1. Dachaihu Tang from "Shanghan Lun"

1. Dachaihu Tang from "Shanghan Lun"

[Composition] Bupleurum 9 grams (half jin), scutellaria 6 grams (three liang), rhubarb 6 grams (two liang), citrus aurantium 9 grams (four pieces), processed pinellia 9 grams (half sheng), white peony 9 grams (three liang), fresh ginger 12 grams (five liang), jujubes four pieces (twelve pieces).

[Administration] Decoct in water and divide into three doses per day.

[Indications] Combined Shaoyang-Yangming syndrome.

[Symptoms] Bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, chest and flank discomfort, restlessness and nausea, reluctance to eat, mild depression, epigastric fullness and pain, abdominal distension and pain, hard stools, thick, dry yellow tongue coating, and a taut, powerful pulse.

[Functions] Externally harmonize Shaoyang, internally purge Yangming.

[Formula Analysis] Bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, chest and flank discomfort, restlessness and nausea are signs of Shaoyang syndrome; mild depression, epigastric fullness and pain, abdominal distension and pain, and hard stools are signs of Yangming organ excess. Pathogenic qi enters from the exterior to the interior and transforms into heat and excess. In this formula, bupleurum resolves Shaoyang pathogenic qi, while scutellaria clears Shaoyang heat; together, these two herbs take on the major task of harmonizing Shaoyang and serve as the primary agents. Shaoyang pathogenic qi enters the interior and turns into heat and excess, so rhubarb, being bitter and cold, purges the excess in Yangming as a supporting agent. Citrus aurantium disperses qi and breaks up stagnation, while pinellia opens up fullness and suppresses reverse flow, and white peony restrains yin and alleviates urgency—all of these serve as complementary agents. Fresh ginger and jujubes harmonize ying and wei and serve as guiding agents.

[Clinical Modifications]

① If the heat is severe and the stools are hard, with a robust pulse, add mirabilite; if there is solid pain in the epigastrium extending to the left flank and the stools are hard, add cucurbita and green peel; if there is confusion and delirium, add coptis and gardenia; if the face and skin turn yellow, add artemisia and phellodendron; if vomiting does not stop, add fresh ginger and bamboo fiber.

② Adding chuanlianzi, yuanhu, musk, and dandelion to this formula creates a compound version of Dachaihu Tang (an empirical formula) that can treat acute perforation of ulcers, acute cholecystitis, and other conditions.

[References]

① Dachaihu combines the pungent, exterior-moving qualities of bupleurum, fresh ginger, and pinellia with the bitter, interior-penetrating qualities of scutellaria, peony, citrus aurantium, and rhubarb, making it a formula that treats both the exterior and interior simultaneously. (From "Shanghan Guanzhu Ji")

② When treating febrile illnesses from Shanghan, if sweating fails to relieve the fever and pathogenic qi enters the interior, turning into heat and excess, resulting in epigastric fullness, nausea, and difficulty in digestion, or alternating chills and fever, thirst, delirium, abdominal distension, and constipation, with exterior symptoms remaining unresolved and interior symptoms becoming urgent, accompanied by a robust pulse or a deep, taut, and rapid pulse, this formula is effective. (From "Chengfang Qieyong")

③ Using this formula to treat acute cholecystitis, acute suppurative cholangitis, and gallstone infections combined with infection has yielded good results, with an effectiveness rate of 73.84%. Among the 172 patients treated, all experienced varying degrees of right upper quadrant and substernal pain, nausea and vomiting, often accompanied by fever and chills, elevated body temperature, and increased white blood cell count. During the acute infection phase, treatment involved Qingdan Tang (a modified version of Dachaihu Tang): bupleurum 15 grams, scutellaria 9 grams, citrus aurantium 9 grams, honeysuckle 30 grams, forsythia 12 grams, half-sheng pinellia 12 grams, dandelion 30 grams, salvia miltiorrhiza 15 grams, rhubarb 3 grams (added later), and yuanming powder 12 grams (taken orally). During the recovery phase, including chronic cholecystitis and gallstones, Liandan Tang could be used (still a modified version of Dachaihu Tang): bupleurum, scutellaria, citrus aurantium, turmeric, powdered ginger, yuanhu, and chuanlianzi each 9 grams, along with musk, frankincense, and myrrh each 6 grams, plus 12 grams of whole cucurbita, all decocted and taken in multiple doses daily. Adjustments could be made according to the condition. For those with severe damp-heat, add artemisia, poria, and gardenia; for those with severe qi stagnation, add fragrant grass, dried orange peel, and magnolia bark; for those with severe vomiting, add bamboo fiber; for those with severe pain, increase chuanlianzi and yuanhu. (From "Hubei University of Traditional Chinese Medicine," "Shanghan Lun")

[Commentary] This formula is not mentioned in "Shanghan Lun" but appears in "Jinkui Yaolue."