Teacher Zhang Qingxiang is a doctoral supervisor in the Basic Teaching and Research Section of Traditional Chinese Medicine at Shandong University of Traditional Chinese Medicine. Through the analysis of the prescriptions, additions and subtractions and the concept of half exterior and half interior of Xiaochaihu Decoction in "Treatise on Febrile Diseases", he believed that Xiaochaihu decoction can clear away heat and dissipate evil, replenish qi and relieve the exterior externally, regulate the liver and spleen, relieve Shaoyang, and clear away yang internally. A prescription for relieving dampness and heat. The author attended the clinic and witnessed with his own eyes that the teacher used Xiaobuihu Decoction as the main prescription to treat various difficult and complicated diseases caused by internal injuries and external infections, and each time achieved miraculous results. Then his understanding and clinical application of Xiaochaihu Decoction are summarized as follows.
Fang Yi
Xiaobuihu Decoction is composed of seven herbs: Bupleurum, Scutellaria baicalensis, Pinellia ternata, ginseng, licorice, ginger, and jujube. Zhang Qingxiang believes that its core pathogenesis lies in regulating Qi. , and often explain the importance of smooth Qi movement by saying, "Flowing water does not rot, door hinges do not become beetroots." "Su Wen·Liu Wei Zhi Da Lun" says: "Without going in and out, there is no way to grow and strengthen the old. Without going in and out, there is no way to grow and collect. Therefore, there is no utensil to go in and out." Bupleurum in the prescription lifts Yang Qi, soothes the liver and relieves pain. Yu, "maintains the heart and soul, removes qi, food accumulation, cold and heat evil qi in the intestines and stomach, and removes the old and promotes the new" ("Shen Nong's Materia Medica"). The dosage of the original prescription is eight liang. "Among the seven herbs in the prescription, Pinellia ternata and Scutellaria baicalensis are all on the list that can be removed, but Bupleurum and licorice should not be removed. You should know that the exchange of cold and heat depends entirely on Bupleurum to relieve the external and licorice to neutralize the middle." ("Collection of Typhoid Laisu"). Scutellaria baicalensis is bitter and cold and relieves heat; Pinellia ternata is pungent and bitter when opened, and when combined with Bupleurum, it rises; when combined with Scutellaria baicalensis, it falls. In addition, ginseng, licorice, ginger, and jujube can replenish qi and nourish the body, reduce qi and stop vomiting, strengthen the spleen and strengthen the vitality, so that good can overcome evil and eliminate evil, and strengthen the body without retaining evil. The combined use of various medicines allows the Qi mechanism to flow upward and downward, harmonizing the internal and external aspects. And when regulating the liver, spleen and stomach, it also has the meaning of "when you see a liver disease, you know that the liver transmits to the spleen, and you should strengthen the spleen first."
Modifications
If there is spleen deficiency and weakness, add Xiangsha Sijunzi Decoction to replenish qi, promote qi and strengthen the spleen; for those with epigastrium and excessive phlegm, add Pingwei Powder to promote qi and relieve swelling. For those with aversion to cold and stuffy nose, add cinnamon twig and white peony root to relieve symptoms and harmonize the body and mind. For those with strong nape and discomfort, add kudzu root and Qianghuo to soothe muscles and dispel cold. For those with insomnia and dreaminess, add keel and oyster to soothe the nerves. For those with dizziness and nausea, add Gastrodia elata, Atractylodes, etc. to dispel wind and reduce phlegm; for those with yellowish vaginal discharge due to dampness and heat, combine Ermiao Powder, Sanmiao Powder, raw yam, reed root, etc. to strengthen the spleen, promote dampness and clear away heat.
Indications
"Treatise on Febrile Diseases" Article 148: "On the fifth or sixth day of Febrile Febrile Diseases, the head will sweat, a slight aversion to cold, the hands and feet will be cold, the heart will be full, the mouth will not want to eat, and the stool will If the pulse is hard and the pulse is thin, this is a Yang micro knot, which must have an exterior and an inside. Sweating is a Yang micro knot. If it is a pure Yin knot, there will be no external symptoms. If it enters the inside, this is half inside and half inside. On the outside, it can be treated with Xiaochaihu Decoction. If it cannot be treated, it will be cured by feces."
It can be seen from this article that the disease location has left the surface and wants to reach the inside, but it does not reach the inside. "When the blood is weak and the Qi is exhausted, the colic is opened, evil energy enters, fights with the righteous energy, and binds under the ribs." Half outside and half inside, however, half outside and half inside is by no means just a membrane between the outside and the inside. From 148 pure Yin knots are all internal syndromes, while yang micro-knots have both external and internal syndromes, and can all be treated with Xiaochaihu decoction. Half external and half internal syndromes should be regarded as Shaoyang cardinals wandering around, involving both the exterior and the interior, then It is reasonable that this prescription is widely used clinically.
In addition, the six-meridian syndrome differentiation theory uses three yin and three yang to summarize the functions and pathological evolution of the organs, meridians, and qi transformation. The gallbladder meridian of Foot Shaoyang originates from the sharp canthus of the eye, goes behind the lower ear, and enters the ear. Its branch goes to the pelvis, in the lower chest, runs through the diaphragm and along the side of the body, and belongs to the liver and gallbladder collaterals. As for the liver and gallbladder, the liver meridian of foot Jueyin wraps around the yin organ, reaches the lower abdomen, runs obliquely to the lower abdomen, holds the stomach, belongs to the liver and gallbladder, injects into the lungs, and goes up to the eye system, reaching the top of the head and surrounding the lips. Therefore, diseases caused by pathogenic factors in the Shaoyang meridian often involve multiple internal organs. Symptoms such as bitter mouth, dry throat, dizziness, alternation of cold and heat, bitterness and fullness in the chest and hypochondrium and other symptoms along the path of the liver and gallbladder meridian, as well as diseases of the liver and gallbladder viscera, can all be treated with Bupleurum Bupleurum. Soup therapy.
Efficacy
Xiao Chaihu Decoction was first seen in Article 96 of "Treatise on Febrile Diseases": "Suffering from stroke on the fifth or sixth day of Febrile Febrile Disease, alternating cold and heat, bitterness and fullness in the chest and flanks, hehe, no desire to eat, upset and vomiting , or if there is irritation in the chest without vomiting, or thirst, or pain in the abdomen, or hardness under the ribs, or palpitations under the heart, or no thirst, slight fever in the body, or cough, Xiao Chaihu Decoction is the treatment. "According to Zhong Jing. The meaning is, "There is Bupleurum syndrome, but if you see one syndrome, you don't need to know it." It can be used clinically to relieve Shaoyang, replenish Qi and relieve external symptoms, regulate the liver and spleen, clear away dampness and heat, etc.
Reconciliation of Shaoyang? Treatment of half-surface and half-surface syndrome caused by evil entering Shaoyang, with the main symptoms being bitter mouth, dry throat, and dizziness. The evil is in Shaoyang, the gallbladder fire is internally depressed, and the three major symptoms are bitter mouth, dry throat, and dizziness. If used accurately, the effect is like a drum.
Released by Jie Ji? It is used to treat cold and heat syndrome caused by evil entering Shaoyang. According to Article 98 of "Treatise on Febrile Diseases", evil is in Shaoyang at this time, good and evil are fighting each other, revolving back and forth, so cold and heat come and go. Zhang Qingxiang believes that Shaoyang has less blood and cannot sweat. Although the Taiyang syndrome is not gone, the signs of evil entering Shaoyang have already appeared, so Guizhi is not used and Bupleurum is chosen.
Replenishing qi and relieving external symptoms? It is used to treat exogenous symptoms in people with qi deficiency and fever caused by qi deficiency. Xiaobuihu decoction contains ginseng, which is an important medicine for replenishing qi. It is combined with licorice and jujube. Therefore, when the patient suffers from external symptoms, Zhang Qingxiang can use Xiaobuihu decoction in addition or subtract according to the syndrome to achieve effective results.
Regulating Qi? It is used to treat liver and spleen imbalance and liver and stomach disharmony caused by imbalance of Zhongjiao Qi. The opening chapter of "Synopsis of the Golden Chamber" states: "When you see a disease of the liver, you know that the liver transmits to the spleen, and you should strengthen the spleen first." Therefore, the onset of clinical spleen and stomach diseases is closely related to the liver.
In the prescription, Bupleurum is the main medicine for soothing the liver and relieving depression, and the four medicines of ginseng, ginger, licorice, and jujube are combined to protect Zhongzhou and protect the spleen from evil. It can be added or subtracted according to the syndrome, and the effect is very good.
Clearing away dampness and heat? It can treat dampness-heat in the middle burner and phlegm-heat in the upper burner caused by abnormal qi mechanism in the middle burner, disorder of body fluid metabolism and distribution, and stagnation and heat dissipation. The spleen governs ascending and the stomach governs descending. The spleen likes dryness and hates dampness, while the stomach likes moistening and hates dryness. However, if the spleen and stomach are weak and cannot transport and transform, they will produce phlegm and dampness, and over time, damp-heat or phlegm-heat will accumulate. Scutellaria baicalensis and Pinellia ternata in the prescription clear away heat and dry dampness, which are products for drying dampness, resolving phlegm and removing dampness. Zhang Qingxiang often uses this prescription in clinical practice to clear away dampness and heat, resolve phlegm and rejuvenate the mind. It can treat stomach distension and pain caused by dampness and heat in alcoholics, insomnia and dreaminess caused by phlegm and heat disturbing the heart, and red and yellow urine caused by dampness and heat. Depending on the syndrome, both evil and positive factors will be taken into consideration, and the phlegm and dampness will be removed, the spleen and stomach will be strengthened, and the dampness will be removed without the disadvantage of damaging the yin, which will be the cause of lingering dampness and heat that is difficult to heal.
Examples of medical records
Chen, female, 55 years old, went to the hospital on September 11, 2009 due to insomnia for several years. He has a history of heart disease, has difficulty falling asleep, and wakes up easily. He is upset when he wakes up, is accompanied by body heat and sweating, palpitations, and bitter mouth and bad breath. The tongue is fat and large, the coating is white and slightly thick, and the pulse is stringy and weak. The syndrome is internal disturbance of phlegm-heat, liver stagnation and heart weakness. Treatment is to clear away heat and resolve phlegm, relieve depression and calm the nerves. Use Xiao Bupleurum Decoction and Erchen Decoction to add flavor. Prescription: 15 grams of Bupleurum, 9 grams of Scutellaria baicalensis, 9 grams each of green peel and tangerine peel, 9 grams ginger pinellia, 10 grams raw sun-dried ginseng, 12 grams Poria, 12 grams each Atractylodes and Atractylodes, 9 grams Yuanhu, and 12 grams Millet Spatholobus. , 18 grams each of raw keel bones and raw oysters, 6 grams of amomum villosum, 3 grams of raw licorice, and 9 grams of fried gardenia. 6 doses, with ginger and jujube as the main ingredients, decoction in water, 1 dose per day.
Second diagnosis: After taking the medicine, the patient fell asleep better, and could go back to sleep after waking up. The upset was relieved, but there were only occasional palpitations, bitter taste in the mouth, sweating, body heat, nausea, occasional headache, and vomiting. The tongue is fat and large, with tooth marks, the tongue is pale, the coating is white and slightly thick, and the pulse is thin and stringy. According to the prescription and medicine, the symptoms of dampness and heat have been reduced, but the pathogenesis is still there, so the effect of the prescription is not changed. It removes the warmth and dryness of Atractylodes and Atractylodes, and the bitterness and coldness of Gardenia. For the symptoms associated with high blood pressure, 15 grams of Uncaria is added to relieve the symptoms. To subdue liver yang, add 18 grams of motherwort to activate blood circulation, facilitate urination, and conduct heat downwards. 6 doses, decoct and take as above.
Third diagnosis: Sleep improved after taking the medicine, headache and vomiting did not occur, upset was relieved, difficulty in falling asleep, excessive sweating, and obvious upset and body heat during sweating. The tongue looks the same as before, and the pulse is stringy and slippery. The symptoms of phlegm and heat were reduced. Because the patient was in menopause and internal heat due to yin deficiency was the main problem, Uncaria and Motherwort were removed, and 15 grams each of keel and oyster were added; 12 grams of Salvia miltiorrhiza was added to activate blood circulation and stimulate the arteries, 9 grams of Artemisia annua and 12 grams of Digupi Ke Qing and reduce deficiency heat. 6 doses, decoct and take as above.
After using the above formula as the basis for conditioning, sleep became normal and remaining symptoms disappeared.