The majority of information in the following is added verbatim or parenthesized from the book Ten key Formula Families in Chinese Medicine by Dr Huang Huang, translated by Michael Max. Other information is from Sharon Wiezenbaum’s blog White Pine Healing Arts and my own personal experience and 3 months training with Dr Huang in Nanjing.

2.1 Xiao Chai Hu Tang 小柴胡汤

Chai Hu 10-20,   Huang Qin 6-10,   Zhi Ban Xia 6-15,   Ren Shen 5-10,   Gan Cao 10,   Sheng Jiang 10,   Da Zao 12

One of the most commonly used formulas in clinical practice. Very safe, very useful, very low side-effects; when you get the right presentation and apply this formula, the results are drastically positive.

Paragraph 96 of the shang han lun: “for alternating chills and fever, a sense of discomfort and fullness in the chest and ribs, being dejected with no desire to eat, irritability of the heart and a tendency to vomit.”

Paragraph 266 of the shang han lun: “when what was originally a tai yang disease is not resolved and shifts into the shao yang, there is firmness and fullness beneath the ribs, dry heaves with an inability to eat, and alternating chills and fever. When neither vomiting nor purging has yet been done and the pulse is sinking and tight, give Xiao Chai Hu Tang.”

1. Chest and hypochondriac fullness and discomfort, or stiffness and fullness beneath the ribs, or focal distention and fullness in the subcostal region.
2. Alternating fever and chills
3. Irritability in the chest with a desire to vomit and lack of desire or inability to eat.
4. A wiry, thin and wiry, slippery and wiry, or sinking and wiry pulse.
5. A tongue coating that is yellow, yellow and white mixed together, pale yellow, or yellow and greasy.

We have introduced a few new herbs here (huang qin, zhi ban xia, and ren shen) so let’s have a look at them and see how they work within the XCHT formula.

Huang Qin (GB, LI, LU, ST): Traditionally used as a herb to clear heat. It can treat illnesses with high fever, irritability and thirst, fevers with cough, diarrhoea, jaundice, headache, abdominal pain, turbid urination, red swollen eyes, restless fetus syndrome, and abcesses and furuncles. Modern research shows that it acts as an anti-inflammatory, anti-allergenic, anti-bacterial, antipyretic, diuretic, and anti-hypertensive medicinal.

Huang Qin is often paired with chai hu to treat alternating fever and chills, chest and hypochondriac fullness with focal distention and pain, and vomiting with bitter taste in the mouth. It is seen paired with chai hu in XCHT, Da Chai Hu Tang, Chai Hu Gui Zhi Gan Jiang Tang, Chai Hu Jia Long Gu Mu Li Tang. It is then further paired with Huan Lian in other formulas such as Ban Xia Xie Xin Tang, when there is 1. epigastric focal distention, 2. irritability, 3. fever with diarrhoea.

Huang Qin Indications:

1. Upper abdominal focal distention and fullness
2. Or abdominal pain

Zhi Ban Xia (LU, SP, ST): Grows in early summer in the shadowy damp places on hillsides, the sides of streams, and mullberry plantations. It is acrid and spicy. Traditionally used to stop vomiting and transform phlegm. Primarily treats symptoms such as nausea, vomiting, coughing with copious amounts of sputum, chest and diaphragm fullness, epigastric focal distention, loss of consciousness due to phlegm, dizziness, headache, and insomnia. Zhang Zhong Jiang often combined Ban Xia with Sheng Jiang to stop vomiting. Where there are intestinal symptoms of nausea with vomiting, epigastric focal distention and bloating with pain, and irritability- Huang Qin + Ban Xis is used.

Ban Xia Indications:

1. Nausea or occasional nausea, which when severe results in vomiting.
2. Slippery or greasy tongue coating
3. Sallow or dull, ashen complexion

Ren Shen (LU, SP): There are three main uses of Ren Shen

1. As a rescue treatment after there has been sweating, vomiting, or diarrhoea, or for those with a minute pulse due to collapse from loss of blood or dehydration, along with a dry tongue.
2. Debility and shortness of breath in the aftermath of an illness.
3. Epigastric focal distention with firmness.

• Note: this type of ‘epigastric and focal distention’ is distension as a feeling of internal pressure, without bloating.

Uses from experience:

Gu:

Treated 86 patients with high fever: 36 URTI, 20 Bile duct infections, 9 UTI, 3 hepatitis, 2 Encephalitis B, 2 common old, 5 mumps, 3 bacterial dysentery. All had alternating fever/chills, headache, dizziness, coughing, chest stuffiness, bitter taste in the mouth, reduced intake of food, sweating with an aversion to wind. All recovered in 1-30 days.

Shen:

Treated 8 women with post-partum fever (38-39.6 degC). Antibiotics didn’t work. Two packets cured most women, 5 packets was the slowest. If there was joint discomfort, Gui Zhi was added.  ‘Sheng hua Tang’ was also added to this formula = addition of chuan xiong, tao ren, dang gui + yi mu cao.

Modifications:

XCHT + Xiao Xian Xiong Tang (minor sinking into the chest decoction = Gua Lou, Huang Lian, Ban Xia) For coughing with sticky phlegm stuck in the chest with hypochondriac fullness and inflamed digestive tract.

XCHT + Ban Xia Hou Po Tang = Chai Po Tang. Use for bronchitis, asthma, neurosis and sensation of something stuck in the throat.

XCHT + Wu Ling San = Chai Ling Tang = Use for XCHT signs with reduction in urinary output, edema and thirst such as in nephritis, acute gastroenteritis, summer heat, and edema.

XCHT + Ping Wei San = Chai Ping Tang for XCHT presentation with abdominal fullness, and a white, greasy tongue coating.

2.2 Chai Hu Gui Zhi Tang 柴胡桂枝汤

Chai Hu 12,   Gui Zhi 10,   Bai Shao 12,   Huang Qing 10,   Ren Shen 6,   Gan Cao 3,   Zhi Ban Xia 10,   Da Zao 10,   Sheng Jiang 6

Made by combining XCHT and Gui Zhi Tang, was traditionally used for those who had fever with a slight aversion to cold, non-=
specific joint pain, slight vomiting, clumping below the heart, and an unresolved cold/flu.

1. Fever with aversion to wind, alternating fever and chills, sweating, sore and painful joints.
2. Chest and hypochondriac pain and discomfort, or abdominal pain, poor appetite, irritability in the chest with a desire to vomit.
3. The tongue body is dark red or dark and pale, with a thin white or yellow, greasy coating.

This formula’s presentation can be seen either as a Gui Zhi constitution experiencing chest and hypochondriac pain and stuffiness, and vomiting with a bitter taste in the mouth, or as a person with a Chai Hu constitution having spontaneous sweating, nasal congestion, abdominal pain, joints that are achy and painful, and muscle spasms.

The presentation of this formula is often seen in disruption of the autonomic nervous system, nervous exhaustion, neurosis, and premenstrual syndrome. It is effective for treating spontaneous sweating, chest stuffiness, abdominal pain, poor appetite, allergic rhinitis, epilepsy, and depression.

Cases:

Soumi Ichiro used this formula for 43 patients with epilepsy. 125 were cured, 79 had significant reduction, the rest did not finish the study.

2.3 Chai Hu Gui Zhi Gan Jiang Tang 柴胡桂枝干姜汤

Chai Hu 12,   Gui Zhi 12,    Gan Jiang 6,    Huang Qin 10,   Gau Lou (or Tian Hua Fen) 12,   Mu Li 15,   Gan Cao 6

This formula is used for calming and restoring energy for those with fatigue from overwork. 

Shang Han Lun states: “Cold damage for five or six days that has already been sweated and purged, chest and hypochondriac pain with slight binding, urinary difficulty and thirst without vomiting, sweating only from the head, alternating chills and fever, and irritability in the chest.”

Although this line is difficult to go by, we go from the experience of others before us, specifically Dr Huang Huang:

1. Chest and hypochondriac pain, or coughing, or sternal pain, especially from the neck up.
2. Alternating fever and chills, or aversion to wind, night sweats or spontaneous sweating, especially from the neck up.
3. Poor appetite, thirst without drinking much, urinary difficulty, loose stools.
4. Irritability, pulsation in the chest and abdomen, insomnia or vivid dreaming, tinnitus.
5. Dry tongue with a thick white coating.

*Because there is sweating Gui Zhi is added, because there is no vomiting, Ban Xia is omitted. Mu Li is added to treat irritability, Gan Jiang treats thick white tongue coating and poor appetite, also loose bowels and normal stool that is sticky at the end.

Conditions: nervous exhaustion, diarrhoea, neurosis, allergic colitis, chronic cholecystitis, dysmenorrhea, and menopausal syndrome.

2.4 Chai Hu Jia Long Gu Mu Li Tang – 柴胡龙骨牡蛎汤

Chai Hu 12,  Huang Qin 5-10,  Ren Shen 5-10,  Ban Xia 6-12,  Sheng Jiang 6,  Da Zao 15,  Gui Zhi 5-10,  Fu Ling 5-12,  Long Gu 10-20,  Mu Li 10-20,  Da Huang 5-10,  Dai Zhe Shi (hematitum) 6-12.

The basic use of this formula is when the Yang Qi can’t descend from the upper jiao when the ‘Shao Yang’ pivot is blocked.

Chronic illness, advanced age, long-term psychological stress, and external injury all can lead to patients with Chai Hu constitution losing their psycho-emotional and neurological equilibrium.

Shang Han Lun, paragraph 107: “Cold damage for 8-9 days, which is purged. If there is fullness in the chest, irritability and
fright, urinary dysfunction, incoherent speech, and the body feels completely and thoroughly heavy with an inability to turn to either side, CHJLGMLT masters it.“

Again, a fairly specific yet difficult to follow passage from the SHL. The first few symptoms are commonly seen, however this formula has many many uses, so lets not get too hung up on the literal translations of the SHL for now.

This formula has been used for thousands of years for psychological and neurological illnesses, especially insomnia, nocturnal emission, nervousness, and anxiety.

1. Chai Hu Presentation
2. Psycho-emotional and nervous system symptoms, especially for those with strong pulsations around the navel, who are easily startled, or have incoherent speech.
3. Tongue: Red tongue with a thick, greasy yellow coating.
4. Pulse: Because the ‘Shao Yang’ is blocked, there upper ‘Cun’ pulses will be fuller. The cun pulses will most likely be floating and moderate, the left ‘Guan’ will likely be Wiry and Big, the right ‘Guan’ will likely be Wiry. The Yang is basically all in the upper jiao and not descending properly. In some cases there will be a very weak or ‘blocked’ left Cun pulse where the heart is not functioning well and will be ‘scattered’ however you will most likely feel an even more ‘forceful’ left guan as the liver portal system becomes ‘backed up’.

Chai hu: stuffiness in the chest

Huang Qin: hypochondriac fullness, inflammation, diarrhoea, bitter taste, heat signs

Ren Shen: exhaustion from long standing illness, epigastric focal fullness, shortness of breath, dehydration

Ban Xia: Greasy tongue coating, epigastric fullness, nausea, phlegm

Gui Zhi: heart palpitations, sore joints

Fu Ling: Often combined with Gui Zhi where there is a swollen wet tongue and chest stuffiness

Long Gu and Mu Li: Strong pulsations around the area of the navel, suppresses and settles ascending yang qi.

Used for insomnia, mental problems, ‘easily startled’, hyperthyroidism, schizophrenia, senile dementia, etc.

2.5 Si Ni San 四逆散

Chai Hu 6-12, Bai Shao 6-30, Zhi Shi 6-10, Gan Cao 3-10

Here Chai Hu treats chest and abdominal stuffiness, Bai Sao + Gan Cao = ‘shao yao gan cao tang’, which is indicated to relieve
spasms and stop pain. Zhi Shi primarily treats chest and abdominal fullness and distension, constipation and prolapse of the stomach and uterus.

Jing Gui Yao Lue says: ‘Zhi Shi and Bai Shao are used specifically to treat “postpartum abdominal pain, irritability, and fullness in the chest such that the patient is unable to lie down.”

These four herbs together primarily target chest, rib and abdominal pain.

Shang Han Lun says, Paragraph 318: Shao Yin disease, disease with cold extremities – the person may have cough or palpitations or urinary dysfunction or pain in the abdomen or draining diarrhea with down-bearing; Si Ni San masters it.’

‘Four Reversals’ means that the extremities of the four limbs are cold. In this case the coldness is not caused by yang qi insufficiency, but the yang qi becoming knotted and constrained in the interior, thus being unable to disperse outward. Thus, cold extremities are often accompanied by heat, especially in the trunk.

Cold hands and feet can be treated as yang qi deficiency, with Gui Zhi Jia Fu Zi Tang or Si Ni Tang, or arise from heat constraint, and can be treated with Bai Hu Tang or Da Cheng Qi Tang. However, this is not the case with Si Ni San. The following
presentations will be observable:

1. Chai Hu presentation with a sensitivity to pain, hands that are often cold, and a tendency to have anxiety and muscle spasms.
2. Chest and hypochondriac fullness and discomfort with pain, and distending abdominal pain.
3. A wiry pulse and a stiff, dark tongue, or a tongue with purple spots.

Common uses: cholecystitis, cholelithiasis, biliary ascariasis, hepatitis, gastritis, peptic ulcers, gastric hypertrophy, gastric neurosis, prolapse of the stomach, recalcitrant stomach pain, allergic colitis, diarrhoea, dysentery, hiccup, appendicitis and appendicular abcess, intestinal obstruction, intestinal adhesions, pancreatitis, cough, coronary heart disease, as well as cold extremities following fever.

2.6 Xue Fu Zhu Yu Tang –  血府逐瘀汤

Chai Hu 5-12,  Bai Shao 6-20,  Zhi Shi 6-10,  Gan Cao 3-6,  Tao Ren 6-12,  Hong Hua 5-10, Dang Gui 6-12,  Chuan Xiong 5-10,  Sheng Di Huang 12,  Jie Geng 6,  Niu Xi 12

This formula is a combination of Si Ni San and Tao Hong Si Wu Tang. Chinese medicine regards blood stasis as both the
product of, as well as the cause of, illness. Infections, fever, bleeding, getting chilled, long-term psycho-emotional upset (especially depression), trauma, and chronic illness can all lead to dis-harmonies of the qi and blood, resulting in the formation of blood stasis.

The distinguishing factors are:

1. Pain that is usually in a fixed location
2. When bleeding occurs, the blood readily congeals and is purple or black in color.
3. Irritability and restlessness, with an unsettled spirit, and mania in extreme cases.
4. The tongue is purple and dark, along with a dark complexion.

The XFZYT presentation is often seen in recalcitrant cases such as insomnia, headaches, abdominal pain, or fever.

Many famous practitioners will default to this formula when everything has been attempted and the results are poor.

2.7 Xiao Yao San 逍遥散

Chai Hu 6-12,  Bai Shao 6-15,  Bai Zhu 6-12,  Fu Ling 10-15,  Dang Gui 6-12,  Sheng Jiang 6, Bo He 6

When we take Si Ni San and remove Zhi Shi, then add Dang Gui, Bai Zhu, Fu Ling, and Bo He, we have Xiao Yao San.

Dang Gui is used primarily to regulate the menses and tonify blood. Add Bai Shao, Bai Zhu and Fu Ling and you make up Dang Gui Shao Yao San, originally prescribed to treat abdominal pain during pregnancy as it tonifies and augments blood. Now it is used more extensively to treat anemia, abdominal pain, back pain, achy lower back, edema and urinary difficulty.

Indications:

1. Chest and hypochondriac fullness and discomfort or pain, abdominal pain and distention, dysmenorrhea, premenstrual breast distention or headache.
2. A feeling of alternating fever and chills, or irregular periods.
3. Poor appetite and edema.
4. Pale red tongue with a thin, white coating.

In practice this formula is often used for women who have a low libido or disinterest in sex, painful intercourse, keep their feelings inside, sulk in anger and are nervous.

2.8 Da Chai Hu Tang 大柴胡湯

Chai Hu 10-15,  Huang Qin 6-10,  Bai Shao 6-20,  Ban Xia 6-10,  Sheng Jiang 3-6,  Zhi Shi 6-10, Da Zao 10-20,  Da Huang 5-10

As this formula contains Da Huang, it has a purging action, which also functions as an anti-pyretic, relaxes muscles, is anti-allergenic, and reduces blood pressure and blood lipid levels.

Shang Han Lun Paragraph 103: “For those who have Chai Hu presentation, first use Xiao Chai Hu Tang, if however there is incessant vomiting, a gripping pain and tenderness in the upper epigastrium, and a sense of constraint and slight irritability, the illness has not yet been resolved. Giving DCHT will purge it to bring a cure.

SHL Paragraph 165: “For cold damage with feverishness and sweating without resolution of the condition with focal distension and hardness in the chest, vomiting, and diarrhea, DCHT masters it.”

SHL paragraph 136: ” “For those with cold damage for more than 10 days, when heat has clumped in the interior and there are repeated bouts of alternating chills and fever, give DCHT.”

This ‘Heat Clumping’ means that there is interior heat which has lead to constipation, abdominal distention, abdominal pain, and heat clumping with circumference (green, watery and foul-smelling diarrhoea).

Presentation:

1. Fever, or alternating fever and chills.
2. Chest and hypochondriac fullness and discomfort with upper abdominal pain from contracted muscles, and other localised muscle tightness.
3. Constipation with yellow urine or watery, smelly diarrhoea or vomiting, jaundice or headache.
4. A dry tongue with white or yellow coating and a slippery, rapid pulse.

This formula is commonly used to treat cholelithiasis, cholecystitis, and pancreatitis.This formula is generally used in those with strong constitutions and physiques, and those with severe chest and hypochondriac fullness and discomfort along with constipation.

2.9 Tong Jing Tang 

Extracted from Sharon Weizenbaums Blog : White Pine Healing Arts.

Painful Menstruation