Xiao Xiangru notes:Today we will study the formulas Gui Zhi Ma Huang Ge Ban Tang (Cinnamon Twig and Ephedra Decoction), Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction), Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction), and Qing Zao Jiu Fei Tang (Moistening Dryness and Rescuing the Lung Decoction).
“Practical Notes on the Diagnosis and Treatment System for External Pathogenic Diseases | Common Formulas for Treating Colds (Part 1)”
“Practical Notes on the Diagnosis and Treatment System for External Pathogenic Diseases | Common Formulas for Treating Colds (Part 2)”
“Practical Notes on the Diagnosis and Treatment System for External Pathogenic Diseases | Common Formulas for Treating Colds (Part 3)”
“Practical Notes on the Diagnosis and Treatment System for External Pathogenic Diseases | Common Formulas for Treating Colds (Part 4)”
01 Gui Zhi Ma Huang Ge Ban Tang
From the “Shang Han Lun” (Treatise on Cold Damage) Article 23: In cases of Tai Yang disease, if it lasts for eight or nine days, resembling malaria, with fever and chills, more heat than cold, the patient does not vomit, and has a desire to defecate, with a pulse that is weak and slow, this indicates a desire for recovery. If the pulse is weak and there is aversion to cold, this indicates both Yin and Yang are deficient, and one should not induce sweating, purge, or vomit further; if the complexion is red, it indicates the condition has not yet resolved, as the patient cannot sweat lightly, and the body will itch. Gui Zhi Ma Huang Ge Ban Tang is indicated.
Gui Zhi Ma Huang Ge Ban Tang is composed of one-third each of Gui Zhi Tang (Cinnamon Twig Decoction) and Ma Huang Tang (Ephedra Decoction), with a formula thought process similar to Ge Gen Tang (Kudzu Decoction), used for mild symptoms of cold damage with exterior excess, where cold obstructs the muscle layer and a light sweat is needed.
Case 25
Gao, female, 7 years old. Initial diagnosis: October 28, 2017.
History of rhinitis for 2 years, with nasal congestion worsening over the past 3 days, accompanied by clear nasal discharge, slight cough, small amount of white phlegm, discomfort in the throat, red tip of the tongue with thin white coating, and floating pulse.
Cold obstructing the muscle layer.
Gui Zhi Ma Huang Ge Ban Tang was lightly induced:Ma Huang 6g, Gui Zhi 6g, Xing Ren 6g, Bai Shao 6g, Zhi Gan Cao 5g, Jie Geng 6g, Huang Qin 5g, Bo He 5g, Xin Yi 6g, Bai Zhi 6g, Sheng Jiang 2 slices, Da Zao 2 pieces.
2 doses.
Second diagnosis: October 30, 2018
Nasal discharge and cough stopped, nasal congestion improved, switched to another treatment for rhinitis.
Discussion:
This child had no fever or aversion to cold, only nasal congestion, runny nose, and cough, indicating a mild case of cold obstructing the muscle layer. Gui Zhi Ma Huang Ge Ban Tang lightly induced sweating, and once the pathogen was expelled, the cough and runny nose ceased.
This formula is commonly used for mild cases of cold damage in the elderly and children.For cold-type urticaria, this formula combined with Dang Gui (Angelica Sinensis) and Bai Xian Pi (Dictamnus dasycarpus) has good efficacy.
02 Ma Xing Shi Gan Tang
From the “Shang Han Lun” Article 63: After inducing sweating, one should not use Gui Zhi Tang again; if sweating occurs and there is wheezing without high fever, one may use Ma Huang Xing Ren Gan Cao Shi Gao Tang.
Article 162: After purging, one should not use Gui Zhi Tang again; if sweating occurs and there is wheezing without high fever, one may use Ma Huang Xing Ren Gan Cao Shi Gao Tang.
Ma Xing Shi Gan Tang is classified as a releasing the exterior formula in TCM textbooks, but it actually does not relate to exterior syndromes.
This formula in the “Shang Han Lun” is mainly used for cases where exterior pathogens have entered the interior and transformed into heat after mismanagement of exterior syndromes, causing cough and wheezing due to phlegm-heat obstructing the lungs, focusing on clearing heat, dispersing lung qi, and relieving wheezing.
Key diagnostic points: fever, sweating, cough, wheezing, yellow and thick phlegm, red tongue, yellow or greasy coating, slippery and rapid pulse.
Case 26
Song, male, 10 years old. Initial diagnosis: June 1, 2017.
Admitted for fever and cough for one week, after intravenous treatment, fever slightly subsided but cough and wheezing persisted, wanted to transfer for treatment.
Upon examination: fever, temperature 38.5°C, cough, wheezing, phlegm rattling in the throat, yellow and thick phlegm difficult to expectorate, dry stool, red tongue with yellow greasy coating, slippery and rapid pulse.
Administered Ma Xing Shi Gan Tang with modifications:Ma Huang 6g, Xing Ren 6g, Shi Gao 30g, Zhe Bei 6g, Gua Lou 10g, Sang Pi 6g, Huang Qin 6g, Zhi Gan Cao 5g, Da Huang 5g, Chao Lai Fu Zi 6g, Su Zi 10g, Di Long 10g.
3 doses.
Second diagnosis: June 4, 2018.
After taking the above medicine, fever subsided and wheezing stopped, still had a cough, phlegm not much, easy to expectorate, smooth bowel movements, red tongue, yellow coating, rapid pulse; removed Da Huang and Chao Lai Fu Zi, added Jie Geng 6g and Qian Hu 6g.
3 doses, cured.
Discussion:
The patient had been hospitalized for a week, and upon examination, there was no exterior syndrome; heat obstructed the lungs, causing fever, cough, and wheezing, with dryness and heat injuring fluids, leading to constipation. Ma Xing Shi Gan Tang was used to clear heat and disperse lung qi;
Da Huang was added to purge and clear heat, Bei Mu (Fritillaria) and Gua Lou cleared heat and transformed phlegm, Sang Pi and Huang Qin cleared lung heat, Su Zi and Di Long descended qi and relieved wheezing.
During the second diagnosis, fever subsided and wheezing stopped, with smooth bowel movements, thus Da Huang and Lai Fu Zi were removed, and Jie Geng and Qian Hu were added to enhance the original formula’s ability to disperse lung qi and stop cough. The medicine matched the symptoms, leading to a quick recovery.
03 Zhu Ye Shi Gao Tang
From the “Shang Han Lun” Article 397: After resolving cold damage, if the patient is weak and has little energy, with qi counterflow and a desire to vomit, Zhu Ye Shi Gao Tang is indicated.
Zhu Ye Shi Gao Tang is commonly used for residual heat after febrile diseases, with both qi and yin injured.
Key diagnostic points: fever or no fever, thirst, poor appetite, severe cases may lead to inability to ingest water or food, vomiting, tender red tongue, little or no coating, weak and rapid pulse.
Case 27
This is a medical case from many years ago, and I cannot recall the exact time.
Patient Pang, male, 86 years old.
Half a month ago, he had a cold with fever, treated with intravenous therapy at home, but after the fever subsided, he had poor appetite, dry vomiting, and gradually could not ingest food or water, leading to gradual decline. At that time, it was near the end of the year, and the family had no choice but to take him to the hospital for treatment. However, both county and city hospitals refused to admit him, stating he was untreatable. At the request of a friend, I went to see him.
Symptoms observed: unable to ingest food or water for a week, dry vomiting, unable to get out of bed, spirit was weak, responded when called but spoke unclearly, tender red tongue, no coating, thin and rapid pulse. I initially wanted to decline treatment, but the family insisted, so I reluctantly agreed to treat him.
Administered Zhu Ye Shi Gao Tang:Zhu Ye 10g, Shi Gao 24g, Mai Dong 15g, Ban Xia 6g, Ren Shen 10g, Zhi Gan Cao 6g, Chao Mai Ya 10g, Lu Gen 15g, Shi Hu 15g, a handful of Jing Mi (glutinous rice).
3 doses.
During the second diagnosis, vomiting stopped, spirit improved, able to ingest a small amount of water and rice porridge. After that, with this formula adjusted, I prescribed over twenty doses, and the patient’s appetite gradually improved, recovering day by day, and after a month, he was able to get out of bed and move around.
He passed away at ninety due to a tumor.
Discussion:
Residual heat after febrile disease, with both stomach qi and fluids injured, leading to vomiting and inability to eat. Zhu Ye Shi Gao Tang clears heat and harmonizes the stomach, tonifies qi and generates fluids, adding Mai Ya to awaken stomach qi, Shi Hu to nourish stomach yin, and Lu Gen to clear heat and harmonize the stomach, descending counterflow and stopping vomiting. Although the condition was severe, he was fortunate to recover.
After this, I used this formula to treat several similar patients, all achieving good results. This shows that Zhu Ye Shi Gao Tang is not only a formula for post-illness recovery, but I also refer to it as a life-saving formula.
04 Qing Zao Jiu Fei Tang
Qing Zao Jiu Fei Tang comes from “Yi Men Fa Lv”. The author states that for all conditions of qi stagnation, weakness, cough, and vomiting related to the lungs, Qing Zao Jiu Fei Tang is indicated.
This formula is commonly used for dryness and heat injuring the lungs, with both qi and fluids injured.
Key diagnostic points: dry cough without phlegm or with little phlegm that is difficult to expectorate, phlegm may be yellow or white, qi counterflow and wheezing, dry throat and mouth, dry red tongue with no coating or thick white dry coating.
Case 28
Bai, female, 62 years old. Initial diagnosis: January 22, 2018.
Half a month ago, she had influenza, treated and fever subsided, but cough persisted, treatment was ineffective, and it has continued until now.
Upon examination: cough, persistent day and night, cough leads to urinary incontinence, no phlegm, dry mouth and throat, red tongue with white coating and little moisture, thin and rapid pulse. Indicated to clear dryness and moisten the lungs.
Administered Qing Zao Jiu Fei Tang with modifications:Ren Shen 10g, Shi Gao 24g, Pi Pa Ye 15g, Sang Ye 10g, Gan Cao 10g, A Jiao 10g, Xing Ren 12g, Mai Dong 15g, Huo Ma Ren 15g, Zhe Bei 10g, Gua Lou 15g, Bai Bu 30g.
3 doses, cured.
Discussion:
After treatment for external pathogenic disease, it is common to see persistent cough; if treated improperly, it can lead to prolonged illness. Dryness and heat injure the lungs, with both qi and yin injured, leading to cough, dry mouth and throat, red tongue with little moisture.
The “Nei Jing” states: Fire stagnation causes it to manifest.
Sang Ye lightly disperses lung dryness, Shi Gao is sweet and cold, clearing lung heat.
The lungs and large intestine are interrelated; if the lungs are dry, the large intestine will also be dry, thus using Xing Ren and Huo Ma Ren to descend lung qi and moisten the large intestine, A Jiao and Mai Dong to protect lung fluids;
“To benefit what injures the lung, tonify its qi,” using Ren Shen and Gan Cao to tonify lung qi, Pi Pa Ye is bitter and neutral, clearing lung heat and descending lung qi; adding Zhe Bei, Gua Lou, and Bai Bu to moisten the lungs, transform phlegm, and stop cough.
All the herbs combined clear lung heat, moisten lung dryness, tonify lung qi, and promote the downward movement of qi, resolving all symptoms.
It is important to note that this formula is not only used for those with a red tongue and no coating; in some cases, those with a red tongue and thick white coating can also benefit from it, often leading to a transition from thick to thin coating and from dry to moist.
In my personal understanding, this may relate to the dryness evil injuring the lungs, preventing normal dispersal and diffusion, leading to qi not transforming fluids, and fluids not being distributed normally, for reference.
I often use this formula to treat cough caused by pharyngitis related to lung dryness and fluid injury, achieving good results.
For cough after a cold, Zhi Sou San, Er Chen Tang, Xing Su San, Sang Xing Tang, Bei Mu Gua Lou San, etc., are commonly used formulas, and should be used according to different syndromes. Due to space limitations, I will not discuss them all.
05 Conclusion
Generally speaking, external pathogenic diseases are easier to treat than internal injuries. However, if not treated properly, they can easily lead to other diseases and prolonged illness, especially in the elderly and children, which requires greater attention.
When treating external pathogenic diseases, the first step is to differentiate between cold and heat.Fever with aversion to cold indicates cold damage exterior syndrome, while fever without aversion to cold, or even aversion to heat, indicates warm disease.Exterior syndrome without sweating indicates Tai Yang cold damage, while sweating indicates Tai Yang wind.
However, it is important to note the mixed conditions of cold and heat, simultaneous exterior and interior diseases, and combined diseases.
Based on the severity and urgency, flexibly use methods such as releasing the exterior and clearing the interior, treating the exterior first and then the interior, treating the interior first and then the exterior, and simultaneous treatment of both exterior and interior.
At the same time, the treatment of external heat diseases should also emphasize the treatment of accompanying syndromes. For example, with dampness, food stagnation, dryness, etc.; special populations, such as the elderly, women, and children, should also emphasize supporting the righteous qi. For those with deficiency, both supporting the righteous qi and expelling pathogens must be used together to achieve good results.
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Note:The cover image is sourced from Shetu Network.
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