Xiao Yang San

Xiao Yang San

From “He Ji Ju Fang”

[Composition] 35 grams of Dang Gui, 35 grams of Baishao, 35 grams of Bai Zhu, 35 grams of Fuling, 15 grams of Zhi Gan Cao, 35 grams of Chai Hu

[Administration] Grind all ingredients into coarse powder, take 6 grams per dose, simmer with 9 grams of fresh ginger and a pinch of peppermint, and take the mixture. Modern usage: it can also be prepared as a decoction, boiled in water, with dosages reduced to one-third of the original amount.

[Indications] Liver qi stagnation with spleen deficiency.

[Suitable Symptoms] Bitter taste in the mouth, dry throat, dizziness, irritability, chest and flank fullness, abdominal distension and fullness, poor appetite, fatigue and weakness.

[Functions] Soothe the liver and strengthen the spleen.

[Formula Explanation] When liver qi stagnation occurs, it turns against the stomach; if this condition persists for a long time, the spleen becomes weak. Liver qi stagnation leads to bitter taste in the mouth, dry throat, irritability, chest and flank fullness, and dizziness; when the spleen becomes weak, abdominal distension and fullness, poor appetite, and fatigue occur. The former leads to the latter, so liver qi stagnation is the root cause, while spleen deficiency is the secondary issue. In this formula, chai hu takes on the major responsibility of opening and clearing the liver’s qi as the primary treatment. Bai Zhu and Fuling strengthen the spleen and replenish qi as auxiliary treatments. The liver stores blood; when qi stagnates, blood is scarce (blood deficiency), so Dang Gui and Baishao nourish liver blood as complementary treatments; peppermint clears heat from the surface, while ginger dispels cold from the surface, working to open the skin’s pores and facilitate qi flow as complementary treatments. Gan Cao harmonizes all the herbs and acts as a guide for harmony.

[Clinical Additions and Subtractions]

① Add Dan Pi and Shan Zhi, creating Dan Zhi Xiao Yang San (from “Nei Ke Zhai Bao”), which treats cases of liver qi stagnation with excessive fire.

② Add Sheng Di or Shu Di to enhance the effects of nourishing yin and replenishing blood, creating Hei Xiao Yang San. (from “Yi Lue Liu Shu · Nu Ke Zhi Ya”)

[Reference Materials] ① "The term 'xiaoyao' originates from the Shuowen Dictionary, where it is connected to 'xiao yao,' as described in Zhuangzi's 'The Wanderer': 'Just as ice melts when sunlight warms it, even if it consumes, it does not harm its original nature; just as a boat moves on water, though it shakes, it does not damage its inner core—similarly, in medicine, dissipating stagnant qi and moving congested blood do not harm the body's fundamental balance.' (Selected Annotations on Ancient Prescriptions from the Jiangxue Garden)

② This formula was used to treat 253 cases of non-hemolytic hepatitis, with symptoms including: abdominal distension and pain in the flank area, hepatomegaly, fatigue, weakness in the limbs, poor appetite, irregular bowel movements, palpitations, shortness of breath, insomnia with frequent dreams, lower back and waist pain, and recurrent chills and fever. The results showed that 36 patients experienced complete recovery of liver function, 139 patients showed improvement, resulting in an overall effective rate of 68.8%. (Guangdong Journal of Traditional Chinese Medicine, 1960.8)

③ Veteran TCM practitioner Yue Meizhong used this formula combined with chrysanthemum, summer bitter grass, mulberry root, red peony bark, gardenia, and female privet seeds to cure a patient with hypertensive encephalopathy. (Collected Cases of Yue Meizhong’s TCM Treatment)

[Commentary] This formula has a wide range of applications, suitable for liver disorders and gastrointestinal issues; it can also be used for women experiencing menstrual irregularities and various conditions related to pregnancy and childbirth; furthermore, it can be employed in ophthalmological treatments.

Danggui Shaoyao Powder

From the Golden Cabinet Essentials

[Composition] Danggui 9 grams (three liang), Bai Shao 50 grams (one jin), Chuan Xiong 9 grams (three liang), Fuling 12 grams (four liang), Ze Xie 25 grams (half jin), Baizhu 12 grams (four liang)

[Usage] Grind into powder, take 6 grams each time, add a small amount of wine and steep in boiling water. In modern practice, it is often prepared as a decoction, with dosages adjusted according to specific proportions.

[Indications] Stagnation of Liver Qi, Dysfunction of Spleen Function

[Indications] Pregnant women experiencing prolonged abdominal pain, mild swelling in the abdomen and lower extremities.

[Functions] Nourish and soothe the Liver, strengthen the Spleen and resolve dampness.

[Formula Explanation] The Liver governs the Chong and Ren channels, which are responsible for fetal development. When Liver Qi stagnates, pregnant women may experience prolonged abdominal pain; when Liver Wood overcomes Earth, lower limb edema may occur. The former represents the cause, while the latter is the consequence. In this formula, Danggui, Bai Shao, Chuan Xiong, and other herbs primarily work to soothe the Liver; Fuling, Baizhu, and Ze Xie support the Spleen in resolving dampness. A small amount of white wine, warm and pungent, helps to promote the flow of Liver Qi and facilitate the dissipation of dampness, serving as an auxiliary to enhance the overall effect.

[Clinical Additions and Subtractions]

① Remove Ze Xie and Fuling from this formula and add Huang Qin, creating Danggui San (from the Golden Cabinet Essentials), a commonly prescribed remedy for pregnant women seeking to stabilize their pregnancies.

② Adding Sandren, Du Zhong, Chuan Xu Duan, Mulberry Root, E Jiao, Mugwort Leaves, and Huang Qin to this formula can help treat threatened miscarriage.

[References]

① "When a woman is pregnant and experiences dull abdominal pain, Danggui Shaoyao Powder is indicated." (Golden Cabinet Essentials)

② Doctor Yue Meizhong used this formula to treat two women who experienced lower abdominal pain. One case involved abdominal pain accompanied by dizziness and vaginal discharge; after several doses of Danggui Shaoyao Decoction, the abdominal pain and dizziness had largely subsided, and the vaginal discharge became lighter. Another case presented with long-term abdominal pain, heavy pressure in the lower abdomen, excessive vaginal discharge, and dizziness; after several doses of Danggui Shaoyao Decoction, both abdominal pain and vaginal discharge decreased, and the patient was subsequently treated with Shaoyu Zhu Yu Decoction for her vaginal symptoms. (Collected Cases of Yue Meizhong’s TCM Treatment)

[Commentary] This formula can be used for habitual miscarriage, threatened miscarriage, dysmenorrhea, chronic nephritis, beriberi, and other similar conditions.

III. Harmonizing the Stomach and Intestines

Harmonizing the Stomach and Intestines refers to treating conditions where pathogenic factors reside in the stomach and intestines, causing alternating cold and heat, and manifesting as fullness or discomfort in the epigastrium, nausea and vomiting, intestinal rumbling, and loose stools. These conditions often arise from improper treatment of Sunyuan diseases, where cold pathogens penetrate internally and combine with the latent Yang energy of the stomach and intestines, leading to a conflict between cold and heat. As the saying goes, “Where there is fullness or discomfort, there must be latent Yang,” indicating that latent Yang plays a crucial role in the development of these conditions. The stomach belongs to Yangming, while the small intestine is in harmony with the heart—both are theoretical bases for the presence of latent Yang.

Banxia Xie Xin Tang

From the Treatise on Cold Damage

[Composition] Banxia 10 grams (half a sheng), Huang Lian 3 grams (one liang), Huang Qin, Gan Jiang, and Ren Shen each 10 grams (three liang), Da Zao 7 pieces (twelve pieces), Zhi Gan Cao 10 grams (three liang)

[Usage] Brew in water and consume.

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

[Indications] Fullness or discomfort in the epigastrium, nausea and vomiting, intestinal rumbling and loose stools, thin yellowish coating on the tongue, and a wiry, fine, or rapid pulse.

[Functions] Open up blockages, relieve fullness, and harmonize the stomach and intestines.

[Formula Explanation] When cold and heat are intertwined in the epigastrium, fullness or discomfort arises. The epigastrium is the location of the stomach and intestines; when cold and heat are combined, the qi of the stomach and intestines cannot flow smoothly—when upward movement fails, intestinal rumbling and loose stools occur; when downward movement fails, nausea and vomiting result. The root cause of these conditions lies in the interplay between cold and heat; in this formula, Banxia and Gan Jiang are pungent and warm, helping to dispel cold blockages; Huang Lian and Huang Qin are bitter and cold, clearing heat and resolving blockages. Together, these four herbs serve as the primary agents for opening up and dispersing blockages. Since the pathogenic factors are often weak, Ren Shen replenishes qi and supports the body’s natural defenses to eliminate the pathogen, while Da Zao strengthens the spleen and nourishes the blood as an adjunct. Zhi Gan Cao harmonizes all the herbs, acting as an auxiliary to guide and unify the formula.

[Clinical Additions and Subtractions]

① Increase the dosage of Zhi Gan Cao to 12 grams, creating Zhi Gan Cao Tang (from the Treatise on Cold Damage), which is used to treat vomiting accompanied by fullness, intestinal rumbling, difficulty in eating, and restlessness.

② Reduce the dosage of Gan Jiang to 3 grams and add 12 grams of fresh ginger, creating Fresh Ginger Xie Xin Tang (from the Treatise on Cold Damage), which treats vomiting accompanied by fullness, intestinal rumbling, and dryness in the throat.

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[References]

① "After five or six days of cold damage, if vomiting and fever occur, the symptoms are consistent with the Chai Hu Decoction pattern, but if other medications are used to treat the condition, and the Chai Hu pattern still persists, then the Chai Hu Decoction should be administered again. Although the patient has already been treated with medication, this is not considered a contraindication; instead, the patient will feel a slight warmth and tremor, and the fever will subside with sweating. If there is fullness in the epigastrium accompanied by abdominal pain, this indicates chest obstruction, which is treated with Da Lie Xiong Tang; however, if there is fullness without pain, this indicates a feeling of fullness, and Chai Hu is not appropriate for such cases—instead, Banxia Xie Xin Tang is recommended." (Treatise on Cold Damage)

② "Fullness refers to a state of fullness without actual fullness. When pathogenic factors penetrate internally, they cannot be expelled through sweating; yet when fullness exists without actual fullness, they cannot be removed through purgation. Therefore, only the pungent and warm properties of Banxia and Gan Jiang can disperse the blockages; the bitter and cold properties of Huang Lian and Huang Qin can clear and reduce the fullness. Though these herbs’ abilities to clear and disperse are significant, they are ultimately driven by the stomach’s own qi. The use of Ren Shen, Zhi Gan Cao, and Da Zao serves to replenish qi and enhance the efficacy of the herbs, as they aid in the body’s ability to overcome the pathogenic factors." (Collection of Key Points on Cold Damage)

③ Veteran TCM practitioner Yue Meizhong used this formula combined with Poria to treat a patient with deficiency of middle-jiao qi and constipation due to dry stools. (Collected Cases of Yue Meizhong’s TCM Treatment)

[Commentary] This formula can be used for chronic gastritis, gastric and duodenal ulcers, chronic intestinal disorders, especially when these conditions are accompanied by autonomic nervous system dysfunction of the gastrointestinal tract.

Huang Lian Tang

From the Treatise on Cold Damage

[Composition] Huang Lian 3 grams (three liang), Banxia 9 grams (half a sheng), Gan Jiang 9 grams (three liang), Gui Zhi 9 grams (three liang), Dang Shen 9 grams (three liang), Zhi Gan Cao 6 grams (three liang), Da Zao 4 pieces (twelve pieces).

[Usage] Brew in water and consume.

[Indications] Heat in the chest, cold in the stomach.

[Indications] Abdominal pain, desire to vomit, chest discomfort and heat, intestinal rumbling and diarrhea, yellow tongue coating, and a wiry, tight pulse.

[Functions] Clear heat from the upper part, warm the lower part.

[Formula Explanation] Chest heat and desire to vomit, along with a yellow tongue coating, indicate heat in the chest; abdominal pain and intestinal rumbling, coupled with a wiry, tight pulse, suggest cold in the stomach. This condition arises from heat in the chest and cold in the stomach, leading to impaired upward and downward movement of qi. In this formula, Huang Lian’s bitter and cold properties clear heat from the chest; Gan Jiang’s pungent and warm properties remove cold from the stomach. Together, these two herbs open up the upper part and warm the lower part, balancing the functions of clearing heat and dispersing cold, serving as the primary agents. Banxia soothes the stomach and reduces reverse flow, Gui Zhi warms yang and elevates qi, and together, these herbs help restore normal upward and downward movement, while supporting the stomach’s health as an auxiliary. Dang Shen and Da Zao nourish the middle jiao and replenish qi, working together to support the body’s natural defenses against the pathogenic factors—Zhi Gan Cao harmonizes all the herbs, acting as an auxiliary to guide and unify the formula.

[Clinical Additions and Subtractions]

① For severe abdominal pain, add Danshen, Mu Xiang, and Sandren; for severe vomiting, add fresh ginger and raw hematite; for pain in the flanks, add Yuan Hu and Chuan Lian Zi.

[References]

① "In the Treatise on Cold Damage, when there is heat in the chest and pathogenic factors in the stomach, accompanied by abdominal pain and a desire to vomit, Huang Lian Tang is indicated." (Treatise on Cold Damage)

② "This condition involves problems in all three jiao—upper, middle, and lower—and at its root, it resides in the stomach. Pathogenic factors are cold, and the stomach is where the Chong Qi resides, serving as the conduit for upward and downward movement. When the stomach is invaded by pathogenic factors, its qi becomes unbalanced, leading to a cessation of upward and downward movement, and the pathways between the upper and lower parts become blocked." (Collection of Key Points on Cold Damage)

[Commentary] This formula can be used for chronic gastritis, gastric and duodenal ulcers, acute gastroenteritis, and gastrointestinal neurosis.

IV. Treating Malaria

Ancient texts often stated that malaria belongs to the Shaoyang category, indicating that the primary approach to treating malaria should still focus on harmonizing and resolving the condition. However, the causes of malaria are quite complex, far beyond what simple harmonizing methods can address. Therefore, the formulas used to treat malaria often differ from those used for harmonizing Shaoyang.