Author: Zhang Zhong-Jing, 張仲景
Year: c. 220
Source: Discussion of Cold Damage (Shang Han Lun, 傷寒論)
Category: Formulas that Clear Heat
Pattern: Injury to Qi and fluids from Yangming Heat; Shang Xiao 上消, Xiao Ke due to Lung and Stomach Heat damaging Fluids and Qi.
Key Symptoms: "Four Greats": Great fever, unquenchable thirst, great sweat, great (large) but forceless pulse; or in Xiao Ke: great thirst with a dry mouth and tongue.
Secondary Symptoms: Aversion to Heat, red face, irritability, headache, toothache, bleeding of the gums and nose, generalised weakness, aversion to cold on the back
Tongue: Likely to be red
Pulse: Large but forceless
Ingredients
Shi Gao
| 30-90g | |
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Pinyin: Shi Gao
Chinese: 石膏
Pharmaceutical: Gypsum Fibrosum / Calcium Sulphate
Taxonomy: CaSO4
English: Gypsum / Plaster of Paris
| |
Tastes: Pungent and sweet
Meridians Entered: Lung and Stomach
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Actions & Indications:
- Clears Heat in the Qi Stage, drains Fire, relieves irritability and quenches thirst
Heat in the Qi Stage or Yangming Heat with high fever, no chills, irritability, intense thirst, profuse sweating, restlessness, encephalitis, a flooding, big pulse and a red tongue with a yellow coat
- Clears Excess Heat from the Lungs
Lung Heat with cough, wheezing, fever and a thick viscous sputum
- Clears Blazing Stomach Fire
Stomach Fire with headache, toothache or swollen gums
- Heals eczema, burns and ulcerated sores and wounds
Sores and wounds (topically or internally)
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Standard Dosage: 15-60g in decoction.
Cautions: The high mineral content of this medication may prevent the oral absorption of the fluoroquinolone class of antibiotics.
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 can sometimes be replaced with Zhi Mu and Mu Dan Pi bit its action difficult to substitute in many cases. The patient may have to rely on OTC mineral based antacids from the pharmacy such as sodium bicarbonate and calcium carbonate which have a similar effect of binding and neutralising the stomach acid, then using herbal medicines as an adjunctive treatment. |
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Zhi Mu
| 9-15g | |
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Pinyin: Zhi Mu
Chinese: 知母
Pharmaceutical: Rhizoma Anemarrhenae
Taxonomy: Anemarrhena asphodeloides
English: Anemarrhena Rhizome
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Tastes: Bitter, sweet, cold
Meridians Entered: Lung, Stomach and Kidney
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Actions & Indications:
- Clears Heat and drains Fire (Clears Heat from the Qi Stage, from the Lungs and from the Stomach)
Heat in the Qi Stage with high fever, irritability, restlessness, thirst and a rapid, flooding pulse.
Lung Heat and Dryness with cough and expectoration of thick, yellow Phlegm
Yang Ming Heat
Stomach Heat
- Nourishes Yin and moistens Dryness
Lung and Kidney Yin Deficiency with night sweats, steaming bone disorder, irritability, afternoon or low grade fever, Five Sole Heat and bleeding gums
(Stomach Yin Deficiency)
Kidney Heat with spermatorrhea, nocturnal emissions and an abnormally elevated sex drive
- Generates Fluids, clears Deficiency Fire and quenches thirst
Oral ulcers and inflammation, steaming bones and Xiao Ke (diabetes) due to Yin Deficiency
- Ameliorates the Dryness of tonifying or warming herbs
For use with herbs such as Rx. Astragali Huang Qi, Ram. Cinnamomi Gui Zhi, Rx. Aconiti Lateralis Preparata Zhi Fu Zi when there is concern that these herbs may be too drying
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Standard Dosage: 5-15g in decoction.
Cautions: It is not suitable for deficiency cold syndrome. Being cold and moist in property, it is prohibited to be used for those who have a spleen-deficiency diarrhea. |
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Ren Shen
| 3-9g | |
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Pinyin: Ren Shen
Chinese: 人參
Pharmaceutical: Radix Panax ginseng
Taxonomy: Panax ginseng
English: Ginseng Root
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Tastes: Sweet, slightly warm
Meridians Entered: Spleen, Lung and Heart
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Actions & Indications:
- Powerfully tonifies Yuan Qi
Extreme collapse of Qi or abandoned conditions that manifest in shallow breathing, shortness of breath, cold limbs, profuse sweating and an almost imperceptible pulse (after blood loss, overly profuse sweating or other problems related to severe fluid loss - it can be used alone in these emergencies)
Collapse of Yang
Collapse of Yin
- Tonifies Spleen and Stomach Qi
Lethargy, anorexia, chest and abdominal distention, chronic diarrhoea and, in severe cases, prolapse of the Stomach, uterus or rectum
- Tonifies Lung Qi
Lung Qi Deficiency with wheezing, shortness of breath and labored breathing on exertion
- Generates Body Fluids and stops thirst
Wasting and thirsting disorder (Xiao Ke) and high fevers with profuse sweating which injures Qi and fluids
- Tonifies Heart Qi and calms the Spirit
Heart Qi and Blood Deficiency with palpitations, anxiety, insomnia, forgetfulness and restlessness
- Treats impotence
With Kidney Yang tonics for impotence
- Tonifies Qi in Deficiency patients with Exterior conditions
Exterior disorder with Interior Deficiency
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Standard Dosage: 5-10g in decoction, 10-30g for exhaustion syndrome due to Qi deficiency.
Cautions: Antagonizing to Li Lu; the warm nature of sun-dried raw Ren Shen is weaker than that of Hong Shen. |
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Zhi Gan Cao
| 3-6g | |
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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)
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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
- 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)
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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. |
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Jing Mi
| 9-15g | | |
Pinyin: Jing Mi
Chinese: 粳米
Pharmaceutical: Semen Oryzae
English: Non-Glutinous Rice Seed
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Tastes: Sweet, neutral
Meridians Entered: Lung and Spleen
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Actions & Indications:
- Tonifies Yang
Diarrhoea due to Yang Deficiency
- Tonifies the Qi of the Lungs, Spleen and Intestines and stops restlessness
Qi Deficiency with spontaneous perspiration and weakness
- Stops thirst and generates fluids
Body Fluid Deficiency
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Standard Dosage: 9-30g in decoction.
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Subsitutions:
In the UK Shi Gao must be substituted but no other substances really suffice in this instance, especially since the decoction already contains Zhi Mu which is the only thing that can occasionally take its place in other formulae.
Xi Yang Shen may be used instead of Ren Shen for its greater fluid generating properties.
Preparation: Decoction.
Actions: Clears Qi level Heat, drains Yangming Fire, generates fluids, alleviates thirst
Contraindications: Cold disorders. Should be discontinued if signs of headache, stiffness in the neck, icy-cold limbs, subjective sensations of cold or impairment of mental faculties occur
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.