小柴胡汤

nullShaoyang-Harmonizing Prescriptions Shaoyang-Harmonizing Prescriptions This type recipes is mainly used to treat shaoyang disease, the pathogenic factors of which are neither located in the exterior nor in the interior but in between.Xiao Chai Hu TangXiao Chai Hu TangMinor Burpleurum DecoctionSource: Discussion of Cold-induced Disorders (Shang han lun) IngredientsIngredientsChaihu 24g Huangqin 9g Banxia 9g Shengjiang 9g Renshen 9g Dazao 4pcs Zhigancao 6gPreparationPreparationThe source text advises to decoct the above ingredients in approximately 12 cups of water until 6 cups remain. The ingredients are removed and the strained decoction is further decocted until 3 cups remain. This is taken warm in three equal doses over the course of one day. Today usually prepared as a decoction in the usual manner. Two-to-three times the dosage of dang shen is commonly substituted for ren shen. ActionsActionsHarmonizing shaoyang.IndicationsIndications1 Cold-induced shaoyang syndromes.SymptomsAlternating fever and chills sensation of fullness in the chest and hypochondrium reduced appetite Irritability, nausea and vomiting bitter taste in the mouth, dry throat dizziness, Tongue：thin white coating Pulse：wiry SymptomsIndicationsIndications 2. Syndrome of heat invading the blood chamber caused by pathogenic wind-cold invasion. Alternating chills and fever at postmenstrual period. IndicationsIndications3 Malaria, jaundice and other diseases with signs of shaoyang syndrome.nullThis is the lesser yang stage of the six stages of disease. At this level the struggle between the pathogenic qi, which is trying to penetrate deeper into the body, and the normal qi, which is trying to force it out, is expressed by three major groups of symptoms. The half-exterior aspect is reflected in the alternating chills and fever and the sensation of fullness in the chest and hypochondria due to heat in the lesser yang channels. nullThe half-interior aspect is reflected in the heat rising upward with a bitter taste in the mouth, a dry throat, and dizziness. The third group of symptoms is associated with the Gallbladder, which is the organ that corresponds to the lesser yang. In this pattern, the Gallbladder qi attacks the Stomach, resulting in heartburn, nausea, vomiting, and reduced appetite. The wiry pulse indicates Liver and Gall-bladder involvement. Sometimes the pulse is thin, which is indicative of the stage between the greater yang and yang brightness stages of disease.ANALYSIS OF FORMULAANALYSIS OF FORMULAchief herb -- chai hu, dispels the pathogenic factor located in the half exterior by driving it out. deputy herb – huang qin, clears out stagnated heat located in the half interior by clearing away it thoroughly. nullchai hu, is the most important herb for venting lesser yang-stage disorders. When combined with the deputy, huang qin, which drains heat from the Liver and Gallbladder (the interior aspect of the lesser yang stage), it vents the pathogenic influence and thereby releases lesser yang-stage disorders. chai hu also spreads the Liver qi with an ascending, cooling action (contrary to most cooling, which causes things to descend). This combination therefore drains the heat without causing it to sink deeper into the body.Assistant herbsAssistant herbsban xia -- warms and transforms phlegm and turbidity in the middle burner ban xia and sheng jiang regulate the function of the stomach and lower the adverse flow of qi. nullren shen and da zao invigorate qi and strengthen the spleen zhi gan cao coordinates the actions of various drugs in the recipe. The combination of sheng jiang and da zao mildly regulates the nutritive and protective qi, and assists chai hu in releasing the half-exterior aspects of this condition.COMMENTARY COMMENTARY In the Discussion of Cold-induced Disorders, the common methods of treating externally-contracted diseases are inducing sweating (to release the exterior) and purging or inducing vomiting (to expel interior accumulations). However, for the condition described above, these approaches are inappropriate. nullThe pathogenic influence is lodged too deeply in the interior to be released by sweating, which would only injure the fluids and the normal qi. Yet the condition is not deep enough to justify purging, which would injure the yin and could lead to palpitations. And because there is no excess in the chest, inducing vomiting would injure the yang of the chest and could lead to palpitations. Therefore a different, harmonizing approach is necessary.nullThis formula, with its many applications, is mentioned over 30 times in Discussion of Cold-induced Disorders and Essentials from the Golden Cabinet. There it states that in patients with injury from cold or wind attack, only one of the symptoms of the xiao chai hu tang pattern is needed to make the diagnosis. Another disorder for which this formula is prescribed in these books is heat entering the chamber of the blood. This condition is characterized by alternating fever and chills, dry throat, and discomfort in the hypochondria in women. This is commonly due to colds contracted after childbirth or during menstruation.nullClinically, the therapeutic scope of this formula has been greatly expanded over the centuries to include a wide variety of problems associated with the presentation above, but which have not necessarily progressed through the stages of an externally-contracted disorder. Today it is thought that any condition which possesses the salient characteristics of this presentation can be regarded as a lesser yang condition. These conditions are not located in a set place in the body and their presentations are typically unpredictable. Modern physicians have used this formula and its modifications in treating a myriad of problems including childhood diarrhea, habitual constipation, renal colic, acute rheumatic fever, malaria, and gastritis from reflux of bile.nullThere is a large discrepancy between the dosage of chai hu prescribed in the source text and that used by most modern practitioners. In part, this is due to a fear of that herb passed on to later generations by the famous physician and chief architect of the warm-febrile disease school, Ye Tian-Shi. Ye believed that it was a dangerous herb that "plunders the yin,'' and should therefore be used sparingly. This is a source of fierce debate today, and many practitioners believe that while a relatively large dosage of the herb is quite safe for most patients, it should be used with caution in patients with yin deficiency.nullWith the appropriate presentation, this formula may be used in treating such biomedically-defined disorders as upper respiratory tract infection, influenza, bronchitis, pulmonary tuberculosis, epidemic parotitis, jaundice, malaria, acute viral hepatitis, post partum fever, acute pyelonephritis, cholecystitis, lymphadenitis, and intercostal neuralgia.CAUTIONS CAUTIONS This formula has an ascending action which can injure the qi and cause headache, dizziness, and bleeding of the gums if taken long-term. For the same reason, unless considerably modified, it is contraindicated in patients with excess above and deficiency below, Liver fire, or bleeding of the gums. Use with caution in cases of ascendant Liver yang, hypertension, or vomiting of blood due to yin deficiency. Patients with relatively weak normal qi may experience fever and chills while taking this formula because the pathogenic influence is vented from the lesser yang stage via the greater yang. MODIFICATIONS MODIFICATIONS For pronounced thirst, omit ban xia and add tian hua fen. For abdominal pain, omit huang qin and add bai shao. For rough, scanty, dark, and painful urination, add jin qian cao and bai hua she she cao. For constipation, loss of appetite, dark urine, irritability, thirst, a yellow tongue coating, and a tight pulse, add huo ma ren and zhi shi. For fever, coughing of yellow sputum, and chest pain, add jie geng, gua lou and chuan bei mu. For vertigo, add ju hua, gou teng and jue ming zi.