Xie Xin Tang

Xie Xin Tang

From “Jinkui Yaolüe”

[Composition] Rheum officinale: 6 grams (two taels); Coptis chinensis: 3 grams (one tael); Scutellaria root: 10 grams (one tael)

[Administration] Decocted in water and taken orally; alternatively, grind the herbs into equal portions, form them into pills with honey, and take 6 grams per dose, dissolving them in warm water.

[Indication] Excessive heat inside the body (combined with dampness, blood obstruction, or toxicity).

[Indications] Fever, constipation, red urine, yellowish and greasy coating on the tongue, a rapid pulse, chest heat and discomfort, fullness in the chest, jaundice, vomiting, nosebleeds, boils and abscesses.

[Function] Clear heat, eliminate dampness, and detoxify.

[Explanation] When heat attacks the three jiao meridians, it rises to the upper part of the body and causes blood to flow abnormally—leading to vomiting and nosebleeds; when it rises to the lower part of the body, it combines with dampness and heat, causing jaundice and a yellow, greasy tongue; when it rises to the middle part of the body, it causes fullness in the chest, constipation, red urine, and fever. When heat accumulates and becomes toxic, it can lead to boils and abscesses. In this formula, Rheum officinale, Coptis chinensis, and Scutellaria root are all bitter and cold herbs, each possessing the effects of clearing heat, drying dampness, and detoxifying. Scutellaria root clears heat, dries dampness, and detoxifies the upper part of the body; Coptis chinensis clears heat, dries dampness, and detoxifies the middle part of the body; Rheum officinale clears heat, dries dampness, and detoxifies the lower part of the body, allowing the heat that has risen to the three jiao meridians to be released, and preventing blood, dampness, and toxicity from arising.

[Clinical Additions and Subtractions] ① Add Citrus peel and Agarwood to create No. 2 Gallbladder Stone-Removing Soup (Dalian Medical College), used to treat gallstones and cholecystitis. ② Add Atractylodes macrocephala, Poria, Alisma, Shenqu, and Citrus peel to create No. 1 Citrus Peel Stomach-Activating Soup (Li Dongyuan), used to treat food stagnation and damp-heat obstruction in the gastrointestinal tract, with symptoms like chest and abdominal fullness, diarrhea with red and white stools. ③ Add Aconite to create No. 1 Aconite Heart-Clearing Soup (Shanghan Lun), used to treat fullness in the chest, chills, and sweating.

[References] ① “When the heart’s Qi is insufficient, vomiting and nosebleeds occur; Xie Xin Tang is the primary remedy.” (Jinkui Yaolüe) “‘Insufficient’ is written as ‘excessive’ in the Medical宗 Jin Jian.” ② "The heart is the fire of the lord; it generates blood, and blood is the spirit of fire. Fire rises, so blood rises; when fire descends, blood also descends. Knowing that blood is born from fire and that fire resides in the heart, we understand that to drain the heart is to drain the fire, and to drain the fire is to stop the bleeding. With only rhubarb as a single ingredient, when it is used to reverse and bring down the rising fire, it can also break up blood stasis and eliminate stagnation, preventing complications. This remedy is often avoided by modern practitioners, who fail to recognize that when qi rises against the blood, this powerful descending agent can harm both yang and yin—this is truly a sacred medicine. Moreover, it does not merely help to lower qi in the stomach; it also reaches every meridian and skin tissue, addressing any condition where qi rises against the blood. Its nature allows it to penetrate deeply, treating all instances of qi being reversed and forcing it to flow in the right direction. Yet many people today hesitate to use it, often allowing the illness to linger and become a problem—what a pity! The formula is called 'Draining the Heart,' a treatment rooted in Zhongjing’s teachings, enabling us to realize that blood is born in the heart, and that the heart is the source of fire—and this understanding alone accounts for more than half of our understanding of blood-related conditions!" (From "Blood Syndrome Treatise")

③ A modified version of the "Draining the Heart" formula was used to treat 196 cases of upper gastrointestinal bleeding, with 94.8% of patients achieving effective hemostasis without the need for other hemostatic agents; most cases stopped bleeding within two days. The method of clearing heat and draining fire is an effective approach to treating upper gastrointestinal bleeding. (Gansu: "Selected Materials on Integrated Chinese and Western Medicine," 1979.1)

④ Patient Li ××, male, 22 years old, suffered from persistent nosebleeds for two days, accompanied by constipation and bright red blood flowing freely. Even using nasal cotton swabs soaked in Ren Shen, no improvement was seen. After administering three doses of the "Rhubarb Draining the Heart" formula supplemented with Rehmannia, Danpi, Black Gardenia, Platycladus, Bambusa, and Achyranthes, the patient's bowel movements improved, and the nosebleed stopped. Subsequently, a four-dose regimen of Liu Wei Di Huang Tang, with additions to nourish yin and soothe the liver, was administered, leading to recovery and discharge. (Guangdong Journal of Traditional Chinese Medicine, 1966.4)

[Commentary] This formula can be adjusted and applied to all acute and chronic infectious diseases, such as boils, carbuncles, erysipelas, cholecystitis, hepatitis, pancreatitis, pelvic inflammatory disease, dysentery, and others; it can also be used for various hemorrhagic conditions, including aplastic anemia, leukemia, and thrombocytopenic purpura. In addition, this formula, when adjusted, can also be employed for hypertension, gastric ulcers, chronic gastritis, and other similar conditions.

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Dao Chi San From "Direct Evidence of Pediatric Medicinal Prescriptions"

[Composition] Equal parts of Rehmannia, Pueraria lobata, and Licorice root

[Administration] Grind the herbs into powder; take 9 grams per dose, dissolving them in water made from 9 grams of Bamboo leaves. In modern times, this formula is often prepared as a decoction.

[Indications] Heat from the heart shifts to the small intestine.

[Suitable Conditions] Heart and chest discomfort, thirst, facial redness, sores in the mouth, dark red urine with a burning sensation during urination.

[Functions] Clear heart fire, promote urination.

[Formula Explanation] When heart fire is excessive, heart and chest feel uncomfortable, there is thirst, facial redness, and sores in the mouth. The heart and small intestine are in a complementary relationship; excess heart fire can rise from the surface to the interior, reaching the small intestine. The small intestine is responsible for storing and separating substances, with the function of distinguishing between pure and impure elements. When the small intestine is hot, urine becomes red and painful, and urination feels sharp and painful. In the formula, Bamboo leaves clear heart fire and promote urination from the bottom, serving as the primary remedy to address both the surface and the interior. Pueraria lobata promotes diuresis and urinary tract clearance, helping to expel excess heart fire through urination, while also treating oral sores on the surface and reducing redness and pain in the urethra—these are secondary remedies. Excess heat easily harms yin; Rehmannia has a sweet, cooling nature, nourishing yin while also cooling the blood, making it a suitable complement to the treatment. Licorice root clears the lower burner and harmonizes the herbs as a guiding agent.

[Clinical Adjustments]

① Add Shengma, Coptis chinensis, and Danpi to the formula, creating Shengma Qingwei Tang (from "Treatment of Disease Causes and Pathways"), which uses Shengma's detoxifying and rash-clearing properties for cases where rashes are difficult to break through.

② Add Carthamus, Hematite, and Collagen to treat hematuria.

③ Combine with Wuling San to treat oral mucosal lesions. (From "Essential Formulas for Practical Use")

[References]

① "This formula is suitable for those with water deficiency but not actual fire, as it helps to remove water without harming yin, and it clears fire without damaging the stomach; however, if heart fire is severe, Coptis chinensis should be added, and in more severe cases, rhubarb may be used—this is a method of drawing fire away from the source." (From "Medical Essentials")

② "Dao Chi means to guide the heat of the heart from the small intestine out, as the heart and small intestine form a complementary relationship. However, conditions such as oral sores, tongue sores, yellow or red urine, pain in the urethra, and difficulty with urination due to heat are all signs of heart heat shifting to the small intestine. Therefore, instead of directly using Coptis chinensis to drain the heart, Rehmannia nourishes the kidneys and cools the heart, Pueraria lobata promotes diuresis and clarity in the small intestine, and Licorice root is used to aid in draining the deepest heat, relieving pain in the urethra and guiding the heat from the heart." (From "Supplemented and Revised Treatises on Famous Physicians")

③ Dao Chi San combined with fresh Bambusa roots cured three cases of hematuria. All three patients experienced difficulty in passing urine, painful urination, blood in the urine, and a rapid pulse. (Jiangxi Medical Journal, 1963.9)

[Commentary] This formula can be adjusted and applied to oral inflammation, urethritis, acute and chronic pyelonephritis; it can also be used for urinary tract stones, urinary tract tuberculosis, and other related conditions.

Long Dan Xie Gan Tang

From "Compendium of Prescriptions"

[Composition] 9 grams of Gentiana scabra (stir-fried in wine), 6 grams of Bupleurum chinense, 6 grams of Pueraria lobata, 6 grams of Alisma orientalis, 6 grams of Scutellaria baicalensis (stir-fried), 3 grams of Plantago major, 6 grams of Gardenia jasminoides (stir-fried in wine), 6 grams of Rehmannia glutinosa, 1.5 grams of Angelica sinensis, and 1.5 grams of Licorice root.

[Administration] Brew the herbs in water and drink the decoction.

[Indications] Excess heat in the liver and gallbladder, damp-heat in the lower burner.

[Suitable Conditions] Bitter taste in the mouth, dry throat, chest and flank discomfort, irritability, red eyes, swollen ears, hearing loss; cloudy urine, swelling of the genitals, itching in the genital area, yellow or white vaginal discharge.

[Functions] Clear excess heat from the liver and gallbladder, clear damp-heat in the lower burner.

[Formula Explanation] The liver resides in the lower burner; because the lower burner is located below, it tends to accumulate dampness (dampness is heavy and tends to descend). Excess liver and gallbladder fire can rise to the upper burner, or combine with dampness to cause downward movement. The former presents with bitter taste in the mouth, dry throat, chest and flank discomfort, irritability, red eyes, swollen ears, and hearing loss; the latter manifests as cloudy urine, swelling of the genitals, itching in the genital area, and yellow or white vaginal discharge. In the formula, Gentiana scabra primarily clears excess liver and gallbladder fire, while simultaneously clearing damp-heat in the lower burner—this dual approach serves as the main treatment. Scutellaria baicalensis and Gardenia jasminoides, together with Gentiana, enhance their ability to clear heat and fire, making their effects even more pronounced; they act as auxiliary remedies. Pueraria lobata, Alisma orientalis, and Plantago major promote diuresis and urinary tract clearance, helping damp-heat to leave through urination—this is considered a complementary treatment. When fire accumulates in the liver meridian, the liver is the organ that stores blood; when fire rises, it can lead to blood loss and yin damage. Rehmannia and Angelica sinensis nourish blood, promote blood circulation, and replenish yin—these are also complementary treatments. Liver fire often arises from liver stagnation; this is known as "stagnation leading to fire." Bupleurum chinense relaxes the liver and resolves stagnation, also serving as a complementary treatment. Licorice root harmonizes the herbs and acts as a guiding agent.

[Clinical Adjustments]

① Remove Pueraria lobata, Alisma orientalis, Plantago major, Bupleurum chinense, Licorice root, and Rehmannia glutinosa; add Coptis chinensis, Phellodendron amurense, Rhubarb, Aloe vera, Indigo naturalis, Agarwood, and Musk, creating Anguilla Longdan Pills (from "Xuan Ming Lun Fang"), which treat excess liver and gallbladder fire, constipation, dizziness, delirium, and abdominal distension.

② Remove Scutellaria baicalensis and Gardenia jasminoides, and Licorice root; this formula is also known as Long Dan Xie Gan Tang (from "Lan Shi Mi Cang"), used to treat itching, foul odor, and heat in the anterior genital area.

③ Remove Angelica sinensis and Rehmannia glutinosa, Pueraria lobata, Alisma orientalis, and Plantago major; add Ginseng, Five-flavor berry, Asparagus, Ophiopogon, Coptis chinensis, and Anemarrhena as well, creating Long Dan Xie Gan Tang (from "Standardized Treatment Guidelines"), used to treat muscle weakness, spasms, and bitter taste in the mouth.

[References]

① "Long Dan Xie Gan Tang clears heat from the yin aspect of the liver, while Bupleurum chinense calms heat from the yang aspect of the gallbladder; Scutellaria baicalensis and Gardenia jasminoides clear heat from the lungs and triple burner to support these efforts. Alisma orientalis drains dampness from the kidney meridian, while Pueraria lobata and Plantago major drain dampness from the small intestine and bladder to support these efforts. However, these herbs are all cold and diuretic; therefore, Rehmannia and Angelica sinensis are used to nourish blood and tonify the liver, while Licorice root soothes the middle burner without harming the stomach—this is the role of the chief physician." (From "Essential Formulas for Practical Use")

② Long Dan Xie Gan Tang was used to treat one case of headache caused by liver fire; it was used to treat one case of convulsions with Danpi, Baizhu, and Gou Teng; it was used to treat one case of nocturnal emission with Zhi Mu, Phellodendron amurense, and Yangchun Sha; it was used to treat one case of leukorrhea with Sophora root bark, Turtle blood, Bupleurum chinense, and White Chicken Comb Flowers; it was used to treat one case of flank pain with Yuan Hu, Jin Ling Zi, and White Peony, all of whom recovered fully. (Fujian Journal of Traditional Chinese Medicine, 1964.5)

③ Long Dan Xie Gan Tang, with adjustments, was used to treat 172 cases of acute jaundice-type infectious hepatitis. Symptoms included loss of appetite, yellow urine, moderate yellowing of the sclera and skin, hepatomegaly, and impaired liver function—all were confirmed by Western medical diagnosis. This formula removed Alisma orientalis, Plantago major, and Gardenia jasminoides, adding Turmeric, Red Date, and continued treatment for 30–40 doses; all 172 patients were cured. (Science Experiment, Hunan, 1973.6)

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

Xie Bai San

From "Direct Evidence of Pediatric Medicinal Prescriptions"

[Composition] 30 grams each of Mulberry bark and Cortex Phellodendri, 3 grams of Licorice root, and a pinch of Japonica rice.

[Administration] Prepare as a decoction, brewed in water and consumed.

[Indications] Heat accumulating in the lungs.

[Suitable Conditions] Fever, cough, wheezing, especially in the late afternoon, hot skin, thick, yellow phlegm that is difficult to expectorate, red tongue with yellow coating, and a rapid, fine pulse.

[Functions] Clear heat and clear the lungs.

[Formula Explanation] Heat is most likely to attack the metal element and invade the lungs. Fever, cough, wheezing, thick, yellow phlegm that is difficult to expectorate, red tongue with yellow coating, and a rapid pulse all indicate that heat is invading the lungs; the hot skin, especially in the late afternoon, suggests that the heat has begun to harm yin. When heat overcomes yin, yin deficiency can lead to increased heat; the two conditions reinforce each other, intensifying the heat. The former represents real heat, while the latter represents false heat—this indicates that the condition is a combination of both real and false heat. Among real and false heat, real heat is the primary concern, while false heat is secondary; in the formula, Mulberry bark clears real heat in the lungs to treat the root cause, while Cortex Phellodendri clears false heat in the lungs to treat the symptoms. "The lungs are the place for coughing," and they are also the "storage chamber for phlegm"; both herbs share the function of stopping coughs and clearing phlegm, making this formula a complementary treatment. Japonica rice strengthens the spleen and nourishes the middle burner—this is also a complementary treatment. Licorice root harmonizes the herbs and acts as a guiding agent.

[Clinical Adjustments]

① When lung heat is severe, add Zhi Mu and Scutellaria baicalensis; when lung qi is deficient and short of breath, add Dangshen and Poria.

② Combine with Er Chen Tang to treat emphysema complicated by infection, with symptoms including cough, wheezing, thick, sticky phlegm, chest tightness, red tongue with yellow, greasy coating, and a tense, rapid pulse.

③ Add Burdock seed, Apricot kernel, Cicada shell, and Mint to treat early-stage childhood pneumonia.

④ Add Baizhu, Aster, Platycodon grandiflorus, Angelica sinensis, and Trichosanthes kirilowii to Xie Bai San (from "Standardized Treatment Guidelines"), used to treat early-stage pulmonary abscesses before pus formation.

⑤ Add Ginseng, Zhi Mu, and Scutellaria baicalensis to Xie Bai San (from "Shen's尊 Life Book"), used to treat lung heat causing cough while also indicating qi deficiency.

[References]

① "Mulberry bark nourishes the deficiency of vital energy, while its pungent flavor clears excess lung qi and eliminates phlegm; Cortex Phellodendri cools hidden heat in the lungs, while its cool and neutral nature helps to clear deficiency heat in the liver and kidneys, cooling blood and eliminating excess heat. Licorice root clears fire while benefiting the spleen; Japonica rice clears the lungs while nourishing the stomach—soil is the mother of metal, and when deficiency occurs, it is necessary to nourish the mother—clearing heat through the urine, as the lungs govern the west, hence the name 'Xie Bai.'" (From "Collection of Medical Formulas")

② "The lungs are delicate organs belonging to metal, governing the skin and hair; their nature is to follow the downward path while resisting the upward path—when heat forces them, the above symptoms appear. To treat this condition, it is best to clear and descend, restoring their clean and orderly nature. Mulberry bark can reach the skin, and its white color can return to the lungs; its sweet and cool nature enters the lungs to clear heat, which goes without saying. Roots go deep into the earth, able to clear and descend, and one can imagine that Cortex Phellodendri extends deep into the underworld, with no end in sight—its sweet and neutral nature, though capable of clearing hidden heat in the lungs, can be understood as having the meaning of entering the liver and kidneys, cooling blood and eliminating excess heat. Thus, the use of both barks lies in descending; when lung qi descends, fire naturally disappears. Licorice root clears fire while benefiting the spleen; Japonica rice clears the lungs while nourishing the stomach, clearing the middle while nourishing, combining nourishment with clearing—though it clears the lungs, it still nourishes the root." (From "Comprehensive Understanding of Medicine")

[Commentary] This formula is often used for acute and chronic bronchitis, bronchial asthma, and emphysema complicated by infection. When combined with Ma Xing Gan Shi Tang, it treats childhood pneumonia with remarkable efficacy.

Qing Wei San

From "Lan Shi Mi Cang"

[Composition] 1 gram of Angelica sinensis, 1 gram of Coptis chinensis, 1 gram of Rehmannia glutinosa, 1 gram of Danpi, 3 grams of Bupleurum chinense

[Indications] Heat rising from the stomach.

[Suitable Conditions] Burning pain in the epigastrium, dry mouth, bad breath, oral sores, gum swelling, bleeding gums, red tongue with yellow coating, and a rapid pulse.

[Functions] Clear heat from the stomach.

[Formula Explanation] The hand yangming meridian runs from the upper jaw through the cheeks into the lower teeth, while the foot yangming meridian enters the upper teeth through the outer side of the nose; this shows that the teeth and gums are locations along the yangming meridian. The stomach is yangming, and when heat rises from the stomach, symptoms such as toothache, gum swelling, and bleeding gums appear. The mouth is the upper opening of the stomach; when heat rises from the stomach, dry mouth, bad breath, and oral sores occur. When the stomach is filled with heat, there is burning pain in the epigastrium, red tongue with yellow coating, and a rapid pulse. In the formula, Coptis chinensis is bitter and cold, primarily used to clear heat from the stomach; Rehmannia glutinosa and Danpi nourish yin while cooling blood, acting as auxiliary remedies; yangming is rich in qi and blood, so Angelica sinensis is added to prevent blood loss—a complementary treatment; Bupleurum chinense guides the medicine upwards to enter yangming, serving as a guiding agent.

[Clinical Adjustments]

① Add gypsum to further enhance the effect of clearing the stomach. (From "Collection of Medical Formulas")

② For those with constipation, add Rhubarb and Mirabilite; for those with thirst, remove Angelica sinensis and add Xuan Shen and Tianhua Fen; for those with toothache, add Bai Zhi and Xi Xin; for those with severe stomach pain, add Danshen, Wood香, and Grass Nut.

[References]

① "When taking medications to treat stomach heat causes unbearable pain in the upper and lower teeth, with a feeling of heat radiating throughout the head, resulting in severe pain—this is because the foot yangming's collateral vessels enter the brain." (From "Discussion on the Spleen and Stomach")

② "For severe damp-heat with toothache, use Cheng Qi Tang; for mild cases, use Qing Wei San. When intestinal heat causes gum swelling and pain, use Qing Wei San; for more severe cases, use Tiao Wei Tang. When six types of stagnation cause pain, use Yue Ju Wan; when qi deficiency causes pain, use Bu Zhong Yi Qi Tang. When mental stress damages the spleen and causes pain, use Gui Pi Tang; when kidney heat causes pain, use Liu Wei Tang." (From "Essential Formulas for Practical Use")

[Commentary] This formula can be used for neuralgia of the teeth, inflammatory dental pain, trigeminal neuralgia, oral inflammation, ulcerative diseases, chronic gastritis, and other conditions.

Yu Nu Jian

From "Complete Works of Jingyue"

[Composition] 5 grams of Forsythia suspensa, 5 grams of Achyranthes bidentata, 15 grams of Gypsum, 15 grams of Rehmannia glutinosa, 6 grams of Ophiopogon japonicus

[Administration] Brew in water and drink.

[Indications] Excess yang in the yangming meridian, deficiency in the yin meridian.

[Suitable Conditions] Hot and thirsty, headaches and toothaches, red tongue with little coating, and a rapid, fine pulse.

[Functions] Clear stomach and nourish yin.

[Formula Explanation] When yangming is excessive, there is hot and thirsty, headaches and toothaches; when yin is deficient, the tongue is red with little coating, and the pulse is rapid and fine. The formula uses Gypsum to clear excess fire in the yangming meridian as the primary remedy; Rehmannia glutinosa and Danpi nourish yin in the yin meridian as auxiliary remedies; Ophiopogon japonicus nourishes the lungs and nourishes yin, embodying the principle of mutual generation between metal and water—this can be considered a complementary treatment; Achyranthes bidentata guides blood heat downwards, serving as a guiding agent.

[Clinical Adjustments]

① Remove Achyranthes bidentata and add Xuan Shen; replace Rehmannia glutinosa with Gypsum to treat cases where the yin meridian is warm and blood is both burned and heated, with thirst, a rapid pulse, and a red tongue. (From "Discussions on Warm Diseases")

② If the fire is severe, add Gardenia jasminoides or Cortex Phellodendri; if there is excessive sweating and thirst, add Five-flavor berry; if urination is difficult or the fire fails to descend, add Alisma orientalis or Poria; if yin is deficient and qi is depleted, add Ginseng. (From "Complete Works of Jingyue")

③ Use a large amount of Gypsum and Achyranthes bidentata, and adjust with raw Hematite and Lotus juice to treat vomiting and nosebleeds caused by blood heat running rampant.

④ Add Sa Shen and Shihu to treat glossitis and oral inflammation.

⑤ Add Bai Zhi and Xi Xin to treat toothache caused by false fire.

[References] "When a woman's true yin is sufficient, water and fire are balanced, and there is never a condition of excessive fire; however, when the true yin of the lungs and kidneys is insufficient, unable to moisten the stomach, the gastric juices become dry, and when fire attacks, it can spread like the White Tiger's syndrome." (From "Formulas for the Spleen and Stomach")

Water; Ophiopogon japonicus protects the lung metal; Forsythia suspensa nourishes lung yin while nourishing kidney water, capable of treating fire that has overcome yin; Gypsum is sweet and cold, with a heavy quality, entering the yangming meridian alone to clear excess heat in the stomach—especially when Rehmannia glutinosa is used in cases of excessive stomach fire, it is important to carefully consider the dosage. While the formula is intended to treat fire, it is also important to read the formula carefully and apply it appropriately." (From "Comprehensive Understanding of Medicine")

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[Commentary] This formula is often used for neuralgia of the teeth, acute oral inflammation, bleeding in blood disorders, and the later stages of acute infectious diseases.

Huang Qin Tang

From "Treatise on Cold Damage"

[Composition] 9 grams of Scutellaria baicalensis (three liang), 9 grams of Peony root (two liang), 3 grams of Licorice root (two liang roasted), and 4 dates (twelve dates split)

[Administration] Brew in water and drink warm, once a day in the morning and once at night.

[Indications] Evil from the yangming meridian pressing into the yangming.

[Suitable Conditions] Bitter taste in the mouth, dry throat, dizziness, diarrhea, burning in the anus, or loose stools, abdominal pain, tenesmus.

[Functions] Clear heat and dry dampness, seal the tissues and relieve pain.

[Formula Explanation] Although evil from the yangming meridian presses into the yangming, other evils remain; thus, there are symptoms such as bitter taste in the mouth, dry throat, and dizziness. When evil enters the yangming, it transforms into fire; the yangming and yin meridians are complementary, and the heat of the yangming combines with the dampness of the yin meridian, leading to symptoms such as diarrhea, anal burning, loose stools, and abdominal pain. This condition focuses on the evil pressing into the yangming—it is a case where the symptoms are acute but the underlying condition is mild; the treatment should focus on clearing heat and drying dampness, to resolve the damp-heat obstructing the yangming. In the formula, Scutellaria baicalensis clears heat and dries dampness, serving as the primary remedy. Peony root seals yin and relieves pain as an auxiliary remedy. Dates strengthen the spleen and benefit qi, making them a complementary treatment. Licorice root harmonizes the herbs and acts as a guiding agent.

[Clinical Adjustments]

① Remove the dates and call the formula Huang Qin Peony Tang (from "Key Techniques in Treatment"), used to treat heat-induced diarrhea, abdominal pain, and tenesmus.

② Add Pinellia and Ginger, calling it Huang Qin Pinellia Ginger Tang (from "Treatise on Cold Damage"), used to treat damp-heat diarrhea combined with vomiting.

③ Remove the dates and add Four Liquids (Poria, Poria, Alisma orientalis, Atractylodes macrocephala), Houpu, Chenpi, and Agarwood, calling it Four Liquids Huang Qin Tang (from "Discussions on Warm Diseases"), used to treat initial cases of intestinal obstruction due to damp food and short urination.

[References]

① "'When the sun and yangming are combined, and there is diarrhea, use Huang Qin Tang.'... This formula's primary symptom is diarrhea. It is caused by evil from the yangming pressing into the yangming. The external symptoms are not obvious, and Huang Qin Tang does not contain any herbs for resolving exterior symptoms." (Hubei College of Traditional Chinese Medicine: "Treatise on Cold Damage")

② "Cold evil is deeply buried and has already transformed into heat... Using Huang Qin Tang as the primary formula, its bitter and cold nature directly clears internal heat; heat is trapped in yin, and bitter flavors firmly bind yin—this is the correct treatment. It is known that warm evil should not be dispersed, and it does not follow the same methods as sudden exposure." (From "Warm Heat Principles")

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

Bai Tou Weng Tang

From "Treatise on Cold Damage"

[Composition] 9 grams of Bai Tou Weng (two liang), 6 grams of Coptis chinensis (three liang), 3 grams of Scutellaria baicalensis (three liang), 9 grams of Paeonia lactiflora (three liang)

[Administration] Brew in water and drink.

[Indications] Damp-heat dysentery.

[Suitable Conditions] Heavy, bloody diarrhea, with pus in the stool, thirst and desire to drink water, abdominal pain and anal burning, yellow and greasy tongue, and a rapid, fine pulse.

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

[Formula Explanation] The Treatise on Cold Damage states: "When diarrhea is heavy and sluggish, use Bai Tou Weng Tang." It also says: "When you want to drink water due to diarrhea, it is because heat is present—use Bai Tou Weng Tang." This shows that the primary symptom of this formula is "heat-induced diarrhea." The diarrhea is caused by dampness, and the heat and dampness combine; when damp-heat combine, they block the flow of qi, leading to heavy diarrhea and abdominal pain; when heat accumulates into toxins, pus appears in the stool. Yellow and greasy tongue, a rapid pulse—all these indicate the combination of damp-heat. In the formula, Bai Tou Weng is bitter and cold, with the functions of clearing heat and drying dampness, detoxifying and stopping dysentery as its primary remedies. Scutellaria baicalensis and Coptis chinensis are both heat-clearing, damp-drying, and detoxifying herbs; when paired with the primary remedy, their effects are even more pronounced—they can be considered auxiliary remedies. Paeonia lactiflora can also clear heat from the liver and gallbladder, aiding the lower burner—this is a complementary treatment.

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[Clinical Adjustments]

① Add Licorice root and Collagen, calling it Bai Tou Weng with Licorice and Collagen Tang (from "Golden Classic of Prescriptions"), used to treat postpartum diarrhea with extreme deficiency.

② Add White Peony, Scutellaria baicalensis, Fresh Herba Lysimachiae, and Fresh Jasmine flowers, calling it Bai Tou Weng Tang with Added Ingredients (from "Commonly Used Treatises on Cold Damage"), a good formula for clearing the liver and strengthening the intestines, clearing heat and stopping dysentery.

③ For those with external symptoms, add Kudzu root, Perilla leaf, Honeysuckle, and Forsythia; for those with obvious abdominal pain and heavy diarrhea, add Agarwood, Areca nut, White Peony; for those with predominantly red diarrhea, add Red Peony, Danpi, and Ground Ivy.

④ Remove Coptis chinensis and add Prince of Wales' Root, Ophiopogon japonicus, Stone Orchid, Licorice root, Lotus seeds, Stone菖蒲, Stone Lotus seeds, to treat locked-down diarrhea.

[References]

① Preliminary observations on 40 cases of acute bacterial dysentery treated with Bai Tou Weng Tang showed a cure rate of 62.5%. The prescription was Bai Tou Weng one liang, Coptis chinensis two qian, Coptis chinensis three qian, Paeonia lactiflora three qian. One dose per day. On average, each case took 7.2 doses. (New Chinese Medicine, 1957.9) ② A case of amoebic dysentery treated with a modified Baitouweng Decoction and enema: The formula consists of 10 grams of Baitouweng, 10 grams of Lianqiao, 20 grams of Huangbai, 20 grams of Zhizhi, and 500 ml of water, which is boiled down to 300 ml. The residue is removed, the solution is cooled and set aside for use. Chen ××, 50 years old, suffered from chronic amoebic dysentery that had recurred for 15 years. Each episode was characterized by abdominal distension, tenesmus, and continuous mucous and bloody stools. In 1958, a stool examination revealed positive amebic cysts. Over the years, the patient had received antibiotic treatments, metronidazole, and traditional Chinese medicine therapies; symptoms were temporarily controlled, but episodes still occurred several times each year. After switching to a modified Baitouweng Decoction combined with enema twice (i.e., two doses), the patient was cured, and no recurrence was observed over a one-year follow-up period. (Xin Zhongyi, 1974, 4:38)

③ A case of eye disease caused by wind-heat treated with Baitouweng Decoction. Chen ×, female, 11 years old, developed the condition more than ten days ago. Her eyelids were red and swollen, her conjunctiva was congested, her vision was blurred, she experienced difficulty seeing objects clearly, and her bowel movements were difficult. Her urine was short and red, and she was diagnosed with acute conjunctivitis in Western medicine. The formula used was: 10 grams of Baitouweng, 5 grams of Huanglian, 20 grams of Huangbai, 30 grams of Qinpi. After three doses of medication, the patient recovered completely. (Xin Zhongyi, 1973, 4)

[Commentary] This formula is used for acute bacterial dysentery, amoebic dysentery, ulcerative colitis, and can also be employed for acute conjunctivitis.

Qingyi Decoction (Tianjin Nankai Hospital)

[Composition] Chaihu 15 grams, Huangqin 10 grams, Dahuang 15 grams, Mangxiao 10 grams, Huhuanglian 10 grams, Muxiang 6 grams, Yuanhu 10 grams, Baishao 15 grams

[Usage] Brewed in water and taken orally.

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

[Indications] Severe abdominal pain, radiating to the chest and flank, fullness and distension throughout the abdomen, often accompanied by lower back and waist discomfort, along with bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, and irritability with nausea and vomiting. The tongue is coated with yellow, thick coating, and the pulse is wiry and rapid.

[Functions] Soothe the liver and regulate qi, clear heat and eliminate excess.

[Formula Explanation] The clinical characteristics of this condition are similar to those of Shaoyang and Yangming syndromes. When it presents as Shaoyang syndrome, the patient experiences bitter taste in the mouth, dry throat, dizziness, alternating chills and fever, and irritability with nausea and vomiting in the chest and flank. When it presents as Yangming syndrome, the patient experiences severe abdominal pain, fullness and distension throughout the abdomen, a yellow, thick tongue coating, and a wiry, rapid pulse. According to the Shanghan Lun, the Da Chaihu Decoction is the primary formula for treating Shaoyang and Yangming syndromes. The Qingyi Decoction’s treatment of pancreatitis shares the same principles, methods, and herbal components as the Da Chaihu Decoction’s treatment of Shaoyang and Yangming syndromes. Chaihu in the Qingyi Decoction soothes the liver and regulates qi to resolve cold in Shaoyang; Dahuang and Mangxiao clear heat and eliminate excess to remove the excessive fire in Yangming, working together to address both Shaoyang and Yangming. Muxiang soothes the liver and regulates qi to assist Chaihu; Huangqin and Huhuanglian clear heat and eliminate pathogenic factors, working together with Mangxiao and Dahuang—these three herbs all support the main formula and can be considered auxiliary agents. Baishao’s function of tonifying yin and relieving pain can be seen as a complementary treatment.

[Clinical Additions and Subtractions]

① For cases involving ascariasis obstruction, remove Dahuang and Yuanhu, and add Pinellia, Chuan Lianzi, and Semen Ziziphi, forming a formula for ascariasis-related pancreatitis. (Tianjin Nankai Hospital)

② Remove Chaihu, Huangqin, and Mangxiao, and add Gentiana, forming Qingyi No. 1 (Zunyi Medical College), suitable for mild pancreatitis.

③ Remove Chaihu and Huangqin, and add Danpi, Zhizhi, and Houpo, forming Qingyi No. 2 (Zunyi Medical College), suitable for severe pancreatitis.

④ Remove Chaihu and Huangqin, and add Shan Zhi, Xixin, and Pinellia, forming Qingyi No. 3 (Zunyi Medical College), suitable for pancreatitis complicated by biliary tract diseases.

[Reference Materials] Chaihu, Huangqin, Huhuanglian, Dahuang, and other herbs all possess significant anti-inflammatory and antibacterial properties. Muxiang and Baishao can regulate the tension of smooth muscles, helping to expand the pancreatic ducts and facilitate drainage. Dahuang and Mangxiao cleanse the intestinal lumen, enhancing pancreatic duct drainage while reducing retrograde infections. Yuanhu relieves pain. Based on these characteristics, this formula has the triple effects of anti-inflammation, spasm relief, and pain relief—completely aligning with modern medical principles for treating pancreatitis. Clinical applications often incorporate supportive therapies such as fluid resuscitation and blood transfusions, resulting in even more satisfactory therapeutic outcomes.

[Commentary] This formula, when combined with antibiotics and fluid resuscitation, can indeed enhance therapeutic efficacy in the treatment of acute pancreatitis.

Biliary Stone-Discharging Decoction (Zunyi Medical College)

[Composition] Qianjin Cao 30 grams, Muxiang 9 grams, Zhike 9 grams, Huangqin 9 grams, Chuan Lianzi 9 grams, Dahuang 6 grams

[Usage] Brewed in water, taken twice daily.

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

[Indications] Alternating chills and fever, bitter taste in the mouth and dry throat, right flank pain, abdominal distension, nausea and vomiting, jaundice of the sclera, yellow and greasy tongue coating, and a wiry, slippery pulse.

[Functions] Clear heat and drain dampness, regulate qi and relieve pain.

[Formula Explanation] This condition often arises from stagnation of liver qi. On one hand, prolonged stagnation of liver qi leads to fire; on the other hand, if liver qi rises against the stomach, dampness accumulates. The former generates heat, while the latter produces dampness—when dampness and heat combine and become trapped in the liver and gallbladder, this condition develops. Alternating chills and fever, bitter taste in the mouth and dry throat, right flank pain, jaundice of the sclera, yellow and greasy tongue coating, and a wiry, slippery pulse all indicate damp-heat accumulation in the liver and gallbladder; abdominal distension and nausea and vomiting result from liver qi rising against the stomach. This formula uses a large dose of Qianjin Cao to clear heat and drain dampness from the liver and gallbladder as its main ingredient; Huangqin clears heat and dries dampness in Shaoyang as an auxiliary herb. When damp-heat combine and obstruct the flow of qi, symptoms such as right flank pain appear; Muxiang, Zhike, and Chuan Lianzi relieve pain and promote qi circulation, while also soothing the liver and resolving stagnation as complementary treatments. Dahuang clears fire and cleanses the intestines, guiding damp-heat downward, thus aiding in harmonization.

[Clinical Additions and Subtractions]

① For chest tightness and flank pain, add Chaihu and Baishao; for a dark tongue, thirst, and a floating pulse, add Sheng Shi Gao, Zhimu, and Huafen; for severe heat, add Er Hua and Diding; for severe pain, add Mangxiao; for poor appetite, add Neijin, Sha Ren, fried barley malt, Shen Qu, and roasted hawthorn; for vomiting, add Ban Xia, Zhu Ru, and fresh ginger; for heavy heat, add Yin Chen. (Zunyi Medical College)

② Remove Zhike, Qianjin Cao, and Chuan Lianzi, and add Chaihu, Ban Xia, and Yujin, forming Biliary Stone-Discharging Decoction No. 2 (Dalian Medical College), used for gallstones, particularly when inflammation is not prominent.

[Reference Materials] This formula is also known as Biliary Stone-Discharging Decoction No. 5, which enhances gallbladder contraction, relaxes the Oddi's sphincter, promotes bile secretion, and exhibits significant antibacterial activity. After eight healthy individuals took this formula orally, gallbladder imaging and X-ray examinations showed remarkable results in three cases; one case showed a significant reduction in gallbladder size within half an hour of taking the medication. Animal experiments also confirmed that this formula possesses three key functions: ① promoting relaxation of the Oddi's sphincter, ② promoting bile flow, and ③ inhibiting bacterial growth. (Zunyi Medical College: “Integrated Traditional and Western Medicine Treatment of Acute Abdominal Conditions”)

[Commentary] Based on the principle of “通畅则不痛,” this formula employs soothing the liver, regulating qi, promoting bile flow, and clearing heat—utilizing all three approaches of soothing, regulating, promoting, and clearing.

Zuo Jin Pill (Danxi Xinfa)

[Composition] Huanglian (stir-fried with ginger juice) 60 grams, Wu Zhu Yu (soaked in saltwater) 10 grams

[Usage] Grind into powder, form into pills with water, and take 1–3 grams per dose. In modern times, it is often prepared as a decoction, taken orally after being brewed in water.

[Indications] Liver fire affecting the stomach.

[Indications] Flank and rib pain, bitter taste in the mouth and dry throat, nausea and vomiting, acid reflux and belching, red tongue with yellow coating, and a wiry, rapid pulse.

[Functions] Clear liver fire.

[Formula Explanation] When liver qi becomes stagnant, it often turns to fire; when liver fire affects the stomach, this condition arises. Bitter taste in the mouth and dry throat, flank and rib pain, red tongue with yellow coating, and a wiry, rapid pulse indicate excessive liver fire; nausea and vomiting, acid reflux and belching indicate disharmony of stomach qi. The principle in the Inner Classic, “All rebellions that surge upward all belong to fire,” perfectly aligns with this condition. Huanglian’s bitter and cold nature both clears liver fire and clears heart fire—this approach involves using the stronger agent to treat the root cause while sparing the weaker one, making it the primary ingredient. Adding Wu Zhu Yu’s bitter and warm properties helps warm the stomach, dispel cold, and relieve reverse flow, while also moderating the coldness of the large dose of Huanglian to prevent stomach injury. With only two herbs—cold and warm—one can soothe the liver and warm the stomach in one pot; the cold is not overwhelming, the warmth is not drying, making it an excellent formula for soothing both liver and stomach.

[Clinical Additions and Subtractions]

① For those with obvious liver qi stagnation, use it in conjunction with Si Ni San; for those with abdominal pain due to diarrhea, use it with Baishao, forming Wu Ji Wan. (He Ji Ju Fang)

② This formula is prepared by stir-frying, removing Wu Zhu Yu, and adding Muxiang, forming Xiang Lian Wan (Bing Bu Shou Ji Fang), used to treat diarrhea with red and white stools and tenesmus.

③ Remove Wu Zhu Yu and add Fuzi, forming Lian Fu Liu Yi Tang (Yi Xue Zheng Zhuan), brewed with ginger and jujubes to treat severe stomach pain.

[Reference Materials]

① “There are several ways to treat the liver: when water is depleted and wood cannot grow, nourish it with Dihuang Wan and similar formulas; when earth is depleted and wood cannot take root, nurture it with Shen, Ling, and Gan Cao; when blood is deficient and fire arises, clear it with Xiaoyao San; when blood is deficient and water is lacking, nourish it with Sì Wu Tang. The method for replenishing fire is the same as that for kidney; the method for clearing fire is similar to that for heart—thus, this formula uses Huanglian as the chief ingredient… However, it is only appropriate when wood qi is strong and earth is not deficient.” (Luo Tianyi)

② “When the liver is abundant, pain arises; the heart is the son of the liver—when it is abundant, treat its son. Therefore, we use Huanglian to clear the heart and clear fire as the chief ingredient, so that fire does not overcome metal, and metal can control wood, thus the liver becomes calm. Wu Zhu Yu’s pungent and warm nature enters the Jueyin (liver) to regulate qi and resolve stagnation, while also guiding heat downward, making it a counter-indicator. One cold, one warm—cold is the primary treatment, while heat is the secondary treatment (using heat to treat heat, or treating heat according to its nature is also called counter-treatment)—thus they complement each other to achieve effective results. The liver resides on the left, the lung on the right; ‘Zuo Jin’ means to let metal move to the left and calm the liver.” (Yi Fang Ji Jie)

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

VI. Clearing Deficiency Heat

Deficiency heat typically falls into two categories: qi deficiency heat and yin deficiency heat. Qi deficiency heat should be treated by replenishing qi and clearing heat—this is known as the “sweetly warming and cooling to remove great heat” method, with major formulas like Buzhong Yiqi Decoction discussed in the context of tonifying agents. Yin deficiency heat, on the other hand, is often caused by yin deficiency and should be treated with yin-nourishing and fire-clearing methods, commonly using Liubai Di Huang Tang or Da Bu Yin Wan, also discussed in the context of tonifying agents. Beyond these two categories, in the later stages of fever, even though the high heat has subsided, the yin fluids have been severely damaged, and yin deficiency leads to fire agitation—such cases should be treated with yin-nourishing and heat-clearing therapies, using Qinghaotai Jia Tang or Danggui Liu Huang Tang.