Herb Formulas Notebook

Ban Xia Xie Xin Tang

Pinellia Decoction to Drain the Heart


Author: Zhang Zhong-Jing, 張仲景

Year: c. 220

Source: Discussion of Cold Damage (Shang Han Lun, 傷寒論)


Category: Formulas that Harmonise

Pattern: Jueyin Syndrome with Heat Above, Cold Below and significant Deficiency; Spleen and Stomach Deficiency Cold with Damp-Heat obstructing the middle Jiao

Key Symptoms: Epigastric focal distention, fullness and tightness with little or no pain, nausea and vomiting, tendency to diarrhoea
Secondary Symptoms: Reduced appetite, dry heaves, belching or hiccup, borborygmus, mouth ulcers, fatigue, neck and shoulder stiffness, restlessness, insomnia

Tongue: Thin, yellow and greasy coating. May have red tip.
Pulse: Wiry, rapid
Abdomen: Hardness and tension in the epigastrium, tension in rectus abdominis muscle, elastic tension and tenderness on pressure around Ren-12, splashing sounds in upper abdomen


Ingredients

Zhi Ban Xia 9-12g
Gan Jiang 9g
Huang Qin 9g
Huang Lian 3g
Ren Shen 9g
Zhi Gan Cao 9g
Da Zao 4pc


Preparation: Decoction.


Actions: Harmonises the Stomach, directs rebellious Qi downward, disperses clumping, eliminates focal distention

Contraindications: Focal distention due to Qi stagnation or harboured food



Notes:
For more pronounced deficiency presentations with restlessness and insomnia increase Zhi Gan Cao to 12g to make Gan Cao Xie Xin Tang.

An alternative version of Gan Cao Xie Xin Tang is presented in the Essential From the Golden Cabinet that used unprocessed Gan Cao to treat restlessness depression with ulceration of the mouth, genitals and anus as a result of Fox Vermin Disease.

For more substantial signs of water clumping or food stagnation and thin mucus lingering internally characterised by dry heaves with a foul odour, the sounds of fluids in the epigastrium, loud borborygmus and diarrhoea, add 12g of Sheng Jiang to make Sheng Jiang Xie Xin Tang.

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This formula is almost identical to Xiao Chai Hu Tang with Chai Hu switched to Huang Lian and Sheng Jiang changed to Gan Jiang. This shifts the focus of the formula from the Shaoyang level, regulating Qi, to the Jueyin level, simultaneously clearing Heat from the Upper Jiao while warming deficiency Cold in the Lower Jiao and resolving a mixture of the two in the Middle.

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One liang is taken as 3g in modern sources but in Eastern Han times it was equivalent to 13.875g. This means that the dosages in classical formulae could have been more than 4x what is given today making them far higher than recommended safe dosages today but prompts consideration of what an effective dose may be (He, 2013).

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Liu Lihong (2019: 532-5, Classical Chinese Medicine) describes using this formula for insomnia due to the relation of the eyes to the trigram Li ☲, Fire, and the eyelids, governed by the Spleen and Stomach, as Kun ☷, Earth. Sleep is therefore represented by the Hexagram ䷣ 明夷 Mingyi, "Darkening the Light", Fire sinking under Earth, which has the image of a sunset. By using Ban Xia to remove obstructions, Huang Lian and Huang Qin to lower Fire and Gan Jiang, Ren Shen, Zhi Gan Cao and Da Zao to raise Earth, this formula exemplifies the hexagram ䷣ 明夷 Mingyi.

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Bob Flaws (2008) provides an example of this formula distilled in alcohol under the heading Ban Xia Ren Shen Jiu.



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