1. Gegen Huangqin Huanglian Tang from "Shanghan Lun"

1. Gegen Huangqin Huanglian Tang from "Shanghan Lun"

[Composition]

Gegen 12 grams (half jin), scutellaria 9 grams (three liang), coptis 9 grams (three liang), prepared licorice 6 grams (three liang).

[Administration]

Decoct in water and take orally.

[Indications]

Exterior symptoms combined with interior heat.

[Symptoms] Headache and fever, dry mouth and thirst, sweating and shortness of breath, body heat and diarrhea, yellow tongue coating and rapid pulse.

[Functions] Harmonize the exterior and purge the interior.

[Formula Analysis] Incorrect use of purgatives for exterior symptoms led to pathogenic heat penetrating the Yangming channel, resulting in unresolved exterior symptoms and excessive interior heat. Headache, fever, dry mouth and thirst, and sweating with shortness of breath are signs of wind-heat exterior symptoms; body heat and diarrhea, along with yellow tongue coating and rapid pulse, indicate interior heat with dampness. In this formula, gengen is heavily used, both to resolve wind-heat on the exterior and to boost the yang qi of the spleen and stomach to treat diarrhea, thus achieving the goal of harmonizing the exterior and balancing the interior. Scutellaria and coptis purge heat and dry dampness, clearing interior heat while also treating diarrhea, serving as supporting agents. Licorice strengthens the middle burner and can be considered a complementary agent, harmonizing all the herbs and serving as a guiding agent.

[Clinical Modifications]

If there is vomiting, add pinellia; if there is food stagnation, add hawthorn and liuqu; if the abdominal pain is severe, add musk; if there is pus and blood in the stool, add angelica, white peony, and sophora japonica; if the fever is severe, add two flowers and white-headed herb.

[References]

① In Sun Disease, when the guizhi syndrome is treated with purgatives, the diarrhea continues unabated, and the pulse becomes rapid, indicating that the exterior symptoms have not been resolved; if there is shortness of breath and sweating, Gegen Huangqin Huanglian Tang is the primary treatment. (From "Shanghan Lun")

② Treating exterior symptoms with purgatives weakens the interior, allowing pathogenic qi to take advantage of the weakness and invade, resulting in continued heat and diarrhea. The exterior shows headache, fever, and chills, indicating that exterior symptoms still exist, while the interior has pathogenic heat, causing shortness of breath and sweating. Since exterior symptoms still exist, gengen and licorice are used to resolve the exterior with their sweet and pungent properties; since the interior has pathogenic heat, scutellaria and coptis are used to clear the interior with their bitter and cold properties. (From "Yifang Kaoshi")

③ Gegen Huangqin Huanglian Tang was used to treat 40 cases of acute bacterial dysentery, 36 of which were cured. One dose per day, with the shortest course lasting 2 days and the longest 12 days. The average time to reduce fever was 27.76 hours, and the average time to control acute symptoms was 3.44 days. Visible pus and blood in the stool disappeared after an average of 2.83 days. (From "Jiangsu Zhongyi," May 1960, p. 33)

④ Gegen Huangqin Huanglian Tang was used to treat pediatric toxic enteritis. The article reported three typical cases, all diagnosed by Western pediatricians as toxic enteritis. Although the severity varied, the common symptoms included watery diarrhea or sudden, forceful diarrhea, yellow, foul-smelling, and soft abdomen, emaciation, irritability, thirst, yellow urine, dry and red lips, white tongue coating, and purple fingerprints—symptoms indicative of heat and diarrhea. All three cases had previously failed to respond to Western medicine and were subsequently treated with traditional Chinese medicine combined with intravenous fluids, achieving cure after 1–4 doses. The basic formula consisted of gengen, coptis, scutellaria, and licorice. For those with severe heat, add honeysuckle; for those with lung heat and cough, add mulberry bark; for those with stagnation, add malt and radish seeds. (From "Fujian Zhongyi," March 1966, p. 8)

[Commentary] This formula can be used for acute gastroenteritis, acute and chronic bacterial dysentery, pediatric indigestion, and typhoid-like intestinal infections.