Yáng Dàn Tāng (陽旦湯) Yáng Dawn Decoction from the Jīn Guì Fāng Gē Kuò

As I am approaching close to 18 months of ardently working on the translation of the second volume of Chén Xiū-Yuàn’s Jīn Guì Fāng Gē Kuò (Formulas from the Golden Cabinet with Songs), I thought it was due time to share a small tidbit of the material.  I am getting quite close to finishing the text and it should be out sometime in the next few months.  

陽旦湯Jīn Guì Fāng Gē Kuò.jpg

Yáng Dàn Tāng

Yáng Dawn Decoction

治產後中風續續數十日不解頭微疼惡寒時時有熱心下悶乾嘔汗出 ,雖久陽旦症續在者可與之。  即桂枝湯增桂加附。  坊本謂加黃芩者未知《傷寒論》太陽篇中已明其方孫真人及各家俱誤。  桂枝湯見《傷寒論》。

A treatment for post-partum wind strike that remains unresolved for several tens of days with, a mild headache, aversion to cold, frequent heat effusion, oppression below the heart, dry retching, and sweating. Even though (the condition) has persisted for a long time, yáng dàn tāng signs are still present, and can be given. (This formula) is guì zhī tāng with increased guì zhī and the addition of fù zǐ.

An old block-printed version of the text refers to this formula as (guì zhī tāng) with the addition of huáng qín, but it is unknown whether this is the same tài yáng formula as in the Shāng hán lùn. Master Sūn Sīmiǎo and various others believed it to be so (for which) they were mistaken. For guì zhī tāng see the Shāng Hán Lùn.

 Commentary by (Chén) Yuánxī 男元犀按:

頭痛發熱、 惡寒汗出太陽表症也。  心下悶者太陽水邪彌漫心下而作悶也。  陽旦湯即桂枝湯倍桂枝加附子。  雖産後數十日不解其邪仍在於太陽之經故仍用桂枝湯解太陽之表邪加桂以化膀胱之水氣加附子以溫固水臟使經臟氣化則內外之邪出矣。  《傷寒論》桂枝加附子治漏汗加桂治氣從少腹上衝心去芍治胸滿俱有明文可據。  孫真人以桂枝湯加黃芩爲陽旦湯其意以心下悶爲熱氣誤矣。  夫有熱氣則當心煩今日心下悶則非熱可知矣。  況微惡寒時時有熱乾嘔汗出爲太陽桂枝湯之的症。  蓋太陽底面便是少陰續續至數十日不解顯系少陰之君火微而水寒之氣盛寒氣上淩陽位是以爲心下悶之苦。  故取桂枝湯增桂以扶君主之陽加附子以鎮水陰之逆使心陽振水臟溫則上逆之陰邪不攻而自散矣。

Headaches, heat effusion, aversion to cold, and sweating are symptoms associated with a tài yáng exterior pattern. (With) oppression below the heart, tài yáng water evils pervade (the area) below the heart and cause oppression. Yáng dàn tāng is guì zhī tāng with double the guì zhī and the addition of fù zǐ. Although there is a lack of resolution ten days post partum, evils are still located in the tài yáng channel, and it is for this reason that guì zhī tāng is used to resolve exterior evils in the tài yáng. Guì zhī is increased in order to transform water qì in the bladder.  Fù zǐ is added to the formula to warm and secure the water viscus, enabling the transformation of qì in the channels and viscera, and ensuring the expulsion of evils in both the interior and exterior. In the Shāng Hán Lùn, guì zhī jiā fù zǐ tāng is used to treat leaking sweat; increasing guì zhī treats surging qì from the lesser abdomen into the heart, and removing sháo yào treats chest fullness. These (principles) are in accordance with the (original) writings. (According to) master Sūn (sīmiǎo), yáng dān tāng is guì zhī jiā huáng qín tāng, (as he felt that) oppression below the heart was due to hot qì; this is a mistake! Now if there were hot qì, then there would be heart vexation, (but) presently with the oppression below the heart, we know there is no heat!  Moreover, slight aversion to cold, and frequent heat (effusion), dry retching, and sweating, is a guì zhī tāng tài yáng presentation. In all (cases) of tài yáng, there is shào yīn at the bottom, and with continuous (wind strike) reaching ten days without resolution, there is a clear relation to the debilitation of shào yīn sovereign fire, with exuberance of cold water qì. Cold qì ascends and encroaches into the position of yáng, resulting in oppression below the heart. Therefore, guì zhī tāng with increased guì zhī, supports sovereign yáng, and with the addition of fù zǐ counterflow of water yīn is settled, heart yáng is vitalized, and the water viscus is warmed.  Then, ascending counterflow of yīn evils will not attack, and dissipate on their own!

Xiǎo Qīng Lóng Tāng from the Zhù Jiě Shāng Hán Lùn

Line 40:

“In cold damage when the exterior has not yet resolved, and there is water qì below the heart, with dry retching, heat effusion, and cough, and possibly thirst or diarrhea, or dysphagia, or inhibited urination and lesser abdominal fullness, or panting, xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) governs”.

In cold damage when the exterior has not yet been resolved and there is water qì below the heart, this will result in the contention of water and cold with cold qì counterflow in the lung manifesting with symptoms of dry retching, heat effusion, and cough. The Acupuncture classic says, “Physical cold with cold rheum damages the lungs”. What this means is that there is contraction of two kinds of cold, and both the center and exterior are damaged, which results in the upward movement of counterflow qì. By administering xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) sweat is effused and water is dissipated. With the steeping of water qì in the interior, several signs can manifest, and therefore it must be resolved and transformed. Cheng Wu-ji.jpeg

Xiǎo Qīng Lóng Tāng (Minor Bluegreen Dragon Decoction)

má huáng (Ephedrae Herba) 3 liǎng (remove nodes), flavor is sweet and warm

sháo yào (Paeoniae Radix) 3 liǎng, flavor is sour and slightly cold

wǔ wèi zǐ (Schisandrae Fructus) ½ shēng, flavor is sour and warm

gān jiāng (Zingiberis Rhizoma) 3 liǎng, flavor is acrid and warm

zhì gān cǎo (Glycyrrhizae Radix preparata) 3 liǎng, flavor is sweet and neutral

guì zhī (Cinnamomi Ramulus) 3 liǎng (remove the bark), flavor is acrid and warm

bàn xià (Pinelliae Rhizoma preparatum) ½ shēng (washed), flavor is acrid and slightly warm

xì xǐn (Asari Herba) 3 liǎng, flavor is acrid and warm.

When cold evils are present in the exterior, without the use of acrid and sweet (medicinals), one would be unable to dissipate them.  Má huáng (Ephedrae Herba), guì zhī (Cinnamomi Ramulus), and gān cǎo (Glycyrrhizae Radix) are acrid and sweet, and can therefore effuse and dissipate cold evils. When there is stoppage of water qì below the heart that fails to move, then the kidney qì will become dry. The Nèi Jīng says, “When the kidneys suffer from dryness, swiftly eat acrid to moisten them”. Gān jiāng (Zingiberis Rhizoma), xì xǐn (Asari Herba), and bàn xià (Pinelliae Rhizoma preparatum) are acrid and can (therefore) move water qì and moisten the kidneys. Coughing counterflow and panting are (the result of) counterflow lung qì.  The Nèi Jīng says, “(When) the lungs desire to be collected (astringed), swiftly eat sour in order to collect them”.  Sháo yào (Paeoniae Radix) and wǔ wèi zǐ (Schisandrae Fructus) are both sour and can collect (astringe) counterflow qì and calm the lungs.

Use one dǒu of water for the eight ingredients above.  First boil the má huáng to reduce the water by two shēng.  Remove the foam collecting on top and add the other ingredients.  Boil until reduced to three shēng, remove the dregs, and take one shēng warm. 

Modifications:

If there is slight diarrhea remove the má huáng and add a piece of ráo huā (Wikstroemia Flos) the size of a chicken egg, and dry fry until red.

With diarrhea one cannot attack the exterior, as when sweat is issued, this will result in distention and fullness. Má huáng effuses yáng, which can lead to the steeping of water into the stomach, inevitably resulting in diarrhea. Ráo huā is able to purge water, and once water is removed, diarrhea will cease. 

If there is thirst, remove bàn xià and add three liǎng of guā lóu gēn (Trichosanthis Radix).

Acrid dries, and bitter moistens. Bàn xià is acrid and can therefore dry fluids, so without thirst it is appropriate.  (Here) there is thirst, and it is therefore eliminated. Guā lóu gēn is bitter and can generate fluids therefore it is added.  

If there is dysphagia, remove má huáng and add one piece of blast-fried fù zǐ (Aconiti Radix lateralis preparata).

The classics say, “when water obtains cold qì, there will be mutual contention amongst them and the person will experience dysphagia”.  Fù zǐ is added to warm and dissipate cold water.  When a person has cold, and sweat is repeatedly effused, this will leave the stomach cold, which will result in the vomiting of roundworms, therefore má huáng is removed out of fear of effusing sweat. 

If urination is inhibited and there is fullness in the lesser abdomen, remove má huáng and add four liǎng of fú líng (Poria).

When there is water amassment in the lower burner that fails to move resulting in inhibited urination and fullness in the lesser abdomen, má huáng is inappropriate as it effuses fluids into the exterior; fú líng discharges amassed water out through the lower, and is therefore used instead. 

Line 40:

If there is panting, remove má huáng and add ½ shēng of xìng rén (Armeniacae Semen amarum), removing the skin and tips.

The Jīn Guì Yào Lüè says, “When a person (suffers) from generalized swelling, one should not add má huáng but instead use xìng rén”.  The reason is that má huáng effuses the yáng. With panting and generalized swelling, water qì is the branch and root of the disease.

Line 41:

“In cold damage when there is water qì below the heart, cough, mild panting, and heat effusion without thirst, (but with) thirst after taking the decoction, this means cold is leaving and (the disease) is about to resolve; xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) governs”.

Cough and mild panting are due to cold water shooting into the lungs. Heat effusion and an absence of thirst are due to an exterior pattern, which has not yet ceased. Xiǎo qīng lóng tāng is given to effuse the exterior and dissipate water. (If) after taking the decoction there is thirst, this means that the interior has been warmed, water qì has been dissipated, and (the disease) is about to resolve.

Má Xìng Gān Shí Tāng from the Zhù Jiě Shāng Hán Lùn

Chéng Wú-Jǐ (1050-1144) images.jpg

A scholar/physician from the Northern Sōng dynasty who compiled the Annotations to the Shāng Hán Lùn (注解伤寒论), which became what’s known as the Sōng version of the Shāng Hán Lùn used to the present day.  Chéng devoted over forty years of his life to compiling his seminal work, which he completed in 1140. However, Chéng never saw it published, which occurred in 1172, close to thirty years after his death. Chéngs’ annotation was extremely comprehensive and detailed, citing numerous sources and references in his attempt to repair and resolve the various inconsistencies that existed amongst the numerous surviving versions of the text.

The following is taken from Chéngs Annotations to the Shāng Hán Lùn

Line 63:

“Following the promotion of sweat, Guì Zhī Tāng should not be given again; (if) there is sweating with panting and the absence of great heat, one can use má xìng gān shí tāng (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction)”. 1

 

With panting after the promotion of sweat, one can typically use guì zhī jiā hòu pò xìng zǐ tāng (Cinnamon Twig Decoction Plus Magnolia Bark and Apricot Kernel), as once sweat (further) effuses, the condition will resolve.  (However) here there is sweating with panting signifying that evil qì is quite severe, therefore guì zhī tāng (Cinnamon Twig Decoction) would be unable to effuse and dissipate (evils), and so this is the reason, the guì zhī tāng should not be given again. Sweating and panting with great heat, indicates the presence of severe hot qì in the interior. The absence of great heat signifies that exterior evils must be severe. In this case it is suitable to give má xìng gān shí tāng in order to dissipate the evils. 

Má Xìng Gān Shí Tāng (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction)

má huáng (Ephedrae Herba) 4 liǎng (remove nodes)- flavor is sweet and warm

xìng rén (Armeniacae Semen amarum) 50 pieces (remove skin and tips)- flavor is sweet and warm

zhì gān cǎo (Glycyrrhizae Radix preparata) 2 liǎng- flavor is sweet and neutral

shí gāo (Gypsum fibrosum) ½ jīn (crushed and cotton wrapped)- flavor is sweet and cold

The Huáng Dì Nèi Jīng says “When the liver suffers from urgency, swiftly eat sweet (flavors) in order to moderate it”. (Here) wind qì passes through the liver and wind evils are severe in the exterior, therefore a purely sweet formula is given to effuse it.

For the four ingredients above use seven shēng of water.  First boil the má huáng and reduce (the water) by two shēng and remove the foam collecting on top. Add the remaining ingredients and boil until reduced to two shēng, remove the dregs and take one shēng warm.  The original text says that the formula should be put into a yellow-eared cup (a Hàn dynasty drinking vessel). 

1. It should be noted here that line 162 is almost identical to this one with the only difference being that the line starts off by saying “following precipitation”.

Guì Zhī Jiù Nì Tāng (Cinnamon Counterflow-Stemming Decoction)

Case of Dr. Hú Xī-Shù (胡希恕)

A twenty-six year old air force translator came in for an initial consultation. Recently while observing the repair of some electric wiring, he (suddenly) became very frightened, which manifested with fright palpitations, flusteredness, insomnia, headaches, poor appetite, nausea, and the occasional sound of phlegm in the back of his throat, which caused him to become uncontrollably angry, restless, and vexed every time he would hear this sound, but over some time (his emotions) would gradually recede slightly. Nonetheless two people assisted him when he had come in for a consultation. 

(Aside from the symptoms above) he had a thick white tongue coat, and his pulse was wiry, slippery and the cùn (inch) position was floating. This pattern is due to the upward harassment of enduring cold rheum, and treatment should involve warming, transforming, and downbearing counterflow. He was given a modified version of (guì zhī) jiù nì tāng (Cinnamon Twig Counterflow-Stemming Decoction). 

guì zhī (Cinnamomi Ramulus) 10g

shēng jiāng (Zingiberis Rhizoma recens) 10g

zhì gān cǎo (Glycyrrhizae Radix preparata) 6g

dà zǎo (Jujubae Fructus) 4 pieces

bàn xià (Pinelliae Rhizoma preparatum) 12g

fú líng (Poria) 12g

shēng mǔ lì (Ostreae Concha) 15g

shēng lóng gǔ (Fossilia Ossis Mastodi) 15g

Results: After taking three packages of the above formula his flusteredness and phlegm sound in the back of his throat were reduced. After six packages, his appetite increased, and his sleep had improved. He continued on the formula and after ten packages all of his symptoms disappeared. 

Line 112 in the Shāng hán lùn (傷寒論 Discussion of Cold Damage) says:

“(When) in cold damage the pulse is floating, and a fire (method) is used to force (sweating), as a result yáng collapses and there will be fright mania, and fidgetiness whether lying or sitting; guì zhī qù sháo yào jiā shǔ qī mǔ lì long gǔ jiù nì tāng governs”.

Analysis: When there is cold damage with a floating pulse, one should consider treating it with má huáng tāng to promote sweating, however, if it is treated with a fire method, which could include moxibustion, fire needling, fire fuming, and other similar methods, to force sweating, it can result in major sweating, and this is an erroneous treatment. When there is major sweating, this will result in the collapse of liquids and humors. Not only will this fail to meet the objective of resolving the exterior, but major sweating, will result in upper vacuity, causing qì to overwhelm the vacuity and surge upwards. This will also stimulate the interior causing the ascent of rheum, which will cloud the clear orifices resulting in symptoms of fright mania, and fidgetiness whether lying or sitting. The suitable treatment here is with guì zhī qù sháo yào jiā shǔ qī mǔ lì long gǔ jiù nì tāng.

Rén Yīng Qiū- A Zhēn Wǔ Tāng (True Warrior Decoction) Case

Hú Xī-Shù-Guì Zhī Jiā Gé Gēn Tāng (Cinnamon Twig Decoction plus Kudzu)

C1889F76D1DD4A168D3241E3F09F193A.jpgHere’s a case of a wind strike pattern. Nothing too enlightening or complicated here, but sometimes we need to be reminded of the simple stuff!!

On December 10, 1965 a twenty one-year-old female presented at the clinic. Yesterday she had contracted a common cold manifesting with symptoms of headache, dizziness, sweating, aversion to cold, weak pain in her shoulders and back, and a tight obstructive pain in the left side of her neck on rotation towards the left. She had a thin white tongue coating, and her pulse was floating and slightly rapid.

A floating, slightly rapid pulse, thin-white tongue coat, aversion to cold, sweating, and headaches signify a Tài Yáng wind strike pattern. Shoulder and back pain, and neck pain on left rotation of the head signify a gé gēn tāng (Kudzu Decoction) pattern. The dizziness indicates that the exterior has not yet been resolved, with upward surging of qì.

Comprehensive analysis: This is a Tài Yáng wind strike pattern with simultaneous stretched stiff nape and back, seen in a guì zhī jiā gé gēn tāng (Cinnamon Twig Decoction plus Kudzu) formula presentation.

Formula:

guì zhī (Cinnamomi Ramulus) 10g

bái sháo (Paeoniae Radix alba) 10g

shēng jiāng (Zingiberis Rhizoma recens) 10g

dà zǎo (Jujubae Fructus) 4 pieces

zhì gān cǎo (Glycyrrhizae Radix preparata) 6g

gé gēn (Kudzu Radix) 12g

Results:  After taking 1 package of the formula, her symptoms decreased, and after 2 more, her symptoms had completely resolved.

Gé Gēn Jiā Bàn Xià Tāng (Kudzu Decoction with Pinellia)

On December 21, 1965 a twenty one-year old female presented at the clinic. The previous day she had contracted a common cold manifesting with symptoms of headache, dizziness, generalized body pain, lumbar pain, nausea with a desire to vomit, aversion to cold, and frequent abdominal pain with loose bowel movements. Her pulse was floating-rapid, and she had a thin white tongue coating.

The white tongue coat, floating-rapid pulse, aversion to cold, headache, generalized body pain, and lumbar pain signify Tài Yáng cold damage. The frequent abdominal pain with loose bowel movements indicates Tài Yīn (disease). The dizziness, and nausea with desire to vomit show that there is interior rheum invading upwards, which is a bàn xià (Pinelliae Rhizoma preparatum) presentation.

Comprehensive analysis: This is a Tài Yáng Tài Yīn combination disease, which fits with a gé gēn jiā bàn xià tāng (Kudzu Decoction with Pinellia) presentation.

Formula:

gé gēn (Kudzu Radix) 12g
má huáng (Ephedrae Herba) 10g
guì zhī (Cinnamomi Ramulus) 10g
shēng jiāng (Zingiberis Rhizoma recens) 10g
bái sháo (Paeoniae Radix alba) 10g
dà zǎo (Jujubae Fructus) 4 pieces
zhì gān cǎo (Glycyrrhizae Radix preparata) 6g
bàn xià (Pinelliae Rhizoma preparatum) 12g

Results: After taking 1 package of the formula, her symptoms decreased, and after 2 packages, her symptoms had completely resolved.

Huáng Qín Tāng [Line 172]

Chéng Wú-Jǐ 成无己

From ‘A commentary on the Annotated Shāng Hán Lùn’ (注解伤寒伦) by Chéng Wú-Jǐ

Line 172 

In a Tài Yáng and Shào Yáng combination disease with spontaneous diarrhea, give huáng qín tāng (Scutellaria Decoction); if there is retching, huáng qín jiā bàn xià shēng jiāng tāng (Scutellaria Decoction plus Pinellia and Fresh Ginger) rules it. 

Commentary: In a Tài Yáng and Yáng Míng combination disease, spontaneous diarrhea is coming from the exterior, and gé gēn tāng (Kudzu Decoction) is given to effuse sweat. In a Yáng Míng and Shào Yáng combination disease, spontaneous diarrhea is coming from the interior, and a chéng qì tāng (Order the Qi Decoction) formula is used to precipitate it. This is a Tài Yáng and Shào Yáng combination disease, and the spontaneous diarrhea is a result of the condition being half in the exterior and half in the interior. Here it would be inappropriate to promote sweat or precipitate, so huáng qín tāng (Scutellariae Decoction) is given to harmonize and resolve the pathogens laying half in the exterior and half in the interior. Retching indicates counterflow of stomach qì so bàn xià (Pinelliae Rhizoma preparatum) and shēng jiāng (Zingiberis Rhizoma recens) are added to dissipate counterflow qì.

Huáng Qín Tāng (Scutellariae Decoction)

huáng qín (Scutellariae Radix) 3 liǎng (9g) [acrid-cold]
zhì gān cǎo (Glycyrrhizae Radix preparata) 2 liǎng (6g) [sweet-neutral]
sháo yào (Paeoniae Radix) 2 liǎng (6g) [sour-neutral]*
dà zǎo (Jujubae Fructus) 12 pieces, broken [sweet-warm]

*In the Běn Cǎo Jīng, sháo yào (Paeoniae Radix) is classified as bitter, and is considered to be mildly cold in the Míng Yī Bié Lù.

Commentary: In vacuity and non-repletion, (the) bitter (flavor) is used to harden, and sour is used to contract. huáng qín (Scutellariae Radix) and sháo yào (Paeoniae Radix) are bitter and sour, and are used to harden and constrain the qì of the stomach and intestines. In weakness and insufficiency, (the) sweet (flavor) is used to supplement. gān cǎo (Glycyrrhizae Radix) and dà zǎo (Jujubae Fructus) are both sweet and can supplement and secure stomach and intestinal weakness.

Simmer the four ingredients above in 1 dǒu of water (2,000ml) until reduced to 3 shēng (600ml). Remove the dregs and take 1 shēng (200ml) heated, twice during the day and one at night. If there is retching, add ½ shēng (100ml) of bàn xià (Pinelliae Rhizoma preparatum) and 3 liǎng (9g) of shēng jiāng (Zingiberis Rhizoma recens)*.

*The Sòng dynasty version does not include this modification but has a separate line for huáng qín jiā bàn xià shēng jiāng tāng (Scutellaria Decoction plus Pinellia and Fresh Ginger).

Xiè Xīn Tāng (Heart Draining Decoction)-泄心汤

From the ‘Interpretation of the Jīn Gùi Yào Lüè’ by Sòng Jiàn-Píng (2009)

I am currently in the process of translating the second volume of the Jīn Guì Fāng Gē Kuò (金贵方歌括) by Chén Xiū-Yuán. I have been so immersed in it lately, that I feel I’ve been neglecting this site, and figured I should work on something to put up. Because of the intense amount of work and dedication this book requires, I figured it would make more sense to translate something I’ve been using as reference, helping myself and others elucidate the deeper meaning behind the formulas discussed in the text. The following is the small section on Xìe Xīn Tāng, for which I recently worked on. I’ve had a bit of a hard time with the line “heart qi insufficiency” (心气不足), as I’ve read several commentaries, including the Qiān Jīn Fāng, which state that this is a typo, and the actual line should read, 心气不定 (heart qi instability/unsettled). Neither one of these still make immediate sense to me, but I am getting closer to understanding what it means and it’s pathological/physiological implications. Since I am still processing and working with this line, I’ll share my thoughts on a later date. I’d love to get other perspectives in the comments section.

[Original Text]  
“(When) heart qì is insufficient, with blood ejection and spontaneous external bleeding, Xiè Xīn Tāng masters it”. (JGYL 17)

Xiè Xīn Tāng also treats sudden turmoil (cholera) disease

Dà Huáng 2 liǎng
Huáng Lián 1 liǎng
Huáng Qín 1 liǎng

Use 3 shēng of water for the three ingredients above, boil until reduced to one shēng, and take in one single dose.

[Comparisons] Heart qì vacuity: In the Qiān Jīn Fāng it is written as heart qì instability/unsettled) (心气不定)

[Presentation] A treatment for patterns of blood ejection and spontaneous external bleeding due to exuberant heat.

[Explanation] Both blood ejection and spontaneous external bleeding are categorized as exuberant heat patterns. The heart stores the shén, and governs the blood vessels. If heart fire is exuberant, it will cause frenetic movement of the blood, which results in blood ejection and spontaneous external bleeding. If the spirit is harassed there will be vexation and disquietude. Xiè Xīn Tāng is the treatment of choice, which clears heat and discharges fire. Within the formula, Huáng Lián and Huáng Qín clear heat, downbear fire, and discharge heat from the heart channel, so heart blood can quiet down on it’s own. Dà Huáng is bitter, cold, downbearing and discharging. It causes the descent of fire qi so blood can be calmed and stop moving frenetically. When these three medicinals are combined, they directly break heat, downbear fire, and stop bleeding.

[Commentary] Xiè Xīn Tāng and Bǎi Yè Tāng both treat blood ejection, however, Bǎi Yè Tāng mainly treats blood ejection due to central qì vacuity cold. Typical signs seen with this presentation are a somber white facial complexion, lassitude of spirit and fatigue, pale tongue body with a white coating, and a vacuous weak pulse. Xiè Xīn Tāng treats blood ejection due to exuberant heat, which is typically accompanied with heart vexation and disquietude, a red complexion, red tongue body, vexation thirst, constipation, a rapid pulse, etc. The two prescriptions above introduce us to two major methods and treatment principles for the treatment of blood ejection. One to warm yáng and restore qì, and one to discharge fire and clear heat in order to stop bleeding. In regards to Xìe Xīn Tāngs’ treatment of blood heat with frenetic movement, bleeding can manifest in several different ways including, vomiting of blood (hematemesis), external bleeding, blood in the urine (hematuria), blood in the stools (hemafecia), etc. which can all be treated quite effectively.

This is a commonly used formula for treating exuberant heat in the three burners, and is used clinically for the congestion of pathogenic-toxic fire and heat causing disorders in either the upper or lower burners, or the exterior or interior. Examples being, the upward harassment of toxic heat causing a red complexion and tongue, ulcerations of the mouth and tongue, tooth swelling and pain, vexation heat, and oppression in the chest, or toxic heat manifesting on the exterior with skin damage due to swollen and toxic sores.

[Case Example] A sixty-year-old female patient presented on April 20, 1994. She has a history of a duodenal ulcer for many years, and has recently been quite fatigued, with unbearable epigastric pain. This morning after eating breakfast, she immediately felt nauseous and had a desire to vomit. Soon after she vomited approximately 300ml of fresh blood, which contained stasis clots but no food from her digestive tract. She has continued to feel nauseous and has been vomiting blood quite frequently up until the time of her consultation. Her tongue was red, with a thin yellow coating, and she had a wiry-slippery-rapid pulse. The diagnosis was blood ejection. The pattern belonged to heat accumulation in the stomach causing frenetic movement of the blood. Treatment involved clearing the stomach, discharging heat, transforming stasis, and stopping bleeding.

Formula:

Dà Huáng 30g
Huáng Qín 9g
Huáng Lián 9g
Dài Zhě Shí 30g

The medicinals above were to be decocted (and drunk) quickly

After taking the formula, the vomiting of blood stopped, and the epigastric pain decreased. She was continued on two more packages of the formula to clear the remaining pathogens.

(Luó Wèi Dōng: Effective Treatments with Classical Formulas, vol. 4.)

A Case of Guì Zhī Fù Zǐ Tāng (Cinnamon Twig and Aconite Accessory Root Decoction)