Rizhoma Bupleuri and Rehmannia Decoction

Rizhoma Bupleuri and Rehmannia Decoction

From “Qian Jin Fang”

[Composition] Rhizoma Bupleuri: 3 grams; Rehmannia glutinosa: 30 grams; Peony root: 12 grams; Paeonia suffruticosa root: 12 grams

[Administration] Grind Rhizoma Bupleuri into juice, then decoct the remaining herbs in water and mix the juices together for consumption.

[Indication] Heat entering the blood vessels.

[Indications] Feverish heat, thirst, confusion, delirium, red rashes caused by poison, vomiting, nosebleeds, bloody stools, hematuria, and hemoptysis, a red and dark tongue without coating, and a fine, rapid pulse.

[Function] Clear heat and detoxify, cool the blood and stop bleeding.

[Formula Explanation] When heat enters the blood vessels, feverish heat and thirst, confusion and delirium, a red and dark tongue without coating, and a fine, rapid pulse appear. When blood heat causes bleeding, red rashes appear due to poison, vomiting, nosebleeds, bloody stools, and hematuria. This formula is intended to treat heat entering the blood vessels, focusing specifically on blood-related issues. The heart governs blood and fire; Rhizoma Bupleuri, with its cold nature, enters the heart to clear heart fire and detoxify heat, while also having the effect of cooling the blood and stopping bleeding. Rehmannia glutinosa, with its sweet and cold nature, cools the blood and stops bleeding, while also serving as a supportive remedy to clear heat and nourish yin. Peony root nourishes yin, and Paeonia suffruticosa disperses blood stasis; when heat enters the blood vessels and causes yin and blood damage, the combined effects of these two herbs—nourishing yin and dispersing blood—can serve as an adjunct treatment.

[Clinical Additions and Subtractions]

① “If the patient suffers from forgetfulness and delirium, add Rheum officinale and Scutellaria baicalensis.” (Qian Jin Fang)

② For severe confusion, use Zi Xue Dan or An Gong Niu Huang Wan in combination; for those who experience anger and liver fire, add Chai Hu, Scutellaria baicalensis, and Zhi Zi to clear the liver and resolve anger; for those with intense heart fire, add Coptis chinensis and Zhi Zi; for severe vomiting and bleeding, add Mao Gen, Zhu Ru, and Dry Lotus Leaf; for significant blood in stool, add Sophora flower and Dendrobium; for severe hematuria, add Mao Gen and Small Thistle.

[References]

① “Compared to Qing Ying Tang, the former combines clearing heat and cooling the blood with clearing qi herbs, allowing heat to be expelled from the blood vessels and resolved in the qi, making it suitable for cases where heat first enters the blood vessels but has not yet caused blood loss. This formula consists entirely of blood-related herbs, focusing on clearing heat and detoxifying, cooling the blood and dispersing blood, to treat blood-related heat. These are the key differences between the two formulas.” (Jiangsu New Medical College: Chinese Medicine Formulaology)

② Using Rizhoma Bupleuri and Rehmannia Decoction with modifications, 10 cases of primary thrombocytopenic purpura were treated. All patients had platelet counts below 80,000/mm³, with 5 cases having platelet counts below 60,000/mm³. Treatment resulted in 6 cases recovering completely, 4 cases showing marked improvement, and no cases resulting in death. For cases with severe heat, use Zi Xue Dan or Antelope Horn; for cases with heavy bleeding, add San Qi Powder or Yunnan White Medicine. (Chinese Medicine Magazine, 1963.11)

[Commentary] This formula is suitable for various acute infectious diseases characterized by bleeding and rash, such as meningitis, Japanese encephalitis, septicemia, trench fever, and epidemic hemorrhagic fever. It can also be used for aplastic anemia, leukemia, thrombocytopenic purpura, acute yellow atrophy of the liver, uremia, and other conditions involving bleeding.

III. Clearing Both Qi and Blood

When heat invades the qi, while simultaneously entering the blood vessels, this condition is referred to as “both qi and blood being burned.” The treatment approach should combine clearing qi and clearing blood while cooling the blood, commonly known as the “both qi and blood clearing” method.