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Editor’s Introduction
The method of clearing heat and detoxifying is a fundamental principle used to eliminate internal and external heat toxins and fire toxins that cause diseases in the human body, and it is widely applied in clinical practice. This method is suitable for conditions such as febrile diseases, warm diseases, damp-heat, and epidemic toxins that lead to symptoms like fever, thirst, sore throat, diarrhea, urinary difficulties, abscesses, ulcers, and itching. So, how should the method of clearing heat and detoxifying be applied to effectively treat these various conditions? According to Zhang Zhongjing’s approach, there are approximately nine aspects to consider—
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The method of clearing heat and detoxifying primarily uses herbs that eliminate fire and epidemic toxins from the body, mostly bitter and cold substances. Bitter can transform dryness and injure yin, while cold can easily harm yang, and toxins can damage the righteous qi. Therefore, those with yin deficiency and little fluid, yang deficiency with excess yin, or insufficient middle qi should reduce the use of these substances.
The effects and application range of the method of clearing heat and detoxifying are widely recognized by practitioners, and will not be elaborated here. A review of the “Shang Han Lun” and “Jin Gui Yao Lue” shows that due to the complexity of pathogenic factors, the duration of the illness, the depth of the pathological changes, and the differences in patient constitution, the method of clearing heat and detoxifying is often combined with other methods in specific applications. In summary, the methods can be categorized as follows: clearing heat and detoxifying, relieving sore throat and pain, using Gan Cao Tang (Licorice Decoction) or Jie Geng Tang (Platycodon Decoction); clearing heat and detoxifying while draining pus, using the Jie Geng Tang from “Qian Jin”; clearing heat, drying dampness, and cooling blood to stop diarrhea, using Bai Tou Weng Tang (Pulsatilla Decoction); clearing heat and stopping diarrhea while nourishing blood and alleviating urgency, using Bai Tou Weng Jia Gan Cao E Jiao Tang (Pulsatilla Decoction with Licorice and Gelatin); clearing heat, cooling blood, drying dampness, and killing insects, using the San Wu Huang Qin Tang from “Qian Jin”; clearing heat, drying dampness, killing insects, and relieving itching, using Lang Ya Tang (Wolf Tooth Decoction); clearing heat, detoxifying, and dispersing blood stasis, using Sheng Ma Bie Jia Tang (Cimicifuga and Soft-Shelled Turtle Decoction); detoxifying, dispersing blood stasis, and protecting yin, using Sheng Ma Bie Jia Tang with the removal of Xiong Huang (Realgar) and Shu Jiao (Sichuan Pepper). There are many such methods, which will be discussed in detail below.
(1) Clearing heat and detoxifying, relieving sore throat and pain
This method is suitable for cases of throat discomfort, redness, swelling, heat, and pain in the throat, or dryness and burning in the mouth and throat. The tongue is red with a yellow coating, and the pulse is rapid or weak. This condition is due to the invasion of fire-heat toxins into the throat, or the upward fire from a Shaoyin disease. The internal heat and fire nature cause inflammation. The treatment should focus on clearing heat and detoxifying, relieving sore throat and pain. The formula used is Gan Cao Tang or Jie Geng Tang. In Gan Cao Tang, the herb Gan Cao (Licorice) is used raw, which is sweet and cool, decocted in water and taken frequently to clear heat and detoxify, relieving sore throat and pain effectively. If Jie Geng (Platycodon) is added, it is called Jie Geng Tang. In this formula, Gan Cao is prepared to clear heat and detoxify, tonifying qi and generating fluids; Jie Geng opens the lung qi, transforms phlegm-heat, and calms cough, enhancing the effects of clearing heat and detoxifying, relieving sore throat and pain. This formula is particularly effective for treating sore throats with burning heat and dryness, redness, swelling, and pain.
This method is currently used clinically to treat acute and chronic pharyngitis and purulent tonsillitis, with significant efficacy.
(2) Clearing heat and detoxifying while draining pus
This method is suitable for cough and wheezing, chest pain, foul-smelling sputum, and in severe cases, coughing up pus and blood resembling rice porridge, with a pulse that is often rapid or slippery. This is caused by wind-heat invading the lungs, heat obstructing blood stasis, and accumulation of pus. The treatment should focus on clearing heat, detoxifying, and draining pus. The formula used is Jie Geng Tang from “Qian Jin”. In this formula, Jie Geng disperses lung obstruction to drain pus and phlegm; Gan Cao detoxifies and clears heat while tonifying qi. The combination of these two herbs has the effect of draining pus, expelling phlegm, detoxifying, and clearing heat, allowing for the removal of decay and the generation of new tissue, ensuring the illness is resolved.
This method is commonly used in clinical practice to treat acute and chronic pharyngitis, scarlet fever, and lung abscesses effectively.
(3) Clearing heat, drying dampness, and cooling blood to stop diarrhea
This method is suitable for abdominal pain with urgency and heaviness, diarrhea with pus and blood, burning in the anus, thirst, or itching in the genitals, with excessive white discharge, yellow coating on the tongue, and rapid pulse. This is due to damp-heat accumulation, pressing on the large intestine, with heat corrupting qi and blood, and qi stagnation, or liver heat transferring to the large intestine. The treatment should focus on clearing heat, drying dampness, and cooling blood to stop diarrhea. The formula used is Bai Tou Weng Tang. This formula includes Bai Tou Weng (Pulsatilla), Huang Lian (Coptis), Huang Bai (Phellodendron), and Qin Pi (Fraxini Cortex), which are all bitter and cold substances that can overcome heat, dry dampness, and eliminate damp-heat, thus alleviating heaviness.
This method is now often used to treat amoebic dysentery, bacterial dysentery, as well as women’s damp-heat discharge and genital itching, with confirmed efficacy.
(4) Clearing heat and stopping diarrhea, nourishing blood and alleviating urgency
This method is suitable for postpartum heat diarrhea injuring yin, with symptoms of diarrhea with pus and blood, fever, abdominal pain, and urgency. It is also suitable for those with yin deficiency and weak blood suffering from heat diarrhea and heaviness. This is due to yin deficiency and blood deficiency, with damp-heat not cleared. The treatment should focus on clearing heat, stopping diarrhea, nourishing blood, and alleviating urgency. The formula used is Bai Tou Weng Jia Gan Cao E Jiao Tang (Pulsatilla Decoction with Licorice and Gelatin). In this formula, Bai Tou Weng Tang is bitter and cold, clearing heat and stopping diarrhea, while E Jiao (Gelatin) nourishes yin and blood, and Gan Cao harmonizes and alleviates urgency.
This method is now used to treat acute and chronic enteritis and dysentery with yin deficiency and blood deficiency, showing certain efficacy.
(5) Clearing heat, cooling blood, drying dampness, and killing insects
This method is suitable for women postpartum with wind-heat, body heat, pain in the limbs, unexpelled lochia, and red or white discharge, with itching in the genitals. This is due to postpartum deficiency failing to resist pathogens, and blood deficiency with heat. The treatment should focus on clearing heat, cooling blood, drying dampness, and killing insects. The formula used is the San Wu Huang Qin Tang from “Qian Jin”. This formula includes Huang Qin (Scutellaria), Ku Shen (Sophora), which are bitter and cold, clearing heat, drying dampness, and killing insects, while Di Huang (Rehmannia) is sweet and cold, nourishing yin and cooling blood. The combination of these three herbs works together to clear heat, cool blood, dry dampness, and kill insects.
This method is now often used to treat postpartum infections and puerperal fever, showing efficacy that deserves further study.
(6) Clearing heat, drying dampness, killing insects, and relieving itching
This method is suitable for damp-heat evil accumulating in the front yin, causing erosion and pain, with discharge and sores in the genitals. This is due to damp-heat descending, corrupting qi and blood. The treatment should focus on clearing heat, drying dampness, killing insects, and relieving itching. The formula used is Lang Ya Tang (Wolf Tooth Decoction). This formula uses Lang Ya, which is decocted, and the liquid is used to soak cotton cloth, which is then inserted into the vagina, or the liquid is used to wash the external genitals, effectively clearing heat, drying dampness, killing insects, and relieving itching.
This method is now used to treat trichomonas vaginitis, candidiasis, as well as hemorrhoids and skin diseases, with significant efficacy.
(7) Clearing heat and detoxifying while dispersing blood stasis
This method is suitable for facial redness with mottled patterns, sore throat, coughing up pus and blood, or skin bruises, grayish complexion, occasional sore throat, bleeding from teeth and nose, weakness, and a pale tongue with a weak pulse. This is due to the invasion of yang-heat epidemic toxins, with the yin-nourishing being affected by the heat, consuming blood and causing movement of blood. The treatment should focus on clearing heat, detoxifying, and dispersing blood stasis. The formula used is Sheng Ma Bie Jia Tang (Cimicifuga and Soft-Shelled Turtle Decoction). In this formula, Sheng Ma (Cimicifuga) is sweet and bitter, slightly cold, primarily detoxifying and dispelling epidemic evil; Bie Jia (Soft-Shelled Turtle) is sour and neutral, non-toxic, softening hardness and dispersing masses; and Dang Gui (Angelica) is bitter, warm, and aromatic, entering the blood, effectively detoxifying the evil toxins affecting the nutritive and defensive qi; Gan Cao (Licorice) is sweet and neutral, used raw to detoxify, while honey-fried enters the spleen to support the middle and expel evil; the unique use of Shu Jiao (Sichuan Pepper) is warm and pungent, with pure yang color, leading the other herbs to detoxify the yang toxins. The combination of these herbs works together to achieve the effect of clearing heat, detoxifying, and dispersing blood stasis.
This method is now commonly used in clinical practice to treat heat-stasis type purpura, lupus erythematosus, and other conditions, showing certain efficacy for clinical reference.
(8) Detoxifying, dispersing blood stasis, and protecting yin
When epidemic toxins invade the nutritive blood, yin loses its nourishing ability, symptoms such as facial redness, body pain as if beaten, and sore throat appear. The treatment is to use Sheng Ma Bie Jia Tang with the removal of Xiong Huang and Shu Jiao to detoxify and protect yin. In this formula, Sheng Ma disperses and detoxifies; Bie Jia, combined with Dang Gui, nourishes yin and blood while dispersing blood; Gan Cao harmonizes and detoxifies. The combination of these herbs allows the toxins to be expelled and the fluids to be restored, leading to recovery.
This method can now be used to treat rheumatoid arthritis, lupus, and other collagen diseases, showing remarkable efficacy when the diagnosis is accurate.
(9) Clearing heat and detoxifying, killing insects, and transforming dampness
The foot jueyin liver meridian surrounds the genitals and ascends to the throat, thus damp-heat descending to the front yin manifests as genital ulcers, and can also ascend to cause dryness in the throat, presenting as fox disease. One can take clearing heat, drying dampness, and detoxifying formulas while externally washing the affected area with Ku Shen Tang (Sophora Decoction) to clear damp-heat and heal the ulcers.
Recommended Good Books
“Clinical Application of Zhang Zhongjing’s Principles, Methods, Formulas, and Medicines“
The principles, methods, formulas, and medicines reflected in Zhang Zhongjing’s “Shang Han Za Bing Lun” lay the foundation for TCM syndrome differentiation and treatment. However, due to the long time since its compilation, its language is profound and its methods are simple yet detailed, making it difficult for beginners to grasp the essentials and enter the field. This book is compiled based on the author’s thirty years of clinical and teaching experience, and draws on the achievements of past masters in the application of Zhang Zhongjing’s academic principles, methods, formulas, and medicines. This book has the following features: highlighting the clinical guiding significance of Zhang Zhongjing’s academic principles and methods; emphasizing the reasonable and standardized application of classical formulas in treating diseases; focusing on the practical application of Zhang Zhongjing’s principles and methods, flexibly using formulas and medicines without being rigid, and including modern empirical formulas and cases guided by classical formula composition ideas.
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Copyright Statement
Some content of this article is selected from “Clinical Application of Zhang Zhongjing’s Principles, Methods, Formulas, and Medicines” (published by China Traditional Chinese Medicine Press, authored by Wang Zhenliang), and the final interpretation rights belong to the original author. This article is recommended for publication by Read TCM (WeChat ID: ydzhongyi), and the cover image is sourced from the internet. Please do not reproduce without authorization!
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