Xin Jia San Ao Tang - 新加三拗汤 - Newly Augmented Three Unbinding Decoction

Author: Yu Gen-Chu, Revised by He Bing-Yuan, 俞根初, 何炳元

Year: Qing dynasty

Source: Revised Popular Guide to the Discussion of Cold Damage (Chong Ding Tong Su Shang Han Lun, 重定通俗傷寒論)

Category: Formulas that Release the Exterior

Pattern: Taiyang Cold attacking the Lungs

Key Symptoms: Headache, chills, fever, absence of sweating, wheezing, nasal resonance, hacking cough, copious thin white sputum

Ingredients

Ma Huang

(entire stalks with nodes)

Pinyin: Ma Huang Chinese: 麻黄 Pharmaceutical: Herba Ephedrae Taxonomy: Ephedra sinica seu intermedia seu equisetina English: Ephedra Stem / Joint Pine / Joint Fir / Mormon Tea / Brigham Tea
Tastes: Pungent, slightly bitter, warm Meridians Entered: Lung and Bladder
Actions & Indications: Induces sweating and releases the Exterior Taiyang Stage Wind-Cold Invasion of the Lung, with anhidrosis, chills, fever, headache and a tight, floating pulse Disseminates and facilitates Lung Qi, calms wheezing and stops coughing Wind-Cold Obstructs Lung Qi Promotes urination and reduces oedema Externally generated oedema Warms and disperses Cold pathogens Wind-Cold Bi Cold extremities (Reynaud's disease) *Breaks up concretions, firmness, accumulations and gatherings (Shen Nong Ben Cao Jing)* Yin sores that are firm, deeply rooted and without a head
Standard Dosage: 1.5-9g in decoction to release the exterior, and 10-15g for the treatment of oedema. Maximum dose is 20g. Toxic dose is considered to be 30-45g but side effects and risks are possible at any dosage. Cautions: It is prohibited to be used for patients with deficient dyspnea without blockage of the lung qi and should be used with caution for patients with hypertension and insomnia because ephedrine can stimulate central nervous system and raise blood pressure. The Shang Han Lun recommends removing the nodes and decocting Ma Huang first, scooping the foam from the top of the decoction. It has been argued this is to reduce the "vexing" effects although the efficacy of this is debated and rarely done today. It should not be used in conjunction with MAOIs, central nervous system stimulants, alkaloids ergotamines and xanthines enhancing their effects by acting as a receptor level agonist. In the UK the maximum daily dose permitted without prescription is 1.8g daily in three 0.6g doses. This makes it difficult to achieve a pharmacologically active effect and must be complemented with other herbs that release the exterior and expel Wind-Cold such as Gui Zhi, Jing Jie, Fang Feng and Zi Su Ye. Huang Hua Zi (Sida cordifolia), more common in Ayurveda where it is known as Bala बला, also contains ephedrine at lower concentrations and has no legal restrictions placed on it by the UK MHRA. It is considered more cooling, Heat clearing and Damp draining without Exterior Releasing properties in Chinese medicine so best used as a substitute in Warm Diseases, especially Damp-Warm Disease, or supplemented with increased warm Exterior Releasing herbs like those described above.

Xing Ren

(unpeeled with the tips left on)

Gan Cao

Pinyin: Gan Cao Chinese: 甘草 Pharmaceutical: Radix Glycyrrhizae Taxonomy: Glycyrrhiza uralensis seu glabra seu inflata English: Liquorice Root
Tastes: Sweet, slightly cold Meridians Entered: Heart, Lung and Spleen (and all 12 meridians)
Actions & Indications: Tonifies the Spleen and augments Qi Spleen Qi Deficiency with shortness of breath, lassitude and loose stools Qi and Blood Deficiency with an irregular pulse and/or palpitations Heart Qi Deficiency or Heart Yang Deficiency Moistens the Lungs, resolves Phlegm and stops coughing Lung Heat or Cold Productive or non-productive coughing Moderates spasms and alleviates pain Painful muscle spasms of the abdomen and legs Clears Heat and relieves Fire Toxicity Raw for Toxic Heat with sore throat or carbuncles and sores (Chuang Yung) Antidote for many toxic substances (internal and topical) Poisoning Bites (after washing the wound, chew Gan Cao and apply a thick layer on the bite wound, changing whenever it dries out; Bao Xiang-Ao, 1846, New Compilation of Proven Formulas) Moderates and harmonizes the harsh properties of other herbs and guides the herbs to all twelve channels Often added in small doses to harmonise formulas Tonifies the Qi while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015) Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
Standard Dosage: Typically 1.5-9g in decoction. Large doses can be up 30g. Cautions: It is contraindicated for combining with Hai Zao, Da Ji, Gan Sui and Yuan Hua because of "eighteen antagonisms". It is also contraindicated in cases of dampness obstruction in middle energizer and edema because it can help dampness obstruct qi, and it is prohibited from long-term usage in large dosage (more than 20g/day) and should be avoided or used with extreme caution in patients with high blood pressure because it may raise aldosterone levels in the blood causing retention of sodium. The NHS recommends avoiding during pregnancy.

Bo He

Jin Ju

5sl

Da Zao

5pcs

Subsitutions:
In the UK Ma Huang is restricted to a maximum daily dose of 1.8g, or 0.6g per dose. If needed it can be supplemented or substituted with Zi Su Ye.

Preparation: Decoction.

Actions: Disseminates Lung Qi and releases the Exterior

Contraindications: Wind-Heat

Research Links:

American Dragon

TCMWiki

Journal of Chinese Medicine

National Resource Centre for Chinese Materia Medica, China

TCM-ID Integrated Database, East China Normal University

TCM-ID Information Database, National University of Singapore

Pubmed

Science Direct

Google Scholar

Bai Du (Chinese)

A+ Medical Encyclopedia (Chinese)

Reference Notes: (click to display)

These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.

Herb Formulas Notebook

新 加 三 拗 汤  Xin Jia San Ao Tang

Newly Augmented Three Unbinding Decoction