Xuān Bì Tāng is a effective formula for treating damp-heat bi syndrome.In Traditional Chinese Medicine (TCM), the term “bi” refers to obstruction, which can be caused by external pathogens such as wind, cold, dampness, and heat invading the body, leading to blockage of the meridians.The meridians include both channels and collaterals, similar to the longitude and latitude of the Earth. They not only circulate qi and blood but also connect the organs with the body surface and all parts of the body, serving as the regulatory system for bodily functions.If the meridians are obstructed, qi and blood cannot flow freely, which can easily lead to symptoms such as muscle pain, joint pain, numbness, heaviness, and difficulty in movement, or even joint swelling and heat. Conditions such as rheumatoid arthritis, rheumatic fever, rheumatoid arthritis, osteoarthritis, fibromyalgia, and neuralgia all fall under the category of TCM “bi syndrome.”With so many manifestations of bi syndrome, it is not appropriate to indiscriminately blame all external pathogens like wind, cold, dampness, and heat, as this would create a tangled mess that is hard to untangle.The “Jīn Kuì Yào Lüè” (Essentials from the Golden Chamber) specifically highlights the damp-heat affecting the meridians, proposing the viewpoint that “heat in the meridians leads to bi syndrome.” When heat toxins invade the joints, or when there is internal stagnation of pathogenic heat combined with external invasion of wind, cold, and dampness, a conflict occurs in the meridians, resulting in heat bi syndrome. This can cause burning, swelling, pain in the joints or muscles, redness of the skin, or the appearance of nodules and erythema. Accompanying symptoms may include fever, thirst without desire to drink, restlessness, a heavy feeling throughout the body, and dark, turbid urine. The tongue may appear red with a yellow greasy coating, and the pulse may be slippery and rapid.Famous Qing Dynasty physician Wu Jutong, starting from the causes of wind, dampness, and heat, developed the formula Xuān Bì Tāng, which is used to treat bi syndrome caused by damp-heat. The key diagnostic points include joint pain, short and red urine, a yellow greasy tongue coating, a grayish tongue color, and a pale yellow complexion.Ingredients:Fáng Jǐ (Stephania tetrandra), Yì Yǐ Rén (Coix seed), Xìng Rén (Apricot kernel), Shí Pí (Talc) each 15 grams; Lián Qiáo (Forsythia), Shān Zhī Zǐ (Gardenia), Bàn Xià (Pinellia), Wǎn Cán Shā (Silkworm feces), Chì Xiǎo Dòu Pí (Red bean skin) (note: Chì Xiǎo Dòu refers to the red beans among the five grains, which are sour and red in color, soaked in cold water, and used for their skin. This is different from the red beans found in pharmacies, which are often wild beans with black seeds and yellow flesh, and are not used in medicine) each 9 grams.This formula aims to clear heat, open the meridians, promote yang, and alleviate pain.1Since the meridians are affected by damp-heat, the herbs must be used to follow the meridians and enter the collaterals. Therefore, Fáng Jǐ and Yì Yǐ Rén are used to quickly eliminate damp-heat from the meridians.Fáng Jǐ has been traditionally classified into two main types: Hàn Fáng Jǐ (Chinese Stephania) and Mù Fáng Jǐ (Wood Stephania). The commonly referred Hàn Fáng Jǐ is actually the powdered form of the Stephania genus, not the Aristolochia genus. Mù Fáng Jǐ refers to the Aristolochia genus and sometimes includes the Stephania genus. Modern TCM practice indicates that Hàn Fáng Jǐ is more effective for promoting urination and reducing swelling, while Mù Fáng Jǐ is more effective for dispelling wind and alleviating pain.The Fáng Jǐ used in this formula is not from the Aristolochia genus, and its bitter and cold properties enter the meridians to dispel dampness and alleviate pain.As for Yì Yǐ Rén, it is renowned for its ability to eliminate dampness, but its properties are sweet, bland, and cool, which do not eliminate cold-dampness but rather damp-heat, making it unsuitable for those with cold-dampness.Internally, it can benefit the lungs, stomach, and intestines, stop coughs, reduce edema, and alleviate diarrhea. Externally, it can dispel pathogenic factors from the muscles and joints, treating muscle and joint stiffness and spasms.2 Given that insufficient yang qi indicates illness, and the damp-heat in this formula cannot be treated by warming yang, the function of “promoting yang” is employed to alleviate bi syndrome and relieve pain.The key to promoting yang lies in the concept of “opening up,” similar to borrowing light through a hole in the wall; one cannot simply install a light bulb directly, as that would generate heat and worsen the condition, making treatment unnecessary.Thus, in terms of medication, the upper, middle, and lower jiao must be viewed as walls, and they must be opened gradually to obtain the light source.First, the lungs are the upper source of water. If the upper source is blocked, the flow below cannot proceed, so promoting lung qi can eliminate dampness.Xìng Rén is bitter and warm, opening lung qi first, dispersing wind and cold, and alleviating wheezing. It can descend lung qi and clear and moisten the lungs. Its dosage is as critical as that of Fáng Jǐ and Yì Yǐ Rén.Yì Yǐ Rén, Shí Pí, Shān Zhī Zǐ, and Lián Qiáo can all help to clear lung fire, especially Shí Pí, which is heavy and helps to descend lung qi and promote urination. Its dosage is also critical, thus matching that of Fáng Jǐ, Yì Yǐ Rén, and Xìng Rén.All five ingredients assist Fáng Jǐ in regulating the water pathways, allowing dampness to flow downward.Second, the spleen and stomach are the middle source of water. Dampness obstructing the spleen and stomach can disrupt the ascending and descending of qi. Therefore, treatment should focus on promoting the middle jiao and unblocking the middle yang.Bàn Xià disperses and warms, entering the spleen, stomach, and lung meridians. It is best at drying dampness and transforming turbidity in the middle jiao, thus unblocking qi flow.Wǎn Cán Shā is sweet and warm, working with Bàn Xià to harmonize the stomach and transform turbidity, resolving dampness in the middle jiao. This helps to relax the muscles, alleviate tension, dispel wind, eliminate dampness, and relieve pain.Shí Pí is bland and cold, unblocking the nine orifices and six bowels, resolving stagnation, quenching thirst, and benefiting the middle jiao.Together, they support the flow of lung qi and the drainage of water pathways, promoting the middle yang.Third, for damp-heat in the lower jiao, the most straightforward method is to allow it to be expelled through urination.Shí Pí, Chì Xiǎo Dòu, and Yì Yǐ Rén are all sweet and bland, promoting urination and allowing dampness and heat to be expelled through urine.Especially, Shí Pí is sweet and bland, nourishing and supplementing deficiency, while its blandness promotes water flow, and its slippery nature opens the orifices, quenching thirst and promoting urination.Chì Xiǎo Dòu is sweet, sour, and neutral (the formula uses the skin of Chì Xiǎo Dòu, but modern practices do not differentiate as clearly). It is active in the heart and small intestine meridians. It not only promotes urination and reduces swelling but also detoxifies and drains pus, making it an excellent remedy for damp-heat bi syndrome, perfectly suited for this formula.At the same time, Shān Zhī Zǐ and Lián Qiáo are both bitter and cold diuretics, which can alleviate restlessness caused by damp-heat bi syndrome.Shān Zhī Zǐ is effective in draining fire and heat, while Lián Qiáo excels in clearing heat and detoxifying, moving heart fire to the small intestine, draining fire, alleviating restlessness, and assisting heat to be expelled through urination.With multiple ingredients working together, this aligns with the famous Qing Dynasty physician Ye Tian Shi’s assertion that “promoting yang does not rely on warming, but on promoting urination.”The entire formula combines spicy warm, bitter warm, and bitter cold ingredients to open the meridians, while sweet and bland diuretics promote upward flow, unblocking the meridians, dispelling dampness, and clearing heat, ultimately promoting yang and expelling damp-heat, allowing light to shine through. With damp-heat eliminated, the meridians are unblocked.No wonder it is a renowned formula for treating damp-heat bi syndrome. This formula is commonly used in modern practice to treat rheumatoid arthritis and symptoms of joint redness and swelling.
Dosage and Administration of Xuān Bì Tāng: Decoction, taken warm in three doses. This formula is also available in prepared form.
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