Banxia Baizhu Tianma Decoction for Treating the Syndrome of Wind-Phlegm Upsurging
Banxia Baizhu Tianma Decoction comes from Volume 4 of Yixue Xinwu (Medical Heart Enlightenment), in the section on "vertigo." The author of that book, Cheng Guopeng, explained vertigo as: "Xuan means darkness before the eyes; yun means the head spinning; what the ancients called head-spinning and eye-darkening is exactly this." Cheng Guopeng divided vertigo into five syndromes: internal stirring of liver fire, obstruction by damp-phlegm, qi deficiency with phlegm, upward flaming of deficient fire, and floating of true yang; these were treated respectively with Xiaoyao Powder, Banxia Baizhu Tianma Decoction, Liujunzi Decoction, Liuwei Decoction, and Bawei Decoction.
Among them, the syndrome of damp-phlegm obstruction is also called the syndrome of wind-phlegm upsurge. Chinese medicine holds that this syndrome is mostly caused by spleen deficiency generating dampness, dampness gathering into phlegm, which stirs liver wind; liver wind carries damp-phlegm upward to harass the clear orifices. Huangdi Neijing states that "all wind, tremor, and dizziness belong to the liver," so Chinese medicine classifies vertigo-type diseases as liver diseases. Note that the liver in Chinese medicine is not the same thing as the liver in modern anatomy. The main symptoms of wind-phlegm upsurge, besides vertigo, often include headache, chest and epigastric fullness and oppression, nausea and vomiting, a white greasy tongue coating, and a wiry slippery pulse.
The composition of Banxia Baizhu Tianma Decoction as recorded in Yixue Xinwu is: Banxia (Pinelliae Rhizoma) 4.5 qian, Tianma (Gastrodiae Rhizoma), Fuling (Poria), and Juhong (Citri Exocarpium Rubrum) each 1 qian, Baizhu (Atractylodis Macrocephalae Rhizoma) 3 qian, Gancao (Glycyrrhizae Radix) 0.5 qian, fresh ginger 1 slice, and jujube 2 pieces, decocted in water for oral use. The book also records another version of Banxia Baizhu Tianma Decoction, in which Baizhu is reduced to 2 qian and Manjingzi (Viticis Fructus) 3 qian is added. Manjingzi is a specific herb for headache, so this modified Banxia Baizhu Tianma Decoction is mainly used to relieve the symptoms of "phlegm-syncope headache, much phlegm in the chest and diaphragm, and vertigo on movement."
Banxia Baizhu Tianma Decoction is actually Erchen Decoction minus Wumei (Mume Fructus), plus Tianma, Baizhu, and jujube. Erchen Decoction is the representative formula in Chinese medicine for drying dampness and resolving phlegm, and for regulating qi and harmonizing the middle; it is also the general formula for drying dampness and resolving phlegm. Erchen Decoction is mainly used for damp-phlegm syndrome, presenting with cough with copious white sputum that is easy to expectorate, chest and diaphragm fullness and oppression, nausea and vomiting, heavy limbs, poor appetite, dizziness and palpitations, a white greasy tongue coating, and a slippery pulse.
Wumei in Erchen Decoction has the action of astringing the lung and stopping cough. Banxia Baizhu Tianma Decoction treats wind-phlegm upsurge, which has no symptoms such as cough with copious sputum, so Wumei is omitted. Wind-phlegm upsurge mainly presents with headache and vertigo, so Tianma—which extinguishes wind and stops spasms, pacifies liver yang, and expels wind and unblocks the collaterals—is added.
Tianma has the effects of lowering blood pressure and unblocking impediment; it is an important herb in Chinese medicine for treating cerebrovascular disease. Manjingzi is even more a specific for headache; therefore, if headache is marked, Manjingzi should also be added to this formula, and in a large dose. In the author's experience, Manjingzi at 30 g has a specific effect on headaches of various causes. When treating headache in cancer patients, Chuanxiong (Ligustici Rhizoma), Baizhi (Angelicae Dahuricae Radix), Qianghuo (Notopterygii Rhizoma), Duhuo (Angelicae Pubescentis Radix), Baihuashe (Bungarus Parvus), Wugong (Scolopendra), Quanxie (Scorpio), and Jiangcan (Bombyx Batryticatus) may also be added.
What role does Baizhu play here? Chinese medicine holds that the main actions of Baizhu are fortifying the spleen and boosting qi, drying dampness and resolving phlegm; at the same time it also strengthens the stomach. Therefore, adding Baizhu to Erchen Decoction both strengthens the action of drying dampness and resolving phlegm and has a stomach-strengthening effect. Jujube is a qi-tonifying and flavor-adjusting Chinese herb; used here, it both harmonizes the medicinal properties of the various herbs and strengthens the stomach.
In sum, this formula mainly relieves symptoms such as weak spleen and stomach, poor appetite, nausea and vomiting, headache, and vertigo. These symptoms are commonly seen in patients with sequelae of cerebrovascular accidents due to hypertension and in patients with depression; they are also common in cancer patients with brain tumors, brain metastases, head and neck tumors, lung cancer, laryngeal cancer, thyroid cancer, and breast cancer. Although this formula cannot cure the above diseases, it has a certain effect in improving patients' clinical symptoms.