Inheriting the flame of Qihuang, a public account with substance and warmthâ–¢Author/Cheng YongminIn the “Treatise on Febrile Diseases” (Shang Han Lun), Section 104: “When the febrile disease does not resolve after thirteen days, with fullness in the chest and hypochondria, vomiting, and tidal fever occurring in the afternoon, followed by slight diarrhea, this is the basic pattern of Chai Hu (Bupleurum) syndrome. If there is no benefit from purging, and now there is a reversal to diarrhea, the physician should know that using pills to purge is not the correct treatment. Tidal fever indicates excess. It is advisable to first take Xiao Chai Hu Tang (Minor Bupleurum Decoction) to resolve the exterior, and then use Chai Hu Jia Mang Xiao Tang (Bupleurum Decoction with Mirabilite) to address it.Chai Hu (Bupleurum) 2 liang 26 zhu; Huang Qin (Scutellaria) 1 liang; Ren Shen (Ginseng) 1 liang; Gan Cao (Licorice) 1 liang (roasted); Sheng Jiang (Fresh Ginger) 1 liang (sliced); Ban Xia (Pinellia) 20 zhu (originally five pieces, washed); Da Zao (Jujube) 4 pieces (split); Mang Xiao (Mirabilite) 2 liangThese eight ingredients are boiled in four sheng of water until two sheng remain, then strain, add Mang Xiao, and boil gently. Divide and take warm; if not resolved, repeat.
The patient has been ill for over ten days without resolution, entering a state of half-exterior and half-interior. Symptoms include fullness in the chest and hypochondria, vomiting, chest tightness, rib pain upon palpation, fullness in the ribs, nausea, and vomiting, all indicating a half-exterior and half-interior syndrome. Tidal fever occurs in the afternoon, typically from three to five o’clock, with intermittent heat sensations followed by slight diarrhea, indicating the body is expelling pathogens. The tidal fever indicates the body is expelling illness to the surface, while slight diarrhea indicates internal expulsion.This is fundamentally a Chai Hu syndrome; if purging does not yield results, and now there is a reversal to diarrhea, the physician should know that using pills to purge is not the correct treatment. In the “Kang Ping Edition of the Treatise on Febrile Diseases”,the phrase “using pills to purge” is enclosed in parentheses, possibly an annotation added by later generations, while the preceding text is the original text of Zhongjing.Tidal fever indicates excess.In the afternoon, the body experiences tidal fever, which generally indicates intestinal blockage.The afternoon coincides with the time of the Kidney meridian’s activity; utilizing the energy of the Kidney meridian directs it to the surface, causing the body to experience tidal fever. Usually, due to blockage, the fluids are restrained, leading to insufficient energy reaching the surface.When symptoms worsen in the afternoon, it generally indicates intestinal blockage related to food accumulation.When symptoms worsen at night, it is generally related to blood stasis.There was a time when I experienced dizziness in the afternoon; upon reflection, I realized my intestines were blocked. After taking Da Huang Gan Cao Wan (Rhubarb and Licorice Pill), I had diarrhea, and the dizziness resolved.At this time, I first used Xiao Chai Hu Tang; why? After more than ten days, the body has been fighting against the pathogenic factors, leading to insufficient body fluids, and the illness has entered a half-exterior and half-interior state. The half-exterior and half-interior syndrome is not suitable for purging; first, Xiao Chai Hu Tang should be used to open up the half-exterior and half-interior, allowing the body to return to normal function, and then clear the internal excess and heat. Since diarrhea has already occurred, the blockage is not severe, but the body still has tidal fever, indicating internal heat that can be addressed with Mang Xiao.Mang Xiao is salty and cold in nature, which can clear heat; thus, Xiao Chai Hu Jia Mang Xiao Tang is used. This actually involves taking two doses of Xiao Chai Hu Tang, and in the third dose, adding a bit of Mang Xiao to clear heat.This represents an intermediate state. Differentiating deficiency and excess, Xiao Chai Hu Tang syndrome is a deficiency syndrome; Da Chai Hu Tang syndrome is an excess syndrome; Xiao Chai Hu plus Mang Xiao syndrome is a mixed deficiency and excess syndrome, using Mang Xiao to attack the excess. There are three situations: for a half-exterior and half-interior syndrome with deficiency, use Xiao Chai Hu Tang; for excess, use Da Chai Hu Tang; for deficiency of body fluids with blockage, use Xiao Chai Hu Tang plus Mang Xiao or Da Huang.Grasping the big picture: deficiency of body fluids with blockage in a half-exterior and half-interior syndrome.Yin and Yang: Yang.Exterior and interior: half, interior.Deficiency and excess: mixed deficiency and excess.Cold and heat: heat.The use of Xiao Chai Hu is due to the illness lasting over ten days, leading to insufficient body fluids. First, Xiao Chai Hu Tang is used to restore the body’s function and replenish fluids. However, once the fluids are restored, the exterior is generally resolved. Then, Mang Xiao is added to address the internal excess heat; this represents a state between deficiency and excess. Xiao Chai Hu Tang uses Ren Shen, Sheng Jiang, Gan Cao, and Da Zao to replenish energy; Da Chai Hu Tang removes Ren Shen and roasted Gan Cao, using Zhi Shi and Da Huang to attack; however, this text describes an intermediate state, requiring the clearing of internal excess heat with Xiao Chai Hu plus Mang Xiao.Later, we will learn about Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Decoction with Dragon Bone and Oyster Shell), Xiao Chai Hu plus Gui Zhi and Da Huang, indicating that there are transitional states. Although there is deficiency of body fluids, there is a mix of deficiency and excess; what to do? In a mixed deficiency and excess state, where both deficiency and excess are present, part of the herbs should replenish energy, while another part should resolve blockage, applying both attack and supplementation. During learning, it is essential to first grasp the obvious syndromes: Xiao Chai Hu Tang treats deficiency syndromes, while Da Chai Hu Tang treats excess syndromes, but it is also important to understand the existence of intermediate states, as there are many variations in syndromes.For example, in a half-exterior and half-interior syndrome, with irritability, preference for vomiting, chest fullness, and hypochondriac pain, but the pulse is weak and deep, indicating a Yin syndrome, Xiao Chai Hu Tang plus Fu Zi (Aconite) is used; simultaneously, if there is a sore throat with yellow nasal discharge and phlegm, Xiao Chai Hu Tang plus Sheng Shi Gao (Gypsum) is used.If the heat syndrome is very obvious, the principle of avoidance should be implemented, removing the hot Sheng Jiang and replacing Xiao Chai Hu with Sheng Shi Gao; if there is a half-exterior and half-interior syndrome with deficiency of body fluids, with surface pain, leg cramps, hand numbness, stomach cold, upper heat, mixed cold and heat, and poor sleep, use Chai Hu Gui Zhi Gan Jiang Tang (Bupleurum Decoction with Cinnamon and Ginger); if the patient with Xiao Chai Hu Tang syndrome has significant water retention, a swollen tongue with tooth marks, and thirst that does not resolve with drinking, add Fu Ling (Poria) and Bai Zhu (Atractylodes).This syndrome has many variations, and the same applies to Da Chai Hu Tang syndrome. Da Chai Hu Tang syndrome can also include intestinal abscess, blood stasis, irritability, oily skin, drowsiness at noon, excessive foul gas, skin issues on the legs, dark lips, irritability, and insomnia at night, using Da Chai Hu plus Mu Dan Pi (Moutan) and Tao Ren (Peach Kernel) to address both intestinal abscess and blood stasis.If Da Chai Hu Tang syndrome is biased towards Yin and cold, with blood stasis, cold hands and feet, dark complexion, dark lips, and stomach cold, Da Chai Hu plus Gan Jiang (Dried Ginger) should be used, along with warming blood stasis herbs such as Chuan Xiong (Ligusticum) and Dang Gui (Angelica). This illustrates the adjustments and variations in the use of herbs for Chai Hu syndrome.If there is intestinal blockage with mild heat, use Da Huang (Rhubarb) to clear the blockage; if diarrhea has occurred, with tidal fever, do not use Da Huang, but use Mang Xiao; however, if diarrhea is present with very foul stools and the body is experiencing tidal fever, the body is expelling blockage, and both Da Huang and Mang Xiao should be used to help the body expel excess heat. In Yangming disease, with a strong and forceful pulse, diarrhea, constipation, foul stools, and teeth grinding, both Da Huang and Mang Xiao should be used together.Article content is for reference only,not for professionaldoctorsplease do not attempt acupuncture or medication
