01
All Courses by Ni Haixia
02
Complete Guide to TCM Treatment of Common Diseases
03
Focused Study on TCM Topics
04
Online Reading of TCM Learning Books
▢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 a pattern of Chai Hu (Bupleurum). If there is no benefit from purging, and now there is a reversal to diarrhea, the physician should know to use pill medicine for purging, which 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 6 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 should be boiled in four sheng of water until two sheng remain, then strain, add Mang Xiao, and boil again until slightly bubbling. Divide and take warm; if it does not resolve, repeat.
When a patient has been ill for over ten days without resolution, they have entered a half-exterior, half-interior condition. Symptoms include fullness in the chest and hypochondria, vomiting, chest tightness, rib pain, fullness in the ribs, and nausea. These are all signs of a half-exterior, half-interior pattern. Tidal fever occurs in the afternoon, typically from 3 to 5 PM, with intermittent heat sensations followed by slight diarrhea, indicating the body is expelling pathogens. The tidal fever indicates the body is expelling illness towards the surface, while slight diarrhea indicates internal expulsion.This is a pattern of Chai Hu; if there is no benefit from purging, and now there is a reversal to diarrhea, the physician should know to use pill medicine for purging, as noted in the “Kang Ping Edition of the Treatise on Febrile Diseases.” The phrase “the physician should use pill medicine for purging” is enclosed in parentheses, possibly added by later annotators, 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.Afternoon is the time when the Kidney meridian is active, and the energy from the Kidney meridian moves towards the surface of the body, causing tidal fever. Usually, due to blockage, the body fluids are constrained, leading to insufficient energy reaching the surface.Worsening symptoms in the afternoon generally indicate intestinal blockage related to food accumulation.Worsening symptoms at night are generally related to blood stasis.There was a time when I experienced dizziness in the afternoon; upon reflection, I realized it was due to intestinal blockage. After taking Da Huang Gan Cao Wan (Rhubarb and Licorice Pill), I had diarrhea and the dizziness resolved.At this time, it is advisable to first use Xiao Chai Hu Tang. Why? After more than ten days, the body has been fighting the pathogenic factors, leading to insufficient body fluids, and the illness has entered a half-exterior, half-interior state. This pattern is not suitable for purging; first, use Xiao Chai Hu Tang to regulate the half-exterior, half-interior condition, 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, hence the use of Xiao Chai Hu Jia Mang Xiao Tang. This actually involves taking two doses of Xiao Chai Hu Tang, and in the third dose, adding a little Mang Xiao to clear heat.This represents an intermediate state. Differentiating deficiency and excess, Xiao Chai Hu Tang is for deficiency; Da Chai Hu Tang (Major Bupleurum Decoction) is for excess; Xiao Chai Hu Jia Mang Xiao Tang is a mixed pattern of deficiency and excess, using Mang Xiao to attack the excess. There are three scenarios: for a half-exterior, half-interior pattern 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 with Mang Xiao or Da Huang (Rhubarb).Grasping the overall situation: deficiency of body fluids with blockage in a half-exterior, half-interior pattern.Yin and Yang: Yang.Exterior and Interior: Half, Interior.Deficiency and Excess: Mixed deficiency and excess.Cold and Heat: Heat.Using Xiao Chai Hu is because the illness has persisted for over ten days, leading to insufficient body fluids. First, use Xiao Chai Hu Tang to restore the body’s function and replenish body fluids. However, once the body fluids are restored, the exterior is generally resolved. Then, add Mang Xiao to eliminate the internal excess heat; this represents a transitional state between deficiency and excess. Xiao Chai Hu Tang includes Ren Shen, Sheng Jiang, Gan Cao, and Da Zao to replenish energy; Da Chai Hu Tang removes Ren Shen and Gan Cao, using Zhi Shi (Bitter Orange) and Da Huang to attack; however, this text refers to an intermediate state, requiring the clearing of internal excess heat with Xiao Chai Hu Jia Mang Xiao Tang.Later, we will learn about Chai Hu Jia Long Gu Mu Li Tang (Bupleurum Decoction with Dragon Bone and Oyster Shell), Xiao Chai Hu Jia Gui Zhi Da Huang Tang (Minor Bupleurum Decoction with Cinnamon Twig and Rhubarb), which represent transitional states. Although there is deficiency of body fluids, there are mixed deficiency and excess patterns. What to do? In cases of mixed deficiency and excess, where both aspects are present, part of the herbs should replenish energy while another part should resolve blockage, employing both attacking and tonifying methods. During learning, it is essential to grasp the clear patterns: Xiao Chai Hu Tang treats deficiency, while Da Chai Hu Tang treats excess, but it is also important to recognize the existence of intermediate states, as there are many variations in patterns.For example, in a half-exterior, half-interior pattern, symptoms include irritability, preference for vomiting, chest fullness, and hypochondriac pain, but the pulse is weak and deep, indicating a Yin pattern. In this case, use Xiao Chai Hu Tang with Fu Zi (Aconite). If there is a sore throat with yellow nasal discharge and phlegm, use Xiao Chai Hu Tang with Sheng Shi Gao (Gypsum). If the heat pattern is very obvious, follow the principle of avoidance by removing the heat-inducing Sheng Jiang and replacing it with Sheng Shi Gao; if there is a half-exterior, half-interior pattern with deficiency of body fluids, 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 pattern has significant water retention, a swollen tongue with tooth marks, and thirst without desire to drink, add Fu Ling (Poria) and Bai Zhu (Atractylodes).This pattern has many variations, and the same applies to Da Chai Hu Tang patterns. Da Chai Hu Tang patterns can also include intestinal abscesses, blood stasis, irritability, oily skin, midday drowsiness, excessive foul gas, skin issues on the legs, dark lips, irritability, and insomnia. In such cases, use Da Chai Hu Tang with Mu Dan Pi (Moutan Root) and Tao Ren (Peach Kernel) to address both intestinal abscesses and blood stasis.If the Da Chai Hu Tang pattern is more Yin and cold, with blood stasis, cold hands and feet, dark complexion, dark lips, and stomach cold, use Da Chai Hu Tang with Gan Jiang (Dried Ginger), and add heat-inducing blood-stasis herbs like Chuan Xiong (Szechuan Lovage) and Dang Gui (Angelica). This illustrates the adjustments and variations in the use of herbs for Chai Hu patterns.For intestinal blockage with mild heat, use Da Huang (Rhubarb) to relieve the blockage; if diarrhea occurs with tidal fever, do not use Da Huang, but use Mang Xiao; however, if diarrhea is very foul-smelling and the body is experiencing tidal fever, the body is expelling blockage, and both Da Huang and Mang Xiao can be used to help the body expel excess heat. In Yangming disease, with a strong, forceful pulse, diarrhea, constipation, foul-smelling stools, and teeth grinding, use both Da Huang and Mang Xiao together.