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 the Exterior
Pattern: Mild Exterior Cold invasion or oedema with pre-existing Yang deficiency
Key Symptoms: Slight fever and chills that is not relieved by wearing more clothing or adding covers or mild oedema with shortness of breath and urinary difficulty, exhaustion with an almost constant desire to sleep
Pulse: Submerged and faint
Ingredients
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Ma Huang
| 6g | |
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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 |
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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
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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. |
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Zhi Fu Zi
| 9g | |
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Pinyin: Fu Zi
Chinese: 附子
Pharmaceutical: Radix Aconiti Lateralis Praeparata
Taxonomy: Aconitum carmichaeli
English: Wolf's-bane Root / Monkshood Root / Aconite Root |
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Tastes: Pungent, sweet, hot, toxic
Meridians Entered: Heart, Kidney and Spleen |
Actions & Indications:
- Restores Devastated Yang and rescues from rebellion
Devastated Yang with diarrhoea containing undigested food, chills, cold extremities and a faint almost imperceptible pulse (often as a result of severe vomiting, diarrhoea or sweating)
- Warms Ming Men Fire and assists Heart, Kidney and Spleen Yang
Heart Yang Deficiency
Spleen Yang Deficiency
Kidney Yang Deficiency
- Disperses Cold and Dampness, warms the channels and stops pain
Wind-Damp-Cold Bi
Cold blocking the organs, channels, bones and Blood vessels
Yin flat abscesses
Gu Parasites /
chronic inflammatory disease (Fruehauf, 2015)
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Standard Dosage: 3-15g in decoction. Fire Spirit practitioners prescribe doses of 60-200g per day (Fruehauf, 2009).
Cautions: It is contraindicated for heat syndrome, yin-deficiency leading to hyperactivity of yang and the pregnant because of its pungent, hot, dry and drastic properties. It must be soaked and decocted for about half and hour to one hour until numbing taste disappears for oral use. Over-dosage and incorrect processing must be avoided.
This herb is prohibited from use in the UK under the banned and restricted herbal ingredients list issued by the MHRA. It is generally substituted with various Yang tonics depending on the presentation although none can imitate its powerful cardiovascular effects making them ineffective substitutes for rescuing devastated Yang. External use is permitted at 1.3% or below. |
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Gan Cao
| 6g | | |
Pinyin: Gan Cao
Chinese: 甘草
Pharmaceutical: Radix Glycyrrhizae
Taxonomy: Glycyrrhiza uralensis seu glabra seu inflata
English: Liquorice Root |
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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).
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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. |
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Subsitutions:
In the UK almost this entire formula needs to be substituted, Ma Huang being strictly limited, Fu Zi being banned and Xi Xin being available but voluntarily banned by the RCHM. Some substitution suggestions include:
Ma Huang == 1.8g Ma Huang + Jing Jie + Fang Feng + Zi Su Ye
Fu Zi == Gan Jiang + Rou Gui
The dosage restrictions on Ma Haung also mean it should be taken in three 0,6g doses per day.
Preparation: Originally Ma Huang is decocted in 10 cups of water until 8 remain, the froth removed and the other ingredients added until 3 cups remain. The strained decoction is then taken in 3 doses over the course of a day. At present Fu Zi is cooked first for 30-60 minutes until there is no numbing of the tongue upon tasting and then the other ingredients are added to the decoction.
Actions: Assists the Yang, releases the Exterior
Contraindications: Only for use in mild Yang deficiency. Where it is severe and there is undigested food in the stool and the pulse is almost imperceptible it could devastate the Yang.
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:
Reference Notes: (click to display)
Most formulas are found in Scheid, Bensky, Ellis & Barolet (2009): Chinese Herbal Medicine: Formulas & Strategies and Chen & Chen (2015) Chinese Herbal Formulas and Applications. Others are from translations of primary sources. It is recommended that the original material is cross-referenced for mistakes and additional information.
Substitutions have been taken from Ken Lloyd & Prof. Leung (2004): Mayway UK Substitution List or the above publications and are intended as suggestions to help navigate the tight restrictions in the UK quickly. More applicable substitutions may be appropriate in specific situations.
Individual herb information has initially been sourced from TCM Wiki and American Dragon for basic data and then updated manually with my own notes.
These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.