Chai Hu Jia Long Gu Mu Li Tang - 柴胡加龍骨牡蠣湯 - Bupleurum Plus Dragon Bone and Oyster Shell Decoction

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: Shaoyang constraint with Heat agitating the Shen

Key Symptoms: Fullness in the chest, emotional instability and mood swings involving irritability, fear and anger, heaviness or stiffness in the upper body
Secondary Symptoms: Insomnia, depressive moods, headaches or heavy-headedness, dizziness, pain or tension in the shoulder or neck, palpitations or rapid heartbeat, urinary difficulty, constipation

Tongue: Red tip, slippery and white or yellow coating
Pulse: Wiry, rapid, forceful
Abdomen: Tenderness in hypochondrium, palpable periumbilical pulsations

Ingredients

Chai Hu

12g

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 The Shen Nong Ben Cao Jing says "It weeds out the stale to bring forth the new." 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 The Shen Nong Ben Cao Jing says "It mainly treats bound qi in the heart, abdomen, intestines, and stomach, food stagnation, cold and heat, and evil qi." 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.

4.5g

4.5g

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.

Fu Ling

4.5g

Long Gu

4.5g

Pinyin: Long Gu Chinese: 龙骨 Pharmaceutical: Ossa Draconis English: Fossilised Bones
Tastes: Sweet, astringent, neutral Meridians Entered: Liver, Heart and Kidney
Actions & Indications: Settles anxiety and calms the Spirit Agitated Heart and Spirit with emotional distress, restlessness, insomnia, palpitations with anxiety, seizures, or withdrawal mania Calms the Liver and anchors and preserves Floating Yang Irritability, restlessness, dizziness, vertigo, blurred vision and a bad temper due to Liver Yin Deficiency with Liver Yang Rising Prevents leakage of fluids Loss of fluids due to Deficiency with spermatorrhea, night sweats, spontaneous sweating, nocturnal emissions, vaginal discharge and uterine bleeding Topically generates muscles and astringes ulcers Chronic non-healing sores and ulcerations Treats Ghost Possession Said in the Shen Nong Ben Cao Jing to treat Heart and Abdomen Ghost Possession, Spiritual Matters (精物 Jing Wu) and Old Ghosts (老鬼). This refers to difficult to treat disorders thought to be of supernatural origin. Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of animal parts which can, with protracted taking, make the body light, enable one to communicate with the Spirit Light (Shen Ming 神明), and lengthen the lifespan. 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. 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 Bai Shao and Wu Wei Zi. 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) could be considered, especially if other signs such as oesteoporosis or muscle cramps are present and 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.

Mu Li

4.5g

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.

Da Huang

(add just before end)

Pinyin: Da Huang Chinese: 大黄 Pharmaceutical: Radix et Rhizoma Rhei Taxonomy: Rheum palmatum English: Chinese Rhubarb Root
Tastes: Bitter, cold Meridians Entered: Large Intestine, Spleen, Stomach, Liver and Heart
Actions & Indications: Drains Heat and purges accumulations Intestinal Heat Excess, with high fever, profuse sweating, thirst, constipation, abdominal distention and pain, delirium, a yellow tongue coat and a full pulse Yang-Ming Fu Stage Qi Level Heat in the Intestines Drains Fire Fire from Excess with intense fever, sore throat, and painful eyes and constipation Fire toxin sores due to Xue Level Heat, especially with constipation Clears Heat, transforms Dampness and promotes urination Damp-Heat with oedema, jaundice, painful urinary dysfunction and acute, hot dysenteric disorders Drains Heat from the Blood Bloody stool either from hemorrhoids or Heat in the Intestines Chaotic movement of hot Blood with hemoptysis or epistaxis with constipation It can be powdered and administered orally for bleeding in the upper digestive tract Invigorates the Blood and dispels Blood Stasis Blood Stasis with amenorrhea, fixed abdominal masses or fixed pain Blood Stasis due to traumatic injury Intestinal abscess Clears Heat and reduces Fire toxicity Topically or internally for burns or skin lesions (Chuang Yung) due to Heat Clears Heat and eliminates Phlegm Chronic Accumulation of Phlegm-Heat with cough, dyspnea, mania, disorientation and other symptoms of Phlegm Misting the Heart
Standard Dosage: 10-15g in decoction. Excessive decoction will reduce the purgative action. Therefore it should be added at end to achieve this purpose and over-decocted to eliminate this action. Cautions: It should be used with caution in case of spleen and stomach deficiency for its bitter and cold property which is easily to damage stomach qi. It is contraindicated to women during pregnancy, menstruation or lactation for it has actions of activating blood and resolving stasis, and can make the purged substances follow lactating out.

Sheng Jiang

3sl

Da Zao

6pc

Subsitutions:
In the UK several of the chief ingredients need to be substituted. Standard substitutions from Mayway are:

Long Gu == Bai Shao + Wu Wei Zi
Mu Li == Xuan Shen + Bai Shao + Wu Wei Zi.

Another option to really focus on the Shen would be to replace Ren Shen with Dan Shen and Long Gu and Mu Li with Hu Po, Wu Wei Zi and Xuan Shen.

Some other alternatives could include Fu Xiao Mai, Ye Jiao Teng or Zhi Zi Dan Dou Tang.

If calcium deficiency is suspected to be the rationale for using Long Gu + Mu Li then supplementation may advisable.

Preparation: Decoction.

Actions: Unblocks the Taiyang and Yangming via the Shaoyang, drains Heat, sedates and calms the Shen

Contraindications: Deficiency conditions, pregnancy, long term use

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 加 龍 骨 牡 蠣 湯  Chai Hu Jia Long Gu Mu Li Tang

Bupleurum Plus Dragon Bone and Oyster Shell Decoction