1. Banxia Xiexin Tang from "Shanghan Lun"

1. Banxia Xiexin Tang from "Shanghan Lun"

[Composition] Banxia 10 grams (half a sheng), Huanglian 3 grams (one liang), Huangqin, Ganjiang, and Renshen each 10 grams (three liang), Dazao 7 pieces (twelve pieces), Zhigancao 10 grams (three liang)

[Administration] Decocted in water and taken orally.

[Indications] Alternating cold and heat in the stomach and intestines.

[Symptoms] Epigastric fullness and distension, nausea and vomiting, intestinal rumbling and diarrhea, thin yellow and greasy tongue coating, and a weak, fine, rapid pulse.

[Functions] Opens blockages and relieves fullness, harmonizes stomach and intestines.

[Formula Analysis] When cold and heat alternate in the epigastrium, there is epigastric fullness and distension. The epigastrium is where the stomach and intestines reside; when cold and heat alternate, the qi of the stomach and intestines cannot flow smoothly—when ascending qi is blocked, there is intestinal rumbling and diarrhea; when descending qi is blocked, there is nausea and vomiting. The root cause of this condition is the alternation of cold and heat. In this formula, Banxia and Ganjiang are warm and spicy, opening up and dispersing cold blockages, while Huanglian and Huangqin are bitter and cold, clearing heat and eliminating hot blockages; together, these four herbs take on the major task of opening up and relieving fullness and blockages. When pathogenic factors gather, the qi must be weak, so Renshen is used to tonify qi and support the elimination of pathogenic factors as a supplementary component. Dazao strengthens the spleen and regulates qi, serving as a complementary treatment, while Zhigancao harmonizes all the herbs and serves as a guiding agent.

[Clinical Modifications] ① Increase the dosage of Zhigancao to 12 grams, creating Gancao Xiexin Tang ("Shanghan Lun"). This formula is mainly used for cases of vomiting and fullness, intestinal rumbling and diarrhea, inability to digest food, and irritability and restlessness. ② Reduce the dosage of Ganjiang to 3 grams and add 12 grams of Shengjiang, creating Shengjiang Xiexin Tang ("Shanghan Lun"). This formula is mainly used for cases of vomiting and fullness, intestinal rumbling and diarrhea, and difficulty swallowing food.

[Reference Materials] ① After five or six days of cold injury, if someone experiences vomiting and fever, they already meet the criteria for Chaihu Tang, but if they are still treated with other medications and the Chaihu Tang symptoms persist, they should be treated again with Chaihu Tang. Even though they have already been treated, it is not considered a setback; rather, the body continues to sweat and shake off the heat. If the epigastrium is full and there is pain, this is a case of "chest fullness," and Daxianxiong Tang is the main treatment; however, if the epigastrium is full but not painful, this is a case of "fullness," and Chaihu Tang is not suitable, so Banxia Xiexin Tang is recommended. ("Shanghan Lun")

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② A痞 is defined as a condition of fullness without actual distention. When pathogenic factors invade the interior, they cannot be expelled through sweating; yet when there is fullness without actual distention, they also cannot be eliminated by purgation. Therefore, only the pungent properties of Pinellia and dried ginger can disperse the obstruction, while the bitter properties of Coptis and Scutellaria can drain the fullness. Although these effects are achieved through the medicinal actions, they are ultimately driven by the stomach qi. The inclusion of ginseng, licorice, and jujubes is intended to address the subsequent deficiency in the middle burner, thus reinforcing qi and assisting the medicinal actions. (From "Shanghan Guanzhu Ji")

③ Banxia Xiexin Tang is a modified formula derived from Xiaochaihu Tang and is one of the representative formulas for harmonizing the stomach and intestines. This formula is primarily indicated for disorders of the intestines themselves; however, it can also be effective when gastrointestinal symptoms such as "pi-man" arise due to diseases affecting other systems. (From "Jiangxi Zhongyi," April 1980, p. 32)

[Commentary] This formula can be used for chronic gastritis, gastric and duodenal ulcers, chronic intestinal diseases, and especially those with accompanying autonomic dysfunction of the gastrointestinal tract.