Shuang Jie Tong Sheng San - 双解通圣丸 - Double Releasing Powder Powder that Sagely Unblocks

Author: Wu Qian, 吳謙

Year: 1742

Source: Golden Mirror of the Medical Tradition (Yi Zong Jin Jian, 醫宗金鑑)

Category: Formulas that Release Exterior-Interior Excess

Pattern: Heat excess in both Interior and Exterior (concurrent Taiyang, Shaoyang and Yangming disorder)

Key Symptoms: Strong fever and chills, light-headedness, dizziness, red and sore eyes, difficulty in swallowing, nasal congestion with a thick and sticky nasal discharge and saliva, bitter taste in the mouth, dry mouth, focal distention in the chest and diaphragm, dark rough urination
Secondary Symptoms: Carbuncles, facial sores, skin rashes, heat rashes, manic behaviour and intestinal wind, obesity and metabolic disorders with Exterior-Interior Heat.

Tongue: Yellow greasy coating
Pulse: Flooding and rapid, or wiry and slippery

Ingredients

Fang Feng

15g

Ma Huang

15g

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.

Jing Jie

15g

Bo He

15g

Zhi Zi

15g

Hua Shi

90g

Pinyin: Hua Shi Chinese: 滑石 Pharmaceutical: Talcum / Magnesium Silicate Taxonomy: Mg₃Si₄O₁₀(OH)₂ English: Talc / Talcum Powder
Tastes: Sweet, bland and cold Meridians Entered: Bladder, Lung and Stomach
Actions & Indications: Promotes urination and drains Heat from the Urinary Bladder (aids the movement of gravel and stones), (expels Damp-Heat) Hot Painful Urinary Dysfunction (Lin Syndrome) with hot, painful urination, dark, painful, burning, scanty urine Damp-Heat diarrhoea Qi Level Heat with Dampness with unremitting fever, heavy feeling in the body, thirst, yellow tongue coat Releases Summeheat and resolves Dampness Summerheat (fever, urinary difficulty, thirst) Absorbs Dampness and clears Heat (topically) Damp skin lesions (eczema, damp sores, prickly heat) Stops bleeding due to Heat Heat type bleeding Nosebleed, vomiting blood (taken internally) Bleeding from wounds and sores (topical) Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of minerals which can, with protracted taking, make the body light, free from hunger 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).
Standard Dosage: 10-20g in decoction, or applied externally. Cautions: Talc can cause granulomas in the rectum, vagina or wounds and prolonged external use has also been linked to ovarian (Wentzensen & O'Brien, 2021), stomach (Chang et al., 2020) and lung (Chang et al., 2017) cancer but other reviews contradict these findings (Goodman et al., 2020) suggesting this may only be an effect seen in rats (Prueitt et al., 2024). For safety it should therefore not be used for prolonged periods. It should also not be in inhaled as it can cause lung irritation and remain in the body for up to 40 years (Johnson, 2021). Mineral 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 Chi Fu Ling and Ze Xie.

30g

15g

30g

30g

15g

Pinyin: Dang Gui Chinese: 當歸 Pharmaceutical: Radix Angelicae sinensis Taxonomy: Angelica sinensis English: Chinese Angelica Root / Tang-Kuei / Dong Quai Root
Tastes: Sweet, Pungent, Warm Meridians Entered: Heart and Liver
Actions & Indications: Tonifies the Blood and regulates the menses Blood Deficiency, especially when affecting the Heart and Liver with pale, ashen complexion, lusterless nails, tinnitus, blurred vision and palpitations Blood Deficiency associated irregular menstruation, amenorrhea and dysmenorrhea Invigorates and harmonizes the Blood and disperses Cold (stops pain due to Blood Stasis) Blood Stasis causing abdominal pain and carbuncles and pain due to Blood Stasis from traumatic injury, especially when accompanied by Deficiency Cold Postpartum menstruation Pregnancy (use with caution) Blood Deficiency with chronic Wind-Damp-Bi Moistens the Intestines and unblocks the bowels Dry Intestines due to Blood Deficiency Reduces swelling, expels pus, generates flesh and alleviates pain Sores and abscess (Chuang Yung), internally and topically Stops coughing and treats dyspnea Used adjunctively for coughing Tonifies the Blood while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015)
Standard Dosage: 6-12g in decoction. Cautions: It is contraindicated in cases of Damp-Heat stagnating in the Middle, Lung Heat with Phlegm Fire, and Yin deficiency with effulgent Yang because it is warm and sweet in properties. In addition, it should be used with caution in cases of loose stool because it can moisten intestines to smooth stool. Many sources recommend using caution, avoiding or only taking under guidance of a TCM physician during pregnancy as it can cause uterine contractions. However, there are no studies supporting this and the only scientific literature seems to suggest that Z-Ligustilide has anti-spasmodic activities that alleviate dysmenorrhoea by inhibiting uterine contractions (Du et al., 2006; Dietz et al., 2016). Caution is also advised in breast cancer patients due to its oestrogen stimulating activity. This based upon Lau et al (2005) who found it may stimulate breast cancer growth in vitro, however Yue et al, (2019) demonstrated that it is not that stimulatory in breast cancer both in vitro and in vivo through a series of tests, although they suggested it should still be used with caution in estrogen receptor-positive breast cancer. Conversely, a large population study in Taiwan by Wu et al (2014) found it reduced the subsequent risk of endometrial cancer in breast cancer survivors taking tamoxifen, especially in those of reproductive age.

Bai Shao

15g

Bai Zhu

15g

Gan Cao

60g

Pinyin: Gan Cao Chinese: 甘草 Pharmaceutical: Radix Glycyrrhizae Taxonomy: Glycyrrhiza uralensis seu glabra seu inflata English: Liquorice Root
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).
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.

Subsitutions:
In the UK several substitutions must be made:
Hua Shi == Chi Fu Ling + Ze Xie
Shi Gao == Zhi Mu

Preparation: Ground into powder and taken in 6-9g doses as a draft with 3 pieces of Sheng Jiang. May also be prepared as a docoction with mofified dosage.

Actions: Disperses Wind, releases the Exterior, drains Heat, unblocks the bowels.

Notes:
This is the same as Fang Feng Tong Sheng San minus Da Huang and Huang, for the same presentation without constipation.

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

双 解 通 圣 丸  Shuang Jie Tong Sheng San

Double Releasing Powder Powder that Sagely Unblocks