Herb Formulas Notebook

Da Chai Hu Tang

Greater Bupleurum 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 Release Exterior-Interior Excess

Pattern: Concurrent Shaoyang and Yangming disorder

Key Symptoms: Alternating chills and fever, fullness in the chest and hypochondria (with or without pain), irritability
Secondary Symptoms: Bitter taste, dizziness, temporal headaches, tension in neck and shoulders, tinnitus, nausea, vomiting, constipation or burning diarrhoea, melancholy

Tongue: Dry and white or yellow coat
Pulse: Wiry and forceful, rapid and slippery, deep, excessive and slow
Abdomen: Hard focal distention or fullness and pain in the epigastrium extending to the flanks and abdomen


Ingredients

Chai Hu 15-24g
Huang Qin 9g
Zhi Ban Xia 9g
Bai Shao 9g
Zhi Shi 9g
Da Huang 6g
Sheng Jiang 10sl
Da Zao 4pc

Subsitutions:
There is debate as to whether Da Huang is included in this formula or not, some saying that the line from Shang Han Lun suggests purging has already failed and should not be tried again, others saying it is not Da Chai Hu Tang without Da Huang and that this formula only purges mildly, compared with Da Cheng Qi Tang which is what has failed. It has also been suggested that there may have been to versions of this formula, with and without Da Huang, depending on the circumstances (Liu, 2016, Discussion of Cold Damage, p. 321-4).


Preparation: Decoction. Boil in 2.4 L of water until 1.2 L remain. Administer 200 ml three times per day when it is lukewarm.


Actions: Harmonises and releases Shaoyang, drains internal clumbing due to Heat

Contraindications: Deficiency



Notes:
This is a combination of Xiao Chai Hu Tang (minus Ren Shen and Gan Cao) and Si Ni San (minus Gan Cao, so it no longer contains Shao Yao Gan Cao Tang) and Xiao Cheng Qi Tang (minus Hou Po), to make a formula that strongly treats Shaoyang and Yangming Excess with no tonification.

The removal of Gan Cao is interesting because it also removes Shao Yao Gan Cao Tang from the formula, which would be useful to help with intestinal spasms and the GI disorders it appears to treat. However, the focus of this formula is purgation and Gan Cao causes the anthroquinones in Da Huang, that are responsible for its laxative actions, to form insoluble precipitates, and reduces their uptake by the gut, especially of rhein (Peng et al., 2018; Jiang et al., 2020). Therefore, the addition of Gan Cao would reduce the purgative aspect of the formula.

This modification (removing Da Huang and reinstating Gan Cao) could therefore be a good candidate for modern GI disorders like dysbiosis and IBS since it would regulate Shaoyang and drain Dampness (Xiao Chai Hu Tang), release Qi constraint (Si Ni San) and alleviate spasms (Shao Yao Gan Cao Tang). Further modifications could include removing Da Zao to remove the fermentable sugar content and reinstating Ren Shen to provide some tonification, or adding Hou Po to reinstate part of Xiao Cheng Qi Tang to include a Yangming draining aspect and emphasise the Damp clearing properties, including some Phlegm transforming aspects, while also incorporating the core of Ban Xia Hou Po Tang, often used for nervous disorders like Plum Pit Qi.

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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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Ploberger (2017), in Westliche und traditionell chinesische Heilkräuter, offers the following alternative using western herbs:

Herba Alchemillae(Lady's Mantle)3g(Emperor)
Herba Millefolii(Yarrow)3g(Minister)
Pericarpium Citri ret.(Orange peel)3g(Minister)
Radix et Rhizome Rhei (Rhubarb root)3g(Minister)
Radix Paeoniae alba(White Peony)4g(Assistant)
Rhizoma Zingiberis recens(Fresh Ginger)3g(Envoy)
Fructus Jujubae(Jujube berries)4pc(Assistant)



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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.