“A series of articles on the ‘Fundamentals of Traditional Chinese Medicine’ aims to help everyone better learn TCM and break free from the cycle of ‘seeking only formulas without learning medicine.’ We will use vivid and interesting language and fascinating phenomena to unveil the mysteries of TCM, opening the door to a new world, while also allowing you to understand TCM ‘both in its essence and its reasons.’
Many people feel that most classical formulas primarily treat symptoms ‘inside’ the body, such as headaches, diarrhea, chronic gastritis, blood stasis, and Yang deficiency. However, the effects of classical formulas extend far beyond this; if you are curious, let’s take a look at what we discuss today.
In our daily lives, in addition to frequently suffering from illnesses like colds, rhinitis, and constipation, we are often tormented by skin diseases, such as skin itching. 
Skin itching is commonly seen in adults and is a symptom of a skin disease characterized solely by itching without primary skin lesions. Skin itching often starts in one area and gradually spreads to the entire body. It is usually paroxysmal, particularly severe at night, and in severe cases, it presents as persistent itching with paroxysmal exacerbation. Alcohol, coffee, tea, emotional changes, spicy foods, mechanical scratching, warm bedding, and even certain suggestions can trigger and worsen itching, causing significant disruption to daily life.
◎ Hand-drawn by an eight-year-old
So what should we do at this time? I would like to introduce a formula: Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Adzuki Bean Decoction), composed of: 6g Ma Huang (Ephedra), 9g Lian Qiao (Forsythia), 9g Xing Ren (Apricot Kernel), 30g Chi Xiao Dou (Adzuki Bean), 12 pieces of Da Zao (Jujube), 10g Sang Bai Pi (Mulberry Root Bark), 6g Sheng Jiang (Fresh Ginger), and 6g Zhi Gan Cao (Honey-fried Licorice). This formula is derived from the “Shang Han Lun” (Treatise on Cold Damage) and can treat damp-heat with exterior symptoms, making it very effective for the skin itching we just mentioned.
In fact, the therapeutic range of Ma Huang Lian Qiao Chi Xiao Dou Tang is quite broad. Clinically, it is used for skin diseases characterized by itching, blisters, erosion, and exudation, such as urticaria, acute eczema, erythroderma, seborrheic dermatitis, common acne, chickenpox, pityriasis rosea, viral herpes, allergic dermatitis, skin itching, and even body odor, all of which belong to damp-heat conditions and can be treated effectively with this formula.
Now, what specific situations is this formula suitable for, and what do we need to understand? You might want to keep reading.
Case Study (1)
Let’s first discuss two case studies. The first is from Mr. Liu Duozhou, but it is not entirely accurate to say it is solely his case, as Professor Hao Wanshan is also involved. Mr. Liu not only has profound academic achievements but has also been engaged in TCM education for over 30 years, making significant contributions to the cultivation of TCM talent. Professor Hao Wanshan, a renowned master of classical formulas at Beijing University of Chinese Medicine, has studied under Mr. Liu, so you can understand that this case study carries weight.
In April 1976, just before the Tangshan earthquake, Professor Hao and Mr. Liu, along with some students, went to the Funing County area of Tangshan to open a school. During this time, one student developed urticaria, itching so severely that he could not sleep at night, and also exhibited mild chills and a white greasy tongue coating. Initially, this student sought treatment from Professor Hao, who prescribed general cooling blood, drying dampness, dispelling wind, and itching-relieving herbs. However, after three days of medication, the young man still could not sleep at night due to itching. He then went back to Professor Hao and said, “Teacher, I have taken your three doses of medicine, but it is still not better.”
At that moment, Professor Hao and Mr. Liu were in the same room, so Mr. Liu took a look, leading to the following dialogue.
Mr. Liu: “What pulse do you think this is?”
Professor Hao said: “This young man is thin, and the pulse can be felt lightly.”
Mr. Liu said: “What pulse can be felt lightly? Do you think it is a floating pulse?”
Professor Hao said: “Teacher, he doesn’t have a cold; can we say it is a floating pulse?”
Mr. Liu said: “Just because he doesn’t have a cold means there is no floating pulse? Where is this young man itchy?”
Professor Hao said: “The skin is itchy.”
Mr. Liu said: “Is the skin exterior or interior?”
Professor Hao said: “The skin is of course exterior, not interior.”
Mr. Liu said: “Since the skin itching is exterior, and the pulse is lightly felt, it is certainly an exterior syndrome.”
Professor Hao said: “Teacher, is this an exterior syndrome?”
Mr. Liu said: “Yes.”
Professor Hao said: “Then what should we do? An exterior syndrome should be treated with sweating, right?”
Mr. Liu said: “Yes.”
Professor Hao said: “Then what formula should we use?”
Mr. Liu said: “Use Ma Huang Lian Qiao Chi Xiao Dou Tang.”
Later, Mr. Liu instructed the young man to take the medicine at night before going to bed, drink more hot water, and cover himself with a quilt to induce sweating for three consecutive nights. After sweating for three nights, the urticaria resolved, and later Professor Hao noticed that the young man had shed a lot of skin flakes, and the urticaria was cured.
Case Study (2)
You may have already noticed some clues from the first case study, so let’s continue. Mr. Wang Zhongmin advocates the integration of Chinese and Western medicine, taking the strengths of both. He is clinically skilled in gynecology, while also addressing internal medicine and pediatrics, with unique insights into some difficult and severe cases. He has co-authored medical works such as “Pediatric Differentiation” and “Essentials of Traditional Chinese Medicine”.
Case Study: A 59-year-old male named Sun has suffered from chronic bronchitis for 12 years. A few days ago, he accidentally caught a chill, and his old ailment recurred, presenting with fever, chills, no sweat, cough, headache, heavy body, difficulty lying flat, chest tightness, shortness of breath, and a large amount of sticky, slightly yellow phlegm. He also experienced poor appetite, nausea, difficulty urinating, and lower limb edema. His tongue was red with a yellow greasy coating, and the pulse was floating and slightly rapid.
Upon auscultation, the heart sounds were faint and distant, with a regular rhythm. Breath sounds were diminished, with prolonged expiration, and moist rales and wheezing were heard at the lung base. His temperature was 38.7°C. Laboratory tests showed white blood cells at 18,200/mm³, with neutrophils at 78%, lymphocytes at 16%, eosinophils at 29/5, and monocytes at 4%. Chest X-ray revealed enhanced lung markings and mild emphysema.
The diagnosis was wind-cold invading the lungs, dampness accumulating and transforming into heat, leading to lung dysfunction. The prescription was Ma Huang Lian Qiao Chi Xiao Dou Tang with modifications: 9g Ma Huang, 12g Lian Qiao, 15g each of Xing Ren, Zhi Sang Bai Pi, and Tian Teng Li, 30g Chi Xiao Dou, and 6g each of Gan Cao and Sheng Jiang, and 10g Chen Pi. Decoction was prepared and taken in two doses.
After taking the above formula for three doses, symptoms were alleviated, cough decreased, he was able to lie flat, phlegm gradually reduced, edema disappeared, and shortness of breath improved significantly, with temperature returning to normal. The previous formula was adjusted and continued for five more doses, and the cough completely resolved.
01
Damp-Heat and Case Analysis
Does it feel like there is a significant gap between these two case studies? This is actually intentional. If today we only discuss that Ma Huang Lian Qiao Chi Xiao Dou Tang can treat skin diseases, then everyone might not remember it deeply. Perhaps after reading today’s article, everyone would only remember that Ma Huang Lian Qiao Chi Xiao Dou Tang can treat skin diseases, but not understand why it can treat them. However, by adding a case of treating cough, the impression will be much deeper.
◎ Hand-drawn by an eight-year-old
Before analyzing the case studies, it is essential to understand the relevant foundational knowledge of TCM.
Damp-heat must be differentiated into dampness and heat. Dampness, as commonly referred to, can be divided into external dampness and internal dampness. External dampness is an external evil known as damp evil, often caused by humid weather, exposure to rain, or living in damp environments, leading to the invasion of external dampness into the body, characterized by heaviness, stickiness, and a tendency to descend. Internal dampness is a pathological product related to dysfunction of the internal organs. Heat is also an evil qi, characterized by inflammation and rising heat, known as fire-heat evil. Heat can also arise from dysfunction of the internal organs, referred to as internal heat.
In fact, it is no longer a novelty that modern humans have damp-heat in their bodies; it can be said that most people have some degree of damp-heat, primarily due to four reasons: exposure to external evils, irregular diet, spleen and stomach dysfunction, and emotional factors. This has been discussed before, and I will provide a link below for you to check out.
01
The general manifestations of damp-heat include: heaviness in the head and body, fever often noticeable in the afternoon, and body heat that does not diminish with sweating (i.e., the skin initially feels warm to the touch, but after a while, it feels hot), with a yellow greasy tongue coating and a rapid pulse.
02
Specific manifestations vary depending on the location of damp-heat: in the skin, it may present as eczema or sores; in the joints and tendons, it may cause localized swelling and pain. However, the term damp-heat usually refers to damp-heat deeply affecting the internal organs, particularly the spleen and stomach, which can manifest as fullness and discomfort in the abdomen, nausea, poor appetite, loose stools, short and yellow urine, and a slippery rapid pulse; other manifestations such as liver and gallbladder damp-heat may present as distension and pain in the liver area, bitter mouth, poor appetite, or alternating fever and chills, with a wiry rapid pulse; bladder damp-heat may present as frequent and urgent urination, painful and scanty urine, with yellow and turbid urine; large intestine damp-heat may present as abdominal pain and diarrhea, even with tenesmus, purulent blood stools, and burning sensation in the anus, along with thirst.
Now that you have a clear understanding of damp-heat, let’s take a look at the case studies. The first case study has already made it clear through dialogue that we initially stated that Ma Huang Lian Qiao Chi Xiao Dou Tang can treat damp-heat with exterior symptoms. What are exterior symptoms? They include aversion to cold, fever, headache, body aches, nasal congestion, absence of sweating, and floating pulse, along with some skin manifestations.
At this point, someone might say, “We don’t know how to take the pulse, and we can’t distinguish floating pulses; what should we do?”
Here, we can summarize this case study with one sentence: for skin itching symptoms, anyone who exhibits aversion to cold, floating pulse, and greasy tongue coating can consider using this formula. How should this be understood? It does not mean that everyone should be bound by these few symptoms; you now know the symptoms of exterior syndrome and the symptoms of damp-heat, and when the two are combined, that is the indication for Ma Huang Lian Qiao Chi Xiao Dou Tang.
If you understand this, then you can also comprehend the case of chronic bronchitis. In the second case study, “cough with a large amount of sticky phlegm, slightly yellow in color, … red tongue with yellow greasy coating” is a manifestation of damp-heat, and this person also had a recurrence of an old ailment due to catching a chill, so exterior symptoms combined with internal damp-heat make Ma Huang Lian Qiao Chi Xiao Dou Tang the most suitable choice.
◎ Hand-drawn by an eight-year-old
02
Analyzing Ma Huang Lian Qiao Chi Xiao Dou Tang
Now that we have discussed the case studies, it’s time to look at the formula. Many people feel intimidated by the formula and find it difficult to understand, but today it is quite simple: “In cases of cold damage, if damp-heat is present internally, the body will surely turn yellow; Ma Huang Lian Qiao Chi Xiao Dou Tang is the main treatment for it.”
It seems simple, but you might be misled 
because there is a lot contained within. First, we just discussed a lot about exterior symptoms and damp-heat; are they completely independent and unrelated? The answer is no. Damp-heat internally is one issue, while external pathogens are another. If the exterior pathogens are not resolved, damp-heat will accumulate; these two are interconnected. If the exterior is not resolved, it will lead to internal damp-heat, and internal damp-heat will also inevitably affect the resolution of the exterior. Therefore, treatment must address both aspects simultaneously, rather than treating them separately.
◎ Image authorized by Qian Ku Network
Note
For example, if we stop treating damp-heat and focus solely on exterior symptoms, this will halt the treatment of damp-heat, potentially leading to the progression of damp-heat conditions, which may eventually result in jaundice. Conversely, if we ignore exterior symptoms and think, “To eliminate external threats, we must first stabilize the internal environment,” and focus solely on resolving damp-heat, this may lead to the internal invasion of exterior pathogens, which is also not feasible.
Therefore, treatment should utilize Ma Huang Lian Qiao Chi Xiao Dou Tang to disperse exterior pathogens while clearing heat and draining dampness internally. This way, we can continue treating damp-heat without interrupting the treatment of exterior pathogens, allowing the disease to resolve.
03
Analysis of Ingredients and Precautions
Now, let’s take a look at the composition of the formula.
This formula is called Ma Huang Lian Qiao Chi Xiao Dou Tang, but actually, the Lian Qiao used here should be Lian Yao, which is the root of Lian Qiao. Lian Qiao can be found in today’s pharmacies, but Lian Yao is not readily available. So what is the characteristic of Lian Qiao? It is capable of pushing the heat from the blood level to the surface, and when combined with Ma Huang, the effect is enhanced.
This formula also contains a herb called Zi Bai Pi, which is the bark of the catalpa tree, bitter and cold, capable of clearing heat and draining dampness, and clearing heat evil. Today, we can’t find it, so we use Sang Bai Pi instead, but the dosage of Sang Bai Pi should not be too much, as excessive amounts can cause vomiting.
This decoction is essentially a Ma Huang base formula, but it is not as extreme as the Ma Huang Tang, as it contains ginger and jujube. The jujube is more abundant, while the ginger is less, which helps to nourish the blood. The small amount of ginger maintains the structure of regulating the defensive and nutritive qi, so overall, it still follows the direction of a dispersing exterior formula. Chi Xiao Dou is a good herb that can drain damp-heat; Mr. Liu Duozhou often uses Chi Xiao Dou to drain damp-heat, for example, in cases of damp-heat arthritis, over time, using Shao Yao Gan Cao Tang or Dang Gui Chi Xiao Dou Tang, along with some other herbs, works very well.
◎ Image authorized by Qian Ku Network
Of course, can it also treat allergic rhinitis? Yes, as long as it is damp-heat combined with exterior symptoms. It can also be used for kidney inflammation, edema, asthma, and body odor, as long as they fit the damp-heat with exterior symptoms, everyone can give it a try. However, it is best to start with a small dose to see if there are any side effects.
04
Damp-Heat Health Preservation
Damp-heat has actually become the number one enemy in people’s lives, and we must face it. Many bad habits in life can lead to the generation of damp-heat, so we need to eliminate them.
1. Dietary Habits: Eat less sweets, sweet drinks, and spicy stimulating foods, and reduce alcohol consumption, as alcohol is the most damp-heat-inducing food. Eat less rich and fatty foods, and maintain a light diet to dispel dampness. It is particularly important to quit smoking and drinking; some people are unwilling to give up this lifestyle, but they must bear the consequences, as the saying goes, “Illness is self-inflicted.” Recommended foods for dispelling dampness include: mung beans, winter melon, loofah, adzuki beans, watermelon, green tea, and flower tea.
2. Daily Living: Avoid staying up late, as it increases damp-heat. Staying up late harms the liver and gallbladder, significantly affecting the upward movement of liver and gallbladder qi, making it easy to generate damp-heat. Additionally, try to avoid working or living in damp environments. For example, if you have a phlegm-damp constitution, avoid buying low-floor apartments, as dark and damp living conditions can exacerbate damp-heat constitution.
3. Simple Formulas and Herbs: Damp-heat constitution is a transitional constitution; very few people maintain a damp-heat constitution into old age. This is because damp-heat constitution often leads to discomfort, skin itching, inflammation, and skin infections, urinary tract infections, etc. It makes people very uncomfortable, and discomfort prompts them to take medication, such as heat-clearing and cold-cooling herbs. Therefore, damp-heat constitution is more common in young and middle-aged individuals. In old age, although there are still factors of damp-heat constitution, it is no longer the primary one.
Generally, herbs for dispelling damp-heat are not very mild and should not be taken for long periods.
◎ Image authorized by Qian Ku Network
Common herbs for dispelling damp-heat include: Huo Xiang (Agastache), Che Qian Cao (Plantago), Dan Zhu Ye (Lophatherum), Hua Shi (Talc), Xi Huang Cao (Hypericum), Ji Gu Cao (Euphorbia), and Mu Mian Hua (Bombax). These are all relatively cold and should not be taken for long periods; they can be used for foot baths.
Common Chinese patent medicines include: Gan Lu Xiao Du Dan, Jun Tai Oral Liquid, Qing Re Qu Shi Powder, and Xi Huang Cao Powder, etc. These should also not be taken for long periods. If damp-heat has been resolved, the tongue coating is no longer yellow and greasy, urine has become clear, and inflammation is not obvious, then you must stop immediately; they should not be taken for long periods.
For example, when there is damp-heat, with symptoms of inflammation, sore throat, urination issues, muscle soreness, etc., and when internal heat is heavy, some can be taken to adjust the constitution, but they should not be taken for long periods. If there is no internal heat, these medications should not be taken, as they can be toxic.
Well, that concludes the discussion on Ma Huang Lian Qiao Chi Xiao Dou Tang. If you have any questions, feel free to leave a comment.
— THE END —
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