Daige San (Indigo-Clam Shell Powder) for Cough and Hemoptysis
Daige San comes from volume 4 of the Yi Shuo (Medical Expositions) by Zhang Gao (Southern Song dynasty), a famous physician of the Xin’an medical school (cited from the Leibian). It is composed of Qingdai (Indigo Naturalis) and bang-fen (clam shell powder) in a 1:10 ratio (one source says 1:1). The original text requires that the clam powder be stir-fried on a new tile until glowing red, then mixed with a small amount of indigo; 3 qian are taken each time with rice water, to treat cough and hemoptysis caused by liver fire invading the lung.In addition, the Qing-dynasty work Weisheng Hongbao by Zhu Buzhai contains Qingge Wan (Indigo-Clam Pill), made from Qingdai (levigated to purity) and Ge-fen (clam shell powder, calcined on a new tile), 3 qian each, formed with refined honey into pills the size of a fingertip. This formula treats phlegm-fire cough with a red face and nose, and 3 pills are held in the mouth to dissolve (sublingual absorption) before sleep.In the 2005 edition of the Pharmacopoeia of the People’s Republic of China (Part I), this formula is named Daige San. Its composition is: Qingdai (Indigo Naturalis) 30 g, Haiqiaoke (Meretricis seu Cyclinae Concha) 300 g. Preparation: crush these two ingredients into a fine powder and mix evenly. Adults take 6 g each time, decocted in a cloth bag, or included as part of a decoction.The pharmacopoeia lists its actions as clearing the liver and benefiting the lung, descending counterflow, and relieving vexation. It is indicated for excess heat of the liver and lung: dizziness and tinnitus; cough with vomiting of blood or epistaxis; lung wilting and lung abscess; obstruction of the throat and diaphragm; thirst and vexation.Daige San has a simple composition and striking efficacy; it is the representative formula for cough caused by liver fire invading the lung. Clinically, the main indications for its use are cough with blood, irritability and irascibility, a red face and nose, a red tongue, and a rapid pulse. These symptoms are commonly seen in bronchiectasis, tracheitis, lung cancer, pertussis, pulmonary tuberculosis, pneumonia, and other such diseases.The Qingdai in this formula is the dried powder or mass made from the Chinese medicine Daqingye (Isatidis Folium), with indirubin, indigo, and related compounds as its main constituents. Traditional TCM holds that it is salty and cold, and has the actions of clearing heat, cooling blood, and resolving toxin. It is used for warm-toxic macules and papules, hematemesis, epistaxis, hemoptysis, cough due to liver fire invading the lung, and swollen painful throat. Modern pharmacology shows that indigo has anti-tumor, anti-inflammatory, antibacterial, and anti-ulcer effects and can enhance human immunity.Ge-fen is the powder ground from sea clam shells, whose main constituents are calcium carbonate and chitin; after calcination, calcium carbonate accounts for over 98%. Traditional TCM holds that clam shell powder is salty and slightly cold, enters the lung, stomach, and kidney meridians, and has the actions of clearing lung heat and resolving phlegm, softening hard masses and dissipating nodules, promoting urination and relieving edema, and neutralizing acid and astringing sores. It is used for phlegm-heat cough, goiter, scrofulous nodules, hypochondriac pain, damp-heat edema, and stomach pain with acid regurgitation.The combination of indigo and clam shell powder has a definite therapeutic effect on cough and hemoptysis caused by various respiratory diseases. Here the dose of indigo should be kept small, because indigo is strongly irritating to the digestive tract; too large a dose easily causes gastrointestinal discomfort. Therefore, modern patients using this formula should follow the proportions in the Pharmacopoeia, preparing it as a powder and decocting it for oral use. When decocting the powder, be sure to wrap it in a non-woven cloth bag; otherwise the powder will disperse into the decoction and be hard to swallow.