Author: Zhang Zhong-Jing, 張仲景
Year: c. 220
Source: Discussion of Cold Damage (Shang Han Lun, 傷寒論)
Category: Formulas that Drain Downward
Pattern: Suspended Thin Mucus (Xuan Yin) clogging up the chest and ribsides.
Key Symptoms: Cough with pain the chest and hypochondria, hard focal distention in the epigastrium
Secondary Symptoms: Dry heaves, shortness of breath, headache, vertigo
Tongue: White slippery coating
Pulse: Submerged and wiry
Abdomen: Hard focal distention in the epigastrium
Ingredients
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Gan Sui
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Pinyin: Gan Sui
Chinese: 甘遂
Pharmaceutical: Radix Euphorbia Kansui
English: Sweet Spurge Root |
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Tastes: Bitter, cold, toxic
Meridians Entered: Lung, Kidney, and Large Intestine |
Actions & Indications:
- Drains water downward and eliminates congested fluids and thin mucus
Severe accumulation of fluid in the chest and abdomen Generalized oedema, facial oedema and abdominal distention
- Expels Phlegm
Epilepsy due to Phlegm Blocking the Heart Orifices Seizures from Wind-Phlegm Withdrawal mania from recalcitrant Phlegm congealing and clumping
- Clears Heat, reduces swelling and disperses hardenings
Swollen, painful, nodular Damp-Heat skin lesions (topical-appropriate for early stages, with oral ingestion of herbs that clear Heat and resolve toxicity)
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Standard Dosage: 0.5-1g in powder form. The active form does not dissolve in water so decoction should be avoided.
Cautions: It is contraindicated to the pregnant women and those anxious about their health. It is antagonistic to Gan Cao. |
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Jing Da Ji
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Pinyin: Jing Da Ji
Chinese: 京大戟
Pharmaceutical: Radix Euphorbiae Pekinensis
Taxonomy: Euphorbia Pekinensis
English: Peking Euphorbia Root |
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Tastes: Bitter, Cold, Toxic
Meridians Entered: Large Intestine, Lung, and Kidney |
Actions & Indications:
- Drives out water accumulation
Oedema, swollen abdomen and fluid in the lungs
- Dissipates swelling and nodulation
Sores and abscesses
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Standard Dosage: 0.5-1g washed in vinegar to reduce toxicity and prepared as powder or pills.
Cautions: It is contraindicated to pregnancy and valetudinarian, and antagonistic to Gan Cao. |
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Yuan Hua
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Pinyin: Yuan Hua
Chinese: 芫花
Pharmaceutical: Flos Genkwa
English: Daphne Genkwa Flower |
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Tastes: Bitter, pungent, warm, toxic
Meridians Entered: Large Intestine, Lung, and Kidney |
Actions & Indications:
- Drains water downward, drives out thin mucus and promotes urination
Accumulation of fluid in the chest, flanks, and abdomen (harsh cathartic and diuretic)
- Resolves Phlegm and stops cough
Coughing and wheezing
Chronic bronchitis with a preponderance of Dampness and Cold (can be taken alone with sugar)
- Kills parasites (topical)
Parasitic infestations such as tinea
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Standard Dosage: 1.5-3g in decoction. 0.6g in powder or pill form.
Cautions: It is contraindicated to pregnancy and valetudinarian, and antagonistic to Gan Cao. |
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Da Zao
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Pinyin: Da Zao
Chinese: 大枣
Pharmaceutical: Fructus Jujubae
English: Jujube Berry / Black Date / Chinese Date |
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Tastes: Sweet, warm
Meridians Entered: Spleen, Stomach and Heart |
Actions & Indications:
- Tonifies the Spleen and Stomach and augments Qi
Spleen and Stomach Deficiency with weakness, shortness of breath, lassitude, anorexia and loose stools
- Nourishes the Blood and calms the Spirit
Blood Deficiency
Restless Organ Syndrome with wan complexion, irritability and severe emotional debility
- Moderates and harmonizes the harsh properties of other herbs
Added to formulas with to counter harsh, drying and draining herbs by fortifying the Spleen, nourishing Blood and settling the Spirit.
- 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: 10-30g in decoction.
Cautions: It is used with cautions in cases of damp-phlegm or food stagnation because it can help dampness produce heat, and induce distention in middle energizer. |
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Subsitutions:
In the UK Gan Sui and Da ji must be substituted. Few other things have their harsh action but Qian Niu Zi and Ting Li Zi may suffice.
Preparation: Grind equal amounts of the first three herbs into powder and take in 0.5-1g doses (may be encapsulated) in the early morning on an empty stomach with a decoction made from the 10 pieces of Da Zao.
Begin with a low dosage that should produce discomfort in the epigastrium followed by borborygmus and abdominal pain that diminishes after a watery bowel movement. Each dose should produce 5-6 bowel movements. If too few then increase the dose. If too many and the patient becomes weak then prescribe easily digested foods (e.g. rice gruel) and tonics.
Actions: Purges and drives out thin mucus.
Contraindications: Extreme caution in weak or pregnant patients. If severe diarrhoea occurs treat with cold rice porridge. If weak then it should be taken in alternation with one that strengthens the Spleen and augments the Qi.
Preparing the entire formula as a decoction should be avoided as it may increase the effects. Preparing the main herbs with vinegar before use may reduce the potential side effects.
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.
