Chu Qi Han Shi Yu Fei Fang - 初寒湿郁肺方 - Early Stage Cold-Damp Lung Stagnation Prescription

Author: Wei Pei-Fang (editor), National Health Commission & National Administration of Traditional Chinese Medicine

Year: 2020

Source: Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7), Chinese Medical Journal 2020, 133(9): 1087-1095. doi: 10.1097/CM9.0000000000000819

Category: Formulas that Expel Dampness

Pattern: Early Stage Cold Damp Stagnation in the Lung from Coronavirus infection

Key Symptoms: Fever, fatigue, sore body, cough, expectoration, chest tightness, suffocation, loss of appetite, nausea, vomiting, sticky stools

Tongue: Teeth marks or light red body with thick white or greasy coating
Pulse: Soggy or slippery

Ingredients

Ma Huang

(raw)

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.

Shi Gao

15g

(raw)

15g

15g

15g

Pinyin: Di Long Chinese: 地龙 Pharmaceutical: Pheretima seu Lumbricus Taxonomy: Pheretima seu Lumbricus English: Earthworm
Tastes: Salty, cold Meridians Entered: Liver, Spleen and Bladder
Actions & Indications: Drains Heat, settles convulsions, extinguishes Wind and stops spasms Extreme Heat generating Wind with loss of consciousness, incoherent speech, convulsions and seizures It can be used alone It has recently been used to treat schizophrenia of the hot-manic type Clears Heat and unblocks and promotes movement in the channels and collaterals Hot or Cold Bi (with appropriate herbs) with swollen, painful joints with a reduced range of motion Hemiplegia due to lack of flow in the channels such as the sequelae of Wind-Stroke Clears Heat and calms wheezing Wheezing due to Lung Heat (can be taken alone as a powder, in capsules or decocted with sugar as a syrup) Clears Heat and promotes urination Hot, painful urinary dysfunction, oedema (severe cases), ascites and jaundice Especially useful for Heat clumping in the Bladder with urinary difficulty or inability to urinate (can be used alone) Anchors Liver Yang and lowers Blood pressure Hypertension due to Liver Yang Rising Promotes healing topically Acute parotitis, chronic ulcers of the lower limbs, burns, boils or carbuncles (powder, mix with sugar and apply topically) Removes the Three Worms and Hidden Corpses, Ghost Possession and Gu Toxins White necked earthworms (白頸蚯蚓 Bai Jing Qiu Yin) are said in the Shen Nong Ben Cao Jing to remove the Three Worms (三蟲) and Hidden Corpses (伏尸), Ghost Possession (鬼注) and Gu Toxins (蠱毒) and kills Long Worms (殺長蟲), suggesting their use to treat a number of invisible, supernatural diseases, presumably because of their own worm-like nature and non-toxic nature.
Standard Dosage: 5-10g in decoction. Cautions: 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 Xi Xian Cao and Gou Teng, although vines like Ji Xue Teng or Ye Jiao Teng could be appropriate too if the principle of worms and vines entering the channels and collaterals wants to be preserved.

15g

15g

15g

45g

30g

(raw)

Shan Zha

(dry fried)

Shen Qu

(dry fried)

Mai Ya

(dry fried)

Hou Po

15g

Bing Lang

(dry fried)

Cao Guo

Sheng Jiang

15g

Subsitutions:
Several herbs have to be substituted in the UK but the formula can be used as a base with which to derive others.

Preparation: Decoction. Boiled with 600 ml water, taking 1/3 of the dose in the morning, 1/3 at noon and the rest in the evening respectively before meal.

Actions: Expels Cold and transforms Dampness, moves stagnation and stop coughing

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

初 寒 湿 郁 肺 方  Chu Qi Han Shi Yu Fei Fang

Early Stage Cold-Damp Lung Stagnation Prescription