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 Release the Exterior
Pattern: Damp-Cold in the Exterior or invasion of Wind-Dampness with chronic Spleen Qi deficiency and Internal Damp
Key Symptoms: Pronounced body aches with irritability
Secondary Symptoms: Cough, wheezing, headaches, simultaneous fever and chills, aversion to cold with absence of sweating
Tongue: White coating
Ingredients
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Ma Huang
| 6-9g | |
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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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Bai Zhu
| 6-12g | |
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Pinyin: Bai Zhu
Chinese: 白朮
Pharmaceutical: Rhizoma Atractylodes macrocephalae
Taxonomy: Atractylodes macrocephala
English: Largehead Atracylodes Rhizome |
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Tastes: Sweet, bitter, warm
Meridians Entered: Spleen and Stomach |
Actions & Indications:
- Tonifies the Spleen and augments Qi
Spleen and Stomach Deficiency with diarrhoea, fatigue, a sallow complexion and lack of appetite
Spleen Yang failure to rise
- Dries Dampness and promotes water metabolism
Spleen Damp or accumulation of fluids affecting the digestion
Edema and reduced urination due to Spleen Deficiency (failure to transform and transport)
Tan Yin, masses, swelling
Auxiliary for Damp painful obstruction
- Stabilizes the Exterior and stops sweating
Qi Deficiency with spontaneous sweating (Wei Qi Deficiency)
With appropriate herbs, other types of sweating
- Calms the fetus
Restless fetus disorder due to Spleen Qi Deficiency
With appropriate herbs, other types of Restless Fetus Disorder
- 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, prolong life and make one free from hunger. 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: 6-12g in decoction.
Cautions: Use with cautions in cases of yin deficiency with fluid injury by dryness-heat pathogen. |
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Gui Zhi
| 4-6g | |
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Pinyin: Gui Zhi
Chinese: 桂枝
Pharmaceutical: Ramulus Cinnamomi
Taxonomy: Cinnamomum cassia
English: Cinnamon Twig |
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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).
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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. |
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Xing Ren
| 6-9g | |
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Pinyin: Xing Ren
Chinese: 杏仁
Pharmaceutical: Semen armeniacae
Taxonomy: Prunus armeniaca seu mandshurica seu sibirica
English: Bitter Apricot Kernel |
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Tastes: Bitter, slightly warm, slightly toxic
Meridians Entered: Lung and Large Intestine |
Actions & Indications:
- Stops coughing and calms wheezing
Coughs due to either Heat or Cold (depending on combination) Wind-Dry coughs (especially useful)
- Moistens the Intestines and unblocks the bowels
Constipation
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Standard Dosage: 3-10g in decoction.
Cautions: It should not be overused for its slight toxicity. It should be used with cautions for infants and patients with diarrhea. |
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Zhi Gan Cao
| 3g | | |
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 the maximum legal dose of Ma Huang allowed without prescription is 1.8g per day, and a maximum of 0.6g per administration. This makes it difficult to get the effects required. If necessary it can be substituted with Zi Su Ye, Jing Jie and Fang Feng or Wei Ling Xian.
Preparation: Decoction. Do not cook for more than 20 minutes.
Actions: Releases the Exterior, expels Wind, resolves Dampness, strengthens the Spleen
Contraindications: Recent blood loss, patients prone to bleeding (especially nosebleeds), hypertension, anxiety and restlessness in patients who tend to be overstimulated
Notes:
In order to mitigate the agitation causing effects of Ma Huang it may be fried in honey first and when decocted the froth removed from the surface with a spoon.
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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).
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.