Discussion on Xie Xin Tang Syndrome, July 24, 1977

Discussion on Xie Xin Tang Syndrome, July 24, 1977

Xie Xin Tang is a famous formula in the “Shang Han Lun,” serving as the primary prescription for treating fullness and hardness in the epigastric region. This condition is commonly referred to as “pi.” Its root cause is still related to improper treatment of exterior syndromes and semi-exterior, semi-interior syndromes. Since all versions of Xie Xin Tang contain both cold and hot herbs, it can be inferred that the pathogenesis of pi is the interplay of cold and heat. Article 149 of the “Shang Han Lun” states: “If the epigastric region is full and hard, with pain, it is Jie Xiong, and Xian Xiong Tang is the primary treatment; however, if it is full but not painful, it is pi, and Ban Xia Xie Xin Tang is the primary treatment.” Thus, the main symptom of pi is fullness in the epigastric region without pain, and Ban Xia Xie Xin Tang is the primary prescription for treating pi. The formula is essentially a modification of Xiao Chai Hu Tang, replacing Chai Hu with Huang Lian and Sheng Jiang with Gan Jiang. This change transforms the original formula, which balanced the Shaoyang energy, into one that combines cold and heat, opening up the potential for both cold condensation and heat dissipation. The cold nature of Huang Lian and the hot nature of Gan Jiang dramatically alter the formula’s character! Later generations summarized the main symptoms of this formula quite accurately as “vomiting and pi, thunderous diarrhea.” The “Shang Han Lun” also discusses other versions of Xie Xin Tang: Article 157 states: “For fullness and hardness in the epigastric region, accompanied by dry belching and bad breath, use Ginger Xie Xin Tang”; Article 158 states: “For fullness and hardness in the epigastric region, accompanied by dry vomiting and restlessness, use Licorice Xie Xin Tang”; Article 154 states: “For fullness in the epigastric region, accompanied by wetness and a floating guan pulse, use Rhubarb and Huang Lian Xie Xin Tang”; Article 155 states: “For fullness in the epigastric region accompanied by chills and sweating, use Aconite Xie Xin Tang.”

Based on these discussions, the consensus reached by generations of physicians is as follows: ① Ban Xia Xie Xin Tang: vomiting and pi, thunderous diarrhea, cold and heat interplay with heat above and cold below; ② Ginger Xie Xin Tang: vomiting and pi, thunderous diarrhea, dry belching and bad breath, compatible with Ban Xia Xie Xin Tang for food stagnation; ③ Licorice Xie Xin Tang: vomiting and pi, thunderous diarrhea, dry vomiting, restlessness, compatible with Ban Xia Xie Xin Tang for heart-spleen deficiency; ④ Three Yellow Xie Xin Tang: fullness in the epigastric region, accompanied by wetness and heat accumulation, leading to pi; ⑤ Aconite Xie Xin Tang: fullness in the epigastric region, accompanied by wetness and sweating, compatible with Yang deficiency, as described in modern medicine. According to modern medical understanding, what Traditional Chinese Medicine calls “pi” is essentially a post-illness gastrointestinal autonomic dysfunction caused by heat. When the vagus nerve function is disrupted (resulting in increased tension), the smooth muscles of the gastrointestinal tract may become irritated, leading to nausea, vomiting, diarrhea, and epigastric fullness. In addition, some chronic gastric diseases, such as ulcers and gastritis, also fall into this category.