Xiao Xiangru notes: Today we continue to study Ge Gen Tang (Kudzu Decoction), Gui Zhi Tang (Cinnamon Twig Decoction), Xiao Qing Long Tang (Minor Blue Dragon Decoction), and Xiao Qing Long Tang jia Shi Gao Tang (Minor Blue Dragon Decoction with Gypsum).
1 Ge Gen Tang
From the Shang Han Lun (Treatise on Cold Damage), Section 31: In cases of Taiyang disease, with stiffness in the neck and back, no sweating, and aversion to wind, Ge Gen Tang is the main treatment.
Section 32: If Taiyang and Yangming are combined, there will definitely be diarrhea; Ge Gen Tang is the main treatment.
Section 33: If Taiyang and Yangming are combined but there is no diarrhea, but vomiting occurs, Ge Gen jia Ban Xia Tang (Kudzu Decoction with Pinellia) is the main treatment.
Key Diagnostic Points:
1. Symptoms of Taiyang cold damage with aversion to cold, fever, no sweating, and a floating tight pulse;
2. Stiffness and pain in the neck and back, which are specific manifestations of Ge Gen Tang syndrome;
3. Commonly seen diarrhea, often watery stools, with or without vomiting; what Western medicine refers to as gastrointestinal flu is often Ge Gen Tang syndrome;
4. In cases without exterior symptoms but with stiffness and pain in the neck and back, Ge Gen Tang may also be applicable;
5. The mechanism of Ge Gen Tang syndrome includes injury to fluids. When exterior symptoms are accompanied by dry mouth and thirst, or a red tongue with cracks, or a white tongue coating with little fluid, it is often Ge Gen Tang syndrome.
Case 5
Zhang, female, 45 years old. Initial diagnosis: June 10, 2016.
The patient went to the countryside with a work team yesterday and returned home to experience continuous diarrhea.
Upon examination: fever, temperature 38.6°C, aversion to cold, muscle pain all over, no sweating, diarrhea several times a day with watery stools, accompanied by dry heaving, pale tongue with white slippery coating, floating tight pulse.
Diagnosis: Taiyang and Yangming combined disease.
Prescribed Ge Gen jia Ban Xia Tang: Ge Gen (Kudzu) 30 grams, Ma Huang (Ephedra) 10 grams, Gui Zhi (Cinnamon Twig) 10 grams, Bai Shao (White Peony) 10 grams, Zhi Gan Cao (Honey-fried Licorice) 6 grams, Ban Xia (Pinellia) 10 grams, Che Qian Zi (Plantago Seed) 15 grams, Sheng Jiang (Fresh Ginger) 15 grams, Da Zao (Jujube) 4 pieces.
3 doses.
After taking one dose, the fever subsided, and after three doses, vomiting stopped and diarrhea ceased.
Discussion:
Fever, aversion to cold, no sweating, and a floating tight pulse indicate a syndrome of cold damage. Diarrhea is due to exterior evil forcing the Yangming, leading to dysfunction of the large intestine, and vomiting is due to the stomach qi reversing.
This is a case of Taiyang and Yangming combined disease, treated with Ge Gen jia Ban Xia Tang, which disperses exterior cold, promotes fluid production to stop diarrhea, and descends qi to stop vomiting; adding Che Qian Zi helps to drain dampness and stop diarrhea.
Case 6
Song, male, 2 years old. Initial diagnosis: January 29, 2019.
Fever for one day, temperature 39.3°C, accompanied by vomiting, poor appetite, no sweating, pale tongue with white greasy coating, floating pulse.
Diagnosis: Taiyang and Yangming combined disease.
Prescribed Ge Gen jia Ban Xia Tang with modifications: Ge Gen 10 grams, Ma Huang 5 grams, Gui Zhi 5 grams, Bai Shao 5 grams, Zhi Gan Cao 3 grams, Ban Xia 5 grams, Jiao Zha (Hawthorn) 6 grams, Chao Lai Fu Zi (Stir-fried Radish Seed) 6 grams, Shen Qu (Fermented Barley) 6 grams, Sheng Jiang 2 slices, Da Zao 2 pieces.
3 doses.
Second diagnosis: February 1, 2019, temperature 37.2°C, spirit improved, no vomiting, foul breath, tongue slightly red with greasy coating.
Prescribed Bao He Wan (Preserve Harmony Pill): Jiao Zha 6 grams, Shen Qu 6 grams, Chen Pi (Aged Tangerine Peel) 5 grams, Ban Xia 5 grams, Fu Ling (Poria) 5 grams, Lian Qiao (Forsythia) 5 grams, Chao Lai Fu Zi 6 grams.
3 doses, cured.
Discussion:
Fever, no sweating, and a floating pulse indicate cold evil on the exterior, vomiting is due to evil qi forcing the Yangming, stomach qi reversing, and poor appetite with a white greasy tongue coating indicates food stagnation. Therefore, Ge Gen Tang is used to release the exterior, with Ban Xia to descend qi and stop vomiting, and Jiao Zha, Chao Lai Fu Zi, and Shen Qu to digest food.
In the second diagnosis, sweating occurred, fever subsided, foul breath, and a slightly red tongue with greasy coating indicate food stagnation transforming into heat. The use of Bao He Wan resolves stagnation and clears heat, leading to recovery.
Case 7
Li, male, 21 years old. Initial diagnosis: February 15, 2019.
Fever for one day, temperature 38.6°C, accompanied by aversion to cold, body pain, no sweating, thirst, dry throat, sore throat, slightly red tongue, white coating, floating tight pulse.
Prescribed Ge Gen Tang with modifications: Ge Gen 30 grams, Ma Huang 10 grams, Gui Zhi 10 grams, Bai Shao 10 grams, Zhi Gan Cao 6 grams, Hua Fen (Pollen) 15 grams, Lian Qiao 15 grams, Ban Lan Gen (Isatis Root) 30 grams, Sheng Jiang 15 grams, Da Zao 4 pieces.
Second diagnosis: February 16, 2019.
After taking one dose, sweating occurred, fever subsided, and dry throat and sore throat were resolved. Due to rhinitis, treatment was stopped and other medications were used for rhinitis.
Discussion:
This case resembles Da Qing Long Tang (Major Blue Dragon Decoction), but the dry throat and thirst indicate the presence of fluid injury, so Da Qing Long Tang was avoided due to its drying nature, and Ge Gen Tang with Hua Fen was chosen to disperse cold and release the exterior, generate fluids, and quench thirst; for sore throat, Lian Qiao and Ban Lan Gen were added to clear heat and detoxify.
This is another application of Ge Gen Tang.
Ge Gen Tang consists of Gui Zhi Tang with Ge Gen and Ma Huang added. It can be used even when there is no stiffness and pain in the neck and back or diarrhea. It is a mild dispersing agent, often used for exterior syndromes that are lighter than Ma Huang Tang and heavier than Gui Zhi Tang, and has applications in conditions such as urticaria, allergic rhinitis at onset, and cervical and lumbar disc protrusion.
Classic indications for Ge Gen Tang include Taiyang cold damage with accompanying neck and back pain or diarrhea.
In cases of Taiyang cold damage with fluid injury and internal dryness, Ge Gen Tang often achieves good results.
If fever, vomiting, abdominal pain, and diarrhea are caused by viral infections, this formula with modifications can be effective.
2 Gui Zhi Tang
From the Shang Han Lun, Section 12: In cases of Taiyang wind, with Yang floating and Yin weak, Yang floating indicates heat is self-releasing, Yin weak indicates sweating occurs, aversion to cold, aversion to wind, slight fever, nasal congestion, and dry vomiting, Gui Zhi Tang is the main treatment.
Section 13: In cases of Taiyang disease, with headache, fever, sweating, and aversion to wind, Gui Zhi Tang is the main treatment.
Key Diagnostic Points:
1. Commonly seen in individuals with weak constitution, especially those with spleen and stomach deficiency, who tend to sweat easily;
2. Fever is not severe, and aversion to cold is lighter than in Ma Huang Tang syndrome;
3. Sweating is a characteristic manifestation of Gui Zhi Tang syndrome;
4. Pale tongue with thin white coating, floating and relaxed pulse.
Case 8
Zhang, female, 45 years old. Initial diagnosis: June 25, 2016.
Yesterday, after working in the countryside under the scorching sun, she experienced continuous sweating. Last night, she began to have a fever.
Upon examination: fever, temperature 37.8°C, sweating soaked her clothes, aversion to cold, cough, itchy throat, expectorating a small amount of white phlegm, weakness all over, poor spirit, pale tongue with white coating, floating relaxed pulse.
Although it is summer, the patient presents with typical Taiyang wind syndrome.
Prescribed Gui Zhi jia Hou Po Xing Ren Tang (Cinnamon Twig Decoction with Magnolia Bark and Apricot Kernel) to release the exterior, disperse cold, and relieve cough.
Gui Zhi 10 grams, Bai Shao 10 grams, Zhi Gan Cao 6 grams, Xing Ren (Apricot Kernel) 10 grams, Chuan Po (Magnolia Bark) 15 grams, Jie Geng (Platycodon) 10 grams, Sheng Jiang 15 grams, Da Zao 4 pieces.
3 doses.
After taking one dose, the fever subsided, sweating decreased, and after three doses, all symptoms resolved.
Case 9
Liu, male, 61 years old. Initial diagnosis: January 15, 2019.
History of type 2 diabetes for over twenty years, body is thin. A month ago, he caught a cold and self-medicated, but has not recovered.
Upon examination: spontaneous sweating, aversion to cold, muscle pain all over, normal temperature, fatigue, poor spirit, pale tongue with white coating, weak pulse.
Prescribed Gui Zhi Xin Jia Tang (Newly Modified Cinnamon Twig Decoction): Gui Zhi 10 grams, Bai Shao 15 grams, Ren Shen (Ginseng) 10 grams, Zhi Gan Cao 6 grams, Sheng Jiang 15 grams, Da Zao 4 pieces.
3 doses, cured.
Discussion:
Case 8 is a middle-aged woman whose illness occurred in summer. After working under the scorching sun, she presented with fever, aversion to cold, and continuous sweating, with a floating relaxed pulse.
Upon careful examination, it is still considered a typical Taiyang wind syndrome, with cough and a small amount of white phlegm indicating evil in the muscle layer and lung qi not being released. Gui Zhi jia Hou Po Xing Ren Tang was chosen to release the exterior, disperse cold, and relieve cough, leading to recovery.
Case 9 is an elderly male with a long-term illness and a thin body. After catching a cold, he has not recovered, and besides showing symptoms of aversion to cold, spontaneous sweating, and weak pulse, the prominent manifestation is muscle pain and fatigue, with a deep and weak pulse.
From the Shang Han Lun, Section 62: “After sweating, if there is body pain and a deep slow pulse, Gui Zhi jia Shao Yao Sheng Jiang (Cinnamon Twig Decoction with Peony and Ginger) is the main treatment.”
Thus, Gui Zhi Xin Jia Tang is used to resolve muscle pain, dispel wind, harmonize Ying and Wei, and tonify qi and blood. In cases of Taiyang wind, whether sweating has occurred or not, if body pain is prominent, this formula is often indicated.
Before studying the Shang Han Lun with Teacher Xiao, I rarely used Gui Zhi Tang, mistakenly believing it to be too simple and weak to achieve the effect of sweating and fever reduction, preferring to use formulas like Shen Su Yin (Ginseng and Perilla Decoction) or Ren Shen Bai Du San (Ginseng Decoction to Overcome Pathogenic Factors).
Case 8 was my first time using Gui Zhi Tang to treat an exogenous disease. The efficacy was remarkable, changing my perspective.
Later, Gui Zhi Tang was studied and contemplated seriously, gradually understanding that the essence of harmonizing Ying and Wei is to tonify the spleen and stomach, leading to more frequent applications.
Now, formulas like Xiao Jian Zhong Tang (Minor Construct the Middle Decoction), Gui Zhi jia Shao Yao Tang (Cinnamon Twig Decoction with Peony), and Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Twig Decoction) are often used, all related to my understanding and comprehension of this formula.
Gui Zhi Tang syndrome often appears in summer, especially in women who usually lack exercise and have weaker bodies. This may be related to the heat of summer, excessive sweating, and a tendency to consume cold drinks.
3 Xiao Qing Long Tang, Xiao Qing Long Tang jia Shi Gao Tang
From the Shang Han Lun, Section 40: In cases of cold damage with unresolved exterior symptoms, with water qi in the chest, dry heaving, fever and cough, or thirst, or diarrhea, or difficulty urinating, fullness in the lower abdomen, or wheezing, Xiao Qing Long Tang is the main treatment.
From the Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet), Section 14: In cases of lung distension, cough with wheezing, irritability and wheezing, with a floating pulse, water is present in the chest; Xiao Qing Long Tang jia Shi Gao Tang is the main treatment.
Key Diagnostic Points:
1. Exterior symptoms of Taiyang cold damage: aversion to cold, fever, no sweating, floating tight pulse, etc.;
2. Internal cold fluids: cough, wheezing, thin white phlegm;
3. Xiao Qing Long Tang has a good function of warming the lungs and transforming fluids; it can also be used for cough and wheezing with thin and clear phlegm without exterior symptoms;
4. If there is internal heat with irritability or dry mouth, dry throat, or even sore throat, red tongue, etc., Xiao Qing Long jia Shi Gao Tang should be used.
Case 10
Wang, male, 3 years old. Initial diagnosis: December 14, 2018.
Cough for one day.
Upon examination: cough, wheezing, runny clear nose, no sweating, pale tongue with white coating, floating pulse. External cold evil, internal phlegm fluids.
Prescribed Xiao Qing Long Tang to release the exterior and transform fluids: Gui Zhi 6 grams, Bai Shao 6 grams, Ma Huang 6 grams, Gan Jiang (Dried Ginger) 5 grams, Xi Xin (Asarum) 2 grams, Ban Xia 5 grams, Wu Wei Zi (Schisandra) 5 grams, Zhi Gan Cao 5 grams, Xing Ren 6 grams, Su Zi (Perilla Seed) 6 grams, Chao Lai Fu Zi 5 grams.
3 doses.
Second diagnosis: December 17, 2018.
Cough and wheezing have stopped, but there is phlegm in the throat that is difficult to expectorate. Prescribed Er Chen Tang (Two Aged Decoction) combined with San Zi Yang Qin Tang (Three Seed Decoction), 3 doses, cured.
Case 11
Song, male, 6 years old. Initial diagnosis: January 2, 2018.
Fever, temperature 39°C, aversion to cold, cough, expectorating white phlegm, sore throat, pale tongue with thin white coating, floating pulse.
External cold and internal fluids, with heat accumulation.
Prescribed Xiao Qing Long jia Shi Gao Tang with modifications: Gui Zhi 6 grams, Bai Shao 6 grams, Ma Huang 6 grams, Gan Jiang 5 grams, Xi Xin 2 grams, Ban Xia 5 grams, Wu Wei Zi 3 grams, Zhi Gan Cao 5 grams, Sheng Shi Gao (Gypsum) 15 grams, Ban Lan Gen 10 grams.
After taking three doses, cured.
Case 12
Li, female, 54 years old. Initial diagnosis: June 9, 2018.
History of allergic rhinitis for half a year. In the past week, she has been coughing, wheezing, with thin white phlegm, itchy nose, runny nose, dry bitter mouth, pale tongue with white slippery coating, thin pulse.
Internal phlegm stagnation in the lungs.
Prescribed Xiao Qing Long Tang with modifications: Gui Zhi 10 grams, Bai Shao 10 grams, Ma Huang 10 grams, Gan Jiang 10 grams, Xi Xin 6 grams, Ban Xia 10 grams, Wu Wei Zi 10 grams, Zhi Gan Cao 6 grams, Xing Ren 10 grams, Su Zi 15 grams, Huang Qin (Scutellaria) 10 grams.
5 doses.
Second diagnosis: June 14, 2018.
Cough and wheezing resolved. Nose itching, occasional runny nose, loose stools, prone to colds, often has stomach acid, pale tongue with white coating, thin pulse.
Prescribed Shen Qi Di Huang Tang (Kidney Qi Pill) combined with Yu Ping Feng San (Jade Windscreen Powder) with modifications: Xi Yang Shen (American Ginseng) 10 grams, Huang Qi (Astragalus) 30 grams, Sheng Di Huang (Rehmannia) 30 grams, Shan Yao (Chinese Yam) 15 grams, Shan Zhu Yu (Cornus) 15 grams, Yun Ling (Poria) 10 grams, Ze Xie (Alisma) 10 grams, Dan Pi (Moutan) 10 grams, Bai Zhu (Atractylodes) 10 grams, Fang Feng (Siler) 5 grams, Jie Geng 10 grams, Bo He (Mint) 10 grams, Chan Yi (Cicada Slough) 10 grams, Huang Lian (Coptis) 6 grams, Ban Xia 10 grams, Wu Zhu Yu (Evodia) 2 grams.
5 doses.
After taking the above formula with modifications for ten doses, on June 28, 2018, during the fourth diagnosis, the allergic rhinitis was also cured.
Discussion:
Xiao Qing Long Tang disperses cold evil externally and transforms water fluids internally, making it a commonly used formula for treating exterior cold and internal fluid stagnation with symptoms of aversion to cold, fever, no sweating, cough, wheezing, and thin white phlegm.
Case 10 is a typical Xiao Qing Long Tang syndrome, with clear runny nose and floating pulse indicating cold evil on the exterior, while cough and wheezing indicate internal fluid stagnation. Xiao Qing Long Tang combined with Xing Ren and Su Zi was used to release the exterior, disperse cold, warm the lungs, transform fluids, and descend qi to stop cough, leading to recovery.
Case 11, in addition to typical external cold and internal fluid syndrome, had a sore throat, indicating the presence of heat accumulation, so Shi Gao and Ban Lan Gen were added to clear heat and detoxify, relieving sore throat.
Case 12 showed no obvious external symptoms, only lung cold fluid stagnation and cough with wheezing and thin phlegm. Xiao Qing Long Tang was used to warm the lungs and transform fluids, and due to dry bitter mouth, Huang Qin was added to clear heat. Later, Shen Qi Di Huang Tang combined with Yu Ping Feng San was used to tonify the kidneys, secure the exterior, and open the orifices, successfully treating allergic rhinitis.
Xiao Qing Long Tang syndrome and Da Qing Long Tang syndrome both belong to the same disease of exterior and interior, but Da Qing Long Tang syndrome is characterized by exterior cold and interior heat, with the main symptoms being no sweating and irritability; Xiao Qing Long Tang is characterized by exterior cold and internal fluid stagnation, and can be used even without exterior symptoms, with the main symptoms being no sweating and cough.
Da Qing Long Tang syndrome and Xiao Qing Long jia Shi Gao Tang syndrome both involve exterior cold and interior heat, but Da Qing Long Tang focuses on releasing the exterior while also clearing heat, emphasizing exterior release; Xiao Qing Long jia Shi Gao Tang treats both exterior and interior, clearing heat while warming the lungs and transforming fluids, and can be used without exterior symptoms, requiring careful differentiation in clinical use.
4 Xiao Chai Hu Tang
To be continued……
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Note: Cover image sourced from Shetu Network.
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