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Adapted from Fair Use Source:

subhuti_dharmananda, Ph.D., Director, institute_for_traditional_medicine, Portland, Oregon: Article yin_qiao_jie_du_pian - A patent_remedy based on yin_qiao_san, paragraph 1

traditional_chinese_herbal_sciences (TCHS) - Self-Study Course 2.0.7 by roger_w._wicke, PhD, 1992-2003 by rmh-publications_trust rocky_mountain_herbal_institute; c/o PO Box 579; Hot Springs, Montana 59845 USA.

minor_bupleurum: My Favorite Formula by bob_flaws, Dipl. Ac. & C.H., FNAAOM, blue_poppy_press http://www.bluepoppy.com/cfwebstorefb/index.cfm?fuseaction=feature.display&feature_id=1432

Minor Bupleurum: My Favorite Formula

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM

(This article was originally published in the RCHM Newsletter. The RCHM is the Register of Chinese Herbal Medicine in the U.K. Since then, I have slightly expanded it and reworded a few sentences.)

There is supposedly a Chinese saying that goes something to the effect that, “New practitioners use many formulas; old practitioners use only a few.” This saying may or may not be apocryphal. However, in my case it is certainly true. After 20 years of practicing Chinese medicine and based on the theories and methodology of li_dong-yuan, I find that I use various combinations and modifications of four basic formulas for 90% of my patients with chronic conditions.

These four formulas are bu_zhong_yi_qi_tang (supplement_the_center_boost_the_qi_decoction), xiao_chai_hu_tang (minor_bupleurum_decoction), xiao_yao_san (rambling_powder), and ban_xia_xie_xin_tang (pinellia_drain_the_heart_decoction).

Although I do not have a favorite from among these four, I would like to discuss xiao_chai_hu_tang, the most commonly prescribed Chinese medicinal formula in the world.

Xiao Chai Hu Tang (Minor Bupleurum Decoction)

radix_bupleuri (chai_hu), 9g

radix_scutellariae_baicalensis (huang_qin), 9-12g

radix_panacis_ginseng (ren_shen), 6-9g

rhizoma_pinelliae_ternatae (ban_xia), 9g

mix-fried radix_glycyrrhizae (gan_cao), 3-6g

fructus_zizyphi_jujubae (da_zao), 3-5 pieces

uncooked rhizoma_zingiberis (sheng_jiang), 2-3 slices

This formula is recorded in zhang_zhong-jing's late han_dynasty shan_han_lun (treatise_on_cold_damage) and is the prototypical formula for harmonizing the defensive and constructive in a shao_yang pattern of cold_damage. However, this formula has a much broader scope of application than that classical description implies.

As a harmonizing formula, it not only harmonizes the defensive and constructive but also the liver and spleen, liver and stomach, spleen and stomach, and stomach and intestines. Since exterior-resolvers and qi-rectifiying medicinals are often interchangable, both up-bearing and tending to effuse_clear_yang, this formula can be used to treat liver_depression qi_stagnation with concomitant spleen_vacuity and dampness. In addition, since out-thrusting is another way of clearing_internal_heat (especially depressive heat), this formula may be used to clear_heat in the liver, gallbladder, stomach, and/or lungs.

li_dong-yuan, author of the pi_wei_lun (treatise_on_the_spleen_and_stomach) and arguably the most famous of the four_great_masters_of_medicine of the jin-yuan_dynasties, was an expert at treating complex, multi-pattern conditions where there was spleen_qi_vacuity, depression_of_the_qi mechanism, and some sort of heat. In such cases, the evil_heat involved is engendered from the middle_burner or lower_burner and only secondarily wafts up to collect in and disturb the upper_burner or body. Li called this type of evil heat “yin_fire.” Why he called it yin is because A) it develops from the lower (vata) or yin part of the body, B) it is often damp (kapha) or yin in nature, and C) it is pathological.

Li's five principles for treating yin_fire conditions, i.e., complicated conditions where there is spleen_vacuity, an inhibited qi mechanism, upward_counterflow, and evil_heat (damp_heat, depressive_heat, vacuity_heat, or upward_stirring of ministerial_fire), are to:

1. fortify_the_spleen and boost_the_qi while harmonizing the stomach and intestines.

2. rectify_the_qi_mechanism, upbear_the_clear and downbear_the_turbid.

3. clear_heat (pitta) of whatever kind from wherever necessary.

4. Do whatever else needs doing depending upon the presenting condition (e.g., quicken_the_blood, transform_phlegm (kapha), eliminate_dampness (kapha or pitta), moisten_dryness (vata), etc.) .

5. Prioritize the above four necessities and apply in appropriate order of precedence and proportion.

Within xiao_chai_hu_tang, bupleurum courses_the_liver and rectifies_the_qi, upbears_the_clear and disinhibits_the_qi_mechanism. ginseng, mix-fried licorice, and red_dates fortify_the_spleen and supplement_the_qi (as well as nourish_the_heart_spirit).

pinellia and uncooked ginger harmonize_the_stomach (vata, agni_dipana), downbear_turbidity, eliminate_dampness (kapha or pitta) and transform phlegm (kapha).

And scutellaria clears_heat (pitta) from the liver (ranjaka_pitta), gallbladder (pitta), stomach (kledaka_kapha and pachaka_pitta and samana_vayu), large_intestine (apana_vayu), and lungs (avalambaka_kapha).

Likewise, because bupleurum is bitter, acrid (spicy or pungent, and cool, it also has some ability to clear both damp_heat (pitta) and depressive_heat (pitta) from the liver / gallbladder_._therefore_this_formula_embodies_li_dong-yuan's five principles of treating yin_fire (pitta-kapha) conditions – in this case, eliminating_dampness and transforming_phlegm in terms of principle number four, and relatively equally supplementing_the_spleen (agni_dipana), rectifying_the_liver, and clearing_heat (pitta) in terms of principle number five.

As the great mid-century architect of modern Chinese medicine, qin_bo-wei said, “When I say to use liu_wei_di_huang_wan (six_flavors_rehmannia_pills), I do not mean to use the ingredients of Liu Wei Di Huang Wan but rather the idea of Liu Wei Di Huang Wan.”

Thus, in clinical practice, I rarely use this formula in its standard, textbook form. If I need to regulate_the_blood in addition to coursing_the_liver and rectifying_the_qi, fortifying_the_spleen and supplementing_the_qi, transforming_phlegm (kapha) and eliminating_dampness, and clearing_heat (pitta) from the lungs, stomach, liver / gallbladder, or large_intestine, I typically will add radix_angelicae_sinensis (dang_gui) and/or radix_albus_paeoniae_lactiflorae (bai_shao) or maybe even all of si_wu_tang (four_materials_decoction).

For instance, when women catch_a_cold (common_cold) or manifest fluey symptoms (flu) before or with each menstruation, this usually indicates a constructive_and_defensive_disharmony complicated by blood_vacuity (vata). In that case, the blood (pitta rakta_dhatu, which is the mother_of_the_qi, is insufficient to nourish and root the defensive_qi. The defensive_qi thus does not do its duty of securing_and_astringing_the_exterior, leaving the body easily invaded by external_wind_evils. Prior to the menses, the blood is downborne (downbearing via the chong_mai / bao_mai from heart to uterus. If there is a blood_vacuity (vata), there may not be sufficient blood left over to nourish_the_liver during the premenstruum. In that case, there will be the engenderment or worsening of liver_depression qi_stagnation. Since exterior-resolving is associated with upbearing and out-thrusting, if the qi_mechanism is depressed due to lack_of_blood to nourish_the_liver premenstrually, then any external_evils invading the body may also not be efficiently out-thrust. Instead, they may linger in the body as hidden or retained evils waiting for the right set of circumstances to become pathologically active once again. In addition, since the spleen_is_the_root_of_phlegm (kapha rasa_dhatu) engenderment, if the liver ( ranjaka_pitta and rakta_dhatu) becomes depressed, the spleen (kledaka_kapha and rasa_dhatu) becomes vacuous (vata) and weak (vata), and the lungs are fettered by external_evils, then accumulation (kapha) of phlegm_dampness (kapha) is all the more likely.

To top this all off, liver_depression complicated by phlegm (kapha_ama) and damp_depression (kapha) is all the more likely to transform into depressive_heat (pitta-kapha or kapha_blocking_pitta) and heat (pitta), which is yang (pitta), tends to float_upwards (pitta fire rises) to accumulate (kapha) in the lungs (avalambaka_kapha), the florid_canopy.

The combination of minor_bupleurum and Four Materials (si_wu_tang or four_materials_decoction) treats this complicated but commonly seen gynecological scenario.

If I need to moisten_dryness (vata) due to persistent_heat (pitta), I typically add tuber_ophiopogonis_japonici (mai_dong) and/or radix_trichosanthis_kirlowii (tian_hua_fen) and may change ginseng to radix_pseudostellariae (tai_zi_shen).

If I need to rectify_the_qi more, I might add rhizoma_cyperi_rotundi (xiang_fu pr musta), radix_linderae_strychnifoliae (wu_yao), and/or radix_auklandiae_lappae (mu_xiang) depending on where the qi_stagnation is manifesting and how serious it is.

If there is more phlegm (kapha), I might add sclerotium_poriae_cocos (fu_ling), pericarpium_citri_reticulatae (chen_pi), and/or bulbus_fritillariae (bei_mu).

If the phlegm (kapha) is in the chest and/or throat, I will probably add radix_platycodi_grandiflori (jie_geng).

If there is phlegm_nodulation (kapha ama), I will probably add some or all of radix_scrophulariae_ningpoensis (xuan_shen), spica_prunellae_vulgaris (xia_ku_cao), concha_ostreae (mu_li), herba_sargassii (hai_zao), thallus_algae (kun_bu), and semen_citri_reticulatae (ju_he).

If there is more dampness due to spleen_vacuity (vata), I might add sclerotium_poriae_cocos (fu_ling) and rhizoma_atractylodis_macrocephalae (bai_zhu).

If the spirit_is_not_quiet (vata), I might add os_draconis (long_gu) and concha_ostreae (mu_li).

If there is more qi_vacuity (vata), I will usually add radix_astragali_membranacei_huang_qi).

If there is more heat (pitta), which medicinals I add will depend on the nature of the heat and where it is located. For instance for either damp_heat (pitta) or heat_in_the_heart, heat_in_the_stomach, and/or heat_in_the_intestines, I will typically add rhizoma_coptidis_chinensis (huang_lian).

If there is depressive heat causing vexation, I might choose Fructus Gardeniae Jasminoidis (Shan Zhi Zi). While if there is damp heat affecting the skin with itching, then Radix Sophorae Flavescentis (Ku Shen) and Cortex Radicis Dictamni Dasycarpi (Bai Xian Pi) might be good choices. And for wind heat evils affecting the throat, Fructus Arctii Lappae (Niu Bang Zi) and Radix Isatidis Seu Baphicacanthi (Ban Lan Gen) are often good choices. In other words, this formula can be modified in numerous ways to fit large numbers of presenting situations. Since most patients with chronic diseases suffer from liver depression (The Heart Transmission of Medicine says, “In general, depression is part of any disease. If depression endures, it will generate disease. If a disease has endured, depression will be generated.”), spleen vacuity (“Enduring disease damages the spleen.”), and some kind of evil heat (viz. the theories of Liu Wan-su, Li Dong-yuan, and Zhu Dan-xi), this formula is an extremely useful one beyond just harmonizing the shao yang division. Caveat: Although Minor Bupleurum is the most commonly prescribed Chinese medicinal formula in the world today and is extremely safe for a wide range of patients and conditions, it should not be used in tandem with Interferon therapy, as in certain types of cancer and chronic active hepatitis. Recently, several patients in Japan died from this combination due to liver failure. Until the exact mechanisms of this complication and all its co-factors are ascertained, I believe this caveat should be considered absolute.

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