Da Chai Hu Tang

Da Chai Hu Tang

From the Treatise on Cold Damage

[Composition]

Chai Hu 9 grams (half a sheng), Huang Qin 6 grams (three liang), Da Huang 6 grams (one liang), Zhi Shi 9 grams (four pieces), Sheng Jiang 12 grams (five liang), Da Zao 4 pieces (twelve pieces), Zhi Gan Cao 9 grams (half a sheng), Bai Shao 9 grams (three liang)

[Usage] Brew in water and divide into three doses daily.

[Indications] Combined Shaoyang and Yangming syndromes.

[Indications] Bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, fullness and discomfort in the chest and flanks, irritability and nausea, a feeling of wanting to eat but unable to, a subtle sense of restlessness, fullness and pain in the epigastrium, constipation, a thick, dry yellow tongue coating, and a wiry, strong pulse.

[Functions] Resolve Shaoyang externally, clear Yangming internally.

[Formula Explanation] Bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, fullness and discomfort in the chest and flanks, irritability and nausea—these are Shaoyang symptoms; a subtle sense of restlessness, fullness and pain in the epigastrium, constipation, and a thick, dry yellow tongue coating are signs of Yangming internal heat. The pathogenic factors enter the interior from the exterior, transforming into heat and forming internal heat; in this formula, Chai Hu resolves Shaoyang’s pathogenic factors, Huang Qin clears Shaoyang’s heat, and together, these two herbs serve as the primary agents for harmonizing Shaoyang. When Shaoyang’s pathogenic factors move inward and transform into heat, Da Huang’s bitter and cold properties help to clear the internal heat and resolve the solidified pathogenic factors—Zhi Shi promotes qi flow and disperses blockages, Banxia opens up the fullness and reduces reverse flow, Bai Shao gathers yin and alleviates tension, all serving as complementary treatments. Sheng Jiang and Da Zao harmonize the vital energy and defensive qi, acting as auxiliaries to guide and unify the formula.

[Clinical Additions and Subtractions]

① If heat is severe and stools are hard, and the pulse is firm and rapid, add Mang Xiao; if fullness and pain in the epigastrium extend to the left flank, and stools are hard, add Gua Lou and Qing Pi; for delirium and confusion, add Huang Lian and Shan Zhi; if the face and skin turn yellow, add Yin Chen and Huang Bo; for persistent vomiting, add fresh ginger and Zhu Ru.

② This formula can be supplemented with Chuan Lian Zi, Yuan Hu, Mu Xiang, and Pueraria, creating the Compound Da Chai Hu Tang (Experiential Formula), which can treat acute perforation of ulcers, acute cholecystitis, and other conditions.

[References]

① "Da Chai Hu contains the pungent and warm properties of Chai Hu, Sheng Jiang, and Banxia, which travel to the exterior; Huang Qin, Bai Shao, Zhi Shi, and Da Huang contain bitter and cold properties that penetrate the interior—this formula treats both exterior and interior simultaneously." (Collection of Key Points on Cold Damage)

② "When a person develops a fever from cold damage, and sweat does not subside, the Yang pathogen enters the interior, heat accumulates inside, causing alternating chills and fever, thirst, delirium, abdominal fullness and constipation—but the exterior symptoms remain unresolved, while the interior symptoms are urgent, with a pulse that is either rapid or deep, wiry, or even tense." (Comprehensive Application of Formulas)

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③ This formula proved effective in treating acute cholecystitis, acute suppurative cholangitis, and biliary calculi complicated by infection, achieving an effective rate of 73.84%. Among 172 treated patients, most experienced varying degrees of right upper quadrant and below the xiphoid process pain, nausea and vomiting, often accompanied by fever and chills, increased body temperature, and elevated white blood cell counts. During the acute infection phase, treatment with Qing Dan Tang (a modified version of Da Chai Hu Tang) included: Chai Hu 15 grams, Huang Qin 9 grams, Zhi Shi 9 grams, Yin Hua 30 grams, Lian Qiao 12 grams, Sheng Jiang Banxia 12 grams, Pueraria 30 grams, Danshen 15 grams, Da Huang 3 grams (added later), Yuan Ming Fen 12 grams (mixed and taken). During the remission phase, including chronic cholecystitis and biliary calculi, treatment with Li Dan Tang (still a modified version of Da Chai Hu Tang) could be used: Chai Hu, Huang Qin, Zhi Ke, Yujin, sliced Turmeric, Yuan Hu, Chuan Lian Zi each 9 grams, Mu Xiang, Lacquer, and Myrrh each 6 grams, all together with Pueraria 12 grams, consumed as a decoction. Take one dose daily, divided into multiple servings. Adjustments can be made according to the patient’s condition. For severe damp-heat, add Yin Chen, Poria, and Gardenia; for severe qi stagnation, consider adding Xiang Fu, Chen Pi, or Hou Po; for severe vomiting, add Zhu Ru; for severe pain, increase the use of Chuan Lian Zi and Yuan Hu. (Hubei College of Traditional Chinese Medicine: Treatise on Cold Damage)

[Commentary] This formula does not contain Da Huang in the Treatise on Cold Damage; Da Huang appears in the Golden Cabinet Essentials.

Fang Feng Tong Sheng San

From the Treatise on Clear Brightness

[Composition] Jing Wei 15 grams, Fang Feng 15 grams, Hua Shi 90 grams, Ma Huang 15 grams, Bai Zhu 15 grams, Jie Gong 30 grams, Dang Gui 15 grams, Chuan Xiong 15 grams, Bai Shao 15 grams, Shi Gou 30 grams, Da Huang 15 grams, Mang Xiao 15 grams, Lian Qiao 15 grams, Huang Qin 30 grams, Bo He 15 grams, Shan Zhi 15 grams, Zhi Gan Cao 60 grams

[Usage] Grind into powder, take 6 grams each time, add three slices of fresh ginger, and drink warm after brewing in water. Modern practice involves preparing the formula as a decoction, drinking it after brewing in water; some also prepare it as pills, taking them with hot water.

[Indications] Exterior symptoms combined with internal heat.

[Indications] Headache, fever and chills, red eyes and sore throat, thirst, fullness and discomfort in the chest and diaphragm, coughing up phlegm and sputum, constipation, a yellowish, greasy tongue coating, and a rapid, wiry pulse.

[Functions] Resolve the exterior and attack the interior.

[Formula Explanation] This formula is used for conditions where external wind pathogens invade and internal heat accumulates. Headache and fever with chills indicate that wind-cold attacks the exterior; thirst, sore throat, and red eyes indicate that wind-heat rises to the upper part of the body—these conditions combine wind-heat in one formula. Fullness and discomfort in the chest and diaphragm, coughing up phlegm and sputum, constipation, a yellowish, greasy tongue coating, and a rapid, wiry pulse indicate that internal heat is accumulating. Ma Huang resolves the wind-cold in the exterior, Lian Qiao disperses the wind-heat in the exterior; together, these two herbs help to disperse the external pathogenic factors. When internal heat and external pathogenic factors coexist, only bitter and cold properties can treat the root cause; the use of nitrate and Huang to clear heat and attack the internal heat, combined with Ma Huang and Lian Qiao to attack the interior and resolve the exterior, creates the major task of resolving the exterior and attacking the interior—both being the primary agents. Jing Wei and Fang Feng assist Ma Huang in resolving the exterior and dispersing cold; Bo He, Jie Gong, and Shan Zhi help nitrate and Huang clear the internal heat. Together, these herbs support the main agent, making them auxiliary. "Wherever pathogenic factors gather, their qi will inevitably be weak," so Dang Gui, Chuan Xiong, and Bai Shao nourish and activate blood circulation; Bai Zhu and Zhi Gan Cao strengthen the spleen and benefit qi, working together to support the body’s natural defenses—Poria clears the urinary tract, helping to drive heat out from the lower part, acting as an auxiliary. Fresh ginger is pungent and warm, aiding the passage of all herbs throughout the body, also acting as an auxiliary.

[Clinical Additions and Subtractions] ① For spontaneous sweating, remove Ma Huang; for mild heat, remove Shi Gou; for dry stools, add Mang Xiao; for severe wind-heat, add Sang Ye and Niu Bang Zi; for acute conditions, remove Dang Gui and Bai Shao to prevent greasiness.

[References] ① "Huan bu shang biao, xia bu shang li, ming se tong sheng, ji yan qi zhi xiu jie er." (Wang Xugao's Six Medical Books) ② This formula is used to treat obesity and can promote the excretion of metabolic products and fat. (Japanese Journal of Chinese Medicine, 1972.10) ③ The patient was an elderly woman who had suffered from persistent headaches for 50 years, with pain primarily located in the right side of her head and the left cheek, accompanied by high blood pressure. About a month ago, she developed mild left facial paralysis and mild speech impairment. Her bowel movements were only once a week, her pulse was tense and strong, without a tongue coating, her abdomen was slightly distended, there was slight resistance in the epigastric region, and her blood pressure was 170/90. After taking this formula along with tangerine peel and processed Pinellia, three doses later, not only did her headache subside, but her speech impairment also improved significantly. (Foreign Medical Journal, 1973.9)

[Commentary] This formula can treat various conditions, including neural headaches, psoriasis, hypertension, sequelae of epidemic cerebrospinal meningitis, habitual colds, and obesity.

II. Solving Exterior and Clearing Interior

This formula is suitable for cases where exterior symptoms are combined with internal heat. When comparing exterior symptoms with internal heat, internal heat is considered the primary factor, while exterior symptoms are secondary. If exterior symptoms are dominant while internal heat is secondary, then this formula falls under the category of formulas that resolve exterior symptoms.