Chai Hu Gui Zhi Gan Jiang Tang - 柴胡桂枝干姜湯 - Bupleurum, Cinnamon Twig and Dried Ginger Decoction

Author: Zhang Zhong-Jing, 張仲景

Year: c. 220

Source: Essentials from the Golden Cabinet (Jin Gui Yao Lue, 金匱要略)

Category: Formulas that Harmonise

Pattern: "Straight Malaria" (正瘧, Zheng Nue): a pathogen lurking in the Shaoyang is stirred by a newly contracted Wind-Cold disorder in late autumn

Key Symptoms: Malarial disorders with pronounced chills and only slight fever or without fever, cold extremities, aversion to drafts, headache, pain in the hypochondria, thirst

Tongue: White, slippery coating
Pulse: Wiry and tight on the left, or wiry and slow on the right

Ingredients

Chai Hu

24g

Pinyin: Chai Hu Chinese: 柴胡 Pharmaceutical: Radix Bupleuri Taxonomy: Bupleurum chinense (Nan Chai Hu) seu scorzoneraefolium (Bei Chai Hu) English: Hare's Ear Root / Thorowax Root
Tastes: Bitter, pungent, slightly cold Meridians Entered: Liver and Spleen
Actions & Indications: *Resolves Shaoyang* disorders and reduces fever (harmonizes the Exterior and Interior)** Shaoyang Stage with alternating chills and fever, a bitter taste,dizziness, tinnitus, flank pain, irritability, vomiting and a stifling sensation in the chest Deficiency Heat (auxiliary) Gallbladder Fire Spreads Liver Qi and relieves Stagnation Liver Qi Stagnation with dizziness, vertigo, chest and flank pain, emotional instability and menstrual problems Disharmony between the Liver and Spleen with epigastric and flank pain, a stifling sensation in the chest, abdominal bloating, nausea and indigestion Liver/Gallbladder Disharmony Raises Yang Qi (specifically the Clear Qi of the Stomach and Gallbladder) Spleen and Stomach Yang Deficiency, Qi collapse (prolapse) with hemorrhoids, vaginal discharge, bleeding or exhaustion Disperses Wind-Heat and resolves Phlegm and congestion Wind-Heat *Guides herbs to the Shaoyang* aspects of the head** Shaoyang headaches Releases the Exterior and Drives Out Snakes Relieves the symptoms of Gu Sydnrome while suppressing parasites (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 brighten the eyes and boost the Essence. 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: Up to 3g to raise sinking Qi, 6-9g to relieve Liver Qi stagnation, 12-24g to release the exterior. Cautions: Anyone who has syndromes of yin deficiency with yang hyperactivity, stirring of liver wind, yin deficiency with effulgent fire and qi going upward adversely, this herb should be used with cautions.

Gui Zhi

Pinyin: Gui Zhi Chinese: 桂枝 Pharmaceutical: Ramulus Cinnamomi Taxonomy: Cinnamomum cassia English: Cinnamon Twig
Tastes: Pungent, sweet, warm Meridians Entered: Lung, Heart, Kidney, Liver
Actions & Indications: *Releases the Exterior, assists Yang, adjusts the Ying* and Wei and releases the muscle layer** Taiyang Wind Strike (Taiyang Zhongfeng, 太阳中风) - a weak person who catches cold easily with spontaneous sweating, aversion to drafts, fever and chills, nasal congestion, stiff and aching head and muscles Warms the channels and collaterals to relieve pain Wind-Cold-Damp Bi *Unblocks Yang* and transforms Qi and thin mucus Edema due to Cold-Phlegm or Yang Qi Deficiency with urinary dysfunction, dizziness and palpitations Assists Heart Yang and warms and facilitates the flow of Yang Qi in the chest** Palpitations due to Yang Obstruction in the chest due to Stagnation or Deficiency Listless chest Yang with upward movement of Phlegm and thin mucus and disorderly descent of Lung Qi with shortness of breath, chest and back pain and palpitations Heart and Spleen Yang Deficiency Warms and facilitates the flow of Qi through the channels and collaterals and Blood through the vessels Wind-Cold-Damp Bi Blood Stasis due to Cold, causing amenorrhea or dysmenorrhea with or without abdominal masses *Warms the Middle and directs Turbid Yin* downward** Middle Jiao Yang Deficiency Heart and Spleen Yang Deficiency (patient usually craves sweets) 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, prevent forgetfulness, and render the face bright and efflorescent, thus forever looking charming, like a child's face. 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: 3-10g in decoction for exterior conditions, or up to 15g for Bi Syndromes. Cautions: This herb induces heat, damages the yin and moves blood. It is prohibited for those with warm pathogens, yin deficiency with effulgent fire, or reckless movement of the blood due to heat in the blood. Use with caution in pregnant women.

Gan Jiang

Tian Hua Fen

12g

Huang Qin

Mu Li

Pinyin: Mu Li Chinese: 牡蛎 Pharmaceutical: Concha Ostreae English: Oyster Shell
Tastes: Salty, astringent, slightly cold Meridians Entered: Liver and Kidney
Actions & Indications: Heavily settles and calms the Spirit Agitated Heart and Spirit with palpitations with anxiety, restlessness and insomnia Calms the Liver, benefits Yin and anchors Floating Yang Liver Yin Deficiency with Liver Yang Rising or Yin Deficiency with internal Heat with restlessness, irritability, palpitations and spontaneous sweating Prevents leakage of fluids Continuous sweat after febrile disease or in patients with steaming bone disorder Loss of fluids due to Deficiency with night sweats, spontaneous sweating, nocturnal emissions, spermatorrhea or vaginal discharge and uterine bleeding Softens hardness and dissipates nodules Various kinds of lumps particularly neck lumps such as goiter or scrofula Absorbs acidity and alleviates pain (calcined) Excessive Stomach pain with a sour taste in the mouth Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of animal parts which can, with protracted taking, fortify the bones and joints (骨节 Gu Jie), kill evil ghosts (邪鬼 Xie Gui), 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: 15-30g in decoction. Cautions: The high mineral content of this medication may prevent the oral absorption of the fluoroquinolone class of antibiotics. Caution should also be taken due to the possibility of heavy metal absorption from the oysters' environment. If decocting it is advisable to leave the dregs at the bottom as heavy metal particles will naturally sink. It is still probably advisable to avoid for long term use unless the source is known to be clean. Animal products are prohibited from use in the UK under the Medicines Act 1968 ch. 67 which restricts herbalists to the use of plant products only. It is generally substituted with Xuan Shen, Bai Shao and Wu Wei Zi or Tian Ma. If viewed from a western perspective as a source of calcium which may cause sleep disturbances, then supplementation or inclusion of high calcium/magnesium content herbs (e.g. Kun Bu which is also salty and softens nodulation) could be considered, especially if other signs such as oesteoporosis or muscle cramps are present and the risk of side effects from calcium/magnesium supplements are low (stones, calcified arteries, GI issues). However, this assumes a mechanism which does not match many of the traditional patterns for which it is prescribed.

Zhi 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.

Subsitutions:
In the UK Mu Li must be substituted with Xuan Shen, Bai Shao and Wu Wei Zi or Tian Ma.

Preparation: Decoction.

Actions: Harmonises and releases the Shaoyang, disperses clumping, warms the Interior and dispels Cold

Contraindications: Pure excess or pure deficiency patterns

Notes:
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).

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

柴 胡 桂 枝 干 姜 湯  Chai Hu Gui Zhi Gan Jiang Tang

Bupleurum, Cinnamon Twig and Dried Ginger Decoction