Five Accumulations Powder from "Harmonizing Formulas Bureau"

Five Accumulations Powder from "Harmonizing Formulas Bureau"

[Composition]

Angelica root 100 grams, peony root 100 grams, chuanxiong rhizome 100 grams, atractylodes rhizome 100 grams, magnolia bark 120 grams, tangerine peel 180 grams, licorice root 100 grams, pinellia tuber 100 grams, poria mushroom 100 grams, ephedra 180 grams, angelica root 100 grams, platycodon root 360 grams, dried ginger 120 grams, cinnamon 100 grams, citrus aurantium 180 grams

[Administration]

Except for cinnamon and citrus aurantium, which are ground separately into coarse powder, the rest of the herbs are coarsely ground together, slowly fried over low heat until the color changes, spread out to cool, then cinnamon and citrus aurantium powders are added and mixed thoroughly. Take 9 grams each time, add three slices of fresh ginger, decoct in water, remove the residue, and take warm.

[Indications]

Exterior wind-cold invasion, interior injury from raw and cold foods.

[Suitable Conditions]

Headache, fever with chills, no sweating, stiffness in the neck and back, distension and fullness in the abdomen, nausea and vomiting, intestinal rumbling and loose stools, cold pain in the abdomen, menstrual irregularities in women.

[Functions]

Disperses exterior cold and warms the middle burner to eliminate accumulation.

[Formula Analysis]

When there is an exterior wind-cold invasion, one experiences headache, fever with chills, no sweating, and stiffness in the neck and back; when there is an interior injury from raw and cold foods, one feels distension and fullness in the abdomen, nausea and vomiting, intestinal rumbling and loose stools, and cold pain in the abdomen. This condition arises from the combination of exterior cold and interior cold; people who already have an inherent interior cold will develop this condition once they are exposed to exterior cold. Cold tends to contract and draw things inward; when both exterior and interior are cold, it often leads to stagnation of food and drink, and may even gradually form phlegm-dampness retention, qi stagnation, and blood stasis. Therefore, this condition involves cold congealing, food stagnation, phlegm accumulation, qi obstruction, and blood stasis—collectively known as the "five accumulations." This formula is designed specifically for the "five accumulations," hence the name "Five Accumulations Powder." Ephedra and angelica root disperse exterior cold; dried ginger and cinnamon warm and dispel interior cold; these four herbs work together to eliminate cold and address the root causes of the five accumulations, making them the main ingredients. Pingwei Powder harmonizes the stomach and removes dampness to eliminate food stagnation; Erchen Decoction strengthens the spleen and moves phlegm to treat phlegm accumulation; platycodon and citrus aurantium both promote qi flow to relieve qi stagnation; angelica root, peony root, and chuanxiong rhizome nourish blood and activate blood circulation to resolve blood stasis. Together, these herbs address food, phlegm, qi, and blood accumulation, serving as auxiliary ingredients. Licorice harmonizes all the herbs and acts as a guiding agent.

[Clinical Modifications]

① If there is exterior deficiency with sweating, ephedra and atractylodes can be removed; if there is qi deficiency and fatigue, citrus aurantium and tangerine peel can be removed, and ginseng and white atractylodes added; if abdominal pain is severe due to cold, add evodia fruit and roasted dried ginger; if yang deficiency causes cold limbs, add processed aconite; if exterior cold is relatively severe, replace cinnamon with cassia twig.

② Combine this formula with Ginseng Detoxifying Powder to form Five Accumulations Plus Powder (from "Collection of Medical Formulas"), which treats cold-dampness-related body heaviness and pain, as well as soreness in the lower back and legs.

③ Use this formula in combination with Jingfang Detoxifying Powder to treat rheumatoid arthritis.

④ Remove ephedra and angelica root, add fragrant cyperus and yuanhu to regulate menstruation and relieve pain, using it to treat menstrual irregularities and dysmenorrhea in women.

[References]

① This is a formula that works for both yin and yang, exterior and interior. Ephedra and cassia twig disperse exterior cold, while licorice and peony root harmonize the middle burner and relieve pain; atractylodes and magnolia bark balance the stomach and remove dampness; tangerine peel and pinellia move qi against the flow to eliminate phlegm; chuanxiong, angelica root, ginger, and angelica root enter the blood circulation to dispel cold-dampness; citrus aurantium and platycodon benefit the chest and diaphragm to clear cold and heat; poria mushroom drains heat, promotes urination, calms the heart, and benefits the spleen. Thus, this formula is both a dispelling-exterior-and-warming-middle-burner-and-removing-dampness agent, as well as a phlegm-clearing, bloating-relieving, and menstruation-regulating remedy—a single formula that can treat many ailments, but only those who know how to adapt it flexibly can truly make use of it. ("Collection of Medical Formulas")

② The Five Accumulations Powder was originally designed to treat the "five accumulations" of cold, food, qi, blood, and phlegm. The author used it to treat postpartum fever, dysmenorrhea, goiter, stomach pain, diarrhea, and knee osteoarthritis, with good results. ("Jiangsu Journal of Traditional Chinese Medicine," May 1980, p. 30)

[Commentary]

This formula is used to treat habitual colds, gastrointestinal neurosis, and loss of appetite associated with various chronic diseases.

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Chapter 5: Heat-Clearing and Fire-Draining Formulas

"Heat is the gradual manifestation of fire," and "fire is the extreme manifestation of heat." It is evident that fire and heat share the same nature, differing only in degree. For heat, the appropriate approach is to clear it; for fire, however, draining is more suitable. Both heat-clearing and fire-draining follow the principle of "cooling what is hot," and most of the drugs used in these formulas are cold or cool in nature. Fire is one of the "six pathogenic factors," and ancient scholars said, "all six energies can turn into fire," highlighting the significant role of fire and heat in causing illness in humans. Fire is divided into "strong fire" and "weak fire." "Strong fire consumes qi," indicating pathological fire; "weak fire generates qi," indicating physiological fire. Generally speaking, the "imperial fire" and "auxiliary fire" both belong to the category of weak fire; once they become excessive, they fall into the category of strong fire. As for strong fire, it is further divided into "deficient fire" and "excessive fire." Deficient fire includes not only the aforementioned excessive imperial and auxiliary fire, but also qi-deficiency fever and yin-deficiency fever; excessive fire, on the other hand, can be divided into two types: external-fever and internal-injury fever. External-fever refers to all fevers caused by external factors, typically diagnosed according to the Wei, Qi, Ying, and Blood levels, with distinctions between heat in the Wei layer, Qi layer, Ying layer, and Blood layer; internal-injury fever, on the other hand, refers to the rise of heat and the intensification of fire caused by imbalances in the yin and yang of the internal organs, commonly known as "organ fire." Moreover, fire-pathogens, when dispersed, become fire, and when aggregated, turn into toxins. By "turning into toxins," we generally mean modern medical purulent infections, such as boils, carbuncles, erysipelas, and sepsis. Based on the above concepts of fire and heat, heat-clearing and fire-draining formulas are usually classified into the following categories: ① clearing heat in the Qi layer; ② clearing heat in the Ying layer and cooling the blood; ③ clearing heat and detoxifying; ④ clearing heat in the organs; ⑤ clearing deficient heat.

I. Clearing Heat in the Qi Layer

When heat-pathogens invade the body, they first affect the Wei layer. This stage is also called wind-heat invading the exterior, and the corresponding treatment formula belongs to the category of pungent-cool exterior-dispelling formulas; once the heat enters the Qi layer, the method of clearing heat in the Qi layer is used. This condition is characterized by high fever, intense thirst, profuse sweating, and a large, rapid pulse—commonly referred to as "high fever, intense thirst, profuse sweating, and a large pulse." Additionally, after a fever, residual heat that has not yet dissipated and causes restlessness and anxiety also falls into this category.

1. White Tiger Decoction from "Treatise on Cold Damage"

[Composition] Gypsum 30 grams (one jin), anemarrhena rhizome 9 grams (six liang), glutinous rice 15 grams (six he), prepared licorice 3 grams (two liang)

[Administration] Decoct in water until the rice is cooked, remove the residue, and take warm.

[Indications] Yangming meridian syndrome.

[Suitable Conditions] Severe fever and intense thirst, profuse sweating and a large, rapid pulse, tongue yellow and dry.

[Functions] Clears heat and drains fire, nourishes yin and generates fluids.

[Formula Analysis] Yangming meridian syndrome means heat resides in the Qi layer. The symptoms include: high fever, intense thirst, profuse sweating, and a large pulse—four major signs of internal heat and fire. This is a case of internal heat and fire, treated by clearing heat and draining fire. In this formula, gypsum, being extremely cold, takes on the primary responsibility of clearing heat and draining fire. Anemarrhena rhizome, being bitter and cold, not only assists gypsum in clearing heat and draining fire, but also nourishes yin and generates fluids, serving as a supporting ingredient. Glutinous rice benefits qi and harmonizes the middle burner, acting as a supplementary treatment, while licorice harmonizes all the herbs and serves as a guiding agent.

[Clinical Modifications] ① Add ginseng to form Ginseng White Tiger Decoction (from "Treatise on Cold Damage"). Indicated for severe internal heat and dual damage to qi and fluids. ② Add cassia twig to form White Tiger Plus Cassia Twig Decoction (from "Essentials of the Golden Cabinet"). Originally used to treat "warm malaria, where the pulse is normal, there is no cold but heat, joint pain and discomfort, and occasional vomiting." Recently used to treat rheumatic heat arthropathy. ③ Add atractylodes to form White Tiger Plus Atractylodes Decoction (from "Living People's Book"), indicated for rheumatoid arthritis, with symptoms including joint swelling and pain, headache as if wrapped up, chest tightness and heat, and thirst without drinking. ④ Add antelope horn and rhino horn to form Antelope-Rhino White Tiger Decoction (from "Warm and Hot Latitude and Longitude"), indicated for external-fever illnesses, where qi and blood are both severely burned, resulting in high fever, intense thirst, confusion, and delirium. ⑤ Add black ginseng and rhino horn to form Spotted Decoction (from "Differentiation of Warm Diseases"), indicated for heat entering the Ying and Blood layers, leading to delirium, rash, and a dark red tongue with yellow coating.

[References] ① The Yangming pathogen transforms into heat, so there is no aversion to cold but rather to heat; heat evaporates outward, causing spontaneous sweating; heat dries the stomach, leading to thirst; when the pathogen is strong and real, the pulse becomes slippery, yet still within the meridian, so it also has a floating quality. After all, Yangming belongs to the stomach, and externally governs the muscles; although there is fire, it has not yet become solid, so it cannot be cured by bitter-cold medicines alone. Gypsum, being pungent and cold, can relieve muscle heat with its pungency and overcome stomach fire with its coldness; its cold nature settles downward, while its pungency goes outward, excelling at both internal and external aspects, thus serving as the principal ingredient. Anemarrhena rhizome, being bitter and moist, uses bitterness to drain fire and moisture to nourish dryness, serving as the secondary ingredient. Using licorice and glutinous rice, they harmonize the central palace and can also drain fire from the earth; the earth can cultivate crops, so cold agents can slow down their coldness, and bitter medicines can balance their bitterness, allowing the settling nature to remain in the stomach, with these two serving as assistants. ... The White Tiger is the Western Metal God, named after the soup, and when autumn metal is in power, summer heat naturally dissipates. ("Medical Treasure Mirror")

② Treated nine cases of lobar pneumonia, all confirmed by X-ray. Used White Tiger Decoction with additional ingredients such as scutellaria, goldthread, honeysuckle, and forsythia to strengthen the heat-clearing and detoxifying effects. Added chuanbei, apricot kernel, turmeric, and orange peel for cough and chest pain; added bamboo root and bamboo shoot for hemoptysis; added gardenia and reed root for mental restlessness and heat; added rhubarb for physical strength; added black ginseng, ophiopogon, flower pollen, and fresh dendrobium for fluid loss; added fuzhen and yi-yuan powder for sleep disturbances. The average cure time was 16.3 days, and all cases were cured. ("Shanghai Journal of Traditional Chinese Medicine," April 1957)

③ White Tiger Decoction with modifications is also frequently used in ophthalmology. Can be used for conditions such as swollen head due to fire, epidemic conjunctivitis, cataracts, silver star-like opacities, and wave-like opacities. Case introduction: Ms. Wang ××, 16 years old, first visit on July 16, 1956. Left eye red and swollen, opacity spreading upward from the bottom, directly covering the pupil, resulting in blurred vision; tongue red and pulse rapid, mouth dry and thirsty. The cause was Yangming stomach heat, treated by clearing stomach heat. Prescription: one liang of fresh rehmannia root, three qian of anemarrhena rhizome, one liang of fresh gypsum, eight qian of fresh rice grain, and one qian of fresh licorice root. Second visit: frequent thirst, confirming stomach heat; previously given six doses of stomach-clearing formula, thirst relieved, eye redness also subsided, but still feeling dryness—this heat severely damaged fluids, water couldn't ascend, treated by increasing fluid intake. Added black ginseng and ophiopogon to the original formula, and after six doses, inflammation inside the eye subsided. ("Shanghai Journal of Traditional Chinese Medicine," April 1964)

④ "Fresh gypsum is equivalent to gold pills, while calcined gypsum is equivalent to poison... Ancient scholars used gypsum in one case up to fourteen jin (see 'Pen Flower Medical Mirror'); in another case up to dozens of jin (see 'Wu Jutong Medical Records'); some even heavily used gypsum after childbirth (see 'Xu Lingtai Medical Records'), but all used fresh gypsum. Even before the Tang and Song dynasties, no one used calcined gypsum; unexpectedly, later herbal texts about gypsum changed the so-called 'slightly cold' in the 'Classic of Materia Medica' to 'extremely cold,' and moreover, claimed that calcining didn't harm the stomach. Once this statement came out, it misled all the people! ("Comprehensive Record of Integrating Eastern and Western Medicine")"

[Commentary] This formula can be used for high fevers caused by various acute and chronic infectious diseases and blood disorders; also applicable to heatstroke, diabetes, and diabetes insipidus; furthermore, it can be used for acute conjunctivitis, eye injuries, and other ophthalmological conditions.

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2. Bamboo Leaf Gypsum Decoction from "Treatise on Cold Damage"

[Composition] Bamboo leaves 9 grams (two handfuls), gypsum 30 grams (one jin), pinellia tuber 9 grams (half a jin), ginseng 4.5 grams (three liang), ophiopogon 18 grams (one liter), licorice 3 grams (two liang), glutinous rice 15 grams (half a liter)

[Administration] First decoct all the herbs and remove the residue, then add glutinous rice, cook until the rice is done, strain the liquid, and take warm.

[Indications] Residual heat not yet cleared, dual damage to qi and yin.

[Suitable Conditions] Body heat with profuse sweating, dry mouth and desire to drink, chest and heart discomfort,虚烦不眠, weakness and lack of qi, reverse qi causing nausea, dry tongue with little coating, and a thin, rapid pulse.

[Functions] Clears heat and relieves annoyance, benefits qi and nourishes yin.

[Formula Analysis] When residual heat remains, one experiences body heat with profuse sweating, dry mouth and desire to drink, chest and heart discomfort, and虛烦不眠; when there is dual damage to qi and yin, one feels weakness and lack of qi, reverse qi causing nausea, dry tongue with little coating, and a thin, rapid pulse. Residual heat often comes with irritation, so the formula uses bamboo leaves and gypsum to clear residual heat and relieve discomfort, addressing the root cause, making them the main ingredients. Ginseng benefits qi, and ophiopogon nourishes yin, together providing the function of benefiting qi and nourishing yin as supporting ingredients. Dry heat damages fluids, and when the stomach loses its ability to descend, qi reverses and causes nausea, so pinellia tuber lowers the reverse qi; dry heat also damages qi, weakening the spleen and stomach, so glutinous rice harmonizes the middle burner, making these two herbs complementary treatments; licorice harmonizes all the herbs and serves as a guiding agent.

[Clinical Modifications] Adding gardenia and fermented soybeans to this formula enhances its effectiveness in clearing heat and relieving annoyance.

[References] ① Although the major pathogen is eliminated, vital energy has not yet recovered, and residual pathogen remains. When qi is insufficient, phlegm forms; when heat is not eliminated, it rises upward, leading to weakness and lack of qi, as well as reverse qi causing nausea. Bamboo Leaf Gypsum Decoction is a variation of White Tiger Decoction, focusing on qi deficiency. Therefore, adding ginseng and ophiopogon to benefit qi, and using pinellia tuber to lower reverse qi and stop nausea. Also, removing the salty-cold anemarrhena rhizome and adding the sweet-cool bamboo leaves, especially beneficial for those with stomach heat and qi deficiency. ("Compendium of Cold Damage Interpretations")

② However, even though the major heat has subsided, residual heat still remains, leading to weakness and lack of qi, reverse qi causing nausea—this is a sign of yin deficiency unable to hold onto yang, compounded by residual heat from external exposure. Therefore, the formula uses bamboo leaves and gypsum to clear external heat, and adds ginseng and ophiopogon to work with gypsum to replenish yin deficiency, because gypsum and ginseng together have a wonderful synergy, able to restore true yin when residual heat remains. Using pinellia tuber to lower reverse qi and stop nausea; using licorice and glutinous rice to harmonize stomach qi and slow down the intrusion of medicinal substances. From a common-sense perspective, after resolving cold damage, why use gypsum again? Medicines like rehmannia, black ginseng, winter melon, and ophiopogon could also handle it, but cold substances leave residual pathogen, potentially laying the foundation for tuberculosis—this should not be overlooked. ("Comprehensive Record of Integrating Eastern and Western Medicine")

③ Used Bamboo Leaf Gypsum Decoction to treat pregnancy ulcers, asthma, and headaches, each case cured. It is said that this formula has functions such as heat-clearing, anti-inflammatory, sedative, and analgesic effects, suitable for both deficient heat and heat damaging qi. ("Jiangxi Journal of Traditional Chinese Medicine," April 1980, p. 35)

[Commentary] This formula can be used for fever caused by tuberculosis, blood diseases, and late-stage influenza. Recently, it has also been used with modifications to treat summer heat in children.

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3. Gardenia Fermented Soybean Decoction from "Treatise on Cold Damage"

[Composition] Gardenia 9 grams (fourteen pieces), fermented soybeans 9 grams (four he)

[Administration] First decoct gardenia, extract the juice and add fermented soybeans, then decoct again and remove the residue, taking warm.

[Indications] Residual heat not yet cleared.

[Suitable Conditions] Body heat and chest fullness, inner frustration,虛烦不眠, even repeated tossing and turning, tongue red with slight yellow coating.

[Functions] Clears heat and relieves annoyance.

[Formula Analysis] Residual heat often disturbs the chest and heart, causing body heat and chest fullness; residual heat is often prolonged, depleting true yin and damaging the mind, leading to inner frustration,虛烦不眠, and even repeated tossing and turning. In this formula, both gardenia and fermented soybeans have the effect of clearing heat and relieving annoyance. This condition focuses on heat as the root cause and annoyance as the symptom; gardenia is bitter and cold, primarily clearing heat; fermented soybeans are sweet and cold, prioritizing relief of annoyance, so gardenia is the main ingredient, fermented soybeans the supporting one, and the two work together to treat both heat and annoyance, complementing each other.

[Clinical Modifications] ① Add prepared licorice to form Gardenia-Licorice-Fermented Soybean Decoction (from "Treatise on Cold Damage"), indicated for those with inner frustration and lack of qi. ② Add fresh ginger to form Gardenia-Ginger-Fermented Soybean Decoction (from "Treatise on Cold Damage"), indicated for those with inner frustration and nausea. ③ Remove fermented soybeans, add magnolia bark and citrus aurantium to form Gardenia-Magnolia-Bark Decoction (from "Treatise on Cold Damage"), indicated for those who feel frustrated and have abdominal fullness after recovering from cold damage, unable to lie down comfortably. ④ Add citrus aurantium, decoct in clear water, forming Citrus Aurantium-Gardenia Decoction (from "Treatise on Cold Damage"), indicated for those who recover from illness but still feel tired and have residual heat; if the recovery is due to food, add rhubarb to clear heat and remove accumulation.

[References] ① After sweating, vomiting, and diarrhea, if one feels restless and unable to sleep, especially if the condition is severe, one will repeatedly toss and turn, feeling inner frustration; Gardenia-Fermented Soybean Decoction is the main treatment for this; if one feels weak and lacks qi, Gardenia-Licorice-Fermented Soybean Decoction is the main treatment; if one feels nauseous, Gardenia-Ginger-Fermented Soybean Decoction is the main treatment. ("Treatise on Cold Damage")

② Mr. Zheng, suffering from stomach pain. After treatment, the pain did not decrease, but instead constipation worsened, chest felt full and uncomfortable, feeling frustrated and wanting to vomit, tossing and turning, eating less and feeling exhausted, lasting seven or eight days. His pulse was deep, tense, and slippery, his tongue was yellow, greasy, and turbid, and the prescriptions often included cinnamon, aconite, and sandalwood. This was originally caused by retained food, and initially only needed digestive aids to get better; now, after prolonged delay, it turned into a situation where food stuck and caused weakness, so supplementing was impossible, and purging was also not advisable. Therefore, targeting the two symptoms of inner frustration and nausea, he was given Gardenia-Ginger-Fermented Soybean Decoction: three qian of fresh gardenia, three qian of fresh ginger, and five qian of fermented soybeans. Divided into two doses, taken warm, after finishing the entire course, all symptoms improved, slept peacefully last night, had a bowel movement this morning, and could eat a little bit. ("Analysis of Treatise on Cold Damage Collection")

【Commentary】 ① According to "Treatise on Cold Damage," patients with loose stools should not take this formula, because loose stools often indicate spleen-stomach cold deficiency, and gardenia is bitter and cold, easily harming the spleen-stomach. ② This formula can be used for neurasthenia, autonomic dysfunction, chronic cholecystitis, coronary heart disease, stomach diseases, and other conditions.

II. Clearing Ying and Cooling Blood

When heat enters the Ying layer and the blood, this method is used. Symptoms include tidal fever and intense thirst, confusion and delirium, faint rashes, vomiting, nosebleeds, bloody stools, tongue red and dark with little coating, and a thin, rapid pulse.

1. Clearing Ying Decoction from "Differentiation of Warm Diseases"

[Composition] Bamboo leaf core 3 grams, salvia root 6 grams, rhino horn 9 grams, forsythia fruit 9 grams, goldthread 4.5 grams, honeysuckle 9 grams, rehmannia root 15 grams, black ginseng 9 grams, ophiopogon 9 grams

[Administration] Decoct in water and take.

[Indications] Heat entering the Ying layer.

[Suitable Conditions] Tidal fever and intense thirst, confusion and delirium, restlessness and insomnia, faint rashes, tongue red with little coating, and a thin, rapid pulse.

[Functions] Clears Ying and cools blood.

[Formula Analysis] When heat enters the Ying layer, it depletes yin and harms the spirit. Symptoms include: tidal fever and intense thirst, confusion and delirium, restlessness and insomnia, faint rashes, tongue red with little coating, and a thin, rapid pulse; entering the Ying layer is close to the blood layer, with faint rashes appearing. In this formula, rhino horn directly enters the Ying and blood layers, excelling at clearing Ying and cooling blood, serving as the main ingredient. When heat enters the Ying layer, the focus is on depleting yin and losing fluids, so rehmannia root, black ginseng, and ophiopogon increase yin and replenish fluids, serving as supporting ingredients. Ancient sayings state, "If dispersed, it becomes heat; if aggregated, it turns into toxin," and warm pathogenic factors are most likely to become toxic, requiring concurrent heat-clearing and detoxifying methods to double the effect. Two flowers, forsythia, and goldthread are all major heat-clearing and detoxifying agents, and when paired with rhino horn, their heat-clearing and detoxifying effects are even more pronounced, making them suitable for concurrent treatment; when heat enters the Ying layer, blood heat is easily depleted, so salvia root enters the blood layer, taking on the responsibility of nourishing blood, activating blood, and clearing blood, also serving as a concurrent treatment. Bamboo leaves clear virtual fire in the heart and relieve annoyance, allowing excess heat to be expelled through urine, acting as a guiding agent.

[Clinical Modifications] ① If one already shows confusion and delirium, tongue stiff and limbs numb, it indicates that the pathogen has entered the pericardium, and can be taken with Niuhuang Pill, Zixue Dan, and other accompanying medicines; if accompanied by convulsions, add antelope horn, hook vine, or take Zixue Dan along with it. ② Adding gypsum, danpi, and licorice can treat scarlet fever. ③ Adding antelope horn, hook vine, and earthworm can treat meningitis and encephalitis; if confusion and delirium are severe, can be taken with Angong Niuhuang Pill and Zhibao Dan.

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[Reference Materials] ① The "Plain Questions: On the Great Principles of Supreme Truth" states: "When heat evil invades internally, treat it with salty and cold herbs, supplemented by sweet and bitter ones." This formula embodies the principle of the Classic to treat pathogenic factors of warm-heat excess within. When warm pathogenic factors first invade the營 (nutritive) level, although there may be restlessness, reduced sleep, a rapid pulse, and a dark red tongue, it is still possible to dissipate the heat and move it to the氣 (qi) level for resolution, just as Ye Tianshi said: "Even when it enters the營, it can still be dissipated and moved to the氣 level." The intention of this formula lies precisely in this. (Jiangsu New Medical College: "Chinese Medicine Formulas") ② It treats summer-heat disease that has invaded the pericardium, presenting symptoms such as restlessness, thirst, a red tongue, and high fever with delirium. Since summer heat is the dominant fire, its energy communicates with the heart, so summer heat inevitably harms the heart; however, the heart is the sovereign organ and should not directly accept pathogenic factors. What it receives is taken over by the collateral channels, but since the heart stores the spirit, when pathogenic factors disturb it, the spirit becomes unsettled, leading to delirium. The heart governs blood, and heat damages the blood, causing the tongue to appear red. Metal is harmed by fire, resulting in restlessness and thirst. Summer heat is the primary pathogenic factor among the six exogenous evils, while warm-heat is an abnormal seasonal qi. When these two combine, they give rise to summer-heat disease, which is broadly similar to spring-heat and autumn-heat diseases, except that summer heat most easily harms the heart. In this formula, rhinoceros horn and coptis both enter the heart to clear fire. Rhinoceros horn has a light and nimble nature, capable of eliminating epidemic toxins; coptis has a bitter and dark quality, able to dry dampness. These two are the principal herbs for treating warm-heat. When heat invades the pericardium, the yin of the營 is scorched, so raw rehmannia and black ginseng are used to nourish kidney water, ophiopogon to nourish lung metal, and salvia miltiorrhiza leads them into the heart, all working together to increase fluid and extinguish the fire. Forsythia, honeysuckle, and bamboo leaves can all penetrate deeply into the heart and extend outward to the surface, providing a pungent and cool relief that naturally calms the spirit, reduces heat, and prevents pathogenic factors from lingering. ("Compendium of Practical Formulas")

[Notes] This formula can be used for various acute febrile infectious diseases, such as typhoid fever, typhus, scarlet fever, meningococcal meningitis, Japanese encephalitis, and others.

2. Xijiao Dihuang Decoction from "Qianjin Fang"

[Composition] 3 grams of rhinoceros horn, 30 grams of raw rehmannia, 12 grams of peony root, 12 grams of moutan bark

[Administration] Grind the rhinoceros horn into juice, decoct the remaining herbs in water, and take them together.

[Indications] Heat entering the blood level.

[Symptoms] Hot flashes and thirst, confusion and delirium, yang toxin-induced petechiae, hematemesis, epistaxis, hematochezia, hematuria, a dark red tongue without coating, and a fine, rapid pulse.

[Functions] Clearing heat and detoxifying, cooling the blood and stopping bleeding.

[Formula Analysis] When heat enters the營 and blood, it causes hot flashes, thirst, confusion, delirium, a dark red tongue without coating, and a fine, rapid pulse; when it forces blood to move, it results in yang toxin-induced petechiae, hematemesis, epistaxis, hematochezia, and hematuria. The main indication of this formula is when heat enters the營 and blood, with a particular focus on the blood aspect. The heart governs blood and fire, and in this formula, rhinoceros horn, being cold in nature, enters the heart, effectively clearing heart fire and detoxifying heat, while also having the function of cooling the blood and stopping bleeding, making it the primary herb. Raw rehmannia is sweet and cold, cooling the blood and stopping bleeding, while also having the effect of clearing heat and nourishing yin as a supplementary action. Peony root nourishes yin, and moutan bark disperses stasis; when heat enters the營 and blood, it damages yin and depletes blood, so these two herbs work together to nourish yin and disperse stasis as complementary actions.

[Clinical Modifications] ① For those who are excessively forgetful and even狂-like, add rhubarb and scutellaria. ("Qianjin Fang") ② For severe confusion, it can be combined with Zixue Dan or Angong Niuhuang Wan; for cases where anger and frustration are accompanied by liver fire, add bupleurum, scutellaria, and gardenia to clear the liver and relieve depression; for excessive heart fire, add coptis and gardenia; for severe vomiting and nosebleeds, add imperata grass, bamboo shavings, and hedyotis; for persistent hematochezia, add sophora flower and george tree bark; for persistent hematuria, add imperata grass and small thistle.

[Reference Materials] ① Compared with Qingying Tang, this formula uses qi-clearing herbs in the heat-clearing and blood-cooling approach, allowing it to penetrate the營 level and move the heat to the氣 level for resolution, making it suitable for cases where heat first enters the營 level and has not yet affected the blood. This formula, on the other hand, consists solely of blood-level herbs, focusing on clearing heat and detoxifying, cooling the blood and dispersing stasis, to treat conditions of intense heat in the blood. This is the key difference between the two formulas. (Jiangsu New Medical College: "Chinese Medicine Formulas") ② Using Xijiao Dihuang Tang with added ingredients to treat 11 cases of primary immune thrombocytopenic purpura. All patients had platelet counts below 80,000/mm³, with 5 cases having counts below 60,000/mm³. The treatment results were 6 cured, 4 markedly improved, and 1 died due to lack of efficacy. For those with severe heat, take Zixue Dan or antelope horn concurrently; for heavy bleeding, add sanqi powder, Yunnan Baiyao, and Shihui San; for internal yin deficiency and internal heat, add turtle shell, donkey-hide gelatin, hedyotis, ligustrum fruit, and ophiopogon. ("Chinese Medicine Journal," November 1963)

[Notes] This formula is suitable for various acute infectious diseases with bleeding and rash symptoms, such as meningococcal meningitis, Japanese encephalitis, sepsis, typhus, and epidemic hemorrhagic fever. It can also be used for aplastic anemia, leukemia, immune thrombocytopenic purpura, acute yellow liver atrophy, and uremia—conditions characterized by bleeding.

3. Clearing Both Qi and Blood

When heat pathogenic factors invade the氣 level and simultaneously enter the營 blood, it is called "dual burning of qi and blood." The treatment method should combine clearing qi and clearing the營 while cooling the blood, commonly referred to as the "dual clearing of qi and blood" method.

Qingwen Baidu Yin from "Yizhen Yide"

[Composition] 6 grams of coptis, 6 grams of scutellaria, 10 grams of gardenia, 6 grams of moutan bark, 10 grams of black ginseng, 15 grams of forsythia, 6 grams of licorice, 12 grams of raw rehmannia, 6 grams of rhinoceros horn, 6 grams of red peony root, 6 grams of anemarrhena, 10 grams of platycodon, 30 grams of gypsum, 6 grams of bamboo leaves

[Administration] First boil the gypsum for dozens of boils, then add the other herbs, and mix the rhinoceros horn juice before taking it.

[Indications] Pathogenic heat trapped inside, dual burning of qi and blood.

[Symptoms] High fever and thirst, profuse sweating and confusion, agitation and delirium, yang toxin-induced petechiae, vomiting, nosebleeds, hematochezia, a dark red tongue with little coating, and a deep, thin or large pulse.

[Functions] Clearing heat and draining fire, nourishing yin and cooling the blood.

[Formula Analysis] When pathogenic heat is trapped in the氣 level, it manifests as high fever and thirst, with a large pulse and abundant sweating; when it enters the營 blood, it causes agitation and delirium, petechiae, vomiting, nosebleeds, hematochezia, and a dark red tongue with little coating. The root cause of these symptoms is pathogenic heat trapped inside. In this formula, gypsum clears heat and drains fire in the氣 level, while rhinoceros horn and raw rehmannia cool the blood and nourish yin in the營 blood, together achieving the effects of clearing heat and draining fire, cooling the blood and nourishing yin, making them the primary herbs. Heat pathogenic factors easily damage yin, so anemarrhena is added to nourish yin and drain fire as a supplementary action, complementing the main herbs and enhancing their fire-draining and yin-nourishing effects. Heat pathogenic factors easily turn into toxins, leading to abscesses, boils, and gangrene; in this formula, gardenia, coptis, scutellaria, forsythia, black ginseng, and platycodon are all heat-clearing and detoxifying herbs, used to clear heat and detoxify before toxins develop, serving as complementary actions. Moutan bark and red peony root cool the blood and promote circulation, facilitating the spread of heat and preventing it from accumulating; bamboo leaves clear heat and promote urination, helping heat to be expelled through urine, also acting as complementary actions. Licorice harmonizes all the herbs, serving as a guiding agent.

[Clinical Modifications] ① If rashes appear with bluish-purple discoloration and are tightly bound, indicating extreme stomach heat and stagnation of qi and blood, add purple gromwell, safflower, and angelica to activate blood circulation and clear heat. ② If the heat is deep and the rash penetrates, with confusion and delirium, combine with Angong Niuhuang Wan and Zixue Dan to open the orifices and release the heat. ③ If the rash appears outside but is accompanied by abdominal distension and pain, with severe constipation, it indicates internal stagnation and blockage of qi flow, so combine with Zhua Wei Chengqi Tang. ④ If heat pathogenic factors injure the muscles and cause twitching, remove platycodon and add chrysanthemum and gentian to clear heat and cool the liver.

[Reference Materials] ① These twelve meridians' fire-draining herbs... using gypsum heavily to directly enter the stomach meridian, spreading its effect throughout the twelve meridians to dispel the rampant heat; supplementing with coptis, rhinoceros horn, and scutellaria to drain heart and lung fire in the upper jiao; moutan bark, gardenia, and red peony root to drain liver meridian fire and save the dying water; platycodon and bamboo leaves carrying the medicine upward; using licorice to harmonize the stomach—this is a powerful cold-detoxifying agent. Heavy use of gypsum means that the worst cases are settled first, and the fire in all the meridians will no longer be restless! ("Wenre Jingwei") ② This formula, with added ingredients, was used for epidemic Japanese encephalitis with dual burning of qi and blood as the indication. The formula used: 1–4 taels of raw gypsum (finely ground and decocted first), 5 qian to 1 tael of fresh raw rehmannia, 3–6 qian of anemarrhena, 1–2 taels of big green leaves, 6 qian to 1 tael of forsythia, 1 tael of honeysuckle, 3–5 qian of scutellaria, 6 qian of moutan bark, 1–3 qian of fresh licorice, and 1–3 taels of fresh reed roots. If there is confusion and convulsions, add rhinoceros horn, antelope horn, and cold water stone; if there is opisthotonus and unrelenting convulsions, add whole scorpion, centipede, earthworm, stone clam, and Zixue Dan; if the limbs are extremely cold, indicating deep heat and deep cold, use more gypsum and fresh raw rehmannia, choose Shenxi Dan, Angong Niuhuang Wan, or Zhibao Dan; if the nose flares and phlegm sounds, add bamboo sap, pinellia, gallstone, Tianzhu Huang, monkey date powder, and Niuhuang Baolong Wan. ("Zhejiang Chinese Medicine Journal," August 1965)

[Notes] This formula is often used for severe influenza, meningococcal meningitis, Japanese encephalitis, toxic dysentery, epidemic hemorrhagic fever, and sepsis.

4. Clearing Heat and Detoxifying

Heat pathogenic factors easily turn into toxins, with clinical manifestations including abscesses, boils, sores, gangrene, malaria-related swelling, and facial swelling. These symptoms all arise from the accumulation of heat, as the ancient saying goes: "If dispersed, it's fire; if accumulated, it's toxin." Thus, even when heat turns into toxin, there may still be scattered heat throughout the body. Symptoms include high fever and thirst, agitation and madness, vomiting and nosebleeds. The method of clearing heat and detoxifying is specifically designed for these conditions. When heat turns into toxin, there is also a distinction between the氣 level and the血 level. For the氣 level, one should use fire-draining herbs; for the血 level, one should use blood-cooling herbs. Commonly used heat-clearing and detoxifying herbs include coptis, scutellaria, phellodendron, gypsum, forsythia, indigo plant, cimicifuga, black ginseng, dandelion, and milkweed, forming the basis of formulas such as Puji Disinfection Drink and Coptis Detoxification Soup.

1. Puji Disinfection Drink (Li Dongyuan)

[Composition] 15 grams of coptis, 15 grams of scutellaria, 3 grams of indigo plant, 6 grams of black ginseng, 3 grams of burdock seed, 3 grams of puffball, 3 grams of forsythia, 6 grams of tangerine peel, 6 grams of licorice, 2.4 grams of silkworm pupa, 6 grams of bupleurum, 3 grams of mint, 5 grams of platycodon, 2.4 grams of cimicifuga

[Administration] Grind into powder and take with soup; or make pills with honey and suck them.

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[Indications] Heat toxin attacking the upper part of the body.

[Symptoms] Mumps and facial swelling, major head epidemics, facial erysipelas; accompanied by chills and fever, sore throat; in severe cases, there may be high fever and thirst, a yellow tongue, and a rapid pulse.

[Functions] Clearing heat and detoxifying, dispersing wind pathogens.

[Formula Analysis] This formula is a general remedy for heat toxin in the head and face. Heat pathogenic factors accumulate and turn into toxins, which can appear anywhere on the body; only when accompanied by wind pathogens can they reach the head and face (only wind can reach the crown of the head). Mumps, facial swelling, major head epidemics, and facial erysipelas are all cases where heat toxin attacks the head and face with the help of wind; chills and fever, along with sore throat, indicate wind-heat. In this formula, coptis and scutellaria primarily drain fire and detoxify in the upper jiao. Burdock seed, forsythia, mint, and silkworm pupa disperse wind-heat in the head and face as supplementary actions. Black ginseng, puffball, indigo plant, platycodon, and licorice clear the throat and detoxify, while tangerine peel promotes qi flow to relieve stagnation, all working together as complementary actions. Cimicifuga and bupleurum raise yang and disperse fire, drawing all the herbs up to the head and face, serving as guiding agents.

[Clinical Modifications] ① Remove cimicifuga, bupleurum, tangerine peel, coptis, and scutellaria, and add two flowers, schizonepeta, and reed roots to treat sore throat. ("Warm Disease Differentiation") ② Remove mint and add ginseng and rhubarb for patients with deficiency of vital energy and excess pathogenic factors. ③ Add neem seeds and gentian to treat mumps complicated by orchitis.

[Reference Materials] ① During major head epidemics, relatives do not visit each other, and many infected people receive no treatment. In the Taihe period, many people suffered from this illness, and doctors treated it with Chengqi Tang plus indigo plant, which provided slight relief, but the next month the condition remained the same. Further treatment brought only temporary relief, eventually leading to critical condition. Li Dongyuan observed: "More than half of the body is governed by heaven's qi; less than half is governed by earth's qi. This pathogenic heat resides between the heart and lungs, attacking the head and face with swelling, so using Chengqi Tang to drain the real heat in the stomach is the best way to eliminate it, as the disease is caused by what it does, thus this formula was created." Many lives were saved, hence the name "Puji Disinfection Drink." ("Formulas Used in Practice") ② With added ingredients, this formula was used in combination with Liu Shen Wan and applied externally with Zijin Ding, successfully curing 100 cases of epidemic mumps. ("Chinese Medicine Journal," July 1958) ③ Puji Disinfection Pills treated 74 cases of wind-toxin disease. This disease is common among southern farmers, frequently occurring in spring, characterized by swelling, burning, numbness, and itching on exposed parts of the face, hands, and backs of the feet. In severe cases, skin swelling may develop into red blisters and even ulceration. The pill formulation is exactly the same as the decoction, made into pills with honey, each weighing one qian. The treatment results showed complete recovery in all cases, with 52 cases cured after one course of treatment, 19 after two courses, and 3 after three courses. Each course lasts three days, with four doses per day, one pill each time. ("Shanghai Chinese Medicine Journal," February 1963)

[Notes] This formula, with modifications, can be used to treat epidemic mumps, acute submandibular lymphadenitis, erysipelas, and other suppurative infections of the head and face.

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802. Coptis Detoxification Soup from "Waitai Mi Yao"

[Composition] 9 grams of coptis, 6 grams of scutellaria, 6 grams of phellodendron, 9 grams of gardenia

[Administration] Decoct in water and take.

[Indications] Heat turning into toxin.

[Symptoms] Boils, sores, erysipelas, facial swelling—any condition where heat accumulates and turns into toxin, sometimes accompanied by fever, irritability, confusion, delirium, yang toxin-induced petechiae, vomiting, nosebleeds, and hematochezia.

[Functions] Draining fire and detoxifying.

[Formula Analysis] When heat pathogenic factors accumulate and turn into toxin, symptoms such as boils, sores, erysipelas, and facial swelling appear; at the same time, heat also damages the spirit and causes blood to move, resulting in confusion, delirium, yang toxin-induced petechiae, vomiting, nosebleeds, and hematochezia. In this formula, coptis primarily drains fire and detoxifies in the heart, addressing the source of the fire; scutellaria drains fire and detoxifies in the lungs, assisting coptis in clearing heart fire; phellodendron drains fire and detoxifies in the lower part, preventing the vital gate fire from moving, serving as a complementary action; gardenia clears fire from the three jiao, allowing toxins to be expelled through urine, acting as a guiding agent.

[Clinical Modifications] ① Add two flowers, forsythia, dandelion, and purpleback sunflower to treat boils and abscesses, with more reliable effects. ② Add citrus peel, agarwood, rhubarb, and artemisia to treat jaundice and flank pain. ③ Add black ginseng, raw rehmannia, and rhubarb to treat various types of bleeding caused by excessive fire forcing blood.

[Reference Materials] ① According to legend, this formula was originally a large dose prescribed by Taicang Gong, and later Cui Shi treated Liu Hujun... Minister Cui said: "If there is dry stool in the stomach, it can cause people to speak nonsense; if the heat is too strong, it can also cause people to speak nonsense. If someone is secretive and speaks nonsense, they should take Chengqi Tang; if they are open and speak nonsense, they should take Coptis Detoxification Soup." ("Formulas Used in Practice") ② Coptis Detoxification Soup was mixed with poplar wood, honeysuckle, forsythia, and anemarrhena to make an injection, 2 milliliters per vial, twice daily, one vial each time, for a 10-day course. It was used to treat chronic bronchitis, with symptoms of cough, excessive phlegm, and shortness of breath, involving 228 cases, achieving an effectiveness rate of 81.9%. ("Xingtai Regional People's Hospital: Selected Recipes for Chronic Bronchitis") ③ A 61-year-old male patient, first visited on September 10, 1962. He had been coughing and spitting phlegm for over a month, with thick phlegm containing pus and blood, a fishy smell, thirst, shortness of breath, fever, occasional chills, and obvious pain in the left chest and flank. X-ray confirmed a left middle lobe lung abscess. The prescription included: 1 qian of fried coptis, 1.5 qian of fried phellodendron, 3 qian of fried scutellaria, 1.5 qian of platycodon, 1 qian of licorice, 3 qian of flower pollen, 3 qian of elephant shell, 3 qian of summer withered grass, 3 qian of defeat sauce grass, 3 qian of purple-flowered dandelion, 1.5 qian of kudzu root, 1 qian of windproof, and 3 qian of gentian. After adjusting the prescription based on the patient's condition, he took a total of 18 doses, and his clinical symptoms disappeared, with the shadow on the lung X-ray absorbed. ("Shanghai Chinese Medicine Journal," January 1964)

[Notes] This formula can be used for boils, abscesses, erysipelas, cellulitis, and other acute suppurative infections, as well as for sepsis, pyemia, dysentery, pneumonia, and infections related to blood diseases.

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5. Clearing Heat from the Internal Organs

When heat pathogenic factors directly attack the internal organs, disrupting the yin-yang balance of the organs, it can lead to an excess of heat in a particular organ. Clinically, conditions such as lung heat, liver-gallbladder fire, and excessive heart fire all fall into this category. In terms of treatment principles, the focus should be on clearing heat from the internal organs, such as using Xiaobai San to drain lung fire, Daochi San and Xiaoxin Tang to drain heart fire, and Longdan Xiegan Tang to drain liver fire.

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1. Xiaoxin Tang from "Jingui Yaolue"

[Composition] 6 grams of rhubarb (two liang), 3 grams of coptis (one liang), 10 grams of scutellaria (one liang)

[Administration] Decoct in water and take; alternatively, grind into powder in equal amounts, make pills with honey, and take 6 grams each time with warm water.

[Indications] Excessive pathogenic fire (accompanied by dampness, forced blood movement, and toxin formation).

[Symptoms] Constipation and reddish urine, yellow tongue coating and rapid pulse, chest discomfort and heat, fullness and distension under the heart, fever, jaundice, hematemesis, nosebleeds, and boils and abscesses.

[Functions] Draining fire, stopping bleeding, removing dampness, and detoxifying.

[Formula Analysis] When pathogenic fire accumulates in the three jiao, if it accumulates in the upper part, it forces blood to move abnormally, manifesting as chest discomfort and heat, hematemesis, and nosebleeds; if it accumulates in the lower part, dampness and heat combine, resulting in fever, jaundice, and a greasy yellow tongue coating; if it accumulates in the middle part, it causes fullness and distension under the heart, constipation and reddish urine, and other symptoms. Heat pathogenic factors accumulate and turn into toxins, leading to boils and abscesses. In this formula, rhubarb, coptis, and scutellaria are all strongly bitter and cold herbs, all possessing the functions of draining fire, drying dampness, and detoxifying. Scutellaria drains fire, dries dampness, and detoxifies in the upper part; coptis drains fire, dries dampness, and detoxifies in the middle part; rhubarb drains fire, guides dampness, and detoxifies in the lower part, thereby resolving the excessive heat in the three jiao and preventing the occurrence of symptoms such as forced blood movement, dampness, and toxin formation.

[Clinical Modifications] ① Add citrus peel and agarwood to create "Bile Duct Stone Removal Decoction No. 2" (Dalian Medical College), mainly for treating gallstones and cholecystitis. ② Add white atractylodes, poria, alisma, fermented wheat bran, and citrus fruits to create "Citrus Fruit Guiding Stagnation Decoction" (Li Dongyuan). Mainly for treating food stagnation, dampness and heat blocking the gastrointestinal tract, chest and abdominal fullness, and diarrhea with red and white stools. ③ Add aconite to create "Aconite Xiaoxin Tang" (from "Shanghan Lun"), mainly for treating heart fullness and distension, chills, and sweating.

[Reference Materials] ① When heart qi is insufficient, hematemesis and nosebleeds occur, and Xiaoxin Tang is the primary treatment. ("Jingui Yaolue") The word "insufficient" was later corrected to "excessive" in "Medical Classics." ② The heart is the dominant fire, producing blood; blood is the soul of fire, and fire is the soul of blood. When fire rises, blood rises; when fire falls, blood falls. Knowing that blood is born from fire and fire is governed by the heart, we understand that draining heart fire is equivalent to draining fire, and draining fire is equivalent to stopping bleeding. With the help of rhubarb alone, the fire is reversed and downward, also breaking up stasis and clearing old residues, preventing problems from arising. Today, many people dare not use this herb, unaware that qi flows against blood, and that this powerful descending herb can harm both yang and yin, truly a sacred medicine. Moreover, it doesn't just act on the qi in the stomach; it reaches every part of the body where qi flows against blood, thanks to rhubarb's nature. Its qi is the strongest, and whenever qi and blood gather in the body, it can use its medicinal qi to overcome and treat them, making those whose qi flows against blood unable to resist. Nowadays, people often hesitate to use it, leaving pathogenic factors to cause trouble—what a pity! The name "Xiaoxin Tang" comes from Zhang Zhongjing's original exploration, allowing us to realize that blood is born from the heart and that the heart is the essence of fire, solving more than half of the problems related to blood. ("Blood Syndrome Theory") ③ Reports show that Xiaoxin Tang, with modifications, was used to treat 196 cases of upper gastrointestinal bleeding, with 94.8% of cases achieving effective hemostasis without using other hemostatic agents, often stopping bleeding within two days. This demonstrates that the method of clearing heat and draining fire is an effective approach for treating upper gastrointestinal bleeding. ("Gansu: Selected Materials on Integrated Chinese and Western Medicine," January 1979) ④ Patient Li ××, male, 22 years old. Nosebleeds persisted for two days, with hard, bloody stools flowing out, and Western medicines like renal cotton balls inserted into the nose were ineffective. After using the Three Yellow Xiaoxin Tang with raw rehmannia, moutan bark, black gardenia, side柏 leaf, white茅 root, and牛膝, the stool finally passed after three doses, and the nosebleeds stopped. Later, he received six doses of modified Six Flavor Rehmannia Tang to nourish yin and soften the liver, completing the treatment and being discharged. ("Guangdong Chinese Medicine," April 1966)

[Notes] This formula, with modifications, can be applied to all acute and chronic infectious diseases, such as boils, abscesses, erysipelas, cholecystitis, hepatitis, pancreatitis, pelvic inflammatory disease, dysentery, and others; it can also be used for various bleeding disorders, such as aplastic anemia, leukemia, and immune thrombocytopenic purpura. Additionally, modifications to this formula can also be used for hypertension, gastric ulcers, and chronic gastritis.

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2. Daochi San from "Xiaoyou Yaozheng Zhijue"

[Composition] Equal parts of raw rehmannia, woodruff, and licorice tips

[Administration] Grind into powder, take 9 grams each time, and brew with bamboo leaves to drink. In modern times, it is also used as a decoction.

[Indications] Heart fire transferring heat to the small intestine.

[Symptoms] Chest and heart discomfort, thirst and flushed face, sores on the mouth and tongue; reddish and stinging urine.

[Functions] Clearing heart fire, promoting urination.

[Formula Analysis]

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Heart fire excess leads to chest and heart discomfort, thirst, flushed face, and oral ulcers; the Heart and Small Intestine are paired organs, so excessive Heart fire can spread from the exterior to the interior and affect the Small Intestine. The Small Intestine is the organ responsible for receiving and transforming substances, with the function of separating clear from turbid. When the Small Intestine is hot, urine becomes red and painful during urination. In this formula, Bamboo Leaves clear Heart fire above and promote urination below, treating both the root and the branch, making it the principal herb. Aristolochia promotes diuresis and relieves urinary obstruction, allowing excess Heart fire to be expelled through urine; it treats oral ulcers above and short, red urine below, making it a supporting herb. Heat pathogen easily damages yin; Rehmannia is sweet and cold, nourishing yin while cooling blood, making it a concurrent treatment. Licorice tip promotes lower-jiao circulation and harmonizes all herbs as an escort.

[Clinical Modifications] ① Add Cimicifuga, Coptis, and Moutan Bark, forming Cimicifuga Clear Stomach Decoction (from "Pulse Diagnosis and Treatment"). The intention is to use Cimicifuga's detoxifying and rash-promoting properties for cases where rashes are difficult to erupt. ② Add Plantago Seed, Human Hair Charcoal, and Donkey-hide Gelatin to treat hematuria. ③ Combine with Wuling Powder to treat oral erosion. (from "Practical Application of Prescriptions")

[References] ① This formula is suitable for those with water deficiency and false fire, as it promotes water elimination without harming yin and drains fire without damaging the stomach; if there is real heat in the Heart Meridian, add Coptis, and in severe cases, even Rhubarb, which is also a method of removing the root cause. (from "Compendium of Medical Classics") ② Guiding Redness means guiding the heat of the Heart Meridian out through the Small Intestine, since the Heart and Small Intestine are paired organs. However, symptoms such as oral erosion, tongue ulcers, yellow-red urine, pain in the urethra, and difficulty urinating due to heat-related urinary obstruction all indicate that Heart heat has spread to the Small Intestine. Therefore, instead of directly using Coptis to drain Heart heat, we use Rehmannia to nourish the Kidney and cool the Heart, Aristolochia to promote Small Intestine circulation, and Licorice tip to drain the lowest-level heat, thereby relieving pain in the urethra and guiding Heart heat out. (from "Supplemented Commentary on Famous Doctors' Formulas") ③ Adding fresh Imperata rhizome to Guiding Redness Decoction cured three cases of hematuria. All three cases were accompanied by symptoms such as difficulty urinating, burning pain, hematuria, and rapid pulse. (from "Jiangxi Medicine," September 1963)

[Commentary] This formula, with modifications, can be used for stomatitis, urethritis, acute and chronic pyelonephritis; it can also be used for urinary tract stones and tuberculosis.

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3. Longdan Xiegan Tang ("Formulary of Harmonious Preparations")

[Composition] Gentiana scabra (wine-fried) 9g, Scutellaria baicalensis (fried) 6g, Gardenia jasminoides (wine-fried) 6g, Bupleurum chinense 6g, Aristolochia fangchi 6g, Alisma orientalis 6g, Plantago psyllium 3g, Rehmannia glutinosa 6g, Angelica sinensis 1.5g, Glycyrrhiza 1.5g

[Administration] Decocted in water and taken orally.

[Indications] Excess fire in the Liver and Gallbladder, damp-heat in the Lower Jiao.

[Symptoms] Bitter taste in the mouth, dry throat, fullness and distension in the chest and hypochondrium, irritability and anger, red eyes, ear swelling, hearing loss; cloudy urine, vulvar swelling, vulvar itching, yellow-white vaginal discharge.

[Functions] Drain excess fire from the Liver and Gallbladder, clear damp-heat in the Lower Jiao.

[Formula Analysis] The Liver resides in the Lower Jiao, and because the Lower Jiao tends to be damp (dampness is heavy and tends to descend), the excess fire of the Liver and Gallbladder can either ascend or combine with dampness and descend. The former manifests as bitter taste, dry throat, fullness in the chest and hypochondrium, irritability, red eyes, ear swelling, and hearing loss; the latter as cloudy urine, vulvar swelling, vulvar itching, and yellow-white vaginal discharge. In this formula, Gentiana scabra drains excess fire from the Liver and Gallbladder above and clears damp-heat in the Lower Jiao below, treating both the root and the branch, making it the principal herb. Scutellaria baicalensis and Gardenia jasminoides both clear heat and drain fire, working together with Gentiana scabra to enhance its fire-draining effect, making them supporting herbs. Aristolochia, Alisma orientalis, and Plantago psyllium promote diuresis and relieve urinary obstruction, helping damp-heat to be expelled through urine, thus serving as concurrent treatments; when fire stagnates in the Liver Meridian, and the Liver stores blood, fire inevitably causes blood movement and yin damage, so Rehmannia and Angelica sinensis, which nourish blood, activate blood, and tonify yin, also serve as concurrent treatments; since liver fire often arises from liver stagnation, which can turn into fire over time, Bupleurum chinense soothes the Liver and resolves stagnation, making it another concurrent treatment. Licorice harmonizes all herbs and acts as an escort.

[Clinical Modifications] ① Remove Aristolochia, Alisma orientalis, Plantago psyllium, Bupleurum chinense, Licorice, and Rehmannia, then add Coptis, Phellodendron, Rhubarb, Aloe, Qingdai, Agarwood, and Musk, forming Angelica Dragon-Coptis Pill (from "Essential Treatises on Medicine"). It treats excess fire in the Liver and Gallbladder, severe constipation, dizziness, delirium, and abdominal distension. ② Remove Scutellaria baicalensis, Gardenia jasminoides, and Licorice from this formula, still calling it Longdan Xiegan Tang (from "Secrets of the Orchid Chamber"), for treating heat, itchiness, and foul odor in the genital area. ③ Remove Angelica sinensis, Rehmannia, Aristolochia, Alisma orientalis, and Plantago psyllium from this formula, then add Ginseng, Schisandra, Asparagus cochinchinensis, Ophiopogon japonicus, Coptis, and Anemarrhena asphodeloides, forming Longdan Xiegan Tang again (from "Standardized Treatise on Diagnosis and Treatment"). It treats muscle weakness, spasms, and bitter taste in the mouth with dry nails.

[References] ① Gentiana scabra cools the Liver and Gallbladder, while Bupleurum chinense calms the Liver and Gallbladder. Scutellaria baicalensis and Gardenia jasminoides clear lung and Triple Burner heat to support the formula. Alisma orientalis drains kidney meridian dampness, while Aristolochia and Plantago psyllium drain small intestine and bladder dampness to support the formula. However, these are all cold and downward-draining herbs, so Rehmannia is used to nourish blood and tonify the Liver, and Licorice is used to moderate the formula and prevent stomach damage, acting as ministers. (from "Practical Application of Prescriptions") ② Longdan Xiegan Tang combined with Rhubarb treated one case of headache caused by Liver fire; combined with Moutan Bark, Fritillaria, and Uncaria to treat convulsions; combined with Anemarrhena asphodeloides, Phellodendron, and Amomum villosum to treat nocturnal emission; combined with Toona sinensis bark, turtle blood, Bupleurum chinense, and White Cock’s Comb Flower to treat vaginal discharge; combined with Corydalis, Lycoris radiata, and White Peony to treat flank pain—all cases were cured. (from "Fujian Traditional Chinese Medicine," May 1964) ③ Longdan Xiegan Tang with added ingredients treated 172 cases of acute icteric infectious hepatitis. Symptoms: loss of appetite, yellow urine, moderate jaundice of sclera and skin, hepatomegaly, and impaired liver function. All were confirmed by Western medicine. This formula removed Alisma orientalis, Plantago psyllium, and Gardenia jasminoides, adding Artemisia capillaris and red dates, and after taking 30–40 doses, all 172 cases were cured. (from "Scientific Experiment," Hunan, June 1973)

[Commentary] This formula can be used to treat acute and chronic pyelonephritis, cystitis, urethritis, and acute pelvic inflammatory disease; it can also be used to treat acute icteric infectious hepatitis, acute and chronic cholecystitis, and suppurative otitis media.

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4. Xiebai San ("Prescription for Children's Medicinal Evidence")

[Composition] Lycium cortex and Morus alba bark, each 30g, and Glycyrrhiza 3g

[Administration] Grind all ingredients into powder, mix with a pinch of Japonica rice, take 6g each time, decoct in water and take orally. In modern times, it is used as a decoction, taken orally.

[Indications] Heat accumulating in the Lung.

[Symptoms] Fever and cough with wheezing, worse in the afternoon, skin feels hot, thick yellow phlegm that is hard to expel, red tongue with yellow coating, and a fine, rapid pulse.

[Functions] Clear heat and drain the Lung.

[Formula Analysis] Heat pathogen most easily harms the Metal element and invades the Lung. Fever, cough, thick yellow phlegm, red tongue with yellow coating, and rapid pulse all indicate that heat has invaded the Lung; the skin feels hot, especially in the afternoon, showing that the fire has grown strong and begun to harm yin. Strong fire can lead to yin deficiency, and yin deficiency can further fuel fire, creating a vicious cycle that intensifies the fire. The former is actual fire, the latter is virtual fire, indicating that this condition is a combination of actual and virtual fire. Among the two, actual fire is the root, while virtual fire is the branch. In this formula, Morus alba bark drains actual fire in the Lung to treat the root, making it the principal herb; Lycium cortex clears virtual heat in the Lung to treat the branch, serving as a supporting herb. "The Lung is the organ of coughing" and also "the storage place for phlegm," so both herbs have the function of stopping cough and dissolving phlegm, embodying the idea of concurrent treatment; Japonica rice strengthens the Spleen and replenishes the middle burner, also serving as concurrent treatment; Licorice harmonizes all herbs and acts as an escort.

[Clinical Modifications] ① If Lung meridian heat is severe, add Anemarrhena asphodeloides and Scutellaria baicalensis; if Lung is deficient and short of breath, add Codonopsis pilosula and Poria cocos. ② Combine with Erchen Tang to treat pulmonary emphysema complicated by infection, with symptoms such as coughing, wheezing, copious sticky phlegm, chest tightness, red tongue with greasy yellow coating, and a tense, rapid pulse. ③ Add Burdock seed, Apricot kernel, Cicada slough, and Peppermint to treat early-stage pneumonia in children. ④ Add Fritillaria, Aster tataricus, Platycodon grandiflorus, Angelica sinensis, and Semen Trichosanthis to form Xiebai San (from "Standardized Treatise on Diagnosis and Treatment"), used to treat early-stage lung abscess before it turns into pus. ⑤ Add Ginseng, Anemarrhena asphodeloides, and Scutellaria baicalensis to form Xiebai San again (from "Shen's Book of Respect for Life"), used to treat lung heat cough combined with qi deficiency.

[References] ① Morus alba bark sweetly supplements insufficient vital energy and pungently drains excess lung qi, clearing phlegm and stopping cough; Lycium cortex coldly drains hidden fire in the Lung, mildly drains virtual heat in the Liver and Kidney, cools blood and reduces steaming; Licorice drains fire and strengthens the Spleen; Japonica rice clears the Lung and nourishes the Stomach (earth is the mother of metal, so when it's deficient, we replenish its mother), and can also drain heat through urine—since the Lung governs the West, it's called "Xiebai" (draining white). (from "Collection of Medical Prescriptions") ② The Lung is a delicate organ belonging to the Metal element, governing the skin and hair, and its nature prefers descending actions over ascending ones; once it's forced by fire, the above symptoms appear. To treat this, we should clear and lower it, restoring its original order of clarity and serenity. Morus alba bark can act on the skin, and white can return to the Lung, its sweet-cold nature naturally entering the Lung to clear heat—no need to say more. Roots go deepest into the earth, able to clear and lower, and we can imagine Lycium cortex going deep into the underworld, with no bottom in sight; its sweet-mild and cold nature can drain hidden fire in the Lung, but judging from its name, it seems to enter the Liver and Kidney, cooling blood and reducing steaming, indicating that both barks are used to lower, and when lung qi lowers, fire naturally disappears. Licorice drains fire and strengthens the Spleen; Japonica rice clears the Lung and nourishes the Stomach, draining and supplementing at the same time, embedding supplementation within drainage—although it clears the Lung, it still focuses on the root. (from "Convenient Reading of Medical Prescriptions")

[Commentary] This formula is often used for acute and chronic bronchitis, bronchial asthma, and pulmonary emphysema complicated by infection. Combined with Maxing Gan Shi Tang, it effectively treats childhood pneumonia.

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5. Qingwei San ("Secrets of the Orchid Chamber")

[Composition] Angelica sinensis 1g, Coptis 1g, Rehmannia 1g, Moutan Bark 1.5g, Cimicifuga 3g

[Administration] Grind all ingredients into fine powder, decoct in water and take orally.

[Indications] Stomach fire rising upward.

[Symptoms] Epigastric burning pain, dry mouth, bad breath, oral erosion, toothache, gum swelling, bleeding from gingival pockets, red tongue with yellow coating, and rapid pulse.

[Functions] Clear and drain stomach fire.

[Formula Analysis] The Hand Yangming Meridian runs from the maxilla through the cheek to the lower teeth, while the Foot Yangming Meridian runs from the outside of the nose to the upper teeth, indicating that teeth and gums are areas where the Yangming Meridian flows. Since the Stomach belongs to the Yangming system, when stomach fire rises upward, symptoms such as toothache, gum swelling, and bleeding from gingival pockets appear. The mouth is the upper opening of the Stomach, so when stomach fire rises upward, dry mouth, bad breath, and oral erosion occur. If the Stomach accumulates heat, epigastric burning pain, red tongue with yellow coating, and rapid pulse will appear. In this formula, Coptis is bitter and cold, directly draining stomach fire as the principal herb; Rehmannia and Moutan Bark nourish yin and cool blood as supporting herbs; the Yangming system is rich in qi and blood, so Angelica sinensis is added to prevent blood depletion, serving as a concurrent treatment; Cimicifuga guides the herbs upward into the Yangming system, acting as an escort.

[Clinical Modifications] ① Add Gypsum to make the Qingwei effect even stronger. (from "Collection of Medical Prescriptions") ② For those with severe constipation, add Rhubarb and Glauber's salt; for those with extreme thirst, remove Angelica sinensis and add Scrophularia ningpoensis and Hua Tianshi; for those with toothache, add Angelica dahurica and Asarum sieboldii; for those with severe stomach pain, add Salvia miltiorrhiza, Agarwood, and Cardamom.

[References] ① Treating unbearable toothache caused by taking warming stomach medicines, leading to head fullness and intense pain—this is the Yangming collateral pathway connecting to the brain. (from "On the Spleen and Stomach") ② For those with severe damp-heat and toothache, use Chengqi Tang; for mild cases, use Qingwei San. For those with colon heat and gum swelling and pain, use Qingwei San; for severe cases, use Tiaowei Tang. For those with six types of stagnation and pain, use Yueju Wan; for those with weak middle qi and pain, use Buzhong Yiqi Tang. For those whose thinking damages the Spleen and causes pain, use Guipi Tang; for those with weak Kidney Meridian and pain, use Liuwei Wan. (from "Practical Application of Prescriptions")

[Commentary] This formula can be used for neuralgic toothache, inflammatory toothache, trigeminal neuralgia, stomatitis, ulcers, chronic gastritis, and other conditions.

6. Yunü Jian ("Complete Works of Jing Yue")

[Composition] Anemarrhena asphodeloides 5g, Achyranthes bidentata 5g, Gypsum 15g, Rehmannia glutinosa 15g, Ophiopogon japonicus 6g

[Administration] Decocted in water and taken orally.

[Indications] Excess Yangming, deficiency of Shaoyin.

[Symptoms] Restlessness, thirst, headache, toothache, red tongue with little coating, and a fine, rapid pulse.

[Functions] Clear stomach and nourish yin.

[Formula Analysis] When Yangming is excessive, there is restlessness and thirst, headache and toothache; when Shaoyin is deficient, there is a red tongue with little coating and a fine, rapid pulse. In this formula, Gypsum primarily drains excess Yangming fire; Rehmannia and Anemarrhena nourish Shaoyin yin as supporting herbs; Ophiopogon japonicus supplements the Lung and nourishes yin, embodying the idea of metal-water mutual generation, making it a concurrent treatment; Achyranthes bidentata guides blood heat downward, acting as an escort.

[Clinical Modifications] ① Remove Achyranthes bidentata, add Scrophularia ningpoensis, and replace Rehmannia with Rehmannia glutinosa to treat Taiyin warm diseases with both qi and blood burning, thirst, rapid pulse, and a dark red tongue. (from "Differentiation of Warm Diseases") ② If fire is too strong, add Gardenia jasminoides and Lycium cortex; if there is excessive sweating and thirst, add Schisandra; if urine is difficult to pass or fire doesn't subside, add Alisma orientalis or Poria cocos; if yin is injured and qi is depleted, add Ginseng. (from "Complete Works of Jing Yue") ③ Use large amounts of Gypsum and Achyranthes bidentata, optionally adding raw ochre and lotus root juice, to treat bleeding and nosebleeds caused by uncontrolled blood heat. ④ Add Adenophora and Dendrobium to treat glossitis and stomatitis. ⑤ Add Angelica dahurica and Asarum sieboldii to treat virtual fire toothache.

[References] A woman's true yin is sufficient, and water and fire are balanced, so she will never suffer from excessive fire; however, if the Lung and Kidney lack true yin, they cannot moisten the Stomach, causing the gastric juices to dry up, and once exposed to fire pathogen, the situation will escalate rapidly, leading to yin deficiency. In this formula, Rehmannia and Achyranthes bidentata nourish the Kidney water; Ophiopogon japonicus protects the Lung metal; Anemarrhena benefits the Lung yin above and nourishes the Kidney water below, effectively dealing with the dominance of Yangming fire; Gypsum is sweet and cold, heavy in nature, and enters only Yangming, clearing excess heat in the Stomach. Although this is the case, if the Stomach fire is particularly fierce, it is advisable to reduce Rehmannia, as virtual fire is also a concern, and it is better to switch to Rehmannia glutinosa instead. Those who use this formula should be mindful and adaptable, making appropriate adjustments as needed. (from "Convenient Reading of Medical Prescriptions")

[Commentary] This formula is often used for neuralgic toothache, acute stomatitis, bleeding disorders, and the later stages of acute infectious diseases.

7. Huangqin Tang ("Treatise on Cold Damage")

[Composition] Scutellaria baicalensis 9g (three liang), Paeonia lactiflora 9g (two liang), Glycyrrhiza 2g (two liang, roasted), Jujube 4 pieces, split open (twelve pieces)

[Administration] Decocted in water and taken warm, once during the day and once at night.

[Indications] Pathogenic factors of Shaoyang pressing inward on Yangming.

[Symptoms] Bitter taste in the mouth, dry throat, dizziness, diarrhea, anal burning, or dysentery, abdominal pain, tenesmus.

[Functions] Clear heat and dry dampness, consolidate the Ying and relieve pain.

[Formula Analysis] Although Shaoyang pathogenic factors press inward on Yangming, the pathogen still exists, hence symptoms such as bitter taste, dry throat, and dizziness; when the pathogen enters Yangming, it turns into fire, and since Yangming and Taiyin are paired organs, Yangming's heat combines with Taiyin's dampness, resulting in symptoms such as diarrhea, anal burning, dysentery, and abdominal pain. This condition focuses on the pathogen pressing Yangming, which is what we call "urgent symptom, slow root"—the principle is to clear heat and dry dampness, draining the damp-heat accumulated in Yangming. In this formula, Scutellaria baicalensis clears heat and dries dampness, serving as the principal herb; Paeonia lactiflora consolidates yin and relieves pain as a supporting herb; Jujube strengthens the Spleen and benefits qi, serving as a concurrent treatment; Glycyrrhiza harmonizes all herbs and acts as an escort.

[Clinical Modifications] ① Remove Jujube, forming Huangqin Paeonia Decoction (from "Essential Treatise on Treatment Methods"). It treats heat-induced dysentery, abdominal pain, and tenesmus. ② Add Pinellia ternata and Ginger, forming Huangqin Pinellia Ginger Decoction (from "Treatise on Cold Damage"), for treating damp-heat diarrhea accompanied by vomiting. ③ Remove Jujube, add Four Ling (Zhu Ling, Fu Ling, Ze Xie, Bai Zhu), Hou Pu, Chen Pi, and Mu Xiang, forming Four Ling Huangqin Paeonia Decoction (from "Differentiation of Warm Diseases"). It treats food-stagnation blockage and initial diarrhea with short urine.

[References] ① When the Sun and Shaoyang diseases occur together, and the patient has diarrhea, use Huangqin Tang. ... The main symptom here is diarrhea, which results from Shaoyang pathogenic factors pressing inward on Yangming. The exterior symptoms are not obvious, and Huangqin Tang does not contain any herbs to dispel exterior symptoms. (Hubei College of Traditional Chinese Medicine: "Treatise on Cold Damage") ② When cold pathogen is deeply hidden and has already turned into heat... use Huangqin Tang as the main formula, its bitter-cold nature directly clears internal heat, and since heat is hidden in yin, its bitterness firmly anchors yin, which is the correct treatment. Know that warm pathogen should not be dispersed, and do not use the same methods as sudden exposure. (from "Warm and Hot Latitude and Longitude")

[Commentary] This formula can treat acute bacterial dysentery and acute gastroenteritis.

8. Baitouweng Tang ("Treatise on Cold Damage")

[Composition] Baitouweng 9g (two liang), Phellodendron amurense 6g (three liang), Coptis 3g (three liang), Qinpi 9g (three liang)

[Administration] Decocted in water and taken orally.

[Indications] Damp-heat toxic dysentery.

[Symptoms] Severe diarrhea with pus and blood, intense thirst, abdominal pain and anal burning, yellow and greasy tongue, and slippery, rapid pulse.

[Functions] Clear heat and dry dampness, detoxify and stop dysentery.

[Formula Analysis] "The Treatise on Cold Damage" says: "For those with severe diarrhea and pus and blood, Baitouweng Tang is the main remedy." It also says: "For those with diarrhea and intense thirst, it's because of heat, so Baitouweng Tang is the main remedy." This shows that the main symptom of this formula is heat-induced diarrhea. Diarrhea is caused by dampness. When heat and dampness combine, they obstruct the flow of qi, resulting in severe diarrhea and abdominal pain; when heat accumulates and turns into toxin, it leads to pus and blood in the stool, yellow and greasy tongue, and slippery, rapid pulse—all signs of the combination of heat and dampness. In this formula, Baitouweng is bitter and cold, with the primary function of clearing heat and drying dampness and detoxifying and stopping dysentery, making it the principal herb; Coptis, Phellodendron, and Qinpi are all herbs that clear heat, dry dampness, and detoxify, working together with the principal herb to enhance its effect, making them supporting herbs; Qinpi can also clear heat in the Liver and Gallbladder, promoting circulation in the Lower Jiao, making it a concurrent treatment.

[Clinical Modifications] ① Add Glycyrrhiza and Donkey-hide Gelatin, forming Baitouweng Glycyrrhiza Donkey-hide Gelatin Decoction (from "Golden Treasury of Prescriptions"), for treating postpartum diarrhea with extreme weakness. ② Add Paeonia lactiflora, Scutellaria baicalensis, fresh Polygonatum, and fresh Jasmine, forming flavored Baitouweng Decoction (from "Popular Treatise on Cold Damage"), a good formula for strengthening the Liver and intestines, draining heat and stopping dysentery. ③ For those with exterior symptoms, add Kudzu, Japanese Mint, Silver Flower, and Forsythia; for those with severe abdominal pain and diarrhea, add Agarwood, Betel Nut, and Paeonia lactiflora; for those with more red dysentery, add Red Paeonia, Moutan Bark, and Sanguisorba officinalis. ④ Remove Phellodendron, add Prince Ginseng, Ophiopogon japonicus, Dendrobium, Glycyrrhiza, Lotus Seed Meat, Acorus calamus, and Lotus Seed, for treating lockjaw dysentery.

[References] ① Preliminary observation of 40 cases of acute bacterial dysentery treated with Baitouweng Tang: the cure rate reached 62.5%. The prescription was Baitouweng one liang, Coptis two qian, Phellodendron three qian, and Qinpi three qian, one dose per day. On average, each case took 7.2 doses. (from "New Traditional Chinese Medicine," September 1957) ② One case of amoebic dysentery lasting fifteen years treated with Baitouweng Tang enema: the formula used Baitouweng one liang, Forsythia one liang, Phellodendron two qian, and Gardenia two qian, boiled down to 300ml from 500ml, filtered, cooled, and ready for use. Patient ××, 50 years old. Suffered from chronic amoebic dysentery, with recurrent attacks for 15 years. Each attack brought abdominal bloating, tenesmus, and continuous mucous bloody discharge. In 1958, a stool test showed positive for amoeba cysts. Over the years, the patient had received antibiotics, drugs like Arsenic, and traditional Chinese medicine treatments, temporarily controlling the symptoms, but still experiencing several attacks each year. After switching to Baitouweng Tang enema twice (two doses), the condition was cured, and follow-up for one year showed no recurrence. (from "New Traditional Chinese Medicine," April 1974, page 38) ③ One case of wind-heat eye disease treated with Baitouweng Tang. Patient ×, female, 11 years old. Had symptoms for more than ten days: eyelid redness and swelling, conjunctival congestion, blurred vision, constipation, and short, red urine. Western diagnosis: acute conjunctivitis. The formula used Baitouweng one liang, Coptis half a qian, Phellodendron two qian, and Qinpi three qian. Three doses cured the condition. (from "New Traditional Chinese Medicine," April 1973)

[Commentary] This formula is used for acute bacterial dysentery, amoebic dysentery, ulcerative colitis, and also for acute conjunctivitis, among others.

9. Qingyi Tang (Tianjin Nankai Hospital)

[Composition] Bupleurum chinense 15g, Scutellaria baicalensis 10g, Rhubarb 15g, Glauber's salt 10g, Coptis 10g, Agarwood 6g, Corydalis 10g, Paeonia lactiflora 15g

[Administration] Decocted in water and taken orally.

[Indications] Acute pancreatitis (combined Shaoyang and Yangming syndrome).

[Symptoms] Severe abdominal and chest pain, radiating to the sides, full abdominal distension involving the back, accompanied by bitter taste, dry throat, dizziness, alternating chills and fever, irritability, nausea, thick yellow tongue coating, and a tense, rapid pulse.

[Functions] Relieve liver stagnation, drain fire, and attack the root cause.

[Formula Analysis] The clinical features of this disease are no different from the combined Shaoyang and Yangming syndrome. Those indicative of Shaoyang include bitter taste, dry throat, dizziness, alternating chills and fever, irritability, nausea, and pain radiating to the sides; those indicative of Yangming include severe abdominal and chest pain, full abdominal distension, thick yellow tongue coating, and a tense, rapid pulse. The "Treatise on Cold Damage" uses Da Chaihu Tang as the main formula for treating combined Shaoyang and Yangming syndrome. Qingyi Tang's treatment of pancreatitis shares the same rationale, methods, and similar formulas with Da Chaihu Tang's treatment of Shaoyang and Yangming syndrome. In this formula, Bupleurum chinense relieves liver stagnation and alleviates Shaoyang's cold and heat; Rhubarb and Glauber's salt drain fire and attack the root cause of Yangming's excess fire, jointly eliminating Shaoyang and Yangming pathogenic factors as the principal herbs. Agarwood helps Bupleurum chinense relieve liver stagnation; Scutellaria baicalensis and Coptis clear heat and drain fire to assist Rhubarb and Glauber's salt, all three herbs assisting the principal herbs, making them supporting herbs. Corydalis activates blood circulation and relieves pain, while Paeonia lactiflora consolidates yin and relieves pain, serving as concurrent treatments.

[Clinical Modifications] ① For those with worm obstruction, remove Rhubarb and Corydalis, add Betel Nut, Chinaberry, and Siraitia grosvenorii, forming Worm Obstruction Pancreatitis Formula. (Tianjin Nankai Hospital)

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② Remove Bupleurum, Scutellaria, and Glauber's salt, add Gentiana scabra, named Qingyi No. 1 (Zunyi Medical College), suitable for mild pancreatitis. ③ Remove Bupleurum and Scutellaria, add Moutan Cortex, Gardenia fruit, and Magnolia bark, named Qingyi No. 2 (Zunyi Medical College), suitable for severe pancreatitis. ④ Remove Bupleurum and Scutellaria, add Gardenia fruit, Asarum, and Areca nut, named Qingyi No. 3 (Zunyi Medical College), suitable for pancreatitis complicated with biliary tract diseases.

[Reference Materials] Bupleurum, Scutellaria, Coptis, Rheum, and other herbs all have obvious anti-inflammatory and antibacterial effects. Acorus tatarinowii and White Peony can regulate the tension of smooth muscles, dilate the pancreatic duct, and facilitate drainage; Rheum and Glauber's salt cleanse the intestinal cavity, which not only enhances pancreatic duct drainage but also reduces retrograde infection; Corydalis stops pain. Therefore, this formula has three functions: anti-inflammation, spasmolysis, and analgesia, which fully conforms to modern medical principles for treating pancreatitis. In clinical practice, it is often used in conjunction with supportive therapies such as fluid replacement and blood transfusion, resulting in more satisfactory efficacy.

[Commentary] When combined with antibiotics and fluid replacement, this formula can indeed improve the therapeutic effect for acute pancreatitis.

10. Biliary Stone-Expelling Decoction (Zunyi Medical College)

[Composition] Herba Lysimachiae 30 g, Acorus tatarinowii 9 g, Citrus aurantium pericarpium 9 g, Scutellaria baicalensis 9 g, Melia toosendan 9 g, Rheum palmatum 6 g

[Administration] Decocted in water, one dose daily, taken twice a day.

[Indications] Cholecystitis with cholelithiasis (damp-heat accumulation in the liver and gallbladder).

[Symptoms] Alternating chills and fever, bitter taste in mouth and dry throat, right flank pain, abdominal distension, nausea and vomiting, scleral jaundice, greasy yellow tongue coating, wiry, slippery, and rapid pulse.

[Functions] Clearing heat and draining dampness, regulating qi and relieving pain.

[Formula Analysis] This condition is mostly caused by stagnation of liver qi. On one hand, prolonged stagnation of liver qi can transform into fire; on the other hand, rebellious liver qi can invade the stomach. The former generates heat, while the latter produces dampness. When dampness and heat combine and accumulate in the liver and gallbladder, this condition arises. Alternating chills and fever, bitter taste in mouth and dry throat, right flank pain, scleral jaundice, greasy yellow tongue coating, and wiry, rapid pulse are all manifestations of damp-heat accumulation in the liver and gallbladder; abdominal distension, nausea, and vomiting are due to rebellious liver qi invading the stomach. This formula uses a large dose of Herba Lysimachiae to clear heat and drain dampness from the liver and gallbladder as the principal herb, with Scutellaria baicalensis to clear heat and dry dampness in the Shaoyang channel as an auxiliary herb. Damp-heat combination obstructs the flow of qi, causing right flank pain; Acorus tatarinowii, Citrus aurantium pericarpium, and Melia toosendan regulate qi and relieve pain, while soothing the liver and resolving depression serve as adjunct treatments. Rheum palmatum clears fire and purges the intestines, guiding damp-heat downward, thus acting as a conduit.

[Clinical Modifications] ① For chest tightness and flank pain, add Bupleurum and White Peony; for dark red tongue, thirst, and full pulse, add Gypsum fibrosum, Anemarrhena asphodeloides, and Ophiopogon japonicus; for severe heat, add Honeysuckle and Prunella vulgaris; for severe pain, add Glauber's salt; for poor appetite, add Chicken Gizzard Membrane, Amomum villosum, roasted malt, Shenqu, and fried hawthorn; for vomiting, add Pinellia ternata, Bamboo Leaf, and fresh ginger; for severe jaundice, add Artemisia capillaris. (Zunyi Medical College) ② Remove Citrus aurantium pericarpium, Herba Lysimachiae, and Melia toosendan, add Bupleurum, Pinellia ternata, and Curcuma wenyujin, named Compound Xiao Chaihu Tang (Tianjin Nankai Hospital), with the same indications as this formula. ③ Remove Herba Lysimachiae and Melia toosendan, add Coptis chinensis, named Biliary Stone-Expelling Decoction No. 2 (Dalian Medical College). Used for cholelithiasis with mild inflammation.

[Reference Materials] This formula is also known as Biliary Stone-Expelling Decoction No. 5, which can promote bile secretion, strengthen gallbladder contraction, relax the sphincter of Oddi, and has obvious antibacterial effects. After eight healthy individuals took this decoction orally, cholecystography was performed, and most gallbladders shrank within one hour of taking the medicine, with particularly significant results in three cases; in one case, intravenous cholangiography showed a marked reduction in the gallbladder half an hour after administration. Meanwhile, animal experiments also proved that this formula indeed has three effects: ① promoting relaxation of the sphincter of Oddi, ② promoting bile flow, and ③ inhibiting bacteria. (Zunyi Medical College: "Integrated Chinese and Western Medicine Treatment of Acute Abdominal Conditions")

[Commentary] According to the principle of "when the channels are unblocked, there is no pain," this formula aims to soothe the liver, regulate qi, promote bile flow, and dissipate heat—soothing, regulating, promoting, and dissipating are all ways to unblock the channels.

11. Zuojin Pill ("Danxi Heart Method")

[Composition] Coptis chinensis (stir-fried with ginger juice) 60 g, Evodia rutaecarpa (soaked in salt water) 10 g

[Administration] Grind into powder, make pills with water, take 1–3 g each time. In modern times, it is often made into a decoction and taken by boiling in water.

[Indications] Liver fire invading the stomach.

[Symptoms] Flank distension and pain, bitter taste in mouth and dry throat, nausea and vomiting, acid regurgitation and belching, red tongue with yellow coating, wiry and rapid pulse.

[Functions] Clearing and draining liver fire.

[Formula Analysis] Stagnation of liver qi eventually transforms into fire; when liver fire invades the stomach, this condition arises. Bitter taste in mouth and dry throat, flank distension and pain, red tongue with yellow coating, and wiry, rapid pulse indicate excessive liver fire; nausea and vomiting, acid regurgitation and belching indicate disharmony of stomach qi. The principle in the "Inner Canon" that "all reverse flows upward belong to fire" perfectly matches this condition. In this formula, Coptis chinensis is bitter and cold, both clearing liver fire and heart fire, embodying the idea of treating the root cause by addressing the child; therefore, it serves as the principal herb. A small amount of Evodia rutaecarpa is added for its bitter-hot nature, to warm the stomach, dispel cold, reverse the flow, and stop vomiting, while also tempering the strong coldness of Coptis chinensis to prevent damage to the stomach. With only two herbs—one cold, one hot—the formula melts together the clearing of liver fire and warming of the stomach in one pot, cold without being greasy, warm without being dry, truly a good remedy for clearing liver fire and harmonizing the stomach.

[Clinical Modifications] ① For those with obvious liver qi stagnation, use in combination with Si Ni San; for diarrhea and abdominal pain, use in combination with White Peony, named Wu Ji Wan. ("Harmonized Formulas Bureau") ② This formula can be stir-fried, omitting Evodia rutaecarpa, adding Acorus tatarinowii, named Xiang Lian Wan ("Military Department Collection of Formulas"). Treats dysentery with red and white stools, urgency and tenesmus. ③ Omit Evodia rutaecarpa, add Aconitum carmichaelii, named Lian Fu Liu Yi Tang ("Medical Orthodoxy"), boiled with ginger and jujube, treats severe epigastric pain.

[Reference Materials] ① There are several methods for treating the liver: when water is deficient and wood cannot grow, nourish with Rehmannia pills and others; when earth is deficient and wood cannot take root, cultivate with ginseng, poria, and licorice; when blood is deficient and fire arises, use Xiaoyao San to clear it; when blood is deficient and there is no water, use Siwu Tang to nourish it. Methods for tonifying fire are similar to those for the kidneys; methods for clearing fire are similar to those for the heart, so this formula uniquely uses Coptis chinensis as the chief herb... However, it is only suitable when wood energy is strong and earth energy is not deficient. (Luo Tianyi) ② When the liver is overactive, it causes pain; the heart is the child of the liver, so if the liver is overactive, the heart must be cleared of fire. Therefore, using Coptis chinensis to clear heart fire as the chief herb ensures that fire does not overpower metal, and metal can control wood, thus stabilizing the liver. Evodia rutaecarpa is pungent and warm, able to enter the Jueyin meridian (liver) to regulate qi and resolve depression, and also guide heat downward, so it serves as a counteragent. One cold, one hot—cold treats directly, hot treats indirectly (treating heat with heat, following its nature, is also called indirect treatment)—thus they complement each other to achieve success. The liver resides on the left, the lung on the right, so Zuojin means making metal function on the left to stabilize the liver. ("Compendium of Medical Formulas")

[Commentary] This formula, with modifications, is used for gastric and duodenal ulcers, chronic gastritis, and non-jaundiced infectious hepatitis.

VI. Clearing Deficient Heat

Deficient heat generally includes two types: qi deficiency heat and yin deficiency heat. For qi deficiency heat, it is advisable to tonify qi and reduce heat—what is known as the method of using sweet and warm herbs to eliminate major heat. The main formulas for this include Buzhong Yiqi Tang and others, which should be discussed under tonifying agents. Yin deficiency heat, on the other hand, is usually caused by excessive yin deficiency fire, so it is advisable to nourish yin and reduce fire. Commonly used formulas include Liuwei Dihuang Tang and Dabuyin Wan, which should also be discussed under tonifying agents. Apart from these two types of formulas, in the later stages of febrile diseases, even though the major heat has subsided, yin fluids are severely depleted, and yin deficiency fire is still active, it is advisable to nourish yin and disperse heat, using formulas such as Qinghao Biejia Tang and Danggui Liuhuang Tang.