Chaihu Shugan San: Spreading the Liver, Moving Qi, and Relieving Pain

Pain in the hypochondria caused by various acute and chronic hepatobiliary diseases, gastritis, reflux esophagitis, gastric neurosis, or coronary heart disease is often attributed in Chinese medicine to liver depression and qi stagnation. The treatment principle is to spread the liver, move qi, and stop pain; the representative formula is Chaihu Shugan San.

I once used modified Chaihu Shugan San to treat severe cancer pain in a tumor patient of the hepatobiliary system. Morphine analgesics had failed, but after Chaihu Shugan San the pain was greatly relieved, showing that the formula targets pain from hepatobiliary disease.

Chaihu Shugan San is an experienced formula of the famous Ming physician Zhang Jingyue. It consists of seven herbs: Chenpi (tangerine peel), Chaihu (bupleurum), Chuanxiong (Sichuan lovage), Xiangfu (cyperus), Chao Zhiqiao (fried bitter orange), Baishao (white peony), and Zhi Gancao (honey-fried licorice). Baishao and Zhi Gancao form the famous Shaoyao Gancao Tang from the Shanghan Lun, a celebrated formula for relaxing urgency and stopping pain.

So the formula may be understood as Shaoyao Gancao Tang plus liver-spreading, qi-moving Chenpi, Chaihu, Chuanxiong, Xiangfu, and Chao Zhiqiao.

Pain from hepatobiliary and gastrointestinal disease shows clear qi-stagnation features: it partly relieves after belching or passing gas. Traditional Chinese medicine attributes this to stagnant qi troubling the body, requiring qi-moving herbs.

The hypochondria, in Chinese medicine, is the domain of the Shaoyang channel. Chaihu, Chenpi, Xiangfu, and Chao Zhiqiao are commonly used Shaoyang-channel herbs, so traditional selection draws on channel-tropism theory to build a targeted prescription.

Many patent-medicine makers produce Chaihu Shugan Wan based on this formula. Its package insert states that it treats liver-qi stagnation. Whenever there is hypochondriac pain, chest tightness with sighing, depression or irritability, belching, epigastric abdominal distention, or a wiry pulse, it may be used. Clinically it is often used for chronic hepatitis, chronic gastritis, and intercostal neuralgia of the liver-depression-qi-stagnation type.

These symptoms are common in cancer patients, especially those with chronic digestive disease. They are most common at the transition between summer and autumn, which Chinese medicine calls late summer, the season of spleen-stomach (digestive) disease. In this season people favor raw and cold foods, which easily trigger old digestive problems through microbes in the food.