Fangfeng Tongsheng San: A Formula That Resolves Both Exterior and Interior, Draining Heat and Purging
Fangfeng Tongsheng San comes from the Xuanming Lunfang; in the Shanghan Biaoben it is also called “Tongsheng San.” Its composition: Radix Saposhnikoviae (Fangfeng), Rhizoma Chuanxiong (Chuanxiong), Angelica (Danggui), white Paeonia (Baishao), Rheum (Dahuang), Mentha (Boheye), Ephedra (Mahuang), Forsythia (Lianqiao), and Natrii Sulfas (Mangxiao), each 5 qian (15 g); Gypsum (Shigao), Scutellaria (Huangqin), and Platycodon (Jiegeng), each 1 liang (30 g); Talcum (Huashi) 3 liang (90 g); Licorice (Gancao) 2 liang (60 g); Schizonepeta (Jingjie), Atractylodis macrocephalae (Baizhu), and Gardenia (Zhizi), each 2.5 qian (7.5 g).
To prepare, grind the herbs into a coarse powder. Take 2 qian each time with one bowl (about 300 ml) of water, add 3 slices of ginger, and decoct to six-tenths of a bowl (about 180 ml); strain and take warm, twice daily.
Fangfeng Tongsheng San, however, is a classic famous formula with marked effect, and many pharmaceutical factories make it into pills. Fangfeng Tongsheng Wan is an OTC and reimbursable medicine sold in most hospitals and pharmacies; pills are more convenient than powder, so modern patients basically take the pills.
According to traditional TCM theory, Fangfeng Tongsheng San is a classic formula that resolves both the exterior and the interior, releasing exterior pathogens and clearing interior heat. Fangfeng, Schizonepeta, Ephedra, mint, and Forsythia are exterior-releasing herbs; Gypsum, Scutellaria, Gardenia, and Licorice clear heat; Rheum and Mirabilitum are purgatives; Talcus promotes diuresis; Chuanxiong, Angelica, and white Paeonia activate and nourish blood; Atractylodes fortifies the spleen.
Thus the formula’s action is very comprehensive; it is the representative formula for wind-heat excess with solid excess in both exterior and interior and all three jiao, presenting fever and irritability, headache and dizziness, bitter mouth and thirst, an uncomfortable throat, stuffy chest and diaphragm, abdominal distending pain, delirium and mania, convulsions of the hands and feet, constipation and scanty dark urine—as well as childhood gan accumulation heat, erysipelas and maculopapular rashes, wind swelling and fire eye, a yellow greasy tongue coating, and a surging rapid or wiry slippery pulse.
Modern use of Fangfeng Tongsheng Wan treats fever, constipation, body pain, urticaria, pityriasis rosea, conjunctivitis, and hordeolum from acute respiratory disease; it may also treat cancer fever and cancer pain with constipation, dark urine, profuse sweating, and dry mouth. It also lowers blood sugar, lipids, and blood pressure, so it is now used for hyperlipidemia, obesity, and type 2 diabetes. Chronic respiratory conditions such as bronchitis, asthma, and sinusitis with the above symptoms during acute flare-ups are also suitable for Fangfeng Tongsheng Wan.
The conditions it treats belong to what TCM calls “warm disease.” TCM holds that in treating warm disease one must open an exit for the warm pathogen, hence diaphoresis, diuresis, and purgation are often needed. Most formulas use only one of these three, but Fangfeng Tongsheng Wan uses all three together, resolving exterior and interior simultaneously.
TCM has long said: “In warm disease, one need not hesitate to purge early; in cold damage, one need not hesitate to delay purging.” In cold-damage types, when the exterior pathogen is still unresolved, diuretics and purgatives must not be used, or the condition worsens. How then to distinguish warm disease from cold damage? The key is whether there is high fever with thirst, dark urine, and constipation: cold-damage fever does not bring dry mouth or thirst, urine is clear, and there is no constipation. Warm disease roughly corresponds to what we today call wind-heat cold, and cold damage to wind-cold cold; their clinical presentations differ, so the medication differs. If cold damage is not treated well, the wind-cold transforms to heat and may become a warm disease. Medication must distinguish the patient’s clinical symptoms and choose the most suitable herbs.
Modern pharmacology shows Fangfeng Tongsheng Wan is also a patent medicine for several modern high-incidence diseases—hyperlipidemia, hypertension, obesity, and arrhythmia. It markedly reduces body weight and retroperitoneal white-fat weight in obese mice, increases mitochondrial cytochrome-C oxidase activity and the thermogenic marker guanosine-diphosphate binding in brown adipose tissue, and activates brown fat. It also regulates blood lipids, counteracts arteriosclerosis, lessens ischemia and necrosis of vascular smooth muscle and rupture of elastic fibers, and inhibits vascular and tissue dysfunction. It lowers heart rate and blood pressure, giving some relief for high blood pressure and tachycardia.
But Fangfeng Tongsheng Wan has a purgative effect, so patients with a chronically weak spleen and loose stools should use it cautiously. The rheum anthraquinones in Rheum also have a bidirectional effect on the bowel: they relieve constipation, yet long-term use causes habitual constipation, so people with chronic constipation (especially senile constipation) should use Rheum-containing Fangfeng Tongsheng Wan cautiously. The talc in the pills, once inhaled, also carries a cancer risk. Long-term use therefore carries some risk; patients should treat it as a temporary medication and not take it for prolonged periods.