve deficiency, and serve as the adjuvant herbs. In combination with Gan Jiang , these herbs also warm the middle Jiao and regulate the stomach and spleen. Gan Cao also acts as the guiding herb, with the function of mediating the properties of the other herbs. These seven ingredients selected for the formula possess both cold and hot drugs as well as bitter and acrid drugs with descending and expelling effects; they invigorate Qi, mediate the middle energizer, dispel pathogenic factors, and restore the ascending and descending of Qi.
Applications in Bio-medicine: Acute and chronic gastritis, enteritis, chronic hepatitis, chronic cholecystitis, and other diseases which pertain to intermingling syndromes of cold and heat, or deficiency and excess, with the key manifestations being abdominal fullness and distension, vomiting, and diarrhea.
(a)For severe fullness and distension in the epigastric region, replace Ren Shen with Immature bitter orange (Zhi Shi, ).
(b)If the constitution is not weak, replace Ren Shen and Da Zao with Citron fruit (Xiang Yuan, ) and Finger citron (Fo Shou, ).
Cautions: This formula is contraindicated for epigastric fullness due to Qi stagnation or retention of undigested food.
(i) Da Chai Hu Tang
Major Bupleurum Decoction
|Composition:||Bupleurum root (Chai Hu, )||15 g|
|Immature bitter orange (Zhi Shi, )||9 g|
|Scutellaria root (Huang Qin, )||9 g|
|White peony root (Bai Shao, )||9 g|
|Pinellia tuber (Ban Xia, )||9 g|
|Rhubarb (Da Huang, )||6 g|
|Fresh ginger (Sheng Jiang, )||15 g|
|Jujube (Da Zao, )||5 pcs|
Preparation: The above herbs are cooked twice with water by decoction.
|Functions:||(a)||To mediate the Shaoyang Meridians;|
|(b)||To purge the accumulated heat.|
Indications: Combined diseases of the Shaoyang and Yangming Meridians, marked by alternate chills and fever, fullness and a stifling sensation in the chest and hypochondriac region, nausea, vomiting, irritability, constipation or diarrhea, a thick yellowish tongue coating, and a taut rapid forceful pulse.
Formula Analysis: This is the commonly used formula for unrelieved pathogenic factors in the Shaoyang Meridian that affect the Yangming Meridian. The pathogenic factors then cause excessive accumulation of heat and undigested food in the intestines. The condition should be treated via a mediating method to purge heat accumulation from the Shaoyang. The large dosage of Chai Hu is used together with Huang Qin , both as chief herbs, to mediate Shaoyang and clear heat so as to eliminate pathogenic factors of Shaoyang. Da Huang and Zhi Shi , the assistant herbs, are considered primary herbs for purging heat accumulation. Da Huang , even in the noted small dosage, provides significant purgation of heat, thus relieving constipation. Zhi Shi removes Qi stagnation. Used as adjuvant herbs, Bai Shao relieves spasms and pain, treats abdominal sthenic pain when used jointly with Da Huang , while Ban Xia and Sheng Jiang regulate the stomach and descend the adverse rising Qi. Da Zao serves as the guiding herb and regulates the properties of the other herbs. All the herbs in the formula achieve the actions of externally relieving Shaoyang and internally purging heat accumulation.
Applications in Bio-medicine: Acute cholecystitis, biliary tract stones, acute pancreatitis, and intestinal obstruction, all of which pertain to the combined diseases of Shaoyang and Yangming. They are characterized by alternate attacks of chills and fever, and abdominal pain with constipation.
(a)For severe vomiting, add Coptis root (Huang Lian, ), Bamboo shavings (Zhu Ru, ), and Evodia fruit (Wu Zhu Yu, ).
(b)In the case of jaundice, add Oriental wormwood (Yin Chen Hao, ) and Cape jasmine fruit (Zhi Zi, ).
(c)For severe constipation, add Glauber’s salt (Mang Xiao, ).
(d)For severe distension and fullness, add Costus root (Mu Xiang, ) and Magnolia bark (Hou Po, ).
(e)For severe pain, add Chinese Angelica root (Dang Gui, ) and Corydalis tuber (Yan Hu Suo, ) or Red peony (Chi Shao, ) and Peach seed (Tao Ren,).