Li Dongyuan's Banxia Baizhu Tianma Decoction for Neurological Diseases
In Li Dongyuan's Treatise on the Spleen and Stomach (Piwei Lun) there is a formula called "Banxia Baizhu Tianma Tang". Its composition is: Huangbai (Phellodendri Cortex) 5 qian (15 g), Ganjiang (dried Zingiber Rhizoma) 7 qian 5 fen (22.5 g); Tianma (Gastrodiae Rhizoma), Cangzhu (Atractylodis Rhizoma), Bai Fuling (white Poria), Huangqi (Astragalus), Zexie (Alismatis Rhizoma), Renshen (Ginseng) each 1 liang 2 qian 5 fen (37.5 g); Baizhu (Atractylodis Macrocephalae Rhizoma), Chao Shenqu (fried medicated leaven) each 1 qian (3 g); Banxia (Pinellia, washed 7 times in hot water), Damaiya Fen (barley sprout), and Jupi (tangerine peel) each 1 qian 5 fen (4.5 g). Grind the above herbs together into coarse powder; each time take 5 qian (15 g), add 300 ml water, decoct to 150 ml, strain, and take warm before meals, 2-3 times daily.
This formula fortifies the spleen and dries dampness, resolves phlegm and extinguishes wind. It is indicated for phlegm-syncope headache, presenting with thick, sticky sputum and saliva, dizziness or headache, chest oppression, nausea and vomiting, a heavy body with cold limbs, and inability to rest peacefully. It is now commonly used for neurological diseases such as Meniere's disease, vasogenic nervous headache, sequelae of cerebral concussion, and post-stroke sequelae; it may also treat otogenic vertigo or sinusitis.
In this formula, Tianma has the action of expelling wind and unblocking the collaterals; it is an important TCM herb for numbness of the limbs, bi pain and paralysis, and inability to move the hands and feet. The ancients called Tianma a "spirit-calming divine herb." The "stroke" syndromes of the ancients mostly correspond to neurological diseases in modern medicine. In ancient medical classics, formulas for treating "all wind patterns characterized by shaking and dizziness" mostly contain Tianma, which is often used with Niuxi (Achyranthis Bidentatae Radix), Duzhong (Eucommiae Cortex), and Fuzi (Aconiti Radix Lateralis). Modern pharmacology shows Tianma acts on the central nervous system in three ways: (1) sedation, (2) anticonvulsant, and (3) analgesia. Tianma also has clear cardiovascular effects: animal experiments show that injecting Tianma injection at 1 mg/kg into rabbit ears markedly lowered blood pressure, slowed heart rate, increased cardiac output, reduced peripheral resistance, and decreased myocardial oxygen consumption in experimental rabbits. Tianma also has anti-inflammatory and immune-enhancing effects and can delay aging.
Li Dongyuan used Tianma together with Renshen, Cangzhu, Bai Fuling, Huangqi, and Zexie, all in large doses. Aside from Tianma, the other herbs—Renshen, Baizhu, Fuling, Huangqi, Zexie, and Cangzhu—all supplement qi and promote urination, so this formula has good efficacy against cerebral edema, a common accompanying symptom of neurological diseases such as stroke. Huangbai is added to clear heat and drain fire; in fact Huangbai is itself a herb with good efficacy against neurological disease—it is anticonvulsant, anti-inflammatory, and sedative. Banxia and Jupi resolve phlegm and stop vomiting; including these two addresses the nausea, vomiting, headache, and dizziness caused by compression of cranial nerves. Barley sprout aids digestion and also soothes the liver and resolves depression.
Combined into a formula, these herbs simultaneously lower blood pressure, improve cerebral circulation, stop vomiting, and reduce cerebral edema. Whether viewed from traditional TCM or modern pharmacology, such a composition has some therapeutic effect on neurological diseases such as Meniere's, vasogenic nervous headache, post-concussion syndrome, and post-stroke sequelae.
If patients need long-term use, this formula may be made into pills. With the same composition, grind the herbs into powder and, using refined honey and starch as excipients, make small honey pills; take 6-9 g each time, 2-3 times daily. The Banxia in the pills must be processed Banxia; never use raw Banxia or Qing Banxia in pills. Raw Banxia is highly toxic, and improper use can kill the patient.