Chapter One. Exterior syndrome and formula composition
CHAPTER CONTENTS
1 Wind-cold syndrome38
CHAPTER OUTLINE
This chapter introduces the principles, methods and strategies for the composition of formulas that stimulate the Qi in the superficial region, expel the exogenous pathogenic factors, and treat the exterior syndrome and other disorders that appear in this pathological process.
Exterior syndrome arises when the exogenous pathogenic factors invade the superficial regions (e.g. the skin, subcutaneous region and meridians). It manifests as fever, chills, a thin tongue coating and a superficial pulse. It is often seen in the initial stage of exogenous disorders. In western medicine it is seen in disorders such as the common cold, influenza, edema, the acute or initial stage of infectious diseases and allergies. According to the different nature of exogenous pathogenic factors, this syndrome is divided into wind-cold syndrome and wind-heat syndrome.
1. Wind-cold syndrome
Wind-cold syndrome is caused by exogenous pathogenic wind and cold. According to different conditions of health and constitutions, the reaction of the body can be different, thus an excess or a deficiency condition can develop.
1.1. Excess condition
Manifestations
Main symptoms
Chills, fever, no sweating, no thirst.
Secondary symptoms
Headache, stiffness of the neck and back, general pain, blocked nose, runny nose, sneezing, shortness of breath, cough.
Coexisting symptoms
Heaviness of the head and body, nausea, vomiting, a bitter taste in the mouth and thirst.
Tongue
Normal tongue body with a white coating.
Pulse
Slightly superficial in a common case; superficial and tight or superficial and wiry in a severe case.
Associated disorders in western medicine
Common cold, influenza, acute respiratory infections, edema and allergy.
Analysis of the syndrome
This syndrome arises when the exterior cold is severe and the superficial region of the person is firm.
• When the cold, which has a contracting nature, attacks the body, the pores are quickly and tightly closed as a reaction, either from the cold itself or from the reaction of the Defensive-Qi. When the Defensive-Qi cannot reach the surface of the body and fails to bring warmth to the skin, one may have chills and aversion to wind and cold.
• When the Defensive-Qi pits its efforts against the pathogenic factors and tries to eliminate them, fever is produced. Because the Defensive-Qi cannot spread its Qi on the surface of the body, it accumulates beneath the surface and fever is produced.
• Because the pores close tightly, there is no sweating.
• Since the pathogenic factors are wind and cold, which cannot injure the body fluid, patients do not feel thirsty.
• No thirst and no sweating are the two key symptoms for differentiating between this syndrome and wind-heat syndrome, which manifests as fever, chills with sweating and thirst.
• Wind-cold, as a Yin pathogenic factor, often firstly attacks the Yang region – the back of the body where the Bladder meridian passes. When the Qi and blood are not able to flow properly in this meridian, headache, stiffness of the neck and back, and general pain may appear.
• Skin relates to the Lung. When the superficial region is blocked by wind-cold, the Lung-Qi is unable to properly disperse and descend, and a blocked or runny nose, shortness of breath and cough may develop.
• Since the disorder is acute, the internal organs are not affected, the tongue is normal and the coating is thin and white. The pulse is superficial and tight in a severe case, and slightly superficial in a common case.
Other syndromes may coexist:
• If dampness also invades the body, which happens in a humid place, it can cause a heavy sensation of the body.
• Sometimes heat can also be generated when the body’s resistance is strong and the pores are closed tightly. Patients may have a bitter taste in the mouth and feel thirsty, indicating the existence of heat.
(See Figure 1.1 on page 54.)
1.2. Deficiency condition
Manifestations
Main symptoms
Chills, fever, slight sweating, aversion to wind.
Secondary symptoms
Headache, general pain or stiffness of the body, blocked nose, runny nose, sneezing, shortness of breath, cough.
Tongue
Normal tongue body with a white coating.
Pulse
Superficial and soft.
Associated disorders in western medicine
Common cold, influenza, acute respiratory infections and allergies.
Analysis of the syndrome
The superficial region is the first defense of the body against exterior pathogenic factors. It depends on the balanced functions of Qi and blood there, specifically the Defensive-Qi and Nutritive-Yin, both of which are directly transformed from food and drink. The Defensive-Qi holds the Nutritive-Yin, circulates in the superficial region of the body, brings warmth and nutrition to this region and controls the appropriate opening and closing of the pores.
A deficiency syndrome arises if the Defensive-Qi is weak.
• When the exterior pathogenic wind-cold attacks the superficial region of the body, the Defensive-Qi is not strong enough to close the pores, and the pathogenic wind and cold can easily invade the body.
• The exogenous wind, which has a moving and dispersing nature, opens the pores, thus patients may have an aversion to wind and have chills.
• When the Defensive-Qi pits its efforts against the pathogenic wind-cold and tries to eliminate it, fever is produced.
• When the pores cannot close tightly, the Nutritive-Yin flows out, manifesting as sweats. When the Nutritive-Yin is weakened, the Defensive-Qi is eventually weakened as well. In a deficiency condition where the cold is not severe and the Defensive-Qi is not strong, the pulse is neither tight nor wiry, but soft.
• The pathological process in the superficial region may affect the Qi movement of both the Bladder and Lung meridians; however, the symptoms are not as severe as in the excess condition.
• When the Qi in the Bladder meridian is obstructed, patients may suffer from headache, general pain or stiffness.
• When the Lung-Qi fails to disperse and descend properly, a blocked and runny nose, sneezing, shortness of breath and cough may develop.
(See Figure 1.2 on page 54.)
Treatment principles
• In the excess condition: Stimulate the Yang and Qi, open the pores and induce sweating so as to expel wind-cold.
• In the deficiency condition: Harmonize and strengthen the Defensive-Qi and Nutritive-Yin so as to release the exterior.
Herb selection principles and formula composition strategies
• First, herbs that are pungent and warm, enter the Bladder meridian and directly stimulate the Qi, induce sweating and expel wind and cold from the superficial region of the body are selected.
• Second, herbs that are pungent and warm, and stimulate blood circulation so as to enhance the action of the herbs that expel wind and cold are selected.
• Third, herbs that are pungent and warm, and regulate the Lung-Qi so as to assist the herbs that expel wind-cold from the superficial region of the body are selected.
• Along with the herbs in the third group, herbs that descend the Lung-Qi to treat cough and wheezing are also selected.
• In a deficiency condition, herbs that are sweet and warm, and gently tonify and stimulate the Defensive-Qi should be selected along with herbs that can strengthen the Nutritive-Yin.
CAUTIONS
1. Avoid overdispersing the Qi and consuming the Yin:
Formulas that release the exterior contain pungent and warm herbs. Their action tendencies are ascending and dispersing, especially the formulas that can cause sweating. Too large a dosage may disperse the Qi too much, consume Yin and cause complications. Among patients who are deficient of Yin or Qi due to their constitution, chronic diseases, stress or dietary habit, the formulas should be used with caution.
2. Caution in bleeding conditions and pregnancy:
As pungent herbs have a moving property, these herbs should be used with caution in bleeding conditions or in pregnancy.
3. Choose appropriate dosage:
The dosage of the herbs in the formula should be adjusted to suit the condition of the individual, the syndrome and the season. For elderly people, children, people with a weak constitution and for mild syndromes, at a place of gentle climate and in the summer, the dosage should be less. For adults with a strong constitution, for treating severe syndromes, in winter or in a cold place, the dosage should be larger.
4. Induce proper sweating:
Sweating is the means of expelling the exterior pathogenic factors, especially wind and cold. The dosage of herbs should be adjusted according to the reaction and any changes in the symptoms. A mild sweat over the whole body is required. After sweating, patients should feel better. Heavy sweat can injure the Yin and the body fluid, and must be avoided.
5. Use only in a short treatment course:
As eliminating wind-cold is not difficult in common cases, formulas to release the exterior should not be used for a long period of time. A period of 3 days is recommended. If the exogenous pathogenic factors have not been removed completely, another 3-day course can be prescribed. With regard to herbs that may cause heavy sweating, the dosage and treatment course should be adjusted according to the reaction of the patient after each use.
Structure of the formula and selection of herbs
Chief: Stimulate the Yang and Qi, induce sweating and expel wind-cold
Jing Jie ( Schizonepetae herba) and Fang Feng ( Saposhnikoviae radix)
Jing Jie and Fang Feng are the most commonly used herbs to treat mild or common cases of wind-cold syndrome. Both herbs are pungent and warm, and can expel wind and cold. In a place with a temperate climate, where wind and cold do not close the pores tightly, they are often applied as chief herbs in the formula for treating exterior wind-cold syndrome, in either excess or deficiency conditions. They treat related diseases in modern medicine such as the common cold, influenza, certain stages of infectious childhood diseases, skin diseases and allergies in which an exterior syndrome exists.
Comparing Jing Jie with Fang Feng, Jing Jie is lighter and more dispersing. It is pungent but not strong, slightly warm but not drying. It is especially good at expelling wind. Fang Feng is sweet, pungent and warm, and enters the Bladder, Lung and Spleen meridians. As its sweet taste moderates the pungent taste, Fang Feng is less strong in dispersing the wind on the surface of the body than Jing Jie. However, as Fang Feng is warmer than Jing Jie and enters the Spleen meridian, it is especially good at expelling dampness and cold in the regions deeper than the body surface, such as the subcutaneous region and muscles that are controlled by the Spleen. When the patient feels pain and heaviness of the muscles, Fang Feng is more suitable to be used than Jing Jie. Since wind-cold attacks both the skin and the subcutaneous region, Jing Jie and Fang Feng are often used together.
Xiang Ru ( Moslae herba), Zi Su Ye ( Perillae folium) and Huo Xiang ( Agastachis herba)
These three herbs are pungent and warm, and enter the Lung and Spleen meridians. They can expel wind-cold in the superficial region of the body as well as eliminate dampness, which often affects the body in a humid climate or is due to cold drinks. They can be selected as chief herbs separately or in groups in a formula.
Xiang Ru is the warmest of these three herbs. It is able to induce sweating, disperse wind and dampness, and release the exterior. It is especially useful when there is fever, general pain and heaviness of the body but no sweating. This herb is also called Summer Ma Huang because it has a similar but gentler action than Ma Huang ( Ephedrae herba)* in the function of inducing sweating. Xiang Ru is more suitable for use in the summer when the pores are not closed as tightly as in the winter. It also has the function of transforming dampness in the Middle-Jiao and treating abdominal pain, vomiting, diarrhea and edema, but this function is not as strong as that of the other two herbs.
Zi Su Ye is a light and aromatic herb. It can gently disperse and expel wind-cold in the superficial region of the body and release the exterior. It is used in a mild case of wind-cold syndrome since it is less warm and pungent than Xiang Ru and it is not able to induce sweating and disperse dampness. However, as it can relieve nausea by soothing the Stomach-Qi, it is an ideal herb to alleviate exterior syndrome that is accompanied by dampness in the Middle-Jiao, such as in gastritis.
Huo Xiang is an excellent herb to expel wind, cold and dampness; it can also transform dampness in the Middle-Jiao. Compared with Xiang Ru, it is stronger in transforming dampness in the Middle-Jiao; compared with Zi Su Ye, it not only expels wind and cold, but also disperses dampness in the superficial regions of the body to treat heaviness and stiffness of body. It is selected especially in the summer to treat the common cold, influenza and acute gastritis.
Sheng Jiang ( Zingiberis rhizoma recens) and Cong Bai ( Allii fistulosi bulbus)
Sheng Jiang and Cong Bai are often used in the initial stage of wind-cold syndrome in either excess or deficiency conditions. In China, a briefly cooked decoction of Sheng Jiang and Cong Bai is a commonly used folk remedy to treat the common cold.
Sheng Jiang is pungent and slightly warm, and enters the Lung, Spleen and Stomach meridians. It can disperse cold and wind, dissolve phlegm in the Lung and stop cough. It also enters the Spleen and Stomach meridians, can warm the Middle-Jiao, soothe the Stomach-Qi, and alleviate nausea and vomiting. This herb is a good choice if a patient suffers from a mild wind-cold syndrome complicated by ascending of the Stomach-Qi, such as in acute gastritis.
Cong Bai is pungent and warm, and enters the Lung and Stomach meridians. The sharp smell and taste can directly stimulate the Qi, expel wind and open up the obstructions. It can be used to treat the sensation of discomfort in the body, sneezing and a blocked and runny nose in a mild exterior wind-cold syndrome.
Qiang Huo ( Notopterygii rhizoma), Cang Zhu ( Atractylodis rhizoma) and Qin Jiao ( Gentianae macrophyllae radix)
These three herbs are able to expel wind, cold and dampness from the skin, subcutaneous region and muscles. They can be selected as chief in a formula to treat a severe excess condition of wind-cold syndrome.
Qiang Huo is commonly used to expel wind, dampness and cold from the body. It has a pungent, bitter taste and is warm in nature. It enters the Bladder meridian primarily and the Liver and Kidney meridians secondly. The pungent and warm nature gives Qiang Huo a strong dispersing and ascending ability, thus it is very effective in quickly expelling wind, dampness and cold from the skin, subcutaneous region and muscles, especially in the upper half of the body. As a result, it can relieve general pain, headache and stiffness of the back.
Cang Zhu can be selected as chief in the formula to treat a reasonably severe excess condition of wind-cold syndrome that includes the symptom of heaviness of the body. Because Cang Zhu is pungent and warm, and enters the Stomach and Spleen meridians, it can strongly dry dampness and disperse wind and cold.
Qin Jiao is neutral, bitter and pungent. Its function of expelling wind, dampness and cold is gentler than that of the other two herbs. It is more suitable for treating a deficiency condition of wind-cold syndrome. It is also used for conditions where there is coexisting heat.
Ma Huang ( Ephedrae herba)*
Ma Huang is used as chief in a formula to treat a severe excess condition of wind-cold syndrome. This herb is considered as the strongest one to induce sweating. Ma Huang is very pungent and warm, its moving speed is high and its action is strong. Ma Huang enters the Lung meridian and can disperse Lung-Qi. It enters the Bladder meridian and can activate the Defensive-Qi; thus it opens the pores, induces sweating and expels wind and cold.
Gui Zhi ( Cinnamomi cassiae ramulus)
Gui Zhi is pungent, warm and sweet, and is used as chief in a formula to treat a deficiency condition of wind-cold syndrome. Its therapeutic effect is achieved through the approach of warming the blood, promoting blood circulation, opening up the meridians and activating the Yang-Qi so that it can expel wind and cold. Compared with Ma Huang, Gui Zhi is not as warm and pungent, but it is sweet. It enters the Heart meridian primarily and the Lung and Bladder meridians secondly. The warm nature of this herb can reduce the cold in the blood. The warm and pungent characters may also activate the blood circulation and open up the meridians. The sweetness moderates the warm and pungent effects so that the medicinal action may be sustained evenly. Since it enters the Lung and Bladder meridians, Gui Zhi can activate Yang-Qi to eliminate wind and cold in the exterior region.
Deputy: Regulate the Qi and blood, enhance the strength of the chief herbs to expel wind-cold; treat the secondary syndrome and coexisting syndromes
Gui Zhi ( Cinnamomi cassiae ramulus)
Gui Zhi is pungent, warm and sweet. Besides expelling wind and cold to treat exterior syndrome, Gui Zhi is able to warm the blood, promote blood circulation and reduce the general pain, stiffness and cold. It is particularly chosen as deputy to enhance the strength of chief herbs to expel wind-cold in treating a severe excess condition of wind-cold syndrome when the general pain of the body is severe.
Chuan Xiong ( Chuanxiong rhizoma)
Chuan Xiong is pungent and warm, and enters the Liver, Gall Bladder and Pericardium meridians. Chuan Xiong is a very effective herb to invigorate the blood and to promote the blood circulation. It is characterized by high moving speed and strength, and is regarded as the herb that moves the Qi in the blood. In treating an exterior wind-cold syndrome, it can be selected as deputy to enhance the herbs that expel wind-cold, as well as to relieve pain of the body and headache.
Bai Zhi ( Angelicae dahuricae radix)
Bai Zhi is warm and pungent with a rich aromatic smell; it possesses strong ascending properties. As it can expel wind-cold, transform phlegm and pus and dry dampness, it can therefore reduce swelling and open the obstruction of the nose. Because it enters not only the Lung meridian, but also the Stomach meridian, it is often applied to treat pain in the forehead where the Yang Ming meridian passes through.
Chai Hu ( Bupleuri radix)
Chai Hu is pungent and neutral, and enters the Liver and Gall Bladder meridians. It is particularly effective in spreading Qi in the Shao Yang meridians, and in treating headache (especially on the lateral sides of the head) and a sensation of fullness in the hypochondriac region. When there is stagnation of Liver-Qi due to stress, which weakens the Defensive-Qi and leads to an exterior syndrome, Chai Hu can be selected.
Xi Xin ( Asari herba)*
Xi Xin is a very pungent and hot herb with an aromatic smell. It does not enter the Bladder meridian, but does enter the Kidney meridian. It can be selected as deputy in the formula to enhance the action of the chief herbs in treating an excess condition of wind-cold syndrome and can release pain.
Xi Xin is very effective in eliminating cold and wind in very deep regions of the body, such as the bones and tendons. Because of its strong aromatic smell, pungent taste and hot nature, it can easily penetrate into the deep layers of the body and is often used in exterior wind-cold syndromes if there is Kidney-Yang deficiency, such as in elderly people, patients who suffer from chronic diseases with internal cold, and patients who suffer from Bi syndrome due to wind-cold invasion. Among these individuals, wind and cold may invade the body more deeply than in common cases. Alternatively, the development can be very acute, the patient feels severe pain in the whole body and the pulse is deep and tight instead of superficial and tight.
As Xi Xin enters the Lung meridian and has an aromatic smell, it is often used for transforming cold and thin phlegm from the Lung, opening the nasal orifices and improving the sense of smell.
A side effect of Xi Xin occurs when it is applied incorrectly. Because it is very hot and pungent, it can easily injure the Yin, blood, body fluid and Qi. It should not be used, or must be used with caution, in patients who suffer from exterior wind-cold syndrome where internal heat also coexists and the Yin, blood and body fluids are deficient. The dosage of Xi Xin should also be controlled carefully in the range of 1–3 g per day for crude herbs. If the powdered herbal extract is used, the dosage should be reduced to 0.1–0.5 g per day. Overdose may cause numbness in the throat and tongue, a stifling sensation in the chest and even death due to paralysis of the diaphragm. Modern research indicates that this herb should be used with caution in patients who suffer from renal disease as it has nephrotoxic effects.
Bai Shao Yao ( Paeoniae radix lactiflora)
Bai Shao Yao is often selected in the deficiency condition of an exterior wind-cold syndrome when the Yin, body fluids and blood are weakened through sweating.
Bai Shao Yao is sour, bitter and slightly cold. Sour and cold may generate the blood, and therefore supplements the shortage of the Yin. It is often used with Gui Zhi ( Cinnamomi cassiae ramulus), which is pungent, sweet and warm, expels wind-cold, and warms and stimulates the blood and Qi. When they are used together, they can harmonize the Defensive-Qi and Nutritive-Yin in the superficial region so as to stabilize the exterior.
Dang Shen ( Codonopsis radix)
Dang Shen is sweet and neutral. It primarily enters the Spleen meridian. It can be used as deputy in an exterior syndrome when the Qi is too weak to eliminate the exterior pathogenic factors. It can tonify the Spleen-Qi so as to strengthen the Lung-Qi and Defensive-Qi, and accelerate the speed of eliminating the exterior pathogenic factors.
Assistant: Regulate the Lung-Qi, stop cough; strengthen the Middle-Jiao in order to assist the chief herbs in expelling wind-cold
Jie Geng ( Platycodi radix) and Xing Ren ( Armeniacae semen)
Jie Geng and Xing Ren are often used together in the formula because they can effectively disperse and descend the Lung-Qi, eliminate phlegm and relieve cough, which is a secondary pathogenic change in a wind-cold syndrome.
Jie Geng is pungent, bitter and neutral. It is able to transform phlegm and stop cough. Pungent and bitter tastes provide Jie Geng with dispersing and dissipating capacities. It is light in weight and in nature, thus its function is characterized by ascending the Lung-Qi gently but sufficiently. It is suitable to treat cough with phlegm, a stifling sensation in the chest and nasal obstruction due to obstruction of the Lung-Qi.
Xing Ren is bitter, warm and slightly poisonous. The bitter taste gives Xing Ren its descending property. Warmth can disperse the accumulation of phlegm and the stagnation of Qi. It contains oil, which gives this herb a moist nature. The function of Xing Ren is characterized by descending the Lung-Qi and transforming phlegm to stop cough. It is particularly useful in treating cough with a large amount of phlegm, fullness in the chest, shortness of breath and nasal obstruction when the exterior pathogenic factors invade the Lung and the Lung-Qi fails to descend.
When Jie Geng and Xing Ren are used together, one moves upwards and the other moves downwards; one disperses the Lung-Qi and the other descends the Lung-Qi. They perfectly match each other in regulating the Lung-Qi, eliminating phlegm and relieving cough, hence the reason that they are often used together.
Zi Su Zi ( Perillae fructus)
Zi Su Zi is warm and pungent, and enters the Lung meridian. It can descend the Lung-Qi and transform phlegm. It is a seed and can both moisten the intestines and promote bowel movement. It can be selected to treat an exterior syndrome if the Lung-Qi is blocked, and there is cough, wheezing and fullness in the chest. If there is constipation, the Qi of the Large Intestine is obstructed, affecting the ability of the Lung-Qi to descend; this herb is a perfect choice in the formula.
Chen Pi ( Citri reticulatae pericarpium) and Zhi Ke ( Aurantii fructus)
Chen Pi is pungent, bitter and slightly warm. It enters the Stomach and Spleen meridians and is effective in regulating the Qi of these organs. Its aromatic smell can stimulate the Spleen, transform dampness and soothe the Stomach-Qi. It is often used in an exterior condition if there are symptoms such as distension and pain in the abdomen, reduced appetite, fullness in the stomach, nausea and vomiting.
Zhi Ke is bitter and slightly cold, and enters the Spleen and Stomach meridians. It can regulate the Spleen-Qi and Stomach-Qi in a gentle and slow way. It moves horizontally in the Upper- and Middle-Jiao, opens the chest and reduces distension. In an exterior syndrome it is used to treat Qi stagnation in the chest, stomach and hypochondria, which causes distension in the upper abdomen, a stifling sensation in the chest, reduced appetite, irritability and depression.
Sheng Jiang ( Zingiberis rhizoma recens), Da Zao ( Jujubae fructus) and Zhi Gan Cao ( Glycyrrhizae radix preparata)
Sheng Jiang is pungent and slightly warm, and enters the Lung, Spleen and Stomach meridians. It can effectively soothe the Stomach-Qi, warm the Middle-Jiao and promote digestion so as to promote the generation of Defensive-Qi.
Da Zao is sweet and warm, and enters the Spleen meridian. It can nourish the blood and tonify the Qi. Sheng Jiang and Da Zao are often used together to strengthen the Middle-Jiao and are used in deficiency conditions.
Zhi Gan Cao is sweet and slightly warm, and enters the 12 regular meridians, especially the Spleen meridian. It can tonify the Spleen-Qi. It is often used in deficiency conditions.
Envoy: Harmonize and integrate the functions of herbs in the formula
Generally speaking, it is not necessary to add an envoy in a formula to expel wind-cold because the chief herb often serves as the guide and enters the superficial region of the body. Herbs with a harmonizing function, such as Zhi Gan Cao ( Glycyrrhizae radix preparata), may slow down the dispersing function and reduce the therapeutic effect of the formula.
Sometimes, however, it is necessary to use an envoy such as Zhi Gan Cao in a formula. It can moderate the harsh properties of herbs and integrate the functions of herbs that work on different aspects of the syndrome in a formula.
Common accompanying symptoms and treatment
• Headache: use Qiang Huo ( Notopterygii rhizoma), Chuan Xiong ( Chuanxiong rhizoma) and Bai Zhi ( Angelicae dahuricae radix) to expel wind and cold, and to regulate the Bladder, Gall Bladder and Stomach meridians to stop headache.
• Itch of the throat: use Chan Tui ( Cicadae periostracum) or Jing Jie ( Schizonepetae herba) to expel the wind in the throat.
• Weakness of Defensive-Qi and easily sweating: use Huang Qi ( Astragali radix) to tonify the Qi and close the pores, use Bai Shao Yao ( Paeoniae radix lactiflora) to nourish the Yin and body fluids and use Fang Feng ( Saposhnikoviae radix) to expel the wind.
• Poor appetite: use Zi Su Ye ( Perillae folium), Sheng Jiang ( Zingiberis rhizoma recens) and Chen Pi ( Citri reticulatae pericarpium) to soothe the Stomach-Qi and improve the appetite.
• Stress: use Chai Hu ( Bupleuri radix), Huang Qin ( Scutellariae radix) and Ban Xia ( Pinelliae rhizoma) to regulate the Qi in the San Jiao meridians, and use Xiang Fu ( Cyperi rhizoma) to regulate the Liver-Qi.
• Stiffness of the neck: add Ge Gen ( Puerariae radix) to ascend the fluid and relax the tendons.
• Beginning of internal heat: add Shi Gao ( Gypsum) to clear the heat.
• Dampness in the meridians: add Qin Jiao ( Gentianae macrophyllae radix) to assist Qiang Huo ( Notopterygii rhizoma) to eliminate wind-damp-cold.
Examples of classical formulas
Ma Huang Tang (Ephedra Decoction) 
Source: Shang Han Lun 
Composition
Ma Huang ( Ephedrae herba)* 6 g
Gui Zhi ( Cinnamomi cassiae ramulus) 4 g
Xing Ren ( Armeniacae semen) 9 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 3 g
Analysis of the formula
This very famous classical formula from Dr Zhang Zhong Jing was devised 2000 years ago. It can strongly induce sweating and expel wind-cold, regulate the Lung-Qi and relieve wheezing. It treats the excess condition of a severe wind-cold syndrome when there are fever, severe chills without sweating, headache, generalized pain and shortness of breath. The patient may have a white tongue coating and a tight, superficial pulse.
In this formula:
• Ma Huang, which is pungent and hot, is used as chief; it directly stimulates the Yang and Qi in the Bladder and Lung meridians, induces sweating and expels the wind and cold. It can disperse and descend the Lung-Qi, release the obstruction of the Lung-Qi and treat shortness of breath.
• Gui Zhi serves as deputy; it can promote blood circulation so as to enhance the action of the chief to induce sweating and relieve general pain of the body.
• Xing Ren is pungent and warm; as a helping assistant it can assist the action of the chief and deputy to disperse the Lung-Qi. Xing Ren is bitter and can also descend the Lung-Qi. This descending action may also serve as a corrective assistant to control the intensive dispersing action of the chief, the very pungent and warm Ma Huang.
• Zhi Gan Cao serves as envoy; it harmonizes and integrates the functions of herbs that work in different directions and at different levels in the formula.
Commentary on strategies
In this formula, several strategies of combination are demonstrated.
• Ma Huang is chosen to induce sweating and it focuses on the main pathological change. As it is a harsh and poisonous herb, it cannot be used in a large dosage.
• In order to achieve a sufficient effect of expelling wind-cold, Gui Zhi is used to enhance the ability of Ma Huang to induce sweating at the blood level, and Xing Ren assists Ma Huang to regulate the Lung-Qi. They make the action of Ma Huang strong, lasting and even.
• The descending tendency of Xing Ren and the moderate nature of Zhi Gan Cao can directly control the intensity of Ma Huang.
These combinations make this formula effective and safe for short-term use in a severe excess condition of a wind-cold syndrome.
Gui Zhi Tang (Cinnamon Twig Decoction) 
Source: Shang Huan Lun 
Composition
Gui Zhi ( Cinnamomi cassiae ramulus) 9 g
Bai Shao Yao ( Paeoniae radix lactiflora) 9 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 6 g
Sheng Jiang ( Zingiberis rhizoma recens) 9 g
Da Zao ( Jujubae fructus) 12 pieces
Analysis of the formula
This formula, also devised by Dr Zhang Zhong Jing, treats a deficiency condition of a wind-cold syndrome. This formula expels wind-cold and releases the exterior by regulating the Nutritive-Yin (Ying-Yin) and Defensive-Qi (Wei-Qi). The manifestations are fever with irregular sweating and aversion to wind, blocked nose and headache. Patients do not feel thirsty. They have a white tongue coating and a superficial, weak or slow pulse.
In this formula, Gui Zhi and Bai Shao Yao are considered as the chief herbs in the formula:
• Gui Zhi is warm and sweet, promotes the blood circulation, strengthens the Yang and stimulates the Qi at the superficial level of the body.
• Bai Shao Yao is sour and cold, and can nourish the Yin and body fluids.
When they are used together, they can restore the physiological balance between the Defensive-Qi and the Nutritive-Yin. These two herbs match each other perfectly and can restore the condition of deficiency and imbalance between the Defensive-Qi and Nutritive-Yin.
The remaining herbs are assistants in the formula:
• Sheng Jiang is pungent and slightly warm, and enters the Lung meridian. It assists Gui Zhi to expel wind and cold. It also enters the Spleen and Stomach meridians and can soothe the Stomach-Qi, warm the Middle-Jiao, aid digestion and promote the generation of Defensive-Qi.
• Da Zao is sweet and warm, and enters the Spleen meridian. It can nourish the blood and enhance the ability of Bai Shao Yao. Together with Zhi Gan Cao, it can tonify the Spleen-Qi and strengthen the Defensive-Qi and Nutritive-Yin.
Commentary on strategies
This formula has several characteristics.
• Gui Zhi and Bai Shao Yao are chosen to harmonize and tonify the Defensive-Qi and Nutritive-Yin and they focus on the main pathological changes in the superficial region. This combination is often used for harmonizing Ying and Wei.
• The combination of Sheng Jiang and Da Zao is also commonly used for strengthening the Middle-Jiao.
• In this formula, there are two very balanced groups: Gui Zhi and Sheng Jiang belong to the Yang tonifying group; Bai Shao Yao and Da Zao belong to the Yin tonifying group. Because of the balanced functions, it is a safe formula and can be used for treating many types of disorder that are linked with Ying and Wei imbalance.
• Most of the ingredients in this formula are used in a Chinese kitchen. As they are safe and with tastes acceptable to most people, this formula is widely used.
Jiu Wei Qiang Huo Tang (Nine-herb Decoction with Notopterygium) 
Source: Si Shi Nan Zhi quoted from the formula of Zhang Yuan Su 
Composition
Qiang Huo ( Notopterygii rhizoma) 5 g
Fang Feng ( Saposhnikoviae radix) 5 g
Cang Zhu ( Atractylodis rhizoma) 5 g
Xi Xin ( Asari herba)* 1 g
Chuan Xiong ( Chuanxiong rhizoma) 3 g
Bai Zhi ( Angelicae dahuricae radix) 3 g
Sheng Di Huang ( Rehmanniae radix) 3 g
Huang Qin ( Scutellariae radix) 3 g
Gan Cao ( Glycyrrhizae radix) 3 g
Analysis of the formula
This formula is able to induce sweating to expel wind-dampness and clear internal heat. It is used for treating the exterior wind-cold-damp syndrome, which manifests as chills, fever, no sweating and headache with tight and heavy sensations, stiffness of the neck and generalized pain with a heavy sensation. At the same time, heat is generated by the tightly closed pores in the superficial region and is manifested as a bitter taste in the mouth and thirst. Patients have a white or yellowish, sticky tongue coating and a superficial pulse.
In this formula:
• Qiang Huo is used as chief; it directly expels the wind, cold and dampness in the superficial region of the body.
• Fang Feng and Cang Zhu serve as deputies; they assist the function of Qiang Huo.
• Xi Xin, Chuan Xiong and Bai Zhi are helping assistants; they work in the same direction as the chief and deputy herbs. In addition, they can promote Qi and blood circulation and relieve headache and general pain.
• The other two assistants are Huang Qin and Sheng Di Huang. As cold herbs, they are particularly used for treating internal heat. At the same time they also serve as corrective assistants to reduce the warming and drying nature of the other herbs in the formula.
• Zhi Gan Cao serves as envoy, again for moderating the actions of the herbs in the formula.
Commentary on strategies
There are several characteristics in this formula.
• The herbs that are used not only expel wind and cold, but also expel dampness in the superficial region.
• It treats warm and cold coexistence in one syndrome, a more complicated and commonly seen syndrome. Warm and cold herbs are used in one formula. The cold herbs not only treat the internal heat, but also reduce the side effects of the pungent and drying herbs.
Jing Fang Bai Du San (Schizonepeta and Ledebouriella Powder to Overcome Pathogenic Influences) 
Source: She Sheng Zhong Miao Fang 
Composition
Qiang Huo ( Notopterygii rhizoma) 5 g
Du Huo ( Angelicae pubescentis radix) 5 g
Chuan Xiong ( Chuanxiong rhizoma) 5 g
Chai Hu ( Bupleuri radix) 5 g
Jing Jie (S chizonepetae herba) 5 g
Fang Feng ( Saposhnikoviae radix) 5 g
Zhi Ke ( Aurantii fructus) 5 g
Jie Geng ( Platycodi radix) 5 g
Qian Hu ( Peucedani radix) 5 g
Fu Ling ( Poria) 5 g
Zhi Gan Cao ( Glycyrrhizae radix preparata) 3 g
Analysis of the formula
This formula can induce sweating and expel wind, cold and dampness. It is used in a common case of an excess condition of a wind-cold syndrome, or at the initial stage of a febrile disease. Patients suffer from chills, fever, headache with a heavy sensation, no sweating and have a blocked nose. A white tongue coating and a superficial, rapid pulse are seen in this syndrome.
In this formula:
• The pungent and warm Qiang Huo and Du Huo are used as chief to expel wind, cold and dampness from the entire body.
• There are several deputies:
– Chuan Xiong can promote blood circulation and therefore reduce headache and generalized pain.
– Chai Hu, Jing Jie and Fang Feng can expel wind and help the chief herbs to release the exterior.
• The assistants can remove phlegm and stop cough and they also focus on regulating the Lung-Qi to assist the chief and deputy herbs:
– Zhi Ke broadens the chest.
– Jie Geng ascends the Lung-Qi and Qian Hu descends the Lung-Qi.
– Fu Ling reduces the dampness.
• Zhi Gan Cao is used as envoy to moderate the speed and drying nature of the herbs in the formula.
Commentary on strategies
This formula is effective in inducing sweating and expelling wind-cold-dampness. It is a commonly used formula for treating an excess condition. Because there are many pungent and drying herbs in the formula, it should be used with caution or modified for treating patients with Yin deficiency.
2. Wind-heat syndrome
Manifestations
Main symptoms
High fever, slight chills, irregular sweating, sore throat and thirst.
Secondary symptoms
Cough, blocked nose, red, swollen eyes, headache.
Tongue
Red tip with a white or slightly yellow coating.
Pulse
Superficial, rapid.
Associated disorders in western medicine
Common cold, influenza, allergies, upper respiratory infections, acute conjunctivitis, rhinitis, tonsillitis.
Analysis of the syndrome
This syndrome is caused by exterior pathogenic wind and heat, which via the nose and throat directly invade the Lung, injure the fluid and disturb the dispersing and descending function of the Lung. As the Lung is related to the skin, the superficial region is also involved.
• When the Defensive-Qi is fighting against the pathogenic factor, heat is produced and fever arises. Heat is also a Yang pathogenic factor; it can directly produce heat and cause fever.
• Heat may injure the body fluids and cause thirst.
• The heat can become so strong that it produces heat-toxin and leads to sore throat.
• The Lung is a very light and delicate organ, which cannot bear excess heat. When the heat invades the Lung, the Lung-Qi cannot disperse and descend appropriately. Thus a blocked nose and a cough appear quite quickly.
• When heat-toxin accumulates in the Upper-Jiao, red, painful and swollen eyes may result.
• If Qi and blood move incorrectly, headache and general pain of the body may appear.
• A tongue with a red tip and a thin yellow coating, and a superficial and rapid pulse indicate clearly the nature and location of the pathogenic factors.
(See Figure 1.3 on page 54.)
Treatment principle: Expel wind, clear heat, regulate the Lung so as to release the exterior
Herb selection principles and formula composition strategies
• First, herbs that are pungent and cold, or aromatic and cold, enter the Lung meridian and expel and clear wind-heat in the Upper-Jiao are selected.
• Second, herbs that are bitter and cold, enter the Upper-Jiao and clear and drain heat are selected.
• Along with the herbs in the second group, herbs that are slightly pungent and warm, and stimulate the Lung-Qi so as to expel wind and assist the herbs that clear wind-heat are selected.
• Herbs that regulate the Lung-Qi so as to assist the herbs that clear wind-heat as well as stop cough are often used.
• Herbs that nourish the fluids and Yin of the Lung should be added when fluids and Yin of the Lung are injured.
• Herbs that tonify the Qi and Yin should be added in the recovery period.
CAUTIONS
Since wind-heat is an exterior pathogenic factor, no matter how much disturbance it has made, treatment should focus on dispersing the exterior pathogenic factor in order to give it a way to leave the body and, at the same time, to clear the heat in the Upper-Jiao (especially from the Lung) and restore the function of the Lung.
Since the Lung is a very delicate organ, pathogenic factors and harsh herbs may injure the Lung and disturb its function. Suitable herbs should be selected with appropriate dosages according to the specific pathological change of the syndrome so as to restore the function of the Lung without delay.
Structure of the formula and selection of herbs
Chief: Clear heat and expel wind
Sang Ye ( Mori folium) and Ju Hua ( Chrysanthemi flos)
Sang Ye and Ju Hua are bitter, sweet and cold, and enter the Lung and Liver meridians. They are often selected as chief herbs in the formula to treat a mild wind-heat syndrome when the wind-heat mainly affects the Lung.
Sang Ye particularly enters the collaterals of the Lung, and can gently but effectively search and expel the wind and heat there. It can also relieve cough.
Ju Hua, especially the yellow Ju Hua, can also clear wind-heat from the Lung. It effectively clears heat from the Lung meridian as well as from the related Gall Bladder meridian. It is particularly selected when the heat is in the head and patients suffer from headache and painful, swollen and red eyes.
Since wind-heat frequently invades the Lung, affecting the nose, skin, head and throat, Sang Ye and Ju Hua are often used together as chief in the formula.
Jin Yin Hua ( Lonicerae flos) and Lian Qiao ( Forsythiae fructus)
These two herbs are often selected as chief herbs in a formula to treat a common case of wind-heat syndrome.
Lian Qiao is bitter, cold and aromatic, and enters the Heart and Small Intestine meridians. Although it does not enter the Lung meridian, it is still often used in formulas to treat wind-heat syndrome as a chief herb. This is because its aromatic smell can disperse the Qi in the Upper-Jiao and gently release the exterior, and it leaches out heat from the Heart through the Small Intestine. It is especially effective in dispersing and clearing heat in the Heart and relieving restlessness and a warm sensation in the chest.
As Jin Yin Hua and Lian Qiao have similar properties and actions, they are often used together in the formula as chief in order to accentuate their functions. As their dispersing capacity is much weaker than their clearing capacity, it is necessary to add other herbs to increase their dispersing action to release the exterior.
Chai Hu ( Bupleuri radix) and Huang Qin ( Scutellariae radix)
These two herbs are used in combination as chief herbs in the formula to disperse the constrained heat and Qi in the Upper-Jiao so as to expel wind-heat.
Chai Hu is pungent and neutral, and enters the Liver and Gall Bladder meridians. It can effectively disperse and ascend the constrained Qi of the Liver and Gall Bladder and facilitate the Qi movement in the San Jiao passage. Through this approach, it can stimulate the Lung-Qi to eliminate the wind-heat and is therefore often used in a formula to release the exterior.
Huang Qin is bitter and cold, and enters the Lung and Large Intestine meridians. It particularly clears heat in the Lung and Upper-Jiao and damp-heat in the intestines. It also enters the Gall Bladder meridian and can reduce fire generated by stress.
When these two herbs are used together, the blockage of Qi can be spread and the heat can be eliminated.
Ma Huang ( Ephedrae herba)* and Shi Gao ( Gypsum)
Ma Huang and Shi Gao can be used in combination as chief substances in a formula to treat a severe case of wind-heat syndrome. They can strongly disperse and clear the intense heat in the Lung.
Ma Huang is very warm and pungent, can effectively stimulate the Lung-Qi, disperse the restrained heat, open the pores and thus eliminate the exterior pathogenic factors.
Shi Gao is pungent, sweet and very cold, can quickly descend the Lung-Qi, powerfully clear heat in the Lung and relieve wheezing. Shi Gao can disperse the Lung-Qi because of its pungent taste, but this function is weaker than its descending function.
The combination of the dispersing action of Ma Huang and descending action of Shi Gao can perfectly regulate the Lung-Qi. The expelling action of Ma Huang and the clearing action of Shi Gao can efficiently eliminate pathogenic wind-heat. When the dosage of Shi Gao is much larger than that of Ma Huang, the function of this combination is to first clear the heat; the moving tendency is mainly downwards.
Deputy: Clear heat and heat-toxin in the Upper-Jiao; regulate, stimulate and strengthen the Lung-Qi so as to expel the wind and heat
Bo He ( Menthae herba)
Bo He is very pungent, aromatic and cold, and enters the Lung and Liver meridians. As deputy, it is often used to enhance the ability of the chief to expel wind-heat as it possesses a very strong dispersing ability. Since its dispersing action is stronger and quicker than that of its clearing action, Bo He is not an appropriate choice for clearing intense heat. Large dosages of Bo He may increase the chance of overdispersing the Qi in the Upper-Jiao; this may injure the fluids of the Lung and further increase the heat.
Niu Bang Zi ( Arctii fructus)
Niu Bang Zi is bitter, pungent and cold, and enters the Lung and Stomach meridians. It is able to either expel the wind-heat or clear heat; however, the clearing function is stronger than that of the dispersing function. It can be used as a deputy to strengthen the function of clearing heat. It is particularly suitable for treating a sore throat in the wind-heat syndrome. As it is a seed and can moisten the intestines, it is more suitable for use in a condition where constipation coexists.
Jie Geng ( Platycodi radix), Xing Ren ( Armeniacae semen) and Qian Hu ( Peucedani radix)
These three herbs are often used as deputies for enhancing the chief herbs to regulate the Lung-Qi.
Jie Geng and Xing Ren are pungent in nature and enter the Lung meridian. Jie Geng moves upwards and Xing Ren moves downwards; one disperses the Lung-Qi and the other descends the Lung-Qi. In this way they can relieve cough, which often exists in a wind-heat syndrome. However, as both are warm and toxic, they should be used in small dosages. Moreover, since they do not have a cold temperature, they should be used with cold herbs in the formula.
Qian Hu is bitter, pungent and slightly cold, and enters the Lung meridian. It can either disperse the Lung-Qi or descend the Lung-Qi, but the main tendency is descending. It can also eliminate phlegm and stop cough. Since its features fit the pathological changes in the Lung in many syndromes, Qian Hu is a commonly used herb for regulating the Lung and stopping cough.
Jing Jie ( Schizonepetae herba) and Dan Dou Chi ( Sojae semen praeparatum)
These herbs are pungent and warm, and enter the Lung meridian. They can be used as deputies to gently stimulate the Qi in the superficial region and open the pores, thus eliminating wind. They help the chief to expel pathogenic wind-heat in an indirect way. Moreover, they are also used as corrective assistants to prevent cold herbs blocking the movement of Yang and Qi in the process of expelling the pathogenic factors.
These two herbs should be used with small dosages in the formula as they should not change the principal temperature of the formula.
Dang Shen ( Codonopsis radix)
Dang Shen is sweet and neutral. It primarily enters the Spleen meridian. It can be used as a deputy in an exterior syndrome when the Qi is too weak to eliminate the exterior pathogenic factors. It can tonify the Spleen-Qi so as to strengthen the Lung-Qi and Defensive-Qi, and accelerate the speed of eliminating the exterior pathogenic factors.
Assistant: Reduce heat from the Upper-Jiao, nourish Yin and body fluids, and treat the coexisting symptoms
Zhu Ye ( Bambusae folium)
Zhu Ye is sweet and cold, and enters the Heart and Lung meridians. It can expel wind-heat in the Upper-Jiao, increase urination and therefore leach out heat from the Heart. It is often used in a wind-heat syndrome when the heat disturbs not only the Lung but also the Heart, which is manifested as restlessness and irritability.
Qiang Huo ( Notopterygii rhizoma) and Bai Zhi ( Angelicae dahuricae radix)
These two herbs are warm in temperature and very effective in treating headache and pain of the eyes and orbitae, which often exist in a wind-heat syndrome, especially in fever. The dosages of these two herbs in a formula should be small to avoid changing the principal temperature of the formula.
Lu Gen ( Phragmitis rhizoma) and Bei Sha Shen ( Glehniae radix)
Lu Gen is sweet and cold, and enters the Lung, Stomach and Kidney meridians. It is often used as assistant in a formula to treat a wind-heat syndrome because it not only clears heat but also generates body fluids, which have been injured by heat in a wind-heat syndrome. In addition, it is also used to treat nausea and belching when the heat from the Lung affects the Stomach.
Bei Sha Shen is sweet and cold, and enters the Lung meridian. It can be used for the same purpose as Lu Gen. However, as it is sweeter and less cold than Lu Gen, it is only used at the recovery stage of a wind-heat syndrome where the exterior wind-heat barely exists but the Lung-Yin is still severely injured.
Envoy: Harmonize the herbs in the formula
Zhi Gan Cao ( Glycyrrhizae radix preparata)
Zhi Gan Cao is used as envoy in a formula to harmonize the functions of herbs and moderate their properties. When it is used with cold herbs, the Yin and body fluids can be generated and stabilized more easily.
Common accompanying symptoms and treatment
• Generalized pain, headache with heavy sensation, thirst and bitter taste in mouth due to excess heat in Yang-Ming meridian: use Bai Zhi ( Angelicae dahuricae radix) and Qiang Huo ( Notopterygii rhizoma) to expel the wind-cold in the Upper-Jiao; use Shi Gao ( Gypsum) and Huang Qin ( Scutellariae radix) to clear the heat in the Yang Ming meridian.
• Headache: use Bo He ( Menthae herba), Man Jing Zi ( Viticis fructus), Shi Gao ( Gypsum) or green tea to reduce wind-heat in the head.
• Sore throat: add Ma Bo ( Lasiosphaera), She Gan ( Belamcandae rhizoma) and Ban Lan Gen ( Isatidis/Baphicacanthis radix) to dissipate the swelling and reduce heat-toxin.
• Blocked nose and loss of sense of smell: add Xin Yi ( Magnoliae flos), Bo He ( Menthae herba) and Bai Zhi ( Angelicae dahuricae radix) to open the nasal orifices.
• Hoarseness and irritation in the throat: use Chan Tui ( Cicadae periostracum) and Ma Bo ( Lasiosphaera) to expel wind-heat in the throat.
• Cough: use Gua Lou Pi ( Trichosanthis pericarpium), Tian Zhu Huang ( Bambusae concretio silicea), Zhe Bei Mu ( Fritillariae thunbergii bulbus) and Sang Bai Pi ( Mori cortex) to clear heat, remove phlegm-heat and stop cough.
• Poor appetite, nausea and vomiting: use Pi Pa Ye ( Eriobotryae folium) and Zhu Ru ( Bambusae caulis in taeniam) to soothe the Stomach-Qi, transform phlegm-heat from the Stomach and improve appetite.
• Thirst: add Ge Gen ( Puerariae radix), Lu Gen ( Phragmitis rhizoma) and Tian Hua Fen ( Trichosanthis radix) to generate body fluids.
• Dark and scanty urine: add Dan Zhu Ye ( Lophatheri herba) or Zhi Zi ( Gardeniae fructus) to reduce heat and promote urination.
• Constipation: add Da Huang ( Rhei rhizoma), Zhi Shi ( Aurantii fructus immaturus) and Zhi Mu ( Anemarrhenae rhizoma) to promote bowel movement.
• Sores and carbuncles due to excess heat-toxin: add Da Qing Ye ( Isatidis folium), Xuan Shen ( Scrophulariae radix), Sheng Di Huang ( Rehmanniae radix), Pu Gong Ying ( Taraxaci herba) and Zi Hua Di Ding ( Violae herba) to reduce the heat-toxin.
Examples of classical formulas
Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction) 
Source: Wen Bing Tiao Bian 
Composition
Sang Ye ( Mori folium) 7.5 g
Ju Hua ( Chrysanthemi flos) 3 g
Xing Ren ( Armeniacae semen) 6 g
Lian Qiao ( Forsythiae fructus) 5 g
Bo He ( Menthae herba) 2.5 g
Jie Geng ( Platycodi radix) 6 g
Gan Cao ( Glycyrrhizae radix) 2.5 g
Lu Gen ( Phragmitis rhizoma) 6 g
Analysis of the formula
This formula is able to expel wind and clear heat, disperse Lung-Qi and relieve cough. It is used at the initial stage of a wind-heat syndrome when the Lung is attacked by wind-heat and the Lung-Qi fails to disperse and descend. The symptoms are cough, mild fever and a slight aversion to wind and cold. Patients may feel slightly thirsty, and have a thin, white or slightly yellowish tongue coating and a superficial and slightly rapid pulse.
In this formula:
• Sang Ye and Ju Hua are used as chief; they directly and gently disperse the wind from the Lung and clear the heat there.
• Bo He, as one of the deputies, has a strong dispersing ability that enhances the dispersing action of the chief. Lian Qiao is another deputy. It can clear heat and disperse heat in the Upper-Jiao, thus enhancing the action of the chief to clear heat.
• Jie Geng and Xing Ren, another two deputies, can disperse and descend the Lung-Qi respectively, thus enhancing the ability of the chief. They can also stop cough and transform phlegm.
• Lu Gen serves as assistant; it nourishes the fluids of the Lung and relieves thirst. Gan Cao is another assistant; it can reduce heat-toxin and swelling of the throat. When it is used with Jie Geng, the function of reducing pain and swelling becomes stronger.
Commentary on strategies
This formula is very gentle, which means gentle in weight, in dosage and in action.
• The herbs gently disperse the Qi of the Lung, gently expel wind and slightly clear heat, and work subtly to restore the function of the Lung and stop cough. It represents the treatment principle of Dr Wu Ju Tong who devised this formula: ‘To treat the disorder of the Lung in the Upper-Jiao is just like holding a piece of feather in the air and only a light blow can keep it steady in the air.’ This formula is only used at a mild or initial stage of a wind-heat syndrome when the pathogenic wind-heat affects the Lung rather than the superficial region.
• Another characteristic of this formula is clearing heat in the Liver. Because wind and Liver are closely related, dispersing the Liver-Qi can assist in dispersing the wind-heat in the Lung. Ju Hua and Bo He are used in the formula for this purpose.
• Most of the herbs in the formula can disperse and descend the Lung-Qi, thus restoring the proper function of the Lung.
• In this formula, the dispersing action is stronger than the descending action; the principal function of this formula is obviously to disperse the wind-heat.
Yin Qiao San (Honeysuckle and Forsythia Powder) 
Source: Wen Bing Tiao Bian 
Composition
Jin Yin Hua ( Lonicerae flos) 9 g
Lian Qiao ( Forsythiae fructus) 9 g
Jie Geng ( Platycodi radix) 6 g
Bo He ( Menthae herba) 6 g
Zhu Ye ( Bambusae folium) 4 g
Niu Bang Zi ( Arctii fructus) 9 g
Gan Cao ( Glycyrrhizae radix) 5 g
Jing Jie ( Schizonepetae herba) 5 g
Dan Dou Chi ( Sojae semen praeparatum) 5 g
All herbs are cooked with Lu Gen ( Phragmitis rhizoma).
Analysis of the formula
This formula is devised for expelling wind-heat and clearing heat-toxin. It is used for treating wind-heat syndrome where the pathogenic wind and heat are located in both the Lung and the superficial region of the body. The manifestations are fever, irregular sweating, a slight aversion to wind and cold, headache, thirst, cough and sore throat. A red tip of the tongue, a thin and white, or thin and yellow tongue coating, and a superficial and rapid pulse indicate the nature and location of the pathogenic factors.
In this formula:
• Jin Yin Hua and Lian Qiao are used as chief. They are aromatic and cold in nature. They can directly expel wind and clear heat. Their clearing action is stronger than their dispersing action.
• There are three groups of deputy herbs:
– Bo He, with its strong dispersing ability, is used to increase the action of the chief in dispersing wind-heat.
– Niu Bang Zi can assist the chief to reduce heat-toxin and swelling and to benefit the throat.
– Jing Jie and Dan Dou Chi are warm in temperature, can open the pores and stimulate the Qi in the superficial region in order to eliminate the wind and release the exterior. They also serve as corrective assistants to prevent the cold herbs blocking the Yang and Qi movement in the process of expelling the pathogenic factors. They are used in small dosages to avoid changing the principal temperature of the formula.
• There are two groups of assistants:
– Jie Geng and Gan Cao can reduce swelling caused by heat-toxin to treat a sore throat.
– Zhu Ye and Lu Gen are able to clear heat and relieve thirst. Lu Gen can generate the fluids that have been injured by the heat. It also serves as corrective assistant to prevent heat continuously injuring the body fluids.
Commentary on strategies
This is a very effective and commonly used formula. Its function of reducing heat and heat-toxin is stronger than that of Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction), yet it is weaker in regulating the Lung-Qi. This formula, devised by Dr Wu Ju Tong, treats a common case of wind-heat syndrome.
• In the preparation of this formula, note that the herbs should not be cooked for a long time. As soon as the aromatic smell emerges, the formula is ready to use. To treat a disorder of the Upper-Jiao, the aromatically dispersing action is essential.
Ma Xing Gan Shi Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction) 
Source: Shang Han Lun 
Composition
Ma Huang ( Ephedrae herba)* 5 g
Shi Gao ( Gypsum) 18 g
Xing Ren ( Armeniacae semen) 9 g
Gan Cao ( Glycyrrhizae radix) 6 g
Analysis of the formula
This formula is able to disperse and clear heat in the Lung, regulate the Lung-Qi and relieve wheezing. It is used when exterior wind-cold invades the superficial region, the Lung-Qi is obstructed and intense heat is generated. The heat strongly disturbs the dispersing and descending function of the Lung. The main manifestations are high fever, an aversion to wind, chills, thirst, a stifling sensation in the chest, shortness of breath and cough. Patients have a thin white or yellow tongue coating and a slippery and rapid pulse.
In this formula:
• Ma Huang and Shi Gao are used in combination as the chief substances:
– Ma Huang is very warm and very pungent, and enters the Lung meridian. It can quickly and efficiently disperse the Lung-Qi and the restrained heat in the Lung. It enters the Bladder meridian and can eliminate the exterior pathogenic wind-cold as well.
– Shi Gao is pungent, sweet and cold, and enters the Lung meridian. It can powerfully clear heat in the Lung, descend the Lung-Qi and relieve wheezing.
These two substances can effectively regulate the Lung-Qi. The ratio of Ma Huang to Shi Gao is about 1 : 4, thus the principal temperature of the formula is cold and it treats a wind-heat syndrome.
• Xing Ren is used as assistant. It is pungent, bitter and warm, and enters the Lung meridian. It can disperse and descend the Lung-Qi and help the chief. As it enhances the function of Ma Huang, Ma Huang can be used in a lower dosage as it is, after all, a strong herb.
• Zhi Gan Cao also serves as assistant. On the one hand, it can protect the Stomach against the side effects of Shi Gao, which is heavy and very cold; on the other hand, it can also be used with Shi Gao to effectively generate the Yin and fluid of the Lung.
Commentary on strategies
There are several strategies shown in the formula.
• The combination of Ma Huang and Shi Gao gives a good example of using warm and cold substances together. Here a pungent herb and a heavy mineral are used together to regulate the Lung-Qi and clear heat. It also suggests that, no matter how high the fever is, if there is chill without sweating, the exterior syndrome is still in existence and herbs that open the pores and disperse the wind and cold should be used as well.
• The arrangement of dosages of Ma Huang and Shi Gao shows another characteristic of the formula. The ratio of Ma Huang to Shi Gao is about 1 : 4. Yet the dosages can be changed according to the symptoms. If the fever is high, which suggests that heat is predominant, the ratio can be 1 : 5, and a larger dosage of Shi Gao can clear heat effectively. If there is no sweating, which suggests that the pores are closed tightly, the ratio can be changed to 1 : 3; a larger dosage of Ma Huang can effectively open the pores.
• The combination of the bitter Xing Ren and pungent Ma Huang can effectively and safely regulate the Lung-Qi, and the combination of sweet Gan Cao and cold Shi Gao can nourish the Yin.
 |
| Figure 1.1 •. |
| Pathology of excess condition of wind-cold syndrome. |
 |
| Figure 1.2 •. |
| Pathology of deficiency condition of wind-cold syndrome. |
 |
| Figure 1.3 •. |
| Pathology of wind-heat syndrome. |
