Experience in Treating a Nasopharyngeal Carcinoma Patient Complicated by Purulent Otitis Media with Sanhuang Xiexin Tang
Sanhuang Xiexin Tang (Three-Yellow Heart-Draining Decoction) is a classical, famous formula from Zhang Zhongjing's Shanghan Lun (Treatise on Cold Damage). Many scholars believe that the Dahuang Huanglian Xiexin Tang in the Shanghan Lun should consist of three herbs—Huanglian (Coptis), Dahuang (Rhubarb), and Huangqin (Scutellaria)—rather than only Dahuang and Huanglian. Some scholars think the Song edition of the Shanghan Lun omitted text. However, to distinguish it from the Dahuang Huanglian Xiexin Tang of the Shanghan Lun, the heart-draining decoction made of Huanglian, Huangqin, and Dahuang is customarily still called Sanhuang Xiexin Tang.
Sanhuang Xiexin Tang is an important formula for draining heat from the upper jiao. Besides treating 'heat-binding' in the chest and epigastrium, it can also treat, caused by upper-jiao heat, swollen and painful gums, coughing blood, vomiting blood, nosebleeds, headache, dizziness, red eyes, tinnitus, deafness, and purulent otitis media. According to the formula's pharmacology, as long as the symptoms form part of upper-jiao heat, this formula can resolve them.
One nasopharyngeal carcinoma patient I treated was a teacher at a school in Suining, Sichuan; the patient had from
I first suggested he try common otitis-media formulas such as Xiao Chaihu Tang or Chaihu Guizhi Tang; the patient tried them with no effect and asked me again. Later I thought that this case should belong to the upper-jiao heat syndrome common in autumn, so I suggested he take Sanhuang Xiexin Tang: Dahuang
A few days after taking the above formula, the symptoms eased considerably; by the time I followed up, the patient reported that, feeling much better, he had on his own taken a few more packets and kept taking it.
When taking Sanhuang Xiexin Tang, unlike ordinary herbal decoctions, the formula needs no decocting; one simply steeps each herb in boiling water, removes the dregs, and drinks the liquid.
Chinese medicine says
In fact, from the viewpoint of modern pharmacology, if herbs like rhubarb and coptis are boiled too long, their active constituents are instead destroyed. So they need not be simmered; one need only steep out their active constituents with boiling water.
Clinically, upper-jiao heat often presents with dry mouth and tongue, bleeding from the mouth and nose, coughing and vomiting blood, upper respiratory infections, and inflammation of the nasopharynx and ear canal. These symptoms all belong to the upper-jiao heat syndrome, so different diseases can be treated with the same method—all with Sanhuang Xiexin Tang.
When Fuzi (Aconite) is added to Sanhuang Xiexin Tang it becomes Fuzi Xiexin Tang, which treats the pattern of upper heat and lower cold with disharmony between the heart and kidney. TCM holds that fire should return to the lower jiao and water should moisten the upper jiao; if fire is exuberant in the upper jiao and water in the lower, it causes upper heat and lower cold, and heart-kidney non-interaction. The patient, while showing upper-jiao heat, also experiences aversion to cold
Fuzi Xiexin Tang adds the single herb Fuzi to Sanhuang Xiexin Tang. For this formula, one simply decocts the Fuzi, then steeps the three herbs Dahuang, Huanglian, and Huangqin in the resulting liquid, removes the dregs, and drinks it. Fuzi Xiexin Tang is also very widely applied.
Add one herb to a TCM formula and its action changes. When treating patients, the clinical TCM physician must communicate carefully and fully, understand all of the patient's symptoms, and then judge what pattern and disease the patient has, before deciding on the formula and herbs.