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ORIGINAL ARTICLE
Year : 2022 | Volume
: 8
| Issue : 4 | Page : 509-513
New analysis of banxia xiexin decoction and its similar prescriptions in Treatise on Febrile Diseases to explore the universality of the treatment and compatibility principle
Ren-Ling Wei1, Zheng-Feng Li2, Ru-Sen Cao2, Jian-Bin Zeng3, Jian-Li Shen4, Qiu-Lan Pei4, Qi-Jun Liang4
1 Department of Clinical Medical, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
2 Department of Endocrinology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
3 Department of Cardiology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
4 Department of Respiratory and Critical Care, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
Correspondence Address:
Dr. Qi-Jun Liang
Department of Respiratory and Critical Care, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, Jiangxi
China
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2311-8571.343651
Objective: The objective of this study is to explore the treatment and compatibility principles of Traditional Chinese Medicine. Materials and Methods: Syndrome differentiation is used to identify the etiology, nature, and location of a disease and the relationship between the healthy Qi and pathogenic factors by analyzing and synthesizing the four diagnostics data. The theory of treatment is to determine the principle and methods of treatment according to the results of syndrome differentiation and implement them as a specific prescription. This paper bears witness to the principle universality by analysis of the articles of the Banxia Xiexin Decoction, and it equally has analogical prescriptions in Treatise on Febrile Diseases. Results: The treatment and compatibility principles of Traditional Chinese Medicine are the same, that is, rectifying the deviation on three dimensions, strengthening the healthy Qi, and eliminating pathogenic factors in the light of its general trend. Conclusion: The treatment and compatibility principles of Traditional Chinese Medicine are the same, The treatment and compatibility principles provide a new thinking for clinical treatment.
Keywords: Banxia Xiexin Decoction, compatibility principle, eliminating pathogenic factors, strengthening the healthy Qi, therapeutic principle, three dimensions, treatment and compatibility principle
The process of syndrome differentiation is used to obtain disease information by observing, smelling, asking, and touching, and then comprehensively judging the etiology, nature, position, and situation of a disease. The process of treatment is used to determine the treatment principle, treatment method, and prescription. The basic treatment principle is determined according to the treatment thought of “Treating cold diseases with hot herbs and treating hot diseases with cold herbs” in Su Wen Zhi Zhen Yao Da Lun of Inner Canon of Huangdi and “Strengthening the healthy Qi and eliminating pathogenic factors in the light of its general trend” in Treatise on Febrile Diseases.[1],[2] The specific treatment method is determined by specific etiology, location, and situation of the disease; thereafter, a decoction is selected or a prescription is created with herbs, and the treatment principle and methods are implemented. Therefore, although the principle of treatment and compatibility of the prescription are two expressions, they are actually the same in thinking process and purpose. The basic treatment and compatibility principle is the same, that is, rectifying the deviation on three dimensions, strengthening the healthy Qi, and eliminating pathogenic factors in the light of its general trend.[3],[4] The purpose of rectifying the deviation on three dimensions is to correct the body deviation on the three dimensions of material, energy, and space and time; the purpose of strengthening the healthy Qi and eliminating pathogenic factors is to enhance body's immunity and dispel pathogenic factors with the body's immune situation.[5] This principle of treatment and compatibility is universal and summarized in the therapy and compatibility thought of Treatise on Febrile Diseases. This paper takes Banxia Xiexin Decoction and its similar prescriptions in Treatise on Febrile Diseases as an example to explain that the principle of rectifying the deviation on three dimensions, strengthening the healthy Qi, and eliminating pathogenic factors in the light of its general trend is universal and applicable.
Analysis of the Principle of Treatment and Compatibility on Banxia Xiexin DecoctionThe 149th provision of Treatise on Febrile Diseases states that “any patient who feels nausea and fever and has been infected with a cold for 5 or 6 days is experiencing the Chaihu Decoction syndrome. The patient should be treated with the Chaihu decoction, even if he has been treated with other decoctions, because the Chaihu syndrome is still present. The treatment with Chaihu Decoction is not against the trend. He must feel steamed and vibrated, and his disease is resolved by fever and perspiration. It is the Daxianxiong Decoction syndrome that should be treated with the Daxianxiong Decoction if the fullness and hard pain is felt under the heart. However, if the syndrome is fullness and not pain, it is a ruffian. It is not suitable for the Chaihu Decoction, though it is suitable for the Banxia Xiexin Decoction.”[6] Nausea and fever are symptoms of the disease in Shaoyang meridian, and while maintaining a healthy Qi and eliminating pathogenic factors from the surface or above, the treatment should comply with the macro-immune situation and expel pathogenic factors out from the surface and above. It is suitable to use the Chaihu Decoction because it is a prescription for strengthening the healthy Qi and removing pathogenic factors from the surface and above, and it can be used as long as a patient has the Chaihu Decoction syndrome.[3] The symptoms of fullness with hard pain under the heart is the accumulation of physical pathogenic factors in the middle Jiao. in Chinese medicine, it is called the “ Disease accumulate in the chest (Jiexiong). The treatment should comply with the gastrointestinal downward trend to dispel pathogenic factors; therefore, the Daxianxiong Decoction, which comprises rhubarb, mirabilite, and euphorbia (Dahuang, Mangxiao, and Gansui), is used to rapidly remove the pathogenic factors. Fullness without pain is a symptom of a disease of Pi whose main pathogenesis is an insufficient and rough Qi in the middle Jiao, which lacks the ability to remove pathogenic factors from the surface and the upward trend and accumulation of physical pathogenic factors in the middle Jiao. As a result, the Chaihu and Daxianxiong Decoctions cannot be used. The treatment principle should be to replenish and smoothen the healthy Qi in the middle Jiao and move the pathogenic factors down.
Next, we analyzed if the treatment thought is reflected by the compatibility of the Banxia Xiexin Decoction. In his preface, Zhang Zhongjing showed that he wrote Treatise on Febrile Diseases referring to the books of Su Wen, Ba Shi Yi Nan, Yin Yang Da Lun, and Tai Lu Yao Lu. Tai Lu Yao Lu's book should have been a monograph on medicinal property, pharmacology, and efficacy that helped Zhang Zhongjing in selecting herb's compatibilities.
It should be closer to Zhang Zhongjing's original thinking to analyze the compatibility of prescriptions in Treatise on Febrile Diseases according to the book. Unfortunately, the book has been lost, and its specific contents cannot be known. However, according to the description and records of this book by other scholars of the same time, its content should be close to herbs' properties, pharmacology, and efficacy as in Shen Nong Ben Cao Jing of the same era. Therefore, we can analyze the compatibility thought of prescriptions in Treatise on Febrile Diseases referring to Shen Nong Ben Cao Jing.
The composition and method of administration of the Banxia Xiexin Decoction are as follows: washed banxia (Pinellia ternata) (½ a l), Scutellaria, dried ginger, ginseng, and roasted liquorice (three Liang [两, a Chinese unit of measure]), Coptis (one Liang), and broken Chinese dates (twelve). To the above seven herbs, add a dou (斗, a Chinese unit of measure) of water; boil it to 6 l; remove the dregs; boil it again to 3 l; and drink 1 l of it, warm at once, three times a day.[6]
Shen Nong Ben Cao Jing defines P. ternata as capable of “treating typhoid fever, cold or fever, firmness under the heart, sore throat, dizziness, chest distension, cough, bowel sounds, descending Qi, and stopping sweat.”[7]P. ternata is an herb used to expel pathogenic factors and treat the firmness under the heart, which can further treat fullness without pain; the fullness without pain is treated to eliminate pathogenic factors and treat the symptoms. “Descending Qi” indicates that Pinellia can reduce Qi and smooth the stomach. Therefore, the purpose of compatibility of Pinellia is to dispel pathogenic factors and the “fullness without pain” and descend the Qi. Shen Nong Ben Cao Jing explains that dried ginger “can cure the chest fullness, coughing, rising Qi, diarrhea, and dysentery, warm up the middle Jiao, stop bleeding and sweating, dispel the Bi of wind and dampness, and make living better.”[7]Scutellaria can treat all kinds of heat, jaundice, dysentery, diarrhea, malignant sores, rotten furuncles, gangrenes, and ulcers and dispel water and blood block down.[7]Coptis can treat hot Qi, eye pain, canthus injury, weeping, diarrhea, dysentery, abdominal pain, diarrhea, swelling, and pain in women's vagina, and make eyes clear.”[7]
In conclusion, ginger can dispel cold dampness, whereas Coptis and Scutellaria can dispel heat dampness. This article does not discuss cold and heat, but it mainly discusses the deficiency of the healthy Qi and pathogenic factors. However, the disease is from cold, so it is a partial cold one. It is Zhang Zhongjing's consistent thinking to use cold and hot herbs together when not discussing cold and hot. If it is partially cold, he will use more hot herbs than cold ones. Therefore, the purpose is to descend the Qi and eliminate pathogenic factors and Pizheng (fullness without pain) using the prescription of P. ternata (½ a l), Scutellaria and dried ginger (three Liang each), Coptis (one Liang), mixing cold and warm herbs together, more heat and less cold, and dried ginseng. Jujube and liquorice are warm herbs, which are used not only to strengthen the body but also to eliminate pathogenic factors. The purpose of compatibility of the whole prescription is to correct the cold deviation of the disease with warm herbs, invigorate the middle Jiao, lower the Qi, and remove the pathogenic factors in the right direction, which corresponds to the required treatment principle.
Analysis of the Principle of Treatment and Compatibility of Shengjiang Xiexin DecoctionThe 157th provision of Treatise on Febrile Diseases states that “after sweat and relief of typhoid fever, the Shengjiang Xiexin Decoction can treat stomach upset, fullness and hardness under the heart, retching and the stink of food, moisture in the flank, thunder in the stomach, and diarrhea.”[6] “Stomach upset and fullness and hardness under the heart” is the Pi syndrome, which is suitable for treatment with the Banxia Xiexin Decoction; however, retching and the stink of food, moisture in the flank, thunder in the stomach, and diarrhea indicate that there is a heavier cold and humidity, and it is more suitable to remove them from the surface. Therefore, treatment and compatibility should be based on the Banxia Xiexin Decoction to increase the strength of dispersing cold and dampness.
The composition and usage of the Shengjiang Xiexin Decoction are as follows: “ sliced ginger (four Liang), fried licorice (three Liang), ginseng (three Liang), dried ginger (one Liang), Scutellaria (three Liang), washed Pinellia (½ a l), Coptis (one Liang), and fragmented Jujube (12 pieces). To the above eight herbs, add a dou of water; boil it to 6 l; remove the dregs; boil it again to 3 l; and drink 1 l of it, warm at once, three times a day.”[6] The Shengjiang Xiexin Decoction is derived from the Banxia Xiexin Decoction when three Liang of dried ginger is reduced from the Banxia Xiexin Decoction to one Liang, and four Liang of ginger is added to the Shengjiang Xiexin Decoction. Ginger also has the effect of warming up the middle Jiao and attenuating hiccup; however, its effect of relieving cold dampness and water vapor is more obvious. In the prescription, the dosage of dried ginger was reduced, and ginger was used heavily. Not only has the purpose of treatment and compatibility of Banxia Xiexin Decoction, the effect of dispersing cold and dampness and removing pathogenic factors from the surface were increased. The principles of treatment and compatibility reflected corresponded to those necessary.
Analysis of the Principle of Treatment and Compatibility of Gancao Xiexin DecoctionThe 158th provision of Treatise on Febrile Diseases states that “the patient who is infected with cold of pathogenic factors or wind of pathogenic factors but treated with a purgative method has diarrhea dozens of times a day, with undigested food, thunder in the abdomen, fullness and hardness under heart, nausea, and upset stomach. The fullness and hardness will be heavier if the doctor sees the fullness under the heart, thinks that the pathogenic factors are not eliminated, and uses the purgative method again. The fullness and hardness are not due to the accumulation of heat pathogenic factors but are due to the Qi deficiency of the rising stomach; this condition is suitable to be treated with the Gancao Xiexin Decoction.”[6] The disease is a kind of Pi syndrome with obvious Qi deficiency. The treatment goal should be to increase the component responsible for tonifying the middle Jiao and supplementing Qi on the basis of the Banxia Xiexin Decoction.
The composition and administration methods of the Gancao Xiexin Decoction are as follows: “fried licorice (four Liang), Scutellaria (three Liang), dried ginger (three Liang), washed Pinellia (½ a l), fragmented jujube (12 pieces), and Coptis (one Liang). To the above six herbs, add a dou of water, boil it to 6 l; remove the dregs; boil it again to 3 l; and drink 1 l of it, warm at once, three times a day.”[6] The Gancao Xiexin Decoction is derived by increasing the amount of the licorice in the Banxia Xiexin Decoction, which can tonify the deficiency, strengthen the healthy Qi, and adjust the middle Jiao. Therefore, the principle of treatment and compatibility demonstrated is the same as that the patient required.
Analysis of the Treatment and Compatibility Principle of Dahuang Huanglian Xiexin DecoctionThe 154th provision of Treatise on Febrile Diseases states that “someone is suitable to be treated with Huanglian Xiexin Decoction when he/she feels distension and fullness under the heart and moistening when pressed and the Guan pulse is floating.”[6] The 164th provision of Treatise on Febrile Diseases states that “it is wrong to remove the surface symptoms and not suitable to attack the distension and fullness; nevertheless, it is suitable to remove the pathogenic factors on the body surface when the patient feels them under the heart and feels coolness after being treated with intense purgation that is followed by sweating. After removing the surface pathogenic factors with the Guizhi Decoction, the fullness can be treated with the Dahuang Huanglian Xiexin Decoction.”[6] The 154th provision of “distention and fullness under the heart and moistening when pressed” means that the disease is formed by invisible pathogenic factors; “Guan shang” reflects the disease under the heart, including the stomach. “When the Guan pulse is floating, it means that there is accumulated heat; the pathogenesis is the accumulation of heat and humidity in the middle Jiao, and the treatment should be to remove pathogenic factors in the light of its general trend and dispelled distension and fullness, just as the 164th provision directly shows. This condition should be treated with the Dahuang Huanglian Xiexin Decoction.” Below is an analysis of the treatment and compatibility of Dahuang Huanglian Xiexin Decoction.
The composition and administration of the Dahuang Huanglian Xiexin Decoction are as follows: “rhubarb (two Liang) and Coptis (one Liang). The two herbs are soaked in Mafei Decoction (boiled water) for a while; the dross is wrung away, and the patient takes the soup warm, twice.”[6]Shennong Bencao Jing describes that “rhubarb reduces blood stasis, retention of food and drink, treats cold and heat, breaks all kinds of accumulation of symptoms, cleans the intestines and stomach, removes the old and promotes the new, promotes the water valley, regulates the middle Jiao and promotes food digestion, and soothes the five Zang organs (viscera of human body).”[3] The basic therapeutic effect of rhubarb is to clear the viscera and remove pathogenic factors. When combined with Coptis, which can clear the heat in the heart and stomach, it can remove the dampness and heat. It is not taken by decocting but by ingesting after soaking it for a while and wringing away the dregs. The purpose is to take two herbs of light and thin Qi to clear and relieve the invisible damp heat, instead of taking the heavy and turbid Qi to drain down the tangible pathogenic factors in viscera.[8] Therefore, the principle of treatment and compatibility demonstrated is the same as the one needed.
Analysis of Principles of Treatment and Compatibility of Fuzi Xiexin DecoctionThe 155th provision of Treatise on Febrile Diseases states that “the patient should be treated with the Fuzi Xiexin Decoction if he feels aversion to cold, sweating, and fullness under the heart.”[6] Fullness under the heart indicates a need to dispel pathogenic factors down in the light of its general trend. Sweating is due to the heat inside that forces the sweat out. Aversion to cold indicates Yang deficiency on the body surface. The disease is Yang deficiency on the outside and heat accumulation on the inside. Treatment can be a combination of cold and hot herbs, warming up Yang and dispersing cold with hot herbs, and relieving heat and eliminating pathogenic factors with cold herbs; the fullness can be eliminated, and the sweating can be stopped.
The composition and usage of Fuzi Xiexin Decoction are as follows: rhubarb (two Liang), Coptis (one Liang), Baikal skullcap (one Liang), and aconite (one piece processed, peeled, broken, and decocted separately for juice). The first three herbs above are cut and soaked in Mafei Decoction (boiled water) for a while, and the dross is wrung away. Then, aconite juice is added, and the soup is taken warm, twice.[6] Aconite is processed and decocted separately to produce juice to use its mellow taste for tonifying Yang deficiency and dispersing cold. The other three herbs are used raw and soaked in Mafei Decoction in order to use their fast-moving Qi to quickly eliminate the heat in the middle and upper Jiao according to the situation; thus, the combination of the cold and heat herbs together leads to Yang recovery, removal of cold and heat, and disappearance of fullness and sweating. When cold herbs and heat herbs are combined, the Yang will return to cold; the heat will be removed; the heart will be full of ruffians; and sweating will disappear. As a result, the principle of treatment and compatibility demonstrated is the same as the one needed.
Analysis of Principles of Treatment and Compatibility of Huanglian DecoctionThe 173rd provision of Treatise on Febrile Diseases states that “the Huanglian Decoction should be administered as treatment to the patient with typhoid fever experiencing heat in the chest, pathogenic factors in the stomach, pain in the abdomen, and nausea.”[6] It is necessary to follow the downward movement trend of the stomach and intestines to eliminate pathogenic factors from the bottom when they are in the chest, stomach, and abdomen. If there is heat in the chest, cold herbs should be used; if there is exogenous typhoid, and the cold or heat pathogenic factors of the stomach and intestines have not been discussed , then the cold and heat herbs should be used together. The treatment should utilize the cold and heat herbs to attenuate hiccup, balance the stomach, and clear away the pathogenic factors from the bottom.
The composition and usage of the Huanglian Decoction are as follows: “Coptis (three Liang), licorice (three Liang), dried ginger (three Liang), peeled cassia twig (three Liang), ginseng (three Liang), washed P. ternata (½ a l), and fragmented jujube (twelve pieces). To the above seven herbs, add a dou of water; boil it to 6 l; remove the dregs; and drink it warm, three times in the day and two times at night.”[6]Coptis can dispel pathogenic factors and clear away heat; dried ginger and cinnamon twigs can disperse cold and promote Yang Qi; cinnamon twigs can attenuate hiccup; and P. ternata can balance the stomach. Ginseng, licorice, and jujube are used to tonify the deficiency. The whole prescription can disperse the cold and clear away the heat, blend the upper and lower parts of body, and return the rise and fall to normal. The abdominal pain and vomiting will then go away on their own. This demonstrates the necessary principles and methods.
Analysis of Treatment Principles and Compatibility of Houpo Shengjiang Banxia Gancao Renshen DecoctionThe 364th provision of Treatise on Febrile Diseases states that “it should not be used to remove pathogenic factors from the surface when the symptoms are diarrhea, cold, and indigestion of food; also, fullness must appear if there is sweating.”[6] There is cold and dampness inside, and the deficiency of healthy Qi is not very serious and can remove the pathogenic factors from the bottom according to the situation. As a result, the symptoms are diarrhea, cold, and indigestion of food. At this time, the pathogenic factors are not on the surface, so it is not suitable to attack the surface and remove pathogenic factors from the surface. The deficiency of the healthy Qi will aggravate and become weaker at eliminating pathogenic factors attacking the surface. Thus, the abdominal distension becomes heavy because of the accumulation of cold and dampness. At this time, the treatment should strengthen, smoothen, and descend the healthy Qi and remove the pathogenic factors from the bottom.
Article 66 of Treatise on Febrile Diseases states that “when the stomach experiences fullness after sweating, it should be treated with Houpo Shengjiang Banxia Gancao Renshen Decoction.”[6]
The composition and usage of the decoction are as follows: “fried magnolia (half Jin), cut ginger (half kg), washed P. ternata (½ a l), licorice (two Liang), and ginseng (one Liang). To the above five herbs, add a dou of water; boil it to 3 l; remove the dregs; and drink 1 l of it at once, warm, three times a day.”[6] Ginseng and licorice can invigorate the healthy Qi; ginger and Pinellia can remove cold and dampness; and Magnolia officinalis can smoothen and descend the healthy Qi. The compatibility of the whole prescription can invigorate, smoothen, and descend healthy Qi and remove cold and dampness from the bottom, which is suitable for the required treatment.
Analysis of the Principles of Treatment and Compatibility of Xuanfu Daizhe DecoctionThe 161st provision of Treatise on Febrile Diseases states that: “those who feel fullness and hardness under the heart and hiccup continuously should be treated with the Xuanfu Daizhe Decoction after their typhoid fever is removed by sweating, vomiting or purgation.” The method of vomiting or purgation is not the right treatment and can damage the healthy Qi, leading to the Qi mechanism disorder of the spleen and stomach, and the endogenesis of phlegm. Afterward, the fullness and hardness under the heart and hiccup continuously appear, and the treatment ought to strengthen the healthy Qi, reduce adverse reactions, balance the stomach, and remove phlegm.
The composition and usage of Xuanfu Daizhe Decoction are as follows: “Inula (three Liang), ginseng (two Liang), ginger (five Liang), red ochre (one Liang), fried licorice (three Liang), washed P. ternata (½ a l), and fragmented jujube (a dozen). To the above seven herbs, add a dou of water; boil it to 6 l; remove the dregs; boil it again to 3 l; drink 1 l of it at once, warm, three times a day.”[6] Ginseng, licorice, and jujube can nourish the Qi; ginger and Pinellia can reduce hiccup and eliminate phlegm dampness; and Inula and red ochre can attenuate hiccup. This corresponds to the rule and law of the need to treat and invigorate the Qi, reduce hiccup, balance the stomach, and reduce adverse reactions and phlegm.
ConclusionIn Treatise on Febrile Diseases, the Banxia Xiexin, Shengjiang Xiexin, and Gancao Xiexin Decoctions are similar. They were mainly used to treat the fullness syndrome of the middle Jiao, with deficiency of the healthy Qi, and pathogenic stagnation and abnormal ascending and descending Qi, whose deficiency is mainly nourished with ginseng, roasted licorice, and jujube. The bitter and cold products of Scutellaria and Coptis relieve heat; P. ternata reduces adverse reactions and eliminates phlegm; dried ginger and ginger warm up the Yang and disperse the cold, hence comprehensively correcting the deviation of cold or heat and the deficiency or pathogenic factors. The Dahuang Huanglian Xiexin, Fuzi Xiexin, and Huanglian Decoctions are similar. Rhubarb and Coptis are used to release heat from the bottom, and aconite is used to warm up the Yang and disperse the cold. The Houpo Shengjiang Banxia Gancao Renshen Decoction can strengthen, smoothen, and descend the healthy Qi and remove the cold and dampness from the bottom. The Xuanfu Daizhe Decoction can strengthen the healthy Qi, reduce hiccup reactions, balance the stomach, and remove phlegm.
In summary, the Banxia Xiexin Decoction and its analogs have differences in herb composition, dosage, and treated symptoms; nevertheless, they embody the same principles of treatment and compatibility, which is “rectifying the deviation on three dimensions, strengthening the healthy Qi, and eliminating pathogenic factors in the light of its general trend.” This principle is a common thought throughout the process of traditional Chinese medicine treatment and compatibility of prescriptions.
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